View source for Exchange transfusion

==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 [[hemolytic anemia|hemolysis]] due to formic acid toxicity
*Severe [[hemolytic anemia|hemolysis]] due to [[malaria]] or [[babesiosis]]
*[[Neonatal jaundice|Neonatal hyperbilirubinemia]], extremely severe or unresponsive to phototherapy
*Neonatal [[polycythemia]]

==Contraindications==
*[[shock|Hemodynamic instability]], [[sepsis]], or otherwise unable to tolerate fluid shifts
*Severe [[hypocalcemia]] (citrate anticoagulant can worsen hypocalcemia)
  
==Equipment Needed==
*Supplies for [[vascular access]]
*Packed [[RBCs]] for transfusion
*Apheresis centrifuge (and any associated supplies) if planning erythrocytapheresis
 
==Procedure==
*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)
*If no apheresis machine available:
**Place at least two peripheral IVs
**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]]
*[[Plasmapheresis]]

==External Links==

==References==
<references/>

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