PowerPoint Presentation

Blood transfusion in dog & catIn The Names of God By:Mahdi-Falsafi

1

History of transfusion medicineEarly 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 hemorrhage 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)It is unclear who first conceived the idea of blood transfusions. Hieronymus Cardanus (15051576) is given credit in some literature, while Magnus Pegelius obtained the right to publish on the topic under Emperor Rodolphus IIs rule in 1593. Andreas Libavius 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.

2

History of transfusion medicineFirst animal-to-animal transfusionRichard Lower (16311691) 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 tubesFirst 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 persistent fever; the child was reported to have a clear and smiling countenance after the transfusion. Denis also performed a transfusion to the son of the Prime Minister of Sweden (Baron Bond), without successfully curing him,

3

Reasons and definitionAnemia, also spelledanaemia, is usually defined as a decrease in the total amount ofred blood cells(RBCs) orhemoglobin in thebloodIt can also be defined as a lowered ability of the blood to carryoxygenCausesAnemia is often categorized based on its cause: hemolysis, blood loss, or erythropoietic failure

4

Reasons and definitionPrimary signs of anemia relate to the reduction in oxygen-carrying capacity of the blood: lethargy, weakness, anorexia, heart,murmur, tachypnea, and pale mucous membranesSecondary signs of anemia often relate to the effects of increased blood cell destruction, such as icterus, splenomegaly, and hepatomegaly from extravascular hemolysis or extramedullary hematopoiesis and discolored urine from the effects of hemoglobin or excess bilirubin excreted.Principles of DiagnosisHistory and physical examination to determine the following: Occurrence of trauma or surgery Drug, chemical, or toxin exposure Underlying infectious, parasitic, or neoplastic disease Duration of disease, sites of blood loss, and presence of organomegaly

5

Reasons and definitionComplete Blood Count Packed cell volume (PCV) Determine plasma protein or total solids by refractometer. Erythrocyte, or red blood cell (RBC), count Hemoglobin (Hgb) concentration in grams perdeciliter Mean cell or corpuscular volume (MCV) reflects erythrocyte size and may be categorized as macrocytic, microcytic, normocytic,(Note that Akita and Shibadogs normally have microcytic erythrocytes-toy and miniature poodles, as well as greyhounds,may have macrocytic erythrocytes)Other erythrocyte indices such as mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) normochromic and hypochromicReticulocyte CountThis is the most accurate method to evaluate regeneration.Perform reticulocyte counts when the PCV falls below 30% in dogs and 20% in cats.

6

Reasons and definition

Normal PCV is considered 45% for dogs and 35% for cats. A corrected percentage for a reticulocyte value greater than 1% indicates increased RBC regeneration.Fecal Examination and UrinalysisThese tests are performed to determine sources of blood loss and function of the kidney.Biochemical ProfileBiochemical profiles may reveal organic disease that can affect the ability to regenerate erythrocytes.

7

Reasons and definition

8

Blood loss anemiaLarge volumes of blood must be lost before appreciable changes occur in the numbers of erythrocytes or PCVThe immediate loss of blood results in little or no change to the PCVEtiologyCauses of blood loss include the following: Trauma Surgery External and internal parasitism Gastric ulcers Tumors of the gastrointestinal (GI) and urinary systems Splenic rupture Coagulation abnormalitiesTreatmentAdminister cross-matched whole blood for acute hemorrhage when the PCV drops to 20% to 25% in the dog or cat

9

Hemolytic anemiaCauses of hemolytic anemia include congenital abnormalities, immune-mediated destruction, infections,chemical or toxic agents, mechanical fragmentation,and hypophosphatemia.some cases, the anemia may occur so rapidly that the animal may have too little time to mount a regenerative response Depending on the severity or acuteness of the destruction and the conjugating ability of the liver,icterus may or may not be present. Plasma protein concentrations usually are normal.

10

Hemolytic anemia

Congenital Erythrocyte Abnormalities

Pyruvate Kinase DeficiencyDuring anaerobic glycolysis, pyruvate kinase is necessary for the production of adenosine triphosphateClinical Signs Young animals usually present with anemia, exercise intolerance, tachycardia, and splenomegaly. The outcome of the disease is usually death by 4 years of age. Myelofibrosis and osteosclerosis may occurDiagnosisThis disease is suggested clinically by the presence of an intense reticulocytosis (1550%), along with frequent nucleated red cells in a young dog. Echinocytosis Polymerase chain reaction (PCR)

11

Hemolytic anemiaCongenital Erythrocyte Abnormalities

Phosphofructokinase DeficiencyThis glycolytic enzyme deficiency causes a decrease in 2,3-diphosphoglycerate(2,3-DPG) concentration, resulting in an increase in intracellular pH. Erythrocytes from affected animals are especially fragile under alkaline conditions.Clinical Signs. The clinical signs may involve lethargy, pale or icteric mucous membranes, mild hepatosplenomegaly, myopathy, and fever. Dogs may have a normal life span if properly managed.Diagnosis. The enzyme deficiency is diagnosed by specialized erythrocyte assays in homozygous and heterozygous animals. A PCR-based testHereditary StomatocytosisErythrocyte numbers are reduced, but the PCV remains normal because of enlarged erythrocytes.

12

Hemolytic anemiaCongenital Erythrocyte Abnormalities

Feline PorphyriaFeline porphyria is an infrequent inheritable trait that results in an enzyme deficiency affecting heme synthesis. Clinical signs include pink urine, pinkish-brown teeth, and severe anemia resulting from the deposition of red non-heme pigments and the lysis of erythrocytes when exposed to sunlight.

13

Hemolytic anemiaInfectious Causes of HemolysisHemoplasmosisHemoplasmosis or hemotrophic mycoplasmosis, previously known as hemobartonellosis, is caused by a mycoplasma organism that infects the erythrocytes of dogs (Mycoplasma haemocanis) and cats (M. haemofelis and Candidatus M. haemominutum).Clinical Signs. Clinical signs include those generally observed with anemia. Weight loss may occur if the anemia develops slowly, whereas acute, severe anemia produces sudden depression and icterus. Splenomegaly often is noted.Diagnosis. Laboratory findings generally reflect a strong regenerative response in the CBC. Thin smears, made directly without anticoagulant, A positive Coombs test PCR-based assaysTreatment Consider whole blood transfusion if the anemia is severe. Prednisolone (2mg/kg PO q12h) to suppress the severe immune-mediateddestruction of erythrocytes. Doxycycline (5 mg/kg PO q12h for 4 weeks) is preferred for dogs Enrofloxacin (5 mg/kg PO q24h for 14 days) can be used in cats intolerant of doxycycline.

14

Hemolytic anemiaInfectious Causes of HemolysisBabesiosistick-borne protozoal disease affecting erythrocytes of dogs (Babesia canis, B. gibsoni).and cats (Babesia felis)Clinical Signs. Clinical signs in babesiosis range from an acute hemolytic crisis to an unapparent subclinical form. Signs of the acute disease include splenomegaly,icterus, anemia, thrombocytopenia, hemoglobinuria, and fever.Diagnosis. Initial diagnosis is made by examination of a blood smear. An indirect fluorescent antibody (IFA) A nested PCR test A Coombs testTreatment Imidocarb dipropionate (Imizol, Schering-Plough)(6.6 mg/kg SC or IM given twice 2 weeks apart) Diminazene aceturate (Berenil, Hoechst) (3.5mg/kgSC or IM given once) Phenamidine isethionate (15mg/kg SC q24h for 2days)

15

Hemolytic anemiaInfectious Causes of HemolysisLeptospirosisLeptospira serovars can cause kidney disease, liver disease, hemolysis, icterus, and coagulopathies. Toxins released from proliferating organisms interfere with cellular metabolism and damage cellsSystemic signs: This can include acute onset of anorexia, depression, fever, vomiting, dehydration,stiff gait,Treatmentfluid and electrolyte therapy,transfusionInitially give parenteral antibiotics, such as penicillin G (25,00040,000 units/kg IV,qvomiting resolves, switch to oral amoxicillin (22 mg/12h) or ampicillin (22 mg/kg IV, q68h). Once kg PO, q812h) and continue treatment for 2 weeks.

16

Hemolytic anemiaChemical or Toxic Injury of ErythrocytesOxidant-Induced (Heinz Body) AnemiaEtiology. Chemicals, drugs, or plants associated with Heinz body formation include acetaminophen, methylene blue, onions, vitamin K3, dl-methionine, zinc, topical benzocaineClinical Signs. Acute hemolysis causes depression, hemoglobinemia, hemoglobinuria, moderate to severe anemia, and occasional icterus.Diagnosis. Diagnosis is made by observation of a single, large, pale-staining area in erythrocytes of Romanowsky-stained blood smears.Treatment Remove the source of oxidant exposure. Use emetics if recent ingestion has occurred. Give blood transfusions or other forms of supportive care, as indicated. For acetaminophen-induced toxicity, give acetylcysteine Mucomyst, (Roxane Laboratories), 140mg/kg of a 5% solution diluted with saline given IV as a loading dose, then give 70 mg/kg of a 5% solution every 4 hours for three to five treatments.Snake Venom ToxicityZinc Toxicity

17

Hemolytic anemiaMechanical Fragmentation of ErythrocytesHeartworm DiseaseDirofilariasis may produce anemia after intravascular hemolysis as large numbers of adult heartworms (Dirofilaria immitis)Postcaval syndrome results from obstruction of the caudal vena cava causing, in addition to hepatic failure, erythrocyte fragmentation (schistocytosis), hemoglobinemia, and hemoglobinuria.

Disseminated Intravascular Coagulopathycause a microangiopathic hemolytic anemia because of fibrin deposition Etiology involves a variety of conditions, such as neoplasia, infections, necrosis, toxins, and immune complex formation. Diagnosis is based on consumption of platelets (thrombocytopenia), reductions in clotting factors, hypofibrinogenemia (prolonged prothrombin time [PT], activated partial thromboplastin time [APTT],

18

Hemolytic anemia

Mechanical Fragmentation of ErythrocytesHypophosphatemiaCases of feline diabetes mellitus and hepatic lipidosis have been associated with hypophosphatemia-induced hemolysisHypomagnesemiaGastrointestinal Causes: Inadequate intake, Chronic diarrhea and vomiting,Malabsorption syndromes, Acute pancreatitis ,Cholestatic liver disease, Nasogastric suction(?)Renal Causes: Renal failure, Renal tubular acidosis, Postobstructive diuresis, Drug-induced tubular injury,Postrenal transplant ,Prolonged intravenous fluid therapy, Diuretics,Digitalis administration, Concurrent electrolyte disorders, Hypercalcemia, Hypokalemia, HypophosphatemiaEndocrine Causes:Diabetes mellitus and diabetic ketoacidosis, Hyperthyroidism,Primary hyperparathyroidism, Primary hyperaldosteronism

19

Hemolytic anemia

Nonregenerative AnemiaChronic, nonregenerative anemias may not require blood transfusion until the PCV falls below 15% in the dog and 12% in the cat.Infectious AgentsFeline Leukemia Virus ,FIV,FIPEhrlichiosis and AnaplasmosisLeishmaniasisCytauxzoonosishighly fatal protozoal disease of cats caused by Cytauxzoon felis. It is a tick-borne infection,most prevalent in the wooded areas.Nutritional Deficiencies: Iron Deficiency- Cobalamin Deficiency- Folate DeficiencyInflammatory DiseaseOrganic Disease: Kidney Disease- Liver DiseaseEndocrine DiseaseDrug and Toxin-Induced DiseaseMyelophthisis

20

immune-mediated hemolytic anemia(IMBH)The bodys immune system mistakenly starts recognizing its own red blood cells (RBCs) as antigens and initiates their destruction. In this process antibodies produced by the immune system bind to the RBCs and destroy them. Thehemolysis(destruction) of red blood cells results in the release ofhemoglobin, which can lead tojaundice, and further on toanemiaSymptomsWeakness *Lethargy *Poor appetite *Fainting *Exercise intolerance *Vomiting *Rapid breathing* Diarrhea *Increased thirst and urinationin some dogs*Fever *Jaundice* Rapid heart rate *Melena *Petechia* Ecchymoses * Joint painsCausesAutoimmune hemolytic anemia (production of antibodies against the bodys own RBCs and their destruction)Systemic Lupus Erythematosus (SLE) (production of antibodies against the bodys own tissues and blood)Certain infections like ehrlichia, babesia, andleptospriainfectionsCertain drugs, like antibioticsVaccinationHeartwormdiseaseNeoplasia (tumor)Neonatal isoerythrolysis (destruction of the red blood cells within a puppy's body system by the action of maternal antibodies)Dysregulated immune systemIdiopathic (unknown cause)

21

immune-mediated hemolytic anemia(IMBH)Most dogs and cats with acute, severe IMHA need oxygencarrying support.

22

COMPLICATIONS OF TRANSFUSION THERAPYDivided into those that are immunologically mediated and those that areof nonimmunologic origin.Immune-mediated reactions: include urticaria, hemolysis, and feverNonimmune-mediated complications include: fever or hemolysis resulting from the transfusion of improperly stored blood, circulatory overload, citrate intoxication, disease transmission, and the metabolic burden associated with the transfusion of aged blood.Signs of immediate immune-mediated hemolysis appear within minutes of the start of transfusion and include tremors, emesis, and fever; these are extremely rare in dogs but common in cats receiving incompatible blood products.Delayed hemolytic reactions are more common and are manifested primarily by an unexpected decline in the HCT after transfusion over days in association with hemoglobinemia,hemoglobinuria, and hyperbilirubinemia

23

COMPLICATIONS OF TRANSFUSION THERAPYCirculatory overload may be manifested by vomiting, dyspnea, or coughing. Citrate intoxication occurs When the infusion rate is too fast or the liver cannot metabolize the citrate. Signs of citrate intoxication are related to hypocalcemia and include tremors and cardiac arrhythmias.PREVENTION OF THROMBOEMBOLISMThromboembolic events (TEs) are a common complication and important cause of death in dogs with IMHA. TEs have been documented at necropsy in 29% to 80% of dogs with IMHAIdentification of certain clinicopathologic abnormalities, such as thrombocytopenia, hyperbilirubinemia, leukocytosis, and hypoalbuminemia, are associated with an increased risk of TE in dogs with IMHA.Treatment options currently used for prevention of thromboembolic complications include heparin, low-molecular-weight heparin, aspirin, or a combination of these modalities

24

COMPLICATIONS OF TRANSFUSION THERAPYThe most serious adverse effect of administration of any red blood cellcontaining component is acute hemolytic transfusion reaction due to recipient antibodies against the donor red blood cellsTransfusions also carry risk of circulatory overload, Type I hypersensitivity reactions, vomiting, and feverThe most common reaction, fever, is believed to be due to cytokines contained in the transfused blood or from antibodies against red blood cells, white blood cells, or platelets. Fever also occurs with bacterial contamination of blood.An increase in body temperature of 1 C should be considered a transfusion-associated fever.Oxyglobin does not contain antigenic red blood cell membranes and will not cause an acute hemolytic transfusion reaction. The most common adverse event associated with Oxyglobin administration is circulatory overload, manifested as pulmonary edema or pleural effusion

25

COMPLICATIONS OF TRANSFUSION THERAPYOxyglobin has strong colloid effect because its colloid osmotic pressure (COP) is 43 mm Hg and it also causes transient discoloration of mucus membranes (muddy pink, icteric orange, or brown), skin, and urine (pigmenturia)

POTENTIAL LONG-TERM PROBLEMS AFTER TRANSFUSIONSDiseases where multiple transfusions , rarely describedOne such adverse event is posttransfusion purpura.In this transfusion complication, thrombocytopenia occurs 1 to 2 weeks following transfusion. The recipient, sensitized by transfusions containing platelet antigens, can produce antibodies against platelets which, in turn, can cause thrombocytopenia. The syndrome usually naturally resolves in 1 to 4 weeksA second long-term problem caused by transfusions in dogs is hemochromatosis.Iron from senescent transfused red blood cells accumulates in the liver, ultimately resulting in liver failure from transfusional hemochromatosis.

26

COMPLICATIONS OF TRANSFUSION THERAPYAll transfusions carry the risk of infectious disease transmission. Of greatest concern in veterinary patients are canine and feline vector-borne diseases and feline retroviral diseases. Blood donor screening recommendations have been made to minimize morbidity and mortality

27

28

Blood productsWhole bloodWB 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 (