Equis ISSN 2398-2977

Blood: transfusion reactions

Contributor(s): Cody Coyne, Mark Holmes, Prof Derek Knottenbelt, Ruth Morgan, Vetstream Ltd

Introduction

  • Reactions seen following administration of blood, most horses receiving blood will show some reaction.
  • There are 8 blood groups in the horse relating to red blood cell surface antigens and others associated with proteins which may lead to incompatibility.
  • During blood transfusion   Blood: transfusion  monitor the recipient horse carefully for signs of reaction.
  • Most reactions cause hemolysis rather than agglutination; this may be very difficult to detect.
  • Cause: transfusion reactions that may be encountered during transfusion of blood, or plasma.
  • The incidence of reaction to plasma infusuion has been reported as approximately 10% in foals.
  • Signs:
    • Immunological reactions:
      • Cardiovascular compromise - tachycardia.
      • Tachypnea.
      • Colic   Abdomen: pain - adult  .
      • Pyrexia.
      • Defecation/diarrhea.
      • Cardiac arrhythmia.
      • Urticaria   Urticaria / angiedema  .
      • Pruritus.
      • Icterus   Mouth: icterus - gums    Sclera: icterus  .
      • Hemoglobinuria.
      • Hemoglobinemia.
    • Non-immunological reactions:
      • Overload (plethora)   →   pulmonary edema.
      • Hypocalcemia   Hypocalcemia    Blood: biochemistry - calcium  (anticoagulant/citrate excess).
      • Hyperkalemia   Blood: biochemistry - potassium  (lysis of red cells releases K+ into circulation).
      • Hemolysis (bad collection/preparation/storage of blood).
      • Micro-aggregates - brain/kidneys, etc will pass through normal blood filters.
      • Infection.
      • Exercise intolerance.
      • Iron toxicity in foals administered large amounts of blood products.

Pathogenesis

Pathophysiology

  • Antibodies in recipient's blood attack surface antigens on donor's red cells leading to hemolysis.
  • Hemolysis releases K+ into the circulation leading to hyperkalemia   Blood: biochemistry - potassium  and cardiac arrythmia   Heart: sinus dysrhythmia  .
  • Fluid overload may lead to pulmonary edema.
  • Excess anticoagulant may lead to hypocalcemia   Hypocalcemia  .
  • Infection may be introduced if blood is not collected   Blood: collection  and administered under aseptic conditions.
  • Hemoglobin in freeform is more insoluble and prone to precipitation within the renal tubules when pH is below physiological levels.

Timecourse

  • Reactions are seen in the immediate period after starting a transfusion.

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Hart K A (2011)Pathogenesis, management and prevention of blood transfusion reactions in horses.Equine Vet Educ23(7), 343-345 VetMedResource.
  • Hardefeldt L Y, Keuler Net al(2010)Incidence of transfusion reactions to commercial equine plasma.J Vet Emerg Crit Care20(4), 421-425 PubMed.
  • Polkes A C, Giguère Set al(2008)Factors associated with outcome in foals with neonatal Isoerythrolysis (72 cases, 19882003).J Vet Intern Med22(5), 1216-1222 PubMed.
  • Wilson E M, Holcombe S Jet al(2009)Incidence of transfusion reactions and retention of procoagulant and anticoagulant factor activities in equine plasma.J Vet Intern Med23(2), 323-328 PubMed.
  • Durham A E (1996)Blood and plasma transfusion in the horse.Equine Vet Educ8(1), 8-12 VetMedResource.


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