Exam 7 L. 3

Question 1

Indications for blood transfusion

Answer 1

1) temporary replacement of:
- RBC’s
- platelets
- plasma proteins/factors

Question 2

Stored whole blood

Answer 2

1) older than 6 hours but less than one month
2) RBCs and plasma
3) does NOT contain: viable platelets, leukocytes, or labile clotting factors (i.e. FVIII, vWF, fibrinogen)
4) indicated when patient needs multiple blood components and volume

Question 3

Packed RBCs

Answer 3

1) contains cells and small amount of plasma and anticoagulant
2) indications: anemia

Question 4

Fresh frozen plasma

Answer 4

1) plasma separated from whole blood and frozen within 8 hours of collection (less than 1 year old)
2) contains: coagulation factors, anti-thrombin and other anticoagulation factors, vWF, albumin, globulins
3) Indications: coagulation disorders resulting in hemorrhage, prophylaxis before surgery in animal with known clotting factor deficiency

Note: do NOT use as a source of albumin! But, plasma can be used as a COLLOID to increase osmotic pressure!

Question 5

Frozen plasma

Answer 5

1) plasma is FFP that has been stored >1 year but <4 years, or plasma separated from RBCs and frozen >8 hours after blood collection
2) contains stable coagulation factors: II, VII, IX, X, albumin
- good product for rodenticide patients!
3) indications: coagulation deficiencies of the above listed factors resulting in active hemorrhage

Question 6

Plasma components

Answer 6

1) fresh frozen plasma: contains all clotting factors and plasma proteins
- broken down into cryo- precipitate and supernatant
2) cryo- precipitate: vWF, F VIII, fibrinogen
3) supernatant: vitamin K-dependent factors, globulins, albumin, AT, other proteins

Question 7

Cryo- precipitate

Answer 7

1) contains: factor VIII, vWF, fibrinogen

2) best product for treating hemophilia a (F VIII deficiency), vWD, and fibrinogen deficient patients

Question 8

Cryo- supernatant

Answer 8

1) contains: active clotting factors (except FVIII and fibrinogen) albumin, and globulin
2) indications: treatment of hemophilia B (FIX deficiency), vitamin K deficiency, oncotic support in hypoproteinemia

Question 9

Canine blood types

Answer 9

1) 5 defined blood groups
- dog erythrocyte antigen 1.1, 3, 4, 5, 7
- DEA 1.1: positive, negative, or weak positive
- DEA 3, 4, 5, 7: positive or negative

NOTE: 95% of dogs have DEA 4! (Not only DEA 4, but have at least this one present)

• *DEA 1.1 IS THE MOST IMMUNOGENIC AND CLINICALLY SIGNIFICANT**
• no preformed antibodies to DEA 1.1: allows us one free transfusion in the canine! (Cats do have preformed antibodies versus the opposite RBC type)

Question 10

Universal dog blood donor

Answer 10

A dog that is DEA 4 positive only!!

-Commonly greyhounds

Question 11

Major Crossmatch

Answer 11

Mix washed donor RBCs with recipient plasma

-agglutination = incompatibility**

Question 12

How much blood to transfuse?

Answer 12

ml of blood = blood volume x weight (kg) x ([PCV desired - PCV recipient]/PCV donor bag)

Blood volume = 90 ml/kg for dog, 60 ml/kg cat

If they aren’t destroyed, the transfused RBCs will last ~3 weeks

Question 13

How fast to transfuse blood

Answer 13

No pumps!

1) reactions occur in approximately 10% of pRBC transfusions
2) 1 ml/kg/hr for 15 minutes
3) if no problems, increase rate to give over 4 hours (up to 10 ml/kg/hr)
4) monitor TPR every 30 minutes and watch for nausea, vomiting, diarrhea, agitation

Question 14

Feline blood types

Answer 14

1) AB system
- Type A: most common
- Type B: uncommon, more in purebred cats
- Type AB
2) **high levels of naturally occurring antibodies to foreign antigens
- Type B cats have a strong reaction to type A blood!
- Type A cats have a mild reaction to type B blood
3) no universal cat donor

Question 15

Mik antigen

Answer 15

1) common RBC antigen
2) Mik negative cats have endogenous Mik antibodies
- can result in hemolytic reaction, even if AB compatible
- for this reason it is recommended to crossmatch ALL cats

Question 16

Acute immune hemolytic reaction (type 2 hypersensitivity)

Answer 16

1) stop the transfusion!
2) begin crystalloid infusion to optimize blood pressure and maintain renal perfusion

Note: if it is a type I hypersensitivity, you may see an allergic reaction ranging from hives to severe anaphylaxis
-stop transfusion and given antihistamine (i.e. diphenhydramine)

Question 17

Acute immune-febrile non-hemolytic reaction

Answer 17

1) temperature increase of more than 1 degree C associated with the transfusion
2) slow transfusion, consider stopping
- consider an antipyretic drug

Question 18

TACO: transfusion-associated circulatory overload

Answer 18

1) blood products have significant oncotic pull
2) monitored closely for signs of volume overload
- retching, vomiting, tachypnea, dyspnea
3) Lasix, oxygen as needed

Question 19

Non-immune transfusion reactions

Answer 19

1) TACO
2) transfusion associated sepsis
3) non-immune mediated hemolysis: improper temperature exposure, mechanical hemolysis from pumps
4) citrate toxicity: HYPOCALCEMIA can occur from the anticoagulant in the blood product!

Question 20

Volume overload

Answer 20

Give diuretics and oxygen!

Question 21

Urticaria, pruritus, edema after transfusion:

Answer 21

Give diphenhydramine and dexamethasone (antihistamine and steroid)