Effect of Exchange Transfusion on Serum Reserve Albumin for Binding of Bilirubin and Index of Serum Bilirubin Toxicity

Abstract

Seventeen newborn infants, who received their first exchange transfusion due to hyperbilirubinaemia and/or rhesus haemolytic 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 method was observed, followed by a smaller decrease after the transfusion. Plasma pH increased both during and after the exchange transfusion. During the exchange transfusion a drastic fall in index of serum bilirubin toxicity was observed, followed by a smaller increase after the transfusion. Citrate was not found to interfere in the binding of bilirubin to albumin. The results are in agreement 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, i.e. bilirubin plus reserve albumin, to total albumin failed to be increased by the exchange transfusion, and a decrease occurred after the transfusion. These findings indicate the presence in infant serum of non-binding albumin. Donor albumin with intact binding potential is partly transformed into the non-binding variety in the course of one hour after the transfusion. In the most severely rhesus sensitized infant a drastic decline of the serum albumin binding capacity was seen during the first day of life.

The Effect of Multiple Exchange Transfusions on Bilirubin Binding

“…Endogenous substances may interfere with bilirubin binding of albumin; this interfemng effect has been found in blood discarded during an exchange transfusion (4). Donor albumin with intact binding potential may be partly transformed into the non-binding variety following the exchange transfusions (3). The difference in the results in this study from those found by other investigators may be due t o the methods used.…”

“…Adult serum albumin binds bilirubin better than neonatal albumin (1). However, bilirubinbinding in infants has been shown to be unaffected or only transiently improved following a single exchange transfusion using adult blood (2)(3)(4)(5). These bilirubin-binding studies using horseradish peroxidase assay method, gel filtration method and the C14 MADDS (monoacetyl diamino diphenyl sulfone) method were all performed either immediately following an exchange transfusion or within 12 hours of the procedure.…”

Low Reserve Albumin for Binding of Bilirubin in Neonates With Deficiency of Bilirubin Excretion and Bronze Baby Syndrome

“…In Table 2 are shown the said parameters determined in the 8th-14th week of life in the four infants with atresia of the extra-or intrahepatic bile ducts. The serum reserve albumin concentration and the ratio of binding fraction of albumin to total albumin were supposed to be low also at that time, since in the 8th-14th week of life values almost like those in adults were to be expected (16), and the found values were much lower than those observed in adults (17).…”

Changes in Globus Pallidus With (Pre)Term Kernicterus

“…38 This hypothesis provided a rationale for the albumin-primed exchange transfusion. 39,40 Increasing the albumin level might redistribute bilirubin from healthy into acidotic organs, and albumin leaking out of injured capillaries might retain bilirubin in such organs. For these and other reasons, the use of albumin other than for priming before exchange transfusion did not become popular.…”