Blood Transfusion for the Veterinary Technician
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Transcript of Blood Transfusion for the Veterinary Technician
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Blood Transfusion for the Veterinary Technician
Dawn Sadowski, CVT
November 3, 2013
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Blood Transfusions
I will be talking about the following today:
1. blood typing and cross-matching
2. administration protocol
3. types of products available with their basic uses, their storage and handling and the product preparation.
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Blood Typing
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Canine Blood Typing
• 8 recognized DEA systems in canines.
• DEA 1.1 is considered most important
• They are either Negative or Positive
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Feline Blood Typing
• 3 recognized blood types A, B and AB
• Cats have naturally occurring alloantibodies against type A or B cells, depending on their own type.
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Feline Blood Typing
• It is critical to blood type all feline donors and recipients
• Can have a reaction to their first transfusion
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Cross-matching
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Cross-matching
• Required for all recipients except those who have received a transfusion for the first time in the past 4-5 days or recipients that have never received any type of transfusion.
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Transfusion Set-up
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Transfusion Set-up
• Aseptic technique is very important
• All the transfusion products are susceptible to contamination
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Transfusion Set-up
• Keep system closed during entire time of administration.
• Keep the lines off the floor
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Transfusion Set-up
• Select the appropriate type of infusion set for the product being administered
• Here at IVG we use 3 different types of filters.
• Select the appropriate infusion pump for the product being used
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Transfusion Set-up
• Blood Set
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Transfusion Set-up
• Blood Set
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Transfusion Set-up
• Hemo-nate filters
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Transfusion Set-up
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Transfusion Set-up
1. Handle with Care
2. Open infusion set package
3. Peel open port to be used on the product
4. Insert infusion set into port on bag
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Transfusion Set-up
5. Allow product to flush through the infusion set, clamp when hits the end
6. Feed into infusion pump
7. Connect to recipient at closest port to recipient
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Transfusion Set-up
8. Follow directions on Transfusion monitoring worksheet.
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Transfusion Set-up
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Patient Monitoring
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Patient Monitoring
• It is extremely important that all patients be closely monitored with all transfusions
• Monitor vitals and demeanor of patient
• Notify doctor with all changes
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Patient Monitoring
• The signs can include weakness, trembling, restlessness, jaundice, vomiting, drooling, edema, hives, itchiness, incontinence, tachycardia, fever, neurological signs, cardiac arrhythmias, dyspnea, hypotension, anaphylactic shock, disseminated intravascular coagulation (DIC), and death.
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Patient Monitoring
• Transfusion reactions can be either immunologic or non-immunologic and they can look the same. Both can be fatal.
• If a patient shows any symptoms of a reaction, stop the transfusion and notify a doctor at once.
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Products Regularly Available
1. Whole blood
2. Packed RBC
3. Fresh Frozen Plasma/Frozen Plasma
4. Oxyglobin
5. Canine Albumin/Human Albumin
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Whole Blood
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Whole Blood
• Whole blood contains red blood cells, plasma proteins, coagulation factors, white cells and platelets.
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Whole Blood
• In whole blood transfusions – contrary to popular belief there are very few platelets that actually make it to the patient in the transfusion.
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Whole Blood
• A blood administering set that is appropriate to size of bag is recommended for transfusing whole blood.
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Whole Blood
• A specialized infusion pump is recommended with whole blood transfusion so does not crush the cells
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Packed Red Blood Cells
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Packed Red Blood Cells
• Only contain red blood cells
• Result of centrifugation or sedimentation of a unit of whole blood
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Packed Red Blood Cells
• Red cells are living cells that require fresh oxygen and carbon dioxide diffusion in and out of each bag.
• Storage can vary between 3-6 weeks
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Packed Red Blood Cells
• The advantage to pRBC is that the volume is low and the PCV is higher than normal blood.
• It is indicated for anemia
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Packed Red Blood Cells
• The disadvantage is it does not contain plasma
• It is contraindicated in cases involving cardiac disease, renal disease or animals without a decreased hematocrit.
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Packed Red Blood Cells
• Warm pRBC to body temperature before administering
• Administer using an aseptic technique and keep closed at all times
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Packed Red Blood Cells
• Use a blood administer set appropriate to size of bag.
• Use with an infusion pump made for administering blood such as a heska pump
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Packed Red Blood Cells
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Frozen Plasma
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Frozen Plasma
• FP should be monitored closely. It is recommended to use an indoor/outdoor thermometer.
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Frozen Plasma
• Plasma is frozen in a horizontal position then stored upright.
• Before using the plasma check bag for any cracks or signs of premature thawing
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Frozen Plasma
• The frozen bags need to be handled carefully to avoid cracking and causing contamination during the thawing process.
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Frozen Plasma
• Here at BVH we thaw the plasma slowly in a bowl of luke warm water.
• The FP is placed in a sealed zip lock bag before placing in the water to prevent contamination.
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Frozen Plasma
• Administer with an appropriate sized blood set or micro filter
• Any infusion pump can be used with plasma
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Canine Fresh Frozen Plasma
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Canine Fresh Frozen Plasma
• Fresh frozen plasma is the liquid component of whole blood that has been separated by centrifugation and subsequently frozen within 6-8 hours of collection
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Canine Fresh Frozen Plasma
• FFP is used to treat a variety of inherited or acquired coagulopathies and hemostatic disorders.
• This includes the treatment of hemophilia A and B, anticoagulant rodenticide toxicities, von Willebrand disease and other factor deficiencies.
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Canine Fresh Frozen Plasma
• It is also used to treat hypoproteinemia caused by multiple disease processes such as pancreatitis, protein losing enteropathies and protein losing nephropathies, DIC, sepsis and hepatic failure.
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Canine Fresh frozen Plasma
• It has a shelf life of 1 year
• Once stored for 1 year, the unit should be pulled and relabeled as frozen plasma and stored for an additional 4 years.
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Canine Frozen Plasma
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Canine Frozen Plasma
• Canine frozen plasma is the expired FFP with a shelf life of 4 years or
• It is plasma that was collected but not completely frozen within the 8 hour time requirement to label it is as FFP.
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Canine Frozen Plasma
• FP is effective in the treatment of acquired deficits of non-labile coagulation factors.
• It can also treat shock and hypoproteinemic states.
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Feline Frozen Plasma
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Feline Frozen Plasma
• A unit of Feline Frozen Plasma is obtained by the centrifugation or sedimentation of feline whole blood.
• It is prepared at any time up to 5 days after the expiration date applicable to the original unit of whole blood.
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Feline Frozen Plasma
• A viable source of the other components of plasma such as albumin, globulins, electrolytes and the replacement of fluid volume.
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Feline Frozen Plasma
• Thawed plasma is used for the parental replenishment of non-labile coagulation factors, albumin, globulins, electrolytes and fluid volume of the patient.
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Oxyglobin
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Oxyglobin
• Is stored in its own foil wrap which acts as an air barrier. Once the foil is opened oxyglobin must be used within 24hrs.
• It comes in 60ml or 125ml single use bags
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Oxyglobin
• Oxyglobin is an oxygen carrying colloid fluid made from bovine hemoglobin. It can be used instead of pRBC’s when oxygen capacity is needed.
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Oxyglobin
• In healthy animals, hemoglobin within red blood cells pick up oxygen from the lungs and deposits it in the tissues via the capillary microcirculation.
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Oxyglobin
• Oxyglobin is used to treat anemia in dogs by increasing the systemic oxygen content and improving the clinical signs associated with anemia.
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Oxyglobin
• Contraindicated in dogs with a predisposition to volume overload such as those with advanced cardiac disease or otherwise severely cardiac function or oliguria or anuria.
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Oxyglobin
• Is approved for use in dogs only, although it has been used in cats.
• It can be used, off label, in cats, but they are easier to fluid overload.
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Oxyglobin
• Has a very minimal risk of transfusion reaction, therefore typing and crossmatching is not needed.
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Oxyglobin
• Cleared quickly from the body
• Beneficial effects last only 24-36 hours
• It is a pigment and will cause yellow/red/brown discoloration of mucous membranes, sclera, urine and skin.
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Oxyglobin
• Handle aseptically – great medium for bacterial growth
• No need for a blood filter
• Can use any infusion set
• Administer through a central line or peripheral vein only
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Oxyglobin
• Watch for circulatory overload when administering
• Close monitoring of CVP’s is recommended during and immediately after the infusion.
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Albumin
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Albumin
• A protein that is synthesized by a normally functioning liver. Inarguably, is one of the most important proteins in the body.
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Albumin
• Is a highly soluble globular protein which accounts for 75-80% of the colloid oncotic pressure in healthy animals.
• It is also a transport protein and binds naturally occurring substances such as bilirubin, fatty acids, hormones and some therapeutic drugs.
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Albumin
• The interstitial pool provides a large storage vat from which to draw during states of albumin loss or decreased albumin synthesis in order to maintain colloid oncotic pressure of the serum.
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Albumin
• It serves a key role in the maintenance of colloid oncotic pressure, free radical scavenging, mediator of coagulation, transport of exogenous and endogenous substrates, buffering of serum and contributor to wound healing
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Albumin
• A wide variety of critical illnesses can result in and become exacerbated by hypoalbuminemia
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Albumin
• Pancreatitis
• Heat induced illness
• Pneumonia
• Parvovirus enteritis
• Sepsis
• Prostatitis
• Pyometra
• Burn injuries
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Albumin
• Fresh Frozen Plasma can be ineffective and inefficient for replenishing albumin when values are low
• FFP will increase serum albumin by only 0.5g/dL, if there are no ongoing losses.
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Albumin
• ~50% serum total protein
• 80% serum colloid oncotic pressure
• Both humans and animals with hypoalbuminemia <2 g/dL will have increased morbidity and mortality
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Albumin
• To administer use a syringe pump, sterile fluid bag or a blood bag without an anti-coagulant.
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Albumin
• Infusion set should either be a filtered blood set or a standard infusion set with an in-line filter such as a hemo-nate filter attached
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Albumin
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Human Albumin
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Human Albumin
• Treatment of hypoalbuminemia
• Decreased colloid oncotic pressure
• As a potent colloid in the treatment of hypotension
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Human Albumin
• Albumin is structurally homologous across species.
• It differs ~20% of its amino acid sequence
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Human Albumin
• Is available in 5% or 25% solutions
• Can be stored at room temperature for up to 3 years
• They do not contain preservatives, should be used within 4 hours of opening
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Human Albumin
• It is recommended to give Diphenhydramine 15 minutes prior to albumin administration
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Canine Albumin
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Canine Albumin
• Stored at a controlled room temperature or refrigerated temperature (34-80F)
• Stable for 24months past expiration date
• Once reconstituted it must be used within 6 hours
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