Transfusion Medicine

Why are greyhounds often selected as canine blood donors?

all of the above

How many blood types do cats have?

three

What happens if you give a cat with type A blood a transfusion from a cat with type B blood?

They may develop a life-threatening type II hypersensitivity (hemolytic) transfusion reaction

What blood type is the universal donor for dogs?

DEA 4

Reasons for a blood transfusion

1. Anemia

2. Thrombocytopenia

3. Coagulopathies

Anemia

• Decrease in PCV, Hematocrit, RBC count, hemoglobin

• Loss/destruction > Production

• Decrease in oxygen being delivered to tissues

Thrombocytopenia

• Decrease in platelet count or platelet defect

What decrease in platelets can lead to

Spontaneous bleeding/brusing

Coagulopathies

Conditions in which the blood's ability to clot is impaired

Acquired coagulopathy conditions

• Liver disease

• Vitamin K deficiency

Genetic coagulopathy condition

Von Willebrand’s disease

Von willibrands disease

caused by a missing, low, or dysfunctions VWF factor that helps platelets stick together and shields clotting protein Factor VIII from breaking down

Clinical signs indicating a blood transfusion

• Pale MM

• Cardiac changes

• Dyspnea

• Weakness/lethargy/collapse

• Hypothermia/Hyperthermia

• Petechia or Ecchymosis

• Hemorrhage

• GI bleeding

Cardiac changes indicating a blood transfusion

• Increased HR

• Systolic heart mumur

• hypotension

Hemorrhage indicating a blood transfusion

• Nose bleed

• Intraocular

• Urine, etc.

GI bleeding indicating a blood transfusion

• Melena

• Hematemesis

• Hematochezia

Patient care

• IV access

• Avoid trauma

• Stabilize

• Monitor

Nomenclature used:

Dog erythrocyte antigen (DEA)

8 Major canine blood types

• DEA 1 (1.1 and 1.2)

• DEA 3

• DEA 4

• DEA 5

• DEA 6

• DEA 7

• DEA 8

Most clinical important canine blood type

DEA 1

Canine blood types screened for

• DEA 1

• DEA 4

• DEA 5

• DEA 7

‘Universal’ canine blood types

• DEA 1-

• DEA 4+

• DEA 5-

• DEA 7-

How we select a canine blood donor

• Healthy dog

• Good vein

• Good with restraint

• 1-8 years of age

• Lean body weight of 50lbs

 

• Blood type screening

• Infectious disease screening

• Local to area

Age for a canine/feline blood donor

1-8 years of age

Body weight for a canine blood donor

Lean body weight of 50lbs

Before collecting from a canine donor

• Fasting unnecessary

• Physical exam before donation

  • TPR, weight

  • PCV/TP

  • PCV should be >40% to prevent anemia in donor

Amount of blood a canine can donate

• Up to 10-15% of blood volume (16-18ml/kg)

• A 50lb dog can donate 450-500ml of whole blood

How often can a dog donate blood

every 3-4 weeks

When collecting blood for dogs and cats

• Rapid, uninterrupted jugular venipuncture

• Compression for 5 minutes

Exercise following blood donation for dogs and cats

No strenuous exercise for 12-24 hours

Canine blood donor collection supplies

• Clippers, non-sterile prep

• Collection bags

  • Anticoagulant with preservatives

    • Citrate + dextrose

    • ACDA (28 days), CPDA-1 (35 days)

• Digital scale

• +/- suction container

• 4x4 gauze, cotton wrap, vet wrap

Supplies: Collection bags

• Anticoagulant with preservatives

  • Citrate + dextrose

  • ACDA (28 days), CPDA-1 (35 days)

Set up for canine blood donor collection

• Set up the blood collection bags on the gram scale

• Lay donor in lateral recumbency on table

• Clip and prep the area of the jugular vein

• Insert the butterfly needle into the jugular vein and allow blood to flow into the collection bags until a full unit is collected (can turn on suction if available)

What vein is used for blood collection

Jugular

Once finished with donation

• When donation is finished, place 4x4 gauze over the insertion site and hold pressure for at least 5 minutes, wrap the neck with pressure wrap

• Feed each donor a meal once done with the donation

Feline blood types

• Type A

• Type B

• Type AB

Feline Type A blood

>96-99% of DSH and DLH in U.S.

Feline Type B blood

<4% in certain lines of purebred cats

Feline Type AB blood

Extremely rare, only cats with type B in population

Who can a blood Type A in felines donate to?

Type A and AB

Who can a blood Type AB in felines donate to?

Type AB

Who can a blood Type B in felines donate to?

Type B

What should you always do for felines?

Always blood type them!!

How we select a feline blood donor

• Healthy cat

• 1-8 years of age

• Weight needs to be at least 10lbs

• Good Anesthesia candidate

 

• Infectious disease screening

• Blood type (A and B cats)

• Indoor cat

• Local to the area

Body weight for a feline blood donor

at least 10lbs

Before collecting from a feline blood donor

• Fasting necessary (sedation or light anesthesia)

• Physical exam before donation

  • TPR, Weight

  • PCV/TP obtained

  • PCV should be >30% to prevent anemia in the donor

The amount of blood a cat can donate

• Up to 10-15% of blood volume (10-15ml/kg)

• A 10lb cat can donate 50mls of whole blood

How often can a cat donate blood

Up to every 2 months

Supplies for feline blood collection

• Sedation or light anesthesia set up

  • Flow by oxygen, mask, ECG leads

• Clippers and non-sterile prep

• 19g butterfly needle

• 60ml syringe (primed with 7mls ACD)

• 4x4 gauze, cotton wrap, vet wrap

ACD

Acid-Citrate-dextrose

Prep for feline blood donation

• Sedate or place donor under light anesthesia

• Hook up flow by oxygen and ECG Leads

• Supplement with SQ fluids (100-150mls)

• Lay cat in lateral recumbency

• Clip and shave area over jugular vein

Collecting feline blood

Insert the butterfly needle into the jugular vein and pull back in small increments while inverting the syringe

After feline blood collection is done

• Place 4x4 gauze over the insertion site for at least 5 minutes, then wrap the neck with pressure wrap

• Recover the donor and feed when fully recovered

Whole blood transfusion indications

• Anemia with a volume deficit

• Massive acute ongoing hemorrhage

• Thrombocytopenia

RBC transfusion indications

Symptomatic anemia

Plasma transfusion indications

• Coagulation factor depletion

• factor deficiencies

• VWD

• hypoproteinemia

• Colloid replacement in hypovolemia shock

• Heatstroke

• DIC (Disseminated intravascular coagulation)

Processing and Storage

• 500ml full unit

• FFP (250ml)

• PRBCs (125ml)

• PRBCs(125ml)

• Refrigerated centrifuge

• Plasma extractors

• Sealant clips

Storage of fresh whole blood

• Platelets viable 6-8 hours with no refrigeration or for 24 hours with refrigeration

• Red blood cells, leukocytes, coagulation factors, plasma proteins

Storage of stored whole blood

• Store at 1-6 degrees C

• Dependent on anticoagulant, can store up to 35 days

• Red blood cells and plasma proteins

• +/- platelets and coagulation factors

• Leukocytes are usually nonviable

Depending on the anticoagulant how long can you store stored whole blood?

up to 35 days

Storage of packed red blood cells

• Units viable for 4 weeks with refrigeration

• Units with PRBC additive solution extend storage life to 5 weeks

• Store at 1-6 degrees C

Storage of fresh frozen plasma

• Frozen <20C within 8 hours of collection

• 1 year

Storage of frozen plasma

• Diminished levels of FV, FVIII, and VWF

• FFP stored >1 year for additional 4 years

What is cryoprecipitate rich in?

VWF, FVIII (Hemophilia A), Fibrinogen

Purpose of cryoprecipitate

• Used to prevent or control bleeding

  • IV or topical application

Preparation of cryprecipitate (CRYO)

• From thaw of FFP or FP

  • Makes short of a slushee, then we can spin it down and take out those specific clotting factors and store it for a dog with difficulty clotting prior to surgery

Administered without risk of volume overload

Major crossmatch

Donors RBCs and Recipients serum

Minor crossmatch

Donors serum and recipients RBCs

Methods for a crossmatch test

• Rapid slide crossmatch

• Test tube cross match

• Commercial crossmatch

• Reference laboratory

How is incompatibilty indicated in a crossmatch test?

by hemolysis or agglutination

When to perform a transfusion

• PCV less than 10% — or — if failing rapidly to less than 20% in dogs or 15% in cats

• TRANSFUSE clinical signs NOT the number

Determining how much blood to transfuse

• (desired PCV - Actual PCV)/(Donor PVC) x Blood volume/kg x Patient weight (kg) = whole blood volume (ml) to be transfused

(divide by 2 for pRBCs)

• Blood volume

  • Dog = 85ml/kg

  • Cat = 60ml/kg

Shortcut on math to raise PCV by about 10%

• 20ml/kg for FWB (2ml/kg to increase 1%)

• 10ml/kg for pRBC (1ml/kg to increase 1%)

Shortcut on math for plasma transfusion

10-20 ml/kg for plasma

Administration

• Blood filter

• Divide by 4 hours

• Calcium niitates coagulation

Blood filter during administration

• Fliter administration set

• Hemo-nate spike for volume <50ml

Administration - divide by 4 hours

• Prevent bacterial growth in bag and lines

• 30 minutes at initial slow rate

  • 1ml/kg/hr 10M

  • 3ml/kg/hr 10M

  • 5ml/kg/hr 10M

• Prime the line and observe for reactions

Administration - calcium initiates coagulation

• Flush IV catheter/T-set

Transfusion monitoring

• Establish baseline values

• TPR, Attitude, MM color/CRT, PCV/TP, and urine color

• Every 10 minutes first 30 minutes then every 60 minutes for 4 hours

• Crossmatching does not prevent incompatibilities

How often should you be monitoring during a blood transfusion?

Every 10 minutes first 30 minutes then every 60 minutes for 4 hours

Major types of transfusion reactions

• Hemolysis

• Acute hypersensitivity (allergic reaction)

• Pyrexia

• Bacterial contamination

• Hypocalcemia

• Vomiting

Things to consider with transfusion reactions

• Acute hemolysis due to major mismatch

• Delayed hemolysis due to minor mismatch

• Bacterial contamination of donor bag

• Temperature extremes (overheating, freezing)

• Citrate toxicity

• Mechanical handling errors (pumps, filters)

Clinical signs of transfusion reactions

• Immediate hypersensitivity

  • V/D, fevers, hives, itching, facial swelling

• Severe anaphylaxis

  • Cats- salivation, vomiting, dyspnea, collapse, death

  • Dogs - Weakness, collapse, comatose, convulsion, death

• STOP AND TREAT!!!

Severe anaphylaxis in cats clinical signs

• Salivation

• vomiting

• dyspnea

• collapse

• death

Severe anaphylaxis in dogs clinical signs

• weakeness

• collapse

• comatose

• convulsions

• death