**3.1. Platelet transfusion**

326 Blood Cell – An Overview of Studies in Hematology

matching is necessary [1, 50].

12-24 h and should not be refrozen [43].

monoxide poisoning [54, 55].

acting steroids are given [53, 57].

diseases [53].

red cells. In order to prevent primary sensitization and risk of developing hemolytic disease in breeding females, cross-matching and/or blood typing is important. In general veterinary

To decrease adverse reactions one sould pay attention to blood typing and crossmatching procedures as much as monitoring. There is always risk in blood transfusions. For this reason, they should be performed only when warranted. When taking history, previous transfusion therapy should be asked and in a history of previous transfusion therapy cross-

Depending on availability and indication for transfusion, whole-blood or blood-component therapy may be administered. RBCs, white blood cells (WBCs), platelets, all the coagulation

In cats, fresh whole blood is the most common product used recently. Stored whole blood, packed red blood cells and fresh frozen plasma (FFP) are also given as transfusions [45].

The heavier cellular elements from the supernatant plasma are sedimented by centrifugation of whole blood sediments. Due to separation of blood collection within 8 hours all protein activity and concentration are maintained in the plasma. The obtained supernatant usually frozen. For subsequent transfusion, it is stored as fresh frozen plasma (FFP). In addition it can also processed to provide cryoprecipitate and cryosupernatant. It can also be transfused immediately as fresh plasma [52, 53]. Fresh frozen plasma have to be stored frozen at -30°C before used. Also it should be identified with the donor blood type, name and collection date. Samples thawed and not used sould discarded or stored in a fridge and used within

Recently an ultra-purified polymerised bovine haemoglobin solution is the only commercially available alternative to red cell transfusion (Oxyglobin). It is not licensed in cats but it has been used in treatment of anaemia in cats and also in therapy of carbon

Hemostatic protein deficiencies lead to hemorrhagic disorders and the treatment is done principally by plasma components [56]. In animals with von Willebrand disease (vWD) and hereditary coagulation factor deficiencies active hemorrhage is controlled by plasma components. Plasma components are also used for preoperative prophylaxis in these

For preparation of plasma components sterile plastic bags are used. After that they are stored and transferred as frozen in individual boxes. Products have to be stored at -20°C or lower. Just before transfusion they warmed to 37°C in a water bath or incubator. Preferred route of administration is the intravenous transfusion of plasma components. If attempts at vascular access have failed, intraosseous transfusion can be used in emergency situations. When acut allergic reactions occur transfusion is stopped and antihistamines and/or short-

Cats have antibodies to non-self blood types within the plasma. Because of this only typespecific plasma should be administered to cats in contrast to dogs. Using one of the

factors, albumin and immunoglobulins constitute whole blood (WB) [51].

practise, blood typing for canine DEA 1.1 and for feline types A and B is applied [1].

Correction of coagulation by fresh platelets are shown by in vitro coagulation studies. Freshly collected platelets correct thrombocytopenia, control associated hemorrhage, and prevent death from bleeding. Hemorrhagic diathesis are prevented by platelet replacement for thrombocytopenia [59].

Severe thrombocytopenia or thrombopathia result in bleeding. Platelet transfusion is used for the control of this bleeding. In veterinary medicine platelet transfusion has been used rarely compared to red blood cell (RBC) and plasma transfusion. In dogs, reports related to platelet transfusion are generally associated with experimental hematopoietic stem cell transplantation. Platelet-rich blood products consist of fresh whole blood (FWB), plateletrich plasma (PRP) and platelet concentrate (PC). They are used for aggressive anticancer therapy and treating complex hematologic disorders. Centrifugation of whole blood constitute platelet-rich plasma (PRP) and centrifugation of platelet-rich plasma constitude platelet concentrates (PC). Platelet activation is induced by centrifugation so that the resuspension of the platelet pellet during PC preparation from dogs is difficult. The preparation efficiency of PC from dogs can be improved by addition of PGE1 in PRP before the centrifugation of PRP. Also therapeutic efficacy of the platelets are maintained. In 10-28 kg body weight dogs plateletpheresis has been used successfully. On the canine donor thrombocytopenia and hypocalcemia are the main adverse effects of plateletpheresis [60-62].

At room temperature (RT) (20-24°C), PRP and PC can be stored for 5-7 days with continuous or intermittent agitation. At RT FWB can be stored for up to 8 hours. The interest in freezed (4°C) storage of platelets is increasing because of the increased risk of bacterial proliferation at RT storage. Storage of human PRP and PC are limited to 5 days because of prevention of bacterial proliferation at room temperature [60- 63].

Platelet transfusions as with RBC and plasma components should be performed with 170 µm filters standard blood administration sets. Transfusion sets which can bind platelets should be exempt from latex [60].

The most common reaction to PC are febrile reactions. The frequency is decreased by prestorage leukoreduction. In immunocompetent dogs receiving multiple transfusions, alloimmunization to platelet antigens occurs. Leukocyte reduction and ultraviolet B irradiation are recently accepted methods for preventing the development of platelet alloimmunization [64-66].

Recently platelet cryopreservation are used to provide long-term storage and immediate availability of platelet products for transfusion. When fresh platelets are unavailable cryopreserved platelets can be activated in vitro and provide therapeutic benefit [63].

Principles of Blood Transfusion 329

The ideal feline blood donors should be healthy, indoor-only cats with an agreeable temperament for easy handling and restraint. Owned pet cats should be donate maximum once every 2 months [43]. The features of feline donor sould be as follows; weigh more than 4.5 kg, have a packed cell volume that is at least 0.35 L/L, have demonstrated a good temperament, and be in good physical condition [3]. Donor cats can donate between 10 and 12 ml/kg. Adult healthy cats can donate 50 ml every weeks. Donors have to be type A. Type B donors may be demanded depending on breed prevalence and geography. Feline leukemia virus, feline immunodeficiency virus (FIV), feline infectious peritonitis, heartworm

For appropriate care of donors some processes needed. These are current vaccinations, if there is contact with new animals every 6 mo fecal floatation, monitorization of hemogram every year, analysing clinical chemistry, screening for infectious diseases and in the dog preventative heartworm therapy in areas where it is necessary. When blood collection is taken the donor's weight, temperature, and packed cell volume have to be analysed [3, 71]. PCV or Hb are measured by taking a blood sample. Preferentially cats with a PCV of 30–

In the cat, blood can be taken by using a 19- to 20 gauge needle or butterfly into a syringe via jugular vein venipuncture. The region over the jugular vein is clipped and prepared aseptically and sedation is administered. It is prefered to use a 1:1 combination of ketamine 100 mg/ml and midazolam 5 mg/ml. It is made up in a small syringe and given intravenously up to a maximum dose of 5 mg/kg ketamine (0.1 ml/kg of combination). Syringe consists of either ACD, CPD, or CPDA- 1 (1 mL/9 mL of blood), or heparin (5 units/mL of blood). Before a preservative solution is used it can be placed in a small blood bag. To access the jugular vein a 19-21G butterfly needle is used. The blood is collected over a total of 10 15 mins. At once a maximum of 10-12 ml/kg blood can be donated. Isotonic crystalloid fluid therapy post-donation at a rate of 60 ml/h for 3 h is given to the cat [3, 43].

Precaution is necessary to prevent damage of the blood product and harm to recipient. Blood typing or crossmatching have to be carried out to provide compatibility before RBC

Transfusions of red blood cell should be administered through a filter. The filter is arranged to remove clots and particles which are potentially harmful to the patient. Blood infusion sets have in-line filters. These filters trap large cells, cellular debris, and coagulated proteins. The pore size range from 170µm to 260µm. A filter may be used to administer 2-4 units of blood to a patient or for a maximum time limit of 4 hours according to human blood banking standards. High protein concentration at the filter surface and room temperature conditions promote proliferation of any contaminating microorganisms. The rate of flow slowed down by accumulated material. After 5 days or more of refrigerated storage constituted microaggregates composed of degenerating platelets, white blood cells (WBCs), and fibrin strands in blood. They are removed by other blood filters with a pore size of 20-40

disease, and Hemobartonella sp have to be excluded in donor cats [1].

35% are used but cats with low–normal PCVs should not be used [43].

**5. Administration** 

transfusion [41].

#### **3.2. Granulocyte transfusion**

Granulocyte transfusion can be used as supportive therapy. It is used in patients with lifethreatening neutropenia caused by bone marrow failure or in patients with neutrophil dysfunction. Granulocyte transfusions is shown to be useful in treatment of infections in patients after treatment with high-dose chemotherapy. It is helpful especially in the chemotherapy associated with conditioning for hematopoietic stem cell transplant. By using granulocyte colony-stimulated factors higher doses of granulocytes for transfusion are produced. Thus recently the use of therapeutic granulocyte transfusion has been increased. The outcome of transfusion are effected by the type of infection being treated, the likelihood of recipient marrow recovery, and recipient alloimmunization [67].

In small animals therapeutic granulocyte transfusions have been used especially in experimental models of myelosuppression and neonatal sepsis. In clinical veterinary medicine they have been used rarely. Granulocytes can be used to identify the site of inflammation. Beside leukapheresis, centrifugation of FWB, with or without colloidfacilitated sedimentation, may be used to isolate canine and feline buffy coats. Only sedimentation may also be used in the cat. At RT granulocytes are stored immobil for 24 hours. The dose for beginning is 1 x 1011 granulocytes/kg in a volume of 15mL/kg. It is used once to twice in a day [68-70].
