Exchange Transfusion

Written by Corinna Underwood | Published on June 15, 2012
Medically Reviewed by George Krucik, MD

What Is an Exchange Transfusion?

Exchange transfusion is a medical procedure where a patient’s blood is removed via a catheter and replaced with an IV transfusion of plasma or donor blood. This procedure is used to save the life of an adult or child with fatal blood abnormalities.

What the Procedure Is For

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

Jaundice is a blood disease that is fairly common in newborns during the first week of their 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 400 African-American babies in the United States is born with SCD. (CDC)

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

Where and How Is the Transfusion Administered?

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 Your blood will be withdrawn in cycles, taking about 5 to 20 milliliters at a time. Usually, each cycle 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?

As with any blood transfusion, there are some minimal risks related to this test. These include mild allergic reactions, fever, trouble breathing, anxiety, nausea, or chest pains.

If you experience one of these side effects, your doctor will stop the transfusion immediately. He or she will then determine whether you need that specific treatment and if the transfusion 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 are very careful to screen all donated blood.

If you need multiple blood transfusions over a relatively short period of time, you may be at risk of an iron overload. This means too much iron has accumulated in your blood. If this is not treated, it 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. According to the National Heart, Lung, and Blood Institute, chelation therapy requires only a simple medication, administered by injection or in pill form. (NHLBI)

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

Preparation for the Test

Before your transfusion, your doctor will administer a simple blood test to confirm your blood type. He or she will 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 will not need to adjust your diet before a blood transfusion.

You should inform your doctor if you have had allergic reactions to blood transfusions in the past.

What to Expect After the Transfusion

Once the doctor has completes your transfusion, he or she will 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.

If the patient is a young child, he or she may need to remain in hospital for several days for observation.

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