Introduction: Leukoreduced (LR) blood components are used for the prevention of several transfusion adverse effects. Advancement in technology has led to newer methods to count residual leukocytes (rWBC) which miss detection on most standard automated hematology analyzers. Materials and Methods: Samples from thirty eight platelet concentrates (prepared by Buffy-coat method) were randomly taken on the day of preparation for rWBC count using Nageotte's chamber and flowcytometer. Results: The rWBC count on Nageotte's ranged from 2.5 WBC/μL to a maximum of 600 WBC/μL where as the flowcytometric count had a lowest of 1.97 WBC/μL to a highest of 740 WBC/μL. We found that the WBC counts using the Nageotte's method and flowcytometeric method are highly correlated. The concordance correlation coefficient or intraclass correlation coefficient which is a measure of reliability was 0.78 Conclusion: In view of the high concordance in correlation coefficient between the two methods, Nageotte's method could be skillfully performed for assessing leukoreduction in LR platelet concentrates of resource constrained blood banks of developing nations.

Background: Pre-transfusion compatibility testing is performed in order to prevent transfusion of incompatible donor red cells that might result in an immune mediated hemolytic transfusion reaction, thereby forming a critical element in the process of transfusion to enhance blood safety. Titers are generally determined with a semi-quantitative assay by serial double-fold dilution. Several different techniques have been employed for titration, of which the conventional tube test (CTT) and column gel card test –Column Agglutination Technique (CAT) are the most frequently used. Historically, CTT has been used as the standard technique for immunohaematological studies, such as direct antihuman globulin test for the diagnosis of autoimmune haemolytic anaemia and in screening for specific antibodies in transfusion medicine. Study Design and Methods: For this study, 51 plasma samples from donors were subjected to antibody titration using the two techniques CAT and CTT. For the purpose of standardization and reproducibility of results, all 51 samples were tested by two technicians and the results obtained were a total of 70 antibody titers. Dilutions were continued to a titer of 1:1024 with the aim of allowing for at least two negative tubes beyond the titer end-point. The statistical analysis of the data has been done in MS-Excel. Results: Out of the 70 titer samples, 57 samples showed identical titer values in the methods performed by both the technicians. 8 samples showed titer values higher in Technician 2 by one dilution as compared to Technician 1, whereas 5 samples showed titer values lower in Technician 2 when compared to Technician 1 (one dilution low in 4 samples and two dilutions low in 1 sample). Conlcusion: CAT titers demonstrated up to a twofold difference as compared to CTT titres, as demonstrated in the figures presented. This disparity is not unusual and can be attributed to the lack of standardization which can be reduced by Column Agglutination Technology. CAT uses specific volumes of red blood cells and the reagents are dispensed by pipettes. Also, the procedure is technically simpler due to the elimination of washing steps and results in well-defined end points. Column Agglutination Technique offers not only sensitivity, but also the best titer turnaround time, eliminating almost 45 minutes of incubation period alone. The results of testing by CAT are comparable to CTT but have the advantages of ease of performance, better standardization of cells, most importantly stable results and reproducibility. Implementation of antibody titers by the gel method would clinically benefit the management of ABO incompatible solid-organ transplant patients.

Background: Ordering of blood is a common practice in elective surgical procedures. Unnecessary blood orders need to be waived to reduce both workload and financial expenditure. We need to optimize the quantity of blood being cross-matched, by assigning each surgical procedure, a tariff of transfusion. To this effect, the maximum surgical blood ordering schedule(MSBOS) is one such approach. The study was performed with the aim of evaluating whether preoperative blood cross-matching in our hospital is well adjusted to the actual intraoperative blood usage. Materials and Methods: A hospital-based retrospective cross-sectional study was conducted in those patients who underwent elective surgeries in Himalayan Institute Hospital Trust hospital over a period of 1year. Blood requisitions and transfusions were compiled and reviewed. The number of units requested, cross-matched and transfused along with number of patients cross-matched and transfused were collected. The blood bank requisition forms, databases, old surgical records, and discharge sheets were reviewed. Following indices were calculated: (i) Cross-match to transfusion ratio(C/T), (ii) Transfusion probability(T%), (iii) Transfusion index(TI), (iv) MSBOS. Results: Atotal of 2370patients underwent 214 different elective procedures are included in this study. Totally, 1184 red blood cells units were cross-matched, and only 625 units(52.7%) were transfused to 331patients. The overall C/T ratio calculated was 1.8, TI was 0.5 and T% was 61.7%. All these figures were found to be within the desirable range. Based on these indices, MSBOS was formulated for each procedure. Conclusion: The study indicated an adequate overall ratio of C/T, T%, and TI except a few surgeries that showed transfusion indices beyond accepted levels. Developing a blood ordering policy(MSBOS), to guide the clinicians regarding blood usage can decrease over ordering of blood thereby reducing unnecessary compatibility testing, returning of unused blood, and wastage due to outdating.

Background: Besides all other measures like predonation donor screening and testing for transfusion-transmitted infections (TTIs) on donated blood, another tool for preventing disease transmission by transfusion is to inform and counsel reactive donors about the status of TTIs reactivity and prevent them for donating blood in future. Materials and Methods: The present observational study was carried out in blood bank of Department of Immunohematology and Blood Transfusion at a Tertiary Care Government Hospital in South Gujarat over a period of 3 years involving total 25,020 donors including 353 reactive donors. The reactive donors were informed by the blood bank counselor about an abnormal test result with an advice to report to the blood bank for one-to-one counseling and repeat testing, as well as for referral to the respective department/integrated counseling and testing center/sexually transmitted disease clinics of the hospital for further management. The response rate of TTIs reactive donors after notification of their abnormal test results was evaluated. Results: Of the 353 TTIs marker-reactive donors, 320 (90.65%) reactive donors could be contacted and of which 261 (81.56%) responded positively to the notification calls and attended counseling at the blood bank and 59 (18.44%) informed donors did not respond at all. Conclusions: In the study, due to incorrect or changed contact details, 33 (9.35%) reactive donors could not be contacted and among 59 nonresponded reactive donors, the major reasons were donor's busy schedule, out of city residence, and not willing to visit the blood bank again.

Introduction: The supply of blood components in Pakistan far outstrips the demand. In addition, appropriate and rationale use of blood components is not widely practiced. To optimally utilize the limited supply of blood products, it is important to identify and define the gaps in practices and system. The specific aim of the study was to document the practices of the use of fresh frozen plasma (FFP) in a premier tertiary care hospital of Islamabad, Pakistan. Materials and Methods: The study was carried out on 107 randomly selected patients who received FFPs in various clinical units of the Shaheed Zulfiqar Ali Bhutto Medical University Hospital from March to October 2014. Information was retrieved from the transfusion request forms and evaluated according to the American College of Pathologist guidelines for the use of FFP. A questionnaire was also developed for interviewing the senior doctors from each specialty to have their feedback about the transfusion services provided. Nineteen clinicians were randomly selected for this purpose. Results: Requests from 107 patients for 460 FFPs were studied (actual number of FFPs issued was 278). Nearly 68.3% (n = 73) of the patients were males and 31.7% (n = 34) were females. Majority of the units were requested from thalassemia and hemophilia center (40.6%). The patients enrolled in the study had multiple disorders, majority being with coagulation disorders at 40.1% (n = 43). Nearly 98.5% (n = 138) of the request forms were brought to blood bank by the patient attendants. Seventy-three (52%) FFP units were appropriately transfused while 67 (48%) were inappropriately transfused. The most inappropriate use of FFP was seen in Mother and Child Health Centre (MCHC), Oncology, Emergency and Casualty, and the most appropriate use was seen in thalassaemia centre, paediatric units, and medical intensive care unit. Clinician interviews indicate poor knowledge base and inappropriate practices. Conclusion: The study highlighted the inappropriate use of FFPs in a tertiary care hospital and threw light on poor transfusion practices and the lack of implementation of the principles of haemovigilance in the utilization of FFPs. Specific recommendations include, administrative intervention with regular screening of requests by blood bank doctors and senior doctors of the departments using FFP and establishment of guidelines in departments regarding the use of blood components including FFP.

Background: Injury is the leading cause of life years lost, and hemorrhage is responsible for 40% of all trauma deaths and is commonly associated with coagulopathy, necessitating the use of blood and blood components. With logistical issues and concerns regarding safety of fresh whole blood because of the abbreviated less-sensitive technologies involved in testing, component therapy has emerged as an effective alternative to fresh whole blood in civilian settings. This study aims to study the outcomes of trauma patients requiring blood transfusion in an emergency setting of a tertiary care hospital. Materials and Methods: This is a 1-year retrospective study conducted at a tertiary care multispecialty hospital from July 2013 to June 2014. During the period, 1352 patients presented to the emergency department; their blood usage and mortality were studied. Results: Of the 1352 patients who presented with trauma due to road traffic accidents, history of fall, and assault, only 107 (7.9%) needed hospitalization due to grievous injuries. Of the hospitalized patients, only 16 (15%) needed blood component transfusions and 6 of them died giving a mortality rate of 5.6%. Five of the six deceased patients had a high prothrombin time ratio over 1.5, but only two of them received fresh frozen plasma transfusions. The mortality rate of 5.6% (6/107) was lower compared to other similar studies. Conclusion: Medical management probably plays a more important role than transfusion of blood in acute trauma cases. Although conventional protocols where transfusion is carried out after laboratory tests for coagulopathy have yielded good survival rates, use of newer point-of-care testing such as thromboelastogram and improved communication between the blood users and blood banks coupled with a good massive transfusion protocol (MTP) will help in better management of bleeding associated with trauma. Adequate randomized controlled studies to demonstrate the superiority of 1:1:1 MTP as opposed to conventional protocols are lacking.

Social marketing is the use of marketing principles and techniques to influence a target audience to voluntarily accept, reject, modify, or abandon a behaviour for the benefit of individuals, groups, or society as a whole. Voluntary Blood donation/Organ donation is an ongoing movement. World over, it is well recognised that collection of blood only from voluntary, non-remunerated blood donors from low- risk populations is an important measure for ensuring safe blood. There is also the problem in the realm of organ donation – due to the shortage of organs and donors for stem cells many thousands of patients are dying globally.The concept of social marketing will add donors to pool and help in overcoming deficiency over period of time.

Despite the current advances in technology in health-care delivery, access to safe blood and blood products and their judicious use remains a big challenge. There is a stark difference between developed and developing nations as less than half of hospitals in developing nation provide blood transfusion services. While the health sector in India has made outstanding accomplishments in the past few decades, it has not reciprocated sufficiently to fulfil the country's objective on blood transfusion facilities. Indian blood transfusion network is plagued by inadequacy of blood storage centers, dominance of private sector over public sectors, lack of proper facilities, storage & quality of services etc. Revamping blood transfusion system is the basic necessity to provide basic care. The challenges to overcome such hindrances may be unification of blood transfusion services to maintain the standard or duplication of services, focus on quality of service provided, adoption of newer technologies, strengthening of reporting and information system to maintain the inventory, emphasis on equitable distribution blood and blood products and many more. These changes can be made through framing a strong policy, functional planning and setting standards.

Background: Establishment of daycare blood transfusion service in a licensed blood transfusion center of Dhaka city for patients needed blood transfusion is a milestone for improving blood service of Bangladesh. Aim: The aim of this study is to assess the daycare blood transfusion service of a licensed blood transfusion center in Dhaka city and evaluation of patients receiving blood transfusion and to determine the pattern of blood groups of the patients. Materials and Methods: This cross-sectional study was done in a licensed blood transfusion center in Dhaka city. The study reveals that 383 patients of various modalities of ailments had their blood transfusion from August 2012 to January 2014. The patient age, sex, diagnosis, and levels of hemoglobin were taken into consideration. The patterns of their blood groups were determined for the study. Results: This cross-sectional study revealed that among 383 patients, 148 were male and 235 were female. With the age range of 14–80 years, mean age was 53.9 ± 2.77 years. Among them, most (148) were in the age range of 55–64 years. Among the patients, 47.00% (180) were suffering from anemia according to severe, moderate, and mild anemia with various diseases. Out of 383 patients, 31.33% (120) were suffering from carcinomas. Among those carcinomas, breast, colon, lung, larynx, tongue, stomach, and esophagus carcinoma and cholangiocarcinoma were prevalent. Others such as chronic kidney disease and leukemia 7.31% (28) were next to take transfusion. Maximum of them, i.e. 235 (61.36%), were in the hemoglobin range of 5.81–7.80 g/dl range and 60 (15.67%) had their hemoglobin level at 3.81–5.80 g/dl range. Out of them, 160 were of A group, 106 were B group, 88 were O group, and 29 were AB group. Conclusion: Although daycare transfusion centers are very few in licensed blood transfusion centers, the need for daycare transfusion is increasing gradually. We recommend establishing more daycare transfusion services for the transfusion needed patients.

The definition of Auto-Immune Hemolytic Anemia (AIHA) is an increment of anti erythrocyte antibodies (AEA) which mediate the destruction of circulating erythrocyte antigens. Antibodies develop against one's own erythrocyte antigens. Diagnosis of AIHA is made on the basis of auto-agglutination and direct anti-globulin test (DAT). The specificity of erythrocyte antibody is often difficult to identify especially in emergency. This study is based on a case of AIHA on a 62 years old female patient. She also had underlying hypothyroidism, diabetes mellitus and Hypertension.

Introduction: Temporary or permanent deferrals lead to loss of valuable blood donors and blood units accessible for transfusion purposes. Understanding the rate and reasons of donor deferral provides direction for recruitment and retention strategies of blood donation. The current study was conducted to investigate the prevalence and causes of deferral in blood donors in Islamabad, the federal capital of Pakistan. Materials and Methods: A structured pilot-tested questionnaire was sent to all 19 licensed blood banks of Islamabad through the Islamabad Blood Transfusion Authority. Data submission is a prerequisite for licensing with the authority. The study was conducted between January and December 2015. Results: Most of the deferrals were because of anemia (41%), which was more prevalent in females. Other common causes for deferral in our study were underweight, low blood pressure, and under/overage. Less common causes were the use of certain medications, recent blood donation, history of fainting, and fear of needle. Conclusion: It is imperative to investigate the rate and reasons of donor deferral to guide the recruitment and retention efforts. Donor sensitization on the criteria of recruitment needs to be addressed on priority basis through the public/donor awareness campaigns.

The Kleihauer–Betke (KB) test is a time-consuming test with a lot of variables which affect the calculation of the extent of fetomaternal hemorrhage (FMH). There have been several formulae proposed by various authors to calculate FMH using KB test. In this article, we propose a simple mathematical alteration to accommodate the correction for some of the factors that lead to falsely high estimation of FMH.

The association of autoimmune hemolytic anemia (AIHA) with primary antiphospholipid antibody syndrome (primary APS) has not been well established. However, the occurrence of AIHA in primary APS may define a subgroup of patients with a significant risk for subsequent development of SLE. We report a case of 28 year old male who presented with clinical features of cerebral arterial thrombosis and symptomatic anemia. Subsequently the diagnosis of primary APS and warm type AIHA was made. Patient was treated for cerebral thrombosis along with glucocorticoids and least incompatible red cell concentrates. After a regular follow up of 20 months, the patient developed positivity for antinuclear antibody and oral mucosal ulcers confirming the diagnosis of SLE. This case emphasizes that patients with primary APS should always be evaluated for AIHA as this combination is not impossible, though rare. It poses a significant risk of development of SLE. Transfusion medicine specialist has a role to play in the diagnosis and management of AIHA.