Use of red cells preserved in extended storage media for exchange transfusion in anti-k haemolytic disease of the newborn

Two well-known authorities on hemolytic disease undertake in this paper to determine the causes for what they consider to be an excessive mortality from this disease in England and Wales at the present time. They state that with correct use of exchange transfusion a mortality of not more than 5% of infants with hemolytic disease born alive should be expected. The authors express the opinion that the deaths at present are at least three times as numerous as should be expected with modern treatment. Analysis of the reported deaths seem to indicate two principal causes for this: (1) failure to anticipate the disease before birth or to recognize the disease early after birth, and (2) either failure to undertake an exchange transfusion or to employ satisfactory technique in the exchange transfusion, particularly to give an adequate exchange. They point out that the best results are to be expected in hospitals where a large number of cases are treated and considerable experience is acquired. In hospitals where the number of cases seen is small it is difficult for the staff to gain the necessary experience and familiarity with the technique of exchange transfusion and the general principles of diagnosis and management. A full discussion of the essential points in prediction and diagnosis of the disorder and of the indications for exchange transfusion, with emphasis on the volumes of blood to be exchanged, are given.

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MODIFICATION OF THE TECHNIC OF TREATING ERYTHROBLASTOSIS FETALIS BY EXCHANGE TRANSFUSION

PEDIATRICS ◽

10.1542/peds.8.1.117 ◽

1951 ◽

Vol 8 (1) ◽

pp. 117-127

Author(s):

ALEXANDER S. WIENER ◽

IRVING B. WEXLER

Keyword(s):

Statistical Analysis ◽

Mortality Rate ◽

Red Blood Cells ◽

Clinical Features ◽

Blood Cells ◽

Exchange Transfusion ◽

Red Cells ◽

Simplified Method ◽

Adult Plasma

A simplified method of treating erythroblastosis by exchange transfusion is described in which the patient is bled and simultaneously transfused with compatible packed red cells. A table is presented which gives the final hematocrit and percentage of inagglutinable red blood cells in the patient's body at the termination of the exchange transfusion, in relation to the patient's initial hematocrit and the amount of blood exchanged. An exchange transfusion with 100 to 150 cc. of packed cells appears to be adequate regardless of the severity of the anemia. Statistical analysis of the result of 106 exchange transfusions shows a progressive drop in mortality rate from 23.7% in 38 cases treated with 500 cc. of whole citrated blood, to 14.6 cc. in 48 cases treated with 1,000 cc. of whole citrated blood, and to 10.0% in 20 cases treated with 120 cc. of packed cells. While the improvement may be accidental, there is no doubt that exchange transfusion with packed cells is a simpler procedure which avoids the introduction into the patient's body of large amounts of adult plasma, and potentially toxic doses of citrate and calcium. Two cases are described in detail which have unusual serologic and clinical features and illustrate the types of problems which may arise when treating erythroblastotic babies.

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EXCHANGE TRANSFUSION IN HÆMOLYTIC DISEASE OF THE NEWBORN

The Lancet ◽

10.1016/s0140-6736(48)91839-x ◽

1948 ◽

Vol 252 (6527) ◽

pp. 522-527 ◽

Cited By ~ 21

Author(s):

P.L. Mollison ◽

M. Cutbush

Keyword(s):

Exchange Transfusion ◽

Haemolytic Disease

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Use of intravenous immunoglobulin in neonates with haemolytic disease and immune thrombocytopenia

Vojnosanitetski pregled ◽

10.2298/vsp1311029m ◽

2013 ◽

Vol 70 (11) ◽

pp. 1029-1033

Author(s):

Gordana Markovic-Sovtic ◽

Borisav Jankovic ◽

Zorica Rakonjac ◽

Jelena Martic ◽

Katarina Pejic

Keyword(s):

Intravenous Immunoglobulin ◽

Bilirubin Level ◽

Exchange Transfusion ◽

Immune Thrombocytopenia ◽

Neonatal Intensive Care ◽

Laboratory Data ◽

Length Of Hospital Stay ◽

Serum Bilirubin Level ◽

Haemolytic Disease ◽

Platelet Number

Background/Aim. Intravenous immunoglobulin is a blood product made of human polyclonal immunoglobulin G. The mode of action of intravenous immunoglobulin is very complex. It is indicated in treatment of neonatal immune thrombocytopenia and haemolytic disease of the newborn. The aim of the study was to present our experience in the use of intravenous immunoglobulin in a group of term neonates. Methods. We analysed all relevant clinical and laboratory data of 23 neonates who recieved intravenous immunoglobulin during their hospitalization in Neonatal Intensive Care Unit of Mother and Child Health Care Institute over a five year period, from 2006. to 2010. Results. There were 11 patients with haemolytic disease of the newborn and 12 neonates with immune thrombocytopenia. All of them recieved 1-2 g/kg intravenous immunoglobulin in the course of their treatment. There was no adverse effects of intravenous immunoglobulin use. The use of intravenous immunoglobulin led to an increase in platelet number in thrombocytopenic patients, whereas in those with haemolytic disease serum bilirubin level decreased significantly, so that some patients whose bilirubin level was very close to the exchange transfusion criterion, avoided this procedure. Conclusion. The use of intravenous immunoglobulin was shown to be an effective treatment in reducing the need for exchange transfusion, duration of phototherapy and the length of hospital stay in neonates with haemolytic disease. When used in treatment of neonatal immune thrombocytopenia, it leads to an increase in the platelet number, thus decreasing the risk of serious complications of thrombocytopenia.

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