Blood for Use in Exchange Transfusion in the Newborn

Biochemical and coagulation parameters were studied in fresh whole citrate‐phosphate‐dextrose (CPD) blood, whole blood stored for four days, and blood reconstituted from four‐day‐old packed cells with fresh frozen plasma. Plasma potassium levels were significantly elevated (mean 9.5 mEq/1) in both stored whole blood and reconstituted blood. The mean factor VIII activity in stored blood was 41 per cent compared with a mean of 75 per cent in both fresh whole blood and reconstituted blood. Platelet microaggregates as measured by the Swank filtration technique were elevated in stored whole blood, but not in fresh whole blood or reconstituted blood. Both stored blood and reconstituted blood were deficient in platelets. Based on in vitro studies, reconstituted blood, supplemented by platelet transfusions if necessary, may be a suitable alternative to fresh whole blood for exchange transfusion in the neonate. Preliminary observations are reported of exchange transfusions performed on sick infants, four receiving whole blood, and three receiving reconstituted blood. Six out of seven infants had a postexchange fall in their factor VIII level. These studies do not show any significant differences in the infants' response to exchange transfusion whether whole blood or reconstituted blood was received. No detectable evidence of adverse effects was seen in the infants receiving reconstituted blood.