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   Table of Contents - Current issue
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July-December 2021
Volume 6 | Issue 2
Page Nos. 117-248

Online since Tuesday, November 30, 2021

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Zarin Soli Bharucha (1940-2021) Highly accessed article p. 117

DOI:10.4103/2468-8398.331633  
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REVIEW ARTICLES Top

Chimeric antigen receptor T-Cell therapy: The way forward! Highly accessed article p. 118
Sunil B Rajadhyaksha, Anisha A Navkudkar, Priti D Desai
DOI:10.4103/gjtm.gjtm_88_21  
Various cytotoxic approaches for cancer therapy have been developed over the years. However, due to their limited efficacy, there is a continual search for therapeutic approaches with better outcomes, such as immunotherapy that develops and augments the patient's immune system. Chimeric Antigen Receptor (CAR) T-cell immunotherapy involves genetic modification of patient's own T-cells to express CAR exclusive for a tumor antigen. It involves bioengineering, ex vivo cell expansion, and re-infusion back to the patient. The application of CAR-T therapy is seen as a potential mainstay treatment for hematologic cancers, while it is still being explored for solid-organ malignancies. In this review, the rationale for the development of genetically modified T-cells, its generations, the process of preparing CAR T cells, challenges and potential strategies, limitations, and various clinical applications are described. Information for review was obtained from available material in Google and PubMed.
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Making transfusion medicine a journey from good to great by using quality indicators and bringing in continuous quality improvement Highly accessed article p. 127
Monica Gupta
DOI:10.4103/gjtm.gjtm_98_21  
From its foundational years, transfusion medicine (TM) has been associated with errors and their reporting. Patient safety and quality were brought to the forefront of health care through the Institute of Medicine's two reports followed by the WHO (2004) forming a world alliance of 140 nations. Error reporting in TM has gradually evolved into continuous quality improvement (CQI) and risk management. The review provides insights into the use of quality indicators (QIs), quality tools, and CQI and the models for improvement in TM. QIs in TM have been identified in the past decade; a comprehensive list is provided by the International Society of Blood Transfusion (2019). Analysis of QIs by different tools aids decision-making. Root cause analysis is best carried out using the 5 Whys along with fishbone analysis. Failure-mode-effect-analysis is useful for risk assessment. A process map helps in identifying bottlenecks in a process. A Pareto diagram identifies the “vital few” problems. Likewise, histogram, run diagrams, scatter diagram, and driver diagram, have their own use. Underperforming indicators need to be taken up for quality improvement projects (QIPs). QIPs are designed and implemented by using any of the models available, depending on the problem on hand: the Model for Improvement, FOCUS-PDCA, Six Sigma, and Lean Six Sigma. The utility of clinical audits in improving the quality of transfusion practices and processes cannot be overemphasized. With a structured approach, “goodness” in TM can be measured, and made better. CQI ensures that the journey does not end at “good to great” but continues to progress from “great to greater.”
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ORIGINAL ARTICLES Top

Adverse reactions to the donation of platelet by apheresis and related factors in a tertiary level care blood center p. 135
Vadivel Arunachalam, Rajendra Kulkarni, Abhishekh Basavarajegowda
DOI:10.4103/GJTM.GJTM_6_21  
Background and Objectives: Although blood donation by apheresis is very safe, it is essential to identify the adverse reactions that happen and address the factors related to it so as to improve the donation experience both to the donors and the center accepting donations. This study was designed to assess the frequency of adverse reaction in donors undergoing apheresis for platelet donation and delineate the factors associated with the occurrence of such adverse donor reactions, if any. Methodology: This was an analytical retrospective study on the available data of all the donors who donated single-donor apheretic platelets in our blood center from January 2014 to October 2018. Results: The overall donor reaction rate was 8.3%, with the majority (4.7%) being a local reaction in the form of a hematoma. The other 3.6% were systemic reactions, among which 2.1% were citrate reactions and 1.5% vasovagal reactions (VVRs). The variables associated with a VVR were body weight <75 kg and diastolic blood pressure of <70 mmHg, whereas for citrate-related toxicities, it was the duration of the procedure and the amount of anticoagulant used. 4.7% of them were localized reactions in the form of the hematoma, which were more common in first-time donors. Conclusion: Adverse donor reactions to plateletpheresis are notable (8.3%) but generally mild. Auditing them to look for factors associated helps us review the policies and improve competencies among the staff to improve the safety of donors.
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Stop frightening and start donating: An experience from a resource constraint country p. 141
Waseem Shahani, Nida Anwar, Naveena Fatima, Haya ul Mujtaba, Tahir Shamsi
DOI:10.4103/gjtm.gjtm_116_20  
Background and Objectives: One of the observed fears that keep people hesitant to donate blood is anemia. We conducted this study to investigate the hemoglobin (Hb) level post donation in first-time donors and compared it with healthy nondonor group. Methods: An analytical cross-sectional study was conducted from February 2018 to December 2018 after approval from the institutional ethics committee. There were two study groups: Group 1 which included donors who donated blood as per the National Blood Donor Policy. Group 2 comprised gender matched healthy participants. Laboratory investigations included complete blood counts. Informed consent was taken from participants of both the groups. Anemia was defined as Hb of <14 g/dl in males and <12 g/dl in females. SPSS version 23.0 was used for inferential statistics. Results: A total of 928 donations were included, with 9 (1%) females and 919 (99%) males. Out of 919 male donors, 601 (65%) were donating blood for the first time. Out of 601 first-time donors, 175 (29%) participants were recruited for analysis. An equal number of gender-matched healthy nondonor participants were included in the analysis. The age range was 18–55 years in both the groups. Independent t-test was applied, and the mean difference in Hb level in both the groups was found statistically nonsignificant (P = 0.713). Conclusion: Our study revealed a similar mean Hb level in both the groups. Some other factors we encountered were scarcity of voluntary and female participation in blood donation.
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Evaluation of prevalence of weak D antigen among rhesus-negative patients in tertiary care hospitals in Bangladesh: A multicenter study p. 146
Tamanna Afroz, Manjuma Rahman, Bepasha Naznin, Md Ashadul Islam, Abu Jafar Mohammed Saleh
DOI:10.4103/gjtm.gjtm_118_20  
Background and Objectives: In 1939, D antigen was discovered which is believed to be the most immunogenic antigen in Rhesus (Rh) blood group system. There are some D variants such as weak D, partial D, and DEL due to gene polymorphism. These variants can cause RhD-positive person to behave like RhD negative which could result in alloimmunization. Clinically weak D antigen is very important due to its strong immunogenicity in spite of its low frequency. Hence, we need to know the prevalence of weak D variants in the community. The purpose of this study is to find out weak D prevalence among the Bangladeshi population. Methods: It is a retrospective study done over the last 5 years, from January 2015 to December 2019, at the department of transfusion medicine of three tertiary care hospitals in Bangladesh. A total of 177,702 patients were enrolled in the study. Blood samples that were negative for RhD were tested for weak D by indirect antiglobulin test according to institutional protocol. Results: Out of 177,702 patients, 7359 (4.1%) were found to be RhD negative and among those, 14 (0.19%) were weak D antigen positive. Conclusion: Weak D antigen is prevalent in Bangladesh and every RhD-negative individual should be checked for the presence of weak D to prevent RhD alloimmunization.
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The evaluation of M-TRAP technology in detection of ABO groups and its subgroups and its efficacy as a point-of-care test for blood grouping p. 150
Tarak R Patel, Sangita D Shah, Nidhi Bhatnagar, Mamta C Shah, Sujata Tripathi, Shital Soni, Ashly Monson Mathew, Tejal Ahuja
DOI:10.4103/gjtm.gjtm_4_21  
Background and Objectives: Accurate ABO blood grouping including detection of subgroups is a core component in transfusion medicine to prevent adverse transfusion reactions. This article highlights the importance of using M-TRAP technology in a pad-based platform as a point-of-care test for offsite blood donation camps, pre release of blood bags from blood center and at patient's bedside for rapid evaluation of blood groups as compared to conventional methods. Methods: ABD-PAD works on principal of membrane trapping technology used for the evaluation of blood group and their subgroup as a point of care test. Result: Total 1,03,987 blood group test were performed, of which 71,885 of patients' and 32,102 of donors' by EMT (Model – QWALYS 3, Manufacturer – Diagast, France). Among them, 4516 blood group discrepancies were detected. Out of 4516 blood group discrepancies, 17 (00.38%) group discrepancies were due to ABO subgroups. Among them, 13 (76.47%) were subgroup A and 4 (23.53%) were subgroup B. These subgroups were detected by M-TRAP technology. Conclusion: The use of M-TRAP technology (ABD PAD) is a reliable method for manual blood grouping and is useful to detect blood group at patient's bedside, outside blood donation camp, and at the time of issue of blood from blood center.
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Blood cell exchange in sickle cell disease: A single center experience p. 156
Mohit Chowdhry, Soma Agrawal, Ankita Sharma, Uday Kumar Thakur
DOI:10.4103/gjtm.gjtm_13_21  
Background and Objectives: Red cell exchange (RCE) is a type of therapeutic apheresis procedure aimed at removing the deformed red blood cells of a patient and replacing them with those obtained from healthy donors. It is a commonly used but yet underutilized procedure for the treatment of hemoglobinopathies such as sickle cell disease (SCD) (acute or chronic), and other diseases and conditions such as ABO-incompatible hematopoietic stem cell transplantation, severe erythrocytosis, hereditary hemochromatosis, severe infection with intra-erythrocytic parasites such as malaria, babesiosis or cases of a drug overdose, poisoning and to perform envenomation. The objective of the study is to study and understand the efficacy of RCE in the management of patients in various clinical scenarios. Methods: This is a retrospective study carried out at a tertiary care hospital in North India over a period of 4 years (2016–2020). All the RCE were performed on Spectra Optia apheresis (System 1 P0 4552 (Terumo BCT, Lakewood, CO, USA) which comes with a built-in software (Version 11) for performing RCE. Results: A total of 8 exchanges were performed in five patients. Three of these patients had undergone the procedure twice. Two out of the five patients were found to be antibody screen positive. Corresponding antigen-negative units of packed red cells were issued for these patients. The targeted and final fraction of red cell remaining values which were kept at ≤30% was achieved in all cases. Conclusion: RCE is a safe and effective therapeutic treatment modality for patients of SCD. It is a simple and relatively safe treatment modality that provides immediate relief in acute complications and also prevents the risk of long-term complications such as iron overload and iron-induced organ damage.
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High yield of minipool NAT in India using a sensitive multiplex assay for blood donor screening Highly accessed article p. 160
Anju Uppal, Parul Priya, Jatinder P Sethi
DOI:10.4103/gjtm.gjtm_7_21  
Background and Objectives: Nucleic acid amplification testing (nucleic acid testing [NAT]) for blood donor screening is increasingly being adopted in India to reduce the risk of transfusion-transmitted diseases. The high sensitivity of NAT enables testing of a large volume of donations in minipool format; reducing the costs of testing compared to individual donation testing. This study was aimed at evaluating the yield of minipool NAT testing for hepatitis B, hepatitis C, and human immunodeficiency virus (HIV) in blood donors from Uttar Pradesh. Methods: Samples from routine blood donors collected between August 16, 2016, and December 31, 2020, that were seronegative for hepatitis B virus (HBV), hepatitis C virus (HCV) and HIV, syphilis, and malaria were further screened by NAT in pools of six donations (MP6) using the cobas TaqScreen MPX Test, version 2.0 (MPX2) on the cobas s 201 System. Members of reactive pools were tested to identify the reactive donation(s). Viral load testing was performed on randomly selected NAT-reactive samples. Results: Of 172,443 seronegative donors, 463 were NAT reactive: 369 HBV, 89 HCV, 2 HIV, and 3 co-infected with HBV and HCV. The overall NAT yield was 0.27%, with individual virus yield rates of 1/464 for HBV, 1/1874 for HCV, and 1/86,222 for HIV. Viral load testing of 19 HBV NAT-yield donations showed low concentrations in 16 samples and undetectable viral load in three; the two HCV NAT-yield donations tested had high viral loads. Conclusion: Screening of blood donations by minipool NAT using the highly sensitive MPX2 assay identified a high yield of serology negative, NAT-positive donations, including HBV reactive donations with low viral concentrations.
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Impact of COVID-19 on blood transfusion services and strategies used in Kerala p. 166
Aboobacker Mohammed Rafi, Ramesh Bhaskaran
DOI:10.4103/GJTM.GJTM_76_20  
Background and Objectives: The ongoing COVID-19 pandemic is creating major disruptions globally at all levels of health care. The novel challenges affecting the efficiency of blood transfusion services range from uncertain patterns of demand for blood components to reductions in the numbers of donations and staffing because of lockdown and quarantine.1 The authors attempt to evaluate the impact of COVID-19 on blood transfusion services and the strategies used in the state of Kerala. Methods: A Google Form questionnaire was framed and was sent across all the blood centres in the state of Kerala through e-mail and other social media platforms; taking into account the various strategies taken to ensure a safe blood supply. Results: Only 28% rvesponded. 85% had reduction in blood. 99% had a specific COVID screening questionnaire. 80% had thermal screening and frequent cleaning. 35% used disposable bed sheets and implemented a token/prior appointment system. Only 10% conducted donation camps. 76% had shortage of staff due to lockdown. 90% had a shift system in the form of work arrangement. 35% were not provided PPE as they had shortage. 57% had a reduction in their salary. Only 7% blood centres faced shortage in consumables. 23% had an increased wastage in blood components and a few reagents. Only 7.5% of the centres were involved in CCP collection. 99% of the blood centres were willing to be part of CCP collection if the need arises. Conclusion: The BTS is responsible to provide an uninterrupted blood supply and it requires coordination at every level. Staff safety in the form of PPE and security in the form of salary should not be deprived of as health-care workers are the main pillars in the fight against COVID-19. The BTS in Kerala responded to the pandemic by strictly following the NBTC guidelines. When the need arises, the infrastructure at various blood centres has to be utilized so that the treatment outcomes of COVID-19 are also improved.
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Alloimmunization to erythrocyte antigens in patients receiving multiple blood transfusions: Clinico-immunohematological and demographic risk factors and impact of extended red cell phenotyping p. 171
Sudipta Sekhar Das, Rathindra Nath Biswas, Mahammad Safi, Rafique Uz Zaman
DOI:10.4103/GJTM.GJTM_68_21  
Background and Objectives: The risk of red blood cell (RBC) alloimmunization is always a concern for multi-transfused patients. Various factors have been found to be associated with alloimmunization. Alloimmunization rates were reported from 4% to 50%, 1.9% to 13% and 1.27% to 13.1% in thalassemic, onco-hematology and renal patients respectively. Transfusion of extended phenotype-matched blood was found to reduce rate of alloimmunization. This study investigated the various risk factors associated with RBC alloimmunization and the impact of transfusing phenotype-matched PRBC to multi-transfused patients. Methods: The retrospective observational study included 4350 multi-transfused patients of hemoglobinopathies, onco-hematological diseases and chronic renal failure (CRF). Pre-transfusion testing that included ABO and Rh(D) typing, antibody screening and crossmatching were performed following departmental standard operating procedure (SOP). Rh (C, c, E, e) and Kell (K) antigen phenotyping of blood donors as well as patients were performed by recommended techniques. Statistical analysis was done using the SPSS statistical package. Results: The mean age of multi-transfused patients was 41.4 years with a female preponderance. A total of 122 alloantibodies with various specificities were found in the 4350 patients (2.8%). Anti-E was the most frequent alloantibody (27.87%) followed by anti-c (11.48%). Frequency of alloimmunization in patients with hemoglobinopathies receiving phenotype-matched blood was 1.89% which was significantly lower than those receiving phenotype-unmatched blood (p=0.0019). Gender, age, splenomegaly status, number of PRBC unit transfused, phenotype-matched status, and transfusion duration in years were independent risk factors of alloimmunization. Conclusion: Alloimmunization to red blood antigens challenge the proper management of multi-transfused patients. Based on the present results we suggest considering antibody screening as an important tool of pre-transfusion testing to ensure safe blood transfusion. It will be prudent to adopt a transfusion policy that provides at least the Rh-Kell phenotype-matched blood to minimize red cell alloimmunization among multi-transfused patients.
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Reappraisal of quality indicators in the blood center of a tertiary care teaching hospital - Are we ready for accreditation? p. 178
Gargi Mukherjee, Parijat Pramanik, Dipmala Das, Asitava Deb Roy
DOI:10.4103/gjtm.gjtm_75_21  
Background and Objectives: Ensuring quality in transfusion services has become an essential part of the hospital quality management system to provide safe blood supply to the patients. To assess the overall quality performance of our blood center, this study was conducted to evaluate the five mandatory quality indicators (QI) put forward by the National Accreditation Board for Hospitals and Healthcare Providers (NABH) and make recommendations, if any, for improvement of the same. Methods: The five mandatory QIs (defined by NABH) were observed and monitored monthly for a period of 1 year from April 2019 to March 2020, information was gathered in a structured manner, root causes for any deviation were analyzed, and specific corrective and preventive actions were taken. Results: The overall performance was found to be satisfactory with the mean transfusion-transmitted infection % being 1.82%, mean transfusion reaction rate 0.30%, and mean wastage rate 13.5%. The turnaround time was maintained at 28.5 min for emergency cases and 141.38 min for routine. There was no case of component quality control failure during the study period. Conclusion: The study observed that by strictly following the quality parameters put forward by NABH, processes can be controlled in a manner that errors are avoided or kept at minimum. This, in turn, shall help in attaining higher levels of performance. The study concluded by putting forward few important recommendations.
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Compliance of documentation by health-care professionals: Evaluation of transfusion practices at bedside p. 183
Naveena Fatima, Nida Anwar, Haya Ul Mujtaba, Tahir Shamsi
DOI:10.4103/gjtm.gjtm_50_21  
Background and Objectives: In transfusion practices, noncompliance with standard guidelines may lead to cause adverse events. Bedside assessment during and posttransfusion is equally important as overall transfusion-related precautions. The current study was conducted to observe the practices of health-care professionals related to transfusion documentation through a structured questionnaire. Methods: A cross-sectional study was conducted from 2018 to 2019 after ethical approval. A questionnaire structured for the documentation of transfusion process at bedside was filled having information of the name of the product receiver, date, time, name of patient with a medical identification number, ABO group match with the product, name of two health-care staff who started transfusion, and start and stop timings of transfusion. Initials of staff and patient vital record at onset, 15 min, and the end of transfusion were also recorded. Analysis was performed by using SPSS 23.0. Results: A total of 500 transfusion episodes were analyzed, out of which 115 (23%) forms were available in the patient files and 88 (76%) forms were filled. The overall compliance rate was 18%. The highest compliance was observed in the documentation of the name of nursing staff at the start of transfusion 79 (90%) and noncompliance was observed in the documentation of duty doctor initials at the completion 85 (96%). Conclusions: We observed scarce practice regarding transfusion-related documentation by health-care staff at the bedside. Stringent steps should be taken to avoid morbidities and mortalities. Training and education in this context is the need of time.
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Matched unrelated donor attrition in a stem cell registry: What makes people break their commitment? p. 189
Vikash Chandra Mishra, Amit K Bhardwaj, Nikki Dey, Dinesh Chandra, Archana Anthwal, Vimarsh Raina
DOI:10.4103/gjtm.gjtm_41_21  
Background and Objective: Increment in voluntary stem cell donor registrations has led to an increase in the chances of a patient finding a perfect match for matched unrelated donor (MUD) hematopoietic stem cell (HSC) transplant. However, it has been seen multiple times that the donor's passion to donate HSCs is short lived. They register with a strong commitment, however, when they are approached to donate, they back out. This write-up is an attempt to quantify and analyze the rate and reasons of MUD deferral in a stem cell registry from North India. Methods: Registered volunteer stem cell donors who backed out after getting matched were interviewed to understand the reasons behind their deferral. Key steps taken for sustaining the passion of registered donors included amendments in the donor recruitment process and maintaining constant communication with the recruited donors. Results: The attrition rate of the registry for final donation during the studied period was 22.91%. A total of 22 cases of donor deferral were observed. Among these, 15 donors (68.19%) who backed out were female and 7 (31.81%) were male. There were three main reasons observed behind this attrition, namely personal reasons, medical reasons from the donor side, and medical reasons from the patient side. Conclusion: To minimize donor deferral, various new strategies could be implemented such as requesting the participation of experienced donors in counseling sessions, requesting guardian's involvement in case the donor is a teen or is in their early twenties (between 18 and 25 years), and requesting the name of the person they consulted before signing up for donation.
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Comparison of two techniques used for the evaluation of point-of-care methodology for testing hemoglobin in blood donors p. 193
Vivek Ranjan, Rashmi Rana, Ravi Kant, Kamini Khillan
DOI:10.4103/gjtm.gjtm_47_21  
Background and Objectives: Precise measurement of Haemoglobin(Hb) is necessary before the blood donation procedure for donor's protection against anemia and to ensure blood elements' quality to ensure the better effect of these blood constituents on the clinical outcomes of recipients. This is a comparative analysis of DiaSpect Tm and AccuSure hemoglobin (Hb) for point-of-care technique (POCT) for testing of Hb and to evaluate their effectivness by using venous blood as sample and Sysmex XP100 cell counter as the reference method. Methods: A total of 544 samples of blood donors between the age group 18 and 65 years were taken for this study. Measurement of Hb was done with the use of three different Hb analyzers – DiaSpect Tm, AccuSure Hb (Model HB101), and Sysmex XP100 Cell counter by using venous blood samples. P < 0.001 was taken statistically significant. Results: AccuSure Hb was found to have lower sensitivity in Hb estimation in the donor's blood compared to that of the DiaSpect Tm analyzer. Among various available techniques, there is a requirement to find a more appropriate technique for the estimation of Hb in the donor's blood. Conclusion: We found that DiaSpect Tm has greater sensitivity in comparison to AccuSure Hb. Furthermore, specificity, positive predictive value, negative predictive value, and accuracy of DiaSpect Tm were greater in comparison to those of AccuSure Hb.
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Evaluation of donor demographic, clinical, and serological characteristics in COVID convalescent plasma donation by plasmapheresis p. 198
Sudipta Sekhar Das, Rathindra Nath Biswas, Rafique uz Zaman, Subrata Sen
DOI:10.4103/gjtm.gjtm_76_21  
Background and Objectives: Passive transfusion of convalescent plasma (CCP) in coronavirus disease 2019 (COVID-19) has proven to be a winning and logistically feasible therapeutic strategy. The efficacy of plasma depends on appropriate donor screening and selection. Ours being a tertiary care hospital with dedicated COVID facility, we obtained prescriptions of CCP from clinicians for the treatment of COVID-19. Here, we discuss the clinical and serological characters of the voluntary donors who altruistically visited the blood center for plasma donation. Methods: The study included 683 voluntary donors who visited the blood center for mandatory eligibility screening to donate plasma. Donor eligibility criteria were applied following established guidelines. Donor details were obtained from blood center records and software. Detailed investigations on blood samples were performed as mandated and discussed. Results: Among 683 donors initially registered 166 (24.3%) were deferred due to various causes The median age of eligible donors was 44 years with a male preponderance. The mean anti- severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) IgG (S/Co) was calculated to be 12.9. An upward trend in anti-SARS-CoV-2 IgG level was observed with increase in fever temperature, disease severity, and symptom-free days (P < 0.05). Conclusion: Donor screening and selection in CCP donation should be performed meticulously to obtain safe and potent plasma products. Based on our findings, we suggest that in addition to optimum anti-SARS-CoV-2 IgG levels, factors such as the severity of disease, fever temperature, and symptom-free days which determine antibody adequacy may be considered while selecting CCP donors.
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Performance evaluation of blood donor screening assays for serological detection of Hepatitis B surface antigen and antibodies to Hepatitis C virus p. 205
Meenu Bajpai, Brinda Kakkar, Ekta Gupta, Guresh Kumar
DOI:10.4103/gjtm.gjtm_79_21  
Background and Objectives: Screening for transfusion transmissible infections in donated blood can be done by either rapid diagnostic tests (RDTs) or enzyme-linked immunosorbent assay (ELISA) or any other available sensitive immunoassay such as chemiluminescence immunoassay (CLIA). The aim of this assay was to evaluate performance of two commercially available RDTs and CLIA against ELISA for serological screening of hepatitis B surface antigen (HBsAg) and anti hepatitis C virus (HCV). In addition, we also tested the seropositive samples by RDTs, CLIA, and/or ELISA by molecular assays (transcription-mediated amplification, transcription-mediated amplification, and quantitative polymerase chain reaction). Methods: In this prospective study, 1000 consecutive blood donors were screened from September 2017 to March 2018. All blood samples collected during the study period were tested by RDTs, CLIA, and ELISA, and the results obtained were compared. Results: On considering ELISA as a reference standard, low analytical sensitivity was noted for both RDTs (64.29%) and CLIA (71.43%) for HBsAg detection. Similar results were also noted for both RDTs (25%) and CLIA (75%). The positive predictive value of CLIA was found to be lower (HBsAg 31.25%; anti-HCV 50%) as compared to RDTs (HBsAg 90%–100%; anti-HCV 100%). High false positivity was noted with CLIA, while RDTs missed seropositive samples. The viral load for HBsAg and anti-HCV seropositive samples ranged from 29.7 IU/ml to 3.4 × 104 IU/ml and 7.56 × 106 IU/ml, respectively. Conclusions: Performance of CLIA as screening assay was better compared to RDTs. CLIA seems to be a suitable screening assay for emergency situations and predonation apheresis donor screening. RDTs may be used as supplemental assay prior to donor notification.
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Prevalence of unexpected red cell antibodies in healthy donor population in a tertiary care center in South Kerala p. 211
AM Gayathri, Debasish Gupta
DOI:10.4103/gjtm.gjtm_60_21  
Background and Objectives: Apart from naturally occurring red cell antibodies Anti-A and Anti-B in human plasma, there are two types of unexpected red cell antibodies: Alloantibodies and auto-antibodies. The presence of these antibodies, alone or in combination, makes difficulties with compatibility testing, thereby delaying in the issue of a compatible blood unit or may reduce posttransfusion red blood cells life span. Antibody screening is mandatory as laid down by the Drug and Cosmetic Act 1940 and Directorate General of Health Services guidelines. This goal of this paper was to study the prevalence of Unexpected Red Cell Antibodies in Healthy Donor Population in a Tertiary Care Centre in South Kerala. Methods: The sample size chosen for this study was 7000 randomly chosen healthy nonremunerated voluntary donors who attended in house and blood donation camps over a period between November 26, 2017, and February 15, 2019. Results: The prevalence of unexpected red cell antibodies was found to be 1 in 1000. Male blood donations were more than female and blood donors among 18–30 years of age were greater in number. There were no cases of direct antiglobulin test positivity encountered. Male: Female ratio is 2.5:1 and males had naturally occurring alloantibodies, whereas females had a previous history of pregnancy. Anti-M and Anti-Lewis antibodies were the most common alloantibodies followed by Anti-Rh (D and C) antibodies and Anti-IH in the current study. Benign cold agglutinins (BCA) were found predominately in the younger male population with a significant seasonal variation noted in the prevalence of these antibodies. Conclusion: All antibodies identified had the ability to cause immune hemolytic transfusion reactions in the recipients. BCA-positive cases were seen more during the winter season and rainy seasons when compared to hot climatic conditions.
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The first data of hemovigilance: Appraised from a single center in Bangladesh p. 218
Sonia Shormin Miah, Mostofa Ahmed Doha, Md Ashadul Islam, Nadia Sharmin
DOI:10.4103/gjtm.gjtm_80_21  
Background and Objectives: Hemovigilance is a prime requirement for safe transfusion practice rather it may be the reflection of laboratory performance in a blood bank. This study is the first report of transfusion errors and adverse reactions recorded in Bangladesh. It is a new approach to collect and analyze the data pertaining to issues associated with blood transfusion in the day care. This study is aimed to perceive the frequency of adverse reactions and the errors associated with its barrier. Methods: This cross-sectional observational study was conducted in the daycare unit of the Department of Transfusion Medicine of Bangabandhu Sheikh Mujib Medical University from July 2018 to June 2019. Any error regarding pretransfusion and transfusion procedure and adverse event following transfusion was noted according to departmental standard operating procedure and collected data were analyzed with Microsoft Excel 2016. Results: Of the 10,762 units of blood component selected for the issue to 6995 patients, 66 units were discarded. For various reasons. Out of 10696 units of blood component transfused, a total of 459 (4.29%) transfusion reactions were observed among which 390 (3.6%) were acute and 69 (0.6%) were delayed. Mild allergic (40.5%) and Febrile nonhemolytic (36.4%) were the most common acute reaction whereas alloimmunization (9.4%) and delayed hemolysis (4.1%) were the most observed delayed transfusion reaction. Among the recipient, transfusion reactions were observed slightly more in males (7.5%) than in females (5%) and the most affected age group was 20–29 years. Conclusion: However, it is not always possible to analyze the relevance of all the transfusions and the outcome of the patient. Now, a developing country like Bangladesh has to face and notify the errors and to solve them in parallel.
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SHORT ARTICLES Top

Comparison of indigenous enzyme-linked immunosorbent assay and chemiluminescent immunoassays for screening for immunoglobulin G antibodies against SARS-CoV-2 in India p. 224
Nitu Chauhan, Ajeet Singh Chahar, Seema Dua, Yatendra Mohan, Satyam Arora, Arti Agrawal, Prem Singh, Garima Kanaujia
DOI:10.4103/gjtm.gjtm_73_21  
Serological screening for antibody against SARS-CoV-2 has been gaining more attention in view of selection for an appropriate donor for COVID-19 convalescent plasma, documenting the past/ recent infection due to the virus as well as now for evaluating the immune response to the vaccination. In beginning of the pandemic an indigenous ELISA kits were developed in India to screen for IgG type of antibody against the whole-cell virus particle. Our retrospective analysis provides a head-to-head comparison of an indigenous ELISA kits (COVID KAWACH IgG MICROLISA) and CLIA (SARS-CoV-2 IgG by Abbott) platform for screening of IgG type of antibody. Total 380 samples from adults were screened on both the platforms, out of which 250 had a history of a positive RT-PCR report and 130 were RT-PCR negative but with a history of symptoms suggestive of COVID-19 or exposure to COVID-19 individual. The overall concordance of detection IgG type of antibody by both the platforms was 52.2% (higher in individuals with known RT-PCR positivity; 70%). The median S/CO ratio (on CLIA) was 3.34 in concordant positive samples and 2.48 in cases of CLIA yield samples. Our study highlights the variation in detection of the antibody by both the platforms due to inherent difference in the design of these platforms and kits.
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Impact of the COVID-19 pandemic on the transfusion practice: Experience of a tertiary healthcare hospital from Sousse, Tunisia p. 228
Salma Riahi, Lamia Ifa, Sihem Boukadida, Meriem Heni, Nihel Haddad, Mahdi Smida, Amina Bouatay
DOI:10.4103/gjtm.gjtm_63_21  
Background and Objectives: The COVID-19 pandemic created a global health crisis with a multisector disruption, particularly in blood transfusion services where restrictive measures unsettled the blood supply. In this context, we have reported our experience during this crisis by evaluating the transfusion activity before and during the pandemic as well as the measures undertaken. Methods: This was a retrospective descriptive study conducted at the blood bank of a tertiary healthcare hospital from Sousse, Tunisia, during the years 2019 and 2020. The analysis focused on the monthly comparison of data of the blood bank including the number of donations recorded and the number of labile blood products produced and distributed during the 2 years of the study. Results: The total number of annual donations in 2020 decreased by 14% compared to 2019. The number of monthly donations decreased significantly, especially during the two epidemic peaks in Tunisia (in April and October 2020). The production of packed red blood cells has decreased by 17% (up to 53% reduction during the first wave). The production as well as the distribution of fresh frozen plasma and platelet concentrates decreased significantly with an annual reduction of 12.3% and 25%, respectively, with a stable rate for the apheresis platelet concentrates. Conclusion: The COVID-19 pandemic constitutes a universal threat on all levels and, in particular, on the safety of transfusion practice. The development of an appropriate management plan would be necessary to surpass this crisis.
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SPECIAL COMMUNICATION Top

Status of blood transfusion service in Bhutan p. 233
Tshering Yangdon, Mahrukh Getshen, Pema Yangzom
DOI:10.4103/gjtm.gjtm_94_21  
Blood transfusion services in Bhutan are operated as a unit of the hospital laboratory services. There are currently 26 hospital-based blood banks that provide blood donation and transfusion services and one National Blood Bank at National Referral Hospital at Thimphu, the capital city of Bhutan. The National Blood Bank serves the additional activities of providing technical support to blood safety program (BSP) under the Ministry of Health and conducting quality assessment scheme for peripheral blood banks in blood group serology. BSP oversees the overall functioning of the blood transfusion services in the country. The program compiles and evaluates the report obtained annually from all the blood banks. This serves as a part of monitoring and assessment for the further improvement of blood transfusion services as per the National Standards for Blood Transfusion Service 2013.
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CASE REPORTS Top

Alloimmunization to minor red cell antigen leading to massive hemolysis in newly diagnosed thalassemia intermedia p. 237
Satyam Arora, Ravi Shankar, Seema Dua, Nita Radhakrishnan
DOI:10.4103/gjtm.gjtm_3_21  
Alloimmunization to red cell antigens is a taxing complication of thalassemia major and intermedia patients who receive routine blood transfusions. The data on alloimmunization in beta-thalassemia are sparse from developing countries. The risk of alloimmunization is higher in thalassemia patients who received their first transfusion after the age of 3 years. We describe the presentation and outcome of a 4.5-year-old girl who presented with massive hemolysis following the first transfusion received following the diagnosis of beta-thalassemia intermedia. Despite best efforts with all available therapeutic modalities, hemolysis could not be controlled and she succumbed to the illness. The case is being presented as such severe hemolysis caused by alloimmunization to a blood group antigen is rare and posed a challenge for both diagnosis and treatment.
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Efficacy of therapeutic leukapheresis in acute lymphoblastic leukemia presenting with leukostasis: A report of two cases p. 240
Tapti Mohapatra, Prabodha Kumar Das
DOI:10.4103/gjtm.gjtm_83_21  
Therapeutic leukapheresis is performed in patients having hyperleukocytosis, leading to leukostasis. The aim of this study was to evaluate the efficacy of therapeutic leukapheresis in reducing white cell count in leukemic patients with symptoms of leukostasis. Two cases of acute lymphoblastic leukemia, admitted to the hematology intensive care unit between January and May 2015, were taken up for therapeutic leukapheresis, using COBE Spectra Cell Separator. The first patient was a 24-year-old male, admitted with fever, weakness, headache, blurred vision, and a total leukocyte count (TLC) of 564,000/μL. The second patient was a 36-year-old male admitted with fever, headache, dyspnea, and a TLC of 530,000/μL. The first patient had a 31.38% and 30.19% reduction in TLC after first and second procedures, respectively. The second patient had a reduction in TLC of 31.7% and 31.41% after first and second procedures, respectively. This significant decrease in white cell count achieved reversal of symptoms of leukostasis. Patients with hyperleukocytosis may present as a medical emergency, requiring prompt recognition and initiation of therapy to prevent respiratory failure or intracranial hemorrhage. Leukapheresis removes circulating blasts quickly to alleviate symptoms.
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LETTERS TO EDITOR Top

Challenges in blood transfusion services during conflicts and humanitarian emergencies: Perspective and initiatives from Afghanistan Highly accessed article p. 244
Enayatullah Hashemi, Usman Waheed, Noore Saba
DOI:10.4103/gjtm.gjtm_84_21  
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Evaluation of effect of COVID-19 pandemic on voluntary blood donors and their donation practices: A survey-based cross-sectional study p. 245
Seema Dua, Satyam Arora, Harmesh Manocha, Pratap Chandnani
DOI:10.4103/gjtm.gjtm_70_21  
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Advocating optimal abstinence period after smoking although before donating blood p. 247
Manish Raturi, Vishesh Dhawan, Ayushi Kediya, Smita Chandra, Anuradha Kusum
DOI:10.4103/gjtm.gjtm_93_21  
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