Bilirubin: IVIG and Exchange Transfusion Guidelines

IVIG CRITERIA

In Rh and isoimmune hemolytic disease, administration of intravenous immunoglobulin (0.5-1g/kg over 2 hours) is recommended if the TSB is rising despite intensive phototherapy or the TSB level is within 2 to 3 mg/dL (34-51 mol/L) of the exchange level (Levels in table below).  If necessary, this dose can be repeated in 12 hours.

IVIG for Coombs positive hemolytic anemia suggestions:

  • First 12h       bilirubin >12 mg/dl
  • 12-24h         bilirubin >16 mg/dl
  • 24-72h         bilirubin >18 mg/dl


EXCHANGE TRANSFUSION CRITERIA FOR INFANTS ³35 WKS GESTATION


Risk factors: isoimmune hemolytic disease, G6PD deficiency, asphyxia, lethargy, temperature instability, sepsis, acidosis or albumin <3 mg/dL (if measured)

 

AAP Subcommittee on Hyperbilirubinemia http://www.pediatrics.org/cgi/content/full/114/1/297   Pediatrics 2004;114;297-316