Abdul Rehman, Shahzadi Asma Tahseen, Tauseef Asma Chaudhry.
Indications and complications of exchange transfusion.
Pak Paed J Jan ;38(1):19-23.

Objective: The purpose of the study is to determine the indications and complications of exchange transfusion done in neonatal section of a tertiary care hospital of a developing country. Methods: This study was conducted in the neonatology section of the Pediatric unit-I, Bahawal Victoria Hospital, Bahawalpur from April 2012 to March 2013. The medical records of infants less than one month who required exchange transfusion were studied. Results: Exchange transfusion was studied in 50 neonates during the study period. Among them 30 (60%) were male and 20 (40%) were female; 35 (70%) neonates were born at home while rest were hospital born. Twelve (24%) neonates were low birth weight. Six (12%) babies were preterm. In this study 2 cases (4%) were infant of diabetic mother, 6 (12%) neonate had respiratory distress syndrome while 20 (40%) were asphyxiated at birth. The mean pre-exchange serum bilirubin level was 24.2 mg/dL (range 18-40mg/dl) while mean post-exchange serum bilirubin levels was 12.4 mg/dl was (range 7.5-27.5mg/dl). Each neonate underwent exchange transfusion once, except two (4%) cases requiring double exchange. The mean age at time of exchange transfusion was 4.6 days (range 2.2- 8days). The mean time taken for the procedure was 70 min (range 60-85min). Regarding indication of exchange transfusion, ABO incompatibility was found in 19 cases (38%), Rh incompatibility 9 cases (18%) and septicemia in 6 cases (12%) ; no cause was found in 16 cases (32%). One neonate died during exchange transfusion. Twenty four neonates (48%) developed complications during and after exchange transfusion. The commonest complication was hypocalcemia (14%), others included thrombocytopenia (10%), hypoglycemia (10%), anemia (8%), hyperkalemia (8%), sepsis (4%) and hypothermia (4%). Conclusion: The most common indication of exchange transfusion was ABO incompatibility. Adverse events after exchange transfusion were common and the procedure may even be associated with death.

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