Exchange Blood Transfusion as an Emergency Tool for Children beyond the Neonatal Age Group

Abstract

Beyond the use of Exchange Blood Transfusion (EBT) in neonatal
hyperbilirubinemia and sickle cell anemia, other applications are yet to be fully explored in clinical practice. The present study sought to expose the benefits of EBT in older children with severe sepsis (unresponsive to antibiotics, blood transfusion nor vasoactive medications) which progressed to be complicated by life threatening conditions including multiple organ dysfunction syndrome, shock or coagulopathy. It is a prospective observational study carried out over a period of 5 months following the introduction of EBT as a treatment modality for sepsis in the Children’s Emergency Room (CHER) ISTH. All the patients who had EBT during the period were recruited. The indications for and response to the
procedure as well as the final outcomes are documented. A total of 7 patients had EBT during the period with indications being severe sepsis with: multiple organ dysfunction syndrome, disseminated intravascular coagulopathy, fulminant hepatic failure and septic shock. The average time (± SD; R) spent in the emergency unit/ state after the EBT was 3.29 (±1.98; 1 - 6) days. There is no acute blood transfusion reaction recorded. There is a direct relationship between the duration of illness prior to the EBT and the total length of hospital admission. The average duration of hospital admission following the EBT was 19.12 (±20.83; 3 - 60) days. The mortality rate was 0%. EBT may be a life saving medical intervention in critically ill children with severe sepsis unresponsive to conventional therapy. Timely intervention with EBT in such severe conditions is imperative to curtail the untoward outcome of the disease process.