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Neonatal Partial Exchange for Polycythemia

Volume of blood to isovolemically exchange for crystalloid in symptomatic neonatal polycythemia.

Neonatal Partial Exchange for Polycythemia
Birth weight
Estimated blood volume
Typical term-neonate blood volume is about 80-90 mL/kg.
mL/kg
Observed hematocrit
%
Desired hematocrit
%
Complete the fields above to see the result.

When to use

  • Symptomatic neonatal polycythemia (venous hematocrit typically >65-70%) to lower hyperviscosity while keeping blood volume constant.

Formula

Exchange volume (mL) = blood volume (mL/kg) x weight (kg) x (observed Hct - desired Hct) / observed Hct. Withdrawn blood is replaced mL-for-mL with isotonic crystalloid.

Pearls and pitfalls

  • Asymptomatic polycythemia is generally managed with hydration and observation rather than exchange transfusion.

References

  1. Rosenkrantz TS. Semin Neonatol. 2003;8(6):419-424 (neonatal polycythemia/hyperviscosity, partial exchange technique).
  2. Bada HS, et al. J Pediatr. 1992;120(4 Pt 1):579-585 (partial exchange for polycythemia).