Aus der Klinik für kleine Haustiere des Fachbereichs Veterinärmedizin der Freien Universität Berlin Studies in feline pre-transfusion testing: Evaluating a novel blood typing device and serial cross-matching in transfusion patients Inauguraldissertation zur Erlangung des Grades eines Doktors der Veterinärmedizin an der Freien Universität Berlin Vorgelegt von Layla Hourani Tierärztin aus Rostock Berlin 2017 Journal-Nr.: 3990 Gedruckt mit Genehmigung des Fachbereichs Veterinä rmedizin der Freien Universitä t Berlin Dekan: Univ.-Prof. Dr. Jürgen Zentek Erster Gutachter: Univ.-Prof. Dr. Barbara Kohn Zweiter Gutachter: Univ.-Prof. Dr. Heidrun Gehlen Dritter Gutachter: Univ.-Prof. Dr. Robert Klopfleisch Deskriptoren (nach CAB-Thesaurus): blood type, blood typing, cat, cross-matching, pre- transfusion testing, point-of-care, transfusion medicine, transfusion safety Tag der Promotion: 19.07.2017 2 To Friedolin, Krikri, Molly, Spotty and the old gibbon couple at Sababurg Zoo 3 Table of contents LIST OF ABBREVIATIONS.....................................................................................................................6 TABLES AND FIGURES .........................................................................................................................7 1 INTRODUCTION ...........................................................................................................................8 1.1 HISTORY OF TRANSFUSION MEDICINE AND TRANSFUSION SAFETY .......................................................9 1.2 PATIENT SAFETY IN TRANSFUSION MEDICINE ............................................................................... 10 1.2.1 Transfusion reactions ........................................................................................... 10 1.2.2 Alloimmunisation ................................................................................................... 14 1.2.3 Strategies to reduce the risks associated with transfusions .............................. 15 1.3 CONSIDERATIONS SPECIFIC TO FELINE TRANSFUSION MEDICINE ....................................................... 18 1.3.1 Feline blood types ................................................................................................. 19 1.3.2 Feline blood donors .............................................................................................. 22 1.3.3 Blood typing in cats ............................................................................................... 23 1.3.4 Cross-matching in cats ......................................................................................... 26 1.4 SIGNIFICANCE OF THE WORK DESCRIBED HERE ............................................................................. 26 2 PUBLICATION I ........................................................................................................................... 27 EVALUATION OF A NOVEL FELINE AB BLOOD TYPING DEVICE........................................................................ 28 2.1 ABSTRACT ........................................................................................................................... 28 2.2 INTRODUCTION .................................................................................................................... 29 2.3 MATERIALS AND METHODS ..................................................................................................... 29 2.3.1 Blood samples ....................................................................................................... 29 2.3.2 Typing methods and equipment .......................................................................... 30 2.3.3 Statistical analysis ................................................................................................. 31 2.4 RESULTS ............................................................................................................................. 32 2.4.1 Blood samples ....................................................................................................... 32 2.4.2 TUBE and GEL test .............................................................................................. 32 2.4.3 IC test ..................................................................................................................... 32 2.5 DISCUSSION ........................................................................................................................ 33 2.6 CONCLUSIONS ..................................................................................................................... 48 2.7 FUNDING ............................................................................................................................ 35 2.8 CONFLICT OF INTEREST .......................................................................................................... 35 2.9 TABLES AND FIGURES ............................................................................................................. 36 2.10 REFERENCES ........................................................................................................................ 37 4 3 PUBLICATION II .......................................................................................................................... 39 ALLOIMMUNISATION IN TRANSFUSED PATIENTS: SERIAL CROSS-MATCHING IN A POPULATION OF HOSPITALISED CATS ………………………………………………………………………………………………………………………………………..40 3.1 ABSTRACT ........................................................................................................................... 40 3.2 INTRODUCTION .................................................................................................................... 41 3.3 MATERIALS AND METHODS ..................................................................................................... 42 3.3.1 Study population.................................................................................................... 42 3.3.2 Transfusions and pre-transfusion testing ............................................................ 42 3.3.3 Cross-matching ..................................................................................................... 43 3.3.4 Statistical analysis ................................................................................................. 44 3.4 RESULTS ............................................................................................................................. 44 3.5 DISCUSSION ........................................................................................................................ 46 3.6 CONCLUSIONS ..................................................................................................................... 48 3.7 ACKNOWLEDGEMENTS .......................................................................................................... 49 3.8 FUNDING ............................................................................................................................ 49 3.9 CONFLICT OF INTEREST .......................................................................................................... 49 3.10 TABLES ............................................................................................................................... 49 3.11 REFERENCES ........................................................................................................................ 51 4 DISCUSSION ............................................................................................................................... 27 4.1 FINDINGS ............................................................................................................................ 54 4.1.1 Evaluation of a novel feline AB blood typing device .......................................... 44 4.1.2 Alloimmunisation in transfused cats .................................................................... 57 4.2 LIMITATIONS ....................................................................................................................... 58 4.2.1 Evaluation of a novel feline AB blood typing device .......................................... 58 4.2.2 Alloimmunisation in transfused cats .................................................................... 59 4.3 SUGGESTIONS FOR FUTURE RESEARCH ....................................................................................... 59 4.4 CONCLUSIONS ..................................................................................................................... 61 5 SUMMARY ................................................................................................................................. 62 6 ZUSAMMENFASSUNG ................................................................................................................ 64 7 BIBLIOGRAPHY ........................................................................................................................... 66 8 LIST OF PUBLICATIONS ............................................................................................................... 76 9 ACKNOWLEDGEMENTS .............................................................................................................. 77 10 DECLARATION OF INDEPENDENT SCHOLARSHIP ........................................................................ 78 5 List of abbreviations ABCD (European) Advisory Board on Cat Diseases ACD Acid citrate dextrose BT Blood transfusion BSAVA British Small Animal Veterinary Association cDNA Complementary DNA CM Cross-match CMAH