Efficacy of Whole Blood Reconstituted (WBR) in Exchange Transfusion (ET) in Hemolytic Disease of New Born (HDN) —A Study of 110 Cases


Aim: This study was aimed to review and establish the practice of exchange transfusion (ET) with whole blood reconstituted (WBR) in hemolytic disease of newborn (HDN). Objectives: To observe fall in indirect serum bilirubin, correction of anemia and comparison with related studies. Background: Hemolytic disease of the Newborn is characterized by presence of IgG antibodies in maternal circulation, which causes hemolysis in the fetus by crossing the placenta and sensitizing red cells for destruction by macrophages in the fetal spleen with consequent hyperbilirubinemia. Exchange transfusion with or without phototherapy is the method of choice for treating the newborn with on going hemolysis Methods/Materials: Sample size consisted of 110 neonates in whom 119 exchange transfusions were carried out with WBR. WBR was prepared by suspending O Rhesus-D (RhD) positive/negative cells (compatible with neonate’s/ mother’s serum) in AB plasma. Double volume exchange transfusion(s) were carried out through umbilical vein by push-pull technique. Results: Out of 110 cases, 61 (55.5%) were of RhD HDN whereas ABO and other group HDN cases were 30 (27.3%) and 19 (17.3%) respectively. An average post-ET fall in indirect serum bilirubin by 54.6% and correction of anemia by3.7 gm/dl were reported in the study. Conclusion: An average post-ET fall in indirect serum bilirubin and correction of anemia was found to be more significant when compared to other studies. Hence we recommend exchange transfusion in HDN with WBR to obtain reasonable fall in indirect serum bilirubin and high average rate of correction of anemia.

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D. Sharma, S. Rai, S. Iyengar, B. Jain, S. Sao, A. Gaur and R. Sapra, "Efficacy of Whole Blood Reconstituted (WBR) in Exchange Transfusion (ET) in Hemolytic Disease of New Born (HDN) —A Study of 110 Cases," Open Journal of Blood Diseases, Vol. 3 No. 1, 2013, pp. 15-20. doi: 10.4236/ojbd.2013.31004.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] A. G. Hadley, “Laboratory Assays for Predicting the Severity of Hemolytic Disease of the Fetus and Newborn,” Transplant Immunology, Vol. 10, No. 2-3, 2002, pp. 191-198. doi:10.1016/S0966-3274(02)00065-5
[2] A. Petrova, R. Mehta, G. Birchwood, B. Ostfeld and T. Hegyi, “Management of Neonatal Hyperbilirubinemia: Pediatricians Practices and Educational Needs,” BioMed Central Pediatrics, Vol. 6, 2006, p. 6.
[3] J. M. Bowman, “Historical Overview: Hemolytic Disease of Fetus and Newborn,” In: M. S. Kennedy, S. Wilson and J. G. Kelton, Eds., Perinatal Transfusion Medicine, American Association of Blood Banks, Arlington, 1990, p. 1.
[4] K. J. Peevy and H. J. Wiseman, “ABO Hemolytic Disease of the Newborn: Evaluation of Management and Identification of Racial and Antigenic Factors,” Pediatrics, Vol. 61, No. 3, 1978, pp. 475-478.
[5] F. H. Allen, “Choice of Blood for Exchange Transfusion,” Transfusion, Vol. 6, No. 2, 1996, pp. 101-103. doi:10.1111/j.1537-2995.1966.tb04705.x
[6] S. D. Roseff, N. L. C. Luban and C. S. Manno, “Guidelines for Assessing Appropriateness of Pediatric Transfusion,” Transfusion, Vol. 42, No. 11, 2002, pp. 1398-1413. doi:10.1046/j.1537-2995.2002.00208.x
[7] B. G. Solheim and M. Gronn, “Hemolytic Disease of Newborn,” In: T. L. Simon, Ed., Rossi Principles of Transfusion Medicine, 3rd Edition, Lippincott Williams & Wilkens, Philadelphia, 2002, p. 442.
[8] R. Jayashree and N. I. C. Luban, “Transfusion Practices,” In: P. de Alarcón, E. Werner and J. L. Naiman, Eds., Neonatal Hematology, Cambridge University Press, Cambridge, 2005, p. 354.
[9] R. Jayashree, “Hemolytic Disease of the Newborn,” In: R. Strauss, C. Hillyer and L. C. Naomi, Eds., Hand Book of Pediatric Transfusion Medicine, Vol. 18, Academic Press, Waltham, 2004, pp. 203-206.
[10] Subcommittee on Hyperbilirubinemia: American Academy of Pediatrics, “Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation,” Pediatrics, Vol. 114, No. 1, 2004, pp. 297-316.
[11] J. R. Martin, “A Double Catheter Technique for Exchange Transfusion in the Newborn Infant,” The New Zealand Medical Journal, Vol. 77, No. 490, 1973, pp. 167-169.
[12] C. R Martin and J. P. Cloherty, “Neonatal Hyperbilibubinemia,” In: J. P. Cloherty and A. R. Stark, Eds., Manual of Neonatal Care, 5th Edition, Lippincott Williams & Wilkins, Philadelphia, 2004, pp. 185-221.
[13] S. S. Mau and B. P. Giroir, “Fresh Blood versus Reconstituted Blood for Pump Priming in Heart Surgery in Infants,” New England Journal of Medicine, Vol. 351, 2004, pp. 1635-1644. doi:10.1056/NEJMoa041065
[14] C. Gruenwald, B. W. McCrindle and C.-L. Lynn, “Reconstituted Fresh Whole Blood Improves Clinical Outcomes Compared to Stored Component Therapy for Neonates Undergoing Cardio-Pulmonary Bypass for Cardiac Surgery,” Circulation, Vol. 116, 2007, pp. 412-413.
[15] D. C. Sharma, S. Rai, A. Mehra, M. Kaur, S. Sao, A. Gaur and R. Sapra, “Study of 25 Cases of Exchange Transfusion by Reconstituted Blood in HDN,” Asian Journal of Transfusion Science, Vol. 1, No. 2, 2007, pp. 56-58. doi:10.4103/0973-6247.33448
[16] T. Kemp, “üben den Emptindlichkeisgrad der Blutk?rperchen Gegenüber Isoh?magghrtininen im F?talleben und im Kindesalter beim Menschen,” Acta Pathologica Microbiologica ET Immunologica Scandinavica, Vol. 7, No. 2, 1930, p. 146.
[17] M. S. Kennedy and A. Waheed, “Hemolytic Disease of Newborn and Fetus,” In: D. M. Harmening, Ed., Modern Blood Banking and Transfusion Practices, 3rd Edition, Jaypee Brothers Medical Publishers LTD, New Delhi, Vol. 20, 1998, pp. 393-396.
[18] M. S. Kennedy and J. Carmen, “Transfusion Therapy,” In: D. M. Harmening, Ed., Modern Blood Banking and Transfusion Practices, 3rd Edition, Jaypee Brothers Medical Publishers LTD, New Delhi, Vol. 16, 1998, pp. 319-324.
[19] W. J. Jablonski, “Risks Associated with Exchange Transfusion,” New England Journal of Medicine, Vol. 266, 1962, pp. 155-160. doi:10.1056/NEJM196201252660401
[20] P. B. Simmons, L. E. Harris and A. J. Bianco, “Complications Following Exchange Transfusion. Report of Two Cases of Septic Arthritis and Osteomyelitis,” Mayo Clinic Proceedings, Vol. 48, No. 3, 1973, pp. 190-193.
[21] G. B. Odell, P. L. Poland and E. M. Ostrea, “Neonatal Hyperbilirubinemia,” In: M. H. Klaus and A. A. Fanaroff, Eds., Care of the High-Risk Neonate, Philadelphia, London,1973, pp. 183-204.
[22] P. E. Waldron and W. J. Cashore, “Hemolytic Disease of Fetus and Newborn,” In: P. A. de Alareou and E. J. Werner, Eds., Neonatal Hematology, Vol. 6, Cambridge University Press, Cambridge, 2005, p. 92.
[23] V. Vengelen-Tyler, “The Serological Investigation of Hemolytic Disease of the Newborn Caused by Antibodies Other than Anti-D,” In: G. Garratty, Ed., Hemolytic Disease of Newborn, American Association of Blood Bank, Arlington, 1984, p. 145.
[24] R. H. Merchant and S. H. Abhyankar, “Exchange Transfusions in Newborns: An Analysis of 100 Cases,” Indian Pediatrics, Vol. 22, No. 5, 1985, pp. 349-353.
[25] J. C. Jackson, “Adverse Event with Exchange Transfusion in Healthy and Ill Newborns,” Pediatrics, Vol. 99, No. 5, 1977, p. e7. doi:10.1542/peds.99.5.e7
[26] Transfusion Guidelines for Neonates and Older Children, “British Committee for Standards in Hematology: Blood Transfusion Task Force,” British Journal Hematology, Vol. 124, No. 4, 2004, pp. 433-453.
[27] M. M. Gharehbaghi and S. S. Hosseinpour, “Exchange Transfusion in Neonatal Hyperbilirubinaemia: A Comparison between Citrated Whole Blood and Reconstituted Blood,” Singapore Medical Journal, Vol. 51, No. 8, 2010, pp. 641-644.

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