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Companion animal praCtiCe

Blood transfusions in dogs and cats 1. Indications

Jenny Helm and Clare Knottenbelt

Jenny Helm graduated from Glasgow in 2005, after which she undertook a small animal rotating internship at the Royal Veterinary College and spent a short time in small animal practice. She subsequently returned to Glasgow to undertake a residency in oncology and internal medicine and where she is currently oncology clinician at the small animal hospital. She holds the RCVS certificate in small animal medicine and is working towards the European diploma in internal medicine.

Transfusion therapy is the mainstay of supportive treatment for dogs and cats with anaemia. The commercial availability of blood and blood products for dogs has resulted in an increase in the number of patients benefiting from transfusion therapies. This article, the first of two discussing the use of blood transfusions in dogs and cats, outlines the indications for transfusion therapy and describes the different options available. Part 2, to be published in the June issue of In Practice, will discuss the practicalities of blood collection in situations where blood products are either unavailable or inappropriate, and will describe how to administer transfusions safely.

Why transfuse?
Anaemia is the most common reason for administering a blood transfusion in veterinary practice. It can be the result of blood loss (haemorrhage or red blood cell destruction) or a lack of red blood cell production (eg, bone marrow disease) (see box below). Although blood transfusions may be life-saving, they are not a definitive treatment for disease. Hence, they are used to: Provide support; Correct deficiencies; Control disease while an underlying diagnosis is found. Patients with a debilitating non-regenerative anaemia benefit greatly from red cell transfusions (either whole blood or packed red blood cells) to provide support while underlying aetiologies are addressed. Patients with acute haemorrhage usually need volume replacement with either crystalloids or colloid fluid therapy initially, but blood transfusion can subsequently be very beneficial if haemorrhage is severe. In animals with chronic blood loss (eg, gastrointestinal

Key facts
Transfuse like with like. Blood transfusions should be carried out using the same blood group for a given species Replace what is lacking. Only replace what the patient is missing or has lost in order to reduce the risk of a transfusion reaction Blood is a biological drug. It should therefore be treated in the same way as every other prescribed medication Blood products are not a cure. In most circumstances, blood products do not provide a cure. Instead, they give support until a diagnosis is reached and/or a treatment is instigated

Clare Knottenbelt graduated from Bristol in 1994 and worked for a year in mixed practice. She subsequently undertook a residency in small animal internal medicine at Edinburgh, after which she became a lecturer at Glasgow, where she is currently a senior clinician in small animal medicine and oncology, and head of the division of companion animal sciences. She holds an MSc in feline transfusion medicine and the RCVS diploma in small animal medicine.

mucosal ulceration and bleeding), blood transfusions can stabilise the patient while diagnostics and treatment regimens are implemented. Animals with haemostatic disorders can also benefit from blood products. Plasma contains clotting factors and proteins that are useful in patients with

Differential diagnoses for anaemia

Regenerative anaemias Haemolytic disorders (causes/triggers) Infectious (viral, bacterial, parasitic) Immune disorders (systemic lupus erythematosus, hypothyroidism, immunodeficiencies) Drugs (vaccines, sulphonamides, methimazole, procainamide, cephalosporins, penicillins, propyluracil) Oxidants (paracetamol, phenothiazines, vitamin K, methylene blue, methionine, propylene glycol) Neoplasia Genetic predisposition Haemorrhage Non-regenerative anaemias Preregenerative anaemias Anaemia of chronic inflammatory disease Iron-deficiency anaemia Bone marrow disorders Infections (viral, mycoplasma, ehrlichiosis, babesiosis) Drugs (chemotherapy, immunotherapy) Myelofibrosis Myelopthistic disease (neoplasia) Myelodysplasia Pure red cell aplasia Ineffective erythropoiesis (deficiencies in erythropoietin, vitamin B12, folic acid, globins or porphyrin)

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acquired or congenital coagulopathies. Specific plasma components (eg, albumin) can also be used to maintain oncotic pressure. Platelet-rich plasma or platelet concentrate can be used to increase platelet numbers but are not currently commercially available in the UK. However, patients with severe thrombocytopenia may benefit from fresh blood to replace losses (eg, red blood cells) due to ongoing haemorrhage. The very small numbers of platelets present in fresh whole blood will not usually cause an increase in circulating platelet numbers, but they may slow haemorrhage in severely thrombocytopenic patients, although this theory is controversial. ple diagnostic investigations should be performed to establish whether a transfusion would be beneficial: Obtain a PCV or haematocrit to determine the degree of anaemia before transfusion. This provides a baseline for continued monitoring; Examine blood smears to determine: If there is polychromasia indicative of regeneration. A reticulocyte count is easy to perform following new methylene blue staining but cannot be performed on an air-dried smear; Potential aetiologies, such as the presence of Myco plasma haemofelis (in cats) or leukaemia (indicated by an abnormal differential white blood cell count or abnormal white blood cells); Test for feline leukaemia virus antigen and feline immunodeficiency virus antibody. Although transfusions are not contraindicated in retrovirus positive cats, the poorer prognosis may influence the decision to transfuse; Evaluate serum or plasma for the presence of ic terus or haemolysis; Evaluate haemostatic parameters (eg, platelet count, prothrombin time and activated partial thromboplastin time) if a bleeding disorder is suspected; Perform slide agglutination and/or Coombs test if immune-mediated haemolysis is suspected. These investigations should be carried out before a blood transfusion is given, as the presence of donor blood following transfusion will otherwise alter the results. Further tests should be performed as indicated to determine the underlying cause of the anaemia (eg, routine clinical chemistry, radiography, ultrasonography, bone marrow aspiration and biopsy).

When to transfuse?
The single most important factor that determines the need for transfusion is the patients clinical condition. An anaemic patient showing signs of cardiovascular compromise (eg, tachycardia, poor pulse quality, weakness, tachypnoea, collapse) will nearly always require a transfusion. In human medicine, an automatic transfusion trigger was set whenever packed cell volume (PCV) in patients dropped below 20 per cent. This figure has been widely debated in the human field and recent evidence suggests that no absolute threshold exists. Patients with chronic anaemia can have a very low PCV but will often be relatively stable at presentation, so the use of such transfusion triggers is not always appropriate. Cats tolerate anaemia well and may show only mild lethargy at a PCV of 10 to 15 per cent. Provided they remain unstressed, cats can tolerate a very low PCV for a number of days; however, the stress of examination, for example, can trigger sudden cardiovascular compromise. Transfusions carry the risk of adverse reactions, so each patient must be individually evaluated by carrying out a risk-to-benefit analysis that takes into account the clinical condition of the animal before transfusion. Transfusions are recommended if: A patient is exhibiting significant clinical signs of anaemia; An animal has a PCV of less than 10 per cent; An animals PCV has fallen rapidly to less than 20 per cent in dogs or 15 per cent in cats. In patients with a poor or absent bone marrow response, red cells are unlikely to be replenished in the short term and, hence, earlier transfusion may be indicated in order to prevent further clinical compromise. Before any blood transfusion is carried out, clinicians should consider: Is the transfusion necessary? That is, does the benefit of a transfusion outweigh the risks? What component of blood is the patient lacking? For example, an animal with immune-mediated haemolytic anaemia will often only have lost red blood cells, while a patient with a haemorrhage will have lost whole blood. Will the use of component therapy minimise the risks and maximise the benefits of a transfusion? How can the effects of a transfusion be assessed? In addition, when a patient does not require an immediate life-saving transfusion, the following sim-

Blood products
Blood is made up of several components (see diagram below) and the transfusion of specific blood products can have distinct advantages. For example, administering packed red blood cells to a normovolaemic patient will reduce the risk of volume overload. In addition, separating one unit of whole blood into two or even three separate blood products maximises the

Clotting factors plasma proteins Plasma

Fresh frozen plasma or fresh plasma Cryoprecipitate or cryosupernatant platelet-rich plasma or platelet concentrate

Whole blood Buffy coat

Red blood cells

packed red blood cells

Separate components of blood that are used to produce a variety of blood products

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Doses and rates of blood products
Whole blood Dose Dose should be calculated using the formula provided in the box below, but a rough guideline is 12 to 20 ml/kg 1 to 4 ml/kg/hour Start at a low dose rate and increase it gradually while monitoring the patient closely packed red blood cells Dose should be calculated using the formula provided in the box below, but a rough guideline is 6 to 10 ml/kg 2 to 4 ml/kg/hour Start at a low dose rate and increase it gradually while monitoring the patient closely Fresh frozen/ frozen plasma 10 ml/kg. Doses of up to 30 ml/kg can be used in cases with severe coagulopathies 2 to 6 ml/kg/hour Beware of volume overload in cats or small patients Cryoprecipitate 1 unit per 10 kg bodyweight oxyglobin 15 to 30 ml/kg (5 to 10 ml/ kg in cats, but doses of up to 30 ml/kg can be used in some circumstances) 05 to 2 ml/kg/hour Beware of volume overload in cats or small patients

Dose rate Other considerations

2 to 6 ml/kg/hour Repeat until bleeding is controlled

The doses and dose rates provided above are a guideline only. However, the flow rate may be increased and decreased depending on an individual patient. The total dosage will also depend on the patients needs. Any blood product transfusion should be completed within four hours

benefits obtained from each individual donation (see table above). Some blood products are now commercially available in the UK, but separation of red blood cells and plasma can be performed by many commercial laboratories.

can therefore be used in many conditions, including acute or severe haemorrhage, haemolytic anaemia, chronic blood loss or non-regenerative anaemia, and coagulopathies if other blood products are not available. Whole blood must be used within four to six hours of collection to maximise its full range of benefits.

Whole blood
Historically, whole blood was the only canine blood product available to veterinary practitioners and, at present, remains the only blood product available for cats.

Stored whole blood

Stored whole blood is fresh whole blood collected into an appropriate bag (usually one designed and used in human medicine) that contains an anticoagulant (eg, citrate phosphate dextrose adenine-1 [CPDA-1]). Whole blood can be stored in a refrigerator at 1 to 6C for up to 28 days. However, after 12 to 24 hours, many plasma proteins will be degraded, making the product ineffective in conditions requiring coagulation factors. As a rule of thumb, 2 ml/kg of whole blood will raise a recipients PCV by 1 per cent or the haemoglobin level by 03 g/dl. An example calculation is shown in the box on the left.

Fresh whole blood

Fresh whole blood contains red blood cells, all clotting factors, plasma proteins and anti-inflammatory proteins, with a small number of platelets. Whole blood

Calculating the amount of blood to be transfused

Haggis weighs 15 kg and has a packed cell volume (PCV) of 10 per cent. His target PCV has been set at 25 per cent. Therefore, as determined by the calculation below, he requires at least 500 ml of whole blood (with a donor PCV of 40 per cent) to achieve this

Effect on storage on blood cells

Red blood cells age more rapidly during refrigeration than they do in vivo (Gabrio and Finch 1954). Red blood cells develop storage lesions, which include changes in morphology, declines in membrane lipid content and cell rigidity. The cell concentration of 2, 3-diphosphoglycerate (2, 3-DPG) is also severely depleted after one week of storage. Since 2, 3-DPG is essential for offloading oxygen to tissues, there is concern that stored red blood cells might not deliver sufficient oxygen to critically ill patients. However, the clinical impact of depleted 2, 3-DPG has been difficult to prove and it is thought that the levels are restored very quickly in vivo and fresh blood offers no real advantage over stored blood in critically ill animals (Klein and others 2007).

Blood volume* Weight (Required PCV Recipient PCV) = k x x to be transfused (kg) PCV of donated blood where k is a constant, which is 90 in dogs and 66 in cats The blood volume required for Haggis is therefore: 50625 ml of = whole blood 40 If packed red blood cells were to be used from a donor with a PCV of 62 per cent, then Haggis would require: 90 x15 x 32661 ml of packed = red blood cells 62 Since the volume of blood required by a recipient depends heavily on a donors PCV, it is important to choose donors with a PCV within the top half of the normal range whenever possible. Note a unit of commercial packed red blood cells will have a series of straws attached to the bag. These straws are full of blood from the individual bag and can be used for cross-matches or determining a donors PCV, without opening the bag and breaching sterility. 90 x15 x *Equation from Pichler and Turnwald (1985) (25 10) (25 10)

Packed red blood cells

Packed red blood cells are created by centrifuging a unit of fresh whole blood and removing the majority of the plasma components. Packed red blood cells have a PCV of 60 to 90 per cent depending on the separation technique. A unit of canine packed red blood cells is about 200 to 250 ml and has the same oxygen carrying capacity as one unit of whole blood (450 ml). As with whole blood, packed red blood cells can be stored in a refrigerator at 1 to 6C for up to 21 days, but some commercial bags contain extra preservative that can extend the storage time for up to 42 days (Sohmer

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and others 2003). The use of packed red blood cells beyond this time can result in transfusion reactions (see Part 2). As packed red blood cells contain only a small amount of plasma, they have a minimal effect on oncotic pressure (5 mmHg compared with 20 mmHg in whole blood) and may therefore be safer than whole blood in patients prone to volume overload (eg, those with cardiac or renal dysfunction). Packed red blood cells are indicated for animals with haemolytic anaemia, chronic blood loss or non-regenerative anaemia. As a rule of thumb, 2 ml/kg of packed red blood cells will raise a recipients PCV by 2 per cent or the haemoglobin level by 06 g/dl.

Cryosupernatant
Cryosupernatant is the plasma that remains following separation of the cryoprecipitate as described above. It is a source of all coagulation and plasma proteins, except for clotting factors VII, VIIIc and XIII, fibrinogen and vWF. When stored at 18C, it is stable for one year. Cryosupernatant can be used for the treatment of most clotting factor deficiencies, except haemophilia A and von Willebrands disease, and can also be used for plasma protein deficiencies.

Haemoglobin-based oxygen-carrying solutions

Oxyglobin (OPK BioTech) is a sterile haemoglobinbased oxygen-carrying solution made from bovine haemoglobin. It is only licensed for the provision of oxygen-carrying support in dogs with anaemia, but its use in cats has been reported. Oxyglobin is a potent colloid with an osmolarity of 300 mOsm/litre and must therefore be used with caution in patients with cardiorespiratory or central nervous system diseases, or those with oliguric renal failure. Oxyglobin should also be used with care in cats due to the risks of volume overload and possible pulmonary bed vasoconstriction.Followingadministration,Oxyglobin causes discoloration of the mucous membranes, sclera and urine, making clinical assessment difficult. It also interferes with some biochemical analysers. The product half-life is proportional to the dose, with over 90 per cent being metabolised and excreted within a week of administration. Oxyglobin is available in 125 ml foil-wrapped sterile bags with a shelf-life of three years (when stored at 2 to 30C) but, once opened, the bags should be refrigerated (to minimise bacterial contamination) and used within 24 hours. The rate of administration depends on the patients volume status and ranges from 05 to 2 ml/kg/hour.

Fresh frozen plasma

Fresh frozen plasma contains clotting factors and other plasma proteins, but must be frozen within six hours of collection to prevent degradation of the clotting factors. Once frozen, it can be stored for up to one year at 18C. However, in a normal household freezer (typically at 4C), fresh frozen plasma will begin to degrade after two to three months. Fresh frozen plasma is administered at a total dose of 10 to 30 ml/kg given over four hours for the treatment of coagulopathies (see table on page 186). Fresh frozen plasma is generally indicated for animals with inherited and acquired coagulopathies and in patients with prolonged clotting times undergoing invasive procedures (eg, liver biopsy). It can be used for some plasma protein deficiencies (eg, immunoglobulin) and may be useful in providing antiparvovirus antibodies and immunoglobulins in cases of parvovirus infection, although conclusive evidence is lacking. However, because the protein content of a single unit of fresh frozen plasma is low, it should not be used to elevate protein concentrations or to maintain blood pressure in patients with hypoalbuminaemia. The use of fresh frozen plasma in animals with acute pancreatitis as a source of alpha-macroglobulin has been suggested but remains controversial, unless there is evidence of a concurrent coagulopathy.

Human serum albumin

Human serum albumin has been used in recent years to provide a source of albumin to dogs with hypoalbuminaemia (Matthews and Barry 2005), but can cause an immunogenic reaction and should therefore be administered with extreme caution in canine patients. Canine serum albumin has recently become available in the USA but is not yet available in the UK.

Frozen plasma
Frozen plasma has lost the action of many clotting factors (V, VIII, von Willebrand factor [vWF]) and plasma proteins, but it still contains vitamin K-dependent factors (II, VII, IX, X). Frozen plasma has either been frozen more than six hours after collection, has been thawed and refrozen, or has been frozen beyond the recommended maximum storage time (see above). This product can be used in patients with deficiencies of the non-labile clotting factors (eg, anticoagulant rodenticide toxicity and some plasma protein deficiencies).

Platelet transfusions
Platelet-containing products, such as platelet concentrate or platelet-rich plasma, are made from fresh whole blood by centrifugation at a slower rate than is used for the production of packed red blood cells and plasma. Such products must be used within 48 hours of collection and are the only ones available that contain enough platelets to be clinically useful in thrombocytopenic patients. In addition, platelet concentrate needs to be stored on a rotating or rocking surface to prevent activation and aggregation, which usually makes storage impractical outside of a blood bank laboratory. There is some experimental veterinary interest in the use of cryopreserved platelets (Appleman and others 2009), but these are not available in the UK. In a patient that is actively bleeding, whole blood may provide enough platelets to stop haemorrhage, but this does not usually raise the circulating platelet count.
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Cryoprecipitate
Cryoprecipitate is made up of approximately 20 per cent fibrinogen, 50 per cent clotting factor VII and 30 per cent clotting factors VIIIc, XIII and vWF. It is separated from the plasma fraction of blood using a process of controlled thawing and centrifugation. Cryoprecipitate must be stored frozen at 18C and is stable at this temperature for up to one year. It can be used in patients with inherited clotting factor deficiencies such as haemophilia A and von Willebrands disease.

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Matching recipients and donors

Although the availability of blood products for dogs makes accessing blood easier for this species, it is important to remember that precautions should be taken to ensure compatibility. Dogs that have not previously received a transfusion can receive uncross-matched blood and blood products, but all dogs that have had a previous transfusion or have an unknown history should ideally be cross-matched before transfusion with a product containing red blood cells. It is possible that plasma and platelet transfusion may be contaminated with red blood cells during the production process, but there is no recommendation to cross-match canine donor blood before using plasma products. Cats must always receive type-specific blood and blood typing is therefore crucial before the first transfusion. At every subsequent blood transfusion or if a cats history is not known, blood typing and crossmatching are essential. As there are no separated blood products available for cats, all transfusions will contain red blood cells, and hence donors and recipients should be appropriately matched before donation. Once a blood transfusion has been administered, it is impossible to determine the recipients true blood type. Therefore, typing must be carried out before transfusions in dogs and cats. In addition, canine blood products are commercially available as dog erythrocyte antigen (DEA) 1.1 negative and DEA 1.1 positive, so it is essential to know a patients blood type in order to choose the correct product.

(above and below) Examples of commercially available blood testing kits

Canine blood types

Karl Landsteiner, the pioneer of the human ABO system, first discovered canine blood types in 1910.

Since then, eight different blood groups have been recognised in the dog, with the major and most immunogenic being DEA 1.1 for which dogs can be either positive or negative. The others include DEA 1.2, DEA 3, DEA 4, DEA 5, DEA 7 and a new antigen in dalmatians called DAL. DEA 1.1 is the most common blood type in dogs and, although naturally occurring antibodies to DEA 1.1 are rare, the determination of DEA

Cross-matching
Cross-matching assesses the effect that recipient serum antibodies have on donor cells (major cross-match) and the effect that donor serum has on recipient cells (minor cross-match). As the main aim of a transfusion is to provide the recipient with red blood cells, it is vital that the recipients serum antibodies do not destroy these cells and, in doing so, evoke a transfusion reaction. The minor cross-match assesses the risk of recipient cell destruction by the donor serum, which poses a much smaller risk because the volume of transfused serum will comprise only a small volume of the recipients total serum. To perform both major and minor cross-matches, blood collected in both heparin and EDTA anticoagulants must be obtained from both the donor and recipient. Cross-matching can be performed by mixing the washed cells and plasma either on slides, or in test tubes or well plates. The use of slides, while more rapid, is less reliable as only serum with high titred antierythrocyte antibody will show agglutination. Although mixing whole blood from a recipient and donor may give a crude indication of compatibility, this method is unreliable and is not recommended.

Cross-matching using feline blood. (above) Results of a conventional in-house crossmatching test. (below) Example of a gel crossmatch kit (RapidVet-H; DMS Laboratories) that indicates a cross-match type A donor to type B cat. The negative control is on the far left and the positive control on the right. The cross-match sample in the middle indicates absolute haemolysis of the sample. (Pictures, Jenny Walton)

Method Centrifuge donor blood in EDTA anticoagulant at 3000 rpm for 10 minutes Remove the supernatant (plasma and buffy coat layer) and wash the erythrocytes by resuspending them in saline Recentrifuge the cells and remove the supernatant Resuspend the erythrocytes in saline to make a 3 to 5 per cent solution Place two drops of cell suspension in contact with heparinised plasma from the recipient (one to two drops) either on a slide or preferably in test tubes or well plates Assess the cell/plasma mixture for haemolysis (diffuse reddening of solution that fails to settle out) or agglutination (granular appearance) Perform a minor cross-match in the same way using recipient cells and donor plasma

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1.1 antigen is strongly recommended as this antigen is highly immunogenic and will result in antibody formation. Naturally occurring antibodies against DEA 7 are present in 15 per cent of dogs, but DEA 7 antigen is rare. These antibodies may be responsible for the occasional mild reactions following first transfusions. To avoid induction of these antibodies, blood that is negative for DEA 1.1, DEA 1.2 and, ideally, DEA 7 should be used, as the induction of antibodies can shorten the survival of transfused red blood cells. However, the overuse of DEA 1.1 negative blood as a precaution in untyped dogs does not make best use of the resources available (given that DEA 1.1 positive dogs are more common); therefore, DEA 1.1 positive blood is preferred in any DEA 1.1 positive recipients. A number of methods of determining canine blood groups have been described (Giger and others 2005) and many are commercially available. The Alvedia CHROM technique and card system are both readily available for typing in practice, and are easy to use and accurate. A study found the Alvedia system had 100 per cent specificity and 88 per cent sensitivity, suggesting that this test had a very high positive predictive value (ie, the likelihood of a true positive) and an overall accuracy of 93 per cent when compared with a laboratory-based gel test. The in-house card-based system also performed well with an overall accuracy of 89 to 91 per cent (Giger and others 2005).

Canine blood groups

Blood type DEA 1 Comment Consists of three antigens (DEA 1.1, 1.2, 1.3). A null type also exists Dogs do not appear to form naturally occurring antibodies to DEA 1.1 and 1.2 DEA 1.1 is dominant, while DEA 1.2, 1.3 appear recessive Not considered clinically significant due to low incidence Naturally occurring antibodies are found in 20 per cent of DEA 3 High incidence in the dog population Antibodies do not occur naturally A low incidence antigen A naturally occurring antibody is present in about 10 per cent of dogs negative for DEA 5 Has caused controversy regarding its clinical significance A naturally occurring antibody is present in 20 to 50 per cent of dogs negative for DEA 7 There is little information available about these antigens A new blood group identified in dalmatians May be the cause of alloautobody formation after blood transfusion in dogs negative for DAL (Blais 2007)

DEA 3 DEA 4 DEA 5

DEA 7

DEA 6 and 8 DAL

so the collection and administration of blood in-house remains the only alternative for cats. In addition, veterinary surgeons should be able to perform blood collection in emergency situations and to administer blood and blood products safely.
References and further reading
ADAMANTOS, S., BOAG, A. & HUGHES, D. (2005) Clinical use of a haemoglobin-based oxygen-carrying solution in dogs and cats. In Practice 27, 399-405 APPLEMAN, E. H., SACHAIS, B. S., PATEL, R., DROBATZ, K. J., GROMAN, R. P., KENNEDY, D. R., ODONNELL, P. A., BRYAN, C. & CALLAN, M. B. (2009) Cryopreservation of canine platelets. Journal of Veterinary Internal Medicine Volume 23, 138-145 BLAIS, M. C., BERMAN, L., OAKLEY, D. A. & GIGER, U. (2007) Canine Dal blood type: a red cell antigen lacking in some dalmatians. Journal of Veterinary Internal Medicine 21, 281-286 CALLAN, M. B. & GIGER, U. (1994) Transfusion medicine. In Consultations in Feline Internal Medicine. Ed J. R. August. Philadelphia, W. B. Saunders. pp 525-532 GABRIO, B. W. & FINCH, C. A. (1954) Erythrocyte preservation. I. The relation of the storage lesion to in vivo erythrocyte senescence. Journal of Clinical Investigation 33, 242-246 GIGER, U., STIERGER, K. & PALOS, H. (2005) Comparison of various canine blood-typing methods. American Journal of Veterinary Research 66, 1386-1392 KLEIN, H. G., SPAHN, D. R. & CARSON, J. L. (2007) Red blood cell transfusion in clinical practice. Lancet 370, 415-426 KNOTTENBELT, C. & MACKIN, A. (1998) Blood transfusions in the dog and cat 1. Blood collection techniques. In Practice 20, 110-114 KNOTTENBELT, C. & MACKIN, A. (1998) Blood transfusions in the dog and cat 2. Indications and safe administration. In Practice 20, 191-199 KNOTTENBELT, C. M., ADDIE, D. D., DAY, M. J. & MAKIN, A. J.(1999) Determination of the prevalence of feline blood types in the UK. Journal of Small Animal Practice 40, 115-118 MATTHEWS, K. A. & BARRY, M. (2005) The use of 25 per cent human serum albumin: outcome and efficacy in raising serum albumin and systemic blood pressure in critically ill dogs and cats. Journal of Veterinary Emergency and Critical Care 15, 110-118 PICHLER, M. E. & TURNWALD, G. H. (1985) Blood transfusion in dogs and cats. Part I. Physiology, collection, storage and indications for whole blood therapy. Compendium on Continuing Education for the Practicing Veterinarian 7, 64-71 SOHMER, P. R., MOORE, G. L., BEUTLER, E. L. & PECK, C. C. (2003) In vivo viability of red blood cells stored in CPDA-2. Transfusion 22, 479-484

Feline blood types

Cats have three main blood types (on the AB system), which are type A, B or AB. The antigens associated with these types are highly immunogenic and type B cats have high levels of naturally occurring antibodies. This means that fatal transfusions can occur with even tiny volumes of incompatible blood (Callan and Giger 1994). Although type AB cats have no naturally occurring antibody, they posses both A and B antigens and donor blood from these animals can therefore cause a significant reaction in recipients, as their cells are susceptible to destruction by antibodies in the donor plasma. Type A cats possess only low titres of anti-B antibodies and so the transfusion of incompatible blood to type A cats only results in a mild reaction with minimal clinical signs. The life span of the transfused cells, however, will be dramatically decreased and the patients PCV will fall within days of the transfusion (Callan and Giger 1994). When compatible blood transfusions are given, the increase in PCV can be maintained for up to two months. The frequency of blood types in cats differs between worldwide geographic areas and breeds (Knottenbelt and others 1999), so it is recommended that cats undergo blood typing and preferably cross-matching before the first and every subsequent transfusion.

Summary
Blood and blood products may be used for a number of applications in veterinary medicine. Understanding the benefits of each product will ensure that maximum benefit is gained from an individual donation. Commercial blood products are available for dogs, but there is currently no feline blood banking system

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Blood transfusions in dogs and cats 1. Indications

Jenny Helm and Clare Knottenbelt In Practice 2010 32: 184-189

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