When was the last time any here were involved with neonatal exchanges? Do you recall the precipitating factor that led to it? (aside from allleviating hyperbilirubinemia i.e.)...what maternal antibodies do you most encounter that lead up to a possible exchange aside from anti-D?

At my institution we've not had to resort to doing one in quite a long time, but we've had close calls of late (usually due to immune anti-D). One M.D. seriously spoke of performing it in a type B neonate (mother was O), but in that case am wondering if he considered G6PD deficiency, since the bili lights did their job within 24 hrs. of birth. Right now we're delivering twins whose mother has an anti-c and most likely an anti-E ... no word yet on the status with the babies or if we will need to transfuse. :cool:

we have had a few this year. There was a JCAHO sentinel event alert about hyperbilirubinemia a few years ago and we have noticed that they seem to be exhanging at a lower bili level than before. But, we also have a very active neonatal intensive care nursery and they tend to exchange the premies at a lower level also. We have had a few exchanges due to anti-c.

We have a very active NICU but have not had an exchange transfusion in more than 3 years. The neonatologists have told me that if they feel they have failed if they have to resort to an exchange. Our most serious cases result in intrauterine transfusions and none of them have resulted in an exchange transfusion after delivery and very few have required supportive transfusions. Anti-D is still the most common problem we see. Just a note, the worst case of HDN I have ever been involved with was due to anti-c. Just because an antibody is not anti-D don't dake it lightly even if the doc does.

Thanks for the replies...fortunately, the twins at my institution turned out to be R1R1 like the mother...otherwise it could have been a bad situation. I suspected that anti-c was a major player at times and you all confirmed this.

Apparently, the M.D. at my institution was not concerned in the least of what could have been a bad scene. Ahead of time, I ordered an R1R1 irradiated, CMV- quad unit to be shared with both babies just in case of an emergency, seeing that our standard O Rh neg unit reserved for neonates would be incompatible with the mother (since most Rh neg donors are either homozygous for c or at the very least heterozygous).

I'm new to this forum and am enjoying the info! Thanks.