**8. Cross-Matching blood**

334 Blood Cell – An Overview of Studies in Hematology

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

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.

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

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

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

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.

Delayed adverse transfusion reactions are consist of delayed hemolytic reaction, transmission of infectious disease, and posttransfusion purpura. Posttransfusion purpura

transfusion reactions developing as a result of naturally occurring alloantibodies [32].

is showing clinical signs of hypocalcaemia calcium should be measured [38, 43].

type blood is applied twice to a DEA- 1-negative dog there is more risk [3].

Type AB or A blood can be received by type AB cats safely [1, 94].

pulmonary edema, and providing oxygen support [3,72, 93].

Also the PCV and total plasma protein should be recorded [43, 51] .

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

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

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

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 performed [98].

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

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.

Blood-typing antiserum is not readily available for horses. Because of this to identify suitable donors equine blood-group testing can be performed by only few diagnostic laboratories. Over 30 different factors have been identified within these seven equine systems. Experimentally many more systems have been identified [99, 100]. Red cell antigens Ca, Aa, and Qa are play an important role in transfusion reactions and neonatal isoerythrolysis. There is no universal equine blood donor. Because of this to prevent inadvertent sensitization of brood mares against the two most common alloantigens (Aa and Qa) involved in neonatal isoerythrolysis, the preferred donor should be negative for factors Aa, Qa, and Ca [100, 101]. Aa and Qa alloantigens are most immunogenic, and most neonatal isoerythrolysis cases are associated with anti-Aa or Qa antibodies. The horse is clinically relevant for blood group incompatibilities. It is the only livestock species for this situation. Blood group antibodies can laed to transfusion reactions or NI and can be found in horses either ''naturally'' or as a result of a blood group incompatible pregnancy [2]. A donkey RBC antigen that has not been found in the horse has been identified, it is unique to the donkey and the mule [1].

Principles of Blood Transfusion 337

lactate and oxygen extraction are useful in chronic or hemolytic anemia cases. In horses, disseminated intravascular coagulation, clotting factor deficiency, hypoalbuminemia, decreased colloid oncotic pressure, and failure of transfer of passive immunity (FPT) are

Colloid is usually used in patients with a total protein less than 4.0g/dL or serum albumin concentration less than 2.0g/dL. When there is oncotic pressure less than 14 mmHg, clinical symptoms like ventral edema, and conditions which increase microvascular permeability

According to plasma obtained by plasmapheresis and centrifugation preparations, plasma prepared by gravity sedimentation contains greater numbers of erythrocytes and leucocytes. The risk of a transfusion reaction can be increased by these cells. During storage leukocytes can degranulate and fragment and release pyrogens and proinflammatory substances [107,

Multiple hyperimmune plasma products are avaible with bacterial or viral specific antibodies. For the treatment of equine endotoxemia, the efficacy of E. coli (J5) and Salmonella tiyphiimiriuni hyperimmune plasma has proved to be useful in some reports; in contrast, there are some reports which disapprove the utility of such products. For the protection of R. equi, the use of Rhodococcus equi hyperimmune plasma has also been controversial. For treatment of specific disease additional plasma products like botulism antitoxin, West Nile virus antibody, and Streptococcus equi antibody are usable. In general equine practice plasma is administered to neonates to provide protective immunoglobulins. Protective immunoglobulins are used for treatment of failure of transfer of passive immunity or prophylaxis against Rhodococcus equi. Also, the albumin content of the plasma used as a colloid for circulatory volume support and in the treatment of proteinlosing enteropathies. In horses heritable and acquired coagulopathies can occur. Specific coagulation factors are not available for supplementation. Also indications include coagulopathies, protein-losing nephropathy and protein loss through third spacing into a

Fresh frozen plasma must be separated and frozen within 8 hours of blood collection. Then it can be colder at -18 °C and stored for up to 1 year. Frozen plasma is considered as plasma

Healthy, young gelding weighing at least 500 kg is the ideal equine blood donor. Donor horses should be performed current vaccinations. To prevent from equine infectious anemia donors should be tested each year. RBC antigens Aa and Qa are the most immunogenic antigens. Because of this in the ideal donor, the Aa and Qa alloantigens should be absent. There are breed-specific blood factor frequencies. Thus a donor of the same breed as the recipient, particularly when blood typing is absent may be preferable. Horses that have taken blood or plasma transfusions and mares that have had foals are not appropriate as

treated by plasma [104].

108, 112].

like sepsis are other indications for colloid usage [104].

body cavity (occurring with peritonitis or pleuritis) [104, 109-113].

separated any time after 8 hours of blood storage [112, 114, 115].

**9.1. Blood donor selection** 

In horses, requirement of blood transfusion include correction of anemia arising from acute blood loss secondary to trauma, surgical complications, ruptured uterine artery, guttural pouch mycosis, and neonatal isoerythrolysis [99, 102].

Generally, whole blood transfusions are applied to horses that have acute blood loss caused by trauma, surgery, or some other conditions like splenic rupture or uterine artery hemorrhage. The transfusion recovers blood volume and oxygen-carrying capacity in cases of blood loss. There is no certain indicative variables for the beginning of transfusion so that physical examination and clinicopathologic parameters should be used to make the transfusion decision. In cases of acute hemorrhage one sould remember that the packed cell volume (PCV) may be normal for up to 12 hours because of the time required for fluid redistribution and the effects of splenic contraction. As the horse is rehydrated with intravenous fluids, serial monitoring of PCV and total protein (TP) can estimate the amount of blood loss. The transfusion decision is made by suspection of large volume blood loss, together with tachycardia, tachypnea, pale mucous membranes, lethargy, and decreasing TP. During an acute bleeding episode when the PCV fall under 20%, blood transfusion is probably required. In acute severe cases, transfusion may be required before there is a significant fall in PCV. PVC shows the need for beginning of transfusion in chronic anemia better whereas in acute hemorrhage, with transfusions proposed for horses with demonstration of tissue hypoxia and a PCV less than 10-12% [103, 104].

Blood is collected and stored in glass bottles containing acid–citrate–dextrose (ACD). The method traditionally used for collecting blood from donor horses. Glass bottles containing ACD are easy and suitable for rapid vacuum blood draw. Because of this they are recommended for equine whole-blood collection. For equine whole blood the optimal storage method is commercial citrate–phosphate–dextrose with adenine (CPDA-1) bags [105, 106].

Packed RBCs (pRBCs) are specified for normovolemic anemia (i.e neonatal isoerythrolysis, erythropoietic failure, and chronic blood loss). Markers of tissue oxygenation, for example lactate and oxygen extraction are useful in chronic or hemolytic anemia cases. In horses, disseminated intravascular coagulation, clotting factor deficiency, hypoalbuminemia, decreased colloid oncotic pressure, and failure of transfer of passive immunity (FPT) are treated by plasma [104].

Colloid is usually used in patients with a total protein less than 4.0g/dL or serum albumin concentration less than 2.0g/dL. When there is oncotic pressure less than 14 mmHg, clinical symptoms like ventral edema, and conditions which increase microvascular permeability like sepsis are other indications for colloid usage [104].

According to plasma obtained by plasmapheresis and centrifugation preparations, plasma prepared by gravity sedimentation contains greater numbers of erythrocytes and leucocytes. The risk of a transfusion reaction can be increased by these cells. During storage leukocytes can degranulate and fragment and release pyrogens and proinflammatory substances [107, 108, 112].

Multiple hyperimmune plasma products are avaible with bacterial or viral specific antibodies. For the treatment of equine endotoxemia, the efficacy of E. coli (J5) and Salmonella tiyphiimiriuni hyperimmune plasma has proved to be useful in some reports; in contrast, there are some reports which disapprove the utility of such products. For the protection of R. equi, the use of Rhodococcus equi hyperimmune plasma has also been controversial. For treatment of specific disease additional plasma products like botulism antitoxin, West Nile virus antibody, and Streptococcus equi antibody are usable. In general equine practice plasma is administered to neonates to provide protective immunoglobulins. Protective immunoglobulins are used for treatment of failure of transfer of passive immunity or prophylaxis against Rhodococcus equi. Also, the albumin content of the plasma used as a colloid for circulatory volume support and in the treatment of proteinlosing enteropathies. In horses heritable and acquired coagulopathies can occur. Specific coagulation factors are not available for supplementation. Also indications include coagulopathies, protein-losing nephropathy and protein loss through third spacing into a body cavity (occurring with peritonitis or pleuritis) [104, 109-113].

Fresh frozen plasma must be separated and frozen within 8 hours of blood collection. Then it can be colder at -18 °C and stored for up to 1 year. Frozen plasma is considered as plasma separated any time after 8 hours of blood storage [112, 114, 115].

#### **9.1. Blood donor selection**

336 Blood Cell – An Overview of Studies in Hematology

the donkey and the mule [1].

pouch mycosis, and neonatal isoerythrolysis [99, 102].

demonstration of tissue hypoxia and a PCV less than 10-12% [103, 104].

Blood-typing antiserum is not readily available for horses. Because of this to identify suitable donors equine blood-group testing can be performed by only few diagnostic laboratories. Over 30 different factors have been identified within these seven equine systems. Experimentally many more systems have been identified [99, 100]. Red cell antigens Ca, Aa, and Qa are play an important role in transfusion reactions and neonatal isoerythrolysis. There is no universal equine blood donor. Because of this to prevent inadvertent sensitization of brood mares against the two most common alloantigens (Aa and Qa) involved in neonatal isoerythrolysis, the preferred donor should be negative for factors Aa, Qa, and Ca [100, 101]. Aa and Qa alloantigens are most immunogenic, and most neonatal isoerythrolysis cases are associated with anti-Aa or Qa antibodies. The horse is clinically relevant for blood group incompatibilities. It is the only livestock species for this situation. Blood group antibodies can laed to transfusion reactions or NI and can be found in horses either ''naturally'' or as a result of a blood group incompatible pregnancy [2]. A donkey RBC antigen that has not been found in the horse has been identified, it is unique to

In horses, requirement of blood transfusion include correction of anemia arising from acute blood loss secondary to trauma, surgical complications, ruptured uterine artery, guttural

Generally, whole blood transfusions are applied to horses that have acute blood loss caused by trauma, surgery, or some other conditions like splenic rupture or uterine artery hemorrhage. The transfusion recovers blood volume and oxygen-carrying capacity in cases of blood loss. There is no certain indicative variables for the beginning of transfusion so that physical examination and clinicopathologic parameters should be used to make the transfusion decision. In cases of acute hemorrhage one sould remember that the packed cell volume (PCV) may be normal for up to 12 hours because of the time required for fluid redistribution and the effects of splenic contraction. As the horse is rehydrated with intravenous fluids, serial monitoring of PCV and total protein (TP) can estimate the amount of blood loss. The transfusion decision is made by suspection of large volume blood loss, together with tachycardia, tachypnea, pale mucous membranes, lethargy, and decreasing TP. During an acute bleeding episode when the PCV fall under 20%, blood transfusion is probably required. In acute severe cases, transfusion may be required before there is a significant fall in PCV. PVC shows the need for beginning of transfusion in chronic anemia better whereas in acute hemorrhage, with transfusions proposed for horses with

Blood is collected and stored in glass bottles containing acid–citrate–dextrose (ACD). The method traditionally used for collecting blood from donor horses. Glass bottles containing ACD are easy and suitable for rapid vacuum blood draw. Because of this they are recommended for equine whole-blood collection. For equine whole blood the optimal storage method is commercial citrate–phosphate–dextrose with adenine (CPDA-1) bags [105, 106].

Packed RBCs (pRBCs) are specified for normovolemic anemia (i.e neonatal isoerythrolysis, erythropoietic failure, and chronic blood loss). Markers of tissue oxygenation, for example

Healthy, young gelding weighing at least 500 kg is the ideal equine blood donor. Donor horses should be performed current vaccinations. To prevent from equine infectious anemia donors should be tested each year. RBC antigens Aa and Qa are the most immunogenic antigens. Because of this in the ideal donor, the Aa and Qa alloantigens should be absent. There are breed-specific blood factor frequencies. Thus a donor of the same breed as the recipient, particularly when blood typing is absent may be preferable. Horses that have taken blood or plasma transfusions and mares that have had foals are not appropriate as

donors. Because they have a higher risk of carrying RBC alloantibodies. Donkeys have a RBC antigen known as "donkey factor". Horses do not have this antigen. Thus donkeys or mules should not be used as donors for horses because horses can develop anti-donkey factor antibodies if transfusion takes place [1, 104, 116].

Principles of Blood Transfusion 339

parameters. Fluid shifts will replace much of the circulating volume so between 25% and 50% of the total blood lost should be replaced by transfusion. Pay attention sould be give to that up to 75% of RBCs lost into a body cavity like hemoperitoneum are within 24-72 hours autotransfused back into circulation. Thus in cases of intracavitary hemorrhage lower percentages of blood volume replacement can be needed. To remove small clots and fibrin

Blood should be given at a rate of approximately 0.3mL/ kg over the first 10-20 minutes for monitoring the transfusion reactions. Heart rate, body temperature, and respiratory rate sould be monitored. Additionally horses have to be monitored for signs of muscle fasciculation, piloerection, and urticaria. Urticaria, hemolysis, pruritis, edema, tachycardia, tachypnea, pyrexia, colic, changes in mentation and acute anaphylactic reactions are adverse reactions indicated in horses taking blood transfusions. The rate of adverse reaction to WB transfusion has been reported as 16% which are mild urticarial reactions and worsening

Transfusion reactions may vary from mild urticarial reactions to anaphylaxis. They are divided into immunogenic and nonimmunogenic reactions. Immunogenic reactions include anaphylaxis, hemolysis, fever, hives, acute lung injury, posttransfusion purpura, immunosuppression, and neonatal isoerythrolysis. Nonimmunogenic reactions include circulatory overload, bacterial contamination, citrate toxicity, coagulopathy, hyperammonemia, and transmission of disease. In horses that have received fresh frozen

In a second plasma or blood transfusion there exists risk for severe adverse reactions in dogs. Also there is a risk of development of neonatal isoerythrolysis in gravid mares. The

In horses suffered from normovolemic anemia polymerized ultrapurified bovine hemoglobin (PUBH) improves hemodynamics and oxygen transport parameters. During infusion to be informed about any adverse reactions patients should be monitored closely. Intense pruritus, tachycardia, and tachypnea can be resolved shortly after stopping the

**10. Principles of and indications for blood transfusion in ruminants and** 

Eleven blood groups have been classified in cattle. The greatest clinical relevance is in groups B and J. The B group is extremely complex, thus closely matched transfusions are very difficult. Newborn calves do not have the J antigen. During the first six months of life they generally acquire it. Cows can be sensitized to erythrocyte antigens by vaccinations of blood origin like some anaplasmosis and babesiosis vaccines. As a result of this neonatal

hemolysis. Also 1 of 44 horses (2%) exhibit a fatal anaphylactic reaction [103, 113].

plasma serum hepatitis has been observed [52, 93, 112, 120].

risk is much more in whole blood transfusions [26, 33, 112].

isoerythrolysis in subsequent calves occur. [1].

blood and plasma products should be given with an in-line filter [104, 119].

**9.4. Adverse reactions** 

infusion [121].

**camelids** 

An immediate blood transfusion can be applied for the first time in an emergency situation with a very minor risk of serious transfusion reaction. Horses can develop alloantibodies within 1 week of transfusion. Thus blood typing and crossmatching are recommended before a second transfusion is given. A second blood transfusion may be given confidently without a blood crossmatch within 2-3 days of the first transfusion. Blood typing and alloantibody screening can be used for the transfusion needed patient to find the most suitable donor horse. Blood typing and antibody screening before initial transfusion are more important for horses. Because subsequent blood transfusions are anticipated and if sensitized to other blood group factors broodmares may produce foals with neonatal isoerythrolysis (NI). For detection of equine RBC antigens Ca and Aa, a rapid agglutination method has been developed. It can be more suitable for pretransfusion testing [99, 103, 104].

#### **9.2. Collection techniques**

Blood is collected from the jugular vein of the donor horse. For this purpose two way used; direct needle cannulation or catheteri-zation. When a large volume of blood is required, a 10 or 12 gauge catheter is recommended. A 14 gauge catheter is also sufficient. Plastic bags and vacum-collection glass bottles in sizes ranging from 450 mL to 2 L are suitable for blood accumulation. Anticoagulation with 3.2% sodium citrate is enough when blood is received for immediate transfusion. In saline-adenine-glucose-mannitol solution red blood cell concentrates stored and they can be used for transfusion for up to 35 days after blood accumulation. Equine blood storage condition resemble to canine and human blood storage condition. According to both in vitro tests and human parameters after 35 days of storage equine erythrocytes remain appropriate for transfusion. Fresh frozen plasma is obtained by separation of erythrocytes and plasma. Both of them can be used alone. RBC survival evaluation sould be doen in vivo [104, 117].

To allow separation of red blood cells by gravity sedimentation the blood is stored in a refrigerator at 5 °C for 48 hours in an upright position. Then the plasma is decanted into a sterile 3-L bag with sterile plastic connecting tubing using gravity. 3-L bags containes a constant weight of plasma (3.4 kg). The red cell fraction is thrown out. The plasma bags are sealed, labeled with the horse's name and the date of decantation. They are stored at -20 °C until needed for plasma transfusion [112, 118].

#### **9.3. Administration**

In acute blood loss cases, PCV is usually impractical for estimation of volume to be transfused because it does not exactly indicate blood loss. Instead of this the volume of blood needed are predicted by estimation of blood loss and evaluation of clinical parameters. Fluid shifts will replace much of the circulating volume so between 25% and 50% of the total blood lost should be replaced by transfusion. Pay attention sould be give to that up to 75% of RBCs lost into a body cavity like hemoperitoneum are within 24-72 hours autotransfused back into circulation. Thus in cases of intracavitary hemorrhage lower percentages of blood volume replacement can be needed. To remove small clots and fibrin blood and plasma products should be given with an in-line filter [104, 119].

#### **9.4. Adverse reactions**

338 Blood Cell – An Overview of Studies in Hematology

**9.2. Collection techniques** 

evaluation sould be doen in vivo [104, 117].

until needed for plasma transfusion [112, 118].

**9.3. Administration** 

factor antibodies if transfusion takes place [1, 104, 116].

donors. Because they have a higher risk of carrying RBC alloantibodies. Donkeys have a RBC antigen known as "donkey factor". Horses do not have this antigen. Thus donkeys or mules should not be used as donors for horses because horses can develop anti-donkey

An immediate blood transfusion can be applied for the first time in an emergency situation with a very minor risk of serious transfusion reaction. Horses can develop alloantibodies within 1 week of transfusion. Thus blood typing and crossmatching are recommended before a second transfusion is given. A second blood transfusion may be given confidently without a blood crossmatch within 2-3 days of the first transfusion. Blood typing and alloantibody screening can be used for the transfusion needed patient to find the most suitable donor horse. Blood typing and antibody screening before initial transfusion are more important for horses. Because subsequent blood transfusions are anticipated and if sensitized to other blood group factors broodmares may produce foals with neonatal isoerythrolysis (NI). For detection of equine RBC antigens Ca and Aa, a rapid agglutination method has been developed. It can be more suitable for pretransfusion testing [99, 103, 104].

Blood is collected from the jugular vein of the donor horse. For this purpose two way used; direct needle cannulation or catheteri-zation. When a large volume of blood is required, a 10 or 12 gauge catheter is recommended. A 14 gauge catheter is also sufficient. Plastic bags and vacum-collection glass bottles in sizes ranging from 450 mL to 2 L are suitable for blood accumulation. Anticoagulation with 3.2% sodium citrate is enough when blood is received for immediate transfusion. In saline-adenine-glucose-mannitol solution red blood cell concentrates stored and they can be used for transfusion for up to 35 days after blood accumulation. Equine blood storage condition resemble to canine and human blood storage condition. According to both in vitro tests and human parameters after 35 days of storage equine erythrocytes remain appropriate for transfusion. Fresh frozen plasma is obtained by separation of erythrocytes and plasma. Both of them can be used alone. RBC survival

To allow separation of red blood cells by gravity sedimentation the blood is stored in a refrigerator at 5 °C for 48 hours in an upright position. Then the plasma is decanted into a sterile 3-L bag with sterile plastic connecting tubing using gravity. 3-L bags containes a constant weight of plasma (3.4 kg). The red cell fraction is thrown out. The plasma bags are sealed, labeled with the horse's name and the date of decantation. They are stored at -20 °C

In acute blood loss cases, PCV is usually impractical for estimation of volume to be transfused because it does not exactly indicate blood loss. Instead of this the volume of blood needed are predicted by estimation of blood loss and evaluation of clinical Blood should be given at a rate of approximately 0.3mL/ kg over the first 10-20 minutes for monitoring the transfusion reactions. Heart rate, body temperature, and respiratory rate sould be monitored. Additionally horses have to be monitored for signs of muscle fasciculation, piloerection, and urticaria. Urticaria, hemolysis, pruritis, edema, tachycardia, tachypnea, pyrexia, colic, changes in mentation and acute anaphylactic reactions are adverse reactions indicated in horses taking blood transfusions. The rate of adverse reaction to WB transfusion has been reported as 16% which are mild urticarial reactions and worsening hemolysis. Also 1 of 44 horses (2%) exhibit a fatal anaphylactic reaction [103, 113].

Transfusion reactions may vary from mild urticarial reactions to anaphylaxis. They are divided into immunogenic and nonimmunogenic reactions. Immunogenic reactions include anaphylaxis, hemolysis, fever, hives, acute lung injury, posttransfusion purpura, immunosuppression, and neonatal isoerythrolysis. Nonimmunogenic reactions include circulatory overload, bacterial contamination, citrate toxicity, coagulopathy, hyperammonemia, and transmission of disease. In horses that have received fresh frozen plasma serum hepatitis has been observed [52, 93, 112, 120].

In a second plasma or blood transfusion there exists risk for severe adverse reactions in dogs. Also there is a risk of development of neonatal isoerythrolysis in gravid mares. The risk is much more in whole blood transfusions [26, 33, 112].

In horses suffered from normovolemic anemia polymerized ultrapurified bovine hemoglobin (PUBH) improves hemodynamics and oxygen transport parameters. During infusion to be informed about any adverse reactions patients should be monitored closely. Intense pruritus, tachycardia, and tachypnea can be resolved shortly after stopping the infusion [121].
