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Randomized controlled trial of Ringer solution versus serum for partial exchange transfusion in neonatal polycythaemia

  • Neonatology
  • Original Paper
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Abstract

We tested whether crystalliod solutions could be used instead of colloid solutions for partial exchange transfusions (PET) in polycythaemic neonates because crystalloid solutions are cheap, carry no risk of anaphylactic reactions and can be sterilized. We randomly assigned 20 term neonates with venous haematocrit (Hct)>0.65 l/l to PET with either a serum preparation (BISEKO) or Ringer solution. Plasma volume (PV) was measured with Evans blue dilution. Blood volume (BV) and red cell mass were calculated from PV and venous Hct. Before PET both serum and Ringer groups had the same Hct (0.69 (0.66–0.76) vs 0.69 (0.66–0.71) l/l; median (range)) and BV (108 (81–116) versus 96 (68–121) ml/kg. During PET an equivalent amount of blood was withdrawn stepwise (19 (14–26) versus 17 (13–25) ml/kg and replaced by either serum or Ringer solution. More of the Ringer solution (median 77%) than of the serum (median 36%) given left the intravascular space within 4 h after PET (P=0.016); but there was no signficant difference in Hct after Ringer-PET compared to serum-PET (median 0.58 vs 0.56 l/l). No infant required repeat PET. Ringer-PET reduced BV from high to normal values (from median 96 to 83 ml/kg;P=0.005), whereas after serum-PET BV remained high (from median 108 to 98 ml/kg; not significant).

Conclusion

PET with Ringer solution resulted in a haemodilution comparable to PET with serum and a correction of hypervolaemia.

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Abbreviations

BV :

blood volume

Hct :

venous haematocrit

PET :

partial exchange transfusion

PV :

plasma volume

References

  1. Black VD, Lubchenko LO (1983) Neonatal polycythemia and hyperviscosity. Pediatr Clin North Am 29:1137–1148

    Google Scholar 

  2. Black VD, Rumack CM, Lubchenco LO, Koops BL (1985) Gastrintestinal injury in polycythemic term infants. Pediatrics 76:225–231

    PubMed  Google Scholar 

  3. Brans YW, Shannon DL, Ramamurthy DS (1981) Neonatal polycythemia: II. Plasma, blood and red cell volume estimates in relation to hematocrit levels and quality of intrauterine growth. Pediatrics 68:175–182

    PubMed  Google Scholar 

  4. Bratteby LE (1967) Studies on erythrokinetics in infancy VIII: mixing, disappearance rates and distribution volume of labelleld erythrocytes and plasma proteins in early infancy. Acta Soc Med Upsal 72:249–256

    PubMed  Google Scholar 

  5. Ingomar CJ, Baekgaard P (1973) The transcapillary escape rate of T-1824 in healthy newborn infants. Acta Paediatr Scand 62:617–620

    PubMed  Google Scholar 

  6. LeBlanc MH, Pate K (1984) Effect of polycythemia on vascular volume in the newborn dog. Am J Physiol 246: H830-H837

    PubMed  Google Scholar 

  7. LeBlanc MH, Kotagal UR, Kleinman LI (1982) Physiological effects of hypervolemic polycythemia in newborn dogs. J Appl Physiol 53:865–882

    Article  PubMed  Google Scholar 

  8. Linderkamp O, Mader T, Butenandt O, Riegel KP (1977) Plasma volume estimation in severely ill infants and children using a simplified Evans blue method. Eur J Pediatr 125:135–141

    Article  PubMed  Google Scholar 

  9. Linderkamp O, Versmold HT, Riegel KP, Bethke K (1984) Contributions of red cells and plasma to blood viscosity in preterm and full-term infants and adults. Pediatrics 74:45–51

    PubMed  Google Scholar 

  10. Maertzdorf WJ, Aldenhuyzen-Dorland W, Slaaf DW, Tangelder GJ, Blanco CE (1991) Circulating blood volume in appropriate and small for gestational age full term and preterm polycythemic infants. Acta Paediatr Scand 80: 620–627

    PubMed  Google Scholar 

  11. Moss GS, Rice CL, Sehgal LR, Gould SA, Rosen AL, Sehgal HL (1991) Use of albumin as a volume expander. In: Hoffman R, Shattil SJ, Furie B, Cohen HJ (eds) Hematology basic principles and practice. Churchill Livingstone, New York, pp 1636–1638

    Google Scholar 

  12. Ramamurthy RS, Brans YW (1981) Neonatal polycythemia: I. Criteria for diagnosis and treatment. Pediatrics 68: 168–174

    PubMed  Google Scholar 

  13. Torre J, Raval D, Pais R, Izquierdo A, Pildes RS (1988) Polycythemia in term infants: partial exchange vransfusion with normal saline versus plasma. Pediatr Res 23:427A

    Google Scholar 

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Roithmaier, A., Arlettaz, R., Bauer, K. et al. Randomized controlled trial of Ringer solution versus serum for partial exchange transfusion in neonatal polycythaemia. Eur J Pediatr 154, 53–56 (1995). https://doi.org/10.1007/BF01972973

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  • DOI: https://doi.org/10.1007/BF01972973

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