Blood transfusion

1. Indications:
►Haemolytic diseases like Anaplasmosis, Babesiosis and Theileriosis.
Profuse blood loss conditions due to accidental trauma or prolonged
surgical interference
A general supportive measure in specific diseases such as haemophilia,
warfarin poisoning and auto immune haemolytic diseases
When HCT has fallen rapidly to below 20% in dogs and 15% in cats
In some conditions like Deficiency of blood constituents, Autoimmune hemolytic
anemia.
A general rule is that if an effective alternative is available,
transfusion should be avoided

2. Definition:
►Transfer of homologous blood from donor to recipient of same
species
Blood Typing:
►A blood typing refers to the presence, absence or variation of
antigens on the
surface
of red blood cells
► Different blood groups are present in the same species of animals
on the base of presence or
Absence of specific antigens

3. Blood Grouping:
►A blood typing refers to the presence, absence or variation
of chemicals/antigens on the surface of red blood cells.
►Blood typing is done to aid in the matching of donors and
recipients. ►To identify breeding pairs potentially at risk of
causing haemolytic diseases in offsprings.
Antisera (Typing Reagents) are used to identify blood
groups.
►The lack of commercial availability of these reagents make
complete typing difficult.
Bovines:
Most complex blood group systems.
Major blood groups are 12 but clinically important are B and
J.

4. Cats:
►AB Blood group system
Blood group A (high titer of antibodies against Bgroup).
Blood group B (high titer of antibodies against Agroup).
Blood group AB (no antibody against group A and B).
Dogs:
►Dogs are routinely typed only for the most potent antigen, DEA 1.1(+ve)
►In addition to DEA 1.1 at least 12 other blood group systems are present.
Random blood transfusion may have 30-40% chances of sensitization of
recipient.
Equines:
8 recognized blood groups (A,C,D,K,P,Q,T,U).

5. Cross Matching:
Cross match detects the presence of pre-existing antibodies that produce and
immediate
hemolytic reaction.
►Pre-existing antibodies could be the natural antibodies or the antibodies produced
against
the previous incompatible transfusion.
There are 2 methods of Cross Matching
1. Direct or Tripod Method:
Take a clean glass slide.
Put one drop of donor blood at first place; one drop of recipients blood at the
second place
and one drop of both donor and recipient blood at the third place and mix
thoroughly.
Agglutination of third drop indicates incompatibility and the transfusion of such
blood should not be carried.

6. 2. Indirect or Cross reaction:
Major Cross Match
Confirms whether the recipient has antibodies against donor R.B.C's
0.1 ml Donor RBCs + Recipient Plasma
Incubate, centrifuge and evaluate Positive Test-Macro or Micro agglutination
present (Incompatible)
Negative Test-Macro or Micro agglutination Absent (Compatible).
Minor Cross Match
Confirms whether the donor have antibody against recipient R.B.C's
Recipient RBCs + Donor Plasma
Positive Test-Macro or Micro agglutination present (Incompatible)
Negative Test-Macro or Micro agglutination Absent (Compatible).

7. Donor Selection:
► Donors should be healthy and completely free of diseases that may be
transmissible in the blood.
► Preference should be given to donors with high haematocrit and haemoglobin
levels.
►Donors PCV should be atleast 40% for dogs and 35% for cats. ►For transfusion in
neonatal animals, the dam of the recipient is usually the most
suitable donor.
No history of blood transfusion or pregnancy.
Genetically related or of same breed.
Age should be between 1-8 years.
A minimum weight is required, Dog must weigh atleast 25 Kg and cats atleast 4.55
Kg. These weights allow 450 ml of blood to be collected from dog and 60 ml from cat
without any harm to donor.

8. Blood Collection:
►Blood can be collected from a donor every 4-6 wks.
► Dogs and cats can donate 10% of their total blood volume with no adverse
effects.
Collection of 20% of the blood volume should not result in clinical significant
anaemia but c cause hypovolemia in short term.
Domestic animals have blood volumes of 7-9 % of their body weight.
Cats have a slightly lower volume of 6.5% of body weight.

9. Site of blood collection:
Animal
Site For collection
Cats
Jugular vein
Sheep/ Goat
Jugular vein
Dogs
Jugular vein
Horse
Jugular/ Transverse Facial vein
Cow
Jugular vein
Camelidae
Right jugular vein/ Cephalic

10. Blood Storage:
►The anticoagulant of choice is citrate phosphate dextrose adenine (CPDA-1)
► Commercial blood bags containing CPDA-1 are available.
► Another anticoagulant Acid citrate dextrose (ACD) is also used.
►Heparin should not be used because it has longer half-life in the recipient and
causes Platelet activation, also heparinized blood can not be stored.
► Blood collected in CPDA-1 with added nutrient solution can be stored at 4C for
4wks.
►Plasma can be removed and stored frozen for later use.
►Plasma must be frozen at -20C to -30C within 6 hours of collection for upto 1
year

11. Cont...
► Blood products should be warmed slowly to body temperature before
administering to prevent hypothermia and reduce vasoconstriction.
► Do not thaw plasma in boiling water or microwave and this will coagulate
plasma protein.

12. Blood Administration:
Administration rate depends upon:
►Anemic status of animal.
►Age of animal.
Health status of animal.
In normovolemic patients at the rate of 5-10ml/kg/hr.
In severely hypovolemic patients upto 20ml/kg/hr.
In compromised patients (cardiac or renal compromised) can be decreased
upto 2ml/kg/hr.
Blood is administered slowly over first 30min (0.25ml/kg) and remainder within 1-
4hr.
Blood should never be infused over a period longer than 4hr.

13. Dosage:
Based on % Hb. It is calculated as
40x body weight in pounds/100-ml of blood required to raise the Hb by 1%
General dosage is 5-10 ml/kg B.W
For example, For Dog of 25 kg the total blood volume of that dog is
Almost 2000ml that is 7-9% of B. W.
If PCV of this dog is 15% then the RBC volume is 300ml.
If the PCV is to be increased to 20% (400ml RBC), we have to inject 100 ml of
RBCs
Or 200ml of whole blood (with PCV 50%)

14. Steps for Blood Transfusions:
STEP1:
Verify the blood expiration date, donor species and blood type ►Inspect visually to
detect any macroscopic abnormalities in color and consistency Bacterial
contaminated blood often appears brown or purple
STEP2:
Eliminate air from IV set and connect it to catheter
Use a catheter with the largest available diameter
Carefully monitor physiologic parameters and adverse reactions The initial infusion
rate should be approximately 0.25 mL/kg for the first
30 minutes, after which the rate can be increased if no reactions are seen.

15. Conti...
STEP3:
After infusion, flush the infusion site with 0.9% saline
Saline (0.9%) is the most compatible fluid with RBC products Check packed cell
volume (PCV) 1 to 6 hours after transfusion.

16. Complications:
Immediate transfusion reactions
Immune mediated:
►Hemolytic transfusion reaction
Febrile reaction
Urticarial reaction
►Noncardiogenic pulmonary edema
Non-immune mediated:
→ Sepsis
Circulatory overload, Fever, vomiting.
Citrate toxicity>Hypocalcemia
Hemolysis
Hyperammonemia

17. Complications:
► Animals having repeated transfusions are at high risk.
► Acute reactions may occur i.e fever, vomiting, shock, collapse, weakness.
► Signs like dyspnoea, weak pulse, shivering, sweating, increased salivation,
frequent micturition and defecation
Transfusion of large volume of blood may cause citrate toxicity resulting
in hypocalcemia
►Transfusion at a too faster rate may cause acute heart failure.
Diseases like Mycoplasma (cats),Babesia(dogs), retrovirus, rickettsia can be
transmitted.

18. Cont...
These reactions respond well with an early attempt and large doses of:
► Immediately stop the transfusion and start oxygen therapy
► Use diurectics
► Administer calcium borogluconate
► Adrenaline (1:1000) @ 5-8ml/IM
► Corticosteroids @3-5ml 1/V
►Chlorphenaramine maleate @5-10 ml I/M

19. Types
•Hemolytic reaction
•Febrile reaction
•Urticarial reactions
•Toxicity from contaminated, outdated, or the wrong blood type
•Blood volume overload
•Citrate toxicity
•Hemolysis from change in temperature
•Hyperammonemia

20. Symptoms of Blood Transfusions Reactions in Dogs
Each type of blood transfusion reaction has its own symptoms which may be the
same or similar.
Immunologic Reactions
Hemolytic
•Fever
•Trouble breathing
•Pale gums
•Vomiting
•Diarrhea
•Dizziness
•Fainting
•Fast heartbeat
•Seizure
•Heart attack

21. Febrile
•Increasing body temperature
•Vomiting
•Shock
•Weakness
•Coughing
•Collapse
Urticarial
•Vomiting
•Breathing difficulty
•Edema
•Itching
•Hives
•Rash

22. Non-Immune Reactions
Sepsis from Contaminated Blood
•Fever
•Hypoglycemia
•Hypotension
•Dizziness
•Vomiting
•Diarrhea
•Blood clots
Sepsis from Wrong Blood Type
•Rapidly increasing body temperature
•Dizziness
•Fainting

23. Sepsis from Outdated Blood
•Trouble bleeding
•Fast heart rate
•Inflammation
•Low blood pressure
•Fainting
Volume of Blood Overload
•Difficulty in breathing
•Rapid breathing
•Cough
•Dizziness

24. Hemolysis from Change in Temperature
•Sudden high body temperature
•Extreme low body temperature
•Chills
•Shaking
•Vomiting
•Shock
Citrate Toxicity
•Vomiting
•Shaking
•Tremor
•Seizure
•Heart attack
Hyperammonemia
•Sleepiness
•Fainting
•Chills
•Seizure
•Coma

25. prognosis for a blood transfusion reaction
Prognosis varies depending on the severity of the reaction and the patient’s
overall health status. Mild reactions in otherwise-healthy dogs have a favorable
prognosis, while the prognosis is more guarded if a sick or elderly dog
experiences a severe reaction.

26. Conclusion
Transfusion medicine may be a life saving modality in case of emergency or
critically ill animals. Blood products are becoming readily available and
transfusions can be performed in many veterinary clinics. The appropriate use
of transfusion medicine should balance the rare but not negligible potential
risks associated with transfusions. Patients should be appropriately screened
with blood typing and cross matching before transfusion.

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