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Original Article

IMJ. 2016; 8(2): 94-98


FACTORS AFFECTING THE EFFICACY OF EXCHANGE TRANSFUSION IN THE TREATMENT OF NEONATAL HYPERBILIRUBINEMIA IN DUHOK, IRAQ

AKREM MOHAMMAD MOSTEFA.

Abstract
OBJECTIVE: To assess the efficacy of this procedure in lowering bilirubin level and factors affecting this efficacy.
STUDY DESIGN: An Interventional prospective study.
PLACE AND DURATION: At Heevi Pediatric Teaching Hospital in Duhok, North of Iraq in one year from June 1st 2014 to June 1st 2015.
METHODOLOGY: Neonates with hyperbilirubinaemia underwent urgent double volume exchange transfusion with whole blood
compatible with neonate's and mother's blood. All patients had serum bilirubin levels (TSB), blood group and Rh, reticulocyte count,
coomb's test, completes blood count, and peripheral blood film. Data collected included age, Initial serum bilirubin levels,
Hematocrit, cause of hyperbilirubinemia (hemolytic or non-hemolytic) and rate of TSB lowering after the procedure, the rate of TSB
change 8 hours after the procedure, the change of hematocrit after the procedure and duration of procedure were all studied.
RESULTS: Total neonates were 132.The mean initial TSB is 24.34 mg/dl (SD 5.13). The mean lowering of TSB after exchange transfusion
is 8.8 mg/dl (SD3.63) with a percentage of 36.15% while the initial PCV is 49.62(SD 9.6). The procedure needed to be repeated in 33.3%
patients. The mean duration of the procedure was 56.48 minutes (SD 12.64). The mean age at which the procedure is done is 4.48 days
(SD 2.2). 33.33% cases, the cause was hemolysis. The serum bilirubin rebounded 8 hours after the procedure in 58.3% cases and the
hematocrit dropped in 61.83% neonates. The age of patients, initial serum bilirubin and duration of procedure have no significant
effect on the efficacy while non hemolytic causes significantly increase the efficacy of the procedure.
CONCLUSION: The mean TSB, mean hematocrit, age at which the procedure is done are comparable to other studies but the efficacy in
lowering TSB is less. The procedure lowers bilirubin more effectively in non hemolytic hyperbilirubinemia.Serum bilirubin rebounds
and hematocrit falls significantly after the procedure in most cases.

Key words: Exchange Transfusion, Hyperbilirubinemia, Neonate, Hemolytic Disease



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