Transfusion Medicine

Key Learning Objectives.

Key Learning Objectives:

• Compare and contrast Fresh Frozen with Frozen Plasma in terms of activity and indications
• Compare and contrast Cryoprecipitate with Cryosupernatant in terms of activity and indications
• Compare and contrast Fresh Whole Blood with Stored Whole Blood in terms of activity and indications
• Explain the indications for and activity of packed red blood cells
• Describe how plasma products should be stored and state the shelf life of each
• Describe how red cell products should be stored and why it is important to maintain optimal unit quality and state the shelf life of each
• Define the term ‘storage lesion’ and explain the impact they have on red cell units  
• Discuss the different platelet products available and any storage considerations
• Identify the albumin products available
• Describe the concept of vein-to-vein traceability and why it is important and explain how this can be achieved in the practice setting
• Describe the process of feline blood collection to include donor selection and criteria, screening, equipment required and the process of donation and donor care
• Describe the process of canine blood collection to include donor selection and criteria, screening, equipment required and the process of donation and donor care
• Calculate the safe donation volumes for feline and canine donors of a given weight

Key Learning Objectives

• Define the terms ‘antigen’ and ‘antibody’
• Describe the canine antigen system and identify all known antigens and comment on their prevalence and transfusion significance
• Explain the immune response to a non-self erythrocyte antigen exposure on the first encounter
• Define the term ‘sensitisation’
• Explain the immune response to exposure of a non-self erythrocyte antigen following sensitisation  
• State all known feline antigens
• Explain the significance of naturally occurring antibodies when considering transfusions in cats   
• Discuss the importance of blood typing canines and felines and the significance of the DEA 1 antigen and AB Type in red cell and plasma product selection
• Explain Feline Neonatal Isoerythrolysis and state strategies that can be employed to reduce the risk of neonate death
• Explain the impact of the major cross match on recipient safety for transfusion naïve and non-naïve canine and feline recipients
• Explain when a minor cross match may be employed and how this differs from a major cross match
• Select a compatible unit based on a cross match result and justify the decision
• Discuss the information that should be passed to a transfusion recipient’s owner at discharge and why

Key Learning Objectives

• Identify where erythropoiesis takes place
• Explain how erythrocytes are formed and identify factors affecting erythropoiesis
• Describe the main morphological differences between immature and mature erythrocytes in dogs
• Describe the appearance and significance of the different reticulocytes in cats
• Define the terms ‘MCV’, ‘MCH’ and ‘MCHC’ and state the information they provide  
• Discuss the limitations of red cell information provided by haematology analysers
• Explain how a diagnosis of anaemia is made and how the anaemia is classified based on the patient’s ability to manufacture replacement red cells and the cause of red cell deficiency
• Identify common erythrocyte abnormalities found on blood smears in anaemic canines and felines and explain how they are formed and an example of a condition where they may be present
• Explain the likely clinical history reported and the physical examination findings commonly associated with anaemia and explain why these signs occur
• Define the term ‘IMHA’ and explain the aetiology and briefly summarise the pathophysiology
• Describe the aetiology of common causes of hypoplastic anaemia
• Discuss the use of blood products in the management of anaemia to include reference to recommendations around unit age and levels of haemolysis

Key Learning Objectives

• Describe the role of platelets in haemostasis and explain how platelet function is assessed
• Define extrinsic, intrinsic and common pathways in relation to coagulation
• Identify the roles of thrombin and fibrinogen in coagulation
• Identify the vitamin-K dependent clotting factors
• Identify common causes of canine and feline hereditary coagulopathies and provide a brief overview of the aetiology
• Identify common causes of canine and feline acquired coagulopathies and provide a brief overview of the aetiology
• Explain the history and clinical examination finding that may be associated with a coagulopathic state
• Describe good technique for the collection of blood samples for coagulation testing
• List the tests that may be used in practice to assess coagulation and briefly outline the techniques involved
• Describe specific nursing considerations for the coagulopathic patient

Key Learning Objectives

Key Learning Objectives

• Explain the difference between the terms immunological and nonimmunological adverse transfusion reaction
• Identify acute immunological reactions and explain their signs, cause and management
• Identify acute non-immunological reactions and explain how the recipient risks might be reduced
• Identify delayed immunological adverse transfusion reactions and explain how they are recognised
• Describe what investigative and reporting action you should take following a suspected adverse transfusion reaction

Key Learning Objectives

• Describe the equipment set up and procedure to perform an autotransfusion for a patient with a traumatic haemoperitoneum
• Identify how the evaluation of PCV can be used when deciding on an autotransfusion following intracavitary haemorrhage
• Compare the use of autologous blood with a whole blood transfusion collected from a donor
• Explain when an autotransfusion would not be performed and why
• Explain the equipment required, set up and the process of autotransfusion for a patient with a traumatic haemothorax
• Outline the technique for cell salvage
• Define the term ‘xenotransfusion’ and explain when and how it would be performed
• Explain the consequences and potential problems associated with xenotransfusion
• Identify other species in which blood transfusions can be performed, summarising, what, if anything, is known about their blood compatibility

Key Learning Objectives.

• Blood banking – history, veterinary blood banking and governance, blood donation and donor safety and welfare, managing the blood supply chain
• Component therapy – what it is, advantages and disadvantages compared to use of whole blood, blood products and their manufacture; techniques and quality assurance

Key Learning Objectives:

• The indications for and action of each blood product
• Storage and shelf life for each blood product
  • Fresh Whole Blood
  • Stored Whole Blood
  • Packed Red Blood Cells
  • Plasma: Fresh Frozen Plasma, Frozen Plasma, Cryoprecipitate, Cryosupernatant
  • Platelet Products
  • Albumin
• Storage lesions
• Vein to vein traceability
• Blood collection in canines: donor criteria, equipment, technique
• Blood collection in felines: donor criteria, equipment, technique

Key Learning Objectives

• What antigens are and how they affect the immune system?
• The significance of antigens and alloantibodies
• Canine erythrocyte antigens and alloantibodies
• Feline erythrocyte antigens and alloantibodies
• Blood typing: the different techniques, how it is performed
• Type compatibility
• Cross matching: what it is, when it is used, the different techniques, interpretation of the results and how they influence the transfusion
• The PBB Cross Match Service
• Important considerations when discharging a blood product recipient

Key Learning Objectives

• Erythropoiesis: where it takes place, the developmental stages and the morphology of erythrocytes as they mature in canines and felines
• Factors influencing erythropoiesis
• Red cell evaluation using the haematology analyser and blood smears
• Diagnosing and classifying anaemia
• Erythrocyte abnormalities that may accompany anaemia, their identification and significance
• Common haemolytic anaemias in canines and felines
• Common hypoplastic anaemias in canines and felines
• Blood product of choice for management of anaemia

Key Learning Objectives

• Basic haemostasis: platelet appearance and function, extrinsic, intrinsic and common pathways, sequential factor activation and clot breakdown
• Common hereditary and acquired coagulopathies encountered in canines and felines
• The clinical signs and physical examination findings associated with clotting disorders
• Tests used in practice to assess coagulation: BMBT, APTT, PT, TEG
• The use of blood products in the management of coagulopathies

Key Learning Objectives

• Factors to consider when deciding to transfuse
• How to correctly prepare units of red cells and plasma for administration
• How to safely administer blood products including recipient preparation and monitoring (plasma and red cell)
• Calculating infusion volumes and rates for a range of different patients and products
• How and when to split blood product units to smaller quantities

Key Learning Objectives

• Factors to consider when deciding to transfuse
• How to correctly prepare units of red cells and plasma for administration
• How to safely administer blood products including recipient preparation and monitoring (plasma and red cell)
• Calculating infusion volumes and rates for a range of different patients and products
• How and when to split blood product units to smaller quantities

Key Learning Objectives

• What autotransfusion is and when it may be performed
• The technique of cell salvage and its benefits and limitations
• The use of Xenotransfusions in veterinary practice
• The use of transfusions in species other than the dog and cat