Double Volume Exchange Transfusion Clinical Pathway, ICU – Bilirubin/Albumin Ratios

Double Volume Exchange Transfusion Clinical Pathway — ICU

Bilirubin/Albumin Ratios At/Above Which Exchange Transfusion Should Be Considered in Infants ≥ 35 wks

The following B/A ratios can be used together with but not in lieu of the total serum bilirubin level as an additional factor in determining the need for exchange transfusion.

Review Hyperbilirubinemia Neurotoxicity Risk Factors

  • Isoimmune hemolytic disease
  • Other hemolytic diseases
    • e.g., G6PD Deficiency
  • Significant clinical instability in the previous 24 hrs:
    • e.g., sepsis, acidosis, asphyxia, significant lethargy, temperature instability
  • Albumin < 3.0 g/dL
Risk Category TSB (mg/dL) / Alb (g/dL)
Infants ≥ 38 0/7 wks with no hyperbilirubinemia neurotoxicity risk factors ≥ 8.0
  • Infants Infants 35 0/7–37 6/7 wks and no risk factors for hyperbilirubinemia neurotoxicity
  • or
  • ≥ 38 0/7 wks if at least 1 hyperbilirubinemia neurotoxicity risk factor
 ≥ 7.2
Infants 35 0/7–37 6/7 wks if 1 or more hyperbilirubinemia neurotoxicity risk factor ≥ 6.8

Reference

Clinical Practice Guideline Revision: Management of Hyperbilirubinemia in the Newborn Infant
35 or More Weeks of Gestation