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Lymphoreticular and haematopoetic > Transfusion Therapy > Flashcards

Transfusion Therapy Flashcards

1
Q

What makes the ideal canine blood donor?

A

Friendly, clinically healthy, over 25kg (not overweight), easily accessible veins, between 1.5-8 years

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2
Q

What makes the ideal feline blood donor?

A

Friendly, clinically healthy, over 4.5kg (not overweight), 1.5-8 years, indoor

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3
Q

What other factors are important for both feline and canine donors?

A

No history of travel abroad so have no blood borne disease, no transfusion themselves so no antibodies against RBC antigens, up to date with vaccination and worming

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4
Q

What tests should be performed before an animal donates for the first time?

A

Full biochemistry and haematology

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5
Q

What tests should be performed each time before an animal donates?

A

Thorough clinical exam to check health
PCV and total protein
Not within 14 days of vaccination
Cats tested for FeLV, FIV and Mycoplasma felis

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6
Q

How much blood is taken from animals?

A

About 15-20% of estimated blood volume?

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7
Q

What is the estimated blood volume of dogs?

A

80-90ml/kg

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8
Q

What is the estimated blood volume of cats?

A

55-65ml/kg

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9
Q

What is the canine donation procedure?

A

12 hour fast, pre-donation examination, clip 1 inch over jugular and prepare aseptically, needle through skin and release clamp, start phlebotomy, collect 405-480g whole blood agitating the bag every 50-75g, pressure over venepuncture site for 2-5minutes then wrap and observe for 15-30 minutes

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10
Q

What is the feline donation procedure?

A

12 hour fast, pre-donation examination, prepare equipment, place IV catheter and administer sedation, clip and aseptically prepare, position cat, raise vein and insert needle, assistant gently aspirate blood, gently rotate syringe during collection, pressure over venepuncture site for 2-5 minutes, wrap and observe for 15-30 minutes, administer 5ml/kg/hr IVFT for 3 hours

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11
Q

What equipment is need for feline blood donation?

A

IV catheter, sedation, 1 60ml syringe/3x20ml syringes with 1ml CPDA for ever 7ml of blood to be collected, sterile preparation for jugular, butterfly needle attached to anti-coagulant syringe, 2 assistants

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12
Q

What position should cats be in to donate blood?

A

Lateral recumbency or held in sternal with head up

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13
Q

What are blood groups determined by?

A

Proteins on RBC membrane

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14
Q

What are the canine blood groups?

A

DEA (Dog Erythrocyte Antigen) 1,3,4,5,7 commonly recognised blood groups and dogs can be positive for any DEA in any combination

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15
Q

Which DEA is most sensitive to sensitisation?

A

DEA 1 with antibodies formed within 1-2 weeks of transfusion

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16
Q

What happens if DEA-1 antibodies are formed?

A

Delayed haemolysis of the transfusion and if the dog receives another DEA-1 transfusion then an acute haemolytic transfusion reaction will occur

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17
Q

Are antibodies made against other DEAs?

A

Yes but reactions tend to be less severe so those blood groups aren’t tested for

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18
Q

What are the feline blood groups?

A

Cats can be type A, B or AB

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19
Q

What is different about RBC antibodies in cats than dogs?

A

Cats have naturally occurring alloantibodies to the blood proteins they don’t have with reactions being peracute and sometimes fatal to B type cats receiving A or AB type

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20
Q

What are the signs of type A or DEA-1 transfusion reaction?

A

Fever, icterus and destruction of transfused cells withing 24 hours

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21
Q

How is blood typing performed?

A

Generally a card system or in-house ELISA typing system and test for DEA-1 and type A and B
ELISA less subjective

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22
Q

When is cross-matching required?

A

Recipient has been transfused more than 4 days previously, history of a transfusion reaction, recipients transfusion history is unknown

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23
Q

What does the minor cross match test for?

A

Donor antibodies to recipient erythrocyte antigen

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24
Q

What does the major cross match test for?

A

Recipient antibodies to donor erythrocyte antigen

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25
Q

What temperatures are cross matches performed at?

A

37, 25 and 4C

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26
Q

What method can be used to test for cross matching in an emergency?

A

Testing for agglutination by taking serum and EDTA sample from recipient and donor, centrifuge for 5 mins then separate, wash EDTA RBC, have four slides for donor control, major CM, minor CM and recipient control, rock slides for 2 minutes, look for agglutination

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27
Q

What is put on each of the slides?

A

Donor control = 2 drops donor serum, one drop donor RBC
Major CM = 2 drops recipients serum, 1 drop donor RBC
Minor CM = 2 drops donor serum, 1 drop recipient RBC
Recipient control = 2 drops recipient serum, 1 drop recipient RBC

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28
Q

Why are blood products used?

A

Can replace exactly what they are missing and so seem a more appropriate fluid, however, natural products are variable so reactions aren’t uncommon

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29
Q

Why should anti-coagulated blood products not be administered with fluids which contain calcium?

A

Can result in formation of calcium salts and microthrombi

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30
Q

What is the most common blood product used in practice setting?

A

Fresh whole blood

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31
Q

What is fresh whole blood ideal for?

A

Patient that has undergone substantial acute haemorrhage

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32
Q

What should be used if not immediately available to resuscitate patients?

A

Crystalloid or colloid therapy

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33
Q

How much fresh blood is needed to raise the PCV?

A

2ml of fresh blood raises recipient PCV by 1%

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34
Q

What is the formula for calculating how much blood to give to canine patient?

A

Volume ml = 85xBW(kg)x (desired PCV-actual PCV)/donor PCV

35
Q

When should auto-transfusion be used?

A

As a salvage technique if there are no other alternatives

36
Q

What is auto-transfusion?

A

Recover blood that has been lost into pleural/abdominal cavity using a sterile percutaneous technique and anticoagulation at rate of 1ml CDPA to 7ml blood

37
Q

What is the risk of using salvaged blood?

A

More prone to haemolysis so must be handled gently

Microthrombi so need to use in-line filter

38
Q

How long after haemorrhage can auto-transfusion be used?

A

Up to 6 hours as after this haemolysis risk is too high

39
Q

How are canine packed red blood cells (PRBC) produced?

A

Centrifugation of whole blood and are available from canine blood banks

40
Q

What temperature should PRBC be stored at?

A

1-6C

41
Q

What are PRBC useful for?

A

Management of patients with blood loss o euvolaemic anaemia

42
Q

Why should PRBC not be used in an emergency?

A

Not fully effective at oxygen carriage immediately following transfusion

43
Q

How much PRBC is required to raise recipients PVC?

A

1ml raises recipients PCV by approximately 1%

44
Q

How is fresh/fresh frozen/stored plasma made?

A

Separation of whole blood by centrifugation within 6 hours

45
Q

Is administration of matched plasma necessary?

A

Not in dogs but it is in cats

46
Q

How is fresh plasma stored?

A

At 1-6C for up to 24 hours

47
Q

How is fresh frozen plasma stored?

A

At -30C for up to 12 months

48
Q

How is stored plasma stored?

A

For up to 4 years at -30C

49
Q

What are the differences between the different storage methods of plasma?

A

Fresh maintains all clotting factors
Fresh frozen has lower levels of clotting factors especially V, VIII and vWF
Stored plasma has sufficient levels of II, VII, IX and X

50
Q

What is the indication for use of plasma?

A

Provision of clotting factors in coagulopathic animals that are at risk of bleeding or have bleeding diatheses
Pre-operatively in patients with inherited coagulopathies

51
Q

What dose is recommended for correction of coagulopathies?

A

10-20ml/kg

52
Q

What is stored plasma good for treating?

A

Animals with rodenticide toxicity

53
Q

What is cryoprecipitate?

A

Concentrated fraction of plasma containing vWF, factors VIII, XI and XII and fibrinogen

54
Q

What is cryoprecipitate used to treat?

A

Haemophilia A, hypofibrinogenaemia and vWD

55
Q

What volume of cryoprecipitate should be given to vWD dogs prior to surgery?

A

1 unit/10kg every 4-12 hours as required

56
Q

What is the advantage of cryoprecipitate over plasma?

A

Smaller volumes can be given and transfusion reactions are less likely

57
Q

What is a typical does of cryoprecipitate?

A

1-2ml/kg although if severe disease then 5ml/kg may be required

58
Q

What is cryosupernatant?

A

The supernatant produced when making cryoprecipitate containing vitamin K dependent clotting factors, albumin and antithrombin

59
Q

What is cryosupernatant used for?

A

Rodenticide toxicity, vitamin K deficiency, haemophilia B and hypoalbuminaemia

60
Q

What other blood products can be made that aren’t available in the UK?

A

Platelet-rich plasma, platelet concentrate, lyophilised platelets

61
Q

How does donor blood differ from recipient blood?

A

Differ in blood type, different levels and types of plasma proteins, cytokines, leukocytes and many other potentially inflammatory mediators

62
Q

Do refrigerated products need to be warmed prior to administration?

A

No unless rapid infusion is planned or the patient is small and already hypothermic as initial rate of infusion is so small

63
Q

How are frozen products thawed?

A

Placed in a 37C water bath for 30 minutes

64
Q

What should be done prior to blood product administration?

A

Invert blood bag gently several times

65
Q

What additional equipment is needed for administration of whole blood or PRBC?

A

270um filter to filter out microthrombi

66
Q

How should blood products be administered?

A

Via a dedicated catheter over 4-6 hours initially at 0.5-1ml/kg/hr for the first 30 mins then rate can be increased to 3-4ml/kg/hr if no reaction is seen

67
Q

What is the maximum rate blood products should be administered at?

A

22ml/kg/hr

68
Q

How often should a patient undergoing a blood transfusion be checked?

A

Not left alone for first hour then checked at least every hour

69
Q

What checks should be performed when monitoring a blood transfusion?

A

Temperature, pulse and RR along with mentation and generalised check for any signs of erythema or swelling
Urine colour if the patient urinates during transfusion

70
Q

Why should the transfusion be stopped?

A

Any unusual vocalisation, vomiting or diarrhoea or if there are any concerns the patient is undergoing a transfusion reaction

71
Q

What are the signs of an acute transfusion reaction?

A

Weakness, tremors, agitation, vocalisation, dyspnoea, tachypnoea, tachycardia/bradycardia, arrhythmia, hypotension, cardiopulmonary arrest, salivation, nausea, vomiting, diarrhoea, urination, seizures, coma, angioedema and urticaria

72
Q

What can cause transfusion reactions?

A

Immune-mediated reaction, excessive volumes or rates of transfusion or changes to the blood product during storage

73
Q

What are the most common transfusion reactions? How are they treated?

A

Angioedema and urticaria treated by antihistamine drugs such as chlophenamine IV

74
Q

Why is temperature monitored during blood transfusion?

A

Non-haemoytic febrile reactions may occur as a response to cytokines that accumulate in the blood

75
Q

How much of a temperature rise should result in the transfusion stopping?

A

1C

76
Q

What symptomatic care is given if an animal suffers from a severe immunological reaction?

A

Oxygen therapy, shock crystalloid fluids, drug therapy for arrhythmias, adrenaline and steroids as necessary

77
Q

Is treatment required for a delayed haemolytic transfusion reaction?

A

No but may need to repeat blood transfusion

78
Q

What is the most common non-immunological transfusion reaction?

A

Volume overload in cats given fresh whole blood

79
Q

Which animals are most at risk of volume overload?

A

Any dog or cat with cardiac or renal disease

80
Q

What is the first sign of volume overload?

A

Increase in RR with harsh lung sounds progressing to crackles

81
Q

What other signs occur with volume overload?

A

Jugular distension and pulsation

82
Q

What are other non-immunological transfusion reactions?

A

Hypothermia, polycythaemia, anaphylactoid reactions, citrate intoxication causing hypocalcaemia, coagulopathy, hyperammoniaemia

83
Q

What is the general management protocol for acute transfusion reactions?

A

Monitor patient carefully to detect transfusion reaction, stop transfusion at first sign of possible reaction, check ECG and blood pressure, start CCPR, antihistamine if angioedema/adrenaline if anaphylaxis, check for evidence of haemolysis and if present get baseline urea and creatinine, rule out microbial contamination, treat dyspnoea with oxygen, antipyretic if temp over 41C, treat arrhythmias/seizures

Lymphoreticular and haematopoetic (12 decks)

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