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Intensive Care and Paediatric Emergency Care Medicine
PO-0326 Comprehensive Analysis Of Exchange Transfusions Performed Over A 6yr Period In A Tertiary Neonatal Intensive Care Unit
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  1. J Egyepong1,
  2. D Wari-Pepple1,
  3. M Rashid2,
  4. C Alford3
  1. 1Neonatal Intensive Care Unit, Luton and Dunstable University Hospital, Luton, UK
  2. 2Paediatric Department, Luton and Dunstable University Hospital, Luton, UK
  3. 3Haematology Department, Luton and Dunstable University Hospital, Luton, UK

Abstract

Introduction

  • In the 1940’s, exchange transfusion (ExT) was introduced to help decrease the morbidity and mortality associated with haemolytic disease of the newborn (HDN) and prevent kernicterus.

  • ExT was subsequently applied to other causes of neonatal hyperbiliribinaemia, severe neonatal anaemia from a variety of causes, some non-immune hydrops cases, Neonatal metabolic conditions such as hyperammonaemia, severe hyperkalaemia and neonatal haemochromatosis.

  • In the 1970’s when ExT was exclusively used for the management of HDN, Lucey et al, predicted a decrease in frequency of this procedure for HDN in future.

  • Complications were estimated to increase due to the lack or decreased frequency of ExT with time.

Objectives To determine.

  • Number of ET done over a 6 yr period.

  • Patients demographics, time of ExT, Indications.

  • Number of Babies who have had Inutero ExT.

  • Maternal details: Blood group, antibodies.

  • The level of bilirubin at which transfusion took place.

  • Prior treatment pre-ExT: In-utero Tx, Intravenous Immunoglobulin (IVIG) use; use of albumin infusion.

  • The ExT-related complications: Any complication not present prior to the ET which occurred within 48 hrs after the ET: Defined as follows- platelet count <150, hypocalaemia, ionised Calcium <0.8, fits, raised INR.

Methods

  • Setting: Level 3 NICU.

  • Retrospective notes review of patients who underwent ExT.

  • January 2008–March 2014 (6.25 yrs).

  • Exclusion criteria: Those for which notes were not obtained.

Results

  • Total admissions to the NICU over the period = 5,000.

  • Number of exchange transfusions done= 15 in 14 patients.

  • 0.3% of admissions over the period.

  • Table of cases.

View this table:
Abstract PO-0326 Table 1

  • Total number of request made to the Blood transfusion department for blood product for exchange.

Conclusion

  • Average ExT/yr in a Level 3 NICU = 2.4/yr.

  • ExT is currently being used for a variety of causes.

  • There were no complications related to the procedure itself.

  • Complications post-ExT were all biochemical (hypocalcaemia- in 13 cases) or haematologic (low platelets 13 cases)

  • Use of IVIG: Given pre-Ext to all ABO, Rh cases except 2 and to the Non-immune hydrops secondary to Parvovirus.

  • 1st documented case of ExT use in hyperbilirubinaemia secondary to accidental Hyperlipidaemia from TPN-Lipid infusion and Haemolysis with Anaemia post-Octenisan wash treatment for MRSA-colonisation treatment in a preterm baby.

https://doi.org/10.1136/archdischild-2014-307384.975

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