Exchange transfusion

An exchange transfusion requires that the patient's blood can be removed and replaced. In most cases, this involves placing one or more thin tubes, called catheters, into a blood vessel. The exchange transfusion is done in cycles: each one usually lasts a few minutes. In conditions such as neonatal polycythemia, a specific amount of the child's blood is removed and replaced with normal saline, plasma (the clear liquid portion of blood), or an albumin solution. This decreases the total number of red blood cells in the body and makes it easier for blood to flow through the body. == Medical uses ==

Sickle cell disease Transfusion therapy is used as an emergency procedure to treat life-threatening complications of sickle-cell disease as well as an elective procedure to stop these complications occurring. • Mesenteric girdle syndrome • To optimise hemoglobin S levels, for example to prevent a stroke occurring in a child. Polycythemia can occur in neonates for multiple different reasons including: babies born after 42 weeks gestation (post-term), babies born to diabetic mothers, twin to twin transfusion, intrauterine growth restriction, and babies with genetic abnormalities. but there is no evidence that it prevents long-term complications. However, in 2013 the CDC examined the limited evidence available and found no evidence that exchange transfusion has any beneficial effects (decreased mortality) in people with very high parasite loads (> 10%). Also, although uncommon, exchange transfusion can cause complications (low blood pressure (hypotension), abnormal heart rhythms (ventricular fibrillation) and breathing problems (acute respiratory distress syndrome)). Based on this evidence, the CDC no longer recommend the use of exchange transfusion in the treatment of malaria. ==Risks==

General risks are the same as with any transfusion. Other possible complications include: • Blood clots • Changes in blood chemistry (high or low potassium, low calcium, low glucose, change in acid-base balance in the blood) • Heart and lung problems • Infection (greatly decreased risk due to careful screening of blood) • Shock due to inadequate replacement of blood ==Recovery==

The person may need to be monitored for several days in the hospital after the transfusion, but the length of stay generally depends on the condition for which the exchange transfusion was performed. Sickle cell disease patients may be exchanged in an outpatient setting and can be sent home the same day. ==History==

The technique was originally developed by Alexander S. Wiener, soon after he co-discovered the Rh factor. ==See also==