Coagulation Relative Treatment Conditions for Hepatobiliary Disorders: Blood Component Therapy
Coagulation Relative Treatment Conditions for Hepatobiliary Disorders: Blood Component Therapy
Blood components | Composition | Dose | Rate | Comments |
|---|---|---|---|---|
Fresh whole blood | RBCs, scant WBCs, plasma factors | 20 mL/kg, as needed | 5–10 mL/kg/h over < 4 h | Platelet function declines within 1 h; preferred over stored whole blood if animal has tendency for hepatic encephalopathy. Administration of 2 mL/kg ↑PCV ~1% |
Stored whole blood | RBCs, scant WBCs, functional platelets, has plasma factors FV & FVIII | 20 mL/kg, as needed | 5–10 mL/kg/h over < 4 h | Older RBCs with greater senescent RBCs may impose protein challenge, provoking hepatic encephalopathy in dogs with hepatic insufficiency and APSSs. Administration of 2.2 mL/kg ↑PCV ~1% |
Packed red blood cells | RBCs, scant WBCs, no coagulation factors, no platelets | 10–15 mL/kg | 5–10 mL/kg/h over < 4 h | As for stored RBCs, increased risk for provocation of HE in animals with hepatic insufficiency and APSS |
Fresh frozen plasma | Coagulation factors, albumin, globulins, antithrombin | 10–20 mL/kg | 5–10 mL/kg/h over < 4 h | For attempted control of bleeding or start 1–2 h before liver biopsy |
Cryoprecipitate | VWF, FVIII, FXIII, fibrinogen | 1 unit/10 kg 1–5 mL/kg | 5–10 mL/kg/h over < 4 h | Potential to fibrinogen concentration by ~1 g/L. Administer 30 min prior to liver biopsy; repeat q 30 min as needed for continuous bleeding. |
Cryoprecipitate-poor plasma (plasma cryoprecipitate decreased) | FII, FVII, FIX, FX, albumin anticoagulants, fibrinolytic factors. Deficient in VWF & FVIII | 10–30 mL/kg | 5–10 mL/kg/h or 1–2 mL/kg/h over < 4 h | Underused resource that avoids supplemental VWF and VIII in hypercoagulability status. |
Lyophilized platelets | Platelets & microparticles | 1 unit/5 kg | Slow bolus | Use cannot be endorsed. |
Platelet-rich plasma | Platelets & microparticles | 1 unit/10 kg | Administer over 4 h | 1 unit/10 kg has potential to increase platelet count by up to 40,000 platelets/mcL. Rare need in patients. |
APSS, acquired portosystemic shunt. VWF, von Willebrand factor. | ||||