Transcript Blood Transfusion

Chapter 25-Small
Animal Medical Nursing
Blood Transfusion
pgs. 793-796 in the
CTVT book
The 1st successful animal to animal blood
transfusion was done by Richard Lower, Feb.
1665 between a Mastiff and a mixed breed dog.
Technicians
 Today, technicians are taking a more
active role in transfusion medicine by
preparing the product for administration,
monitoring the transfusion recipient, and
setting up blood donor programs, among
other tasks.
Blood Transfusion
 Is an effective method of fluid
replacement but a potentially
hazardous form of treatment.
 Clear indication for its use must be
present. The effectiveness of
transfusion is temporary.
 Every effort must be made to
identify and correct underlying
problems.
Why Perform Blood Transfusions
 Severe blood loss (trauma, surgery)
 Chronic anemia (respiratory distress, weakness)
Blood is used for its oxygen-carrying
capabilities.
 Defects of coagulation. (Hemophilia, Von
Willebrand disease) Use platelet rich plasma
over blood.
 Autoimmune hemolytic anemia (in lifethreatening situations)
 PCV levels should not dictate giving a blood
transfusion. While a PCV of 12% may be life
threatening for one animal it may represent a
totally different scenario for another patient.
Platelets
 Survive for less than 12 hours in stored
blood, therefore freshly drawn blood
should be used immediately.
 Platelet rich plasma is the preferred
transfusion method when needing to
replace platelets. (Note: use the same guidelines
when performing a plasma transfusion as you would with
a blood transfusion.)
Why use Platelets?
 Animals with abnormal platelet function
 Hereditary or acquired bleeding disorders:
 Hemophilia
 Von Willebrand disease (vWD)
 Disseminated intravascular
coagulation (DIC) pg. 832-833
 You want to provide adequate
concentrations of the deficient coagulation
factor at the bleeding site.
Microscopic view of platelets
Autoimmune Hemolytic Anemia
 The animal’s immune system actually attacks
its own red blood cells leading to their
destruction-hemolysis. The antibodies attack
the cell membrane.
 Red blood cell transfusion is only
administered in life-threatening situations, as
the patient’s immune system will also attack
and destroy these RBCs as well.
 If transfusion is necessary as a life-saving
measure, only the absolute minimum number
of RBCs should be administered. (12ml/kg of
body wt.)
Do you remember what WBCs are?
 The body’s army
 Fight off infections by increasing in
numbers. They attack germs!
Leukopenia
 Low white blood cell
(WBC) count
 Blood transfusions
are impractical
Hypoproteinemia
 Low serum protein
 Blood transfusions
are impractical
WBC
RBC
Platelet
Canine Blood Groups
Canine Blood Groups
 There are 19 + known blood groups in dogs,
while there are 6 well characterized blood types
known as dog erythrocyte antigens.
 DEA=dog erythrocyte antigen. Canine blood
types are designated by the presence of specific
DEAs. The antigens are DEA 1.1, 1.2, 3, 4, 5,
and 7. Every dog is either positive or negative
for these blood types.
 The blood type of most importance is DEA 1.1
because of transfusion reactions.
 A good resource: www.rapidvet.com/help.htm
 Antigens=proteins
DEA 1.1
DEA 3
DEA 7
DEA 4
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.
Blood-Typing
 A method of identifying the antigens
(proteins and carbohydrates) on the
surface of red blood cells.
 Samples can be sent out to a laboratory.
 Blood typing cards can be utilized. These
cards can only detect DEA1.1 in dogs; and
feline blood types A, B, and AB. The cards
are easy to use but the results may pose
difficult to interpret.
Blood 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 1.1
 Is the most antigenic and is associated
with most blood transfusions. It is said that
about 40% or more dogs are positive for
the DEA 1.1.
 Breeds more commonly DEA 1.1 positive
are Golden Retrievers and Labradors.
 Breeds more likely to be DEA 1.1 negative
are Greyhounds, Boxers, Irish Wolf
Hounds, German Shepherds, Dobermans,
and Pit Bulls.
Ideal blood
Donor is
Negative
For DEA 4.
Universal
Blood
Donor is
Negative
For
DEA 1.1
Some experts suggest
that dogs may
actually have 12
or more blood
types.
Universal 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 Donor
 The blood group of canines synonymous
with the term “universal donor” is DEA 1.1
and DEA 1.2 negative.
Can my dog donate blood?
 Dogs that test negative for DEA 1.1 can
give blood to dogs that are DEA 1.1
negative and DEA 1.1 positive. These
dogs are considered “universal blood
donors”.
 Dogs that test positive for DEA 1.1 can
only give blood safely to dogs that are
DEA 1.1 positive.
Universal Recipients
 Dogs positive for DEA 1.1 are considered
universal recipients.
 Do you understand the difference between
a donor and a recipient?
Feline Blood Groups
Feline Blood Groups
1) Blood group A is the most common in
cats overall in the United States.
2) Blood group B is common in European
breeds. (Devon rex, Abyssinian, British
shorthair)
3) Blood group AB is rare.
 There is no universal feline blood
donor.
 Blood typing and cross-matching
should ALWAYS be performed on cats!
Each and every time!
 Cats naturally have antibodies against
blood types that they do not have,
meaning that mismatched blood can be
fatal to them.
 Always blood type and crossmatch feline
blood and blood products before
administering.
 Do not transfuse canine blood or blood
products to felines or vice versa.
Feline Blood Groups
 Although transfusing different blood types can be
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fatal in cats the following information was taken
from an article in the Veterinary Technician
magazine, July 2006.
Type B cats have high anti-A alloantibodies
Type A cats have weak anti-B alloantibodies,
meaning that if transfused with B blood they will
have a mild reaction to the blood and the RBCs
will have a half-life of 29 to 39 days.
Type B cats receiving type A blood; RBCs will be
rapidly destroyed within a few minutes to hours.
These cats will have severe reactions possibly
followed by death.
Type AB cats can receive either A or B blood with
little to no clinical reactions.
Feline Blood Tying Cards
Crossmatching
 A laboratory test that predicts a transfusion
recipient’s response to a donor’s RBCs and plasma
by detecting any serum (plasma) incompatibility
between the donor and the recipient.
 This is a two part test.
 Dogs do not have naturally occurring antibodies
against blood types they lack, like cats do. It is
more important to crossmatch than to blood type a
canine recipient before transfusion.
Blood Crossmatching Procedure
Step 1
Step 2
 MAJOR crossmatch
 Donor Blood +
 MINOR crossmatch
 Recipient Blood +
Recipient Plasma
 Positive Test=Macro
or Microagglutination
present
(Incompatible)
 Negative Test=Macro
or Microagglutination
Absent (Compatible)
Donor Plasma
 Positive Test=Macro
or Microagglutination
present
(Incompatible)
 Negative Test=Macro
or Microagglutination
Absent (Compatible)
Macroagglutination
Microagglutination with
Rouleaux formation
Healthy red blood cells (upper left) are
smooth and round. Hemolytic red blood
cells (lower right).
Minor CM: detects antibodies
in the donor plasma
directed against the
recipients erythrocytes.
Major CM: performed to detect
antibodies in the recipients
serum that may agglutinate
or lyse the donors
erythrocytes.
Auto-Agglutination Saline Test
 Purpose of test: Is your patient autoagglutinating.
 What does this mean? First, what does
auto mean? What does agglutination
mean?
Auto-Agglutination Saline Test
 Clumping of red blood cells within a patient’s
own serum; can be caused by diseases such as
IMHA formerly known as autoimmune hemolytic
anemia.
 This test is included in the RapidVet-H canine
DEA 1.1 test kit. No microscope required!
 This test can also be done with a drop of saline
and a drop of blood (unspun from your purple
top tube) on a microscope slide. You will need a
microscope as well.
 Why do this you may ask? Remember the major
and minor crossmatch?
Sudden death is unlikely in dogs during
blood transfusions but can occur in cats.
Blood Collection Guidelines
 Collection site: jugular vein in
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cats & dogs
Can be sedated, but not
necessary in dogs. Sedation is
common in cats
Surgical aseptic preparation of
the collection site is performed
Clean stick and rapid
withdrawal is preferred due to
clotting
Do you need to use some sort
Read CTVT pgs. 793-796
of anticoagulant?
As blood is collected, it
should be mixed gently in a
back and forth motion as
seen below.
After the donor dog has
been clipped and surgically
prepped, the collection
needle is inserted into the
jugular vein.
Administering Blood and/or blood
products
 Should be gradually warmed to room
temperature. Never place in a microwave!
 Once a blood container has been opened
it should be used within 24 hours.
 Use a micropore filter to reduce
microemboli.
⃠
Blood Products
 Whole Blood
 (FWB=Fresh whole blood, <8 hours
old)
 (SWB=Stored whole blood, >8 hours
old)
 Packed Red Blood Cells (pRBCs)
 Plasma (FFP=Fresh Frozen
Plasma)
 Platelet-Rich Plasma (PRP)
 Cryoprecipitate
Cryoprecipitate
 This is the cold, insoluble
portion (slushy) of plasma that
precipitates after FFP has
been thawed slowly in the
refrigerator.
 Cryoprecipitate contains von
Willebrand factor, fibrinogen,
and factor VIII and is used to
treat this disease as well as
hemophilia A, and fibrinogen
deficiencies.
Blood 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
components are exposed to the environment. This
type of system is most commonly used in cats and
often used with dogs.
Cont. Blood Collection Systems
 Use of glass bottle blood collection
systems should be avoided since they are
not closed systems and allow the blood to
be exposed to room air.
 Glass bottles also cause platelet
inactivation and clumping on contact with
the glass surface.
CTVT pg. 794
Blood and blood
products are always
administered slowly
and intravenously
through a sterile
bloodadministration
kit.
Donor Guidelines
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Good general health and temperament
1 to 8 years of age
Easily accessible venipuncture site
No infectious diseases
No medications (except heartworm or flea
preventatives)
 No history of pregnancy
 Females must be spayed.
 Annual blood work.
Ideal Canine Blood Donors
 50 lbs or more
 Medium build
 Disease free/in good
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health
Good temperament
Negative for
heartworms
Current on vaccines
Minimal PCV of 40%
Ideal Feline Blood Donors
 Disease free/in good
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health
Current on vaccines
Heartworm neg.
Good temperament
8 lbs or more but not
overweight
Minimal PCV of 35%
Just how much blood can
you take?
 10 to 20 ml of blood per kilogram of
body weight may be drawn every 3
weeks from the canine donor.
 60 ml can be drawn every 3 weeks
without excessive stress to the feline
donor.
 Some clinics will only allow their
donors to donate blood every 4 to 5
weeks.
Acute Blood Transfusion Reactions
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Hyperthermia
Vomiting
Tachycardia
Tachypnea
Weakness
Muscle tremors
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Facial swelling
Agitation
Vocalizing
Hypotension
Hemoglobinemia
Hemoglobinuria
Although acute reactions are rare, they are considered
The most serious!
Food, Water and Meds
 Because vomiting is a potential
adverse reaction to a
transfusion, food, water, and
medications should be withheld
from the patient during the
transfusion.
 Be sure to ask the DVM when
food and water can be
reintroduced to the animal.
Antihistamines
 Diphenhydramine hydrochloride may be
administered to the patient 30 minutes
prior to transfusion to reduce the risk of
blood transfusion reactions.
What is the
Common name
For this drug?