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    Neonatal Partial Exchange for Polycythemia

    Estimates the volume of whole blood to remove and volume of crystalloid to infuse in neonatal polycythemia.
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    IMPORTANT

    This dosing tool is intended to assist with calculation, not to provide comprehensive or definitive drug information. Always double-check dosing of any drug and consult your institution's blood bank or a pharmacist as necessary.

    When to Use
    Pearls/Pitfalls
    Why Use

    Neonatal polycythemia can occur during the first week of life, when the hematocrit is >65% or hemoglobin >22 g/dL. The increased viscosity associated with polycythemia impairs tissue oxygenation and can lead to congestive heart failure, CNS, pulmonary and renal complications or necrotizing enterocolitis (NEC). Partial exchanges can be used to achieve a decrease in hematocrit (generally a goal of 55-60% to avoid complications associated with large decreases) by replacing whole blood with crystalloid. Plasma replacement is generally avoided due to an association with NEC.

    • Crystalloid replacement is used due to an association between plasma replacement and NEC.
    • Neonatal blood volume can be estimated as 85 mL per kg for full term neonates and 100 mL per kg for premature neonates. 

    Calculating the volume of whole blood for replacement by crystalloid can help achieve normalization of neonatal hematocrit and avoid complications associated with polycythemia.

    oz
    Pre-term
    Term
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    %

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    Next Steps
    Evidence

    Advice

    The partial exchange procedure should be performed by an experienced clinical team member according to institutional policies. Replacement by crystalloid should be utilized to avoid an increased risk of NEC.

    Formula

    Volume of replacement fluid = [ blood volume, mL × (Hct(actual) - Hct(goal)) ] / Hct(actual)

    Where blood volume = 100 mL/kg if preterm and 85 mL/kg if term.

    Example calculation:

    • Patient blood volume = 200 mL, Hct(actual) = 70, Hct(goal) = 60
    • (200 mL × (0.7 – 0.6)) / 0.7
    • Replacement volume is 29 mL (remove 29 mL whole blood, replace 29 mL crystalloid) 
    Content Contributors
    • Alex Ryder, MD, PhD
    • Caleb Cheng, MD
    • Christopher Tormey, MD
    Content Contributors
    • Alex Ryder, MD, PhD
    • Caleb Cheng, MD
    • Christopher Tormey, MD