Blood products, product management and whole blood collection

Question 1

What components make up whole blood, and what is the primary purpose of whole blood transfusions?

Answer 1

Whole blood consists of plasma, erythrocytes (red blood cells), platelets (thrombocytes), and leukocytes (white blood cells). Whole blood transfusions are used to provide all components in balanced levels to restore oxygen-carrying capacity.

Question 2

What is the shelf life of fresh whole blood (FWB) and what is the critical timeframe for its administration?

Answer 2

FWB has a short shelf life of 24 hours. It should ideally be administered within six hours of collection to maintain coagulation factors and platelet activity.

Question 3

What is the purpose of haemostatic resuscitation, and what components are given in balanced ratios during this approach?

Answer 3

Haemostatic resuscitation aims to reduce the risk of the acute coagulopathy of trauma. It involves giving packed red blood cells (PRBC), fresh frozen plasma (FFP), and apheresis platelets in a balanced 1:1:1 ratio.

Question 4

What is the primary use of packed red blood cells (PRBC), and what is the benefit of PRBC transfusions regarding plasma proteins?

Answer 4

PRBC transfusions are primarily used to manage conditions resulting in the loss of adequate oxygen-carrying capacity through erythrocyte loss or dysfunction (e.g., anemia, blood loss). PRBC units contain very few plasma proteins, minimizing the effect on recipient clotting function and plasma protein levels.

Question 5

What are additive solutions used for in PRBC units, and how do newer solutions differ from older ones?

Answer 5

Additive solutions are used to extend the shelf life of PRBC units and slow storage changes. Newer solutions are chloride-free, buffered, and isotonic or hypotonic, maintaining a more alkaline pH and supporting red cell metabolic activity.

Question 6

What is plasma, and how is it used in transfusion medicine?

Answer 6

Plasma is the straw-colored liquid component of blood. It is used for transfusion to manage clotting factor deficiencies, among other uses.

Question 7

What are some key plasma proteins, and what are their functions?

Answer 7

Notable plasma proteins include albumin (colloidal oncotic pressure), immunoglobulins (antibodies), protease inhibitors (inhibit protein break down), and fibrinogen (essential in clot formation).

Question 8

What is the difference between labile and non-labile haemostatic proteins?

Answer 8

Labile haemostatic proteins are less stable and more easily inactivated. Non-labile proteins are more stable and withstand prolonged storage and temperature changes better.

Question 9

What is fresh frozen plasma (FFP), and what components does it contain?

Answer 9

FFP is plasma separated from whole blood and frozen within eight hours of collection. It contains a complete profile of haemostatic proteins, coagulation factors, albumin, immunoglobulins, and protease inhibitors.

Question 10

What are the indications for using FFP in veterinary medicine?

Answer 10

FFP is indicated for managing clotting factor deficiencies, coagulopathies, haemostatic resuscitation, and specific conditions like angiostrongylosis or adder envenomation.

Question 11

How is cryoprecipitate different from FFP, and what factors does it contain?

Answer 11

Cryoprecipitate is the cold-insoluble portion of FFP and contains high molecular weight proteins such as factor VIII, fibrinogen, factors V, XIII, and von Willebrand factor.

Question 12

What are the primary indications for using cryoprecipitate in veterinary patients?

Answer 12

Cryoprecipitate is indicated to treat deficiencies of fibrinogen, vWF, factors V, VIII, and XIII. It is used in conditions like vWD, hemophilia A, and certain bleeding tendencies.

Question 13

What is cryosupernatant, and when is it used in veterinary medicine?

Answer 13

Cryosupernatant is the liquid removed when cryoprecipitate is made and contains factors II, VII, IX, X, XI, and XII, along with other plasma constituents. It can be used in cases with specific clotting factor deficiencies, hypoproteinemia, and volume resuscitation.

Question 14

How are plasma products used in cats, and what are their indications?

Answer 14

FFP is commonly used in cats to manage clotting factor deficiencies and non-platelet-related coagulopathies. It can also be used for volume replacement in trauma cases or to provide plasma proteins in various conditions.

Question 15

What is the primary function of albumin in the body?

Answer 15

Albumin plays a crucial role in maintaining colloid oncotic pressure, acts as a carrier for various substances (hormones, drugs, ions), and functions as an oxygen free radical scavenger and mediator of coagulation.

Question 16

Why might hypoalbuminemia occur, and what are the clinical implications?

Answer 16

Hypoalbuminemia can occur in critically ill patients, and it can lead to clinical issues like tissue edema. Albumin replacement therapy may be necessary in such cases.

Question 17

Canine-specific albumin (CSA) is mentioned. What are the advantages of using CSA over human albumin (HSA), and when is CSA preferable?

Answer 17

CSA is preferable because it has minimal adverse effects, while HSA has been associated with hypersensitivity reactions. CSA is more efficient than plasma in increasing serum albumin.

Question 18

Are there specific indications for using CSA (Canine-specific albumin) in veterinary patients?

Answer 18

CSA can be used for hypovolemia and hypoproteinemia.

Question 19

What is the role of platelets in the body’s hemostasis and thrombosis mechanisms?

Answer 19

Platelets play a vital role in plugging gaps in damaged blood vessels and are activated to help prevent blood loss when there is damage.

Question 20

What conditions and factors can lead to thrombocytopenia and thrombocytopathia in animals?

Answer 20

Conditions like immune-mediated thrombocytopenia (IMTP), disseminated intravascular coagulation (DIC), and certain infections or drug use can cause low platelet counts.

Question 21

What are the primary indications for platelet transfusions in veterinary medicine?

Answer 21

Platelet transfusions are used for short-term hemostasis in patients with thrombocytopenia or thrombocytopathia.

Question 22

What are the different forms of canine platelet products, and what are their characteristics?

Answer 22

Canine platelet products can be “wet” (fresh, liquid) or “dry” (separated and preserved). “Wet” products provide more platelets but have a short shelf life, while “dry” forms are easy to store but contain fewer platelets.

Question 23

What is Platelet Rich Plasma (PRP), and how is it produced?

Answer 23

PRP is created through centrifugation to separate platelets and the buffy coat from plasma.

Question 24

How is cryopreserved platelet concentrate different from other platelet products, and what are its characteristics?

Answer 24

Cryopreserved platelet concentrate can be frozen for a longer shelf life but may lose platelets during the freeze-slow thaw process.

Question 25

What is lyophilized platelets, and how do they differ from other platelet products?

Answer 25

Lyophilized platelets are freeze-dried preparations with an extended shelf life, and they are reconstituted before transfusion.

Question 26

What are the primary biochemical and morphological changes that occur during the storage of red blood cells, and how do they impact the functionality and lifespan of the cells?

Answer 26

Changes include reduced ATP levels, increased glucose consumption, elevated lactate production, intracellular potassium leakage, and oxidative stress. These changes can affect the quality of transfused red blood cells.

Question 27

What measures are taken to slow or minimize red cell storage lesions?

Answer 27

Red cell additives, leukoreduction, and proper storage conditions can help mitigate these lesions.

Question 28

How is the shelf life of red blood cells determined, and what are the factors that influence it?

Answer 28

The shelf life depends on the type of red cell product and additives used, with PRBC + additive having a shelf life of up to 42 days.

Question 29

What are the recommended storage conditions for red blood cells to maintain their quality and longevity?

Answer 29

Red cells should be stored between 1-6 °C, with constant temperature monitoring and good air circulation.

Question 30

What are platelet storage lesions, and how do they affect the viability and haemostatic capacity of platelets?

Answer 30

Platelet storage lesions result in the activation and degradation of platelets, reducing their effectiveness. Platelets need to remain inactive until transfused.

Question 31

Q: What steps are taken to prevent or minimize platelet storage lesions?

Answer 31

Platelet additive solutions, improved oxygen availability, and leukoreduction are used to address these issues.

Question 32

What are the storage conditions for platelets, and how does temperature affect their shelf life?

Answer 32

Platelets are stored at room temperature, and higher temperatures increase the risk of bacterial proliferation, reducing shelf life to 5 days.

Question 33

How are plasma products stored, and what are the temperature requirements for maintaining haemostatic proteins?

Answer 33

Plasma products are stored frozen at -18 °C or lower. Lower temperatures preserve haemostatic proteins better.

Question 34

Are there specific storage considerations for frozen plasma products, and what is their shelf life?

Answer 34

Frozen plasma products can be brittle, and their shelf life depends on the specific product, with potential extensions if relabeled.

Question 35

What measures are in place to ensure the traceability of blood components from vein to vein, and why is this important?

Answer 35

Vein-to-vein traceability involves detailed records of donor and recipient information, blood results, and ongoing contact with recipients. It is crucial for ensuring the safety and efficacy of transfused blood components.

Question 36

What are the two underpinning questions that must be satisfied when approving a donor for blood donation?

Answer 36

Is blood donation going to harm this donor?
Is the donated blood going to harm the recipient?

Question 37

What health considerations are essential for selecting a canine blood donor?

Answer 37

Health considerations include a lack of indications of underlying or previous disease, a physical examination to rule out issues such as systemic disease or active infection, and normal blood parameters checked by a veterinary surgeon.

Question 38

What age range is typically suitable for canine blood donors, and why is it important?

Answer 38

The age range is typically 1-8 years. This range avoids developmental damage in immature dogs and minimizes the risk of exacerbating pre-existing sub-clinical diseases in older dogs.

Question 39

How does weight factor into the selection of a canine blood donor?

Answer 39

Weight is important to determine the safe volume to donate and the anticoagulation to blood ratio. It’s essential to prevent over-donation and to ensure the dog’s safety.

Question 40

Name some exclusions that may disqualify a dog from being a blood donor.

Answer 40

Exclusions include frequent donations, medications, a recent blood transfusion, travel outside the UK, pending or recent surgical procedures, pregnancy or nursing, on-call working dogs, live attenuated vaccine within two weeks, and testing positive for transfusion transmissible infections.

Question 41

Describe the key components of the blood collection setup for canine blood donation.

Answer 41

The key components include scales for weighing the dog, a high table for the donor, skin disinfectant, bandage material, and a blood collection system with a needle, collection bag, and anticoagulant.

Question 42

What are some key elements of the blood donation process in dogs, including blood flow rate and precautions to prevent microbial contamination?

Answer 42

During donation, blood should flow at a rate of 40-50 ml per minute, and precautions should be taken to prevent microbial contamination. The collection bag is sealed with a clamp, and blood is stripped from the collection line.

Question 43

What post-donation care and monitoring is necessary for canine blood donors?

Answer 43

Post-donation care includes applying direct digital pressure to the venepuncture site, followed by light pressure bandaging. The donor’s perfusion parameters are checked, and they should be rested for 24 hours.

Question 44

What is the purpose of applying direct digital pressure to the venepuncture site after blood donation?

Answer 44

Direct digital pressure is applied to the venepuncture site to prevent bleeding and ensure clot formation, reducing the risk of post-donation complications.

Question 45

What is the recommended rest period for canine blood donors after a donation, and why is it important?

Answer 45

The recommended rest period is 24 hours. It’s important to allow the donor to recover and avoid strenuous activities that could disrupt the clot formed at the venepuncture site.

Question 46

What health considerations are essential for selecting a feline blood donor?

Answer 46

Health considerations include a lack of indications of underlying disease, a comprehensive physical examination, normal blood parameters, and negative tests for feline leukemia virus (FeLV) and feline immunodeficiency virus (FIV). Cats should also have an echocardiogram or a normal serum N-terminal pro-B type natriuretic peptide (NT pro-BNP) test to rule out cardiac disease.

Question 47

What is the recommended age range for feline blood donors, and why is this important?

Answer 47

The recommended age range for feline blood donors is 1-8 years. This range minimizes the risk of potential age-related organ decline and allows for safe blood donation.

Question 48

How does a cat’s weight factor into becoming a blood donor, and what is the minimum weight recommended?

Answer 48

Weight is flexible and should be calculated per cat. A minimum of 5 kg is advisable. The recommended donation volume is no more than 18% of the cat’s total blood volume.

Question 49

What is the significance of differentiating between indoor and outdoor donor cats?

Answer 49

Indoor donor cats have a lower risk of exposure to pathogens, but this may reduce the donor pool. Both indoor and outdoor cats should be screened for infections. Pregnancy should be ruled out in outdoor roaming, entire female donors.

Question 50

Why is a cat’s character important in selecting a suitable blood donor?

Answer 50

The character of the cat, including its behavior during veterinary visits, travel, and handling, is essential to ensure the highest level of donor welfare. A stressed or difficult-to-handle cat is not a suitable blood donor.

Question 51

What are some common exclusions that may disqualify a cat from being a blood donor?

Answer 51

Common exclusions include recent donations, current drug therapy, previous blood transfusion, travel, recent medical procedures, pregnancy or nursing, cardiac issues, recent live attenuated vaccination, and testing positive for transfusion transmissible infections.

Question 52

How is the maximum donation volume calculated for a cat, and what is the recommended maximum donation volume for a 5 kg cat?

Answer 52

The maximum donation volume is calculated as 12 ml per kg of body weight. For a 5 kg cat, this equals a maximum donation volume of 60 ml. However, less may be taken if it’s not needed.

Question 53

What are the components of feline blood collection systems, and why are they different from canine systems?

Answer 53

Feline blood collection systems include a syringe to generate a vacuum, and anticoagulant is added to the syringe. Feline systems are different from canine systems as they use gravity flow less often, and smaller syringes are used for better control and slow transfusion if needed.

Question 54

What is the recommended procedure for handling a cat during blood donation, including sedation and aftercare?

Answer 54

Cats should be handled with feline-friendly practices, including a quiet and warm environment. Sedation with appropriate medications such as butorphanol, midazolam, and ketamine may be used. After donation, pressure should be applied, monitoring performed, and cats offered food, water, and litter facilities.

Question 55

What is the potential issue with excessive aspiration pressure during blood collection, and what is “flutter”?

Answer 55

Excessive aspiration pressure can lead to hemolysis or “flutter.” Flutter occurs when the vein’s wall is drawn over the needle during aspiration, causing vibration that can be felt through the collection line and vessel wall collapse.

Question 56

What post-donation care and procedures are recommended for feline blood donors?

Answer 56

Post-donation care includes applying pressure, monitoring, offering food, water, and a litter tray, providing intravenous fluid therapy (IVFT), and keeping the cat indoors overnight.