Table 1.

Manual red cell exchange (modified from ref. 11).

For pediatric patients, use smaller comparable volumes (such as 5–10 cc/kg for bleeds and saline and calculate red cell volume based on 1- to 1.25-fold the amount of blood removed in bleeds). 
If patient has a starting hemoglobin close to or more than 10, this protocol may result in significantly higher hemoglobin after fluid equilibration post exchange. The red cell volume withdrawn in the two 500 cc bleeds is less than the red cells administered by the two units of blood (by the amount the patient’s hemoglobin is less than normal). You may wish to consider a 500 mL bleed at the end or alternate infusing 1 unit instead of 2 units in the second (and fourth if needed) cycle of 3 steps. While this difference is even greater for those with lower hemoglobins, such patients are less likely to exceed a hemoglobin of 10 g/dL by the end of the procedure. 

  • Calculate exchange volume as 1.5 red cell volumes.

  • Red cell volume = hematocrit × total blood volume.

    • Assume total blood volume is 70 cc/kg if over 20 kg, 85 cc/kg if under 20 kg.

    • Each standard unit has a red cell volume of ~200 cc (Hct ~40 × 500 cc)

  • Perform adult manual exchange as follows:

    1. Bleed 500 cc and then infuse 500 cc saline

    2. Bleed 500 cc and then infuse 2 units packed red cells

    3. Repeat steps 1 and 2 until volume of packed cells administered is equal to planned exchange volume (up to three or even four repeats for large adults)

 
For pediatric patients, use smaller comparable volumes (such as 5–10 cc/kg for bleeds and saline and calculate red cell volume based on 1- to 1.25-fold the amount of blood removed in bleeds). 
If patient has a starting hemoglobin close to or more than 10, this protocol may result in significantly higher hemoglobin after fluid equilibration post exchange. The red cell volume withdrawn in the two 500 cc bleeds is less than the red cells administered by the two units of blood (by the amount the patient’s hemoglobin is less than normal). You may wish to consider a 500 mL bleed at the end or alternate infusing 1 unit instead of 2 units in the second (and fourth if needed) cycle of 3 steps. While this difference is even greater for those with lower hemoglobins, such patients are less likely to exceed a hemoglobin of 10 g/dL by the end of the procedure. 

  • Calculate exchange volume as 1.5 red cell volumes.

  • Red cell volume = hematocrit × total blood volume.

    • Assume total blood volume is 70 cc/kg if over 20 kg, 85 cc/kg if under 20 kg.

    • Each standard unit has a red cell volume of ~200 cc (Hct ~40 × 500 cc)

  • Perform adult manual exchange as follows:

    1. Bleed 500 cc and then infuse 500 cc saline

    2. Bleed 500 cc and then infuse 2 units packed red cells

    3. Repeat steps 1 and 2 until volume of packed cells administered is equal to planned exchange volume (up to three or even four repeats for large adults)

 
View Large
Close Modal
This Feature Is Available To Subscribers Only

or Create an Account

Close Modal
Close Modal