Blood Transfusion

Dr. Fakhar-e-Alam (DVM) Contact: drfakharealam786@gmail.com

Blood transfusion is generally the process of

receiving blood products into one's circulation

intravenously.

Transfusions are used for various medical

conditions to replace lost components of the

blood. Early transfusions used whole blood,

but modern medical practice commonly uses

only components of the blood, such as red

blood cells, white blood cells, plasma, clotting

factors, and platelets.

Why Perform Blood Transfusions:

1) Massive blood loss (trauma, surgery)

2) Cancer patients

3) For surgeries

4) Relatively simple to perform

5) Low cost possible

6) Economically justifiable

7) Chronic anemia (respiratory distress,

weakness) Blood is used for its oxygen-

carrying capabilities.

8) Defects of coagulation. (Hemophilia, Von

Willebrand disease) Use platelet rich plasma

over blood.

9) Live-saving therapy in cases of life-

threatening anemia.

10) 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.

11) Is an effective method of fluid replacement

but a potentially hazardous form of treatment.

Blood Transfusion in Canine & Feline:

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.

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.

1666 Dog to Dog

1667 Animal to Human

1818 Human to Human

1901 Discovery of A, B, O groups

1907 Cross Matching

1914 Anticoagulant Discovered

1936 First Blood Bank

1939/40 Rh Factor Discovery

1950 Plastic Blood Containers

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.

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 Wolfhounds, German Shepherds,

Dobermans, and Pit Bulls.

Canine Blood Types in United States:

Some experts suggest that dogs may

actually have 12 or more blood types.

Ideal blood Donor is Negative for DEA 4.

Universal Blood Donor is Negative for

DEA 1.1.

Universal Donor: Universal Blood donors

test negative for both DEA 1 alleles. These

dogs should also test negative for heartworms,

Ehrlichia canis, babesia canis and

Haemobartonella canis.

Universal Recipients: Dogs positive for

DEA 1.1 are considered universal recipients.

Canine Blood Units:

1 canine U = amount of product collected from

450 ml whole canine blood

1 U Whole Blood 450ml Blood + 63

ml Anticoagulant

1 U Plasma 200-250 ml

1 U Packed Cells 200-250 ml

1 U Cryoprecipitate 60-70 ml

1U cryo-poor

Plasma

about 100 ml

1U Platelet Rich

Plasma

200-250 ml

Ideal Canine Blood Donors:

50 lbs or more

Medium build

Disease free/in good health

Good temperament

Negative for heartworms

Current on vaccines

Minimal PCV of 40%

Feline Blood Groups:

Blood group A is the most common in cats

overall in the United States. Blood group B is

common in European breeds. (Devon rex,

Abyssinian, British shorthair). 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!

Blood Types in Long & Short hair Cats

according to geographic location:

Feline Breed with Type B Blood:

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. Although transfusing

different blood types can be 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 Units:

1 feline U = product collected from 50-60 ml

whole feline blood

1 U whole blood 50-60 ml + 5-9 ml

of anticoagulant

1 U plasma or

packed cells

20-30 ml

Blood 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.

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.

Auto-Agglutination Saline Test:

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.

Feline Blood Typing Cards:

Blood Collection Guideline:

Collection site: jugular vein in 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

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.

Ideal Feline Blood Donors:

Disease free/in good health

Current on vaccines

Heartworm neg.

Good temperament

8 lbs or more but not overweight

Minimal PCV of 35%

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 blood transfusion filter to

reduce microemboli.

Fresh whole blood:

5-10 ml/lb/day

Packed Red Cells:

3-5 ml/lb every 12-24 hours

Can add saline to packed cells to decrease

viscosity and improve flow, if extra volume

will be tolerated

Fresh Frozen Plasma:

3-5 ml/kg every 8-12 hours

Platelet Rich Plasma:

3-5 ml/kg every 8-12 hours

Human Immunoglobulin:

0.5-1 g/kg IV over 6-8 hours

1 unit produced from plasma of 1,000 donors.

It is very expensive used to treat IMHA and

IMT in dogs.

Oxyglobin – Hb substitute:

3-5 ml/kg added to fluids running at 0.5-

2ml/lb/hr Or 10 ml/kg/hr for up to 3 hours.

Maximum 30 ml/kg/day

Blood Collection System:

This is an example of a “Closed system of

blood collection”. The components of blood

are spun down but not separated into satellite

bags.

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.

Donor Guideline:

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.

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:

Hyperthermia, Vomiting, Tachycardia,

Tachypnea, Weakness, Muscle tremors, Facial

swelling, Agitation, Vocalizing, Hypotension,

Hemoglobinemia, Hemoglobinuria.

Although acute reactions are rare, they are

considered the most serious!

Vomiting is a potential adverse reaction to a

transfusion, food, water, and medications

should be withheld from the patient during the

transfusion.

Diphenhydramine hydrochloride may be

administered with dose rate of 0.5-1 mg/lb to

the patient 30 minutes prior to transfusion to

reduce the risk of blood transfusion reactions.

Monitor temp and RR every 10 minutes for

30 minutes, then every 30 minutes

Stop or slow transfusion and consider

dexamethasone if vomiting, tachypnea or

weakness.

Blood Transfusion in L/S Ruminants:

The practice of blood transfusion in large

animals is less common. Blood transfusion in

large animals is performed as an emergency

lifesaving procedure. The risk of a transfusion

reaction is low due to which this practice can

be performed in same species of animals

without the risk of reaction except equines.

In horses, a complete match is rarely possible,

even when donor and recipient are compatible.

Indications:

Complication after caesarian section, Uterus

prolaps, Umbilical vessel damage by a

newborn calf, Trauma, Anaemia and melena,

Tick born protozoan parasite (Babesia

divergens), Destruction of erythrocytes.

Procedure

Donor:

Quiet to handle

Healthy

Not heavily pregnant

Large animal with a normal BCS

Non-lactating, since the administration of

xylazine will necessitate a milk withholding

period

Equipment required:

Xylazine, Procaine, Scalpel, Large bore

needle, Tourniquet, Funnel, Na-citrate,

Physiological serum, Collapsible plastic

containers for blood collection.

Blood Collection:

Restraint is achieved using a halter,

Head tied up

Sedation: xylazine

Prepare the collection site in the mid-jugular

area

Local anesthesia

Small incision in the skin

Some anesthetic subcutaneously around

jugular vein

Large bore needle (diameter 4 – 5 mm)

Raise the vein with tourniquet (chain, rope

with small round block or digital pressure)

Insert the large bore needle trough the skin

incision and into the jugular vein

Blood collected by using a funnel inserted

into the top of the collection vessel (plastic water bottles 1.1/2 liters) with anti-coagulants.

Agitate gently the collected blood to mix it

with the anti-coagulant solution

Look out for contamination

After collection of 5 to 8 litres(+/- 10 min),

release pressure and remove needle

Close the skin with a couple sutures

For small amounts (450 ml), use human

disposable vacuum bags(Terumo)

Before collecting: coat the needle and funnel

with the anti-coagulant solution, otherwise

blood clot forming occur during collection.

Collected blood should be used within two

hours.

Anti-Coagulants Solutions:

Sodium citrate:

100 ml of a 3.8 to 5 % per litre blood

Heparin sodium:

Solution 5000 units in 5 ml vials

5000 units for 1-liter blood

Administration of blood:

Restraint the recipient animal

Sedation mostly not necessary

Prepare the insertion area

Local anesthesia

Small skin incision

Insert a 12 gauge 8 cm catheter and suture in

place

Attach the giving set to the catheter

Transfusion of 5 to 8 liters will take 30 to 45

minutes

Monitor transfusion reactions

Blood may be given intraperitoneally, red

cells will taken up in an unaltered state,

absorption is relatively slow.

Transfusion Reaction signs:

Usually reactions are rare and mild

Increase of respiratory rate

Hiccupping

Sweating

Tachycardia

Violent movements

Severe respiratory distress

Coma and death

Treatment: Adrenaline 5 ml (1: 1000,

1mg/ml solution) IM

The End