Utbytestransfusion

Utbytestransfusion, or exchange transfusion, is a medical procedure in which a patient’s blood is gradually removed and replaced with donor blood or plasma. The goal is to rapidly reduce circulating substances such as bilirubin or pathogenic antibodies, or to modify the patient’s red cell population in certain diseases. It is most commonly performed in newborns with severe hyperbilirubinemia caused by immune hemolytic disease, but it is also used for other immune-mediated or toxin-related conditions and in selected cases of critical illness.

Indications include serious neonatal jaundice due to hemolytic disease of the newborn (such as Rh or ABO incompatibility), immune-mediated destruction of red cells, polycythemia with hyperviscosity, and certain poisonings. In adults and older children, exchange transfusion is less common and may be used for severe intoxication or as part of treatment for some sickle cell complications, though erythrocytapheresis is more typical nowadays.

During the procedure, a portion of the patient’s blood is gradually removed and replaced with donor red blood cells, plasma, or a balanced replacement solution. The process can be performed as a partial or total exchange and is typically done using an extracorporeal circuit with precise volume management, with close monitoring of temperature, electrolytes, acid-base status, and hemodynamics.

Risks include transfusion reactions, electrolyte abnormalities (such as hypocalcemia from citrate), hypothermia, volume overload, sepsis, and vascular access complications. The procedure requires specialized facilities and experienced personnel.

Results are generally rapid, with substantial reductions in bilirubin levels and maternal antibodies contributing to improved outcomes for affected neonates. The decision to perform an exchange transfusion depends on clinical status, bilirubin level, and response to other therapies, and is guided by established pediatric hematology and neonatology guidelines.