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The page below is a sample from the LabCE course Hemolytic Disease of the Fetus and Newborn. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Postnatal Treatment: Exchange Transfusion

A hallmark of HDFN treatment is to induce labor as early as possible once lung maturity has been attained so that the newborn will be able to survive.
Once the infant is born, the main treatment for severe HDFN due to anti-D (and other antibodies causing severe disease) is exchange transfusion.
In exchange transfusions, up to 85–90% of the infant's blood can be exchanged with donor blood by a process of removing 5–20 mL of blood at a time and injecting an equivalent amount until the exchange is complete.
An exchange transfusion accomplishes the following:
  1. Removes bilirubin and thus helps prevent kernicterus
  2. Removes sensitized red cells that have not been broken down yet
  3. Removes circulating maternal antibody
  4. Provides antigen-negative red cells that will not be destroyed by the maternal antibody, thus will survive and provide oxygen to the tissues.