4  Case selection for Blood Transfusion in Cattle

Transcript

Greetings veteririans,

In the last presentation we saw about how to collect the donor blood from the donor cows. Now in this we will go and see how to use the collected blood, and how to transfuse them, and out what are the cases, how to be select such cases, right.

The most important thing is the practitioner should assess the essentiality for the transfusions, okay. Since, transfusion is always a little expensive offer, a time consuming one, lot of stressful thing to the animals, so we need to be very very cautious and to decide that. Acute loss of 20 to 25 percent of the blood volume will result in market clinical science like anemia and then maniacal behavior sometimes tachycardia, so identify for such science and decide these things. Then along with your clinical guidance use the PCV as the guidance and acutely if the animal develops a pc of 15 person or less then that is the case you need to go for the transfusion and some of the cases with the chronic PCV or very low PCV with 7 to 12 percent they may even tolerate that low levels without transfusion, but if it gets reduced probably we need to go for a transfusion so PCV has to be taken into account but don’t decide purely based on the PCV because PCV sometimes that’s what I say even with the seven percent PCV the animal may not exhibit such alarming signs so always take into clinical presentation plus PCV for transfusion.

Now we need to know certain basics about the transfusion practices. 75% of the transfused RBCs will get destroyed within 48 hours of the transfusion, so that is the most important thing we need to keep in mind. Whatever we do this RBC will get destroyed within 48 hours almost 70 percent gets destroyed in this point of time. And, what is the transfusion rate we use to administer the blood? We need to use a rate of 10 to 20 ml per kg that will appreciably increase the PCV levels so 10 to 20 ml per kg is the rate with which we need to use. Basically, a non[1]pregnant donors can contribute into 10 to 15 liters of body weight, okay and you can even collect it at two to four weekly intervals, so that is the benefit for the case. Now this is a field collection where just using restraining the animal and with a few people and start using the human blood bag and collect and somebody has to agitate the bag so that it mix up easily. Now once collected you can take them to the laboratory and check at the use the blood weighing monitoring monitor weigh the blood and you can calculate the amount of blood collected and then you can use the transfusion set.

This is the most important thing you can’t use your regular intravenous fluid therapy lines these transfusion sets are special filters, so these transfusions sets should be purchased and used, not the regular IV sets, that is the most important thing and again always ensure which sort of anticoagulant is present in the particular bag. Sodium citrate that is very effective but the other one is ACD- acid citrate dextrose. When we use acid citrate dextrose commonly when you prefer to store the blood we use the ACD if you are going for a direct transfusion you can use the sodium citrate, and once you are deciding for the storage don’t store for more than two weeks, okay, try to use them within that. And use of Heparin not normally a good one. So heparin is basically an unsuitable anticoagulant.

Now the most important point is doing a cross matching you need to do major versus minor cross matching, Okay. In the field conditions it is always easy how we do? Cross matching is just inject 200 ml of the donor blood into the adult, then wait for about 10 minutes, just infuse 200 ml a small volume, wait for 10 minutes, if there is no transfusion reaction occurs then slowly start transfusing the remaining blood, if there is any transfusion reaction occur within this 10 minutes or the first 15 minutes then don’t use that blood. So adverse reactions normally, they are seen in the very young animal, and the pregnant animal, and the adult you may not able to see, and don’t massively transfuse all the volume in a rapid rate, always maintain the rate very very slow.

Which are the needy cases where you need to do? Mainly the Tick borne (TBD) diseases especially a condition called taba, theileria associated bovine anemia where, almost invariably the drug therapy alone is not sufficient, we need to keep transfusing lot of blood for making the animal to survive. Those cases which we do not do blood transfusion many of them succumbs so tawba or theileria associated bone anemia is a typical case where blood blood is blood has to be collected and transfuse. Blood transfusion helps is the clients are very happy when we are making some effort and we do blood transfusion, because they realize the importance how much the doctor takes to save these cattle. So, it is a kind of Public Relationship Building for the veterinary practices and the farmer feels how much effort he and his team has put in. So always make all the best efforts to do transfusions of the field level and the Recipient Cows.

Now which start of the cows we need to select? Any cow which is less than 10 percent PCV. So, these are the ones they require transfusion and those cows between 10 and 15 PCV they also get benefited. So, they will also get benefited from the transfusion. And again please keep it in mind the cows don’t actually look sick until the PCV falls below 12 percent so PCV may get misguide us. So always ensure clinical science plus PCV to do the transfusion decision. Always prepare to watch for transfusion reactions in any case transfusion reaction can happen, if you are doing the transfusion, always keep ready some of the Antihistamine. then adrenaline at least five to 10 ml of adrenaline keep it ready so that if any reaction comes you can use.

Now the veterinarians need to know basically the transfusion reactions in the bovines. It is not a similar one like what you see in the human medicine or small animal practice. Many times you may not even realize these things the reason is we are almost 11 to 13 blood groups, and Bovine red cells do not agglutinate that much easily, and we need to keep in mind the isohaemolysins. Sometimes preformed isohaemolysins may present in a very low low quantity so in such cases repeated transfusions within seven days they carry the risk for transfusion reactions. So, though it is not a very common one transfusion reactions can occur especially if we are going for the repeated transfusions.

Now what sort of transfusion reactions you can see whenever there is things but that’s what I said, usually the reactions are rare and very mild. The commonly observed transfusion reactions are like hiccup, the tachycardia, Tachypnea, sweating. Sometimes tremors, tremors is the most easiest one we can identify, saliva and cough all of a sudden there will be increase in salivation. Lacrimation mostly if it is a incompatible blood lacrimation will happen. Then after transfusion there is every possibility that hematuria and hemoglobinuria can occur. If it is very severe the animal may even collapse. So these are the transfusion reactions you need to watch for in the cattle.

The rate with which you need to administer is 10 ml/ kg/hour. So, it’s a very slow transfusion 10 ml per kg per hour is the transfusion faster rates. Sometimes you can use whenever there is a per acute hemorrhage. You want to rapidly replace blood to prevent collapse and plasma this can be used when there is failure of absorption of the antibodies, especially with the protein losing entropy or protein losing nephropathy you can consider use of plasma. And whenever the protein levels are getting reduced less than three grams and if the admin goes less than 1.5 gram these are the cases where you can use plasma.

Now when you encounter any transfusion reaction how would you manage such transfusion reaction. So usually epinephrine is the one we use, intravenously epinephrine, one in dilution, one in thousand dilution for example about point two to point five ml intravenous are at the rate of four to five ml intramuscularly which you can use if there is a transducer reactions. Either, you can go with low dose iv or about 5ml intramuscularly. Some of the field practice people start using antipyretics even before transfusion is being done, but that is a double edged weapon we may not even able to identify if there is a temperature rise after transfusion. So, it will be better if you go with after the transfusion and to as a time there is a reactions, okay, and blood the other easiest thing is blood or plasma if you give it rapidly it may end up in cardiovascular overload. So, a rapid transfusion result in overload and sometimes acute collapse can also happen. Acute heart failure or hypertension collapse will be happened. And the other drug is Furosemide, why we are using furosemide is when you are giving rapidly there is buildup of overload, to decrease this overload you can use furosemide.

And for transfusion of plasma you can store it using your household refrigerator or even the freezer. The freezer is the best one because at the household we can’t store for longer years, but if you have a professional grade freezer you can store plasma at minus 15 to 20 for almost like a year, because plasma is rich in coagulation factors. If you start using early fresh it will be good, but after two to four months the coagulation factors will start coming down as they are getting destroyed. If you want to really maintain the viability of these coagulation factor then the best alternative is to use minus 80 degree freezes to store your buoyant plasma, almost up to an year or less than 12 months we can use it.

The Administering Plasma okay, again the same kind of special built-in filter should be used at the transfusion set not a regular iv set. And whenever you thawed the most important thing all the frozen plasma has to be thawed before use. Sometimes there could be precipitations and these microaggregates may result in a fatal reaction. So when you thaw the plasma always check it, it is free from the microaggregates. If you just take it in a, and shake it you can easily visualize the microaggregates.

So, in this presentation we saw how to transfuse the collected donor blood as well as the stored blood products like plasma to the cattle. We have a reference material and reading materials given for your further reading. You can go through them if you have any queries please let us know we will be clarifying that.

Thank you