Role of Manual Red Cell Exchange Transfusion in Management of Refractory Methemoglobinemia

Acquired methemoglobinemia is a potentially lethal complication of various oxidative chemicals. In most patients symptoms are mild and resolve without specific therapy, however severe cases require treatment with intravenous 1% methylene blue1. In cases refractory to methylene blue, hyperbaric oxygen or red cell exchange transfusion can be beneficial. Red cell exchange can be done manually or by apheresis equipment's, the principle of which is removing patient's red cells, with concomitant replacement with AHG crossmatch compatible donor cells. Manual red cell exchange in a patient with acquired methemoglobinemia is presented.