Acid-Base and Electrolyte Changes during Exchange Transfusion

In connection with blood exchange transfusions carried out on forty newborn infants it has been found that the majority of the newborns requiring exchange transfusion have metabolic acidosis increasing to possibly critical severity by the end the exchange transfusion. The acidosis, however, is soon normalized spontaneously. Pretreatment with sodium bicarbonate infusion normalizes the pretrans fusion shift in acid-base balance and vents the development of a severe acidosis following the exchange transfusion without risking a subsequent alkalosis. Before exchange transfusion a slight hypernatraemia has often been observed and this increases transiently after blood exchange. Pretreatment with infusion did not modify this phenomenon. In our material no hyperpotassaemia has been encountered by the end of ex- change transfusion. I n response to pre-treatment with sodium bicarbonate infusion the plasma K⁺ level decreased slightly. By promoting the conjugation of bilirubin to proteins, pretreatment with sodium bicarbonate may presumably improve also the efficiency of the exchange transfusion; this, however, requires further proof.     

Effect of Additional Albumin Administration During Exchange Transfusion on Plasma Albumin-binding Capacity

A total of 33 infants undergoing exchange transfusion for hyperbilirubinaemiawas divided into two albumin-treated groups and a control group. Bothalbumin-treated groups showed significantly higher levels of plasma albumin and ofreserve albumin-binding capacity in the phase of bilirubin rebound 8 hours or moreafter exchange. It was not possible to state which method of albumin administrationwas the more efficient. Up to two-thirds of administered albumin probably diffusesinto the extravascular space of newbom infants within 2-3 hours.     

Exchange Transfusion with Fresh Heparinized Blood is a Safe Procedure

1069 newborns were subjected to exchange transfusion with fresh heparinized blood in the years 1968, 1971, 1974, 1977 and 1981. There were 258 infants with Rh disease, 328 with hyperbilirubinemia with ABO incompatibility, 436 with hyperbilirubinemia without ABO incompatibility and 47 infants without hyperbilirubinemia or evidence of hemolytic disease. The total annual number of infants decreased gradually from 279 in 1968 to 130 in 1981. A total of 48 infants of the 1069 newborns died during neonatal period but the death was possibly related to exchange transfusion in four of them. There were serious complications in 14 infants during and in only five infants after the procedure. Morbidity related to exchange transfusion was the highest among newborns with serious basic disease. Using the presented bilirubin nomograms and fresh heparinized blood we have not found that the hazards of exchange transfusion would have overgone the risks of hyperbilirubinemia.     

Automated Exchange Transfusion and Exchange Rate

An automated blood exchange transfusion (BET) with a two-site technique has been devised by Goldmann et al and by us, using an infusion pump. With this method, we successfully performed exchange transfusions 189 times in the past four years on 110 infants with birth weights ranging from 530 g to 4,000 g. The exchange rate by the automated method was compared with the rate by Diamond's method. Serum bilirubin (SB) levels before and after BET and the maximal SB rebound within 24 hours after BET were: 21.6 ± 2.4, 11.5 ± 2.2, and 15.0 ± 1.5 mg/dl in the automated method, and 22.0 ± 2.9, 11.2 ± 2.5, and 17.7 ± 3.2 mg/dl in Diamond's method, respectively. The result showed that the maximal rebound of the SB level within 24 hours after BET was significantly lower in the automated method than in Diamond's method (p<0.01), though SB levels before and after BET were not significantly different between the two methods. The exchange rate was also measured by means of staining the fetal red cells (F cells) both in the automated method and in Diamond's method, and comparing them. The exchange rate of F cells in Diamond's method went down along the theoretical exchange curve proposed by Diamond, while the rate in the automated method was significantly better than in Diamond's, especially in the early stage of BET (p<0.01). We believe that the use of this automated method may give better results than Diamond's method in the rate of exchange, because this method is performed with a two-site technique using a peripheral artery and vein.     

Disseminated Intravascular Coagulation Due to an Exchange Transfusion With Over-heated Blood

Seshadri, R.S. and Blake, G.P. (1979). Aust. Paediatr. J., 15, 33–35. Disseminated intravascular coagulation due to an exchange tranfusion with over-heated blood. A newborn baby accidentally received over-heated blood (> 50°C) during an exchange transfusion. The baby developed severe disseminated intravascular coagulation following the accident. The management of the problem is discussed.     

不同比例重组血对新生儿溶血病换血治疗后血液内环境的影响

目的 探讨不同比例重组血对新生儿溶血病换血后血液内环境的影响.方法 对31例新生儿溶血病患儿采用不同比例重组血行外周动静脉同步换血术,均采用0型洗涤红细胞和AB型血浆,其中治疗组(16例)二者比例为1:1(即O型洗涤红细胞2 U:AB型血浆200 mL)按80±mL/kg单倍量换血,对照组(15例)为2:1(即O型洗涤红细胞4 U:AB型血浆200 mL)按150～180 mL/kg双倍量换血,监测换血前后新生儿血清总胆红素换出率、血RBC、血红蛋白(Hb)、红细胞比容(HCT)、换血量、住院天数等指标的变化.结果 治疗组与对照组患儿血清胆红素换出率分别为(44.92±3.99)%和(45.69±5.06)%,二组比较无显著性差异(P=0.639);住院天数[(8.13±1.13)d vs(8.19±0.91)d]亦无显著性差异(P=0.884).治疗组换血后RBC、Hb及HCT的水平均提高(P<0.05,0.01,0.001),但提高的水平略低于对照组,贫血已基本纠正,临床症状改善,在换血量方面比较治疗组显著低于对照组(P=0).结论 采用1:1单倍量重组血治疗新生儿溶血病,既能降低血中胆红素水平,又可减少换血量.     

影响换血疗法治疗新生儿高胆红素血症疗效及不良事件发生的多因素分析

目的 探讨影响新生儿高胆红素血症双管同步换血疗法疗效及不良事件发生的因素.方法 回顾性分析重庆医科大学附属儿童医院新生儿诊治中心2006年6月-2009年6月收治的160例经外周动静脉双管同步换血治疗的高胆红素血症患儿的临床资料.不良事件定义为发生如下情况之一:换血过程中发生血氧饱和度曾低于85%并持续5 min以上,发生低血压、呼吸暂停或抑制、心率低于100次·min-1并持续5 min以上.分析换血前患儿的疾病状态、内环境指标、换血量及换血速度对不良事件的影响.结果 本研究中不良事件发生率为30.63%(49/160例).换血过程中有不良事件组新生儿的肺动脉高压患病率高于无不良事件组(8.2% vs 0,P=0.008),有不良事件组患儿换血前血清钾、钠、氯、钙及镁离子水平、Hb水平与无不良事件组比较差异均无统计学意义(Pa>0.05),2组单位体质量换血量、单位时间单位体质量换血量比较差异也均无统计学意义(Pa>0.05).胆红素下降数值与单位体质量换血量呈正相关(r=0.330,P=0.000),与换血前胆红素数值呈正相关(r=0.829,P=0.000).结论 影响换血疗法治疗新生儿高胆红素血症胆红素下降幅度的因素为单位体质量换血量及换血前胆红素水平;影响不良事件发生的主要因素为肺动脉高压.     

Changes in Plasma Concentrations of Atrial Natriuretic Peptide during Exchange Transfusion in Premature Infants

ABSTRACT. Plasma concentrations of atrial natriuretic peptide (ANP) and hemodynamic parameters were investigated in five premature infants undergoing exchange transfusion. Baseline values of ANP were 51.7 ± 21.2 fmol/ml. Volume depletion by withdrawal of 10 ml blood did not cause changes in systolic blood pressure (79.4 ± 4.3 vs. 71.4 ± 5.6 mmHg) and heart rate (115 ± 5.2 vs. 115 ± 2.4 b/min). ANP levels in plasma remained unaltered (53.4 ± 24.9 fmol/ml). Replacement of 10 ml blood increased central venous pressure by 33% and ANP concentration in the plasma by nearly 30%, while heart rate and blood pressure remained unchanged. Our data indicate that the heart of the premature infant responded to acute blood replacement with increased ANP-release, while blood removal appeared not to influence hormone regulation.     

交换输血术对高胆红素血症新生儿血清免疫球蛋白的影响

目的 评估高胆红素血症新生儿的体液免疫状态及其进行交换输血治疗(换血术)前后的血清免疫球蛋白(Ig)水平变化情况,了解换血术对新生儿血清Ig的影响.方法 对62例高胆红素血症新生儿进行换血治疗,治疗前后分别测定其血清Ig(IgG、IgA、IgM)水平,并依据病因分成ABO溶血病组、Rh溶血病组、脓毒症组和其他组进行分析.结果 1.换血术前:ABO溶血病组、Rh溶血病组IgG水平均显著高于脓毒症组及其他组(Pa＜0.01),各组间IgA、IgM水平无明显差异(Pa>0.05).2.换血术后ABO溶血病组、Rh溶血病组IgG水平均较换血前显著下降(Pa＜0.05);其他组及脓毒症组IgG水平均较换血前升高,但差异无统计学意义(P=0.387,0.091).3.换血后4组IgA水平均较换血前升高,且其他组、ABO溶血病组和Rh溶血病组治疗前后比较差异有统计学意义(Pa=0.000),脓毒症组治疗前后无统计学意义(P=0.185).4.换血后4组IgM水平均较换血前升高,其他组、ABO溶血病组和Rh溶血病组治疗前后比较均有统计学意义(Pa＜0.05),但脓毒症组治疗前后无统计学意义(P=0.081);且其他组、ABO溶血病组和Rh溶血病组各组间治疗后比较有统计学意义(P＜0.01).结论 1.新生儿溶血病患儿术前血清IgG水平较高,换血术能迅速降低溶血病患儿血IgG水平,提升患儿血IgA、IgM水平;2.换血术对脓毒症患儿血清IgG、IgA、IgM的水平无明显影响;3.换血术能提高其他高胆红素血症患儿血清IgA、IgM水平,但对血清IgG水平无明显影响.     

动静脉同步换血换血量与胆红素水平关系的回归再分析

目的通过对加大样本量的线性回归分析,进一步研究适用于一般临床外周动静脉同步换血应用的反映换血量和总胆红素(TBIL)下降关系的回归方程。方法对75例采用外周动静脉同步换血疗法的高胆红素血症新生儿,按换血前TBIL数值高低依序分为5组,对每换血50 ml/kg进行TBIL值检测和回归分析,并对回归方程参数的95%置信区间进行分析和检验。结果 (1)每增加50 ml/kg换血量,TBIL累积换出率差异有非常显著意义(P0.01);经200 ml/kg换血后TBIL的累积换出率均值为61.5%。(2)换血过程中TBIL浓度(y)与换血量(x)呈线性相关(r值在0.96～0.98之间,P0.001)。(3)分组系列回归方程的斜率(a)与换血前TBIL浓度初始值(y0)也呈高度线性相关,其(r=0.99,P0.001)。(4)各组方程参数回归效果的方差分析检验结果均有非常显著统计学意义(P0.01)。(5)对换血回归方程参数适用区间95%置信度的检验结果有非常显著统计学意义(P0.001)。结论经分别对换血过程TBIL浓度值y与换血量x相关性依模型y=y0-ax以及对方程斜率参数a与换血前TBIL浓度初始值y0相关性依模型a=αy0+β进行的线性回归分析,可建立适用于临床指导换血用量的综合单自变量线性回归方程y=y0-ax=y0-(0.0035 y0-0.081)x。     

A Bacteriological Comparison between Two Methods of Exchange Transfusion

Twenty-three cases of hyperbilirubinemia in newborn babies were treated with exchange transfusions according to the method of Sanchez. Bacteriological samples were examined from the inner surface of the fresh cut end of the umbilical stump and from the part of the umbilical vein used in Sanchez's method. Growth was obtained in 16 cases from the stump and in three cases from the vein.