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Transfusing IMHA Patients

    • 299 posts
    August 23, 2018 2:12 PM EDT

    Questions submitted during the Underlying Disease Screening in Dogs with IMHA webinar related to blood transfusions:  


    Have you seen a clinical difference in patients that receive fresh PRBCs
    (<2 wks old ) vs older units? 

    I run a large dog blood bank and we get calls for product for IMHA dogs all the time. Do you have a preference for using the blood type of these patients for their transfusion and cross matching any units used? Or would you go with a universal donor always?

     

     

     

    • 14 posts
    August 29, 2018 10:38 AM EDT

    Regarding:  Have you seen a clinical difference in patients that receive fresh PRBCs (<2 wks old ) vs older units? 

    Great question! A very large study showed increased mortality associated with pRBC age only in dogs with hemolysis, the majority of whom had IMHA. We have  just completed a study that adds to human and veterinary studies that show that procoagulant microparticles accumulate in aged units (to be submitted for publication shortly). We have also shown that procoagulant microparticles are increased in some dogs with IMHA. Kidd L, Geddings J, Hisada Y. Procoagulant microparticles in dogs with immune-mediated hemolytic anemia. J Vet Intern Med. 2015;29(3):908-16Others have shown that procoagulant NETS (neutrophil extracellular traps) increase in stored PRBCs and are increased in some dogs with IMHA. Jeffery U, Ruterbories L, Hanel R. et al. Cell-Free DNA and DNase Activity in Dogs with Immune-Mediated Hemolytic Anemia. J Vet Intern Med. 2017.  Sept. 31(5):1441-1450 Interestingly a study investigating the nature of the red cell targets of antibody induced in dogs by Babesia infection showed more reactivity to aged RBCs. Therefore there are a number of reasons why fresh units are indicated in these patients. 

    Regarding:  I run a large dog blood bank and we get calls for product for IMHA dogs all the time. Do you have a preference for using the blood type of these patients for their transfusion and cross matching any units used? Or would you go with a universal donor always?

    This great question is better addressed by the clinical pathologists and others who perform the tests. It is actually addressed in the upcoming treatment of IMHA in dogs consensus statement soon to be published in the Journal of Vetiernary Internal Medicine. I would recommend crossmatching if possible to find the best donor for an individual patient. Apparently autoagglutination interferes with some of the typing POC tests, speaking to a clinical pathologist and the manufacturers may help answer your question. 


    This post was edited by Linda Kidd at August 29, 2018 10:39 AM EDT