Clinical, hematological, blood gasometric and electrolytic changes in dogs receiving whole blood transfusions

Blood transfusion is a tool capable of saving lives. Patients undergoing blood transfusion usually present several alterations in the acid-base and electrolyte balance, aggravating the condition of critically ill patients. Some studies have demonstrated haematological alterations in certain species that received whole blood transfusions, however, few studies have evaluated acid base and electrolyte changes in dogs undergoing whole blood haemotherapy. The aim of this study was to analyze clinical, hematological, blood gas and electrolyte changes in anemic dogs after whole blood transfusion. Twenty nine dogs transfused due to anemia were enrolled in the study. Donors blood was collected in a transfusion bag containing citrate phosphate adenine dextrose and stored up to 24 h. Blood collections and evaluations were made before and 24 h after the transfusion. Data distribution normality was tested by the Shapiro Wilk Test. The means of the variables were compared by paired t-test. It was observed an increase in diastolic blood pressure and a reduction in heart rate (P < 0.05). There was a not significant increase in systolic blood pressure, temperature, and a reduction in respiratory rate per minute. Erythrocyte, haemoglobin and haematocrit averages were significantly increased after blood transfusion (P < 0.05). It was observed a reduction in the mean values of pH (P < 0.05), potassium (P > 0.05) and ionized calcium (P > 0.05) and an increase in the mean partial pressure of carbon dioxide (pCO2 ) (P < 0.001), bicarbonate (P > 0.05) and sodium (P < 0.05). The probable cause of anemia was monocytic ehrlichiosis (14/29), visceral leishmaniasis (1/29), babesiosis (1/29), co-infection of Ehrlichia canis and Leishmania infantum (2/29), co-infection of E. canis and Babesia vogeli (1/29). It was not possible to determine the etiology of the anemia in ten dogs. Heart rate significantly reduced after transfusion, probably because of the increase in hematocrit, hemoglobin and erythrocyte values. It may be justified by the displacement of extravascular fluid to the intravascular space. Mean values of systolic blood pressure were slightly elevated before transfusion and remained elevated afterwards, while diastolic and mean arterial pressure increased significantly after transfusion. These changes may be due to the morbid condition and may be influenced by many other factors. Haematocrit, haemoglobin and erythrocyte values increased significantly after transfusion, according to what was observed in other studies. The significant reduction in pH and increase in pCO2 reflects the compensatory mechanism for metabolic acidosis to increase ventilation, leading to pCO2 reduction and changes in pH. The reduction in pH due to the contact of the collected blood with conservative solutions is one of the main changes thar occurs during blood storage. It was described significantly lower pH in dogs' whole blood samples stored for more than 24 h in vacutainer plastic containing CPDA-1. We may assume there was no intense pH reduction in the present study because the bags were stored for up to 24 h. Although not statistically significant, the increase of pO2 mean reflects the improvement of tissue oxygen perfusion. It was observed a significant increase in sodium ions. The mean sodium ion concentration before transfusion was very close to the maximum reference value. Hyperkalaemia was not observed, nor was there significant reduction of potassium ions after transfusion. Several studies report hyperkalaemia and transfusion-associated cardiac arrests in humans, associated with infusion of large volumes of blood. Whole blood transfusion increased erythrogram values and did not negatively affect the electrolyte or acid-base status, representing a safe and useful tool in the intensive care of small animals.(AU)

Leucorredução de hemocomponentes na medicina veterinária / Leukoreduction of blood components in veterinary medicine

Essa revisão tem como objetivo informar e atualizar sobre a utilização daredução leucocitária na terapia transfusional, com ênfase na técnica defiltração de leucócitos e suas aplicabilidades na medicina veterinária. Aleucorredução (LR) é um procedimento realizado para reduzir o número deleucócitos de um hemocomponente, a fim de se evitar as reações adversasprovocadas pela exposição dos leucócitos do doador ao receptor. Dentre asvárias técnicas de leucorredução existentes, a filtração tem-se mostradocomo a mais eficiente, com retenção de aproximadamente 99,9% dosleucócitos. Na medicina, a filtração de leucócitos mostrou eficácia naredução de casos de febre não hemolítica, aloimunização, refratariedadeplaquetária e transmissão de citomegalovírus. Estudos com animaistambém observaram a redução dos casos de refratariedade plaquetária emcães e a diminuição da concentração de mediadores pró-inflamatórios debolsas leucorreduzidas armazenadas. A redução de leucócitos dehemocomponentes ainda é pouco conhecida e raramente adotada naterapia de animais. Diversos benefícios vêm sendo relatados para aaplicação clínica da LR, e potencialmente, outros estudos podem serconduzidos com sangue total e seus subprodutos na medicina veterinária.

The article aims to inform and update on the use of leukocyte reduction in transfusion therapy, with emphasis on filtering technique of leukocytes and their applicability in veterinary medicine. Leukoreduction is a procedure to reduce the number of leukocytes from a blood component, in order to avoid the adverse reactions caused by the exposure of leukocytes donor to recipient. Among the various methods of leukoreduction, filtration has proven to be the most efficient, with retention of approximately 99.9% of leukocytes. In medicine, leukocyte filtration was effective in reducing cases of febrile nonhemolytic reactions, alloimmunization, platelet refractoriness and cytomegalovirus transmission. Animal studies also observed the reduction of platelet refractoriness cases in dogs and decreased concentration of proinflammatories mediators of leukoreduction stored bags. The blood components leukocyte reduction is still little known and rarely adopted in the pet therapy. Several benefits have been reported for the clinical application of LR and potentially another studies could be conducted with whole blood and its products in veterinary medicine.

Leucorredução de hemocomponentes na medicina veterinária / Leukoreduction of blood components in veterinary medicine

Essa revisão tem como objetivo informar e atualizar sobre a utilização daredução leucocitária na terapia transfusional, com ênfase na técnica defiltração de leucócitos e suas aplicabilidades na medicina veterinária. Aleucorredução (LR) é um procedimento realizado para reduzir o número deleucócitos de um hemocomponente, a fim de se evitar as reações adversasprovocadas pela exposição dos leucócitos do doador ao receptor. Dentre asvárias técnicas de leucorredução existentes, a filtração tem-se mostradocomo a mais eficiente, com retenção de aproximadamente 99,9% dosleucócitos. Na medicina, a filtração de leucócitos mostrou eficácia naredução de casos de febre não hemolítica, aloimunização, refratariedadeplaquetária e transmissão de citomegalovírus. Estudos com animaistambém observaram a redução dos casos de refratariedade plaquetária emcães e a diminuição da concentração de mediadores pró-inflamatórios debolsas leucorreduzidas armazenadas. A redução de leucócitos dehemocomponentes ainda é pouco conhecida e raramente adotada naterapia de animais. Diversos benefícios vêm sendo relatados para aaplicação clínica da LR, e potencialmente, outros estudos podem serconduzidos com sangue total e seus subprodutos na medicina veterinária.(AU)

The article aims to inform and update on the use of leukocyte reduction in transfusion therapy, with emphasis on filtering technique of leukocytes and their applicability in veterinary medicine. Leukoreduction is a procedure to reduce the number of leukocytes from a blood component, in order to avoid the adverse reactions caused by the exposure of leukocytes donor to recipient. Among the various methods of leukoreduction, filtration has proven to be the most efficient, with retention of approximately 99.9% of leukocytes. In medicine, leukocyte filtration was effective in reducing cases of febrile nonhemolytic reactions, alloimmunization, platelet refractoriness and cytomegalovirus transmission. Animal studies also observed the reduction of platelet refractoriness cases in dogs and decreased concentration of proinflammatories mediators of leukoreduction stored bags. The blood components leukocyte reduction is still little known and rarely adopted in the pet therapy. Several benefits have been reported for the clinical application of LR and potentially another studies could be conducted with whole blood and its products in veterinary medicine.(AU)

ANORMALIDADES CLÍNICAS E LABORATORIAIS EM CÃES TRANSFUNDIDOS COM SANGUE TOTAL

A transfusão sanguínea é uma ferramenta emergencial capaz de salvar vidas, indicada em casos em que há déficit de compostos sanguíneos e necessidade de aumento no transporte de oxigênio em casos de hemorragia, hemólise ou eritropoiese ineficaz. Sua administração está associada a complicações como edema pulmonar, alcalose metabólica e hipocalcemia e o teste de compatibilidade e a tipagem sanguínea são importantes para que algumas das reações sejam evitadas. O objetivo deste estudo prospectivo foi avaliar as alterações clínicas, eletrolíticas e acidobásicas em 29 cães com anemia severa, acima de um ano de idade, submetidos a transfusão sanguínea com sangue total. A avaliação hematológica, mensuração de cálcio e proteína totais e hemogasometria venosa foram realizadas antes e 24 horas após a transfusão. Alterações significativas foram observadas nas médias de eritrócitos, hemoglobina, hematócrito, pH, pCO2 e Na+. A transfusão sanguínea elevou os valores do eritrograma e não desencadeou desequilíbrio acidobásico ou eletrolítico grave, representando uma ferramenta útil e segura na medicina intensiva de pequenos animais. A monitoração dos cães deve ser realizada durante e após a transfusão sanguínea, a fim de detectar qualquer reação transfusional em uma fase inicial, melhorando assim, o prognóstico do animal.

Blood transfusion is a life-saving emergency tool indicated in cases where there is a deficit of blood compounds and the need for increased oxygen transport in cases of bleeding, hemolysis or ineffective erythropoiesis. Its administration is associated with changes such as pulmonary edema, metabolic alkalosis and hypocalcemia, and donor-recipient compatibility testing and blood typing are important for some of them to beavoided. The purpose of this prospective study was to evaluate electrolyte and acid base changes in 29 dogs older than one year with whole blood transfusion. The transfusion was justified by the intense anaemia. The evaluation was performed based on blood count, calcium and total protein measurements and venous blood gas analysis before and 24 hours after transfusion. Significant changes were observed in erythrocyte, hemoglobin, hematocrit, pH, pCO2 and Na media. The blood transfusion increased the erythrogram values and did not trigger acid basic or electrolyte imbalance, representing an useful and safe tool in the intensive care of small animals. These animals should be monitoried during and after blood transfusion, to detect any transfusional reaction at an early stage, thereby improving these animals prognosis.