Feline Red Blood Cells

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	A-S RBC Nutrient Solution	Total Fluid Volume	Range
FELINE RED BLOOD CELLS (packed RBC's) (1 unit)	-0-	approx. 20 mL	-0-	Approx. 10 mL	approx. 30 mL	28-34 mL

FELINE RED BLOOD CELLS is a transfusion product aseptically obtained from healthy cats 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 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.

A unit of FELINE RED BLOOD CELLS, (packed RBC's) is the highly cellular fluid remaining in the primary blood bag, after approximately 95% of the plasma and CPDA-1 have been aseptically moved into the satellite bag; 10 mL of A-S RBC Nutrient Solution 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 30 mL. Tubing aliquots are present for cross matching.

Feline Red Blood Cells Indications

FELINE 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.

Feline Red Blood Cells Dosage And Administration

The clinician/surgeon should first determine the desired PCV of the recipient. The following formula may be used to calculate the volume of blood to transfuse:

1 mL of whole blood / 1 pound of body weight = Approx. 1.5% increase in PCV of recipient. This is only a guide. Actual increase will depend on PCV of whole blood, blood compatibility, disease process, etc.

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 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) 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 blood 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. 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 adaptor 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 therefore minimizing volume overload.

5. If the bolus technique is preferred, simply aspirate the blood 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.

For bags without an integral needle port, access can be obtained by using a Hemo-Tap Spike.

6. For kittens 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 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, RBC's 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).

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)

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 cat.

Precaution(s)

The product has a shelf-life of 30 days from the date of collection from the donor cat. 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 enhanced by the plastic bag's ability to breathe).

Feline 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 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 without a blood filter.

6. Do not add Lactated Ringer's solution to whole blood. 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 cross matching.

Discussion

Cross matching:

Current research divides feline blood types into three blood groups. Feline blood group A, B, and AB. There is no universal blood type in cats. 95% of the feline population is type A. Unlike dogs, cats are born with antigens against unlike blood types.

It is recommended that 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 cross matching is recommended prior to every transfusion (in addition to using donor blood of the same blood type as the recipient). A major cross match should be conducted prior to each transfusion involving red blood cells. A minor cross match cannot be run on RBC's as the plasma has been removed.

1. Collect 2 mL of recipient blood in a serum 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 both 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 and save. Retain the donor packed RBC's. The recipient serum tube may remain as is.

5. Temporarily ignoring the recipient serum tube, wash the donor packed RBC tube 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 tube of packed RBC's (donor).

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

7. Now prepare two more glass tubes as follows:

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

Tube 2: Two drops recipient serum and one drop donor 4% RBC suspension (major cross match).

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 cross match 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 tube with the major tube.

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

A cross match 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 FELINE RED BLOOD CELLS are supplied refrigerated, in blood grade plastic bags, with one IV line diaphragm port, and reference aliquots [tubing segments]).

Nac No.

13980040