media control - Startseite · 2016-08-13 · Trim Size: 216mm x 279mm Yagi933022 .tex V3 - 06/16/2016 11:21 A.M. Page iii Manual of Veterinary Transfusion Medicine and Blood Banking

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Manual of Veterinary Transfusion Medicine and Blood Banking

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Manual of VeterinaryTransfusion Medicine andBlood BankingEDITED BY

Kenichiro Yagi BS, RVT, VTS (ECC, SAIM)ICU Manager

Blood Bank Manager

Adobe Animal Hospital

San Jose, California, USA

Marie K. Holowaychuk DVM, DACVECCCritical Care Vet Consulting

Calgary, Alberta, Canada

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This edition first published 2016 © 2016 by John Wiley & Sons, Inc

Editorial offices: 1606 Golden Aspen Drive, Suites 103 and 104, Ames, Iowa 50010, USAThe Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK9600 Garsington Road, Oxford, OX4 2DQ, UK

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The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended andshould not be relied upon as recommending or promoting a specific method, diagnosis, or treatment by health science practitioners for anyparticular patient. The publisher and the author make no representations or warranties with respect to the accuracy or completeness of thecontents of this work and specifically disclaim all warranties, including without limitation any implied warranties of fitness for a particularpurpose. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of informationrelating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the packageinsert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usageand for added warnings and precautions. Readers should consult with a specialist where appropriate. The fact that an organization or Websiteis referred to in this work as a citation and/or a potential source of further information does not mean that the author or the publisherendorses the information the organization or Website may provide or recommendations it may make. Further, readers should be aware thatInternet Websites listed in this work may have changed or disappeared between when this work was written and when it is read. No warrantymay be created or extended by any promotional statements for this work. Neither the publisher nor the author shall be liable for any damagesarising herefrom.

Library of Congress Cataloging-in-Publication Data

Names: Yagi, Kenichiro, 1977- , editor. | Holowaychuk, Marie K., 1980- ,editor.

Title: Manual of veterinary transfusion medicine and blood banking / [edited by] Kenichiro Yagi, Marie K. Holowaychuk.Description: Ames, Iowa : John Wiley & Sons Inc., 2016. | Includes bibliographical references and index.Identifiers: LCCN 2016009156 | ISBN 9781118933022 (pbk.) | ISBN 9781118933046

(epub)Subjects: | MESH: Blood Transfusion–veterinary | Blood BanksClassification: LCC SF919.5.B55 | NLM SF 919.5.B55 | DDC 636.089/539–dc23 LC record available at http://lccn.loc.gov/2016009156

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To Dr. Dave Roos, who gave me the opportunity to grow and explore as a veterinary technician and taught me the

importance of being true, and to my second family at Adobe Animal Hospital.

To Nancy Shaffran, who opened my eyes up to the world as a credentialed technician, being kind, and sharing my

passion with the profession, Andrea Steele, who inspired me to call emergency and critical care my specialty, Harold

Davis, who showed me the true meaning of integrity, dedication, and vision, and all of my colleagues who continue

to push the envelope for progress in veterinary technology and nursing.

To Iris, Harumi, Haruto, and Haruka, with your radiant presence I am able to continue reaching for new heights.

Kenichiro Yagi

I am forever grateful to the mentors who guided me, the colleagues who inspired me, the students who challenged

me, the friends and family who encouraged me, and to Faith for being my constant furry companion during endless

hours of writing and editing. Without all of your support this textbook would not have been possible.

Marie K. Holowaychuk

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Contents

Contributors, ix

About the Editors, xi

Preface, xiii

Section I: Introduction to VeterinaryTransfusion Medicine

1 Evolution of Veterinary Transfusion Medicine and

Blood Banking, 3

Marie K. Holowaychuk and Kenichiro Yagi

2 Component Therapy, 13

Julie M. Walker

Section II: Blood Products

3 Red Blood Cell Products, 29

Caroline Kisielewicz

4 Plasma Products, 43

K. Jane Wardrop and Marjory Brooks

5 Platelet Products, 55

Mary Beth Callan and Kimberly Marryott

6 Hemoglobin-Based Oxygen Carrier Solutions, 70

Marie K. Holowaychuk and Thomas K. Day

7 Alternative Plasma Protein Products: Albumin and

Human Immunoglobulin Therapy, 83

Nicole Spurlock

8 Miscellaneous Blood Product Usage, 103


Section III: Blood Product Administration

9 Canine Recipient Screening, 117

Lynel J. Tocci

10 Feline Recipient Screening, 129

Anthony C.G. Abrams-Ogg

11 Transfusion-Associated Complications, 155

Shauna L. Blois

12 Recipient Monitoring, 172

Kenichiro Yagi and Marie K. Holowaychuk

Section IV: Blood Banking

13 Canine Donor Selection, 189

Kenichiro Yagi and Brandee L. Bean

14 Canine Blood Collection, 199

Kenichiro Yagi

15 Feline Donor Selection, 212

Charlotte Russo and Karen Humm

16 Feline Blood Collection, 223

Robyn K. Taylor and Karen Humm

17 Blood Component Processing and Storage, 237

Cheryl L. Mansell and Manuel Boller

Section V: Meeting Blood Product Demands

18 Blood Product Sources, 259

Sally Lester

19 Donor Program Management, 271

Rebecca J. Nusbaum

20 Limiting Allogenic Blood Transfusions, 284

Marie K. Holowaychuk

21 Alternative Transfusion Methods, 296

Sophie Adamantos and Caroline Smith

Section VI: Transfusion Medicine in OtherSpecies

22 Equine Transfusion Medicine, 309

Margaret C. Mudge and Olivia H. Williams

23 Food and Fiber Animal Transfusion Medicine, 321

Brent C. Credille and Kira L. Epstein

24 Avian Transfusion Medicine, 334

Stephen Cital, Angela M. Lennox and Andrea Goodnight

25 Small Mammal Transfusion Medicine, 345

Jody Nugent-Deal and Kristina Palmer

26 Reptile and Amphibian Transfusion Medicine, 358

Stephen Cital and Andrea Goodnight

27 Primate Transfusion Medicine, 366

Stephen Cital, Angela Colagross-Schouten and Laura Summers

Index, 377

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Contributors

Anthony C.G. Abrams-Ogg, DVM, DVSc, DACVIM (SAIM)Professor

Department of Clinical Studies

Ontario Veterinary College

University of Guelph

Guelph, Ontario, Canada

Sophie Adamantos, BVSc, CertVA, DACVECC, DECVECC,MRCVS, FHEAClinician in Emergency and Critical Care

Small Animal Hospital

Langford Veterinary Services

University of Bristol

Langford, North Somerset, UK

Brandee L. Bean, CVT, VTS (ECC)Adobe Animal Hospital

Los Altos, California, USA

Shauna L. Blois, DVM, DVSc, DACVIMAssistant Professor

Department of Clinical Studies

Ontario Veterinary College

University of Guelph

Guelph, Ontario, Canada

Manuel Boller, Dr. Med. Vet., MTR, DACVECCSenior Lecturer

U-Vet Werribee Animal Hospital

Faculty of Veterinary and Agricultural Sciences

University of Melbourne

Werribee, Victoria, Australia

Marjory Brooks, DVM, DACVIMDirector, Comparative Coagulation Section

Department of Population Medicine and Diagnostic Sciences

College of Veterinary Medicine

Cornell University

Ithaca, New York, USA

Mary Beth Callan, VMD, DACVIMProfessor of Medicine

Department of Clinical Studies – Philadelphia

School of Veterinary Medicine

University of Pennsylvania

Philadelphia, Pennsylvania, USA

Stephen Cital, RVT, SRA, RLATDirector of Anesthetic Nursing and Training, United Veterinary Specialty

and Emergency

Veterinary Technician, San Francisco Zoo

San Jose, California, USA

Angela Colagross-Schouten, DVM, MPVM, DACLAMSenior Veterinarian

California National Primate Research Center

Davis, California, USA

Brent C. Credille, DVM, PhD, DACVIMAssistant Professor, Food Animal Health and Management Program

Department of Population Health


University of Georgia

Athens, Georgia, USA

Thomas K. Day, DVM, MS, DACVA, DACVECCEmergency and Critical Care Specialist, Anesthesiologist

Veterinary Emergency Service/Veterinary Specialty Center

Middleton, Wisconsin, USA

Kira L. Epstein, DVM, DACVS, DACVECCClinical Associate Professor

Department of Large Animal Medicine


University of Georgia

Athens, Georgia, USA

Andrea Goodnight, DVMVeterinarian, Oakland Zoo

Associate Veterinarian, CuriOdyssey Science and Wildlife Center

Oakland, California, USA

Marie K. Holowaychuk, DVM, DACVECCCritical Care Vet Consulting

Calgary, Alberta, Canada

Karen Humm, MA, VetMB, CertVA, DACVECC, DECVECC,FHEA, MRCVSLecturer in Emergency & Critical Care

Royal Veterinary College

Queen Mother Hospital for Animals

Hatfield, Hertfordshire, UK

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x Manual of Veterinary Transfusion Medicine and Blood Banking

Caroline Kisielewicz, MVB, CertSAM, DECVIM-CAChestergates Veterinary Specialists

Chester, Cheshire, UK

Angela M. Lennox, DVM, DABVP (Avian & ExoticCompanion Mammal), DECZM (Small Mammals)Senior Veterinarian, Avian and Exotic Animal Clinic of Indianapolis

Section Editor, Journal of Exotic Pet Medicine AEMV

Indianapolis, Indiana, USA

Sally Lester, DVM, MVSc, DACVP (Clinical and Anatomic)Laboratory Director

Pilchuck Veterinary Hospital

Seattle Veterinary Specialists

Seattle, Washington, USA

Cheryl L. Mansell, BMLS, DipVNAustralian Red Cross Blood Service

Melbourne, Victoria, Australia

Kimberly Marryott, CVTManager, Penn Animal Blood Bank

Matthew J. Ryan Veterinary Hospital

University of Pennsylvania

Philadelphia, Pennsylvania, USA

Margaret C. Mudge, VMD, DACVS, DACVECCAssociate Professor

The Ohio State University

Department of Veterinary Clinical Sciences

Columbus, Ohio, USA

Jody Nugent-Deal, RVT, VTS (Anesthesia/Analgesia)(CP - Exotics)Small Animal Anesthesia, Surgery and Neurology Supervisor

University of California Davis

William R. Pritchard Veterinary Medical Teaching Hospital


Rebecca J. Nusbaum, CVT, VTS (ECC)HemoSolutions

Colorado Springs, Colorado, USA

Kristina Palmer, RVT, VTS (CP - Exotics)Companion Avian and Exotic Animal Medicine Supervisor

William R. Pritchard Veterinary Medical Teaching Hospital

University of California Davis


Charlotte Russo, FdSc RVN, Dip AVNBlood Transfusion Nurse

Royal Veterinary College

Queen Mother Hospital for Animals

Hatfield, Hertfordshire, UK

Caroline Smith (Hirst), BVetMed, MVetMed, DACVECC,DECVECC, MRCVSClinician in Emergency and Critical Care

Small Animal Hospital

Langford Veterinary Services

University of Bristol

Langford, North Somerset, UK

Nicole Spurlock, DVM, DACVECCSmall Animal Specialist Hospital

North Ryde, New South Wales, Australia

Laura Summers, DVM, DACLAMFaculty Veterinarian

Carrington College

Stockton, California, USA

Robyn K. Taylor, RVNCritical Care and Transfusion Nurse

The Royal Veterinary College

North Mymms, Hertfordshire, UK

Lynel J. Tocci, DVM, DACVECC, MT(ASCP)SBBDepartment of Emergency and Critical Care

Lauderdale Veterinary Specialists

Fort Lauderdale, Florida, USA

Julie M. Walker, DVM, DACVECCClinical Assistant Professor

Department of Medical Sciences

School of Veterinary Medicine

University of Wisconsin

Madison, Wisconsin, USA

K. Jane Wardrop, DVM, MS, DACVPProfessor

Department of Veterinary Clinical Sciences


Washington State University

Pullman, Washington, USA

Olivia H. Williams, RVTPiedmont Equine Associates

Madison, Georgia, USA

Kenichiro Yagi, BS, RVT, VTS (ECC, SAIM)ICU Manager/Blood Bank Manager, Adobe Animal Hospital

Instructor, Department of Veterinary Technology, Foothill College

Los Altos, California, USA

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About the Editors

Kenichiro Yagi, BS, RVT, VTS (ECC, SAIM)

Kenichiro Yagi is a veterinary technician practicing at Adobe Ani-

mal Hospital in Los Altos, California as an ICU and Blood Bank

Manager. He has established and operates a veterinary blood bank

with a sustained blood donor program and the ability to process

blood components. He is an active educator lecturing internation-

ally and providing practical instruction on site and online, having

written textbook chapters and numerous articles on topics includ-

ing veterinary transfusion medicine, blood banking, respiratory

care, and critical care nursing. He has contributed to the progres-

sion of the veterinary technician profession and emergency and

critical care through his service as a board member for the Vet-

erinary Emergency Critical Care Society as well as the Academy

of Veterinary Emergency and Critical Care Technicians, and as

the State Representative Committee Chairperson of the National

Association of Veterinary Technicians of America. He is also pur-

suing a graduate degree in Biomedical Sciences with an empha-

sis in veterinary medicine and surgery through the University of

Missouri. Ken invites everyone to ask “Why?” to understand the

“What” and “How” of our field, and to constantly pursue new lim-

its as veterinary professionals.

Marie K. Holowaychuk, DVM, DACVECC

Dr. Marie Holowaychuk is a specialist in emergency and critical

care, and is an accomplished speaker, consultant, researcher, and

locum living in Calgary, Alberta, Canada. She grew up in Edmon-

ton, Alberta and after two years of pre-veterinary medicine at the

University of Alberta, she entered veterinary school at the Western

College of Veterinary Medicine at the University of Saskatchewan.

She received her Doctor of Veterinary Medicine in 2004 and then

completed a yearlong rotating internship in small animal medicine

and surgery at Washington State University. Thereafter, she com-

pleted a three-year small animal emergency and critical care

residency at North Carolina State University. After becoming

board certified in 2008, she was Assistant Professor of Emergency

and Critical Care Medicine at the Ontario Veterinary College for

five years until she moved home to Alberta. Dr. Holowaychuk

has been primary or co-author of over 25 manuscripts published

in peer-reviewed journals and is also an Assistant Editor for the

Journal of Veterinary Emergency and Critical Care.

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Preface

The practice of transfusion medicine and blood banking has grown

enormously during the past decade and this has created a demand

for a comprehensive guide to the discipline. There are hundreds of

publications in the veterinary literature pertaining to this subject

area, with new studies being made available each month. Despite

the rapidly increasing amount of information available, a textbook

dedicated to this topic has not previously been published. While

there are chapters in textbooks dedicated to the practice of trans-

fusion medicine or blood banking, no references focus solely on

this important subject area. Likewise, resources usually pertain to

dogs and cats, with little information applicable to food animals,

horses, or exotic pets.

We recognized the need to fill the gap and communicate

best practices by providing a manual of veterinary transfusion

medicine and blood banking. Both of us have a strong interest

in transfusion medicine, as well as clinical and research experi-

ence with blood banking. We eagerly accepted the challenge of

providing an evidence-based resource that brings information

regarding all species and aspects of transfusion medicine and

blood banking together in one place. We compiled this textbook

with the goal of providing a resource that would be helpful for

veterinary professionals working in academic, referral, or gen-

eral practice, as well as technicians and residents preparing for

specialty certification exams. Whenever possible, authors used

recent peer-reviewed veterinary (and sometimes human) journal

articles and supplemented with other resources or anecdotal

experience when peer-reviewed information was lacking. Over-

all, we feel the result is a practical and thorough presentation of

the current knowledge of veterinary transfusion medicine and

blood banking.

We are also aware that the disciplines of transfusion medicine

and blood banking are very reliant on a veterinarian-technician

team. As such, we proudly co-edited this textbook as a

veterinarian and technician team. Similarly, many of our chapters

are co-written by a veterinarian and technician. We both person-

ally learned a great deal from these different perspectives and feel

that this insight from all members of the group that would be par-

ticipating in blood banking or transfusion administration within

the hospital is beneficial. This textbook contains evidence-based

descriptions of theory and practical step-by-step procedures per-

taining to blood products, blood product administration, blood

banking, and meeting blood product demands. While most of

these sections pertain to small animals, additional chapters focus

on large animals and exotic pets in the section on transfusion

medicine in other species.

Probably the most challenging aspect of writing this textbook

was staying current with all of the literature in the field of veteri-

nary transfusion medicine and blood banking during the editing

process. We finally had to forego our concern that we would

miss the opportunity to include groundbreaking research and

submit the content for publication. In the meantime, we found

ourselves adding new publications right up until the point of

submission. Even so, we recognize that knowledge gaps exist, and

the most up-to-date information will still come from the most

recently published literature and that new and exciting research

will need to be included in future editions of the textbook. We

welcome any suggestions, ideas, or corrections that should be

incorporated into new editions that we look forward to providing

in the not-too-distant future.

We would like to thank the Wiley-Blackwell editorial team

for responding to our endless emails and supporting us through-

out this endeavor. We also gratefully acknowledge our authors

without whose contributions this textbook would not have been

possible.


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SECTION I

Introduction to Veterinary TransfusionMedicine


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1 Evolution of Veterinary Transfusion Medicineand Blood BankingMarie K. Holowaychuk1 and Kenichiro Yagi21 Critical Care Vet Consulting, Calgary, Alberta, Canada2 Adobe Animal Hospital, Los Altos, California, USA

Introduction

From ancient times to the modern day, knowledge of transfusion

medicine and blood banking has advanced from blood existing

as a spiritual fluid of vitality to it being a lifesaving therapeutic

resource used on a regular basis. The most significant advance-

ments in transfusion medicine have been made during the past

200 years, with veterinary transfusion medicine becoming a

specialized area of interest for the past few decades. Transfusion

medicine has progressed from fresh whole blood transfusions

to targeted component therapy, with veterinary professionals

performing transfusions in small, large, and exotic animals. Pro-

viding a safe and reliable blood product with availability that

meets demands is now an emerging focus, as new knowledge

cautions practitioners that transfusions, even when properly

administered, can be harmful to patients.

Advancements in veterinary transfusion medicine include

blood typing, compatibility testing, laboratory diagnostics to

determine whether a transfusion is indicated, proper admin-

istration and dosage of blood products, as well as prevention,

monitoring, and treatment of transfusion-associated compli-

cations. Veterinary blood banking has progressed from whole

blood collection on an emergency basis with minimal regard to

pre-transfusion compatibility testing, to the collection, storage,

and processing of blood components and transfusion only after

suitable recipient screening. This has led to the establishment of

commercial blood banks and processing of blood products using

specialized equipment, with evidence-based guidelines regarding

donor screening. Additional advancements include methods to

maximize the limited donor pool and awareness of storage lesions,

as well as safety measures such as leukoreduction. Professional

organizations such as the Veterinary Emergency and Critical Care

Society (VECCS), American College of Veterinary Emergency and

Critical Care (ACVECC), American College of Veterinary Internal

Medicine (ACVIM), and American College of Veterinary Anes-

thesia and Analgesia (ACVAA), among others, actively pursue

advancement of knowledge in the field of veterinary transfusion

medicine and blood banking. Veterinary transfusion medicine

as a specialty area of knowledge is growing, as seen through

the re-emergence of efforts to establish sustainable organiza-

tions such as the International Association of Veterinary Blood

Manual of Veterinary Transfusion Medicine and Blood Banking, First Edition. Edited by Kenichiro Yagi and Marie K. Holowaychuk.© 2016 John Wiley & Sons, Inc. Published 2016 by John Wiley & Sons, Inc.

Banks (IAVBB), the Association of Veterinary Hematology and

Transfusion (AVHTM), and the proposed Academy of Veterinary

Transfusion Medicine Technicians (AVTMT). Veterinary transfu-

sion medicine is a discipline in its own right and will continue to

play a vital role in veterinary medicine in an effort to improve

patient care.

History of transfusion medicine

Ancient knowledgeEarly practices and customs relating to the blood of ancient

days include people drinking the blood of fallen gladiators to

gain strength, religious figures attempting to heal themselves

by drinking blood from the youth, and doctors inducing hem-

orrhage to let out “bad blood” due to the belief that blood was

one of the four fundamental humors of Hippocratic medicine

and blood-letting would bring balance to the humors and restore

health (Greenwalt 1997). Early practices were often influenced

by religion and superstition, as well as innate emotions and fears

elicited by the sight of blood. People believed blood was the

key to vitality, even though the discovery and description of the

circulatory system did not occur until the 17th century.

Early conceptsIt is unclear who first conceived the idea of blood transfusions.

Hieronymus Cardanus (1505–1576) is given credit in some litera-

ture, while Magnus Pegelius obtained the right to publish on the

topic under Emperor Rodolphus II’s rule in 1593. Andreas Libav-

ius was the first person clearly documented in history to advocate

for blood transfusions; he recorded his thoughts on using a silver

tube to connect the arteries of two individuals to allow blood from

the young man to “pour” into the artery of the old man. However,

there is no evidence indicating that transfusions were performed

by Libavius (Greenwalt 1997).

Following William Harvey’s description of the circulatory sys-

tem, Francesco Folli of Florence published the first book on trans-

fusions stating that transfusions could be used to treat illness and

rejuvenate aged men. However, Folli stated in the book that that

he had never performed a transfusion with the apparatus that he

described was needed for the procedure (Greenwalt 1997).

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4 Manual of Veterinary Transfusion Medicine and Blood Banking

Figure 1.1 A portrait of Richard Lower, a physician who performed the firstreported animal-to-animal transfusion. (Public domain.)

First animal-to-animal transfusionRichard Lower (1631–1691) performed the first successful

animal-to-animal transfusion in February 1665; previous to

this he had years of failed attempts due to clotting in the tubes

(Figure 1.1). Lower used a medium-sized dog and exsanguinated

it until “its strength was nearly gone”, and then connected the

cervical arteries of two large mastiffs to the jugular vein of the

exsanguinated dog. The recipient in the experiment was “ap-

parently oblivious to its hurts” and “soon began to fondle its

master and to roll on the grass to clean itself of blood”, indicating

his first successful attempt to use a blood transfusion as a form

of resuscitation. While Lower’s report was published in 1666,

Jean-Baptiste Denis (1635–1704) also claimed to have performed

the first successful animal-to-animal transfusion; unfortunately,

his report was delayed from publication for a year due to the

imprisonment of the editor of the publication (Greenwalt 1997).

First animal-to-human transfusionsWhile similar uncertain claims to the first human transfusion have

been made, Jean-Baptiste Denis is believed to have performed the

first animal-to-human transfusions. He performed a transfusion of

lamb blood to a 15-year-old child who was suffering from a per-

sistent fever; the child was reported to have “a clear and smiling

countenance” after the transfusion. Denis also performed a trans-

fusion to the son of the Prime Minister of Sweden (Baron Bond),

without successfully curing him, and to others without complica-

tions (Greenwalt 1997).

Lower, who had performed the first animal-to-animal transfu-

sion, also performed an animal-to-human transfusion in 1667 to

Figure 1.2 A depiction of an animal-to-human transfusion performed inthe 1600s. (Wellcome Library, London. Boutesteyn Leyden 1692. CreativeCommons.)

Arthur Coga, who was described as a “harmless lunatic” and “ec-

centric scholar” at Pembroke College. He received a transfusion

from the artery of a sheep and was reported to have “found him-

self well” afterwards.

The most notable report of an animal-to-human transfusion

was on 19 December 1667, when Denis treated a patient named

Antoine Mauroy, a 34-year-old newlywed husband who ran away

to Paris to spend time indulging in sensual pleasures (Figure 1.2).

Denis thought that a transfusion of calf blood would help calm

Mauroy’s urges due to the gentle nature of calves. The transfusion

was reported to improve Mauroy’s issues, making him quieter. The

procedure was repeated several days later, but that time Mauroy

experienced burning in his arm, pain over his kidneys, and tight-

ness in his chest. A day later, he exhibited bleeding from his nose

and dark urine. This signifies the first report of a severe transfusion

reaction, likely acute hemolysis. Mauroy’s wife insisted that Mau-

roy be treated a third time 2 months later when he was exhibiting

similar behavior, but Mauroy did not comply. He died the follow-

ing night without receiving the transfusion. Mauroy’s wife was

bribed by Denis’ enemies to state that a transfusion killed her

husband, leading to Denis’ trial for manslaughter, for which he

was exonerated. Rumors suggest that Mauroy’s wife poisoned him

with arsenic, although the truth is unknown (Farr 1980).

Because of Denis’ experiences in France, his enemies were able

to instate the Edict of Châtelet, effectively banning transfusion

practices in France. It is likely that the magistrates in Rome and

the Royal Society also enacted similar bans, therefore while some

experimental transfusions were performed in other parts of the

world, advancements in transfusion medicine were halted for the

next 150 years (Greenwalt 1997).

18th and 19th centuriesDuring the 18th century, the value of transfusions in patients with

severe wounds and hemorrhage was revealed. In 1749, a member


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Chapter 1: Evolution of Veterinary Transfusion Medicine and Blood Banking 5

Figure 1.3 A portrait of James Blundell, a physician who performed thefirst reported human-to-human transfusion. (Public domain: The NationalPortrait Gallery, Volume II, 1820.)

of the Faculty of Paris named Cantwell stated that transfusions

should not be forbidden in desperate situations. In 1788, Michele

Rosa published is findings that animals in severe shock required

whole blood instead of serum for successful resuscitation.

During the 19th century, James Blundell (1790–1877), who

had witnessed many women die from postpartum hemorrhage,

performed experiments with animals in preparation for transfu-

sions to his patients (Figure 1.3). He limited his patients receiving

transfusions to those suffering from severe hemorrhage and

applied the knowledge gained by John Leacock on the apparent

harm of xenotransfusions (transfusion of blood from a different

species), thus attempting human-to-human transfusions. While

the archives are somewhat contradictory regarding the number

of successful cases, records show that in 1829 Blundell was

able to successfully save a 25-year-old woman with postpartum

hemorrhage by transfusing blood from one of the surgical team

members. The blood transfusion was performed with a brass

syringe, although Blundell later developed an instrument called

the “impellor”, a funnel-like apparatus that was used well into the

late 19th century (Figure 1.4). While Blundell voiced his opinion

against the transfusion of animal blood to human patients, the

practice remained prevalent as transfusion therapy returned to

medical practice. However, reports of transfusions were rare,

likely due to the fact that blood clotting was a common limitation

in performing transfusions (Greenwalt 1997).

Blood groups discoveredIn the late 1800s there was significant work done by various

physicians to study the effects of transfusions between differ-

ent species. In 1874, Ponfick presented his findings of residues

from lysed red blood cells (RBCs) in a patient who died after

receiving a transfusion from a sheep. Ponfick also observed

detrimental physical effects including respiratory distress, defe-

cation, and convulsions, as well as post-mortem findings such

as dilated hearts, pulmonary and serosal hemorrhage, enlarged

and congested kidneys, and hemorrhage of the liver in dogs,

cats, and rabbits receiving sheep blood. Ponfick also described

Figure 1.4 A section of the impellor device developed by James Blundell for blood transfusions. (Wellcome Library, London. Creative Commons.)


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the accumulation of hematin in the renal tubules of surviving

animals that developed kidney insufficiency. Ponfick’s findings

were consistent with Panum, Landois, and Euhlenberg’s findings

suggesting that adverse outcomes could be seen with transfusions

between different species, secondary to hemolysis, kidney injury,

and hyperkalemia (Greenwalt 1997).

In the 1800s, human-to-human transfusions were performed

with a reasonable degree of success, frequently without signs of

adverse reactions. This is probably because ABO incompatibilities

in the general Caucasian population were only anticipated in

one-third (35.6%) of randomly paired individuals (Greenwalt

1997). Nevertheless, there were still significant numbers of

human-to-human transfusions resulting in fatal complications,

which could not be explained by the work of Ponfick and oth-

ers investigating inter-species transfusions (Greenwalt 1997).

It was not until Landsteiner demonstrated agglutination using

the serum from healthy humans mixed with another human’s

blood that the concept of blood groups (A, AB, B, and O) was

established, which led to advancements in compatibility testing

using assessments for agglutination (Landsteiner 1961). In 1910,

von Dungern and Hirszfeld published a report on the inherited

nature of blood groups; the practice of exclusively using O donors

for transfusions began in the 1930s (Greenwalt 1997).

Advent of anticoagulationThe impellor was the tool designed by Blundell and used for

transfusions until the 20th century. Another cannula device

was devised by Crile in an effort to prevent blood clotting; it

enabled the temporary joining of the recipient’s vein and donor’s

artery, although it took significant surgical skill and strong donor

will to accomplish this procedure. Other methods of transfusion

included using paraffin to line the blood collection container,

defibrinating the blood, and transfusing the non-clotted portion

of blood (Greenwalt 1997).

Various anticoagulants were also studied in an effort to make

the transfusion process more feasible, including the use of

sodium phosphate by the well-known Braxton-Hicks, but none

of his four patients receiving transfusions survived. Ammonium

sulfate, sodium bicarbonate, sulfarsenol, ammonium oxalate,

arsphenamine, sodium iodide, sodium sulfate, and hirudin

(extracted from leeches) were all anticoagulant compounds

investigated and reported by various physicians in the 19th and

20th centuries. In 1890, Nicolas Maurice Arthus reported that

sodium citrate was able to permanently keep blood in liquid form,

but it was not until 1915 that the invention of sodium citrate

for blood transfusion was officially claimed. In 1955, Lewisohn

was awarded the American Association of Blood Banks (AABB)

Landsteiner Award for producing the first sodium citrate solu-

tion in a vial. Citrate was initially blamed as a cause of febrile

non-hemolytic transfusion reactions, which were later deter-

mined to be the result of endotoxin from bacterial contamination

(Greenwalt 1997).

Concept of blood bankingWhile blood mixed solely with 3.8% sodium citrate exhibited

hemolysis after 1 week of storage, a mixture of blood, sodium

citrate, and dextrose did not demonstrate hemolysis for 4 weeks.

During World War I, Oswald H. Robertson established the first

blood bank at the United States Army Base Hospital No.5 by

using collection sets that were autoclaved and designed to collect

up to 800 mL of blood into 160 mL of 3.8% sodium citrate. In

1937, an article written by Bernard Fantus at the Cook County

Hospital in Chicago describes collecting 500 mL of blood into

70 mL of 2.5% sodium citrate into a chilled flask, then stor-

ing it under refrigeration at 4–6 ∘C. This became known as the

first blood bank, which stored blood for 4–5 days (McCullough

2012).

While dextrose solutions were known to increase the stor-

age time of RBCs, maintaining sterility was still an issue due

to caramelizing of the dextrose solution during autoclaving of

the collection system. In the 1940s, acid-citrate dextrose (ACD)

solutions were developed; the addition of acidic forms of sodium

citrate prevented caramelization, which allowed extension of

storage of RBC products to 21 days (Greenwalt 1997).

As the potential storage time for RBCs increased, concerns

regarding RBC metabolism during storage arose. It was already

recognized that 2,3-diphosphoglycerate (2,3-DPG) was a sub-

stance present in RBCs, even though its role in oxygen binding

was not yet elucidated. The level of 2,3-DPG was also observed

to be lower in more acidic environments, leading to the devel-

opment of citrate-phosphate-dextrose (CPD) solutions in 1947.

These solutions raised the pH to 5.6 and the addition of phos-

phate resulted in better preservation of 2,3-DPG. By 1960, the

introduction of additive solutions containing adenine increased

the storage time (Nakao et al. 1960) and the RBC survival

time was extended to 42 days (Simon et al. 1962). This vastly

improved the ability to store RBCs instead of using fresh whole

blood.

Plasma component useThe introduction of plasma component therapy occurred during

World War II, mainly for the treatment of shock. Edwin J. Cohn

and his colleagues developed the method of fractionation, thus

enabling the use of human albumin and plasma as resuscitation

fluids. Cohn’s methods continue to be used today, with some mod-

ifications (Greenwalt 1997).

Invention of plastic bags and componentprocessingThe patent for plastic containers for blood component therapy was

filed by Carl Walter in 1950, which led to the development of

component separation and transfusions that otherwise would not

have been possible. The American Red Cross Blood Program expe-

rienced an increase in the use of packed red blood cells (PRBCs)

from 0.8% to 88% of reported transfusions between 1967 and

1978 with the implementation of multi-chambered plastic bags

connected by tubing (Greenwalt 1997). Baxter Corporation com-

mercialized the invention with the Fenwal division (named partly

after “Wal”ter), which later became its own company. The abil-

ity to separate plasma from RBCs led to the abundant supply of

plasma and production of plasma protein concentrates, as well as

the ability to produce platelet concentrates.


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Plasma protein concentratesIn 1965, Judith Pool discovered that fresh frozen plasma (FFP)

thawed at refrigeration temperatures would allow coagulation

factor VIII to remain precipitated, leading to the administration of

high concentrations of factor VIII to hemophilia patients during

cryoprecipitate transfusions (Pool and Shannon 1965). In addi-

tion, Edwin Cohn developed the technique of creating factor VIII

concentrates through fractionation, allowing for home storage of

factor VIII in refrigerators and self-administration of factor VIII by

hemophilia patients.

PlateletsThe advent of multi-chambered plastic bags allowed for the sepa-

ration of platelets into concentrates. The National Cancer Institute

played a major role in investigating the use of platelet concen-

trates for the treatment of thrombocytopenia during the 1960s

(McCullough 2012). Methods of preparing platelet concentrates

and performing transfusions were established and reduced mor-

tality rates in oncology patients with thrombocytopenia. The lifes-

pan of platelet concentrates was initially a limitation as they were

only viable for several hours, although Murphy and Garner estab-

lished that they could be stored for several days at room temper-

ature, which vastly improved the ability of platelets to be used as

a transfusion product (Murphy and Gardner 1969).

ApheresisJack Latham developed the concept of separating blood com-

ponents and selectively extracting the portions necessary for

treatment, and established a semi-automated system for plasma-

pheresis (McCullough 2003). More recent improvements have

allowed the separation and extraction of platelets, as well as

leukocytes. Plasmapheresis is currently being investigated for its

ability to remove antibodies and toxins (Crump and Seshadri

2009; Khorzad et al. 2011; Nakamura et al. 2012). Plateletpheresis

continues to be a method of collection for platelet concentrates.

LeukoreductionAs fractionation of components into RBCs, platelets, and plasma

became more common, the white blood cells (WBCs) that

remained were considered residual in nature. WBCs cause febrile

non-hemolytic reactions, transfusion-related immunomodula-

tion, and can aid the transmission of specific viruses (Zimring et al.

2009). In the 1980s, methods of filtration by passing collected

blood through a membrane were developed and termed “filter

leukoreduction”. This method is used in the majority of human

blood banks today to reduce transfusion-related complications.

Development of apheresis also led to the harvesting of com-

ponents that do not contain leukocytes and is termed “process

leukoreduction” (Zimring 2009).

The veterinary fieldWhile the first experimental animal-to-animal transfusion was

performed prior to transfusions between animals and humans,

the development of veterinary transfusion medicine and blood

banking is relatively recent. The first commercial veterinary blood

banks were established in the late 1980s and more blood banks

exist now than ever before. Many of the same concepts found

in human transfusion medicine are employed in the veterinary

field, with progressively larger numbers of veterinary studies

being performed and findings presented to refine the practice of

veterinary transfusion medicine.

Current veterinary transfusion and bloodbanking practices

Despite how common the practice of administering blood prod-

ucts has become in veterinary clinics worldwide, there is a

remarkable lack of information regarding the transfusion prac-

tices used. While studies have been published documenting

transfusion-related complications such as transfusion reactions,

organ injury, or coagulopathies, little has been described in

the literature as to how veterinary professionals are actually

administering blood products or taking steps to ameliorate the

consequences of transfusions. Comparatively, even less informa-

tion is available describing the current use of veterinary blood

donors. The little veterinary information published in this regard

is in the form of surveys. While these surveys have selection bias

and do not represent the views of the entire veterinary field,

they function to provide some insight as to current veterinary

transfusion practices.

Surveys on veterinary transfusion medicineand blood bankingThe first survey documenting transfusion practices was published

more than 20 years ago and included responses from 25 small ani-

mal clinics geographically stratified across the United States. It was

a telephone survey that asked questions to exclusively small ani-

mal practices performing at least six canine blood transfusions per

year. The survey responses revealed that the primary source of

donor blood was from a “borrowed dog” at 48% of practices, an

“in-house dog kept on the premises” at 48% of practices, and a

“nearby veterinary school” at one practice. Two-thirds of practices

performed infectious disease screening of blood donors and eval-

uated hematologic variables prior to donation, but only one-third

determined the donor blood type. None of the practices reported

blood typing recipients, but this survey was performed prior to

the availability of in-hospital dog erythrocyte antigen (DEA) 1

blood-type tests. Approximately half of the practices surveyed did

not recover the costs of the transfusion, which was considered a

“lifesaving measure” in 80% of cases (Howard et al. 1992).

Two decades later, a web-based survey was performed, which

compiled information regarding blood donor and transfusion

practices from 20 veterinary teaching hospitals and 53 private

referral hospitals located in the United States, Canada, Europe,

and Australia. This survey reflects the practice of a select number

of specialty hospitals performing blood transfusions, as only

emergency and critical care or internal medicine specialists (not

general practitioners) were surveyed (Jagodich and Holowaychuk

2016). However, the information collected provides an idea of

what the current transfusion and blood banking practices are

amongst some veterinary hospitals worldwide, demonstrating


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how much transfusion practices have changed since the previous

survey, performed more than 20 years earlier.

Current veterinary transfusion practicesThe survey performed in 2012 provides information on transfu-

sion practices used in specialty veterinary hospitals with regards

to the blood products stored and/or administered, as well as

recipient screening. PRBCs and FFP were the most frequently

reported canine and feline blood products routinely purchased or

collected by hospitals (Table 1.1), confirming a shift in transfusion

practice from the collection and administration of whole blood

to the routine use of component blood products (Jagodich and

Holowaychuk 2016). This is in stark contrast to earlier transfusion

practices as only 16% of previously surveyed small animal hos-

pitals reported separating canine whole blood into components

(Howard et al. 1992). Likewise, 96% of hospitals reported blood

typing or crossmatching canine and feline recipients prior to

blood product administration (Jagodich and Holowaychuk 2016),

which is likely a reflection of the increase in knowledge and

understanding of safe transfusion practices, as well as the avail-

ability of cage-side blood type kits, which were not available

decades prior when routine recipient typing was not performed

(Howard et al. 1992).

Current veterinary blood banking practicesThe 2012 survey also provides information regarding the

blood banking practices used in specialty veterinary hospi-

tals, specifically concerning blood donor selection and screening.

Approximately 50% of respondents reported using a combina-

tion of purchased blood products and hospital-run blood donor

Table 1.1 Percentage of surveyed hospitals that reported how frequently they purchased or collected differentcanine and feline blood products (Jagodich and Holowaychuk 2016).

Purchased Canine Feline

Blood product Never Rarely Occasionally Routinely Never Rarely Occasionally Routinely

FWB 45 55 0 0 59 29 6 6

SWB 90 5 5 0 65 18 18 0

PRBC 0 0 0 100 6 0 18 82

FFP 0 0 0 100 6 0 29 71

CP 25 45 25 5 – – – –

PC 40 45 5 10 – – – –

PRP 45 35 15 5 – – – –

LCP 60 25 10 5 – – – –

Lalb 55 25 25 0 – – – –

HBOC 70 25 0 5 82 18 0 0

Collected Canine Feline

Blood product Never Rarely Occasionally Routinely Never Rarely Occasionally Routinely

FWB 5 25 42 28 0 25 20 55

SWB 47 21 21 11 63 9 9 19

PRBC 40 2 6 52 66 6 6 22

FFP 42 2 6 50 67 6 6 21

CP 77 11 6 6 – – – –

CPP 77 13 4 6

PC 40 45 5 10 – – – –

PRP 70 13 15 2 – – – –

CP, cryoprecipitate; CPP, cryopoor plasma; FFP, fresh frozen plasma; FWB, fresh whole blood; HBOC, hemoglobin-based oxygen

carrier; Lalb, lyophilized albumin; LCP, lyophilized cryoprecipitate; PC, platelet concentrate; PRBC, packed red blood cells; PRP,

platelet-rich plasma; SWB, stored whole blood.


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programs to provide canine blood products, whereas 19% of hos-

pitals provided canine blood products using hospital-run blood

donor programs only. The majority (85%) of those hospitals

reported routinely using staff-owned dogs as blood donors with

fewer respondents (53%) using client-owned dogs. Only 11%

of hospitals reported having a colony of canine donors in the

hospital (Jagodich and Holowaychuk 2016). These results differ

substantially from previously reported practices, which rarely pur-

chased blood products and more commonly used in-house dogs

(Howard et al. 1992). The change over the years is likely due to

the development of commercial blood banks and a shift in ethical

beliefs regarding keeping in-hospital colonies of donor dogs.

Infectious disease screening of canine blood donors was rou-

tinely performed at 94% of hospitals with a hospital-run blood

donor program and 53% reported blood typing canine donors for

DEA 1 (Jagodich and Holowaychuk 2016). This also represents an

increase in diligent blood donor screening compared to that which

was reported previously, likely due to an improvement in knowl-

edge and understanding regarding safe transfusion practices.

While feline blood donor practices have not been previously

reported, the survey performed revealed that similar to dogs, half

of all hospitals obtained blood products from a combination of pur-

chased blood products and hospital-run blood donor programs,

whereas 26% reported obtaining feline blood products using only

a hospital-run blood donor program. Staff-owned cats were used

by 73% of hospitals, compared to 40% of hospitals that reported

having a colony of feline donors and 36% using client-owned

cats. Routine screening of feline blood donors for infectious dis-

eases was reported by 98% of survey respondents (Jagodich and

Holowaychuk 2016). These findings demonstrate a slight differ-

ence in thought with regards to using colony feline versus canine

donors, but a high diligence with regards to enforcing safe trans-

fusion practices.

Advancements in veterinary transfusionmedicine

Several advancements have been made in the field of veterinary

transfusion medicine during recent years and will continue to be

made as more well-designed research studies are published. A

PubMed search using the terms “transfusion”, “veterinary”, and

“dog or cat” yielded 426 publications in the field of small animal

transfusion medicine between 1965 and 2015 (Figure 1.5). Of

these publications, 161 were published within the last 10 years. It

seems that whereas studies used to be sparse, articles pertaining

to veterinary transfusion medicine are now being published on

a routine basis. Likewise, there has been a shift towards more

prospective studies rather than case reports or retrospective

investigations. All of these publications have served to enhance

knowledge in the field of veterinary transfusion medicine and

encourage an evidence-based approach to transfusion practices.

Evidence-based guidelinesThe evidence-based approach to formulating veterinary transfu-

sion guidelines has culminated in the publication of a consensus

statement by the ACVIM regarding blood donor screening. This

00

50

100

150

200

1965–1974 1975–1984 1985–1994

Year

1995–2004 2005–2014

Num

ber

of p

ublic

atio

ns

Figure 1.5 Graphical depiction of the number of veterinary publicationsrelated to transfusion medicine in dogs or cats.

consensus statement was drafted by a group of experts in the

field of veterinary infectious disease and blood banking, and was

first published more than 10 years ago (Wardrop et al. 2005). As a

testament to the quickly growing body of research in the field of

transfusion medicine, these guidelines were re-drafted and a

preliminary view was provided at the ACVIM Forum in June

2015. The final recommendations were not published at the time

of writing, but are anticipated to be published in 2016. Changes

will likely reflect our increasing knowledge of infectious disease,

including adjusted screening for feline leukemia virus (i.e., provi-

ral DNA PCR testing) in cats, as well as banking samples from

donors to allow retroactive testing.

The IAVBB is in the process of drafting and publishing veteri-

nary blood banking standards modeled after guidelines provided

by the AABB in the human field. These guidelines are expected

to cover important details regarding the operation of a veterinary

blood bank, such as the organizational structure, blood banking

resources, equipment standards, supplier and customer issues,

process control and improvement, documentation, facility stan-

dards, and safety. Without a doubt these guidelines will be the

first of many to be published guiding veterinary transfusion and

blood banking practices in the future.

Blood typing and recipient screeningSeveral advancements have also been made with regards to blood

typing and recipient screening in dogs and cats. Whereas blood

typing was previously only available at commercial laboratories

and almost never performed at veterinary hospitals, the use of

in-hospital blood type tests has become commonplace. This has

served to improve the safety of blood transfusions administered in

veterinary practice and likely has also enhanced the comfort level

of practitioners administering blood products. Continued develop-

ments in this field have also improved typing methods, resulting

in the availability of new canine and feline blood typing cartridges

that use immunochromatographic test strips. Unlike agglutina-

tion card tests, the results of immunochromatographic tests can

be interpreted even when auto-agglutination is present (Seth et al.

2012).


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Other advancements in the field of blood typing include the

discovery of new RBC antigens, including canine Dal and feline

Mik (Blais et al. 2007; Weinstein et al. 2007). The detection of

these antigens has changed recommendations with regards to

donor and recipient screening, given that these antigens are not

tested for by conventional blood typing methods. As such, some

believe that all dogs and cats should routinely have a crossmatch

performed prior to transfusions in order to maximize the poten-

tial to detect any incompatibilities not detected by conventional

blood typing methods. This recommendation is emphasized by a

recent study determining that feline red cell transfusion recipients

that were blood type and crossmatch compatible had a higher

post-transfusion increase in packed cell volume, compared to cats

that were not crossmatched (Weltman et al. 2014).

The nomenclature of canine blood types has also recently

changed, as it was discovered using flow cytometry that the DEA

1.2 and 1.3 blood types, which were previously thought to be

different alleles, are likely a variation in the strength of mono-

clonal antibodies to DEA 1.1 (Acierno et al. 2014). Therefore, the

nomenclature of DEA 1.1, 1.2, and 1.3 has become obsolete and

is now described simply as DEA 1. This has already been reflected

in a blood-type kit manufacturer’s decision to rename the kit DEA

1, previously DEA 1.1 (DEA 1 Quick Test, Alvedia, France).

Transfusion triggersModification of the traditional transfusion triggers of 30/10

(packed cell volume 30%/hemoglobin 10 g/dL [100 g/L]) has

occurred in human transfusion medicine in light of a multitude

of studies demonstrating that a more conservative transfusion

strategy (i.e., transfusing at a lower hemoglobin) is equal, if not

superior, to the traditional and more liberal transfusion strategies

(Carless et al. 2010). While research into the use of transfusion

triggers is lacking in veterinary medicine, a scoring system has

been developed to assist veterinarians in determining when a

RBC transfusion might be warranted in anemic dogs (Kisielewicz

et al. 2014). This score will likely guide veterinarians with less

experience giving transfusions to more objectively determine

when a transfusion might be warranted and also function to

stratify patients being enrolled in future prospective transfusion

studies.

Storage and administration of blood productsA relatively large number of studies investigating the effect of stor-

age conditions and administration methods on the viability of vet-

erinary blood products have been published in recent years. These

include studies investigating various freeze-thaw conditions and

storage temperatures on the activity of clotting factors in canine

plasma products (Yaxley et al. 2010; Grochowsky et al. 2014; Wal-

ton et al. 2014; Pashmakova et al. 2015), as well as the impact of

syringe or fluid pump administration methods on red blood cell

viability (McDevitt et al. 2011; Heikes and Ruaux 2014). These

studies, while experimental in nature, have improved our knowl-

edge and understanding of the potential impact of storage, thaw-

ing, and administration methods on blood product viability and

have immediate potential for clinical application.

Storage lesions and leukoreductionInterest in storage lesions and the impact of the age of blood prod-

ucts on patient morbidity and mortality has recently increased

(Obrador et al. 2015), along with research investigating the ben-

eficial effects of pre-storage leukoreduction (McMichael et al.

2010; Graf et al. 2012; Herring et al. 2013; Corsi et al. 2014; Smith

et al. 2015). There are also veterinary studies documenting the

negative impact of administering older stored blood compared to

blood stored for a shorter duration of time (Hann et al. 2014),

while a clinical reduction in adverse effects associated with

the use of leukoreduction filters has yet to be documented. As

such, despite the relatively widespread use of leukoreduction in

human medicine, routine use remains rare in veterinary medicine

(Jagodich and Holowaychuk 2016). Likewise, the delineation of

“fresh” versus “old” stored blood products is wrought with prob-

lems, including the increased disposal of expired blood products

not used due to the negative connotations of stored red cell

products (Holowaychuk and Musulin 2015). More information

is needed with regards to the impact of storage lesions and

leukoreduction on transfusion-related complications before firm

recommendations can be made.

Therapies to reduce allogenic transfusionsEven though veterinarians are administering transfusions as

safely as possible by performing diligent donor and recipient

screening, and using appropriate administration and monitoring

protocols, there is a growing concern regarding complications

such as transfusion-related immunomodulation occurring sec-

ondary to allogenic transfusions (Hart et al. 2015). This has led

to reports describing methods to reduce the administration of

allogenic blood products. Examples include the use of specialized

equipment such as cell salvage devices to enable safe and efficient

autotransfusion of body cavity hemorrhage (Kellett-Gregory et al.

2013), as well as the administration of antifibrinolytic medica-

tion to ameliorate post-operative hemorrhage and transfusion

requirements in predisposed breeds such as greyhounds (Marin

et al. 2012a,b). It is likely that studies focused on reducing allo-

genic transfusions will continue to be performed as veterinarians

seek out alternatives.

Future directions

Even though the number of veterinary studies published in the

field of transfusion medicine is rapidly growing, there is still

much work to be done and more knowledge to be gained in

order to guide transfusion and blood banking practices. While

retrospective studies have documented transfusion-related com-

plications and demonstrated their association with a negative

outcome, prospective studies are needed to further characterize

what can be done to ameliorate these complications. Whether

this will mean changing donor and recipient screening, adjusting

transfusion triggers, using leukoreduction filters, altering blood

storage and administration protocols, or seeking alternatives to

allogenic transfusions remain to be determined.


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Sourcing of sufficient donors to meet blood bank demands

is also a consistent issue. Efforts to create wider public aware-

ness of the need for donors, find an effective and sustainable

supply of donated blood products, and use alternatives such

as hemoglobin-based oxygen-carrying solutions and stem-cell

derived RBCs, in addition to further refinement and widespread

education regarding the appropriate use of blood products should

help meet blood product demands. There is no doubt that the

coming years will bring a plethora of veterinary publications that

will serve to enhance knowledge and understanding of transfu-

sion medicine and blood banking, enabling the creation of more

evidence-based guidelines.

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erythrocytes analyzed by immunochromatographic and flow cytometric

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2 Component TherapyJulie M. WalkerDepartment of Medical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, Wisconsin, USA

Introduction

Blood collected from a donor can be utilized in many ways.

Although a unit of whole blood (WB) can be transfused or stored

after collection without further processing, separation of the unit

into blood components can provide several benefits. This chapter

provides an explanation of component therapy as it compares

to the transfusion of WB, highlighting the advantages and dis-

advantages of these practices. A general overview of the most

commonly administered blood components will also be provided.

Whole blood

Description and contentsVeterinary hospitals and blood banks that practice traditional

blood banking begin by collecting a standardized volume of

blood from a donor, which is immediately mixed with an

anticoagulant-preservative solution as it flows into the primary

collection container. At the time of collection, WB contains all

components of circulating blood including red blood cells (RBCs)

and white blood cells (WBCs), platelets, coagulation factors,

albumin, globulins, electrolytes, etc., at concentrations that were

present in the donor. This product, known as fresh whole blood

(FWB), can be transfused immediately or stored briefly (<8 hours)

at room temperature prior to transfusion. WB can also be stored

at 4 ∘C (stored whole blood, SWB) for up to 35 days depending on

the anticoagulant-preservative solution used, or can be processed

into blood components (Bucheler and Cotter 1994; Callan 2010).

Platelets in FWB maintain the ability to aggregate for at least

8 hours when stored at room temperature (Tsuchiya et al. 2003).

However, platelet aggregation and factor V and VIII concentrations

in SWB decrease in a time-dependent manner during storage at

4 ∘C (Nilsson et al. 1983; Nolte and Mischke 1995; Solheim et al.

2003; Jobes et al. 2011; Pidcoke et al. 2013).

IndicationsThe transfusion of FWB is indicated for the treatment of anemia

that occurs concurrently with coagulopathy, thrombopathia, or

severe thrombocytopenia. Patients with severe traumatic injury

Manual of Veterinary Transfusion Medicine and Blood Banking, First Edition. Edited by Kenichiro Yagi and Marie K. Holowaychuk.© 2016 John Wiley & Sons, Inc. Published 2016 by John Wiley & Sons, Inc.

and marked hemorrhage who require massive transfusion might

also benefit from a FWB transfusion (Kauvar et al. 2006; Repine

et al. 2006; Spinella 2008; Spinella et al. 2009; Cotton et al. 2013).

Similarly, SWB is indicated for the treatment of anemia with coag-

ulopathy, but this product would not be appropriate to correct

thrombocytopenia, thrombopathia, or deficiency of factors V or

VIII. WB, while not ideal, can also be administered to patients with

euvolemic non-coagulopathic anemia, particularly when compo-

nent therapy is not readily accessible.

AdvantagesThe most notable advantages of collecting and transfusing WB are

availability and practicality for private practices that infrequently

administer blood transfusions. With proper understanding of

transfusion principles, identification of a healthy blood donor and

proficiency in venipuncture and aseptic technique, FWB collec-

tion and transfusion can be safely performed in most veterinary

settings. If SWB will be kept for later use, the hospital must use a

refrigerator that can consistently maintain a constant temperature

between 1 and 6 ∘C. Conversely, FWB can be collected in a more

flexible manner when used immediately; the phlebotomist can

even draw the desired amount of blood into syringes that have

been pre-filled with anticoagulant-preservative solution. This

practice allows the collection of only the desired volume of blood,

but is inappropriate for long-term storage as this method utilizes

an open collection system, which limits storage time to less than

24 hours (Roback et al. 2011).

DisadvantagesBeing able to perform blood donation at the time of patient need

makes it necessary to complete comprehensive health and infec-

tious disease screening on donors well in advance of donation. It

can be challenging to find blood donors that are available at all

times for blood donation on an “on call” basis. When a patient

has an urgent need for a blood transfusion, the delay in treatment

that occurs while contacting the blood donor’s owner, awaiting

donor arrival, and collecting the FWB unit can also be a significant

disadvantage. Additionally, the administration of FWB or SWB

to anemic patients without hypovolemia or coagulopathy pre-

disposes recipients to volume overload and antigenic stimulation

13


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secondary to unnecessary plasma administration. Because of this,

banking and administration of component therapy has several

advantages over FWB and SWB.

Component therapy

Background conceptsThe separation of WB into its constituents for further storage

prior to administration is known as component therapy. FWB can

be processed into a variety of different components that can be

transfused based on individual patient need (Table 2.1). Most

established in-hospital and commercial blood banks are able to

create these WB-derived components. While most veterinary

blood banks process components by centrifugation of collected

blood, specific blood components can also be collected directly

from a donor using apheresis, an extracorporeal process that

employs differential centrifugation within a tubing system to

selectively collect one or more blood components (e.g., platelets

or plasma), while immediately returning the unused portion to

the donor. There has been an increase in the use of apheresis for

the collection of RBC, platelet, and plasma units from human

blood donors in the United States from 2008 to 2011 (Depart-

ment of Health and Human Services 2013). The production of

apheresis-derived components requires access to and experi-

ence with specialized equipment, therefore these techniques are

Table 2.1 Overview of blood products, including contents, indications, and storage conditions.

Contentsa Main indications Storage conditions

Fresh whole bloodRBC, WBC, platelets, all coagulation factors,

albumin, globulin

Anemia with coagulopathy/platelet disorder,

severe hemorrhage requiring massive

transfusion

Room temperature for up

to 8 hours

Stored whole blood

RBC, WBC, non-viable platelets, coagulation

factors excluding labile factors, albumin,

globulin

Blood loss anemiaRefrigerated at 1–6 ∘C for

up to 28 daysb

Packed red blood cellsRBC, WBC, non-viable platelets, small

amount of plasmaSymptomatic anemia of any etiology

Refrigerated at 1–6 ∘C for

up to 42 daysb

Platelet-rich plasmaPlatelets, all coagulation factors, albumin,

globulin

Marked thrombocytopenia with critical

hemorrhage

Room temperature storage

under constant gentle

agitation for up to 5 daysPlatelet concentrate Platelets, low volume of fresh plasma

DMSO-preserved frozen

canine platelet concentrate

Platelets, small volume of plasma, 6%

dimethyl sulfoxide

Frozen at≤ –18 ∘C for up to

6 months

Lyophilized canine platelets PlateletsRefrigerated at 1–6 ∘C for

up to 24 months

Fresh frozen plasma All coagulation factors, albumin, globulin

Coagulopathy with clinical evidence of

hemorrhage, coagulopathy without

hemorrhage but with planned invasive

procedure, coagulopathy without

hemorrhage or planned invasive procedurec


12 months

Frozen plasmaAll coagulation factors (lower

concentrations of factors V, VIII, vWF)

Anticoagulant rodenticide intoxication;

coagulopathy due to factors II, VII, IX, X, XI

or fibrinogen deficiency


5 years

Refrigerated plasmaAll coagulation factors with mildly reduced

concentrations of some factors

Emergent treatment of life-threatening

coagulopathy


up to 14 days

CryoprecipitateConcentrated factors VIII, XIII, vWF,

fibrinogen, and fibronectin

Hemophilia A, von Willebrand disease,

fibrinogen deficiency


12 months

Lyophilized cryoprecipitateConcentrated factors VIII, XIII, vWF,

fibrinogen, and fibronectin

Hemophilia A, von Willebrand disease,

fibrinogen deficiency


up to 18 months

Cryosupernatant Factors II, V, VII, IX, X, and XI

Deficiency of factors II, V, VII, IX, X, or XI

such as anticoagulant rodenticide

intoxication


12 months

RBC, red blood cells; WBC, white blood cells; vWF, von Willebrand Factor.aMinimal leukocyte content if leukoreduction techniques are applied.bShelf life depends on the anticoagulant-preservative solution used.cControversial.

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