Hematology - Levine Blood Transfusion SG

Question 1

List three benefits of component blood therapy.

Answer 1

Allows the most specific and safe product to be used for each animal

Minimizes transfusion volume

Conserves products

Question 2

List some clinical signs that would indicate an anemic animal does need a packed red blood cell transfusion.

Answer 2

Hypotension, weak, dehydration, and only RBCs are missing

Question 3

List the components contained in a bag of fresh whole blood.

Answer 3

RBCs, all plasma components, platelets, and white cells

Question 4

What would transfusing whole blood (as opposed to blood components) be appropriate>

Answer 4

Patient needs multiple blood components

Patient needs volume

Question 5

What is the specific indication for packed red cells?

Answer 5

Anemia - only RBCs are missing

Question 6

To which patient would you give fresh frozen plasma?

1. A dog with hemophilia B who is having a fun day at the dog park
2. A dog with hemophilia B who is going to be spayed this afternoon
3. A dog who ate anticoagulant rodenticide and now has a hemoabdomen
4. Both a and b
5. Both b and c

Answer 6

e. both b and c

Question 7

Your colleague has a patient with an albumin of < 1 g/dl. He wants to give the dog a fresh frozen plasma transfusion to improve his albumin, but asks your opinion. What do you tell him?

Answer 7

It is not a good source of albumin – you would need to give plasma at a dose of 45 mL/kg to increase albumin concentration by 1 g/dl

Question 8

You have a bag of frozen plasma in the freezer that is 3 years old. You want to use it before it is 4 years old and you have to throw it out. If you see an appropriate patient, you will administer this frozen plasma instead of fresh frozen plasma. List two such appropriate patients for frozen plasma transfusion, one with a hereditary bleeding disorder and one with an acquired one.

Answer 8

Von Willebrand’s Disease

Rodenticide toxicity

Question 9

What are three common sources of blood components?

Answer 9

Commercial blood bank, in-house blood donors, and client-owned (non-resident blood donors)

Question 10

How are blood groups defined?

Answer 10

by inherited antigens on the surface of the RBC

Question 11

Canine blood groups are classified by the ______ ______ _______ system.

Answer 11

Dog erythrocyte antigen (DEA)

Question 12

What is the most clinically significant canine blood type because it is the most antigenic?

Answer 12

DEA 1

Question 13

Do dogs have any clinically important alloantibodies present prior to sensitization with a blood transfusion?

Answer 13

No, dogs require sensitization prior to the formation of antibodies

Question 14

Describe what would happen if a canine patient that is DEA 1 negative receives blood from a donor that is DEA 1 positive, then receives another unit of blood 10 days later from a DEA 1 positive donor.

Answer 14

The recipient will make anti-DEA 1 antibody – it takes 4-7 days to occur

When that dogs receives another unit of blood an acute hemolytic crisis can occur

Question 15

All canine donors, at minimum, should be DEA __ typed.

Answer 15

1

Question 16

What are the three feline blood types?

Answer 16

Type A, Type B, and Type AB

Question 17

Type A cats can have anti-type ___ antibodies.

Answer 17

B

Question 18

Type B cats have anti-type ___ antibodies.

Answer 18

A

Question 19

What will likely happen if a type B cat receives type A blood? Why?

Answer 19

It can kill the cat because type B cats have a strong antibody reaction to type A blood

Question 20

Do cats with type AB blood have alloantibodies?

Answer 20

No they have no antibodies against either A or B

Question 21

A type AB cat should receive what blood type, if available?

Less ideally, what blood type could be given?

What type should not be given to an AB cat?

Answer 21

Ideally AB

Less ideally A

B should not be given because of the strong anti-A antibodies present in the donor blood

Question 22

A major crossmatch involves mixing _____ or plasma and _____ _____ ____ cells.

Answer 22

serum; donor red blood

Question 23

Why can you perform a transfusion in a dog without crossmatching first, if it is the first transfusion?

Answer 23

Because there are no naturally occuring antibodies in the dog

Question 24

Do you need to crossmatch if the dog has received a transfusion 2 weeks prior? Why?

Answer 24

Yes because the dog could’ve developed antibodies to the blood given at the first transfusion

Question 25

Can you think of a reason why crossmatching might be hard in some patients with IMHA? Hint: Think about what you use to decide a crossmatch is not compatible.

Answer 25

Agglutination is one of the main mechanisms of IMHA. The presence of agglutination or hemolysis is what rules a crossmatch as incompatible. Since IMHA patients already have agglutination in their blood, it is difficult to determine if the agglutination is due to the IMHA or the incompatibility of the crossmatch.

Question 26

Why is it important to know the blood type of the donor and the recipient in cats (think about whether there is a universal cat donor)?

Answer 26

Because cats have high levels of naturally occurring antibodies to foreign antigens. There is no universal cat donor, so you can’t just give a transfusion and hope that everything will be okay

Question 27

__ ml/kg of pRBCs raises the PCV by 1%.

Answer 27

1 ml/kg

Question 28

The two broad classes of acute transfusion reactions are:

Answer 28

Immune-mediated (specific)

Nonimmune-mediated (nonspecific)

Question 29

What is a common example of an acute immunologic hemolytic transfusion reaction?

Answer 29

Type B cats receiving Type A cells (type II reaction)

Question 30

What likely causes acute immunologic febrile non-hemolytic reactions? How would you treat this?

Answer 30

1. Cytokines in blood product or anti-WBC or anti-platelet antibodies in recipient against donor WBCs or platelets
2. Treat – slow transfusion, consider stopping, or consider an anti-pyretic dog
   
   1. Consider stopping if you are worried this could be a more severe reaction like sepsis

Question 31

What causes acute allergic reactions?

If mild (hives) how would you treat this?

Answer 31

IgE mediates hypersensitivity reactions against proteins in donor plasma that bind to preformed IgE antibodies on mast cells in recipient

What to do – stop transfusion and give an antihistamine +/- a glucocorticoid

Question 32

What are four examples of acute reactions that are not immune mediated?

Answer 32

Transfusion-associated circulatory overload (TACO)

Transfusion-associated sepsis

Nonimmune-mediated hemolysis

Citrate toxicity

Question 33

A 3 yr M Chihuahua named Bell with hemophilia A and a subcutaneous hematoma was given fresh frozen plasma. However, 40 ml were given over 5 minutes. The dog started retching and became tachypneic. What type of reaction do you suspect, why, and what will you do (Hint: The answer might pair well with his name)?

Answer 33

TACO

Give Lasix and provide oygen

Question 34

Describe two things you could have done to prevent this reaction in Bell (2^nd one we didn’t directly discuss but is in the extra slides for the overachievers! –won’t be tested on. You can give a product that contains the missing clotting factor in hemophilia A, but with less volume than plasma).

Answer 34

Filter the blood and give it slowly

Unsure about this answer

Question 35

A 4 yr FS mixed breed dog presents to you for coughing. You take x-rays and see what looks like trace fluid in the thorax. On CBC the dog is mildly anemic. Other than the cough, she looks bright and alert. Because of the thoracic fluid, you perform coagulation times and find that both aPTT and PT are significantly prolonged. You ask about possible exposure to rodenticide and the owners admit they have a mouse problem and just put out D-con last week. Name 3 different blood products that you could use in this case.

Answer 35

Fresh Frozen Plasma, Frozen Plasma, and whole blood

Question 36

A 4 yr FS mixed breed dog presents to you for coughing. You take x-rays and see what looks like trace fluid in the thorax. On CBC the dog is mildly anemic. Other than the cough, she looks bright and alert. Because of the thoracic fluid, you perform coagulation times and find that both aPTT and PT are significantly prolonged. You ask about possible exposure to rodenticide and the owners admit they have a mouse problem and just put out D-con last week.

Why would whole blood not be necessary in this case and what is a better choice?

Answer 36

Whole blood is indicated when patients need replacement of other components of blood as well as blood volume. If there is no indication that there is loss of multiple components then it is a waste of product.

Frozen plasma is what is best