Clinical Analysis Of10Cases Of Hemolytic Disease Of The Newborn(HDN)Treated With Two Synchronous Exchange Transfusions In Peripheral Artery And Vein

Objective:To approach the clinical characteristic, treatment and outcome of the cases treated with two synchronous exchange transfusions in peripheral artery and vein in our Neonatal Center.Method:Collect the cases treated with two synchronous exchange transfusions in peripheral artery and vein in our Neonatal Center from July2008to January2012, summary the clinical history, exchange transfusion treatment, some laboratory examnations, treatment outcomes and follow-up results.Results:10newborn infants with the diagnosises of Rh haemolysis disease (5cases) and ABO haemolysis disease (5cases) were treated with two synchronous exchange transfusions in peripheral artery and vein.1Before the first exchange transfusion1.1Important clinical history:Rh haemolysis disease group:most of the newborns were found with a yellowing of skin in24hours after birtn.One was found at2hours old, and one was found24hours later after birth.The average time was17±15hours.ABO haemolysis disease group: all of them were found with jaundice in48hours after birth.One was found at1+hour old.The average time was24±16hours.1.2The hemolysis indicators before the first exchange transfusion:Rh haemolysis disease group:they all had hemolytic anemia,with65-121g/L of Hb(mean value95g/L)and22.5-35.9%of HCT (mean value29.7%).ABO haemolysis disease group:2newborns didn’t have anemia.All the HCT values were lower than the LLN value(50%),and the mean value of them was37.9%.1.3The bilirubin level before the first exchange transfusion:The jaundice of Rh haemolysis disease developped more rapidly than of ABO haemolysis disease.The rise of bilirubin was main in indirect bilirubin.1.4The ratio of total bilirubin to albumin (B/A) before the first exchange transfusion:The mean value of9newborns’B/A before the first exchange transfusion was0.83±0.06.1.5Hemolytic disease of the newborn screening:The result of screening test of5Rh haemolysis disease cases were modified Coombs test positive.4ABO haemolysis disease cases’results were modified Coombs test, free antibody test and antibody release test positive and1ABO haemolysis disease case’s was modified Coombs test negative, free antibody test and antibody release test positive.2About the exchange transfusions 2.1Exchange transfusion treatment:All the first exchange transfusions were performed in the first day of admission.The operation was always controlled in2hours. The average exchange transfusion volume was approximately170ml/kg.The time interval between two exchange transfusions was in24hours.Clinically, they are similar performances to treat the HDN infants with two exchange transfusions, as well as all simple exchange transfusions.3The analysis about some changes before and after exchange transfusion3.1Bilirubin changes before and after exchange transfusion:Bilirubin changes before and after exchange transfusion for most of the newborns shows a similar line chart.The total bilirubin changes before and after the first and second exchange transfusion both had statistical significance (P<0.01, P<0.01)3.2Exchange rate of bilirubin:The second exchange rates of TBIL were higher than the first ones.The average rate of total bilirubin’s decline after two exchange transfusions was61.9±8.8%.The mean value of exchange rates of the19effective exchange transfusions was48.4±10.0%, the lowest one is24.6%, the highest one is69.0%.3.3Blood routine changes before and after exchange transfusion: Anemia of Rh haemolysis disease was more serious than of ABO haemolysis disease.Exchange transfusion can improve the hemolytic anemia.Most of the newborns’hemoglobin values decreased in the interval between two exchange transfusion. WBC values decreased after most of the operations, and PLT values did after all the operations.4Treatment and follow-up4.1Treatment:9newborns all had the treatment of phototherapy, alkalinization of blood, rehydration before and after the exchange transfusion. They also were treated with20%human albumin or globulin.hi addition to one newborn who gived up treatment, bilirubin could decrease in the observation range after a continuous blue light phototherapy of3-5days (mean4days)4.2Examinations to evaluate bilirubin brain injury:9newborns’ completion during the hospitalization:8/9of otoacoustic emissions,3/9of BAEP,2/9of head ultrasound,1/9of head CT,1/9of head MRI and4/7of NBNA score.4.3Complication and follow-up:Rh haemolysis disease group had cardiogenic shock in1case, gastrointestinal hemorrhage in2cases, breath holding in1case. ABO haemolysis disease group had breath holding in1case.of9children who survives,7children’s families was connected by telephone.7children did not appear the abnormality.Conlusion:Synchronous exchange transfusions in peripheral artery and vein is a timely and effective approach to lower serum bilirubin concentration and prevent bilirubin encephalopathy. Hemolytic disease of the newborn may require a two exchange transfusions therapy for the reason of early onset, rapid progression and severe jaundice.Timely and effective two exchange transfusions assisted with blue light phototherapy, alkalinization of blood, rehydration, abumin, globulin therapies could help the younger newborn babies suffering from HDN get through the hemolytic reaction polar phase and the high risk period of bilirubin encephalopathy.