Exchange transfusion - Revision history

Elcatracho: /* Procedure */

2022-01-04T10:46:05Z

Procedure

← Older revision		Revision as of 10:46, 4 January 2022
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	==Procedure==		==Procedure==
	*Exact steps dependent on whether blood will be exchanged via an apheresis machine and specific model		*Exact steps dependent on whether blood will be exchanged via an apheresis machine and specific model
	*Apheresis may require large-bore [[central venous catheter]] (e.g. HD line or pheresis catheter		*Apheresis may require large-bore [[central venous catheter]] (e.g. HD line or pheresis catheter)
	*If no apheresis machine available:		*If no apheresis machine available:
	**Place at least two peripheral IVs		**Place at least two peripheral IVs

ClaireLewis at 16:08, 9 October 2019

2019-10-09T16:08:58Z

← Older revision		Revision as of 16:08, 9 October 2019
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	**[[Sulfhemoglobinemia]], severe		**[[Sulfhemoglobinemia]], severe
	**[[Methemoglobinemia]] in patients with [[G6PD]] or with methemoglobinemia due to nitrite treatment of cyanide		**[[Methemoglobinemia]] in patients with [[G6PD]] or with methemoglobinemia due to nitrite treatment of cyanide
	**Severe hemolysis due to formic acid toxicity		**Severe [[hemolytic anemia\|hemolysis]] due to formic acid toxicity
	*Severe hemolysis due to [[malaria]] or [[babesiosis]]		*Severe [[hemolytic anemia\|hemolysis]] due to [[malaria]] or [[babesiosis]]
	*~~Neonatal~~ [[hyperbilirubinemia]], extremely severe or unresponsive to phototherapy		*[[Neonatal jaundice\|Neonatal hyperbilirubinemia]], extremely severe or unresponsive to phototherapy
			*Neonatal [[polycythemia]]

	==Contraindications==		==Contraindications==
	*Hemodynamic instability, sepsis, or otherwise unable to tolerate fluid shifts		*[[shock\|Hemodynamic instability]], [[sepsis]], or otherwise unable to tolerate fluid shifts
	*Severe hypocalcemia (citrate anticoagulant can worsen hypocalcemia)		*Severe [[hypocalcemia]] (citrate anticoagulant can worsen hypocalcemia)

	==Equipment Needed==		==Equipment Needed==
	*Supplies for [[vascular access]]		*Supplies for [[vascular access]]
	*Packed RBCs for transfusion		*Packed [[RBCs]] for transfusion
	*Apheresis centrifuge (and any associated supplies) if planning erythrocytapheresis		*Apheresis centrifuge (and any associated supplies) if planning erythrocytapheresis

ClaireLewis: /* Procedure */

2017-04-03T17:36:14Z

Procedure

← Older revision		Revision as of 17:36, 3 April 2017
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	==Procedure==		==Procedure==
	*~~Place at least two peripheral IVs~~		*Exact steps dependent on whether blood will be exchanged via an apheresis machine and specific model
	*Next steps dependent on whether blood will be exchanged via apheresis		*Apheresis may require large-bore [[central venous catheter]] (e.g. HD line or pheresis catheter
	*If no apheresis machine available:		*If no apheresis machine available:
			**Place at least two peripheral IVs
	**Slowly remove 5-20mL of patient's blood		**Slowly remove 5-20mL of patient's blood
	**Replace phlebotomized blood with warmed RBCs (or saline/albumin/plasma) in equal or greater amounts		**Replace phlebotomized blood with warmed RBCs (or saline/albumin/plasma) in equal or greater amounts

ClaireLewis at 17:11, 3 April 2017

2017-04-03T17:11:26Z

← Older revision		Revision as of 17:11, 3 April 2017
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	==Contraindications==		==Contraindications==
			*Hemodynamic instability, sepsis, or otherwise unable to tolerate fluid shifts
			*Severe hypocalcemia (citrate anticoagulant can worsen hypocalcemia)

	==Equipment Needed==		==Equipment Needed==
	*Supplies for [[vascular access]]		*Supplies for [[vascular access]]
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	*[[Transfusion]]		*[[Transfusion]]
	*[[Sickle cell disease]]		*[[Sickle cell disease]]
			*[[Plasmapheresis]]

	==External Links==		==External Links==

ClaireLewis: /* References */

2017-04-03T17:06:03Z

References

← Older revision		Revision as of 17:06, 3 April 2017
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	[[Category:Procedures]]		[[Category:Procedures]]
	[[Category:Heme/Onc		[[Category:Heme/Onc]]

ClaireLewis: Created page with "==Overview== *Technically, "exchange transfusion" can refer to any blood product, but typically Involves removing patient's RBCs and replacing with donor RBCs **When treating..."

2017-04-03T17:05:34Z

Created page with "==Overview== *Technically, "exchange transfusion" can refer to any blood product, but typically Involves removing patient's RBCs and replacing with donor RBCs **When treating..."

New page

==Overview==
*Technically, "exchange transfusion" can refer to any blood product, but typically Involves removing patient's RBCs and replacing with donor RBCs
**When treating neonatal polycythemia, RBCs are replaced with normal saline, albumin, or plasma rather than donor RBCs
*In contrast to simple transfusion, avoids hyperviscosity and volume overload
*Erythrocytapheresis: involves separating out patients RBCs from other blood components extracorporeally in a centrifuge, then returning the rest of the patient's blood to them with the donor RBCs

==Indications==
*Severe complications of [[sickle cell disease]]
**[[Stroke]]
**[[Acute chest syndrome]] (reserved for severe cases)
**[[Priapism]] (conflicting evidence for benefit)
**Other complications requiring transfusion when Hb >10
*Toxicities
**[[Sulfhemoglobinemia]], severe
**[[Methemoglobinemia]] in patients with [[G6PD]] or with methemoglobinemia due to nitrite treatment of cyanide
**Severe hemolysis due to formic acid toxicity
*Severe hemolysis due to [[malaria]] or [[babesiosis]]
*Neonatal [[hyperbilirubinemia]], extremely severe or unresponsive to phototherapy

==Contraindications==

==Equipment Needed==
*Supplies for [[vascular access]]
*Packed RBCs for transfusion
*Apheresis centrifuge (and any associated supplies) if planning erythrocytapheresis

==Procedure==
*Place at least two peripheral IVs
*Next steps dependent on whether blood will be exchanged via apheresis
*If no apheresis machine available:
**Slowly remove 5-20mL of patient's blood
**Replace phlebotomized blood with warmed RBCs (or saline/albumin/plasma) in equal or greater amounts
**Repeat prior steps until desired amount transfused

==Complications==
*[[Hypovolemia]], [[shock]] (if more blood removed than transfused)
*Acute [[transfusion reactions]]
**[[Intravascular hemolytic transfusion reaction]]
**[[Febrile nonhemolytic transfusion reaction]]
**[[Allergic transfusion reaction]]
**[[Transfusion-associated circulatory overload]] (TACO)
**[[Transfusion-related acute lung injury]] (TRALI)
**[[Transfusion-associated graft-versus-host disease]]
**[[Fluid overload]]
**[[Sepsis]]
*Delayed transfusion reactions
**[[Extravascular hemolytic transfusion reaction]]
**[[Graft-vs-host disease]]
**Infection
*[[PE]]/[[DVT]]
*[[Hypokalemia]], [[hyperkalemia]], [[hypocalcemia]], [[hypoglycemia]]

==See Also==
*[[Transfusion]]
*[[Sickle cell disease]]

==External Links==

==References==
<references/>

[[Category:Procedures]]
[[Category:Heme/Onc