Blood-Volume Estimates in Coombs-Test-Positive Infants

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Abstract
Blood volume (estimated from the 10-minute T-1824 albumin space and mixed venous hematocrit) was determined before exchange transfusion in 32 neonates with nonhydropic Coombs-test-positive hemolytic disease. Rhesus or ABO incompatibility was commonly accompanied by perinatal asphyxia, anemia, elective prematurity and operative delivery. Although neonates with hemolytic disease are generally believed to be hypervolemic, this study suggests that they are normovolemic if premature and hypovolemic at maturity. Blood volume was linearly related to hematocrit (r = 0.616, p<0.001), but it was not affected by mode of delivery, degree of perinatal asphyxia or postnatal study age. These data suggest that common clinical practices such as denial of placental transfusion, venesection and maintenance of a volume deficit after exchange transfusion should be avoided. (N Engl J Med 290:1450–1452, 1974)