Canine Blood Products — Veterinary FAQ


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CANINE BLOOD PRODUCTS — VETERINARY FAQ

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GENERAL TRANSFUSION TIPS

Crossmatching red cells with the patient is strongly recommended; patients can have a transfusion reaction even with their first donation.

Felines should always be blood typed and crossmatched prior to transfusing as they have naturally occurring alloantibodies.

​To avoid circulatory overload dosage calculations and flow rates should be calculated as part of the total 24-hour fluid volume.

Patients should be regularly monitored throughout the transfusion. CABB provides a transfusion monitoring form with every blood product.

All blood products require the use of a blood filter. Use a standard blood filter when transfusing amounts more than 50 mL. Microaggregate filters are available for transfusing amounts less than 50 mL.

SALINE ONLY! ​Never use lactated ringers or other dextrose solution. Do not add these solutions to a blood product or run at the same time as the transfusion (even if the lines are in different limbs). LRS is not compatible with the anticoagulant used in blood products and will cause clotting and/or hemolysis.

Thaw or warm blood products at temperatures not exceeding 37° C. NEVER use a microwave oven.

Frozen blood products are fragile. Seams and ports may crack or split if the unit is handled roughly or undergoes a rapid temperature change. Enclose the unit in a zipper style plastic bag when thawing.

Blood products should always be administered using gravity feed or syringe push. Do not administer blood products through an IV pump as it can cause hemolysis.

The rate of transfusion is governed by the clinical condition of the recipient. Blood products may be transfused as quickly as the patient can tolerate it but should be completed within 4 hours with some exceptions. Rapid transfusion is essential if the patient is in acute shock from blood loss. Normally, a slow drip for the first 10 to 30 minutes is advised. Most acute reactions occur during this time period and the transfusion can be stopped before a large amount has been transfused. The rate can be increased if the patient is tolerating the infusion well.​

WHAT IS THE DIFFERENCE BETWEEN FRESH FROZEN PLASMA AND PLASMA?

Fresh Frozen Plasma contains all blood clotting factors including the heat labile Factors V and VIII.

Plasma contains all blood clotting factors with reduced amount of the heat labile Factors V and VIII.

Fresh Frozen Plasma is used to treat a suspected or known deficiency or malfunction in clotting Factors V and VIII. It is also used to replace all clotting factors if a patient has had a massive bleed where its total blood volume has been replaced in less than 24 hours. Fresh Frozen Plasma is also used to treat disseminated intravascular coagulation (DIC).

Both Fresh Frozen Plasma and Plasma can be used to treat conditions such as parvovirus infection, coumarin/warfarin toxicosis, albumin replacement, passive immunity to orphaned neonates. In a case of parvovirus infection, Fresh Frozen Plasma should be reserved to treat severe intestinal bleeding.

Whenever possible, use Plasma if the patient does not require Factor V and VIII correction or replacement. This allows for a more efficient use of available blood products.

Remember: Always use a blood filter when transfusing Plasma and Fresh Frozen Plasma.

Fresh Frozen Plasma and Plasma are available in two sizes to suit the patient’s needs:

Full Size » 200 mL
Half Size » 100 mL

HOW DO I CROSSMATCH FOR RED CELLS ON A DOG WITH AUTO IMMUNE HEMOLYTIC ANEMIA?

Crossmatching a dog with AIHA is an extremely difficult situation. The patient’s autoantibody is coating its own red cells. Free autoantibody in the patient’s serum will attach to any red cell encountered. In most cases, a crossmatch is interpreted as inconclusive because the control test (mixture of patient’s serum and patient’s red cells) and all red cell units matched will be positive. No conclusion as to compatibility can be drawn.
When the decision is made to transfuse and the crossmatch is inconclusive, what is the blood of choice?

The dog’s blood type is known

Use donor blood of the same blood type. This will prevent the formation of an immune antibody.

The dog’s blood type is unknown

• Alvedia Quick Test can be used to determine a canine blood type (most card test typing is usually inconclusive for AIHA patients) Although DEA 1.1 negative blood is often a preferred choice, DEA 1.1 Positive blood is valuable option.

Development of immune antibodies usually takes about three days. If the dog develops immune antibodies to the transfused red cells, the cells would be destroyed at the same rate as the patient’s own red cells. The chills, rigor, and fever associated with a hemolytic reaction are usually not seen. However the survival of the transfused cells would be short and the benefits of the transfusion short lived.

WHAT ARE THE CLINICALLY SIGNIFICANT CANINE BLOOD TYPES?

Canine blood groups were first described in 1910. There are currently eight internationally recognized blood group antigens. An old classification system used letters to name the antigens. The new classification system is called the DEA system. The following chart compares the two nomenclatures and clinical significance.

DEA Group “Old” Classification Presence of Naturally Occurring Antibody Transfusion Significance
1.1 A1 No Clinically significantantibody – can cause an acute hemolytic transfusion reaction
1.2 A2 No Clinically significantantibody – can cause an acute hemolytic transfusion reaction
3 B Yes Delayed reaction. No hemolysis of red cells
4 C No None
5 D Yes Delayed reaction. No hemolysis of red cells
6* F No  Unknown
7 Tr Yes Delayed reaction. No hemolysis of red cells. Usually reacts only at colder temperatures.
8* He No  Unknown

* Antisera is no longer available for these antigens

Antibodies to DEA 1.1 are found in DEA 1.1 negative dogs that were sensitized during pregnancy or after receiving DEA 1.1 positive blood.

Ideally, a dog should receive blood of the same blood type for DEA 1.1 and DEA 1.1 Negative. The first transfusion of incompatible blood may appear to be successful. However, a subsequent transfusion of incompatible blood will probably result in an acute hemolytic reaction, usually with a fatal outcome.

Blood typing client dogs is highly recommend. The Canadian Animal Blood Bank can type for DEA 1.1. Please phone the blood bank for details on this service. An easy blood typing kit (Alvedia Quick Test – www.alvediaVET.com ) for canine and feline testing is also available for purchase through the Canadian Animal Blood Bank.

HOW DO I CALCULATE THE DOSAGE FOR BLOOD PRODUCTS?

The following chart shows rate of infusion guidelines for several blood products. These qualitative guidelines are usually sufficient to calculate the appropriate dosage.

Component Dosage Rate
Whole Blood 12 – 20 mL/kg 3 – 4 mL/kg
Red Cell Concentrate 6 – 10 mL/kg 4 – 6 mL/kg
Cryoprecipitate 1 unit/10 kg Repeat until bleeding is controlled
FFP & Plasma 6 – 10 mL/kg 4 – 6 mL/kg

The duration for infusion should not exceed 4 hours.

Fresh Frozen Plasma infusion can be done over 8 – 12 hours when treating a patient with von Willebrand’s disease. Begin the infusion one hour before anesthesia if the FFP is to be given because of surgery.

To reduce the risk of circulatory overload, calculate the FFP or plasma dosage as a part of the daily total fluid intake during treatment.

HOW DO I TREAT A TRANSFUSION REACTION?

Crossmatching will prevent some, but not all, transfusion reactions. If you believe that the patient is reacting to the blood product, use the following steps:

  1. STOP THE TRANSFUSION
  2. DETERMINE THE TYPE OF REACTION
  3. INITIATE APPROPRIATE TREATMENT IF NECESSARY

The symptoms of a transfusion reaction are similar in several types of reactions. Many of these symptoms may also be due to the underlying disease condition or patient stress. Recording the patient’s vital signs and conditions before starting the transfusion and regular monitoring during the transfusion will assist in determining if a reaction is truly occurring.

  • Permanently discontinuing the transfusion is not always necessary depending on the type and severity of the reaction.
  • Transfusion reactions are caused by immune or non-immune mechanisms. Reactions that occur within 24 hours from the start of infusion are acute reactions. Those that occur after 24 hours from the start of the infusion are delayed reactions.

IMMUNE REACTIONS NON-IMMUNE REACTIONS
Acute hemolytic reaction Disease transmission
Delayed hemolytic reaction Septicemia
Febrile reaction Air embolism
Anaphylactic reaction Citrate toxicity

Circulatory overload

Hypercalemia

Hemorrhagic diathesis

  • Treatment is based on the type and severity of the reaction presented. Reactions can range from an “annoyance” level to life threatening. Acute reactions must be addressed quickly.


General Rules of Thumb

Hemolytic reaction – Keep an intravenous line open with saline. Treat hypotension with fluid replacement. Induce and maintain urinary flow to prevent renal shutdown.

Febrile reactions – Administer antipyretics based on the severity of the reaction. The transfusion can be re-started if the reaction is mild.

Anaphylactic reaction – Treat mild anaphylaxis with antihistamines and re-start the transfusion if desired. Follow standard treatments for anaphylaxis based on the severity of the reaction.

THERE ARE “THINGS” FLOATING IN THIS BLOOD COMPONENT!

During the storage period for blood components, certain artifacts develop which are completely normal. This sheet will help you to differentiate normal from abnormal storage changes.

Concentrated Red Cells and Whole Blood

Artifact What is it ? What to do
Irregular clumps of white or off-white material White blood cells and platelet aggregates Use a blood filter when transfusing
Layer of white or off-white material floating on top White blood cells and platelet aggregates Use a blood filter when transfusing
Regular, entire white bodies Possible bacteria colonies DO NOT USE THIS UNIT. Discard into a biohazardous waste container.
White flecks resembling paint chips Fat Fat will dissolve into solution as the unit is warmed.
Visible hemolysis in the segments or unit Outdated or contaminated with bacteria DO NOT USE THIS UNIT. Discard into a biohazardous waste container.


Fresh Frozen Plasma

Artifact What is it ? What to do
Whitish stringy material Precipitated coagulation Factor VIII and fibrinogen Caused by thawing the unit in the fridge rather than in a 37° C water bath. Will be removed by blood filter.

Plasma and Fresh Frozen Plasma

Artifact What is it ? What to do
Milky white in colour when thawed Fat Not esthetically pleasing but safe to transfuse
Regular, entire white bodies Possible bacteria colonies DO NOT USE THIS UNIT. Discard into a biohazardous waste container.

 

WHAT ARE THE RISKS TO A PATIENT REQUIRING A TRANSFUSION?

Blood and blood products for transfusion are best described as prescription drugs of biologic origin. Transfusion therapy is a standard treatment in veterinary practice.

Transfusion Associated Diseases and Donor Screening Protocols

  • All of our donor dogs MUST be immunized for Rabies, hepatitis, parvovirus, distemper, adenovirus 2, and parainfluenza virus in order to participate in the blood donor program.
  • Although not transmitted through blood transfusion, we recommend that all donor dogs be on a heartworm preventative regime. This is for the donor’s safety as blood donation while infected with heartworm could result in cardiac or pulmonary collapse.
  • Lyme Disease – caused by bacteria Borrelia burgdorferi. Although not transmitted through blood transfusions, we test every unit and prophylactically notify owners and primary veterinarians of any donor dogs positive test results. Donors are temporarily deferred from donating until after treatment completion.
  • All blood collections are screened for specific vector borne diseases. These include but are not limited to Brucellosi, Babeiosis, Leishmaniasis, Ehrlichiosis, Anaplasmosis, and Mycoplasmaheamocanis.

Transfusion Reactions

As with any drug, reactions may occur. Reactions are not common, and in most cases are mild and not life threatening. The rarest and most dangerous type of reaction can usually be prevented by a simple laboratory test called a crossmatch. A crossmatch is recommended whenever red blood cells are to be transfused. This test is not necessary if only plasma is transfused.

Knowing your dog’s blood type is highly recommended. Your veterinarian can choose the most compatible blood for your dog if the blood type is known. This saves valuable time in an emergency and increases the safety of the transfusion. The Canadian Animal Blood Bank offers blood type testing. Please speak to your veterinarian about this service.