Neonatal Exchange Transfusion

The main difference between blood product specifications for intra-uterine and neonatal exchange transfusion is the haematocrit range.

• Components sourced from donors with at least one previous transfusion in the last two years, and negative for all mandatory microbial investigations (to reduce risk of infection).
• Components processed on day 0 (as opposed to those stored at ambient temperature for up to 24hr).
• All components should be free of clinically-significant antibodies, including high-titre anti-A and anti-B (to reduce the risk of RBC haemolysis).
• Group O (if not group O, then ABO compatible with both maternal and fetal blood group).
• Negative for any antigens against which maternal alloantibodies are directed.
• In citrate-phosphate-dextrose (CPD) additive solution (reduces the risk of toxicity from mannitol and adenine additives). 
• Less than 5 days old (to reduce the risk of hyperkalaemia from haemolysed RBCs).
• Irradiated (shelf-life 24hrs post-irradiation, to prevent transfusion-associated GVHD, only absolutely required if neonate received IUT. Ideal for all other neonatal exchange transfusions unless the irradiation process causes undue delay).
• HbS negative (sickle screen negative).
• K-negative (unless the maternal alloantibody is anti-k, in which case k-negative blood should be given)
• Haematocrit 0.5-0.6 (tight Hct range to reduce the risk of post-exchange anaemia or polycythaemia).
• CMV seronegative.
• IAT crossmatch-compatible against maternal plasma.
• Approx volume: 355ml.
• Simple top-up transfusion volume: 15ml/kg.