Background: It is well-known that alloimmunization to red blood cell antigens resulting from the genetic disparities between donor and recipient is one of the risks of blood transfusion. The antibody screening cells are used to detect unexpected antibodies. The risk of alloimmunization is higher in patients who have received multiple blood transfusions such as thalassemia, other hematological disorders, renal failure patients on dialysis who receive blood transfusions, and females with bad obstetric history. Antibody screening test using 2–3 cells panel is not a mandatory pretransfusion testing in India and is performed routinely in limited blood centers. Materials and Methods: This bicentric study has been carried out to look at prevalence of antibodies in multi-transfused patients who have higher risks of alloimmunization such as patients who have received multiple blood transfusions such as thalassemia, other hematological disorders, renal failure patients on dialysis who receive blood transfusions, and females with bad obstetric history in the North as well as South India. The study was conducted at two blood centers, one regional blood transfusion of North India and one at South India. Totally, 4569 cases were analyzed and 258 patients were selected for antibody screening and identification. Results: Of total 4569 patients, 258 multi-transfused patients were studied. Among these, seven patients (2.71%) were found alloimmunized. The risk of alloimmunization was 2.90% in thalassemia, 0% in chronic renal failure patients, 3.77% in pregnant females with bad obstetric history, and 2.78% in other multi-transfused patients like cancer. Discussion: Regular monitoring through antibody screening and transfusion of blood matched for minor erythrocyte antigens are recommended in these patients.

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Thromboelastography (TEG) is a novel viscoelastic method which provides a comprehensive assessment of hemostasis from clot initiation and development to fibrinolysis involving both cellular and plasmatic components of hemostatic system. Apart from surgery its role is expanding into medical specialties with increasing integration into laboratory settings. TEG complements the conventional coagulation tests in assessment of bleeding disorders. Further hemotherapy based on TEG results has been shown to reduce transfusion requirements in varied clinical settings besides helping in identifying coagulopathies in patients with major bleedings. This review article addresses briefly the methodology, clinical applications, interpretation of TEG results including authors' own experience of TEG in different clinical scenarios and limitations of TEG. Overall, this technique seems to be helpful for evaluation of hypercoagulable state and in detecting fibrinolysis which are difficult to be detected with conventional coagulation tests. Kaolin activated citrated blood samples analyzed within 30-60 min of sampling can provide reliable results in a laboratory setting. However, multiple assays using different activators or modifiers may be required for accurate results in selected cases. The operator should be aware about the various preanalytical and analytical variables which can affect the results including limitations of this technique. The tracing of the thromboelastography should be interpreted cautiously taking into consideration the clinical picture of the patient and results of other laboratory tests. With improved model and availability of more assays it is hoped that TEG and other such hemostasis analyzers would bring in the paradigm shift in the hemostasis monitoring and treatment of patients in future.

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Coronavirus (CoV) disease-2019 (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome-CoV-2. The disease started in 2019 in Wuhan, China, and has spread globally, resulting in a pandemic. Common symptoms include fever, cough, and shortness of breath. Muscle pain, sputum production, and sore throat are less common symptoms. While the majority of cases result in mild symptoms, some progress to pneumonia and multiorgan failure. The deaths per number of diagnosed cases is estimated at between 1% and 5%, but varies by age and other health conditions. The infection is spread from one person to others via respiratory droplets, often produced during coughing and sneezing. It takes 2–14 days to develop symptoms from the day of exposure. Reverse transcription-polymerase chain reaction from a nasopharyngeal swab or oropharyngeal swab is the standard method of diagnosis. The infection can also be diagnosed from a combination of symptoms, risk factors, and a chest computed tomography scan showing features of pneumonia. Measures recommended to prevent the disease include frequent hand washing, maintaining distance from other people, and not touching one's face. The use of masks is recommended for those who are suspected to have the virus and to their caregivers, but not the general public. As of now, there is no vaccine or specific antiviral treatment for COVID-19; management involves treatment of symptoms, supportive care, and experimental measures. The World Health Organization declared the 2019–2020 CoV outbreak a pandemic and a Public Health Emergency of International Concern.

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Background: Blood is precious and should be utilized judiciously with minimal wasting. By analyzing the data and the reasons for discard, the blood transfusion service can develop plans to evaluate causes that lead to discard of blood and its components and interventions that can be used to optimize their use by training and education. Aim: (1) The aim of the study was to evaluate causes that lead to discard of blood and its components and interventions that can be used to optimize their use by training and education, (2) to introduce possible strategies for minimizing blood wastage, and to observe and compare the discard rate after the implementation of strategies. Materials and Methods: The study of analysis on discard of blood and its products was carried out retrospectively from January 2014 to December 2016 (36-month period), and the data were collected from the blood bank database system using Easy Software in the Department of Transfusion Medicine, Shri M P Shah Govt. Medical College, Jamnagar in Western India. The results were analyzed using Microsoft Excel 2007 database sheet, percentage calculated and Chi-square test was applied between different variables with P value set a significant when <0.05. Results: A total of 66,255 blood units were collected during the study period of 36 months. Out of 66,255 blood units collected, 44,617 were whole blood (WB) whereas components were prepared from remaining blood units. A total of 21,638 packed red blood cells (PRBCs), 6840 platelet concentrate (PC), and 14,372 fresh frozen plasma (FFP) were prepared. Average discard rate of the present study was 6.95%. Discard rate for WB, PRBC, PC, FFP was 3.15%, 2.26%, 28.39%, and 5.36%, respectively. Conclusion: To minimize wastage of blood, there should be proper implementation of blood transfusion policies and coordination between hospital and blood bank staff. Strict adherence to donor selection criteria, taking proper predonation history and counseling, software to identify transfusion transmitted infection (TTI) positive donors, and deferring suspected professional donors who have been screened previously may help in reducing discard due to TTI positivity. Process improvements such as technical expertise in phlebotomy, prevent red blood cells (RBC) contamination during platelet and FFP preparation, precaution during thawing of FFP to prevent leakage, and increased use of apheresis technique prevent wastage of blood components. Continued medical education for technical staff to maintain self-audit, tracking quality indicators of processing and preparation of the blood components, rational use of blood and components, and review the blood management system will further help in reducing the discard rate.

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Daratumumab (DARA), a monoclonal anti-CD38 antibody, belongs to the new generation of immunotherapy in refractory relapsed multiple myeloma. CD38 is weakly expressed on human erythrocytes. By its intrinsic anti-CD38 activity, DARA also interferes in routine pretransfusion compatibility testing such as antibody screening for red blood cells (RBCs) alloantibodies and compatibility testing. Treating RBCs with dithiothreitol eliminates the DARA interference. We report two cases of serological interference of DARA in pretransfusion testing and how timely information before starting the second patient on DARA prevented the delay in pretransfusion compatibility testing and blood availability.

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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.

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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.

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Blood transfusion contributes to saving millions of lives every year, improves life expectancy, and the quality of life of patients suffering from life-threatening conditions and supports complex medical and surgical procedures. Every country should put in place policies, a legislative framework, systems and structures to ensure the safety, quality, accessibility, and timely availability of blood and blood products to meet the needs of all patients who require transfusion. However, there are numerous situations, particularly in the less developed world, where these prerequisites have barely been implemented. A literature search was done on matching combinations of legislation, regulation, legislation framework, with blood and blood transfusion, which resulted in almost exclusively references with respect to national and international legislation. The Ministry of Health should provide effective leadership and governance in developing a national blood system that is fully integrated into the health-care system. Essential functions of a national blood system include policy formulation, a legislation framework spelling out the principles and boundaries, standard setting, strategic and operational planning, provision of resources and national coordination, and management to ensure an adequate supply of blood and blood products and safe clinical transfusion. The structure of the national blood system will depend on the organization and level of development of the health-care system. However, all critical activities within a national blood system should be coordinated nationally to promote uniform standards, economies-of-scale, consistency in quality and safety of blood and blood products. and best transfusion practices. Keys are formulation and oversight of the implementation of the national blood policy and strategic plan; defining the roles, responsibilities, and accountability of institutions; and setting national standards for blood and blood products, services, processes, and systems; defining requirements for the registration, licensing, and operation.

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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.

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Background and Aim: Blood transfusion plays an important role in improving the health and saves lives. However, it is a double-edged sword, which should be used judiciously as it is also inherently embedded with adverse reactions ranging in severity from minor to life threatening events. Haemovigilance programme of India (HvPI) aims to ensure the transfusion safety by monitoring every step of transfusion process from donor to recipient. Recipient hemovigilance is reporting of adverse transfusion reactions (ATRs) in the patient. Contributing to this program as registered member, this study aimed to determine the frequency and type of ATRs in blood recipients. Materials and Methods: The study was conducted in the Department of Transfusion Medicine of a University Teaching Hospital of South India. This was a retrospective, observational study in which all ATRs reported by the department to HvPI observed in patients admitted in various clinical departments over a period of 24 months (January 2014 to December 2015) were reviewed and analyzed. Results: During the study, a total of 31,687 blood and blood components were issued, out of which a total of 66 (0.2%) ATRs were reported. The most common type of reaction observed was febrile nonhemolytic transfusion reaction (FNHTR) 54.55% (n = 36), followed by allergic 33.33% (n = 22). The other reactions observed were nonspecific reactions 9.09% (n = 6), acute hemolytic reaction 1.52% (n = 1), and mixed type reaction of FNHTR and allergic reaction in 1.52% (n = 1). No case of transfusion-related acute lung injury, transfusion-associated circulatory overload, anaphylaxis, and transfusion-related sepsis was reported. The ATRs were seen mostly with packed red blood cells (78.8%). Conclusion: The frequency of ATR in our institution was 0.2%. Febrile and allergic reactions were the most common type.

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Objective: There have been quite a few publications on audit of clinical use of blood components. However, there is paucity of studies on red blood cell (RBC) clinical use. Therefore, a study was designed to determine the appropriate clinical use of RBC in various departments in a tertiary care setting. Materials and Methods: It was a prospective observational study conducted from January 2017 to April 2017 in a large tertiary care hospital in north India. The study population included all consecutive admitted patients who received RBC transfusion during the study period. Patients undergoing RBC transfusions the in operation theater were excluded. An algorithmic approach was used which analyzed the “appropriateness” on the basis of hemoglobin thresholds, symptoms in patient, comorbidities, and imminent blood loss in a sequential manner. Results and Discussion: Of a total of 1024 transfusions, 924 (90.02%) episodes were appropriate. This was higher than the previous published reports because of algorithmic approach, higher hemoglobin threshold (8 g%), and possibly better informed physicians in tertiary care setting. Conclusion: There were a high percentage of appropriate RBC transfusions in large tertiary care settings.

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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.

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Context: Platelet transfusion is an essential part of managing cancer. Refractoriness to platelet transfusion poses great challenge in the treatment of thrombocytopenic patients. Aims: The prospective study was undertaken to correlate and evaluate the result of the platelet cross-matching with posttransfusion count increment and to ascertain the effectiveness of routinely performing platelet cross-matching in Indian perspective. Subjects and Methods: ABO compatible, leukoreduced, random-donor platelets were randomly transfused to 30 thrombocytopenic, oncology patients. Platelet cross-match and platelet antibody screen were performed using solid-phase red-cell adherence (SPRCA) techniques and corrected count increment (CCI) was ascertained. Statistical Analysis: Statistical Package for Social Sciences version 16, Chi-square test were used for statistical analysis. Multivariate analysis and step-wise regression procedure were used to choose the set of best predictors. Results: One hundred and twenty-two units (86%) were negative cross-matched while 20 units (14%) were positive platelet cross-matched. Mean CCI was 28,927 ± 23,007 which was more and statistically significant in females than in males. Four cases (13.33%) showed platelet refractoriness with CCI <5000 including three cases of leukemia (25% of hematological malignancies). Patients with low CCI showed positive cross-match and antibodies against platelets. Conclusion: Platelet cross-match using SPRCA is an effective and rapid first-line approach for selecting compatible platelets as compared to human leucocyte antigen-matched platelets in the treatment of thrombocytopenic cancer patients. Platelet cross-match along with testing for anti-platelet antibodies should be an important component in the management of oncology patients which is less time-consuming and cost-effective than the molecular testing.

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Introduction: Although CDC has been the gold standard for many years, this assay is certainly not perfect and its use is associated with several problems. The Luminex anti-HLA antibody detection assay is reportedly more sensitive and specific. One of the test is Luminex DSA cross match which is more sensitive than CDC cross match. It is also considered cost effective tool to evaluate pre and post renal transplant cases. Material and Methods: We started Luminex based Donor specific antibody Cross Match tests (DSA Xm) with lysate by the end of 2009 along with CDC after standardization. This study is planned to evaluate the results of DSA Xm of last three years & also to observe antibody medicated rejections after renal transplant. Results: Total 3137 Luminex DSA Cross Match tests were done & 515 tests were positive cross match with negative CDC xm result. Out of 515 positive results 164 were positive for class I, 223 were positive for class II and 128 were positive for both class I & II. In the three years total 1129 renal transplants were done at various centers and total 42 cases of Antibody medicated rejections were reported. Out of 42 patients, 36 patients had pre transplant history of CDC negative & Luminex DSA xm positive. Conclusion: We evaluated our three year results of DSA Xm test and found a cost effective, sensitive and useful supplementary test to evaluate pre and post renal transplant cases.

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We report a rare case of Oh (D)-negative female with in vitro fertilization (IVF) pregnancy. Blood grouping was reported as O Rh (D) negative elsewhere and was referred at 28 weeks gestation for anti-D titration to our center. Blood grouping repeated at our laboratory was Oh Rh (D) negative. Owing to the absence of H antigen-negative cells, we did anti-H adsorption studies on the patient serum to look for underlying red cell alloantibodies, which were absent. The Ig (G) anti-H titer was 256, but there were no signs of fetal anemia as seen on the fetal middle cerebral artery (MCA) peak systolic volume studies also. The patient was on follow-up with anti-H titers and fetal MCA-Doppler studies every 2 weeks. The patient was started on oral iron and erythropoietin as hemoglobin was 8.5 g% which then improved to 11.5 g% after two doses of erythropoietin. Owing to risk of bleeding due to low-lying placenta, the treating obstetrician wanted to keep two units of red cell concentrate ready before elective lower segment cesarean section. Hence, close family members of the patient were screened for Oh phenotype, but none of them were found to be of Oh phenotype. Hence, autologous predeposit with fetal monitoring was considered but not implemented owing to legal and patient concerns. Pregnancy was uneventful and a healthy female baby was delivered at term. The baby did not have any signs of hemolytic disease of newborn. Blood grouping of baby was O positive and direct antiglobulin test done at the referring center was negative.

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Introduction: The significance of appropriate completion of blood request forms (BRFs) is frequently underrated by the clinicians which results in wastage and increased risk of inappropriate therapy. The judicious use of blood components can be assessed by the crossmatch-to-transfusion ratio (C:T), transfusion probability (%T), and transfusion index (TI). The current study assessed the standard of completion of BRFs and blood components utilization at a Tertiary Care Hospital Blood Bank. Materials and Methods: This was a cross-sectional, prospective study conducted at the Department of Blood Transfusion Services, Shaheed Zulfiqar Ali Bhutto Medical University Hospital, Islamabad, from January to April 2016. A total of 5957 BRFs received between January and April 2016 were reviewed. The data were entered in SPSS version 20.0 (IBM SPSS Statistics for Windows, IBM Corp., Armonk, NY, USA) and analyzed for completeness, legibility, and blood component utilization through calculation of key indicators including C:T ratio, transfusion probability (%T), and TI. Results: Out of the 5957 request forms reviewed, only 12.7% forms were completed in full. The overall C:T ratio, %T, and TI were 1.52, 65.38, and 0.65, respectively. The same indicators for the Maternal and Child Health Centre (MCHC) were 10.7, 9.32, and 0.09. Conclusion: Incomplete blood transfusion request forms create difficulties for the blood bank staff in comprehending the requests which may compromise patient safety. Similarly, the efficiency of MCHC blood transfusion services is far from optimum. The Hospital Transfusion Committee can play a key role in solving this problem and thus improving the standards of Patient Blood Management.

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Background and Aim: Platelet transfusion plays an important role in the treatment of hematological, oncological, surgical, and transplant patients. Aphaeresis technology is widely available in the world and some part of India, but it is new for our region. The present study aims at various aspects of plateletpheresis including donor safety, donor hematological changes following single donor platelet (SDP) donation, quality of product, and impact on patient following SDP transfusion. Materials and Methods: Preprocedural hematological count such as total platelet count (TPC), hemoglobin, red blood cells, and white blood cells count was recorded. All donors were observed for adverse donor reactions. Postdonation (after 30 min) sample was drawn to see the hematological parameters and compared to that of pre donation hematological parameters. Quality control of all SDP products was done. All recipients were observed for any transfusion reactions. Post 24 h transfusion sample was obtained from the SDP recipient and compared to that of pretransfusion sample to see the platelet increment. Results: A total of 135 plateletpheresis procedures were performed on cell separator. SDP was collected from the donors as per standard operating procedure. All donors were observed for adverse donor reaction. We found an adverse event with one donor. There was decrease in mean value of all hematological parameters in the postdonation sample. There was no thrombocytopenia either clinically or from laboratory value. Similar trend was seen with double yield collection. Mean acid citrate dextrose (ACD) used was 328, mean blood volume processed 3385 ml, mean product volume was 249 ml, mean time was 76.8 min during the procedure. Quality control of all SDP products was done. Mean yield was found to be 4.18 ± 0.95 × 10¹¹ per unit. A positive correlation was seen between pre TPC of donor and product yield. Post 24 h transfusion sample was obtained from the SDP recipient and compared to that of pretransfusion sample to see the platelet increment. We observed mean increment of platelet count to be 76.15 × 10⁹/L. Overall therapeutic benefit was observed in all cases. Conclusion: The study found that plateletpheresis procedure is very safe from donor point of view and SDP product is effective from recipient's point of view.

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Introduction: Karnataka state has a total of 176 blood banks, with a total collection of around 650,000 units annually. From January 2014, all units under the Department of Health and Family Welfare services are tested at NAT Lab established at the Central facility and from September 2014, standalone Regional Blood Transfusion Centre was included in the State Government project. Aim and Objective: The aim of the study is to analyze the nucleic acid testing (NAT) for our donor population and demonstrate consolidation of blood transfusion service through a centralized testing center for NAT and also to assess safety benefits of implementing individual donor NAT (IDNAT). Materials and Methods: We collect nearly 40,000 units annually from voluntary donors with 30% repeat donations. The donors undergo strict predonation counseling, donor questionnaire, and medical examination. The units collected are tested for human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) by ECI using VItros 3600. All the units are tested by NAT at Central NAT Lab, screened by Procleix^® Panther System by Grifols. Results: From September 2014 to March 2016, total 50,903 samples tested for NAT. Of 50,903 samples, 588 samples (1.15%) were reactive by Chemiluminescence including 265 for HBV, 188 for HCV, and 135 for HIV. Total NAT reactive samples were 254, out of this 11 reactive for HIV-1 (0.02%), 2 reactive for HCV (0.003%), 235 (0.46%) reactive for HBV. There was one HIV and 10 HBV infection cases that were not detected by serology but reactive by NAT. The yield detected is 0.021% or one in 5000. Conclusion: The IDNAT project has helped in preventing window period infections thus reducing the treatment cost and burden on healthcare. It has added benefits in blood safety and should be considered along with the basic quality assured blood transfusion system such as volunteer base for blood donation, provision of donor self-deferral, donor notification, and quality assured sensitive serological methods.

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Alloimmunization to antigens of Rh blood group system is of clinical relevance during pregnancy. Despite the use of antenatal anti-D immunoglobulin prophylaxis, some proportion of RhD-negative pregnant women still become immunized. RhD-negative pregnant women with a heterozygous partner can be reassured and managed less intensively if RhD-negative status of the fetus was confirmed. The conventional techniques used for prenatal testing of fetal RhD status are mainly invasive such as chorionic villus sampling, amniocentesis and cordocentesis, and carry risk of transplacental hemorrhage and pregnancy loss. The discovery of cell-free fetal DNA (cffDNA) in maternal plasma in 1997 has opened up new possibilities for noninvasive prenatal diagnosis. With the use of real time polymerase chain reaction technology, circulating fetal DNA has been detected robustly in the plasma of pregnant women, even in the first trimester of pregnancy. Various assays have been developed to confirm the fetal RHD status by targeting the cffDNA using a combination of multiple RHD exons. The commonly used exons are 4, 5, 7, and 10. Common causes leading to discordant results in fetal RHD typing are low fetal DNA concentration due to extraction inefficiency, lack of fetal DNA control, silent maternal RHD alleles, and manual error. False negative results can prove critical in case of alloimmunized pregnancies and hence use of appropriate controls and strict reporting criteria is important to increase the sensitivity of the assay. Owing to the wide genetic variation of the Rh blood group system, the development of fetal genotyping strategies according to ethnic origin of the patients would further increase the sensitivity. Fetal blood group genotyping by noninvasive method is safe, and numerous groups have reported fetal RHD genotyping in D-negative mothers with close to 100% accuracy. Noninvasive fetal RHD typing can be performed in RhD-negative alloimmunized and nonimmunized pregnancies to decide on clinical management and to restrict the anti-D immunoglobulin prophylaxis, respectively. Thus, the introduction of this test for screening all RHD-negative pregnant women is highly desirable.

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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.

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Objective: Blood products are vital resources to health-care institutions with constantly growing demands. Gross over-ordering of blood causes exhaustion of valuable supplies and resources and add financial burden to patients undergoing surgical procedure. Aims: Study was undertaken to evaluate blood requisition, utilization, and management in cardiac surgery patients in a tertiary care hospital. Materials and Methods: Prospective study was conducted in cardiac surgery patients over 3 years from 2013 to 2015. Blood utilization indices were computed. Cross match to transfusion ratio (C:T) ratio of 2.0 and below, transfusion index (TI) value of 0.5 or more, and transfusion probability (%T) value of 30% and above were considered indicative of significant blood usage. Statistical analysis was done using Student's t-test. Results: During the study, a total of 15,392 patients' requisitions were received. Out of 25,190 units of blood cross-matched, 18,741 units were issued (C:T ratio 1.34) implying that overall 25.60% of blood was unutilized. From a total of 2752 units cross-matched for cardiac surgery cases, only 1296 units were transfused with C:T Ratio 2.12 implying that 52.91% of blood was unutilized which was much higher and statistically highly significant than in total patients. Overall TI was 1.22 and %T as 83.07% while for cardiac patients, TI was 2.32 with %T as 85.84%. Conclusions: Blood transfusion plays a major role in resuscitation and management of cardiac surgery patients. Blood transfusion services need to adopt blood conserving policies. Efforts should be made to adopt more conservative transfusion thresholds, conduct regular auditing, and periodic feedback to improve blood ordering, handling, distribution, and utilization practices of this scarce resource.

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Introduction: Nigeria has a national policy on blood services, however, most medical facilities find difficulties in establishing a viable, efficient blood banking system; therefore, it becomes necessary to ensure judicious utilization of this scarce commodity. Therefore, this study hopes to determine the pattern of demand for blood transfusion in our institution. Materials and Methods: This study was a 1-year retrospective analysis of the request for blood transfusion. Results: There were 1958 blood requests, consisting of 554 for males (28.3%) and 1404 for females (71.7%) with male:female ratio of 1:2.5. The obstetrics and gynecology department (52.3%) had the highest request for blood transfusion, while medicine had the least (9.3%). Whole blood was the most common form of blood product requested (87.3%) while only two (0.1%) request for plasma was made. The most common indication for blood transfusion was anemia (52.2%), followed by the need for blood transfusion during surgery (30.4%); however, exchange blood transfusion was the least with only 16 requests (0.8%). A total of 3766.4 pints of blood were requested during the study period; however, obstetrics and gynecology had the highest request of 2350 pints (62.4%) while pediatrics had the least request of 255.4 pints (6.8%). Over 90% of requested blood and blood products were dispatched. The months of August, September, and October recorded the highest need for blood transfusion whereas January and February recorded the least. Conclusion: The obstetrics and gynecology department had the highest request for blood transfusion; this demand was experienced mostly toward the last quarter of the year, and most requests were dispatched, and there was judicious utilization of blood donated.

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