Chapter 44 ■ Exchange Transfusions 317

(2) Blood may be anticoagulated with citrate phosphate dextrose (CPD or CPDA1) or heparin

(heparinized blood is not licensed for use in the

United States). Additive anticoagulant solutions

are generally avoided; if there is no other option,

packed red cells stored in additive solutions may

be washed or hard packed prior to reconstitution

for ET (24).

(3) Hematocrit (Hct) may be adjusted within the

range of 45% to 60%, depending on desired end

result.

(4) Blood should be as fresh as possible (<7 days)

(5) Irradiated blood is recommended for all ET to

prevent graft-versus-host disease. There is a significant increase in potassium concentration in

stored irradiated units, so irradiation should be

performed as close to the transfusion as possible

(<24 hours).

(6) Standard blood-bank screening is particularly

important, including sickle cell preparation, HIV,

hepatitis B, and CMV.

(7) Donor blood should be screened for G-6-PD

deficiency and HbS in populations endemic for

these conditions (25).

b. In presence of alloimmunization (e.g., Rh, ABO) special attention to compatibility testing is necessary (9)

(1) If delivery of an infant with severe HDN is

anticipated, O Rh-negative blood cross-matched

against the mother may be prepared before the

baby is born.

(2) Donor blood prepared after the infant’s birth

should be negative for the antigen responsible

for the hemolytic disease and should be crossmatched against the infant.

(3) In ABO HDN, the blood must be type O and

either Rh-negative or Rh-compatible with the

mother and the infant. The blood should be

washed free of plasma or have a low titer of antiA or anti-B antibodies. Type O cells may be used

with AB plasma, but this results in two donor

exposures per ET.

(4) In Rh HDN, the blood should be Rh-negative

and may be O group or the same group as the

infant.

c. In infants with polycythemia, the optimal dilutional

fluid is isotonic saline rather than plasma or albumin (26).

Volume of Donor Blood Required

a. Whenever possible, use no more than the equivalent of one whole unit of blood for each procedure,

to decrease donor exposure.

b. Quantity needed for total procedure = volume for

the actual ET plus volume for tubing dead space

and blood warmer (usually an additional 25 to

30 mL)