|How to cite this article:|
. OP Transcon 2018 Compilation. Asian J Transfus Sci 2019;13, Suppl S1:2-8
| OP 1: Are physicians utilizing blood appropriately? A retrospective study of transfusion practices in a tertiary care hospital|| |
Abhinav Verma, Pradeep Negi, Jitendra Kumar, Mohsin Khan, Swaroop Singh
Max Super Speciality Hospital, Ghaziabad, Uttar Pradesh, India
Background: Excessive cross matching in addition to being wasteful of resources has adverse consequences on the management of blood inventory and blood quality. Crossmatch/to transfusion (C:/T) ratio is an important measure that is used to assess how the physicians are utilizing the blood transfusion services. A C:T ratio of >2 indicates excessive ordering of crossmatched blood.
Aims: The main aim of this study was to analyse the pattern of blood cross matching and transfusion requests requirements by the physicians with the aim of creating updated local policies that minimize resource wastage.
Methods: 76 months of retrospective data from may 2012 to august 2018 was collected which included RBC crossmatch requirements requests and all RBC units transfused.
Results: A total of 40,908 units of packed red blood cells were crossmatched and 24,787 units were used. The overall C:T ratio was 1.65 corresponding to 60.59% of red cell usage and 39.41% of wastage. The Obstetrics and Gynaecology department had the highest C:T ratio of 2.8 followed by surgery department with 2.2. The department of medicine had the lowest C:T ratio of 1.2 followed by department of oncology with 1.4.
Conclusion: The primary outcome of the study was compliance of overall C:T ratio with the international guidelines. We found that current deficiency of MSBOS (Maximum Surgical Blood Order Schedules in the departments like obstetrics and gynaecology and surgery departments were the major factor responsible for high C:T ratio. Therefore MSBOS were suggested for common elective procedures in both the departments.
| OP 2: Review of transfusion support in 60 patients of thalassemia and sickle cell disease with emphasis on auto/alloimmunization|| |
Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
Background: Transfusions are the primary therapy for thalassemia and sickle cell disease but alloimmunization to red cell antigens is one of the most important immunological transfusion reaction and results in ineffective transfusion.
Aims: To analyse the immuno-haematological changes detected in thalassemia and sickle cell patients.
Methods: Reviewed all the red cell serological tests in clinically diagnosed patients of thalassemia major/intermedia (45+1), sickle cell anemia/disease patients (14) between Aug.2011 to June 2018 Total 60 patients. ABO Rh and Kell grouping, Direct and Indirect Coomb's test, Antibody screening for Auto/Allo antibodies, Anti body identification by 3 cell panel, 11 cell panel and select cells was done in all the cases.
Results: Allo antibodies like Anti –c, E, e, C, D (Rh system), Duffy, Kidd and MNS were identified in 15/60 (25%) patients. Both auto and allo antibodies were present in 8 patients 8/60 (20%). Minor blood group mismatch transfusions occurred in 14/60 (20%) patients.
Conclusion: RBC transfusions without antibody screening and extended phenotype cross matching were associated with minor blood group mismatched red cell transfusions and alloimmunization.
| OP 3: Preoperative red cell exchange in patients with sickle cell disease undergoing liver transplantation|| |
G Deepthi Krishna, Deepti Sachan, Suryatapa Saha, Ilankumaran Kaliamoorthy, Srinivas M Reddy, Mohammed Rela
Global Hospital, Chennai, Tamil Nadu, India
Background: Sickle Cell disease (SCD) is a common hemoglobinopathy which can affect multiple organ systems in the body. The hepatibiliary system is commonly affected in 10-40% with range of manifestations often referred as 'sickle cell hepatopathy'. Red cell exchange (RCE) is an effective and underutilized therapy for treating complications of Sickle cell disease.
Methods: Preoperative automated RCE was performed using OPTIA Spectra cell separator (Terumo BCT, Lakewood, CO, USA) with final target of Hct 30% and HbS <30%. Antibody screening was performed before each transfusion according to standard antiglobulin techniques and less than 7 day old leucodepleted packed red cells were used as replacement fluid.
Results: Among the four cases, 3 males were liver transplant recipients and one female was liver donor who underwent hepatectomy. Average age was 39 (23-68) years. One RCE procedure was done for each patient before undergoing surgery. Baseline HbS levels were 52.8% (34 -84.5) which fell significantly to 26.8% (23.1-24.0). An average of 1742 (1210–2164) ml of RCE was performed with average FCR 48%. Mean Post surgery and at discharge HbS levels were 14.8% (11.9-19.1) and 23.8% (14.3-30.1) and all were discharged.
Conclusion: There is no evidence regarding optimal perioperative management of sickle cell disease patients undergoing liver surgery. Automated RCE is well tolerated in patients with SCD and results in good control of HbS without increase in viscosity and minimises the complications of SCD in perioperative period. This is the first report highlighting the role of RCE in liver transplantation.
| OP 4: Role of arterial blood gas analysis and thromboelastography as point of care testing in massive transfusion cases|| |
N Deshpande, S Rajadhyaksha, P Desai, V Patil, A Navkudkar, N More
Department of Transfusion Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
Background: Massive transfusion is a lifesaving treatment in massive haemorrhages but it is associated with complications like metabolic acidosis, coagulopathy and other electrolyte abnormalities. Rapid identification of coagulopathy in massive transfusions can be done with the use of Point of Care (POC) testing technology. Data supporting the use of POC in guiding the transfusions are reviewed in the following 5 cases.
Description: Five male patients of age group 18-56 years, diagnosed with solid tumours underwent massive transfusion during surgery. TEG-based resuscitation and intra-operative ABG monitoring were done.
Results: Serial monitoring of ABG in the five cases showed decrease in pH, HCO3-, ionized calcium, potassium and increase in the negative base excess, anion gap and lactate indicating Metabolic Acidosis. Paradoxical decrease in the potassium observed could be due to metabolism of citrate leading to increased urinary excretion of potassium. Increased lactate, an independent parameter which reflects poor tissue perfusion or shock and predicts the need for massive transfusion was increased in all the 5 cases. In two of the five cases, TEG showed increase in R time, decrease in the K time, alpha angle and maximum amplitude indicating decrease in clotting factors, fibrinogen and platelets which was supported by appropriate component transfusion.
Conclusion: TEG as a POC testing is an important tool in the appropriate blood component therapy in massive transfusions. Serial monitoring of ABG helps in monitoring the acid-base status of the patient and thus a guide in the correction of electrolytes in patients undergoing massive transfusion.
| OP 5: Hemodynamic stability in liver failure patients undergoing therapeutic plasma exchange|| |
Dnyaneshwar Patale, Rakhi Maiwall, Meenu Bajpai
ILBS, New Delhi, India
Background: The management of liver failure remains a challenge for physicians. Liver failure patients are susceptible for developing arterial hypotension, brain edema, hepatic encephalopathy (HE) and renal failure. Therapeutic plasma exchange (TPE) improves consciousness levels and tends to normalize hyperkinetic circulation by removing neurotoxic substances from the systemic circulation.
Aims: To observe the effects of TPE on MAP, VDI and vasopressor score (hemodynamic stability) and also its impact on vasopressor requirement during and post procedure in liver failure patients.
Methods: Retrospective study conducted in liver failure patients during period of January 2018 to April 2018. TPEs were performed using Specta Optia (Terumo BCT, Lakewood, CO) with FFP/albumin as replacement fluid in the intensive care unit. Clinical and laboratory data was taken from Hospital Information System. Physiological and therapeutic data (hourly recordings) and TPE procedure details were collected from TPE record files/ICU 24 hour flow charts. Statistical analysis was done by repeated measure analysis followed by post hoc comparison by Bon Ferroni Method.
Results: Baseline values for primary outcome measures were: “MAP” 82 mmHg (IQR 72 – 92.5), “vasopressor score” 8.35 (IQR 3.62 – 24.6) and “VDI” 0.10 (IQR 0.05 – 0.31). MAP was significantly higher immediately after TPE compared to baseline (p = 0.039), however when corrected for change in vasopressor requirement there was no significant change in VDI with TPE (p = 0.953). Twelve hours after TPE the MAP, vasopressor score and VDI were not significantly different from baseline (p = 0.563, p = 0.317 and p = 0.214 respectively).
Conclusion: With TPE, MAP increases favourably throughout the procedure till 1hr post procedure making patients hemodynamically stable but effect doesn't last long and MAP slowly falls back to pre-procedure level in next 6 to 12 hr. TPE significantly decreases vasopressor requirements and preserves the patient's hemodynamic stability.
| OP 6: Interventions in pretransfusion protocols in thalassemic children in a tertiary health centre in south India|| |
Indranil Das, Rajendra G Kulkarni, CG Delhi Kumar, Aaditya Shivhare, Soumya Das
JIPMER, Puducherry, India
Background: Thalassemic children require repeated periodic blood transfusions and are at risk of multiple complications. The objective of this study was to assess the pre-transfusion practices, the transfusion-related complications in them, and the effectiveness of some modifications in reducing such complications.
Methods: This was a before and after intervention study done between the Departments of Transfusion Medicine and Paediatrics in JIPMER, Pondicherry. After intervention study was on 546 transfusions in 31 transfusion-dependent thalassemic children (≤12 years), from August 2016 to June 2018. After pre-transfusion testing, these children were issued packed red cells (≤14 days shelf-life) which were modified (saline-washed/buffy-coat depleted/leucofiltered). Before intervention (retrospective) study was on 730 transfusions in 28 of these children, as per data available in case records. Data were collected in a proforma and, based on their distribution, analysed using Wilcoxon Signed Rank/Paired T/Independent T tests.
Results: After intervention, there was increase in average volume per transfusion, but decrease in inter-transfusion interval and extramedullary hematopoiesis (decreased reticulocyte count and spleen size). The incidence of adverse reactions in relation to total transfusions decreased from 4.79% (35/730) before intervention to 2.75% (15/546) after intervention. There was no red cell allo-immunization. There was increase in serum ferritin levels and some children had to receive two oral iron-chelating drugs.
Conclusion: This study helped us in standardising pre-transfusion practices for thalassemic children, to maintain adequate transfusions, reduce adverse transfusion reactions, etc. in a resource-constraint setting as ours. Further improvising will make JIPMER an established centre for managing thalassemias.
| OP 7: Prevalence of irregular red cell antibody in healthy blood donors attending a tertiary care teaching hospital in south India|| |
C Keerthi, MD Praveen, R Arun, B Suresh, IS Chaitanya Kumar, KV Sreedhar Babu
Department of Transfusion Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
Background: Alloantibodies may be detected in healthy blood donors with sensitization history or without sensitization history. If not detected, these antibodies can cause transfusion reactions especially in large volume transfusions. This study was done to assess the prevalence of irregular red cell antibodies in healthy blood donors at a tertiary care teaching hospital in SouthIndia.
Materials and Methods: This is a retrospective study where a total of 17764 donor samples were screened for irregular red cell antibodies between 1st Jan 2017 to 30th Jun 2018 at the Department of Transfusion Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati. Antibody screening and identification was done using 3 cell and 11 cell reagent cells from Ortho Clinical Diagnostics. The data were retrieved and entered into Microsoft excel sheet and analysis was performed using SPSS software.
Results: Antibody screening was positive in 11 (0.0006%) donor samples. All of the 11 samples had alloantibody. Anti-H was found in 5 donors followed by anti-Leb in 2 donors, anti-D in one donor and two antibodies were inconclusive.
Conclusion: As the antibodies identified were clinically significant reactive at 370c, antibody screening is vital in order to provide safe blood to patient, thereby decreasing the possibility of transfusion reactions.
| OP 8: Therapeutic plasma exchange in treatment of patients with neurologic disorders: An experience from a tertiary care teaching hospital|| |
Mohit Chowdhry, Soma Agrawal, Muthukumaravel, Shiva Prasad, Uday Thakur, Naveen Murphy
Indraprastha Apollo Hospital, New Delhi, India
Background: The term therapeutic plasma exchange (TPE) refers to the removal of the plasma component of blood and its replacement with various fluids. TPE has been used to treat a variety of conditions that are associated with an aberrant immune response as per indication of American Society for Aphaeresis (ASFA) guidelines. We present our experience with TPE in treatment of various neurological diseases during the study period.
Materials and Methods: Patients with neurological disorder who underwent TPE procedures between January 2017 to August 2018 at our centre were retrospectively reviewed. Informed Consent was taken from patient or his kin before each procedure.
Results: A total of 742 procedures were performed on 196 patients during the study period. Of these 15 were neurological disorders. Total 98 procedures performed on these 15 (11 males and 4 females) patients. The mean number of TPE session per patient was 6.5 ± 3.9. Age ranged between 19 to 75 years with a mean age of 47.33 years. 72 procedures were performed on MCS+ and 26 were on Spectra Optia. Replacement fluid used was primarily fresh frozen plasma (FFP) in TTP and 5% albumin with FFP in rest of the cases. Thrombotic Thrombocytopenic Purpura (TTP) (73.33%, n=11) was the main indication for TPE, followed by Guillain Barre Syndrome (GBS) (6.6%, n=1), Myasthenia Gravis (MG) (6.6%, n=1), Acute Disseminated Encephalomyelitis (ADEM) (6.6%, n=1) and Neuromyelitis Optica (NMO) (6.6%, n=1). Out of 15 cases, 12 were Category I (11 TTP, 1 MG), 2 were Category II (1 NMO, 1 ADEM) and 1 was Category III (AIDP Post IvIG) indication for TPE according to ASFA guidelines. All exchanges were performed with a minimum time interval of 24 hours. Nine patients (TTP – 7, MG – 1 and NMO – 1) had resolution of neurological symptoms. Two patients (ADEM – 1 & GBS – 1) had partial recovery. One patient (TTP) had left against medical advice. Three patients with TTP expired due to other associated co-morbidities. No adverse events related to the procedure were encountered during the study period.
Conclusion: Our small series of data on TPE procedures from neurology perspective has shown safety and efficacy of the therapy. TPE is effective modality of treatment in autoimmune neurological disorders according to the evidence-based guidelines for TPE. There is need of further detail evaluation on large number of cases for proper evidence based practice.
| OP 9: Platelet audit in viral thrombocytopenia in a tertiary care teaching hospital|| |
P Pallavi, B Vijaya
JSS Academy of Higher Education and Research, JSS Medical College, Mysuru, Karnataka, India
Background: Viral fevers especially dengue fever has emerged as a major public health problem in the recent years. Platelets due to the short shelf life are frequently in scarcity in the blood bank, which recommends its usage very aptly. Hence this study was undertaken to assess the appropriateness of platelet transfusions in viral thrombocytopenia. Our study objective was to assess the appropriateness of platelet transfusions in viral fever with thrombocytopenia during the study period.
Methodology: A retrospective study was conducted in Department of Immunohematology and blood transfusion of a tertiary care teaching hospital between 1st May and 30th August 2017. All patients with viral thrombocytopenia who received platelet transfusion formed the subjects of study. Patients clinical data, laboratory results, platelet count and platelet transfusions were analyzed. National Guidelines suggested by ministry of health and family welfare, Government of India and prophylactic platelet transfusion thresholds as per American association of blood bank technical manual, 18th edition were used to analyze the appropriateness of platelet transfusions.
Results: A total of 3441 random donor platelets (RDP) were transfused during the study period among 675 patients with viral thrombocytopenia. Among 675 patients who received RDP transfusions, prophylactic transfusion were given in 527 (78.1%) patients and therapeutic in 148 (21.9%) patients. Among 527 patients who received prophylactic transfusion, 57 (10.8%) patients had a platelet count <5,000/cumm, 225 (42.7%) patients had platelet counts in the range of 5,000 to 10,000/cumm, 199 patients (37.76%) had platelet counts in the range of >10,000 to 20,000/cumm while the remaining 46 (8.73%) patients had platelet count of >20,000/cumm. Of the prophylactic platelet transfusions of RDPs, inappropriate transfusions were 46.5%.
Conclusion: In a developing country like India with limited resources, judicial use of platelet concentrates is a necessity. The study emphasizes the need for development of specific guidelines for transfusion of platelets in viral thrombocytopenia, constant interaction and co-ordination amongst clinicians and transfusion centre for implementation of these guidelines and a regular medical audit to review the optimal utilization of blood components.
| OP 10: Hemolytic disease of newborn due to multiple red cell alloantibodies|| |
Chaudhary Rajendra, Singh Bharat, Katharia Rahul
Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
Background: Hemolytic disease of fetus and new born (HDFN) is a leading cause of mortality and morbidity in the antenatal and neonatal periods. Maternal alloimmunization against red blood cell antigens is the most important cause of HDFN.
Aims and Objectives: To know effect of multiple red cell antibodies on the outcome in pregnant females with HDFN.
Methodology: Rh(D) Negative antenatal women were screened for irregular erythrocyte antibodies using reagent red cell panels. Women with positive screen were followed regularly during antenatal and postnatal period to obtain data related to development HDFN and its squeal.
Results: Out of of 172 Rh(D) negative antenatal women screened, 57 (33%) had positive antibody screen. Out of 57 sensitized women, 46 had anti-D alone while 11 cases had anti-D combined with at least 1 additional antibody. Majority of cases with multiple antibodies were severely affected (77.7%) compared to single antibody (P =0.03). Odds of developing severe HDFN for patients with anti-D combined with 1or more additional red cell antibody were3.22 times the odds for women with anti-D antibodies alone (95% confidence interval).
Conclusion: Women with multiple antibodies are at greater risk of developing severe HDFN than those with a single antibody. Findings of this study may be helpful to the clinicians interms of starting more aggressive antenatal management and better prediction of pregnancy outcome.
| OP 11: Duffy gene polymorphisms and vivax malaria in inhabitants of malaria endemic regions in India|| |
Roshan Shaikh, Ajit C Gorakshaka
Department of Transfusion Medicine, ICMR-National Institute of Immunohaematology, Mumbai, Maharashtra, India
Background: India (population >1 billion) is a major contributor to the burden of vivax malaria, accounting for 18% of the globally confirmed infections. Duffy blood group polymorphisms are important in areas where Plasmodium vivaxpredominates. This molecule acts as a receptor for this protozoan. In the present study, Duffy blood group genotyping in P. vivaxconfirmed malaria patients from six different endemic areas is reported, exploring significant associations between blood group variants and susceptibility or resistance to malaria.
Aims: To explore significan t associations between Duffy blood group variants and susceptibility or resistance to malaria.
Methodology: The Duffy blood group was genotyped by PCR-RFLP in 362 malaria patients from six centres at different states. To assess the statistical significance, Pearson's Chi-Square test was employed.
Results: The data show a high frequency of the FYA/FYBgenotype, followed by FYA/FYA, FYB/FYB. The FYB-33/FYB-33was found to account for 1.01% in the studied groups. Some of the Duffy genotypes frequencies showed correlation with malaria infectivity.
Conclusion: The data suggest that individuals with FYA/FYBgenotype have higher susceptibility to malaria. The presence of the FYB-33allele had been shown to have a selective advantage in the population, reducing the rate of infection by P. vivax. In this study, 1.01% of the malaria patients tested carried the FYES allele. The FYES allele, which silences erythroid expression of the Duffy antigen, is no longer a biological obstacle for invasion by malaria parasite. These results provide insights on the host susceptibility for P. vivaxinfections that has never before been investigated in malaria samples from India.
| OP 12: Evaluation of efficient blood usage in a tertiary care hospital in south India|| |
Soumee Banerjee, S Sitalakshmi
Department of Transfusion Medicine and Immunohematology, St John's Medical College, Bengaluru, Karnataka, India
Background: Blood ordering, especially for surgeries is based on anticipation of the worst case scenario, meaning blood cross-matched for one patient is not available for others. Most common indices evaluating efficiency of blood usage are- C/T ratio, transfusion probability and transfusion index. This study, in a tertiary care hospital in South India, compares blood utilisation across major medical and surgical departments.
Aims: To compare blood utilization and transfusion indices across major medical and surgical departments.
Methods: All 282 requests for PRBCs received at the our centre over 10 days of May 2018 were analysed for patient demographics, number of units, indication. Blood bank records provided the number of units cross-matched, number of units issued against each of them. C/T ratio, transfusion index, transfusion probability and 2 additional indices- Wastage as percentage of issue (WAPI) and Non-use Probability (NUP) were calculated.
Results: Of 282 requests, 127 (45%) were from medical departments, 155 (55%) were from surgical departments. The values- C/T ratio:1.2 and 2.39, transfusion probability: 85.3% and 52.7%, transfusion index: 1.6 and 0.65 for medical and surgical departments, respectively. For C/T ratio no subspeciality crossed the highest acceptable value (2.5) except gynaecology and obstetrics (3.5). The lowest transfusion probability (30%) was met by all departments. The minimum value (0.5) for transfusion Index was met by all departments except gynaecology and obstetrics (0.33) and paediatric surgery (0.44).
Conclusion: Blood ordering efficiency is satisfactory in medical departments. For surgical departments, blood ordering pattern and maximum surgical blood ordering guidelines need to be revised and audited to avoid unnecessary cross-matches and wastage of blood products.
| OP 13: Comparative evaluation of enzyme linked immunosorbent assay with rapid plasma reagin for screening of syphilis in blood donors|| |
Suchet Sachdev1,2,3, Arun K Sharma1,2,3, Sunil Sethi1,2,3, Sachin Garg1,2,3, Divjot Singh Lamba1,2,3, Ratti Ram Sharma1,2,3, Neelam Marwaha1,2,3
Departments of 1Transfusion Medicine, 2Gastroenterology and 3Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Background: World Health Organisation (WHO) recommends screening of syphilis in low prevalence populations of blood donors by treponemal tests like Enzyme Linked Immunosorbent Assay (ELISA), whereas in India screening is done by Rapid Plasma Reagin (RPR), a modification of the Veneral Disease Laboratory Test (VDRL) for rapid testing.
Aims: To compare the performance of ELISA and RPR in screening donations for Treponema Pallidum.
Methods: The performance of ELISA was compared to RPR, keeping Treponema Pallidum Hemagglutination Assay (TPHA) as a reference test on 600 blood donor samples and 43 repeat reactive RPR repository samples. Biological false positivity (BFP) was calculated with reference to the reference test. Receiver Operating Curve (ROC) was applied to find out sensitivity, specificity, NPV, PPV for different values of signal to cut-off ratio. Medcalc software was used for statistical analysis.
Results: ELISA was equally sensitive (100%), more specific (56.3% vs. 0%), more accurate (83.7% vs. 62.7%), had better PPV (79.4% vs. 62.8%) and NPV (100% vs. 0%), and less BFP (37.2% vs. 20.6%) when compared to RPR. However, at signal to cut-off ratio of 7.72, ELISA had a sensitivity of 100% (95% CI: 87.2% to 100%), 93.75% specificity (95% CI: 69.8% to 99.8% ), PPV of 96.4% (95% CI: 81.7% to 99.9%) and NPV of 100% (95% CI: 78.2% to 100%) with Area under the curve (AUC) of 99.3% (95% CI: 90.5% to 100%) at p=0.0001.
Conclusion: The WHO recommendations of screening for syphilis in low prevalence population of blood donors using ELISA in transfusion services that have facility of ELISA.
| OP 14: Indian-specific RHD genotyping assay for identification of RHD variants|| |
Swati Kulkarni, Disha Parchure, Harita Gogri, Manisha Madkaikar, Kanjaksha Ghosh, Yann Fichou
ICMR-National Institute of Immunohaematology, Mumbai, Maharashtra, India
Background: The RhD antigen has a heterogeneous phenotypic expression. Apart from the normal D antigen other variants, such as weak Ds, partial Ds and DELs also exist. As various commercial anti-D reagents are directed against the different epitopes of the D antigen and the techniques used vary from one laboratory to another, an RhD variant can be mistyped as D negative in routine testing. The phenotypic variability is actually due to genetic polymorphisms, which involve several mutational mechanisms. Molecular analyses of the gene may therefore be required to predict the correct RhD status.
Aim: To characterize the molecular bases of weak D expression in Indians.
Methods: Samples presenting with a weak D phenotype by serological analyses (n = 223) was genotyped in the RHDgene by conventional molecular approaches. Alternatively copy number variations of RHDexons were analyzed by RHDQMPSF for exon quantitation.
Results: None was samples were characterized as weak Dtype 1 and/or weak Dtype 3 alleles (most common mutations in Caucasians) and single nucleotide variations were found in only in few samples. A novel ~12-kilobase duplication event, including exon 3, was identified predominantly in 58.3% of weak D samples. Further molecular and functional analyses showed that this genetic variation results in the expression of several transcripts, including a wild-type product and thus weaker expression of D antigen. A standard, multiplex PCR assay was designed, including: GAPDH, RHDexon 10, RHDexon 5 and RHDexon 3 duplication-specific marker.
Conclusion: Weak D phenotype in Indians is predominantly due to a novel variant RHDallele. For identification of the novel allele an “Indian-specific, RHDgenotyping assay” was standardized which may be easily implemented at the laboratory level and will contribute to improve Rh blood group diagnostics in Indians.
| OP 15: Therapeutic plasma exchange as an adjuvant therapy in haemophagocytic lymphohistocytosis|| |
Trupti Lokhande, Sweta Nayak, Meenu Bajpai
Institute of Liver and Biliary Science, New Delhi, India
Background: Hemophagocytic lymphohistiocytosis (HLH) is a disorder characterized by immune dysregulation. In such patients, disease activity can be suppressed via cytokine removal by therapeutic plasma exchange (TPE). HLH is a Category III indication for TPE as per ASFA (American Society for Apheresis) 2016 recommendation.
Aims: To evaluate effect of TPE in HLH.
Methods: We performed a retrospective study from October 2016 to July 2018. The diagnosis and treatment of HLH was based on the HLH 2004 protocol. TPE was performed on Spectra Optia (Terumo BCT, Lakewood, CO) using FFP as replacement fluid to exchange 1.5 to 2 plasma volumes. Data was collected from HIS and Blood Bank TPE record files. It includes patient's age, gender, primary disease, clinical and laboratory data, TPE procedure details and patient outcome. Primary outcome measures were changes in S.Ferritin, blood counts and symptomatic improvement. Statistical analysis was performed by using Microsoft Excel and Statistical Package for Social Sciences (SPSS).
Results: Thirty-nine TPE procedures were performed on 11 HLH patients. Mean age was 13 yrs (IQR 2-28) and MELD score was 20 (IQR 9-34).All patients had fever, hyperferritenemia, cytopenia and hemophagocytsis in bone marrow. Mean S.Ferritin was 28099 μg/dL, S. Fibrinogen 151.76 mg/d and S.Triglyceride 463 mg/dL. With TPE, 80% (8 out of 10) of the patients improved. S.Ferritin, S.Bilirubin, TLC and platelet decreased significantly (p < 0.05) with TPE. With each plasma volume exchanged, there is 1.4 log reduction in S.Ferritin levels which is one of the markers of mortality in HLH.
Conclusion: TPE may be a useful adjuvant therapy in HLH patients improving survival until definitive therapy can be instituted. Observational studies show promising results but they need to corroborated by RCTs.
| OP 16: Rh and kell blood group antigen frequencies in voluntary blood donors of south Gujarat|| |
Keyuri F Jariwala, Avni Shah, Kanjaksha Ghosh
Surat Raktadan Kendra and Research Centre, Surat, Gujarat, India
Background: Phenotyping of clinically important blood group systems is one of the important methods of reducing red cell alloimmunisation. This study was performed to provide information on frequencies of Rh and Kell blood group antigens in voluntary blood donors at our blood bank and to compare the same with other population worldwide.
Aims: To study the antigen frequencies of Rh and Kell blood group systems amongst donors of South Gujarat and to compare them with populations worldwide.
Methods: Voluntary blood donors were serologically typed for Rh and Kell blood group antigens that is D, C, c, E, e, K and k antigens. Monoclonal anti-sera from DIAGAST were used for each antigen. Standard tube technique was done to see the agglutination and manufacturers' instructions were followed. Data was entered in to the excel sheet and frequency of each antigens was calculated using Microsoft excel.
Results: Total 800 'O' grouped voluntary blood donors were screened for Rh blood group antigens and 4,027 'O' grouped voluntary blood donors were screened for Kell blood group antigens. The most common Rh antigen was e (99.8%) followed by D (96.6%), C (91.1%), c (50.1%), and E (16.1%). Amongst Kell blood group antigens K (1.86%) and k (99.6%) was present in voluntary blood donors.
Conclusion: Red cell antigens tested on our blood donors show quite a few variations in different red cell antigen distribution compared to other population in the world.
| OP 17: Prevalence of Rh and kell blood group antigens in voluntary blood donors of Saurashtra region, Gujarat|| |
Shivangi Hapaliya, Jyoti P Bhatt, Nishith A Vachhani, Sanjeev Nandani
Life Blood Centre, Rajkot, Gujarat, India
Background: The Rh and Kell system is the major blood group system besides ABO system. Knowledge of the antigen frequencies is important to assess risk of antibody formation and help to find antigen negative donor blood, which is especially useful to find compatible blood for patients having multiple transfusions. Keeping in view the heavy financial burden of complete phenotying of blood; the determination of only Rh & Kell phenotypes can play a major role in preventing allo immunization.
Aims: This study was carried out to determine the frequencies of D, C, c, E, e and K antigens in over 1600 voluntary blood donors of Rajkot, Saurashtra, to build blood bank data for multipurpose utilities.
Methods: Samples of 1606 voluntary blood donors from Rajkot and nearby areas were collected for partial antigen phenotyping. Written consent was taken. Antigen phenotyping was carried out on fully automated analyzer based on SPRCA technique.
Results: Among Rh and Kell antigens, e was the most common 99.1%, followed by D-91.0%, C-86.0%, c-60.9%, E-16.7% and K-2.3% with R1R1 (38.67%)being the most common phenotype and the least common phenotype is r'r', R2RZ (0.06%).Thus 'e' was the most common and 'K' was the least.
Conclusion: Regional population based frequency data of Rh & Kell phenotypes can play a major role in minimizing allo immunization rate, and improving blood safety.
| OP 18: Impact of donor physiognomic on red cell quality: an analysis from a tertiary care transfusion centre|| |
P Nagaraju, S Ojha, R Dhokle, M Poojary, AA Tirlotka
Department of Transfusion Medicine, Tata Memorial Centre – ACTREC, Navi Mumbai, Maharashtra, India
Background: Donor physiognomic is critical for ensuring the quality of packed red cell unit (PRBC) which has cardinal influence on the transfusion recipient. Hence, we planned a study to know effectiveness of the same in our blood centre.
Aims: To study the effect of donor physiognomic on the quality of PRBC.
Methods: Randomly selected 250 blood donors from January 2015 to August 2018 were retrospectively analysed on several factors like donor age, gender, weight, and haemoglobin prior to donation (PHB). Similarly, PRBC collected from these donors were analysed based on volume of blood collected using 350ml (T3) and 450ml (T4) bags, processing methods, age of PRBC and percent haemolysis on storage. Parameters like hematocrit, per unit total haemoglobin (UTHB) and red cell mass were subsequently evaluated.
Results: There was a mean weight of 69.8 kg observed in donors whose age group lie between 18 to 28 years when compared with other higher age groups who had 74.46 kg. Donor with lower PHB (12.5 to 13.0 g/dL) had less UTHB. Overall mean UTHB yielded among 450ml bags separated by buffy coat method was low in contrast with T3 and T4 PRBC prepared using PRP method. There was a significant (p = 0.01) correlation between PRBC age and haemolysis observed in all units.
Conclusion: Donor PHB plays significant role in quality of PRBC prepared. Mean UTHB is less when prepared with buffy coat method. Red cell haemolysis is seen more in older units.. Gender, age and weight of donors does not affect PRBC quality significantly. However, larger sample size is required to draw any definitive conclusion.
| OP 19: Granulocytopheresis in a tertiary care hospital: A single center experience|| |
Mohit Chowdhry, Soma Agrawal, Uday K Thaku
Department of Transfusion Medicine, Indraprastha Apollo Hospital, New Delhi, India
Background: Bacterial and fungal infections are the main cause of morbidity and mortality in neutropenic patients. The transfusion of granulocytes to restore host defenses in severely neutropenic patients has been studied for a long time. However, inadequate dosage of granulocytes and inconsistent efficacy has limited the usage of these transfusions in the past. Granulocyte aphaeresis is a safe and effective method for granulocyte collection. It is the one treatment option for haemato-oncology patients with severe neutropenia complicated by bacterial/fungal infections unresponsive to standard antibiotic/antifungal treatment. In this study, we describe the experiences from our center.
Methods: The data for the granulocyte apheresis performed at our tertiary care center from June 2015 to September 2018 was retrospectively retrieved and analyzed. Information on donor selection, mobilization regimen, granulocyte yield & side effects if anywas obtained and analyzed. All mandatory screening tests i.e. Anti-HIV I & II, HBsAg, Anti-HCV (CMIA-Architect, Abbott), Malaria, Syphilis, ABO and Rh grouping, complete blood counts (Coulter-Beckman) were performed. G-CSF (5 mg/kg body weight) & Dexamethasone (8 mg.) was the mobilization regimen used. 21 granulocytapheresis were performed on MCS+ (Haemonetics, USA) and 1 on Spectra Optia (Terumo BCT, USA). All granulocyte apheresis units were irradiated and transfused within 24 hours of collection.
Results: A total of 22 granulocyte apheresis units were collected for 11 patients of which one patient received 5 units. Of them, 18 (81.81%) were male and 4 (18.19%) were female with a mean age of 31 years. 10 (45.45%) donors were mobilized before collection. The mean granulocyte yield was 1.36 × 1010/per unit from the mobilized donors and 0.39 × 1010/per unit of the donors who were not mobilized. The minimum required dose was obtained only by stimulation of the donors for mobilization of granulocytes.
Conclusion: Based on our experience, granulocytapheresis is a safe and effective method for obtaining adequate dosage of granulocytes but the yield is significantly influenced by the mobilization regimen.
| OP 20: Molecular basis of RHD negativity in individuals with RR (CDE/CDE) phenotype|| |
Garima Mishra, Disha Parchure, Harita Gogri, Manisha Madkaikar, Swati Kulkarni
ICMR-National Institute of Immunohaematology, Mumbai, Maharashtra, India
Background: In India, about 4-7% of individuals have RhD negative phenotype. Molecular mechanisms responsible for D negativity include deletion of entire RHD gene, SNPs, gene rearrangements between RHD and RHCE gene etc. Frequency of these mutations varies with different ethnic groups. A comprehensive study to understand the molecular mechanisms responsible for D negativity in Indians is lacking.
Methods: RhD negative individuals (n=200) with rr phenotype were enrolled for this study. Serological testing was carried out with various clones (P3X61, MCAD, LDM1, P3x21223B10, P3x290, P3x35) of anti-D reagents to confirm the absence of RhD antigen. All samples were screened by multiplex PCR assay (specific for RHD exon 5 & 10) to determine presence of RHD gene. Quantitative multiplex polymerase chain reaction of short fluorescent fragments (QMPSF) was carried out to detect copy number variations in RH gene exons.
Results: Out of 200 RhD negative samples with rr phenotype, three samples (1.5%) showed presence of RHD exon 5 and 10 when typed with Multiplex PCR screening assay. QPMSF analysis of these samples indicated presence of one intact copy of RHD gene. In the remaining samples (197) complete RHD gene was deleted.
Conclusions: This is the first study showing molecular basis of RhD negativity in Indian individuals with rr phenotype. Around 98.5% of RhD negative individuals with rr phenotype showed deletion of entire RHD gene as the major cause of D negativity. However, knowledge of other mechanisms will help in developing molecular strategy for RhD negative individuals.
| OP 21: Importance of serum IgA level in preventing anaphylactic transfusion reaction|| |
NR Ramesh Kumar, S Shanmugam
Life Line Blood Bank and Research Centre, Tirunelveli, Tamil Nadu, India
Background: IgA anaphylactic reaction is a rare event, estimated to occur 1 in 20,000 to 47,000 transfusions.
Aims: We had a severe anaphylactic reaction in a 46 year old Male with severe upper G.I bleed, following 2nd unit of FFP. His transfusion reaction work up did not reveal any major ABO mismatch and antibody screen was negative on both pre and post transfusion sample. Direct agglutination test (DAT) was also negative on both occasions. The remaining FFP was sent to culture and proved to be sterile after 72 hours of incubation. Further we did Serum IgA level for the Patient and we found that the level was not detectable. This leads us to definite role of IgA deficiency in patients and donors.
Methods: The blood samples were taken from Patients who were requested for FFP transfusion and blood donors who donated blood in our blood bank. The level of serum IgA was measured using the Specific Protein Analyser, (MISPA-i2, Nephelometric technology from AGAPPE DIAGNOSTICS LTD,). We have not done Anti-IgA level, due to high cost.
Results: During the year 2017, we have done IgA level for 4510 voluntary blood donors and 922 patients whom were requested for FFP transfusion. We found that 3 donors to be IgA deficiency with range below 20 mg/dL (Adult Normal Range 50 to 350 mg/dL) and 7 patients with IgA deficiency with the range between Not detected to below 20 mg/dL, 2 patient's IgA level was not detected and 5 patients IgA level below 20mg/dL For the patients who are in not detected range we have transfused the FFP collected from the Donor Low range of IgA level. And for another 3 patients with low level IgA, we transfused FFP from normal IgA level. One patient developed anaphylactic reaction immediately after 2nd unit of FFP transfusion. 2 patients were not transfused FFP.
Conclusion: In our study, we found that FFP prepared from IgA deficient donor is suitable for IgA deficient Patients. The incidence of IgA deficiency in blood donors is very low. But, anaphylaxis risk exists in performing blood transfusion to IgA-deficient individual, and measures should be taken to reduce IgA anaphylaxis. A This important variant in anaphylaxis should be always remembered in anaphylactic reaction in Transfusion Medicine.
Source of Support: None, Conflict of Interest: None