Acute leukemia has the highest risk of mortality and morbidity at presentation when associated with hyperleukocytosis. [ncbi.nlm.nih.gov]

• Falling

  All cases resulted in an approximate fall in indirect bilirubin by 52.01%, which is more than documented literature, [8], [9] in which the approximate fall of indirect bilirubin was 51.9 and 50% respectively. [ajts.org]

  Falling blood pressure and other markers (clinical and biochemical) of hemodynamic compromise prompted fluid resuscitation followed by ionotropes. Dobutamine was started to augment the falling cardiac output. [springerplus.springeropen.com]

  Once your baby's bilirubin levels have stabilised or started to fall, they'll be checked every 6 to 12 hours. Phototherapy will be stopped when the bilirubin level falls to a safe level, which usually takes a day or two. [nhs.uk]

• Surgical Procedure

  Sickle C (SC) disease is a relatively uncommon hematologic disorder that poses special challenges when the patient requires a major surgical procedure. [ncbi.nlm.nih.gov]

  A study in adult surgical procedures in SCD also found cholecystectomy to be the most common procedure followed by splenectomy, hip replacement and obstetric‐gynaecological procedures ( Adam 2008 ). [doi.org]

  Another difficulty that may be encountered when blood is administered rapidly under pressure is that of air embolism. autologous transfusion reinfusion of a patient's own blood, done by either of two methods: (1) patients having a planned surgical procedure [medical-dictionary.thefreedictionary.com]

  Elective indications in sickle cell disease Exchange transfusion may be undertaken electively in preparation for a planned surgical procedure to reduce the risks of surgery/anaesthesia or to improve its outcome. [gosh.nhs.uk]

• Malaise

  A 32-year-old male patient presented with fever, shivering, malaise, and loss of appetite. He had travelled to West Africa. Laboratory findings were as follows: hemoglobin: 8.8 g/dL and anti-HIV: positive. [ncbi.nlm.nih.gov]

• Respiratory Distress

  However, respiratory distress and multiorgan failure progressed, and she died after 16 days. [ncbi.nlm.nih.gov]

  Also, although uncommon, exchange transfusion can cause complications (low blood pressure (Hypotension), abnormal heart rhythms (Ventricular fibrillation) and breathing problems (acute respiratory distress syndrome)). [en.wikipedia.org]

  Respiratory distress (respiratory rate 70/minute), subcostal retractions and falling saturations necessitated initiation of bubble CPAP. CPAP of 8 cm of water and FiO 2 of 50 % were needed to maintain oxygen saturations above 90 %. [springerplus.springeropen.com]

• Pneumonia

  An 8-wk-old girl was diagnosed with malignant pertussis (extreme leukocytosis, seizures, pneumonia, and secondary severe hypoxic respiratory failure associated with pulmonary hypertension). [ncbi.nlm.nih.gov]

  Reference 2: Romano MJ, Weber MD, Weisse ME, Siu BL (2004) Pertussis pneumonia, hypoxia, hyperleukocytosis and pulmonary hypertension: improvement in oxygentation after a double volume exchange transfusion. Paediatrics 114(2): e264-6. [gosh.nhs.uk]

• Dyspnea

  In general, patients should be transfused if there is evidence of physiologic derangement, such as heart failure, dyspnea, hypotension, or marked fatigue. [sickle.bwh.harvard.edu]

• Hypotension

  Exchange transfusion was utilized in the treatment of a 1871 gram female, 32 weeks gestational age, who received an IV bolus of aminophylline at 11 h for the treatment of apnea, with subsequent tachycardia and hypotension. [ncbi.nlm.nih.gov]

  Also, although uncommon, exchange transfusion can cause complications (low blood pressure (Hypotension), abnormal heart rhythms (Ventricular fibrillation) and breathing problems (acute respiratory distress syndrome)). [en.wikipedia.org]

• Jaundice

  Hypothyroidism was one of the commonest cause of jaundice requiring Exchange transfusion. [ncbi.nlm.nih.gov]

  In healthy babies, the liver breaks down bilirubin, but in jaundiced babies, the liver can't break it down. In most cases, jaundice doesn't require treatment, and it resolves itself. [cohenscounsel.com]

  Data was evaluated separately with regards to the cause of jaundice. [cochrane.org]

• Neonatal Jaundice

  Neonatal transfusion (2002) In: The clinical use of blood—handbook. World Health Organization, Blood Transfusion Safety, Geneva, p 222 Google Scholar 15. Gartner L (1980) Chapter 6: neonatal jaundice A selected retrospective. [link.springer.com]

  […] for sever neonatal jaundice. 2 The most common indication of exchange transfusion is ABO- Hemolytic Disease of the Newborn (ABO-HDN). 3 Therefore, many infants with severe neonatal jaundice should undergo exchange transfusion, even before identification [jpma.org.pk]

  The search terms were: ‘neonatal hyperbilirubinemia', ‘neonatal jaundice', ‘exchange transfusion', ‘bilirubin encephalopathy', and/or ‘kernicterus'. [karger.com]

  BACKGROUND: Exchange transfusion (ET) has been known as an effective treatment in sever neonatal jaundice. Prescribing appropriate blood group makes an important role in patient's outcome and no single component is unequivocally the best. [ncbi.nlm.nih.gov]

  ‘Phototherapy remains the mainstay of treatment for neonatal jaundice, and newer recommendations reserve exchange transfusion for only the most severe cases of hyperbilirubinemia.’ [oxforddictionaries.com]

• Hydrops Fetalis

  We report a case of homozygous alpha-thalassaemia with hydrops fetalis presenting at 22 weeks of gestation. In utero exchange transfusion was performed with maternal blood at 23 weeks. 25 weeks and 29 weeks of gestation. [ncbi.nlm.nih.gov]

  Infant 4 was a 33-week gestation, 2435-g infant with respiratory failure from hydrops fetalis. During the exchange transfusion, the infant suffered respiratory deterioration necessitating discontinuation of the exchange transfusion. [pediatrics.aappublications.org]

• Withdrawn

  The person's blood is slowly withdrawn using small tubes, called catheters. The catheters, placed in to a vein in the arm of the individual, takes in about 5 to 20 mL of blood at a time, depending on the person's size. [hospital.uillinois.edu]

  At the beginning of the exchange transfusion, the first blood sample withdrawn should be sent for for 1)total and direct bilirubin; 2) hemoglobin and hematocrit; 3) glucose; and 4) calcium. [uichildrens.org]

  The patient's blood is slowly withdrawn (usually about 5 to 20 mL at a time, depending on the patient's size and the severity of illness). An equal amount of fresh, prewarmed blood or plasma flows into the patient's body. [nicklauschildrens.org]

  The person's blood is slowly withdrawn (most often about 5 to 20 mL at a time, depending on the person's size and the severity of illness). An equal amount of fresh, prewarmed blood or plasma flows into the person's body. [nlm.nih.gov]

• Fear

  Investigators of the Multicenter Study of Hydroxyurea in Sickle Cell Anemia NEJM. 1995), unfortunately many eligible patients are not treated due to psychosocial reasons and fear of teratogenicity or malignancy or have painful crisis refractory to hydroxyurea [bloodjournal.org]

  Strict adherence to the level of 20 mg/dL has been jocularly referred to as vigintiphobia (fear of 20). [emedicine.medscape.com]

• Stroke

  BACKGROUND: Chronic exchange transfusion is effective for primary and secondary prevention of stroke in children with sickle cell anemia (SCA). [ncbi.nlm.nih.gov]

  The target is usually to maintain a hemoglobin S level below 30% to prevent complications occurring.The commonest routine reason is to prevent a stroke occurring or re-occurring. [en.wikipedia.org]

  Risk of recurrent stroke in children with sickle cell disease receiving blood transfusion therapy for at least five years after initial stroke. J Pediatr. 140, (3), 348-354 (2002). Koehl, B., et al. [jove.com]

• Headache

  Early and thorough investigation of neurologic symptoms, especially severe headache, is warranted in this clinical setting. [ncbi.nlm.nih.gov]

  Signs and symptoms indicating such a reaction include burning sensation along the vein where the transfusion is given, facial flushing, chills and fever, headache, low back pain, rash, red urine, and shock. [medical-dictionary.thefreedictionary.com]

His laboratory workup revealed a markedly raised direct hyperbilirubinaemia and transaminases with prolonged prothrombin time. His serology was negative for HbsAg, HBc IgM, anti-HCV, HAV IgM, HEV IgM, and IgG. [ncbi.nlm.nih.gov]

A comatose, 14-day-old boy was referred to our emergency department (ED) after an overdose of phenobarbital, which was used for the treatment of long-standing jaundice. Plasma phenobarbital concentration was 112.4 microg/ml before treatment. [ncbi.nlm.nih.gov]

The etiology was unidentified in 103 patients (16.8%), of whom 62 (60.1%) developed ABE and 9 (8.7%) had a poor prognosis. [ncbi.nlm.nih.gov]

This recommendation is based on the early studies by Field [ 34 ] that demonstrated a correlation between high levels of parasitemia and poor prognosis. [cid.oxfordjournals.org]

The etiology was unidentified in 103 patients (16.8%), of whom 62 (60.1%) developed ABE and 9 (8.7%) had a poor prognosis. [ncbi.nlm.nih.gov]

Commenda 12, 20122 Milan, Italy. [email protected]. 3 Neonatal Intensive Care Unit, Department of Pediatrics and Child Neuropsychiatry, "Sapienza" University of Rome, Viale del Policlinico 155, 00161 Rome, Italy. [email protected]. 4 Epidemiology [ncbi.nlm.nih.gov]

The Retrovirus Epidemiology Donor Study. N Engl J Med 1996; 334:1685-90. 29. Siegel JF, Rich MA, Brock WA. Association of sickle cell disease, priapism, exchange transfusion and neurological events: ASPEN syndrome. J Urol 1993; 150:1480-2. 30. [sickle.bwh.harvard.edu]

The proposed pathophysiology of these neurological events is related to cerebral ischemia after an acute increase in per cent total hemoglobin, concomitant decrease in per cent hemoglobin S and subsequent release of vasoactive substances during penile [ncbi.nlm.nih.gov]

In terms of HbS decrease, stroke prevention, and iron overload prevention, this method showed comparable efficiency to erythrapheresis. [ncbi.nlm.nih.gov]

The target is usually to maintain a hemoglobin S level below 30% to prevent complications occurring.The commonest routine reason is to prevent a stroke occurring or re-occurring. [en.wikipedia.org]