LQPB250X - CMLE - Exchange Transfusion as an Emergency Treatment for Hyperbilirubinemia for Hemolytic Disease of the Newborn-Exchange Transfusion as an Emergency Treatment for Hyperbilirubinemia for Hemolytic Disease of the Newborn

Exchange Transfusion as an Emergency Treatment for Hyperbilirubinemia for Hemolytic Disease of the Newborn

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This document from Rush University (2025) provides a comprehensive review of transfusion medicine focused on the management of Hemolytic Disease of the Fetus and Newborn (HDFN), particularly addressing immune hyperbilirubinemia and exchange transfusion in neonates.<br /><br />HDFN is an immune-mediated condition where maternal IgG antibodies target fetal red blood cell (RBC) antigens inherited from the father, leading to hemolysis. Clinical severity ranges from mild jaundice to life-threatening conditions such as hydrops fetalis. The most severe cases involve anti-RhD antibodies, with ABO incompatibility being common but usually mild. Other blood group antigens implicated include Kell (K), Duffy, Kidd, MNS, and P1PK system antibodies. Prenatal monitoring for HDFN includes ultrasound, amniocentesis, fetal blood sampling, and maternal antibody screening with titration.<br /><br />Neonatal indirect hyperbilirubinemia (IHB) occurs when unconjugated bilirubin accumulates due to hemolysis, risking kernicterus if untreated. Initial management involves phototherapy and intravenous immunoglobulin (IVIG). However, severe cases may require emergency double volume exchange transfusion (DVE), replacing twice the infant’s blood volume rapidly to remove bilirubin, circulating maternal antibodies, and sensitized RBCs, and correct anemia. The procedure typically replaces about 85-86% of total blood volume, reducing bilirubin levels by approximately 55%.<br /><br />Blood products used for exchange transfusion must be compatible with both infant and mother. Fresh (<5 days old), leukoreduced, irradiated, CMV-safe, Hemoglobin S-negative group O RhD-negative packed red blood cells (PRBCs) are combined with group AB plasma to prepare reconstituted whole blood at ~45-55% hematocrit for transfusion. For preterm infants, washed RBCs are preferred.<br /><br />Neonatal blood bank testing includes ABO typing, Rh typing (forward only), maternal antibody screening, and crossmatching with maternal or neonatal eluate specimens. Post-exchange, bilirubin is closely monitored to avoid rebound.<br /><br />While often lifesaving, exchange transfusion carries risks such as metabolic disturbances, infections, thrombosis, and hemodynamic instability. Collaboration between clinical and laboratory teams is essential for optimal management.<br /><br />In summary, exchange transfusion plays a critical role in managing severe hyperbilirubinemia from HDFN by rapidly reducing bilirubin and antibody burden to prevent neurotoxicity and improve neonatal outcomes.

Keywords

Hemolytic Disease of the Fetus and Newborn

HDFN

immune hyperbilirubinemia

exchange transfusion

neonatal phototherapy

intravenous immunoglobulin

maternal antibody screening

blood group incompatibility

double volume exchange transfusion

neonatal blood bank testing