As I opened the crate door and backed up a bit, I was tense with anticipation. I wasn’t sure what to expect. After a few seconds, the baby spider monkey tentatively walked out, sat down just in front of the crate, turned and looked me directly in the eye, and ever so gently placed her little hand in mine. She needed help, and I was going to give it to her!
An hour and several laboratory diagnostic tests later, it was clear: this little primate was severely anemic and in need of a blood transfusion. My only choice was to obtain a donation from an adult in our existing group of spider monkeys. Several hours later, I crossed my fingers and started her transfusion. Fifteen minutes into the procedure, she became a new monkey! I had to hold and entertain her for the remaining one and a half hours of the transfusion to keep her in one place. Subsequently, she grew into a strong adult and never looked back.
Many veterinarians have witnessed the incredible power of transfusion medicine like I did with my little spider monkey patient. However, transfusion medicine is actually not new. The first known successful blood transfusion occurred in 1665 in England when Dr. Richard Lower transfused dogs with blood from other dogs in order to keep them alive1—that’s right, animal research for the win!
Following Dr. Lower’s success with dog-to-dog transfusions, Dr. Lower and Dr. Jean-Baptiste Denis in France recorded successful transfusions from lambs to humans. However, when Dr. Denis’s fourth transfusion patient died, his surviving wife accused the physician of murder. Although the doctor was cleared of the charge in court, the court also banned blood transfusions because of the rate of adverse reactions, and the rest of the world soon followed suit.2
The 1800s saw continued efforts in refining transfusion medicine, including the first human-to-human blood transfusions to treat postpartum hemorrhage and hemophilia. In the late 1800s, U.S. physicians were using milk from cows, goats and humans instead of blood for transfusions. As one might imagine, transfusion reactions to milk were frequent and severe, so saline replaced milk as a “blood substitute.”
The turn of the century brought about the recognition of different human blood groups and efforts to cross-match prior to transfusion in order to avoid adverse reactions. Once anticoagulation compounds and refrigeration were integrated into the storage and handling of blood, early blood depots were utilized to save lives during WWI. And, in 1932, the first blood bank was established in Leningrad hospital. World War II saw the emergence of albumin transfusions (rather than whole blood) to treat shock in victims of the attack on Pearl Harbor.
In the 1950s, the plastic bag for blood collection and the development of a refrigerated centrifuge allowed for more precise blood component therapy. And, as recently as the 1980s, the era of transfusion medicine began and doctors could be trained specifically in blood transfusion for patient care. From there, the growth of blood component therapy continued to soar.
In one of the latest developments to allow for even greater shelf-life and use in austere settings, the FDA issued an emergency use authorization to allow the U.S. military to use freeze-dried plasma to treat hemorrhage in combat settings in 2018.
While veterinary medicine may not yet have reached the point of transfusion medicine as specialty or administering freeze-dried blood components, transfusion with blood products has seen some incredible changes in the last 50 years. For most practitioners, the blood donor dog living in the clinic is long gone and has been replaced with either a list of client-owned dogs available for presentation and blood collection when necessary, or use of a commercial veterinary blood bank.
Typically, client-owned donors are provided free or discounted preventive care and blood-borne disease screening with a nominal payment for each donation, but programs vary significantly among clinics. What seems far more interesting is the emergence and rapid growth in commercial veterinary blood banks.
The Association of Veterinary Hematology and Transfusion Medicine currently lists 12 veterinary-specific blood banks in operation with one of those being exclusively feline.3 While the exclusively-feline blood bank harvests blood from cats owned by shelters prior to their purchase by new owners, other facilities use either client-owned pets or have on-site colonies and kennels from which to harvest blood. Many, if not all, facilities with on-site donors have a program by where the animals may find a home in the community following their retirement from donating blood.
Some states, like California, control animal blood banks with significant regulations such as requiring licensing fees and recently allowing for transition to “community animal blood banks” utilizing “volunteer” donors from the community, etc.4 However, most states do not address animal blood banks, making it prudent for practitioners to do their own research in selecting a bank to work with.
Most commercial veterinary blood banks not only provide blood components, but also offer support to practitioners in the form of ancillary supplies for transfusions and guidance on appropriate administration, as well as other clinical advice. For the general practitioner who performs transfusions less commonly than their emergency and urgent care colleagues, technical support from those better versed in transfusion medicine can be critically important to clinical success. Indeed, proper selection of pre-transfusion diagnostics, clinical indications for component therapy versus whole blood administration and adverse event mitigation are all key to a successful clinical resolution.
Veterinary transfusion medicine has become incredibly advanced in the last 20-30 years and, in this clinician’s opinion, practitioners should consider moving beyond the “donor in the back of the clinic” paradigm and engage the services of a professional veterinary blood bank.
Now, if veterinary blood banks could just accommodate spider monkey-specific components… +
References:
1. Highlights of Transfusion Medicine History. Aabb. https://www.aabb.org/news-resources/resources/transfusion-medicine/highlights-of-transfusion-medicine-history
2. The Strange, Grisly History of the First Blood Transfusion. Encyclopedia Britannica. https://www.britannica.com/story/the-strange-grisly-history-of-the-first-blood-transfusion
3. Veterinary Blood Banks. AVHTM. https://www.avhtm.org/resourceslinks
4. AB-1282 Veterinary Medicine: Blood Banks for Animals. (2021, Oct, 11). California Legislative Information. https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202120220AB1282
