Double Volume Exchange Transfusion Research Articles

Irregular erythrocyte antibodies among antenatal women and their neonatal outcome at a tertiary care hospital in Northern India

BackgroundRed blood cell alloimmunisation during the pregnancy is a significant cause for neonatal mortality and morbidity. This study was planned to determine the prevalence and specificity of irregular erythrocyte antibodies...

Severe Hemolytic Disease of Newborn Due to Alloimmune Anti-E Antibodies: A Case Report

Hemolytic disease in the newborn (HDN) as a cause of early jaundice is mostly due to Rh (D), ABO incompatibility, and rarely due to other minor blood group incompatibility. We report case of Rh anti-E isoimmunization presenting as significant unconjugated jaundice within the 24 h of life. Baby presented with severe jaundice and anemia on day 1 of life. Baby was treated with intensive phototherapy, double volume exchange transfusion (DVET), and intravenous immunoglobulins. On evaluation, both mother and baby had O positive (Rh) blood group; however, the infant showed evidence of severe hemolysis. Positive direct Coombs test (DCT) and 11 cell antibody panel showed anti-E antibodies. This case highlights the importance of early identification and evaluation of HDN in the absence of Rh(D) and ABO incompatibility and possibility of severe hemolysis in Rh anti-E isoimmunization needing DVET.

A prospective study on etiological factors and clinical indicators in term and near term neonates admitted with hyperbilirubinemia in nicu in a tertiary care hospital in Hyderabad, India

1.To study the etiology and risk factors of neonatal hyperbilirubinemia in term and near-term infants. 2. To study the clinical course of these infants during NICU stayThe present study was conducted at NICU, Department of Pediatrics, Princess Esra hospital, Deccan Medical College, Hyderabad, India, from October 2019 to October 2020. Term and late preterm infants admitted in NICU with Serum Bilirubin levels more than 12mg/dl were included in the study. The risk factors, etiology and clinical profile of these infants during NICU stay were studied. 210 neonates were admitted in NICU with hyperbilirubinemia (Serum Bilirubin >12mg/dl) during the study period, out of which 118 were male (56.20%) and 92 were female (43.80%). Neonates were further distributed based on gestational age, in which 46 (21.90%) were late pre-terms i.e. between 34-37 weeks and 164 neonates (78.10%) were full term i.e. greater than 37 weeks. The neonates were also classified based on their birth weight, with neonates between 2500-3000 grams having the highest incidence (46.19%). Lastly, the etiological and risk factors were assessed and quantified, with physiological jaundice occurring as the major cause and late prematurity as the most common risk factor associated with neonatal hyperbilirubinemia. The average duration of phototherapy was 2.50 days and 3 babies required Double Volume Exchange Transfusion (DVET) for significant hyperbilirubinemia.None of the babies requiring DVET had clinical features of Bilirubin Induced Neurological Dysfunction (BIND) during NICU stay. 1. Most common cause of neonatal hyperbilirubinemia was found to be Physiological followed by Septicemia and Idiopathic etiologies. Blood group incompatibilities were less common causes. 2. Phototherapy is a cheap and effective way to reduce bilirubin levels in neonatal jaundice. 3. Exchange transfusion is a safe procedure and should be considered when indicated, to decrease the incidence of BIND. All cases requiring DVET were due to blood group incompatibility.

Exchange transfusion in the management of critical pertussis in young infants: a case series.

It is proposed that severe leucocytosis mainly contributes to pulmonary hypertension by blocking pulmonary capillaries and restricting blood flow. Exchange transfusion (ET) in pertussis has been demonstrated as a safe and useful technique for depleting the leucocyte mass. We aim to discuss four cases of pertussis-induced respiratory distress and the effectiveness of ET in such a setting. We conducted a retrospective case series at the Infectious Disease Department of Children's Hospital 2 in Ho Chi Minh City, Vietnam, and included four pertussis patients that were confirmed by PCR tests on respiratory secretions, presented with severe leucocytosis and respiratory distress and required mechanical ventilation. Among the included patients, three underwent a double volume ET for leucodepletion, two of whom were discharged after the procedure with proper vitals and laboratory test results. On the other hand, one patient died despite ET, performed late in the course of the disease. Exchange transfusion was not performed in the last patient who died as well. Early ET may be a useful and rapid life-saving treatment in children with critical pertussis and severe leucocytosis before cardiopulmonary complications appear.

Evaluation of Risk Factors for Exchange Range Hyperbilirubinemia in Neonates from Eastern Part of Nepal


 
 
 
 Introduction: Neonatal hyperbilirubinemia continues to be the commonest cause of nursery and NICU admissions and readmissions in the neonatal period worldwide. Although most cases are physiological, toxic levels of un-conjugated bilirubin can lead to acute and chronic bilirubin encephalopathy. Hence, this study aimed to study the risk factors for exchange range hyperbilirubinemia in neonates.
 Methods: This was a hospital-based prospective observational study conducted in a teaching and referral NICU over a period of one year from July 2019 to August 2020. All neonates with diagnosis of hyperbilirubinemia requiring double volume exchange transfusion were included in the study. Risk factors for significant hyperbilirubinemia were analysed with descriptive statistics. P-value of < 0.05 was considered significant wherever applicable.
 Results: The mean gestational age and birth weight were 38.06 ± 2.13wks and 2611.72 ± 389.39 gm respectively. Fifteen percent of the babies (162) developed hyperbilirubinemia and 28 (17.3%) required double volume exchange transfusion. Among neonates requiring exchange transfusion, 17 were females and 11 were males. Among 28 babies who required DVET, 20 (71.4%) were SGA. ABO incompatibility was present in 14 (50.0%) neonates and Rh incompatibility in 13 (46.4%) neonates. ABO along with Rh incompatibility was present in eight (28.6%) neonates. DCT was positive in six neonates with ABO incompatibility and nine neonates in Rh incompatibility. G6PD deficiency was present in four (14.3%) neonates.
 Conclusions: The most important risk factors identified were small for gestational age, ABO and Rh incompatibility followed by oxytocin use and sibling treated for jaundice.
 
 
 

EXCHANGE TRANSFUION IN HEMOLYTIC DISEASE OF NEWBORN:EFFICACY OF WHOLE BLOOD RECONSTITUTED (WBR) OVER WHOLE BLOOD

INTRODUCTION: hemolytic disease of newborn; also known as erythroblastosis fetalis, is an preventable blood group disorder that occurs when the blood types of mother and fetus are incompatible. A prospective study was MATERIAL AND METHOD: carried out on the cases suffering with HDN in the year 2018-2020 in the Blood Bank of the Department of Pathology, G.R. Medical College, Gwalior. The affected cases were given double volume exchange transfusion by reconstituted blood or whole blood and the outcome was studied. 150 cases of HDN RESULT: were studied out of which RhD HDN was found to be the most common cause seen in 61.3% and exchange transfusion by reconstituted blood was found to be an effective therapy. The reconstituted blood is found to be immunologicall CONCLUSION: y much safer and better than whole blood for purpose of exchange transfusion in hemolytic disease of fetus and newborn because of its superiority in minimizing transfusion reactions and in achieving all the therapeutic effects of exchange transfusion in better way.

P0230 / #833: A DIFFERENT USE OF EXCHANGE TRANSFUSION

Aims & Objectives:Bordetella pertussis is a common, under-recognized, and vaccine-preventable cause of critical illness with a high mortality in infants worldwide. Severe pertussis is characterized by refractory hypoxemia, pneumonia, cardiogenic shock and requires intensive care. When pertussis is associated with hyperleukocytosis, mortality rate approaches to 80% with the degree of leukocytosis consisting an independent predictor of death. It is proposed that severe leukocytosis may contribute to pulmonary hypertension by blocking pulmonary capillaries and restricting blood flow. Aims:To describe the use of exchange transfusion in pertussis as a safe and useful technique for reducing leukocyte mass. Methods: A 2.5 month-old girl admitted to PICU due to an apnoeic cyanotic episode. She had presented cough, rhinitis and poor feeding for 10 days and B. pertussis had been detected by PCR on nasal secretions. She presented a second apnoeic cyanotic episode with bradycardia and was intubated. Due to severe and persistent hypercapnoea, she was ventilated in high frequency oscillatory ventilation with no amelioration. As she presented leukocytosis and hemodynamic instability with tachycardia, she underwent a double volume exchange transfusion through a central line, and white blood cells reduced from 72,000/μL to 19,000/μL. The benefits of the procedure were clear and immediate, as the respiratory parameters improved and the heart rate stabilized in normal range in less than 24 hours. Although the course was prolonged, the outcome was favorable. Results: She was discharged without any neurological sequelae. Conclusions: Exchange transfusion should be considered as useful therapeutic tool in children with severe pertussis and severe leukocytosis before shock has occurred.

Developmental outcome of severe neonatal indirect hyperbilirubinemia

Background: Indirect hyperbilirubinemia is one of the most common causes of hospitalization in the neonatal period and its potential association with brain damage is well established. This study was conducted to determine neurodevelopmental outcome of children who had severe indirect hyperbilirubinemia in neonatal period and received intensive phototherapy with or without double volume exchange transfusion for its management. Material & methods: This descriptive analytical study was performed in healthy infants with the history of severe indirect hyperbilirubinemia and need intensive phototherapy with or without exchange transfusion. We invited the enrolled infants at their 2-3 years age. Neurodevelopmental assessment was performed by a trained nurse using Ages and Stages Questionnaire. Results: The mean total serum bilirubin (TSB) of studied children was 26.4±4.1 mg/dl at their neonatal period. The estimated rate of severe hyperbilirubinemia with the TSB of 25-30 mg/dl was 48.7/100,000 live born infants and 11.4 /100,000 for hyperbilirubinemia higher than 30 mg/dl. The most common cause of jaundice in patients with exchange transfusion was ABO incompatibility. At their follow up examination, the classic form of bilirubin induced encephalopathy (Kernicterus) was diagnosed in 3 neonates. Two of them had sensory neural hearing loss too. Eleven children had low score based on ASQ in at least one area. The score was less than 2SD in 3 patients. Conclusion: Severe hyperbilirubinemia and kernicterus is still occurring in term and late pre-term infants. Early detection and management of severe hyperbilirubinemia may improve the neurodevelopmental outcome in high risk infants.

Hemolytic Disease of the New-born Due to Anti-c Isoimmunization: A Case Report

Introduction:The Rhesus (Rh) blood group system is one of the complex blood group systems in humans. The Rh system plays important role in transfusion and clinical applications. The Rh antibodies are being the main cause ofHemolytic Disease of Newborn (HDN). Anti-D is the most common cause of severe HDN [1], but it does not mean other Rh antibodies won’t cause HDN. The second common cause of severe HDN is Anti-cantibodies [2] which might miss during the routine screening of antenatal patients. Here we are discussing a case of HDN caused by Anti-c antibody isoimmunization. The relative ability of antigen to cause clinically significant HDN has been the focus of debate [3].Material and Method:The blood grouping was done for both mother and newborn in QWALYS 3 (DIAGAST) and confirmed with gold standard test tube method. Direct and Indirect Antiglobulin Test was done with polyspecific column agglutination card (BIORAD). The Antibody screening was done with 3- cell panel (BIORAD) and Antibody identification was done with 11-cell panel (BIORAD).Results:The blood group of mothers is “O” positive and the blood group of newborns is confirmed as “O” positive. The newborn got DAT Grade 4 positive. The mother sample is tested for IAT which gave Grade 3 positive. The antibody screening shows positive and antibody identification shows the presence of Anti-c antibody in the mother’s serum.Discussion:The newborn had severe hemolytic anemia in which the cause was found to be Anti-c antibody. Though the antibody is severe next to Anti- D, still it produces very severe hemolytic disease. Among all severe HDN Anti-c antibodies cause 8.5% of cases [5].Conclusion:The newborn is treated with double volume exchange transfusion with same blood group [5] and discharged after 10 days. The case report shows the importance of implementation of protocols for screening irregular antibodies to avoid perinatal mortality.

Outcome of neonatal jaundice in term neonates with ABO incompatibility at tertiary level center

Background: Neonatal jaundice is extremely common as almost every new-born develops an unconjugated serum bilirubin level of more than 1.8 mg/dl during the first seven days of life. ABO incompatibility is associated in about 20% of all pregnancies but manifestations of ABO haemolytic disease of new-born occurs in <10% of these cases. True incidence of ABO incompatibility, particularly in developing countries like Nepal, is not understood sufficiently. Furthermore, the confirmation of severe ABO incompatibility cannot be made accurately using only a single test. Hence, this study was done to know the outcome of jaundice in ABO incompatibility patients.Methods: This was a descriptive cross-sectional study done at Department of Paediatrics, between August 2018 to July 2019. All term neonates born to ‘O’ positive mother, with blood group A or B positive, and fulfilling the selection criteria were included in the study. Sample size was calculated to be 114 with confidence level at 95% and prevalence of ABO haemolytic disease as 11.4% with margin of error 5%.Results: Severe ABO incompatibility as evident by presence of jaundice within 24 hours of life, a positive result on direct coomb’s test and haemolytic picture on peripheral blood smear was observed in 12% of the total enrolled 200 neonates. Modalities of treatment showed significant relation with severe ABO incompatibility indicating increased need for double volume exchange transfusion in neonates with severe ABO incompatibility.Conclusions: Phototherapy was found to be effective in the management of most of the cases of neonatal jaundice in term ABO incompatible neonates but some cases, requiring exchange transfusion can occur, mostly in presence of positive result on direct Coomb’s test.

Rh Alloimmunisation: Current Updates in Antenatal and Postnatal Management.

In spite of advances in medical science, Rh alloimmunisation remains one of the leading causes of preventable neuro-morbidities and significant neonatal hyperbilirubinemia in lower-middle income countries. Despite availability of effective antenatal preventive strategy (Anti-D), its uptake in antenatal period is low due to ignorance. Further, once diagnosed, there is lack of adequate antenatal follow up in health care facility. Some of these cases even remain undiagnosed in antenatal period only to present as a case of severe hyperbilirubinemia and kernicterus in late neonatal period. Thus, there is an urgent need for creating awareness and educating health care professionals for early detection and timely management in both antenatal and postnatal period. Following two doses of anti-D prophylaxis (one in antenatal period and one in immediate postnatal period) the incidence of Rh alloimmunisation can reduce to <1%. It is recommended to follow all Rh alloimmunised pregnancies antenatally with serial indirect Coombs test titre (till critical titre is reached) followed by serial Doppler velocimetry of middle cerebral artery in a perinatal centre where facility for intrauterine transfusion as well as advanced neonatal care is available. Postnatal management of these infants comprises of confirmation of diagnosis, aggressive phototherapy and in selective cases, double volume exchange transfusion. With appropriate antenatal and postnatal management, the prognosis of Rh alloimmunised pregnancy remains favourable and long term outcome of Rh alloimmunised infants remain comparable with their normal counterparts.

Role of DVET in severe neonatal sepsis in an era of high antibiotic resistance: a retrospective observational study

Aim Sepsis is a significant cause of mortality and morbidity in the NICU despite the potent armamentarium of antibiotics. Recently, there has been a considerable increase in antimicrobial resistance even to high-end 3rd line antibiotics. Thus, there is a need to look into adjunctive therapies. This study aims to study the role of double volume exchange transfusion (DVET) in reducing mortality due to severe sepsis. Methods All neonates with severe sepsis admitted in NICU from January 2017 to September 2019 were included in the study. Seven neonates who met inclusion criteria and received DVET were compared to 21 gestation and severity matched controls, who received standard therapy (ST) alone. The primary outcome studied was mortality before discharge in both the groups. Other results analyzed were the incidence of persistent thrombocytopenia and refractory shock. Results There was a significant reduction in mortality in the intervention group (57% vs. 71% (p = .004). There was also a significant reduction both in the incidence of refractory shock (71% vs. 75%; p = .01) and persistent thrombocytopenia (86% vs. 65%; p = .03) in the DVET group. No significant adverse effects occurred following DVET. Conclusions In neonates with severe sepsis, DVET may be a useful adjunct therapy. It may reduce mortality and decreased the incidence of refractory shock and thrombocytopenia. DVET is a safe procedure in severely sick and septic neonates.

Minor blood group incompatibility due to blood groups other than Rh(D) leading to hemolytic disease of fetus and newborn: a need for routine antibody screening during pregnancy.

Minor blood group incompatibility due to blood groups other than Rh(D), although an uncommon cause of neonatal hyperbilirubinemia, has the potential to cause severe hyperbilirubinemia and its sequelae in infants, if left undiagnosed and untreated. Here, we describe clinical presentation, diagnosis and treatment of three cases of minor blood group incompatibility due to anti-E and anti-c antibody. All three neonates presented with pallor, icterus and splenomegaly within the first three days of life. Investigations showed indirect hyperbilirubinemia and a positive direct coombs test. Indirect coombs test was positive in the mothers. There was no setting of ABO or Rh(D) incompatibility in any of the neonates. When tested for minor blood group incompatibility, anti E antibody was found to be responsible for hemolysis and hyperbilirubinemia in the first case, and anti c antibody was found in the second case and third case had both anti c and anti E antibodies. While hyperbilirubinemia improved with intensive phototherapy in the first two cases, the third case required a double volume exchange transfusion. On follow up, bilateral sensorineural hearing loss was seen in one of the patients. All three neonates were otherwise healthy, gaining weight and developmentally normal.

Delayed cord clamping in Rh-alloimmunised infants: a randomised controlled trial.

Despite advancement in medical care, Rh alloimmunisation remains a major cause of neonatal hyperbilirubinaemia, neuro-morbidity, and late-onset anaemia. Delayed cord clamping (DCC), a standard care now-a-days, is yet not performed in Rh-alloimmunised infants due to paucity of evidence. Hence, we randomised these infants of 28- to 41-week gestation to delayed cord clamping (N = 36) or early cord clamping (N = 34) groups. The primary outcome variable was venous packed cell volume (PCV) at 2h of birth. The secondary outcomes were incidence of double volume exchange transfusion (DVET) and partial exchange transfusion (PET), duration of phototherapy (PT), functional echocardiography (parameters measured: superior vena cava flow, M-mode fractional shortening, left ventricular output, myocardial perfusion index, and inferior vena cava collapsibility) during hospital stay, and blood transfusion (BT) until 14weeks of life. Neonates were managed as per unit protocol. The baseline characteristics of enrolled infants were comparable between the groups. The median (IQR) gestation and mean (SD) birth weight of enrolled infants were 35 (33-37) weeks and 2440 (542) g, respectively. The DCC group had a higher mean PCV at 2h of life (48.4 ± 9.2 vs. 43.5 ± 8.7, mean difference 4.9% (95% CI 0.6-9.1), p = 0.03). However, incidence of DVET and PET, duration of PT, echocardiography parameters, and BT until 14weeks of postnatal age were similar between the groups.Conclusion: DCC in Rh-alloimmunised infants improved PCV at 2h of age without significant adverse effects.Trial registration: Clinical Trial Registry of India (CTRI), Ref/2016/11/012572 http://ctri.nic.in/Clinicaltrials, date of trial registration 19.12.2016, date of first patient enrolment 1 January 2017.What is Known:•Delayed cord clamping improves haematocrit, results in better haemodynamic stability, and decreases the need of transfusion in early infancy.•However,due to lack of evidence,potential risk of hyperbilirubinaemia, andexacerbation of anaemia(following delayed cord clamping), early cord clamping is the usual norm in Rh-alloimmunised infantsinfants.What is New:•Delayed cord clamping in Rh-alloimmunised infants improves haematocrit at 2h of life without any increase in incidence of serious adverse effects.

Neonatal exchange transfusion: Experience in Korea

BackgroundExchange transfusion (ET) is an established, efficacious, and reliable practice for severe neonatal hyperbilirubinemia, hemolytic disease of the newborn, and neonatal sepsis. This study assessed the indications and clinical outcomes of ET performed in a tertiary hospital in Korea. Materials and methodsWe studied 64 ET sessions performed on 23 neonates between March 1999 and March 2018. ET was performed based on estimated double volume exchange transfusion using fresh red blood cells and fresh frozen plasma. Patients’ clinical information, including demographic data and ET indication, and laboratory data were collected pre- and post-ET. ResultsThe most common ET indication was hyperbilirubinemia with hemolytic anemia due to non-ABO maternal blood group discrepancies. In three preterm babies, ETs were performed for severe anemia, leukocytosis, and hyperkalemia cases. Before ET, the patients showed slightly high WBC counts, low hemoglobin levels, and low platelet counts. After ET, blood examination revealed normal WBC counts, increased hemoglobin levels, and decreased platelet counts (all P < 0.001). Bilirubin levels decreased immediately after ET (P < 0.001). Electrolyte and C-reactive protein levels showed no significant changes after ETs. Adverse events occurred in 11 (47.8 %) patients; the most common were hypoxemia and hypotension. One infant experienced cardiorespiratory arrest due to hypercalcemia and was successfully resuscitated. No one died within 24 h of ET. However, five infants showed hyperbilirubinemia aggravation. ConclusionsET is an effective treatment modality for leukocytosis and hyperbilirubinemia with low mortality but involves common adverse events post-ET. This report provides an overview of current ET practices in Korea.

Neurodevelopmental outcome of healthy term newborn with serum bilirubin >15 mg/dl at one year.

Neonatal hyperbilirubinemia is a common medical emergency in early neonatal period. Unconjugated bilirubin is neurotoxic and can lead to lifelong neurological sequelae in survivors. To find out the association between serum bilirubin and neurodevelopmental outcome at 1 year of age using Development Assessment Scale for Indian Infants (DASII). A prospective cohort study was conducted in the Department of Pediatrics of a tertiary care institution of Central India between January 2018 and August 2019. Total 108 term healthy neonates, with at least one serum bilirubin value of >15 mg/dl, were included. Subjects were divided into three groups based on the serum bilirubin; group 1: (15-20 mg/dl) -85(78.7%) cases, group 2: (20-25 mg/dl) -17(15.7%), and group 3: (>25 mg/dl) -6(5.5%). Developmental assessment was done using DASII at 3, 6, 9, 12 months of age. Out of 108 cases, 101(93.5%) received phototherapy, and 7(6.5%) received double volume exchange transfusion. Severe delay was observed in 5(4.6%) and mild delay in 2(1.9%) cases in the motor domain of DASII at one year. Severe delay in the motor domain was associated with mean TSB of 27.940±2.89 mg/dl and mild delay with mean TSB of 22.75±1.76 mg/dl (p = 0.001). On cluster analysis, delay was observed in locomotion 1 score in 11(13%) cases (p = 0.003) and manipulation score in 6(7.1%) cases in group 1. Increased serum bilirubin was a significant risk factor for the delayed neurodevelopment in babies with neonatal jaundice. Even a moderate level of bilirubin significantly affects the developmental outcome.

Severe ABO Hemolytic Disease of the Newborn Requiring Exchange Transfusion.

ABO incompatibility (ABOi), the most common cause of hemolytic disease of the newborn (HDN), is nearly always mild and treatable with phototherapy. Reports of ABOi HDN requiring neonatal exchange transfusion are extremely rare since the inception of modern guidelines. Here, a case of ABOi HDN clearly met criteria for exchange transfusion. An O-positive African American mother delivered a B-positive neonate that quickly developed hyperbilirubinemia. The neonatal DAT was positive from anti-B and anti-A,B, and maternal IgG titer was 1024. Double volume exchange transfusion resulted in a favorable outcome. Given early discharge of newborns, further understanding of factors predicting severe disease is needed.

Hemolytic disease of newborn caused by multiple Rh antibodies

Hemolytic disease of Fetus and Newborn (HDFN) usually results due to natural occurring antibodies or alloimmunization in mother but the presence of multiple red cell antibodies increases the risk of development of significant HDFN. Here author reported a case of hemolytic disease of fetus and newborn in a preterm baby caused by multiple maternal antibodies. Direct Antiglobulin Test (DAT) on neonate blood sample was positive (3+) with monospecific DAT showed IgG type which was confirmed by heat elution. Antibody identification of eluate was done using commercial 11-cell panel by gel method showing specificity to anti-D and anti-C antibody which was differentiated from anti-G by sequential adsorption and elution studies. Neonate was treated with double volume exchange transfusion (DVET) using leucoreduced, irradiated O Rh D and C negative PRBC suspended in AB plasma and discharged 6th day in a stable condition. So, all pregnant women should be at least advised for ICT irrespective of Rh D negative status. If ICT is positive, they should be referred to higher center for proper Immunohematological work up, so that proper blood unit for DVET could be identified.

Exchange transfusion in neonatal hyperbilirubinemia: A single Centre experience from Northern India

ObjectiveTo determine the indication, efficacy and adverse events related to exchange transfusion (ET) with reconstituted blood (RB) in neonatal hyperbilirubinemia (NNH). MethodsBlood bank records of neonates who underwent double volume ET for NNH from January 2013 to July 2018 were retrospectively reviewed. Demographic details, cause of NNH, details of ET and ET related adverse events were recorded. ResultsA total of 23 ET (average: 1.64/neonate) were performed in 14 neonates (9 males; 5 females) with a mean age of 9.8 ± 7.6 days. Ten (71.4%) neonates underwent 1 session of ET, while 4 (28.6%) underwent repeated sessions (average: 3.25/neonate). A total of 5912 ml of RB was transfused (average: 422 ml/neonate). A statistically significant reduction was noted in total serum bilirubin (TSB) level post-ET (p < 0.001) with overall TSB reduction/procedure being 46%.Of the 14 neonates with NNH, 11 (78.6%) had Rh haemolytic disease of foetus and new-born (HDFN), 2 (14.3%) had ABO HDFN and 1 (7.1%) had hyperbilirubinemia due to prematurity. Of the 11 neonates with Rh HDFN, only 5 underwent intrauterine transfusion (average: 1.8/neonate).Post-ET, top-up transfusions were noted in 8 (57.1%) neonates with packed red blood cell and/or platelet concentrate. ET related adverse were noted in 5 (21.7%) procedures only. ConclusionRh HDFN was the most common cause of NNH in our study population.Exchange transfusion is a safe treatment modality for treating NNH, as it results in the rapid elimination of serum bilirubin, thus, lowering the risk of kernicterus in these patients.

Neonatal hyperbilirubinaemia necessitating exchange transfusion due to maternal sickle cell crisis

Abstract Background Pregnancy in women with sickle cell disease (SCD) is associated with a number of fetal complications such as intra-uterine death, intra-uterine growth restriction (IUGR), preterm birth, low birth weight and an increased perinatal mortality and morbidity. Hyperbilirubinaemia necessitating exchange transfusion in an infant of a mother with SCD, to the best of our knowledge, has not been previously described. Case presentation An infant was delivered at 33 weeks and 5 days of gestation due to a maternal sickle cell crisis. The infant had an unconjugated bilirubin level of 153 μmol/L on admission to the neonatal intensive care unit at 30 min of age. Phototherapy was immediately commenced, intravenous immunoglobulin administered and then a double-volume exchange transfusion was performed. There was, however, no evidence of haemolysis in the infant and the infant’s haemoglobin level remained stable following the exchange. No further exchange transfusions were required. The mother had a high unconjugated bilirubin level (151 μmol/L) prior to delivery. Conclusion High neonatal unconjugated bilirubin levels necessitating exchange transfusion can occur due to haemolysis in the maternal circulation, in this case due to SCD.