Bonus Round: Blood Transfusions

Common transfusion reactions

300

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

Crossmatching shenanigans

200

 Define a major/minor crossmatch and the components of both.

• Major: donor RBC + recipient plasma

• Minor: donor plasma + recipient RBC

What do you give?

100

Which blood product is most appropriate for a dog with rodenticide toxicity and active bleeding?

Fresh frozen plasma

Help the puppy case

500

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

Less common transfusion reactions

500

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