Exchange Transfusion

Excerpt

Unlike a simple blood transfusion, where a patient receives blood or its components without any blood removal, exchange transfusion involves removing the patient's blood or its constituents and replacing them with donor or blood components. The therapeutic apheresis process removes abnormal cells or substances from the blood associated with specific disease states through either plasma exchange or cytapheresis. Plasmapheresis separates plasma via centrifugation or filtration, whereas cytapheresis involves separating red blood cells, white blood cells, and platelets, typically for subsequent use in another individual. During an exchange transfusion, patients undergo therapeutic cytapheresis to remove abnormal or excess cellular components, followed by replacement through the transfusion of allogenic blood products. Exchange transfusion is commonly used to lower hemoglobin S levels in patients with sickle cell disease and treat unconjugated hyperbilirubinemia or polycythemia in neonates.

Whether performed manually or using an automated machine, exchange transfusion poses risks of errors and complications, necessitating careful implementation by healthcare professionals. Careful monitoring is essential to avoid and manage common adverse events such as hypothermia, fluid overload, hypoglycemia, and hypocalcemia. With advances such as intravenous immune globulin, phototherapy, and Rho(D) immune globulin, exchange transfusion is not a standard clinical procedure in modern medicine. However, healthcare professionals must be well-versed in the indications, techniques, and possible complications for patients who do not respond to standard therapy.