The Analysis Of The Adverse Reactions Associated With Exchange Transfusion In Neonatal Hyperbilirubinemia

Background and Objective:Hyperbilirubinemia is one of the common diseases of the newborn, and severe hyperbilirubinemia would lead to bilirubin encephalopathy, which was abnormal energy metabolism and tissue structure, and threat neonatal life and health. Previous studies suggested that the mortality was higher than10%and the morbidity of long term disabilities, such as cerebral palsy and Vision and hearing impairment was70%if bilirubin encephalopathy was delayed treatment.It was considered that exchange transfusion was the most effective treatment for hyperbilirubinemia. The main factors of hyperbilirubinemia including ABO and RH hemolytic disease, G6PD deficieny, severe infection and septicemia. Exchange transfusion can eliminate antibodies and sensitization or enzyme deficiency of red blood cells, and reduce bilirubin (60%), antibodies and sensitization of red blood cells(85%) quickly, and prevent newborn from getting bilirubin encephalopathy, otherwise, it can significantly treat anemia and cardiac failure which was due to hemolysis. Exchange transfusion can also be used to treat several neonatal diseases such as septicemia, disturbances of blood coagulation and intoxication. It was known that O red blood cell suspension and AB blood plasma would be mixed as1:1ratio in exchange transfusion, but the red blood cell suspension contain several Synthetic anticoagulant fluids of maintenance, and it would lead the whole body blood circulation and internal environment in unstable state when this mixed blood exchange in several hours, it would also lead fluctuations or disorder of internal environment and some complications such as platelet decline, low blood calcium, metabolic acidosis, hypoglycaemia, high potassium, arrhythmia, fluctuation of blood pressure, respiratory distress, hyperspasmia and even dead. Especially in the past decades, exchange transfusion through umbilical artery and umbilical veins and this often lead to necrotic enteritis, thrombus and infection, above all,it was considered that exchange transfusion is a high risk treatment. With procedure and methods of exchange transfusion advances, adverse reactions has much fewer than before, but the internal environment change was still a problem and the different results of anomaly indicators before and after the change were still controversy. Some studies reported that internal environment change could be recover in a short time, but there were few studies reported about the clinical manifestation change and adverse reaction after exchange transfusion.We retrospective analyze the blood routine and blood biochemistry changes of120newborn who were born in department neonatalogy of nanfang hospital and diagnosed as hyperbilirubinemia and treated with exchange transfusion in the past5years. The abnormal changes of clinical manifestation and adverse reaction will be observed in the convalescent of internal environment indicators during and after exchange transfusion,in order to investigate the pathogenesis of complications of exchange transfusion and improve safety of exchange transfusion. Method:1. Subjects and Methods:A retrospective analysis methods collected120cases of hyperbilirubinemia exchange transfusion of children with clinical data during the past five years from January2008to March2013, from neonatology of Nanfang Hospital. All the children were in line with the indications for exchange transfusion, blood source in addition to the Rh hemolytic disease are O-concentrated washed red blood cells and AB plasma mixed blood, double blood, peripheral arteriovenous synchronous exchange transfusion surgery, programfollow the neonatal jaundice intervention recommended program developed by the Chinese Medical Science neonatology group,2. Methods:Compare the changes of blood bilirubin, blood chemistry and blood routine, analyze the incidence of the blood Indexes and clinical abnormal performance from the whole process of exchange transfusion to within7days of the exchange transfusion.3. Statistical analysis:Using SPSS13.0statistical software. Measurement data were expressed as mean±standard deviation (x±s), using a paired t-test before and after exchange transfusion, P<0.05as difference of statistical significance.Result:1. Changes in bilirubin before and after exchange transfusion in120neonates with hyperbilirubinemiaTotal bilirubin before exchange transfusion is405.29±106.21/after exchange transfusion179.15±58.30(μmol/L),(p=0.000), total bilirubin dropped by55.80%than before the exchange transfusion; indirect bilirubin before exchange transfusion is384.45±106.18/after exchange transfusion169.06±56.28(μmol/L),(p=0.000), indirect bilirubin dropped by56.03%,the results showed significant effect to reduce bilirubinemia of exchange transfusion therapy.2. Changes in blood routine examination before and after exchange transfusion in120neonates with hyperbilirubinemiaAll parameters of blood routine were lower than before and differences were statistically significant except red blood cells.White blood cell before the exchange transfusion is12.26±5.09/after exchange transfusion6.66±3.01(G/L),(p=0.000), white blood cell dropped by45.68%than before the exchange transfusion.Red blood cell before the exchange transfusion is4.27±0.78/after exchange transfusion4.23±0.72(T/L),(p=0.658), red blood cell dropped by45.68%than before the exchange transfusion.Hemoglobin before the exchange transfusion is151.57±26.43/after exchange transfusion126.18±21(g/L),(p=0.000), hemoglobin dropped by16.75%than before the exchange transfusion.Hematocrit before the exchange transfusion is0.4390±0.07/after exchange transfusion0.3703±0.06(L/L),(p=0.000), hematocrit dropped by15.65%than before the exchange transfusion.Blood platelet before the exchange transfusion is304.49±105.90/after exchange transfusion99.45±36.03(G/L),(p=0.000), blood platelet dropped by67.34%than before the exchange transfusion.3. Changes in blood biochemical indexes before and after exchange transfusion in120neonates with hyperbilirubinemia.After exchange transfusion serum sodium, serum chloride, serum potassium, serum magnesium decreased than before, rather than serum calcium, serum phosphorus increased compared with the previous.Before and after exchange transfusion, serum sodium139.29±3.61/137.65±4.18 (mmol/L),(p=0.000), serum sodium dropped by1.18%than before the exchange transfusion.Before and after exchange transfusion, serum chloride104.11±4.35/100.39±4.39(mmol/L),(p=0.000), serum chloride dropped by3.57%than before the exchange transfusion.Before and after exchange transfusion, serum potassium4.71±0.66/3.84±0.66(mmol/L),(p=0.000), serum potassium dropped by18.47%than before the exchange transfusion.Before and after exchange transfusion, serum magnesium0.88±0.16/0.74±0.21(mmol/L),(p=0.000), serum magnesium dropped by15.90%than before the exchange transfusion.Before and after exchange transfusion, serum calcium2.29±0.22/2.52±0.32(mmol/L),(p=0.000), serum calcium dropped by10.04%than before the exchange transfusion.Before and after exchange transfusion, serum phosphorus2.05±0.33/2.43±0.33(mmol/L),(p=0.000), serum phosphorus dropped by18.54%than before the exchange transfusion.4. Adverse reactions during and after exchange transfusion of120cases in children with hyperbilirubinemia Blood tests indicators:Thrombocytopenia53cases accounted for44.17%(including platelets<5g/L7cases accounted for5.83%), hypercalcemia48cases accounted for40.00%, hyperphosphatemia32cases (26.67%), hypokalemia29cases accounted for24.17%, anemia28cases accounted for23.33%, hyperglycemia25cases accounted for20.83%, hyponatremia20cases (16.67%), hypomagnesemia7cases accounted for5.83%, the hypochloremia6cases (5.00%).Adverse reactions of the clinical manifestations during and after the exchange transfusion:cyanosis8cases (6.67%), transfusion of blood after exchange transfusion7cases accounted for5.83%, shock3cases accounted for2.50%, apnea2cases accounted for1.67%, renal failure1case accounted for0.84%, acidosis1case accounted for0.84%.5. the cases of disorder within the environment lasting more than24hours after exchange transfusion of the46cases(1) Hypokalemia19cases accounted for41.30%, hyponatremia, hypercalcemia, leukopenia5cases each, accounted for10.87%respectively, hyperphosphatemia, thrombocytopenia, anemiain4cases each, accounted for8.70%respectively.(2) Including disorder within the environment persists for more than a day: Hypokalemia2cases accounted for4.35%, thrombocytopenia, leucopenia1case each, accounted for2.17%respectively.More than two days:Hypokalemia6cases accounted for13.04%, leukopenia3cases accounted for6.52%, thrombocytopenia, anemia2cases each, accounted for4.35%respectively, hyponatremia1case accounted for2.17%.More than three to four days:Hypokalemia4cases accounted for8.70%, hyponatremia3cases accounted for6.52%, hypercalcemia2cases accounted for4.35%, leucopenia and anemia1case each, accounted for2.17%.More than five days:Hypokalemia7cases accounted for15.22%, hyperphosphatemia4cases accounted for8.70%, Hypercalcemia3cases accounted for6.52%, Hyponatremia, thrombocytopenia, and anemia1cases each, accounted for2.17%respectively.Conclusion:1. The results confirmed the exchange transfusion therapy quickly and significantly reduce the bilirubin, however it can cause significant changes of the within the environment in blood of newborn children, the most prominent are thrombocytopenia (44.17%), hypercalcemia (40.00%), hypokalemia (24.17%), high glycemic (20.83%).2. Despite of the changes in the environment of the neonates during or after the exchange transfusion, the vast majority of neonates can recover on its own in a relatively short period of time, no significant complications, does not affect the time to discharge. A few children combined with other complications due to premature birth, and the change of the environmental indicators may be extended for a few days, to be given the drug intervention.3. The results suggest that regular exchange transfusion therapy is safe for uncomplicated full-term children under careful monitoring. However a small number of newborn, a small number of newborn, combined with infections or other complications, can cause serious clinical adverse reactions or events, the most prominent are cyanosis and oxygen saturation decreased in5cases (4.17%), abnormal heart rate and blood pressure fluctuations in3cases (2.50%), apnea, even a serious shock, renal failure.4. This study suggests that a children with high-risk factors for exchange transfusion, it is recommended to perform not be copied by ordinary change blood stereotyped, depending on the condition and individual case to make proper adjustments. During the whole process of exchange transfusion, including before it, actively prevention or intervention should be given to prevent the occurrence of serious adverse events.