Neonatal polycythemia: effects of partial exchange transfusion using fresh frozen plasma, Haemaccel and normal saline

Neonatal polycythemia remains a significant clinical problem in Thailand. Partial exchanges transfusion (PET) with fresh frozen plasma (FFP) has been the mainstay of management for this condition in Thailand. Since FFP is difficult to find in certain areas and can cause concerns of transfusion related diseases, this study was undertaken to investigate the possibility of using plasma substitute and normal saline (NSS) for PET in the newborn infant with polycythemia.

1. To compare the rate and duration of decrease of venous hematocrit (Hct) before and after PET with FFP, Haemaccel and NSS. 2. To compare any complications from using FFP, Haemaccel and NSS such as coagulation defect, electrolytes change, etc. in PET.

A randomized prospective trial was conducted in Neonatal Unit, Department of Pediatrics, Ramathibodi Hospital. The first phase of study: July 1, 1993 to June 30, 1994: randomized prospective trial using FFP or Haemaccel for PET in 26 newborn infants with polycythemia. The second phase of study: July 1, 1994 to June 30, 1995: consecutive enrollment trial using NSS for PET in 38 consecutive newborn infants with polycythemia.

There was significant decrease in Hct in both groups after PET but there was no statistically significant difference in the rate of decrease of Hct. There was no significant difference in biochemical profiles in both groups of infants 24 hours after PET. In the NSS group, there was significant decrease of Hct level after PET. There was no significant change of biochemical profiles and coagulation activity in these patients 24 hours after exchange transfusion. There were 2 patients with complications related to umbilical venous catheter and PET.

Haemaccel and NSS can be safely used for PET to treat neonatal polycythemia. However, the attending physician should be aware of possible complications related to umbilical venous catheterization and PET.