Chapter 25-Small Chapter 25-Small Animal Medical NursingAnimal Medical Nursing

Blood TransfusionBlood Transfusion

pgs. 793-796 in the pgs. 793-796 in the CTVT bookCTVT book

The 1st successful animal to animal blood transfusion was done by Richard Lower, Feb.

1665 between a Mastiff and a mixed breed dog.

TechniciansTechnicians

Today, technicians are taking a more Today, technicians are taking a more active role in transfusion medicine by active role in transfusion medicine by preparing the product for administration, preparing the product for administration, monitoring the transfusion recipient, and monitoring the transfusion recipient, and setting up blood donor programs, among setting up blood donor programs, among other tasks.other tasks.

Blood TransfusionBlood Transfusion

Is an effective method of fluid Is an effective method of fluid replacement but a potentially replacement but a potentially hazardous form of treatment.hazardous form of treatment.

Clear indication for its use must be Clear indication for its use must be present. The effectiveness of present. The effectiveness of transfusion is temporary.transfusion is temporary.

Every effort must be made to identify Every effort must be made to identify and correct underlying problems.and correct underlying problems.

Why Perform Blood TransfusionsWhy Perform Blood Transfusions

Severe blood loss (trauma, surgery)Severe blood loss (trauma, surgery) Chronic anemia (respiratory distress, weakness) Chronic anemia (respiratory distress, weakness)

Blood is used for its oxygen-carrying Blood is used for its oxygen-carrying capabilities.capabilities.

Defects of coagulation. (Hemophilia, Von Defects of coagulation. (Hemophilia, Von Willebrand disease) Use platelet rich plasma Willebrand disease) Use platelet rich plasma over blood.over blood.

Autoimmune hemolytic anemia (in life-Autoimmune hemolytic anemia (in life-threatening situations) threatening situations)

PCV levels should not dictate giving a blood PCV levels should not dictate giving a blood transfusion. While a PCV of 12% may be life transfusion. While a PCV of 12% may be life threatening for one animal it may represent a threatening for one animal it may represent a totally different scenario for another patient.totally different scenario for another patient.

PlateletsPlatelets

Survive for less than 12 hours in stored Survive for less than 12 hours in stored blood, therefore freshly drawn blood blood, therefore freshly drawn blood should be used immediately.should be used immediately.

Platelet rich plasma is the preferred Platelet rich plasma is the preferred transfusion method when needing to transfusion method when needing to replace platelets. replace platelets. (Note: use the same guidelines (Note: use the same guidelines when performing a plasma transfusion as you would with when performing a plasma transfusion as you would with a blood transfusion.)a blood transfusion.)

Why use Platelets?Why use Platelets?

Animals with abnormal platelet functionAnimals with abnormal platelet function Hereditary or acquired bleeding disorders:Hereditary or acquired bleeding disorders:

HemophiliaHemophiliaVon Willebrand disease (vWD)Von Willebrand disease (vWD)Disseminated intravascular Disseminated intravascular

coagulation (DIC) pg. 832-833coagulation (DIC) pg. 832-833 You want to provide adequate You want to provide adequate

concentrations of the deficient coagulation concentrations of the deficient coagulation factor at the bleeding site.factor at the bleeding site.

Microscopic view of plateletsMicroscopic view of platelets

Autoimmune Hemolytic AnemiaAutoimmune Hemolytic Anemia

The animal’s immune system actually attacks The animal’s immune system actually attacks its own red blood cells leading to their its own red blood cells leading to their destruction-hemolysis. The antibodies attack destruction-hemolysis. The antibodies attack the cell membrane.the cell membrane.

Red blood cell transfusion is only Red blood cell transfusion is only administered in life-threatening situations, as administered in life-threatening situations, as the patient’s immune system will also attack the patient’s immune system will also attack and destroy these RBCs as well.and destroy these RBCs as well.

If transfusion is necessary as a life-saving If transfusion is necessary as a life-saving measure, only the absolute minimum number measure, only the absolute minimum number of RBCs should be administered. (12ml/kg of of RBCs should be administered. (12ml/kg of body wt.)body wt.)

Do you remember what WBCs are?Do you remember what WBCs are?

The body’s armyThe body’s army Fight off infections by increasing in Fight off infections by increasing in

numbers. They attack germs!numbers. They attack germs!

Leukopenia HypoproteinemiaLeukopenia Hypoproteinemia

Low white blood cell Low white blood cell (WBC) count(WBC) count

Blood transfusions Blood transfusions are impractical are impractical

Low serum proteinLow serum protein Blood transfusions Blood transfusions

are impracticalare impractical

RBC

WBC

Platelet

Canine Blood GroupsCanine Blood Groups

Canine Blood GroupsCanine Blood Groups

There are 19 + known blood groups in dogs, There are 19 + known blood groups in dogs, while there are 6 well characterized blood types while there are 6 well characterized blood types known as dog erythrocyte antigens.known as dog erythrocyte antigens.

DEA=dog erythrocyte antigen. Canine blood DEA=dog erythrocyte antigen. Canine blood types are designated by the presence of specific types are designated by the presence of specific DEAs. The antigens are DEA 1.1, 1.2, 3, 4, 5, DEAs. The antigens are DEA 1.1, 1.2, 3, 4, 5, and 7. Every dog is either positive or negative and 7. Every dog is either positive or negative for these blood types.for these blood types.

The blood type of most importance is DEA 1.1 The blood type of most importance is DEA 1.1 because of transfusion reactions. because of transfusion reactions.

A good resource: A good resource: www.rapidvet.com/help.htmwww.rapidvet.com/help.htm Antigens=proteinsAntigens=proteins

Because this dog’s blood is positive for DEA 1.1 transfusing into a dog that is negative for DEA 1.1 could be fatal.

DEA 7

DEA 3

DEA 1.1

DEA 4

Blood-TypingBlood-Typing

A method of identifying the antigens A method of identifying the antigens (proteins and carbohydrates) on the (proteins and carbohydrates) on the surface of red blood cells.surface of red blood cells.

Samples can be sent out to a laboratory.Samples can be sent out to a laboratory. Blood typing cards can be utilized. These Blood typing cards can be utilized. These

cards can only detect DEA1.1 in dogs; and cards can only detect DEA1.1 in dogs; and feline blood types A, B, and AB. The cards feline blood types A, B, and AB. The cards are easy to use but the results may pose are easy to use but the results may pose difficult to interpret. difficult to interpret.

Blood Typing CardsBlood Typing Cards

Dogs have various proteins, also called "antigens", which

are associated with the surface of red blood cells. In dogs, these proteins, rather than being associated with letters to distinguish them from each other, have been

assigned numbers. Thus, we have the dog erythrocyte antigen (DEA) system of

canine typing.

DEA 1.1DEA 1.1

Is the most antigenic and is associated Is the most antigenic and is associated with most blood transfusions. It is said that with most blood transfusions. It is said that about 40% or more dogs are positive for about 40% or more dogs are positive for the DEA 1.1.the DEA 1.1.

Breeds more commonly DEA 1.1 positive Breeds more commonly DEA 1.1 positive are Golden Retrievers and Labradors.are Golden Retrievers and Labradors.

Breeds more likely to be DEA 1.1 negative Breeds more likely to be DEA 1.1 negative are Greyhounds, Boxers, Irish Wolf are Greyhounds, Boxers, Irish Wolf Hounds, German Shepherds, Dobermans, Hounds, German Shepherds, Dobermans, and Pit Bulls.and Pit Bulls.

Some experts suggestthat dogs may

actually have 12 or more blood

types.

Ideal blood Donor isNegative

For DEA 4.

UniversalBlood

Donor isNegative

For DEA 1.1

Universal Dog DonorUniversal Dog Donor

Universal Blood donors test negative for both DEA 1 alleles. Can you remember the numbers associated with this?

These dogs should also test negative for heartworms, Ehrlichia canis, babesia canis and Haemobartonella canis.

Universal DonorUniversal Donor

The blood group of canines synonymous The blood group of canines synonymous with the term “with the term “universal donoruniversal donor” is DEA 1.1 ” is DEA 1.1 and DEA 1.2 negative.and DEA 1.2 negative.

Can my dog donate blood?Can my dog donate blood?

Dogs that test negative for DEA 1.1 can Dogs that test negative for DEA 1.1 can give blood to dogs that are DEA 1.1 give blood to dogs that are DEA 1.1 negative and DEA 1.1 positive. These negative and DEA 1.1 positive. These dogs are considered “universal blood dogs are considered “universal blood donors”.donors”.

Dogs that test positive for DEA 1.1 can Dogs that test positive for DEA 1.1 can only give blood safely to dogs that are only give blood safely to dogs that are DEA 1.1 positive.DEA 1.1 positive.

Universal RecipientsUniversal Recipients

Dogs positive for DEA 1.1 are considered Dogs positive for DEA 1.1 are considered universal recipients. universal recipients.

Do you understand the difference between Do you understand the difference between a donor and a recipient?a donor and a recipient?

Feline Blood GroupsFeline Blood Groups

Feline Blood GroupsFeline Blood Groups

1)1) Blood group A is the most common in Blood group A is the most common in cats overall in the United States.cats overall in the United States.

2)2) Blood group B is common in European Blood group B is common in European breeds. (Devon rex, Abyssinian, British breeds. (Devon rex, Abyssinian, British shorthair)shorthair)

3)3) Blood group AB is rare.Blood group AB is rare. There is no universal feline blood donor.There is no universal feline blood donor. Blood typing and cross-matching should Blood typing and cross-matching should

ALWAYS be performed on cats! Each and ALWAYS be performed on cats! Each and every time!every time!

Cats naturally have antibodies against Cats naturally have antibodies against blood types that they do not have, blood types that they do not have, meaning that mismatched blood can be meaning that mismatched blood can be fatal to them.fatal to them.

Always blood type and crossmatch feline Always blood type and crossmatch feline blood and blood products before blood and blood products before administering. administering.

Do not transfuse canine blood or blood Do not transfuse canine blood or blood products to felines or vice versa. products to felines or vice versa.

Feline Blood GroupsFeline Blood Groups Although transfusing different blood types can be Although transfusing different blood types can be

fatal in cats the following information was taken fatal in cats the following information was taken from an article in the Veterinary Technician from an article in the Veterinary Technician magazine, July 2006.magazine, July 2006.

Type B cats have high anti-A alloantibodiesType B cats have high anti-A alloantibodies Type A cats have weak anti-B alloantibodies, Type A cats have weak anti-B alloantibodies,

meaning that if transfused with B blood they will meaning that if transfused with B blood they will have a mild reaction to the blood and the RBCs have a mild reaction to the blood and the RBCs will have a half-life of 29 to 39 days.will have a half-life of 29 to 39 days.

Type B cats receiving type A blood; RBCs will be Type B cats receiving type A blood; RBCs will be rapidly destroyed within a few minutes to hours. rapidly destroyed within a few minutes to hours. These cats will have severe reactions possibly These cats will have severe reactions possibly followed by death.followed by death.

Type AB cats can receive either A or B blood with Type AB cats can receive either A or B blood with little to no clinical reactions.little to no clinical reactions.

Feline Blood Tying CardsFeline Blood Tying Cards

CrossmatchingCrossmatching

A laboratory test that predicts a transfusion A laboratory test that predicts a transfusion recipient’s response to a donor’s RBCs and plasma recipient’s response to a donor’s RBCs and plasma by detecting any serum (plasma) incompatibility by detecting any serum (plasma) incompatibility between the donor and the recipient.between the donor and the recipient.

This is a two part test.This is a two part test. Dogs do not have naturally occurring antibodies Dogs do not have naturally occurring antibodies

against blood types they lack, like cats do. It is against blood types they lack, like cats do. It is more important to crossmatch than to blood type a more important to crossmatch than to blood type a canine recipient before transfusion. canine recipient before transfusion.

Blood Crossmatching ProcedureBlood Crossmatching Procedure

MAJOR crossmatchMAJOR crossmatchDonor Blood + Donor Blood +

Recipient PlasmaRecipient PlasmaPositive Test=Macro Positive Test=Macro

or Microagglutination or Microagglutination present present (Incompatible)(Incompatible)

Negative Test=Macro Negative Test=Macro or Microagglutination or Microagglutination Absent (Compatible)Absent (Compatible)

MINOR crossmatchMINOR crossmatch Recipient Blood + Recipient Blood +

Donor PlasmaDonor PlasmaPositive Test=Macro Positive Test=Macro

or Microagglutination or Microagglutination present present (Incompatible)(Incompatible)

Negative Test=Macro Negative Test=Macro or Microagglutination or Microagglutination Absent (Compatible)Absent (Compatible)

Step 1 Step 2

MacroagglutinationMicroagglutination with

Rouleaux formation

Healthy red blood cells (upper left) are smooth and round. Hemolytic red blood

cells (lower right).

Major CM: performed to detect antibodies in the recipients serum that may agglutinate

or lyse the donorserythrocytes.

Minor CM: detects antibodiesin the donor plasmadirected against the

recipients erythrocytes.

Auto-Agglutination Saline TestAuto-Agglutination Saline Test

Purpose of test: Is your patient auto-Purpose of test: Is your patient auto-agglutinating. agglutinating.

What does this mean? First, what does What does this mean? First, what does auto mean? What does agglutination auto mean? What does agglutination mean?mean?

Auto-Agglutination Saline TestAuto-Agglutination Saline Test Clumping of red blood cells within a patient’s Clumping of red blood cells within a patient’s

own serum; can be caused by diseases such as own serum; can be caused by diseases such as IMHA formerly known as autoimmune hemolytic IMHA formerly known as autoimmune hemolytic anemia.anemia.

This test is included in the RapidVet-H canine This test is included in the RapidVet-H canine DEA 1.1 test kit. No microscope required!DEA 1.1 test kit. No microscope required!

This test can also be done with a drop of saline This test can also be done with a drop of saline and a drop of blood (unspun from your purple and a drop of blood (unspun from your purple top tube) on a microscope slide. You will need a top tube) on a microscope slide. You will need a microscope as well.microscope as well.

Why do this you may ask? Remember the major Why do this you may ask? Remember the major and minor crossmatch?and minor crossmatch?

Sudden death is unlikely in dogs during Sudden death is unlikely in dogs during blood transfusions but can occur in cats.blood transfusions but can occur in cats.

Blood Collection GuidelinesBlood Collection Guidelines Collection site: jugular vein in Collection site: jugular vein in

cats & dogscats & dogs Can be sedated, but not Can be sedated, but not

necessary in dogs. Sedation is necessary in dogs. Sedation is common in catscommon in cats

Surgical aseptic preparation of Surgical aseptic preparation of the collection site is performedthe collection site is performed

Clean stick and rapid withdrawal Clean stick and rapid withdrawal is preferred due to clottingis preferred due to clotting

Do you need to use some sort of Do you need to use some sort of anticoagulant?anticoagulant?

Read CTVT pgs. 793-796

After the donor dog has been clipped and surgically

prepped, the collection needle is inserted into the

jugular vein.

As blood is collected, it should be mixed gently in a

back and forth motion as seen below.

Administering Blood and/or blood Administering Blood and/or blood productsproducts

Should be gradually warmed to room Should be gradually warmed to room temperature. Never place in a microwave!temperature. Never place in a microwave!

Once a blood container has been opened Once a blood container has been opened it should be used within 24 hours.it should be used within 24 hours.

Use a micropore filter to reduce Use a micropore filter to reduce microemboli.microemboli. ⃠�⃠�

Blood ProductsBlood Products

Whole Blood Whole Blood (FWB=Fresh whole blood, <8 hours (FWB=Fresh whole blood, <8 hours

old)old) (SWB=Stored whole blood, >8 hours (SWB=Stored whole blood, >8 hours

old)old)

Packed Red Blood Cells (pRBCs)Packed Red Blood Cells (pRBCs) Plasma (FFP=Fresh Frozen Plasma (FFP=Fresh Frozen

Plasma)Plasma) Platelet-Rich Plasma (PRP)Platelet-Rich Plasma (PRP) CryoprecipitateCryoprecipitate

CryoprecipitateCryoprecipitate This is the cold, insoluble This is the cold, insoluble

portion (slushy) of plasma that portion (slushy) of plasma that precipitates after FFP has precipitates after FFP has been thawed slowly in the been thawed slowly in the refrigerator. refrigerator.

Cryoprecipitate contains von Cryoprecipitate contains von Willebrand factor, fibrinogen, Willebrand factor, fibrinogen, and factor VIII and is used to and factor VIII and is used to treat this disease as well as treat this disease as well as hemophilia A, and fibrinogen hemophilia A, and fibrinogen deficiencies.deficiencies.

Blood Collection SystemsBlood Collection Systems

This is an example of a “Closed system of blood collection”. The components of blood are spun down but not separated into satellite bags.

This type of system allows for collection, processing, and storage of blood and blood components without exposing them to the environment, therefore reduces the risk of bacterial contamination. This system is most often used with dogs.

The components of blood have been separated and transferred to satellite bags.

WOW:FFP contains coagulation factors and plasma proteins.Long-term plasma can be stored for 4 yrs. at -4º F to -22º F

Open System Disadvantage: blood and blood Open System Disadvantage: blood and blood components are exposed to the environment. This components are exposed to the environment. This type of system is most commonly used in cats and type of system is most commonly used in cats and

often used with dogs.often used with dogs.

Cont. Blood Collection SystemsCont. Blood Collection Systems

Use of glass bottle blood collection Use of glass bottle blood collection systems should be avoided since they are systems should be avoided since they are not closed systems and allow the blood to not closed systems and allow the blood to be exposed to room air. be exposed to room air.

Glass bottles also cause platelet Glass bottles also cause platelet inactivation and clumping on contact with inactivation and clumping on contact with the glass surface. the glass surface.

CTVT pg. 794

Blood and blood products are alwaysadministered slowlyand intravenouslythrough a sterile

blood-administration

kit.

Good general health and temperamentGood general health and temperament 1 to 8 years of age1 to 8 years of age Easily accessible venipuncture siteEasily accessible venipuncture site No infectious diseasesNo infectious diseases No medications (except heartworm or flea No medications (except heartworm or flea

preventatives)preventatives) No history of pregnancyNo history of pregnancy Females must be spayed.Females must be spayed. Annual blood work.Annual blood work.

Donor Guidelines

Ideal Canine Blood DonorsIdeal Canine Blood Donors

50 lbs or more50 lbs or more Medium buildMedium build Disease free/in good Disease free/in good

healthhealth Good temperamentGood temperament Negative for Negative for

heartwormsheartworms Current on vaccinesCurrent on vaccines Minimal PCV of 40%Minimal PCV of 40%

Ideal Feline Blood DonorsIdeal Feline Blood Donors

Disease free/in good Disease free/in good healthhealth

Current on vaccinesCurrent on vaccines Heartworm neg.Heartworm neg. Good temperamentGood temperament 8 lbs or more but not 8 lbs or more but not

overweightoverweight Minimal PCV of 35%Minimal PCV of 35%

Just how much blood can you Just how much blood can you take?take?

10 to 20 ml of blood per kilogram of body 10 to 20 ml of blood per kilogram of body weight may be drawn every 3 weeks from weight may be drawn every 3 weeks from the canine donor.the canine donor.

60 ml can be drawn every 3 weeks 60 ml can be drawn every 3 weeks without excessive stress to the feline without excessive stress to the feline donor.donor.

Some clinics will only allow their donors Some clinics will only allow their donors to donate blood every 4 to 5 weeks.to donate blood every 4 to 5 weeks.

Acute Blood Transfusion ReactionsAcute Blood Transfusion Reactions

• Hyperthermia

• Vomiting

• Tachycardia

• Tachypnea

• Weakness

• Muscle tremors

• Facial swelling

• Agitation

• Vocalizing

• Hypotension

• Hemoglobinemia

• Hemoglobinuria

Although acute reactions are rare, they are considered The most serious!

Food, Water and MedsFood, Water and Meds Because vomiting is a potential Because vomiting is a potential

adverse reaction to a adverse reaction to a transfusion, food, water, and transfusion, food, water, and medications should be withheld medications should be withheld from the patient during the from the patient during the transfusion.transfusion.

Be sure to ask the DVM when Be sure to ask the DVM when food and water can be food and water can be reintroduced to the animal.reintroduced to the animal.

AntihistaminesAntihistamines

Diphenhydramine hydrochloride may be Diphenhydramine hydrochloride may be administered to the patient 30 minutes administered to the patient 30 minutes prior to transfusion to reduce the risk of prior to transfusion to reduce the risk of blood transfusion reactions.blood transfusion reactions.

What is theCommon nameFor this drug?