Blood transfusion Flashcards
What types of blood product are available?
Fresh whole blood packed RBC FFP Cryoprecipitate Platelet rich plasma
What does fresh whole blood contain?
RBCs WBCs, clotting factors, proteins, platelets
WBCs and platelets not functioning after 4-6 hours
Outline the use of whole blood
Not economical as a patient rarely needs everything
Mostly used when nothing else available
WBCs can act as a source of inflammation in the host, increasing the chance of a transfusion reaction
10-25ml/kg
2ml/kg increases PCV bu 1%
Outline the use of packed RBCs
Nutrition through SAG-M added
WBCs and platelets removed with filters
Same 02 capacity as whole blood but with less volume
6-10ml/kg
2ml/kg increases PCV by 2%
Only use to treat anaemia (and when clinically isn’t coping with PCV)
Outline the use of FFP
20ml/kg over 3-4 hours
Recheck clotting times after to ensure more aren’t needed
Thaw in a water bath <37 degrees or proteins will be denatured
What is cryoprecipitate and when is it used?
From thawing FFP
A white precipitate forms, plasma is centrifuged off
Is very high in concentrated factor VIII, VWF, fibrinogen
Same coagulation abilities as FFP
More appropirate if limited volume is required (e.g. volume overload/ CHF)
1 unit per 10kg
What is cryo poor plasma
The plasma that is centrifuged from the white precipitate from FFP
Has vitamin K dependent factors
Good for rodenticide toxicity
What is PRP?
Prepped from fresh whole blood
Centrifuged at slower rate
Platelets are resuspended in a small volume of plasma
Store at 20-24 degrees, needs continuous agitation
Only lasts 4-5d
How useful are platelet transfusions
Only last a day
Most removed by the spleen within 1-2 hours
Poor availability
What pre-transfusion testing can be done?
Rapid Vet-H card typing - not useful if agglutinating
Alvedia cartridges - can be used
Cross match if >4d passed since a transfusion
Major = donor RBC mixed with recipient plasma
Minor = recipient RBC mixed with donor plasma
Cats need matching even with plasma
Dogs dont for initial plasma transfusion, but the transfusion will prevent testing at a later date from being valuable and they may need it later on so worthwhile doing
How do you administer blood products when the patient is euvolaemic
warm to body temp to prevent hypothermia and cold induced coagulopathy
1ml/kg/hr first 30 mins, then increase rate to be given within 4 hours
How do you administer blood products when the patient is hypovolaemic?
Bolus crystalloids to improve perfusion
Ensure blood has its own line
Bolus blood to improve oxygen carrying capacity
How do you monitor transfusions?
TPR every 10 mins for the first 30 mins
Then at 60 mins and each hour
What are the main types of transfusion reactions?
Acute immunological within 2-3 hours
Delayed immunological (after has finished, can be months)
Acute non-immunologic
Delayed non-immunologic
Outline the main acute immunologic transfusions
ABs in plasma elicit immune response, caused by donor or recipient plasma
Acute haemolytic reaction, can be rapid and fatal
Most common in cats
Alloantibodies bind RBCs inducing lysis
Can see fever, v+, icterus, possible death
Increased k+ due to haemolysis
Increased free Hb can lead to AKI
Can also get febrile non haemolytic - usually self limitting, antipyretic may be used
Or Urticaria, more common in plasma based products
H1 antagonists normally enough
Sometimes 0-1-0.2 dexamethasone needed
