in response to acute blood loss in horses. J. Am. Vet. Med. Assoc. 229 (9): 1458–1462.26 26 Schonauer, C., Tessitore, E., Barbagallo, G., et al. (2004). The use of local agents: bone wax, gelatin, collagen, oxidized cellulose. Europ. Spine. J. 13: S89–S96.
27 27 Sileshi, B., Achneck, H.E., and Lawson, J.H. (2008). Management of surgical hemostasis: topical agents. Vascular. 16 (1): S22–28.
28 28 Garcia‐Morales, L.J., Racmchandani, M., and Loebe, M. (2014). Intraoperative sealant application during cardiac defect repair. Texas Heart Inst. J. 41 (4): 440–442.
29 29 Hart S.K., Sullins K.E. (2011). Evaluation of a novel post‐operative treatment for sinonasal disease in the horse (1996–2007). Equine Vet. J. 43 (1): 24–29.
30 30 Zhao, Y.C. and Psaltis, A.J. (2016). Hemostasis in sinus surgery. Curr. Op. Otol. Head Neck Surg. 24 (1): 26–30.
31 31 Wyn‐Jones, G., Jones, R.S., and Church, S. (1986). Temporary bilateral carotid artery occlusion as an aid to nasal surgery in the horse. Equine Vet. J. 18 (2) 125–128.
32 32 Tennent‐Brown. B.S., Wilkins. P.A., Lindborg. S. et al/ (2010). Sequential plasma lactate concentrations as prognostic indicators in adult equine emergencies. J. Vet. Intern. Med. 24 (1): 198–205.
33 33 Rasmussen. K.C., Secher. N.H., and Pedersen. T. (2016). Effect of perioperative crystalloid or colloid fluid therapy on hemorrhage, coagulation competence, and outcome: A systematic review and stratified meta‐analysis. Medicine. 95 (31): 1–10.
34 34 Gratwick, Z., Viljoen, A., Page, P.C. et al. (2016). A comparison of the effects of a 4% modified fluid gelatin and a 6% hydroxyethyl starch on haemodilution, colloid osmotic pressure, haemostasis and renal parameters in healthy ponies. Equine Vet. J. {early view, doi: 10.1111/evj.12594]
35 35 Waters, J.H. (2013). Intraoperative blood recovery. A.S.A.I.O.J. 59 (1): 11–17.
36 36 Kellett‐Gregory, L.M., Seth, M., Adamantos, S. et al. (2013). Autologous canine red blood cell transfusion using cell salvage devices. J. Vet. Emerg. Crit. Care. 23 (1): 82–86.
37 37 Florey, H. and Witts, L.J. (1928). Absorption of blood from the peritoneal cavity. Lancet. June 30: 1323–1325.
38 38 Waguespack, R., Belknap, J., and Williams, A. (2001). Laparoscopic management of postcastration hemorrhage in a horse. Equine Vet. J. 33 (5): 510–513.
39 39 Wong, D.M., Brockus, C., Alcott, C. et al. (2009). Modifying the coagulation cascade: available medications. Compend. Equine. June: 224–236.
40 40 Fletcher, D.J., Brainard, B.M., Epstein, K. et al. (2013). Therapeutic plasma concentrations of epsilon aminocaproic acid and tranexamic acid in horses. J. Vet. Internal. Med. 27 (6): 1589–1595.
41 41 Tang, Z.L., Wang, X., Yi, B. et al. (2009). Effects of the preoperative administration of Yunnan Baiyao capsules on intraoperative blood loss in bimaxillary orthognathic surgery: A prosective, randomized, double‐blind, placebo‐controlled study. Int. J. Oral Maxillo. Surg. 38 (3): 261–266.
42 42 Gray, S.N., Dechant, J.E., LeJeune, S.S. et al. (2015). Identification, management and outcome of postoperative hemoperitoneum in 23 horses after emergency exploratory celiotomy for gastrointestinal disease. Vet. Surg. 44: 379–385.
43 43 Doyle, A.J., Freeman, D.E., Rapp, H. et al. (2003). Life‐threatening hemorrhage from enterotomies and anastomoses in 7 horses. Vet. Surg. 32: 553–558.
44 44 Hirshberg, A., Wall, M.J., Ramchandani, M.K. et al. (1993). Reoperation for bleeding in trauma. Arch. Surg. 128: 1163–1167.
45 45 Kilcoyne, I., Watson, J.L., Kass, P.H. et al. (2013). Incidence, management, and outcome of complications of castration in equids: 324 cases (1998–2008). J. Am. Vet. Med. Assoc. 242 (6): 820–825.
8 Complications of Blood Transfusion
Margaret C. Mudge VMD, DACVS, DACVECC
The Ohio State University, Columbus, Ohio
Overview
Blood transfusion can be a necessary treatment for intraoperative or postoperative hemorrhage, but transfusion of blood products is not without risk. There are 8 recognized equine blood types with at least 30 different factors within 7 of these groups. There is no recognized “universal donor” and the incidence of adverse reactions to equine blood transfusion is much higher than the incidence for human transfusions. The reported incidence of transfusion reactions in horses transfused with whole blood or pRBCs is 16%, with a 2% incidence of fatal anaphylactic reaction [1]. Immune reactions may involve recipient antibodies to donor red blood cell (RBC) antigens, donor antibodies to recipient RBC antigens, or reactions to plasma proteins, white blood cells, or platelets. Nonimmune reactions can occur when there is excessive overall fluid volume administered or when blood is stored improperly. See Chapter 6: Complications of Fluid Therapy, for information about complications associated with plasma administration.
Complications Associated with Blood transfusion
Immune reactions
Allergic and febrile reactions
Transfusion‐related acute lung injury
Nonimmune reactions
Transfusion‐transmitted infections
RBC storage lesion
Immune Reactions
Hemolytic Transfusion Reactions
Definition
Acute hemolytic transfusion reactions can involve destruction of red blood cells within 24 hours of transfusion, and more often within several hours of transfusion. The hemolysis can involve the donor red blood cells (RBCs) or the recipient RBCs. Hemolysis can be intravascular or extravascular. Delayed hemolytic transfusion reactions occur within 5 days of the transfusion.
Risk factors
Incompatible blood types, especially in a horse that has been previously transfused or exposed to a different blood type (e.g. broodmare) and has developed alloantibodies
Crossmatch‐incompatible blood
Improper storage of blood products (non‐immune reaction)
Pathogenesis
Acute hemolytic reactions typically occur when there is major incompatibility (donor RBCs and recipient plasma), resulting in rapid destruction of the transfused RBCs. Hemolysis of recipient red blood cells can occur if there are RBC antibodies in the donor plasma. Delayed hemolytic reactions occur >24 hours after transfusion, likely due to RBC antibody production shortly after transfusion. Clinical signs of acute hemolysis include hemoglobinemia, hemoglobinuria, and anemia. In severe cases, shock and cardiovascular collapse may occur. Clinical signs with delayed
