Blood Donations (Walking Blood Banks)

When canine WB is not available and is needed for a critically injured or ill MWD, blood can be collected from other canines for donation. U.S.-based MWDs are the recommended first-choice for walking-blood donors, since the U.S. Army Veterinary Corps knows that these canines are well-cared for, healthy, up-to-date on all major vaccinations and preventative medications, and clear of blood-borne infectious diseases. If an U.S.-based MWD is not available, consider a US based contract working dog as an alternative donor. Due to the high risk of disease transmission, NEVER use an indigenous canine as a blood donor. An ideal MWD to select for further screening is a canine that has never received a prior transfusion of any blood product (to include plasma products), weighs over 60 pounds (27 kg), are deemed healthy (based on physical examination), and not receiving any medication other than standard preventive medications (heartworm, flea and tick).

## SCREENING 21

- If not previously known or performed, use a commercial DEA-1 blood-type kit to determine the blood type of the potential MWDs (see below section on typing and cross matching).
- Screen ALL canines for infectious diseases caused by Dirofilaria immitis, Borrelia burgdorferi, Ehrlichia canis, Ehrlichia ewingii, Anaplasma phagocytophilum, Anaplasma platys, Leishmania utilizing in-house diagnostic tests.
- Obtain a minimum database (complete blood count, serum chemistry profile, urinalysis, and fecal floatation) to assure that no underlying conditions are present that precludes donation.
- MWDs that are negative for infectious diseases and have no significant abnormalities noted on their minimum database are considered acceptable donors unless other extenuating circumstances deem the donor not acceptable.

Note: In an emergent situation when time is critical, it is reasonable to consider any healthy MWD as a blood donor even if they have not had the aforementioned screenings.

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## BLOOD COLLECTION

- Do not collect blood from donors more frequently than every two months.
- Do not work or fly (via fixed wing aircraft) a donor for 24 hours following a donation to allow recovery from donation.
- Consider administering intravenous isotonic crystalloids to a donor following blood collection as needed to replace the volume donated.

### Anticoagulants

- Recommend the use of CPDA-1 (citrate phosphate dextrose adenine). CPDA-1 results in the longest blood shelf life at 28 days for canine WB. If CPDA-1 is not available, collect WB into bags containing CPD.

Note: Canine WB anticoagulated with CPD results in a recommended shelf-life of up to 21 days when properly stored at 6°C (+/- 2°C). Approximately 1 mL of anticoagulant is used per 9 mL of blood collected from a dog. Caution: Accidental intravenous injection of undiluted citrate anticoagulants may cause cardiac arrest.

### Sedation

- Always take the MWD’s temperament into consideration prior to administering any sedatives. Although most MWDs require sedation in order to keep them still to facilitate blood collection, not all MWDs require the same levels of sedation.
- For most MWDs, consider the following initial protocol:
  - Butorphanol (0.1 – 0.4 mg/kg IV/IM) combined with,
  - Midazolam (0.25 – 0.5 mg/kg IV/IM).

If butorphanol is not available consider hydromorphone (0.05-0.1 mg/kg) IV/IM combined with midazolam.

Considering the average size MWD weighs approximately 30 kg, consider the following doses as acceptable for initial sedation in situations when a MWD’s weight is unknown and/or not obtainable:

- Butorphanol (3 to 12 mg IV/IM) OR hydromorphone 1.5-3 mg IV/IM combined with,
- Midazolam (8 to 15 mg IV/IM).

Note: Most MWD Handlers have a weight-based MWD drug card that includes drugs doses that are specific to their MWD. Check for this card prior to making any weight-based drug calculations.

- Some MWDs may require heavier sedation to facilitate blood collection and avoid complications such as damage to the blood vessel (aka. blown vein) leading to contamination and/or insufficient collection. For these cases, consider adding ketamine (2 to 4 mg/kg IV/IM) to the above listed protocol.
- AVOID the following drugs in the sedation protocol:
- Acepromazine: May influence platelet function; therefore, is not recommended in situations that warrants active platelets.
- Dexmedetomidine: May causes clinically significant bradycardia and peripheral vasoconstriction, which interferes/hinders blood flow and collection.

## PROCEDURE

- Employ aseptic technique
  1. Wash hands with soap and water prior to the procedure and don sterile gloves.
  2. Clip and surgically prepare the area over the external jugular vein.
- Do not allow air to enter the blood collections system. Most commercial blood collections systems designed for humans possess an in-line device that prevents air from entering the line. If not using a human-designed commercial blood collection system, consider the following to prevent air from entering the system.
  1. Clear the collection line of air by turning the bag upside down, removing the needle cover and allowing a few drops of anticoagulant to exit the needle.
  2. The collection line is then immediately clamped and not released until the venipuncture has been accomplished.
- Using a standard human tri or quad commercial blood donation bag set, sterilely insert the attached needle into the left or right external jugular vein. Once inserted, the in-line cannula is broken to allow the flow of blood to begin.
- Utilize a balance or gram scale for collection. Prior to collection, tare the scale with the collection bag to “Zero”.
- Blood is collected by gravity flow into a standard 500 mL CPD or CPDA-1 blood bag to the appropriate volume.
  1. Place the MWD in lateral or sternal recumbency.
  2. Place the collection bag on the floor or at a location lower than the MWD.
- Ensure the ratio of blood collected to anticoagulant is exact to assure an appropriate level of anticoagulation as well as to maximize cell viability:

The specific ratio is 450 mL blood +/- 10% (i.e. 405 mL to 495 mL) per 63 mL of anticoagulant (CPD or CPDA-1).

- Gently rock the bag during collection to insure adequate mixing of the blood and anticoagulant.
- Discontinue collection when the total weight of the blood collected is 430 to 450 grams.
- At the end of collection:

1. Clamp or tie off the line before removing the needle from the vein; this prevents air from entering the bag before all the blood has cleared the walls of the line.
2. Remove the needle from the vein and apply appropriate pressure to the venipuncture site for at least 5 minutes to prevent further bleeding.

- After the collection line is tied or clamped, use a tube stripper to “strip” the blood left in the line into the bag.

1. Gently rotate the bag to mix the blood and anticoagulant;
2. Invert the bag and allow the line to refill.
3. Repeat four to five times to assure thorough mixing of the blood in the line with the anticoagulant in the bag.

- When collecting WB, satellite bags should be removed using heat sealers or clamps leaving only the collection bag containing WB.

1. The line is then heat sealed, clamped or tied in segments for use in future cross-matches.

Note: The line has a series of numbers printed on the surface that correspond to segments. Fill the line, then use the heat sealer to separate it into appropriate segments (approximately 6 to 8 segments) or ‘pigtails’. These “pigtails” are used for cross-matching.

1. Heat seal the line then cut the needle from line and discard the needle according to safety procedures.

- Mark the outside of the bags with: collection date, donor’s name, weight of the bag, and PCV of the donor. Make three labels – one for the transfusion sheet, one to remove and place in the inventory log book, and one to stay on the bag.
- Store fresh WB upright in a designated refrigerator, with a temperature record maintained daily and recorded on the outside of the refrigerator.

Table 11. Supplies needed for MWD blood donation