Infants who receive an exchange transfusion often see their platelet count drop sharply, leaving them at greater risk of bleeding, according to a recent study published in the journal Vox Sanguinis.
An exchange transfusion is a procedure in which doctors slowly remove a newborn’s blood and replace it with donated blood at the same time. It is used to treat various conditions, including hemolytic disease of the fetus and newborn (HDFN), serious infections or blood that is too thick. The blood used for the procedure is made of donor red blood cells and plasma—but under current guidelines, no platelets are added. Platelets are the tiny cell fragments in blood that help it clot and stop bleeding.
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In this study, researchers reviewed 114 exchange transfusions given to 78 infants at a single hospital in India between 2016 and 2021. About four out of five of the infants had HDFN. Platelet counts fell in most cases—from a typical count of roughly 113,000 before the procedure to about 60,000 afterward. In 47 of the transfusions, or about four in 10, platelet counts dropped to a level considered severely low.
Because so many infants ended up needing platelets anyway, the researchers argued that “transfusion centers, therefore, should consider adding platelets while reconstituting blood unit[s] for exchange transfusion.”
Reconstituting blood units means mixing red blood cells with plasma.
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Another finding was that babies who began with low platelet counts were in worse condition, and they were also the ones most likely to need platelets afterward.
Meanwhile, the baby’s sex, gestational age, birth weight, place of birth or blood groupBlood group A classification of blood based on inherited markers found on red blood cells. The ABO and Rh blood groups are most common in HDFN., and the mother’s age, blood group, or history of pregnancy loss and the timing or number of transfusions made no measurable difference.
The researchers cautioned that their work looked backward through old records at one hospital and covered a relatively small number of patients.
