Metabolic and hormonal changes during and after exchange transfusion with heparinized or ACD blood

Abstract

Plasma glucose, free fatty acid (FFA), insulin, and growth hormone concentrations were measured during and for 3 hours after exchange transfusion in two comparable groups of newborn infants suffering from jaundice due to haemolytic disease, infection, or prematurity. 10 transfusions were performed using blood preserved with acid citrate and dextrose (ACD) and in these there was a doubling of plasma glucose and a fourfold rise in plasma insulin. Plasma FFA fell in ACD transfusions but doubled during 9 transfusions in which heparinized blood was used. Plasma glucose and insulin remained unchanged in heparin transfusions and no significant change in plasma growth hormone occurred during or after either type of transfusion. After the transfusion plasma glucose fell rapidly in the ACD group, but despite the falling plasma glucose concentration plasma insulin levels rose further and did not begin to fall until 60 minutes after transfusion. Plasma FFA remained steady for one hour and then rose to twice the pretransfusion level at 3 hours. In the heparin group plasma FFA remained high and did not change significantly in the 3-hour post-transfusion period, whereas plasma glucose and insulin remained at pretransfusion levels throughout. Infants transfused with ACD blood are at risk from post-transfusion hypoglycaemia, whereas those given heparinized blood are at risk from a greater rebound rise in unbound unconjugated bilirubin. Both risks may be reduced by feeding the infant as soon as is practicable.