blood transfusion for the veterinary technician

Blood Transfusion for the Veterinary Technician

Dawn Sadowski, CVT

November 3, 2013

Blood Transfusions

I will be talking about the following today:

1. blood typing and cross-matching

2. administration protocol

3. types of products available with their basic uses, their storage and handling and the product preparation.

Blood Typing

Canine Blood Typing

• 8 recognized DEA systems in canines.

• DEA 1.1 is considered most important

• They are either Negative or Positive

Feline Blood Typing

• 3 recognized blood types A, B and AB

• Cats have naturally occurring alloantibodies against type A or B cells, depending on their own type.

Feline Blood Typing

• It is critical to blood type all feline donors and recipients

• Can have a reaction to their first transfusion

Cross-matching

Cross-matching

• Required for all recipients except those who have received a transfusion for the first time in the past 4-5 days or recipients that have never received any type of transfusion.

Transfusion Set-up

Transfusion Set-up

• Aseptic technique is very important

• All the transfusion products are susceptible to contamination

Transfusion Set-up

• Keep system closed during entire time of administration.

• Keep the lines off the floor

Transfusion Set-up

• Select the appropriate type of infusion set for the product being administered

• Here at IVG we use 3 different types of filters.

• Select the appropriate infusion pump for the product being used

Transfusion Set-up

• Blood Set

Transfusion Set-up

• Blood Set

Transfusion Set-up

• Hemo-nate filters

Transfusion Set-up

Transfusion Set-up

1. Handle with Care

2. Open infusion set package

3. Peel open port to be used on the product

4. Insert infusion set into port on bag

Transfusion Set-up

5. Allow product to flush through the infusion set, clamp when hits the end

6. Feed into infusion pump

7. Connect to recipient at closest port to recipient

Transfusion Set-up

8. Follow directions on Transfusion monitoring worksheet.

Transfusion Set-up

Patient Monitoring

Patient Monitoring

• It is extremely important that all patients be closely monitored with all transfusions

• Monitor vitals and demeanor of patient

• Notify doctor with all changes

Patient Monitoring

• The signs can include weakness, trembling, restlessness, jaundice, vomiting, drooling, edema, hives, itchiness, incontinence, tachycardia, fever, neurological signs, cardiac arrhythmias, dyspnea, hypotension, anaphylactic shock, disseminated intravascular coagulation (DIC), and death.

Patient Monitoring

• Transfusion reactions can be either immunologic or non-immunologic and they can look the same. Both can be fatal.

• If a patient shows any symptoms of a reaction, stop the transfusion and notify a doctor at once.

Products Regularly Available

1. Whole blood

2. Packed RBC

3. Fresh Frozen Plasma/Frozen Plasma

4. Oxyglobin

5. Canine Albumin/Human Albumin

Whole Blood

Whole Blood

• Whole blood contains red blood cells, plasma proteins, coagulation factors, white cells and platelets.

Whole Blood

• In whole blood transfusions – contrary to popular belief there are very few platelets that actually make it to the patient in the transfusion.

Whole Blood

• A blood administering set that is appropriate to size of bag is recommended for transfusing whole blood.

Whole Blood

• A specialized infusion pump is recommended with whole blood transfusion so does not crush the cells

Packed Red Blood Cells

Packed Red Blood Cells

• Only contain red blood cells

• Result of centrifugation or sedimentation of a unit of whole blood

Packed Red Blood Cells

• Red cells are living cells that require fresh oxygen and carbon dioxide diffusion in and out of each bag.

• Storage can vary between 3-6 weeks

Packed Red Blood Cells

• The advantage to pRBC is that the volume is low and the PCV is higher than normal blood.

• It is indicated for anemia

Packed Red Blood Cells

• The disadvantage is it does not contain plasma

• It is contraindicated in cases involving cardiac disease, renal disease or animals without a decreased hematocrit.

Packed Red Blood Cells

• Warm pRBC to body temperature before administering

• Administer using an aseptic technique and keep closed at all times

Packed Red Blood Cells

• Use a blood administer set appropriate to size of bag.

• Use with an infusion pump made for administering blood such as a heska pump

Packed Red Blood Cells

Frozen Plasma

Frozen Plasma

• FP should be monitored closely. It is recommended to use an indoor/outdoor thermometer.

Frozen Plasma

• Plasma is frozen in a horizontal position then stored upright.

• Before using the plasma check bag for any cracks or signs of premature thawing

Frozen Plasma

• The frozen bags need to be handled carefully to avoid cracking and causing contamination during the thawing process.

Frozen Plasma

• Here at BVH we thaw the plasma slowly in a bowl of luke warm water.

• The FP is placed in a sealed zip lock bag before placing in the water to prevent contamination.

Frozen Plasma

• Administer with an appropriate sized blood set or micro filter

• Any infusion pump can be used with plasma

Canine Fresh Frozen Plasma

Canine Fresh Frozen Plasma

• Fresh frozen plasma is the liquid component of whole blood that has been separated by centrifugation and subsequently frozen within 6-8 hours of collection

Canine Fresh Frozen Plasma

• FFP is used to treat a variety of inherited or acquired coagulopathies and hemostatic disorders.

• This includes the treatment of hemophilia A and B, anticoagulant rodenticide toxicities, von Willebrand disease and other factor deficiencies.

Canine Fresh Frozen Plasma

• It is also used to treat hypoproteinemia caused by multiple disease processes such as pancreatitis, protein losing enteropathies and protein losing nephropathies, DIC, sepsis and hepatic failure.

Canine Fresh frozen Plasma

• It has a shelf life of 1 year

• Once stored for 1 year, the unit should be pulled and relabeled as frozen plasma and stored for an additional 4 years.

Canine Frozen Plasma

Canine Frozen Plasma

• Canine frozen plasma is the expired FFP with a shelf life of 4 years or

• It is plasma that was collected but not completely frozen within the 8 hour time requirement to label it is as FFP.

Canine Frozen Plasma

• FP is effective in the treatment of acquired deficits of non-labile coagulation factors.

• It can also treat shock and hypoproteinemic states.

Feline Frozen Plasma

Feline Frozen Plasma

• A unit of Feline Frozen Plasma is obtained by the centrifugation or sedimentation of feline whole blood.

• It is prepared at any time up to 5 days after the expiration date applicable to the original unit of whole blood.

Feline Frozen Plasma

• A viable source of the other components of plasma such as albumin, globulins, electrolytes and the replacement of fluid volume.

Feline Frozen Plasma

• Thawed plasma is used for the parental replenishment of non-labile coagulation factors, albumin, globulins, electrolytes and fluid volume of the patient.

Oxyglobin

Oxyglobin

• Is stored in its own foil wrap which acts as an air barrier. Once the foil is opened oxyglobin must be used within 24hrs.

• It comes in 60ml or 125ml single use bags

Oxyglobin

• Oxyglobin is an oxygen carrying colloid fluid made from bovine hemoglobin. It can be used instead of pRBC’s when oxygen capacity is needed.

Oxyglobin

• In healthy animals, hemoglobin within red blood cells pick up oxygen from the lungs and deposits it in the tissues via the capillary microcirculation.

Oxyglobin

• Oxyglobin is used to treat anemia in dogs by increasing the systemic oxygen content and improving the clinical signs associated with anemia.

Oxyglobin

• Contraindicated in dogs with a predisposition to volume overload such as those with advanced cardiac disease or otherwise severely cardiac function or oliguria or anuria.

Oxyglobin

• Is approved for use in dogs only, although it has been used in cats.

• It can be used, off label, in cats, but they are easier to fluid overload.

Oxyglobin

• Has a very minimal risk of transfusion reaction, therefore typing and crossmatching is not needed.

Oxyglobin

• Cleared quickly from the body

• Beneficial effects last only 24-36 hours

• It is a pigment and will cause yellow/red/brown discoloration of mucous membranes, sclera, urine and skin.

Oxyglobin

• Handle aseptically – great medium for bacterial growth

• No need for a blood filter

• Can use any infusion set

• Administer through a central line or peripheral vein only

Oxyglobin

• Watch for circulatory overload when administering

• Close monitoring of CVP’s is recommended during and immediately after the infusion.

Albumin

Albumin

• A protein that is synthesized by a normally functioning liver. Inarguably, is one of the most important proteins in the body.

Albumin

• Is a highly soluble globular protein which accounts for 75-80% of the colloid oncotic pressure in healthy animals.

• It is also a transport protein and binds naturally occurring substances such as bilirubin, fatty acids, hormones and some therapeutic drugs.

Albumin

• The interstitial pool provides a large storage vat from which to draw during states of albumin loss or decreased albumin synthesis in order to maintain colloid oncotic pressure of the serum.

Albumin

• It serves a key role in the maintenance of colloid oncotic pressure, free radical scavenging, mediator of coagulation, transport of exogenous and endogenous substrates, buffering of serum and contributor to wound healing

Albumin

• A wide variety of critical illnesses can result in and become exacerbated by hypoalbuminemia

Albumin

• Pancreatitis

• Heat induced illness

• Pneumonia

• Parvovirus enteritis

• Sepsis

• Prostatitis

• Pyometra

• Burn injuries

Albumin

• Fresh Frozen Plasma can be ineffective and inefficient for replenishing albumin when values are low

• FFP will increase serum albumin by only 0.5g/dL, if there are no ongoing losses.

Albumin

• ~50% serum total protein

• 80% serum colloid oncotic pressure

• Both humans and animals with hypoalbuminemia <2 g/dL will have increased morbidity and mortality

Albumin

• To administer use a syringe pump, sterile fluid bag or a blood bag without an anti-coagulant.

Albumin

• Infusion set should either be a filtered blood set or a standard infusion set with an in-line filter such as a hemo-nate filter attached

Albumin

Human Albumin

Human Albumin

• Treatment of hypoalbuminemia

• Decreased colloid oncotic pressure

• As a potent colloid in the treatment of hypotension

Human Albumin

• Albumin is structurally homologous across species.

• It differs ~20% of its amino acid sequence

Human Albumin

• Is available in 5% or 25% solutions

• Can be stored at room temperature for up to 3 years

• They do not contain preservatives, should be used within 4 hours of opening

Human Albumin

• It is recommended to give Diphenhydramine 15 minutes prior to albumin administration

Canine Albumin

Canine Albumin

• Stored at a controlled room temperature or refrigerated temperature (34-80F)

• Stable for 24months past expiration date

• Once reconstituted it must be used within 6 hours