Effect of cross‐match on packed cell volume after transfusion of packed red blood cells in transfusion‐naïve anemic cats

Abstract

BackgroundNovel feline RBC antigens might contribute to decreased efficacy of RBC transfusion and increased incidence of acute transfusion reactions (ATR).ObjectivesTo examine the effect of major cross‐match in transfusion‐naïve anemic cats on the incidence of acute immunologic transfusion reaction and transfusion efficacy for up to 24 hours after transfusion.AnimalsForty‐eight client owned transfusion‐naïve anemic cats.MethodsProspective, randomized, controlled study. All transfusion‐naïve cats receiving packed red blood cells (pRBC) transfusions from January 2016 to August 2017 were eligible for inclusion. Cats in the study group received cross‐match and blood type compatible pRBCs and cats in the control group received noncross‐matched blood type compatible pRBCs. Incidence of ATR and change in PCV after transfusion was recorded.ResultsNo significant difference in incidence of transfusion reactions between cross‐matched and noncross‐matched groups (CM+ 4/24; 17%, CM– 7/24; 29%, P = .16). No significant difference between groups in mean change in PCV after transfusion scaled to dose of pRBCs administered at any time point after transfusion (immediate: CM+ 0.62 ± 0.59, CM– 0.75 ± 0.48, P = .41; 1 hour: CM+ 0.60 ± 0.66, CM– 0.74 ± 0.53, P = .43; 12 hours: CM+ 0.70 ± 0.55, CM– 0.66 ± 0.60, P = .81; 24 hours: CM+ 0.64 ± 0.71, CM– 0.55 ± 0.48, P = .70).Conclusions and Clinical ImportanceOur results do not support use of the major cross‐match test to increase efficacy of, and to decrease adverse events associated with, RBC transfusion in AB blood typed transfusion‐naïve cats.

Prevalence of naturally occurring non‐AB blood type incompatibilities in cats and influence of crossmatch on transfusion outcomes

“…In a study of 20 hospitalized cats in Germany undergoing serial crossmatching to detect alloimmunization to transfused RBCs, major crossmatch incompatibility was not found in any transfusion‐naive cats 18. The reason for the higher prevalence of non‐AB blood‐type incompatibilities in transfusion‐naive cats in our and another US study15 is unclear, but potential explanations include geographical variation (the United States versus Germany and the United Kingdom), larger sample population (154 transfusion‐naive cats in our study), subtle differences in crossmatch technique, and subjective interpretation of low grade (1+) agglutination reactions, of which the clinical relevance is uncertain. Of the 23 transfusion‐naive cats in our study with non‐AB blood type incompatibilities, 17 cats (74%) had a 1+ major incompatibility, whereas 6 cats (26%) had 2+ to 3+ incompatibility on the major crossmatch.…”

“…A subsequent prospective study evaluating the change in PCV (scaled to the dose of pRBCs) at 4 time points posttransfusion did not detect a difference between cats with (+0.60 ± 0.66%/mL/kg at 1 hour posttransfusion) and without (+0.74 ± 0.53%/mL/kg at 1 hour posttransfusion; P  = 0.43) a pretransfusion crossmatch 15. Similarly, in our study, cats receiving crossmatch‐compatible pRBCs did not have a greater increase in PCV posttransfusion compared to cats without a pretransfusion crossmatch.…”

“…With 3 of 65 blood donor cats having naturally occurring anti‐ Mik alloantibodies,12 the prevalence of naturally occurring, non‐AB RBC alloantibodies would be expected to be at least 5%, not taking into account the possibility of alloantibodies to RBC antigens other than Mik . In a prospective, randomized, controlled study of 48 transfusion‐naive cats in the United States, 24 cats had a pretransfusion crossmatch performed, with 7 cats (29%) incompatible to ≥1 type‐specific pRBC unit 15. In a study evaluating transfusion practices in cats during a 3‐year period at a university teaching hospital in Germany, pretransfusion crossmatching of 60 cats identified a major crossmatch (non‐AB blood type) incompatibility in 1 transfusion‐naive cat 16.…”

“…In our retrospective study, we could not control for these variables, but there was no significant difference in ΔPCV between cats with blood loss or hemolysis compared to other causes of anemia. However, in the prospective study,15 none of the cats received IV fluids during the pRBC transfusions, and PCVs were checked at set time points (0, 1, 12, and 24 hours) posttransfusion. The lack of difference in efficacy (defined as mean change in PCV posttransfusion scaled to the dose of pRBCs) between crossmatched and non‐crossmatched pRBCs administered to transfusion‐naive cats (along with no difference in adverse events) prompted the authors to conclude that there is no support for pretransfusion crossmatching to increase efficacy and decrease adverse events associated with RBC transfusions in AB‐typed transfusion‐naive cats 15…”

“…The frequency of adverse events associated with RBC transfusions in cats has been reported to range from 1.2% to 20.8%, with febrile transfusion reactions being most common 15, 16, 19, 20. Febrile, nonhemolytic transfusion reactions were noted in 5% of cats in our study, with cats receiving AB type‐specific, non‐crossmatched pRBCs having significantly more febrile reactions (8 of 79 cats) compared to cats receiving crossmatch‐compatible pRBCs (4 of 161 cats).…”