In the intensive care unit last night, I did something I’ve never done before: replaced a patients entire blood volume with fresh, new blood. It’s called an exchange transfusion — literally, your goal is to exchange as much of a patient’s blood volume as you can with new blood. And when I say that I did it, I mean that on every day of the week but Saturday, my hospital has machines to do this procedure, but on Saturdays, it’s the resident who has the privilege of moving all that blood into and out of the patient. For four and a half hours, it was my job to draw off 165 milliliters of blood from my patient’s arterial line every 10 minutes, as bag after bag of fresh blood dripped into a intravenous line in his other arm.

By the end of the first hour, I had it down to an exact science; I could get the 165 ml off in four minutes, leaving me with a luxurious six more minutes to rush around the ICU taking care of my other patients before I had to be back at his bedside to repeat the cycle. By the end of the second hour, the novelty had long worn off, and I was cursing my hospital for not having the mechanized exchange machine available. (I was also growing curious about the three or four plastic urinals full of discarded blood that had already accumulated at the foot of the bed.) By the end of the full four and a half hours, I was just amazed at what we had done — taken over four liters of blood out of a fifteen year-old boy, and replaced it with blood that had been donated by over a dozen people, none of whom could know that they were helping this young man avoid going onto a ventilator. This morning, the patient was saying that he felt a lot better; given how much manual labor went into the procedure, that made me feel a lot better, too.


While that is amazing and wonderful that you could save his life like that, it still makes my stomach turn just thinking of all that blood. Proving once again that medicine was never the field I was meant to be in.

Now if this nagging sore throat/sinus crud ever goes away, I’m going in to finally donate some A- platelets! (I’ll just close my eyes while they have the big needles out.)

• Posted by: Christine on Apr 6, 2003, 11:40 PM

Hasn’t Keith Richards been doing it for decades?

• Posted by: Al on Apr 7, 2003, 12:17 AM

Y’know - if we could make total blood replacement cheap, effective and painless it could revolutionize the liquor industry.

I suppose that would be irresponsible, though.

• Posted by: billy on Apr 7, 2003, 11:01 AM

I’m curious. Why did he need this procedure?

• Posted by: Jeff on Apr 8, 2003, 1:54 PM

Billy, there is a (relatively) cheap, painless, and effective alternative to blood replacement — blood filtering, known to the layperson as dialysis. But it’s not all that fun…

And Jeff, the patient is a sickle cell disease sufferer, and there are certain times when the sickling of blood cells is so bad that you’d rather just get as many of ‘em all out of the body as you can and get non-sickling blood in.

• Posted by: Jason on Apr 8, 2003, 6:11 PM

Boy, you got the basis for a pretty good episode of “ER” there (considering every other med drama on TV has disappeared; of course, it’s been so long since I’ve Must-Seen that TV, they might’ve already done it). Imagine the possible plot complications - no, my mind is rushing with much more slapsticky scenarios now, you’d better sell it to “Scrubs”. Anyway, job well done. Your infrequent accounts of everyday medical heroism are a refreshing change from most of the rest of current bloggery. Now, tell us what you were doing the day you let the MetaFilter server go ‘glurp’… ;)

• Posted by: wendell on Apr 8, 2003, 11:16 PM
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