Exchange transfusions may be indicated in cases of severe poisoning where conventional treatments, such as activated charcoal or gastric lavage, are ineffective or insufficient. Specific scenarios include poisoning with substances that are poorly removed by the kidneys or liver, or when the substance has a high affinity for red blood cells. Examples include severe anemia due to hemolysis, severe neonatal jaundice caused by high bilirubin levels, and certain drug overdoses like methotrexate toxicity.
