Collection and administration of blood products in horses: Transfusion indications, materials, methods, complications, donor selection, and blood testing

Abstract

Background Blood transfusion is a lifesaving treatment for horses with acute hemorrhage and other causes of anemia. Transfusions improve oxygen delivery to the tissues via increased blood volume and hemoglobin concentration. Certain aspects of equine blood transfusion are challenging, especially in the field situation, and practitioners may be unfamiliar or feel overwhelmed with the process. An understanding of the indications, materials, methods, and techniques as well as donor selection and possible complications will help practitioners successfully implement blood transfusion in clinical practice. Procedures Blood transfusion involves several steps including appropriate donor selection, cross‐matching, blood collection, and administration, as well as monitoring and handling of transfusion reactions. Guidance for each of these steps are detailed in this review. Summary Blood transfusion is an effective and often lifesaving treatment for managing diseases of blood loss, hemolysis, and decreased RBC production. Equine practitioners require a thorough understanding of the indications for blood transfusion, the immunological principles behind compatibility testing and transfusion reactions, and the technical skills to aseptically collect and administer blood products Key points Equine practitioners require a thorough understanding of the indications for blood transfusion, the immunological principles behind compatibility testing and transfusion reactions, and the technical skills to aseptically collect and administer blood products. Because there are over 400,000 possible equine RBC phenotypes, no universal donor exists, and some blood type incompatibilities are likely between any donor and recipient. Therefore, prior to any blood transfusion, donor and recipient blood should be cross‐matched Inadequate delivery of oxygen (Do2) to the tissues, resulting from low hemoglobin (Hb) concentration, is the most important indication for blood transfusion Neonatal isoerythrolysis most commonly occurs following an anamnestic response in late gestation; it rarely occurs following a primary exposure because the immune response is not strong enough to produce clinically significant alloantibody titers.

Effect of donor blood storage on gel column crossmatch in dogs

“…5 However, it is unknown whether storage of equine blood in other anticoagulant-preservative solutions would result in similar loss of crossmatch compatibility over time compared with freshly collected samples. 27 In our study, canine blood crossmatches were performed using CPD-anticoagulated whole blood segments, routinely attached to canine pRBC units for the purpose of crossmatching a recipient to stored pRBCs. Crossmatches that were compatible on day 0 remained compatible in weekly crossmatches performed through day 35, indicating that storage of canine blood in CPD does not lead to spurious incompatibility results over time.…”

“…The recommendation is to use fresh rather than stored blood donor samples for equine crossmatches 5 . However, it is unknown whether storage of equine blood in other anticoagulant‐preservative solutions would result in similar loss of crossmatch compatibility over time compared with freshly collected samples 27 …”

“…Since equine blood transfusions are administered infrequently compared to small animal practice and storage of equine blood is challenging due to the open collection systems often used, blood for transfusion is collected on an as-needed basis, and CPDanticoagulated whole blood segments are not typically available for crossmatching. 27 In an experimental study assessing the effect of donor sample storage on blood crossmatching in horses, blood samples were collected in glass tubes with acid-citrate-dextrose (ACD) solution and refrigerated for 0 to 4 weeks. 5 Saline agglutination and hemolysin tube crossmatches were performed weekly using stored donor samples and compared with crossmatches using fresh blood from the same horses.…”

Blood Transfusion in Equids—A Practical Approach and Review

“…Screening should include testing for Equine Infectious Anemia (EIA), the equine hepaciviruses, and Equine Viral Arteritis (EVA) [ 49 ]. In regions where Brucellosis Piroplasmosis, Glanders and Dourine are endemic, these should be included in screening protocols [ 50 ]. Additionally, it is pertinent to perform hematology, serum biochemistry, and inflammatory marker screenings at regular intervals.…”

Effect of leukoreduction on the metabolism of equine packed red blood cells during refrigerated storage

“…Storage lesions are timedependent modifications of red blood cell (RBC) structure and metabolisms, which increase susceptibility to hemolysis. 7,[10][11][12][13] Storage lesions are widely studied in human transfusion medicine, and in recent decades, metabolomics technologies have contributed insights regarding the molecular changes RBC undergo during refrigerated storage. 11,[13][14][15][16][17] The major strength of metabolomics is the possibility of simultaneously studying a large number of molecules that, through an integrated approach, enrich the understanding of cellular metabolism to improve strategies for donor selection, additive solutions, effect of leukoreduction (LR) or the research of quality markers to improve blood quality and safety of blood products.…”