| Frequently, the need for blood transfusions is acute, as in acute hemolysis or hemorrhage; transfusions are also appropriate in treatment of acute or chronic anemias. Animals with hemostatic disorders often require repeated transfusions of either whole blood, red cells, plasma, or platelets. Blood transfusions must be given with care because they have the potential for further compromising the recipient. The diversity of blood groups in animals and the lack of commercially
available blood-typing reagents make complete typing and matching difficult but should not preclude the clinical use of transfusions. In horses and dogs, the blood group antigens most commonly implicated in transfusion incompatibilities are known; by selecting donor animals that lack these groups, or that match the recipient, the risk of sensitization of the recipient to the most important antigens can be minimized. Previously sensitized recipients can be detected by crossmatching,
which will preclude administration of incompatible blood. In the USA, >99% of cats are of blood group A, so the risk of incompatible transfusion is low. However, certain breeds, including Abyssinian, Birman, British Shorthair, Devon Rex, Himalayan, Persian, Scottish Fold, and Somali, have a higher frequency of blood group B. Any incompatible transfusion in cats results in rapid destruction of transfused cells, so typing or crossmatching should be done before any transfusion. |
| Whole blood frequently is not the ideal product to be administered. If the need is to replace the oxygen-carrying capability of the blood, then packed RBC are more appropriate; if replacement of circulatory volume is needed, crystalloid or colloid solutions may be used to replace volume, with packed RBC added as needed. Platelet numbers rise rapidly after hemorrhage, so replacement is rarely needed. Plasma proteins equilibrate from the interstitial space, so plasma is not needed
except in massive hemorrhage (>1 blood volume in 24 hr). Animals that require coagulation factors benefit most from administration of fresh-frozen plasma or cryoprecipitate if the need is specifically for factor VIII, von Willebrand factor, or fibrinogen. Platelet-rich plasma or platelet concentrates may be of value in thrombocytopenia, although immune-mediated thrombocytopenia usually does not respond to administration of platelets because they are removed rapidly by the spleen. |
| The amount of RBC required to treat anemia is based on the volume necessary to increase the PCV or Hgb concentration to the desired value. All domestic animals have blood volumes of ~7% of their body weight except cats, which have a blood volume of 4% of their body weight. By determining the recipient’s blood volume and knowing the animal’s PCV, the required replacement RBC volume can be calculated. For example, a 25-kg dog has a total blood volume of ~2,000 mL; with a PCV of 15%,
the RBC volume is 300 mL; if the PCV is to be increased to 20%, that equals an RBC volume of 400 mL. Therefore, 100 mL of RBC or 200 mL of whole blood (with PCV of 50%) would be required to increase the recipient’s PCV to the desired level. These calculations assume no ongoing losses of RBC through hemorrhage or hemolysis. No more than 25% of a donor animal’s blood should be collected at one time. |
| Collection, storage, and transfusion of blood must be done aseptically. The anticoagulant of choice is citrate phosphate dextrose adenine (CPDA-1). Commercial blood bags containing the appropriate amount of anticoagulant are less damaging to blood cells than are vacuum collection bottles. Heparin should not be used as an anticoagulant because it has a longer half-life in the recipient and causes platelet activation; also, heparinized blood cannot be stored. |
| Blood collected in CPDA-1 may be safely stored at 4°C for 3 wk. If the blood will not be used immediately, the plasma can be removed and stored frozen for later use as a source of coagulation factors or albumin for acute reversible hypoalbuminemia. Chronic hypoproteinemia is not helped by plasma because the total body deficit of albumin is so large that it could not be improved by the small amount contained in plasma. Plasma must be frozen at -20° to -30°C within 6 hr of collection
to assure that levels of factor VIII are adequate and will remain so for 1 yr. |
| Risks of Transfusion: |
| The most serious risk of transfusion is acute hemolysis. Fortunately, this is rare in domestic animals. Dogs rarely have clinically significant preformed antibodies, so only those that have received repeated transfusions are at risk. The most common hemolytic reaction in dogs that have received multiple transfusions is delayed hemolysis, seen clinically as shortened survival of transfused RBC and a positive Coombs’ test. Even crossmatch-compatible RBC given to horses or cattle
survive only 2-4 days. Repeated transfusions can cause acute hemolysis. Nonimmune causes of hemolysis include improper collection or separation of blood, freezing or overwarming of RBC, and infusing under pressure through a small needle. |
| Other complications include sepsis from contaminated blood, hypocalcemia from too much citrate, and hypervolemia (especially in animals with preexisting heart disease or in very small animals). Urticaria, fever, or vomiting are seen occasionally. Transfusions can also spread disease from donor to recipient, such as RBC parasites (eg,
Haemobartonella
,
Anaplasma
, or
Babesia
) and viruses (eg, retroviruses such as feline or bovine leukemia, equine infectious anemia, or other slow viruses). Other diseases, such as those caused by rickettsia or other bacteria, can also be spread if the donor is bacteremic. |
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