Double Volume Exchange Transfusion Clinical Pathway, ICU – Indications

Double Volume Exchange Transfusion Clinical Pathway — ICU

Indications for a Double Volume Exchange Transfusion in Infants

This pathway should be used to guide the management of infants requiring a double volume exchange transfusion in the N/IICU/CICU/PICU using the following criteria:

Immediate Exchange Transfusion Indications

Signs of Acute Bilirubin Encephalopathy

  • Early: lethargy, hypotonia, high pitched cry, poor feeding
  • Intermediate: irritability, retrocollis, opisthotonos, fever
  • Advanced: apnea, stupor, coma

Total Serum Bilirubin (TSB) is ≥ 5mg/dL (85 µmol/L) above threshold. See below.

Exchange Transfusion Indications for Hyperbilirubinemia

Evaluate for 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
    • GA ≥ 35 wks: < 3.0 g/dL
    • GA < 35 wks: < 2.5 g/dL

Gestational age ≥ 35 wks
Exchange transfusion thresholds

Gestational age < 35 wks

Other Clinical Indications

  • High ammonia
  • Severe electrolyte abnormalities
  • Antibody mediated diseases
    • Hemolytic disease of the newborn (Rh disease or other)
    • Neonatal hemochromatosis: gestational alloimmune liver disease (GALD), consult GI
  • Hyperleukocytosis for infants too small for leukapheresis

Reference

Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation