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Fresh and Stored Citrated Blood for Exchange Transfusions FREE

LAGRIMAS SANCHEZ, M.D.; ROBERT E. CARTER, M.D.
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Submitted for publication April 25, 1961.


Am J Dis Child. 1962;103(4):597-602. doi:10.1001/archpedi.1962.02080020610010.
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The technique of exchange transfusion in infants has been perfected through experience with thousands of procedures in medical centers in this country and abroad. Reliable methods have been developed and used with gratifying results. In the great majority of these transfusions, an anticoagulant solution of acid citrate dextrose USP (ACD solution) has been used for the donor blood, although several authors have reported using heparinized blood with satisfactory results.1-5

Complications during exchange transfusion due to high potassium levels in stored blood were recognized soon after the procedure came into general use. The need for caution in using stored blood has been emphasized repeatedly,1,6-10 although in at least one study blood stored up to 4 days did not cause hyperkalemia in the recipient infants despite moderately elevated potassium levels in the blood at the time it was used.8 A variety of complications have been ascribed directly and indirectly to

REFERENCES

Kelsall, G. A., and Vos, G. H.:  Premature Induction of Labour in the Treatment of Haemolytic Disease of the Newborn , Lancet 2:161 ( (July 23) ) 1955;.
Pew, W. L.:  Exchange Transfusion Using Heparinized Blood , J. Pediat. 49:570 ( (Nov.) ) 1956;.
Bessis, M.:  The Use of Replacement Transfusion in Diseases Other than Hemolytic Disease of the Newborn , Blood 4:324 ( (April) ) 1949;.
Valentine, G. H.:  Heparinized Blood for Exchange Transfusion , Lancet 2:21 ( (July 5) ) 1958;.
Bentley, H. P., Jr.; Ziegler, N. R., and Krivit, W.:  The Use of Heparinized Blood for Exchange Transfusion in Infants , A.M.A. J. Dis. Child. 99:8 ( (Jan.) ) 1960;.
Kelsall, G. A., and Vos, G. H.:  Antibody Titre in Maternal and Infants' Serum as an Indication for Treatment in Hemolytic Disease of the Newborn , Med. J. Aust. 1:349 ( (March 15) ) 1952;.
Miller, G.; McCord, A. B.; Joos, H. A., and Clausen, S. W.:  Studies of Serum Electrolyte Changes During Exchange Transfusion in Infants with Erythroblastosis Fetalis , Abstract, A.M.A. Amer. J. Dis. Child. 84:637 ( (Nov.) ) 1952;.
Miller, G.; McCoord, A. B.; Joos, H. A., and Clausen, S. W.:  Studies of Serum Electrolyte Changes During Exchange Transfusion , Pediatrics 13:412 ( (May) ) 1954;.
Boggs, T. R., Jr.:  Exchange Transfusion as a Therapeutic Measure with Special Reference to Its Use in Erythroblastosis Fetalis, in Progress  in Hematology , edited by L. M. Tocantino, New York, Grune & Stratton, Inc., 1956;, Vol. 1, p. 47.
Wheeler, W. E., and Ambuel, J. P.:  The Efficient Use of Exchange Transfusions in the Treatment of Erythroblastosis , Pediat. Clin. N. Amer. 4:383 ( (May) ) 1957;.
Farquhar, J. W., and Smith, H.:  Clinical and Biochemical Changes During Exchange Transfusion , Arch. Dis. Child. 33:142 ( (April) ) 1958;.
Nakasone, N.; Watkins, E., Jr.; Janeway, C. A., and Gross, R. E.:  Experimental Studies of Circulatory Derangement Following the Massive Transfusion of Citrated Blood , J. Lab. Clin. Med. 43:184 ( (Feb.) ) 1954;.
Ames, R.; Syllin, I., and Rapoport, S.:  Effect of Infusions of Citrated Plasma on the Plasma Citrate Level of Infants , Pediatrics 6:361 ( (Sept.) , Pt. 1) 1950;.
Bolande, R. P.; Traisman, H. S., and Philipsborn, H. F., Jr.:  Electrolyte Considerations in Exchange Transfusions for Erythroblastosis Fetalis , J. Pediat. 49:401 ( (Oct.) ) 1956;.
Wexler, I. B.; Pincus, J. B.; Natelson, S., and Lugovoy, J. K.:  III. The Fate of Citrate in Erythroblastotic Infants Treated with Exchange Transfusion , J. Clin. Invest. 28:474 ( (May) ) 1949;.
Zuelzer, W. W., and Cohen, F.:  ABO Hemolytic Disease and Heterospecific Pregnancy , Pediat. Clin. N. Amer. 4:405 ( (May) ) 1957;.
Hsia, D. Y. Y.; Allen, F. H., Jr.; Gellis, S. S., and Diamond, L. K.:  Erythroblastosis Fetalis: VIII. Studies of Serum Bilirubin in Relation to Kernicterus , New Engl. J. Med. 247:668 ( (Oct. 30) ) 1952;.
Allen, F. H., and Diamond, L. K.: Erythroblastosis Fetalis , Boston, Little, Brown & Company, 1958;.
Hsia, D. Y. Y.; Allen, F. H., Jr.; Diamond, L. K., and Gellis, S. S.:  Serum Bilirubin Levels in Newborn Infant , J. Pediat. 42:277 ( (March) ) 1953;.
Grossman, M. I.; Palm, L.; Becker, G. H., and Moeller, H. C.:  Effect of Lipemia and Heparin on Free Fatty Acid Content of Rat Plasma , Proc. Soc. Exp. Biol. Med. 87:312 ( (Nov.) ) 1954;.
Johnson, L.; Garcia, M. L.; Figueroa, E., and Sarmiento, F.:  Kernicterus in Rats Lacking Glucuronyl Transferase: II. Factors which Alter Bilirubin Concentration and Frequency of Kernicterus , Amer. J. Dis. Child. 101:322 ( (March) ) 1961;.

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References

Kelsall, G. A., and Vos, G. H.:  Premature Induction of Labour in the Treatment of Haemolytic Disease of the Newborn , Lancet 2:161 ( (July 23) ) 1955;.
Pew, W. L.:  Exchange Transfusion Using Heparinized Blood , J. Pediat. 49:570 ( (Nov.) ) 1956;.
Bessis, M.:  The Use of Replacement Transfusion in Diseases Other than Hemolytic Disease of the Newborn , Blood 4:324 ( (April) ) 1949;.
Valentine, G. H.:  Heparinized Blood for Exchange Transfusion , Lancet 2:21 ( (July 5) ) 1958;.
Bentley, H. P., Jr.; Ziegler, N. R., and Krivit, W.:  The Use of Heparinized Blood for Exchange Transfusion in Infants , A.M.A. J. Dis. Child. 99:8 ( (Jan.) ) 1960;.
Kelsall, G. A., and Vos, G. H.:  Antibody Titre in Maternal and Infants' Serum as an Indication for Treatment in Hemolytic Disease of the Newborn , Med. J. Aust. 1:349 ( (March 15) ) 1952;.
Miller, G.; McCord, A. B.; Joos, H. A., and Clausen, S. W.:  Studies of Serum Electrolyte Changes During Exchange Transfusion in Infants with Erythroblastosis Fetalis , Abstract, A.M.A. Amer. J. Dis. Child. 84:637 ( (Nov.) ) 1952;.
Miller, G.; McCoord, A. B.; Joos, H. A., and Clausen, S. W.:  Studies of Serum Electrolyte Changes During Exchange Transfusion , Pediatrics 13:412 ( (May) ) 1954;.
Boggs, T. R., Jr.:  Exchange Transfusion as a Therapeutic Measure with Special Reference to Its Use in Erythroblastosis Fetalis, in Progress  in Hematology , edited by L. M. Tocantino, New York, Grune & Stratton, Inc., 1956;, Vol. 1, p. 47.
Wheeler, W. E., and Ambuel, J. P.:  The Efficient Use of Exchange Transfusions in the Treatment of Erythroblastosis , Pediat. Clin. N. Amer. 4:383 ( (May) ) 1957;.
Farquhar, J. W., and Smith, H.:  Clinical and Biochemical Changes During Exchange Transfusion , Arch. Dis. Child. 33:142 ( (April) ) 1958;.
Nakasone, N.; Watkins, E., Jr.; Janeway, C. A., and Gross, R. E.:  Experimental Studies of Circulatory Derangement Following the Massive Transfusion of Citrated Blood , J. Lab. Clin. Med. 43:184 ( (Feb.) ) 1954;.
Ames, R.; Syllin, I., and Rapoport, S.:  Effect of Infusions of Citrated Plasma on the Plasma Citrate Level of Infants , Pediatrics 6:361 ( (Sept.) , Pt. 1) 1950;.
Bolande, R. P.; Traisman, H. S., and Philipsborn, H. F., Jr.:  Electrolyte Considerations in Exchange Transfusions for Erythroblastosis Fetalis , J. Pediat. 49:401 ( (Oct.) ) 1956;.
Wexler, I. B.; Pincus, J. B.; Natelson, S., and Lugovoy, J. K.:  III. The Fate of Citrate in Erythroblastotic Infants Treated with Exchange Transfusion , J. Clin. Invest. 28:474 ( (May) ) 1949;.
Zuelzer, W. W., and Cohen, F.:  ABO Hemolytic Disease and Heterospecific Pregnancy , Pediat. Clin. N. Amer. 4:405 ( (May) ) 1957;.
Hsia, D. Y. Y.; Allen, F. H., Jr.; Gellis, S. S., and Diamond, L. K.:  Erythroblastosis Fetalis: VIII. Studies of Serum Bilirubin in Relation to Kernicterus , New Engl. J. Med. 247:668 ( (Oct. 30) ) 1952;.
Allen, F. H., and Diamond, L. K.: Erythroblastosis Fetalis , Boston, Little, Brown & Company, 1958;.
Hsia, D. Y. Y.; Allen, F. H., Jr.; Diamond, L. K., and Gellis, S. S.:  Serum Bilirubin Levels in Newborn Infant , J. Pediat. 42:277 ( (March) ) 1953;.
Grossman, M. I.; Palm, L.; Becker, G. H., and Moeller, H. C.:  Effect of Lipemia and Heparin on Free Fatty Acid Content of Rat Plasma , Proc. Soc. Exp. Biol. Med. 87:312 ( (Nov.) ) 1954;.
Johnson, L.; Garcia, M. L.; Figueroa, E., and Sarmiento, F.:  Kernicterus in Rats Lacking Glucuronyl Transferase: II. Factors which Alter Bilirubin Concentration and Frequency of Kernicterus , Amer. J. Dis. Child. 101:322 ( (March) ) 1961;.

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