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   Table of Contents - Current issue
July-December 2022
Volume 7 | Issue 2
Page Nos. 107-218

Online since Saturday, November 5, 2022

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Regulations in blood transfusion services: Impetus or impediment? Highly accessed article p. 107
Aikaj Jindal
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Disaster and Emergency Preparedness: Role of the Blood Establishment and Hospital Transfusion Service in the Management Highly accessed article p. 109
Cees Theodoor Smit Sibinga, Sangeeta Pahuja, Mujtaba Al-Lawati, Shabneez Hussain
Disasters and emergencies do happen all over the world, both natural and human-made. It is important to carry out a gap analysis and a risk assessment before making plans for disaster and emergency preparedness at national, regional, and local levels. It is equally important to decide in advance what to do and how to react to such situation to restore the “business as usual.” The blood system is an integral part of the health-care system and should be ready to act when necessary – donor mobilization, triage, personnel, stock management, and distribution. In the hospital, one should have a plan and be prepared in advance to introduce priority setting, stock management, restricted transfusion practice, and communication. The article provides a list of recommendations to prepare for such expected and unexpected situation to mitigate as much as possible the deleterious consequences.
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Clinical audits – A quality improvement tool in transfusion medicine Highly accessed article p. 115
Monica Gupta, Mustafa F Ranapurwala
A clinical audit is a quality improvement process that seeks to improve services and outcomes through a systematic review of care against explicit criteria. It is now a recognized tool for improving clinical quality of care. However, in transfusion medicine, they have been utilized in a limited manner. This review intends to discuss the methodology of carrying out a clinical audit systematically. Clinical audit is not research and focuses on the improvement of ordinary and routine practices. Various methodologies for selecting and prioritizing a good audit topic can be employed. Based on the Donabedian model, process-based audits from donor selection to the actual bedside transfusion could be audited to bring in improvement. Likewise, transfusion processes can be audited based on the dimensions of quality in the context of timeliness, effectiveness, and appropriateness. Prioritization of a topic can be done through a quality impact assessment. The objectives help quantify the aim of the audit, while the standards include criteria that are quantified against targets, based on the current evidence for the best possible care. A snapshot sample (20–50 cases) is sufficient to carry out a clinical audit. Where targets are not met, root-cause analysis and quality improvement tools guide the implementation of changes in transfusion practices. To ensure that change is implemented and internalized, it is necessary to have the entire team and the management on board; communication with all stakeholders is key. Re-audit, after the change has been internalized, is an essential part of all clinical audits. Meticulously planning and proper implementation ensure improvement of the care that transfused patients receive.
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Storage lesions after irradiation: Comparison between blood stored in citrate phosphate dextrose adenine and saline adenine glucose mannitol p. 123
Pramanya Balasubramanyam, Abhishekh Basavarajegowda, Nandeesha Hanumanthappa, Anusuya Ram, Vir Singh Negi
Background and Objectives: Saline adenine glucose mannitol (SAGM) with citrate phosphate dextrose (CPD) or CPD adenine (CPDA) are two common red cell preservatives used in our country. This study analyzed and compared serial biochemical changes on different days of storage in irradiated packed red blood cells stored in CPDA and SAGM solutions. The aim of this study was to see if these changes are influenced by or different, if any, in these two storage solutions. Patients and Methods: Ninety units of RBCs were randomly chosen, with 45 units each collected in CPDA and SAGM, respectively. Nine units each were irradiated by gamma irradiator using cobalt 60 (BI 2000) on days 1, 7, 14, and 21 of their storage, respectively. Nine units were not irradiated and used as controls. All the units were weekly assessed for their plasma levels of potassium, sodium, glucose, lactate dehydrogenase (LDH), and lactate by Clinical Chemistry Auto-analyzer, Beckman Coulter AU680. The values were documented and analyzed by SPSS. Results: Baseline values on day 1 for potassium, lactate, and LDH were similar between SAGM- and CPDA-stored blood bags. Glucose and sodium levels were slightly higher in SAGM bags compared to CPDA. Postirradiation, the changes (increase in K+, Lactate, LDH and decrease in Na+, glucose) were higher in CPDA bags than SAGM bags, and the difference in this trend was not significantly different from that seen in nonirradiated blood bags stored in these two preservative solutions. Conclusion: Storage lesions (biochemical parameters) after irradiation were severe, but paralleled that observed in nonirradiated bags. The storage solution, either SAGM or CPDA, made no difference to these changes.
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Knowledge, attitude, practice, and motivation toward blood donation among citizens of Albania p. 129
Idris Sula, Mateq Ali Alreshidi
Background and Objectives: Blood donation is a remarkably safe medical procedure. However, it can easily be affected by attitudes, beliefs, and level of knowledge. A knowledgeable, attitudinal, and practical survey has been used in Albania, to understand and identify (1) The factors that influence blood donation, (2) the factors stopping people from blood donation, (3) the behavior and approach of the people toward blood donation in the future, (4) the knowledge level among donors and nondonors, and (5) misconceptions related to blood donation. Materials and Methods: This search was conducted on online surveys using Google Forms, which were shared through social media platforms such as Facebook, WhatsApp, and Gmail, and a self-administered questionnaire was shared to random people through social media platforms. Results: Of the 858 people answering the questionnaire from Albania, only 32% of the people were blood donors. The motifs that encouraged the people in Albania mostly to donate were to help others in need and save lives and donations for family members. The main reasons preventing people from donation were the fact that they were not asked for and medical reasons. In Albania, 88.6% would donate if called upon. Conclusion: Some of these results reflected an encouraging attitude toward blood donation. Further future planning with emphasis on educational programs and more organizations of donor recruitment campaigns could result in an increase of donations and thus fulfilling the needs of the patients in the country but not only.
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Immune response against Hepatitis B vaccine in transfusion-dependent thalassemic children vaccinated in early infancy p. 134
Fatema Hossain, Ayesha Khatun, Md. Ashadul Islam, Sonia Shormin Miah, Subarna Saha, Nusrat Noor Tanni
Background and Objectives: Children with thalassemia are much more vulnerable to being infected by hepatitis B virus (HBV) through transfusion of blood and blood products. Although active immunization against HBV in early infancy is being conducted in Bangladesh by the inclusion of the hepatitis B vaccine (HepB) in the expanded programme on immunization schedule, these children might have altered immune response against HepB due to inevitable iron overload resulting from the disease thalassemia itself as well as repeated transfusion therapy and also from exposure to different allogeneic antigens. The present study was designed to determine the immune response of HepB among transfusion-dependent thalassemic children. Patients and Methods: This cross-sectional study was conducted at a university hospital in Bangladesh. A total of 45 transfusion-dependent thalassemic children were included according to inclusion and exclusion criteria. Data collection was conducted through a structured questionnaire after taking written informed consent from each participant's guardian. Each patient underwent a detailed history taking and antibody to hepatitis B surface antigen (anti-HBs) titer was estimated to see the immune response against HepB. Results: Collected data were analyzed using SPSS version 23. The mean age of the studied children was 9.03 ± 3.78 standard deviation with slight female predominance (51.1% female and 48.9% male). According to the level of anti-HBs titer, the majority (44.4%) had moderate protection, whereas others had no (28.9%) or strong (26.7%) protection. No significant association between the total number of transfusions (approximate), different age groups, and postvaccination interval with anti-HBs titer was observed (P > 0.05). Conclusion: The present study observed an overall poor immune response against HepB as approximately only one-fourth of the study participants got strong protection against HBV. Assessment of anti-HBs titer followed by booster dose or revaccination if necessary is needed to be considered in transfusion-dependent thalassemic children vaccinated in early infancy.
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An audit of clinical cases of dengue fever and the usage of platelets in such cases in a Tertiary Care Hospital in Hyderabad p. 139
Sumaiya Isharat, Aparna Sharma, Bhawani Goru, MD Ayatullah Molla
Background and Objectives: Dengue is an acute self-limited systemic viral infection caused by the dengue virus of the family Flaviviridae. The incidence of dengue fever has been increasing for the past few years and dengue has become a global problem. The current data required for further improving the treatment policies are scanty. Our study aims to capture the demographic and clinical characteristics of the patients enrolled in the study, to see any correlation between thrombocytopenia and bleeding tendencies and other transfusion-related parameters. Methods: The study is a prospective cohort study. All seropositive dengue cases were included in the study. A format was prepared for documenting the demographic data, history, clinical characteristics, spectrum of the disease, the laboratory details of the patient (platelet count, prothrombin time, activated partial thromboplastin time, Hematocrit, and indication). All the transfusion requirement data were collected from the blood center registers. Overall mortality in the study group, number of hospital readmissions, and episodes of exacerbation of symptoms was recorded separately. Results: A total of 270 cases were included in the audit who fulfilled the inclusion and exclusion criteria. The median age of the patient pool was 27 (4–66 years range). Twenty-six percent of the cases developed hemorrhages. Eighty-four single-donor platelets (SDPs) and 340 random-donor platelets (RDPs) were used. A mean of 270 ml of products was transfused per patient. The mortality rate was 0.8%. The mean duration of hospitalization was 1 week. In 72% of cases, platelet count was restored in single-unit transfusion. Ninety-nine percent of the product utilization were within the guidelines recommended. Conclusion: A good monthly audit of blood product utilization is a good guide for treatment. Quality control and rational use of SDPs and RDPs are important in sick and thrombocytopenic patients resulting in better clinical outcomes.
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Transfusion challenges and use of best match blood transfusion in autoimmune hemolytic anemia patients: Experience from a Tertiary Care Hospital of South India p. 144
Dibyajyoti Sahoo, S Anuragaa, Abhishekh Basavarajegowda, Rajendra G Kulkarni
Background and Objectives: In autoimmune hemolytic anemia (AIHA) patients, there is decreased survival of red blood cells (RBCs) because of increased destruction by patients' autoantibodies. Due to decreased survival of RBCs, there is an increase in erythropoiesis and other biochemical parameters of hemolysis. One of the vital tests in AIHA is direct Coombs test (DCT). In this study, we share our experience on the difficulties faced by us during the compatibility testing and providing transfusion support to these patients. Methods: This is a retrospective study done in the department of transfusion medicine in a tertiary care hospital of South India. Patients from January 2020 to March 2021 with the diagnosis of AIHA requiring transfusion were included in this study. A total of 136 patients with positive DCT with AIHA diagnosis requiring transfusion support were included in our study. Results: Out of 136 cases, 58% (n=79) of patients had incompatibility during cross matching while in 42% (n=57) had cross matched compatible unit. In all incompatible cases best match blood was transfused. Most transfusions were done for patients with DCT Grade 4+. Out of 45 patients with mixed AIHA, 40 (88.8%) patients required a transfusion (P < 0.05). Of that 104 patients with transfusion support, 66 (63%) were with primary AIHA and 38 (36.04%) with secondary AIHA. Conclusion: It is tough and challenging to get compatible units in AIHA patients. Best-matched blood is useful when transfusion becomes essential during life-threatening anemia.
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Ultrasound-tailored treatment of subacromial shoulder pain: Exploring the role of platelet-rich plasma versus steroids p. 149
Shailesh Kumar Mishra, Depinder Kaur, Manjeet Singh Dhanda
Background and Objectives: Subacromial shoulder pain is the most common cause of shoulder pain consultation in musculoskeletal practice. Partial supraspinatus tendon tears have frequently been treated using a subacromial corticosteroid injection or surgery. The clinical use of a platelet-rich plasma (PRP) injection is an alternative treatment method for the condition, despite the paucity of evidence of its efficacy. The objective of the study was to assess the clinical effectiveness of autologous PRP in comparison to steroid injection in terms of pain relief and functional restoration in subacromial shoulder pathology. Methodology: All the patients above 18 years of either sex presenting with complaints of shoulder pain and painful abduction and elevation of arm for more than 6 weeks and not received any steroid injection in the previous 6 months were included in the study. In intra-articular PRP (IA-PRP), i.e., test group, 20 patients received 3 ml of single IA PRP injection, and in the steroid group (control group), 20 patients received 1 ml of intra-articular corticosteroid (IA CS) into glenohumeral joint under ultrasound (US) guidance. All patients were prospectively followed for 6 months. Results: There were no differences in visual analog scale (VAS) and disability scores between the PRP and corticosteroid groups at 1-month follow-up. However, the PRP group had better scores than the corticosteroid group on both the VAS and disability scores at 3- and 6-month follow-up. The VAS and disability scores did not change significantly at 6-month follow-up in the corticosteroid group; however, the PRP group showed continued improvement in both VAS and disability scores between 1- and 6-month follow-up. The PRP group had better scores than the corticosteroid group on shoulder range of motion after postintervention follow-up after 1 month. There were no complications in either group. Conclusion: Both subacromial PRP and corticosteroid injections had a positive clinical response in the treatment of shoulder pain. In view of the reached results, it may be assumed that steroid injections may provide symptomatic relief but not promote healing which makes PRP injection a good alternative as it is simple, easy to use, easily available, prepared from patient's own blood, and cost-effective. US-guided injections may increase the efficacy of accurately targeted injections.
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Utilization of blood and blood components in a Tertiary Care Hospital at Bogura, Bangladesh p. 155
Shuvra Podder, Abdullah Al Masud, Nahida Anwar Poly, Brindaban Biswas, Raed Almannie
Background and Objectives: Blood and blood components should be transfused cautiously due to potential risks of various transfusion reactions. It is very important for clinicians to be aware of these potential risks. Great progress had been made in the 20th century, by introducing blood component therapy. Now the term “Rational use of blood” came forward. Hence, indiscriminate use of whole blood (WB) should be avoided or minimized. The aim of our article is to demonstrate and evaluate the quantity and pattern of components used in our hospital. Materials and Methods: A retrospective study was carried out in the Department of Transfusion Medicine at a Medical College Hospital from July 2021 to December 2021. Transfusion details were obtained from blood bank records for each patient. Data of all the used blood and components were evaluated and analyzed. Results: Among the male recipients, the majority was of the age group <10 and >50 years, whereas among females, the majority were of age 21–30 and then >50 years. The majority of used blood units were WB (76.48%) followed by red cell concentrate (22.23%) and then platelet concentrate (0.94%). Fresh frozen plasma and cryoprecipitate were not used. The majority of WB was used in patients of trauma or fracture (17.57%), followed by pregnancy-related cases (17.23%), malignancy (10.20%), kidney diseases (7.43%), and others. Conclusion: The use of WB was the most predominant in spite of prevailing facilities for component preparation in our hospital. Our physicians should be oriented to consider and utilize the advantages of using blood components.
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Donor notification and response rate in a stand-alone blood center in Western India p. 159
Spruha Dholakiya, Sanjiv Nandani, Nishith Vachhani
Background and Objectives: Counseling and notification of reactive blood donors play an important part in maintaining the chain of safe blood. The process of notification involves informing donors about the status of their reactivity against five major and mandatory transfusion-transmitted infections (TTIs). Such notification and timely follow-up till the donor reaches the referred place help in reducing the burden of TTI in society, thereby improving blood safety. The aim of this study is to highlight the importance of prompt donor notification, referral, and follow-up. Materials and Methods: This was a retrospective cross-sectional study carried out at a stand-alone blood center from January 2019 to October 2021. A total of 36,162 donations were screened for the five mandatory TTIs-HIV (I and II), hepatitis C virus (HCV), hepatitis B virus (HBV), syphilis, and malaria. All reactive results were retested with a duplicate tube sample and a bag sample to confirm the reactivity. Donors were notified regarding the serostatus by phone and called for reporting at our blood center, and referred to Integrated Testing & Counseling Centre (ICTC) or any other referral center. Results: A total of 212 (0.58%) out of 36162 donors were tested reactive during the study period. Out of them, 40.56% (n = 86) were hepatitis B virus reactive, 21.7% (n = 46) were HIV (I and II) reactive, 20.7% (n = 44) were HCV reactive, and remaining 17.1% (n = 36) were syphilis reactive. All the donors were informed. Out of them, 71.69% (n = 152) responded to the communication and 52.83% (n = 112) personally visited the blood center or respective ICTC for further evaluation. Conclusion: Even after laying strict criteria for predonation screening and counseling, few donors do conceal their high-risk behavior or even their serostatus and continue to donate blood, leading to the wastage of resources. Thorough follow-up of seroreactive donors helps in improving blood safety and also improves their quality of life by the commencement of timely treatment.
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Occurrence of erythrocyte alloimmunization in women attending antenatal care clinic p. 164
Heeya Gupta, Anuradha Kusum, Manish Raturi
Background and Objectives: There is limited literature available on the alloimmunization rates among pregnant women in India. Our primary aim was to estimate the occurrence of irregular erythrocyte alloantibody (IEA) immunization amongst women attending our antenatal care (ANC) clinic and to guide our obstetricians for improved ANC as well as their fetal outcomes. Methods: A cross-sectional study was performed at the blood center in North India over 12 months. We recruited a total of 212 study participants. Antibody screening and identification were performed by using semi-automated column agglutination technology and commercially available 3-red cell antibody screen panel with reagent cards having anti-human globulin (AHG) (Ortho Clinical Diagnostics Inc., USA) and 11-red cell antibody identification panel with reagent cards having AHG (Resolve Panel A; Ortho Clinical Diagnostics Inc., USA) respectively. Once identified, the semi-quantitative doubling dilutions, i.e., serial titrations of the respective IEA were performed by the conventional tube technique to assess their potency. The association of various antibodies identified was analyzed using the Pearson's Chi-square test. Results: Of the 7248 pregnant women attending our ANC clinics, the antibody screening was requested for 212 cases. Out of these, 10.8% (n = 23/212) of women were positive and were sensitized both by active and passive immunization. Their average age (in years) was 27.6 ± 3.52 (20 to 34). The majority belonged to the Dehradun district of Uttarakhand. ABO system-wise, the most common type amongst the included subjects was A as recorded in 34.4%, followed by B (30.18%), O (24.12%) and AB (11.3%), respectively. Rh system-wise, nearly 47% (n=100/212) of subjects had Rh (D) negative blood group. Interestingly, amongst these 23 ANC cases with positive IAT, nearly 13% had a history of having received a blood transfusion. Conclusion: To sum up, the screening of majority of ANC in our hospital is restricted to Rh (D) negative pregnancies. Perhaps, more awareness among obstetricians regarding the universal screening of all ANC cases irrespective of their Rh (D) status is the need of the hour.
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Incidence and analysis of acute transfusion reactions in a hospital-based hemovigilance system at a Tertiary Care Center in Bangladesh: A 5-year retrospective evaluation p. 169
Tamanna Afroz, Rakia Hossain Ishra, Abu Jafar Mohammed Saleh
Background and Objectives: Blood transfusion is a life-saving intervention but may cause nonfatal to fatal untoward events. Therefore, for safe blood transfusion, various adverse reactions need to be identified and steps should be taken to reduce such events. The aim of this study was to determine the incidence and analyze the types of acute transfusion reactions (ATRs) with associated factors. Patients and Methods: All ATRs reported to the transfusion medicine department from January 2016 to December 2020 were retrospectively reviewed and analyzed. The incidence of ATRs and its associated factors were assessed. Results: During the study period, a total of 39,070 units of blood were issued, out of which there was an incidence of 0.24% (n = 95) ATRs mostly seen in females and older patients aged above 60 years. Most common ATR was febrile nonhemolytic transfusion reactions (51.6%, n = 49), followed by allergic reaction (35.8%, n = 34). The most common symptom was chills and rigor (41.1%). The frequency of reactions was significantly higher with packed red blood cell transfusion (62.1%). Patients with previous transfusion history (n = 63, % = 66.3, P = 0.711) had more ATRs. Conclusion: By this study, the authors want to create awareness among health personnel involved in the transfusion chain is necessary to establish a proper hemovigilance system.
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Comparison of three methods for enumeration of residual white blood cells in single donor apheresis platelets: A pilot study from Eastern India as a part of quality monitoring process for leukoreduction p. 174
Nasir Nabi Naikoo, Sabita Basu, Animesh Bajpayee, Deepak Kumar Mishra, Suvro Sankha Datta
Background and Objectives: The aim of this study was to compare three platforms side-by-side: Nageotte hemocytometer, flow cytometry (FC), and standard hematology analyzer for enumeration of residual white blood cells (rWBCs) in single donor platelets (SDPs) apheresis. Materials and Methods: This was a prospective observational study conducted in a tertiary care oncology center by evaluating 36 units of SDP that were collected and tested in parallel by three different methods for the enumeration of rWBCs. All tests were performed within 24 h of collection according to the manufacturers' recommended methods. Counting by the Nageotte hemocytometer was done by: rWBC/μl = (cells counted × dilution/gridded area volume [50 μl]) and FC calculation was performed by: rWBC/μl = (total beads × total number of leukocyte events/total beads acquired × total sample volume). Results: The number of rWBCs detected by FC was between 1 white blood cell (WBC)/μl and 8 WBCs/μl; whereas, those detected by Nageotte chamber were between 3 WBC/μl and 6 WBCs/μl. The range of rWBC detected by hematology analyzer was 100 WBC/μl to 270 WBCs/μl. There was no correlation observed between the results obtained in standard hematology analyzer with any of the other two methods. The concordance correlation coefficient was measured by kappa analysis and found to be 0.71 between hemocytometry and FC. Linear regression analysis also showed a moderate correlation (R2 = 0.42) between the two methods. However, the coefficient of variation was found to be 49.32% in Nageotte method compared to the 17.55% in FC (P < 0.001). Conclusion: FC followed by Nageotte chamber counting is a better method compared to the standard hematology analyzer for the enumeration of rWBCs. To overcome the cost of FC it is high time to explore the scope and feasibility of a centralized quality monitoring system in India for all leukoreduced blood components.
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A study to formulate maximum surgical blood order schedule at a Tertiary Care Referral Teaching Institute in Andhra Pradesh p. 178
Gudditi Sandhya, Bandi Suresh Babu, KV Sreedhar Babu, Arun Rajendran, Abha Chandra, Hulikal Narendra, Y Mutheeswaraiah, V Venkatarami Reddy, VV Ramesh Chandra, Nallabothula Anil Kumar, C Keerthi, C Ravikanth, G Prashanth
Background and Objectives: Blood transfusion is the mainstay of treatment for several serious illnesses, surgical, and trauma patients. The aim of this study is to develop maximum surgical blood order schedule (MSBOS) for surgeries in our institute to formulate certain guidelines to prevent the over-ordering of blood and promote reasonable ordering of blood. Patients and Methods: All the patients undergoing surgeries in General Surgery, Surgical Gastroenterology, surgical oncology, Cardiovascular and Thoracic Surgery, Neurosurgery, Urology, and Orthopedics Departments requesting blood were included in this study. Cross-match-to-transfusion (CT) ratios, transfusion probability (TP), and transfusion index (TI) were calculated for individual specialties and surgeries. Based on these parameters, MSBOS was formulated. Results: During the study period, a total of 2724 patients posted for elective surgical procedures necessitating blood among various surgical departments were included in the study. A total of 5812 units of packed red blood cells were requested and cross-matched for the study population. Among these, 1831 units were transfused with a blood utilization percentage of 31.50% (6%–60%). The overall CT ratio of our study was 4.21. The overall TP was 31.69% and the overall TI was 0.56. Conclusion: Implementation of MSBOS is helpful in achieving the goal of rational usage of blood. Based on the results, we grouped the surgical procedures which need type and screen, type and hold, and type and cross-match.
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Sero-prevalence of COVID-19 in blood donors of North India – Single-center report p. 186
Aseem K Tiwari, Swati Pabbi, Geet Aggarwal, Arghyadeep Marik, Shruti Sharma, Manish Singh, Shubham Gupta, Sunil Golia
Background and Objectives: COVID-19 has infected and caused the deaths of millions of people globally with India being the second most affected country in the world. The primary objective of the study was to determine the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) antibodies in healthy blood donors in North India. The secondary objective of the study was to find the association of vaccination and infection with seropositivity in the blood donors. Methods: All blood donor samples were screened for the presence of IgG antibodies against SARS CoV2 spike (S1) protein. Anti-SARS CoV2 IgG antibody status, demographic data, history of past COVID infection, and vaccination of all eligible donors in the study period were collected. Seroprevalence was calculated as the percentage of total number of donors positive for anti-SARS CoV2 IgG antibodies. Month-wise seroprevalence was also calculated and analyzed. Results: Out of 1456 donors, 874 were found to be seropositive, resulting in a seroprevalence of 60%. Seroprevalence was found to be 38.3% and 77%, respectively, in the months of April and May 21. Seropositivity was 100%, 92%, 79%, and 54% in those with a history of both COVID infection and vaccination, vaccination only, infection only, and no history of vaccination or infection, respectively. Conclusion: Blood donors represent an easy access to seroprevalence studies and need to be tapped at the national level to obtain a temporal picture of the COVID-19 situation to guide healthcare policies, mark regions where vaccination drives need to be intensified.
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Syphilis reactivity in blood donors and their response rate – A study from 'Westernized” Western India and the need of the hour for a structured screening methodology p. 190
Merline Augustine, Ankita Mahambare, MV Mallya, Maria Jose Wiseman Pinto
Background and Objectives: An increasing prevalence of sexually transmitted infections especially Syphilis in blood donors may lead to increased donor deferrals and lessen the donor pool. Hence it is the need of the hour to device a structured screening methodology for Syphilis reactive donors. The aim of the study is to estimate the prevalence of syphilis in blood donors and to estimate the response rate of notified blood donors. Patients and Methods: This was a retrospective study, conducted in a Blood Centre (BC) on the blood donors visiting for donation from January 2020 to September 2021. The donors screened positive on chemiluminescence immunoassay were included after informed consent was obtained, and donor demographics and follow-up response rate were analyzed. Frequency and percentages were used to express descriptive statistics and Chi-square was used to test the relationship between categories( p<0.05 considered significant). Results: Out of 26,698 donations during the study period, 133 donors were screened positive for syphilis. 127 (96%) donors consented to postdonation. Out of 127, only 61 were notified regarding the infection and were advised about further followup. 52% of the donors who consented to postdonation counseling were not notified due to erroneous contact details. Out of 46 responders, only 17 underwent further testing. Conclusions: The prevalence rate of syphilis was found to be 0.49%. Among the donors notified, 75% responded back to the BC. Due to social stigma and inadequate knowledge about the disease, often, donors are hesitant to give a reliable exposure history. Adequate education and adapting to a structured screening methodology is the need of the hour to reduce the risk of transfusion-transmitted syphilis.
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Effect of donor and patient variables on the platelet increment and percent platelet recovery: Experience from tertiary care center in North-Western India p. 196
Sarita Sharma, Praveen Kumar Joshi, Sunita Bundas, Amit Sharma
Background and Objectives: Platelet (PLT) deficiency is a common cause of bleeding and PLT transfusions are often indicated for the same. PLT refractoriness is a challenging complication in patients dependent on PLT transfusions. The present study aimed to find out any effect of the donor, recipient, and machine variables on PLT increment (PI) and percent PLT recovery. Patient and Methods: A total of 600 apheresis PLT donors and 600 patients were included in this study; however, the PI and percent platelet recovery (PPR) were analyzed for only 535 patients. The data were collected such as the donor's age, gender, preapheresis hemoglobin (Hb), PLT count, PLT product yield, patient's age, gender, weight, pre- and posttransfusion Hb, and PLT count. PI and PPR were calculated and compared across different groups. Results: Refractoriness was more seen in hematological disorders in comparison to nonhematological disorders (P = 0.00001). However, no significant association of donor and recipient characteristics with PI was seen. Conclusion: PI does not depend on recipient characteristics such as age, gender, pretransfusion PLT count, and Hb.
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Role of therapeutic plasma exchange in neuromyelitis optica: A case series p. 201
Rashmi Parashar, Amit Sharma, Ankit Sharma
Neuromyelitis optica (NMO) is an inflammatory demyelinating disease of the optic nerves and spinal cord and generally has a relapsing course. It is an autoimmune demyelinating disorder of the central nervous system caused by the binding of aquaporin-4 immunoglobulin G to water channel protein at the astrocyte foot process. Here, we are presenting the effectiveness of therapeutic plasma exchange (TPE) therapy in the improvement of disability scores of 11 patients with NMO. A total of 49 procedures were done, and the mean number of TPE sessions was 4.45. The outcome was analyzed in the form of improvement in the Expanded Disability Status Scale score and visual acuity.
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Detection of weak “B” phenotype while resolving an ABO discrepancy: A rare case of B subgroup p. 205
Muhammad Ibrash-uz-Zaman, Mamona Mushtaq, Aamir Saeed, Neelum Mansoor
Quantitative and/or qualitative differences in ABO phenotypes give rise to ABO discrepancies causing difficulties in establishing the accurate phenotype. These discrepant serological reactions result in significant delays in blood bank. The correct typing of the blood group is imperative to prevent ABO incompatibility issues. However, the discrepant results encountered in routine settings are a challenge to immunohematologists. The variants of the ABO occur very rarely particularly true for B subgroups. Here, we present a case study of a healthy blood donor, discrepant results in forward and reverse blood grouping led us to perform adsorption-elution test. The presence of anti-B in the eluate confirmed the presence of weaker variant of B antigen on the surface of red blood cells. Correct identification of blood group is mutually important for donor and recipient to prevent the occurrence of any transfusion reaction. The serologically determined weak B phenotypes, however, require further confirmation through genomic analysis.
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Role of double-filtration plasmapheresis in ABO- and human leukocyte antigen-incompatible kidney transplant p. 209
Smriti Sinha, Shri Ram Kabra, Saikat Mandal, Vivek Bansal, Tanuj Paul Bhatia, Sumit More, Ranjan Kumar, Vibhu Ranjan Gupta
Kidney transplant has significantly improved the quality of life in end-stage renal disease patients compared to maintenance hemodialysis. Recipients can receive a living-donor or a deceased-donor kidney transplant. However, the presence of donor specific anti human leukocyte antigen (HLA) antibodies or anti A or B antibodies in the recipient makes the transplant incompatible and provokes to cause hyperacute, acute, or chronic rejection. Desensitization which is usually applied before to reduce incompatibility can be achieved by apheresis and preventing donor-specific antibody resynthesis by targeting both T and B cells. Here, we present two such cases transplanted successfully by desensitizing with double-filtration plasmapheresis (DFPP). Case 1 which was a female with high-titer anti-HLA antibody was managed with rituximab, 4 sessions of DFPP, antithymocyte globulin, and posttransplant Tacrolimus (Tac). Case 2 who had both high-titer anti-HLA and anti-A (IgG 1:256) antibody was managed with rituximab, 3 sessions of DFPP, and posttransplant Tac. In both cases, perioperative complications due to DFPP such as bleeding, thrombocytopenia, hypotension, and need of transfusion was minimal. These cases point toward successful application of DFPP in desensitization protocol, leading to successful HLA antibody-incompatible and ABO-incompatible renal transplant with minimal adverse incident and cost.
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A retrospective audit of red cell serology requisition forms received at a reference Testing Center for work-up p. 213
Prashant Pandey, Supriya Kumari, Divya Setya
Background and Objectives: Audits identify areas of problems in immunohematology workup and transfusion practice which can be corrected by the education of medical staff, formulation of guidelines, and algorithms. An audit is a series of simple, direct questions, which when answered and reviewed, tell us whether the laboratory is performing its procedures, activities, and policies correctly. The aim of this study was to analyze immunohematology request forms sent from red cell serology laboratories to our reference testing center (RTC) to ascertain their completeness. Materials and Methods: This was a retrospective, observational study conducted in the department of transfusion medicine at a tertiary-level health-care center from November 2019 to June 2021. We ascertained whether the immunohematology workup forms details were complete, absent, or incomplete. Results: The study was conducted over a period of 20 months, with 264 forms being audited. In this overall total number, almost one-third of 1894 (34.16%) of the immunohematology workup requisition form details were complete and 716 (12.91%) of these entries were incomplete. However, almost half of the overall number of 2934 (52.92%) of the requisitions were absent. Conclusion: From our study, we concluded that an audit of all the RTC requisitions at the point of receiving can be an important tool to detect requisition errors and results of RTC workup. We received a sample for RTC advanced immunohematological testing from all over India. There is a need for the organization of CME and training of staff to increase compliance regarding sending appropriate RTC advanced immunohematological requisitions and samples.
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Can we tweak the golden number of 12.5 gm% hemoglobin for blood donation? p. 217
Abhishekh Basavarajegowda, Saptarshi Mandal
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