Indication of Exchange Transfusion

i) Early exchange transfusion is indicated in the presence of hydrops and is often indicated by a history of previously severely affected infants or a known sensitized infant. The objective of early exchange transfusion is to correct anemia, stop haemolysis and prevent a rise in bilirubin level. In hemolytic disease, immediate exchange transfusion is usually indicated if:

a) The cord bilirubin level is over 4.5 mg/dl and the cord hemoglobin level is below 11 gm/dl.

b) The bilirubin level is rising 1 mg/dl per hour despite phototherapy.

c) The hemoglobin level is between 11 to 13 gm/dl and the bilirubin level is rising over 0.5 mgdl per hour despite phototherapy.

d) The bilirubin level is 20 mg/dl or it appears that it will reach 20 mg/dl at the rate it is rising.

e) There is progression of anemia despite control of bilirubin by other methods e.g. phototherapy.

ii) Later exchange transfusion are indicated at bilirubin levels that may be toxic, or if the bilirubin level may be expected to reach such levels. Repeat exchanges are usually indicated, when after the early rebound the bilirubin continues to rise over 1 mg/dl per hour or when there is a severe persistent hemolytic anemia.