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Coagulation Relative Treatment Conditions for Hepatobiliary Disorders: Blood Component Therapy

Coagulation Relative Treatment Conditions for Hepatobiliary Disorders: Blood Component Therapy

Blood components

Composition

Dose

Rate

Comments

Fresh whole blood

RBCs, scant WBCs, plasma factors

20 mL/kg, as needed

5–10 mL/kg/h over < 4 h

Platelet function declines within 1 h; preferred over stored whole blood if animal has tendency for hepatic encephalopathy.

Administration of 2 mL/kg ↑PCV ~1%

Stored whole blood

RBCs, scant WBCs, functional platelets, has plasma factors FV & FVIII

20 mL/kg, as needed

5–10 mL/kg/h over < 4 h

Older RBCs with greater senescent RBCs may impose protein challenge, provoking hepatic encephalopathy in dogs with hepatic insufficiency and APSSs.

Administration of 2.2 mL/kg ↑PCV ~1%

Packed red blood cells

RBCs, scant WBCs, no coagulation factors, no platelets

10–15 mL/kg

5–10 mL/kg/h over < 4 h

As for stored RBCs, increased risk for provocation of HE in animals with hepatic insufficiency and APSS

Fresh frozen plasma

Coagulation factors, albumin, globulins, antithrombin

10–20 mL/kg

5–10 mL/kg/h over < 4 h

For attempted control of bleeding or start 1–2 h before liver biopsy

Cryoprecipitate

VWF, FVIII, FXIII, fibrinogen

1 unit/10 kg

1–5 mL/kg

5–10 mL/kg/h over < 4 h

Potential to fibrinogen concentration by ~1 g/L. Administer 30 min prior to liver biopsy; repeat q 30 min as needed for continuous bleeding.

Cryoprecipitate-poor plasma (plasma cryoprecipitate decreased)

FII, FVII, FIX, FX, albumin anticoagulants, fibrinolytic factors. Deficient in VWF & FVIII

10–30 mL/kg

5–10 mL/kg/h

or 1–2 mL/kg/h over < 4 h

Underused resource that avoids supplemental VWF and VIII in hypercoagulability status.

Lyophilized platelets

Platelets & microparticles

1 unit/5 kg

Slow bolus

Use cannot be endorsed.

Platelet-rich plasma

Platelets & microparticles

1 unit/10 kg

Administer over 4 h

1 unit/10 kg has potential to increase platelet count by up to 40,000 platelets/mcL. Rare need in patients.

APSS, acquired portosystemic shunt. VWF, von Willebrand factor.