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Exchange transfusion
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<h2 id="description">Description</h2> <p>An exchange transfusion requires that the patient's blood can be removed and replaced. In most cases, this involves placing one or more thin tubes, called catheters, into a blood vessel. The exchange transfusion is done in cycles: each one usually lasts a few minutes.<a class="footnote-ref" id="fnref:5" href="#fn:5"><sup>5</sup></a> </p><p>The patient’s blood is slowly withdrawn (usually about 5 to 20 mL at a time, depending on the patient’s size and the severity of illness), and a slightly larger amount of fresh, prewarmed blood or plasma flows into the patient's body. This cycle is repeated until the correct volume of blood has been replaced.<a class="footnote-ref" id="fnref:6" href="#fn:6"><sup>6</sup></a> </p><p>After the exchange transfusion, catheters may be left in place in case the procedure needs to be repeated. </p><p>In diseases such as <a href="/facts/Transfusion_therapy_(Sickle-cell_disease)/5cXGEvsd">sickle cell anemia</a>, blood is removed and replaced with donor blood.<a class="footnote-ref" id="fnref:7" href="#fn:7"><sup>7</sup></a> </p><p>In conditions such as neonatal polycythemia, a specific amount of the child’s blood is removed and replaced with normal saline, plasma (the clear liquid portion of blood), or an albumin solution. This decreases the total number of red blood cells in the body and makes it easier for blood to flow through the body.<a class="footnote-ref" id="fnref:8" href="#fn:8"><sup>8</sup></a> </p> <h2 id="medical-uses">Medical Uses</h2> <h3>Sickle Cell Disease</h3> <p><a href="/facts/Transfusion_therapy_(Sickle-cell_disease)/5cXGEvsd">Transfusion therapy</a> is used as an emergency procedure to treat life-threatening complications of <a href="/facts/Sickle_cell_disease/93LT7ATq">sickle-cell disease</a> as well as an elective procedure to stop these complications occurring.<a class="footnote-ref" id="fnref:9" href="#fn:9"><sup>9</sup></a><a class="footnote-ref" id="fnref:10" href="#fn:10"><sup>10</sup></a> </p> <h4>Treatment of life-threatening complications</h4> <ul><li>Acute <a href="/facts/Stroke/DwpjdzY0">cerebrovascular event</a> (stroke)<a class="footnote-ref" id="fnref:11" href="#fn:11"><sup>11</sup></a><a class="footnote-ref" id="fnref:12" href="#fn:12"><sup>12</sup></a></li> <li>Acute chest syndrome with respiratory failure<a class="footnote-ref" id="fnref:13" href="#fn:13"><sup>13</sup></a><a class="footnote-ref" id="fnref:14" href="#fn:14"><sup>14</sup></a></li> <li>Multi-organ failure<a class="footnote-ref" id="fnref:15" href="#fn:15"><sup>15</sup></a><a class="footnote-ref" id="fnref:16" href="#fn:16"><sup>16</sup></a><a class="footnote-ref" id="fnref:17" href="#fn:17"><sup>17</sup></a></li> <li>Mesenteric girdle syndrome<a class="footnote-ref" id="fnref:18" href="#fn:18"><sup>18</sup></a></li></ul> <p>The commonest emergency reason is to treat an acute chest syndrome.<a class="footnote-ref" id="fnref:19" href="#fn:19"><sup>19</sup></a> </p> <h4>Prevention</h4> <ul><li>Prior to surgery in people with sickle cell anemia (HbSS) who already have a hemoglobin above 85g/L, or who require a prolonged operation with general anesthetic, or who need high-risk surgery<a class="footnote-ref" id="fnref:20" href="#fn:20"><sup>20</sup></a><a class="footnote-ref" id="fnref:21" href="#fn:21"><sup>21</sup></a><a class="footnote-ref" id="fnref:22" href="#fn:22"><sup>22</sup></a><a class="footnote-ref" id="fnref:23" href="#fn:23"><sup>23</sup></a></li> <li>To optimise hemoglobin S levels, for example to prevent a stroke occurring in a child.<a class="footnote-ref" id="fnref:24" href="#fn:24"><sup>24</sup></a><a class="footnote-ref" id="fnref:25" href="#fn:25"><sup>25</sup></a> The target is usually to maintain a hemoglobin S level below 30% to prevent complications occurring.<a class="footnote-ref" id="fnref:26" href="#fn:26"><sup>26</sup></a><a class="footnote-ref" id="fnref:27" href="#fn:27"><sup>27</sup></a></li></ul> <p>The most common routine reason is to prevent a stroke occurring or re-occurring.<a class="footnote-ref" id="fnref:28" href="#fn:28"><sup>28</sup></a> </p> <h3>Hemolytic Disease of the Newborn</h3> <p>Exchange transfusion to treat <a href="/facts/Hemolytic_disease_of_the_newborn/gAFrcRQ7">hemolytic disease of the newborn</a> is now uncommon since the introduction of <a href="/facts/Rho(D)_immune_globulin/gqp0gMGt">Anti-D prophylaxis</a> in pregnancy. However, it can occur due to the development of other antibodies such as <a href="/facts/Hemolytic_disease_of_the_newborn_(anti-Rhc)/RjLQaxkg">anti-c</a>, <a href="/facts/Hemolytic_disease_of_the_newborn_(anti-RhE)/ffKBR4rE">anti-E</a>, and <a href="/facts/Hemolytic_disease_of_the_newborn_(ABO)/Ga7jmmTF">ABO</a>.<a class="footnote-ref" id="fnref:29" href="#fn:29"><sup>29</sup></a> </p> <h3>Polycythemia</h3> <p><a href="/facts/Polycythemia/I2pkwLtQ">Polycythemia</a>, a condition in which the number of red cells in the blood is too high, is usually diagnosed when the <a href="/facts/Hematocrit/wg1UalUh">hematocrit</a> is above 65%.<a class="footnote-ref" id="fnref:30" href="#fn:30"><sup>30</sup></a><a class="footnote-ref" id="fnref:31" href="#fn:31"><sup>31</sup></a> Polycythemia can occur in neonates for multiple different reasons including: babies born after 42 weeks gestation (post-term), babies born to diabetic mothers, <a href="/facts/Twin-to-twin_transfusion_syndrome/bryytamS">twin to twin transfusion</a>, <a href="/facts/Intrauterine_growth_restriction/IrLlQ8aS">intrauterine growth restriction</a>, and babies with genetic abnormalities.<a class="footnote-ref" id="fnref:32" href="#fn:32"><sup>32</sup></a> Polycythemia can make the blood thicker than normal and therefore lead to complications. Partial exchange transfusion has been used as a treatment to prevent complications, and has been shown to improve cerebral blood flow,<a class="footnote-ref" id="fnref:33" href="#fn:33"><sup>33</sup></a> but there is no evidence that it prevents long-term complications.<a class="footnote-ref" id="fnref:34" href="#fn:34"><sup>34</sup></a> </p> <h3>Severe malaria</h3> <p>Exchange transfusion has been used for the treatment of severe <a href="/facts/Malaria/rN3g58CX">malaria</a> in the past.<a class="footnote-ref" id="fnref:35" href="#fn:35"><sup>35</sup></a><a class="footnote-ref" id="fnref:36" href="#fn:36"><sup>36</sup></a> However, in 2013 the CDC examined the limited evidence available and found no evidence that exchange transfusion has any beneficial effects (decreased mortality) in people with very high parasite loads (> 10%).<a class="footnote-ref" id="fnref:37" href="#fn:37"><sup>37</sup></a> Also, although uncommon, exchange transfusion can cause complications (low blood pressure (<a href="/facts/Hypotension/BhrdVVRS">hypotension</a>), abnormal heart rhythms (<a href="/facts/Ventricular_fibrillation/7rCnI7zf">ventricular fibrillation</a>) and breathing problems (<a href="/facts/Acute_respiratory_distress_syndrome/1V3mxJkU">acute respiratory distress syndrome</a>)).<a class="footnote-ref" id="fnref:38" href="#fn:38"><sup>38</sup></a> Based on this evidence, the CDC no longer recommend the use of exchange transfusion in the treatment of malaria.<a class="footnote-ref" id="fnref:39" href="#fn:39"><sup>39</sup></a> </p> <h2 id="risks">Risks</h2> <p>General risks are the same as with any transfusion. Other possible complications include:<a class="footnote-ref" id="fnref:40" href="#fn:40"><sup>40</sup></a> </p> <ul><li><a href="/facts/Thrombosis/8Y3wh2UX">Blood clots</a></li> <li>Changes in blood chemistry (high or low <a href="/facts/Potassium/FWPwS7Rj">potassium</a>, low <a href="/facts/Calcium/hf252CC0">calcium</a>, <a href="/facts/Hypoglycemia/BlAmuP6k">low glucose</a>, change in acid-base balance in the blood)</li> <li>Heart and lung problems</li> <li>Infection (greatly decreased risk due to careful screening of blood)</li> <li><a href="/facts/Shock_(circulatory)/aIKGDS0e">Shock</a> due to inadequate replacement of blood</li></ul> <h2 id="recovery">Recovery</h2> <p>The person may need to be monitored for several days in the hospital after the transfusion, but the length of stay generally depends on the condition for which the exchange transfusion was performed. Sickle Cell Disease patients may be exchanged in an outpatient setting and can be sent home the very same day.<a class="footnote-ref" id="fnref:41" href="#fn:41"><sup>41</sup></a> </p> <h2 id="history">History</h2> <p>The technique was originally developed by <a href="/facts/Alexander_S._Wiener/6vtQpVys">Alexander S. Wiener</a>, soon after he co-discovered the <a href="/facts/Rh_blood_group_system/ur0d2d9r">Rh factor</a>[<i>broken anchor</i>].<a class="footnote-ref" id="fnref:42" href="#fn:42"><sup>42</sup></a> </p> <h2 id="see-also">See also</h2> <ul><li><a href="/facts/Plasmapheresis/pt2AfdrU">Plasmapheresis</a></li> <li><a href="/facts/Neonatal_red_cell_transfusion/1J1jI0gC">Neonatal red cell transfusion</a></li> <li><a href="/facts/Hemolytic_disease_of_the_newborn/gAFrcRQ7">Hemolytic disease of the newborn</a></li> <li><a href="/facts/Transfusion_therapy_(Sickle-cell_disease)/5cXGEvsd">Exchange transfusion in sickle cell disease</a></li></ul> <h2 id="external-links">External links</h2> <ul><li><a href="https://nicutools.org/#PET">Neonatal Partial Exchange Transfusion Calculator</a></li></ul> <h2 id="references">References</h2> <ol> <li id="fn:1"><p>"Exchange transfusion". Nlm.nih.gov. MedlinePlus. <a href="https://www.nlm.nih.gov/medlineplus/ency/article/002923.htm" target="_blank">https://www.nlm.nih.gov/medlineplus/ency/article/002923.htm</a> <a href="#fnref:1" class="footnote-back-ref">↩</a></p></li> <li id="fn:2"><p>"Spectra Optia for automatic red blood cell exchange in patients with sickle cell disease | Guidance and guidelines | NICE". www.nice.org.uk. 2 March 2016. Retrieved 2019-01-04. <a href="https://www.nice.org.uk/guidance/mtg28" target="_blank">https://www.nice.org.uk/guidance/mtg28</a> <a href="#fnref:2" class="footnote-back-ref">↩</a></p></li> <li id="fn:3"><p>Davis, Bernard A.; Allard, Shubha; Qureshi, Amrana; Porter, John B.; Pancham, Shivan; Win, Nay; Cho, Gavin; Ryan, Kate (2017). "Guidelines on red cell transfusion in sickle cell disease. Part I: principles and laboratory aspects". British Journal of Haematology. 176 (2): 179–191. doi:10.1111/bjh.14346. ISSN 1365-2141. PMID 28092109. S2CID 3462324. <a href="https://doi.org/10.1111%2Fbjh.14346" target="_blank">https://doi.org/10.1111%2Fbjh.14346</a> <a href="#fnref:3" class="footnote-back-ref">↩</a></p></li> <li id="fn:4"><p>"Evidence-Based Management of Sickle Cell Disease: Expert Panel Report, 2014 | National Heart, Lung, and Blood Institute (NHLBI)". www.nhlbi.nih.gov. Retrieved 2019-01-04. <a href="https://www.nhlbi.nih.gov/health-topics/evidence-based-management-sickle-cell-disease" target="_blank">https://www.nhlbi.nih.gov/health-topics/evidence-based-management-sickle-cell-disease</a> <a href="#fnref:4" class="footnote-back-ref">↩</a></p></li> <li id="fn:5"><p>"Exchange transfusion". Nlm.nih.gov. MedlinePlus. <a href="https://www.nlm.nih.gov/medlineplus/ency/article/002923.htm" target="_blank">https://www.nlm.nih.gov/medlineplus/ency/article/002923.htm</a> <a href="#fnref:5" class="footnote-back-ref">↩</a></p></li> <li id="fn:6"><p>"Exchange transfusion". Nlm.nih.gov. MedlinePlus. <a href="https://www.nlm.nih.gov/medlineplus/ency/article/002923.htm" target="_blank">https://www.nlm.nih.gov/medlineplus/ency/article/002923.htm</a> <a href="#fnref:6" class="footnote-back-ref">↩</a></p></li> <li id="fn:7"><p>"Manual exchange blood transfusion protocol". www.gosh.nhs.uk. Archived from the original on 2019-04-12. Retrieved 2019-01-04. <a href="https://web.archive.org/web/20190412234705/https://www.gosh.nhs.uk/health-professionals/clinical-guidelines/manual-exchange-blood-transfusion-protocol" target="_blank">https://web.archive.org/web/20190412234705/https://www.gosh.nhs.uk/health-professionals/clinical-guidelines/manual-exchange-blood-transfusion-protocol</a> <a href="#fnref:7" class="footnote-back-ref">↩</a></p></li> <li id="fn:8"><p>"Manual exchange blood transfusion protocol". www.gosh.nhs.uk. Archived from the original on 2019-04-12. Retrieved 2019-01-04. <a href="https://web.archive.org/web/20190412234705/https://www.gosh.nhs.uk/health-professionals/clinical-guidelines/manual-exchange-blood-transfusion-protocol" target="_blank">https://web.archive.org/web/20190412234705/https://www.gosh.nhs.uk/health-professionals/clinical-guidelines/manual-exchange-blood-transfusion-protocol</a> <a href="#fnref:8" class="footnote-back-ref">↩</a></p></li> <li id="fn:9"><p>Davis, Bernard A.; Allard, Shubha; Qureshi, Amrana; Porter, John B.; Pancham, Shivan; Win, Nay; Cho, Gavin; Ryan, Kate (2017). "Guidelines on red cell transfusion in sickle cell disease. Part I: principles and laboratory aspects". British Journal of Haematology. 176 (2): 179–191. doi:10.1111/bjh.14346. ISSN 1365-2141. PMID 28092109. S2CID 3462324. <a href="https://doi.org/10.1111%2Fbjh.14346" target="_blank">https://doi.org/10.1111%2Fbjh.14346</a> <a href="#fnref:9" class="footnote-back-ref">↩</a></p></li> <li id="fn:10"><p>"Evidence-Based Management of Sickle Cell Disease: Expert Panel Report, 2014 | National Heart, Lung, and Blood Institute (NHLBI)". www.nhlbi.nih.gov. Retrieved 2019-01-04. <a href="https://www.nhlbi.nih.gov/health-topics/evidence-based-management-sickle-cell-disease" target="_blank">https://www.nhlbi.nih.gov/health-topics/evidence-based-management-sickle-cell-disease</a> <a href="#fnref:10" class="footnote-back-ref">↩</a></p></li> <li id="fn:11"><p>Davis, Bernard A.; Allard, Shubha; Qureshi, Amrana; Porter, John B.; Pancham, Shivan; Win, Nay; Cho, Gavin; Ryan, Kate (2017). "Guidelines on red cell transfusion in sickle cell disease. Part I: principles and laboratory aspects". British Journal of Haematology. 176 (2): 179–191. doi:10.1111/bjh.14346. ISSN 1365-2141. PMID 28092109. S2CID 3462324. <a href="https://doi.org/10.1111%2Fbjh.14346" target="_blank">https://doi.org/10.1111%2Fbjh.14346</a> <a href="#fnref:11" class="footnote-back-ref">↩</a></p></li> <li id="fn:12"><p>"Evidence-Based Management of Sickle Cell Disease: Expert Panel Report, 2014 | National Heart, Lung, and Blood Institute (NHLBI)". www.nhlbi.nih.gov. Retrieved 2019-01-04. <a href="https://www.nhlbi.nih.gov/health-topics/evidence-based-management-sickle-cell-disease" target="_blank">https://www.nhlbi.nih.gov/health-topics/evidence-based-management-sickle-cell-disease</a> <a href="#fnref:12" class="footnote-back-ref">↩</a></p></li> <li id="fn:13"><p>Davis, Bernard A.; Allard, Shubha; Qureshi, Amrana; Porter, John B.; Pancham, Shivan; Win, Nay; Cho, Gavin; Ryan, Kate (2017). "Guidelines on red cell transfusion in sickle cell disease. Part I: principles and laboratory aspects". British Journal of Haematology. 176 (2): 179–191. doi:10.1111/bjh.14346. ISSN 1365-2141. PMID 28092109. S2CID 3462324. <a href="https://doi.org/10.1111%2Fbjh.14346" target="_blank">https://doi.org/10.1111%2Fbjh.14346</a> <a href="#fnref:13" class="footnote-back-ref">↩</a></p></li> <li id="fn:14"><p>"Evidence-Based Management of Sickle Cell Disease: Expert Panel Report, 2014 | National Heart, Lung, and Blood Institute (NHLBI)". www.nhlbi.nih.gov. Retrieved 2019-01-04. <a href="https://www.nhlbi.nih.gov/health-topics/evidence-based-management-sickle-cell-disease" target="_blank">https://www.nhlbi.nih.gov/health-topics/evidence-based-management-sickle-cell-disease</a> <a href="#fnref:14" class="footnote-back-ref">↩</a></p></li> <li id="fn:15"><p>"Evidence-Based Management of Sickle Cell Disease: Expert Panel Report, 2014 | National Heart, Lung, and Blood Institute (NHLBI)". www.nhlbi.nih.gov. Retrieved 2019-01-04. <a href="https://www.nhlbi.nih.gov/health-topics/evidence-based-management-sickle-cell-disease" target="_blank">https://www.nhlbi.nih.gov/health-topics/evidence-based-management-sickle-cell-disease</a> <a href="#fnref:15" class="footnote-back-ref">↩</a></p></li> <li id="fn:16"><p>"Manual exchange blood transfusion protocol". www.gosh.nhs.uk. Archived from the original on 2019-04-12. Retrieved 2019-01-04. <a href="https://web.archive.org/web/20190412234705/https://www.gosh.nhs.uk/health-professionals/clinical-guidelines/manual-exchange-blood-transfusion-protocol" target="_blank">https://web.archive.org/web/20190412234705/https://www.gosh.nhs.uk/health-professionals/clinical-guidelines/manual-exchange-blood-transfusion-protocol</a> <a href="#fnref:16" class="footnote-back-ref">↩</a></p></li> <li id="fn:17"><p>Davis, Bernard A.; Allard, Shubha; Qureshi, Amrana; Porter, John B.; Pancham, Shivan; Win, Nay; Cho, Gavin; Ryan, Kate (2017). "Guidelines on red cell transfusion in sickle cell disease Part II: indications for transfusion" (PDF). British Journal of Haematology. 176 (2): 192–209. doi:10.1111/bjh.14383. ISSN 1365-2141. PMID 27858994. S2CID 3534824. <a href="http://discovery.ucl.ac.uk/10072500/3/Davis_Guidelines%20on%20indications%20red%20cell%20transfusion%20in%20sickle%20cell%20disease%20v%207%20March%202016.pdf" target="_blank">http://discovery.ucl.ac.uk/10072500/3/Davis_Guidelines%20on%20indications%20red%20cell%20transfusion%20in%20sickle%20cell%20disease%20v%207%20March%202016.pdf</a> <a href="#fnref:17" class="footnote-back-ref">↩</a></p></li> <li id="fn:18"><p>Davis, Bernard A.; Allard, Shubha; Qureshi, Amrana; Porter, John B.; Pancham, Shivan; Win, Nay; Cho, Gavin; Ryan, Kate (2017). "Guidelines on red cell transfusion in sickle cell disease Part II: indications for transfusion" (PDF). British Journal of Haematology. 176 (2): 192–209. doi:10.1111/bjh.14383. ISSN 1365-2141. PMID 27858994. S2CID 3534824. <a href="http://discovery.ucl.ac.uk/10072500/3/Davis_Guidelines%20on%20indications%20red%20cell%20transfusion%20in%20sickle%20cell%20disease%20v%207%20March%202016.pdf" target="_blank">http://discovery.ucl.ac.uk/10072500/3/Davis_Guidelines%20on%20indications%20red%20cell%20transfusion%20in%20sickle%20cell%20disease%20v%207%20March%202016.pdf</a> <a href="#fnref:18" class="footnote-back-ref">↩</a></p></li> <li id="fn:19"><p>Davis, Bernard A.; Allard, Shubha; Qureshi, Amrana; Porter, John B.; Pancham, Shivan; Win, Nay; Cho, Gavin; Ryan, Kate (2017). "Guidelines on red cell transfusion in sickle cell disease Part II: indications for transfusion" (PDF). British Journal of Haematology. 176 (2): 192–209. doi:10.1111/bjh.14383. ISSN 1365-2141. PMID 27858994. S2CID 3534824. <a href="http://discovery.ucl.ac.uk/10072500/3/Davis_Guidelines%20on%20indications%20red%20cell%20transfusion%20in%20sickle%20cell%20disease%20v%207%20March%202016.pdf" target="_blank">http://discovery.ucl.ac.uk/10072500/3/Davis_Guidelines%20on%20indications%20red%20cell%20transfusion%20in%20sickle%20cell%20disease%20v%207%20March%202016.pdf</a> <a href="#fnref:19" class="footnote-back-ref">↩</a></p></li> <li id="fn:20"><p>Davis, Bernard A.; Allard, Shubha; Qureshi, Amrana; Porter, John B.; Pancham, Shivan; Win, Nay; Cho, Gavin; Ryan, Kate (2017). "Guidelines on red cell transfusion in sickle cell disease. Part I: principles and laboratory aspects". British Journal of Haematology. 176 (2): 179–191. doi:10.1111/bjh.14346. ISSN 1365-2141. PMID 28092109. S2CID 3462324. <a href="https://doi.org/10.1111%2Fbjh.14346" target="_blank">https://doi.org/10.1111%2Fbjh.14346</a> <a href="#fnref:20" class="footnote-back-ref">↩</a></p></li> <li id="fn:21"><p>"Evidence-Based Management of Sickle Cell Disease: Expert Panel Report, 2014 | National Heart, Lung, and Blood Institute (NHLBI)". www.nhlbi.nih.gov. Retrieved 2019-01-04. <a href="https://www.nhlbi.nih.gov/health-topics/evidence-based-management-sickle-cell-disease" target="_blank">https://www.nhlbi.nih.gov/health-topics/evidence-based-management-sickle-cell-disease</a> <a href="#fnref:21" class="footnote-back-ref">↩</a></p></li> <li id="fn:22"><p>Davis, Bernard A.; Allard, Shubha; Qureshi, Amrana; Porter, John B.; Pancham, Shivan; Win, Nay; Cho, Gavin; Ryan, Kate (2017). "Guidelines on red cell transfusion in sickle cell disease Part II: indications for transfusion" (PDF). British Journal of Haematology. 176 (2): 192–209. doi:10.1111/bjh.14383. ISSN 1365-2141. PMID 27858994. S2CID 3534824. <a href="http://discovery.ucl.ac.uk/10072500/3/Davis_Guidelines%20on%20indications%20red%20cell%20transfusion%20in%20sickle%20cell%20disease%20v%207%20March%202016.pdf" target="_blank">http://discovery.ucl.ac.uk/10072500/3/Davis_Guidelines%20on%20indications%20red%20cell%20transfusion%20in%20sickle%20cell%20disease%20v%207%20March%202016.pdf</a> <a href="#fnref:22" class="footnote-back-ref">↩</a></p></li> <li id="fn:23"><p>Estcourt, Lise J; Fortin, Patricia M; Trivella, Marialena; Hopewell, Sally (2016-04-06). "Preoperative blood transfusions for sickle cell disease". Cochrane Database of Systematic Reviews. 4 (4): CD003149. doi:10.1002/14651858.cd003149.pub3. ISSN 1465-1858. PMC 4854326. 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