Thursday, November 15, 2012

Exchange Transfusion for Rh Incompatibility : NICU

Case Of a baby with Hyperbilirubinemia due to Rh incompatibility - hemolysis"
A baby was delivered via Emergency Cesarean section at 36 weeks of gestation for Rh isoimmunization. A 2.6 kg Male baby was born with Apgar score 7/10, 8/10  to a 26 years Gravida 2 mother of "O Negative" blood group. She had delivered a child of Rh Positive blood group 6 years back in another hospital settings and had missed a Rhogam " Anti-D Antibody" injection during the pregnancy. Thus in the settings of Rh isoimmunization and history of previous Rh positive baby, baby was transferred to Neonatal Intensive care Unit ( NICU ).
As per the protocol, the Cord blood was sent for Investigations:
1 Hemoglobin, PCV,Plateletes
2. Retics
3. Peripheral smear
4. Direct Coomb Test in Baby's blood
5. Blood Grouping and Rh Typing.

Arrangement for fresh "O negative " Donor was made.
Transcutaneous bilirubnometer ( TcB) showed reading of 6 mg/dl in 4 hours so, Photo therapy was started immediately and Serum total bilirubin (TSB )level was sent.  TSB readings were 8 mg/dl at 6 hrs. Extensive phototherapy was continued while the all the reports had arrived.
Blood group : A positive
Hb: 14 g/dl, PCV- 45g, plateletes- 214,000
Cord blood TSB- 3.8mg/dl
DCT- Negative
Retics- 8%
Peripheral smear showed no features of hemolysis

Mother received Anti-D antibody injection.
The phototherapy was continued as there was no immediate need for Exchange transfusion.

Repeat Hb and TSB was sent after 4 hours
Report showed- Hb - 10.2g/dl and TSB= 10mg/dl
There was a significant drop in hemoglobin, with rising serum bilirubin despite phototherapy. Baby looked Pale clinically with no organomegaly appreciable
Exchanged Tranfusion was required to save the baby. Parents were counselled about the procedure in details and Settings were Setup in NICU for the procedure.
Strict sterile precautions were needed and were followed.
Exchanged transfusion Set was prepared.
Baby was placed under Radiant warmer with phototherapy on till the actual procedure was started.
All the doctors and nurses involved in the procedure were as aseptic as possible with cap, mask , sterile gowns, gloves.

It was my first exchange transfusion experience.
In the next Article, i will be discussing the Indications and Procedure : exchange transfusion along with hazards and long term outcomes.
Keep reading

2 comments:

  1. where did you get that image?. I took that image when i devised this exchange transfusion setup at my hospital, You can keep it but permission would have been nice

    ReplyDelete
    Replies
    1. Dr Amjad, If you can provide us source we will be happy to credit you for the image.

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