Asian Journal of Transfusion Science
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Year : 2014  |  Volume : 8  |  Issue : 3  |  Page : 6-25
38th ISBTI Annual Conference, TRANSCON 2013, Surat

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Date of Web Publication17-Apr-2014

How to cite this article:
. 38th ISBTI Annual Conference, TRANSCON 2013, Surat. Asian J Transfus Sci 2014;8, Suppl S1:6-25

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. 38th ISBTI Annual Conference, TRANSCON 2013, Surat. Asian J Transfus Sci [serial online] 2014 [cited 2022 May 23];8, Suppl S1:6-25. Available from:

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Developing a plateletpheresis donor panel: Issues and challenges

Meenu Bajpai, Ripu Daman

Institute of Liver and Biliary Sciences, New Delhi

Background: Recruitment of blood donors is a challenging task, and recruiting voluntary donors for plateletpheresis is even more challenging. This is because, as a procedure, plateletpheresis is much more demanding of the donor in terms of the time and commitment required. Because of a continuous shortage of platelet donors at our institute, we decided to develop a plateletpheresis donor panel from accessible donors.

Aims: To develop a voluntary plateletpheresis donation panel to provide patients with apheresis platelets when there is an emergency requirement.

Materials and Methods: All donors (relative and voluntary) donating at the Institute of Liver and Biliary Sciences (ILBS) since February 2013 were scrutinized on filling the donor registration form. Donors who came from nearby areas (within 5-7 km) were counseled post donation regarding the need for voluntary plateletphersis donors and were explained the procedure. Those donors who agreed to be a part of the panel were recruited.

Results: During the period from February 2013 to July 2013, around 2456 donors donated blood/platelets at the ILBS. Two hundred and forty donors were found to be eligible on initial scrutiny, of whom 53 (all males) agreed to be a part of the plateletpheresis donor panel. We presently have five A group, 20 B group, 17 O group and 11 AB group donors on our panel. There were emergency requirements on two occasions, and the voluntary donors responded to our calls. We invited all volunteers to the institute on the world blood donor day (14 June).

Conclusion: A Voluntary plateletpheresis donation panel was a very challenging initiative for the Department of Transfusion Medicine at the ILBS. The dedication of our staff, who regularly called up the donors and kept in touch with them, have paid off and now we are one of the few centers in the country where voluntary apheresis donation is performed. This has been a boon to patients coming from far off areas for treatment at the ILBS.

Reminder card: A strategy succeeded to encourage repeat blood donations

Kusum Thakur, Hardeep Singh Sanor

GMC Patiala, Punjab

Background: Recruitment of donors becomes one of the most important aspects of blood transfusion services. Any healthy adult males can donate every 3 months while females can donate every 4 months. According to the NACO guidelines, efforts should be directed toward encouraging and retaining an adequate number of repeat donors. A pre-fixed venue, time and dates help donors to plan their donations. This study was planned last year to have fixed dates (5 th and 20 th ) every month, fixed venue (blood bank) and fixed time (9 AM to 12 NOON) for blood donation, and after donation a reminder card be given to the donor with the next date of donation. Follow-up was performed for repeat donations.

Aims: To retain donors.

Materials and Methods: A reminder card was designed in Punjabi language depicting dates, time and venue. Publicity was carried out in the hospital premises and outdoor camp sites. The study started was commenced with effect from 5 May 2012.

Results: Till 5 August 2013, 31 such camps were held, with a total of 593 donations and 115 repeat donors. Of the 115 repeat donors, three were five times donors, seven were four times donors, 29 donated three times and the remaining 76 donated two times.

Conclusion: An innovative thought of reminder card has borne fruits, and, in a short span of about 1 year, 115 new donors have become repeat donors. In the future, the journey will go on and more with more repeat donors with full blood safety hence ensuring patient safety.

Approaches to retain repeat voluntary donors

Abhay G Jhaveri, Snehalata Gupte

Surat Raktadan Kendra and Research Center, Surat, Gujarat

Background: To fulfill the motto of safe blood, we need to recruit voluntary non-remunerated repeat voluntary donors.

Aims: To determine the reasons to why people do not come forward to donate and why one-time donors do not convert to regular donors and try to motivate eligible persons to be regular voluntary donors.

Materials and Methods: An informal survey was carried to determine the different reasons as to why people do not come forward to donate or one-time donors do not convert to repeat voluntary donors. An attempt was made to arrange more camps in the summer and Diwali vacations to overcome the scarcity by persuading the camp organizers. The reasons of temporary deferral were analyzed and donors were given guidance and medications depending on their underlying condition. Complaints/suggestions of our donors were addressed with prompt, polite and relevant answers.

Results: During the last 3 years, the number of donors increased from 31,291 to 37,344, and the number of camps increased from 408 to 467. In the months of scarcity, the average increase in total collection was 52% and 70% in the summer and Diwali, vacations respectively. The most common reason for deferral is low Hb (41%). The Hb level of donors, who had nutritional anemia, increased from a median of 11.30 g/dl on the first occasion to a maximum median of 14.00 g/dl after treatment, with the success rate being 100%. Many of them returned to the donor pool after successful treatment. During the last 4 years, the percentage of female donors increased from 2.88 to 5.41, and the rejection rate due to low Hb reduced from 82% to 72%.

Conclusion: Targeting the temporarily deferred donors with appropriate modalities can help in the recruitment and retention of voluntary, non-remunerated donors.

Organization and Management of Blood Bank Services

Equipment planning in a new multispeciality hospital-based blood bank

Deepak Kumar, Vijay Kumar Parewa, Sushil Pawar, Tarun Kumar, Alok Sharma, Rashmi Sood

Saket City Hospital, New Delhi

Background: Blood transfusion service is a vital part of the National Health Service, and there is no substitute for human blood and its components. Increasing advancement in the field of Transfusion Technology has necessitated enforcement of stricter control over the quality of blood and its products. The blood banking system has advanced in all facets of donor management, storage of blood, component preparation, grouping and cross-matching, testing of transmissible diseases, rationale use of blood and distribution. Use of modern and quality-certified instruments not only improves the efficiency and accuracy but also ensures safety of the patient and technical staff. A well-equipped and managed blood bank is instrumental in supporting hospitals to determine blood demand, and is significant in individual patient treatment, while implementing the best quality management practices for blood usage. This study was carried out in the Saket City Hospital (a unit of the Gujarmal Modi Hospital and Research Centre for Medical Sciences), New Delhi, having 1000 beds and multispeciality facilities along with a stem cell project facility in the future.

Materials and Methods: During the study, we have checked all aspects like equipment technical specification, equipment planning and positioning, electrical load, quality marked and Indian trademark, International trade mark, users input, working technical person experience and customer support.

Results: We purchased the equipment based on the above-mentioned points and committed to give 100% efficiency without any interruption.

Conclusion: By the end of the study, we performed the set up of our new blood bank with the latest equipment for better results. A blood bank joint inspection was carried out on 3 April 2013 and there no objection was raised from the Drug Controller Auditors regarding equipment planning. They suggested that your planning of equipment is the next level, and we received a recommendation in the first joint inspection for whole blood and component preparation. Finally, a blood bank license was received on 12 July 2013.

Quality assurance of reagent red blood cells by DNA analysis

Swati Kulkarni, Bhavika Choudhary, Harita Gogri, K Vasantha, K Ghosh

National Institute of Immunohaematology, ICMR, Mumbai, Maharashtra

Background: Reagent red blood cells (RBCs) selected for antibody screening and identification are comprehensively typed for all common polymorphic blood group antigens and also for low- and high-incidence antigens. Accurate antigen typing and antigen strength of reagent RBC panels is critical to ensure that all antibodies are detected and identified. This phenotype information of reagent RBCs depends on the availability of reliable antisera. Many of these antisera are increasingly in short supply, are often only weakly reactive and are costly. With the knowledge of the molecular basis of blood group antigens, and that many of them are straightforward single nucleotide polymorphisms, it is logical that we should apply DNA-based testing to improve the quality assurance of reagent RBCs. DNA-based assays can also readily determine homozygosity or heterozygosity, unlike serological tests.

Aim: The aim of the study is to: (1) use DNA-based assays, i.e. polymerase chain reaction (PCR), for confirming the antigen phenotype of reagent RBCs of an in-house red cell panel and (2) select a panel of reagent RBCs for screening and identification of antibodies from O group regular donors by serology and molecular techniques.

Materials and Methods: We standardized a PCR assay for predicting common antigens of the Rh (C, c, D, E, e), Duffy (Fy a , Fy b ), Kidd (Jk a , Jk b ), Kell (K, k) and MNS (M, N, S, s) blood group systems. All in-house panel RBCs were also tested for the above antigens. Seventy-five O group regular donors were screened for blood group antigens of the above-mentioned blood group systems by serological and PCR-based techniques.

Results: Genotype and serological phenotype was compared for 15 antigens of five clinically significant blood group systems (Rh, Duffy, Kell, Kidd and MNS) for all the in-house panel red cells. Genotype and phenotype results were in concordance for all in-house panel red cells for these antigens. Seventy-five O group regular donors were also tested for these blood group antigens and two sets of screening RBCs were selected among these for preliminary detection of antibodies against D, C, c, E, e, Fy a , Fy b , Jk a , Jk b , K, k, M, N, S and s antigens. One eight-cell reagent RBC panel was also selected among these regular donors for identification of antibodies against the above-mentioned antigens.

Conclusion: DNA-based typing of blood group antigens of reagent RBCs for antibody screening and identification provides greater quality assurance.

Clinically significant anti-M antibodies: A case series

Shah S, Kalgutkar S, Sawant R, Deshpande A

P. D. Hinduja National Hospital and MRC, Mumbai, Maharashtra

Background: Experts concur that anti-M, not reactive at 37°C, is not clinically significant. Some reports of clinically significant anti-M antibodies causing hemolytic disease of the fetus and the newborn (HDFN) and delayed hemolytic transfusion reaction (DHTR) are available.

Aim: To assess the clinical significance of ANTI-m, not reactive at 37°C.

Materials and Methods: We identified anti-M antibodies using column agglutination technology (CAT) and an 11-cell identification panel.

Results: Of all the antibodies identified in our institute during the study period, anti-M constituted about 14%. All 13 cases of anti-M were alloantibodies, and were found in patients of varied age group (11 months to 85 years) and had varied clinical diagnosis. Two of the 13 (both male) patients had a history of prior transfusion. Three of the 13 patients were females, and all were multigravida. In all cases, antibody screening was positive at room temperature as well as at IAT phase. The cross-match with ABO group identical units was incompatible at room temperature and at 37°C in all cases. This indicated the presence of IgM and IgG components; however, testing with Dithiothreitol (DTT) was not performed in any case. M-antigen-negative status was confirmed by extended red cell phenotyping in all 13 patients. A total of 192 donor units were screened for "M"-antigen-negative status, of which 42 units were found to be "M"-antigen negative. A total of 31 units were transfused to 11 patients. None of these patients developed any new allo-antibody or developed DHTR within a follow-up period of 6 months.

Conclusion: If the patients' anti-M reacts at 37°C, it should be honored as clinically significant and further investigated for the potential to cause DHTR and HDFN. Providing "M"-negative transfusions is the best therapy in this situation. The probability of finding an "M"-antigen-negative donor is one in five in our experience. Provision of an RBC antigen phenotyped donor registry shall ensure quick provision of antigen-negative blood for transfusion in emergency situations.

Prevalence and specificity of unexpected red cell antibodies and factors affecting their formation in multi-transfused thalassemia patients: A prospective study at a tertiary care center

Sweta Gupta, MD Gajjar, Nidhi Bhatnagar, Tarak Patel, Rajeshkumar Sonani, Darshan Adulkar

P. D. Hinduja National Hospital and MRC, Mumbai, Maharashtra

Background: Alloimmunization to erythrocyte antigens is one of the major complications of transfusions, particularly in multi-transfused thalassemia patients.

Aims and Objectives: To screen and identify unexpected antibodies in multi-transfused thalassemia patients and to study the effect of splenectomy, age of start of transfusion and number of transfusions on formation of alloantibody and autoantibody.

Materials and Methods: A total of 200 patients diagnosed with β-thalassemia major, who received regular transfusions, were screened using BIORAD three-cell panels. In patients who were found to be screen positive, antibodies were identified by an 11-cell identification panel.

Results: Red cell alloimmunization was found in eight (4%) patients. Of these patients, four (50%) patients developed anti-K antibody, three (37.5%) patients developed anti-E antibody and one patient developed both anti-E and anti-Jk a . Of 200 patients, 38 (19%) were likely to develop autoantibodies, as determined by a persistent or transient positive direct antiglobulin test (DAT) using a polyspecific Coombs gel card. Of the 38 patients who were positive for DAT, 33 (86.84%) had IgG antibody and five (13.15%) had cold IgM antibody. Two (1%) of the patients developed both alloantibody and autoantibody. Of the 38 (19%) DAT-positive patients, 15 patients had positive auto-control, confirming the presence of autoantibody.

Conclusion: Across the world, the frequency of alloimmunization among thalassemics ranges from 3.7% to 38%, with the most common alloantibodies being directed against the Rh and Kell blood group systems. There are many complications of allo-immunization, including, but not limited to, delayed hemolytic reaction due to anamnestic antibody formation. It is difficult to find compatible blood in patients having multiple alloantibodies. It has been observed that transfusion at an early age (less than 3 years) may offer some immune tolerance and protection against alloimmunization. To prevent alloimmunization to RBC antigens, antigen-matched RBC transfusion (at least Rh and Kell) should be provided to all thalassemia patients. Routine extended red cell phenotyping should be carried out for all chronically transfused thalassemia patients before starting RBC transfusions. A nationwide standard transfusion policy is the need of the hour for these patients.

Use of in-house screening and panel red cells for antibody detection and identification: Need of the hour

Manoj A Kahar

Kesarkunj, Near Ramaben Hospital, Kaharwad, Navsari, Gujarat

Background: Antibody (Ab) detection and identification in the recipient is performed in most reputed blood centers worldwide for compatibility testing. Majority of the blood centers in India do not perform the same due to issues related to availability, shelf-life and cost of screening and panel cells from commercial sources.

Aims: Antigen typing for other major blood group systems was done in 175 "O" blood group donors using the conventional tube technology and column agglutination technique (CAT). The main aim of the study was to formulate in-house screening and panel cells using the US FDA and BCSH guidelines. The other aim of the study was to validate these cells as regards their storage and performance against commercial screening and panel cells for Ab detection and identification.

Materials and Methods: One hundred and seventy-five samples were collected in ethylene diammine tetraacetic acid from "O" blood group donors. One hundred and fifteen random samples were antigen typed for other major blood group systems using monoclonal and polyclonal antisera by the conventional tube technique, and the data obtained were used for comparing antigen frequencies reported in other studies from India. A further 60 samples were antigen typed by CAT. The in-house screening and panel cells were stored in modified Alsever's solution. One hundred recipient samples from multi-transfused recipients were collected to evaluate the in-house panel performance against those from the Diamed and Immucor panels.

Results: Antigen frequencies for other major blood group systems found in the initial random 115 samples were similar to those reported in other studies from India. Difficulties were encountered to find enough number of R 2 R 2 cells and Rh-negative cells having appropriate antigen constitution to formulate the in-house cells.

Conclusions: Blood centers in India can formulate in-house panel red cells at reasonable cost and labor without depending on the commercial reagent cells.

Seroprevalance of transfusion-transmitted infections among blood donors

Dipmala Patel, Jasmin Jasani, JJJ Falleiro, SP Pandya, RK Pasale

SBKSMI and RC, Sumandeep Vidyapeeth, Piparia, Vadodara, Gujarat

Background: The World Health Organization recommends universal and quality-controlled screening of blood donations for the major transfusion-transmitted infections (TTIs): Human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) and syphilis.

Aim: The study objectives were to determine the seroprevalence of these TTIs among blood donors at the Dhiraj General Hospital. The emergence of TTI, especially HIV/acquired immunodeficiency syndrome, has created a huge obstacle in ensuring blood safety. To assess the situation in the Dhiraj General Hospital, we carried out a retrospective study of blood donors for the prevalence of TTIs.

Materials and Methods: The study population included all donors who donated blood from January 2010 to December 2012. The seroprevalence of HIV, HBV and HCV was studied using an enzyme-linked immunosorbent assay in voluntary and replacement blood donors. A RPR was performed for the screening of syphilis.

Results: A total 7172 units of blood were collected from 1904 voluntary blood donors, and the remaining 5268 units were collected from family replacement donors. The seroprevalence for TTIs was 0.19% HIV, 1.54% HBV, 0.16% HCV and 0.55% syphilis.

Conclusion: Infections are slightly more common among replacement donors compared with voluntary donors. This study reflects that blood transfusion is one of the risk factors of spread of the TTIs, which showed the need and importance of the mandatory screening of these infectious markers in blood donations.

Western blot testing in blood donors and patients: Our experience

Mamta Mishra, Nikhil Shetge, Neha Borde, Rajesh Sawant, Anand Deshpande

P. D. Hinduja National Hospital and MRC, Mumbai, Maharashtra

Background: In spite of the considerable improvement of screening and confirmatory tests available for the detection of human immunodeficiency virus (HIV) infection in donors and patient populations, indeterminate results are still frequently obtained in confirmatory assays. The Western Blot assay, which visualizes the antibody reaction to separate native HIV antigens, is used to confirm positive anti-HIV screening test results. However, the Western Blot is also known to yield negative or indeterminate results in early stages of HIV infection.

Aim: To determine the correlation of HIV-enzyme-linked immunosorbent assay (ELISA) results with that of the HIV Western Blot results.

Materials and Methods: Blood samples of donors and patients were screened by the ELISA method using an Abott Axsym/Architect 4 th generation system using the MEIA and CMIA principles, respectively. Western Blot was performed using Genelab fits. The World Health Organization criteria (3 bands rule) were used for interpretation of the test results.

Results: Data of 1873 cases were complete and available for analysis. ELISA for HIV-1 was positive in 1336 (71.1%), negative in 455 (24.2%) and indeterminate in 79 (4.2%) cases. Meanwhile, ELISA for HIV-2 was positive in 83 (4.4%) cases (Spot tests), negative in 1787 (95.4%) cases and indeterminate in three (0.16%) cases. Eighty-three (4.4%) cases were indicative of HIV-2 infection on Western Blot testing. Among the ELISA-positive cases, 13 (1.04%) were negative and 58 (4.6%) were indeterminate by the Western Blot test. The probability of HIV-1-positive ELISA to be tested negative by Western Blot was significant (Kappa-0.779) and that of a negative HIV-1 ELISA being indeterminate on Western Blot was also high (Kappa-0.736). A similar correlation was not observed in case of HIV-2.

Conclusion: There is an overall good correlation between ELISA and Western blot results for HIV. Individuals with indeterminate results with HIV Western blot need to be counseled and followed-up further.

Nucleic acid testing for blood safety against human immunodeficiency virus-1 (HIV-1) and hepatitis B (HBV) and hepatitis C (HCV) viruses in blood donors

Kanchan Mishra, Apeksha Trivedi, Snehalata Gupte

Surat Raktadan Kendra and Research Center, Surat, Gujarat

Background: We started nucleic acid testing (NAT) at our blood bank in April 2013. The test simultaneously detects human immunodeficiency virus-1 (HIV-1), hepatitis B virus (HBV) and hepatitis C virus (HCV). Because the window period is reduced, the NAT transfusion safety is increased.

Aims: To detect the viral infection by NAT among the enzyme-linked immunosorbent assay (ELISA)-negative donors and prevent transfusion-associated transmission of infection in patients.

Materials and Methods: The NAT on mini-pools of five was started in April 2013. The blood samples of all voluntary blood donors were first tested by ELISA, and then the sero-negative samples were tested by real-time polymerase chain reaction (PCR) in a single triplex assay to detect HIV-1, HBV and HCV. HBV DNA, HCV RNA and HIV-1 RNA were isolated from 200 μl of individual or pooled plasma samples with the use of a High Pure viral nucleic acid kit. If the pool was found to be positive, then the NAT was carried out on individual samples of the pool to identify a positive donor.

Results: Till the end of July 2013, 2000 pools (10,000 samples) were screened and nine (0.09%) NAT-positive donors were detected. Thus, the NAT yield was 0.9/1000 donations. Of these nine samples, two (0.02%) were reactive for HIV and seven (0.07%) were reactive for HBV. None of the donors were HCV positive. The observed NAT yield for HIV and HBV was 0.2 in 1000 and 0.7 in 1000, respectively. Because we supply blood as components (packed red cells, fresh frozen plasma and platelet concentrate), these 9 units of blood would have yielded 27 components and hence 27 patients could have been infected.

Conclusion: NAT testing has successfully identified pre-seroconversion infectious blood units. Despite its cost-effectiveness issues, NAT-based screening of blood supply is expected to become a standard in transfusion medicine due to the public acuity of infectious diseases acquired through blood transfusion.

Role of local application of autologous platelet-rich plasma in the management of pressure ulcers

PK Sehgal

Pt. B.D. Sharma PGIMS, Rohtak, Haryana

Background: Autologous platelet-rich concentrate (PRP) is a concentrate of platelets and growth factors that are an effective therapy for pressure sores. Degranulation of platelets takes place due to the activation of the PRP with 10% calcium chloride, which transforms them to a bioactive state. Activated platelets release transforming growth factor-ί, vascular endothelial growth factor and platelet-derived growth factor. Thus, the platelets at the repair site ultimately set the page of wound repair. PRP is being extensively used worldwide for chronic wounds, and it promises to be a useful tool in their healing.

Aims: To evaluate the role of local applications of autologous PRP in the management of pressure ulcers (PrUs).

Materials and Methods: The present study was conducted on 25 patients of PrU admitted in the Department of Orthopaedic Surgery, Paraplegia and Rehabilitation at the Pt. B.D Sharma PGIMS, Rohtak. PrUs were graded according to the European Pressure Ulcer Advisory Panel (1999). PRP was applied in grade IV PrUs. A photograph was taken before the application of PRP and after every week to observe the healing of the PrU. After observation and measurement, the PrU was categorized with respect to surface area, exudates and type of wound tissue. A sub-score was recorded for each of these ulcer characteristics. Punch biopsy was taken from the margins of the wound initially and in the first, third and fifth weeks to monitor histopathological signs of healing.

Results: The decrease in wound surface area was statistically significant (t = 4.98, P = 0.000). The mean healed surface area of the PrUs reduced at the final follow-up. After 5 weeks of PRP therapy, 60% of the wounds had shown well-formed granulation with epithelization on histopathology. In the present study, 96% of the PrUs cases were improved after PRP therapy.

Conclusion: PRP application on PrUs is a simple, rapid, cost-effective and complication-free procedure with excellent outcome.

Correlation between IL-8 and leukocyte content in platelet concentrate

Rinku Shukla, Snehalata Gupte

Surat Raktadan Kendra and Research Center, Surat, Gujarat

Background: Cytokine generation is due to new synthesis and release of cytokines from residual white blood cells (WBCs) or from dead WBCs. Interleukin (IL)-8 is a neutrophil chemotactic and activating factor and is a marker to monitor leukoreduction as it is mainly secreted from the leukocytes.

Aim: To determine the correlation between leukocyte count and IL-8 in different types of platelet concentrate (PC).

Materials and Methods: Fifteen each of PCs were prepared by the platelet-rich plasma (PRP) and Buffy coat (BC) methods. A total of 120 supernatant plasma samples were collected after 1, 18, 65 and 112 h of preparation. Fourteen single-donor platelets (SDPs) prepared on a cell separator Trima were collected on the 0, 3 rd and 5 th days. Platelet and WBC counts of BC-PC and SDP were performed using a hematology analyzer, Nihon Kohden. WBC count was also performed on a Nageotte chamber. IL-8 estimation was performed using enzyme-linked immunosorbent assay (ELISA).

Results: The WBC count in PRP PC was 7.4 ± 3.75 × 10 7 and in BC-PC was 3.9 ± 2.2 × 10 7 , which was significantly lower (P < 0.0005). In SDP, it was 0.40-0.21 × 10 8 /unit. The platelet count was comparable in PRP and BC-PC, but significantly high in SDP (P < 0.0005), as expected. IL-8 increased continuously from 1 h in both the type of PCs. It was 986 pg/ml in PRP PC and 481 pg/ml in BC-PC at 112 h. IL-8 was below the detection limit (<2 pg/ml) up to 5 days storage in all SDP samples.

Conclusion: Increase in IL-8 concentration in platelet products predominantly depends on the degree of leukocyte contamination thus showing high levels in PRP PC than in BC-PC and SDP.

Autologus platelet-rich plasma as a treatment modality in androgenetic alopecia (male pattern hair loss)

KK Mishra, Urmil Dhuria, SS Agarwal

Swasthya Kalyan Blood Bank and Thalassemia Research Centre, Jaipur, Rajasthan

Background: Hair loss is one of the most emerging problems in the youth of the age group of 20-30 years. Autologous platelet-rich plasma (PRP) prepared from whole blood is a biological delivery system of a complex mixture of bioactive protein essential to natural repair.

Aims: The study was designed to evaluate the efficacy of intra-dermal injection of PRP as a treatment option for hair loss.

Materials and Methods: A total of 12 patients in 2011-12 and 13 patients in 2012-13 with hair loss were treated by PRP after obtaining informed consent. About 350/450 ml blood from the antecubital vein was collected in a blood bag with CPDA1 as an anticoagulant and preservative solution. It was then centrifuged at soft spin and separated in packed cell and PRP. The packed cell bag was disconnected after adding SAGM. Now, we have a PRP bag with one attached satellite bag. Fifty milliliters of PRP was transferred to the satellite bag and kept in an agitator, while the remaining PRP bag was centrifuged at hard spin and 10-20 ml of the platelet concentrate was kept in a PRP bag and the supernatant was discarded. The platelet concentrate was kept undisturbed for 1 h and then mixed gently and issued both PRP and platelet concentrate.

Result: All the patients were homogenous with respect to age and sex. Statistically significant improvement was noted after an average of 3-4 months. After 1 month, there was a decrease in hair loss, after which hair growth occurred.

Conclusion: The results of our study support the effectiveness of PRP injection in hair growth.

Quality management procedure of platelet concentrate

Deval Patel, Jasmin Jasani, JJJ Falleiro, SP Pandya, RK Pasale, Shashikant Mavadiya

Department of Pathology, S.B.K.S.M.I. and R.C., Sumandeep Vidyapeeth, Vadodara, Gujarat

Background: Platelet concentrates are increasingly being used as part of supportive therapy in the management of hematological malignancies. Platelet transfusion therapy is also indicated in thrombocytopenia due to various causes including all forms of bone marrow failure. Production of platelet concentrates is expensive and rigorous. They also deteriorate rapidly during storage and have a short shelf-life. Therefore, it is important to evaluate the quality of the platelet concentrates transfused so as to prevent wastage, ensure efficacy and maximum benefit of the patient as well as to avoid exposing a patient to multiple transfusions.

Aim: The aim of this study was to assess the processes employed in preparation of the concentrates and to determine and describe the several quality parameters of platelet concentrates.

Materials and Methods: Whole blood samples from 80 donors and the respective platelet concentrate units were tested. Platelet concentrates were tested (platelet count, aggregation and pH) on Days 1, 3 and 5 of storage. Additionally, a leukocyte count was performed only on Day 1 and microbiological tests were performed on Day 5 of storage.

Results: The results show that the platelet count present in whole blood is 100% and that in separated platelet-rich plasma is 90%; less than 10% of the platelets should be left in whole blood after a low spin (1 st round). After the hard spin of the 2 nd round, the count of the platelets is 83%; less than 10% of the platelets should be left in platelet-rich plasma.

Conclusion: The quality management of platelet concentrate includes a selection of donor, quality of the blood bag container, technique of phlebotomy, storage temperature of blood bags before centrifugation, setting or programming of the refrigerated centrifuge machine, platelet concentrate separating procedure or method and storage of platelet concentrate in an incubator and agitator in proper temperature.

Leukoreduction, use of leukocyte filters

Varsha Doctor, JJJ Falleiro, RK Pasale

S.B.K.S.M.I. and R.C., Sumandeep Vidyapeeth, Piparia, Vadodara, Gujarat

Background: Leukoreduction is the removal of leucocytes from the donated blood or blood components. It has become an increasingly important part of transfusion medicine over the past several years. The rapidly growing size of hemato-oncological patients in our country requiring multiple transfusions of blood and components during the course of their management pose a great challenge to transfusion services for the provision of red cell and platelet antigen-matched products in alloimmunized subjects. Transfusions that contain leukocytes may cause adverse effects through multiple mechanisms.

Aims: Removal of leukocytes from various blood products minimizes febrile non-hemolytic transfusion reactions, HLA alloimmunization, platelet refractoriness in multi-transfused patients and prevention of transmission of leukotropic viruses such as EBV and CMV. Removal of leucocytes below a certain threshold, ≤5 × 10 6 , in the blood components certainly helps in the prevention of alloimmunization and associated risks.

Materials and Methods: Leukocyte reduction can be achieved by various techniques: Centrifugation, leukocyte filtration, sedimentation, washing of RBCs with saline, freeze-thawing and apheresis. Of these, the most commonly used technologies are centrifugation and filtration. Filtration can be performed in the pre-storage and post-storage phases of component preparation.

Results: Use of leuko-reduced blood reduced the frequency of post-transfusion infection by 50%. Currently, the best leukoreduction is the method that can achieve at least a 99.9% reduction in leukocyte numbers per unit (450 ml) of blood.

Conclusion: Pre-storage leukoreduction is associated with a reduction of infectious complications in patients. Furthermore, this protective effect appears more pronounced in patients receiving massive transfusion.

Superior method of platelet retrieval: Platelet-rich plasma or Buffy coat method?

Manish Patil, GV Puranik

Topiwala National Medical College and BYL Nair Ch Hospital, Mumbai, Maharashtra

Background: There are different methods of platelet concentrate (PC) preparations, viz. platelet-rich plasma (PRP), Buffy coat (BC) and apheresis platelets. In the blood bank where this study was conducted, PCs are prepared by the PRP and BC methods.

Aims: To establish which method - PRP or BC - yields superior quality PC.

Materials and Methods: This was a prospective study over 3 years at a tertiary care hospital blood bank. PRP and BC PC were compared on the basis of various quality parameters (mentioned below).

Results: During the study period, a total of 16,740 PCs were prepared, of which 200 (100 PRP and 100 BC) (i.e., 1.2%) were tested for the below-mentioned quality parameters.

Conclusion: In our study, both PRP and BC PC met the minimum desirable standards for all quality parameters. BC PC fared better than PRP PC in most of parameters except pH and WBC contamination. Our study infers that BC PC is superior to PRP PC in terms of overall quality parameters.

Blood component separation procedures

Shefali Chauhan, JJJ Falleiro, RK Pasale

S.B.K.S.M.I. and R.C., Sumandeep Vidyapeeth, Piparia, Vadodara, Gujarat

Background: In modern transfusion medicine, the process of separating blood components from whole blood is essential and made possible by the development of plastic bags, because the indications for use of unfractionated whole blood (WB) are decreasing. Because the blood is easily perished, component separation and administration will help us in rationalizing the use of blood.

Aims: This study focuses on various blood component separation procedures. The data for the number of components made were obtained retrospectively for the years 2011-2012 in the Dhiraj Hospital. The primary aim of component separation was to provide the right component to the right patient in the right quantity at the right time in the right quality.

Materials and Methods: The total number of WB collections for the year 2011 and 2012 were 5216. The total number of red cell concentrates and fresh frozen plasma (FFP) made by the sedimentation and centrifugation methods were 2987. The total preparation of platelet-rich plasma and platelet concentrate (PC) from random donor platelet by the centrifugation method were 204.

Results: The separation of blood into its components was accelerated by centrifugation, which is based on different physicochemical properties, such as density of blood cells. Changing the centrifugation parameters such as time, temperature and rotation speed affected the composition of the separated fractions.

Conclusion: A common goal of component separation methods is to produce RBCs, PCs, and FFP that contain maximum amounts of therapeutic blood elements and minimum amounts of unnecessary residual cells. With development of the processing technique, blood component preparation has become a routine procedure worldwide.

Quantitative analysis of coagulation factors in fresh-frozen plasma prepared by rapid freezing vs slow freezing

Atul Sonker, Lalit Dhantole, RK Chaudhary

Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP

Background: Human plasma is an important blood component that is used in replacement therapy as a source of coagulation factors for patients with different coagulopathies. In order to preserve the activity of coagulation factors, the process of post-separation freezing of plasma and plasma products has to be optimized. Because coagulation factors V, VII and VIII are more prone to time- and temperature-bound deterioration, they are suitable indicators for efficiency in handling, freezing and thawing of human plasma. Several aspects of the freezing process of plasma may influence the coagulation factor activity. One important factor is the rapidity of freezing of plasma. Few of the blood transfusion services in India, including ours, have started using the contact shock freezing technique for rapid freezing of plasma in view of improving quality.

Aims: The aim of this study was to determine the influence of the freezing technique, i.e. contact shock freezing versus conventional mechanical freezing technique, on coagulation factor V, VII, VIII and fibrinogen activity.

Materials and Methods: In the present study, plasma units were obtained from whole blood donations as per the standard operating procedure for blood components separation. Thirty units of whole blood were collected in 450 mL (±10%) in a conventional top-and-top quadruple-bag system and were separated into components using an automated device. Fifteen plasma pools were prepared each from two ABO and Rh (D)-matched whole blood-derived plasma components. After pooling, each unit was split into two halves: One aliquot (235-315 ml) was subjected to the contact shock freezing technique and the second aliquot (225-235 ml) was kept in a deep freezer at -80°C. After 1 week of frozen storage, the plasma samples were thawed at 37°C and immediately subjected to testing for coagulation factor activity.

Results: Rapid freezing caused a better yield of factor V (144-200%), factor VII (162-220%) and factor VIII (55-81%), which is statistically significant as compared with slow freezing, which yielded lower yield of factor V (100-140%), factor VII (58-88%) and factor VIII (68-94%). The fibrinogen content was almost the same in plasma obtained by both the methods of freezing.

Conclusion: It is concluded that the quantity of labile coagulation factors in plasma frozen rapidly by the contact shock freezing method were better preserved than plasma slowly frozen by the conventional mechanical freezing method, while the level of fibrinogen was not affected significantly.

An audit of transfusion process: An important tool for transfusion safety

Amruta Indulkar, Rakhi Malwankar, Rajesh Sawant, Anand Deshpande

P.D. Hinduja National Hospital and MRC, Mumbai, Maharashtra

Background: Hemovigilance is a quality process that takes into account all the activities of a blood transfusion chain with the aim to improve quality and enhance safety of blood transfusion. We have implemented a transfusion feedback reporting mechanism in our hospital as a part of hemovigilance. The current study aims to collect and analyze this data to improve our transfusion system.

Aim: To systematically analyze the transfusion process from issue of blood components to completion of the transfusion.

Materials and Methods: The transfusion feedback forms received back at the transfusion medicine department during a 3-month period were systematically analyzed for documentation related to patient identification, product identification, documentation, completeness, etc. Results were analyzed statistically for specific correlation with patient's location, time of transfusion and type of component transfused.

Results: Three thousand four hundred and seventy-four blood components were issued during the study period. Transfusion feedback forms were received for 2000 (57.5%) blood components as follows: PRBC - 800 (40%), platelets - 651 (32.5%) and FFP - 441 (20.7%). Patient identification number/wrist band check was not performed in 25 (1.25%) cases. Pre-transfusion verification of blood group, patient's name and patient's identification number was performed in 1963 (98.15%) cases. Cross-checking of component unit with request form was missed in 16 (0.8) cases. Pre-transfusion and post-transfusion monitoring of blood pressure were documented in 698 (34.9%) episodes and monitoring of pulse in 696 (34.8%) episodes, while patient's temperature was monitored in 681 (34%) episodes. Signature of nurse was missing in 86 (4.3%) and that of medical officer in 11 (05%) of the forms. Adverse transfusion reaction was documented in 1/2000 forms, whereas the transfusion reactions notified at the blood bank during the same period were 2. Five hundred and fifty-three (27.65%) transfusions were carried out during non-routine work hours. The mean time between the issue of the components and start of transfusion was 28 min for RBC components, 21 min for platelets and 16 min for FFP. Patient identification and monitoring and product identification-related non-compliances significantly correlated with out of routine transfusions (P = 0.002).

Conclusion: Although the overall compliance with the established procedure for transfusion was evident, activities related to unit identification, patient monitoring and identification and reporting of adverse reactions were not well documented. This emphasizes the need for ongoing training of nursing staff and medical doctors in safe blood administration practices.

Hemovigilance in managing blood transfusion needs thorough transfusion audit

Ruchi Agrawal, Richa Garg, JJJ Falleiro, RK Pasale

S.B.K.S.M.I. and R.C., Sumandeep Vidyapeeth, Piparia, Vadodara, Gujarat

Background: Transfusion audits are useful tools in the education of those ordering blood components, potentially resulting in the reduction of inappropriate use of blood components.

Aim: Educating clinicians to improve documentation of transfusions, in addition to appropriate indications for transfusion, may serve to enhance the efficiency of the blood utilization and safer transfusion practices.

Materials and Methods: A retrospective analysis of 512 consecutive requests for transfusion in a 5-months period was performed. The blood bank requisition forms sent by the clinicians were analyzed and details of patients for the following factors - age, sex, diagnosis, department, type, amount and indication of blood products at time of retrospective data collection - were noted.

Results: The total blood units supplied were 953. The male to female ratio was 2.2:1. Packed red blood cells were the most utilized product, followed by whole blood. Supply of blood was the maximum to surgical wards. The patients of elective surgery followed by trauma required blood most commonly. The most common indications for whole blood, packed red cells, fresh frozen plasma and platelets were elective surgical procedures, anemia, bleeding and thrombocytopenia, respectively.

Conclusion: This retrospective study shows a positive relation between the lack of knowledge about transfusion indication prescribing medical officers. This information is relevant for quality management of transfusion practice, cost analyses and for planning local and regional blood donation programs.

Mesenchymal stem cells: Cell biology and potential use in therapy - A review

Deepti Agarwal, RK Pasale

SBKS MI and R.C., Sumandeep Vidyapeeth, Vadodara, Gujarat

Mesenchymal stem cells are clonogenic, non-hematopoietic stem cells present in the bone marrow and are able to differentiate into multiple mesoderm-type cell lineages and also non-mesoderm-type lineages. Several methods are currently available for isolation of the mesenchymal stem cells based on their physical and immunological characteristics. Because of the ease of their isolation and their extensive differentiation potential, mesenchymal stem cells are among the first stem cell types to be introduced in the clinic. Recent studies have demonstrated that the life span of mesenchymal stem cells in vitro can be extended by increasing the levels of telomerase expression in the cells and thus allowing culture of large number of cells needed for therapy. In addition, it has been shown that it is possible to culture the cells in a xeno-free environment without affecting their growth or differentiation potential. Finally, the mesenchymal stem cells seem to be hypoimmunogenic and thus allogenic mesenchymal stem cell transplantation is possible. It is envisaged that mesenchymal stem cells can be used in systemic transplantation for generalized diseases, local implantation for local tissue defects, as a vehicle for genes in gene therapy protocols or to generate transplantable tissues and organs in tissue engineering protocols. The results of these initial trials are very encouraging and several clinical trials are under way to study the efficacy and long-term safety of therapeutics based on mesenchymal stem cells.

A study on autologous and allogeneic peripheral blood stem cell transplantation for hematological malignancies and benign blood disorders using apheresis technology

Vyasa Paresh

Supratech Voluntary Blood Bank, Ahmedabad, Gujarat

Background: In recent years, in India, apheresis technology is widely used for autologous and allogeneic peripheral blood stem cell transplantation for hematological malignancies and benign blood disorders. This study was performed to evaluate the efficacy of the apheresis technology to achieve an adequate stem cell dose for transplantation.

Aims: To evaluate the efficacy of apheresis technology to harvest peripheral blood stem cell using the Haemonetics MCS+ cell separator to achieve an adequate stem cell dose for the peripheral blood stem cell transplantation for hematological malignancies and benign blood disorders referred to our blood bank.

Materials and Methods: Several patients with hemato-oncological and benign blood disorders admitted in Ahmedabad, India, during 2008-2013, who were referred to our blood bank for peripheral blood stem cell collection were enrolled in this study. All patients had standard indications for transplant. All the patients were given standard conditioning regimens such as BEAM for lymphoma and Bucy regime for AML, or were in 100% remission of the disease before peripheral blood stem cell mobilization by granulocyte-colony stimulating factor (G-CSF) and transplantation. Human leukocyte antigen (HLA) matching has been performed for all allogeneic transplant patients. All patients were given prophylactic oral antibiotics and antifungal drugs. Stem cells were harvested using a Haemonetics MCS+ cell separator using the peripheral blood stem cell protocol. The harvesting procedures were carried out with an aim of obtaining the target dose of CD34+ cells for transplantation (2.0-2.5 × 10 6 /kg body weight). Cryopreservation was carried out when indicated. The patient's neutrophil and platelet counts were monitored daily after transplantation of the harvested stem cells.

Results: A total of 65 patients with an age of 10-60 years were enrolled for the study for auto- and allogeneic mobilized peripheral blood stem cell transplantation. We were able to achieve the adequate stem cell dose in two sittings of apheresis in most of the autologous cases and single sitting in the allologous cases. All patients were engrafted before Day 15 in terms of absolute neutrophil count at ≥500/cu mm and platelet count ≥20,000/cu mm for three consecutive days. all Patients were engrafted.

Conclusion: The engraftment of auto- and allogeneic peripheral blood stem cell transplantation has been successful without transplant-related mortality (in terms of induction, conditioning, harvesting and engraftment).

Thalassaemia awareness program: An effective approach for thalassaemia eradication

Jignasa Gami, RP Singh

Rajkot Voluntary Blood Bank and Research Centre, Rajkot, Gujarat

Background: Thalassaemia (Thal) screening of the young population of the age group of 18-28 years should be focused on eradicating this dreaded disease from our region. Appropriate information about Thal and its consequences must require understanding impact of the disease. We largely carried out a mass awareness program followed by a Thal screening camp for college going students.

Aims: To assess the impact of awareness campaigning for achieving the goal of a Thal-free society.

Materials and Methods: The Indian Medical Scientific Research Foundation (IMSRF) assessed 50 Thal-minor couples having a Thal-major child to check the level of information about Thal at the time of their marriage. One hundred percent of them were unaware about the disease till they had a Thal-major child. Since 1991, the IMSRF carried out various Thal awareness programs that were analyzed and improved to obtain desired outcomes sequentially. To get momentum at all levels of society, various technique were used together.

Results: From April 1993 to 10 August 2013, the IMSRF reached out to more than 14 lack people through mass awareness campaigning. In terms of people screening themselves for a Thal test after the awareness program, which was 26.66% reached to 82.45% after improving and implementing the newer strategies. Since, 1993 to till date, the IMSRF counseled 28,731 Thal carriers, carried out 19,660 antenatal screenings and saved 101 Thal-major births.

Conclusion: We have observed a remarkable increase in Thal screening. The young population and Thal-minor couples are receptive to the Thal eradication program if they have appropriate knowledge. This study exaggerates the need of accurately designing and implementing focused awareness programs to accomplish the dream of a Thal-free society.

Quantification of mscs0 , GFs and cytokines from peripheral blood in between traditional elisa0 vs advanced bead-based multiplexing technologies in terms of sensitivity and reproducibility of results: Implication in non-healing cutaneous wounds

Roopam Jain, Preeti Jain, S Sharma, Shivanshu Srivastava, VK Mahadik

Assistant Professor and In-Charge Transfusion Services, R. D. Gardi Medical College, Ujjain

Introduction: Non-healing cutaneous wounds represent a challenging problem and are commonly related to peripheral vascular disease, infection, trauma, neurologic and immunologic conditions, as well as neoplastic and metabolic disorders. As we have learned, growth factors and cytokines are bioactive proteins responsible for attracting macrophages, mesenchymal stem cells and osteoblasts, which not only promotes removal of necrotic tissue but also enhances tissue regeneration and healing. It is widely accepted that growth factors play a central role in the healing process and tissue regeneration. A recent strategy to promote the wound-healing cascade is to prepare autologous mesenchymal stem cells (MSCs), growth factors (GFs) and cytokines, and to administer it to the wound sites. It can affect inflammation, post-operative blood loss, infection, narcotic requirements, osteogenesis, wounds and soft tissue healing. In addition to local hemostasis at sites of vascular injury, this autologous material contains an abundance of growth factors and cytokines that are pivotal in soft tissue healing and bone mineralization. The purpose of this study was to quantitate growth factors released from a prepared platelet concentrate.

Aims and Objectives: (1) Quantification of growth factors by traditional enzyme-linked immunosorbent assay (ELISA) versus advanced bead-based multiplexing technologies in term of sensitivity and reproducibility of results, (2) to access the role of MSCs, GFs and cytokines in the healing process and tissue regeneration, (3) to access the role of MSCs, GFs and cytokines in early wound closure and epithelization and (4) to access the role of MSCs, GFs and cytokines in decreased pain, lower blood loss and fewer narcotic requirements.

Materials and Methods: The blood collection system should be closed, minimizing any opportunity for contamination, and sterile disposables should be used on the selected patients. About 100 ml of whole blood is drawn into the syringe in ACD or CPD, under aseptic techniques from the anticubital. An 18 or 19 g butterfly needle is advised, in efforts of avoiding irritation and trauma to the platelets that are in a resting state. The MSCs, GFs and cytokines are separated from blood by multiple buffering and activation procedures. Quantification of platelet and growth factors was carried out in terms of platelet-derived growth factor (PDGF)-BB, transforming growth factor (TGF)-(beta)1, vascular endothelial growth factor (VEGF), epidermal growth factor (EGF) and insulin-like growth factor (IGF)-1 measurements from whole blood by traditional ELISA versus advanced bead-based multiplexing technologies by assessing the sensitivity and reproducibility of the results. The growth factors applied on the non-healing cutaneous ulcers and the effect of these growth factors have been thoroughly studied.

Results: Quantification of GFs and interleukins was determined for each patient by the traditional ELISA versus fully automated bead-based multiplexing technologies. The PDGF, TGF-(beta)1, VEGF, and EGF cytokines were all significantly greater in the PRP samples than in the whole blood baseline samples by both methods. On average, the PDGF-BB increased from 3.3 ± 0.9 ng/ml to 17 ± 8 ng/ml, TGF-(beta)1 increased from 35.7 ± 7 ng/ml to 120 ± 42 ng/ml, VEGF increased from 155 ± 110 pg/ml to 955 ± 1030 pg/ml and EGF increased from 128 ± 61 pg/ml to 470 ± 317 pg/ml. The increase was calculated per patient for both platelet number and growth factor levels. The greatest increase is seen with VEGF (6.1-fold increase), followed by PDGF-BB (5-fold increase) and EGF and TGF-(beta)1 (4- and 3.7-fold, respectively) by advanced bead-based multiplexing ELISA. Results from this study demonstrate that GFs and cytokines can be sequestered and concentrated 8-fold from whole blood without activation before desired. To understand the better sensitivity/reproducibility of the results, we cross-checked our samples in a fully automated multiplex ELISA.

Conclusion: It is concluded that the fully automated advanced bead-based multiplexing ELISA method is highly sensitive and reproducible, is less time consumable and economic than the traditional ELISA. These GFs and cytokines are capable of decreasing inflammation, post-operative blood loss, infection and narcotic requirements and play a central role in the healing process and tissue regeneration.

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Donor management

MP Singh

Gold Field College of Education, BlB. FBD Faridabad, Haryana

Background: Nobody is born as a donor, but, after 18 years, some are donors.

Aim: We want to remove the misconception myths and fear complex around blood donation by counseling and care. People are generally not self-motivated to donate blood.

Materials and Methods: We will provide information and knowledge by poster, story chart, Badge, Hording with best message, key rings, carry bag, Purse Greeting Cards file cover, folder, Journal, newsletter, leaflets, Books, Magazines, audio-video, T.V., Radio, Print and Electronic Media, Visual Slider, etc.

Results: By the above media, a donor will get correct information and knowledge and facts about blood donation and other related matters. Awareness will be integrated and spread about misconceptions. Myths and fears will be removed. College students will take part more readily and know about their health status. They will explain the benefit of blood donation, by which others will be interested and keen to donate their blood.

Conclusion: By these methods, a true voluntary blood donor will come ahead and more voluntary blood donation camps will be organized. Self-motivated donors will motivate others to do the same. We will be able to fulfill demand and supply, and nobody will die due to blood lass; blood will wait for the patient but a patient will not wait for blood.

Swot analysis of blood donation camps: An experience of a tertiary care hospital blood bank

Aarti Hirve, Ojha S, Poojary M, Sumathi H

Tata Memorial Centre Advanced Centre for Treatment, Research and Education in Cancer (ACTREC) Kharghar, Navi Mumbai, Maharashtra

Background: Blood donation camps (BDCs) are happy veins for all blood banks worldwide. A blood bank faces many challenges in striking a balance between commitment and altruism of voluntary blood donors and making blood donation a safe and pleasant experience for them.

Aims: To perform a Strength, Weakness, Opportunities and Threat (SWOT) analysis of organizing blood donation camps in the previous 3 years.

Materials and Methods: A 3-year retrospective analysis of 100 BDCs was performed for the period of March 2010 to April 2013, of which 36 were from socio-cultural organizations, 26 from the corporate sector, 12 from educational institutions, 12 from housing societies, seven from government organizations and five from railway stations. Analysis was carried out based on the following parameters: 4 for strength, 16 for weakness, 4 for opportunities and 6 for threat. The above parameters were categorized as per the incidence reporting by blood donors' experience, feedback of camp organizers and blood bank personnel.

Results: Major strengths of the analysis were high awareness level among donors and camp organizers regarding voluntary blood donation and well-trained staff. Among weaknesses, long-distance camps and unorganized spacing of blood donors were major impediments. Opportunities can be provided by organizing awareness camps for platelet donation, cancer screening, etc. The main threat can be due to a lack of coordination between camp organizers and community, leading to less donor participation.

Conclusion: Insights gained by SWOT analysis definitely showed a pathway for better future camps that will help in finding better strategies to improve the overall quality and donor experience.

Understanding the donors perception of blood donation process

Vidya Patne, Prateik Jondhale, Rajesh Sawant, Anand Deshpande

P. D. Hinduja National Hospital and MRC, Mumbai, Maharashtra

Background: Over the past two decades, more complex donor screening protocols, deferral criteria and regulatory requirements have made the donation process more complicated and time consuming. Donors' satisfaction with the donation process is an important factor in planning for donor recruitment and retention programs.

Aims: To have a better understanding of how donors perceive satisfaction with their blood donation experience and increase understanding of donor motivational factors.

Materials and Methods: A questionnaire with questions on donor demographics, overall blood donation experience, intention to donate in the future, awareness regarding bone marrow and organ donation and motivation and preference of various incentives for future donations was administered to all the donors donating blood at our blood bank. The results of the analysis of the first 290 responses are presented here.

Results: Among 290 blood donors, 53% were repeat and 47% were first-time donors. The mean score for overall donation experience was 8.9 on a scale of 10. Ninety-two percent of the donors rated their current donation experience as better than their previous one; however, 4.5% of the donors did not intend to return for future donations. 58.5% of the donors agreed that incentives are attractive for their future donations and chose being called for blood donation (30%), free complete blood count (24%) and free health consultation with the blood bank doctor (22%) as the most preferred incentives. 58.5% of the blood donors were aware of organ and marrow donation; however, only 16.5% of the donors indicated their willingness to register for the same. Social responsibility (50.5%), health benefits of blood donation (33.5%), sense of duty (31%) and altruism (28.5%) were the most common motivations leading to blood donation. High level of satisfaction with the current donation process was significantly associated with the intent to return for future donations (P = 0.0035). Younger donors were more motivated by being called more often for blood donation than older donors (P = 0.03).

Conclusion: The donors' perception of blood donation process and their motivation to donate blood has a very significant impact on intention to return for future donations. Better service to the donors should be implemented for a robust donor recruitment and retention program.

Donor management

Madhur Modi

Department of Pathology, S.B.K.S. Medical Institute and Research Centre, Piparia, Vadodara, Gujarat

Donor management is an important role played by the blood bank officer in the hospital. At the Dhiraj Hospital, Sumandeep Vidhyapeeth, about 10 blood units are collected per day. On average, we get about nine donors everyday or 3600 per year. About 120 per year of donors are deferred due to a history of previous illnesses, anemia, jaundice, underweight, underage, alcohol consumption, epilepsy and convulsions. Counseling to the donor is given about the advantages from a social aspect, philanthropic view and health view. Disadvantages, negative views and wrong myths about the donation are dispelled. Physical examination was performed. We did not encounter any donors having high blood pressure, anemia, etc. During donations, we have encountered 15 per year of inadequate blood collections (quantity not adequate), 60 per year donors had both hands punctured and 20 per year had hematomas. No arteries were punctured. The donors were then adequately treated and counseled on follow-up. The staff members having difficulty in proper collection of blood were asked to reflect on their mistakes and take care the next time. Post donations, we encountered 50 per year donors having nausea, vomiting and vaso-vagal fainting attacks. They were effectively managed by hydration, liquid drinks and, in very severe cases, with IV saline and atropine. The donors were profusely thanked for their selfless donation and followed-up every 3 months to motivate them to be permanent donors.

Standardization of number of gel packs for transportation of blood from camps

Hetal Randeri, Rinku Shukla, Snehalata Gupte

Surat Raktadan Kendra and Research Center, Surat, Gujarat

Background: Blood must be strictly kept at a defined temperature range to maintain red cells and to prevent the growth of any bacterial contamination. During transportation of blood from camps, similar temperature ranges apply.

Aims: To standardize the number of gel packs required to maintain the temperature at 2-10° C during the transportation of blood from camps.

Materials and Methods: Different approaches were used to standardize the number of gel packs instead of ice packs required for maintaining the temperature. Blood collected in camps was kept in an insulated box with gel packs kept in three layers - first layer at the bottom covered with silver foil and then blood units, one layer in the center and one layer above. The temperature during transportation was monitored using a data logger calibrated against a temperature indicator with a PT-100 sensor used as the reference and calibrated outside. The number of blood units, gel packs, the distance of camps and storage time and temperature were recorded.

Results: The data logger was kept in 60 blood donation camps. For 32 ± 9 blood bags, 16 ± 5 gel packs were kept at the camps. The mean distance of the camps was 16.7 ± 6.9 km and the storage time of blood from collection to reaching the blood bank was 2.5 ± 1.26 h. The temperature maintained was in the range of 7.7 ± 3.9° C to 11 ± 4° C.

Conclusion: We conclude that the number of gel packs should be 50% of the blood units kept in the insulated box.

Standards of blood banks in ten medical colleges of Punjab state (India) - 2013

Kusum K Thakur

GMC, Patiala, Panjab

Background: Blood transfusion services is like a factory with men, money, materials, methods and machines. In India, it is being ploughed by fragmented management, a situation not conductive to blood safety. Standards vary from state to state, city to city and even one center to another within the same city. In order to improve the standards in our country, the NACO has formulated comprehensive standards to ensure better a quality control system on all aspects.

Aims: To determine the standards of blood banks in 10 medical colleges of Punjab State and to compare it with the national standards.

Materials and Methods: All 10 medical colleges were observed for a period of 1 year from April 2012 to March 2013, for certain parameters like category of blood bank, licensing status, equipment, staff position, annual blood collection, testing of blood, annual utilization, facility of components, biomedical waste management and quality control, etc.

Results: Private sector blood banks are doing better than the government sector in respect of licensing status, testing, equipment maintenance, staff position, quality control and finance. Charges are not uniform in government as well as private blood banks. Hospital transfusion committees are not functional.

Conclusion: Voluntary blood donation (VBD) should be allowed in private medical colleges also for blood safety. Standards of testing, staff, blood utilization, preventive maintenance and repair policies for equipment, charges of blood/components and quality control should be uniform in all blood banks.

Anti-N antibody in a patient of chronic renal failure on hemodialysis

Paramjit Kaur, Sabita Basu, Gagandeep Kaur, Ravneet Kaur, Bankim Das

Government Medical College and Hospital, Chandigarh

Background: Anti-N is a rare antibody. It has been reported in renal failure patients on hemodialysis. We report a case of anti-N antibody in a patient of chronic renal failure on regular maintenance hemodialysis.

Case History: A 36-year-old male patient presented with breathlessness, distention of abdomen and decreased urine output. The patient was a known case of chronic renal failure on maintenance hemodialysis with a history of previous transfusion. Laboratory investigations revealed Hb of 5.4 g/dl, blood urea of 140 mg/dl and serum creatinine of 5.2 mg/dl. Liver function tests were also deranged. The patient was advised hemodialysis and a request for two units of packed red cells was received. The blood group of the patient was B positive on cell grouping. However, in serum grouping, there was reaction with O cells at room temperature, which was enhanced at 4°C. Auto control and direct antiglobulin test (DAT) were negative. Antibody screening and identification revealed anti-N antibody. The antibody was further confirmed with enzyme-treated red cells. The reaction strength diminished with enzyme treatment. The patient was phenotyped as N- and was safely transfused N antigen-negative cross-match-compatible units.

Discussion: Patients on chronic hemodialysis who are treated with reusable dialyzers sterilized with formaldehyde are known to form antibodies with N-like specificity irrespective of whether the patient is N+ or N-. The formaldehyde used to sterilize the dialysis membranes alters the N antigen, which is further recognized as foreign, leading to antibody formation. The antibody titer decreases when dialysis treatment and exposure to formaldehyde is stopped. Although anti-N is usually clinically insignificant, rarely has it been reported to cause hemolytic disease of newborn and hemolytic transfusion reaction. Such patients should receive N antigen-negative red cell units.

Dat-negative severe dhtr0 in a patient with multiple alloantibodies: No reason to panic!

Shah S, Kalgutkar S, Sawant R, Deshpande A

P. D. Hinduja National Hospital and MRC, Mumbai, Maharashtra

Background: Patients with multiple allo-antibodies often pose significant challenges to the transfusion service in terms of interpretation of compatibility test results, interference with detection of new blood group allo-antibodies, etc. This may lead to significant delays in the provision of compatible red blood cells by necessitating additional testing, and, sometimes, it may be virtually impossible to find compatible RBCs for some patients.

Case Report: We report a case of a 64-year-old male with multiple allo-antibodies with delayed hemolytic transfusion reaction (DHTR) due to anti-Jk b antibody. The patient, a case of alcoholic liver disease, recurrent celiac disease and ankylosing spondylitis presented with autoimmune hemolytic anemia (AIHA), indirect antiglobulin test (IAT) positive with a Hb of 9.3 g/dl, 5 years back. Anti-c and anti-E allo-antibodies were detected on the immunohematological work-up. The patient was transfused two units of blood and put on a steroid regime. He then presented with anemia (Hb 6.2 g/dl) after 5 years and was transfused two "c" and "E" antigen-negative blood units. Within 10 days, he presented again with an Hb of 6.6 g/dl and was transfused two antigen negative units as above. After transfusion of the first unit, the patient developed signs of acute transfusion reaction and had total bilirubin of 9.6 mg/dl, with indirect bilirubin of 7.8 mg/dl, increased lactate dehydrogenase and decreased haptoglobin. Anti-Jk b antibody was identified on further work-up of the patient's blood sample. However, the direct antiglobulin test (DAT) was negative at this juncture. The second blood unit was then transfused uneventfully and the patient's Hb increased to 9.0 g/dl post-transfusion. Both the donor units were subsequently phenotyped and found to be negative for "Jk b" antigen. On phenotyping of the units transfused 10 days back, both were found to be positive (one homozygous and other heterozygous expression) for Jk b antigen. The patient's phenotype was Jk a+ Jk b- . The cause of DAT negative, severe DHTR may be explained by anti-Jk b antibodies destroying the previously transfused JK b+ RBCs. This case highlights the unique presentation of severe DHTR caused by anti-Jk b antibody.

Alloimmunization in liver disease patients

Pankaj Jain, Sapna Rathod

Institute of Liver and Biliary Sciences, New Delhi

Background: Liver disease patients form a distinct group of patients. They usually require repeated transfusion support as they are usually anemic and have coagulopathies. This makes them susceptible to alloimmunization, which is one of the common side-effects of repeated transfusions.

Aims: In this study, we aim to analyze the incidence and nature of allo-antibodies in this group of patients.

Materials and Methods: Blood grouping and antibody screening are carried out on samples of all patients (in-patients) admitted at the Institute of Liver and Biliary Sciences. In patients with a positive screen or incompatible cross-match, an expanded grouping that includes testing for anti-H, Anti-A1 and anti-AB as per the requirements is performed. This is followed by a direct antiglobulin test (DAT). The patient's serum is tested against an identification panel (courtesy Bio-Rad).

Results: Over the last 1 year, we have received requests for blood from approximately 2316 patients. Our study mostly consists of patients with chronic liver disease, acute liver disease, carcinoma of the liver, gall bladder and pancreas as well as other liver-related ailments. Incompatible cross-matches/positive antibody screen were detected in 24 patients. The most commonly detected antibodies were anti-c and anti-E.

Conclusion: Liver disease patients usually have anemia and coagulopathies, and require transfusion support over long periods of time. This predisposes them to alloimmunization, but as liver disease also affects the immune response making it sluggish, the incidence of alloimmunization is much lower ( approx. 1%) as compared with other multitransfused patient groups. Early serological work-up, prompt action and good communication between the clinicians and the transfusion services can facilitate successful transfusion management of these patients.

Comparison of column agglutination technique with the conventional test tube for titration of red blood cell alloantibody

Anju Dubey, Atul Sonker 1 , RK Chaudhary 1

All India Institute of Medical Sciences, Rishikesh, Uttarakhand 1 Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP

Background: The titration of an alloantibody to a red cell antigen is a useful semi-quantitative screening tool that can detect an increased production of maternal antibody during pregnancy. The conventional tube test (CTT) is the traditional method for performing titration studies. The column agglutination technique (CAT) is also a sensitive method to detect RBC alloantibodies.

Aims: The aim of this study was to compare the CAT with the CTT technique in the performance of Rh and K alloantibody titration.

Materials and Methods: Patients' serum samples (n = 50) that contained an RBC alloantibody with a single specificity were identified during routine work-up in the immunohematology laboratory. Parallel titration studies were performed on these samples by both the CTT method and the CAT (gel column assay, Biorad). Red blood cells (R1R1 phenotype) were used, with a final concentration of 3% for tube and 0.8% for gel. Serial two-fold dilutions were prepared for each technique, followed by reading in an antiglobulin phase.

Results: The study comprised of 50 samples including 32 anti-D, two anti-C, six anti-c, seven anti-E, one anti-e and two anti-K. Overall, the two methods generated identical results in nine samples only. For 38 samples (76%), the titers were two fold or higher by CAT and, for the remaining three samples, the titers were higher with CTT.

Conclusion: Anti-D titration in the CAT showed higher titers than the CTT in most of the samples studied. Based on this data, titers obtained by CAT are not reliable for managing the alloimmunized pregnancies.

A case of blood group discrepancy: Detection of sub-group in a donor

Pritesh Rajani, SK Raj, G Panday, S Rathore, Meenu Bajpai

Institute of Liver and Biliary Sciences, New Delhi

Background: This case highlights the importance of advanced immunohematology techniques in solving the group discrepancy in case of weaker antigen/antibody and also in the detection of the rarer sub-groups. Various types of B cells reacting weakly or not at all with Anti-B have been described. B 3 cells show a mixed field agglutination pattern with B in the saliva of the secretors; B x shows a weak agglutination pattern, weak Anti-B is found in the serum and B el cells are not agglutinated by Anti-B, which can be subsequently eluted: H but not B is found in the saliva of the secretors.

Aim: To detect the presence of weaker B sub-group using the adsorption-elution technique.

Case Report: A 20-year-old female donor for living donor liver transplant (LDLT) was admitted for transplant work-up. The cell grouping showed O Rh positive, while the serum grouping showed group B at room temperature and at 37°C, while at 4°C agglutinates in all the three pooled cells were seen. The direct and indirect antihuman globulin tests were negative. On performing adsorption and elution of the fresh sample, the eluate showed 2+ reaction with B cells at room temperature and at 37°C incubation.

Results: The positive reaction of the eluate with the B cells showed the presence of weaker B antigens, which were adsorbed onto the Anti-B from the serum of Group A donors. The group therefore was found to be a sub-group of B, most likely to be B el , which can be further confirmed by molecular grouping.

Conclusion: This is a case of weak ABO expression from the inheritance of a weak ABO sub-group. Some patients with leukemia and other malignancies can also show weakened ABO expression. In detecting weak B antigens, the preparation of an eluate may be helpful in two ways-first it may be possible to prepare quite a potent eluate from the cells that agglutinate only very weakly; second, an eluate prepared from cells with a very weak antigen may agglutinate the cells, even though they are not agglutinated by the whole serum used in the making of the serum.

Study of an immune response of non-irradiated and irradiated blood group antigen "M" and "N" by rabbit immunization

Priyanka V Shah, Avani P Shah, Keyuri F Jariwala, Snehalata C Gupte

Surat Raktadan Kendra and Research Center, Surat, Gujarat

Background: MN antigens are clinically important and occasionally involved in the transfusion reaction. Irradiation of blood is carried out to prevent TA-GvHD. If MN antigens are weakened by irradiation, then their ability to immunize the recipient may be impaired.

Aim: To determine the immunogenicity of irradiated and non-irradiated red cells of healthy donors having M and N antigens.

Materials and Methods: Irradiation of RBC was performed at 25 Gy on a gamma irradiator (BI-2000). For immunization, 20 rabbits were selected on the basis of age, sex and weight. They were divided into two groups, 10 each of M and N antigens. Of 10 rabbits, five rabbits were immunized with irradiated cells and five with non-irradiated cells. Pre-immunized and post-immunized rabbit's blood samples were collected. After removal of complement, rabbit's serum was absorbed with A 1 M, A 1 N, OM and ON human red cells. Absorbed rabbit's serum was investigated for the presence of anti-M or anti-N antibodies against known red cells having M and N antigens.

Results: The blood group of all rabbits was "B" negative. Among 20 rabbits, two of those injected with non-irradiated M antigen and one injected with non-irradiated N antigen showed immune response. The titer of anti-M was 1:8 and 1:16, respectively, and for anti-N serum was 1:8. None of the rabbits injected with irradiated M or N group RBC produced immune response.

Conclusion: The above study shows that the immunogenicity of "M" and "N" antigens may be impaired after gamma irradiation. Therefore, their ability to immunize the recipient may be decreased.

Study the effect of gamma-radiation on blood group antigens from whole blood and rcc0 units during storage

Avani P Shah, Priyanka V Shah, Keyuri F Jariwala, Snehalata C Gupte

Surat Raktadan Kendra and Research Center, Surat, Gujarat

Background: Antigens of the ABO and Rh systems are more potent than other antigens like "Fy a", "Fy b", "M" and "N," which are easily destroyed by enzymes. Gamma irradiation of blood is carried out to prevent TA-GvHD. Irradiation of RBC increases extracellular potassium due to alterations in red cell membrane. Therefore, it is possible that blood group antigens may be impaired.

Aim: To investigate whether there is reduction in red cell antigen potency after gamma irradiation.

Materials and Methods: Ten units of whole blood and red cell concentrates each were selected for the study of "A," "B," "H," "D," "Fy a ," "Fy b ," "M" and "N" antigens on Days 0, 7, 14, 21 and 28. Gamma irradiation was performed at 25 Gy on a blood irradiator. Antigen potency of the non-irradiated and irradiated RBCs was checked by a manual titration method by scoring the strength of the agglutinins. The antigenic sites per RBC were determined on a flow cytometer.

Results: After titration, the results were recorded and scored as follows: +4 = 10, +3 = 8, +2 = 6, +1 = 4, +w = 2 and negative = 0. The mean ± SD scores and the range were calculated for each sample. The flow cytometry results were analyzed for median fluorescence intensity (MFI). There was no significant difference in the scoring and MFI values of non-irradiated and irradiated samples for any antigen on different days of storage of whole blood and RCC using the χ2 test (P > 0.05).

Conclusion: From the above study, it appears that after gamma irradiation, blood group antigens "A," "B," "D," "H," "M," "N," "Fy a" and "Fy b" may not be weakened.

Preparation, evaluation and comparison of anti-A 1 reagents

Keyuri F Jariwala, Snehalata C Gupte

Surat Raktadan Kendra and Research Center, Surat, Gujarat

Background: Dolichous biflorous lectin is used for the preparation of anti-A 1 lectin reagent to detect the A 2 group. The reagents of different manufacturers often give different results creating confusion. Therefore, evaluation of the quality is essential.

Aim: To prepare and standardize the anti-A 1 reagent from the seeds of Dolichous biflorus and its comparison with commercially available anti-A 1 reagents of different companies to evaluate the quality.

Materials and Methods: A few grams of Dolichous biflorus seeds were crushed by grinding and soaking in normal saline overnight at 4°C. The supernatant was separated by centrifugation and checked for pH 7. It was incubated again till the precipitates settled down. 0.01% sodium azide having pH 7 was added as the preservative. The reagent titer was performed using red cells of different groups like A 1 , A 1 B, A 2 , A 2 B, B and O. The reagent quality was evaluated against lectin anti-A 1 of different companies. Diagast A 2 cells and some known A 2 patients' cells were used to assess the ability of these reagents to pick up the A 2 group.

Result: The reagent was specific for A 1 antigen and A 2 , A 2 B, B and O cells gave a negative reaction. The avidity and titer was within the acceptable range required for standard anti-A 1 reagent.

Conclusion: Manually prepared lectin from the seeds of Dolichous biflorus gives the result as per standard requirements. We observed that many of the commercially available lectin reagents give false-positive reactions. We can conclude that a manually prepared lectin reagent can be the best option if commercial reagents are of poor quality.

Significance of extended partial-D typing in suspected RhD-incompatible allogenic bone marrow transplant: A case report

Poojary M, Ojha S, Tirlotkar A, Sumathi SH,

Kulkarni S 1 , Rajadhyaksha S 2

Tata Memorial Centre Advanced Centre for Treatment, Research and Education in Cancer (ACTREC) Kharghar, Navi Mumbai, Maharashtra, 1 National Institute of Immunology, ICMR, Mumbai, Maharashtra, 2 Department of Transfusion Medicine, Tata Memorial Hospital, Mumbai, Maharashtra

Background: High immunogenicity of Rhesus D Antigen (RhD) can become a major complicating factor in transfusion support of allogenic bone marrow transplant (BMT). The distinction between Weak D and Partial D status is important for appropriate selection of blood and blood components to prevent post-transplant complications like hemolysis, delayed engraftment and red cell aplasia.

Aims: To highlight the importance of extended epitope profiling for partial D phenotypes in cases of suspected RhD-incompatible allogenic BMT. To discuss the approach for resolution of discrepancy between Weak D and partial D status.

Materials and Methods: RhD typing was performed by monoclonal and polyclonal anti-D. Weak D/partial D analysis was carried out using an indirect antiglobulin test (IAT) by the conventional tube and gel card methods and phenotyping by monoclonal anti-D epitope panel. All tests were carried out as per the manufacturer's instructions.

Results: No discrepant result was observed in RhD typing in the patient. Donor's RhD typing showed a weak reaction with monoclonal anti-D and negative reaction with polyclonal anti-D. The IAT procedure showed the presence of Weak D and phenotyping by monoclonal anti-D epitope panel showed reactivity pattern of Weak D, ruling out the presence of partial D.

Conclusion: As per the AABB guidelines for transfusion support in RhD-incompatible allogeneic BMT, Rh-negative components should be transfused during the peri-transplant phase (Phase II). However, determination of partial D or Weak D status is important in BMT as different transfusion protocols would be followed to prevent allo-immunization to potentially immunogenic RhD antigen. The significance of extended partial D typing in the above case ensured the provision of RhD-positive blood components to the patient and to conserve rare RhD-negative blood components.

Counseling and blood donor management

Kusum K Thakur

GMC Patiala, Punjab

Background: Counseling in blood transfusion services (BTSs) is an essential part of the quality system in blood donor management. As defined by the NACO, "Counseling is a helping process where one person, explicitly and purposefully, gives his/her time, attention, and skills to assist a client to explore their situation, identity and act upon solutions with in the limitations of their given environment." According to the National Blood Policy-2002, blood bags are tested for six mandatory transfusion transmissible infections (TTIs) in India. Proper follow-up of donors, with extended services of BTS in the form of referral to the ICTC/special clinics, increases the blood safety as there will be a self-deferral by them in the future.

Aims: To determine the status of counseling and donor management at our center.

Materials and Methods: An analysis of the records of donors for TTI status from August 2011 to July 2012 was carried out.

Results: The total number of donors was 16,755 - voluntary 14,260 (85%) and replacement 2495 (15%). The total TTIs that were positive were 237 (1.4%), HCV 120 (0.7%), HBV 109 (0.6%) and HIV reactive were 8 (0.05%). All donors were contacted, but only 153 (65%) responded and only 82 (35%) came to the department. Of the 82, five (2%) donors were sent to the ICTC and 73 (30%) donors were sent to special clinics.

Conclusion: Similar studies at the GMC, Chandigarh, showed that 22% of the reactive donors returned for post-donation counseling as compared with our study of 35% and MGRU Chennai of 44%. About 65% donors positive for TTIs could not be counseled for referral and further management, which is a sad state of affairs. The causes for low response will be scrutinized in detail and actions will be taken accordingly.

Vertical transmission of human immunodeficiency virus, hepatitis B and hepatitis C virus infections in Surat, Gujarat

Avani P Shah, Snehalata Gupte

Surat Raktadan Kendra and Research Center, Surat, Gujarat

Background: During pregnancy or child birth, mothers infected with hepatitis B virus (HBV), hepatitis C virus (HCV) or human immunodeficiency virus (HIV) may transmit the infection to her child.

Aim: To investigate the incidence of mother to child vertical transmission of HBV, HCV and HIV infections.

Materials and Methods: A total of 10,510 pregnant women from various maternity hospitals were investigated. A detailed consent form and proforma were filled prior to blood collection. All women were tested for HBsAg, anti-HCV and anti-HIV1 and 2 by the enzyme-linked immunosorbent assay (ELISA) method to detect HBV, HCV and HIV infections, respectively. HIV 1 and 2 differentiation was made by the rapid method. Infected mothers' children were called for follow-up when the child was about 18 months old and blood samples were collected. The different markers of HBV, HCV or HIV infections were tested using ELISA.

Results: The prevalence of HIV, HBV and HCV was 0.54%, 1.01% and 0.29%, respectively, in pregnant women. Forty-two children were tested for vertical transmission of HBV infection, and the incidence of transmission was 21.4%. For HIV and HCV investigation, we were able to collect only 16 and 14 children's samples, respectively. The prevalence of vertical transmission of HIV infection was found to be 37.5%, whereas no case of vertical transmission was found for HCV infection.

Conclusion: From this study, it appears that the prevalence of vertical transmission of HIV infection was higher than that of HBV and HCV infections, but a conclusion cannot be drawn as a small number of samples is tested.

Seroprevalance of co-infections among blood donors in the Swasthya Kalyan Blood Bank, Jaipur

KK Mishra, Urmil Dhuria, SS Agarwal

Swasthya Kalyan Blood Bank and Thalassemia Research Centre, Jaipur, Rajasthan

Materials and Methods: Forty-eight thousand and thirty-three donors were screened for co-infections from April 2011 to March 2013. First, the donors underwent a routine blood selection process and then their samples were screened for human immunodeficiency virus (HIV), Hepatitis B and Hepatitis C using III- and IV-generation enzyme-linked immunosorbent assay (ELISA) kits. Syphilis was screened using the RPR test and malaria was screened by ELISA.

Results: Of the 48,033 blood units, 13 units were found to be positive for more than one marker. One donor was seroreactive for Hepatitis C virus (HCV) and syphilis, four for HBsAg and HCV, three for HBsAg and syphilis, three for HIV and syphilis and two donors were seroreactive for HIV and HBsAg. In 2011-12, the total donations were 23,659, of which eight donors were seropositive for more than one marker. Therefore, the seroprevalance for co-infection was 0.033%. In 2013, the total donations were 24,374, of which five donors were seroreactive for multiple infections, and the seroprevalance was 0.020%. The overall seroprevalance in 2 years was 2.818%. The total seropositive cases over 2 years were 1354. Thus, the seroprevalance of co-infections among the positive cases was 0.96%.

Conclusion: There is a definite risk to recipients. We should follow more stringent techniques for pre-donation screening.

Seroprevalence and trends in transfusion-transmitted infections among blood donors at the sps0 Apollo Hospitals, Ludhiana, Punjab

Hitish Narang

SPS Apollo Hospitals, Ludhiana, Punjab

Background: Blood is the nectar of life. Transfusion of blood and blood components saves millions of lives worldwide each year and reduces morbidity. Blood transfusion is also associated with a large number of complications, trivial and potentially life-threatening, demanding meticulous pre-transfusion testing and screening, particularly for transfusion transmissible infections (TTIs). These TTIs are a threat to blood safety. Thus, the priority of blood transfusion service is to ensure safety, adequacy, accessibility and efficiency of blood supply at all levels.

Aims: The objective of the present study is to assess the prevalence of TTIs among blood donors.

Materials and Methods: In the Department of Transfusion Medicine of the SPS Apollo Hospitals, Ludhiana, during the period from January 2006 to June 2013, the prevalence of TTIs among blood donors was determined. A retrospective review of the donors' record was carried out. All samples were screened for HIV, HBsAg, HCV, syphilis and malaria.

Results: Of the 27,962 blood donors, 27,365 (97.86%) were replacement donors and the remaining 597 (2.13%) were voluntary donors. The prevalence of HIV, HBsAg, HCV, syphilis and malaria parasite was 0.29, 0.74, 1.89, 0.67 and 0.02%, respectively. Majority were replacement donors with a male preponderance. In all the markers tested, there was an increased prevalence of TTI among the replacement donors as compared with the voluntary donors.

Conclusion: The implementation of strict donor criteria and use of sensitive screening tests can reduce the incidence of TTI in the Indian scenario.

Seroprevalance of TTIs and co-infection rates among blood donors at a tertiary care institute: A five-year study

JK Upadhyay, HC Pandey, RK Chaudhary

Department of Transfusion Medicine SGPGIMS Lucknow, UP

Background: Transfusion-transmitted infections (TTIs) have always been a concern to transfusion medicine, of which a lot of effort has been made to reduce this risk associated with transmission of human immunodeficiency virus (HIV), hepatitis B virus (HBV), Hepatitis C virus (HCV) and syphilis. Screening blood donors for these not only prevents the transmission of infections but also helps in gaining insights into the epidemiological aspects of these agents in the community.

Aim: To find out the seroprevalance as well as the co-infection rates of HIV, HBV, HCV and syphilis among blood donors at our center over a 5-year period.

Materials and Methods: Blood donor records for the past 5 years (2008-2012) were retrospectively reviewed for the prevalence of HIV, HBV, HCV and syphilis seropositivity. The screening of donors was performed using a fourth-generation enzyme-linked immunosorbent assay (ELISA) kit for HIV (HIV-1 p24 antigen and HIV-1 and -2 antibodies), third-generation ELISA kit for HCV and HBV and RPR for syphilis as per the departmental standard operating procedures.

Results: A total of 110,502 blood donations were performed during the study period. The overall prevalence for TTI markers was 3.70%. Individual seroreactivity rates for HIV, HBV, HCV and syphilis were 0.46%, 2.13%, 0.72% and 0.38%, respectively. The co-infection rate was found to be 0.03% (36 donors). Seropositivity among voluntary and replacement donors was 0.21% and 3.49%, respectively.

Conclusion: Compulsory screening of blood/components must be carried out using approved and sensitive tests. Newer methods of TTI screening should be tested at the earliest and incorporated into the screening tests. Moreover, efforts should be undertaken to educate the population and increase the voluntary donor base for a safe blood supply.

Retrospective analysis of prevalence for HIV, HBV, HCV, VDRL and Malaria in a south Indian tertiary care centre of 1,89,856 blood donors: A hospital-based study of thirteen years (2000-2012)

C Vishala Sharma, B Shanthi, S Vijaya Laxmi

Nizam's Institute of Medical Sciences, Hyderabad, Andhra Pradesh

Background: The changing trends of human immunodeficiency virus (HIV) and viral hepatitis prevalence in blood donors is based on the increased awareness among the people, safe sex practice, vaccination, newer anti-retroviral drugs and national programs in controlling the infections.

Aims: To analyze the changing trends and associated factors like type of blood donation, sex, blood group, reagents, kits and multiple viral marker reactivity in blood donors.

Materials and Methods: All the blood units collected (1,89,856) during the study period from Jan 2000 to Dec 2012 were tested for HIV, Hepatitis B virus (HBV), Hepatitis C virus (HCV), Venereal Diseases Research Laboratory (VDRL) and malaria. Third- and fourth-generation enzyme-linked immunosorbent assay (ELISA) reagent kits were used for viral marker screening, VDRL with RPR and TPHA method and malaria with QBC and ELISA methods.

Results: The seropositivity of different transfusion-transmitted infectious markers ranged as HIV - 0.17-1.01%, HBsAg - 1.21-4.03%, HCV - 0.21-1.25%, VDRL - 0.28-1.2%, HBC Ig - 16.23-23.08%, anti-HBsAg - 5.5-8.2% and MP - 0.03%. The incidence of HIV, HBsAg and HCV showed a decreasing trend. Among the male replacement donors, the incidence of positive viral markers was high. The O and B groups are more commonly associated with viral marker positivity. HBV + HCV seropositivity contributed to 22% of the total combined infections, and HIV + HBV - 18%, HIV + VDRL - 18% and HIV + HCV - 8%.

Conclusion: The seroprevalance of retroviral and HBV infections is significantly decreased in these 13 years. There is a definite need to encourage voluntary blood donors and going for newer modes of screening tests like nucleic acid amplification testing to reduce transfusion-transmitted infections.

Seroprevalence of HBsAg and HCV in healthy blood donors at a tertiary care hospital of Punjab

Kanchan Bhardwaj

4-A, Dhillon Marg, Model Town, Patiala, Punjab

Background: Hepatitis B and hepatitis C threaten the safety of the recipients and the community as a whole, and are a subject of real concern worldwide.

Aims: To assess the seroprevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) among blood donors at a tertiary care hospital-based blood bank in Punjab.

Materials and Methods: In a cross-sectional study, 7000 blood donors (5450 voluntary and 1550 replacement donors) were included. All the blood donors were screened for HBsAg and anti-HCV antibodies (third-generation enzyme-linked immunosorbent assay [ELISA]). The statistical analysis was carried out by the Chi-square test.

Results: The seroprevalence of HBsAg and HCV were 0.91% and 0.83%, respectively. Seropositivity was higher among replacement donors than that among voluntary donors in HBsAg (1.39% vs. 0.79%) and HCV (1.22% vs. 0.72%). Seroprevalence was higher in the age group 31-40 years and higher in rural area donors. The incidence decreased in repeat donors.

Conclusion: Prevalence of HBsAg was higher than anti-HCV. Stringent measures need to be taken, including dissemination of information and vigilant donor screening, screening of blood units with sensitive techniques like the nucleic acid amplification technique (NAT) and inclusion of antibody to hepatitis B core antigen. Repeat voluntary donors are safest, and inclusion of sensitive techniques like NAT, antibodies to HBcAg and HCV RNA for donor screening will improve blood safety further. Educating rural masses about the prevention of viral diseases is vital.

Prevalence of transfusion-transmitted infection markers and geographic mapping to identify safe areas for holding blood donation camps in Surat city

Rinku Shukla, Avani Shah, Snehalata Gupte

Surat Raktadan Kendra and Research Center, Surat, Gujarat

Background: Our regional blood transfusion center collects about 35,000 blood units annually and supplies about 50,000 units to about 500 hospitals and nursing homes.

Aims: To assess variation in Hepatitis B virus (HBV), Hepatitis C virus (HCV), human immunodeficiency virus (HIV 1 and 2) and syphilis infection rates in voluntary donors from different areas of Surat city and to identify trends of transfusion-transmitted infections (TTIs) over a period of time.

Materials and Methods: This study presents the data of 241,915 blood units collected in 3588 camps from 2001 to 2010. In Surat city, 218,497 blood units were collected in 3219 camps. The samples were screened for tests like HIV 1 + 2, HCV, hepatitis B surface antigen (HBsAg) and Venereal Diseases Research Laboratory (VDRL). The city was divided into nine groups each having an average area of 33.24 sq. km. The prevalence of TTI among blood donors in these areas has been estimated.

Results: Camp blood collection increased from 99,523 in 2001-05 to 142,392 in 2006-10. The average rate of TTI in Surat was 0.24% HIV, 0.96% HBsAg, 0.17% HCV and 0.15% VDRL. HIV prevalence declined from 0.38% to 0.14%, HBsAg from 1.17% to 0.83%, HCV from 0.31% to 0.07% and VDRL from 0.23% to 0.09% in 2006-10 compared with 2001-05. Areas of group 1 have maximum seropositivity for HBsAg and VDRL with groups 7, 8 and 9 having seropositivity more for HIV and HCV.

Conclusion: This study has identified the safe areas for conducting blood donation drives, which are groups 5, 6 and 7. Groups 1, 8 and 9 appear to be the high-risk areas for TTI and should be avoided for holding blood donation camps.

Seroprevalence of transfusion transmissible infections among voluntary and replacement blood donors of a tertiary care hospital of Punjab

Sonia Gupta

Dayanand Medical College and Hospital, Ludhiana, Punjab

Aims: Blood is a life-saving source, but is also an important mode of transmission of infections in the recipients. Voluntary blood collection and proper screening of blood are the cornerstones of transfusion medicine.

Materials and Methods: During the period of 01.01.2008 to 31.12.2012, i.e. over a period of 5 years, a total of 157,477 units of blood were collected from healthy voluntary and replacement donors in the Department of Immunohaematology and Blood Transfusion, Dayanand Medical College and Hospital, Ludhiana. Of these, 115,300 (73.2%) were replacement and 42,177 (26.8%) were voluntary. There were 150,404 males and 7073 females in the age group of 18-60 years. All blood samples were screened for anti-human immunodeficiency virus (HIV) 1-2 (Biomerieux 4 th Generation), anti-Hepatitis C virus (HCV), HBsAg (Biomereux 3 rd Generation), Venereal Disease Research Laboratory (VDRL) (Immuno Chromatography method by Beacon) and malaria (one step Malaria LDH Rapid Test by Microgene). The total number of seroreactive cases and their distribution were analyzed.

Results: All blood samples were tested for anti-HIV 1/2, anti-HCV and Hepatitis B surface antigen, VDRL for syphilis and malaria. It was observed that 434 (0.26%) were HIV, 1689 (1.07%) were Hepatitis B, 2524 (1.6%) were Hepatitis C, 2855 (1.8%) were VDRL and 10 (0.006%) were positive for malaria. The seropositivity was more in the replacement than in the voluntary donors. The prevalence of HCV and VDRL are higher in our study. The female donor percentage is low for all the 5 years as compared with the male donors.

Conclusion: Strict quality control, proper counseling of donors and training of blood transfusion personnel including deferring of suspected donors may help to prevent wastage of huge resources and reduce the inventory. Efforts should be made to improve the number of female donors. More awareness among the female population by holding camps in women's colleges, training and recruiting more female staff and an improvement in privacy of these blood camps should be performed to encourage more females to donate blood. Apart from recruiting new donors, measures should be taken to retain previous donors.

Influence of overnight holding Buffy coat at room temperature for preparation of platelet concentrate stored in plasma

Tirlotkar Amol Anant, Ojha Shashank, Sumati SH, Poojari M, Rajadhyakshya SB, Chavan PD, Patil V,

Assari U

Tata Memorial Centre - ACTREC, Kharghar, Navi Mumbai, Maharashtra

Background: Platelet concentrate (PC) prepared from Buffy coat (BC) processing after overnight holding at room temperature is not an uncommon practice given its operational feasibilities. However, the metabolic activity of cells in BC and its effect on quality of platelets vis-ΰ-vis overnight holding time needs to be ascertained.

Aims: To compare the quality of PCs prepared from fresh and overnight hold BC stored in plasma at room temperature.

Materials and Methods: The whole blood (450 ml + 10%) units were prospectively collected in quadruple bags from healthy voluntary donors. The units were further processed to separate platelets from BC either after 2 h: Group A (n = 30) or after hanging overnight at room temperature for 8-12 h: Group B (n = 30). The quality indicative parameters of PCs, including biochemical markers like glucose, lactate concentration and lactate dehydrogenase (LDH) were analyzed and compared on Day 1.

Results: The overnight PCs showed a higher platelet count over fresh PCs (mean: 9.3 × 10 10 /unit v/s 8.1 × 10 10 /unit), whereas no significant difference was observed in volume, WBC count and RBC count of the PCs prepared from either method. The mean pH levels were similar in both study groups, whereas the mean lactate and LDH were significantly higher in overnight PCs (15.5 mmol/L and 236 U/L, respectively) than fresh PCs (6.9 mmol/L and 151 U/L, respectively) (P < 0.05). The glucose concentration was higher in Group A PCs than in Group B PCs (P < 0.05). Both groups of PCs were found to be equally sterile.

Conclusion: Significantly higher concentration in biochemical parameters was noted among Group B PCs but no quality compromise was seen. Hence, these findings need to be investigated on a long-term basis through platelet activation and in vivo survival studies. However, such holding time might help to overcome logistic problems.

Effectiveness of FFP in correcting PT in patients of chronic liver disease

Shweta Mehta, Bhumika Gharia

S.B.K.S.M.I. and R.C., Piparia, Gujarat

Background: A two-part study was conducted, i.e. retrospective and prospective, to evaluate the effectiveness of fresh frozen plasma (FFP) in correcting the prothrombin time (PT) in patients with chronic liver disease.

Aims: To study the effectiveness of FFP in correcting PT in patients of liver cirrhosis.

Materials and Methods: All patients had evidence of cirrhosis of the liver, either by liver biopsy or by clinical, biochemical and/or imaging criteria. In the retrospective analysis, a total of 50 patients were included with a pre-transfusion prolongation of the PT of more than 3 s above the control value. In this prospective study, 20 patients were studied. The indications for FFP transfusions in the prospective study were active bleeding: four patients; prior invasive procedure: 11 patients; and concern for spontaneous bleeding: five patients.

Results: In the retrospective analysis, the mean PT prior to FFP transfusion was 17.5 s, the mean number of FFP units transfused was 3.75 units and the mean PT following the FFP transfusion was 15.9 s. The mean change in PT after FFP, 1.5 s, was statistically significant; however, only 12.5% of the patients corrected their PT to within 3 s of their control value. In the prospective study, the mean PT prior to FFP transfusion was 20.0 s, the mean number of FFP units transfused was 2.9 units and the mean PT following the FFP transfusion was 17.3 s. The mean change in PT following FFP, 3.75 s, was statistically significant; however, only 10% of the patients corrected their PT to within 3 s of the control value.

Conclusion: Mild-to-moderate elevations of the PT were corrected by FFP in almost all patients.

Our experience with platelet apheresis: A 5-year study

Rajni Bassi, Kanchan Bhardwaj, Poonam Singal, Aradhana Sharma, Harnoor Singh Bhardwaj

Government Medical College, Patiala, Punjab

Background: Plateletpheresis has dramatically improved clinical outcome in patients with thrombocytopenia. Apheresis of the platelets provides an adequate therapeutic dose and minimizes donor exposure and human leukocyte antigen (HLA) allo-immunization.

Aims: To study the pattern of plateletpheresis in our hospital.

Materials and Methods: Plateletpheresis procedures were performed in the Transfusion Medicine Department, Rajindra Hospital, Patiala from January 2008 to December 2012 with a Fenwal Amicus Separator. Donor selection criteria were as per the criteria laid out in the DGHS, Technical Manual 2003 Government of India. The procedures are carried out under the direct supervision of a trained medical officer.

Results: One hundred and ninety plateletpheresis procedures were carried out on voluntary 5 (2.6%) and replacement donors 185 (97.3%). Fifty-six (29%) donors were first-time donors and 134 (71%) donors were repeat donors. Majority of the donors, 99 (52%), were in the age group of 20-29 years. One hundred and twenty-nine (67%) donors had a platelet count between 2 and 3 lakh/mm 3 . These units were transfused to 168 patients. Majority of the patients had dengue fever, with thrombocytopenia 153 (91%), hemato-oncology 8 (4.7%), septicemia with thrombocytopenia 3 (1.7%), neurosurgery 2 (1.2%) and pregnancy-associated thrombocytopenia 2 (1.2%). Fifty-two (31%) of the patients who received plateletpheresis therapy had a platelet count between 10,000 and 15,000/mm 3 . Eighty-six percent of the plateletpheresis transfusions were appropriate as recommended by the BCSH guidelines.

Conclusions: Plateletpheresis therapy is of immense utility in thrombocytopenic patients. Apheresis platelet concentrates provide an adequate leukoreduced dose with limited donor exposure and reduce the risk of bleeds, HLA alloimmunization and transfusion-transmitted disease, but is limited by the high cost of disposable kits required for their preparation.

Quality evaluation of red blood cell concentrates

Manish Patil, GV Puranik

Topiwala National Medical College and BYL Nair Ch Hospital, Mumbai, Maharashtra

Background: Red blood cell concentrates (RBC) are units of whole blood with most of the plasma removed. Periodic quality testing of RBC units is necessary to meet regulatory requirements.

Aims: To assess the quality of red cell concentrates prepared at a tertiary care hospital blood bank.

Materials and Methods: This was a prospective study over 3 years, during which 1% of the total RBC concentrates prepared were tested for quality parameters (mentioned below) on a monthly basis. The results were analyzed and compared with known standards (i.e., DGHS, AABB and Council of Europe).

Results: During the study period, a total of 33,898 units of RBC concentrate [with and without additive solution (AS)] were prepared, of which 1%, i.e. 350 units (175 each with AS and without AS) were tested for quality parameters.

Results are summarized in the table below.

Thus, overall, 33% of the RBCs without AS were non-compliant while 27% of the RBCs with AS were non-compliant for various quality standards. These erroneous results, especially for hematocrit values, are an eye opener and call for standardizing more meticulous and stringent standard operating procedures for RBC concentrate preparation. Some of the corrective measures include standardization of centrifugation technique, standardization of volume of blood collected and automated process for separating plasma, automated component separation and technical training of staff with motivation to achieve the desired standards.

Comparison of platelet concentrate prepared by two different methods: Platelet-rich plasma and Buffy coat method

Tanvi Patel, Rinku Shukla, Snehalata Gupte

Surat Raktadan Kendra and Research Center, Surat, Gujarat

Background: Two types of platelet concentrates (PCs) are prepared in our blood bank by the platelet-rich plasma (PRP) and Buffy coat (BC) methods. Platelet count as well as WBC count need to be monitored while checking the quality of the PC. The removal of leukocytes from various blood components minimizes many adverse transfusion reactions.

Aim: To compare the quality parameters like platelet count and WBC count in PRP-PC and BC-PC.

Materials and Methods: We prepared 87 PRP-PC manually and 87 BC-PC using a Blood Component Extractor Optipress-II from whole blood collected in a triple bag and top and bottom Fenwal bags, respectively. After 1 h of platelet preparation, volume, WBC count and platelet count of PC were measured by using a hematology analyzer. The WBC count of BC-PC was also measured by using a Nageotte chamber.

Results: Platelet count in BC-PC was 7.35 ± 1.85 ×10 10 /unit, which was significantly higher than in PRP-PC 5.64 ± 1.25 ×10 10 /unit (P < 0.0001). In case of leukocyte count, no significant difference in PRP-PC 4.36 ± 2.81 ×10 7 /unit and BC-PC 3.78 ± 2.58 ×10 7 /unit was observed (P > 0.005). There was a significant difference between the two methods of counting of WBC by using a hematology analyzer (5.83 ± 3.42 × 10 7 /unit) and Nageotte chamber (3.78 ± 2.58 ×10 7 /unit) in case of BC-PC (P < 0.0001).

Conclusion: The platelet yield was higher in BC-PC than in PRP-PC. Leukocyte count was almost same in both products. Hence, leukoreduction was also achieved in PRP-PC. For reliable counting of contaminated leukocytes in platelets, it is advisable to use a Nageotte chamber.

Pattern of blood procurement and utilization at The SPS Apollo Hospitals, Ludhiana, Punjab, India

Hitish Narang

SPS Apollo Hospitals, Ludhiana, Punjab

Background: Blood transfusion is the life-saving intervention. Blood donors are the only source of a safe and adequate supply of blood and blood components. The main objective of this study was to review the pattern of blood procurement, utilization and causes of discarding blood at the SPS Apollo Hospitals, Ludhiana.

Materials and Methods: The present retrospective study was conducted at the SPS Apollo Hospitals from January 2006 to June 2013 for 90 months. The data were collected for the number of donors, their types, cross-match: Transfusion ratio and pattern of discard of blood and its component units.

Results: A total of 27,962 blood donations were collected in the specified 90-month period. 97.86% were male donors and 93.38% were replacement donors, including family donors. Rh-negative blood donors comprised 10.04% of the study population. The infective causes for discarding blood were human immunodeficiency virus (HIV) antibody (0.29%), Hepatitis B surface antigen (0.74%), Hepatitis C antibody (1.89%), Venereal Disease Research laboratory (VDRL) (serological test for syphilis) (0.67%) and malaria (0.02%). The common non-infective causes of discarding blood/components were: Expired unit, shelf life and blood unit insufficient quantity. The average blood component preparation rate was 79%. The most commonly ordered blood components were packed red blood cells and fresh frozen plasma. The cross-match:transfusion ratio was 1.06, which resulted in efficient utilization of manpower resources and materials.

Conclusion: Hospital transfusion committees are a good platform for presenting the performance of blood banks and to bring forward the deficiencies of the existing system. Blood bank internal audits and regular review of statistics are vital tools for a successful blood transfusion service.

Assessment and utilization in a tertiary care hospital of Punjab

Abha Singla, Kanchan Bhardwaj, MS Bal, Harpal Singh, Poonam Singal, Rajni Bassi

Government Medical College, Patiala, Panjab

Background: Blood component therapy has benefited many patients by meeting their specific transfusion needs from a single blood donation. Non-compliance to various guidelines of platelet transfusion therapy is frequently seen. There is a need for rationale use of platelet transfusions. Therefore, audits are important to reduce inappropriate transfusions.

Materials and Methods: This study was performed from 1 October 2012 to 31 May 2013 to audit the usage of platelet transfusions in the blood bank of the Rajindra Hospital, Patiala. The guidelines of the British Committee for Standards in Haematology (BCSH) were followed to determine the appropriateness for platelet transfusions. Platelet concentrates prepared from both random donor platelets (RDPs) and single donor platelets (SDPs) were included.

Results: Total platelet concentrates prepared were 1930 (SDPS and RDPs), of which 1015 (52.59%) were utilized. Of the 1015 transfusions, 1005 (99%) were RDPs and 10 (1%) were SDPs. The appropriate use of platelet transfusions as RDPs was 777 (77.3%) and SDPs was 7 (70%). The maximum number of transfusions were in the Medicine Department, i.e. 648 (63.84%) in patients of dengue, alcoholic liver disease, aplastic anemia followed by surgery, 145 (14.2%), pre-operatively in patients of major surgeries. The maximum number of appropriate transfusions was in the Gynecology Department (98.05%) antenatal cases, followed by surgery (93.1%). Overall, of the 1015 transfusions, 784 (77.24%) were appropriate.

Conclusions: Internal audit and sensitizing clinicians for proper usage of platelet transfusions in the patients with severe and life-threatening bleeding are very important.

Audit of implementation of transfusion protocols

Hetal Dave, Shruti Trivedi, Faruq Mulla, Monica Gupta, Menka Shah

Shree Krishna Hospital, Pramukhswami Medical College, Karamsad, Gujarat

Background: Transfusion audit is a quality improvement process that seeks to improve patient care and outcomes through the systematic review of the use of transfused blood components according to transfusion guidelines.

Aims: (1) To assess the transfusion practices at the Shree Krishna Hospital (SKH) and to compare them with the transfusion protocols established by the hospital blood transfusion committee (HBTC) of the SKH. (2) To improve the blood transfusion practices at the SKH on the basis of the audit findings.

Materials and Methods:
A retrospective audit of 142 patients transfused with 590 blood products was conducted over 6 months using the following audit criteria:

  1. Presence and completeness of consent forms, transfusion reaction forms, requisition form and monitoring forms.
  2. Pre- and post-transfusion laboratory testing.
  3. Adherence to transfusion protocols.

Results: Monitoring forms: Absent in 30.7% and incomplete in 37.36% of the total cases, of which the majority were from the Medicine Department (94.32%), while in Pediatrics there was 100% documentation. Blood transfusion protocols were followed in a majority of the cases, except: RCC: 15% cases; of these, 33.3% cases in surgery were outliers. FFP: 100% cases in Obstetrics and 33.33% in Pediatrics; platelets: 100% cases on Obstetrics and Surgery and 33.3% cases in Medicine. Documentation of the remaining of the parameters also needs improvement.

Conclusion: Areas of improvement in the context of documentation and transfusion practices at the SKH were identified. The strategy for improvement, which included education and monitoring, was planned at the HBTC.

Transfusion audit in Obstetrics and Gynecology

Rinku Shukla, Snehalata Gupte

Surat Raktadan Kendra and Research Center, Surat, Gujarat

Background: Anemia is a common indication of transfusion in pregnancy. The blood is also required for Obstetric/Gynecology bleeding, Obstetric/Gynecology surgeries and disseminated intravascular coagulation.

Aim: To audit the utilization of blood/blood components in Obstetric and Gynecology practice by analyzing data from April 2007 to March 2012.

Materials and Methods: The details of whole blood (WB)/components supplied for pregnancy anemia, Obstetric/Gynecology surgery and bleeding cases were analyzed using data from the requisitions and blood components issued, which were entered in Microsoft Excel.

Results: During 2007-08, 1216 blood units were used for 607 cases of pregnancy anemia, 258 (21.2%) WB and 958 (78.8%) red cell concentrate (RCC). For 361 surgery cases, 743 units were used including 376 (50.6%) WB and 355 (47.8%) RCC, while the remaining units were of platelets. For 440 bleeding cases, 1161 blood units were issued. Of them, 496 (42.7%) were WB, 452 RCC (38.9%), 170 (14.6%) fresh frozen plasma (FFP), 35 (3.01%) platelets and 8 (0.7%) cryoprecipitate. A decreased trend was observed for the use of WB over 5 years, which was 13.9% in the pregnancy anemia cases, 25.83% in surgery and 16.26% in bleeding patients during 2011-12. Similarly, components like RCC, FFP, platelets and cryoprecipitate were more frequently used in 2011-12.

Conclusion: There is a rising trend of component utilization by Obstetricians and Gynecologists, but still the utilization of WB is considerable. It is essential to create awareness by organizing Continuing Medical Education programs if 0% use of WB transfusion is to be achieved.

A comparative study to establish the role of conventional plateletpheresis procedure in reducing the pathologically high platelet count in a liver transplant recipient (post-transplant) to prevent portal vein thrombosis: A case report from a tertiary healthcare center

Aseem K Tiwari, Prashant Pandey, Kshitij Domadia, Geet Aggarwal, Rahul, Ravi Dara, Vimarsh Raina

Medanta - The Medicity Hospital, Gurgaon, Haryana

Background: Reactionary thrombo - leukocytosis, although uncommon, is encountered in cirrhotic patients after liver transplantation during the post-operative period. Control of thrombo - leukocytosis is very important for the prevention of portal vein thrombosis. We could find one published report where the plateletpheresis procedure was used in a post-liver transplant recipient who developed portal vein thrombosis as a result of reactionary thombocytosis. We present a case report where reactionary thrombo - leukocytosis was treated in a post-liver transplant recipient using the conventional plateletpheresis procedure and an apheresis procedure meant for peripheral hematopoietic stem cell harvest. This case report demonstrates the superior performance of the conventional plateletpheresis procedure over the specialized leukapheresis procedure in reducing the platelet count in the patient having extremely high platelet count.

Case Report: A 41-year-old male patient with the diagnosis of ethanol-related chronic liver disease underwent living donor liver transplantation on 21/7/13 at a tertiary care center. His hematological workup revealed a steady increase in platelet and WBC count after the transplant peaking on Day +8, when the platelet count reached 821 × 10 9 /L. A total of three consecutive conventional plateletpheresis procedures were performed on Day eight (one procedure) and Day nine (two procedures on the same day) post-transplant and one leukapheresis procedure (used for peripheral hematopoietic stem cell harvest) performed post-transplant on Day 14. All the apheresis procedures were performed on the COM.TEC (Fresenius Kabi, Germany), a fully automated apheresis platform, using the departmental Standard Operating Procedures. Prophylactic calcium supplementations were given during each procedure in the form of oral calcium carbonate at a dose of 500 mg hourly.

Results: A total of four apheresis procedures were performed. Three procedures performed were the conventional plateletpheresis procedures while one procedure was leukapheresis, where the target was to remove the Buffy coat containing a dense population of platelets. During the three plateletpheresis procedures, the mean volume processed was 9500 ml. The mean drop in platelet count was 380 × 10 9 /L while the mean time consumed was 180 min. The mean drop in hemoglobin was found to be 0.5 gm//dl. During the leukapheresis procedure, we processed a total of 10,500 ml and we noticed a drop in platelet count of 391 × 10 9 /L. The time consumed during the procedure was 210 min and the mean drop in hemoglobin during the leukapheresis procedures was noticed to be 1.6 gm/dl. During both kinds of apheresis procedures, the patient did not complain of any adverse events in terms of citrate toxicity, etc.

Conclusion: Reactionary thrombo - leukocytosis, although uncommon, can lead to serious consequences in terms of portal vein thrombosis after a liver transplant procedure. The apheresis procedure being performed routinely in blood transfusion services plays a very important role in the management of this situation. The comparable findings, easy accessibility and the lesser expertise required makes plateletpheresis a preferable choice in this kind of clinical scenario compared with the leukapheresis procedure.

Adverse blood transfusion reactions

SK Chavan, GA Patil, PR Rajopadhye

Krishna Institute of Medical Sciences, Karad, Maharashtra

Background: All blood and blood products transfused carry a small risk of an adverse effect to the recipient. It is necessary to recognize the transfusion reactions and prompt response and report to the blood bank by the clinicians. It is the responsibility of the blood bank to investigate in detail all the transfusion reactions and report to the clinicians which will help to guide the management of the patient.

Aims: To analyze adverse transfusion reactions at a tertiary care hospital.

Materials and Methods: The present study was carried out at the Krishna Hospital Blood Bank during the period from January 2011 to July 2013. We have retrospectively analyzed the adverse transfusion reactions occurring in patients at the Krishna Hospital, Karad. Data for the study are collected from the transfusion reaction workup records in the blood bank. Data are analyzed by applying statistical methods, and the results of the study are presented herein.

Adverse blood transfusion reaction

Kuntal Patel, Shashikant Mavadia, JJJ Falletro,

RK Tandon, RK Pasale

S.B.K.S.M.I. and R.C., Sumandeep Vidyapeeth, Piparia, Vadodara, Gujarat

Background: Transfusion therapy remains the main treatment for patients with severe anemia, but can cause adverse reactions that may be classified as immediate or delayed. The use of targeted prevention with drugs and treatments of blood components in selected patients can contribute to reducing the development of some reactions.

Aims: To determine the basic steps required to work-up in a transfusion reaction, to be aware of the available treatment options for acute allergic transfusion reactions and to formulate a diagnostic differential for an acute transfusion reaction.

Materials and Methods: A 24-year-old female, a case of suspected infective endocarditis, underwent mitral valve replacement surgery after antibiotic therapy. Post-operatively, she became progressively more anemic and transfused 2 units of packed cell volume (PCV). The patient was febrile prior to the transfusion and received PCV over a 3.5-hr period. During the administration of the second unit, her fever increased and she developed hoarseness and facial edema, with stable vitals. When transfusion was stopped, the patient had received approximately 50% of the product. She was immediately treated with 25 mg IV Benadryl, with resolution of her symptoms. The blood bank was notified and the post-transfusion reaction investigations were performed.

Result: Severe allergic reaction to transfused PCV.

Conclusion: Preventive measures are required for patients with every transfusion. The targeted use of drugs, combined with washing and/or double filtration of red blood cells, can reduce the rate of transfusion (allergic) reactions. An adverse reactions detection system and training of staff involved in transfusion therapy are critical points to prevent adverse reactions.

Knowledge, attitude and practices of parents of thalassemic children undergoing treatment at the Government Medical College, Patiala

Poonam Singal, Kanchan Bhardwaj, Rajni Bassi, Aradhana Sharma, Harnoor Singh Bhardwaj

Government Medical College, Patiala, Punjab

Background: β-thalassemia is a transfusion-dependent genetic disorder. Control of thalassemia requires treatment of individual patients as well as a community-based educational effort to increase the awareness of this problem.

Aims: To study the knowledge regarding thalassemia, to understand the relationship between disease knowledge and treatment adherence and the role of treatment options available in parents of thalassemic children.

Materials and Methods: The study was conducted at a thalassemia day care center in the blood bank of the Rajindra Hospital, Patiala (RHP) on parents of 100 children of thalassemia major coming regularly for blood transfusion (BT) at the RHP. A questionnaire was drafted and an interview technique was adopted to fill the questionnaire and data were analyzed statistically. Statistical analysis was carried out using the Chi square test.

Results: Of the 100 cases analyzed, 41% of the parents knew that thalassemia is a blood disorder and 84% knew that it is a genetic disorder. Seventy-six percent of the parents knew that BT is needed and 60% of the parents knew about the role of chelation therapy. Seventy-three percent of the parents had knowledge about bone marrow transplant, 43% had knowledge about splenectomy and only 10% knew the role of hydroxyurea. The only way to prevent the disease and to reduce the morbidity and mortality is by educating the general population, and specifically by improving the knowledge and awareness of parents of thalassemic children about the disease, its prevention and treatment options available in our country.

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Source of Support: None, Conflict of Interest: None

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2006 - Asian Journal of Transfusion Science | Published by Wolters Kluwer - Medknow
Online since 10th November, 2006