589 INCREASING SAFETY OF EXCHANGE TRANSFUSION

Abstract

In the period 1963-1976, 1006 exchange transfusions have been carried out with heparinized blood with only 4 deaths being directly related (0.39%). Of the “directly related” deaths none occurred during the procedure but, on review, no other primary cause could be identified. Three of these 4 deaths occurred in infants who had also had fetal transfusions. Of these three, two died of a graft vs. host (GVH) reaction and one of a sudden apparent anaphylactoid reaction not related to any obvious mismatch. The fourth infant had an intracranial hemorrhage. Since the occurrence of the two GVH infants, irradiated blood has been used for all infants needing intrauterine transfusions and subsequent exchange transfusions and no further GVH has been seen. Of the 951 surviving infants one had 3 intrauterine transfusions and 19 exchange transfusions and, though needing a period of respirator support, at 3 years of age is in excellent health. There were 51 deaths not attributable to the exchange transfusion procedure per se, ranging from hydrops, extreme prematurity, HMD, to chronic lung disease of prematurity, prior intracranial hemorrhage and congenital anomalies.From 1950-1960 800 exchange transfusions were carried out using ACD blood and there were 12 deaths occurring during the exchange transfusion procedure (1.5%) mostly thought primarily due to the procedure. It is proposed that exchange transfusions, when carried out with present methods, are extremely safe procedures in terms of short range morbidity and mortality and should not be “avoided at all costs.”