Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.
Vox Sang. 2010 Jul 1;99(1):65-70. doi: 10.1111/j.1423-0410.2010.01307.x. Epub 2010 Mar 15.
To study the effect of a restrictive guideline for exchange transfusion (ET) on the number of top-up transfusions in neonates with Rh hemolytic disease.
Retrospective study of all (near)-term neonates with Rh hemolytic disease admitted to our center between 2000 and 2008. In December 2005, policy changed from using liberal ET criteria to more restrictive ET criteria. We recorded the number of ETs and the number of top-up transfusions in the group of neonates before (group I, n = 156) and after (group II, n = 27) the guideline change.
The percentage of neonates requiring an ET decreased from 66% (103/156) in group I to 26% (7/27) in group II (P < 0.01). The percentage of neonates receiving a top-up transfusion increased from 68% (105/154) in group I to 81% (22/27) in group II (P = 0.25). The median number of top-up transfusions increased from 1 (interquartile range 0-2) in group I to 2 (interquartile range 1-3) in group II (P = 0.01).
In this study, restrictive ET criteria in neonates with Rh hemolytic disease lead to a reduction of the rate of ET but an increase in the number of top-up transfusions for neonatal anemia.
研究换血治疗（exchange transfusion，ET）限制指南对 Rh 溶血病新生儿输血次数的影响。
对 2000 年至 2008 年期间在我院住院的所有（近）足月 Rh 溶血病新生儿进行回顾性研究。2005 年 12 月，我们的治疗策略从使用宽松 ET 标准改为更为严格的 ET 标准。我们记录了在指南改变前（第 I 组，n = 156）和改变后（第 II 组，n = 27）新生儿 ET 次数和输血次数。
第 I 组需要 ET 的新生儿比例从 66%（103/156）降至 26%（7/27）（P < 0.01），第 I 组接受输血的新生儿比例从 68%（105/154）增至 81%（22/27）（P = 0.25）。第 I 组输血中位数从 1（四分位间距 0-2）增至 2（四分位间距 1-3）（P = 0.01）。
在本研究中，Rh 溶血病新生儿采用严格 ET 标准可降低 ET 使用率，但会增加新生儿贫血的输血次数。
