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Canine blood transfusions can save wounded military working dogs

Army Capt. Gabrielle Montone, Ft. Benning, Georgia, Veterinary Clinic intern, instructs 908th Airlift Wing Aeromedical Evacuation Squadron Commander Lt. Col. Amy Sanderson in canine CPR techniques at Maxwell Air Force Base, Alabama, March 7, 2021. Montone and her team conducted canine-specific medical training designed to prepare 908 AES members to provide proper care to Military Working Dogs who are injured in the line of duty. Montone is using a training mannequin. Army Capt. Gabrielle Montone, Ft. Benning, Georgia, Veterinary Clinic intern, instructs 908th Airlift Wing Aeromedical Evacuation Squadron Commander Lt. Col. Amy Sanderson in canine CPR techniques at Maxwell Air Force Base, Alabama, March 7, 2021. Montone and her team conducted canine-specific medical training designed to prepare 908 AES members to provide proper care to Military Working Dogs who are injured in the line of duty. Montone is using a training mannequin. (U.S. Air Force photo by Maj. John Stamm)

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Military working dogs have become vital members of many military units in recent years, often supporting the most high-risk missions.

That’s why the military has expanded medical support available for the canine teammates who may suffer catastrophic injuries and need blood infusions. 

Providing these military working dogs, also known as MWDs, with canine blood products can vastly increase their chances of survival. 

Basically, replacing blood with blood is the best strategy.

“Any MWD that requires a transfusion subsequent to trauma-induced hemorrhage should receive [whole blood] as the product of choice when available,” according to the current MWD Transfusion Clinical Practice Guideline.

The DOD required blood typing for all MWDs starting in May 2020 to reduce the potential risk for adverse reactions to a blood transfusion.

The Issue

The problem with whole blood (WB) and plasma is that it needs to be refrigerated and is not stable for long periods of time.

Stored whole blood can last up to 28 days at 4º C. Fresh frozen plasma is good for one year. That means there is always a need for a new supply at in-theatre medical units, said Army Lt. Col. Sean Majoy, Tufts University School of Veterinary Medicine, who deployed to Afghanistan to work with military dogs.

The issue Majoy faced in Afghanistan was that only about 10% of locations had the capability to keep fresh canine blood on hand, he said.

Solutions?

A pilot program under the auspices of the Marine Forces Special Operations Command demonstrated that fresh whole canine blood could be delivered to U.S. Central Command and then provided to medical and veterinary units as needed, explained Army Lt. Col. Sarah Cooper, chief of animal medicine for the Defense Health Agency’s (DHA) Veterinary Service. The pilot program proved canine WB can be delivered to a theater of operations where it is most needed.

There is an ongoing collaboration with the Armed Services Blood Program (ASBP) to establish guidance for providing canine chilled, whole blood throughout the Military Health Service (MHS), Cooper said, meaning the transportation, storage, and distribution will be standardized and safe.

Another solution is “walking blood banks,” which are military canines available near the frontline that can donate fresh whole blood to wounded dogs.

The downside to using walking blood banks is that the donor dogs are then out of commission for 24 hours as they recover and can only donate every two months, Cooper said. Depending on how many dogs are in the area, this could impact the mission, or there may not be enough donor dogs available.

Cooper said there needs to be an enterprise-wide ability to ship, store, and transfuse canine WB to wherever a MWD needs it. 
“No matter where the battlefield is, there is a need to have an established system in place for MWDs to receive the blood products they need,” she said.

Military members secure an injured canine for transportation
Army Sgt. Kelli Hellfinstine, Maxwell Veterinary Service non-commissioned officer in charge, instructs 908th Airlift Wing Aeromedical Evacuation Squadron Senior Airmen Daquan Foster (left) and Tyson Eggleson (right) on proper techniques to secure an injured canine for transportation at Maxwell Air Force Base, Alabama, March 7, 2021. They are using a training mannequin. (U.S. Air Force photo by Maj. John Stamm)

Future MWD Blood Products

Because of the limited capacity of storing canine whole blood, there are freeze-dried products that could help stabilize MWDs on the battlefield.

The military is looking at freeze-dried platelets, freeze-dried plasma, and a liquid oxygen carrier, added Clifford Snyder Jr., a product manager in the Warfighter Protection and Acute Care Project Management Office, U.S. Army Medical Materiel Development Activity at Fort Detrick in Maryland. 

Freeze-dried platelets are available commercially.

In June 2020, the DHA concluded that advanced development of canine freeze-dried plasma and freeze-dried platelets should proceed with an evaluation for treatment of dogs that have experienced traumatic blood loss. 

A study now underway is looking at four different treatments for civilian dogs that have experienced trauma. The standard of care is administration of crystalloids (balanced salts) to restore blood volume. The other groups will receive reconstituted freeze-dried plasma; reconstituted platelets; or a combination of reconstituted plasma and platelets.

The goal is to gather data on 60 dogs. 

“Our plan is to have the clinical trial completed in 2022,” Snyder said. The next step would be submission of study results to the Food and Drug Administration for a full approval for treatment of canines that have experienced traumatic blood loss.

Oxygen Carriers Show Promise

“Our vets have come to a consensus that we need an oxygen carrier, that plasma and platelets aren’t enough,” Snyder said.

A liquid oxygen carrier could be used to reconstitute freeze-dried plasma or platelets, rather than sterile water.
The oxygen carrier could also help the canines by increasing the level of oxygenation in the blood, Snyder explained. The product is stable at close to body temperature, making it suitable for battlefield use.

“FDA approved one oxygen carrier, Oxyglobin, for veterinary use some time ago,” Snyder said. Oxyglobin is one of the candidates that will be reviewed for possible furthermilitary development; it is not now in production. 

It will probably be “one or two years” until it’s back in production, he said.

Tranexamic Acid (TXA)

Majoy explained how Tufts is conducting a study on tranexamic acid. TXA is a drug that helps blood clotting and so would be useful in the field to stop canine traumas with heavy blood loss.

The study is looking at civilian dogs and has data on 20-25 dogs so far, Majoy said. A medic or handler could carry the product in his or her bag ready to deploy.

“The end goal,” Cooper said, “is to ensure the appropriate blood products, whether WB or shelf-stable blood components, are available to provide hemostatic resuscitation for MWDs at the point of need. All these lines of effort – publishing guidance, health care provider training, collaboration with ASBP, and research and development -- are working toward that goal.”

[This article is the second in a three-part series on military working dogs. The first appeared June 25, 2021, on research collaboration. The third in the series will focus on the need for a MWD trauma registry.]

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