A partial exchange transfusion is a procedure performed to correct polycythaemia or severe anaemia without hypovolaemia or using either one catheter or two catheter push pull technique:

1.    The treatment/correction of polycythaemia.

• Polycythaemia is used as a crude measure for hyperviscosity and is defined by a venous haematocrit of greater than 65% (0.6-0.65)
• Affected infants often have associated thrombocytopenia, hyperbilirubinaemia and hypoglycaemia.
• Treatment is generally based upon the presence of consistent signs and symptoms.  The aim is to decrease the haematocrit by removing the red cells and simultaneously replacing the volume with an equal amount of 4% albumin or normal saline (NaCl) or a combination of both.

Common Reasons for polycythaemia:

• Delayed cord clamping may increase the blood volume and red cell mass of the infant by as much as 55%.
• Twin to twin transfusion.
• Maternal factors
  • diabetes
  • smoking
  • hypertension syndromes
• Fetal factors:
  • Beckwith Wiedemann Syndrome
  • Neonatal thyrotoxicosis

Partial Exchange Transfusion Procedure

• Use either One Catheter or Two Catheter  push pull Set up for Guidance.
• The partial exchange transfusion procedure is very much subject to Consultant preference. Therefore they MUST give guidance as to their personal requirements for this procedure.
• This need not always be a complex procedure.  For example, for polycythaemia, saline can be given through an IV as blood is removed from the UVC.
• This procedure is still to be treated as an exchange transfusion and must follow the same technique and procedure guidelines as a full exchange.

Polycythaemia (Nicu tools: partial exchange calculator)

Anaemia

• Blood volume = 70-90 ml/kg for term and 85-110 ml/kg for preterm infants.