Effect of Sample Storage on Blood Crossmatching in Horses

BackgroundRecognition of the feline red blood cell (RBC) antigen Mik and the presence of naturally occurring anti‐Mik antibodies resulting in acute hemolytic transfusion reactions prompted the recommendation to perform a crossmatch before a cat's first RBC transfusion, but this guideline has not yet become a standard practice.ObjectiveTo determine the prevalence of naturally occurring non‐AB alloantibodies detectable by tube crossmatch, and to compare transfusion outcomes in cats with and without a crossmatch performed.AnimalsThree hundred cats that received an RBC transfusion, with or without a major crossmatch performed.MethodsRetrospective study.ResultsMajor crossmatch incompatibilities were documented in 23 of 154 transfusion‐naive cats (14.9%) and in 15 of 55 previously transfused cats (27%; P = 0.042). Type‐specific packed RBCs (pRBCs) were administered to 167 and 82 cats with and without a crossmatch, respectively. Median volume of pRBCs administered during the first transfusion was 5.3 mL/kg (range, 2.4‐18 mL/kg). Median change in PCV scaled to dose of pRBCs was +0.8%/mL/kg; administration of crossmatch‐compatible pRBCs was not associated with a greater increase in PCV. Febrile transfusion reactions occurred more often in cats that received non‐crossmatched (10.1%) compared to crossmatched (2.5%) pRBCs (P = 0.022). Seventy‐six percent of cats that received pRBC transfusions survived to hospital discharge. A crossmatch was not associated with improved survival to discharge or at 30 or 60 days posttransfusion.Conclusions and Clinical ImportanceThe prevalence of naturally occurring non‐AB incompatibilities is sufficiently high to justify the recommendation to perform a crossmatch before all (including the first) RBC transfusions in cats.

Section: Discussionmentioning

confidence: 99%

Section: Recognition Of the Feline Rbc Antigen Mik And Naturally Occumentioning

confidence: 99%

Prevalence of naturally occurring non‐AB blood type incompatibilities in cats and influence of crossmatch on transfusion outcomes

McClosky

Brown

Weinstein

et al. 2018

“…Cross‐matching is often more readily available in equine referral hospitals and is commonly relied upon to detect the presence of antibodies that could cause a transfusion reaction. The entire cross‐match procedure can take a few hours to complete because donor blood must be collected each time a cross‐match is performed and the reactions have to incubate, especially to detect hemolysins. For this reason, in emergency situations, a first transfusion is often performed without compatibility testing.…”

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confidence: 99%

Survival Time of Cross‐Match Incompatible Red Blood Cells in Adult Horses

Tomlinson

Taberner

Boston

et al. 2015

BackgroundThere is a markedly reduced half‐life of transfused RBCs when donor and recipient cats or humans are cross‐match incompatible. Only 10–20% of horses have naturally occurring alloantibodies. Therefore, cross‐match testing before blood transfusion is not always performed.HypothesisCross‐match incompatibility predicts shortened RBC survival time as compared to that of compatible or autologous blood.AnimalsTwenty healthy adult horses.MethodsProspective trial. Blood type, anti‐RBC antibody screen (before and 1 month after transfusion) and major and minor cross‐match determined 10 donor‐recipient pairs. Two pairs were cross‐match compatible, the remainder incompatible. Donor blood (4 L) was collected into citrate phosphate dextrose adenine‐1, labeled with NHS‐biotin, and transfused into recipients. Samples were collected at 1 hour and 1, 2, 3, 5, 7, 14, 21, 28, and 35 days after transfusion, and biotinylated RBCs were detected by flow cytometry. Horses were monitored for transfusion reaction during transfusion and daily for 5 days.ResultsCross‐match incompatibility was significantly associated with decreased RBC survival time (P < .001). The half‐life of transfused incompatible (cross‐match >1+) allogenic equine RBCs was 4.7 (95% CI, 3.2–6.2) days versus 33.5 (24–43) days for compatible pairings. Cross‐match incompatibility was associated with acute febrile transfusion reaction (P = .0083). At day 30, only 1 horse had developed novel anti‐RBC antibodies.Conclusions and Clinical ImportanceCross‐match incompatibility was predictive of febrile transfusion reaction and shortened transfused RBC survival, but did not result in production of anti‐RBC antibodies at 30 days. Cross‐match testing before transfusion is recommended.

“…Eleven of the 21 horses were blood typed in February 2017 and 10 in January 2018. This laboratory uses a herd of typed horses, previously described standard antisera and macroscopic tube crossmatch methods for determining antibody profiles and blood types . Briefly, screening for antibodies was performed by incubating serial dilutions of a serum sample with a series of equine RBC of known blood types.…”

Section: Methodsmentioning

confidence: 99%

“…This test was performed using the standard macroscopic and microscopic agglutination and hemolysis method used for routine crossmatches in the Clinical Pathology Laboratory. In this assay, no‐additive tubes were centrifuged at 3800 g for 5 minutes to harvest serum.…”

Section: Methodsmentioning

confidence: 99%

Agreement of stall‐side and laboratory major crossmatch tests with the reference standard method in horses

Fenn

Bortsie‐Aryee

Perkins

et al. 2020

Background Crossmatching is used to prevent life‐threatening transfusion reactions in horses. Laboratory methods are laborious and technically challenging, which is impractical during emergencies. Hypothesis/Objectives Evaluate agreement between a stall‐side crossmatch kit (KIT) and a laboratory method (LAB) in horses with known and unknown blood types. Animals Twenty‐four blood‐typed and alloantibody‐screened healthy adult horses (Aim 1) and 156 adult horses of unknown blood type (Aim 2). Methods Prospective, blinded study. Expected positive (n = 35) and negative (n = 36) crossmatches among 24 antibody and blood‐typed horses were used to determine sensitivity and specificity of KIT and LAB against the reference method. Agreement in 156 untyped horses was evaluated by reciprocal crossmatch (n = 156). Results Sensitivity (95% confidence interval [CI]) for LAB and KIT compared with expected reactions was 77.1% (59.9%‐90.0%) and 91.4% (77.0%‐98.2%), and specificity 77.8% (60.9%‐89.9%) and 73.5% (55.6%‐87.1%), respectively. The KIT was 100% sensitive for Aa reactions; LAB was 100% sensitive for Qab; and both were 100% sensitive for Ca. Cohen's κ agreement for LAB and KIT with expected positive and negative reactions (n = 71) was moderate (0.55 [0.36‐0.74]) and substantial (0.65 [0.47‐0.82]), respectively. Agreement was fair comparing LAB with KIT in Aim 1 (0.30 [0.08‐0.52]) and in untyped horses in Aim 2 (0.26 [0.11‐0.41]). Conclusions and Clinical Importance Agreement between KIT and LAB with expected reactions was blood type dependent. Performance of both methods depends on blood type prevalence.