How do I perform whole blood exchange?

T here are a number of clinical scenarios in which simultaneous exchange of the patient’s plasma and red blood cells (RBCs) are indicated. Some of these clinical indications for therapeutic whole blood exchange (WBEx) include hemolytic disease of the newborn, severe autoimmune hemolytic anemia (AIHA), babesiosis, sickle cell disease, and hyperleukocytosis. WBEx has been performed with manual, semiautomated, and fully automated methods using replacements fluids (i.e., RBCs with plasma, RBCs with 5% albumin, and whole blood [WB]) reconstituted to a prespecified target hematocrit (Hct); however, methodologies vary widely and each carry advantages and disadvantages. Here, we describe our combined experiences in performing WBEx, including clinical indications, technical methods, and issues related to their application in the treatment of patients.