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Little known and less understood: the benefits of a lower hematocrit (~40%) in reconstituted blood for double volume exchange transfusion

Journal of Perinatology volume 43, pages 1446–1448 (2023)Cite this article

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Abstract

A double volume exchange transfusion (DVET) is an important, if infrequently performed, intervention to acutely lessen the total serum bilirubin (TSB) and reduce the extravascular CNS bilirubin exposure when neonatal hyperbilirubinemia poses a neurotoxicity risk. The current analysis based on the seminal works of Valaes, and Sproul and Smith, predicts that a DVET blood product of lower hematocrit (~40%) via its greater plasma volume and corresponding higher albumin content optimizes the benefits of an DVET in several ways. First, by augmenting bilirubin clearance from the extravascular space and thereby further reducing the CNS bilirubin exposure, second, by favorably positioning the intravascular albumin-bilirubin binding capacity at DVET completion to accommodate additional bilirubin equilibration and rebound hyperbilirubinemia post-exchange, and third by correcting anemia if present.

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Fig. 1: Qe, Qf, and Qe + Qf, expressed in mg, are shown as a function of DVET blood hematocrit.
Fig. 2: The final neonatal plasma volume (PVf expressed in cc) and corresponding bilirubin-albumin binding capacity (BBC expressed in mg) immediately upon completion of DVET are shown as a function of DVET blood hematocrit.

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References

  1. Valaes T. Bilirubin distribution and dynamics of bilirubin removal by exchange transfusion. Acta Paediatr. 1963;52 Suppl 149:1–117.

    Google Scholar 

  2. Sproul A, Smith L. Bilirubin equilibration during exchange transfusion in hemolytic disease of the newborn. J Pediatr. 1964;65:12–26.

    Article  CAS  PubMed  Google Scholar 

  3. Wong ECC, Punzalan RC. Neonatal and pediatric transfusion practice. In: Cohn CS, Delaney M, Johnson ST, Katz LM, editors. AABB technical manual. 20th ed. Bethesda, MD: AABB; 2020, p. 673–704.

  4. Sinkin RA, Chisholm CA. Perinatal Continuing Education Program (PCEP) book 4: specialized newborn care. 4th ed. Itasca, IL: American Academy of Pediatrics; 2021, p. 25.

  5. Klein HG, Anstee DJ. Haemolytic disease of the fetus and the newborn. In: Klein HG, Anstee DJ, editors. Mollison’s blood transfusion in clinical medicine. 12th ed. West Sussex, UK: John Wiley & Sons, Ltd; 2014, p. 303–55.

  6. Weaving G, Batstone GF, Jones RG. Age and sex variation in serum albumin concentration: an observational study. Ann Clin Biochem. 2016;53:106–11.

    Article  CAS  PubMed  Google Scholar 

  7. Amin SB. Bilirubin binding capacity in the preterm neonate. Clin Perinatol. 2016;43:241–57.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Kemper AR, Newman TB, Slaughter JL, Maisels MJ, Watchko JF, Downs SM, et al. Clinical practice guideline. American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. revision: management of hyperbilirubinemia in the newborn infant 35 or more weeks gestation. Pediatrics. 2022;150:e2022058859.

    Article  PubMed  Google Scholar 

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  1. Professor Emeritus, Division of Newborn Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Jon F. Watchko

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Correspondence to Jon F. Watchko.

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Watchko, J.F. Little known and less understood: the benefits of a lower hematocrit (~40%) in reconstituted blood for double volume exchange transfusion. J Perinatol 43, 1446–1448 (2023). https://doi.org/10.1038/s41372-023-01674-9

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