Valaes T, Hyte M
Pediatrics. 1977 Jun;59(6):881-7.
The bilirubin titration point--the lowest bilirubin concentration at which loosely bound bilirubin could be demonstrated by Sephadex gel filtration--was determined in samples collected before, during, and on completion of 17 exchange transfusions as well as in the discarded and donor blood. The bilirubin titration point expressed either as bilirubin concentration or as bilirubin/albumin molar ratio failed to be increased by the exchange transfusion and, in each case at the end of the procedure, the titration point was below the expected level, assuming that the donor albumin was going to retain its binding properties in the infant's circulation. The bilirubin titration point was also depressed in the discarded blood, and the depression was inversely related to the amount of bilirubin removed by the exchange transfusion (expressed as mg/kg of body weight/mg of initial bilirubin concentration). These results are interpreted as an indication that interfering substances are responsible for the decreased binding of bilirubin in newborn, particularly preterm, infants. In practical terms the criteria for a repeat exchange transfusion should be the same as for the initial one, as no change in the bilirubin binding properties of the serum is likely to occur following exchange transfusion.
在17次换血治疗前、治疗期间及治疗结束时采集的样本以及废弃血液和供血者血液中，测定了胆红素滴定点（即通过葡聚糖凝胶过滤法能够检测到游离胆红素的最低胆红素浓度）。以胆红素浓度或胆红素/白蛋白摩尔比表示的胆红素滴定点并未因换血治疗而升高，并且在每次治疗结束时，滴定点均低于预期水平，假设供血者白蛋白在婴儿循环中会保持其结合特性。废弃血液中的胆红素滴定点也降低了，且这种降低与换血治疗去除的胆红素量（以毫克/千克体重/初始胆红素浓度毫克表示）呈负相关。这些结果被解释为表明干扰物质是导致新生儿尤其是早产儿胆红素结合减少 的原因。实际上，重复换血治疗的标准应与首次换血相同，因为换血治疗后血清胆红素结合特性不太可能发生变化。
