Exchange transfusions

Several methods of transfusion maybe used, including simple transfusion, exchange transfusion, or erythrocytapheresis. The goal of chronic transfusion therapy is to maintain the HbS level at less than 30% (0.30) of total hemoglobin concentration. Transfusions usually are administered every 3 to 4 weeks depending on the HbS concentration. For secondary stroke prevention, current studies have indicated that lifelong transfusion may be required, with an increased incidence of recurrence once transfusions are stopped.6... 

Acute neurologic events, such as stroke, will require hospitalization and close monitoring. Patients should have physical and neurologic examinations every 2 hours.27 Acute treatment may include exchange transfusion or simple transfusion to maintain hemoglobin at around 10 g/dL (100 g/L or 6.2 mmol/L) and HbS concentration at less than 30%. Patients with a history of seizure may need anticonvulsants, and interventions for increased intracranial pressure should be initiated if necessary. Children with a history of stroke should be initiated on chronic transfusion therapy. Adults presenting with ischemic stroke should be considered for thrombolytic therapy if it has been less than 3 hours since the onset of symptoms.6,27... 

Exchange transfusion that may be required in patients with P. falciparum malaria in whom parasitemia may be between 5% and 15% remains a questionable modality. Either peritoneal or hemodialysis may be indicated in renal failure. 

Mier, R.J. 1988. Treatment of aniline poisoning with exchange transfusion. Clin. Toxicol. 26 357— 364. 

Levinsky et al. (1970) reported on three men exposed to an unknown concentration of arsine for an estimated, 2, 3, and 15 min. Signs and symptoms of exposure (malaise, headache, abdominal pain, chills, nausea, vomiting, oliguria/ anuria, hematuria, bronze skin color) developed within 1-2 h. All three individuals required extensive medical intervention to save their lives. Clinical findings were indicative of massive hemolysis and repeated blood exchange transfusions were necessary for the survival of these individuals. 

Pinto (1976) also reported similar characteristics regarding acute arsine poisoning. Although, an exposure concentration was unavailable, exposure to newly formed arsine for less than 1 h resulted in severe (likely fatal without medical intervention of exchange transfusion) signs and symptoms, including... 

Exchange transfusion of whole blood. This will transiently decrease circulating anti-factor VIII C antibodies. 

Treatment for nonketotic hyperglycinemia is less effective than that available for other aminoacidurias. There is no specific therapy. Exchange transfusion and dialysis usually do not alter the progressive neurological deterioration. Sodium benzoate has been administered in the hope that glycine would react with it to form hippuric acid, but this approach is not helpful. It may be that a combination of benzoate and carnitine therapy is more effective [28]. Similarly, the restriction of dietary protein... 

Dialysis, including hemodialysis and peritoneal dialysis, relieves acute toxicity during fulminant hyperammonemia. Exchange transfusions also have been performed, but this technique has not been equally useful in removing ammonia. 

Sakai H, Takeoka S, Park SI, et al. Surface modification of hemoglobin vesicles with poly(ethylene glycol) and effects on aggregation, viscosity, and blood flow during 90% exchange transfusion in anesthetized rats. Bioconugate Chem 1997 8 23. 

Awasthi VD, Garcia B, Klipper R, et al. Kinetics of liposome-encapsulated hemoglobin after 25% hypovolemic exchange transfusion. Int J Pharm. 2004 283 53. 

Izumi Y, Sakai H, Kose T, et al. Evaluation of the capabilities of a hemoglobin vesicle as an artificial oxygen carrier in a rat exchange transfusion model. ASAIO J 1997 43 289. 

Hypocalcemia - To correct plasma calcium levels (eg, neonatal tetany and tetany due to parathyroid deficiency, vitamin D deficiency, alkalosis) prevention of hypocalcemia during exchange transfusions conditions associated with intestinal malabsorption. 

Exchange transfusions in newborns 0.5 mL (0.11 g) after every 100 mL of blood exchanged. 

In complicated falciparum malaria exchange transfusion can be considered if high parasitemia s (>5%) is present, although the benefit has not been proven with a randomised controlled trial. In these severe cases i.v. quinine (with loading dose) is gradually being replaced by artesunate, wich has proven less mortality and less side effects than good old ... 

Sjoberg, P, Bondesson, U., Sedin, G. Grrstafssorr, J. (1985b) Dispositions of di- and mono-(2-ethylhexyl) phthalate in newborn irrfants srrbjected to exchange transfusions. Eur. J. din. Invest., 165, 430-436... 

Gerard P, Malvaux P, De Visscher M. Accidental poisoning with thyroid extract treated by exchange transfusion. Arch Dis Child 1972 47(256) 981-982. 

The supportive treatment of aspirin poisoning may include gastric lavage (to prevent the further absorption of salicylate), fluid replenishment (to offset the dehydration and oliguria), alcohol and water sponging (to combat the hyperthermia), the administration of vitamin K (to prevent possible hemorrhage), sodium bicarbonate administration (to combat acidosis) and, in extreme cases, peritoneal dialysis and exchange transfusion. 

In a small proportion of cases of hemolytic disease of the newborn (inspissated bile syndrome), large amounts of conjugated bilirubin as well as free bilirubin accumulate in the plasma due to obstruction (J3, L2, S16). Conjugated bilirubin is apparently nontoxic to the brain so that exchange transfusions in such infants are indicated only if the free bilirubin and not the total bile pigment concentration is rising above 20 mg/100 ml plasma. 

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