Blood transfusions Flashcards
why are blood transfusions done?
for trauma/blood loss, immune mediated diseases, chronic renal failure, coagulation issues
what can be transfused?
fresh whole blood, packed red blood cells, fresh frozen plasma, cryoprecipitate, cryosupernatant, platelet rich plasma
what tests do we do before transfusions?
blood typing and crossmatching to determine if donor and recipient are compatible (survival of transfused red blood cells can’t be guaranteed in recipient’s circulation)
who do you do blood typing and crossmatching tests on?
donor and recipient
how are canine blood types numbered?
according to dog erythrocyte antigen (DEA) system
DEA 1 = most antigenic, most severe reactions
DEA 1.1 positive and DEA 1.1 negative are the most transfused types
what is the most common blood type in dogs?
DEA 4 positive
97-99% of dogs have this blood type
what is the newly discovered canine blood type?
Dal
found in 11% of Dalmatians, 43% of Dobermans, and 57% of shih tzus
originally discovered in a Dalmation
what is the most common myth about canine transfusions?
the first transfusion is free
dogs don’t have naturally occurring alloantibodies but they can develop antibodies to the antigens ~ 4 days after transfusion and may have a delayed reaction
feline blood types
AB blood group is most widely recognized
includes A, B, AB, mik
type A: 99% of cats
type B: ~ 1% of cats
type AB: < 1% of cats (usually Turkish vans and Devon Rexs)
alloantibodies
immune antibodies that are only produced after exposure to foreign red blood cell antigens
cats and alloantibodies
they can produce alloantibodies to all red blood cell antigens they lack and are naturally occurring (unlike dogs)
what are the different cat blood types and their antibodies?
type B: have strong anti-type A antibodies (can cause fatal reaction with as little as 1 mL of blood)
type A: have weak anti-type B antibodies
type AB: have neither antibodies
mik blood type
newly discovered blood type in cats when incompatibilities were found in a donor named Mike
blood typing
look for red blood cell antigens
dogs and cats don’t have naturally occurring alloantibodies to the antigens that they don’t have
blood typing kits
card based agglutination tests or immunochromatography assays
crossmatching
detects serologic incompatibility by identifying antibodies present in the recipient’s plasma against a donor’s red blood cell antigens or vice versa
what are the 2 types of crossmatching?
major: mixing the recipient’s plasma with the donor’s red blood cells
minor: mixing the donor’s plasma with the recipient’s red blood cells
reactions are indicated by hemolysis, agglutination, or both in crossmatching
good canine donor
age: 1-8 years (best younger)
weight: 23 kg for 450 mL or 13 kg for 250 mL
up to date on vaccines
blood typing performed and full labs
screened for infectious diseases: Rickettsial diseases, babesia, brucellosis, bartonella, mycoplasma, heartworm
poor canine donors
on medication, heart murmur or cardiac disease, seizures/seizure-like activity, heartworm disease or unknown, chronic illness, in heat (hormones and bleeding), anxious/fearful (cortisol in blood)
good feline donors
age: 1-8 years (best younger)
weight: at least 10 lbs (4.5 kg)
up to date on vaccines
indoor only
screened for infectious diseases (FeLV, FIV, intestinal parasites, heartworm)
thyroid tested and urinalysis done
how much can a dog/cat donate?
dog: 80 mL/kg x BW (kg)
cat: 70 mL/kg x BW (kg)
can donate up to 10% of their blood
fresh whole blood dog collection
sedate if necessary
prep site: jugular
obtain FWB (fresh whole blood) using collection set (kits available in various sizes: 10-20 mL/kg)
use within 8 hours
replace fluid loss with IV or SQ fluids
closed collection system
used for dogs
contains a single use main collection bag with anticoagulant solution, tubing, and a 16G needle
fresh whole blood feline collection
sedate if needed
prep site: jugular
obtain FWB using heparinized 60mL syringe (use 5-10 units of Heparin/mL)
use within 8 hours
replace fluid loss with IV or SQ fluids
open collection system
done through syringe collection
used for cats since collection bags are too big
19/21G butterfly catheter attached to a 3-way stopcock and a sterile 10-30mL syringe containing an anticoagulant, mix blood in the syringe as its collected, transfer from syringe into a sterile empty bag or transfer pack for easy delivery
A-C-D vacuum bottle
don’t use!!!!
used to be a method of collection but the glass of the bottle starts the clotting cascade and it collects blood fast which causes foam buildup
collection tubing
has a filter within the drip chamber or as a component in the line that is designed to filter out clots that might form despite anticoagulation but it doesn’t filter out microorangisms or bacteria
autotransfusion
blood is collected from patient and re-transfused
decreases risk of reactions
good for trauma patients with blood pooling in a cavity
contraindications: septic effusion and neoplasia
patient monitoring
check vitals every 10-15 minutes for the 1st hour (TPR, mentation, note any vomiting or diarrhea)
PCV checks can be helpful to determine if hemolytic reactions are happening
reactions can be acute or delayed, and immunologic (hemolytic) or non-immunologic (non-hemolytic)
hemolytic acute and delayed reactions
acute: occurs within 30-60 min
symptoms: recumbency, tachycardia, distress, tachypnea, hypotension, bradycardia, pulmonary edema, vomiting, diarrhea, tremors, hypersalivation, death
delayed: may not be seen until 48 hours after transfusion
symptoms: juandice, fever, anorexia, hemoglobinuria, slow decrease in PCV over the course of a few days
non-hemolytic reaction
caused by antibodies to platelets, white blood cells, or plasma proteins
often manifest as: angioedema, urticaria, pruritis, vomiting, diarrhea, fever
usually resolve by stopping transfusion and giving antihistamines or sometimes steroids
can cause anaphylaxis or shock
non-immunologic reactions
arise from physiological consequences of blood component contents and infectious agents
hemolysis can be caused by red blood cell trauma due to overheating product, freezing product, mixing RBC product with other fluids causing cellular damage, warming then refrigerating product, collecting or infusing through small needles
transfusion-associated circulatory overload (TACO)
most common non-immunologic transfusion reaction
blood products add volume to circulatory system and increase BP
results in pulmonary edema in cardiac patients
other non-immunologic reactions
bacterial pyrogens and sepsis: patients will mount a febrile response within 15-20 mins from transfusion start
citrate intoxication: causes hypocalcemia
hypothermia
