Mortality and Morbidity of Exchange Transfusion

One hundred and fifty exchange transfusions, using citrated donor blood, were investigated to determine the mortality rate from the procedure. One infant died during manipulation of the catheter in the umbilical vein. Four infants died of combined causes including anemia, prematurity and elevated potassium in the donor blood. Sixty-two exchange transfusions were investigated in detail to determine the incidence of clinical disturbances. Vomiting, retching, respiratory distress, convulsions or tetany developed during 23 exchanges. A rapid rate of exchange, elevated potassium in the donor blood, and failure to administer calcium during the exchange were major factors contributing to these disturbances. Exchange transfusion with citrated blood can be safeguarded by (1) using donor blood less than five days old, (2) employing a rate of exchange of 2 ml./kg./min. and (3) injecting calcium gluconate during the exchange.