Intensive phototherapy vs. exchange transfusion for the treatment of neonatal hyperbilirubinemia: a multicenter retrospective cohort study / 中华医学杂志(英文版)

BACKGROUND@#Intensive phototherapy (IPT) and exchange transfusion (ET) are the main treatments for extreme hyperbilirubinemia. However, there is no reliable evidence on determining the thresholds for these treatments. This multicenter study compared the effectiveness and complications of IPT and ET in the treatment of extreme hyperbilirubinemia.@*METHODS@#This retrospective cohort study was conducted in seven centers from January 2015 to January 2018. Patients with extreme hyperbilirubinemia that met the criteria of ET were included. Patients were divided into three subgroups (low-, medium-, and high- risk) according to gestational week and risk factors. Propensity score matching (PSM) was performed to balance the data before treatment. Study outcomes included the development of bilirubin encephalopathy, duration of hospitalization, expenses, and complications. Mortality, auditory complications, seizures, enamel dysplasia, ocular motility disorders, athetosis, motor, and language development were evaluated during follow-up at age of 3 years.@*RESULTS@#A total of 1164 patients were included in this study. After PSM, 296 patients in the IPT only group and 296 patients in the IPT plus ET group were further divided into the low-, medium-, and high-risk subgroups with 188, 364, and 40 matched patients, respectively. No significant differences were found between the IPT only and IPT plus ET groups in terms of morbidity, complications, and sequelae. Hospitalization duration and expenses were lower in the low- and medium-risk subgroups in the IPT only group.@*CONCLUSIONS@#In this study, our results suggest that IPT is a safe and effective treatment for extreme hyperbilirubinemia. The indication of ET for patients with hyperbilirubinemia could be stricter. However, it is necessary to have a contingency plan for emergency ET as soon as IPT is commenced especially for infants with risk factors. If IPT can be guaranteed and proved to be therapeutic, ET should be avoided as much as possible.

Recambio de Hematíes en gestante con Anemia de Células Falciformes: reporte de un caso en el Hospital Regional de Talca / Red blood cell exchange in pregnant women with Sickle Cell Anemia: report of a case in the Regional Hospital of Talca

Sickle cell anemia or sickle cell disease is an autosomal recessive disease, caused by a mutation in the hemoglobin gene, where glutamic acid is substituted for valine at position 6 of the beta chain of hemoglobin, resulting in hemoglobin S The diagnosis is made with electrophoresis. The clinical manifestations are varied, the most frequent being the vaso-occlusive crisis, which can increase in pregnancy, during which sickle cell disease also increases the risk of maternal-fetal complications, caused by pre-eclampsia infections, intrauterine growth restriction, and premature delivery. and miscarriage. The usual treatment for the management of seizures is hydroxyurea, a drug that is teratogenic, so its use is contraindicated during pregnancy. Other treatment alternatives are red blood cell transfusion and red blood cell exchange. Next, the first case of red blood cell exchange or exchange transfusion in a pregnant patient with sickle cell anemia at the Hospital Regional de Talca is presented.

Research advances in the treatment strategies for severe pertussis in children / 中国当代儿科杂志

At present, effective antibiotics and comprehensive symptomatic/supportive treatment as early as possible are mainly used for the treatment of severe pertussis in clinical practice. However, some children with severe pertussis have unsatisfactory response to commonly used drugs and treatment measures in the intensive care unit and thus have a high risk of death. Studies have shown that certain treatment measures given in the early stage, such as exchange transfusion, may help reduce deaths, but there is still a lack of uniform implementation norms. How to determine the treatment regimen for severe pertussis and improve treatment ability remains a difficult issue in clinical practice. This article reviews the advances in the treatment of severe pertussis, in order to provide a reference for clinical treatment and research.

Effect of red blood cell storage duration on the clinical effect of exchange transfusion and internal environment in neonates with hyperbilirubinemia / 中国当代儿科杂志

OBJECTIVE@#To study the effect of red blood cell (RBC) storage duration on the clinical effect of exchange transfusion (ET) and internal environment in neonates with hyperbilirubinemia.@*METHODS@#A retrospective analysis was performed for the clinical data of 135 neonates with hyperbilirubinemia who received ET between January 2015 and August 2018. According to RBC storage duration, the neonates were divided into short-term storage group (RBCs were stored for ≤7 days) with 56 neonates and long-term storage group (RBCs were stored for >7 days) with 79 neonates. The two groups were compared in terms of serum total bilirubin (TBIL) level and the rate of TBIL reduction at 0 and 12 hours after ET, as well as the duration of continued phototherapy and rate of repeated ET. Routine blood test parameters, electrolytes, blood glucose, and blood gas parameters were measured before ET and at 0 hour after ET.@*RESULTS@#At 0 hour after ET, there were no significant differences in the TBIL level and the rate of TBIL reduction between the two groups (P>0.05). At 12 hours after ET, the long-term storage group had a significantly higher TBIL level and a significantly lower rate of TBIL reduction than the short-term storage group (P7 days in ET for neonates with hyperbilirubinemia does not affect the immediate effect of ET, but these neonates tend to have a poor outcome after continued phototherapy and high risk of hyponatremia, hyperkalemia, and metabolic acidosis.

Exanguinotransfusión como tratamiento de metahemoglobinemia secundaria a dapsona. reporte de caso / Exchange transfusion to treat dapsone-induced methemoglobinemia. a case report

La dapsona es una sulfona utilizada en una variedad de enfermedades dermatológicas que incluye el pénfigo, lametahemoglobinemia es un síndrome clínico potencialmente mortal debido a la disminución del aporte de oxígenodesde la sangre hacia los tejidos; la metahemoglobinemia adquirida es la forma más frecuente y es un conocidoefecto adverso del uso de dapsona. Describimos el caso de un varón con pénfigo foliáceo y tratamiento reciente condapsona, que presentó cianosis, disnea y choque circulatorio ante concentraciones elevadas de metahemoglobina(21%); el tratamiento inicial incluyó oxigenoterapia, soporte ventilatorio invasivo, hemodinámico y administraciónde azul de metileno intravenoso, ante la ausencia de respuesta clínica se realizó exanguinotransfusión como terapiade segunda línea con respuesta óptima, el nivel sérico de metahemoglobina fue 2,3% tres horas posteriores alrecambio sanguíneo.

Dapsone is a sulphone used for a variety of dermatologic conditions including pemphigus. Methemoglobinemia isa potentially lethal syndrome due to a diminished supply of oxygen from blood to tissues, the acquired form is themost frequent presentation and it is a recognized adverse effect of dapsone. We report the case of a male patientwith pemphigus treated with dapsone that developed cyanosis, dyspnea and shock in the presence of elevatedconcentrations of methemoglobin (21%). Initial treatment included oxygen, invasive ventilatory support andintravenous administration of methylene blue, but due to lack of response, exchange transfusion was performedwith optimal response, serum level of methemoglobin after the procedure was 2.3%.

Whole blood pathogen reduction technology and blood safety in sub-saharan Africa: a systematic review with regional discussion

Background: Despite vast improvements in transfusion services in sub-Saharan Africa over the last decade, there remain serious concerns on the safety and adequacy of the blood supply across the region. Objective: This review paper ascertains the role of pathogen reduction technology (PRT) in improving blood safety and supply adequacy in the region. Method: The state of blood safety in sub-Saharan Africa was reviewed. Meetings, seminars and correspondence were undertaken with key clinicians, scientists and professional bodies in the region, including the World Health Organization's Regional Office for Africa, to examine the suitability of PRT for improving the safety of whole blood transfusion, a prevalent transfusion format in the region. Results: Existing literature suggests that combining PRT with current blood safety measures(such as serology) would improve the safety and adequacy of the blood supply for transfusions in sub-Saharan Africa. This was echoed by the findings of the stakeholder meetings. Conclusion: Following a detailed appraisal of two leading PRT systems, the Mirasol® PRT System and the Cerus S-303 System, we suggest that companies conduct comprehensive toxicological evaluation of the agents used for PRT and publish this in the scientific literature. We also recommend that the safety and efficacy of these technologies should be established in a randomised clinical trial conducted in sub-Saharan Africa

Heart valve surgery in patients with homozygous sickle cell disease: A management strategy.

Background: Patients with the homozygous sickle cell disease have increased perioperative mortality. Some indications like heart valve surgery, may justify an exchange blood transfusion to reduce the proportion of hemoglobin S (HbS) and complications. Subjects and Methods: We report two female cases aged 20 and 27, of African origin with homozygous sickle cell anemia who underwent heart valve surgery to treat mitral valve regurgitation. This presentation describes the perioperative considerations including anesthesia and postoperative care. Results: A partial exchange blood transfusion decreased HbS levels from respectively, 90% and 84%, 9% to 27% and 34%, and simultaneously treated the anemia. Neither sickling crisis nor acidosis occurred in any patient, and no special postoperative complication occurred. Average hospital stay was 10 days. Currently, the two patients remain alive and free of cardiac symptoms. Discussion: Although the presence of sickle cell disorders is associated with increased risk of sickling and thus vaso‑occlusive complications, they should not be taken as a contraindication for heart valve surgery. Nevertheless, monitoring of certain parameters such as venous, arterial oxygen content, pH, and body temperature is mandatory for a better outcome. Furthermore, preoperative exchange transfusion has a positive influence on the outcome of surgery and on the survival of patients undergoing heart valves surgery. Avoiding intraoperative hypoxia, hypothermia, and vaso‑constrictive agents, minimizing HbS levels with preoperative exchange transfusion, and ensuring a stress‑free environment with the judicious use of sedatives made surgery relatively safe in these cases.

Importancia de la resonancia magnética en la encefalopatía bilirrubínica / Importance of magnetic resonance imaging in bilirubin encephalopathy

Con el objetivo de resaltar el valor diagnóstico de la resonancia magnética en la encefalopatía bilirrubínica se presenta el caso clínico de un recién nacido de 37 semanas de edad gestacional que reingresa al octavo día de vida por ictericia constatándose cifras de bilirrubina indirecta de 30,1 mg/dl. La disminución de las mismas se logró con exanguinotransfusión, fototerapia intensiva y adecuado aporte. Se solicita resonancia magnética de cráneo que informa, a nivel de ambos globos pálidos y subtalámico, un aumento de la señal en T1 y T2; contribuyendo al diagnóstico de encefalopatía bilirrubínica aguda.

In order to highlight the value of magnetic resonance imaging in the diagnosis of bilirubin encephalopathy, the clinical case of a 37 week of gestational age newborn is presented. The newborn was readmitted to hospital with jaundice on the eighth day of life, indirect bilirubin being 30.1 mg/dl. This level was decreased with exchange transfusion, intensive phototherapy and the appropriate oral supply. Magnetic resonance imaging of the skull was requested, revealing T1 and T2 hyperintensity within the globus pallidus, and the subthalamic nuclei; which contributed to the diagnose of acute bilirubin encephalopathy.

Uso posnatal de altas dosis de gamma globulina EV en el tratamiento de la enfermedad hemolítica RH / Postnatal use of high doses of EV gammaglobulin in the treatment of hemolytic disease RH

El uso posnatal de altas dosis de inmunoglobulina endovenosa (IgGEV) aparece promisorio, en los escasos trabajos publicados, en reducir la necesidad de exsanguinotransfusiones (EXT) en el recién nacido (RN) con enfermedad hemolítica RH (EHRH). Objetivo: Evaluar la eficacia de la IgGEV para moderar la severidad de la hemólisis: necesidad de EXT, tiempo de luminoterapia (LMT) y número de transfusiones (T) en el RN con EHRH. Diseño: Ensayo clínico controlado y randomizado. Lugar de estudio: Hospital Materno Infantil “Ramón Sardá”. Población y métodos: Todos los RN con EHRH [Coombs directa (+)], fueron estratificados en 3 grados (leve, moderado y severo) según la severidad de la hemólisis evaluada intraútero. Solicitado el consentimiento informado a los padres, los RN de cada grado se randomizaron en: Grupo tratado: recibió IgGEV (500mg/kg/día por tres días, la primera dosis antes de las 2 horas posnatales) más LMT, y grupo control: solo LMT. Las variables estudiadas fueron: mínimo hematocrito (Hto), bilirrubina (Bi) máxima, n° de EXT y/o T, LMT (hs), internación (días) y tiempo hasta la EXT. Resultados: Entre febrero/99 y mayo/00 fueron enrolados 46 RN (grado leve: 24 y grado moderado-severo (gM-S): 22). 23 RN pertenecieron al grupo tratado y 23 al control. Ambos grupos fueron comparables en sexo, peso, EG y Hto, Bi, Hb y prot. totales de cordón. No se observaron diferencias significativas excepto en n° de EXT. De los 23 RN tratados, 5 requirieron EXT (21.74%) cuando su bilirrubina alcanzó el nivel establecido en las guías del hospital; 18 de los 23 RN controles requirieron EXT (78,26%), Chi2 0.0011. El número necesario a tratar (NNT) fue 1,8 para prevenir una EXT. La probabilidad de sufrir EXT es significativamente menor en un paciente tratado que en un control, en cualquier momento del período de estudio (Log Rank test p= 0,0024). Conclusiones: Estos resultados apoyan el beneficio clínico de tratar con IgGEV a los RN con incompatibilidad RH.

Neonatal polycythemia: risk factors, clinical manifestation and treatment applied

Polycythemia is defined as a venous hematocrit above 65%. Polycythemia is sometimes associated with hyper viscosity of blood. The etiology of polycythemia is related either to intra-uterine hypoxia or secondary to fetal transfusion. Increased viscosity of blood is associated with symptoms of hypoperfusion. Clinical features related to hyper viscosity may affect all organ systems. To evaluate the prevalence of polycythemia among neonates who were admitted to the nursery care unit, to evaluate the difference between peripheral and central hematocrit [PCV] and to have an idea about the main presentation and modes of treatment of polycythemia. A case - control study was done in the nursery care unit of AL - Kadhyimia Teaching Hospital, one hundred neonates [50 polycythemic and 50 control healthy neonates] were taken, for each neonates, information regarding [name, age, sex, gestational age, mode of delivery, body weight, length, head circumference, clinical presentation and risk factors] were taken, investigations including hematocrite [PCV], random blood sugar and total serum bilirubin were done for all neonates. The prevalence of neonatal polycythemia was [2.2%], male was affected more than female with male: female ratio equal to [1.5:1]. The difference between peripheral and central PCV was [4 - 15%] with a mean and standard deviation of [7 +/- 0.33%]. The main signs and symptoms were jaundice [58%], lethargy [30%], respiratory distress [26%] and hypoglycemia [26%]. Risk factors were preterm [36%], neonates of diabetic mother [20%], small for gestational age [18%], twin pregnancy [12%] and down's syndrome [10%]. Partial exchange transfusion was done to 28 cases [56%]. Males were affected more than females. Jaundice was the main presentation followed by lethargy, respiratory distress and hypoglycemia. Higher risk in twin pregnancy, neonates of diabetic mother, small for gestational age, preterm and down's syndrome while delivery by caesarian section reduce the risk of polycythemia.

Exanguinotransfusión parcial en un paciente con anemia falciforme homocigota sometido a cirugía cardíaca con circulación extracorpórea: reporte de caso / Partial exchange transfusion in a patient with homozygous sickle cell disease undergoing heart surgery with cardiopulmonary bypass: a case report

En pacientes con anemia falciforme, el circuito de circulación extracorpórea promueve la polimerización de la hemoglobina y la formación de drepanocitos. La exanguinotransfusión reduce los niveles circulantes de hemoglobina S. Reportamos el manejo de un niño con anemia falciforme homocigótica que requirió cirugía de cierre de comunicación interauricular. Se realizó exanguinotransfusión parcial intraoperatoria disminuyendo los niveles de hemoglobina S de 89 por ciento a 23 por ciento. La circulación extracorpórea fue conducida en normotermia utilizando cardiología fría, realizando el procedimiento quirúrgico en paro sinusal.

In patients with sickle cell anemia, the extracorporeal circulation circuit promotes the polymerization of hemoglobin and sickle cell formation. Exchange transfusion reduces circulating levels of hemoglobin S. We report the management of a child with homozygous sickle cell anemia who required surgical closure of atrial septal defect. Partial intraoperative exchange transfusion was performed that decreased hemoglobin S levels from 89 percent to 23 percent. Cardiopulmonary bypass was conducted at normothermia with cold blood cardioplegia and the surgical procedure was performed in sinus arrest.

High-throughput genotyping multiplex ligation-dependent probe amplification for assisting diagnosis in a case of anti-Di(a)-induced severe hemolytic disease of the newborn / 南方医科大学学报

<p><b>OBJECTIVE</b>To report a rare case of hemolytic disease of the newborn (HDN) with kernicterus caused by anti-Di(a) diagnosed using high-throughput genotyping multiplex ligation-dependent probe amplification (MLPA).</p><p><b>METHODS</b>Conventional serological methods were used to detect the antibodies related with HDN. The genotypes of more than 40 red blood cell antigens for the newborn and her parents were obtained using the high-throughput MLPA assay. The antibody titers were tested using a standard serological method.</p><p><b>RESULTS</b>The unknown antibody against the low-frequency antigens was predicted based on the primary serological tests. The genotyping results for more than 40 red blood cell antigens of the newborn and her parents showed incompatible antigens of MNS and Diego blood group system, indicating the existence of anti-N or anti-Di(a). Further serological tests confirmed anti-Di(a) existence in the plasma of the newborn and her mother. The titer of anti-Di(a) in the mother's plasma was 1:32.</p><p><b>CONCLUSION</b>Severe HDN including kernicterus can result from anti-Di(a). High-throughput genotyping MLPA assay can help type some rare antigens in complicated cases. The reagent red cell panels including Di(a)-positive cells are necessary in routine antibody screening test in Chinese population.</p>

Complications of PORT-A-CATH in patients with sickle cell disease

Red cell exchange/transfusion is frequently used in the management of patients with medical complications related to acute severe sickle cell disease [SCD]. However, peripheral venous access is often difficult without central venous catheters [CVCs] in adult patients with moderate or severe SCD. To review our experience with the use of the PORT-A-CATH device in sixteen patients with SCD undergoing exchange or simple transfusions. Among a cohort of 550 patients who frequently visited the inpatient service, sixteen SCD patients required the insertion of a PORT-A-CATH device. These patients included 3 males and 13 females, aged 25-44years [31.1 +/- 2.3; mean +/- [SD]. A total of 24 PORT-A-CATH devices were implanted in these 16 patients during the study period. Eleven patients had 1 device implanted, three patients had 2 devices, one patient had 3 devices, and one patient had 4 devices implanted. Out of the 24 devices implanted, 17 required removal, due to either infection associated with sepsis and/or thrombosis. The organisms involved were Candida spp. [3], C. Parapsilosis [2], C. albicans [1], C. famata [1], C. lusitanice [1], Staphylococcus spp. [6], and S. aureus [3], as well as the coagulase-negative Staphylococcus [2], alpha hemolytic Streptococcus [1], Diphtheroidbacilli [2], Pseudomonas aeruginosa [2], Ps. Spp. [3], Escherichia coli [3], Klebsiella oxytoca [1], Klebsiella pneumoniae [1], Klebsiella spp. [1], Serratia liquefaciens [1], Serra-tia fanticola [1], Achromobacter spp. [2] Chromobacterium violaceum [1], Delftia acidovirans [1], Stenotrophomonas maltophile [1], Alcaligenes faecalis [1], and Enterobacter cloacae [1]. Two episodes of documented thrombosis were observed

Evaluation of auditory brainstem responses [ABR] in healthy term infants with elevated bilirubin levels requiring exchange transfusion

Hyperbilirubinemia is a common neonatal abnormality. Severe hyperbilirubinemia is a risk factor for auditory system injury. Auditory brainstem responses [ABR] are important in early diagnosis of hearing impairments in healthy term infants with elevated bilirubin levels requiring exchange transfusion. During a two- year- period [2007 - 2009], in a prospective descriptive analytical study, in Tehran Milad Hospital, 64 [32 female, 32 male], healthy term [> 37 weeks] infants, who required treatment or were treated with phototherapy or received exchange transfusion for elevated bilirubin levels or jaundice, were studied. After obtaining a written consent from their parents, the infants were tested with auditory brain responses and results were analyzed using SPSS 16 software. No significant correlation was found between ABR and age, weight, bilirubin level or ABO blood group. Nineteen out of 64 infants received exchange transfusion. Three out of 19 infants [16%] exhibited abnormal ABR and 16 infants [84%] had normal ABR. There was no significant correlation between exchange transfusions and ABR [P>0.05]. The results pointed out that 14% of the infants with elevated bilirubin who required exchange transfusion had abnormal ABR. This indicates that elevated bilirubin levels even without inducing kernicterus should be considered as risk factors for hearing impairments. Further studies are needed on how long these tests may remain abnormal

Complete recovery following sudden sensorineural hearing loss in a patient with sickle cell disease

A sickle cell disease [SCO] patient with vaso-occlusive crisis [VOC] developed sudden senserinural hearing loss [SNHL], which responded well to a rapid course of corticosteroids along with exchange transfusions. The otolaryngologist should be aware of the otologic manifestations of SCD such as SNHL A good response to steroids, which averted a permanent hearing loss, warrants further studies to define the augmentive benefits of such therapy along with exchange transfusions in patients with SCD in VOC who develop sudden SNHL

[ effects of intravenous immunoglobulin [IVIG] in hemolytic jaundice of the newborn due to ABO and Rh isoimmunization]

Recent studies suggested the role of IVIG in decreasing immune hemolytic jaundice of the newborn and need to exchange transfusion using. This study evaluated the effects of IVIG on hemolytic jaundice of newborn due to ABO and Rh isoimmunization. This clinical trial study was performed on 80 hospitalized newborns with hemolytic jaundice due to ABO and Rh isoimmunization in neonatal ward of Tehran Mahdieh hospital between October 2007 and October 2008. Neonates were assigned randomly to control [phototherapy] and case [phototherapy plus IVIG] groups. IVIG was administered as 500 mg/kg during 4 hours and up to maximum 3 doses, if it was required. Severity of jaundice, duration of phototherapy, hospitalization stay, need to exchange transfusion and complications of IVIG administration were evaluated. Data was analysed using SPSS software and by Chi-square and independent T tests. Duration of phototherapy, hospitalization and exchange transfusion were significantly lower in neonates who took IVIG in addition to phototherapy than control group. No complications of IVIG were observed. Administration of IVIG is an effective and safe method for decreasing severity of immune hemolytic jaundice of newborns and need to exchange transfusion using

Automated peripheral arteriovenous exchange transfusion for treatment of severe hyperbilirubinemia in neonates / 南方医科大学学报

<p><b>OBJECTIVE</b>To study the effect of automated peripheral arteriovenous exchange transfusion for treatment of severe hyperbilirubinemia in neonates.</p><p><b>METHODS</b>Fifty-three neonates with severe hyperbilirubinemia underwent automated peripheral arteriovenous exchange transfusion, and the changes in the blood gas, electrolytes and some biochemical indices after the exchange transfusion were evaluated.</p><p><b>RESULTS</b>Treatment with the exchange transfusion resulted in a significant reduction in the total serum bilirubin with an exchange rate of 53.12% (P<0.01). The levels of serum kalium, calcium, magnesium, white blood cell count, platelets, and pH showed reductions while blood glucose exhibited a significant elevation changes after the transfusion (P<0.01), which all recovered the normal levels within 48 h. No obvious alterations occurred in the respiration, heart rate, blood pressure, or saturation of blood oxygen during the transfusion.</p><p><b>CONCLUSION</b>Automated peripheral arteriovenous exchange transfusion can rapidly reduce serum bilirubin levels in neonates with severe hyperbilirubinemia without obviously affecting the blood gas balance or blood electrolyte or glucose levels.</p>

Effects of exchange transfusion and phototherapy on neonatal thyroid functions

Hyperbilirubinemia is one of the most common problems encountered in term newborns. Phototherapy or exchange transfusion may be indicated for treatment at certain bilirubin levels. Aim of the work: Is to study the effects of exchange transfusion and phototherapy on thyroid functions in full term neonates with indirect hyperbilirubinemia by assessing thyroid functions before and after exchange transfusion and during phototherapy. The present study was carried on 60 full term neonates who were grouped as follows: Group I: Included 20 neonates with hyperbilirubinemia reaching the level that indicated exchange transfusion. Group II: included 20 neonates with hyperbilirubinemia at the level of treatment by phototherapy. Group Ill: included 20 healthy neonates as a control group. All studied groups were subjected to full medical history, clinical examination and laboratory investigations including Free T3, Free T4, TSH before, immediately after and 4 days after exchange transfusion in group I, Free T3, FreeT4, TSH before and 2 days after the beginning of phototherapy in group II, Free T3, Free T4, TSH in group Ill, Free T3, T4, and TSH levels were assessed in donor blood bags prepared for exchange transfusion. In addition liver function tests, complete blood count, Coombs' test, C reactive protein, blood group of baby and mother were assessed for neonates in group I and II. We found that the levels of thyroid functions [FT3, FT4, TSH] were statistically significantly higher in neonates before exchange transfusion than immediately after exchange while there was no statistical significant difference in levels of thyroid functions before exchange transfusion and 4 days post exchange transfusion. Furthermore, the study revealed no significant differences between thyroid function tests before and during phototherapy. Moreover, there were no significant correlations between thyroid function tests and either bilirubin or hemoglobin levels of group I before exchange transfusion and group II before phototherapy. We found that exchange transfusion causes a decrease in thyroid functions immediately after exchange than before exchange and they return to normal levels four days post exchange. On the other hand, phototherapy does not affect thyroid function tests

Hepatic crisis in a ten-year-old Kuwaiti boy with sickle cell disease

Hepatic sickle crisis [HSC] is a rare complication of sickle cell disease [SCD] which responds to proper hydration, simple transfusion, or exchange blood transfusion. We describe the case of a ten-year-old boy who presented with severe right upper quadrant abdominal pain, jaundice, and elevated liver enzymes. Abdominal ultrasonography showed only sludge, with no gallstones or abnormal biliary tree. He did not respond to initial management with analgesics and intravenous fluids. There was prompt resolution of symptoms and biochemical derangement following exchange blood transfusion

causes of icter which lead to the blood exchange transfusion in neonates admitted in Milad Hospital NICU

Jaundice in neonatal period is a common disorders that increase bilirubin deposision in tissues such as skin occurs.excessive bilirubin deposision in the brain increase the risk encephalopathy and kernicterus. there are several therapeutic procedures to reduce bilirubin level. One of the most important method especially in emergency situation is exchang transfusion [ET]. This study was performed to find the causes of sever hyper bilirubinemia which required ET. This study was an analytical descriptive retrospective and prospective study which was performed in 48 cases in milad hospital [Tehran -Iran] from 1381 - 1386. the data were collected by pediatrician in a detailed questionnaire. This data were fully analyzed by SPSS 16 software. In this study 48 neonates age 1-32 days were enrolled. 24 patients [50%] were male and 50% were female 34 patient [77%] were term and 14 patient [23%] were preterm. retic count in most patient were low [less than 2%]. There was no specific cause for jaundice in 12 [24%] cases. ABO incompatibility was the most common cause of jaundice. ABO incompatibility was the most common cause ET which can be prevented by in paying attention to postnatal visit. there was no specific cause of jaundice 12 [24%] cases which required further investigation. In this study no positive coomb,s test was seen .coomb,s test under this situation little value