Transfusion Medicine (Administration)
Posted: Friday, August 27th, 2021 | Updated: Wednesday, December 7th, 2022
Posted: Friday, August 27th, 2021 | Updated: Wednesday, December 7th, 2022
General Administration Guidelines:
Blood products ideally should be administered within 4 hours. The initial infusion rate is given at 0.25-0.5 ml/kg/hr for the first 15 to 30 minutes. Watch for any transfusion reactions such as; low blood pressure, elevated heart rate, elevated respiratory rate, fever, and/or vomiting. A 170-270 microliter filter should be used for blood products. Hemo-Nate blood filters (18 micron) are described to be used for whole blood volumes of 50 ml or less and packed red cell volumes of 20 ml or less. Avoid running concurrently with Calcium containing fluids like LRS or solutions with dextrose. When mixed with LRS, clotting may be initiated and when mixed with dextrose solutions, RBC lysing may occur due to differing osmolalities. Studies have shown blood products may be administered concurrently with 0.9% NaCl and most recently, Plasmalyte 148
Administration Dosages:
1. 20 ml/kg whole blood will raise the PCV by roughly 10%
2. 10 ml/kg pRBC will raise the PCV by roughly 10%
3. 12-20 ml/kg Cryoprecipitate is given as needed every 10 to 12 hours until bleeding stops
4. 10-20 ml/kg FFP or Frozen Plasma is typically given if needed
5. 45 ml/kg Plasma is given for patients needing albumin increased by 1 g/dL
When to Administer Blood:
If the patient is clinical for anemia, administer blood products as needed. Anemic patients generally have an elevated heart rate, elevated respiratory rate, bounding pulses, pale gums, and an overall weakness. Typically, most animals with an acute PCV drop below 15% will require a blood transfusion. Occasionally, you will have patients that are hypotensive with a prolonged capillary refill time and hypoxemic as well
When to Crossmatch:
Crossmatching is the golden standard. However, some situations require immediate attention and blood products may have to be given as soon as possible in order to save a life. A patient must be crossmatched after 4-5 days of receiving an initial transfusion
How to Administer:
Start the transfusion very slowly and monitor patient vitals every 10-15 minutes. Administer blood products at a rate of 0.50 to 1 ml/kg/hr during this time. Stop the transfusion if you notice any sign of a transfusion reaction. If there is no reaction during the first 15 minutes, gradually increase the delivery rate up to your desired ml/hr. It's recommended that patients with cardiac concerns have a maximum transfusion rate of 3 ml/kg/hr and normovolemic patients a maximum rate of 10 ml/kg/hr. If needed, blood may be given as a bolus at 5-10 ml/kg doses in severe cases of hemorrhagic shock. Temporarily postpone fluid therapy and any intravenous medications if additional venous access has not been obtained. Steroids and anti-histamines are not indicated prior to a transfusion because of their ability to mask transfusion reaction signs. Note any pigmenturia, hemolysis, vomiting, facial edema, hives, or abnormalities of the patient prior to the transfusion. Discontinue or slow the transfusion if you notice that the temperature of the patient is rising more than 1.5 degrees F above the initial temperature, if the heart rate is 1.5 times higher than the initial heart rate, or if the respiratory rate is 1.2 times higher than the initial value. Administering via a free drip protocol is the golden standard. Transfusions given via a syringe or fluid pump are known to damage the red blood cells
Blood products ideally should be administered within 4 hours. The initial infusion rate is given at 0.25-0.5 ml/kg/hr for the first 15 to 30 minutes. Watch for any transfusion reactions such as; low blood pressure, elevated heart rate, elevated respiratory rate, fever, and/or vomiting. A 170-270 microliter filter should be used for blood products. Hemo-Nate blood filters (18 micron) are described to be used for whole blood volumes of 50 ml or less and packed red cell volumes of 20 ml or less. Avoid running concurrently with Calcium containing fluids like LRS or solutions with dextrose. When mixed with LRS, clotting may be initiated and when mixed with dextrose solutions, RBC lysing may occur due to differing osmolalities. Studies have shown blood products may be administered concurrently with 0.9% NaCl and most recently, Plasmalyte 148
Administration Dosages:
1. 20 ml/kg whole blood will raise the PCV by roughly 10%
2. 10 ml/kg pRBC will raise the PCV by roughly 10%
3. 12-20 ml/kg Cryoprecipitate is given as needed every 10 to 12 hours until bleeding stops
4. 10-20 ml/kg FFP or Frozen Plasma is typically given if needed
5. 45 ml/kg Plasma is given for patients needing albumin increased by 1 g/dL
When to Administer Blood:
If the patient is clinical for anemia, administer blood products as needed. Anemic patients generally have an elevated heart rate, elevated respiratory rate, bounding pulses, pale gums, and an overall weakness. Typically, most animals with an acute PCV drop below 15% will require a blood transfusion. Occasionally, you will have patients that are hypotensive with a prolonged capillary refill time and hypoxemic as well
When to Crossmatch:
Crossmatching is the golden standard. However, some situations require immediate attention and blood products may have to be given as soon as possible in order to save a life. A patient must be crossmatched after 4-5 days of receiving an initial transfusion
How to Administer:
Start the transfusion very slowly and monitor patient vitals every 10-15 minutes. Administer blood products at a rate of 0.50 to 1 ml/kg/hr during this time. Stop the transfusion if you notice any sign of a transfusion reaction. If there is no reaction during the first 15 minutes, gradually increase the delivery rate up to your desired ml/hr. It's recommended that patients with cardiac concerns have a maximum transfusion rate of 3 ml/kg/hr and normovolemic patients a maximum rate of 10 ml/kg/hr. If needed, blood may be given as a bolus at 5-10 ml/kg doses in severe cases of hemorrhagic shock. Temporarily postpone fluid therapy and any intravenous medications if additional venous access has not been obtained. Steroids and anti-histamines are not indicated prior to a transfusion because of their ability to mask transfusion reaction signs. Note any pigmenturia, hemolysis, vomiting, facial edema, hives, or abnormalities of the patient prior to the transfusion. Discontinue or slow the transfusion if you notice that the temperature of the patient is rising more than 1.5 degrees F above the initial temperature, if the heart rate is 1.5 times higher than the initial heart rate, or if the respiratory rate is 1.2 times higher than the initial value. Administering via a free drip protocol is the golden standard. Transfusions given via a syringe or fluid pump are known to damage the red blood cells
Sources:
Animal Blood Resources International. www.abrint.net
Nusbaum, Rebecca. "Blood Transfusions in Anemic Dogs and Cats". Today's Veterinary Nurse. vol. 4, no. 3. Summer 2021. pp. 49-59.
Poli, Gerardo. MiniVet Guide: Companion Animal Medicine. InHouse Publishing, 2016.
Schoeffler, Gretchen Lee. “Canine and Feline Transfusion Medicine (Proceedings).” DVM 360, 1 Aug. 2009, www.dvm360.com/view/canine-and-feline-transfusion-medicine-proceedings.
Animal Blood Resources International. www.abrint.net
Nusbaum, Rebecca. "Blood Transfusions in Anemic Dogs and Cats". Today's Veterinary Nurse. vol. 4, no. 3. Summer 2021. pp. 49-59.
Poli, Gerardo. MiniVet Guide: Companion Animal Medicine. InHouse Publishing, 2016.
Schoeffler, Gretchen Lee. “Canine and Feline Transfusion Medicine (Proceedings).” DVM 360, 1 Aug. 2009, www.dvm360.com/view/canine-and-feline-transfusion-medicine-proceedings.