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Manual of Veterinary Transfusion Medicine and Blood Banking
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Manual of VeterinaryTransfusion Medicine andBlood BankingEDITED BY
Kenichiro Yagi BS, RVT, VTS (ECC, SAIM)ICU Manager
Blood Bank Manager
Adobe Animal Hospital
San Jose, California, USA
Marie K. Holowaychuk DVM, DACVECCCritical Care Vet Consulting
Calgary, Alberta, Canada
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This edition first published 2016 © 2016 by John Wiley & Sons, Inc
Editorial offices: 1606 Golden Aspen Drive, Suites 103 and 104, Ames, Iowa 50010, USAThe Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK9600 Garsington Road, Oxford, OX4 2DQ, UK
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The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended andshould not be relied upon as recommending or promoting a specific method, diagnosis, or treatment by health science practitioners for anyparticular patient. The publisher and the author make no representations or warranties with respect to the accuracy or completeness of thecontents of this work and specifically disclaim all warranties, including without limitation any implied warranties of fitness for a particularpurpose. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of informationrelating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the packageinsert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usageand for added warnings and precautions. Readers should consult with a specialist where appropriate. The fact that an organization or Websiteis referred to in this work as a citation and/or a potential source of further information does not mean that the author or the publisherendorses the information the organization or Website may provide or recommendations it may make. Further, readers should be aware thatInternet Websites listed in this work may have changed or disappeared between when this work was written and when it is read. No warrantymay be created or extended by any promotional statements for this work. Neither the publisher nor the author shall be liable for any damagesarising herefrom.
Library of Congress Cataloging-in-Publication Data
Names: Yagi, Kenichiro, 1977- , editor. | Holowaychuk, Marie K., 1980- ,editor.
Title: Manual of veterinary transfusion medicine and blood banking / [edited by] Kenichiro Yagi, Marie K. Holowaychuk.Description: Ames, Iowa : John Wiley & Sons Inc., 2016. | Includes bibliographical references and index.Identifiers: LCCN 2016009156 | ISBN 9781118933022 (pbk.) | ISBN 9781118933046
(epub)Subjects: | MESH: Blood Transfusion–veterinary | Blood BanksClassification: LCC SF919.5.B55 | NLM SF 919.5.B55 | DDC 636.089/539–dc23 LC record available at http://lccn.loc.gov/2016009156
A catalogue record for this book is available from the British Library.
Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.
Cover image: ©Vladimir Arndt/Gettyimages
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1 2016
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To Dr. Dave Roos, who gave me the opportunity to grow and explore as a veterinary technician and taught me the
importance of being true, and to my second family at Adobe Animal Hospital.
To Nancy Shaffran, who opened my eyes up to the world as a credentialed technician, being kind, and sharing my
passion with the profession, Andrea Steele, who inspired me to call emergency and critical care my specialty, Harold
Davis, who showed me the true meaning of integrity, dedication, and vision, and all of my colleagues who continue
to push the envelope for progress in veterinary technology and nursing.
To Iris, Harumi, Haruto, and Haruka, with your radiant presence I am able to continue reaching for new heights.
Kenichiro Yagi
I am forever grateful to the mentors who guided me, the colleagues who inspired me, the students who challenged
me, the friends and family who encouraged me, and to Faith for being my constant furry companion during endless
hours of writing and editing. Without all of your support this textbook would not have been possible.
Marie K. Holowaychuk
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Contents
Contributors, ix
About the Editors, xi
Preface, xiii
Section I: Introduction to VeterinaryTransfusion Medicine
1 Evolution of Veterinary Transfusion Medicine and
Blood Banking, 3
Marie K. Holowaychuk and Kenichiro Yagi
2 Component Therapy, 13
Julie M. Walker
Section II: Blood Products
3 Red Blood Cell Products, 29
Caroline Kisielewicz
4 Plasma Products, 43
K. Jane Wardrop and Marjory Brooks
5 Platelet Products, 55
Mary Beth Callan and Kimberly Marryott
6 Hemoglobin-Based Oxygen Carrier Solutions, 70
Marie K. Holowaychuk and Thomas K. Day
7 Alternative Plasma Protein Products: Albumin and
Human Immunoglobulin Therapy, 83
Nicole Spurlock
8 Miscellaneous Blood Product Usage, 103
Marie K. Holowaychuk and Kenichiro Yagi
Section III: Blood Product Administration
9 Canine Recipient Screening, 117
Lynel J. Tocci
10 Feline Recipient Screening, 129
Anthony C.G. Abrams-Ogg
11 Transfusion-Associated Complications, 155
Shauna L. Blois
12 Recipient Monitoring, 172
Kenichiro Yagi and Marie K. Holowaychuk
Section IV: Blood Banking
13 Canine Donor Selection, 189
Kenichiro Yagi and Brandee L. Bean
14 Canine Blood Collection, 199
Kenichiro Yagi
15 Feline Donor Selection, 212
Charlotte Russo and Karen Humm
16 Feline Blood Collection, 223
Robyn K. Taylor and Karen Humm
17 Blood Component Processing and Storage, 237
Cheryl L. Mansell and Manuel Boller
Section V: Meeting Blood Product Demands
18 Blood Product Sources, 259
Sally Lester
19 Donor Program Management, 271
Rebecca J. Nusbaum
20 Limiting Allogenic Blood Transfusions, 284
Marie K. Holowaychuk
21 Alternative Transfusion Methods, 296
Sophie Adamantos and Caroline Smith
Section VI: Transfusion Medicine in OtherSpecies
22 Equine Transfusion Medicine, 309
Margaret C. Mudge and Olivia H. Williams
23 Food and Fiber Animal Transfusion Medicine, 321
Brent C. Credille and Kira L. Epstein
24 Avian Transfusion Medicine, 334
Stephen Cital, Angela M. Lennox and Andrea Goodnight
25 Small Mammal Transfusion Medicine, 345
Jody Nugent-Deal and Kristina Palmer
26 Reptile and Amphibian Transfusion Medicine, 358
Stephen Cital and Andrea Goodnight
27 Primate Transfusion Medicine, 366
Stephen Cital, Angela Colagross-Schouten and Laura Summers
Index, 377
vii
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Contributors
Anthony C.G. Abrams-Ogg, DVM, DVSc, DACVIM (SAIM)Professor
Department of Clinical Studies
Ontario Veterinary College
University of Guelph
Guelph, Ontario, Canada
Sophie Adamantos, BVSc, CertVA, DACVECC, DECVECC,MRCVS, FHEAClinician in Emergency and Critical Care
Small Animal Hospital
Langford Veterinary Services
University of Bristol
Langford, North Somerset, UK
Brandee L. Bean, CVT, VTS (ECC)Adobe Animal Hospital
Los Altos, California, USA
Shauna L. Blois, DVM, DVSc, DACVIMAssistant Professor
Department of Clinical Studies
Ontario Veterinary College
University of Guelph
Guelph, Ontario, Canada
Manuel Boller, Dr. Med. Vet., MTR, DACVECCSenior Lecturer
U-Vet Werribee Animal Hospital
Faculty of Veterinary and Agricultural Sciences
University of Melbourne
Werribee, Victoria, Australia
Marjory Brooks, DVM, DACVIMDirector, Comparative Coagulation Section
Department of Population Medicine and Diagnostic Sciences
College of Veterinary Medicine
Cornell University
Ithaca, New York, USA
Mary Beth Callan, VMD, DACVIMProfessor of Medicine
Department of Clinical Studies – Philadelphia
School of Veterinary Medicine
University of Pennsylvania
Philadelphia, Pennsylvania, USA
Stephen Cital, RVT, SRA, RLATDirector of Anesthetic Nursing and Training, United Veterinary Specialty
and Emergency
Veterinary Technician, San Francisco Zoo
San Jose, California, USA
Angela Colagross-Schouten, DVM, MPVM, DACLAMSenior Veterinarian
California National Primate Research Center
Davis, California, USA
Brent C. Credille, DVM, PhD, DACVIMAssistant Professor, Food Animal Health and Management Program
Department of Population Health
College of Veterinary Medicine
University of Georgia
Athens, Georgia, USA
Thomas K. Day, DVM, MS, DACVA, DACVECCEmergency and Critical Care Specialist, Anesthesiologist
Veterinary Emergency Service/Veterinary Specialty Center
Middleton, Wisconsin, USA
Kira L. Epstein, DVM, DACVS, DACVECCClinical Associate Professor
Department of Large Animal Medicine
College of Veterinary Medicine
University of Georgia
Athens, Georgia, USA
Andrea Goodnight, DVMVeterinarian, Oakland Zoo
Associate Veterinarian, CuriOdyssey Science and Wildlife Center
Oakland, California, USA
Marie K. Holowaychuk, DVM, DACVECCCritical Care Vet Consulting
Calgary, Alberta, Canada
Karen Humm, MA, VetMB, CertVA, DACVECC, DECVECC,FHEA, MRCVSLecturer in Emergency & Critical Care
Royal Veterinary College
Queen Mother Hospital for Animals
Hatfield, Hertfordshire, UK
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x Manual of Veterinary Transfusion Medicine and Blood Banking
Caroline Kisielewicz, MVB, CertSAM, DECVIM-CAChestergates Veterinary Specialists
Chester, Cheshire, UK
Angela M. Lennox, DVM, DABVP (Avian & ExoticCompanion Mammal), DECZM (Small Mammals)Senior Veterinarian, Avian and Exotic Animal Clinic of Indianapolis
Section Editor, Journal of Exotic Pet Medicine AEMV
Indianapolis, Indiana, USA
Sally Lester, DVM, MVSc, DACVP (Clinical and Anatomic)Laboratory Director
Pilchuck Veterinary Hospital
Seattle Veterinary Specialists
Seattle, Washington, USA
Cheryl L. Mansell, BMLS, DipVNAustralian Red Cross Blood Service
Melbourne, Victoria, Australia
Kimberly Marryott, CVTManager, Penn Animal Blood Bank
Matthew J. Ryan Veterinary Hospital
University of Pennsylvania
Philadelphia, Pennsylvania, USA
Margaret C. Mudge, VMD, DACVS, DACVECCAssociate Professor
The Ohio State University
Department of Veterinary Clinical Sciences
Columbus, Ohio, USA
Jody Nugent-Deal, RVT, VTS (Anesthesia/Analgesia)(CP - Exotics)Small Animal Anesthesia, Surgery and Neurology Supervisor
University of California Davis
William R. Pritchard Veterinary Medical Teaching Hospital
Davis, California, USA
Rebecca J. Nusbaum, CVT, VTS (ECC)HemoSolutions
Colorado Springs, Colorado, USA
Kristina Palmer, RVT, VTS (CP - Exotics)Companion Avian and Exotic Animal Medicine Supervisor
William R. Pritchard Veterinary Medical Teaching Hospital
University of California Davis
Davis, California, USA
Charlotte Russo, FdSc RVN, Dip AVNBlood Transfusion Nurse
Royal Veterinary College
Queen Mother Hospital for Animals
Hatfield, Hertfordshire, UK
Caroline Smith (Hirst), BVetMed, MVetMed, DACVECC,DECVECC, MRCVSClinician in Emergency and Critical Care
Small Animal Hospital
Langford Veterinary Services
University of Bristol
Langford, North Somerset, UK
Nicole Spurlock, DVM, DACVECCSmall Animal Specialist Hospital
North Ryde, New South Wales, Australia
Laura Summers, DVM, DACLAMFaculty Veterinarian
Carrington College
Stockton, California, USA
Robyn K. Taylor, RVNCritical Care and Transfusion Nurse
The Royal Veterinary College
North Mymms, Hertfordshire, UK
Lynel J. Tocci, DVM, DACVECC, MT(ASCP)SBBDepartment of Emergency and Critical Care
Lauderdale Veterinary Specialists
Fort Lauderdale, Florida, USA
Julie M. Walker, DVM, DACVECCClinical Assistant Professor
Department of Medical Sciences
School of Veterinary Medicine
University of Wisconsin
Madison, Wisconsin, USA
K. Jane Wardrop, DVM, MS, DACVPProfessor
Department of Veterinary Clinical Sciences
College of Veterinary Medicine
Washington State University
Pullman, Washington, USA
Olivia H. Williams, RVTPiedmont Equine Associates
Madison, Georgia, USA
Kenichiro Yagi, BS, RVT, VTS (ECC, SAIM)ICU Manager/Blood Bank Manager, Adobe Animal Hospital
Instructor, Department of Veterinary Technology, Foothill College
Los Altos, California, USA
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About the Editors
Kenichiro Yagi, BS, RVT, VTS (ECC, SAIM)
Kenichiro Yagi is a veterinary technician practicing at Adobe Ani-
mal Hospital in Los Altos, California as an ICU and Blood Bank
Manager. He has established and operates a veterinary blood bank
with a sustained blood donor program and the ability to process
blood components. He is an active educator lecturing internation-
ally and providing practical instruction on site and online, having
written textbook chapters and numerous articles on topics includ-
ing veterinary transfusion medicine, blood banking, respiratory
care, and critical care nursing. He has contributed to the progres-
sion of the veterinary technician profession and emergency and
critical care through his service as a board member for the Vet-
erinary Emergency Critical Care Society as well as the Academy
of Veterinary Emergency and Critical Care Technicians, and as
the State Representative Committee Chairperson of the National
Association of Veterinary Technicians of America. He is also pur-
suing a graduate degree in Biomedical Sciences with an empha-
sis in veterinary medicine and surgery through the University of
Missouri. Ken invites everyone to ask “Why?” to understand the
“What” and “How” of our field, and to constantly pursue new lim-
its as veterinary professionals.
Marie K. Holowaychuk, DVM, DACVECC
Dr. Marie Holowaychuk is a specialist in emergency and critical
care, and is an accomplished speaker, consultant, researcher, and
locum living in Calgary, Alberta, Canada. She grew up in Edmon-
ton, Alberta and after two years of pre-veterinary medicine at the
University of Alberta, she entered veterinary school at the Western
College of Veterinary Medicine at the University of Saskatchewan.
She received her Doctor of Veterinary Medicine in 2004 and then
completed a yearlong rotating internship in small animal medicine
and surgery at Washington State University. Thereafter, she com-
pleted a three-year small animal emergency and critical care
residency at North Carolina State University. After becoming
board certified in 2008, she was Assistant Professor of Emergency
and Critical Care Medicine at the Ontario Veterinary College for
five years until she moved home to Alberta. Dr. Holowaychuk
has been primary or co-author of over 25 manuscripts published
in peer-reviewed journals and is also an Assistant Editor for the
Journal of Veterinary Emergency and Critical Care.
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Preface
The practice of transfusion medicine and blood banking has grown
enormously during the past decade and this has created a demand
for a comprehensive guide to the discipline. There are hundreds of
publications in the veterinary literature pertaining to this subject
area, with new studies being made available each month. Despite
the rapidly increasing amount of information available, a textbook
dedicated to this topic has not previously been published. While
there are chapters in textbooks dedicated to the practice of trans-
fusion medicine or blood banking, no references focus solely on
this important subject area. Likewise, resources usually pertain to
dogs and cats, with little information applicable to food animals,
horses, or exotic pets.
We recognized the need to fill the gap and communicate
best practices by providing a manual of veterinary transfusion
medicine and blood banking. Both of us have a strong interest
in transfusion medicine, as well as clinical and research experi-
ence with blood banking. We eagerly accepted the challenge of
providing an evidence-based resource that brings information
regarding all species and aspects of transfusion medicine and
blood banking together in one place. We compiled this textbook
with the goal of providing a resource that would be helpful for
veterinary professionals working in academic, referral, or gen-
eral practice, as well as technicians and residents preparing for
specialty certification exams. Whenever possible, authors used
recent peer-reviewed veterinary (and sometimes human) journal
articles and supplemented with other resources or anecdotal
experience when peer-reviewed information was lacking. Over-
all, we feel the result is a practical and thorough presentation of
the current knowledge of veterinary transfusion medicine and
blood banking.
We are also aware that the disciplines of transfusion medicine
and blood banking are very reliant on a veterinarian-technician
team. As such, we proudly co-edited this textbook as a
veterinarian and technician team. Similarly, many of our chapters
are co-written by a veterinarian and technician. We both person-
ally learned a great deal from these different perspectives and feel
that this insight from all members of the group that would be par-
ticipating in blood banking or transfusion administration within
the hospital is beneficial. This textbook contains evidence-based
descriptions of theory and practical step-by-step procedures per-
taining to blood products, blood product administration, blood
banking, and meeting blood product demands. While most of
these sections pertain to small animals, additional chapters focus
on large animals and exotic pets in the section on transfusion
medicine in other species.
Probably the most challenging aspect of writing this textbook
was staying current with all of the literature in the field of veteri-
nary transfusion medicine and blood banking during the editing
process. We finally had to forego our concern that we would
miss the opportunity to include groundbreaking research and
submit the content for publication. In the meantime, we found
ourselves adding new publications right up until the point of
submission. Even so, we recognize that knowledge gaps exist, and
the most up-to-date information will still come from the most
recently published literature and that new and exciting research
will need to be included in future editions of the textbook. We
welcome any suggestions, ideas, or corrections that should be
incorporated into new editions that we look forward to providing
in the not-too-distant future.
We would like to thank the Wiley-Blackwell editorial team
for responding to our endless emails and supporting us through-
out this endeavor. We also gratefully acknowledge our authors
without whose contributions this textbook would not have been
possible.
Marie K. Holowaychuk and Kenichiro Yagi
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SECTION I
Introduction to Veterinary TransfusionMedicine
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1 Evolution of Veterinary Transfusion Medicineand Blood BankingMarie K. Holowaychuk1 and Kenichiro Yagi21 Critical Care Vet Consulting, Calgary, Alberta, Canada2 Adobe Animal Hospital, Los Altos, California, USA
Introduction
From ancient times to the modern day, knowledge of transfusion
medicine and blood banking has advanced from blood existing
as a spiritual fluid of vitality to it being a lifesaving therapeutic
resource used on a regular basis. The most significant advance-
ments in transfusion medicine have been made during the past
200 years, with veterinary transfusion medicine becoming a
specialized area of interest for the past few decades. Transfusion
medicine has progressed from fresh whole blood transfusions
to targeted component therapy, with veterinary professionals
performing transfusions in small, large, and exotic animals. Pro-
viding a safe and reliable blood product with availability that
meets demands is now an emerging focus, as new knowledge
cautions practitioners that transfusions, even when properly
administered, can be harmful to patients.
Advancements in veterinary transfusion medicine include
blood typing, compatibility testing, laboratory diagnostics to
determine whether a transfusion is indicated, proper admin-
istration and dosage of blood products, as well as prevention,
monitoring, and treatment of transfusion-associated compli-
cations. Veterinary blood banking has progressed from whole
blood collection on an emergency basis with minimal regard to
pre-transfusion compatibility testing, to the collection, storage,
and processing of blood components and transfusion only after
suitable recipient screening. This has led to the establishment of
commercial blood banks and processing of blood products using
specialized equipment, with evidence-based guidelines regarding
donor screening. Additional advancements include methods to
maximize the limited donor pool and awareness of storage lesions,
as well as safety measures such as leukoreduction. Professional
organizations such as the Veterinary Emergency and Critical Care
Society (VECCS), American College of Veterinary Emergency and
Critical Care (ACVECC), American College of Veterinary Internal
Medicine (ACVIM), and American College of Veterinary Anes-
thesia and Analgesia (ACVAA), among others, actively pursue
advancement of knowledge in the field of veterinary transfusion
medicine and blood banking. Veterinary transfusion medicine
as a specialty area of knowledge is growing, as seen through
the re-emergence of efforts to establish sustainable organiza-
tions such as the International Association of Veterinary Blood
Manual of Veterinary Transfusion Medicine and Blood Banking, First Edition. Edited by Kenichiro Yagi and Marie K. Holowaychuk.© 2016 John Wiley & Sons, Inc. Published 2016 by John Wiley & Sons, Inc.
Banks (IAVBB), the Association of Veterinary Hematology and
Transfusion (AVHTM), and the proposed Academy of Veterinary
Transfusion Medicine Technicians (AVTMT). Veterinary transfu-
sion medicine is a discipline in its own right and will continue to
play a vital role in veterinary medicine in an effort to improve
patient care.
History of transfusion medicine
Ancient knowledgeEarly practices and customs relating to the blood of ancient
days include people drinking the blood of fallen gladiators to
gain strength, religious figures attempting to heal themselves
by drinking blood from the youth, and doctors inducing hem-
orrhage to let out “bad blood” due to the belief that blood was
one of the four fundamental humors of Hippocratic medicine
and blood-letting would bring balance to the humors and restore
health (Greenwalt 1997). Early practices were often influenced
by religion and superstition, as well as innate emotions and fears
elicited by the sight of blood. People believed blood was the
key to vitality, even though the discovery and description of the
circulatory system did not occur until the 17th century.
Early conceptsIt is unclear who first conceived the idea of blood transfusions.
Hieronymus Cardanus (1505–1576) is given credit in some litera-
ture, while Magnus Pegelius obtained the right to publish on the
topic under Emperor Rodolphus II’s rule in 1593. Andreas Libav-
ius was the first person clearly documented in history to advocate
for blood transfusions; he recorded his thoughts on using a silver
tube to connect the arteries of two individuals to allow blood from
the young man to “pour” into the artery of the old man. However,
there is no evidence indicating that transfusions were performed
by Libavius (Greenwalt 1997).
Following William Harvey’s description of the circulatory sys-
tem, Francesco Folli of Florence published the first book on trans-
fusions stating that transfusions could be used to treat illness and
rejuvenate aged men. However, Folli stated in the book that that
he had never performed a transfusion with the apparatus that he
described was needed for the procedure (Greenwalt 1997).
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4 Manual of Veterinary Transfusion Medicine and Blood Banking
Figure 1.1 A portrait of Richard Lower, a physician who performed the firstreported animal-to-animal transfusion. (Public domain.)
First animal-to-animal transfusionRichard Lower (1631–1691) performed the first successful
animal-to-animal transfusion in February 1665; previous to
this he had years of failed attempts due to clotting in the tubes
(Figure 1.1). Lower used a medium-sized dog and exsanguinated
it until “its strength was nearly gone”, and then connected the
cervical arteries of two large mastiffs to the jugular vein of the
exsanguinated dog. The recipient in the experiment was “ap-
parently oblivious to its hurts” and “soon began to fondle its
master and to roll on the grass to clean itself of blood”, indicating
his first successful attempt to use a blood transfusion as a form
of resuscitation. While Lower’s report was published in 1666,
Jean-Baptiste Denis (1635–1704) also claimed to have performed
the first successful animal-to-animal transfusion; unfortunately,
his report was delayed from publication for a year due to the
imprisonment of the editor of the publication (Greenwalt 1997).
First animal-to-human transfusionsWhile similar uncertain claims to the first human transfusion have
been made, Jean-Baptiste Denis is believed to have performed the
first animal-to-human transfusions. He performed a transfusion of
lamb blood to a 15-year-old child who was suffering from a per-
sistent fever; the child was reported to have “a clear and smiling
countenance” after the transfusion. Denis also performed a trans-
fusion to the son of the Prime Minister of Sweden (Baron Bond),
without successfully curing him, and to others without complica-
tions (Greenwalt 1997).
Lower, who had performed the first animal-to-animal transfu-
sion, also performed an animal-to-human transfusion in 1667 to
Figure 1.2 A depiction of an animal-to-human transfusion performed inthe 1600s. (Wellcome Library, London. Boutesteyn Leyden 1692. CreativeCommons.)
Arthur Coga, who was described as a “harmless lunatic” and “ec-
centric scholar” at Pembroke College. He received a transfusion
from the artery of a sheep and was reported to have “found him-
self well” afterwards.
The most notable report of an animal-to-human transfusion
was on 19 December 1667, when Denis treated a patient named
Antoine Mauroy, a 34-year-old newlywed husband who ran away
to Paris to spend time indulging in sensual pleasures (Figure 1.2).
Denis thought that a transfusion of calf blood would help calm
Mauroy’s urges due to the gentle nature of calves. The transfusion
was reported to improve Mauroy’s issues, making him quieter. The
procedure was repeated several days later, but that time Mauroy
experienced burning in his arm, pain over his kidneys, and tight-
ness in his chest. A day later, he exhibited bleeding from his nose
and dark urine. This signifies the first report of a severe transfusion
reaction, likely acute hemolysis. Mauroy’s wife insisted that Mau-
roy be treated a third time 2 months later when he was exhibiting
similar behavior, but Mauroy did not comply. He died the follow-
ing night without receiving the transfusion. Mauroy’s wife was
bribed by Denis’ enemies to state that a transfusion killed her
husband, leading to Denis’ trial for manslaughter, for which he
was exonerated. Rumors suggest that Mauroy’s wife poisoned him
with arsenic, although the truth is unknown (Farr 1980).
Because of Denis’ experiences in France, his enemies were able
to instate the Edict of Châtelet, effectively banning transfusion
practices in France. It is likely that the magistrates in Rome and
the Royal Society also enacted similar bans, therefore while some
experimental transfusions were performed in other parts of the
world, advancements in transfusion medicine were halted for the
next 150 years (Greenwalt 1997).
18th and 19th centuriesDuring the 18th century, the value of transfusions in patients with
severe wounds and hemorrhage was revealed. In 1749, a member
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Chapter 1: Evolution of Veterinary Transfusion Medicine and Blood Banking 5
Figure 1.3 A portrait of James Blundell, a physician who performed thefirst reported human-to-human transfusion. (Public domain: The NationalPortrait Gallery, Volume II, 1820.)
of the Faculty of Paris named Cantwell stated that transfusions
should not be forbidden in desperate situations. In 1788, Michele
Rosa published is findings that animals in severe shock required
whole blood instead of serum for successful resuscitation.
During the 19th century, James Blundell (1790–1877), who
had witnessed many women die from postpartum hemorrhage,
performed experiments with animals in preparation for transfu-
sions to his patients (Figure 1.3). He limited his patients receiving
transfusions to those suffering from severe hemorrhage and
applied the knowledge gained by John Leacock on the apparent
harm of xenotransfusions (transfusion of blood from a different
species), thus attempting human-to-human transfusions. While
the archives are somewhat contradictory regarding the number
of successful cases, records show that in 1829 Blundell was
able to successfully save a 25-year-old woman with postpartum
hemorrhage by transfusing blood from one of the surgical team
members. The blood transfusion was performed with a brass
syringe, although Blundell later developed an instrument called
the “impellor”, a funnel-like apparatus that was used well into the
late 19th century (Figure 1.4). While Blundell voiced his opinion
against the transfusion of animal blood to human patients, the
practice remained prevalent as transfusion therapy returned to
medical practice. However, reports of transfusions were rare,
likely due to the fact that blood clotting was a common limitation
in performing transfusions (Greenwalt 1997).
Blood groups discoveredIn the late 1800s there was significant work done by various
physicians to study the effects of transfusions between differ-
ent species. In 1874, Ponfick presented his findings of residues
from lysed red blood cells (RBCs) in a patient who died after
receiving a transfusion from a sheep. Ponfick also observed
detrimental physical effects including respiratory distress, defe-
cation, and convulsions, as well as post-mortem findings such
as dilated hearts, pulmonary and serosal hemorrhage, enlarged
and congested kidneys, and hemorrhage of the liver in dogs,
cats, and rabbits receiving sheep blood. Ponfick also described
Figure 1.4 A section of the impellor device developed by James Blundell for blood transfusions. (Wellcome Library, London. Creative Commons.)
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6 Manual of Veterinary Transfusion Medicine and Blood Banking
the accumulation of hematin in the renal tubules of surviving
animals that developed kidney insufficiency. Ponfick’s findings
were consistent with Panum, Landois, and Euhlenberg’s findings
suggesting that adverse outcomes could be seen with transfusions
between different species, secondary to hemolysis, kidney injury,
and hyperkalemia (Greenwalt 1997).
In the 1800s, human-to-human transfusions were performed
with a reasonable degree of success, frequently without signs of
adverse reactions. This is probably because ABO incompatibilities
in the general Caucasian population were only anticipated in
one-third (35.6%) of randomly paired individuals (Greenwalt
1997). Nevertheless, there were still significant numbers of
human-to-human transfusions resulting in fatal complications,
which could not be explained by the work of Ponfick and oth-
ers investigating inter-species transfusions (Greenwalt 1997).
It was not until Landsteiner demonstrated agglutination using
the serum from healthy humans mixed with another human’s
blood that the concept of blood groups (A, AB, B, and O) was
established, which led to advancements in compatibility testing
using assessments for agglutination (Landsteiner 1961). In 1910,
von Dungern and Hirszfeld published a report on the inherited
nature of blood groups; the practice of exclusively using O donors
for transfusions began in the 1930s (Greenwalt 1997).
Advent of anticoagulationThe impellor was the tool designed by Blundell and used for
transfusions until the 20th century. Another cannula device
was devised by Crile in an effort to prevent blood clotting; it
enabled the temporary joining of the recipient’s vein and donor’s
artery, although it took significant surgical skill and strong donor
will to accomplish this procedure. Other methods of transfusion
included using paraffin to line the blood collection container,
defibrinating the blood, and transfusing the non-clotted portion
of blood (Greenwalt 1997).
Various anticoagulants were also studied in an effort to make
the transfusion process more feasible, including the use of
sodium phosphate by the well-known Braxton-Hicks, but none
of his four patients receiving transfusions survived. Ammonium
sulfate, sodium bicarbonate, sulfarsenol, ammonium oxalate,
arsphenamine, sodium iodide, sodium sulfate, and hirudin
(extracted from leeches) were all anticoagulant compounds
investigated and reported by various physicians in the 19th and
20th centuries. In 1890, Nicolas Maurice Arthus reported that
sodium citrate was able to permanently keep blood in liquid form,
but it was not until 1915 that the invention of sodium citrate
for blood transfusion was officially claimed. In 1955, Lewisohn
was awarded the American Association of Blood Banks (AABB)
Landsteiner Award for producing the first sodium citrate solu-
tion in a vial. Citrate was initially blamed as a cause of febrile
non-hemolytic transfusion reactions, which were later deter-
mined to be the result of endotoxin from bacterial contamination
(Greenwalt 1997).
Concept of blood bankingWhile blood mixed solely with 3.8% sodium citrate exhibited
hemolysis after 1 week of storage, a mixture of blood, sodium
citrate, and dextrose did not demonstrate hemolysis for 4 weeks.
During World War I, Oswald H. Robertson established the first
blood bank at the United States Army Base Hospital No.5 by
using collection sets that were autoclaved and designed to collect
up to 800 mL of blood into 160 mL of 3.8% sodium citrate. In
1937, an article written by Bernard Fantus at the Cook County
Hospital in Chicago describes collecting 500 mL of blood into
70 mL of 2.5% sodium citrate into a chilled flask, then stor-
ing it under refrigeration at 4–6 ∘C. This became known as the
first blood bank, which stored blood for 4–5 days (McCullough
2012).
While dextrose solutions were known to increase the stor-
age time of RBCs, maintaining sterility was still an issue due
to caramelizing of the dextrose solution during autoclaving of
the collection system. In the 1940s, acid-citrate dextrose (ACD)
solutions were developed; the addition of acidic forms of sodium
citrate prevented caramelization, which allowed extension of
storage of RBC products to 21 days (Greenwalt 1997).
As the potential storage time for RBCs increased, concerns
regarding RBC metabolism during storage arose. It was already
recognized that 2,3-diphosphoglycerate (2,3-DPG) was a sub-
stance present in RBCs, even though its role in oxygen binding
was not yet elucidated. The level of 2,3-DPG was also observed
to be lower in more acidic environments, leading to the devel-
opment of citrate-phosphate-dextrose (CPD) solutions in 1947.
These solutions raised the pH to 5.6 and the addition of phos-
phate resulted in better preservation of 2,3-DPG. By 1960, the
introduction of additive solutions containing adenine increased
the storage time (Nakao et al. 1960) and the RBC survival
time was extended to 42 days (Simon et al. 1962). This vastly
improved the ability to store RBCs instead of using fresh whole
blood.
Plasma component useThe introduction of plasma component therapy occurred during
World War II, mainly for the treatment of shock. Edwin J. Cohn
and his colleagues developed the method of fractionation, thus
enabling the use of human albumin and plasma as resuscitation
fluids. Cohn’s methods continue to be used today, with some mod-
ifications (Greenwalt 1997).
Invention of plastic bags and componentprocessingThe patent for plastic containers for blood component therapy was
filed by Carl Walter in 1950, which led to the development of
component separation and transfusions that otherwise would not
have been possible. The American Red Cross Blood Program expe-
rienced an increase in the use of packed red blood cells (PRBCs)
from 0.8% to 88% of reported transfusions between 1967 and
1978 with the implementation of multi-chambered plastic bags
connected by tubing (Greenwalt 1997). Baxter Corporation com-
mercialized the invention with the Fenwal division (named partly
after “Wal”ter), which later became its own company. The abil-
ity to separate plasma from RBCs led to the abundant supply of
plasma and production of plasma protein concentrates, as well as
the ability to produce platelet concentrates.
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Chapter 1: Evolution of Veterinary Transfusion Medicine and Blood Banking 7
Plasma protein concentratesIn 1965, Judith Pool discovered that fresh frozen plasma (FFP)
thawed at refrigeration temperatures would allow coagulation
factor VIII to remain precipitated, leading to the administration of
high concentrations of factor VIII to hemophilia patients during
cryoprecipitate transfusions (Pool and Shannon 1965). In addi-
tion, Edwin Cohn developed the technique of creating factor VIII
concentrates through fractionation, allowing for home storage of
factor VIII in refrigerators and self-administration of factor VIII by
hemophilia patients.
PlateletsThe advent of multi-chambered plastic bags allowed for the sepa-
ration of platelets into concentrates. The National Cancer Institute
played a major role in investigating the use of platelet concen-
trates for the treatment of thrombocytopenia during the 1960s
(McCullough 2012). Methods of preparing platelet concentrates
and performing transfusions were established and reduced mor-
tality rates in oncology patients with thrombocytopenia. The lifes-
pan of platelet concentrates was initially a limitation as they were
only viable for several hours, although Murphy and Garner estab-
lished that they could be stored for several days at room temper-
ature, which vastly improved the ability of platelets to be used as
a transfusion product (Murphy and Gardner 1969).
ApheresisJack Latham developed the concept of separating blood com-
ponents and selectively extracting the portions necessary for
treatment, and established a semi-automated system for plasma-
pheresis (McCullough 2003). More recent improvements have
allowed the separation and extraction of platelets, as well as
leukocytes. Plasmapheresis is currently being investigated for its
ability to remove antibodies and toxins (Crump and Seshadri
2009; Khorzad et al. 2011; Nakamura et al. 2012). Plateletpheresis
continues to be a method of collection for platelet concentrates.
LeukoreductionAs fractionation of components into RBCs, platelets, and plasma
became more common, the white blood cells (WBCs) that
remained were considered residual in nature. WBCs cause febrile
non-hemolytic reactions, transfusion-related immunomodula-
tion, and can aid the transmission of specific viruses (Zimring et al.
2009). In the 1980s, methods of filtration by passing collected
blood through a membrane were developed and termed “filter
leukoreduction”. This method is used in the majority of human
blood banks today to reduce transfusion-related complications.
Development of apheresis also led to the harvesting of com-
ponents that do not contain leukocytes and is termed “process
leukoreduction” (Zimring 2009).
The veterinary fieldWhile the first experimental animal-to-animal transfusion was
performed prior to transfusions between animals and humans,
the development of veterinary transfusion medicine and blood
banking is relatively recent. The first commercial veterinary blood
banks were established in the late 1980s and more blood banks
exist now than ever before. Many of the same concepts found
in human transfusion medicine are employed in the veterinary
field, with progressively larger numbers of veterinary studies
being performed and findings presented to refine the practice of
veterinary transfusion medicine.
Current veterinary transfusion and bloodbanking practices
Despite how common the practice of administering blood prod-
ucts has become in veterinary clinics worldwide, there is a
remarkable lack of information regarding the transfusion prac-
tices used. While studies have been published documenting
transfusion-related complications such as transfusion reactions,
organ injury, or coagulopathies, little has been described in
the literature as to how veterinary professionals are actually
administering blood products or taking steps to ameliorate the
consequences of transfusions. Comparatively, even less informa-
tion is available describing the current use of veterinary blood
donors. The little veterinary information published in this regard
is in the form of surveys. While these surveys have selection bias
and do not represent the views of the entire veterinary field,
they function to provide some insight as to current veterinary
transfusion practices.
Surveys on veterinary transfusion medicineand blood bankingThe first survey documenting transfusion practices was published
more than 20 years ago and included responses from 25 small ani-
mal clinics geographically stratified across the United States. It was
a telephone survey that asked questions to exclusively small ani-
mal practices performing at least six canine blood transfusions per
year. The survey responses revealed that the primary source of
donor blood was from a “borrowed dog” at 48% of practices, an
“in-house dog kept on the premises” at 48% of practices, and a
“nearby veterinary school” at one practice. Two-thirds of practices
performed infectious disease screening of blood donors and eval-
uated hematologic variables prior to donation, but only one-third
determined the donor blood type. None of the practices reported
blood typing recipients, but this survey was performed prior to
the availability of in-hospital dog erythrocyte antigen (DEA) 1
blood-type tests. Approximately half of the practices surveyed did
not recover the costs of the transfusion, which was considered a
“lifesaving measure” in 80% of cases (Howard et al. 1992).
Two decades later, a web-based survey was performed, which
compiled information regarding blood donor and transfusion
practices from 20 veterinary teaching hospitals and 53 private
referral hospitals located in the United States, Canada, Europe,
and Australia. This survey reflects the practice of a select number
of specialty hospitals performing blood transfusions, as only
emergency and critical care or internal medicine specialists (not
general practitioners) were surveyed (Jagodich and Holowaychuk
2016). However, the information collected provides an idea of
what the current transfusion and blood banking practices are
amongst some veterinary hospitals worldwide, demonstrating
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8 Manual of Veterinary Transfusion Medicine and Blood Banking
how much transfusion practices have changed since the previous
survey, performed more than 20 years earlier.
Current veterinary transfusion practicesThe survey performed in 2012 provides information on transfu-
sion practices used in specialty veterinary hospitals with regards
to the blood products stored and/or administered, as well as
recipient screening. PRBCs and FFP were the most frequently
reported canine and feline blood products routinely purchased or
collected by hospitals (Table 1.1), confirming a shift in transfusion
practice from the collection and administration of whole blood
to the routine use of component blood products (Jagodich and
Holowaychuk 2016). This is in stark contrast to earlier transfusion
practices as only 16% of previously surveyed small animal hos-
pitals reported separating canine whole blood into components
(Howard et al. 1992). Likewise, 96% of hospitals reported blood
typing or crossmatching canine and feline recipients prior to
blood product administration (Jagodich and Holowaychuk 2016),
which is likely a reflection of the increase in knowledge and
understanding of safe transfusion practices, as well as the avail-
ability of cage-side blood type kits, which were not available
decades prior when routine recipient typing was not performed
(Howard et al. 1992).
Current veterinary blood banking practicesThe 2012 survey also provides information regarding the
blood banking practices used in specialty veterinary hospi-
tals, specifically concerning blood donor selection and screening.
Approximately 50% of respondents reported using a combina-
tion of purchased blood products and hospital-run blood donor
Table 1.1 Percentage of surveyed hospitals that reported how frequently they purchased or collected differentcanine and feline blood products (Jagodich and Holowaychuk 2016).
Purchased Canine Feline
Blood product Never Rarely Occasionally Routinely Never Rarely Occasionally Routinely
FWB 45 55 0 0 59 29 6 6
SWB 90 5 5 0 65 18 18 0
PRBC 0 0 0 100 6 0 18 82
FFP 0 0 0 100 6 0 29 71
CP 25 45 25 5 – – – –
PC 40 45 5 10 – – – –
PRP 45 35 15 5 – – – –
LCP 60 25 10 5 – – – –
Lalb 55 25 25 0 – – – –
HBOC 70 25 0 5 82 18 0 0
Collected Canine Feline
Blood product Never Rarely Occasionally Routinely Never Rarely Occasionally Routinely
FWB 5 25 42 28 0 25 20 55
SWB 47 21 21 11 63 9 9 19
PRBC 40 2 6 52 66 6 6 22
FFP 42 2 6 50 67 6 6 21
CP 77 11 6 6 – – – –
CPP 77 13 4 6
PC 40 45 5 10 – – – –
PRP 70 13 15 2 – – – –
CP, cryoprecipitate; CPP, cryopoor plasma; FFP, fresh frozen plasma; FWB, fresh whole blood; HBOC, hemoglobin-based oxygen
carrier; Lalb, lyophilized albumin; LCP, lyophilized cryoprecipitate; PC, platelet concentrate; PRBC, packed red blood cells; PRP,
platelet-rich plasma; SWB, stored whole blood.
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Chapter 1: Evolution of Veterinary Transfusion Medicine and Blood Banking 9
programs to provide canine blood products, whereas 19% of hos-
pitals provided canine blood products using hospital-run blood
donor programs only. The majority (85%) of those hospitals
reported routinely using staff-owned dogs as blood donors with
fewer respondents (53%) using client-owned dogs. Only 11%
of hospitals reported having a colony of canine donors in the
hospital (Jagodich and Holowaychuk 2016). These results differ
substantially from previously reported practices, which rarely pur-
chased blood products and more commonly used in-house dogs
(Howard et al. 1992). The change over the years is likely due to
the development of commercial blood banks and a shift in ethical
beliefs regarding keeping in-hospital colonies of donor dogs.
Infectious disease screening of canine blood donors was rou-
tinely performed at 94% of hospitals with a hospital-run blood
donor program and 53% reported blood typing canine donors for
DEA 1 (Jagodich and Holowaychuk 2016). This also represents an
increase in diligent blood donor screening compared to that which
was reported previously, likely due to an improvement in knowl-
edge and understanding regarding safe transfusion practices.
While feline blood donor practices have not been previously
reported, the survey performed revealed that similar to dogs, half
of all hospitals obtained blood products from a combination of pur-
chased blood products and hospital-run blood donor programs,
whereas 26% reported obtaining feline blood products using only
a hospital-run blood donor program. Staff-owned cats were used
by 73% of hospitals, compared to 40% of hospitals that reported
having a colony of feline donors and 36% using client-owned
cats. Routine screening of feline blood donors for infectious dis-
eases was reported by 98% of survey respondents (Jagodich and
Holowaychuk 2016). These findings demonstrate a slight differ-
ence in thought with regards to using colony feline versus canine
donors, but a high diligence with regards to enforcing safe trans-
fusion practices.
Advancements in veterinary transfusionmedicine
Several advancements have been made in the field of veterinary
transfusion medicine during recent years and will continue to be
made as more well-designed research studies are published. A
PubMed search using the terms “transfusion”, “veterinary”, and
“dog or cat” yielded 426 publications in the field of small animal
transfusion medicine between 1965 and 2015 (Figure 1.5). Of
these publications, 161 were published within the last 10 years. It
seems that whereas studies used to be sparse, articles pertaining
to veterinary transfusion medicine are now being published on
a routine basis. Likewise, there has been a shift towards more
prospective studies rather than case reports or retrospective
investigations. All of these publications have served to enhance
knowledge in the field of veterinary transfusion medicine and
encourage an evidence-based approach to transfusion practices.
Evidence-based guidelinesThe evidence-based approach to formulating veterinary transfu-
sion guidelines has culminated in the publication of a consensus
statement by the ACVIM regarding blood donor screening. This
00
50
100
150
200
1965–1974 1975–1984 1985–1994
Year
1995–2004 2005–2014
Num
ber
of p
ublic
atio
ns
Figure 1.5 Graphical depiction of the number of veterinary publicationsrelated to transfusion medicine in dogs or cats.
consensus statement was drafted by a group of experts in the
field of veterinary infectious disease and blood banking, and was
first published more than 10 years ago (Wardrop et al. 2005). As a
testament to the quickly growing body of research in the field of
transfusion medicine, these guidelines were re-drafted and a
preliminary view was provided at the ACVIM Forum in June
2015. The final recommendations were not published at the time
of writing, but are anticipated to be published in 2016. Changes
will likely reflect our increasing knowledge of infectious disease,
including adjusted screening for feline leukemia virus (i.e., provi-
ral DNA PCR testing) in cats, as well as banking samples from
donors to allow retroactive testing.
The IAVBB is in the process of drafting and publishing veteri-
nary blood banking standards modeled after guidelines provided
by the AABB in the human field. These guidelines are expected
to cover important details regarding the operation of a veterinary
blood bank, such as the organizational structure, blood banking
resources, equipment standards, supplier and customer issues,
process control and improvement, documentation, facility stan-
dards, and safety. Without a doubt these guidelines will be the
first of many to be published guiding veterinary transfusion and
blood banking practices in the future.
Blood typing and recipient screeningSeveral advancements have also been made with regards to blood
typing and recipient screening in dogs and cats. Whereas blood
typing was previously only available at commercial laboratories
and almost never performed at veterinary hospitals, the use of
in-hospital blood type tests has become commonplace. This has
served to improve the safety of blood transfusions administered in
veterinary practice and likely has also enhanced the comfort level
of practitioners administering blood products. Continued develop-
ments in this field have also improved typing methods, resulting
in the availability of new canine and feline blood typing cartridges
that use immunochromatographic test strips. Unlike agglutina-
tion card tests, the results of immunochromatographic tests can
be interpreted even when auto-agglutination is present (Seth et al.
2012).
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10 Manual of Veterinary Transfusion Medicine and Blood Banking
Other advancements in the field of blood typing include the
discovery of new RBC antigens, including canine Dal and feline
Mik (Blais et al. 2007; Weinstein et al. 2007). The detection of
these antigens has changed recommendations with regards to
donor and recipient screening, given that these antigens are not
tested for by conventional blood typing methods. As such, some
believe that all dogs and cats should routinely have a crossmatch
performed prior to transfusions in order to maximize the poten-
tial to detect any incompatibilities not detected by conventional
blood typing methods. This recommendation is emphasized by a
recent study determining that feline red cell transfusion recipients
that were blood type and crossmatch compatible had a higher
post-transfusion increase in packed cell volume, compared to cats
that were not crossmatched (Weltman et al. 2014).
The nomenclature of canine blood types has also recently
changed, as it was discovered using flow cytometry that the DEA
1.2 and 1.3 blood types, which were previously thought to be
different alleles, are likely a variation in the strength of mono-
clonal antibodies to DEA 1.1 (Acierno et al. 2014). Therefore, the
nomenclature of DEA 1.1, 1.2, and 1.3 has become obsolete and
is now described simply as DEA 1. This has already been reflected
in a blood-type kit manufacturer’s decision to rename the kit DEA
1, previously DEA 1.1 (DEA 1 Quick Test, Alvedia, France).
Transfusion triggersModification of the traditional transfusion triggers of 30/10
(packed cell volume 30%/hemoglobin 10 g/dL [100 g/L]) has
occurred in human transfusion medicine in light of a multitude
of studies demonstrating that a more conservative transfusion
strategy (i.e., transfusing at a lower hemoglobin) is equal, if not
superior, to the traditional and more liberal transfusion strategies
(Carless et al. 2010). While research into the use of transfusion
triggers is lacking in veterinary medicine, a scoring system has
been developed to assist veterinarians in determining when a
RBC transfusion might be warranted in anemic dogs (Kisielewicz
et al. 2014). This score will likely guide veterinarians with less
experience giving transfusions to more objectively determine
when a transfusion might be warranted and also function to
stratify patients being enrolled in future prospective transfusion
studies.
Storage and administration of blood productsA relatively large number of studies investigating the effect of stor-
age conditions and administration methods on the viability of vet-
erinary blood products have been published in recent years. These
include studies investigating various freeze-thaw conditions and
storage temperatures on the activity of clotting factors in canine
plasma products (Yaxley et al. 2010; Grochowsky et al. 2014; Wal-
ton et al. 2014; Pashmakova et al. 2015), as well as the impact of
syringe or fluid pump administration methods on red blood cell
viability (McDevitt et al. 2011; Heikes and Ruaux 2014). These
studies, while experimental in nature, have improved our knowl-
edge and understanding of the potential impact of storage, thaw-
ing, and administration methods on blood product viability and
have immediate potential for clinical application.
Storage lesions and leukoreductionInterest in storage lesions and the impact of the age of blood prod-
ucts on patient morbidity and mortality has recently increased
(Obrador et al. 2015), along with research investigating the ben-
eficial effects of pre-storage leukoreduction (McMichael et al.
2010; Graf et al. 2012; Herring et al. 2013; Corsi et al. 2014; Smith
et al. 2015). There are also veterinary studies documenting the
negative impact of administering older stored blood compared to
blood stored for a shorter duration of time (Hann et al. 2014),
while a clinical reduction in adverse effects associated with
the use of leukoreduction filters has yet to be documented. As
such, despite the relatively widespread use of leukoreduction in
human medicine, routine use remains rare in veterinary medicine
(Jagodich and Holowaychuk 2016). Likewise, the delineation of
“fresh” versus “old” stored blood products is wrought with prob-
lems, including the increased disposal of expired blood products
not used due to the negative connotations of stored red cell
products (Holowaychuk and Musulin 2015). More information
is needed with regards to the impact of storage lesions and
leukoreduction on transfusion-related complications before firm
recommendations can be made.
Therapies to reduce allogenic transfusionsEven though veterinarians are administering transfusions as
safely as possible by performing diligent donor and recipient
screening, and using appropriate administration and monitoring
protocols, there is a growing concern regarding complications
such as transfusion-related immunomodulation occurring sec-
ondary to allogenic transfusions (Hart et al. 2015). This has led
to reports describing methods to reduce the administration of
allogenic blood products. Examples include the use of specialized
equipment such as cell salvage devices to enable safe and efficient
autotransfusion of body cavity hemorrhage (Kellett-Gregory et al.
2013), as well as the administration of antifibrinolytic medica-
tion to ameliorate post-operative hemorrhage and transfusion
requirements in predisposed breeds such as greyhounds (Marin
et al. 2012a,b). It is likely that studies focused on reducing allo-
genic transfusions will continue to be performed as veterinarians
seek out alternatives.
Future directions
Even though the number of veterinary studies published in the
field of transfusion medicine is rapidly growing, there is still
much work to be done and more knowledge to be gained in
order to guide transfusion and blood banking practices. While
retrospective studies have documented transfusion-related com-
plications and demonstrated their association with a negative
outcome, prospective studies are needed to further characterize
what can be done to ameliorate these complications. Whether
this will mean changing donor and recipient screening, adjusting
transfusion triggers, using leukoreduction filters, altering blood
storage and administration protocols, or seeking alternatives to
allogenic transfusions remain to be determined.
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Chapter 1: Evolution of Veterinary Transfusion Medicine and Blood Banking 11
Sourcing of sufficient donors to meet blood bank demands
is also a consistent issue. Efforts to create wider public aware-
ness of the need for donors, find an effective and sustainable
supply of donated blood products, and use alternatives such
as hemoglobin-based oxygen-carrying solutions and stem-cell
derived RBCs, in addition to further refinement and widespread
education regarding the appropriate use of blood products should
help meet blood product demands. There is no doubt that the
coming years will bring a plethora of veterinary publications that
will serve to enhance knowledge and understanding of transfu-
sion medicine and blood banking, enabling the creation of more
evidence-based guidelines.
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2 Component TherapyJulie M. WalkerDepartment of Medical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, Wisconsin, USA
Introduction
Blood collected from a donor can be utilized in many ways.
Although a unit of whole blood (WB) can be transfused or stored
after collection without further processing, separation of the unit
into blood components can provide several benefits. This chapter
provides an explanation of component therapy as it compares
to the transfusion of WB, highlighting the advantages and dis-
advantages of these practices. A general overview of the most
commonly administered blood components will also be provided.
Whole blood
Description and contentsVeterinary hospitals and blood banks that practice traditional
blood banking begin by collecting a standardized volume of
blood from a donor, which is immediately mixed with an
anticoagulant-preservative solution as it flows into the primary
collection container. At the time of collection, WB contains all
components of circulating blood including red blood cells (RBCs)
and white blood cells (WBCs), platelets, coagulation factors,
albumin, globulins, electrolytes, etc., at concentrations that were
present in the donor. This product, known as fresh whole blood
(FWB), can be transfused immediately or stored briefly (<8 hours)
at room temperature prior to transfusion. WB can also be stored
at 4 ∘C (stored whole blood, SWB) for up to 35 days depending on
the anticoagulant-preservative solution used, or can be processed
into blood components (Bucheler and Cotter 1994; Callan 2010).
Platelets in FWB maintain the ability to aggregate for at least
8 hours when stored at room temperature (Tsuchiya et al. 2003).
However, platelet aggregation and factor V and VIII concentrations
in SWB decrease in a time-dependent manner during storage at
4 ∘C (Nilsson et al. 1983; Nolte and Mischke 1995; Solheim et al.
2003; Jobes et al. 2011; Pidcoke et al. 2013).
IndicationsThe transfusion of FWB is indicated for the treatment of anemia
that occurs concurrently with coagulopathy, thrombopathia, or
severe thrombocytopenia. Patients with severe traumatic injury
Manual of Veterinary Transfusion Medicine and Blood Banking, First Edition. Edited by Kenichiro Yagi and Marie K. Holowaychuk.© 2016 John Wiley & Sons, Inc. Published 2016 by John Wiley & Sons, Inc.
and marked hemorrhage who require massive transfusion might
also benefit from a FWB transfusion (Kauvar et al. 2006; Repine
et al. 2006; Spinella 2008; Spinella et al. 2009; Cotton et al. 2013).
Similarly, SWB is indicated for the treatment of anemia with coag-
ulopathy, but this product would not be appropriate to correct
thrombocytopenia, thrombopathia, or deficiency of factors V or
VIII. WB, while not ideal, can also be administered to patients with
euvolemic non-coagulopathic anemia, particularly when compo-
nent therapy is not readily accessible.
AdvantagesThe most notable advantages of collecting and transfusing WB are
availability and practicality for private practices that infrequently
administer blood transfusions. With proper understanding of
transfusion principles, identification of a healthy blood donor and
proficiency in venipuncture and aseptic technique, FWB collec-
tion and transfusion can be safely performed in most veterinary
settings. If SWB will be kept for later use, the hospital must use a
refrigerator that can consistently maintain a constant temperature
between 1 and 6 ∘C. Conversely, FWB can be collected in a more
flexible manner when used immediately; the phlebotomist can
even draw the desired amount of blood into syringes that have
been pre-filled with anticoagulant-preservative solution. This
practice allows the collection of only the desired volume of blood,
but is inappropriate for long-term storage as this method utilizes
an open collection system, which limits storage time to less than
24 hours (Roback et al. 2011).
DisadvantagesBeing able to perform blood donation at the time of patient need
makes it necessary to complete comprehensive health and infec-
tious disease screening on donors well in advance of donation. It
can be challenging to find blood donors that are available at all
times for blood donation on an “on call” basis. When a patient
has an urgent need for a blood transfusion, the delay in treatment
that occurs while contacting the blood donor’s owner, awaiting
donor arrival, and collecting the FWB unit can also be a significant
disadvantage. Additionally, the administration of FWB or SWB
to anemic patients without hypovolemia or coagulopathy pre-
disposes recipients to volume overload and antigenic stimulation
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14 Manual of Veterinary Transfusion Medicine and Blood Banking
secondary to unnecessary plasma administration. Because of this,
banking and administration of component therapy has several
advantages over FWB and SWB.
Component therapy
Background conceptsThe separation of WB into its constituents for further storage
prior to administration is known as component therapy. FWB can
be processed into a variety of different components that can be
transfused based on individual patient need (Table 2.1). Most
established in-hospital and commercial blood banks are able to
create these WB-derived components. While most veterinary
blood banks process components by centrifugation of collected
blood, specific blood components can also be collected directly
from a donor using apheresis, an extracorporeal process that
employs differential centrifugation within a tubing system to
selectively collect one or more blood components (e.g., platelets
or plasma), while immediately returning the unused portion to
the donor. There has been an increase in the use of apheresis for
the collection of RBC, platelet, and plasma units from human
blood donors in the United States from 2008 to 2011 (Depart-
ment of Health and Human Services 2013). The production of
apheresis-derived components requires access to and experi-
ence with specialized equipment, therefore these techniques are
Table 2.1 Overview of blood products, including contents, indications, and storage conditions.
Contentsa Main indications Storage conditions
Fresh whole bloodRBC, WBC, platelets, all coagulation factors,
albumin, globulin
Anemia with coagulopathy/platelet disorder,
severe hemorrhage requiring massive
transfusion
Room temperature for up
to 8 hours
Stored whole blood
RBC, WBC, non-viable platelets, coagulation
factors excluding labile factors, albumin,
globulin
Blood loss anemiaRefrigerated at 1–6 ∘C for
up to 28 daysb
Packed red blood cellsRBC, WBC, non-viable platelets, small
amount of plasmaSymptomatic anemia of any etiology
Refrigerated at 1–6 ∘C for
up to 42 daysb
Platelet-rich plasmaPlatelets, all coagulation factors, albumin,
globulin
Marked thrombocytopenia with critical
hemorrhage
Room temperature storage
under constant gentle
agitation for up to 5 daysPlatelet concentrate Platelets, low volume of fresh plasma
DMSO-preserved frozen
canine platelet concentrate
Platelets, small volume of plasma, 6%
dimethyl sulfoxide
Frozen at≤ –18 ∘C for up to
6 months
Lyophilized canine platelets PlateletsRefrigerated at 1–6 ∘C for
up to 24 months
Fresh frozen plasma All coagulation factors, albumin, globulin
Coagulopathy with clinical evidence of
hemorrhage, coagulopathy without
hemorrhage but with planned invasive
procedure, coagulopathy without
hemorrhage or planned invasive procedurec
Frozen at≤ –18 ∘C for up to
12 months
Frozen plasmaAll coagulation factors (lower
concentrations of factors V, VIII, vWF)
Anticoagulant rodenticide intoxication;
coagulopathy due to factors II, VII, IX, X, XI
or fibrinogen deficiency
Frozen at≤ –18 ∘C for up to
5 years
Refrigerated plasmaAll coagulation factors with mildly reduced
concentrations of some factors
Emergent treatment of life-threatening
coagulopathy
Refrigerated at 1–6 ∘C for
up to 14 days
CryoprecipitateConcentrated factors VIII, XIII, vWF,
fibrinogen, and fibronectin
Hemophilia A, von Willebrand disease,
fibrinogen deficiency
Frozen at≤ –18 ∘C for up to
12 months
Lyophilized cryoprecipitateConcentrated factors VIII, XIII, vWF,
fibrinogen, and fibronectin
Hemophilia A, von Willebrand disease,
fibrinogen deficiency
Refrigerated at 1–6 ∘C for
up to 18 months
Cryosupernatant Factors II, V, VII, IX, X, and XI
Deficiency of factors II, V, VII, IX, X, or XI
such as anticoagulant rodenticide
intoxication
Frozen at≤ –18 ∘C for up to
12 months
RBC, red blood cells; WBC, white blood cells; vWF, von Willebrand Factor.aMinimal leukocyte content if leukoreduction techniques are applied.bShelf life depends on the anticoagulant-preservative solution used.cControversial.