**5. Administration**

328 Blood Cell – An Overview of Studies in Hematology

**3.2. Granulocyte transfusion** 

once to twice in a day [68-70].

**4. Donor selection** 

Recently platelet cryopreservation are used to provide long-term storage and immediate availability of platelet products for transfusion. When fresh platelets are unavailable

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

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

To select permanent blood donors, blood typing have to be performed. Donors should be healthy young adults. They undergo routine physical check up and hematology and clinical chemistry evaluations are done. They should never taken a blood transfusion and should be

Nulliparous and spayed female dog and cat donors have to be chosen. Blood have be collected via jugular venipuncture aseptically. Acepromazine interferes with platelet

Every 3 to 4 weeks, dogs can donate between 13 and 17 ml of blood per kilogram of body weight. Features of donors sould include well nourished, supplemented with oral iron, bled less than once per month to prevent iron deficiency, greater than 25 kg, and negative for antigens for DEAs 1.1, 1.2, 3, 5, and 7. Donors should not have heartworm disease, babesiosis, brucellosis, ehrlichiosis, and Rocky Mountain spotted fever. Donors have appropriate neck skin that allows easy entrance to the jugular vein, have a packed cell volume that is at least 0.40 L/L, have demonstrated a good temperament and be in good physical condition, have no past time history of transfusion or pregnancy, and have got

cryopreserved platelets can be activated in vitro and provide therapeutic benefit [63].

of recipient marrow recovery, and recipient alloimmunization [67].

free of blood parasites and other infectious diseases [1].

sufficient levels of von Willebrand factor (vWF) [1, 3].

function. Because of this donors should not be sedated with it [1].

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 transfusion [41].

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

Jim. For transfusions of RBCs primarily microaggregate filters are designed. In administering small volumes of blood (<50 mL WB or <25mL pRBCs) to cats and small dogs a pediatric micro-aggregate blood filter (18 um pore size, priming space <lmL) is especially helpful. Because of a progressive decrease in pore size due to increased blood filtered larger volumes of blood administration can result in hemolysis [41].

Principles of Blood Transfusion 331

Blood components like cryoprecipitate and platelet-rich plasma are used infrequently. Cryoprecipitate contains vWF, factors VIII, XIII, fibrinogen, and fibronectin. In vWFdeficient patients cryoprecipitate is recommended particularly when surgery is planned or patient affected by blood loss. Bleeding hemophilia A patients, or patients having hypo or

Sometimes platelet-rich plasma is used in veterinary practice. In small-sized animals it is more useful because in larger dogs it is difficult to gain enough volume and management of platelet count. An alternative to platelet-rich plasma are frozen platelet concentrates [79].

For expansion of plasma volume, different types of colloids as dextrans and hetastarch are used as alternatives to blood products. Altering hemostasis is one of the problems of dextrans and hetastarch. Oxyglobin is a hemoglobin-based oxygen carrier. It is approved for use in the dog in 1998. In emergency situations it is used instead of blood products when

In clinical signs of anaemia and as a therapy for carbon monoxide poisoning oxyglobin is used in cats. Because it is a potent colloid (colloid osmotic pressure 43 mmHg), the main risk associated with administration is volume overload. In patients with normovolaemic anaemia conservative administration rates are needed such as as low as 0.2-0.4 ml/kg/h and to a maximum of 1 ml/kg/h. Careful monitorization of patients with paying particular

A recent study described the clinical outcome in dogs experiencing massive transfusion. Also this study documented predictable changes in electrolytes and coagulation status. Massive transfusion is different from usual transfusions in terms of volume and rate of blood transfusion and blood components administered. Transfusion of a volume of whole blood or blood components has been described as massive transfusion. The administrated blood is greater than the patient's predicted blood volume within a 24-hour period or arranged as replacement of half the patient's predicted blood volume in 3 hours. In a study, massive transfusion receiving dogs were investigated and in this study the mean volumes of pRBCs was 66.5mL/kg and FFP was 22.2mL/kg. As a result of this mean plasma, RBC ratio was 1:3. After transfusion clinicopathologic changes consists of electrolytes disturbances, dilutional coagulopathy, ionized hypocalcemia and hypomagnesemia and progressive thrombocytopenia and prolongation of prothrombin and activated partial thromboplastin

**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

there is limited time for preparing it or performing compatibility testing [3, 80].

attention to their heart and respiratory rate is recommended [81, 82].

times [41, 83].

access is difficult [43, 75, 84].

dysfibrinogenemia are the other indications for choosing it [3, 78].

If plasma is taken from blood preservative solutions can be put in. Blood preservative solutions are dextrose, adenine, mannitol, and the sodium chloride. They are necessary for RBCs to carry on their energy metabolism and viability during storage [3]. Canine pRBCs stored in a RBC preservative can be applied directly. Other pRBC products have to be diluted by putting 10mL of saline feline pRBCs or 100mL of saline to the blood bag so that the viscosity of the donor blood decreased [41].

In the dog, if sedation is needed, butorphanol (0.1 mg/kg BW, IV) is generally used for sedation. But acepromazine should not be used because it may cause platelet function disturbance [72]. In the cat, ketamin may be used 2 to 4 mg/kg BW, IV for sedation. In addition to ketamin is very successful when it is used together with 0.1 to 0.2 mg/kg BW diazepam [3]. Also combinations of ketamine hydrochloride, midazolam and butorphanol tartrate, or mask administration of sevoflurane can be used [73, 74].

Generally, intravenous administration is used for RBC transfusions. In addition intraosseous administration is a perfect alternative. Peripheral veins may be preferred to central veins because of an increased bleeding predisposition [41].

Blood is administered through administration sets containing 0.9% saline intravenously. Contraindications include hypotonic saline, 5% dextrose in water and lactated Ringer's solution. Cardiac arrest may be caused by injection of undiluted citrate containing anticoagulants [1].

Using a syringe driver or by hand the transfusion should begin slowly at 0.25 ml/kg/h. If no adverse affects are encountered after the first 30–60 mins of administration the rate can be increased. Due to the urgency of the requirement for whole blood and any underlying concurrent disease the rate of administration can vary [75].

With a PCV of 20%, dogs and cats with chronic anemia can be cardiovascularly stable [76]. Conversely in patients with an acute onset of anemia and continuing blood loss or hemolysis, transfusion to a higher PCV is necessary for stabilization. Generally administration of 2mL/kg of WB or lmL/ kg of pRBCs will increase the patient's PCV by 1% if there is no continuing hemorrhage or hemolysis [41].

Patient's overall condition determine the rate of blood administration. The maximum rate of transfusion is 10-20mL/ kg/h in normovolemic anemic patients, to avoid circulatory overload [41].

To provide blood volume again fluid therapy with crystalloids or colloids is necessary. If the patient's total blood volume do not decrease under 20% this is usually enough for losses. If losses are more than 20% whole blood or packed red cell transfusion is used. Between 20% and 50% of blood volume losses are treated by crystalloids and packed RBCs [3, 77].

Blood components like cryoprecipitate and platelet-rich plasma are used infrequently. Cryoprecipitate contains vWF, factors VIII, XIII, fibrinogen, and fibronectin. In vWFdeficient patients cryoprecipitate is recommended particularly when surgery is planned or patient affected by blood loss. Bleeding hemophilia A patients, or patients having hypo or dysfibrinogenemia are the other indications for choosing it [3, 78].

330 Blood Cell – An Overview of Studies in Hematology

volumes of blood administration can result in hemolysis [41].

tartrate, or mask administration of sevoflurane can be used [73, 74].

central veins because of an increased bleeding predisposition [41].

concurrent disease the rate of administration can vary [75].

if there is no continuing hemorrhage or hemolysis [41].

the viscosity of the donor blood decreased [41].

anticoagulants [1].

overload [41].

Jim. For transfusions of RBCs primarily microaggregate filters are designed. In administering small volumes of blood (<50 mL WB or <25mL pRBCs) to cats and small dogs a pediatric micro-aggregate blood filter (18 um pore size, priming space <lmL) is especially helpful. Because of a progressive decrease in pore size due to increased blood filtered larger

If plasma is taken from blood preservative solutions can be put in. Blood preservative solutions are dextrose, adenine, mannitol, and the sodium chloride. They are necessary for RBCs to carry on their energy metabolism and viability during storage [3]. Canine pRBCs stored in a RBC preservative can be applied directly. Other pRBC products have to be diluted by putting 10mL of saline feline pRBCs or 100mL of saline to the blood bag so that

In the dog, if sedation is needed, butorphanol (0.1 mg/kg BW, IV) is generally used for sedation. But acepromazine should not be used because it may cause platelet function disturbance [72]. In the cat, ketamin may be used 2 to 4 mg/kg BW, IV for sedation. In addition to ketamin is very successful when it is used together with 0.1 to 0.2 mg/kg BW diazepam [3]. Also combinations of ketamine hydrochloride, midazolam and butorphanol

Generally, intravenous administration is used for RBC transfusions. In addition intraosseous administration is a perfect alternative. Peripheral veins may be preferred to

Blood is administered through administration sets containing 0.9% saline intravenously. Contraindications include hypotonic saline, 5% dextrose in water and lactated Ringer's solution. Cardiac arrest may be caused by injection of undiluted citrate containing

Using a syringe driver or by hand the transfusion should begin slowly at 0.25 ml/kg/h. If no adverse affects are encountered after the first 30–60 mins of administration the rate can be increased. Due to the urgency of the requirement for whole blood and any underlying

With a PCV of 20%, dogs and cats with chronic anemia can be cardiovascularly stable [76]. Conversely in patients with an acute onset of anemia and continuing blood loss or hemolysis, transfusion to a higher PCV is necessary for stabilization. Generally administration of 2mL/kg of WB or lmL/ kg of pRBCs will increase the patient's PCV by 1%

Patient's overall condition determine the rate of blood administration. The maximum rate of transfusion is 10-20mL/ kg/h in normovolemic anemic patients, to avoid circulatory

To provide blood volume again fluid therapy with crystalloids or colloids is necessary. If the patient's total blood volume do not decrease under 20% this is usually enough for losses. If losses are more than 20% whole blood or packed red cell transfusion is used. Between 20%

and 50% of blood volume losses are treated by crystalloids and packed RBCs [3, 77].

Sometimes platelet-rich plasma is used in veterinary practice. In small-sized animals it is more useful because in larger dogs it is difficult to gain enough volume and management of platelet count. An alternative to platelet-rich plasma are frozen platelet concentrates [79].

For expansion of plasma volume, different types of colloids as dextrans and hetastarch are used as alternatives to blood products. Altering hemostasis is one of the problems of dextrans and hetastarch. Oxyglobin is a hemoglobin-based oxygen carrier. It is approved for use in the dog in 1998. In emergency situations it is used instead of blood products when there is limited time for preparing it or performing compatibility testing [3, 80].

In clinical signs of anaemia and as a therapy for carbon monoxide poisoning oxyglobin is used in cats. Because it is a potent colloid (colloid osmotic pressure 43 mmHg), the main risk associated with administration is volume overload. In patients with normovolaemic anaemia conservative administration rates are needed such as as low as 0.2-0.4 ml/kg/h and to a maximum of 1 ml/kg/h. Careful monitorization of patients with paying particular attention to their heart and respiratory rate is recommended [81, 82].

A recent study described the clinical outcome in dogs experiencing massive transfusion. Also this study documented predictable changes in electrolytes and coagulation status. Massive transfusion is different from usual transfusions in terms of volume and rate of blood transfusion and blood components administered. Transfusion of a volume of whole blood or blood components has been described as massive transfusion. The administrated blood is greater than the patient's predicted blood volume within a 24-hour period or arranged as replacement of half the patient's predicted blood volume in 3 hours. In a study, massive transfusion receiving dogs were investigated and in this study the mean volumes of pRBCs was 66.5mL/kg and FFP was 22.2mL/kg. As a result of this mean plasma, RBC ratio was 1:3. After transfusion clinicopathologic changes consists of electrolytes disturbances, dilutional coagulopathy, ionized hypocalcemia and hypomagnesemia and progressive thrombocytopenia and prolongation of prothrombin and activated partial thromboplastin times [41, 83].
