Partial Volume Exchange Transfusion, Clinical Pathway, ICU

Evaluation Prior to PVET

Most common reasons for PVET include severe chronic anemia or Polycythemia/Hyperviscosity syndrome. If exchange transfusion is also needed for antibody removal/significant associated hyperbilirubinemia, see double volume exchange transfusion clinical pathway.

History and Physical

Birth History	Gestational age Date, time of birth Maternal blood type Maternal antibody history Patient blood type History of intrauterine transfusions Date of last and total # of transfusions Birth hospital Prior blood bank workup of patient at birth hospital
History	Prior interventions (simple transfusion, fluid administration, etc.) Feeding status (should be made NPO for procedure as soon as determined exchange might be indicated) Sepsis assessment (link to sepsis pathway) Antibiotic therapy Signs/symptoms of Anemia: Tachycardia, lethargy, pallor Signs/symptoms of Polycythemia: Hypoglycemia, respiratory distress, cyanosis*, oxygen requirement, thrombocytopenia, jitteriness, apnea, poor feeding, lethargy, seizures, tremors, plethora, hematuria
Physical Assessment	Vital signs, weight General appearance Hydration status Cardiac exam: active precordium, murmur, gallop Respiratory exam: respiratory distress, oxygen requirement Neurologic exam: jitteriness, tremors, apnea, seizures Skin exam: pallor, plethora, cyanosis, petechiae/signs of thrombocytopenia Abdominal exam: hepatosplenomegaly Miscellaneous: edema
Labs	Send the following labs STAT if not already sent: CBC Reticulocyte count Type and screen Blood type confirmation Bilirubin Glucose
*In the setting of polycythemia, patients may have normal oxygen saturation despite cyanotic appearance

If you have questions about any of the clinical pathways or about the process of creating a clinical pathway, please contact us.

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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Partial Volume Exchange Transfusion, Clinical Pathway, ICU

Evaluation Prior to PVET

History and Physical

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Partial Volume Exchange Transfusion — Evaluation Prior to PVET — Clinical Pathway: ICU

Partial Volume Exchange Transfusion, Clinical Pathway, ICU

Evaluation Prior to PVET

History and Physical