Week 5: Drugs Acting on the Blood, Blood Products and Transfusion

BLOOD

carries O2
collects CO2
conveys nutrients conduit for by products and toxins

Blood

composed of cells produced in the bone marrows suspended in plasma

ERYTHROCYTES

LEUKOCYTES

THROMBOCYTES

ERYTHROCYTES

hemoglobin and rbc

LEUKOCYTES

1. granulocytes

• neutrophil - phagocytosis

• eosinophil - parasitic inf.

• basophil - inflammatory and allergic rx.

2. agranulocytes

• lymphocyte - specific immune response; b and t lymph. and nk cell

• monocyte - fight off vacteria virus and fungi

THROMBOCYTES

platelets (megakaryocytes)

COMPONENTS OF RBC PRODUCTION

1. VITAMIN B12

• Cyanocobalamin

COMPONENTS OF RBC PRODUCTION: 1. VITAMIN B12

Cyanocobalamin

Maturation factor

Diet, Gut microbes

Stored in liver

COMPONENTS OF RBC PRODUCTION

COMPONENTS OF RBC PRODUCTION

2. FOLIC ACID

   
   

COMPONENTS OF RBC PRODUCTION: 2.FOLIC ACID

Co-factor for DNA synthesis

Methyl donor for vitamin B12
Diet; Gut microbes

COMPONENTS OF RBC PRODUCTION

3. Iron

COMPONENTS OF RBC PRODUCTION: 3. Iron

Ferrous >>> ferric

Administer with Vitamin C

Interacts with tetracyclines, antacids

GRANULOPOIETIN AND RELATED PRODUCTS

1. G-CSF/FILGRASTIM

GRANULOPOIETIN AND RELATED PRODUCTS: 1. G-CSF/FILGRASTIM

Stimulates committed progenitors
Recombinant human GCSF

GRANULOPOIETIN AND RELATED PRODUCTS

2. G-CSF/LENOGRASTIM

GRANULOPOIETIN AND RELATED PRODUCTS: 2. G-CSF/LENOGRASTIM

Not usually used in veterinary medicine

GRANULOPOIETIN AND RELATED PRODUCTS

3. SERRATIA MARCESCENS EXTRACT

GRANULOPOIETIN AND RELATED PRODUCTS: 3. SERRATIA MARCESCENS EXTRACT

Stimulates cytokine production
Not commercially available

CLOTTING PATHWAY

intrinsic pathway

extrinsic pathway

common pathway

ANTICOAGULANTS

1. HEPARIN

2. CLOPIDOGREL BISULFATE

3. EDTA

4. COUMARIN DERIVATIVES

5. ASPIRIN

6. ACID CITRATE DEXTROSE

ANTICOAGULANTS

1. HEPARIN

ANTICOAGULANTS: 1. HEPARIN

Prevents conversion of prothorombin to thrombin
Blood testing, blood transfusion, heart disorders

May treat DIC or laminitis in horses

ANTICOAGULANTS: 1. HEPARIN

May treat DIC or laminitis in horses

ANTICOAGULANTS

2. CLOPIDOGREL BISULFATE

ANTICOAGULANTS: 2. CLOPIDOGREL BISULFATE

Inhibits platelet aggregation

Prevents ADP binding
Prevention of thrombi formation in cats

ANTICOAGULANTS: 2. CLOPIDOGREL BISULFATE

Prevention of thrombi formation in cats

ANTICOAGULANTS:

3. EDTA

ANTICOAGULANTS:3. EDTA

Chelates calcium
Can be used in cases of lead poisoning
Side effects: vomiting, diarrhea, renal toxicity

ANTICOAGULANTS:

Can be used in cases of lead poisoning

ANTICOAGULANTS:

4. COUMARIN DERIVATIVES

ANTICOAGULANTS: 4. COUMARIN DERIVATIVES

Blocks vitamin K conversion
for long term treatment of thromboembolism
Side effects: bleeding and weakness

Example: warfarin

ANTICOAGULANTS: 4. COUMARIN DERIVATIVES

for long term treatment of thromboembolism

ANTICOAGULANTS: 4. COUMARIN DERIVATIVES

Example: warfarin

ANTICOAGULANTS

5. ASPIRIN

ANTICOAGULANTS: 5. ASPIRIN

Inhibits COX-1
Prevents thromboembolism assoc. with CHW and cardiomyopathies (cats)
Side effects: bleeding (GI) and vomiting

ANTICOAGULANTS: 5. ASPIRIN

Inhibits COX-1

ANTICOAGULANTS: 5. ASPIRIN

Prevents thromboembolism assoc. with CHW and cardiomyopathies (cats)

ANTICOAGULANTS

6. ACID CITRATE DEXTROSE

ANTICOAGULANTS: 6. ACID CITRATE DEXTROSE

Chelates Ca2+
Found in blood bags as preservative, antocoagulant

HEMOSTATICS

1. PHYTONADIONE

2. PROTAMINE SULFATE

3. TRANEXAMIC ACID

4. STYPTICS

HEMOSTATICS

1. PHYTONADIONE

HEMOSTATICS: 1. PHYTONADIONE

Vitamin K1
For Tx of rodenticide poisoning, bleeding disorders

Side effect: anaphylaxis

HEMOSTATICS: 1. PHYTONADIONE

For Tx of rodenticide poisoning, bleeding disorders

HEMOSTATICS

2. PROTAMINE SULFATE

HEMOSTATICS: 2. PROTAMINE SULFATE

Alkaline protein
For heparin toxicity, bracken fern poisoning
Side effect: hypotension, bradycardia

HEMOSTATICS: 2. PROTAMINE SULFATE

For heparin toxicity, bracken fern poisoning

HEMOSTATICS

3. TRANEXAMIC ACID

HEMOSTATICS: 3. TRANEXAMIC ACID

Synthetic derivative of lysine

Binds to lysine-binding sites on plamsinogen
Side effect: nausea

HEMOSTATICS

4. STYPTICS

HEMOSTATICS: 4. STYPTICS

Silver nitrate
Hemostat powder
Gelfoam (R) gelatin sponge

Topical thrombin solution

HEMOSTATICS: 4. STYPTICS

Silver nitrate
Hemostat powder

HEMOSTATICS: 4. STYPTICS

Gelfoam (R) gelatin sponge

Topical thrombin solution

TRANSFUSION THERAPY

• administration blood/blood

products from one patient to

another

INDICATIONS

• To replace deficiency in blood constituents

TRANSFUSION THERAPY

INDICATIONS

acute blood loss

coagulopathies

toxicoses

IMHA

CKD
severe anemia

TRANSFUSION THERAPY

INDICATIONS

highly based on Px PCV/Hct
also consider overall disposition of Px

BLOOD PRODUCTS

INDICATIONS

1. fresh whole blood

2. pRBCs

3. Plt-rich plasma

4. FFP

BLOOD PRODUCTS

Whole blood:

• RBC, WBC, platelets and plasma

BLOOD PRODUCTS

Packed RBCs

• RBCs seperated from platelets and plasma

BLOOD PRODUCTS

Fresh frozen plasma

• album and cryoprecipitate

DONOR SELECTION AND EVALUATION

Dogs

middle aged
no hx of transmissible/blood-borne diseases
30-50kg
updated vaccinations

DONOR SELECTION AND EVALUATION

Dogs

middle aged
30-50kg

DONOR SELECTION AND EVALUATION

Cats

young
indoors
from a small population household at least 5kg
updated vaccinations

DONOR SELECTION AND EVALUATION

Cats

young
from a small population household at least 5kg

CROSS MATCHING

=

BLOOD COLLECTION

Sedation

Dogs: opioids/benzodiazepine

Cats: ketamine/diazepam

BLOOD COLLECTION

DOGS

G18-16needle
by gravity or vacuum

BLOOD COLLECTION

DOGS

blood volume:90 mL/kg BW
15% blood volume
20% blood volume + fluid therapy

BLOOD COLLECTION

CATS

butterfly

catheter
60 mL syringes

BLOOD COLLECTION

CATS

blood volume: 60mL/kg BW

maximum of 40- 50mL per cat

BLOOD COLLECTION

ACD
CPDA-1
13-14mL anticoagulant/100mL blood

store at 4-6 C

BLOOD COLLECTION

13-14mL anticoagulant/100mL blood

TRANSFUSION PROPER

Premedication

Diphenhydramine IV/IM 2mg/kg

TRANSFUSION PROPER

Post-medication

Dexamethasone 2mg/kg IV

Transfusion Rate

Initial: 1- 2mL/kg/hour
remainder of the transfusion should be finished within 4 hours

TRANSFUSION PROPER

WHOLE BLOOD TRANSFUSION CALCULATIONS

INOTROPIC DRUGS

POSITIVE INOTROPES

1. Pimobendan

2. Dobutamine

3. Dopamine

4. Epinephrine (Adrenaline)

5. Norepinephrine (Noradrenaline)

6. Digoxin

INOTROPIC DRUGS

POSITIVE INOTROPES

1. Pimobendan

INOTROPIC DRUGS

POSITIVE INOTROPES

1. Pimobendan

Increased myocardical contractility

Causes vasodilation; decreases preload and afterload
MMVD

INOTROPIC DRUGS

POSITIVE INOTROPES

2. Dobutamine

INOTROPIC DRUGS

POSITIVE INOTROPES

2. Dobutamine

β1-adrenergic agonist

Mild peripheral vascular resistance
Cardiogenic Shock

INOTROPIC DRUGS

POSITIVE INOTROPES

3. Dopamine

INOTROPIC DRUGS

POSITIVE INOTROPES

3. Dopamine

Dose-dependent Catecholamine

Moderate (β1 - heart) and Higher dose (α1 - vasoconstriction) Hypotension, shock, low-output

INOTROPIC DRUGS

POSITIVE INOTROPES

4. Epinephrine (Adrenaline)

INOTROPIC DRUGS

POSITIVE INOTROPES

4. Epinephrine (Adrenaline)

Stimulates β1, β2, & α1 receptors

Cardiopulmonary arrest
Also used in severe anaphylaxis

INOTROPIC DRUGS

POSITIVE INOTROPES

5. Norepinephrine (Noradrenaline)

INOTROPIC DRUGS

POSITIVE INOTROPES

5. Norepinephrine (Noradrenaline)

Predominantly α1 agonist, with β1 activity

β1 activity provides some positive inotropes
Severe vasodilatory hypotension/ septic shock

INOTROPIC DRUGS

POSITIVE INOTROPES

6. Digoxin

INOTROPIC DRUGS

POSITIVE INOTROPES

6. Digoxin

Cardiac glycoside

Inhibits Na+/K+-ATPase

increased intracellular Ca2+ positive inotropic effect

CHF

INOTROPIC DRUGS

NEGATIVE INOTROPES

1. β-blockers (e.g. atenolol, metoprolol, propanolol)

2. Calcium channel blockers (e.g. verapamil, diltiazem

INOTROPIC DRUGS

NEGATIVE INOTROPES

1. β-blockers (e.g. atenolol, metoprolol, propanolol)

Block β-adrenergic stimulation

decreases heart rate and contractility

Reduced myocardial oxygen demand

tachyarrhythmias and hypertrophic cardio

INOTROPIC DRUGS

NEGATIVE INOTROPES

2. Calcium channel blockers (e.g. verapamil, diltiazem

INOTROPIC DRUGS

NEGATIVE INOTROPES

2. Calcium channel blockers (e.g. verapamil, diltiazem

Reduce CA2+ entry into cardiac myocytes

decreases contractility and slow AV nodal conduction
Supraventricular tachyarrhythmias