I was on call a couple of nights ago, and a nurse new to our NICU came up to me at midnight and said the same thing- and I teared up and then it literally got me through the night! Really appreciate the sentiment- without comments like these we would have stopped a long time ago! So THANK YOU!!
Waw doctor thank you so much 🥰.my son and whent traugh this in 1996 in Czech republic the did brilliant job but no one explain to me as you did.thank you and god bless you and your family 🥰.
Thank you so much for sharing! He sounds like an ideal son then!!!! So happy this helped with your understanding. You must be an excellent parent- he seems like a very fulfilled thriving individual :)
Another great video! I'm a new graduate nurse looking for a job, and I so badly want to work on a NICU... Your vidoes really quench my thirst for neonatology. I can't thank you enough.
Congratulations and thank you for watching! A lot of nurses in the NICU have worked elsewhere first- Labor and delivery or in the newborn nursery. Any exposure is good at the start of your career! you can always end up in the NICU- what we believe to be the best area !!!
You're as always God’s Angel Sent to all of Medical Professionals! We love you Doctor Tala especially your Compassionate Heart for your Job! More God’s continued provisions! Take care! ❤️
My daughter was born about 5 days ago and since then she has been through phototherapy but the jaundice isn't dropping. So the doctor is suggesting an exchange Transfusion. Hoping and praying God does his will for my first born.
My son today is in the navy after going traugh this and he was hyper Activ he had a lot of learning difficulties but very joyful boy, intelligent funny 🤣 but very naughty.
Hello Jenn! Thanks for watching and subscribing! That is a great, very helpful topic. I will try to convince Arianna or Justin to come on with me- as they've both got brilliant techniques!
Hello! We're figuring out a way of showing procedures with babies- we are tying to get a really good simulation model so we can show a bunch of things!!! Thanks again for being here :)
Very informative 👏,thank you I have a question So procedure is ,taking out of 5-10 ml blood ,side by side fresh Rh -ve blood is given, but how will we be sure, removal blood are from baby's(Rh+ve) ,not that blood which is simultaneously we are giving.thank you
Hello! Sorry took so long to answer- lots going on! So first we aren’t always doing exchange transfusions for Rh disease- can be done for any reason for high bili (or other reason like hemochromatosis etc). But that’s why we do a DOUBLE volume transfusion. Because we know when we’re taking out that next aliquot by definition some of the blood we just put in will come out too. So we have to accept that. We can’t just remove ALL patients blood and then replace all! So with a double volume transfusion we are able to replace most approx 85% of the baby’s blood. Does this make sense?
Very informative. Thanks for this video. I have one question. In Rh incompatibilty hyberbiliribinemia, why do we transfuse mother's blood instead of baby's? could you please explain this Thanks in advance.
Hello Melgy! So for example if mother is O negative and the baby is O Positive and the baby has anti-Rh antibodies floating around its body. If we gave the baby Rh positive blood, then the antibodies the baby has will break those red blood cells down too. So we need to give Rh negative blood so the baby's antibodies don't attack the transfused cells. (However we rarely give mother's actual blood because they're usually anemic after birth). Does this answer your question?
Another great video! Can you explain exactly what an aliquot is?? I’ve worked in several NICUs & I’ve heard this term in one of them but not quite sure how to describe it if someone were to ask me. Is it the same as a unit / bag of blood?
Thank you! An aliquot is just a unit of volume- normally a sample of a larger volume. So in this case we're using the term aliquot to describe the mls of blood we push and pull with each round of the double volume exchange. Let's say the infant weighs 2kg. And we use aliquots of 10mls (2 -kgs- X 5ml). That means for a double volume exchange that's 2 x 80mls x 2= 320 mls. So we would have 32 rounds of pushing and pulling 10mls aliquots. Does that make sense? Thanks so much for watching and commenting!
Hello Juby! We talked about it in the jaundice videos- the hemolytic one. So if you go to home page you can find it there. Let me know if something else?
Mam..I have one question.in order for the exchange transfusion to be effective what necessary steps we should consider..sometimes we do exchange transfusion for pathological indirect hyperbillirubinemia but the drop in serum bilirubin level is not satisfactory...mam plzz expalin it..thanks
Hello! Generally if we're doing an exchange transfusion for ABO or Rh incompatibility- the drop in bilirubin is normally enough to get the levels out of kernicterus concerns (especially since we're also getting rid of a lot of the antibodies that were circulating around the baby's blood). And remember- you're still using phototherapy and good hydration etc too. If the bilirubin is staying high- then you're more likely to be dealing with something else going on- e.g. a Criggler Najjar, or a horrible HSV infection or something. In these extreme cases, sometimes a second exchange is needed. Hope this helps!
@@TalaTalksNICU actually i need a chart that shows which blood group can be transfused to a neonate safely for exchange transfusion in blood group incompatibilities or non incompatibility situations ..
Hello Jessy! Everyone always tells me I speak too fast! I'm sorry- I've been trying to slow it down a lot in videos- obviously not enough! I will try harder! Thanks for watching and commenting!
Yes! exactly- whole blood is removed and replaced normally with PRBCs mixed with FFP (the red blood cells and the plasma- which has all the clotting proteins in it). The RBCs and the plasma is donated.
Hello! Great question! Because babies still have a lot of fetal hemoglobin they don’t get sickle cell crises. Normally this can start at ~ 6 months of age.
Hello! a person's bone marrow will always produce the same blood. (If a patient had a stem cell transplant with a different blood type- that is the ONLY very rare situation where that may change). So if a baby were B positive, and they got O negative blood, for a short period while the blood is in the system -probably approx 2 months, they would have both blood types circulating. But once all the O negative cells had died- somewhere between 2-4 months, the infant would have just B Positive floating around again. Does this make sense?
Excellent point Sherine, thanks! Not wrong! We didn't get into this- but normally the Hct of PRBCs you get from the blood bank is around 65%- but it can be higher than this (up to like 80%). So the classic thing to do would be to 'reconstitute' the PRBCs with the FFPs to a lower Hct (somewhere around 45-50). If the Hct is too high- you'd worry about the effects of polycythemia. The problem is that reconstitution can take a really long time by the lab-(should be max 4 hrs- but can take much longer) and so often, it is much more efficient to give the blood and plasma separately. (Especially in a baby with a really high bili- where time is of the essence). You just need to make sure that the baby doesn't end up polycythemic (and that all other labs are OK too) Thanks for bringing this up- and thanks for watching too. We really appreciate you!
@@TalaTalksNICU And plasma every 2 weeks I'm Australian . You can give plasma every 2 weeks blood every 12 . Not sure if that is the same in the rest of the world .
Thanks a lot Doc. As a medical student, i found your video really helpful as i prepare for my exams in Paediatrics
So glad you found it helpful- thanks so much for letting us know :)
Love your videos sooo much! Really glad you used some of your precious time to make these!
I was on call a couple of nights ago, and a nurse new to our NICU came up to me at midnight and said the same thing- and I teared up and then it literally got me through the night! Really appreciate the sentiment- without comments like these we would have stopped a long time ago! So THANK YOU!!
Not a single minute distraction, complete informative
Wow! Thanks so much Akshay- so happy you think that. :)
Waw doctor thank you so much 🥰.my son and whent traugh this in 1996 in Czech republic the did brilliant job but no one explain to me as you did.thank you and god bless you and your family 🥰.
Thank you so much for sharing! He sounds like an ideal son then!!!! So happy this helped with your understanding. You must be an excellent parent- he seems like a very fulfilled thriving individual :)
Another great video! I'm a new graduate nurse looking for a job, and I so badly want to work on a NICU... Your vidoes really quench my thirst for neonatology. I can't thank you enough.
Congratulations and thank you for watching! A lot of nurses in the NICU have worked elsewhere first- Labor and delivery or in the newborn nursery. Any exposure is good at the start of your career! you can always end up in the NICU- what we believe to be the best area !!!
You're as always God’s Angel Sent to all of Medical Professionals! We love you Doctor Tala especially your Compassionate Heart for your Job! More God’s continued provisions! Take care! ❤️
What a lovely comment! Thanks for writing and for subscribing :)
Thank you dr tala realy you are amazing doctor please keep up the videos
What a lovely comment- thank you!
My daughter was born about 5 days ago and since then she has been through phototherapy but the jaundice isn't dropping. So the doctor is suggesting an exchange Transfusion. Hoping and praying God does his will for my first born.
I hope your daughter's jaundice improves and you find good answers. We wish you luck and health.
My son today is in the navy after going traugh this and he was hyper Activ he had a lot of learning difficulties but very joyful boy, intelligent funny 🤣 but very naughty.
Those are all the best characteristics!!!
Thank u , and u r a great teacher
Thanks so much for watching and for the lovely compliment.
Great explanation, thanks you , madam
Thank you so much for watching :)
Very well explained..thankyou
Thank you so much for watching and commenting Doctor Priyanka!
Very well explained 🌷
Thank you so much Iman- for watching and for the compliment :)
Very informative doc😘
Thank you so much- we appreciate you commenting Mashudu.
Very nicely explained
Thank you very much- we appreciate you being here!
Love your videos! Would you consider doing one with techniques for blood draws/heel sticks??
Hello Jenn! Thanks for watching and subscribing! That is a great, very helpful topic. I will try to convince Arianna or Justin to come on with me- as they've both got brilliant techniques!
So good thank you! Can you also talk about when you would use different types of blood products like FFP versus Cryo versus Albumin?
Yes! Nicole- great idea. Thanks- look for it soon! Thanks for watching and commenting
Very nice video. Is it possible to do a demonstration of the procedure? Thank you
Hello! We're figuring out a way of showing procedures with babies- we are tying to get a really good simulation model so we can show a bunch of things!!! Thanks again for being here :)
Thank you nice video ❤
Thanks so much Mohamed :)
Very informative 👏,thank you
I have a question
So procedure is ,taking out of 5-10 ml blood ,side by side fresh Rh -ve blood is given, but how will we be sure, removal blood are from baby's(Rh+ve) ,not that blood which is simultaneously we are giving.thank you
Is not mix up fresh Rh -ve blood with baby's own blood Rh+ve blood?
Hello! Sorry took so long to answer- lots going on! So first we aren’t always doing exchange transfusions for Rh disease- can be done for any reason for high bili (or other reason like hemochromatosis etc).
But that’s why we do a DOUBLE volume transfusion. Because we know when we’re taking out that next aliquot by definition some of the blood we just put in will come out too. So we have to accept that. We can’t just remove ALL patients blood and then replace all! So with a double volume transfusion we are able to replace most approx 85% of the baby’s blood. Does this make sense?
See below!
Very informative. Thanks for this video. I have one question. In Rh incompatibilty hyberbiliribinemia, why do we transfuse mother's blood instead of baby's? could you please explain this Thanks in advance.
Hello Melgy! So for example if mother is O negative and the baby is O Positive and the baby has anti-Rh antibodies floating around its body. If we gave the baby Rh positive blood, then the antibodies the baby has will break those red blood cells down too. So we need to give Rh negative blood so the baby's antibodies don't attack the transfused cells. (However we rarely give mother's actual blood because they're usually anemic after birth). Does this answer your question?
Another great video! Can you explain exactly what an aliquot is?? I’ve worked in several NICUs & I’ve heard this term in one of them but not quite sure how to describe it if someone were to ask me.
Is it the same as a unit / bag of blood?
Thank you! An aliquot is just a unit of volume- normally a sample of a larger volume. So in this case we're using the term aliquot to describe the mls of blood we push and pull with each round of the double volume exchange.
Let's say the infant weighs 2kg. And we use aliquots of 10mls (2 -kgs- X 5ml). That means for a double volume exchange that's 2 x 80mls x 2= 320 mls.
So we would have 32 rounds of pushing and pulling 10mls aliquots.
Does that make sense?
Thanks so much for watching and commenting!
Hi Dr.Tala,can u explain about the coobs test?
Hello Juby! We talked about it in the jaundice videos- the hemolytic one. So if you go to home page you can find it there. Let me know if something else?
@@TalaTalksNICU . ABO, Rh I seen, but coobs test is positive means what
Positive coombs means the antibodies are actually sticking on the RBCs and actively destroying them (not just in circulation)
Thank you ❤
Thank you for being here!
Wonderful!
Thanks so much Dr. Trivedi!
Mam..I have one question.in order for the exchange transfusion to be effective what necessary steps we should consider..sometimes we do exchange transfusion for pathological indirect hyperbillirubinemia but the drop in serum bilirubin level is not satisfactory...mam plzz expalin it..thanks
Hello! Generally if we're doing an exchange transfusion for ABO or Rh incompatibility- the drop in bilirubin is normally enough to get the levels out of kernicterus concerns (especially since we're also getting rid of a lot of the antibodies that were circulating around the baby's blood). And remember- you're still using phototherapy and good hydration etc too. If the bilirubin is staying high- then you're more likely to be dealing with something else going on- e.g. a Criggler Najjar, or a horrible HSV infection or something. In these extreme cases, sometimes a second exchange is needed. Hope this helps!
Which blood group is taken for double volume exchange?
Whichever blood group matches with patients blood (still needs to be matched). That’s why important to send type and cross match on baby.
Great to listen,
Thanks as always Azam!
Can you share a chart on the selection of blood groups for exchange transfusion
Hello Salman! Do you mean the blood types that can be donors? Or which recipients can receive what? Or was there something else you were wondering?
@@TalaTalksNICU actually i need a chart that shows which blood group can be transfused to a neonate safely for exchange transfusion in blood group incompatibilities or non incompatibility situations ..
very nice vedios ,but some speech speeds,please next vedios mam some keep in slow .thank you.mam i needed to more details.
Hello Jessy! Everyone always tells me I speak too fast! I'm sorry- I've been trying to slow it down a lot in videos- obviously not enough! I will try harder! Thanks for watching and commenting!
Does it mean whole newborn blood has to be removed.
And then replace it with donor blood?
Yes! exactly- whole blood is removed and replaced normally with PRBCs mixed with FFP (the red blood cells and the plasma- which has all the clotting proteins in it). The RBCs and the plasma is donated.
Would this help babies with SCD?
Hello! Great question! Because babies still have a lot of fetal hemoglobin they don’t get sickle cell crises. Normally this can start at ~ 6 months of age.
@@TalaTalksNICU So would the transfusion help at 6 months + to eliminate the crises? Would you suggest a bone marrow transplant?
@LaS88709 this is out of my wheelhouse!!!! I took care of many kids with SCD in residency over 15 years ago- but none since.
@@TalaTalksNICU AB ok!!! Thank you for responding!!!
In exchange transfusion, after transfusion of maternal blood group , does the baby's blood group change?
Kindly answer my question
Hello! a person's bone marrow will always produce the same blood. (If a patient had a stem cell transplant with a different blood type- that is the ONLY very rare situation where that may change). So if a baby were B positive, and they got O negative blood, for a short period while the blood is in the system -probably approx 2 months, they would have both blood types circulating. But once all the O negative cells had died- somewhere between 2-4 months, the infant would have just B Positive floating around again. Does this make sense?
we used to to make the double exchange with Packed RBCs , then we give plasma on dose of 10 mg /kg , is this wrong ?????
Excellent point Sherine, thanks! Not wrong! We didn't get into this- but normally the Hct of PRBCs you get from the blood bank is around 65%- but it can be higher than this (up to like 80%). So the classic thing to do would be to 'reconstitute' the PRBCs with the FFPs to a lower Hct (somewhere around 45-50). If the Hct is too high- you'd worry about the effects of polycythemia.
The problem is that reconstitution can take a really long time by the lab-(should be max 4 hrs- but can take much longer) and so often, it is much more efficient to give the blood and plasma separately. (Especially in a baby with a really high bili- where time is of the essence).
You just need to make sure that the baby doesn't end up polycythemic (and that all other labs are OK too)
Thanks for bringing this up- and thanks for watching too. We really appreciate you!
Interesting an adult with jaundice must be tricky
Yes! Nearly always direct and related to something going on with the liver or it’s drainage system.
❤
THANKS!
I am regular Blood Donor O-
That's great- fantastic that you're donating blood :)
@@TalaTalksNICU And plasma every 2 weeks I'm Australian . You can give plasma every 2 weeks blood every 12 . Not sure if that is the same in the rest of the world .
That's amazing Alexi-the lives you are saving!
My husband is the same blood type. I’ll have to encourage him to donate.
@@TalaTalksNICU I made my 25th Donation on Easter Monday. Here in Australia we get an extra day off to get home clean and sober up .
Up
Not sure what this means!