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Exchange Transfusion for HDN

Exchange transfusion is performed for neonates with hemolytic disease of the newborn when bilirubin is rising high enough, in spite of phototherapy, to increase the risk of encephalopathy. A double-volume red cell exchange will remove 85-90% of the antibody-coated fetal red cells and up to 50% of the circulating bilirubin. It may also reduce the risk of needing a second exchange transfusion. To minimize the risk of hyperkalemia, the red cell component should be less than 5 days from donation. The product may be irradiated at any time within that window of time, but must be used within 24 hours of irradiation. The hematocrit of the component should range from 50 to 60% to reduce risk of both post-exchange anemia and polycythemia. This is achieved by removing plasma from the unit to achieve the desired hematocrit. For intrauterine transfusions, the desired hematocrit of the transfused product is 70 to 80%.


  • European Directorate for the Quality of Medicines, (2015). Guide to the preparation, use and quality of assurance of blood components, EDQM.
  • New, H. V., J. Berryman, P. H. B. Bolton-Maggs, C. Cantwell, E. A. Chalmers, T. Davies, R. Gottstein, A. Kelleher, S. Kumar, S. L. Morley, S. J. Stanworth and H. the British Committee for Standards in (2016). "Guidelines on transfusion for fetuses, neonates and older children." British Journal of Haematology 175(5): 784-828.
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