Some history of transfusion Why we need blood transfusion in animals Types of anemia-signs and treatment Complications of transfusion therapy Blood products Donor selection Pre-transfusion actions Operation (Transfusion) and notes

1. BLOOD TRANSFUSION IN DOG & CAT
In The Names of God
By:
Mahdi-Falsafi

2. HISTORY OF TRANSFUSION MEDICINE
 Early practices and customs relating to the blood of ancient days include people drinking the
blood of fallen gladiators to gain strength, religious figures attempting to heal themselves by
drinking blood from the youth, and doctors inducing hemorrhage to let out “bad blood” due to
the belief that blood was one of the four fundamental humors of Hippocratic medicine and
blood-letting would bring balance to the humors and restore health (Greenwalt 1997)
 It is unclear who first conceived the idea of blood transfusions. Hieronymus Cardanus (1505–
1576) is given credit in some literature, while Magnus Pegelius obtained the right to publish
on the topic under Emperor Rodolphus II’s rule in 1593. Andreas Libavius was the first person
clearly documented in history to advocate for blood transfusions; he recorded his thoughts
on using a silver tube to connect the arteries of two individuals to allow blood from the
young man to “pour” into the artery of the old man.

3. HISTORY OF TRANSFUSION MEDICINE
 First animal-to-animal transfusion
Richard Lower (1631–1691) performed the first successful animal-to-animal
transfusion in February 1665; previous to this he had years of failed
attempts due to clotting in the tubes
 First animal-to-human transfusions
While similar uncertain claims to the first human transfusion have been
made, Jean-Baptiste Denis is believed to have performed the first animal-
to-human transfusions. He performed a transfusion of lamb blood to a
15-year-old child who was suffering from a persistent fever; the child was
reported to have “a clear and smiling countenance” after the transfusion.
Denis also performed a transfusion to the son of the Prime Minister of
Sweden (Baron Bond), without successfully curing him,

4. REASONS AND DEFINITION
Anemia, also spelled anaemia, is usually defined as
 a decrease in the total amount of red blood cells (RBCs)
 or hemoglobin in the blood
 It can also be defined as a lowered ability of the blood to carry oxygen
Causes
Anemia is often categorized based on its cause:
hemolysis, blood loss, or erythropoietic failure

5. REASONS AND DEFINITION
 Primary signs of anemia relate to the reduction in oxygen-carrying capacity of the blood:
lethargy, weakness, anorexia, heart,murmur, tachypnea, and pale mucous membranes
 Secondary signs of anemia often relate to the effects of increased blood cell destruction, such as
icterus, splenomegaly, and hepatomegaly from extravascular hemolysis or extramedullary
hematopoiesis and discolored urine from the effects of hemoglobin or excess bilirubin excreted.
Principles of Diagnosis
Historyandphysicalexaminationto determinethefollowing:
• Occurrenceoftraumaorsurgery
• Drug,chemical, ortoxinexposure
• Underlyinginfectious,parasitic,orneoplasticdisease
• Durationof disease, sitesofbloodloss,andpresence oforganomegaly

6. REASONS AND DEFINITION
Complete Blood Count
• Packed cell volume (PCV)
• Determine plasma protein or total solids by refractometer.
• Erythrocyte, or red blood cell (RBC), count
• Hemoglobin (Hgb) concentration in grams perdeciliter
• Mean cell or corpuscular volume (MCV) reflects erythrocyte size and may be categorized as
macrocytic, microcytic, normocytic,
(Note that Akita and Shibadogs normally have microcytic erythrocytes-toy and miniature poodles, as well as greyhounds,may
have macrocytic erythrocytes)
• Other erythrocyte indices such as mean corpuscular hemoglobin (MCH) and mean corpuscular
hemoglobin concentration (MCHC) normochromic and hypochromic
Reticulocyte Count
• This is the most accurate method to evaluate regeneration.
• Perform reticulocyte counts when the PCV falls below 30% in dogs and 20% in cats.

7. REASONS AND DEFINITION
• Normal PCV is considered 45% for dogs and 35% for cats. A corrected percentage for a
reticulocyte value greater than 1% indicates increased RBC regeneration.
Fecal Examination and Urinalysis
 These tests are performed to determine sources of blood loss and function of the kidney.
Biochemical Profile
Biochemical profiles may reveal organic disease that can affect the ability to regenerate
erythrocytes.

8. REASONS AND DEFINITION

9. BLOOD LOSS ANEMIA
 Large volumes of blood must be lost before appreciable changes occur in the numbers of
erythrocytes or PCV
 The immediate loss of blood results in little or no change to the PCV
Etiology
Causes of blood loss include the following:
• Trauma
• Surgery
• External and internal parasitism
• Gastric ulcers
• Tumors of the gastrointestinal (GI) and urinary systems
• Splenic rupture
• Coagulation abnormalities
Treatment
 Administer cross-matched whole blood for acute hemorrhage when the PCV drops to 20% to 25% in
the dog or cat

10. HEMOLYTIC ANEMIA
 Causes of hemolytic anemia include congenital abnormalities, immune-mediated destruction,
infections,chemical or toxic agents, mechanical fragmentation,and hypophosphatemia.
 some cases, the anemia may occur so rapidly that the animal may have too little time to mount a
regenerative response
• Depending on the severity or acuteness of the destruction and the conjugating ability of the
liver,icterus may or may not be present.
• Plasma protein concentrations usually are normal.

11. HEMOLYTIC ANEMIA
Congenital Erythrocyte Abnormalities
Pyruvate Kinase Deficiency
During anaerobic glycolysis, pyruvate kinase is necessary for the production of adenosine
triphosphate
Clinical Signs
• Young animals usually present with anemia, exercise intolerance, tachycardia, and
splenomegaly. The outcome of the disease is usually death by 4 years of age.
• Myelofibrosis and osteosclerosis may occur
Diagnosis
This disease is suggested clinically by the presence of an intense reticulocytosis (15–50%),
along with frequent nucleated red cells in a young dog. Echinocytosis
• Polymerase chain reaction (PCR)

12. HEMOLYTIC ANEMIA
Congenital Erythrocyte Abnormalities
Phosphofructokinase Deficiency
• This glycolytic enzyme deficiency causes a decrease in 2,3-diphosphoglycerate(2,3-DPG)
concentration, resulting in an increase in intracellular pH. Erythrocytes from affected
animals are especially fragile under alkaline conditions.
Clinical Signs. The clinical signs may involve lethargy, pale or icteric mucous membranes, mild
hepatosplenomegaly, myopathy, and fever. Dogs may have a normal life span if properly
managed.
Diagnosis. The enzyme deficiency is diagnosed by specialized erythrocyte assays in
homozygous and heterozygous animals. A PCR-based test
Hereditary Stomatocytosis
Erythrocyte numbers are reduced, but the PCV remains normal because of enlarged
erythrocytes.

13. HEMOLYTIC ANEMIA
Congenital Erythrocyte Abnormalities
Feline Porphyria
Feline porphyria is an infrequent inheritable trait that results in an enzyme deficiency affecting
heme synthesis.
• Clinical signs include pink urine, pinkish-brown teeth, and severe anemia resulting from the
deposition of red non-heme pigments and the lysis of erythrocytes when exposed to sunlight.

14. HEMOLYTIC ANEMIA
Infectious Causes of Hemolysis
Hemoplasmosis
Hemoplasmosis or hemotrophic mycoplasmosis, previously known as hemobartonellosis, is caused
by a mycoplasma organism that infects the erythrocytes of dogs (Mycoplasma haemocanis) and
cats (M. haemofelis and “Candidatus M. haemominutum”).
Clinical Signs. Clinical signs include those generally observed with anemia. Weight loss may occur
if the anemia develops slowly, whereas acute, severe anemia produces sudden depression and
icterus. Splenomegaly often is noted.
Diagnosis. Laboratory findings generally reflect a strong regenerative response in the CBC.
• Thin smears, made directly without anticoagulant,
• A positive Coombs test
• PCR-based assays
Treatment
• Consider whole blood transfusion if the anemia is severe.
• Prednisolone (2mg/kg PO q12h) to suppress the severe immune-mediated
destruction of erythrocytes.
• Doxycycline (5 mg/kg PO q12h for 4 weeks) is preferred for dogs
• Enrofloxacin (5 mg/kg PO q24h for 14 days) can be used in cats intolerant of doxycycline.

15. HEMOLYTIC ANEMIA
Infectious Causes of Hemolysis
Babesiosis
tick-borne protozoal disease affecting erythrocytes of dogs (Babesia canis, B. gibsoni).and
cats (Babesia felis)
Clinical Signs. Clinical signs in babesiosis range from an acute hemolytic crisis to an unapparent
subclinical form. Signs of the acute disease include splenomegaly,icterus, anemia, thrombocytopenia,
hemoglobinuria, and fever.
Diagnosis. Initial diagnosis is made by examination of a blood smear.
• An indirect fluorescent antibody (IFA)
• A nested PCR test
• A Coombs test
Treatment• Imidocarb dipropionate (Imizol, Schering-Plough)(6.6 mg/kg SC or IM given twice 2 weeks
apart)
• Diminazene aceturate (Berenil, Hoechst) (3.5mg/kgSC or IM given once)
• Phenamidine isethionate (15mg/kg SC q24h for 2days)

16. HEMOLYTIC ANEMIA
Infectious Causes of Hemolysis
Leptospirosis
Leptospira serovars can cause kidney disease, liver disease, hemolysis, icterus, and coagulopathies.
Toxins released from proliferating organisms interfere with cellular metabolism and damage cells
Systemic signs: This can include acute onset of anorexia, depression, fever, vomiting,
dehydration,stiff gait,
Treatment
fluid and electrolyte therapy,transfusion
Initially give parenteral antibiotics, such as penicillin G (25,000–40,000 units/kg IV,qvomiting resolves,
switch to oral amoxicillin (22 mg/12h) or ampicillin (22 mg/kg IV, q6–8h). Once kg PO, q8–12h) and
continue treatment for 2 weeks.

17. HEMOLYTIC ANEMIA
Chemical or Toxic Injury of Erythrocytes
Oxidant-Induced (Heinz Body) Anemia
Etiology. Chemicals, drugs, or plants associated with Heinz body formation include acetaminophen,
methylene blue, onions, vitamin K3, dl-methionine, zinc, topical benzocaine
Clinical Signs. Acute hemolysis causes depression, hemoglobinemia, hemoglobinuria, moderate to severe
anemia, and occasional icterus.
Diagnosis. Diagnosis is made by observation of a single, large, pale-staining area in erythrocytes of
Romanowsky-stained blood smears.
Treatment
• Remove the source of oxidant exposure. Use emetics if recent ingestion has occurred.
• Give blood transfusions or other forms of supportive care, as indicated.
• For acetaminophen-induced toxicity, give acetylcysteine Mucomyst, (Roxane Laboratories), 140mg/kg of
a 5% solution diluted with saline given IV as a loading dose, then give 70 mg/kg of a 5% solution every 4
hours for three to five treatments.
Snake Venom Toxicity
Zinc Toxicity

18. HEMOLYTIC ANEMIA
Mechanical Fragmentation of Erythrocytes
Heartworm Disease
Dirofilariasis may produce anemia after intravascular hemolysis as large numbers of adult heartworms
(Dirofilaria immitis)
Postcaval syndrome results from obstruction of the caudal vena cava causing, in addition to hepatic
failure, erythrocyte fragmentation (schistocytosis), hemoglobinemia, and hemoglobinuria.
Disseminated Intravascular Coagulopathy
cause a microangiopathic hemolytic anemia because of fibrin deposition
• Etiology involves a variety of conditions, such as neoplasia, infections, necrosis, toxins, and immune
complex formation.
• Diagnosis is based on consumption of platelets (thrombocytopenia), reductions in clotting factors,
hypofibrinogenemia (prolonged prothrombin time [PT], activated partial thromboplastin time [APTT],

19. HEMOLYTIC ANEMIA
Mechanical Fragmentation of Erythrocytes
Hypophosphatemia
Cases of feline diabetes mellitus and hepatic lipidosis have been associated with
hypophosphatemia-induced hemolysis
Hypomagnesemia
Gastrointestinal Causes: Inadequate intake, Chronic diarrhea and vomiting,Malabsorption
syndromes, Acute pancreatitis ,Cholestatic liver disease, Nasogastric suction(?)
Renal Causes: Renal failure, Renal tubular acidosis, Postobstructive diuresis, Drug-induced tubular
injury,Post–renal transplant ,Prolonged intravenous fluid therapy, Diuretics,Digitalis administration,
Concurrent electrolyte disorders, Hypercalcemia, Hypokalemia, Hypophosphatemia
Endocrine Causes:Diabetes mellitus and diabetic ketoacidosis, Hyperthyroidism,Primary
hyperparathyroidism, Primary hyperaldosteronism

20. HEMOLYTIC ANEMIA
Nonregenerative Anemia
Chronic, nonregenerative anemias may not require blood transfusion until the PCV falls below 15% in the
dog and 12% in the cat.
Infectious Agents
 Feline Leukemia Virus ,FIV,FIP
 Ehrlichiosis and Anaplasmosis
 Leishmaniasis
 Cytauxzoonosis
highly fatal protozoal disease of cats caused by Cytauxzoon felis. It is a tick-borne infection,most
prevalent in the wooded areas.
Nutritional Deficiencies: Iron Deficiency- Cobalamin Deficiency- Folate Deficiency
Inflammatory Disease
Organic Disease: Kidney Disease- Liver Disease
Endocrine Disease
Drug and Toxin-Induced Disease
Myelophthisis

21. IMMUNE-MEDIATED HEMOLYTIC ANEMIA(IMBH)
The body’s immune system mistakenly starts recognizing its own red blood cells (RBCs) as antigens and initiates their
destruction. In this process antibodies produced by the immune system bind to the RBCs and destroy them.
The hemolysis(destruction) of red blood cells results in the release of hemoglobin, which can lead to jaundice, and further on
to anemia
Symptoms
Weakness *Lethargy *Poor appetite *Fainting *Exercise intolerance *Vomiting *Rapid breathing* Diarrhea *Increased thirst and
urination in some dogs*Fever *Jaundice* Rapid heart rate *Melena *Petechia* Ecchymoses * Joint pains
Causes
 Autoimmune hemolytic anemia (production of antibodies against the body’s own RBCs and their destruction)
 Systemic Lupus Erythematosus (SLE) (production of antibodies against the body’s own tissues and blood)
 Certain infections like ehrlichia, babesia, and leptospria infections
 Certain drugs, like antibiotics
 Vaccination
 Heartworm disease
 Neoplasia (tumor)
 Neonatal isoerythrolysis (destruction of the red blood cells within a puppy's body system by the action of maternal
antibodies)
 Dysregulated immune system
 Idiopathic (unknown cause)

22. IMMUNE-MEDIATED HEMOLYTIC ANEMIA(IMBH)
 Most dogs and cats with acute, severe IMHA need oxygencarrying support.

23. COMPLICATIONS OF TRANSFUSION THERAPY
Divided into those that are immunologically mediated and those that are
of nonimmunologic origin.
 Immune-mediated reactions: include urticaria, hemolysis, and fever
 Non–immune-mediated complications include: fever or hemolysis resulting from the transfusion
of improperly stored blood, circulatory overload, citrate intoxication, disease transmission, and
the metabolic burden associated with the transfusion of aged blood.
 Signs of immediate immune-mediated hemolysis appear within minutes of the start of transfusion
and include tremors, emesis, and fever; these are extremely rare in dogs but common in cats
receiving incompatible blood products.
 Delayed hemolytic reactions are more common and are manifested primarily by an unexpected
decline in the HCT after transfusion over days in association with
hemoglobinemia,hemoglobinuria, and hyperbilirubinemia

24. COMPLICATIONS OF TRANSFUSION THERAPY
 Circulatory overload may be manifested by vomiting, dyspnea, or coughing.
 Citrate intoxication occurs When the infusion rate is too fast or the liver cannot metabolize the
citrate. Signs of citrate intoxication are related to hypocalcemia and include tremors and cardiac
arrhythmias.
PREVENTION OF THROMBOEMBOLISM
 Thromboembolic events (TEs) are a common complication and important cause of death in dogs
with IMHA. TEs have been documented at necropsy in 29% to 80% of dogs with IMHA
 Identification of certain clinicopathologic abnormalities, such as thrombocytopenia,
hyperbilirubinemia, leukocytosis, and hypoalbuminemia, are associated with an increased risk of
TE in dogs with IMHA.
 Treatment options currently used for prevention of thromboembolic complications include
heparin, low-molecular-weight heparin, aspirin, or a combination of these modalities

25. COMPLICATIONS OF TRANSFUSION THERAPY
• The most serious adverse effect of administration of any red blood cell–containing
component is acute hemolytic transfusion reaction due to recipient antibodies against
the donor red blood cells
• Transfusions also carry risk of circulatory overload, Type I hypersensitivity reactions,
vomiting, and fever
• The most common reaction, fever, is believed to be due to cytokines contained in the
transfused blood or from antibodies against red blood cells, white blood cells, or
platelets. Fever also occurs with bacterial contamination of blood.
• An increase in body temperature of 1° C should be considered a transfusion-associated
fever.
• Oxyglobin does not contain antigenic red blood cell membranes and will not cause an
acute hemolytic transfusion reaction. The most common adverse event associated with
Oxyglobin administration is circulatory overload, manifested as pulmonary edema or
pleural effusion

26. COMPLICATIONS OF TRANSFUSION THERAPY
• Oxyglobin has strong colloid effect because its colloid osmotic pressure
(COP) is 43 mm Hg and it also causes transient discoloration of mucus
membranes (muddy pink, icteric orange, or brown), skin, and urine
(pigmenturia)
POTENTIAL LONG-TERM PROBLEMS AFTER TRANSFUSIONS
Diseases where multiple transfusions , rarely described
• One such adverse event is posttransfusion purpura. In this transfusion
complication, thrombocytopenia occurs 1 to 2 weeks following transfusion.
The recipient, sensitized by transfusions containing platelet antigens, can
produce antibodies against platelets which, in turn, can cause
thrombocytopenia. The syndrome usually naturally resolves in 1 to 4 weeks
• A second long-term problem caused by transfusions in dogs is
hemochromatosis. Iron from senescent transfused red blood cells
accumulates in the liver, ultimately resulting in liver failure from transfusional
hemochromatosis.

27. COMPLICATIONS OF TRANSFUSION THERAPY
• All transfusions carry the risk of infectious disease transmission. Of greatest concern in
veterinary patients are canine and feline vector-borne diseases and feline retroviral
diseases. Blood donor screening recommendations have been made to minimize
morbidity and mortality

29. BLOOD PRODUCTS
 Whole blood
WB contains all components of circulating blood including red blood cells (RBCs) and white blood
cells (WBCs), platelets, coagulation factors ,albumin, globulins, electrolytes, etc., at concentrations
that were present in the donor. This product, known as fresh whole blood (FWB), can be transfused
immediately or stored briefly (<8 hours) at room temperature prior to transfusion.
WB can also be storedat 4 ∘C (stored whole blood, SWB) for up to 35 days depending on the
anticoagulant-preservative solution used, or can be processed into blood components
Platelets in FWB maintain the ability to aggregate for at least 8 hours when stored at room
temperature
Disadvant: administration of FWB or SWB to anemic patients without hypovolemia or coagulopathy
predisposes recipients to volume overload and antigenic stimulation secondary to unnecessary
plasma administration

30. BLOOD PRODUCTS
 Component therapy
The separation of WB into its constituents for further storage prior to administration is known as
component therapy. FWB can be processed into a variety of different components that can be
transfused based on individual patient need

31. BLOOD PRODUCTS

32. BLOOD PRODUCTS
 Packed red blood cells
WB is centrifuged and the supernatant plasma is separated into a
satellite bag, the unit of RBCs that remains is called PRBCs
For the production of canine PRBC units, an additive solution is
often combined with the concentrated RBCs. Additive solutions
contain dextrose, adenine, and other ingredients that maintain red
cell viability by supporting red cell energy production and reducing
hemolysis
Indications for any patient with symptomatic anemia, including
anemia due to hemorrhage, hemolysis, or decreased production
(e.g., bone marrow suppression).
 Feline packed red blood cells
Preparation of feline PRBC units can be challenging and requires
careful handling of blood units to avoid breakage. Since blood
collection sets for feline blood donation are not available with pre-
loaded anticoagulant-preservative solutions and additive solutions,
anticoagulants (such as acid-citrate-dextrose, ACD)

33. BLOOD PRODUCTS
Platelet products
platelet-containing blood products include FWB, platelet-rich plasma, platelet concentrate, frozen
platelet concentrate ,and lyophilized platelets.
These products require careful preparation using specialized techniques and are not always
available from all commercial blood banks
Fresh platelet products likely offer the highest number of functional platelets, but also have the
shortest storage times. Preservation techniques sacrifice platelet quantity and quality, but offer
prolonged storage times and enhanced availability
 Platelet-rich plasma & platelet concentrate
(PRP) is produced when FWB is centrifuged at slow speeds (“soft spin”) at room temperature, after
which the plasma and buffy coat are transferred into an attached satellite bag
further processed into platelet concentrate (PC). To produce PC, a unit of PRP is again centrifuged
at room temperature at a slightly faster speed in order to concentrate platelets (and any
remaining red and white blood cells) in the gravity-dependent portion of the bag

34. BLOOD PRODUCTS
Platelet products
 Frozen platelet concentrate(cryopreserved platelet concentrate)
6% dimethyl sulfoxide (DMSO) is added to a unit of apheresis platelet
concentrate, which allows the product to be stored in a freezer for up to
6 months

35. BLOOD PRODUCTS
Plasma products
 Fresh frozen plasma(FFP)
FFP is plasma that has been separated from other blood
constituents and frozen within 8 hours of collection of WB from a
donor
 Frozen plasma(FP)
FP refers to plasma that has been separated from WB and frozen
more than 8 hours after collection, or plasma initially designated as
FFP that was frozen for more than12 months
 Refrigerated or liquid plasma(LP/RP)
When treating a patient with rapidly exsanguinating hemorrhage
due to coagulopathy, having plasma available in its liquid form
might save valuable time (LP), is the name given to plasma
separated from SWB and never frozen. kept at refrigerated
temperatures for up to 14 days.

36. BLOOD PRODUCTS
Plasma products
 Cryoprecipitate and cryosupernatant
Also known as cryoprecipitated anti-hemophilic factor, is produced
from the precipitated protein that forms when a unit of FFP is slowly
thawed at refrigerated temperatures
Cryoprecipitate is rich in factors VIII and XIII, fibrinogen, and
fibronectin, and can be stored in a freezer for up to 12 months
This concentrated source of clotting factors and vWF permits the pre-
emptive treatment of patients with hemophilia A (factor VIII deficiency)
and von Willebrand disease, while administering a lower transfusion
volume, thereby reducing the risk of circulatory overload
 Cryosupernatant, also known as cryopoor plasma or
cryoprecipitate-reduced plasma, is the supernatant product
removed during the production of cryoprecipitate
Factors II, V, VII, IX, X, and XI, specifically for patients with anticoagulant
rodenticide intoxication or hemophilia B or C

37. BLOOD PRODUCTS
Platelet products
 Autologous serum eye drops
 Autologous blood patch pleurodesis
 Autologous platelet-rich plasma
 Autologous conditioned plasma
tendon and ligament lesions
Osteoarthritis
Hyaluronan,…

38. DONOR SELECTION
Age
A typical age range recommended for canine donors is 1–8 years old
Weight
The donor body weight correlates with the blood volume circulating in the blood vessels.
The total blood volume in a dog is approximately 85 mL/kg (80–90 mL/kg)
The standard donation volume is 450mL because closed blood collection systems used for component separation in
people are of this size. A 250mL donation can be collected from dogs weighing over (13.2 kg) into single-chamber bags
available for transfusion of this volume of whole blood.
History
Determine their health status. The dog’s clinical history should be carefully considered to detect any potential previous
exposure to blood products or infectious diseases, as well as any health concerns. Echocardiography
Heart murmurs were detected in 22 of 103 (21%) overtly healthycats that were candidates for blood donation
Behavior/temperament
An ideal temperament for a canine donor is a dog that remains relaxed and cooperative during the entire blood
collection process. Current understanding of canine behavior and blood banking has led most operations to perform
blood collections without sedation, which is ideal since it signifies the closest a dog can get to being a “volunteer”
donor

39. DONOR SELECTION

40. DONOR SELECTION

41. BLOOD COLLECTION
Recommendations for minimizing stress
 The number of instances the dog is handled by blood bank personnel should be limited
 The physical examination and sampling of blood for pre-donation testing can be performed
during a single interaction,
 Immediately after the physical examination is also an opportune time to apply topical
anesthetic cream to the venipuncture site used for donation, as the creams typically require 30
or more minutes to fully take effect.
 Two commonly used topical anesthetic creams are eutectic mixture of local anesthetics (EMLA)
and liposomal lidocaine

42. BLOOD COLLECTION
Blood tests
Packed cell volume and total protein
In addition to the annual comprehensive blood work and bloodborne pathogen screening,
evaluation of packed cell vol- ume (PCV) and total protein (TP) on the day of the donation are
required.
Preparing materials
 Anticoagulants
citrate is an anticoagulant that also provides nutrients that prolong the lifespan of RBCs during
storage and is used most commonly.

43. BLOOD COLLECTION
Collection systems
Small volume whole blood collection
Rarely, a small volume transfusion of whole blood might be collected for immediate transfusion to a
patient. Such a situation is typically limited to small dogs and neonates that can benefit from a
transfusion of fresh whole blood containing RBCs, coagulation factors, and platelets.
Standard volume whole blood collection
Whole blood collection sets consisting of a single plastic bag with tubing connected to a large bore
needle are available from commercial suppliers. Bags of 250 mL and 450 mL collection volume are
commonly used. The bags are pre-filled with anticoagulant at a ratio appropriate for the designated
collection volume

44. BLOOD COLLECTION
Sedation
Many canine donors become suitable “volunteer” donors, there- fore the majority of blood donor
programs employ non-sedation canine donations with a large degree of success. However, sedation
might be considered under extenuating circumstances for certain donors, especially those that have a
very desirable blood type.
Intravenous catheter placement
Donor positioning
The canine donor can be positioned in lateral or sternal recumbency
Lateral recumbency generally allows better comfort and control of the head to prevent inadvertent
movement and subsequent trauma or needle redirection.
When performing gravity-assisted collection, the donor will be required to be on a surface higher than
the bag, typically on a treatment table. If a vacuum-assisted collection system is being used, the donor
can be positioned on the floor, which can be more comfortable for some donors

45. BLOOD COLLECTION

46. BLOOD COLLECTION

47. BLOOD COLLECTION

48. BLOOD COLLECTION
Post-donation care
 Digital pressure on the venipuncture site should be provided until hemostasis is achieved.
 A light pressure wrap can then be placed so that the donor can get up andwalk around while
they are monitored
 If any signs of hypotension or hypovolemia arise, such as weakness, pale mucous membranes,
prolonged capillary refill time, weak pulses, or altered mentation, the donor should be given
intravenous fluids to replace the lost volume and monitored for immediate resolution of their
signs.

49. Incentives
First and foremost, it is imperative that the blood donation be a positive experience for the owner and the dog
BLOOD COLLECTION

50. BLOOD COLLECTION
Blood processing & banking
 Storage of RBC products

51. BLOOD TYPING
Dogs:
Over 13 canine blood groups have been described. Eight DEA (Dog Erythrocyte Antigen) types
are recognized as international standards.
Dogs with only DEA 4 or DEA 6 can thus serve as blood donors for the majority of the canine
population
 Dogs that are DEA 1.1 positive (33 to 45% of the population) can be considered to be universal
recipients
 Dogs that are DEA 1.1 negative can be considered to be universal donors
 Blood from DEA 1.1 positive dogs should never be transfused into DEA 1.1 negative dogs
 Recently, new blood groups have been identified, in dogs .Dal appears to be common in dogs
and transfusion of Dal− dogs with Dal+ blood results in antibody production that may lead to
an acute hemolytic transfusion reaction. The Dal antigen appears to be lacking in some
Dalmatians

52. BLOOD TYPING
Cats:
The commonly recognized system of feline blood designates cats as A, B, or AB
The vast majority of cats in the United States are Type A, but the percentage of Type B cats
increases in other countries, such as Australia
 Type A and B cats have naturally occurring alloantibodies to the opposite blood type,
although the reaction of Type B cats to Type A blood is more severe than vice versa
 Mik− cats appear to have a naturally occurring anti-Mik alloantibody that may cause
transfusion incompatibility without prior transfusion

53. PRE-TRANSFUSION ACTIONS
Blood-typing methods
most often based on the hemagglutination of patient RBC
antigens with known antibody or antisera
Card, slide, tube, solid phase microwell, and gel column testing
methods are used

54. PRE-TRANSFUSION ACTIONS
Blood-typing methods

55. PRE-TRANSFUSION ACTIONS
Blood-typing methods

56. PRE-TRANSFUSION ACTIONS
Blood-typing methods

57. PRE-TRANSFUSION ACTIONS
Blood-typing methods

58. PRE-TRANSFUSION ACTIONS
Cross matching:
Perform cross-matching before transfusion.
The procedure, which involves collection of
erythrocytes and serum or plasma from the
donor and the patient, is as follows:
• Wash erythrocytes and pellet 3 times in 0.9%
saline.
• Make a 4% cell suspension by adding 4.8 ml
of saline to 0.2 ml of cells.
• Measure compatibility between donor and
patient optimally at three temperatures: 37∞C,
20∞C, and 4∞C.
• Donors are incompatible if any agglutination
or hemolysis occurs in the major cross-match.

59. PRE-TRANSFUSION ACTIONS

60. PRE-TRANSFUSION ACTIONS
 Preparing the RBC product
Blood product warming is indicated in cases when large blood volumes (massive transfusion) or
high transfusion rates are required or if the animal is hypothermic.
Prior to transfusion, the blood product should be examined for normal color and consistency and
not administered if any abnormalities are identified
 Preparing the patient
It is imperative that cats receive blood of their own blood type for all transfusions, including the
first transfusion. Although the first blood transfusion in dogs could be of a different blood type
Some clinicians advocate the use of prophylactic premedication with antihistamines

61. PRE-TRANSFUSION ACTIONS
 Dosage and rate
Historically, blood has been transfused until the signs of anemia have improved or resolved, such
as achieving normal heart and respiratory rates or normal lactate concentrations.
Calculation of dose:
DISEASE DOSAGE
Packed red blood cells* 6-10 mL/kg
Packed red blood cells in additive solution 10-15 mL/kg
Leukoreduced packed red blood cells 15 mL/kg
Whole blood 10-20 mL/kg

62. PRE-TRANSFUSION ACTIONS
 Dosage and rate
Calculation of rate:
Depends on the animal’s cardiovascular status, in addition to the severity of anemia. Relatively
stable dogs and cats without severe ongoing blood loss should have an initial rate of 0.25–
0.5mL/kg for 15–30 minutes to allow early detection of possible transfusion reactions. Thereafter,
the rate can be increased to 2–10 mL/kg/hour until completion of the transfusion.
The maximum recommended transfusion rate for euvolemic anemic animals is 10–20 mL/kg/hour.
Slower rates are indicated in animals with cardiac disease and conditions when circulatory
overload can result from transfusions, such as kidney insufficiency
In emergency situations involving major blood loss, the initial slow rate can be omitted and the
maximum transfusion rate can be further increased as needed to match ongoing hemorrhage

63. PRE-TRANSFUSION ACTIONS
 Administration methods
Blood products are routinely administered intravenously through an indwelling catheter,
Although intraosseous routes have been described when venous access is not possible, such as in
neonates
Intraperitoneal blood absorption is slow; therefore, transfusion through this route is considered
inefficient for managing severe anemia.

64. TRANSFUSION
Multiple factors must be considered in determining a transfusion protocol:
1-PCV (or Hb concentration or Hct) provides information about the oxygen-carrying capacity of
the blood
2-perfusion status, the ability of the lungs to oxygenate the blood, the chronicity of the anemia,
and the regenerative capacity of the bone marrow
Perfusion status is reflected by the state of volume repletion and cardiac output, include the
ability of tissues to increase their oxygen extraction ratio, the ability of the heart to increase
cardiac output, and adaptations in the Hb’s ability to uptake oxygen from the lungs and
download oxygen to the tissues
 31% of dogs over 8 years of age had a PCV below the reference range, indicating anemia is
moderately frequent in dogs
 Dogs and cats with coagulation disorders often require treatment of anemia in addition to
coagulopathy treatment

65. TRANSFUSION
The goals of a red blood cell transfusion are to reduce morbidity, mortality, and functional impairment
caused by inadequate delivery of oxygen
 When a second transfusion is administered more than 4 days after the first transfusion, a
crossmatch should be performed in both dogs and cats to determine compatibility of the red blood
cells to be transfused
 If Oxyglobin is the product being used to treat anemia, blood typing and crossmatching are not
necessary
 Oxyglobin is a hemoglobin-based oxygen carrier (HBOC), and although it is used to treat anemia, it
does not contain red blood cells. Measurement plasma Hb and total Hb should be used to
determine the response to administration of Oxyglobin.
Glutaraldehyde crosslinked hemoglobin
O-raffinose crosslinked hemoglobin
Diaspirin crosslinked hemoglobin,…
 Signs of gastrointestinal distress including esophageal spasm, abdominal discomfort, pain, nausea,
and vomiting have been reported in people after HBOC solution administration. Oxyglobin should
be used cautiously in dogs and cats with cardiovascular disease and circulatory overload states.

66. TRANSFUSION

67. TRANSFUSION
 Body temperature, respiratory rate, heart rate, capillary refill time, mucous membrane color,
mentation, and blood pressure should be monitored prior to red blood cell transfusion and
intermittently during and for several hours after a transfusion to promote early identification of
a transfusion-related adverse event
 Transfusion should be discontinued if vomiting, diarrhea, collapse, or urticaria are noted.

68. TRANSFUSION

69. TRANSFUSION FOR BLOOD LOSS ANEMIA
 Acute blood loss resulting in hemodynamic instability
 If blood loss is internal, approximately 50% of the hemorrhaged red blood cells will reenter the
circulation over 24 hours, dosage can be more conservative than in cases of external
hemorrhage
 Massive transfusion is defined as transfusion dose greater than 1 blood volume in a 24-hour
period. In the dog, this had been defined as 90 mL/kg in 24 hours or 45 mL/kg in 3 hours.
The large volume of citrate-based anticoagulant administered with the red blood cells results in
hypocalcemia and hypomagnesemia.
Dilutional coagulopathy results if the blood administered has been stored
Acid-base abnormalities may also occur after a massive transfusion
M o n i t o r i n g !

70. TRANSFUSION FOR OTHER ANEMIA
FOR IMMUNE-MEDIATED HEMOLYTIC ANEMIA
Red blood cell transfusion was discouraged because of the fear it would promote hemolysis and
worsen the patient’s condition.
Determining the patient’s requirement for increased oxygen-carrying capacity has become the
major factor
 A reasonable recommendation is to transfuse DEA 1.1–negative red blood cells in the smallest
volume necessary to improve a dog or cat’s clinical status
 Concerns of inducing accelerated hemolysis have led to the recommendation to use a HBOC
(Oxyglobin) for increasing oxygen-carrying capacity in IMHA

71. TRANSFUSION FOR OTHER ANEMIA
FOR ANEMIA OF ERYTHROPOIETIC FAILURE
.Animals with this type of anemia are usually normovolemic or hypervolemic
Erythropoietic failure typically takes weeks to resolve, red blood cell–containing products are
optimal.
The half-life of red blood cell–containing products depends on the storage medium but ranges
from 21 to 35 days. The half-life of Oxyglobin is 18 to 43 hours when it is administered at a dose
of 10 to 30 mL/kg.
 Packed red blood cell products have an advantage over both whole blood and Oxyglobin

72. TRANSFUSION FOR OTHER ANEMIA
IN COAGULOPATHIC DOGS AND CATS
Treated with fresh frozen plasma and its related products, cryoprecipitate and cryosupernate
plasma, platelet-rich plasma, or platelet concentrates
 Coagulation test results are commonly abnormal in cats with liver disease, neoplasia, and
infectious diseases
 In dogs the most common inherited coagulation disorder is von Willebrand disease (vWD) and
the most common acquired coagulation disorder is immune-mediated thrombocytopenia
 Compatibility testing, is not routinely performed in the dog,
but blood type–compatible plasma must be given to cats since Type A cat plasma contains anti-B
antibodies and Type B cat plasma contains anti-A antibodies
 A dog or cat with hemorrhage should be evaluated for coagulopathy using a prothrombin
time (PT) and either an activated partial thromboplastin time (aPTT) or activated clotting time(if
1/5 time of normal, admin plasma trns)+ Platelet count
 Kidney biopsies are associated with more bleeding complications than liver biopsies

73. TRANSFUSION FOR OTHER ANEMIA
 Frozen plasma products must be thawed prior to administration, but warming is not usually
required
 Warming may be advantageous if large volumes of cold products are being administered
 A blood transfusion administration set with an integral filter should be used to administer all plasma
products
 . Plasma products are typically administered intravenously, but can successfully be administered
interosseously or intraperitoneally
 Vitamin K is the antidote for the rodenticide-induced depletion of coagulation factors.
Cryosupernatant plasma is the ideal product for treatment of anticoagulant rodenticide intoxication
because it contains factors II, VII, IX, and X
 In pets with life-threatening hemorrhage, central nervous system hemorrhage, pulmonary or
pleural hemorrhage, or hemorrhage resulting in severe anemia, replacement of coagulation factors
by transfusion should be initiated in addition to administration of vitamin K.
 Deficiency of von Willebrand factor (vWF, FVIIIR:a)
Evidence suggests using cryoprecipitate prepared by treating donors with arginine vasopressin (1
µg/kg SQ) prior to blood donation
PRODUCT ADMINISTRATION RATE
Fresh frozen plasma 4-6 mL/min
Cryoprecipitate Over 1 hour
Platelet concentrate (frozen) Over 1-2 hours
Platelet-rich plasma
1-2 mL/min cats
3-6 mL/min dogs
Cryosupernatant plasma Over 2-4 hours

74. TRANSFUSION FOR OTHER ANEMIA
IN PATIENTS WITH DECREASED COLLOID OSMOTIC PRESSURE
The serum albumin concentration contributes 60% to 70% of the
vascular COP(Starling’s forces)is critical in maintaining fluid homeostasis
In daily clinic practice, hypoalbuminemia is a common finding
Repair of hypoalbuminemia with 25% human albumin has been
described in critically ill dogs and cats with hemorrhage, protein-losing
enteropathy and nephropathy, liver failure, malnutrition, and septic
peritonitis
Administration of 25% human albumin results in an increase in total
solids, albumin concentration, and blood pressure

75. TRANSFUSION FOR OTHER ANEMIA
 IN Failure of Passive Transfer
Neonatal puppies and kittens that have failed to receive adequate colostrum may benefit for
replacement of immunoglobulin through transfusion
Fresh plasma, fresh frozen plasma, frozen plasma, or serum may all be used as the source of
immunoglobulin
 Pretransfusion testing is not recommended
 A dose of 22 to 40 mL/kg of serum has been recommended in puppies with passive transfer
 In kittens with failure of passive transfer, a dose of 150 mL/kg of serum administered SC or IP
has raised serum IgG to normal levels

76. POSTTRANSFUSION MONITORING & COMPLICATIONS
 Emphasis should be placed on monitoring respiratory rate and heart rate and performing
thoracic auscultation to identify circulatory overload
 The most common adverse event associated with administration of plasma-containing
transfusions is urticaria. Slowing the rate of transfusion and administering antihistamines and
glucocorticoids are adequate
 Removal of leukocytes (LR) has been shown to eliminate or attenuate many of the adverse
effects of transfusion in experimental animals and humans.
 Diseases where multiple transfusions are given over a prolonged period :
1. Purpura. In this transfusion complication, thrombocytopenia occurs 1 to 2 weeks following
transfusion. The recipient, sensitized by transfusions containing platelet antigens, can produce
antibodies against platelets which, in turn, can cause thrombocytopenia
2. Hemochromatosis. Iron from senescent transfused red blood cells accumulates in the liver,
ultimately resulting in liver failure
3. All transfusions carry the risk of infectious disease transmission. Of greatest concern in
veterinary patients are canine and feline vector-borne diseases and feline retroviral
diseases. Blood donor screening recommendations

77. POSTTRANSFUSION MONITORING

78. RESOURCE

79. THE END!
Thanks For Patient !
Please Be Kind With Animals