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Crossmatching donor red blood cells with the patient’s plasma is strongly recommended to reduce the risk of transfusion reactions. Because most dogs do not have clinically relevant naturally occurring antibiotics, their risk of a transfusion reaction during a first transfusion is rare, but not impossible. To be safe, and when time and budget permits it, a crossmatch is recommended. Learn more about crossmatching dogs here.

All blood donor programs must consider weakly DEA 1+ dogs to be DEA 1+ positive for the safety of DEA 1- recipients. For a more detailed explanation, please refer to the blog post “What is the significance of DEA 1 weakly positive donors?”. 

DEA 1 is considered the most clinically significant blood group in dogs due to its very strong antigenicity and risk of hemolytic transfusion reaction on subsequent transfusions to DEA 1 negative dogs. For a more detailed explanation and description of other canine blood types, please refer to the blog post “What are the clinically significant canine blood types?”.

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.

Excessive warming of red cell products can damage the red cells; therefore, routine warming is generally not recommended. Red cell products tend to warm to room temperature as they are being administered. The recipient’s temperature should be monitored during the transfusion and external warming devices used as needed for hypothermia.

Frozen plasma 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 in a warm water bath that does not exceed 37 degrees celsius.

Blood products should be administered using gravity flow, syringe pump, or fluid pumps approved for the administration of blood products. Fluid pumps not approved for blood product administration can cause hemolysis. Always check with the fluid pump manufacturer to ensure that it is safe for blood products.

The rate of transfusion is governed by the clinical condition of the recipient. Rapid transfusion is essential if the patient is in hypovolemic shock from blood loss. Otherwise, blood products can be transfused as quickly as the patient tolerates it but should be completed within 4 hours (with some exceptions). This is to prevent bacterial growth within the product while at room temperature. Normally, a small volume or slow drip is administered for the first 10 to 30 minutes of a routine transfusion. Most acute transfusion reactions occur during this time period and the transfusion can be stopped before a large amount has been transfused. The rate can then be increased if the patient is tolerating the transfusion well.​ Learn more about transfusion-related complications here.

Normal saline (0.9% NaCl) is the safest fluid to administer along with blood products. Lactated Ringer’s solution (LRS) or dextrose-containing fluids should not be used. LRS is not compatible with the anticoagulant used in blood products and may cause microclots to form. Dextrose in high concentrations may cause red cell lysis.

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

1. STOP THE TRANSFUSION;
2. DETERMINE THE TYPE OF REACTION;
3. INITIATE APPROPRIATE TREATMENT, AS NECESSARY.

To learn more about the different types of transfusion reactions, associated clinical signs, and recommended treatments, please read “What do I do if I think my patient is having a transfusion reaction?” .

As with administration of any treatment, there are immunologic and nonimmunologic complications to be aware of when administering a transfusion. Please click here to read more about these risks.

Before transfusion, it is crucial to conduct a thorough visual inspection of blood components to mitigate the risk of adverse reactions. Several visual changes can occur in blood components that may indicate potential issues with the product’s safety or quality. You can find out more about these changes here.

To avoid circulatory overload, transfusion dosage calculations and flow rates should be calculated as part of the total 24-hour fluid volume. Patients should also be regularly monitored throughout the transfusion and afterward for signs of circulatory overload. CABB provides a transfusion monitoring form with every blood product. Learn more about how much blood to transfuse here and about transfusion-related complications here.

Choosing a plasma component can be determined by considering the goal for therapy and recent evidence supporting use in specific patient populations. Please click here for more information.

The formula for calculating blood transfusion dosage depends on the type and severity of anemia that your patient is experiencing. Click here to read more about the formulas used to calculate transfusion volumes for administration.

It is best practice to try to incorporate major crossmatch testing into the pre-transfusion plan for all feline patients when the time and resources permit it. For a more detailed explanation, please refer to the blog post “Do recipient cats need to be crossmatched?”. 

When a cat is emergently in need of blood and there are no compatible feline products available, canine blood can be administered, but only once and with informed consent from the owner. For a more detailed explanation, please refer to the blog post “Can you give dog blood to cats?”.