Is a cross-match necessary before a cat’s first blood transfusion?

Ben Safrany,Sophie Adamantos

doi:10.18849/ve.v5i2.306

Abstract

PICO question In transfusion-naïve cats receiving a type specific blood transfusion is cross-matched blood (major and minor) associated with an increased haematocrit development and reduction in acute transfusion reactions when compared with those receiving non-crossmatched blood?  Clinical bottom line Category of research question  Treatment The number and type of study designs reviewed Ten papers were critically reviewed. There were four retrospective case series, three prospective cross-sectional surveys, a retrospective cohort study, a prospective case series and a prospective randomised control trial. Strength of evidence  Weak Outcomes reported It would appear that in the United Kingdom the incidence of non-AB transfusion reactions is low. A single study suggests that cross-matching may result in a greater improvement in haematocrit, but this is unlikely to be clinically significant. There is evidence to support the hypothesis that non-AB antigens (for example the Mik antigen) differ with geographic distribution. Conclusion Based on the information available it is it is challenging to establish a meaningful clinical conclusion on which to base a recommendation.  How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care. 

Highlights

There was no difference in the rate of transfusion reactions, post-transfusion PCV, or survival between groups
There was no significant difference in the rate of transfusion reactions between groups
No significant difference in mean PCV post-transfusion scaled to the dose of pRBC administered was detected between groups

Summary

Conclusion

Based on the information available it is it is challenging to establish a meaningful clinical conclusion on which to base a recommendation. You wonder whether to proceed with transfusion of blood from this cat immediately, or whether to perform a cross-match first. Type independent cross-match incompatibilities are not the primary outcome studied in most papers. This has led to inconsistency in areas of study design including methodology of blood typing and cross-matching, criteria for transfusion, blood product used (packed red blood cells versus whole blood), data collected and methods for calculating scaled haematocrit development (if used). It is challenging to establish a meaningful clinical conclusion

Summary of the evidence

Limitations:

Findings

Methodology Section