Download Introduction to Blood Banking Jordin Karalunas LVT, VTS (ECC

Introduction to Blood Banking
Jordin Karalunas LVT, VTS (ECC)
Oakland Veterinary Referral Services
1400 Telegraph
Bloomfield Hills, Mi 48302
As veterinary medicine progresses, so does our ability to provide advanced services and
quality care. One area this is most evident, is the constantly changing practices of transfusion medicine.
With that said, we must continually evolve our blood banking protocols to meet the standards of quality
control needed to uphold patient safety and transfusion efficacy. Blood banking can be done in a
multitude of ways, i.e. a designated “hospital cat” who donates on an as needed basis, on to an advanced
commercial blood bank.
Blood Banks
There are two types of blood banks, commercial and volunteer based. Commercial blood banks
consist of a closed colony of donors that have minimal exposure to infectious diseases. These donors
have been pre-screened for blood borne diseases. Due to the ability to closely monitor the donors,
donations are taken every 3-4 weeks. Volunteer based blood banks rely solely on the donors’ owner to
provide the opportunity for blood donation. These donors are also pre-screened for blood borne diseases.
The risk for disease exposure is increased with volunteer programs, which reinforces the necessity for
screening standards. Donations with a volunteer blood donor are typically taken every 3-4 months. It is
also important to reward volunteer donors with an incentive, such as complimentary lab work or food, for
donating. In addition to incentives for donating, it is important to remember our donors once they become
retired blood donors. Sending a retired donor a gift basket and card thanking them for their life-saving
services is another way to convey how important volunteer donors are to veterinary medicine.
Donor Screening
It is important to consider disease transmission, blood type, health status, age, and attitude when
screening for potential donors. Donor requirements and screening protocols are listed below, and broken
down by species.
Canine: Between 1-7 yrs (retired at 8 yrs)
Over 50 lbs
Current on vaccines and year round heartworm prevention
Friendly and calm disposition, easily restrained
Full chemistry panel, CBC, heartworm test, and average HCT 40%
Full blood typing (DEA 1.1, 1.2, 4, & 7)
Brucella, Babesia, Leishmaniasis, Erlichiosis, Anaplasmosis, Hemoplasmosis, Bartonellosis
(Vector borne disease testing varies with region)
Feline: Between 1-7 yrs (retired at 8 yrs)
Over 10 lbs
Current on vaccines and year round heartworm prevention
Normal echocardiogram
Indoor only
Friendly and calm disposition is ideal
Full chemistry panel, CBC, heartworm test, and average HCT 30%
Blood typing (A, B, or AB)
Felv/FIV, Mycoplasma haemofelis, Anaplasma, Bartonella, Cytauxzoon felis, Erlichia (testing
varies with region)
Blood Typing
Given the donor screening protocol above, it is important to be familiar with both canine and feline blood
typing. Recognizing how canine and feline blood types can be utilized in the blood bank can maximize the
donor pool. There are 13 canine blood groups, and blood type considerations vary with region (Dogs,
unlike cats, acquire antibodies through exposure.). The typing sera we most commonly use are DEA 1.1,
1.2, 4, & 7. D.E.A. (or Dog Erythrocyte Antigen) refers to antigens on the surface of the red blood cell.
These antigens are responsible for initiating hemolytic transfusion reactions. Thus it is important to type
donor and recipient before transfusing, and cross match when indicated. D.E.A. 1.1 is most antigenic, and
recipients can easily be screened “in-house” using RapidVet card typing and Alvedia typing kits. Donors
should be screened for the typing sera listed above at an outside lab to ensure accuracy. The “Universal”
type is considered D.E.A. 1.1 & 1.2 negative, 4 positive, and 7 negative. Although most dogs are D.E.A.
1.1 positive, as long as they are 1.2 negative, 4 positive, and 7 negative, they can be used in the donor
pool. This increases your available donors greatly, and also reinforces recipient typing to avoid
transfusion reactions. Cats, however, have naturally occurring antibodies (similar to humans) against
other blood types. Thus it is extremely important to type donor and recipient, and ideally cross match prior
to every transfusion. It is these antibodies that are responsible for fatal acute hemolytic transfusion
reactions. Screening for Types A, B, and AB are imperative in the donor screening process. Though type
B cats are rare, an increase has been seen. Feline donor typing should also be performed at an outside
lab to ensure accuracy. Recipient typing can be done using Alvedia testing kits, as well as RapidVet-H IC
and RapidVet typing cards along with RapidVet crossmatching kits.
The Donation Process
It is important to ensure donor safety and compliance during the donation process. It should
always be a positive experience for the donor. That said, the materials you will need are listed below:
Pheromone spray (such as Adaptil)
Bedding
Gram Scale
Blood collection system
Alcohol and scrub prep
Bandage material
Clippers
Line strippers
Metal clamps
Anesthesia machine/monitoring equipment/ET tubes/heat support/crystalloid (for feline donation)
Reward for donor post donation
Canine donation process:
Canine donors should have a TPR, weight, physical exam and CBC before each donation (with full lab
work and heartworm screening annually). Place blood collection bag on gram scale and zero out. Donor
is laid in lateral recumbancy (on previously pheromone sprayed bedding), extending the head for
visualization of the jugular vein (It is ideal to alternate jugular veins with each donation). Have assistant
hold off the jugular vein, and once visualized clip a 2x2 inch area for venipuncture. Use a three scrub prep
in the shaved area. Insert needle from collection bag into the jugular vein, and collect approximately 475
grams (maximum donation is 22ml/kg). Be sure to gently agitate the collection bag during donation to
adequately mix anticoagulant and blood. Once the desired amount has been collected, clamp line,
remove and cap the needle. Apply a neck wrap, and leave in place for approximately 1 hour. Reward
donor with a treat or toy to reinforce the positive aspects of the experience. It is imperative to monitor the
donor closely post donation for any signs of hypotension, weakness, and pale mucous membranes. It is
also suggested to offer a small meal after donating.
Feline donation process:
Feline donors should also have a TPR, weight, physical exam, and CBC before each donation (with full
lab work and heartworm screening annually). It is highly suggested that cats be anesthetized for blood
donation. Have an anesthetic machine, monitoring equipment, heat support, and endotracheal tubes
prepared. It is suggested to mask the cat down to allow intubation, vs. a tank method of anesthetizing.
This will vary however, with donor compliance. Once the donor has been intubated, have assistant
monitor vitals during donation. Similar to dogs, hold off and visualize the jugular vein, being sure to
alternate jugular veins with each donation. Shave a 2x2 inch area and use a three scrub prep at the site.
Using the needle on the collection system, insert into the jugular vein. Collect approximately 50mls
(maximum donation is 15ml/kg) while mixing gently with anticoagulant. Collection amount varies with the
type and amount of anticoagulant and preservative used. Remove needle once collection is complete,
cap needle and place bandage on neck. Leave neck wrap in place for approximately 1 hour. It is
suggested to administer SQ fluids, equivalent to the volume of blood taken from the donor. Recover from
anesthesia and monitor closely until fully awake. It is recommended to offer a small meal after donation.
Blood Components and Separation
To maximize blood products and ensure transfusion safety, component therapy is strongly relied
upon. Separation of blood products after donation, along with proper handling and storage is necessary.
Once you have collected your blood, it is then important to make aliquots using line strippers and metal
sealant clamps/heat sealant. Aliquots will allow for future cross matching without spiking a unit. Once
aliquots are made, blood product separation is achieved using a centrifuge at 5,000 rpms for 8 minutes.
This will separate the unit into packed red blood cells and plasma. The use of a blood product separator
stand will remove the plasma from the unit, creating a unit of prbc’s and plasma. Plasma aliquots should
also be made for future cross matching. Depending on the preservative used, prbc’s can typically be
stored 21-35 days at 1-6̊ C. Plasma (if frozen within 8 hours if collection) can typically be stored for 1 year
at -18̊ C, and maintain coagulation factors. This is then labeled fresh frozen plasma. If plasma is not
frozen within the allotted amount of time, is thawed and re-frozen, or has been frozen greater than 1 yr it
is, then labeled as frozen plasma and no longer has viable coagulation factors. Frozen plasma can be
stored for an additional 4 years. If whole blood is desired, do not centrifuge unit, and it will remain fresh
whole blood for 6-8 hours after collection. Fresh whole blood not only contains red blood cells, but also
viable platelets, coagulation factors, albumin, and plasma proteins.
Complications and Contraindications
Complications can arise when maintaining a blood bank. What is important, is how we address
these problems. Pre-donation screening is one avenue to prevent complications and contraindications.
This can help detect any changes lab work, health, and well being in the donor. This is especially
important when conversing with the owner of the volunteer donor. Be sure to ask if there are any health
changes, new medications, or behavioral changes as it may be contraindicated to donate at that time.
These questions ensure the safety of the transfusion recipient. Also, when a donor is not cooperative, or
apprehensive regarding the donation process, it can be beneficial to administer mild sedation. This not
only eases the donor, it allows for a smooth collection. When choosing a sedative, it is important to
consider the effects it will have on the cardiovascular system. Butorphanol and midazolam can typically
be safely used due to their cardiorespiratory sparing effects. Additional problems that arise during
donation are inadequate collection, in which case the unit should not be salvaged. Inadequate collection
can lead to citrate toxicity.
Recent Findings
There are some recent findings that cause us to take note, and possibly change blood banking
protocols in the future. Leukoreduction filters, though still being studied, may decrease the risk of nonhemolytic febrile transfusion reactions. This is one of the most common transfusion reactions seen. The
theory is that by removing donor leukocytes, there is a decrease in markers of inflammation.
Leukoreduction filters are cost prohibitive however, and require additional research.
The DAL antigen is a recently discovered dog erythrocyte antigen and requires attention when
transfusing Dalmations in particular. This antigen exists commonly in most dogs, but is not found in some
Dalmations. Thus transfusing a dog that does not have the antigen, with the DAL antigen can lead to
severe transfusion reaction. It is strongly recommended to cross match any Dalmation before transfusion.
More recently, this antigen is found to be lacking in Dobermans as well. Cross matching Dobermans prior
to transfusion is also suggested.
MiK is an antigen that has been recently identified in cats. MiK is found to be present in most
cats; however some have naturally occurring antibodies against this antigen. If a cat has naturally
occurring antibodies to MiK, and is transfused with this antigen, hemolytic transfusion reaction will occur.
The importance of cross matching each cat prior to transfusion must be stressed.
Xenotransfusion is the transfusion of blood from one species to another. This has been studied in
the past with k-9 to feline transfusions. However these studies are dated and patients had severe and
often fatal transfusion reactions. This practice is not currently recommended, and requires further study.
Cryopreservation (freezing) of red blood cells is currently performed in human medicine, in cases
of mass casualty, by some of our armed forces. Through a process of glycerolization and
deglycerolization of red blood cells, the product can be considered to have a stable shelf life of 10 years.
This process does require special equipment and tools. However, by removing the plasma and washing
the white blood cells, there is a significant decrease in transfusion reactions. Some articles show
evidence of virtually no transfusion reactions with this product. There are no current studies using this
cryopreservation process in veterinary medicine.
When starting up a blood bank, or designating a hospital pet for donation, it is imperative that
appropriate screening be performed. It is also important to be aware of new technology and findings in
regard to blood banking and transfusion medicine. In order to maintain a productive, prosperous, and
efficient blood bank, strict protocol and standards must be met.