Can Post Exchange Blood Transfusion Haematocrit Be Predicted in Neonates?

Abstract

Background: Double volume exchange transfusion (DVET) primarily treats severe hyperbilirubinaemia; it also corrects coexisting anaemia when donor blood haematocrit is appropriately adjusted. In resource poor countries, blood for exchange transfusion (ET) is limited to fresh whole blood, the haematocrit of which is rarely documented. In Nigeria, top up transfusion is given to correct anticipated post ET anaemia. This practice is a potential cause of hypervolemia, polycythaemia and hyperviscosity. Objectives: We set out to determine the predictability of post ET haematocrit as this could help identify jaundiced babies that will benefit from post- exchange top up tranResults: Forty out of 56 babies (30 term) met the inclusion criteria and were analyzed. Mean donor haematocrit was 41.2(4.3)%. This was not significantly different from the pre ET haematocrit (39.9(9.0)% P=.366. Pre ET haematocrit was also similar to post ET haematocrit {39.1(3.7)% P=.107}. Estimated haematocrit {40.5(4.1)%} was similar to post ET observed haematocrit. There was a significant level of agreement between observed and estimated haematocrit. Mean difference =-0.887±3.44 (95% CI=-7.8, 6.0: P=.422). Conclusion and Recommendation: It is concluded that post ET haematocrit can be estimated with a reasonable level of accuracy provided the donor blood haematocrit is known. Jaundiced babies should be selectively identified for post exchange transfusion.sfusion. Results: Forty out of 56 babies (30 term) met the inclusion criteria and were analyzed. Mean donor haematocrit was 41.2(4.3)%. This was not significantly different from the pre ET haematocrit (39.9(9.0)% P=.366. Pre ET haematocrit was also similar to post ET haematocrit {39.1(3.7)% P=.107}. Estimated haematocrit {40.5(4.1)%} was similar to post ET observed haematocrit. There was a significant level of agreement between observed and estimated haematocrit. Mean difference =-0.887±3.44 (95% CI=-7.8, 6.0: P=.422). Conclusion and Recommendation: It is concluded that post ET haematocrit can be estimated with a reasonable level of accuracy provided the donor blood haematocrit is known. Jaundiced babies should be selectively identified for post exchange transfusion. Subjects and Methods: Severely jaundiced newborn babies exchanged using the hospital standard protocol were prospectively studied. Blood was drawn from baby before commencement and within one hour after completing the procedure for pre and post ET haematocrit respectively. Donor blood haematocrit was also documented. Post ET haematocrit was calculated on the assumption that DVET resulted in 90% replacement of baby’s blood. Bland-Altman analysis was done to estimate the level of agreement between calculated and observed post ET haematocrit.Background: Double volume exchange transfusion (DVET) primarily treats severe hyperbilirubinaemia; it also corrects coexisting anaemia when donor blood haematocrit is appropriately adjusted. In resource poor countries, blood for exchange transfusion (ET) is limited to fresh whole blood, the haematocrit of which is rarely documented. In Nigeria, top up transfusion is given to correct anticipated post ET anaemia. This practice is a potential cause of hypervolemia, polycythaemia and hyperviscosity. Objectives: We set out to determine the predictability of post ET haematocrit as this could help identify jaundiced babies that will benefit from post- exchange top up transfusion. Subjects and Methods: Severely jaundiced newborn babies exchanged using the hospital standard protocol were prospectively studied. Blood was drawn from baby before commencement and within one hour after completing the procedure for pre and post ET haematocrit respectively. Donor blood haematocrit was also documented. Post ET haematocrit was calculated on the assumption that DVET resulted in 90% replacement of baby’s blood. Bland-Altman analysis was done to estimate the level of agreement between calculated and observed post ET haematocrit.