Feline Plasma

Manufacturer: A.B.B.

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
Frozen (1 unit)	-0-	-0-	approx. 20 mL	approx. 5 mL	approx. 25 mL	23-27 mL

FELINE PLASMA, Frozen is a transfusion product aseptically obtained from healthy cats maintained in an isolated, controlled access colony. Blood is not pooled (i.e. each unit of blood is from a single-donor) and euthanasia donors are never used. All colony donors are serologically negative for Feline immunodeficiency virus and Feline leukemia virus. The blood type of each donor cat is indicated on the product label. The colony receives intensive on site veterinary health care, and all animals are current on immunizations, to include: Feline rhinotracheiti, calici, panleukopenia, pneumonitis, and rabies.

The anticoagulant CPDA-1 is present. It consists of citrate, phosphate, dextrose, and adenine.

A unit of FELINE PLASMA, Frozen is prepared via the centrifugation or sedimentation of feline whole blood. A unit of FELINE PLASMA, Frozen is prepared at any time up to five days after the expiration date applicable to the original unit of whole blood. Clinically, this results in reduced amounts of some coagulation factors in the older product, as well as slightly increased levels of potassium and ammonia; however, such plasma is a viable source of the other components of plasma such as albumin, globulins, and electrolytes, as well as replacement fluid volume. A unit of FELINE PLASMA, Frozen has a total fluid volume of approximately 25 mL; and a shelf-life of five years.

Feline Plasma Indications

FELINE PLASMA, Frozen when properly thawed, is indicated for parenteral replenishment of non-labile coagulation factors, albumin, globulins, electrolytes, and fluid volume, as indicated by the clinician's/internist's evaluation of the patient.

Feline Plasma Dosage And Administration

Blood Filter: A blood filter should always be used when administering plasma. 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) cap (or peel back one tab on some bags) 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 port found on the bags should remain in place. Non-vented fluid administration sets should be used when 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 adapter end of the Venoset into the female end of a Hemo-Nate neonatal filter,.

3. Then attach the male end of the filter to the female end of an extension set.

4. 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 plasma from the blood bag's needle port into a sterile syringe, then aseptically place the Hemo-Nate filter between the syringe and a fresh sterile needle/catheter, before transfusing.

A needle port can be added to the plasma bag by inserting a Hemo-Tap port into one of the diaphragm ports.

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 feline 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. Following the initial 30 minute trial infusion, in a animal with a normal state of hydration, plasma may be infused at a rate of 10 mL/lb. BW per 24 hours (22 mL/kg BW per 24 hours). For hypovolemic patients the rate may be increased up to 10 mL/lb. BW per hour; however, given the wide range between those two rates, close monitoring of the patient is essential, with the actual rate being adjusted accordingly.

4. 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).

5. If plasma is being administered for hypoproteinemia, a suggested dose is 6 to 10 mL/kg BW (@ 2.7 to 4.5 mL/lb. BW).

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 CVP may be utilized in some cases. In all cases, infusion rates should be calculated (rather than estimated) and closely monitored.

Contraindication(s)

The plasma was frozen in a horizontal position then stored upright. If the frozen plasma bag shows cracks or signs of premature thawing and refreezing (ie. thicker at the bottom than at the top) do not administer.

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 cat.

Precaution(s)

1. Frozen plasma bags must be carefully handled to avoid cracking the plastic bags and to avoid contamination during thawing. Thawing should be conducted at 86 to 98.6°F (30 to 37°C). Do not exceed 98.6°F at any time. The use of a controlled temperature circulating warm water bath is the preferred thawing method. Microwave thawing is not recommended.

2. Always conduct a minor cross match before transfusing plasma.

3. Infusion of plasma should begin within six hours of thawing. Do not re-freeze plasma once it has been warmed above 50 degrees.

Frozen Plasma has a shelf-life of five years from the date of collection of the original unit of whole blood. They should be maintained in a freezer at below 0°F. (chest type freezers work best). Store the frozen plasma bags in a vertical position (to detect thawing, as they were originally frozen in an horizontal position). Caution, the defrost cycle on some freezers allows the temperature to briefly rise above zero. This can be partially compensated for by sandwiching plasma bags between bags of deep frozen artificial ice. (This technique will only work if the artificial ice has been pre-frozen to a temperature of below 0°F).

A method of monitoring freezer and refrigerator temperatures is to install an indoor/outdoor thermometer on the freezer, such that the sensor is inside the freezer, yet the gauge is mounted on its casing so that the temperature can be easily read without opening the door or lid.

It is recommended that one of the hospital technicians view and record, at least twice a day, the internal temperature of the plasma freezer.

Feline Plasma 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. Use gloves when handling the dry ice, which is used when shipping frozen plasma.

4. Do not allow dry ice to contact bare skin.

5. 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.

6. For use in domestic cats 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 any of these blood products without a blood filter.

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

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

References

Available upon request.

Presentation

Units of FELINE PLASMA, Frozen are supplied frozen (packed in dry ice), in blood grade plastic bags (with one IV set coupling port, and reference aliquots [tubing segments]).

Nac No.

13980030