Chapter 25-Small Animal Medical Nursing

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Chapter 25-Small Animal Medical Nursing

• Blood Transfusion
• pgs. 793-796 in the CTVT book

The 1st successful animal to animal blood
transfusion was done by Richard Lower, Feb. 1665
between a Mastiff and a mixed breed dog.
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Technicians

• Today, technicians are taking a more active role
  in transfusion medicine by preparing the product
  for administration, monitoring the transfusion
  recipient, and setting up blood donor programs,
  among other tasks.

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Blood Transfusion

• Is an effective method of fluid replacement but a
  potentially hazardous form of treatment.
• Clear indication for its use must be present. The
  effectiveness of transfusion is temporary.
• Every effort must be made to identify and correct
  underlying problems.

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Why Perform Blood Transfusions

• Severe blood loss (trauma, surgery)?
• Chronic anemia (respiratory distress, weakness)
  Blood is used for its oxygen-carrying
  capabilities.
• Defects of coagulation. (Hemophilia, Von
  Willebrand disease) Use platelet rich plasma over
  blood.
• Autoimmune hemolytic anemia (in life-threatening
  situations)
• 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.

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Platelets

• Survive for less than 12 hours in stored blood,
  therefore freshly drawn blood should be used
  immediately.
• Platelet rich plasma is the preferred transfusion
  method when needing to replace platelets. (Note
  use the same guidelines when performing a plasma
  transfusion as you would with a blood
  transfusion.)?

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Why use Platelets?

• Animals with abnormal platelet function
• Hereditary or acquired bleeding disorders
• Hemophilia
• Von Willebrand disease (vWD)?
• Disseminated intravascular coagulation (DIC) pg.
  832-833
• You want to provide adequate concentrations of
  the deficient coagulation factor at the bleeding
  site.

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Microscopic view of platelets
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Autoimmune Hemolytic Anemia

• The animals immune system actually attacks its
  own red blood cells leading to their
  destruction-hemolysis. The antibodies attack the
  cell membrane.
• Red blood cell transfusion is only administered
  in life-threatening situations, as the patients
  immune system will also attack and destroy these
  RBCs as well.
• If transfusion is necessary as a life-saving
  measure, only the absolute minimum number of RBCs
  should be administered. (12ml/kg of body wt.)?

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Do you remember what WBCs are?

• The bodys army
• Fight off infections by increasing in numbers.
  They attack germs!

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Leukopenia Hypoproteinemia

• Low white blood cell (WBC) count
• Blood transfusions are impractical

• Low serum protein
• Blood transfusions are impractical

WBC
RBC
Platelet
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Canine Blood Groups
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Canine Blood Groups

• There are 19 known blood groups in dogs, while
  there are 6 well characterized blood types known
  as dog erythrocyte antigens.
• DEAdog 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.
• A good resource www.rapidvet.com/help.htm
• Antigensproteins

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DEA 1.1
DEA 3
DEA 7
DEA 4
Because this dogs blood is positive for DEA 1.1
transfusing into a dog that is negative for DEA
1.1 could be fatal.
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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.

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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.
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DEA 1.1

• 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 Wolf Hounds, German
  Shepherds, Dobermans, and Pit Bulls.

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Ideal blood Donor is Negative For DEA
4. Universal Blood Donor is Negative For DEA
1.1
Some experts suggest that dogs may actually
have 12 or more blood types.
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Universal Dog Donor
Universal Blood donors test negative for both DEA
1 alleles. Can you remember the numbers
associated with this?
These dogs should also test negative for
heartworms, Ehrlichia canis, babesia canis and
Haemobartonella canis.
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Universal Donor

• The blood group of canines synonymous with the
  term universal donor is DEA 1.1 and DEA 1.2
  negative.

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Can my dog donate blood?

• Dogs that test negative for DEA 1.1 can give
  blood to dogs that are DEA 1.1 negative and DEA
  1.1 positive. These dogs are considered
  universal blood donors.
• Dogs that test positive for DEA 1.1 can only give
  blood safely to dogs that are DEA 1.1 positive.

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Universal Recipients

• Dogs positive for DEA 1.1 are considered
  universal recipients.
• Do you understand the difference between a donor
  and a recipient?

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Feline Blood Groups
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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!

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• 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.

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Feline Blood Groups

• 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.

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Feline Blood Tying Cards
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Crossmatching

• A laboratory test that predicts a transfusion
  recipients response to a donors RBCs and plasma
  by detecting any serum (plasma) incompatibility
  between the donor and the recipient.
• This is a two part test.
• 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.

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Blood Crossmatching Procedure
Step 1
Step 2

• MAJOR crossmatch
• Donor Blood Recipient Plasma
• Positive TestMacro or Microagglutination present
  (Incompatible)?
• Negative TestMacro or Microagglutination Absent
  (Compatible)?

• MINOR crossmatch
• Recipient Blood Donor Plasma
• Positive TestMacro or Microagglutination present
  (Incompatible)?
• Negative TestMacro or Microagglutination Absent
  (Compatible)?

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Microagglutination with Rouleaux formation
Macroagglutination
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Healthy red blood cells (upper left) are smooth
and round. Hemolytic red blood cells (lower
right).
Minor CM detects antibodies in the donor
plasma directed against the recipients
erythrocytes.
Major CM performed to detect antibodies in the
recipients serum that may agglutinate or lyse
the donors erythrocytes.
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Auto-Agglutination Saline Test

• Purpose of test Is your patient
  auto-agglutinating.
• What does this mean? First, what does auto mean?
  What does agglutination mean?

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Auto-Agglutination Saline Test

• Clumping of red blood cells within a patients
  own serum can be caused by diseases such as IMHA
  formerly known as autoimmune hemolytic anemia.
• 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.
• Why do this you may ask? Remember the major and
  minor crossmatch?

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Sudden death is unlikely in dogs during blood
transfusions but can occur in cats.
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Blood Collection Guidelines

• 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
• Do you need to use some sort of anticoagulant?

Read CTVT pgs. 793-796
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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.
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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 filter to reduce microemboli.

?
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Blood Products

• Whole Blood
• (FWBFresh whole blood, lt8 hours old)?
• (SWBStored whole blood, gt8 hours old)?
• Packed Red Blood Cells (pRBCs)?
• Plasma (FFPFresh Frozen Plasma)?
• Platelet-Rich Plasma (PRP)?
• Cryoprecipitate

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Cryoprecipitate

• This is the cold, insoluble portion (slushy) of
  plasma that precipitates after FFP has been
  thawed slowly in the refrigerator.
• Cryoprecipitate contains von Willebrand factor,
  fibrinogen, and factor VIII and is used to treat
  this disease as well as hemophilia A, and
  fibrinogen deficiencies.

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Blood Collection Systems
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This is an example of a Closed system of blood
collection. The components of blood are spun
down but not separated into satellite bags.
This type of system allows for collection,
processing, and storage of blood and blood
components without exposing them to the
environment, therefore reduces the risk of
bacterial contamination. This system is most
often used with dogs.
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The components of blood have been separated and
transferred to satellite bags.
WOWFFP contains coagulation factors and plasma
proteins. Long-term plasma can be stored for 4
yrs. at -4º F to -22º F
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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.
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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.

CTVT pg. 794
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Blood and blood products are always administered
slowly and intravenously through a sterile
blood-administration kit.
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Donor Guidelines

• 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.

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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

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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

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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.

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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!
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Food, Water and Meds

• Because vomiting is a potential adverse reaction
  to a transfusion, food, water, and medications
  should be withheld from the patient during the
  transfusion.
• Be sure to ask the DVM when food and water can be
  reintroduced to the animal.

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Antihistamines

• Diphenhydramine hydrochloride may be administered
  to the patient 30 minutes prior to transfusion to
  reduce the risk of blood transfusion reactions.

What is the Common name For this drug?
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The End