Exchange transfusion, at what Hgb value to initiate?

[DrMetal]

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If you've decided an exchange transfusion is necessary for a sickler (ACS), at what Hgb number do you pull the trigger on it?

Obviously, if the Hgb is 4, you'd do a simple transfusion first, right? So what if it were 6, or 9, is there a particular number where you can go straight to exchange? (or do you go straight to exchange, irrespective of the number, given the clinically necessity?).

 

[boxin]

We usually do at Hgb of 8 for exchange; do simple transfusion if needed to get there

 

[CatFactorial]

9ish?

if they’re stroking out or super duper bad ACS or similarly severe problems then can consider earlier exchange