Indications and complications of exchange transfusion

Objective: the purpose of the study is to determine the indications and complications of exchange transfusion done in neonatal section of a tertiary care hospital of a developing country. methods: this study was conducted in the neonatology section of the pediatric unit-i,bahawal victoria hospital,bahawalpur from april 2012 to march 2013. the medical records of infants less than one month who required exchange transfusion were studied. results: exchange transfusion was studied in 50 neonates during the study period. among them 30 (60%) were male and 20 (40%) were female; 35 (70%) neonates were born at home while rest were hospital born. twelve (24%) neonates were low birth weight. six (12%) babies were preterm. in this study 2 cases (4%) were infant of diabetic mother,6 (12%) neonate had respiratory distress syndrome while 20 (40%) were asphyxiated at birth. the mean pre-exchange serum bilirubin level was 24.2 mg/dl (range 18-40mg/dl) while mean post-exchange serum bilirubin levels was 12.4 mg/dl was (range 7.5-27.5mg/dl). each neonate underwent exchange transfusion once,except two (4%) cases requiring double exchange. the mean age at time of exchange transfusion was 4.6 days (range 2.2- 8days). the mean time taken for the procedure was 70 min (range 60-85min). regarding indication of exchange transfusion,abo incompatibility was found in 19 cases (38%),rh incompatibility 9 cases (18%) and septicemia in 6 cases (12%); no cause was found in 16 cases (32%). one neonate died during exchange transfusion. twenty four neonates (48%) developed complications during and after exchange transfusion. the commonest complication was hypocalcemia (14%),others included thrombocytopenia (10%),hypoglycemia (10%),anemia (8%),hyperkalemia (8%),sepsis (4%) and hypothermia (4%). conclusion: the most common indication of exchange transfusion was abo incompatibility. adverse events after exchange transfusion were common and the procedure may even be associated with death.