Feline blood transfusions

practical guidelines for vets

This ‘Practice Indications Feline blood types and
Pointers’ article Severe anaemia blood-type reactions
from the ISFM Severe anaemia with associated clini- Cats have three main blood types, A, B
is complemented cal signs – particularly if anaemia has and AB, based on the blood type
developed acutely, with little time for antigens they possess. Other blood
by practical
compensatory mechanisms to develop types (eg, mik) have been reported
guidelines for
– is the principal reason why a blood in the literature but are not routinely
vet nurses, and tested for. The presence of other blood
transfusion may be performed in a cat.
an information If there is concurrent hypovolaemia types may, however, may be a reason
sheet for owners (eg, blood loss), whole blood will be for reduced survival of transfused
on offering their most appropriate. If the cat is normo- cells in cats of the same (A or B) blood
cat as a blood volaemic (eg, haemolysis), packed red type.
donor. Together blood cells (RBCs) are most appropri-
the series is ate, although not readily available so
intended to whole blood is usually given.
In the UK most
improve the non-pedigree cats are
practice of blood Provision of clotting factors type A, with a smaller
In some cats, a requirement for clotting factors contained In contrast to
transfusions percentage of type B and type
within fresh plasma may warrant a transfusion; consideration dogs, cats pos-
and, in turn, the sess naturally
AB, although the prevalence of
can be given to separating red cells/plasma for an individual
welfare of the patient, but this is rarely performed in the UK. Note that occurring allo-
type B appears to be increasing
cats involved. among non-pedigrees. Type B can
clotting factors degrade relatively quickly even if blood/ antibodies reac-
be very prevalent (approaching
plasma is refrigerated. Furthermore, transfusions are not a tive against the
50%) in some pedigree breeds,
good source of platelets, although whole blood does contain blood-type anti-
especially the British Shorthair,
some functional platelets, so may be of some benefit in gen that they
Ragdoll, Birman and Rex breeds.
thrombocytopenic patients. are lacking:
Type B cats are also commonly
● >70% of type
encountered among Persians,
A cats have anti-
Somalis, Abyssinians and
B alloantibodies,
Scottish Folds. Siamese
mostly at low titres;
Weighing up the risks versus benefits ● All type B cats cats are almost
invariably type A.
There are potential risks to the donor cat associated with have anti-A alloantibod-
blood collection that must be carefully weighed up against the ies, often at high titres;
potential gain for the recipient cat. In all cases it is important ● Type AB cats are not
to be certain that a blood transfusion thought to have alloantibodies to
is definitely the most either type A or type B antigens.
appropriate treatment. These alloantibodies are responsible for the two main
Not every anaemic cat The potential gain to the blood-type reactions seen in cats: haemolysis due to
will need a blood recipient cat must outweigh incompatible blood transfusion reactions, even with a first
transfusion and so the the risk to the donor. transfusion, and neonatal isoerythrolysis. Incompatible blood
cat’s condition must be fully transfusion reactions can be fatal in type B cats given type
assessed and every treatment A blood, as the recipient’s anti-A alloantibodies rapidly
option considered. If the cat’s anaemia is regenerative it may haemolyse the donor type A RBCs. In type A cats given type
be that supportive treatment is adequate for a short period B blood, the transfusion reaction is unlikely to be fatal, but
of time while the patient replaces its own RBCs. Blood the transfused cells will be extremely short-lived. Neonatal
substitutes such as Oxyglobin (OPK Biotech) may also be isoerythrolysis can cause kitten mortality and fading kitten
appropriate. The impact of diagnostic investigations, and the syndrome and typically arises when a type B queen (having
cause of the anaemia, need to be considered too; in a cat with mated with a type A tom) has type A kittens which ingest anti-
a terminal illness (eg, neoplasia, FeLV) the potential benefit of A alloantibodies in the first 24 hours of life via their mother’s
a blood transfusion may not outweigh the risk to the donor. colostrum. These anti-A alloantibodies rapidly destroy the
kitten’s type A RBCs and can cause death.

practice
p o i n t e r s
clinical advice from the International Society of Feline Medicine www.isfm.net
2 p o i n t e r s
Vet checklist prior to collecting blood from a donor
Which type to give?
● Type A cats must only receive type A blood ● Checked donor eligibility 
● Type B cats must only receive type B blood ● Talked through owner information sheet and owner signed 
● Type AB cats should receive type AB blood, but when consent form
not available type A blood is the second choice ● Blood typed 
● Ensured not donated blood in the past month 
Choosing a blood donor ● Full history and physical examination (including weight) 
The following are prerequisites for a blood donor:
performed, with no findings of concern
● Large (>4 kg) and non-obese;
● Calm temperament; ● Blood pressure checked on day of donation 
● Aged 1 to 8 years (ideally 1 to 5 years); ● Routine haematology and biochemistry confirmed to be 
● Most importantly, healthy (indoor, fully vaccinated cats are within normal limits, at least within the past 6 months but as
ideal) and clinically well. close to the time of donating blood as possible
In practice, this requires a number of (initial and ongoing) ● Confirmed Haemoplasma-negative as close to the time 
assessments: of donating blood as possible
● Comprehensive clinical examinations should be ● Negative FeLV/FIV ELISA on day of donation 
performed, and a complete donor history collected;
● PCV determined on day of donation 
● Haematology (complete blood count) and biochemistry
(urea, creatinine, total protein/albumin/globulin, ALT, ALP,
blood glucose, Na, K, Cl) should be confirmed to be normal;
● The cat should be screened for bloodborne infectious ● A diagnostic DNA PCR test, performed on blood or
diseases (FeLV-, FIV- and Haemoplasma-negative essential; buccal swabs, is available in the US (www.vgl.ucdavis.edu/
± Bartonella screening) as close to the time of donation as services/abblood.php) that can differentiate type B from type
possible. Haemoplasma testing may be omitted in an emer- A or AB cats (but cannot determine if a cat is type A or AB).
gency situation, but owners should be made aware of this if This may be most appropriate for breeders in the selection of
testing is not performed; mating pairs to avoid the risk of neonatal isoerythrolysis. This
● Packed cell volume (PCV) of the donor should be deter- test has not been validated in all breeds, however.
mined before each donation and be ≥35%;
● The donor’s blood pressure should ideally be checked Cross-matching
before each donation to ensure this is normal (120–180 Cross-matching may be performed in addition to blood typ-
mmHg). Occult heart disease and other conditions can be ing if previous transfusions have been given (>5 days earlier)
associated with low blood pressure that is exacerbated by or if a non-A/B blood group system incompatibility is sus-
sedation and blood donation; pected, provided both sufficient time and blood is available.
● Echocardiography should ideally also be performed in all ● The major cross-match tests for alloantibodies in the
cats prior to donation, to assess for occult heart disease. recipient’s serum/plasma against donor RBCs. An incompat-
ible major cross-match can result in an acute haemolytic
Blood typing transfusion reaction, where donor erythrocytes are destroyed
Donors and recipients must be blood typed before transfu- by alloantibodies in the recipient’s plasma.
sions. A number of methods are available that can type the ● The minor cross-match tests for alloantibodies in the
cat as being A, B or AB. donor’s serum/plasma against recipient RBCs. A minor
● EDTA blood samples can be submitted to veterinary cross-match incompatibility is less likely to cause a trans-
laboratories (eg, at the Universities of Bristol and Glasgow). fusion reaction because the volume of donor plasma is small
● Various in-house kits are available, allowing immediate and becomes markedly diluted in the recipient.
results. Examples include: The cross-match procedure, described below, is relatively
– In-house cards (Rapid Vet-H). These use a small quantity complex; where possible it should be performed by some-
of EDTA blood and the result is based on visualisation of an one with experience of doing this.
agglutination reaction on the card. See www.rapidvet.com for
more details.
– Strip test (Feline Quick Test A+B). This uses a small quantity
Cross-matching
of EDTA blood and the result is based on visualisation of a test
line on the strip. See www.alvediavet.com/products_ new.php Procedure
for more details. 1 Take 1 ml EDTA blood and 1 ml of plain clotted blood from both donor and patient.
(Ideally serum should be used in a cross-match but, if this is problematic, plasma
derived from a larger sample of EDTA blood can be used instead.) Label tubes.
2 Centrifuge (at 3000 rpm for 5–10 minutes) and separate plasma and serum
Blood typing from RBCs. Discard the plasma. Store serum in a separate tube, and label.
It is essential that 3 Wash RBCs by adding 2–3 ml of normal saline solution to the RBCs, mixing
all feline donors, gently, centrifuging (at 3400 rpm for 1 minute), then removing the supernatant
regardless of saline. Repeat twice.
breed, as well as 4 After the third wash, decant the supernatant and resuspend the RBCs with
recipients are saline to give a 4% RBC suspension (ie, 0.2 ml RBCs with 4.8 ml saline).
blood typed prior 5 Label four tubes and place the following in each tube:
to collecting blood Major cross-match 1 drop patient serum and 1 drop donor RBC suspension;
to prevent Minor cross-match 1 drop donor serum and 1 drop patient RBC suspension;
incompatibility of Patient control 1 drop patient serum and 1 drop patient RBC suspension;
mismatched Donor control 1 drop donor serum and 1 drop donor RBC suspension.
transfusions. 6 Incubate the tubes for 15 minutes at 37°C.
7 Centrifuge the tubes (at 3400 rpm for 15 seconds).
8 Read the tubes. (cross-matching continues on page 3)
 p o i n t e r s 3

Collection of blood from the donor ● Prepare blood collection equipment. Flush through
Remember blood collection takes time, syringes, needle, T-port and three-way tap with anti-
approximately 30 minutes on aver- coagulant, and place 1–1.5 ml anticoagulant into each
age. If immediate support of 10 ml syringe, or 3 ml into each 20 ml syringe. Heparin is not
How much blood can a collapsed cat is required, recommended as an anticoagulant unless no other options
safely be collected? an alternative to a blood are available. (If using heparin, add 125 units per 10 ml of
● Total blood volume in cats is approximately 66 ml/kg, transfusion will be blood. Blood must be used immediately if heparinised.)
so a 4 kg cat has around 260 ml of blood needed (see later). ● Place an intravenous catheter in the donor.
● Collection of up to 20% of blood volume is usually safe but ● Check the weight ● Set up intravenous fluids (normal saline or lactated
intravenous crystalloid fluids should be given to prevent of the donor and Ringer’s solution) for the donor. A total of twice the volume of
hypovolaemia measure its PCV blood removed (ie, 100 ml) should be given over about 1–2
● Collection of <10% blood volume from a donor does using blood collected hours, starting during or immediately after blood collection.
not usually require intravenous fluids from the cephalic vein ● Blood is collected aseptically from the jugular vein via a
● A 4–5 kg cat can give approximately 50 ml to preserve
of blood, equivalent to 20% of its the jugular
blood volume veins.
● Sedation of the
donor is usually required. An
intramuscular combination of 5 mg/kg keta-
mine and 0.25 mg/kg midazolam is recom-
mended (0.1 ml increments of a mixture of 2.5
mg/kg ketamine and 0.125 mg/kg midazolam
can be given intravenously to the donor as
top-up doses if sedation wears off). Other
sedative agents may be suitable but advice
should be sought to ensure an appropriate
choice is made for the individual cat. Seda-
tive agents that have a significant effect on
blood pressure (eg, medetomidine, ACP)
should be avoided.
● Application of local anaesthetic (EMLA;
AstraZeneca) cream to the jugular area 30
minutes prior to donation can be helpful in
providing local analgesia.

needle attached to the T-port, which is connected via the

Blood collection equipment three-way tap to a 10 or 20 ml syringe. The easiest way of
achieving this is by restraining the donor in an upside-down
● Anticoagulant: citrate phosphate dextrose acid (CPDA) or acid citrate
position, with the handler raising the vein at the base of the
dextrose (ACD) from human blood collection bags is preferred
neck and the bleeder holding the cat’s head and
● Syringes: 5–6 x 10 ml or 3 x 20 ml
extending its neck. The bleeder inserts the needle into the
● 21G needle and T-port or 19G butterfly needle jugular (aiming towards the base of the neck for a cat posi-
● Three-way tap tioned as just described) and draws back the 10 or 20 ml
● Small (100 ml) blood collection bag if available (or human blood collec- syringe to collect the blood. The syringe must be regularly
tion bag emptied of anticoagulant), with exit tubing tied off/blocked; inverted to allow mixing of the anticoagulant and blood to
or Hemonate filter and syringe driver prevent clotting. It may be easier, while the bleeder holds the
needle steady within the jugular vein, for a third person to
hold the collection syringe, enabling rotation of the syringe
as blood is collected into it.
Cross-matching (continued)
● Once the first syringe is filled, the three-way tap is closed
Interpretation off, the syringe is disconnected and a 19G needle is placed
Macroscopic With compatible blood there should be no clumping or agglutina- on the hub. A second syringe is attached, the three-way tap
tion – when the tubes are rotated, RBCs should float off freely from the is opened and blood collection continues until all five or six
centrifuged ‘pellet’ of erythrocytes. Supernatant should be free of haemolysis. 10 ml syringes (or three 20 ml syringes) are filled. Filled
Microscopic A drop of the RBC/serum mixture is placed on a slide and a cover syringes should be inverted intermittently to prevent clotting.
slip is applied. Under the microscope RBCs should appear as individual cells ● Transfer the collected blood slowly into a blood collection
and not in clumps. Rouleaux formation, where RBCs appear as stacks of coins, bag via a 19G needle,
can look macroscopically like agglutination and can be confirmed by microscopy. and attach a blood
filter giving set to the
bag for administra-
tion to the patient.
Alternatively, blood
Emergency situation
can be administered
An emergency cross-match may be performed more easily in-house
directly from the sy-
by mixing two drops of patient serum and one drop of donor RBCs on a glass
ringe using an in-line
slide and examining microscopically for agglutination (differentiate from
Hemonate filter (Utah
Rouleaux as above) after 1–5 minutes. Patient and donor
Medical Products)
controls should also be performed.
and a syringe driver.
4 p o i n t e r s
Administration of blood to
the recipient How much blood to transfuse?
● Blood is usually administered via the cephalic
or jugular veins, but intraosseous administra- Volume to be transfused = 66 x weight of patient (kg) x (desired PCV* – patient PCV)
tion via the proximal femur is possible if PCV of donor
peripheral access is not available.
(*The desired PCV is usually about 20%, to allow significant clinical improvement in the patient.
● Blood is transfused at an initial rate of
Usually 50 ml are collected from a donor, as discussed earlier.)
0.5 ml/kg/hour over the first 5–15 minutes,
with the recipient being observed closely
Generally, 2 ml/kg of whole blood increases a patient’s PCV by 1%. This is a rough guideline only,
for adverse reactions. The rate can then be
however, and the precise increase in PCV will be dependent on the interaction of
increased to 10 ml/kg/hour. In hypovolaemic
multiple dynamic factors within the patient. The response to transfusion should
patients, the rate of administration can be
always be assessed by measurement of PCV post-transfusion and
increased to 20 ml/kg/hour. If the patient has renal or
evaluation of improvement in clinical signs.
cardiac failure, a rate of 2 ml/kg/hour should be used to
prevent circulatory overload. The heart rate, pulse rate and temper-
ature should be frequently monitored throughout the transfusion. The trans-
fusion should be completed within 4 hours of blood collection, to minimise
the risk of bacteraemia. ● Adverse transfusion reactions mani-
fest as tachycardia, urticaria (facial
swelling), hypotension, and haemoglobin- Transfusion
uria if there is severe intravascular reactions
haemolysis. Vomiting may occur as a If an adverse reaction
non-specific finding or due to rapid is suspected, stop
administration of blood. Dyspnoea and the transfusion
tachypnoea may arise where there is and consider treatment
circulatory overload. Pyrexia can develop with glucocorticoids,
as a self-limiting febrile non-haemolytic antihistamines, rapid
reaction, but can also be seen with rate intravenous fluids
haemolysis or sepsis. Severe transfusion and/or adrenaline.
reactions are rare if appropriately typed Antipyretics may be
blood is used. required in some cases.
If circulatory overload
Alternatives to blood has resulted in
transfusion pulmonary oedema,
● If the cat is hypovolaemic, consider vol- diuretic treatment and
ume support with crystalloids and colloids. oxygen support may
● If oxygen-carrying volume support is be required.
required immediately, Oxyglobin is an
alternative treatment for stabilising the
patient, or offers an alternative to blood
transfusion if a donor is not available. Obviously, it only provides oxygen-
carrying support and not the other benefits of whole blood (eg, clotting
factors). Oxyglobin is a haemoglobin solution which is stable at room
temperature. It is unlicensed for use in cats.
– Dose: 5–10 ml/kg at 0.5–2 ml/kg/hour.
– 0.2–2 ml/kg boluses over 5–10 minutes can be used, and repeated up
to a total of 10 ml/kg over 30 minutes, in severely collapsed hypovolaemic
patients.
– The patient should be monitored using haemoglobin values. Great care
should be taken in cases prone to circulatory overload, such as cats with
cardiac disease (occult hypertrophic cardiomyopathy), as well as cats
with renal disease and respiratory disease.

Further information in the ‘Feline blood transfusions’ series:

● Vet nurse pointers: ● Cat owner pointers:

‘Feline blood transfusions: practical guidelines for vet nurses’ ‘Offering your cat to be used as a blood donor’
at www.isfm.net at www.fabcats.org

We gratefully acknowledge a generous legacy from the estate of Mr Alan Hoby,

which has made these leaflets possible.

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