Which of the following is an indication for an exchange transfusion?

• A. Alloimmune hemolytic disease for correction of anemia and hyperbilirubinemia
• B. In place of simple transfusion and phototherapy
• C. Significant conjugated hyperbilirubinemia due to any cause
• D. None of the above

Answer: (A)

In newborns with alloimmune hemolytic disease, the exchange transfusion is used to rapidly reduce the burden of bilirubin and to correct significant anemia by removing the antibody-coated red cells and replacing them with compatible donor cells. This addresses both ongoing hemolysis and the high unconjugated bilirubin that can lead to kernicterus. It’s a targeted intervention for immune-mediated hemolysis, not a general substitute for phototherapy or simple transfusion, and it isn’t indicated for conjugated (direct) hyperbilirubinemia, which reflects liver dysfunction or bile flow issues rather than red cell destruction.