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Emergency release uncross-matched packed red blood cells for immediate double volume exchange transfusion in neonates with intermediate to advanced acute bilirubin encephalopathy: timely but insufficient?

Journal of Perinatology volume 38, pages 947–953 (2018)Cite this article

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Abstract

Given the urgency of double volume exchange transfusion (ExT) in an infant with intermediate to advanced stages of acute bilirubin encephalopathy (ABE), it has been suggested that emergency release uncross-matched packed red blood cells (ER-PRBC) be used. The efficacy of an ExT in removing bilirubin from the brain, however, is a direct function of the mass of albumin exchanged. The very low albumin content of ER-PRBC may fail to be neuroprotective. Predicted changes in total serum bilirubin (TSB), serum albumin, the bilirubin/albumin (B/A) ratio, plasma volume (PV), and bilirubin equilibration from the extravascular space during ER-PRBC ExT are described. ExT using ER-PRBC is efficacious in lowering the TSB. However, this result is falsely reassuring as significant concurrent serum albumin loss, resultant hypoalbuminemia, contraction of PV, limited bilirubin clearance from the extravascular space, and sustained B/A ratio elevations above recommended ExT treatment thresholds suggest that bilirubin neurotoxicity will continue.

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Acknowledgements

The author thanks Darrell Triulzi, Mark Yazer, Angelo Lamola, Chuck Ahlfors, Sara Watchko, and Richard Wennberg for their insightful suggestions and comments and acknowledges the generous support of the 25 Club of Magee-Womens Hospital and the Mario Lemieux Foundation.

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  1. Division of Newborn Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA

    Jon F. Watchko

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Correspondence to Jon F. Watchko.

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Dr. Watchko reports serving as a consultant in legal cases related to neonatal jaundice. No other potential conflict of interest relevant to this article was reported.

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Watchko, J.F. Emergency release uncross-matched packed red blood cells for immediate double volume exchange transfusion in neonates with intermediate to advanced acute bilirubin encephalopathy: timely but insufficient?. J Perinatol 38, 947–953 (2018). https://doi.org/10.1038/s41372-018-0168-x

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