This article reviews the use of transfusion medicine in veterinary medicine and discusses current research regarding donor screening and component therapy. Typing and crossmatching methodologies are discussed. Available components, potential uses, and controversies in treatment are also discussed.

Transfusion Medicine in Small Animals

Protein-losing enteropathy is common in dogs but rare in cats. In the vast majority of cases, it is associated with inflammatory bowel disease, intestinal lymphoma, or intestinal lymphangiectasia. The diagnosis is based on identification of hypoalbuminemia and ruling out urinary loss and liver failure. Identification of the intestinal lesion with appropriate biopsy method is important to rule out neoplasm or infectious causes. The treatment is based on intensive nutritional support, therapy for the causative condition, and early monitoring of possibly life-threatening complications, such as hypocobalaminemia, massive pleural or abdominal fluid collection, thromboembolism, and hypocalcemia or hypomagnesemia.

Protein-losing enteropathies in dogs.

Objective
To assess changes in serum albumin concentration (ALB), colloid osmotic pressure (COP), and Doppler blood pressure (DBP) following transfusion of 5% lyophilized canine-specific albumin (CSA) in hypoalbuminemic dogs following surgical source control for septic peritonitis.

Design
Prospective randomized clinical trial November 2009 – November 2010.

Setting
University teaching hospital.

Animals
Fourteen client-owned dogs with hypoalbuminemia (<27 g/L [2.7 g/dL]) following surgical source control for septic peritonitis.

Interventions
Dogs were randomized to clinician-directed therapy (CDT) and CSA groups. Dogs enrolled in the CSA group received 800 mg/kg of CSA within 24 hours following surgical intervention.

Measurements and Main Results
At enrollment, ALB, COP, and DBP were not different between groups. ALB, COP, and DBP were significantly increased in the CSA group 2 hours following completion of the transfusion compared with the CDT group (P = 0.0234, 0.0078, 0.0156, respectively). In comparison to the CDT group, there was a significant change in ALB in the CSA group 24 hours after transfusion (P = 0.0039), but no difference in COP (P = 0.3914) or DBP (P = 0.5145). ALB was significantly higher in the CSA group at 24 hours compared with the CDT group (P = 0.0367) At the time of death or discharge, there was no difference between groups regarding ALB, COP, or DBP, but an association between ALB and survival was identified (P = 0.0273). One dog experienced tachypnea during transfusion of CSA; this dog died of unknown respiratory causes 120 hours after transfusion.

Conclusions
The administration of CSA in dogs with septic peritonitis results in an increase in ALB, COP, and DBP 2 hours after administration. An increase in ALB persisted at 24 hours compared with a CDT group. Administration of this product was not associated with owner-reported delayed adverse events in this population of dogs.

The use of canine-specific albumin in dogs with septic peritonitis.

Practical relevance Blood transfusions are a potentially life-saving procedure that are within the reach of most small animal practitioners. Only minimal equipment is required.Patient group Any cat with clinical signs attributable to a reduced red blood cell mass that is affecting oxygen transport (as a result of reduced packed cell volume or acute blood loss) is a potential candidate for a transfusion.Clinical challenges Although the principles of transfusion medicine are not complicated, there can be fatal consequences if certain steps are omitted.Diagnostics Blood typing kits and blood filters are readily available from veterinary wholesalers, laboratories and blood banking services.Evidence base Over the past three decades, a substantial body of clinical research and reports has built up covering feline blood types and transfusion medicine. This article draws on that research to provide clinical guidance aimed at all veterinarians in feline or small animal practice who either currently practise transf...

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Feline blood transfusions: A pinker shade of pale

OBJECTIVES: 
To (1) review the development and medical applications of hydroxyethyl starch (HES) solutions with particular emphasis on its physiochemical properties; (2) critically appraise the available evidence in human and veterinary medicine, and (3) evaluate the potential risks and benefits associated with their use in critically ill small animals.

DATA SOURCES: 
Human and veterinary original research articles, scientific reviews, and textbook sources from 1950 to the present.

HUMAN DATA SYNTHESIS: 
HES solutions have been used extensively in people for over 30 years and ever since its introduction there has been a great deal of debate over its safety and efficacy. Recently, results of seminal trials and meta-analyses showing increased risks related to kidney dysfunction and mortality in septic and critically ill patients, have led to the restriction of HES use in these patient populations by European regulatory authorities. Although the initial ban on the use of HES in Europe has been eased, proof regarding the benefits and safety profile of HES in trauma and surgical patient populations has been requested by these same European regulatory authorities.

VETERINARY DATA SYNTHESIS: 
The veterinary literature is limited mostly to experimental studies and clinical investigations with small populations of patients with short-term end points and there is insufficient evidence to generate recommendations.

CONCLUSIONS: 
Currently, there are no consensus recommendations regarding the use of HES in veterinary medicine. Veterinarians and institutions affected by the HES restrictions have had to critically reassess the risks and benefits related to HES usage based on the available information and sometimes adapt their procedures and policies based on their reassessment. Meanwhile, large, prospective, randomized veterinary studies evaluating HES use are needed to achieve relevant levels of evidence to enable formulation of specific veterinary guidelines.

Controversies in the use of hydroxyethyl starch solutions in small animal emergency and critical care.

Objectives – To describe the administration of 5% human serum albumin (HSA) in 588 critically ill hypoalbuminemic dogs and cats, and report outcome to discharge, changes in albumin concentration, and adverse effects during hospitalization.

Design – Retrospective clinical study.

Setting – Private emergency and general veterinary center.

Animals – Client-owned dogs and cats.

Interventions – None.

Measurements and Main Results – The medical records of 588 critically ill hypoalbuminemic animals (418 dogs and 170 cats) were reviewed. All animals had hypoalbuminemia (serum albumin <20 g/L [2.0 mg/dL]) at admission, received an infusion of 5% HSA, and received no other colloid infusion. The HSA solution was administered through a peripheral vein at 2 mL/kg/h for 10 h/d (total volume 20 mL/kg/d) until albumin reached 20 g/L. The number of days of HSA infusion (median and range) was 4 days (2–11 d) for dogs and 3 days (2–7 d) for cats. Three hundred and sixteen dogs (75.6%) survived to discharge; 56 of 418 (13.4%) died in hospital. One hundred and twenty-three cats (72.3%) survived to discharge; 21 of 170 (12.4%) died in hospital. Severe hypersensitivity reactions such as anaphylaxis, angioedema, and urticaria were not noted. Interruption of albumin infusion and specific treatment of reactions were not required in any animal.

Conclusions – In this study, administration of 5% HSA appeared to be safe in a large group of critically ill, hypoalbuminemic dogs and cats. The results should be interpreted with caution due to the retrospective, descriptive nature of the study, the absence of control groups and the lack of follow-up data, as well as the potentially life-threatening complications of HSA administration.

Administration of 5% Human Serum Albumin in Critically Ill Small Animal Patients With Hypoalbuminemia: 418 Dogs and 170 Cats (1994-2008)

Effect of sampling time on urinary electrolytes following oral furosemide administration in dogs with myxomatous mitral valve disease.

OBJECTIVES
To assess treatment satisfaction and owner preference for two delivery devices (VetPen, MSD Animal Health, and U40 insulin syringes) and the effect on glycaemic control in diabetic dogs treated with porcine insulin zinc suspension.


MATERIALS AND METHODS
Randomised prospective cross-over study with two arms, each of 8 weeks. Twenty client-owned diabetic dogs on insulin treatment by U40 syringe were enrolled. Dogs were randomly assigned to receive insulin by syringe or pen injector for 2 months, followed by 2 months of the other injection method. Treatment satisfaction and owners' insulin delivery device preference were assessed using a questionnaire. Glycaemic control was assessed using a clinical score, serum fructosamine and glycated haemoglobin (HbA1c%) at the time of the enrolment (T0) and the end of each arm of treatment (T2 and T4).


RESULTS
Treatment satisfaction differed for the two types of the delivery device when the order that each device was used was taken into consideration. Owners who used the syringe first did not have a significant preference for an injection device. In contrast, owners who used the pen injector first expressed a significant preference for VetPen compared to syringes. No significant differences in the number of dogs of Groups 1 and 2 with good and poor glycaemic control at T2 and T4 were detected.


CLINICAL SIGNIFICANCE
Overall treatment satisfaction and preference for the two delivery methods were similar. However, VetPen was preferred by owners who were randomised to use this device first. Glycaemic control did not appear to be affected by the insulin delivery device used.

Linda Perissinotto

Papers

Administration of 5% Human Serum Albumin in Critically Ill Small Animal Patients With Hypoalbuminemia: 418 Dogs and 170 Cats (1994-2008)

Effect of sampling time on urinary electrolytes following oral furosemide administration in dogs with myxomatous mitral valve disease.

Owner preference for insulin delivery device and glycaemic control in diabetic dogs.