Canine Red Blood Cells

Manufacturer: Animal Blood Resources International

Ca Vet. Biol. Lic. No.

83

Active Ingredient(s)

Each 10 mL CPDA-1 contains:

Dextrose (hydrous)	317 mg USP
Sodium citrate (hydrous)	263 mg USP
Citric acid (hydrous)	33 mg USP
Monobasic sodium phosphate (monohydrate)	22 mg USP
Adenine	2.7 mg USP
Water	q.s. USP

Table of Product Contents:

	Whole Blood	RBC’s	Plasma	CPDA-1	Total Fluid Volume	Range
CANINE RED BLOOD CELLS (packed RBC’s) (1 unit)	-0-	approx. 100 mL	approx. 13 mL	approx. 13 mL	approx. 125 mL & 250 mL dbl. unit	115-140 mL

CANINE RED BLOOD CELLS is a transfusion product aseptically obtained from healthy dogs maintained in an isolated, controlled access colony. Blood is not pooled (ie. each unit of blood is from a single-donor) and euthanasia donors are never used. All colony donors are serologically negative for Canine brucellosis, Ehrlichia canis, Borrelia burgdorferi (Lyme Disease), and Dirofilaria immitis. The blood type of each donor dog is indicated on the product label. The colony receives intensive onsite veterinary health care, and all animals are current on immunizations, to include: Canine distemper, hepatitis, leptospirosis, parainfluenza, canine parvo virus, and rabies.

A unit of CANINE RED BLOOD CELLS, (packed RBC’s) is the highly cellular fluid remaining in the primary blood bag, after approximately 80% of the plasma and CPDA-1 have been aseptically moved into the transfer bag; 12 mL of CPDA-1 having then been aseptically added back to the RBC’s to retain the 35 day shelf-life of the original unit; for a total fluid volume of approximately 125 mL. Tubing aliquots are present for crossmatching. 250 mL units are also available.

Canine Red Blood Cells Indications

CANINE RED BLOOD CELLS (packed RBC’s) are indicated for parenteral replenishment of RBC’s (such as in conditions of chronic anemia) and especially in situations where the patient is additionally at risk of fluid volume overload. May be used in conjunction with crystalloids for treatment of acute blood loss.

Canine Red Blood Cells Dosage And Administration

The clinician/surgeon should first determine the PCV of the blood in the donor blood bag by aspirating the contents of an attached numbered tubing segment [reference aliquot] (shake the segment to mix its contents before aspirating), and centrifuging the sample. After ascertaining the microhematocrit of the donor blood, the following formula may be used to calculate the volume of blood to transfuse:

mLs of donor blood needed =

(Recipient wt. [lbs.] x 40 mL / lb.) x (PCV desired - Recipient PCV)

_____________________________________________________

PCV of blood in donor bag

or

mLs of donor blood needed =

(Recipient wt. [lbs.] x 32 mL / lb.) X (Hb desired - Recipient Hb)

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Hb of blood in donor bag

Refrigerated blood should be warmed to room temperature before transfusing. Do not exceed 98.6°F (37°C).

Blood Filter: A blood filter should always be used when administering red blood cells (packed RBC’s). When administering over 50 mL of blood to a patient, use the standard blood administration set with its integral 170-230 micron clot screen filter. When administering less than 50 mL of blood to a patient, the standard blood administration set's filter (with a relatively huge surface area) will trap too much blood. Therefore, when transfusing less than 50 mL of blood, the following configuration is recommended:

1. Remove one (1) red cap (white on some models) from the blood bag's diaphragm port, and insert the spike of the drip chamber end of a Venoset 70 Microdrip set into the now uncovered blood bag diaphragm port. The second red cap, found on red blood cell bags, should remain in place. This second port is available for piggybacking a second IV system into the primary blood bag; or for attaching a transfer bag to extract plasma. Technically, non-vented fluid administration sets are safer then using blood bags. This can be simulated by aseptically replacing the Venoset's air filter with the male end of a 3 mL syringe, with its plunger in place. Never leave the Venoset's air filter port uncovered.

2. Attach the needle adaptor end of the Venoset into the female end of a Hemo-Nate neonatal filter, model #HN-179.

3. Then attach the male end of the filter to the female end of Abbott’s 30 inch IV extension set.

4. Finally, attach the male end of the extension set to an IV catheter pre-positioned in the patient.

With the above technique, transfusion can be obtained via a slow continuous drip over several hours (or longer), therefore minimizing volume overload.

5. If the bolus technique is preferred, simply aspirate the blood (from the blood bag's brown hypodermic needle port) into a sterile syringe, then aseptically place the Hemo-Nate filter between the syringe and a fresh sterile needle/catheter, before transfusing.

Red blood cell bags have an integral brown hypodermic needle port for syringe access.

6. For puppies and other small patients, adding 0.9% NaCl (not Lactated Ringer's) to the blood will tend to reduce its viscosity and therefore facilitate the use of 22 or 24 gauge needles/catheters.

Route of Administration: The jugular, cephalic, and saphenous veins are common sites for IV catheter placement. The intramedullary cavity of the femur and humerus are alternate sites. Additionally, intraperitoneal transfusions have application in selected patients.

Rate of Infusion:

1. There is virtually no rate of blood infusion that is safe for all canine patients; therefore the following are only general guidelines. The actual rate of infusion of blood must be tailored to each individual patient.

2. If clinical conditions permit, the initial rate should be slow (about 0.11 mL/lb. BW over a 30-minute period), in order to observe the patient for transfusion reactions.

(0.11 mL/lb. = @ 0.25 mL/kg).

3. Red blood cells (packed RBC’s) can generally be infused at the same rate as whole blood. Transfusion of red blood cells tends to be safer than whole blood in normovolemic patients with chronic anemia.

In treating chronic conditions with red blood cells, the blood may be administered as part of a continuous drip system in conjunction with 0.9% NaCl in a piggyback set or in a secondary set, or in a Y-set.

In using the continuous drip method, the blood products' volume is merely included in the 24 hour IV fluid requirements of the animal; then the drip rate is calculated by converting the 24 hour volume into a certain number of drips per minute, or per second (depending on if an infusion pump is being used or the drip rate is being visually monitored).

Post-Transfusion Patient Care: During and after transfusions, the patient should be closely monitored. In addition to physical examinations and temperature monitoring, measurement of PCV, urine output, body weight, and EKG are recommended. Measurement of PCV may be utilized in some cases. In all cases, infusion rates should be calculated (rather than estimated) and closely monitored.

Contraindication(s)

Do not administer if the blood bags are leaking or if the supernatant exhibits brown or purple discoloration or if excessive hemolysis is present.

Do not administer (via the same infusion system) in conjunction with other fluids or drugs, except 0.9% NaCl.

Do not administer to species other than the domestic dog.

Precaution(s)

Because these units have 12 mL CPDA-1 added back to them after extracting the plasma, they have a shelf-life of 35 days from the date of collection of the original unit of whole blood. It should be maintained at a temperature of 33.8° to 42.8°F (1 to 6°C), except during shipment, when 33.8 to 50°F (1 to 10°C) is approved. Store the blood bags in a vertical position, with airspace between each bag (ie. avoid a sardine effect - RBC storage survival is apparently enhanced by the plastic bag's ability to breathe - that is one reason why glass is a less desirable storage container for blood).

Canine Red Blood Cells Caution(s)

1. During transfusions, fluid flow rates must be carefully calculated and monitored, based on the patient's size, weight, age, and clinical condition. It is recommended that urine output be monitored as well.

2. Gently oscillate each bag before use in order to mix contents.

3. Complications of transfusions are manifest by a variety of clinical signs including jaundice, fever, cardiac arrythmias, erratic respiration, salivation, hemoglobinuria, edema, DIC, hemorrhage, vomiting, and urticaria. If any of these clinical signs develop, immediately stop the transfusion and institute appropriate supportive measures, as determined by the patient's clinical condition and the clinician's medical judgment.

4. For use in domestic dogs only.

Warning(s)

1. Circulatory overload can occur quickly unless all patient parameters are closely monitored.

2. Do not add medications to the blood bags nor via the same infusion system.

3. In spite of serological screening, disease organisms may still be present in these transfusion products.

4. Platelets are not viable in these products.

5. Do not administer without a blood filter.

6. Do not add Lactated Ringer's solution to red blood cells. It is safest to use 0.9% NaCl as the only fluid/drug administered in conjunction with this product.

7. Transfusion reactions can still occur in spite of correct blood typing and proper crossmatching.

Discussion

Crossmatching: Current research divides canine blood types into eight blood groups. Canine blood group A₁ (DEA 1.1 = dog erythrocyte antigen 1.1) has the most clinical significance, followed by Canine blood group A₂ (DEA 1.2). Canine blood group T_r (DEA 7) has apparently limited clinical significance.

For purposes of identifying the blood types of the dog donors, the phrase A negative indicates that the donor does not possess either the DEA 1.1 or 1.2 antigen. Likewise, the phrase A positive is on blood bags to indicate that the donor is positive for DEA 1.1 or 1.2.

It is recommended that A-/A+ blood typing be a routine presurgical procedure and a routine part of each animal's first physical examination (and recorded in its permanent medical record), in order to facilitate subsequent transfusion therapy.

Blood crossmatching is recommended prior to every transfusion (in addition to using donor blood of the same blood type as the recipient). A major and minor crossmatch should be conducted prior to each transfusion involving red blood cells; a minor crossmatch should be conducted prior to every transfusion of plasma.

1. Collect 2 mL of recipient blood in a serum tube and 1 mL of recipient blood in an EDTA or heparin tube.

2. Remove (cut) one or two numbered tubing segments from the bag of donor blood; gently shake this segment(s) in order to mix the contents; then collect 2 mL of this donor blood into an empty tube (the Animal Blood Bank donor blood already has CPDA-1 anticoagulant in it; therefore do not add more anticoagulant).

3. Centrifuge all three glass tubes at 3400 x G for one minute (or allow the cells to sediment down by letting the samples stand for 30 minutes or longer).

4. Decant recipient plasma, retaining recipient packed RBC’s. Carefully remove and save the donor plasma, retaining the donor packed RBC’s as well. The recipient serum tube may remain as is.

5. Temporarily ignoring the recipient serum tube, wash the two packed RBC tubes as follows: (i) add 2 or 3 mL of 0.9% saline to each RBC tube; (ii) resuspend the cells; (iii) centrifuge as in step (3) above; (iv) discard supernatant, retaining packed RBC’s; (v) repeat this wash two more times, ending with two tubes of packed RBC’s (donor and recipient).

6. In addition to the donor plasma and recipient serum saved from step (4), prepare new tubes as follows: donor 4% RBC suspension (0.2 mL of packed RBC’s plus 4.8 mL of 0.9% saline); and recipient 4% RBC suspension (0.2 mL of recipient packed RBC’s plus 4.8 mL of 0.9% saline).

7. Now prepare four more glass tubes as follows:

Tube G-1: Two drops donor plasma and one drop donor 4% RBC suspension (donor control - should not react).

Tube G-2: Two drops recipient serum and one drop recipient 4% RBC suspension (recipient control - should not react).

Tube G-3: Two drops donor plasma and one drop recipient 4% RBC suspension (minor crossmatch).

Tube G-4: Two drops recipient serum and one drop donor 4% RBC suspension (major crossmatch).

8. If time permits, prepare three sets of the tubes listed in step (7), and incubate one set at 77°F (25°C); one set at 98.6°F (37°C); and the third set at 39.2°F (4°C). If unable to prepare three sets, conduct the crossmatch at 25°C.

9. Now centrifuge all step (8) tubes at 3400 x G for one minute.

10. Examine the supernatant of all step (9) tubes for hemolysis, then gently tap the tubes to resuspend the red cells and observe for agglutination. Compare the control tubes with the major and minor crossmatch tubes.

If the major or minor crossmatch shows any agglutination or hemolysis, it is strongly recommended that a different donor blood be considered for that particular recipient.

A crossmatch should still be conducted even if the donor and recipient are known to have the same blood type.

References

Available upon request.

Presentation

Units of CANINE RED BLOOD CELLS are supplied refrigerated, in blood grade plastic bags (with integral hypodermic needle injection port, two IV line coupling ports, and reference aliquots [tubing segments]).

Nac No.

13980011