Bilirubin/albumin ratio thresholds for performing exchange transfusion in term and late preterm newborns with unconjugated hyperbilirubinemia

GA (weeks)	B/A ratio threshold for exchange transfusion
GA (weeks)	No neurotoxicity risk factors*	One or more neurotoxicity risk factors*
≥38	≥8.0	≥7.2
35 to 37	≥7.2	≥6.8

This table summarizes our suggested B/A ratio thresholds for performing exchange transfusion in newborns ≥35 weeks gestation with unconjugated hyperbilirubinemia. The B/A ratio is an index of the amount of bilirubin bound to albumin. It is used in conjunction with TSB values and other risk factors to determine the need for exchange transfusion. The B/A ratio can be calculated as a mass ratio or molar ratio. The guidance in this table is based upon the mass ratio.

B/A mass ratio is calculated as follows:

Using conventional units: Divide TSB (in mg/dL) by the serum albumin (in g/dL).
Using SI units: Divide TSB (in micromol/L) by the serum albumin (in g/L) and then multiply by a factor of 0.585.

This table is intended for use in conjunction with other content. Refer to UpToDate's content on exchange transfusion in newborns with neonatal hyperbilirubinemia for additional details.

B/A ratio: bilirubin/albumin ratio; GA: gestational age; TSB: total serum or plasma bilirubin; SI: Système International; G6PD: glucose-6-phosphate dehydrogenase.

* In addition to prematurity, other risk factors for bilirubin neurotoxicity include hemolytic conditions (eg, alloimmune hemolytic disease of the newborn, G6PD deficiency), clinical instability in the previous 24 hours, clinical concern for sepsis, and hypoalbuminemia (albumin <3.0 g/dL).

Graphic 139860 Version 1.0

خرید پکیج

Bilirubin/albumin ratio thresholds for performing exchange transfusion in term and late preterm newborns with unconjugated hyperbilirubinemia