Exchange Transfusion

EXCHANGE TRANSFUSION

Q. 1

A neonate delivered at 38 weeks of gestation with a birth weight of 2.2 kg develops intolerance to feed /abdominal distension on second day. Physical examination is unremarkable. Sepsis screen is negative. PCV is observed to be 72%. Which of the following represents the best management option?

 A

Hydration with IV Fluids

 B

Partial Exchange Transfusion

 C

Presumptive treatment for sepsis

 D

Medical Management for intestinal obstruction

Q. 1

A neonate delivered at 38 weeks of gestation with a birth weight of 2.2 kg develops intolerance to feed /abdominal distension on second day. Physical examination is unremarkable. Sepsis screen is negative. PCV is observed to be 72%. Which of the following represents the best management option?

 A

Hydration with IV Fluids

 B

Partial Exchange Transfusion

 C

Presumptive treatment for sepsis

 D

Medical Management for intestinal obstruction

Ans. B

Explanation:

Neonate mentioned in the case is suffering from neonatal polycythemia.

Long term complications of neonatal polycythemia can be prevented by treating symptomatic children with partial exchange transfusion of blood.

Ref: Neurology in Clinical Practice: The neurological disorders – Page 1108; Blueprints pediatrics By Bradley S. Marino, Katie Snead Fine, Julia A. McMillan, Page 183.


Q. 2

A 32 weeks premature infants, 900gm weight on the third days. The serum bilirubin is 13 mg%. The treatment of choice is –

 A

Exchange transfusion

 B

Phototherapy

 C

Wait and watch therapy

 D

Pharmacologic therapy

Q. 2

A 32 weeks premature infants, 900gm weight on the third days. The serum bilirubin is 13 mg%. The treatment of choice is –

 A

Exchange transfusion

 B

Phototherapy

 C

Wait and watch therapy

 D

Pharmacologic therapy

Ans. A

Explanation:

Ans. is ‘a’ i.e., Exchange transfusion

Total serum bilirubin (TSB) (mg/dL)

Gestation & birth weight           Healthy baby                  Sick baby

Phototherapy    Exchange transfusion       Phototherapy       Exchange transfusion

 

Preterm babies

 

 

 

 

<1000 g

5-7

11-13

4-6

10-12

1001-1500g

7-10

13-15

6-8

11-13

1501-2000g

10-12

15-18

8-10

13-15

2001-2500g

12-15

18-20

10-12

15-18

Term babies

 

 

 

 

>2500 g

15-18

20-25

12-15

18-20


Q. 3

In Rh Iso Imunisation, exchange transfusion is indicated if-

 A

Cord blood hemoglobin is less than 10 g %

 B

Cord bilirubin is more than 5 mg.

 C

History of previous sibling affected

 D

All

Q. 3

In Rh Iso Imunisation, exchange transfusion is indicated if-

 A

Cord blood hemoglobin is less than 10 g %

 B

Cord bilirubin is more than 5 mg.

 C

History of previous sibling affected

 D

All

Ans. D

Explanation:

Ans. is ‘a’ i.e., Cord blood hemoglobin is less than 10 g %; ‘b’ i.e., Cord bilirubin is more than 5 mg; `c’ i.e., History of previous sibling affected

Indications of Exchange transfusion

o Cord hemoglobin              10g/dL                 o Bilirubin protein ratio > 3.5              o Prematurity

o Cord bilirubin                 > 5mg/d                 o Reticulocyte count > 15%

o Previous kernicterus or severe erythroblastosis in a sibling


Q. 4

Indications for exchange transfusion are all except‑

 A

Unconjugated bilirubin > 18 mg/100 ml

 B

Cord hemoglobin < 10 mg/100 ml

 C

Cord bilirubin < 5 mg/100 ml

 D

Bilirubin protein ratio > 3.5

Q. 4

Indications for exchange transfusion are all except‑

 A

Unconjugated bilirubin > 18 mg/100 ml

 B

Cord hemoglobin < 10 mg/100 ml

 C

Cord bilirubin < 5 mg/100 ml

 D

Bilirubin protein ratio > 3.5

Ans. C

Explanation:

Ans. is ‘c’ i.e., Cord bilirubin < 5 mg/100 ml 

Cord bilirubin 5 or more is an indication.


Q. 5

A neonate delivered at 38 weeks of gestation with a birth weight of 2.2 kg develops intolerance to feed/ abdominal distension on second day. Physical examination is unremarkable. Sepsis screen is negative. PCV is observed to be 72%. Which of the following represents the best management option ‑

 A

Hydration with IV Fluids

 B

Partial Exchange Transfusion

 C

Presumptive treatment for sepsis

 D

Medical Management for intestinal obstruction

Q. 5

A neonate delivered at 38 weeks of gestation with a birth weight of 2.2 kg develops intolerance to feed/ abdominal distension on second day. Physical examination is unremarkable. Sepsis screen is negative. PCV is observed to be 72%. Which of the following represents the best management option ‑

 A

Hydration with IV Fluids

 B

Partial Exchange Transfusion

 C

Presumptive treatment for sepsis

 D

Medical Management for intestinal obstruction

Ans. B

Explanation:

Ans is ‘b’ i.e., Partial Exchange Transfusion

o PCV 72% in a neonate suggests the diagnosis of neonatal polycythemia.

o Polycythemia is defined as central venous hematocrit Ialso called packed cell volume (PCV) or erythrocyte volume fraction (EVF)J level ofgreater than 65%.

o The neonate in question is also having intolerance to feed and abdominal distension.

  • So, this neonate is having symptomatic neonatal polycythemia.

Treatment of neonatal polycythemia

Therapy in newborns with polycythemia is based on both the measured central venous hematocrit level and the presence or absence of symptoms.

(1)       Symptomatic polycythemia

o Partial exchange transfusion is the treatment of choice.

(2)       Asymptomatic polycythemia

o In asymptomatic polycyhthemia, treatment depend upon hematocrit level (PCV).

PCV 65-75%

Perform cardiorespiratory monitoring and monitoring of hematocrit and glucose levels every 6-12 hours and observe the patients for symptoms

If hematocrit (PCV) becomes more than 75%, consider partial exchange transfusion (PET). (ii) PCV> 75%

o Partial exchange transfusion (PET) is the treatment of choice.



Leave a Reply

%d bloggers like this:
Malcare WordPress Security