Exsanguinotransfusion

The exsanguinotransfusion is a technique allowing the replacement of most of the Sang of an individual. According to the proportion of blood exchanged, small and it is about a transfusion-bleeding, indicated in the drépanocytose for example, or important, from two to three blood masses, and it is about a true exsanguinotransfusion.

Historical indications

This technique was very much used to avoid the complications of the haemolytic Maladie of the newborn. This technique, by replacing 85 to 95% of the blood mass, had four positive actions:

it removed the incompatible globules (generally Rh positive, D, the Rhésus incompatibility, RH1 or D, representing the majority of the incompatibilities, followed RH4 or C, and Kell) not yet destroyed by the maternal antibodies, and thus decreased the hémolyse.

it brought compatible red globules (D, C or K according to the incompatibility) insensitive with the action of these antibodies, globules which have a normal lifespan then. One thus obtained an immediate correction of anemia.

it eliminated most of the maternal antibodies circulating, the remaining antibodies continuing to fix themselves on the érythrocytes manufactured by the child, on the level of osseous marrow, and thus to involve a hémolyse globules manufactured.

it eliminated the bilirubine, product breakdown of hemoglobin, resulting from the hémolyse. This bilirubine gives a yellow color to the teguments, it is a ictère, commonly called jaundice. However an excess of bilirubine (>200 mg/L, or 340 μmol/L) is toxic for the nervous cells and could involve serious after-effects (reached auditive, ictère nuclear).

Current indications

This technique is now much used. Into 20 years, of 1972 to 1992, the number of exsanguinotransfusions practiced in Paris region was divided by 20. This reduction is due to several reasons:

the number of serious incompatibilities fell much since the installation since the years 1970 of the systematic prevention of the haemolytic disease of the newborn by injection of anti-D immunoglobulins to the mother at the time of the birth, and since 2005, also as of the 28° week of pregnancy, to avoid the immunizations of the third quarters.

phototherapy makes it possible to limit the rate of bilirubine well, and to avoid the neurological complications. Radiation UV degrades the free bilirubine in a nontoxic derivative.

anemia is compensated by a certain number of simple transfusions in compatible concentrates érythrocytaires (D, C, or K) during the first two months of life.

This technique however has still some indications in the serious incompatibilities, either with the birth, for anemia and, or, important hyperbilirubinemy, or sometimes even in utéro (transfusion-bleeding) to reduce anemia, the bilirubine in this case being eliminated by placental way.

Other exceptional indications exist, as well in the child as in the adult, in certain intoxications or parasitoses having an impact on the hemoglobin which becomes not functional calculus (Méthémoglobine inter alia), or on the érythrocytes which hémolysent massively. Chlorates or arseniuretted hydrogen can ête quoted like poisons, paludism with neurological attack like parasitosis, for example.

Monitoring

As for all transfusion of ric of contamination exists more especially as the exsanguinotransfusion is old. It is thus advisable to control certain serologies (Hepatitises B and especially Hépatite C, HIV) according to the date of the exsanguinotransfusion. Except the search for irregular Antibodies, to make after a six weeks deadline, these serologies are not regarded any more as useful since, in addition to traditional serologies of search for antibody, the presence of viruses HIV and VHC is required in molecular biology on the blood donations.

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