Related Experiment Video
Updated: Jul 28, 2026
Continuous Manual Exchange Transfusion for Patients with Sickle Cell Disease: An Efficient Method to Avoid Iron Overload
Published on: March 14, 2017
Exchange transfusion in severe infant salicylism
Adriana Manikian1, Susan Stone, Richard Hamilton
1Department of Pediatrics, New York University School of Medicine, NY 10016, USA.
Insights
Exchange transfusion effectively removed salicylate (ASA) in an infant with severe poisoning when hemodialysis was not feasible. This procedure safely treated the infant, offering a viable alternative for salicylate toxicity management in infants.
Area of Science:
- Pediatric Toxicology
- Emergency Medicine
- Cardiovascular Procedures
Background:
- Severe salicylate poisoning in infants presents a critical management challenge.
- Hemodialysis is often the preferred treatment but may be precluded by patient size.
- Alternative methods for toxin removal are crucial in pediatric cases.
Observation:
- An infant with severe salicylate poisoning (ASA level 85 mg/dL) deteriorated despite standard treatments.
- Hemodialysis was not feasible due to the infant's small size.
- Exchange transfusion was performed using packed red blood cells and fresh frozen plasma.
Findings:
- Exchange transfusion significantly reduced salicylate levels from 70.1 mg/dL to 34.4 mg/dL immediately post-procedure.
- Salicylate levels continued to decrease post-procedure, reaching < 2 mg/dL by 48 hours.
- The procedure was performed without complications, and the infant recovered fully.
Implications:
- Double volume exchange transfusion is a safe and effective alternative to hemodialysis for severe infant salicylate poisoning.
- This approach expands treatment options for pediatric toxicological emergencies.
- Highlights the importance of considering exchange transfusion in specific pediatric poisoning scenarios.
Abstract:
We used exchange transfusion as an alternative to hemodialysis in an infant with severe salicylism. A 4-mo old, 5 kg male was presented to a local hospital with acute vomiting, tachypnea, hyperpnea and intermittent agitation and lethargy. Shortly after a generalized tonic-clonic seizure he passed several tablets in his stool. Salicylate (ASA) level was 85 mg/dL. He was transferred to our institution for further management: i.v. fluids, activated charcoal, whole bowel irrigation and supplementation with sodium bicarbonate, potassium and calcium. The patient's mental status and gas exchange deteriorated and he was intubated. Despite large amounts of sodium bicarbonate and potassium, severe hypokalemia, anion gap metabolic acidosis and aciduria persisted for 10 h. The small size of the infant precluded use of hemodialysis. An exchange transfusion using 180 mL/kg packed red blood cells reconstituted in fresh frozen plasma was performed. The pre-exchange transfusion ASA level was 70.1 mg/dL; the post-exchange transfusion ASA level was 34.4 mg/dL. There was rebound elevation of ASA to 35.2 mg/dL at 6 h post-exchange transfusion. The 18, 36 and 48 h post-exchange transfusion ASA levels were 20.2, 6.8 and < 2 mg/dL respectively. The ASA level dropped 17.6% before, 41.9% in 8.5 h during, and 40.5% by 48 h after the exchange transfusion. There were no complications. The patient recovered completely to his pre-morbid state. Double volume exchange transfusion was used safely as an effective alternative to hemodialysis in this case of severe infant salicylate poisoning.
