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Red Blood Cell Transfusions – Peer Reviewed VETcpd - Internal Medicine Jenny Walton BVM&S MRCVS Jenny qualified from R(D)SVS in Red blood cell transfusions – 1998 - she worked in mixed practice when, what and how to do it! for 4 years before moving into the Red cell transfusions are now a relatively common intervention in veterinary practice field of small in the UK and help in the treatment of many patients. This is largely due to the animal emergency availability of blood products, such as Packed Red Blood Cells (PRBC) , from blood and critical care banks supplying directly to practices. After donation, red cells are separated from with Vets Now for 12 years. Through plasma into a concentrated packed cell form, a nutrient extender is then added to Vets Now, she ran the practical trial them. This allows the red cells to be stored for up to 42 days before being transfused researching canine blood banking in 2005-2006 – launching Pet Blood Bank into patients. DEA 1 blood typing prior to transfusion is essential and cross matching UK (PBB) alongside Wendy Barnett should be performed for second transfusions. Blood products are administered in 2007. She acts as the Veterinary through a filtered giving set and patients monitored closely for transfusion reactions. Supervisor for PBB, her role includes Transfusion reactions are thankfully rare but potentially life threatening. advising practitioners daily on the appropriate use of PBB blood products, Key words: Canine, Packed Red Blood Cells (PRBC), transfusion, blood typing, overseeing the practical and VMD cross matching, transfusion reactions legislative veterinary aspects of blood collection at PBB and leading research on future development opportunities. Clinical presentation Banked canine PRBC are readily available Alongside this role she works part-time in in the UK and this article primarily covers general practice. Without doubt, blood transfusions can be PRBC transfusion in the dog. However, one of the most rewarding interventions Pet Blood Bank UK the general principles of transfusion in veterinary medicine, as increasing red Units 21and 22 medicine apply to all of our companion cell numbers and the associated improved Loughborough Centre for Technology animal species and many exotic species. oxygen carriage makes an obvious and Epinal Way, Loughborough For specific species, Pet Blood Bank UK Leicestershire LE 11 3GE immediate difference to the patient. (PBB) can guide you on blood collection In many instances these transfusions and banking advice or refer you to an preserve life and many of the advances in Simon Tappin MA VetMB external advisor who has experience with veterinary medicine and surgery would CertSAM DipECVIM-CA MRCVS that species. not be possible without the ability to Simon graduated transfuse patients. from the University Red cell products of Cambridge and As with any intervention, there are mul- Red cell products available in the UK are after two years tiple considerations and with transfusions Canine Packed Red Blood Cells (PRBC), in small animal these must be carefully considered. practice undertook Fresh Whole Blood (collected and a residency at the Firstly blood is not ‘just another fluid’, administered within 4-6 hours) and Stored University of Bristol but a complex, physiologically balanced, Whole Blood. Fresh Whole Blood has the in Small Animal biological mixture. An understanding of advantage of containing platelets but the Medicine and Intensive Care. He gained its content is important when considering number and function decline 4-6 hours the European Diploma in Small Animal administering transfusions. Red cells are after collection. Stored Whole Blood is Medicine. He is currently working as a uncommonly used, as platelet numbers and consultant in internal medicine at Dick living cells and need to be carefully looked after before administration to the patient levels of Von Willebrand factor (vWF) and White Referrals where he sees cases in coagulation factors I (Fibrinogen), V and all areas of internal medicine. which leads to practical storage and trans- port requirements for these products. VIII decline quickly. Stored Whole Blood Dick White Referrals, The Six Mile Bottom has a shelf life of 21-28 days depending Veterinary Specialist Centre, Station Farm, Secondly, blood products are a very pre- on the anticoagulant used. If blood is to London Road, Six Mile Bottom, Suffolk, cious and limited resource. All blood avail- be stored, then separating the plasma and CB8 0UH able for transfusion is donated and so the freezing it as Fresh Frozen Plasma (FFP) health and wellbeing of the donor should (Figure 1), and then resuspension of the always be considered. It is also important that these products are used respect- fully and rationally, in patients with fair prospects of making a recovery, so that the benefit of this resource can be maximised. Used with forethought and care, the ability to give transfusions is a great addition to the veterinary therapeutic armoury and with the progression of blood banking in For Internal Medicine referrals in the UK, easily within the realms of pos- your area: vetindex.co.uk/medicine sibility for all small animal practitioners. Figure 1: PRBC and Fresh Frozen Plasma (FFP) VETcpd - Vol 4 - Issue 4 - Page 29 VETcpd - Internal Medicine red cells in a nutrient solution (SAG-M) allows the most efficient use of the whole Table 1: The indications for using whole blood and packed red blood cells unit of blood. This extends PRBC shelf Disease Process Whole Blood Packed Red Blood Cells life to 42 days and plasma products have a frozen shelf life of up to five years. Regenerative anaemia ◆ ★ Table 1 illustrates the utility of the PRBC versus whole blood, and Table 2, specific Non regenerative anaemia ◆ ★ differences in their content. If plasma is frozen within 24 hours of collection Pancytopenia Fresh of the whole blood unit, Fresh Frozen Plasma (FFP) is produced, the use of Anaemia with hypoproteinaemia ◆ ★ which is outside the scope of this article but is discussed in more detail in Kit Anaemia with hypovolemia ◆ ★ Sturgess’s article on fresh frozen plasma (Sturgess 2014). Anaemia with coagulopathy ◆ ★ Indications for DIC ◆ ◆ red cell transfusions Liver disease with anaemia ◆ ◆ Patients with a wide variety of conditions causing symptomatic anaemia will benefit Thrombocytopenia Fresh from red cell transfusions alongside treat- ment of their underlying condition. Thrombocytopathia Fresh If a diagnosis has not been reached, transfusion can enable further diagnostic Neonatal isoerythrolysis ★ tests to be performed safely. Put simply, red cell transfusions are indicated for any ◆ Indicates suitable blood products that can be utilised in treating the disease process. patient developing clinical signs of low ★ Designates the superior product choice when more than one suitable product can be utilized. tissue oxygenation due to anaemia, which (Courtesy of Dr Anne Hale). usually manifests as weakness and lethargy, their clinical presentation and diagnosis has The purpose of a red cell transfusion in pale mucous membranes, tachycardia and to be considered before making a decision companion animals would be to alleviate tachypnoea on examination. The speed whether to transfuse or not. clinical signs but not to remove stimulus at which the anaemia develops will also for the patient’s own red cell production impact on the need for transfusion. If In human medicine, detectable changes in (if this capacity still exists in the recipient). red cell numbers fall slowly, for example tissues at the cellular level start to occur As a rough guide, in canines capable of a chronic anaemia secondary to bone secondary to reduced oxygenation at a regeneration, transfusion to a stable end marrow disease, then adaptive mechanisms PCV of 30% or less and the same is likely point of 25-30% PCV would be suggested. such as increased 2,3-diphosphoglycerate true in our patients. On a clinical level in In those incapable of regeneration, aiming improve the efficiency of oxygen carriage animals (especially with chronic anaemias), for mid-range of normal PCV (35%-55%) leading to a delay in the development clinical signs are not often seen until PCV may be beneficial. of clinical signs. Conversely if red cell drops to a much lower value. Sympto- The average lifespan of a canine red cell numbers fall quickly, for example blood matic anaemias typically present as a weak, is usually stated as 120 days. Cellular life loss secondary to a road traffic accident, tachypnoeic, tachycardic patient with expectancy may be reduced due to the there is no time for adaptation and the altered mucous membrane colour. Pale collection and storage process, although a clinical need for transfusion may occur mucous membranes are consistent with consensus as to what degree this impact with relatively modest blood loss. anaemia, but can also be seen in severe is has not been reached. The red cells in The causes of anaemia are wide ranging shock. Icteric mucous membranes can be each unit of transfused blood will be of but can be broadly defined into three seen in animals with pre-hepatic jaundice variable age and as a result the effect of a aetiological groups: secondary to red cell destruction. transfusion will wane over time. Response • Loss of red cells (e.g. haemorrhage) In acute instances, transfusion should be to transfusion is also dependant on the host response to the red cells and the • Destruction of red cells (e.g. immune considered where whole blood loss is underlying disease process. mediated disease)
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