Page 31 - JSOM Spring 2024

to collect canine blood may be challenging in an operational FIGURE 1 Collection of military working dog whole blood unit.
environment.

Development of Blood Collection, Storage, and
Transport Protocols in Austere Environments
The isolation of active working dogs indicates that the most
effective way to source canine blood is to collect it at a larger
facility and transport it to more austere locations for storage
and potential use. This concept is new to the HOA, so we
sought to develop a local standard operating procedure (SOP)
to fill this gap in canine casualty care. This initiative started
as a request from canine handlers in preparation for high-risk
operations and has transitioned to regularly scheduled collec-
tion at a central location with a large repository of MWDs,
followed by distribution to all outstations housing MWDs.

For routine canine whole blood (CWB) collections, donors
are selected from those assigned to HOA units and residing at
Camp Lemonnier, Djibouti (CLDJ), either long-term or tran-
siently. Most MWDs are great candidates for this program
because of consistent veterinary health screenings and disease
prevention measures. Donors are screened using the current
9
guidelines. An extensive history is taken to ensure no lapses
in monthly parasite prevention as well as awareness of current
medications, travel history, date of last donation, and previ-
ous transfusions. Physical examination and lab diagnostics
are performed to screen for vector- and nonvector-borne in-
fectious diseases; tests include blood smear, fecal examination, via aseptic jugular venipuncture using standard sterile tech-
urinalysis, complete blood count, and blood chemistry anal- niques. Midazolam and ketamine are used for additional se-
ysis. Immediate disqualifying characteristics include canines dation if necessary. Dexmedetomidine may cause decreased
that do not have a temperament suitable for blood donation, mean arterial pressure and therefore it is avoided if possible.
are positive for infectious diseases, receive regular medications Acepromazine is also contraindicated because of a potential
other than for monthly prevention, or have previously received transient reduction in platelet count and function. If signs
a blood transfusion. Figure 1 shows how collection of blood of hypovolemia or hypotension present following collection,
is completed. administration of an isotonic crystalloid through a periph-
eral intravenous catheter is indicated to replace lost volume.
Bland treats and a bowl of water are offered once the donor
Obstacles Encountered in Program Implementation
has recovered from sedation. The collection of canine blood
8
Multiple obstacles were encountered in the implementation of is almost identical to that of human blood. The principles,
this program. The main challenges included scarcity of vet- storage, and equipment used are identical. The main differ-
erinary-specific collection sets in the deployed environment, ence lies in the donor as many dogs must be sedated for the
transportation of collected units, communication regarding procedure.
the distribution of units, and development of a tracking sys-
tem for canine blood (including transportation, storage, use, Timely transport of canine blood units to various outstations
and expiration). proved to be another obstacle. With flight schedules constantly
shifting due to operational concerns, ensuring that donated ca-
The authors devised all protocols for collection, processing, nine blood makes it to the flight line and onto the aircraft
and storage from the Joint Trauma System guidelines for requires coordination. Because of these logistical challenges,
MWD transfusion, the standard of practice for MWD blood developing a sustainable process with steady communication
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collections or transfusions in a deployed environment. Re- is essential. In this situation, the United States Air Force Criti-
search performed and draft procedures written by the previous cal Care Air Transport Team (CCATT) serves as an intermedi-
CLDJ Veterinary Services (VS) Officer-In-Charge (OIC), CPT ary between collection by the veterinarian and delivery to the
Brent Von Schaumburg, greatly contributed to the initial de- flight line for transport. The CCATT team transports blood to
velopment of this program. their storage facility via a Golden Hour box. Then it is pack-
aged in an insulated, cooled, flight-approved box (Collins box)
Although veterinary-specific collection supplies exist, it is for transportation to its final destination. On arrival to the
difficult to acquire such items in a forward deployed envi- outstation, the blood is unpacked and confirmation of arrival
ronment without advanced planning. Human supplies are is communicated to the veterinarian. Storage and transpor-
authorized for use as they utilize the same anticoagulants: tation requirements were formulated based on local human
citrate phosphate dextrose adenine (CPDA-1) with a 28-day blood program protocols. This includes strict temperature
storage time and citrate phosphate dextrose (CPD) with a 21- control (storage at 3°C–5°C) to reduce the chance of bacterial
day storage time. After sedation with an opioid (butorpha- growth and adherence to expiration dates (depending on anti-
nol or hydromorphone), 430–450 grams of CWB is collected coagulant used).

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