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The role of exchange transfusion as a therapy for neonatal DIC.

Journal of the Korean Pediatric Society 1991;34(1):31-40.
Published online January 31, 1991.
The role of exchange transfusion as a therapy for neonatal DIC.
Jung Tak Kim, Kook In Park, Ran Namgung, Dong Gwan Han, Kir Young Kim
Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
신생아 파종성 혈관내응고병증에 대한 교환수혈의 치료 효과
김정탁, 박국인, 남궁란, 한동관, 김길영
연세대학교 의과대학 소아과학교실
Received: 19 June 1990   • Accepted: 11 September 1990
A clinical study on the effects of exchange transfusion on disseminated intravascular coagulation was conducted on 32 patients with DIC who were admitted to the pediatric department of YUMC from January 1984 to June 1989. We diagnosed DIC when symptoms were compatible to the diagnosis and there were more than 3 abnormal laboratory findings out of the following 5, which were platelet count, PT, aPTT, fibrinogen and FDP. The following results were obtained: 1) A higher incidence was observed in males (71.9%) and there was no relation to intrauterine period and birth weight. 2) Regarding the etiologic aspect, sepsis was the most common cause in 24 cases (75%), following by respiratory distress syndrome, perinatal asphyxia, obstetrical complications, hemolytic disease of newborn, surgical complications due to congenital anomalies and necrotizing enterocolitis, in order. 3) The most common infecting organisms were gram negative in 12 cases (50%), with gram positive in 8 cases (33.4%), and anaerobic bacteria in 2 cases (8.3%). Gram negative organisms were mainly Klebsiella pneumoniae (29.2%) and Staphylococcus epidermidis (20.8%) was the most common gram positive organism. 4) Clinical manifestations of DIC patients were abdominal distension, poor feeding, pallor, cons- ciousness change and irritabilty, in order. 5) Laboratory findings showed anemia in all patients, with thrombocytopenia and positive FDP in 31 cases (96.9%), prolonged PT in 24 cases (75%), prolonged aPTT in 28 cases (87.5%) and decreased fibrinogen in 23 cases (71.9%). 6) The therapeutic response of exchange transfusion in DIC patients showed improvement in 18 cases (56.2%) according to clinical and laboratory criteria and the survival rate was 50%. 7) According to our investigation, it took 24hrs for PT and fibrinogen, 7days for PTT and FDP and 7-14 days for platelet count to be in the normal range. The results of this study suggest that exchange transfusion is effective for the treatment of neonatal DIC.
Key Words: Disseminated intravascular coagulation, Exchange transfusion

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