Blood Transfusion in Animals

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Information about Blood Transfusion in Animals

Published on December 25, 2010

Author: adnanmalik


Blood Transfusion in Animals : Blood Transfusion in Animals Group No. 2 Indications of Blood Transfusion : Indications of Blood Transfusion Acute massive blood loss Deficiency of blood constituents Decreased oxygen carrying capacity of blood Precautionary measure for surgery Auto immune hemolytic anemia Blood poisoning Disseminated intravascular coagulopathy Cattle Pulmonary hemorrhage Abomasal ulcer Enzootic hematuria with bladder bleeding Rupture of middle uterine artery in prolapse Very heavy infestation of Hook worm Thieleriasis, anaplasmosis, babesiosis Indications : Indications Horses Blood transfusions should be considered in patients with a PCV 12% hemoglobin concentrations less than 8 g/dl, Traumatic injury Hemophilia Heavy infestation with strongyles Blood Groups : Blood Groups Blood groups are based on genetically transmitted glycoproteins / glycolipids present on the cell membrane of erythrocytes called antigens Dogs Dogs have 10 different blood types identified as dog erythrocyte antigens (DEA) 1.1, 1.2, 1.3, 3, 4, 5, 6, 7, 8 and Dal Use of DEA 1.1+ and 1.2+ blood from the donor to incompatible recepient may cause hemolysis Cats Cats have AB blood group system Three types A, B and AB (rarely) A and B are alleles Phenotype A is expressed if genotype is A/A or A/B Blood Groups : Blood Groups Phenotype B is expressed if genotype is B/B Phenotype AB is due to the presence of third allele A group is present in 74-100% of population and B group is present in 0-26% AB group is present in 0-10% 75% cats are A+ and 25% are B+ Group B cats have high anti-A isoantibodies which is a potent agglutinin and hemolysin Type A cats have weak anti-B isoantibodies Horses There are eight recognized blood groups in the horse: A, C, D, K, P, Q, T, and U. Bovines In cattle, major blood groups are 12, variation in each group lead to 60 blood groups Dose Calculation : Dose Calculation Dose of blood depends upon Degree of anemia Acute or chronic hemorrhage Laboratory test results Level of Hb As a rule, in most animals normal Hb values are 13 to 15 g/100 ml In dog and cat when Hb is less than 7gm/dl (hematocrit 21%) Level of PCV PCV is monitored after hemorrhage Most species of domestic animals have PCV from 38-45% 20% PCV significant loss of RBC If PCV is decreasing than 12% then blood transfusion is indicated If PCV is constant between 12-20% then not indicated for blood transfusion Dose Calculation : Dose Calculation Amount of blood or blood product required Normal blood volume is assumed 8% Liters of blood lost = ((normal PCV – patient PCV) / normal PCV) * (0.08 * patient wt. in kg) same for horses we provide the 30-40% of the blood loss calculated by this method If we assume normal PCV to be 40% 2.2 ml of whole blood / kg body weight will increase the PCV by 1% (same for horse) Volume to be transfused = Body wt (kg) * K * ((desired PCV – recepient PCV) / donor PCV ) Where K= 88 for dogs and K= 66 for cats Dose Calculation : Dose Calculation Computation is based on size of animal, approximate blood volume per unit weight, composition of blood or blood product Approximate blood volume for dog is 88 ml/kg and 66 ml/kg for cat If 20 kg dog’s blood volume is 1,760 ml and hematocrit is 11% the circulation almost 200 ml of erythrocyte To have posttransfusion hematocrit of 25% dog would need 440 ml of erythrocyte, so 240 ml of erythrocyte is needed to be administered The amount of blood required to administer depends upon the hematocrit of product administered If there is 60% hematocrit then 400 ml is to be administered Donor Selection : Donor Selection Objectives Minimize risk of trasnfusion reaction Avoid blood transmissible diseases Characteristics Adult animal with good body condition and good body size No history of blood transfusion No history of blood based vaccines Preferably a male, if female then nulliparous. Female should preferably be spayed Genetically related or of same breed. Free from blood transmitted diseases as anaplasmosis, equine infectious anemia Donor Selection : Donor Selection Dogs Cooperative temperament, short hair coat and not be obese Ideal blood donor for dog should be more than 25 kg, they are able to donate 450 ml of blood at one time after 3 week interval For dog Age should be between 1 to 8 years Dog PCV should be 40% Dog must be free from be free from burcellosis, ehrlichiosis and microfilaremia, trypanosomiasis Dogs should be chosen for their quiet disposition and ease of handling. For dog, donor should be preferably negative for DEAs 1.1, 1.2 and 7 Approximately 40% dogs are negative for DEAs 1.1 and 1.2 Approximately 60% dogs are positive for DEAs 1.1 and 1.2 i.e, universal recepients Donor Selection : Donor Selection Dogs positive for DEA 4 and negative for all others are best as universal donors Greyhounds Greyhounds are frequently used as donors as they have low frequency of DEA 1.1 and 1.2 They are gentle, patient dogs They have very thin skin, making the insertion of the needle easier. They have a high packed cell volume They bleed reasonably quickly. They have no congenital blood disorders Greyhounds should be preferably checked for Babesia canis titer Dobermans should be preferably checked for von Willebrand factor Donor Selection : Donor Selection Hemolytic reactions are unlikely to occur after first transfusion even after the negative 1.1 and 1.2 recepient is given blood from positive 1.1 and 1.2 donor But the animal would be sensitized and there would be immediate hemolysis following second transfusion of 1.1 and 1.2 positive donor Cats Cat must be free from feline leukemia virus, feline immunodeficiency virus feline infectious peritonitis, toxoplasmosis and hemobartonellosis Free from ticks, fleas and intestinal parasites, particularly hook worms There are no feline universal donors Type A is used preferably Donor Selection : Donor Selection For cat Ideal blood donor should be more than 5 kg Cat PCV should be 35% Cats must live indoors only Horses For recepient mare, horse should be Aa and Qa negative Belgium draft horses are more suitable Initial transfusions rarely are associated with adverse reactions because horses infrequently produce strongly reactive natural erythrocyte alloantibodies vaccinations of rhinopneumonitis, tetanus toxoid, eastern and western encephalitis, botulism toxoid, and rabies toxoid should have been done Donor Selection : Donor Selection Alloantigens Aa of the A system and Qa of the Q system are the most immunogenic of the equine alloantigens and are highly prevalent among light breed horses. Transfusion of blood from a donor positive with these alloantigens will result in the development of a high alloantibody titer in the recipient that can cause severe hemolysis upon subsequent exposure. Donors lacking those alloantigens are considered safe blood donors. Blood Typing : Blood Typing Objectives Future sensitization and transfusion reactions To avoid fetal isoerythrolysis Blood typing detects antigens on cell surface while cross matching detects antibodies on cell surface Reagents or antibodies are mixed with RBCs If there is hemolysis or agglutination then it shows incompatibility In dogs 6 serotypes have been commercially prepared and coommercial card system is used for blood typing Blood Typing : Blood Typing Alvedia Technique for Dogs The system is based on the migration of red blood cellson a membrane, that has previously been specially treated antibody specific to the DEA 1.1 antigen has been in the membrane. This antibody will retain positive DEA 1.1 red blood cells. It is characterized by the presence of a red band on the mid portion of this membrane If whereas the test is negative, The red control band, located on the upper part of the membrane has to appear, ensuring the test has run successfully. If not the test must be repeated. Blood Typing : Blood Typing Alvedia Technique for Dogs Crossmatching : Crossmatching Principle Crossmatch detects the presence of pre-existing antibodies that produce and immediate hemolytic reaction Pre-existing antibodies could be the natural antibodies or the antibodies produced against the previous incompatible transfusion A compatible crossmatch does not preclude sensitization to subsequent transfusion Procedure Collect anticoagulated blood and serum from donor and recepient Wash RBC in 0.9% saline solution and prepare 5-10% RBC suspension Major crossmatch Put 2 drops of donor cells and 2 drops of recepient serum and mix In second tube, Crossmatching : Crossmatching Minor crossmatch put 2 drops of recepient cell and donor serum Controls are set with serum and cells of donor and recepient separately Incubate for 30 min at room temperature, centrifuge for 1 min at 1000 rpm Examine the tubes for hemolysis, shake tubes to resuspend cells and check for hemagglutination microscopically Incompatibilty in minor crossmatch can be used if other compatible donor is not available Crossmatch is repeated if more than 4 days elapsed between transfusion Crossmatching is not required if platelets or cryoprecipitate is to be transfused Cats must had been crossmatched before transfusion Anticoagulants : Anticoagulants ACD and CPD Acid, citrate, dextrose (ACD) or citrate, phosphate, dextrose (CPD) anticoagulant solutions are recommended, especially when storage of blood products is recommended These also provide nutrients for metabolism and stabilization of RBCs 14 ml of ACD or CPD solution is used per 100 ml of blood Oxygen carrying capacity is maintained for 4 weeks in CPD solutions and for 3 weeks in ACD solution for dog Oxygen carrying capacity is maintained for 5 weeks in CPD solutions and for 4 weeks in ACD solution for cat Erythrocyte preservation is better in CPD All preservative solution contains citrate as anticoagulant Anticoagulants : Anticoagulants Na Citrate 3.85% Na citrate solution at the rate of 1 part of anticoagulant to 9 parts of blood Heparin 0.2 mg of heparin is used per ml of blood Heparin is not recommended because it activates platelets Blood containing heparin has accelerated glycolysis and deteriorates rapidly Heparin and Na citrate have no preservative function, so blood should be transfused within 8 hours of collection Limitations Anticoagulant-preservative solutions do not inhibit the growth of microbial contaminants. Refrigeration of red cells will assist in stalling microbial growth Blood Collecting Equipments : Blood Collecting Equipments Blood is collected in sterile plastic bags or siliconized glass container as vacuum bottles or syringes Vacuum bottles Large volumes can be obtained easily and rapidly To minimize hemolysis tilt the bottle so that blood flows down the side of the container But the chances of bacterial contamination are there Separation of blood components is most difficult and involves additional contamination Glass surfaces can activate coagulation factors and platelets There is adhesion of platelets to glass bottles Blood Collecting Equipments : Blood Collecting Equipments Plastic Bags Plastic bags remain closed throughout the collection and administration, contamination is not the problem Separation of blood components is easy Surfaces of plastic bags activate the coagulation factors and platelets less than the vacuum bottles But Collection is less easy with plastic bags A vacuum assist device is used to facilitate blood collection Syringes Blood can also be collected in syringes which are connected with butterfly catheter Technique is suitable when blood is to be given to a cat, puppy or other small dog Anticoagulant is placed in 60 ml syringe Blood Collecting Equipments : Blood Collecting Equipments Blood collecting bags and bottles Donor Preparation : Donor Preparation Dogs should not be fed prior to blood collection to limit lipids in the blood. Materials required are • Clippers • Skin disinfectants • Gloves • Sterile swabs • Local anaesthetic cream • Blood collection bag • Bandaging material • Weighing scales • Plastic clamps* • Metal clips* • Hand sealer* • Line stripper Blood Collection : Blood Collection Sedation Some dog may require sedation for blood donation Most cats require sedation for blood collection Butorphanol (0.1 mg/kg BW, IV) is administered 10-15 min before collection in the dog In the cat, ketamine may be used as 2 to 4 mg/kg BW, IV, plus 0.1 to 0.2 mg/kg BW diazepam, IV it is best to avoid acepromazine, as it may alter platelet function Procedure The hair over the jugular vein is clipped and site is aseptically prepared the jugular vein is raised and the needle inserted. Blood collection bags should be held below the donor and agitated gently to mix the blood with the anticoagulant solution, Blood Collection : Blood Collection Blood collection sets Blood Collection : Blood Collection Blood collection from jugular vein in Greyhounds Blood Collection : Blood Collection Blood collection Blood Collection : Blood Collection Blood collection from Labrador Retriever Blood Collection : Blood Collection Most commercial collection bags will collect a maximum 450- 500ml of blood and contain 63ml of anticoagulant and preservative. A volume of 405-495ml is required. A minimum of 405ml must be collected otherwise a ‘short draw’ will occur where the ratio of anticoagulant to blood is too high It causes citrate toxicity when administered to the recipient. Blood and anticoagulant are gently mixed during the collection process To ensure no air enters the blood collection system the line must be clamped before removing the needle from the donor. The blood is then forced into the bag with the hand stripper, mixing the blood with anticoagulant before being allowed back into the tubing. Blood Collection : Blood Collection A transfusion should be completed within 4 hours Container is labeled after collection Dogs The dog can be standing or sitting, but greater control is achieved when the donor is restrained in lateral recumbency. Blood is collected from jugular vein or femoral artery 12-14 G needle is used 10-20 ml/kg body wt. for dog can be withdrawn of a dog with a maximum of 22 ml/kg Blood donation could be repeated every 21-28 day Blood Collection : Blood Collection Cats For cats blood is more conveniently collected in large syringes added with anticoagulant 19-20 G butterfly catheter is used to connect syringe containing either ACD or CPD (1 mL/9 mL of blood) 10 ml/kg for cat can be drawn off at one time. Minimum interval between next collection should be 21 days Maximum of 40 ml is drawn from donor cat Blood collection takes approximately 10-20 min Horses In 2 liter evacuated glass container 200 ml ACD is added High flow delivery sets are used to collect blood Vacuum is not allowed to loss during collection Blood Collection : Blood Collection Blood collection by syringes Blood Collection : Blood Collection Either a 10-gauge catheter or 14-gauge needle is inserted into the jugular vein. We collect 15–22 ml/kg of body weight at one time Precautions Temperature, heart rate and respiratory rate is checked every 10 min during first 30 min and then every 30 min throughout transfusion Anticoagulant bags are sensitive to light and should be stored in the foil packs they are supplied in. An ‘open’ system exposes blood to the air at some time throughout the process. So blood must be used within four hours or 24 hours if stored at 1–6°C. Single clean venepuncture followed by the completion of collection is important Donor Care : Donor Care Dietary supplementation with vitamin B12, folic acid, pyridoxine and iron intake is advisable To sustain optimum bone marrow productivity, protein of meat origin is provided Hematological findings should be monitored With adequate husbandry and nutritional support 20-25 ml/kg body wt. blood can be routinely withdrawn every 14-21 days Use of Blood Components : Use of Blood Components Objectives Maximize the utilization of limited source blood To optimally preserve the constituents of blood To minimize bacterial contamination and proliferation Uses Plasma For acute hypoalbuminemia For clotting factors Packed RBCs For lowered Hb and PCV Use of Blood Components : Use of Blood Components Blood bag with satellite bags Blood bags in centrifuge machine Plasma and cells separated Storage : Storage Factors affect erythrocyte survival and function are Metabolic changes altering the erythrocyte oxygen affinity ATP and 2,3-DPG and pH of the medium decline during storage These decrease oxygen delivery to tissues Whole Blood Whole Blood is stored at 4-6°C Fresh Whole Blood If blood is stored in 8 hours of collection then it is termed fresh whole blood It contains functional coagulation factors, platelets Shelf life is 21-35 days depending upon type of anticoagulant Stored Whole Blood If blood is stored after 8 hours it losses labile coagulation factors and functional platelets and termed stored whole blood Storage : Storage Gentle mixing of blood twice weekly during storage maximizes exxposure to preservative Shelf life is 21-35 days depending upon type of anticoagulant Presence of cloudy, brown color suspects contamination If blood is warmed to 10°C, then it should be used within 24 hours Packed RBCs Erythrocytes should be stored at 4-6°C and temperature should be kept uniform Shelf life is 21-35 days depending upon type of anticoagulant Plasma Fresh frozen Plasma If plasma is frozen at -20°C within 8 hours of collection it maintains activity of factor VIII and V and termed fresh frozen plasma Shelf life of FFP is 1 year Storage : Storage Blood components are being separated Storage : Storage Bags containing plasma and pRBC’s Indications for Blood Components : Indications for Blood Components Whole blood is indicated if there is more than 30% blood loss Packed RBC are indicated for anemia due to blood loss, hemolysis and bone marrow dysfunction Packed RBCs with crystalloids is indicated if there is 30-50% blood loss The major indication for platelet transfusion is to stop severe, uncontrolled or life-threatening bleeding in patients with significantly decreased platelet number and/or function. FFP for coagulation factor deficiencies, vitamin K dependent coagulopathy, hemophilia A, hemophilia B For these diseases 6-10 ml plasma per kg is given Cryoprecipitate is used to treat hemophilia and fibrinogen deficiency Administration : Administration Before infusion rectal temperature, pulse rate, respiratory rate, mucous membrane color, capillary refill time, hematocrit, plasma and urine color should be monitored. Blood administration sets are commercially available Standard filter screens are incorporated in these units of 170 um pore size These restrain the blood clots and other large particles Debris composed of RBC, platelets, leukocytes and fibrin is formed if blood is stored To remove debris 20-40 um filters are used Blood should be warmed to room temperature or preferably to body temperature Administration : Administration Blood transfusion set Administration : Administration Blood transfusion syringe for catBlood transfusion bag for horse Administration : Administration Avoid excessive heat as fibrinogen precipitates at 56°C and autoagglutination occurs at more than 45°C Blood is best administered IV, if it is impossible then can be given intramedullary or intrapertoneally 0.25 ml/kg/hr should be given for first 15 min (same for horse) Animal is watched for 15-20 min if no untoward reaction occurs Recommended infusion rate for whole blood or plasma product 13-22 ml/kg per 24 hours Dog Cephalic vein, tarsal vein or jugular vein in dog 8-10 ml/kg/hr in dog Rate may be increased to 20 ml/kg/hr for hypovolumic patient and decreased to 2 ml/kg/hr for animal of cardiac and renal disease Administration : Administration Blood transfusion in dog Administration : Administration Cat Butterfly catheter is used For practical purposes, feline patients initially receive one unit of whole blood (40–50 mL) or one unit of PRBC (20–25 mL) or one unit of fresh-frozen plasma (20–25 mL). Most transfusions are completed in 2 hours and in 1 hour in cat Horse and Cattle Jugular vein in cattle and horse Administer 0.25 ml/kg/hr for first 15 min then rate is maintained at 70 drops per min (20-30 ml/kg/hr) in horses and 120 drops per min in cattle Administration : Administration Blood transfusion in catBlood transfusion in horse Transfusion Reactions : Transfusion Reactions Immunological reactions Accelerated destruction of RBC Intravascular hemolysis lead to hemoglobinemia and hemoglobinuria Extravascular hemolysis hyperbiliribunemia and hyperbiluribunurea Usually donated RBCs are destroyed but recepient RBC can also be hemolysed by the antibodies in donor plasma Dogs If 1.1 or 1.2 negative animal is given blood of 1.1 or 1.2 positive donor then animal would be sensitised Second transfusion from 1.1 or 1.2 positive donor will lead to immediate hemolysis If sensitized animal is female and is bred with 1.1 or 1.2 positive donor then there offspring is likely to suffer neonatal isoerytherolysis Transfusion Reactions : Transfusion Reactions Random transfusions are relatively safe in dogs provided patient does not have immune mediated hemolytic anemia and does not need sequential transfusions and is not a breeding female Transfusion reactions for first time transfusion of non typed or noncrossmatched blood are 15% Cats Administration of A+ erythrocytes to B+ cats frequently produce adverse reactions Characterized by profound hypotension, tachycardia, dyspnea and sometimes atrioventricular blockade Reactions are usually evident in first 10 min of administration If type B blood is transfused into type A cat then transfused RBCs may destroy in 1-2 weeks which normally survive 29-39 days Transfusion Reactions : Transfusion Reactions Horses Horses develop sensitivity to the first transfusion and show serious anaphylactic reactions to the second transfusion from the same donor In horses uneasiness, shallow and rapid breathing, defecation, urination severe hemorrhage and fell down. Cattle In cattle hiccough, dyspnea, urticaria, frequent urination and defecation, muscular tremor, salivation and lacrimation Delayed onset reactions occur from 3-21 days chracterised by pyrexia and anorexia Transfusion Reactions : Transfusion Reactions Non immunological reactions Overloading blood causes acute heart failure, cardiac insufficiency and pulmonary edema. Signs of circulatory overload include vomiting, urticaria, tachycardia, coughing, dyspnea and cyanosis, death may occur Excessive Na citrate may cause citrate toxicity leading to hypocalcemia especially in cats Hypersensitivity reactions, fever, chills, restlessness, nausea, vomiting and urticaria Administration of blood containing bacteria or bacterial endotoxins may cause hypotension, fever, chills or shock Microcirculatory blockade may occur, particularly in the lungs Ammonia is accumulated in blood druing storage causing decrease in liver functions and glycolysis in muscles Treatment for Reactions : Treatment for Reactions Depending upon the severity of reaction, slow or stop the infusion If transfusion is to be stopped then continue IV with normal saline or Hartmann’s solution Avoid using lactated ringers solution, which contains calcium that can deactivate the citrate in the anticoagulant resulting in clot formation Avoif 5% dextrose in water that may cause red cells to clump in the infusion line If hemolysis then give fluids and diuretics Administer antipyretics if there is increased in temperature Adrenaline and other antihistaminic drugs should be given in allergic anaphylactic reacations or pulmonary edema Adrenaline with 1:1000 concentration @ 5 ml/450 kg SC or IM (same for horse) Treatment for Reactions : Treatment for Reactions Corticosteroids used as dexamethasone @ 0.1 mg/kg IV in case of allergy, urticaria and pulmonary edema Solu-delta-cortef 1 mg/kg for horse For citrate toxicity Ca gluconate as 10 ml of 10% per liter of blood To avoid citrate toxicity heparin should be used To avoid overload use packed red cells instead of whole blood Diuretics are used to compensate overload Practical Tips : Practical Tips In dogs and horses the sever reaction at first transfusion is rare In cattle blood groups are so numerous that often cross match is no done and 4 to 6 liters of blood can be transfused. Blood transfusion is not the treatment it is just supportive therapy One should not go straightly go for blood transfer before it all possible measures should be tried Thank You Blood should Circulate!!! : Blood should Circulate!!! Refernces : Refernces Books Scatter, D. H., Text Book of Small Animal Surgery, Volume I, (74-81) W. B. Saunders Company. Saxena, O. P., Dabas, Y. P. S., Veterinary Practitioner’s Manual, 2nd Edition (190-195), CBS Publishers & Distributers, India Radostitis, O. M., Gray, C. C., Veterinary Medicine, 9th Edition (405-406), W. B. Saunders Company. Bonagura, J. D., 2000, Kirk’s Current Veterinary Therapy VIII, (400-403), W. B. Saunders Company. Michael, J. D., Clinical Immunology of Dog and Cat, 2nd Edition (115-119), Manson Publishing, Spain Bernard, F. F., Joseph, G., 2000, Schalm’s Veterinary Hematology, 5th Edition, (833-836), Willey Blackwell, USA. Stephen, J. E., 2001, Pocket Companion to Text Book of Veterinary Internal Medicine, 3rd Edition, (170-173), W. B. Saunders Company. References : References Journals & Articles Giger, U., 2005, Ensuring Blood Compatibility Update on Canine Typing and Crossmatching, Proceedings, 23rd ACVIM, Baltimore, Mathan, M. S., 2001, How to Approach Whole Blood Transfusion in Horses, Vol. 47, AAEP Proceedings Lanevschi, A., 2001, Principles of Transfusion Medicine in Small Animals, Can Vet J, Vol. 42. McGrath, J., Canine Blood Transfusion, Irish Veterinary Journal, Vol. 63, No. 8. Website -

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