Evidence Based Practice and Use of Canine Plasma Transfusions

By on

The concept of evidence-based medicine (EBM) has recently been revised to become evidence-based practice (EBP).  Evidence–based practice represents a more complete discipline that combines research science and publications with the art of medicine, namely clinical and patient experience plus expert opinion.

Another medical field that relies to a great extent on the principles of evidence-based practice is transfusion medicine, both for its human and veterinary applications. Performing randomized, controlled clinical trials in transfusion medicine are frequently impractical, impossible or unethical to perform. For example, in veterinary medicine, a randomized trial in orphan puppies or those with life-threatening canine parvovirus enteritis would be unethical. Who would want to volunteer their puppies for such trials with the threat of death looming overhead?

One could also argue that experimentally-induced canine parvovirus studies to compare the efficacy of plasma transfusion therapy with a placebo fluid would subject the puppies to unnecessary suffering, especially when clinical evidence supports the life-saving advantage of plasma transfusions from healthy adult donor dogs or recovered parvovirus cases.

Background

The history of veterinary transfusion medicine began in 1665 with the first reported transfusion of canine blood.  From that time to the present day, whole blood and blood component administration has been used to treat many disease states and for surgery in veterinary medicine.  Early complications associated with transfusions of animal blood were attributed to incompatibilities, inadequate anticoagulation, sepsis, and circulatory overload.  Today, modern techniques in blood banking and more widespread use of component therapy are being advocated by veterinary clinicians and specialists.

Until recently, most veterinarians gave blood transfusions as whole blood from un-typed and non-crossmatched donors for emergency life-saving measures to combat traumatic or surgical shock, severe anemia and hypoproteinemia, and bleeding.  This would usually be the animals’ first transfusion.  Current research in veterinary transfusion medicine has provided a wealth of practical knowledge that can be applied directly by veterinary clinicians, and the reagents and supplies needed to provide transfusion support are now available.

While it is important that veterinarians use typed, compatible blood whenever a transfusion is given, determining the blood type of animals requiring immediate transfusion can be impractical and costly for individual clinics. To meet this need, commercial, large emergency and specialty clinics, and veterinary teaching hospitals have developed animal blood bank programs which depend upon in-house or local blood donors that have been pre-screened for blood type compatibility and transfusion-transmitted infectious diseases.  For dogs, blood donors are selected for overall health and vigor, ease of bleeding and docile temperament, and they should have what is termed “universal donor” blood type (DEA 4).  This means their red blood cells do not carry any of the surface antigens associated with transfusion reactions or incompatibilities.

Our program at Hemopet opened in 1991, and provides canine blood components for transfusion from our in-house colony of 200+ greyhounds, retired from the racing industry and then adopted out from our facility as family companions. [Hemopet’s canine animal blood bank is licensed and inspected annually by the California Department of Food and Agriculture; Biologics License # 84.]

The blood plasma we supply [Fresh-Frozen Plasma (FFP)] has several important uses beyond providing coagulation factors to control bleeding and plasma protein therapy for physiological shock. It also provides a critical source of antibodies (globulins) to protect weak, fading or orphan newborns against the common infectious agents to which they are exposed, and for emergency treatment of viral diseases such as canine parvovirus infection.

Treating Orphaned or Fading Puppies

Fresh Frozen Plasma treatment for orphaned puppies or for those receiving only minimal colostrum after birth should be given in the first 24-48 hrs of life.  Treatment for healthy newborns may be repeated at 5 to 14 days of age and then again at 3 to 4 weeks of age.  For sick newborns, more frequent transfusions of FFP may be necessary. These transfusions are usually given intraperitoneally (IP), but they can also be given orally (by mouth) in the first 24-36 hours of life [as FFP is salty, it should be followed with a little drop of honey or syrup on the tongue].  When puppies are two days of age or older, the route of administration must be IP, IV or subcutaneously – but not oral – as the antibodies in plasma will no longer be absorbed through the gastrointestinal tract.  For kittens, the same protocol is followed using feline FFP.

The recommended dose is 3 to 5 mL per pound of body weight (0.25 x weight of puppy in ounces = the amount of plasma given in mL) and is given to each puppy orally, IP or subcutaneously.

Please remember not to mix Fresh-Frozen Plasma with any solution, including formula, Lactated Ringers, or water. The plasma by itself is very stable, but addition of any foreign solution may adversely affect its composition and efficacy.

Treating Canine Parvovirus Cases

The protocol Hemopet routinely recommends is three doses of Fresh-Frozen Plasma (3 to 5 mL/lb; IV or IP), with the first two doses given 12 hours apart on the first day and the third dose given the following morning. Additional doses of FPP are given as needed. In instances when apparently healthy puppies have been exposed to affected puppies, we recommend that one or two doses (3 to 5 mL/lb) of FFP be given prophylactically. Our experience over the past two decades has shown this protocol to be very successful when used in conjunction with supportive care and fluid therapy, as needed.

There are many remarkable success stories related by veterinary clinicians (even some that were initially skeptical or reluctant to try plasma therapy), pet owners and breeders about the use of Fresh-Frozen Plasma in these medical emergency circumstances.  Here are two examples:

This stuff is so amazing.  I just helped a Boston breeder with a fader – she did not believe anything could be done, but was willing to try something new (she already bought a plant to over the pups grave).  The pup received Fresh-Frozen plasma for 3 days.  She can’t believe the pup is still alive and is catching up to the other pups in weight.  Thanks for another Happy Ending! – Chihuahua Breeder from York Haven, Pennsylvania

I had plasma to assist in saving my Briard puppy, Bourbon, who had parvo.  This wonrful product saved his life.  Thank you for the bottom of my heart.  Please give Rich (Hemopet Greyhound a special pat and snuggle from us. –  Briard Breeder from South Dakota

Share this message: