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Is a cross-match necessary before a cat’s first blood transfusion?
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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.
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Appraisal, application and reflection
Traditionally, it has been advised that a cross-match has only been required prior to administering type specific blood to cats if they had a previous transfusion more than 4 days previously. Recently cross-match incompatibilities and transfusion reactions independent of the AB system have been reported. It has been hypothesised that naturally occurring alloantibodies to alternative red blood cell antigens are responsible, with particular interest paid to the Mik antigen, first reported by Weinstein in 2007.
Weltman et al. (2014) showed that administering cross-match compatible blood lead to greater haematocrit development when compared with non-crossmatched transfusions. Binangia et al. (2016), Hourani et al. (2017) and Sylvane et al. (2018) failed to repeat these findings in more recent studies, but did identify a reduced frequency of pyrexic (non-haemolytic) transfusion reactions in cross-matched cats. However, Weingart et al. (2007) reports two cases with an incompatible cross-match where transfusion did not increase PCV, suggesting treatment failure.
It is noteworthy that all reports of non-AB transfusion reactions in transfusion naïve cats originate in the United States, raising the possibility that a geographical element exists. In 2014, Tasker et al. were unable to demonstrate cross-match incompatibilities independent of the AB system in a cohort of cats from the United Kingdom.
A limitation of the papers reviewed were inconsistencies relating to the method of cross-match and whether only a major cross-match, or major and minor cross-matches were performed. In a major cross-match the donor’s erythrocytes are screened for incompatibility with the recipient’s plasma, whereas a minor cross-match tests for incompatibilities between donor plasma and recipient erythrocytes. Goy-Thollot et al. (2019) report an increased sensitivity of a feline antiglobulin-enhanced gel column method of cross-matching which was not used in any of the other studies. It is possible that such a technique is more sensitive that other techniques, however, the clinical significance of this is yet to be investigated.
The application of these studies to clinical cases is still debatable. The only prospective randomised study (Sylvane et al., 2018) failed to show a difference in transfusion reactions between cross-matched and non-crossmatched cats and no difference in increase in haematocrit following transfusion. Based upon the studies presented here it is challenging to establish a meaningful clinical conclusion on which to base a recommendation.
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