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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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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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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Background: Turnaround time (TAT) is an important quality indicator in blood banking. This study evaluated the effectiveness of the pneumatic tube system (PTS) to reduce TAT and its effect on the quality of the blood products. Materials and Methods: The PTS (Swisslog GMBH, Germany) which connects to 29 stations was installed at our 2032-bedded tertiary care referral center. The system transports the carrier at an average speed of 25 feet/s (7.6 m/s). Acknowledgment slips were sent along with the blood components through this carrier system to know the time of receipt. Quality control parameters were checked before and after PTS transport in 10 bags of each of the blood components (packed red blood cells [PRBC], platelet concentrate, and fresh frozen plasma [FFP]). Data were analyzed using IBM SPSS Statistics 20. Results: PTS was used for 220 events to deliver 69% PRBC (n = 152), 15% FFP (n = 34), 14% platelets (n = 30), and 2% cryoprecipitate (n = 4), respectively, to 11 destinations. The average transport time by PTS was 1.36 ± 0.34 min and for human-based transport, it was 7.92 ± 1.40 min and this difference was found to be statistically significant (P < 0.001). The mean latent time was 5.85 ± 4.39 min. Conveyance in the PTS did not reinforce any negative changes on the quality of any blood component. Conclusion: PTS is rapid and reliable for the transport of the blood products to bedside.

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We present a case of 62 year male with dyspnea, cough and abdominal pain. There was a diagnostic dilemma for TTP as Hemolytic uremic syndrome, dengue, malaria and autoimmune hemolytic anemia were ruled out by investigations. ADAMTS-13 testing could not be performed due to financial constraints. The deteriorating life threatening condition of the patient compelled us to perform TPE on urgent basis. The close association of pathologist, clinician , intensivist and transfusion specialists improved patient outcome.

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The strengthening of the regulatory authorities is the backbone of the blood safety systems reforms being implemented in Pakistan. One of the key elements of this reform process is the re-activation of blood transfusion authorities (BTAs) to guide and steer the overall development of the blood sector in Pakistan. The success of these efforts will also help fulfill the government's international commitment in achieving the millennium development goals. The revived Islamabad BTA has in a very short time developed a very successful model of regulation based on constructive nonpunitive approach. A database of facilities providing blood services in Islamabad has been created, their registration and licensing completed and a system of regular inspections and re-inspections developed and capacity building of the technical and management staff conducted. In addition, as a result of strict adherence to the minimum licensing criteria, the standard of practices, equipment, manpower, and financial resource allocations of the blood centers in Islamabad have improved significantly in the public as well as the private sector. The successful demonstration of a practical model of regulation best suited to the prevailing scenario in Pakistan has provided a framework which will be followed in all confederating units through the provincial authorities.

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