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Observational Study
. 2024 Dec:275:114225.
doi: 10.1016/j.jpeds.2024.114225. Epub 2024 Jul 31.

Use and Waste of Reconstituted Whole Blood Exchange Transfusions: An 11-year National Observational Study

Derek P de Winter  1 , Enrico Lopriore  2 , Christian V Hulzebos  3 , Michaël V Lukens  4 , J H Harriët Klinkspoor  5 , Michaela van Bohemen  6 , Gijs den Besten  7 , Karen M K de Vooght  8 , Sabine L A G Vrancken  9 , Amanda M P Trompenaars  10 , Angelique Hoffmann-Haringsma  11 , N C V Nathalie Péquériaux  12 , Peter Andriessen  13 , Karlijn Gijzen  14 , J L A M Jacqueline van Hillegersberg  15 , Janneke C Zant  16 , Maaike C van Rossem  17 , A J Adriaan van Gammeren  18 , Floor Weerkamp  19 , Clare E Counsilman  20 , F R Rachel Knol  21 , I A M Irene Schiering  22 , Gerdina H Dubbink-Verheij  23 , E J T Joanne Verweij  24 , Masja de Haas  25 ; WISE investigators
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Free article
Observational Study

Use and Waste of Reconstituted Whole Blood Exchange Transfusions: An 11-year National Observational Study

Derek P de Winter et al. J Pediatr. 2024 Dec.
Free article

Abstract

Objectives: To identify indications for exchange transfusions, assess the use and waste of exchange transfusion products (ie, reconstituted whole blood exchange transfusions), and determine nationwide distribution and prevalence of these transfusions in the Netherlands.

Study design: All 9 neonatal intensive care units and 15 non-neonatal intensive care unit hospitals participated in this retrospective, observational, cohort study. We retrieved data on the indications for and use of all exchange transfusion products ordered by participating centers over an 11-year period.

Results: A total of 574 patients for whom 1265 products were ordered were included for analyses. Severe ABO (32.6%) and non-ABO (25.2%) immune hemolysis and subsequent hyperbilirubinemia were the most frequent indications. Rare indications were severe leukocytosis in Bordetella pertussis (2.1%) and severe anemia (1.5%). Approximately one-half of all ordered products remained unused. In 278 of 574 neonates (48.4%), ≥1 products were not used, of which 229 (82.7%) were due to the resolving of severe hyperbilirubinemia with further intensification of phototherapy. The overall prevalence of neonates who received an exchange transfusion was 14.6:100 000 liveborn neonates.

Conclusions: A considerable proportion of products remained unused, and annually a limited number of patients are treated with an exchange transfusion in the Netherlands, highlighting the rarity of the procedure in the Netherlands.

Keywords: Exchange transfusion; hyperbilirubinemia; pertussis; prevalence.

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Conflict of interest statement

Declaration of Competing Interest This study is researcher initiated and not externally funded. No funds, grants, or other support were received. D.P.d.W. received funding from Momenta Pharmaceuticals, Inc., which was acquired by Johnson & Johnson, and is an investigator for a phase 2 trial (NCT03842189) of a new drug for the treatment of HDFN. E.J.T.V. is the principal investigator for a phase 2 trial (NCT03842189) and a phase 3 trial (NCT05912517) of a new drug for the treatment of HDFN, which is sponsored by Janssen Pharmaceuticals. E.L. is a sub-investigator for a phase 2 trial (NCT03842189) of a new drug for the treatment of HDFN, which is sponsored by Janssen Pharmaceuticals. All other authors reported to have no conflict of interest or financial disclosures.

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