Exchange Transfusion: Purpose, Procedure & Preparation
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Exchange Transfusion

What Is an Exchange Transfusion?

An exchange transfusion is a medical procedure in which your blood is removed and replaced with plasma or donor blood. This is done via a catheter. The procedure is used to save the life of an adult or child with life-threatening blood abnormalities.

Why Are Exchange Transfusions Done?

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An exchange transfusion reverses or counteracts the symptoms of jaundice or other blood diseases, such as sickle cell anemia.

Jaundice is a blood disease that’s fairly common in newborns during the first few weeks of life. It causes a yellow discoloration of their skin and whites of their eyes. Jaundice is a result of an excess of a chemical called bilirubin in the body.

Sickle cell disease (SCD) is a group of blood disorders that cause red blood cells to stiffen and become crescent-shaped. This shape impedes their flow through the circulatory system and causes blockages in capillaries. According to the Centers for Disease Control and Prevention, one in every 500 African-American babies in the United States is born with SCD.

Your doctor may also recommend an exchange transfusion to treat other problems in your blood chemistry or to counteract the toxic effects of drugs or poisons.

Where and How Is the Transfusion Administered?

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An exchange transfusion is performed in a hospital or clinic. During the procedure, your blood will be removed and replaced with donor blood or plasma.

Your doctor will place two small tubes (called catheters) into a vein in your arm. Your blood will be withdrawn in cycles. The catheters will take in about 5 to 20 milliliters at a time and each cycle usually takes just a few minutes. As each cycle of blood is removed, a fresh cycle of donor blood or plasma is pumped into your body through another catheter.

What Are the Risks of an Exchange Transfusion?

Risk Factors

As with any blood transfusion, there are some risks and side effects related to this procedure. These risks include:

  • mild allergic reactions
  • fever due to infection
  • trouble breathing
  • anxiety
  • electrolyte abnormalities
  • nausea
  • chest pains

If you experience one of these side effects or reactions, your doctor will stop the transfusion immediately. Your doctor will decide right away whether to continue with the transfusion or if it can be resumed later.

Although very rare, it’s possible for donor blood to be infected with hepatitis B or C, variant Creutzfeldt-Jakob disease (the human variant of mad cow disease), or a virus, such as HIV. To prevent this from happening, blood banks very carefully to screen all donated blood.

If you need multiple blood transfusions over a relatively short period of time, you may be at risk of iron overload. This means too much iron has accumulated in your blood. Without treatment, this can cause damage to your heart, liver, and other organs. In that case, your doctor will provide chelation therapy to remove the excess iron from your body. Chelation therapy requires only a simple medication, either injected or taken as a pill.

Lung damage is another side effect of a blood transfusion. This side effect is rare and usually happens within the first six hours of the transfusion. Most patients recover from lung injury, though in rare cases it may be fatal.

Preparation for the Test

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Before your transfusion, your doctor will give you a simple blood test to confirm your blood type. They’ll prick your finger with a small needle to get a few drops of blood.

Your blood will then be labeled and sent to a lab where a machine will analyze it to determine your blood type. This ensures that the blood you receive by transfusion is a match for your own blood type. If the donor blood is not a match, it will make you sick.

In most cases, you won’t need to adjust your diet before a blood transfusion.

You should let your doctor know if you’ve had allergic reactions to blood transfusions in the past.

What to Expect After the Transfusion

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Once the doctor completes your transfusion, they’ll check your blood pressure, heart rate, and temperature. If all these readings are normal, the intravenous lines will be removed.

You may experience mild bruising at the site of the needle for a few days after the transfusion.

Your doctor may also recommend follow-up blood tests to monitor your blood.

Young children receiving a transfusion may need to stay in hospital for several days for observation.

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