Fantoms

EXCHANGING IMMUNOGLOBULIN FOR EXCHANGE TRANSFUSION …

Thanks to anti-D immunoglobulin prophylaxis, there is not a lot of haemolytic disease of the newborn around any more, but the basic treatment is unchanged: phototherapy and exchange transfusion. Exchange transfusion is a hazardous procedure in its own right, it exposes babies to the risk of infection with blood borne viruses, and its evidence base consists of only two randomised controlled trials, both of which used mortality as their end point. So it is a real advance to find that the use of intravenous high dose immunoglobulin offers an opportunity to spare one in three babies the need for exchange transfusion at all, reduces the donor exposure of those who do need an exchange, and gives every affected baby the chance of a shorter hospital stay. We should not forget that the immunoglobulin itself may carry a tiny risk of virus transmission, that haemolytic disease from other isoantibodies …