heparinised whole blood or citrated blood for exchange transfusion

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SËinasi O È zsoylu Heparinised whole blood or citrated blood for exchange transfusion Received: 31 July 2000 Accepted: 4 October 2000 PetaÈjaÈ et al. [1] showed some statistical dierences between postexchange para- meters when heparinised versus composite citrated blood CB) was used for exchange transfusion ET) in hyperbilirubinemic newborns due to haemolytic anaemia of Rh or ABO isoimmunisation. Although haemoglobin and packed cell volume values diered slightly between the pre- and post-ET groups P < 0.05 for both), they were both lower in those new- borns who received heparinised blood for ET. Considering their diagnosis of haemo- lytic anaemia, lower post-ET haemoglobin and packed cell values could not be inter- preted as favourable in those newborns who underwent ET by heparinised blood. Higher post-ET blood glucose values could be attributed to the preparation of composite CB from citrate-dexrose-phos- phate-adenosine anticoagulated blood, which also increases the osmolality. Ionized calcium was statistically lower in post-ET newborns when composite CB was used. However, its clinical signi®cance was not indicated by the authors. Since haemolysis sign was not present in this blood [2], hyperphosphataemia was most likely related to phosphate in the composite CB, which could also be the cause of ionized hypocalcaemia. Despite the statistical signi®cance of some parameters following ET in new- borns, the authors did not indicate any clinical importance of these ®ndings. Therefore, with their data the conclusion `heparinised blood should be kept an available option for neonatal exchange transfusions' does not hold, especially when haemoglobin and packed cell volume are considered. Reference 1. PetaÈjaÈ J, Johansson C, Anderson S, Heikinheimo M 2000) Neonatal exchange transfusion with heparinised whole blood or citrated composite blood: a prospective study. Eur J Pediatr 159: 552±553 2. O È zsoylu SË, Mestci L 1998) Hyper- phosphataemia in haemolysis. Lancet 1: 53 SË. O È zsoylu Department of Paediatric and Haematology, Fatih University Medical Faculty, Alparslan TuÈrkesË cad. No.57, Emek-06510, Ankara, Turkey Fax: +90-312-2213276 j REPLY Jari PetaÈjaÈ á Christian Johansson á Sture Andersson á Markku Heikinheimo Heparinised and composite blood for exchange transfusions Received: 31 July 2000 Accepted: 4 October 2000 Sir: We thank Prof. O È zsoylu for his interest in our study concerning heparinised HB) and composite blood CB) for exchange transfusions in hemolytic anemia of the newborn. We understand his major criticism to be our failure to demonstrate `clinical signi®- cance' for the observed dierences in mul- tiple laboratory parameters between the HB and CB groups. Our main purpose was to convey an evidence-based word of caution that use of CB is associated with an acute increase in serum osmolality, and in that respect, we feel our data to be quite clear. It is evident that in sick, premature infants, acute osmolality changes are potentially hazardous for the cerebral microcirculation and may contribute to the development of intraventricular hemorrhage as well as white matter disease. Ethical and practical issues make it highly unlikely that the safety aspects of HB and CB in the subgroup of high-risk premature infants could be compared in an adequately powered, randomized clinical trial. Quite simply, among a multitude of other clinical factors aecting homeostasis in cerebral microcir- culation, osmolality may have a clinical eect, and therefore the goal to maintain it normal and stable is well accepted in neonatal intensive care. Iatrogenic changes in osmolality should be avoided, and in the case of exchange transfusion, choosing HB instead of CB may partly help to serve this goal. J. PetaÈjaÈ á C. Johansson S. Andersson á M. Heikinheimo Children's Hospital, University of Helsinki, StenbaÈckinkatu 11, 00290 Helsinki, Finland j Eur J Pediatr 2001) 160: 194±195 Ó Springer-Verlag 2001 CORRESPONDENCE

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