Blood Transfusion in Goats

Episode 145
For the Love of Goats

There have been instances where a goat owner watched a severely parasitized, anemic goat die because they did not realize that a life-saving blood transfusion was an option for their animal. Surprising as it may be, it is!

In this episode, Dr. Ryan Breuer, Assistant Clinical Professor of Large Animal Internal Medicine at the University of Wisconsin-School of Veterinary Medicine and Diagnostic Case and Outreach Coordinator at the Wisconsin Veterinary Diagnostic Lab, discusses blood transfusions in small ruminants. He covers when a transfusion may be needed, whole blood vs plasma transfusions, potential risks, and whether or not goats are always crossmatched with their donors.

Dr. Breuer also talks about his research on the practice of xenotransfusions, which is transferring blood from one species to another–from cow to goat in his study. He discusses why they chose a cow as the donor and whether or not xenotransfusions can be successful in emergency situations when a same-species donor is not available. 

Related episode: Learn more about the causes of severe internal bleeding in goats in Uterine Rupture and Hemorrhage in Goats.

Transcript – Blood Transfusion in Goats

Introduction 00:02
For the love of goats. We are talking about everything goat. Whether you’re a goat owner, a breeder, or just a fan of these wonderful creatures, we’ve got you covered. And now, here’s Deborah Niemann.

Deborah 00:17
Hello everyone, and welcome to today’s episode. I feel like this is an incredibly important episode, because we’re going to talk about something that most people do not even realize is an option for them if they have a goat that’s severely anemic. A few weeks ago, we had Dr. Van Saun here from Penn State who talked about anemia in goats, and during that, we did briefly talk about blood transfusions, but we’re going to cover that specific part in a lot more depth today. And we are joined by Dr. Ryan Breuer, an Assistant Clinical Professor of Large Animal Internal Medicine at the University of Wisconsin-School of Veterinary Medicine and he’s also the Diagnostic Case and Outreach Coordinator at the Wisconsin Veterinary Diagnostic Lab. Welcome to the show today, Dr Breuer.

Dr. Breuer 01:02
Thanks, Deborah, it’s great to be here.

Deborah 01:04
I am so excited. I heard you first speak on a podcast for the American Association of Small Ruminant Practitioners, and you talked about doing a blood transfusion on goats using bovine blood, which totally blew me away. And so I thought it would be a great opportunity to have you talk about the whole topic of blood transfusions in goats in general, and then also get into your research that you had done. So first of all, for people who didn’t hear the episode with Dr. Van Saun about anemia, talk a little bit about why somebody’s goat might need a blood transfusion, and if there is a reason other than anemia that they might need it.

Dr. Breuer 01:46
Yeah, yeah, great kind of laying down the base work of why transfusions are needed. And so that everyone understands, transfusions aren’t necessarily all whole blood. We can also have plasma transfusions as well, and then I’ll let you know why we use one over the other.
But as far as different disease processes, there are a lot of different disease processes that can cause anemia in goats, whether that is due to active bleeding, or hemorrhage, or loss of blood through a lesion, or something that might be internal. We can have internal hemorrhage, or we can have loss of blood through a disease process, such as internal parasites, or copper toxicity where we have a hemolytic crisis where copper causes fragility, or fragileness of the red blood cell, and they basically are destroyed within the bloodstream, and then they lose that oxygen-carrying ability of the red blood cell.

So those are a few reasons we might need blood transfusions. And I always tell people that blood transfusions are very life saving. We usually use them in emergency type of situations, but they are also only, for lack of better words, a Band-Aid, because we’re giving the animal the opportunity to do what it needs to do to catch up to its anemia and allow that bone marrow, where the blood red blood cells are produced, to catch up to their current state, basically. So we give that blood transfusion so that these animals can have about a five to seven day window utilizing another animal’s blood to generate their own red blood cells.

Now, for an animal that might not need red blood cells, but needs the other components of blood, such as plasma, there’s a lot of great immune capabilities and proteins that are needed for animals that might need fluid volumes or ways of keeping their blood volume at a high level without losing it through their vessels because of lack of oncotic pressure, which is the pressure that keeps the fluid within the circulatory system and doesn’t allow it to leak out of those vessels. So what we call plasma is a colloid, and that keeps the blood volume quite high.

And we use a lot of plasma for animals that might be losing protein, such as a protein losing enteropathy, so diarrhea or protein losing nephropathy, so kidney disease that might be acute, or their third spacing it so they have an infection somewhere, and that blood is leaking, so we need to regain that fluid volume by giving them a colloid such as plasma. They utilize that a lot in neonates, because sometimes they have failure of transfer of passive immunity, and a lot of times those immune proteins or immunoglobulins are found in plasma, so we can give that to our neonates in the way of a plasma transfusion. So those are the different types of uses, not all blood transfusion, but blood component transfusions, such as plasma transfusions.

Deborah 05:03
Okay, and then on the subject of plasma transfusions–I think that might sound a little bit more foreign and challenging to somebody than a blood transfusion. Would you get plasma from another live animal? Or where would you get plasma from?

Dr. Breuer 05:19
Yes, great question regarding the availability of blood transfusion, or plasma transfusion. So, unfortunately, for many large animal species, there are not commercially available whole blood transfusion products out there. So a lot of times you have to go to a hospital, or if the veterinarian that you work with knows how to collect, and has the materials to collect blood from a donor, and then give it to the recipient that needs that, they can certainly do that on-farm. But unfortunately, there’s no cold blood transfusions that I know that are commercially available, and if they are, they’re extremely expensive. So that’s when we utilize animals on the farm or in a hospital type setting.

Now for plasma transfusions, there are different companies out there that do provide commercially available plasma for small ruminants, camelids, and our bovine and equine patients as well. They, again, can be fairly high in their cost, but they are life-saving and they can be frozen, unlike our whole blood transfusions where we cannot freeze them, because otherwise the red blood cells would burst, and we’re basically getting rid of what we need in that blood transfusion, which is the whole red blood cells. So, there’s a shelf life of approximately 21 to 45 days on whole blood, and we keep that refrigerated. But after that, a lot of times, those red blood cells start to die, and we can’t use that blood transfusion because it’s not efficacious.

But for plasma–because we don’t have to worry about the cellular component but we’re most concerned about the proteins and the immunoglobulins within it–is quite stable and can be frozen and has the extended shelf life of a year or more. And again, they can be commercially available, but just make sure that you do your homework and make sure that the animal that plasma is being collected from is appropriately screened, especially for diseases. And we do that in our whole blood transfusion as well. Make sure that they’re coming from either an animal from that same farm or from an animal that is screened for infectious diseases.

Deborah 07:26
Okay, so to get plasma, would somebody have to go to a university vet hospital? Because it doesn’t seem like something that your average vet would have on hand.

Dr. Breuer 07:36
Yeah, not typically do a lot of vets have plasma on hand, but there are some that do that, especially if they work a lot with neonates. So we see a lot of equine practitioners that are working with a lot of neonates during foaling season or calving operations that will have that on hand. It’s a little bit harder to get plasma and not utilize it within an expiration date. Again, they do have expirations dates of about a year or so, sometimes they’re shorter than that. So if there’s not a high demand, then your veterinarian might not have them, and nor do you want to just keep plasma in your freezer too, because it will get old and it needs to be utilized. If you don’t have a purpose for it, you really shouldn’t have that need to purchase it.

But there are institutions that you might live close to, such as a teaching hospital like I work at, at the University of Wisconsin, that might have them on hand, and your veterinarian could certainly call that university if they have a good relationship with them. Or they might recommend just referring that animal in, because they also have the equipment that goes along with those transfusions, because they have to have a filtration set and all kinds of other equipment to make sure that the animal is receiving the plasma appropriately.

Because this type of procedure, both whole blood transfusion and plasma transfusions, have to occur at a very slow pace, because these animals will have a higher risk of having a reaction, such as an anaphylactic reaction, which may be seen as increased heart rate, increased temperature, increased respiratory rate. We might see other physical signs, such as having hair that stands on end, or we call that erection of the hair follicles. They also can get hives or urticaria, and then can become hyperemic at their mucus membranes. So these are all kind of reactions that they might have, although not very serious if they’re caught early. But if they’re allowed to continue, they can become quite serious if you don’t have the proper medications and you don’t stop the transfusion when they’re initially seen.

Deborah 09:41
Okay. So, on our farm, we had one goat that had to have a blood transfusion, and it was after kidding. And so I always want to point this out to people, that if your goat is hemorrhaging after kidding, it’s not going to be pouring out of them, because they’re horizontal, and so they bleed out into their abdomen.

But you know, she was just completely lethargic, laying in the corner, checked out. And so I took her in to the University of Illinois, and they did a blood transfusion, because her PCV was really low. It was in the low teens. And they were like “A blood transfusion is the only thing that’s going to save her at this point.” And so we used another goat for a donor in that case. And I would think that for most people, if you’ve got a big, meaty wether available, that you could use your own animal for the transfusion. Is that usually what happens?

Dr. Breuer 10:37
Yeah, you bring up a great point. I’ve worked with some small ruminants like that myself, especially after a bad kidding or a difficult kidding where they’ve needed some kind of support afterwards, and you’re exactly right. You won’t see that external hemorrhage. But you can certainly see it on their mucous membranes by looking at their eyes or their gums, or even their vulvas start turning really pale. And that’s more of an emergency type of situation.

So going back to what constitutes for a good donor–a lot of times, if you’re working with a veterinarian, and I know of many veterinarians that are fully capable of doing blood transfusions on farms, but again, if they’re unable to, or they don’t have the appropriate equipment and solutions, because you can, you can certainly take blood from another individual, but you have to have an anticoagulant in that blood transfusion bag to make sure you don’t take blood and then it clots on you before it gets to the recipient.

So going back to the donors, yes, typically, an animal that is the same size or larger, does not have any other health concerns–so it doesn’t have pneumonia. It’s not being treated for a GI issue. Doesn’t have parasites. Typically, is not a gestating animal, so is not pregnant. And is of an adult age, not geriatric. And not an animal that’s still growing. So these are all things that we look for in a good donor. And, like you said, a large, well, stout wether is a great donor, so having them around is great as a backup. But a lot of times, even in the hospital settings, we may not have those donors. It takes a lot of money, time, space, and feed to have donors at the hospital, and it also takes up space in the hospital.

Interesting program that we have at the University of Wisconsin is that Wisconsinites that live around the area and have goats–we support those goats as donors. And if some goat is coming in that needs a blood transfusion, we call up those people and say, “Hey, would your goat be available to be a donor for a goat that we have coming into the hospital?” And they go through the proper testing. So we test for any communicable diseases, look at parasite load to make sure that their parasite load is low, and that they have a packed cell volume (PCV) and total protein measurement, or TP.

So the typical packed cell volume on a goat is anywhere between 22 to 38%, so if your donor is below that 20%, it’s not the best donor. And a lot of times we see that to be an issue, especially if the herd is kind of going through a troublesome time, such as GI parasites. Typically when we see high worm burdens, it’s not just an individual issue, it’s a herd level issue. So if one animal needs a blood transfusion, but we also have another good donor, possible donor, but his or her packed cell volume is below that 22%, it doesn’t make for a great donor. So it’s good to screen and check the animals every once in a while. But then, if you don’t have them, there’s other possibilities to at large animal hospitals, such as those around the country.

Deborah 13:59
Okay. And then if you don’t have a goat available, and you don’t have plasma available, commercial plasma available, then this is where your research comes in. Which is so cool, because people always ask me, when I mention the possibility of a blood transfusion if they have a severely parasitized animal, sometimes they’re in such bad shape they might not survive without a blood transfusion. Just killing the worms might not be good enough, because once the eyelid is white, you don’t know how low the PCV is. Like, it could just be barely white, or it could be three-hooves-in-the-grave white. Without doing the blood test and knowing exactly what that PCV is, you don’t know how quickly they’re going to recover, if at all.

Dr. Breuer 14:41
Correct. And kind of bringing into the focus that we had on a project that I did with a few colleagues back in my residency, because we knew that this xeno blood transfusion, or xenotransfusion, which is the process of transferring blood from one species to a different species. And we knew this worked from veterinary literature for dogs and cats. So they had used this in emergency situations. So this is not commonplace, these xenotransfusions, but used in emergency situations when donors might not be available.

I do want to caution everyone that they should work with a veterinarian when considering this, and even then, xenotransfusions do carry a very high risk of increased reactions. Our study was only done on a very small amount as a pilot study, just to see what kind of things we had to look for and how long those bovine red blood cells were still viable in a goat after blood transfusion.

So we did have two Boer goats. They had a lower PCV, but still in the normal range. And we used blood from a normal, healthy, non-pregnant bovine. And the reason we wanted to look into this is because we know that cows are typically 10 times larger than our small ruminants, so they have a very large blood volume to give, and we usually can take 10-15% of total blood volume from our donors. But that might mean only about 300 mils from a small ruminant, when we could take maybe five to six liters of blood from an adult cow, depending on their weight and their blood volume. And we typically like to replace that blood volume from the donor with some saline or lactated ringers, not fluid deplete them, but make sure that they stay well-hydrated after we take that blood volume away from them. There is a specialized equation, which takes a lot of going through, but we do do a lot of calculations to determine how much blood is required, how much can be donated. And then we go from there.

We also have to reduce the amount of reactions by premeding them with either an antihistamine or an anti-inflammatory. Typically, we use anti-inflammatories because the injectable forms of antihistamines can be quite expensive as well as they can also incite reactions such as hypotension and hallucinations, or sometimes, there’s been reports that they cause hypnotic events in people. So you have to be very cautious, and that’s why monitoring them basically 10 to 15 minutes, very early on during the transfusion, to make sure that they’re not having these reactions. And we look at their normal parameters, such as their temperature, heart rate, and respiratory rate to make sure that they’re not having those reactions. But again, going back to having a good donor and evaluating them to make sure that they can donate is key.

Deborah 17:51
Okay, awesome. We’ll make sure to put a link to your study in the show notes with the citation, so that people can look up the whole thing and share that with their vets. So is there anything else that people need to be aware of before doing this?

Dr. Breuer 18:07
Yeah, so another thing to kind of keep in mind is we typically do not perform crossmatching when we do blood transfusions, and that’s important to understand, because there is a greater risk for reactions such as anaphylactic reactions with blood transfusions, just because these are emergent type of events. So it’s late at night, and maybe the personnel that do the crossmatches in a laboratory setting aren’t available, and again, those take a lot of reagents and training to understand what a crossmatch involves. So a lot of times, crossmatching does not occur.

At the University of Wisconsin, we do crossmatch to the best of our abilities on every transfusion. With crossmatching, or if you don’t have crossmatching, it is important to understand that goats or small ruminants that are quite severely anemic may need more than one blood transfusion, and typically, it’s best to take from the same donor, because they won’t have a triggered response, especially within a 10 day window. After that 10 day window, all bets are off. They can certainly react much, much more severely to that donor or another donor as well.

We’re lucky to know that in blood transfusions with our small ruminants, goats have the blood group systems, or blood types, as we would refer to them in human medicine, they have six different blood types in goats and seven different blood types in sheep. But we don’t have to worry as much about factors such as glycolipid antigens that cause these reactions, because goats lack these glycolipid antigens, so we have less cause or concern for the different reactions. But that doesn’t mean that those reactions are not null and void. They can still happen because it’s a foreign object that you’re putting into another animal, and the immune system is going to say, “Hey, this is not right. We have to get rid of this.” And the body certainly can do that. And they’ll start destroying these red blood cells, and then you’ll see anemia return sooner. And typically, once an animal needs a second or even third transfusion, we typically see that those transfusions don’t last as long as the first.

And going back to our study with cattle, that’s what we wanted to look at to see how long red blood cells of cows would be present in goats. And we looked out about four or five days, and we noticed that even from the first day of the transfusion, it was reduced by about half, and we could tell the difference between red blood cells and cows versus the red blood cells from the goat, because the diameter of the red blood cell of a cow is quite a bit larger than our small ruminant.

So again, this was just a pilot study to see, okay, what kind of reactions would we get? Would this be a safe scenario? And we did have to stop the transfusions on these goats after about 300 milliliters, which is good. We got 300 mils of life saving blood into these animals, and didn’t have to stop after five or 10 minutes. And we typically see reactions, if they’re going to occur within that first half an hour to an hour of transfusion. If it’s going to be severe, it’s going to be right away, within the first five to 10 minutes. So we knew that with the whole blood from cows transfused to goats, especially in these two individuals, was successful.

Deborah 21:33
Yeah, so were you saying that the PCV would fall over the course of the first few days after the transfusion?

Dr. Breuer 22:03
Yeah, so we have to monitor PCV quite closely. It’s not a one and done type of procedure. So these animals might need blood draws at least once a day, or maybe once every other day, but we do anticipate them to fall because, again, like I stated before, blood transfusions are a Band- Aid to allow the marrow to produce more of the animal’s own red blood cells, and they might be suffering from a disease in the bone marrow that won’t generate or regenerate new blood cells, and we’ll see that over time too.

So the red blood cell has a life that over time, the body will discard it through the spleen and get rid of it after it’s done its job, and then that’s why we get new red blood cells. So the body will identify these abnormal red blood cells or a donor’s red blood cell and likely clear them out of the circulation faster than they would our own red blood cells. And typically we can get about seven to 10 days, sometimes less, maybe five days, of those donated red blood cells to stay in circulation. And again, that red blood cell donation is going to provide good circulation, keep up the blood volume, as well as be a conduit for oxygen-carrying capacity or tissues that need oxygen to survive, and that’s what the blood transfusion is providing.

Deborah 23:02
Awesome. That has been really helpful. I’m sure people are going to find that really interesting, and it’s great to know that they’ve got another option if they’ve got an animal that’s very anemic, rather than just giving up.

Dr. Breuer 23:13
Yes, and that’s what we wanted to look at. And one of the colleagues that was on the paper with me, he is at a different institution now, but they are looking at, and I think there’s a publication going to be coming out on whole blood transfusions with cows as the donors and pigs, pot belly pigs as a pet, as the recipients. So looking at other species as well, from what we know here in our small ruminant species.

Deborah 23:36
Wow, that’s interesting. Going from a cow to a pig seems like an even bigger jump than a cow to a goat.

Dr. Breuer 23:43
Yes. I haven’t read that study, so I don’t know if it was successful or not, but I do know that it is being studied.

Deborah 23:51
Okay, wow, that’s amazing. So obviously this is something that somebody needs to get their vet involved with and maybe even, you know, people are like, Oh, I don’t have a vet in my area who can do this. I always tell people to go to a university. Most people have a university within two or three hours of them or less, and they are open to the public. You know, they’ve got a vet hospital that you could take them to.

Dr. Breuer 24:17
Yeah, and I would even suggest that even if their vet doesn’t particularly know a lot about small ruminant veterinary practice, or if they’re working with their small animals–meaning dog or cat veterinarian–they might have contacts in the veterinary world that do have small ruminant background. So I know that sometimes we’re a dime a dozen–small ruminant practitioners out there–but it is a close knit community, and contacts are available.

Deborah 24:42
Yeah, definitely. And is it okay if vets contact you to get more information about this, if they need to do it and haven’t done it before?

Dr. Breuer 24:51
Yeah, so veterinarians can certainly contact me. I can’t do a lot of client communication just because I’m so busy otherwise, but I can do a lot more distribution from vet-to-vet communication and education. So I can certainly discuss with them and give them more information on blood transfusions and small ruminants as well. So if there are veterinarians that or your veterinarian needs a little bit more information or would like to contact me, I’m certainly available to provide information.

Deborah 25:19
Yeah. Well, thank you so much for joining us today. Did you have any final thoughts?

Dr. Breuer 25:23
Again, I would say that the xenotransfusions–I’m very happy to speak on them because it’s a very interesting, new cutting edge, emergency medicine approach. And that’s what I would say–if it’s needed, use it as an emergency. I would not utilize this all the time if you don’t have donors for blood transfusion that are of the same species, because there is a greater risk to it. It’s not foolproof but certainly can be utilized in a fashion when you don’t have a donor of the same species that a recipient might need blood transfusion from.

Deborah 25:59
Yeah, awesome. Well, thank you so much for joining us today.

Dr. Breuer 26:03
Yeah, my pleasure. Great to be here.

Deborah 26:05
And that’s it for today’s show. If you haven’t already done so, be sure to hit the “subscribe” button so that you don’t miss any episodes. To see show notes, you can always visit ForTheLoveOfGoats.com and you can follow us on Facebook at Facebook.com/LoveGoatsPodcast. See you again next time. Bye for now!