Exchange Transfusion

Indications

Severe hemolytic disease of the newborn
Sickle cell crisis

Calculation of various blood volumes

Total blood volume (TBV)

Gilcher's Rule of Fives

patient	Blood volume (ml/kg)
	fat	thin	normal	muscular
male	60	65	70	75
female	55	60	65	70
infant/child	-	-	80/70	-

Nadler's formula
- male: TBV(ml) = (0.006012 x ht)/(14.6 x wt) + 604
- female: TBV(ml) = (0.005835 x ht)/(15 x wt) + 183
- (ht = height in inches; wt = weight in lbs)

Packed red cell volume (ml) = TBV x Hct
Plasma volume (ml) = TBV x (1-Hct)

Exchange for therapeutic manipulation of hematocrit

volume of PRBC (when increasing hemoglobin) =

(Wt(kg) x 75 ml/kg x desired change in Hct)/ {Hct(infused units) - [(initial Hct + desired Hct)/2]}
volume of FFP (when decreasing hemoglobin) =

(Wt(kg) x 75 ml/kg x desired change in Hct)/ Observed Hct

Risks of exchange transfusion

Infectious	Bacterial, fungal, viral
Metabolic	Hyperkalemia, hypocalcemia, citrate toxicity, hypernatremia, hypoglycemia, hyperglycemia, late-onset alkalosis
Cardiac	Volume overload, cardiac arrest
Hematologic	Hemolysis, thrombocytopenia, neutropenia, hyperbilirubinemia, coagulopathy, GVHD
General	Vomiting, hypothermia