Page 97 - JSOM Summer 2019

An Ongoing Series

In Vitro Compatibility of Canine and Human Blood

A Pilot Study

1*
Thomas H. Edwards, DVM, MS, DACVECC ; Nathan A. Wienandt, DVM, DACVP ;
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Rebecca L. Baxter, DVM ; Erin Long Mays, DVM, DACVECC ;
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Sean D. Gay ; Andrew P. Cap, MD, PhD, MS, FACP 6

ABSTRACT
Military working dogs (MWDs) are force multipliers that are of blood components in relatively equal ratios and restriction
2–4
exposed to the same risks as their human counterparts on the of crystalloid fluids to optimize hemostasis. Acute traumatic
battlefield. Hemostatic resuscitation using blood products is coagulopathy (ATC) is a consumptive coagulopathy that is as-
a cornerstone of damage control resuscitation protocols for sociated with excessive bleeding and at least a 4-fold increase
both humans and dogs. Canine-specific blood products are in in death. ATC occurs in 25% to 33% of severely injured peo-
5–8
short supply in mature theaters due to logistic and regulatory ple and is exacerbated by crystalloid fluid administration.
concerns and are almost nonexistent in austere environments, Although prehospital crystalloid resuscitation has been asso-
whereas human blood products are readily available at most ciated with increased risk of adverse outcomes and death, 9,10
surgical facilities. The objective of this study was to evaluate increased use of transfusion products such as plasma during
the in vitro compatibility of human and canine blood by using resuscitation is associated with reduced mortality. 4,11
standard crossmatching techniques with the canine blood act-
ing as the recipient and the human blood acting as the donor. The military working dog (MWD) is a powerful asset and force
Blood samples were collected from 20 government-owned ca- multiplier in military and law enforcement operations. Because
nines (GOCs) and 7 healthy human volunteers in addition to of the nature of their duty, these animals are at high risk of
washed red blood cells (RBCs) from a commercial blood typ- blunt, penetrating, and blast trauma. Data collected from US
ing kit. Major and minor crossmatches were conducted as well military operations in Iraq and Afghanistan between 2003 and
as a protein denatured crossmatch. All samples in this study 2009 document a 62% mortality rate in ballistically wounded
showed strong cross-reactivity, with the majority demonstrat- working dogs. All except one of these fatally injured dogs were
12
ing profound hemolysis and a minority showing substantial killed in action (died before reaching a medical facility), high-
agglutination. Based on the results of this study, transfusion lighting the importance of prehospital trauma care and trans-
of human blood to an MWD cannot be recommended at this fusion products for working dogs. These data represent only
time. a small subset of working dog combat trauma, as much of this
information remains unpublished. Hazardous duty and high-
Keywords: xenotransfusion; crossmatch; canines risk training environments extend the risk of trauma beyond
the setting of combat. Indeed, advanced canine trauma care for
the working dog is needed both on and off the battlefield. In the
civilian sector, canine trauma represents 11% to 13% of urban
Introduction
veterinary hospital admissions and is the second most common
Trauma-associated hemorrhage causes more than 90% of cause of death in juvenile and adult dogs. 13,14 Mortality follow-
preventable human deaths in combat. Military conflict has ing trauma in treated dogs ranges from 5.7% to 12%. 15–17
1
stimulated a surge of trauma research during the past decade,
yielding improved methods of resuscitation. Modern principles Although veterinary medical and surgical resources are well
of combat trauma resuscitation now prioritize administration established for MWDs in mature theaters, resources are
*Correspondence to thomas.h.edwards.mil@mail.mil
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1 LTC Edwards is the chief of the Research Support Division at the US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX. MAJ
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Wienandt is the chief of Comparative Pathology at the US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX. MAJ Baxter is
a veterinarian with the US Army Special Operations Command. MAJ Long is a criticalist at Veterinary Specialty Services in Manchester, MO,
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and is assigned to DOD Military Working Dog Veterinary Service, JBSA Lackland, TX, in the Army Reserves. SPC Gay is a laboratory science
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technician at the US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX. COL Cap is the chairman of the Blood and Coagulation
Research Department at the US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX.
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