EFFECT OF EXCHANGE TRANSFUSION ON SERUM RESERVE ALBUMIN FOR BINDING OF BILIRUBIN AND INDEX OF SERUM BILIRUBIN TOXICITY

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Abstract
Newborn infants (17), who received their 1st exchange transfusion due to hyperbilirubinemia and/or rhesus hemolytic disease, were studied. The exchange transfusions were performed with fresh, citrated blood. During the exchange transfusion a marked increase in the serum reserve albumin concentration for binding of bilirubin measured by the [14C]-MADDS [monoacetyl-diamino-diphenyl sulfone] method was observed, followed by a smaller decrease after the transfusion. Plasma pH increased during and after exchange transfusion. During exchange transfusion a drastic fall in index of serum bilirubin toxicity was observed, followed by a smaller increase after the transfusion. Citrate did not interfere in the binding of bilirubin to albumin. Results agreed with the clinical finding that an exchange transfusion performed with fresh, citrated blood effectively reduced the risk of bilirubin encephalopathy. The ratio in serum of binding albumin, bilirubin plus reserve albumin, to total albumin failed to be increased by exchange transfusion and a decrease occurred after transfusion. Findings indicated the presence in infant serum of non-binding albumin. Donor albumin with intact binding potential was partly transformed into the non-binding variety in the course of 1 h after the transfusion. In the most severely rhesus sensitized infant a drastic decline of the serum albumin binding capacity was seen during the 1st day of life.

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