Blood transfusion in anemic patients

(DOSE, ADMINISTRATION OF BLOOD AND COMPONENT

THERAPY)

By:Dr. Yasmeen AhmedDr. Ajay Srivastava

M.V.Sc. Scholar, Indian Veterinary Research Institute

DOSE /QUANTITY OF BLOOD

• Quantity of blood to be transfused depends upon:

• Degree of anemia

• Acute hemorrhage-there will be loss of blood volume results in hypotension but no drop in PCV –PLASMA or DEXTRAN is good enough.

• Chronic Anaemia-decision of transfusion based on bone marrow response and on PCV

CALCULATION OF DOSE• Calculated on the percentage of haemoglobin present and percentage

to which it should be elevated( minimum 75% of normal level

• Animal contains about 90ml of blood/kg of body weight:

ml of blood need to raise Hb to 1% = 90 x bw (kg)/100

ml of blood deficit = wt(kg) of recipient x 90 x [PCV desired – PCV recipient] / PCV of donor

ADMINISTRATION OF BLOOD

PRACTICAL CONSIDERATIONS WHILE BLOOD ADMINISTRATION

Total replacement of lost blood not necessary

Attaining a PCV of 25% is a REASONABLE GOAL.

Approx. 2.2ml of whole blood/ kg BW: increase PCV by 1%.

Blood transfusion should be viewed as temporary therapeutic measure.

Reference: vety. Med. By Radostits, Gay, Blood, Hinchcliff. 10th edition, Page no. 405

ROUTES OF BLOOD TRANSFUSION

INTRAPERITONEAL ROUTE INTRAVENOUS ROUTE INTRAOSSEOUS ROUTE SUBCUTANEOUS ROUTE

INTRAPERITONEAL ROUTE

50% of transfused blood enters the circulation within 24 hrs Max. conc. of transfused cells in circulation 2-3 days after injection Satisfactory in case of Piglets Indicated in Shocked & Uncooperative animals RATE OF TRANSFUSION THROUGH I.P. ROUTE-100 drops/min.

MERITS OF I.P. ROUTE

Valuable in replacement of erythrocytes Treatment of Hemolytic Anemia in lambs

DEMERITS OF I.P. ROUTE Not satisfactory for treatment of Hypovolemic Shock Absorption of RBCs slow Not recommended in Ascites, Peritonitis, Abdominal distention, Peritoneal adhesion

2. INTRAVENOUS ROUTE Best method in large % of cases Slow I.V. drip usually most desirable method and is stopped immediately if urticaria develops.

Jugular vein is preferred in ruminants

Dogs- Cephalic or Recurrent tarsal vein RATE OF TRANSFUSION THROUGH I.V. ROUTEHORSE- 10-20 ml/ kg/ hr CATTLE- 4.5 l/ hr DOG- 8-10 ml/ kg/ hr

In dogs, sod. Citrate causes overloading and heart failure so administer blood very slowly or use heparin as anticoagulant.

Heparin mixed blood- safely transfused at faster rate either IV or IP.

MERITS OF I.V. ROUTE

Satisfactory in treatment of Hypovolemic Shock. Therapeutic effects of transfusion delivered by I.V. injection are extremely rapid Suitable method when large volume of blood is transfused Useful in Emergency Cases

DEMERITS OF I.V. ROUTE

Administration at too rapid rate a) Overloading of circulation b) Acute Heart Failure

Other complications a) Heart rate increases rapidly

b)Dyspnoea precedes collapse

3. Limited application in Kittens & Small Dogs 95% of RBCs transfused into Medullary Cavity being absorbed intact Maximal uptake in 5 minutes Mainly given in long bones like femur

INTRAOSSEOUS ROUTE

MERITS OF I.O. ROUTE Provides rapid access to central compartment of

circulatory system Demonstrates efficacy & onset of action.

DEMERITS OF I.O. ROUTE Contraindicated for placement of Bone marrow

needle- Skeletal abnormality, Skin & Wound infection, Abscess & Fracture

Contraindicated in Septic Shock

SUBCUTANEOUS ROUTE Less frequently used Less than 3% of RBCs are absorbed, 97% are destroyed

RATE OF TRANSFUSION The recommended administration rate varies (08-10ml/kg

BW/hr) but never exceed 22ml/kg/day in dogs & cats. Patients with cardiac insufficiency may not be able to

tolerate >5ml/kg/day.

A drop in PCV 36% to 12% (500kg animal) represent loss of 27 lit of blood. In this case 8lit. Of blood is req. to transfuse.

0.1ml/kg given over 5-10 min. & evaluate the vital parameters, if parameters & attitude are unchanged, the transfusion can be continued @ not exceed 20ml/kg/hr.

Reference: Manual of Small Animal Internal Medicine, 2nd edition by Nelson & Couto, page no. 773

Reference: Large Animal Internal Medicine by Bradford P. Smith 4th edition, page no. 1145

ELSEVIER MOSBY PUBLICATION

4.5lit blood/hr to administer to a cow and comparable rate in small species.

In adult horse 10-20ml/kg/hr & with faster rate with rates in foal (40ml/kg/hr).

Reference: vety. Med. By Radostits, Gay, Blood, Hinchcliff. 10th edition, Page no. 406

Component therapy • Definition: Whole blood is often centrifuged & processed

into blood components, such as packed RBC, plasma, platelets & cryoprecipitate, by using multiple, sterile connected plastic bags.

• Advantages: - better conservation of blood resources- longer storage of components- more specific therapy- fewer complications from circulatory overload

because of minimum volume administered

RED BLOOD CELL PRODUCTS Only indication- clinically symptomatic Anemia

Patients asymptomatic for anemia- No transfusion unless exact Hb conc./ Hematocrit level known

Should be transfused immediately when level of Hb is one third of the normal Hb level or normal heamatocrit value.

WHOLE BLOOD (WB) BLOOD COLLECTED FROM DONOR PLUS ANTICOAGULANT

MOST COMMON IN VETY. PRACTICE SINCE IT CAN BE PRODUCED WITHOUT ANY EXPENSIVE EQUIPMENT.

TYPICALLY USED TO TRANSFUSE CATS, RARELY DOGSIN CATS- 40-50 ml BLOOD + 5-9 ml ANTICOAGULANTINDICATIONS: Pediatric transfusions (SMALL PUPS)

Exchange transfusions Hypovolemic anemia from hemorrhage

CONTRAINDICATED: IN NORMOVOLEMIC ANEMIA, because of risk of volume overload from additional plasma volume adds to transfusion.

DOSE: 10-20 ml/kg b.wt

PACKED RBCs (pRBCs) Cells & a small amount of plasma after plasma/ anticoagulant removal PCV= 80% (VERY VISCOUS) 0.9% NSS added to decrease viscosity & improve flow INDICATIONS: Clinically symptomatic anemia DOSAGE- 6-10 ml/kg

pRBCs IN ADDITIVE SOLUTION

100 ml ADDITIVE SOLUTION ADDED TO SEPARATED RBCs

PCV= 55-60%

Additive Solutions: DEXTROSE MANNITOL SODIUM CHLORIDE ADENINE

DOSE- 10-15 ml/kg

LEUKOCYTE REDUCED pRBCs

99.9% WBCs REMOVED

WBCs removed as cause certain TRANSFUSION REACTIONS- Non-hemolytic fever, immunosuppression

DOSE- 15 ml/kg

PLASMA COMPONENTS

FRESH FROZEN PLASMA (FFP) Plasma from WB & RBCs removed within 6 hrs of collection

Anticoagulants remains in plasma fraction during processing.

WHEN FROZEN AT (-20 degree celsius), CLOTTING FACTORS MAINTAIN ACTIVITY FOR 1 yr at this temp.

EXCELLENT SOURCE OF CLOTTING FACTORS

Indications: HEMOPHILIA von WILEBRAND’S DISEASE RODENTICIDE INTOXICATION

DOSAGE= 6-10 ml/kg sid-tid

FROZEN PLASMA (FP)

PLASMA NOT PROCESSED & FROZEN WITHIN 6 hrs OF COLLECTION or FFP STORED AT -20 deg celsius FOR > 1 yr

EXCELLENT SORCE OF ALBUMIN Indications: FAILURE OF PASSIVE

TRANSFER DOSAGE- 6-10 ml/kg sid-tid

CRYOPRECIPITATE

During thawing of FFP at 4 deg. Celsius, a WHITE PPT. forms in plasma & separated by centrifugation.

Excellent source of vWf, FACTOR 1(fibrinogen), factor 8

Indications: von WILLEBRAND’S DISEASE

HEMOPHILIA- A FIBRINOGEN DEF.

Stored at -20 deg. Celsius for 1 yr DOSAGE- 1 unit/10 kg BW

CRYO-POOR PLASMA

Plasma remaining after cryoppt. Removed

Excellent source of FACTOR 2, 7, 9, 10

Indication: RODENTICIDE INTOXICATION

DOSAGE- 1 unit/10 kg BW

PLATELET- RICH PLASMA (PRP)

Prepared from fresh WB by centrifugation at a slower centrifuge rate than for production of pRBC/ plasma

PLATELETS SUSPENDED IN PLASMA TO FACILITATE TRANSFUSION & TRANSFUSED WITHIN HOURS OF COLLECTION

Indication: THROMBOCYTOPAENIA

DOSAGE- 1 unit/10 kg BW

TRANSFUSION REACTION BY COMPONENTS OF BLOOD

PRODUCT CONTENT USES DOSAGE REACTION

Whole blood

RBCs, WBCs, Plasma, Platelets, Anticoagulant

Hypovolemic-ane,feline transfusion,pediatric trans,

10-20ml/kg Fever,acute hemolytic anemia, vol overload

Packed RBCs

RBCs Clinic-symptomtic anemia

6-10ml/kg Fever,acute hemolysis

Fresh frozen plasma

Plasma,anticoagulant,clottingfactor,Igs

Coagulation factor defic,passive transfer failure,von wilebrand’s

6-10ml/kg Vol overload,allergy,fever

Frozen Frozen plasmaplasma

Plasma,anticoagulant,low level of clotting factors,Igs

Failure of passive transfer,

6-10ml/kg Vol overload,allergy,fever

Cryoprecipitate

Factors-VIII,XIII,Fibrinogen

Deficiency of these VonWillebrand’sdis,Hemophilia-A

1unit/10kg Allergy,fever

Cryo-poor plasma

Factors-II,IV,IX,X

Rodenticide-intoxication

6-10ml/kg -do-

Platelet-richplasma

Platelets,plasma

Decreased platelet production

1unit/10kg -do-

Frozen platelets 1*10*11platelets DMSO,Plasma

undefined 1unit/10kg b.wt bradycardia

REFERENCES1.TEXTBOOK of Veterinary Internal Medicine, 6th EDITION- STEPHEN J. ETTINGER

2.VETERINARY MEDICINE- A TEXTBOOK OF DISEASE OF CATTLE, SHEEP, PIG, GOAT AND HORSES- OTTO M. RADOSTITS, CLIVE C. GRAY, DOUGLAS C. BLOOD, KENNETH W. HINCHCLIFF

3.VETERINARY HEMATOLOGY AND CLINICAL CHEMISTRY- MARY ANNAL THRALL, DALE C, BAKER, E DUAVE

4.LAB MANUAL OF CLINICAL VETERINARY MEDICINE -2