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Exchange transfusion is performed to reduce the level of bilirubin (jaundice) in newborns who suffer from severe hemolytic disease of the newborn. This procedure used to be performed fairly frequently because of Rh-factor incompatibility disease; now that condition is so rare that most exchanges are done for ABO blood group incompatibility problems.
The goal is to remove enough bilirubin to prevent the severe complication of brain damage due to kernicterus.
The procedure specifically involves removing many small quantities of the baby's blood and replacing them with equal volumes of adult donor blood (not mother's) which is type-compatible with the mother's blood. This new blood is not attacked by the mother's antibodies and does not break down abnormally fast. Thus the burden of excessive bilirubin production is removed. Additionally, the excessive bilirubin present in the baby's system is physically washed out as the baby's blood is progressively removed and replaced.