Common transfusion reactions
Which blood product is most appropriate for a dog with rodenticide toxicity and active bleeding?
Fresh frozen plasma
Define a major/minor crossmatch and the components of both.
Major: donor RBC + recipient plasma
Minor: donor plasma + recipient RBC
What is the most common type of transfusion reaction in dogs/cats, the criteria for this, and what you should do when encountering it?
Febrile, non hemolytic reaction
Increase of 1C temperature from baseline
Stop the transfusion, restart in 20-30 minutes at a slower rate
A 12kg Hound puppy comes in after impaling his caudal vena cava with a stick. He receives 3 units of blood in less than an hour in an attempt to stabilize him. What is this called, and what other therapy is required when doing this?
Massive transfusion
Criteria:
Transfusion of a volume equal to or greater than a whole blood volume w/in a 24 hour period
Replacement of half of the patient’s estimated blood volume within 3 hours
Administration of blood products at a rate of 1.5mL/kg/min over 20 min
Replacement of 150% of a patient’s blood volume irrespective of time
Component therapy: 1:1:1 ratio of pRBC:FFP:platelets to prevent dilutional coagulopathy
List and discuss transfusion reactions as seen in dogs/cats (other than febrile, non-hemolytic reactions)
Type I hypersensitivity (allergic reactions): urticaria, hives, wheals, facial swelling, treated w/ diphenhydramine and can resume transfusion at slower rate with resolution of signs
Type I hypersensitivity (anaphylaxis): acute onset integumentary, GI, or respiratory signs w/ hypotension, treated with epinephrine, stop the transfusion and DO NOT resume
Type II hypersensitivity: acute hemolysis (pre-formed antibodies to RBC surface antigen), immediately life-threatening, stop transfusion and cross-match before the next one; delayed hemolysis is the induction of antibody production against other blood groups
TRALI (transfusion associated acute lung injury): non-cardiogenic pulmonary edema, can be acute or delayed, treated with supportive care, supplemental oxygen, a single dose of furosemide may be beneficial
Transfusion associated circulatory overload (TACO): too much blood volume, treated with furosemide and oxygen therapy
Citrate toxicity: citrate binds calcium (tremors, pawing at face, seizures), treat w/ calcium gluconate