Table 3.
Sample Calculations for Manual Exchange Transfusion
| Phlebotomy and tranfusions volumes | Example: 30-kg child with HbS 90%, Hb 7 g/dl, HCT 21% | |
|---|---|---|
1. Estimate the patient’s total blood volume (TBV).
|
1. ____ ml |  |
2. Calculate the desired change in HbS (∆HbS).
|
2. ____ |  |
3. Calculate the whole-blood volume to remove (WBV).
|
3. ____ ml |  |
| Infuse 10–20 ml/kg of crystalloid before starting. Remove this volume in 4-6 aliquots, 15–30 minutes apart. | Infuse 300-600 ml crystalloid. Remove 300 ml every 30 minutes for 5 cycles. | |
4. Calculate the erythrocyte volume to remove (EV).
|
4. ____ ml |  |
5. Convert the EV to a base RBC volume to transfuse.
|
5. ____ ml |  |
6. Add RBC volume to raise the hemoglobin concentration.
|
6. ____ ml |  |
7. Calculate the total RBC volume to transfuse.
|
7. ____ ml |  |
| Transfuse in 4–6 aliquots, between phlebotomy cycles. Infuse 10–20 ml/kg of crystalloid after completion. |
Transfuse 195 ml every 30 minutes for 5 cycles. Infuse 300–600 ml crystalloid. |
|
Notes: There are multiple equations to estimate TBV. Assume a starting HbS of 100% if the patient’s HbS is not available. Hematocrit of RBC units and the expected rise in Hb per mL transfused may vary by institution; consult local blood bank.
Abbreviations: HbS, hemoglobin S; HCT, hematocrit; Hb, hemoglobin concentration (g/d); RBC, transfused red blood cells.