We have presented the experience of an exchange transfusion service in performing 1,139 procedures over a 7-year period. The design and practices of this service have been described in order to provide the background necessary for a critical analysis of our results. Since no definition exists for "Mortality of Exchange Transfusion," we have suggested one.

The outstanding features of this experience were:

1. The umbilical vein approach proved to be an extremely easy technique by which to initiate an exchange transfusion.

2. The great majority of the procedures were completed as planned.

3. In all but a very few exchange transfusions, a volume of donor blood at least 1.5 times the infant's blood volume was infused. We could show no correlations between the volume of donor blood employed in an initial procedure and the need for a repeat exchange.

4. Most of our exchange transfusions were completed in less than 1 hour; many in less than 30 minutes. We were unable to demonstrate a higher morbidity or mortality in infants being subjected to a faster as opposed to a slower procedure.

5. The best definition of the mortality rate of exchange transfusion appears to be the number of infants dying during or within 6 hours of a procedure expressed as a percentage of the number of infants transfused and again as a percentage of the number of exchange transfusions performed.

6. The incidence of death during or within 6 hours of an exchange transfusion appeared to be more closely related to an infant's clinical status at the beginning of a procedure then to the procedure itself. Most of the deaths occurred among critically ill infants with Rh-hemolytic disease. Vigorous infants, full-term or premature, regardless of diagnosis, tolerated exchange transfusions well. Our mortality rate in vigorous infants was very low.

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