Incidence of acute lung injury in dogs receiving transfusions

Thomovsky, Elizabeth; Bach, Jonathan F.

doi:10.2460/javma.244.2.170

Cited by 39 publications

(34 citation statements)

References 16 publications

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“…TRALI is suspected in dogs and has a higher incidence in human patients after FFP than other blood products but has not been confirmed to occur in cats. 28 Suspicion for TRALI was not noted in the medical records of this population.…”

Section: Discussionmentioning

confidence: 79%

Retrospective evaluation of fresh frozen plasma use in 121 cats: 2009–2016

Lane

Sinnott‐Stutzman

2020

J Vet Emergen Crit Care

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Objectives To document indications for fresh frozen plasma (FFP) use in cats, doses administered, and frequency of adverse transfusion reactions (ATR). Design Retrospective observational study from January 2009 to November 2016. Setting Large urban referral and emergency facility. Animals One hundred twenty‐one client‐owned cats that received FFP. Interventions None. Measurements and Main Results Signalment, indication(s), dose, pre‐ and posttransfusion total plasma protein, prothrombin time, activated partial thromboplastin time, as well as possible ATR, primary disease process, and outcome were recorded. Doppler blood pressure was increased posttransfusion (mean pre 99.5 ± 30.8 mm Hg; post 108.5 ± 32.5 mm Hg, P = .027). Cats were significantly less likely to be coagulopathic posttransfusion (P < 0.001). Most common indications were suspected coagulopathy (n = 105, 83%), hemorrhage (n = 45, 35%), and hypotension (n = 32, 25%). Median dose was 6 mL/kg (interquartile range = 3 mL/kg) and was negatively correlated with body weight (r = –.598, P < 0.001). Possible ATR occurred in 17 of 108 (16%, 95% confidence interval [CI], 10–24%) of transfusions. Increased body temperature was most common in 11 of 108 (10%, 95% CI, 5–18%), followed by tachypnea/dyspnea in 8 of 108 (7%, 95% CI, 3–13%). Common primary disease processes included liver disease (n = 41, 34%), neoplasia (n = 19, 16%), and sepsis (n = 15, 12%). Overall mortality was 54%. Improvement of clotting times was associated with increased odds of survival (odds ratio = 2.4; 95% CI, 1.1–5.3; P = 0.023). Conclusions Clinician justifications for FFP transfusions are comparable to that reported in dogs; however, the mL/kg dose is lower. Coagulopathy and blood pressure significantly improve posttransfusion. Possible ATR were as frequent as that reported with feline packed RBCs transfusions and classified as mild.

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Section: Discussionmentioning

confidence: 79%

Retrospective evaluation of fresh frozen plasma use in 121 cats: 2009–2016

Lane

Sinnott‐Stutzman

2020

J Vet Emergen Crit Care

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“…Increases in circulating NET biomarkers in TRALI human patients' blood and presence of NETs in the alveoli of mice and people with TRALI suggest there could be a key role for NETs in TRALI pathogenesis 12,13 . Although the incidence of TRALI in veterinary medicine is likely much lower than it is in human medicine 32 or might not occur at all, 1 the proinflammatory nature of NETs makes them likely players in other transfusion reactions as well 9‐11 . Transfusion of NLR RBC to healthy dogs induces significant inflammation which is eliminated by LR of the RBC units before storage 4 .…”

Section: Discussionmentioning

confidence: 99%

Neutrophil extracellular traps in stored canine red blood cell units

McQuinn

Smith

Viall

et al. 2020

Veterinary Internal Medicne

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Background: Neutrophil extracellular traps (NETs), webs of DNA and citrullinated histones extruded from activated neutrophils cause transfusion-related acute lung injury. Supernatants of stored red blood cell (RBC) units might promote NETosis in neutrophils from the units or from transfusion recipients. Hypotheses: (1) NETs form during storage of canine RBC, (2) leukoreduction (LR) before storage of RBC reduces NETosis, and (3) supernatant from stored, nonleukoreduced (NLR) RBC units induces NETosis in healthy canine neutrophils modeling transfusion recipients. Animals: Six healthy purpose-bred research dogs were utilized for blood donation. Methods: Prospective controlled study. RBC units were collected from each dog, aseptically divided into 2 equal subunits, 1 of which was leukoreduced, and stored for 42 days. Stored units were sampled biweekly for quantification of NET markers citrullinated histone H3 (Western blot) and cell-free DNA (cfDNA) (DNA dye binding). Unit supernatants were applied ex vivo to canine neutrophils and extracellular DNA release representing NETosis was assessed. Results: Markers of NETs increased during RBC storage (cfDNA P < .0001 and citrullinated H3 P = .0002) and were higher in NLR than LR units (day 42 LR cfDNA 0.34 ± 0.82 ng/mL vs day 42 NLR 1361.07 ± 741.00 ng/mL, P < .0001; day 42 LR citrullinated H3 0.19 ± 0.13 AU vs NLR 0.57 ± 0.34 AU, P = .007). Isolated neutrophils did not form NETs when exposed to stored canine RBC supernatant. Conclusions and Clinical Importance: NETosis occurs in stored canine NLR RBC units, and is attenuated by LR before storage. NETs might be mediators of transfusion reactions.

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“…There was no difference in severity of illness between the transfused and nontransfused groups based on acute physiology and chronic health evaluation (APACHE) III scores. A recent prospective study of 54 dogs receiving transfusions of any type reported that 2/54 were suspected to have developed veterinary acute lung injury (VetALI) based on a PaO 2 :FiO 2 ratio < 300, post transfusion development of radiographic pulmonary infiltrates, or development of respiratory compromise . However, as these 2 patients had underlying diseases that already predisposed them for the development of ALI, the role that transfusion played in the development of ALI is unclear …”

Section: Introductionmentioning

confidence: 99%

Controversies in the use of fresh frozen plasma in critically ill small animal patients

Beer

Silverstein

2015

J Vet Emergen Crit Care

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The use of FFP in critically ill patients remains controversial. In the absence of clinical bleeding or a risk for clinical bleeding associated with a planned procedure, treatment use of FFP is not recommended in human patients. There are insufficient data in critically ill animals to enable formulation of recommendations. Further research is warranted in dogs and cats to establish evidence-based guidelines.

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Incidence of acute lung injury in dogs receiving transfusions

Abstract: VetALI occurred in dogs that received transfusions at a frequency similar to that previously reported for ARDS in ill dogs that did not receive transfusions.

Cited by 39 publications

References 16 publications

Retrospective evaluation of fresh frozen plasma use in 121 cats: 2009–2016

Retrospective evaluation of fresh frozen plasma use in 121 cats: 2009–2016

Neutrophil extracellular traps in stored canine red blood cell units

Controversies in the use of fresh frozen plasma in critically ill small animal patients

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