**6. Preparations used for transfusions and blood transfusions indications**

The gold standard approach is that the donor and recipient are cross-matched before administration. Administration is maintained mainly intravascular with the use of peripheral or centrally placed catheter. Also intraosseous catheters can be used to administer all blood products. It is useful in collapsed neonatal patients where vascular access is difficult [43, 75, 84].

In acute hemorrhage, anemia, decreased red cell mass, severe methaemoglobinaemia, paracetamol toxicity, chronic non-regenerative anaemia, coagulation disorders, and thrombocytopenia fresh whole blood is used [1, 45].

Principles of Blood Transfusion 333

the patient through an appropriate fitler. To prevent clotting anticoagulant like acid citrate

The indication of transfusion reactions can be immunologic or nonimmunologic. They can be immediate or delayed. Antibodies to surface antigens of transfused erythrocytes cause immune-mediated hemolytic reactions. According to surface antigens canine blood is grouped. For six of these antigens typing is available. Except DEA 4, canine universal donor is negative for all dog erythrocyte antigens (DEAs). Universal donors should be examined. If other donors are known to be compatible with the recipient they can be also used. Acute hypersensitivities mediated by IgE antibodies are one of the possible immunologic reaction. The other can be leukocyte or platelet sensitivity caused by recipient antibodies to the donor's white cells or platelets. The mechanisms of nonimmunologic reactions are various. According to the specific reaction the type and severity of clinical signs vary [17] Adverse reaction occurs in 2 types. First one is immediate reaction and following transfusion it occurs within 1 to 2 h. Second is delayed reaction and it may begin within days, months, or years later [17]. Adverse reaction varies from mild (fever) to severe (death). Transfusion reactions can be acute or delayed. In animals receiving incompatible transfusions, acute intravascular hemolysis with hemoglobinemia and hemoglobinuria may be seen. Acute hemolytic reaction is the most serious transfusion reaction that can be prevented. It is an immunological reaction and it happens when circulating natural or acquired antibodies towards donor erythrocytic antigens are given. Hemoglobinuria, vasoconstriction, renal ischemia occur due to intravascular hemolysis. Intravascular hemolysis determine clinical signs. Disseminated intravascular coagulopathy (DIC) can be caused by release of thromboplastic substances. Secondary to the release of vasoactive substances, hypotension and shock can ocur. Also acute renal failure and death can develop. After transfusion a decrease in hematocrit between 2 days and 2 weeks resulted in suspicion of delayed hemolysis. As a result of extravascular hemolysis, hyperbilirubinemia and bilirubinuria may occur. In dogs clinical signs are as follows: fever, tachycardia or bradycardia, hypotension, dyspnea, cyanosis, excessive salivation, tearing, urination, defecation, vomiting, collapse, opisthotonos, cardiac arrest, hemoglobinemia, and hemoglobinuria. When an acute hemolytic reaction occured transfusion sould be interrupted at once and shock should be treated. Also blood product being used sould be checked out and the steps that led to the

To detect transfusion reactions earlier requires careful evaluation of patient's behavior, vital signs, and perfusion before, during, and after a RBC transfusion. Pre- and post-transfusion measurement of PCV and total solids for example instantly and at 24 hours are needed. Also

In the dog the acute hemolytic reaction is rare because in this species naturally occurring anti-erythrocytic antibodies prevalence is low [3]. Alloantibodies against the common canine erythrocyte antigens 1.1 and 1.2 do not exist in dogs. As a result of this generally first

evaluation of the plasma and urine for the presence of Hgb is done [41].

dextrose should be included at a ratio of 1:7 [39, 43].

transfusion sould be examined [1, 3, 17, 93].

**7. Transfusions reactions** 

The reason of anaemia in cats requiring transfusion are haemorrhage and primary immunemediated haemolytic anaemia. Hemorrhage is caused as a result of peri- or postoperative bleeding, trauma, gastrointestinal bleeding, abdominal neoplasia, primary immunemediated thrombocytopenia and coagulopathies [85, 86, 87]. Also in a number of infectious diseases anaemia is reported such as especially feline immuno-deficiency virus (FIV) and feline leukaemia virus (FeLV) infections, and feline infectious peritonitis [88, 89]. Other infectious diseases which cause anemia are Ehrlichia species, Bartonella species, Haemoplasmas (Mycoplasma haemofelis, 'Candidatus Mycoplasma haemominutum' and 'Candidatus Mycoplasma turicensis'), Anaplasma phagocytophilum, Neorickettsia risticii, Cytauxzoon felis and Rickettsia felis have additionally been associated with anaemia [43, 90].

The indication of whole blood is in a patient whom needed several blood components or has acutely lost more than 50% of its total blood volume. When 50% of total blood volume is lost oxygen carrying capacity and oncotic activity should be recovered. In anemia, stored whole blood is used. For anemic animals packed erythrocytes especially those with volume overload are prefered. For tissue reoxygenation the transfusion of packed RBCs are used. They are also useful for normovolemic, anemic patient. Before administration, to dilute any potentially damaging antibodies these erythrocytes can be washed with saline. Refrigerated whole blood should be warmed to room temperature. Before administration it sould be gently agitated to resuspend the red blood cells. Infusion rate is limited by colder blood which has a higher viscosity [3, 41, 91].

The usage of transfusion of fresh-frozen or stored-frozen plasma (FFP) are as follows; lack of coagulation factors associated with hepatic insufficiency, disseminated intravascular coagulation (DIC), vitamin K deficiency, rodenticide toxicosis, liver insufficiency, biliary tract obstruction, sepsis/multiple organ dysfunction syndrome, pancreatitis, hypoalbuminemia, and DIC without associated laboratoryproven coagulopathy, malassimilation syndrome, chronic antibiotic use, a need for plasma volume expansion, or a massive blood loss within a few hours. Other It is also used in congenital or a hereditary deficiency in coagulation factors (i.e hemophilia A, B, or von Willebrand's disease and hypoproteinemia), [1, 3, 39]. Plasma (FP or FFP) is used especially in the emergency conditions like excessive protein loss such as enteropathy, nephropathy, exudative dermatitis or inadequate intake. It is not appropriate for using as long-term source of protein in these patients [3, 92]. In cats, reactions have not been reported following transfusions of FFP [46].

The collection and re-transfusion of the cat's own blood is called autotransfusion. It is a useful technique in an emergency situation. It can be obtained when animals bleed into body cavities. It should not be used if the blood is contaminated with urine, bacteria or bile. Blood is collected from the body cavity in a sterile manner. After that it re-transfused into the patient through an appropriate fitler. To prevent clotting anticoagulant like acid citrate dextrose should be included at a ratio of 1:7 [39, 43].

## **7. Transfusions reactions**

332 Blood Cell – An Overview of Studies in Hematology

which has a higher viscosity [3, 41, 91].

transfusions of FFP [46].

anaemia [43, 90].

thrombocytopenia fresh whole blood is used [1, 45].

In acute hemorrhage, anemia, decreased red cell mass, severe methaemoglobinaemia, paracetamol toxicity, chronic non-regenerative anaemia, coagulation disorders, and

The reason of anaemia in cats requiring transfusion are haemorrhage and primary immunemediated haemolytic anaemia. Hemorrhage is caused as a result of peri- or postoperative bleeding, trauma, gastrointestinal bleeding, abdominal neoplasia, primary immunemediated thrombocytopenia and coagulopathies [85, 86, 87]. Also in a number of infectious diseases anaemia is reported such as especially feline immuno-deficiency virus (FIV) and feline leukaemia virus (FeLV) infections, and feline infectious peritonitis [88, 89]. Other infectious diseases which cause anemia are Ehrlichia species, Bartonella species, Haemoplasmas (Mycoplasma haemofelis, 'Candidatus Mycoplasma haemominutum' and 'Candidatus Mycoplasma turicensis'), Anaplasma phagocytophilum, Neorickettsia risticii, Cytauxzoon felis and Rickettsia felis have additionally been associated with

The indication of whole blood is in a patient whom needed several blood components or has acutely lost more than 50% of its total blood volume. When 50% of total blood volume is lost oxygen carrying capacity and oncotic activity should be recovered. In anemia, stored whole blood is used. For anemic animals packed erythrocytes especially those with volume overload are prefered. For tissue reoxygenation the transfusion of packed RBCs are used. They are also useful for normovolemic, anemic patient. Before administration, to dilute any potentially damaging antibodies these erythrocytes can be washed with saline. Refrigerated whole blood should be warmed to room temperature. Before administration it sould be gently agitated to resuspend the red blood cells. Infusion rate is limited by colder blood

The usage of transfusion of fresh-frozen or stored-frozen plasma (FFP) are as follows; lack of coagulation factors associated with hepatic insufficiency, disseminated intravascular coagulation (DIC), vitamin K deficiency, rodenticide toxicosis, liver insufficiency, biliary tract obstruction, sepsis/multiple organ dysfunction syndrome, pancreatitis, hypoalbuminemia, and DIC without associated laboratoryproven coagulopathy, malassimilation syndrome, chronic antibiotic use, a need for plasma volume expansion, or a massive blood loss within a few hours. Other It is also used in congenital or a hereditary deficiency in coagulation factors (i.e hemophilia A, B, or von Willebrand's disease and hypoproteinemia), [1, 3, 39]. Plasma (FP or FFP) is used especially in the emergency conditions like excessive protein loss such as enteropathy, nephropathy, exudative dermatitis or inadequate intake. It is not appropriate for using as long-term source of protein in these patients [3, 92]. In cats, reactions have not been reported following

The collection and re-transfusion of the cat's own blood is called autotransfusion. It is a useful technique in an emergency situation. It can be obtained when animals bleed into body cavities. It should not be used if the blood is contaminated with urine, bacteria or bile. Blood is collected from the body cavity in a sterile manner. After that it re-transfused into The indication of transfusion reactions can be immunologic or nonimmunologic. They can be immediate or delayed. Antibodies to surface antigens of transfused erythrocytes cause immune-mediated hemolytic reactions. According to surface antigens canine blood is grouped. For six of these antigens typing is available. Except DEA 4, canine universal donor is negative for all dog erythrocyte antigens (DEAs). Universal donors should be examined. If other donors are known to be compatible with the recipient they can be also used. Acute hypersensitivities mediated by IgE antibodies are one of the possible immunologic reaction. The other can be leukocyte or platelet sensitivity caused by recipient antibodies to the donor's white cells or platelets. The mechanisms of nonimmunologic reactions are various. According to the specific reaction the type and severity of clinical signs vary [17] Adverse reaction occurs in 2 types. First one is immediate reaction and following transfusion it occurs within 1 to 2 h. Second is delayed reaction and it may begin within days, months, or years later [17]. Adverse reaction varies from mild (fever) to severe (death). Transfusion reactions can be acute or delayed. In animals receiving incompatible transfusions, acute intravascular hemolysis with hemoglobinemia and hemoglobinuria may be seen. Acute hemolytic reaction is the most serious transfusion reaction that can be prevented. It is an immunological reaction and it happens when circulating natural or acquired antibodies towards donor erythrocytic antigens are given. Hemoglobinuria, vasoconstriction, renal ischemia occur due to intravascular hemolysis. Intravascular hemolysis determine clinical signs. Disseminated intravascular coagulopathy (DIC) can be caused by release of thromboplastic substances. Secondary to the release of vasoactive substances, hypotension and shock can ocur. Also acute renal failure and death can develop. After transfusion a decrease in hematocrit between 2 days and 2 weeks resulted in suspicion of delayed hemolysis. As a result of extravascular hemolysis, hyperbilirubinemia and bilirubinuria may occur. In dogs clinical signs are as follows: fever, tachycardia or bradycardia, hypotension, dyspnea, cyanosis, excessive salivation, tearing, urination, defecation, vomiting, collapse, opisthotonos, cardiac arrest, hemoglobinemia, and hemoglobinuria. When an acute hemolytic reaction occured transfusion sould be interrupted at once and shock should be treated. Also blood product being used sould be checked out and the steps that led to the transfusion sould be examined [1, 3, 17, 93].

To detect transfusion reactions earlier requires careful evaluation of patient's behavior, vital signs, and perfusion before, during, and after a RBC transfusion. Pre- and post-transfusion measurement of PCV and total solids for example instantly and at 24 hours are needed. Also evaluation of the plasma and urine for the presence of Hgb is done [41].

In the dog the acute hemolytic reaction is rare because in this species naturally occurring anti-erythrocytic antibodies prevalence is low [3]. Alloantibodies against the common canine erythrocyte antigens 1.1 and 1.2 do not exist in dogs. As a result of this generally first

transfusion can be safely given without regard for donor blood type. Thus the recipient can be sensitized to immunogenic antigens (i.e 1.1, 1.2, 7, and others). On first transfusion it can cause shortened survival times of the transfused cells. Subsequent predisposition to severe transfusion reaction can develop. DEA 1.1 which is the strongest antigen in dogs, leads to the most severe transfusion reaction [1]. In the second transfusion especially when DEA-1 type blood is applied twice to a DEA- 1-negative dog there is more risk [3].

Principles of Blood Transfusion 335

has been reported in the dog. It is characterized by the appearance of severe

Anemia, regardless of underlying cause, is troublesome for clinicians in respect to stabilising and supporting the patient. The survival rate of all reasons for a transfusion is 84% in the first 24 h. It is 75% for blood loss anaemia and 49.6% for ineffective erythropoeisis

The incompatibilities between the donor's red blood cells and recipient's plasma are identified by major cross-match. The incompatibilities between the donor's plasma and

Cross-Matching usually is identified as either ''major'' or ''minor'' cross-matches. A major cross-match include putting patient serum into donor cells and determine the presence of agglutinating and/or hemolytic antibodies in the patient aganist the donor antigens. The principle of this test is hemolytic or agglutinating reaction. In this test the reagent or antibody reacts with the RBCs. Serological discordance between a candidate donor and the patient is identified by the crossmatching. It does not determine the blood group [3]. A positive in vitro reaction is caused by the presence of antibodies. In patients that had no antibodies at the time of transfusion, a mild reaction can be seen in 4 to 14 days after mismatched transfusions. When blood is transfused to a patient in which antibodies are already present, a severe reaction occurs. This antibody can be developed by either naturally occurring or as a result of a previous mismatched transfusion. Furthermore, high concentrations of antibodies can be caused by isosensitization from transplacental immunization. In dogs that have received transfusions before, a crossmatch should always be performed. A minor cross-match include putting donor serum into patient erythrocytes. This step is not necessary for the donor whom previously tested negative for antibodies. Transfusing packed or washed erythrocytes rather than whole blood can prevent

thrombocytopenia in the week following a second transfusion. [3, 95, 96].

recipient's red blood cells is identified by a minor cross-match [43].

administration of antibodies in donor blood against patient erythrocytes [1].

next discordant blood transfusions and to prevent neonatal isoerythrolysis [3].

**9. Principles of blood transfusion in horses** 

Before transfusion the reason of analysis with these methods are to prevent acute hemolytic reaction due to transfusion, to provide optimal lifetime of the transfused RBCs, to prevent

Because there are blood types that have not been described and it is not possible to type for Mik it is recommended that cross-matching is performed before any transfusion. If the recipient has received a transfusion before more than 4 days cross-matching should be

Horses have eight RBC groups or systems: A, C, D, K, P, Q, U, and T. The first seven systems are recognized by the International Society of Animal Blood Grouping Research.

at 10 days [43, 97].

performed [98].

**8. Cross-Matching blood** 

In cats receiving typed or crossmatched transfusions low rates of transfusion reactions have been indicated. Transfusions with whole blood or packed red blood cells transfusion reactions were reported [45]. But transfusions with FFP no reactions have been reported in cats [46].

Initial or subsequent AB-mismatched transfusions in cats can cause acute hemolytic incompatibility reactions. Erythrocytes are destroyed immediately in cats because of alloantibodies. On the contrary in dogs, delayed transfusion reactions are more often occur. A type B transfusion to type A cat causes mild signs. In this situation shortened erythrocyte survival can occur. This causes ineffective therapy. Acute hemolytic transfusion reaction with massive intravascular hemolysis with serious clinical signs occurs in type A transfusion to a type B cat. These symptoms may occur even if it is the first transfusion. Type AB or A blood can be received by type AB cats safely [1, 94].

The transfusion should be stopped immediately if a transfusion reaction is suspected. The recipient sould be monitored continually for follow up. The most severe is acute haemolytic transfusion reactions developing as a result of naturally occurring alloantibodies [32].

Clinical signs are restlessness, vocalisation, tachypnoea, bradycardia, tachycardia, hypotension and hypertension. Pyrexia is seen frequently as a result of reactions to donor leukocytes, platelets and plasma proteins. As a result of binding by citrate, there is potential for hypocalcaemia when administering large volumes of blood products. Thus, if the patient is showing clinical signs of hypocalcaemia calcium should be measured [38, 43].

The next hour after transfusion nonhemolytic fever can ocur as adverse reactions. If contaminated blood products applied by mistake, fever may occur in an acute hemolytic reaction in association with septicemia. Vomiting or diarrhea can be seen after plasma administration. Rarely urticaria may cause trouble to patient. It can be treated with antihistamines, with or without glucocorticosteroids. If whole blood is administered with rapid administration of a large volume of blood component to normovolemic cats or smallsized dogs hypervolemia can be observed. Hypervolemia can result in pulmonary edema. Cough, tachypnea, dyspnea, or cyanosis can occur due to hypervolemia. Treatment can be done by stopping the transfusion, administering diuretics (furosemide) to reduce pulmonary edema, and providing oxygen support [3,72, 93].

The recipient should be carefully examined before the procedure. Its heart rate, respiratory rate, mucous membrane colour, capillary refill time and temperature sould be recorded. Also the PCV and total plasma protein should be recorded [43, 51] .

Delayed adverse transfusion reactions are consist of delayed hemolytic reaction, transmission of infectious disease, and posttransfusion purpura. Posttransfusion purpura has been reported in the dog. It is characterized by the appearance of severe thrombocytopenia in the week following a second transfusion. [3, 95, 96].

Anemia, regardless of underlying cause, is troublesome for clinicians in respect to stabilising and supporting the patient. The survival rate of all reasons for a transfusion is 84% in the first 24 h. It is 75% for blood loss anaemia and 49.6% for ineffective erythropoeisis at 10 days [43, 97].
