Autotransfusion in the trauma patient

Autologous blood transfusion in dogs with thoracic or abdominal hemorrhage: 25 cases (2007-2012)

OBJECTIVE

To describe the use and outcome following autologous blood transfusion (ABT) in dogs.

DESIGN

Retrospective study (January 2007-July 2012).

SETTING

Private veterinary referral center.

ANIMALS

Twenty-five dogs that underwent ABT secondary to thoracic or abdominal hemorrhage.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

The hospital transaction database was searched using the keyword "autotransfusion" from January 2007 to July 2012. Data collected included signalment, body weight, etiology of hemorrhage, source and method of collection, volumes and method of ABT administration, use of anticoagulant, reported complications, and outcome. Twenty-five dogs were included for a total of 27 ABTs. Causes of hemorrhage included vascular trauma (14/25 dogs, 56%), ruptured tumor (8/25, 32%), and coagulopathy attributed to brodifacoum toxicosis (3/25, 12%). Autologous blood was collected from the abdominal (19/25, 76%), thoracic (5/25, 20%), or abdominal and thoracic cavities (1/25, 4%). Anticoagulant was added to the ABT blood in 13 of 25 (52%) cases. A median ABT volume of 29.3 mL/kg (range 2.9-406.9 mL/kg) was infused through either a 210 μm blood administration filter (21/27, 78%) or an 18 μm hemonate filter (6/27, 22%). Reported complications that may have been associated with ABT included hypocalcemia (4/17, 24%), hemolyzed serum (5/19, 26%), and prolonged coagulation times (4/5, 80%). These complications were considered of minimal clinical significance. Additional blood products were administered in 17 of 25 (68%) dogs. Seventeen (68%) dogs survived to discharge. Cause of death in the remaining cases was euthanasia or cardiac arrest secondary to uncontrollable hemorrhage.

CONCLUSIONS

ABT is an adjunct to volume replacement in dogs with thoracic or abdominal hemorrhage secondary to vascular trauma, ruptured tumor, or anticoagulant rodenticide toxicosis. ABT may be used as bridge to definitive hemorrhage control, particularly when other blood products are not available or affordable. Complications may include hypocalcemia, prolonged coagulation times, and hemolysis.

Transfusion medicine in veterinary emergency and critical care medicine

Transfusion medicine is a vital part of veterinary emergency and critical care medicine. The goals of this article are to review blood banking and the transfusion principles surrounding care of the critically ill or injured small animal, to highlight the differences in emergency/critical care transfusions compared with standard transfusion medicine, and to discuss traumatic blood loss and sepsis as unique entities in emergency and critical medicine.

Autotransfusion in the emergency patient

As the need for blood products increases in the veterinary emergency setting, the technique of autologous transfusion is being re-explored. Analogous transfusions provide an immediate source of blood with known compatibility to the patient. With the advent of passive canister collection systems, the technique is becoming simplified and affordable for the veterinary community. Although complications such as coagulopathies and microemboli have been reported with the procedure, attention to patient selection, technique, and patient monitoring following transfusion greatly minimizes potential drawbacks.