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Transfusion (Blood Products (Whole blood(WB) (Fresh : RBCs, serum proteins…
Transfusion
Blood Products
whole blood(fresh/stored), packed RBC, platelet-related products
Plasma products : fresh frozen plasma, frozen plasma, cryoprecipitate, cryoprecipitate poor plasma
Whole blood(WB)
Fresh : RBCs, serum proteins, clotting factors, platelets
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Indications : availability, acute hemorrhage, multiple blood components required
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Dose : 2ml/kg increases PCV 1% or kg x {90(dogs) or 70(cats)} x {(desired PCV - patient PCV)/donor PCV}
Packed RBCs(pRBC)
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Indications : hemolytic anemia, chronic blood loss, acute blood loss not requiring colloid support, chronic anemia
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Storage lesion : low pH(lactate, pyruvate), low 2,3-DPG, increased O2 affinity
Dose : kg x {90(dogs) or 70(cats)} x {(desired PCV - patient PCV)/donor PCV} or 1.5ml/kg increases PCV 1%
Fresh frozen plasma(FFP)
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electrolytes, albumin, globulins, coagulation factors and other proteins
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Indications
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Congenital factor deficiency : hemophilia A & B, Von Willebrand's dz
Frozen plasma(FP)
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deficient in factors Ⅴ, Ⅷ, and vWF
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Cryoprecipitate
factors VIII, XIII, vWF, fibrinogen and fibronectin 함유
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Indications : vWD, hemophilia A, fibrinogen deficiency
Dose : 1unit/10kg, q4~12h
Cryo-poor plasma
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Contains factors II, VII, IX, X, AT, albumin and globulins
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Indications : rodenticide toxicity, hemophilia B
Albumin
human & canine albumin ← human albumin은 구하기 쉬우나, anaphylaxis를 유발할 가능성 있음.
indicated in patients w/ hypoalbuminemia(<1.5g/dL), especially if effusion is present or surgery is likely
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Platelet transfusion
Products
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Indications : thrombocytopathia or thrombocytopenia w/ hemorrhage or prior to surgery cf) immune-mediated thrombocytopenia에는 사용하지 말 것
TEG hemostasis system : thrombocytopathia, PRP transfusion에 이용
Oxyglobin-Hemoglobin based oxygen carrier : purified, polymerized bovine hemoglobin solution ← 지금은 구하기 어려움.
Indications
보통 acute, non-regenerative일 때
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degree of anemia, cellular oxygenation, PE
빈혈뿐만 아니라 응고병증, Plt disorders, hypoproteinemia일 때에도 수혈
Clinical judgement : tachycardia, tachypnea, weakness
Pre-Transfusion
Blood donor screening : blood type, CBC, chemistry panel, fecal analysis, infectious dz
Blood typing
Dog erythrocyte antigen(DEA) 1.1; 1.2; 3; 4; 5; 6; 7 ← DEA 1.1과 1.2의 구분이 의미가 없다고 해서 그냥 DEA1이라고 하기도. kit는 현재 DEA1만 있음(다른 type은 보통 고려하지 않음).
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Cross matching test
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Do not guarantee normal RBC survival : delayed transfusion reactions and reactions to donor leukocytes or plasma proteins are not prevented by cross matching.
Hemagglutination test : slide, tube, gel column, immunochromatography(더 선호)
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Transfusion Process
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Monitoring
transfusion rxn이 있는지 확인
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urticaria, vomiting, diarrhea, collapse