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Companion animal practice

Blood transfusions in dogs and cats

1. Indications

Jenny Helm and Clare Knottenbelt

Transfusion therapy is the mainstay of supportive treatment for dogs and

cats with anaemia. The commercial availability of blood and blood products
for dogs has resulted in an increase in the number of patients benefiting from
Jenny Helm graduated from transfusion therapies. This article, the first of two discussing the use of blood
Glasgow in 2005, after which transfusions in dogs and cats, outlines the indications for transfusion therapy
she undertook a small animal and describes the different options available. Part 2, to be published in the
rotating internship at the Royal June issue of In Practice, will discuss the practicalities of blood collection in
Veterinary College and spent a situations where blood products are either unavailable or inappropriate, and
short time in small animal practice. will describe how to administer transfusions safely.
She subsequently returned to
Glasgow to undertake a residency
in oncology and internal medicine
and where she is currently
oncology clinician at the small Why transfuse?
Key facts
animal hospital. She holds the
RCVS certificate in small animal Anaemia is the most common reason for administering ■■ Transfuse like with like. Blood transfusions
medicine and is working towards a blood transfusion in veterinary practice. It can be should be carried out using the same blood group
the European diploma in internal the result of blood loss (haemorrhage or red blood cell for a given species
medicine. destruction) or a lack of red blood cell production (eg, ■■ Replace what is lacking. Only replace what the
bone marrow disease) (see box below). Although blood patient is missing or has lost in order to reduce the
risk of a transfusion reaction
transfusions may be life-saving, they are not a defini-
■■ Blood is a biological drug. It should therefore be
tive treatment for disease. Hence, they are used to: treated in the same way as every other prescribed
■■ Provide support; medication
■■ Correct deficiencies; ■■ Blood products are not a cure. In most
■■ Control disease while an underlying diagnosis is circumstances, blood products do not provide a
found. cure. Instead, they give support until a diagnosis
Patients with a debilitating non-regenerative anae- is reached and/or a treatment is instigated
mia benefit greatly from red cell transfusions (either
whole blood or packed red blood cells) to provide sup-
port while underlying aetiologies are addressed. mucosal ulceration and bleeding), blood transfusions
Clare Knottenbelt graduated Patients with acute haemorrhage usually need vol- can stabilise the patient while diagnostics and treat-
from Bristol in 1994 and worked ume replacement with either crystalloids or colloid ment regimens are implemented.
for a year in mixed practice. fluid therapy initially, but blood transfusion can subse- Animals with haemostatic disorders can also ben-
She subsequently undertook a quently be very beneficial if haemorrhage is severe. In efit from blood products. Plasma contains clotting
residency in small animal internal
animals with chronic blood loss (eg, gastrointestinal factors and proteins that are useful in patients with
medicine at Edinburgh, after which
she became a lecturer at Glasgow,
where she is currently a senior Differential diagnoses for anaemia
clinician in small animal medicine
and oncology, and head of the Regenerative anaemias Non-regenerative anaemias
division of companion animal ■■ Haemolytic disorders (causes/triggers) ■■ Preregenerative anaemias
●● Infectious (viral, bacterial, parasitic) ■■ Anaemia of chronic inflammatory disease
sciences. She holds an MSc in
●● Immune disorders (systemic lupus erythematosus, ■■ Iron-deficiency anaemia
feline transfusion medicine and
hypothyroidism, immunodeficiencies) ■■ Bone marrow disorders
the RCVS diploma in small animal ●● Drugs (vaccines, sulphonamides, methimazole, ■■ Infections (viral, mycoplasma, ehrlichiosis, babesiosis)
medicine. procainamide, cephalosporins, penicillins, ■■ Drugs (chemotherapy, immunotherapy)
propyluracil) ■■ Myelofibrosis
●● Oxidants (paracetamol, phenothiazines, ■■ Myelopthistic disease (neoplasia)
vitamin K, methylene blue, methionine, ■■ Myelodysplasia
propylene glycol) ■■ Pure red cell aplasia
●● Neoplasia ■■ Ineffective erythropoiesis (deficiencies in
●● Genetic predisposition erythropoietin, vitamin B12, folic acid, globins
■■ Haemorrhage or porphyrin)
doi:10.1136/inp.c2226

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Companion animal practice

acquired or congenital coagulopathies. Specific plasma ple diagnostic investigations should be performed to
components (eg, albumin) can also be used to maintain establish whether a transfusion would be beneficial:
oncotic pressure. ■■ Obtain a PCV or haematocrit to determine the
Platelet-rich plasma or platelet concentrate can be degree of anaemia before transfusion. This pro-
used to increase platelet numbers but are not currently vides a baseline for continued monitoring;
commercially available in the UK. However, patients ■■ Examine blood smears to determine:
with severe thrombocytopenia may benefit from fresh ●● If there is polychromasia indicative of regeneration.

blood to replace losses (eg, red blood cells) due to A reticulocyte count is easy to perform following new
on­going haemorrhage. The very small numbers of plate- methylene blue staining but cannot be performed on
lets present in fresh whole blood will not usually cause an air-dried smear;
an increase in circulating platelet numbers, but they ●● Potential aetiologies, such as the presence of Myco­

may slow haemorrhage in severely thrombocytopenic plasma haemofelis (in cats) or leukaemia (indicated
patients, although this theory is controversial. by an abnormal differential white blood cell count
or abnormal white blood cells);
■■ Test for feline leukaemia virus antigen and feline
When to transfuse? immunodeficiency virus antibody. Although trans-
fusions are not contraindicated in retrovirus posi-
The single most important factor that determines the tive cats, the poorer prognosis may influence the
need for transfusion is the patient’s clinical condition. decision to transfuse;
An anaemic patient showing signs of cardiovascular ■■ Evaluate serum or plasma for the presence of ic­terus
compromise (eg, tachycardia, poor pulse quality, weak- or haemolysis;
ness, tachypnoea, collapse) will nearly always require a ■■ Evaluate haemostatic parameters (eg, platelet count,
transfusion. prothrombin time and activated partial thrombo-
In human medicine, an automatic ‘transfusion trig- plastin time) if a bleeding disorder is suspected;
ger’ was set whenever packed cell volume (PCV) in ■■ Perform slide agglutination and/or Coomb’s test if
patients dropped below 20 per cent. This figure has immune-mediated haemolysis is suspected.
been widely debated in the human field and recent These investigations should be carried out before a
evidence suggests that no absolute threshold exists. blood transfusion is given, as the presence of donor blood
Patients with chronic anaemia can have a very low following transfusion will otherwise alter the results.
PCV but will often be relatively stable at presentation, Further tests should be performed as indicated to
so the use of such transfusion triggers is not always determine the underlying cause of the anaemia (eg,
appropriate. Cats tolerate anaemia well and may show routine clinical chemistry, radiography, ultrasonogra-
only mild lethargy at a PCV of 10 to 15 per cent. phy, bone marrow aspiration and biopsy).
Provided they remain unstressed, cats can tolerate a
very low PCV for a number of days; however, the stress
of examination, for example, can trigger sudden car- Blood products
diovascular compromise. Transfusions carry the risk
of adverse reactions, so each patient must be individu- Blood is made up of several components (see diagram
ally evaluated by carrying out a risk-to-benefit analysis below) and the transfusion of specific blood products
that takes into account the clinical condition of the can have distinct advantages. For example, admin-
animal before transfusion. istering packed red blood cells to a normovolaemic
Transfusions are recommended if: patient will reduce the risk of volume overload. In
■■ A patient is exhibiting significant clinical signs of addition, separating one unit of whole blood into two
anaemia; or even three separate blood products maximises the
■■ An animal has a PCV of less than 10 per cent;
■■ An animal’s PCV has fallen rapidly to less than 20
per cent in dogs or 15 per cent in cats.
In patients with a poor or absent bone marrow
Fresh frozen plasma
response, red cells are unlikely to be replenished in the • Clotting factors or fresh plasma
• Plasma proteins
short term and, hence, earlier transfusion may be indi- Cryoprecipitate or
Plasma
cated in order to prevent further clinical compromise. cryosupernatant

Before any blood transfusion is carried out, clini- Platelet-rich plasma or

platelet concentrate
cians should consider:
■■ Is the transfusion necessary? That is, does the bene­
Whole
fit of a transfusion outweigh the risks? blood
■■ What component of blood is the patient lacking? Buffy coat
For example, an animal with immune-mediated
haemolytic anaemia will often only have lost red
blood cells, while a patient with a haemorrhage will
have lost whole blood. Red blood cells Packed red
blood cells
■■ Will the use of component therapy minimise the
risks and maximise the benefits of a transfusion?
■■ How can the effects of a transfusion be assessed?
In addition, when a patient does not require an
immediate life-saving transfusion, the following sim- Separate components of blood that are used to produce a variety of blood products

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Companion animal practice

Doses and rates of blood products

Fresh frozen/
Whole blood Packed red blood cells frozen plasma Cryoprecipitate Oxyglobin
Dose Dose should be calculated Dose should be calculated 10 ml/kg. Doses of up to 30 1 unit per 10 kg 15 to 30 ml/kg (5 to 10 ml/
using the formula provided using the formula provided ml/kg can be used in cases bodyweight kg in cats, but doses of up
in the box below, but a rough in the box below, but a rough with severe coagulopathies to 30 ml/kg can be used in
guideline is 12 to 20 ml/kg guideline is 6 to 10 ml/kg some circumstances)
Dose rate 1 to 4 ml/kg/hour 2 to 4 ml/kg/hour 2 to 6 ml/kg/hour 2 to 6 ml/kg/hour 0·5 to 2 ml/kg/hour
Other Start at a low dose rate and Start at a low dose rate and Beware of volume overload Repeat until Beware of volume overload
considerations increase it gradually while increase it gradually while in cats or small patients bleeding is in cats or small patients
monitoring the patient closely monitoring the patient closely controlled
The doses and dose rates provided above are a guideline only. However, the flow rate may be increased and decreased depending on an individual patient. The total
dosage will also depend on the patient’s needs. Any blood product transfusion should be completed within four hours

benefits obtained from each individual donation (see can therefore be used in many conditions, including
table above). Some blood products are now commer- acute or severe haemorrhage, haemolytic anaemia,
cially available in the UK, but separation of red blood chronic blood loss or non-regenerative anaemia, and
cells and plasma can be performed by many commer- coagulopathies if other blood products are not avail­
cial laboratories. able. Whole blood must be used within four to six hours
of collection to maximise its full range of benefits.
Whole blood
Historically, whole blood was the only canine blood Stored whole blood
product available to veterinary practitioners and, at Stored whole blood is fresh whole blood collected into
present, remains the only blood product available for an appropriate bag (usually one designed and used
cats. in human medicine) that contains an anticoagulant
(eg, citrate phosphate dextrose adenine-1 [CPDA-1]).
Fresh whole blood Whole blood can be stored in a refrigerator at 1 to 6°C
Fresh whole blood contains red blood cells, all clotting for up to 28 days. However, after 12 to 24 hours, many
factors, plasma proteins and anti-inflammatory pro- plasma proteins will be degraded, making the product
teins, with a small number of platelets. Whole blood ineffective in conditions requiring coagulation factors.
As a rule of thumb, 2 ml/kg of whole blood will
raise a recipient’s PCV by 1 per cent or the haemoglob-
Calculating the amount of blood to be transfused in level by 0·3 g/dl. An example calculation is shown in
the box on the left.

Effect on storage on blood cells

Haggis weighs 15 kg and
has a packed cell volume
(PCV) of 10 per cent. His Red blood cells age more rapidly during refrigeration
target PCV has been set than they do in vivo (Gabrio and Finch 1954). Red blood
at 25 per cent. Therefore, cells develop ‘storage lesions’, which include changes in
as determined by the
calculation below, he
morphology, declines in membrane lipid content and cell
requires at least 500 ml rigidity. The cell concentration of 2, 3-diphosphoglyc-
of whole blood (with a erate (2, 3-DPG) is also severely depleted after one week
donor PCV of 40 per cent) of storage. Since 2, 3-DPG is essential for offloading
to achieve this
oxygen to tissues, there is concern that stored red blood
cells might not deliver sufficient oxygen to critically
Blood volume* Weight (Required PCV – Recipient PCV)
= k x x ill patients. However, the clinical impact of depleted
to be transfused (kg) PCV of donated blood
2, 3-DPG has been difficult to prove and it is thought
where k is a constant, which is 90 in dogs and 66 in cats that the levels are restored very quickly in vivo and fresh
The blood volume required for Haggis is therefore: blood offers no real advantage over stored blood in criti-
(25 – 10) cally ill animals (Klein and others 2007).
506·25 ml of
90 x15 x =
40 whole blood
Packed red blood cells
If packed red blood cells were to be used from a donor with a PCV of 62 per cent, then
Packed red blood cells are created by centrifuging a
Haggis would require:
unit of fresh whole blood and removing the majority of
(25 – 10) 326·61 ml of packed
90 x15 x = the plasma components. Packed red blood cells have a
62 red blood cells PCV of 60 to 90 per cent depending on the separation
Since the volume of blood required by a recipient depends heavily on a donor’s PCV, technique. A unit of canine packed red blood cells is
it is important to choose donors with a PCV within the top half of the normal range about 200 to 250 ml and has the same oxygen carrying
whenever possible. Note a unit of commercial packed red blood cells will have a series of
capacity as one unit of whole blood (450 ml). As with
‘straws’ attached to the bag. These straws are full of blood from the individual bag and
whole blood, packed red blood cells can be stored in
can be used for cross-matches or determining a donor’s PCV, without opening the bag
and breaching sterility. a refrigerator at 1 to 6°C for up to 21 days, but some
commercial bags contain extra preservative that can
*Equation from Pichler and Turnwald (1985)
extend the storage time for up to 42 days (Sohmer

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Companion animal practice

and others 2003). The use of packed red blood cells Cryosupernatant
beyond this time can result in transfusion reactions Cryosupernatant is the plasma that remains following
(see Part 2). As packed red blood cells contain only a separation of the cryoprecipitate as described above.
small amount of plasma, they have a minimal effect on It is a source of all coagulation and plasma proteins,
oncotic pressure (5 mmHg compared with 20 mmHg except for clotting factors VII, VIIIc and XIII, fibrino-
in whole blood) and may therefore be safer than whole gen and vWF. When stored at –18°C, it is stable for one
blood in patients prone to volume overload (eg, those year. Cryosupernatant can be used for the treatment of
with cardiac or renal dysfunction). Packed red blood most clotting factor deficiencies, except haemophilia A
cells are indicated for animals with haemolytic anae- and von Willebrand’s disease, and can also be used for
mia, chronic blood loss or non-regenerative anaemia. plasma protein deficiencies.
As a rule of thumb, 2 ml/kg of packed red blood
cells will raise a recipient’s PCV by 2 per cent or the Haemoglobin-based oxygen-carrying
haemoglobin level by 0·6 g/dl. solutions
Oxyglobin (OPK BioTech) is a sterile haemoglobin-
Fresh frozen plasma based oxygen-carrying solution made from bovine
Fresh frozen plasma contains clotting factors and haemoglobin. It is only licensed for the provision
other plasma proteins, but must be frozen within six of oxygen-carrying support in dogs with anaemia,
hours of collection to prevent degradation of the clot- but its use in cats has been reported. Oxyglobin is a
ting factors. Once frozen, it can be stored for up to one potent colloid with an osmolarity of 300 mOsm/litre
year at –18°C. However, in a normal household freezer and must therefore be used with caution in patients
(typically at –4°C), fresh frozen plasma will begin to with cardiorespiratory or central nervous system dis-
degrade after two to three months. eases, or those with oliguric renal failure. Oxyglobin
Fresh frozen plasma is administered at a total dose should also be used with care in cats due to the risks
of 10 to 30 ml/kg given over four hours for the treat- of volume overload and possible pulmonary bed
ment of coagulopathies (see table on page 186). vasoconstriction.Followingadministration,Oxyglobin
Fresh frozen plasma is generally indicated for ani- causes discoloration of the mucous membranes, sclera
mals with inherited and acquired coagulopathies and and urine, making clinical assessment difficult. It
in patients with prolonged clotting times undergoing also interferes with some biochemical analysers. The
invasive procedures (eg, liver biopsy). It can be used for product half-life is proportional to the dose, with over
some plasma protein deficiencies (eg, immunoglobu- 90 per cent being metabolised and excreted within a
lin) and may be useful in providing antiparvovirus week of administration. Oxyglobin is available in 125
antibodies and immunoglobulins in cases of parvo­ ml foil-wrapped sterile bags with a shelf-life of three
virus infection, although conclusive evidence is lack- years (when stored at 2 to 30°C) but, once opened,
ing. However, because the protein content of a single the bags should be refrigerated (to minimise bacterial
unit of fresh frozen plasma is low, it should not be used contamination) and used within 24 hours. The rate of
to elevate protein concentrations or to maintain blood administration depends on the patient’s volume status
pressure in patients with hypoalbuminaemia. The and ranges from 0·5 to 2 ml/kg/hour.
use of fresh frozen plasma in animals with acute pan-
creatitis as a source of alpha-macroglobulin has been Human serum albumin
suggested but remains controversial, unless there is Human serum albumin has been used in recent years
evidence of a concurrent coagulopathy. to provide a source of albumin to dogs with hypoalbu-
minaemia (Matthews and Barry 2005), but can cause
Frozen plasma an immunogenic reaction and should therefore be
Frozen plasma has lost the action of many clotting fac- administered with extreme caution in canine patients.
tors (V, VIII, von Willebrand factor [vWF]) and plas- Canine serum albumin has recently become available
ma proteins, but it still contains vitamin K-dependent in the USA but is not yet available in the UK.
factors (II, VII, IX, X).
Frozen plasma has either been frozen more than six Platelet transfusions
hours after collection, has been thawed and refrozen, Platelet-containing products, such as platelet concen-
or has been frozen beyond the recommended maxi- trate or platelet-rich plasma, are made from fresh whole
mum storage time (see above). This product can be blood by centrifugation at a slower rate than is used for
used in patients with deficiencies of the non-labile the production of packed red blood cells and plasma.
clotting factors (eg, anticoagulant rodenticide toxicity Such products must be used within 48 hours of collec-
and some plasma protein deficiencies). tion and are the only ones available that contain enough
platelets to be clinically useful in thrombocytopenic
Cryoprecipitate patients. In addition, platelet concentrate needs to be
Cryoprecipitate is made up of approximately 20 per cent stored on a rotating or rocking surface to prevent acti-
fibrinogen, 50 per cent clotting factor VII and 30 per vation and aggregation, which usually makes storage
cent clotting factors VIIIc, XIII and vWF. It is separated impractical outside of a blood bank laboratory.
from the plasma fraction of blood using a process of There is some experimental veterinary interest in
controlled thawing and centrifugation. Cryoprecipitate the use of cryopreserved platelets (Appleman and oth-
must be stored frozen at –18°C and is stable at this tem- ers 2009), but these are not available in the UK. In a
perature for up to one year. It can be used in patients patient that is actively bleeding, whole blood may pro-
with inherited clotting factor deficiencies such as hae- vide enough platelets to stop haemorrhage, but this does
mophilia A and von Willebrand’s disease. not usually raise the circulating platelet count.

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Companion animal practice

Matching recipients and donors

Although the availability of blood products for dogs

makes accessing blood easier for this species, it is impor-
tant to remember that precautions should be taken to
ensure compatibility. Dogs that have not previously
received a transfusion can receive uncross-matched
blood and blood products, but all dogs that have had
a previous transfusion or have an unknown history
should ideally be cross-matched before transfusion
with a product containing red blood cells. It is possible
that plasma and platelet transfusion may be contami-
(above and below) Examples of commercially available
nated with red blood cells during the production proc-
blood testing kits
ess, but there is no recommendation to cross-match
canine donor blood before using plasma products.
Cats must always receive type-specific blood and
blood typing is therefore crucial before the first trans-
fusion. At every subsequent blood transfusion or if a
cat’s history is not known, blood typing and cross-
matching are essential. As there are no separated blood
products available for cats, all transfusions will con-
tain red blood cells, and hence donors and recipients
should be appropriately matched before donation.
Once a blood transfusion has been administered,
it is impossible to determine the recipient’s true blood
type. Therefore, typing must be carried out before
transfusions in dogs and cats. In addition, canine
blood products are commercially available as dog Since then, eight different blood groups have been rec-
erythrocyte antigen (DEA) 1.1 negative and DEA 1.1 ognised in the dog, with the major and most immu-
positive, so it is essential to know a patient’s blood type nogenic being DEA 1.1 for which dogs can be either
in order to choose the correct product. positive or negative. The others include DEA 1.2, DEA
3, DEA 4, DEA 5, DEA 7 and a new antigen in dalma-
Canine blood types tians called DAL. DEA 1.1 is the most common blood
Karl Landsteiner, the pioneer of the human ABO type in dogs and, although naturally occurring anti-
system, first discovered canine blood types in 1910. bodies to DEA 1.1 are rare, the determination of DEA

Cross-matching
Cross-matching assesses the effect that recipient serum antibodies have on donor cells (major
cross-match) and the effect that donor serum has on recipient cells (minor cross-match). As
the main aim of a transfusion is to provide the recipient with red blood cells, it is vital that the
recipient’s serum antibodies do not destroy these cells and, in doing so, evoke a transfusion
reaction. The minor cross-match assesses the risk of recipient cell destruction by the donor
serum, which poses a much smaller risk because the volume of transfused serum will
comprise only a small volume of the recipient’s total serum. To perform both major and minor
cross-matches, blood collected in both heparin and EDTA anticoagulants must be obtained
Cross-matching using feline blood.
from both the donor and recipient. (above) Results of a conventional in-house cross-
Cross-matching can be performed by mixing the washed cells and plasma either on slides, matching test. (below) Example of a gel cross-
or in test tubes or well plates. The use of slides, while more rapid, is less reliable as only serum match kit (RapidVet-H; DMS Laboratories) that
with high titred antierythrocyte antibody will show agglutination. Although mixing whole indicates a cross-match type A donor to type B
blood from a recipient and donor may give a crude indication of compatibility, this method cat. The negative control is on the far left and
is unreliable and is not recommended. the positive control on the right. The cross-match
sample in the middle indicates absolute haemolysis
of the sample. (Pictures, Jenny Walton)
Method
■■ Centrifuge donor blood in EDTA anticoagulant at 3000 rpm for 10 minutes
■■ Remove the supernatant (plasma and buffy coat layer) and wash the erythrocytes
by resuspending them in saline
■■ Recentrifuge the cells and remove the supernatant
■■ Resuspend the erythrocytes in saline to make a 3 to 5 per cent solution
■■ Place two drops of cell suspension in contact with heparinised plasma from the
recipient (one to two drops) either on a slide or preferably in test tubes or well
plates
■■ Assess the cell/plasma mixture for haemolysis (diffuse reddening of solution that fails
to settle out) or agglutination (granular appearance)
■■ Perform a minor cross-match in the same way using recipient cells and donor
plasma

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Companion animal practice

1.1 antigen is strongly recommended as this antigen is Canine blood groups

highly immunogenic and will result in antibody for-
Blood type Comment
mation. Naturally occurring antibodies against DEA
DEA 1 Consists of three antigens (DEA 1.1, 1.2, 1.3). A null type also exists
7 are present in 15 per cent of dogs, but DEA 7 anti-
Dogs do not appear to form naturally occurring antibodies to DEA 1.1 and 1.2
gen is rare. These antibodies may be responsible for DEA 1.1 is dominant, while DEA 1.2, 1.3 appear recessive
the occasional mild reactions following first transfu- DEA 3 Not considered clinically significant due to low incidence
sions. To avoid induction of these antibodies, blood Naturally occurring antibodies are found in 20 per cent of DEA 3
that is negative for DEA 1.1, DEA 1.2 and, ideally, DEA 4 High incidence in the dog population
DEA 7 should be used, as the induction of antibodies Antibodies do not occur naturally
can shorten the survival of transfused red blood cells. DEA 5 A low incidence antigen
However, the overuse of DEA 1.1 negative blood as A naturally occurring antibody is present in about 10 per cent of dogs negative
a precaution in untyped dogs does not make best use for DEA 5
of the resources available (given that DEA 1.1 positive DEA 7 Has caused controversy regarding its clinical significance
dogs are more common); therefore, DEA 1.1 positive A naturally occurring antibody is present in 20 to 50 per cent of dogs negative
for DEA 7
blood is preferred in any DEA 1.1 positive recipients.
A number of methods of determining canine blood DEA 6 and 8 There is little information available about these antigens
groups have been described (Giger and others 2005) DAL A new blood group identified in dalmatians
and many are commercially available. The Alvedia May be the cause of alloautobody formation after blood transfusion in dogs
negative for DAL (Blais 2007)
CHROM technique and card system are both readily
available for typing in practice, and are easy to use and
accurate. A study found the Alvedia system had 100
per cent specificity and 88 per cent sensitivity, sug- so the collection and administration of blood in-house
gesting that this test had a very high positive predic- remains the only alternative for cats. In addition, veter-
tive value (ie, the likelihood of a true positive) and an inary surgeons should be able to perform blood collec-
overall accuracy of 93 per cent when compared with tion in emergency situations and to administer blood
a laboratory-based gel test. The in-house card-based and blood products safely.
system also performed well with an overall accuracy of
89 to 91 per cent (Giger and others 2005).
References and further reading
ADAMANTOS, S., BOAG, A. & HUGHES, D. (2005) Clinical
Feline blood types use of a haemoglobin-based oxygen-carrying solution in dogs
Cats have three main blood types (on the AB system), and cats. In Practice 27, 399-405
which are type A, B or AB. The antigens associated with APPLEMAN, E. H., SACHAIS, B. S., PATEL, R., DROBATZ, K. J.,
these types are highly immunogenic and type B cats GROMAN, R. P., KENNEDY, D. R., O’DONNELL, P. A., BRYAN,
have high levels of naturally occurring antibodies. This C. & CALLAN, M. B. (2009) Cryopreservation of canine platelets.
Journal of Veterinary Internal Medicine Volume 23, 138-145
means that fatal transfusions can occur with even tiny
BLAIS, M. C., BERMAN, L., OAKLEY, D. A. & GIGER, U.
volumes of incompatible blood (Callan and Giger 1994). (2007) Canine Dal blood type: a red cell antigen lacking in some
Although type AB cats have no naturally occurring dalmatians. Journal of Veterinary Internal Medicine 21, 281-286
antibody, they posses both A and B antigens and donor CALLAN, M. B. & GIGER, U. (1994) Transfusion medicine.
blood from these animals can therefore cause a signifi- In Consultations in Feline Internal Medicine. Ed J. R. August.
cant reaction in recipients, as their cells are susceptible Philadelphia, W. B. Saunders. pp 525-532
GABRIO, B. W. & FINCH, C. A. (1954) Erythrocyte
to destruction by antibodies in the donor plasma.
preservation. I. The relation of the storage lesion to in vivo
Type A cats possess only low titres of anti-B anti-
erythrocyte senescence. Journal of Clinical Investigation 33,
bodies and so the transfusion of incompatible blood to 242-246
type A cats only results in a mild reaction with minimal GIGER, U., STIERGER, K. & PALOS, H. (2005) Comparison
clinical signs. The life span of the transfused cells, how- of various canine blood-typing methods. American Journal of
ever, will be dramatically decreased and the patient’s Veterinary Research 66, 1386-1392
PCV will fall within days of the transfusion (Callan KLEIN, H. G., SPAHN, D. R. & CARSON, J. L. (2007) Red
blood cell transfusion in clinical practice. Lancet 370, 415-426
and Giger 1994). When compatible blood transfusions
KNOTTENBELT, C. & MACKIN, A. (1998) Blood transfusions
are given, the increase in PCV can be maintained for in the dog and cat 1. Blood collection techniques. In Practice 20,
up to two months. The frequency of blood types in 110-114
cats differs between worldwide geographic areas and KNOTTENBELT, C. & MACKIN, A. (1998) Blood transfusions
breeds (Knottenbelt and others 1999), so it is recom- in the dog and cat 2. Indications and safe administration.
mended that cats undergo blood typing and preferably In Practice 20, 191-199
cross-matching before the first and every subsequent KNOTTENBELT, C. M., ADDIE, D. D., DAY, M. J. & MAKIN,
A. J.(1999) Determination of the prevalence of feline blood types
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Blood transfusions in dogs and cats 1.

Indications
Jenny Helm and Clare Knottenbelt

In Practice 2010 32: 184-189

doi: 10.1136/inp.c2226

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