(2)
Selection of blood for exchange transfusion.
(a) Donor blood selected for exchange transfusion should:
1 Lack the RBC antigens corresponding to the maternal
antibodies.
2 Be crossmatched with the mother's serum.
3 Be less than 5 days old.
(b) For ABO-HDN, group O RBCs of the same Rh type as the baby
should be used for exchange transfusion. In order to avoid transfusing the anti-A, and
anti-B in the plasma, group O RBCs, either as RBCs or frozen deglycerolized, can be
used in combination with compatible plasma (for example, group AB). If group O whole
blood is used for the exchange transfusion, the whole blood must be free of excessive
hemolytic anti-A and anti-B activity.
(c) In RhO, and "other" HDN, it is desirable to perform the exchange
transfusion with blood of the infant's own ABO group, when the mother's serum is
ABO-compatible. If the infant's condition is so critical that exchange transfusion cannot
be delayed and the donor unit is to be prepared prior to delivery, for RhOHDN, select a
group O RhO-negative unit that lacks excessive hemolytic activity. For "other" HDN
when the donor unit is prepared prior to delivery, select a group O RhO-negative unit
which lacks the corresponding RBC antigen and which is low in hemolytic
anti-A or anti-B activity. In either RHO-HDN or "other" HDN, it may be helpful to prepare
a donor unit of the mother's ABO group simultaneously. This may make it possible to
use group-specific blood if the exchange transfusion can be delayed until the infant's
own ABO group is determined.
(d) Select donor blood of the baby's ABO group if it is compatible with
the mother's serum (if not, group O is used), if the request for the donor unit is received
after the baby has been blood-typed There is no advantage in using Rh-negative donor
blood for an Rh-positive baby unless the hemolytic disease is caused by anti-RhO(D).
e) When the decision is made as to the proper ABO and Rh type of
donor blood to use, select the freshest processed unit of this type for the compatibility
tests. The maximum age for this unit should be less than 5 days from collection. This
requirement is based on the three following characteristics important to the baby:
1 Maximum RBC viability to minimize the extra pigment, and the
potassium loads released from nonviable RBCs.
2 Maximum two, three-DPG levels to ensure immediate good
hemoglobin function.
MD0846
2-32
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