Asian Journal of Transfusion Science
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   Table of Contents - Current issue
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July-December 2021
Volume 15 | Issue 2
Page Nos. 119-259

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ORIGINAL ARTICLES  

Impact of COVID-19 pandemic on the pattern of blood donation and blood safety: Experience from a hospital-based blood center in North India Highly accessed article p. 119
Singh Bharat, Katharia Rahul, Das Indraneel, Srivastava Anubha, Priyadarshi Atul, Elhence Preeti, Chaudhary Rajendra
DOI:10.4103/ajts.ajts_29_21  
INTRODUCTION: Although coronavirus disease-2019 (COVID-19) pandemic does not result in increased blood needs, blood supply can be considerably compromised due to the unavailability of blood donors. The objective was to share our experience about blood donation patterns and concerns on blood safety during COVID-19 pandemic in India. METHODS: This was a retrospective study of approximately 4.5 months of data including both lockdown period (LD) and LD phases. LD phase was further subdivided into four phases of varying durations. Data of blood collected and various reasons for deferral of prospective donors were analyzed. The effectiveness of mitigation strategies adopted to maintain adequate blood inventory was also assessed. Events in transfusion services during the LD were compared with the pre-LD (P-LD) phase. RESULTS: The mean collection per day for WB and SDP was reduced by 70% and 50%, respectively, compared to pre-LD. Approximately 23% of WB and 27% of SDPs were collected on an appointment basis during LD. The proportion of indoor voluntary blood donation was increased by 7–8 times during LD compared to P-LD. Approximately 2% of total prospective donors screened were deferred after thermal scanning and due to risk of being infected with COVID-19. Donor deferrals due to high-risk behavior increased significantly in the LD phase compared to P-LD period. CONCLUSION: COVID-19 pandemic has a significant impact on the pattern of blood donation and blood safety. Transfusion services must develop appropriate plans to respond efficiently to various challenges posed by such pandemics.
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Buffy coat pooled platelet concentrate: A new age platelet component Highly accessed article p. 125
Rakesh Kumar, Hari Krishan Dhawan, Ratti Ram Sharma, Jyotdeep Kaur
DOI:10.4103/ajts.AJTS_72_19  
BACKGROUND: Buffy coat pooled platelet concentrate (BCPP) is a new blood component mainly used in Europe, which has good attributes of both random donor platelets and apheresis platelets in terms of high platelet count, leukoreduced and available in emergency. We planned this study to compare quality parameters and biochemical activation markers among buffy coat pooled platelets and apheresis platelet concentrate (AP-PC) to establish the quality and safety of this new blood component during storage. MATERIALS AND METHODS: Three different preparations of BCPP were prepared: Nonleukoreduced (BCPP Part A), leukoreduced (BCPP Part B), and leukoreduced with platelet additive solution (PAS) (BCPP Part C) using a pool of 15 ABO-matched, nonreactive buffy-coats in each experiment to avoid any donor-related variations. Ten such experiments were done. Each BCPP was equivalent to 5 buffy coat units. Ten apheresis platelets were taken as control. Serial samplings were done on day 0, 3, and 5 of collection and were assessed for: volume, platelet count, white blood cell count, swirling, pH, sterility, glucose, lactate, soluble p-selectin, Interleukin (IL)-6, IL-1 β, and tumor necrosis factor alpha (TNF-α). RESULTS: BCPP Part C (leukoreduced with PAS) maintained the best quality parameters in terms of maintenance of pH, least lactate accumulation, least sP-selectin levels, and least accumulation of inflammatory mediators (IL-6, IL-1 β, and TNF-α) than the other groups >BCPP part B >AP-PC and >BCPP Part A. On day 5 of storage pH for BCPP Part A, Part B, Part C, and AP-PC was: 6.33, 6.42, 6.64, and 6.29, respectively, and soluble p-selectin (ng/ml) was 201 ± 22, 186 ± 11, 149 ± 18, 200 ± 23, respectively. BCPP Part B and AP-PC had comparable quality parameters and activation markers. CONCLUSIONS: Buffy coat pooled platelet has comparable and even better-quality control parameters (especially leukofiltered with PAS) than conventional platelet preparation and is a good alternative for meeting platelet transfusion requirements of critical patients during emergency hours in resource-constraint setting.
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An insight into the utilization of allogenic blood transfusion and factors affecting blood transfusion in total knee replacement surgery in a tertiary care hospital in Eastern India p. 133
Sudipta Sekhar Das, Ranjan Kamilya, Rathindra Nath Biswas, Susanta Ghosh
DOI:10.4103/ajts.ajts_186_20  
BACKGROUND: Significant blood loss and requirement of allogenic blood transfusion during or after total knee replacement (TKR) have been reported. Incidence of blood transfusion in TKR is highly variable and depends on several factors. We investigated the blood utilization in patients undergoing TKR in our hospital and depicted the important risk factors that determine the need of allogenic blood transfusion in primary unilateral TKR. MATERIALS AND METHODS: The study included 1241 consecutive patients undergoing primary unilateral total knee arthroplasty. All the surgeries were performed by a single surgical team of orthopedists following standard procedure. Patient and disease details were obtained from patient file and hospital information system. Compatibility test was performed in blood bank before blood reservation following mandatory guidelines. Details of test, blood issue, and blood transfusion were documented in the blood bank. RESULTS: Of 1241 enrolled patients, 1069 (86.2%) were female. The median age of patients was 66 years with mean preoperative hemoglobin of 9.9 g/dL. Allogenic blood transfused was needed in 223 (17.9%) patients. Diabetes mellitus, hypertension, thyroid disorders, and chronic heart diseases were the major comorbid conditions. Risk factors such as gender, American Society of Anesthesiologists score, preoperative hemoglobin, and intraoperative and postoperative blood losses were significantly associated with blood transfusion. CONCLUSION: The risk factors determining blood transfusion in TKR vary between studies, however, all centers should establish standard operating procedures describing the surgical procedure and transfusion support in TKR. In addition, each center may develop specific blood management strategy to rationalize blood transfusion in TKR and overall successful care in TKR.
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Prevalence of dengue NS1 antigenemia among healthy blood donors in a tertiary care hospital in Southern India p. 140
Remi Remakanth, Abhishekh Basavarajegowda, Rahul Dhodapkar
DOI:10.4103/ajts.ajts_51_21  
INTRODUCTION: Transmission of dengue by transfusion of blood products has been documented, although the frequency of these occurrences and the level of viremia required to cause clinical dengue are unknown. The primary objective was to assess the prevalence of dengue NS1 antigen among healthy blood donors at our blood center. METHODOLOGY: This was a cross-sectional study conducted in the Department of Transfusion Medicine, a tertiary care hospital in South-eastern India, from February 2019 to January 2020. A total of 968 donor samples were included in the study. Dengue NS1 antigen detection was done using enzyme-linked immunosorbent assay. Data regarding clinical, epidemiological, and demographic characteristics were collected from the donor questionnaire and records. RESULTS: In the study, the overall prevalence of Dengue NS1 antigen was 0.9%, with nine positive samples among the 968 samples tested. Eight of them were male, and 1 was a female donor. All of them were in the age group <32 years. Half of the positive donors were detected during December-January, the immediate post rainy season in this part of the country. Two-third of the positive donors were from rural areas. CONCLUSION: This study with a 0.9% throws light on the seroepidemiological prevalence of dengue among asymptomatic donors and gives an insight into whether dengue screening is required to be implemented in routine transfusion transmissible infection screening in blood transfusion services and shall assist in devising strategies to be adapted as to improve the blood safety.
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Effect of prolonged storage at 2°C–6°C for 120 h on the coagulation factors of thawed cryoprecipitate: Can we extend its shelf life post thaw beyond 4 h? p. 146
Arghyadeep Marik, Joseph Philip, Rajiv Singh Mallhi, Neerja Kushwaha, Sudeep Kumar, Amit Kumar Biswas, Arvind Kumar Yadav
DOI:10.4103/ajts.AJTS_38_19  
BACKGROUND: Cryoprecipitate helps in replenishing important coagulation factors like fibrinogen, Factor VIII and von Willebrand factor without running the risk of volume overload. It is very useful in the treatment of trauma patients with active bleeding and works best when administered early. Extending the shelf life of thawed cryoprecipitate beyond 4 hours enables us to manage inventory better, reduces the burden of demand vs supply as well as minimizes wastage. It can also help in logistically supporting the transfusion services in making cryoprecipitate readily available in mass casualty scenarios (war, natural calamity) in remote locations by reducing the time required for thawing cryoprecipitate and the need for costly storage equipment. AIM: The aim of this study was to compare the levels of Factor VIII, Fibrinogen and von Willebrand factor on thawed cryoprecipitate after prolonged storage for 5 days at a temperature of 2-6°C. METHODOLOGY: The above mentioned coagulation factors were analyzed in cryoprecipitate at the time of product thaw and again after 120 hours of 2 to 6°C storage using fully automated coagulation analyser (STA Compact Max). All parameters were expressed as Mean ± Standard deviation and were analyzed using paired t-test with level of significance, P < 0.05. RESULTS: There was a significant decrease in the level of Factor VIII, whereas the levels of fibrinogen and von Willebrand Factor remained stable during the storage period. All the cryoprecipitate units retained factor activities above therapeutic range even after 5 days of storage at 2-6°C. CONCLUSION: Although the levels of clotting factors are reduced during storage, they are still maintained above the therapeutic range. In scenarios where maintaining frozen cryoprecipitate inventory is a logistical challenge and emergency massive demands of cryoprecipitate are foreseen, the use of pre-thawed cryoprecipitate can be considered as a viable option.
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Determination of mononuclear cell count using peripheral smear and flow cytometry in peripheral blood stem cell products: A retrospective study from an Indian cancer center p. 151
Aswathi Krishnan, Mohandoss Murugesan, Bindu Therayangalath, Kandathil Joseph Philip, Sangeetha K Nayanar, Chandran K Nair
DOI:10.4103/ajts.AJTS_21_20  
BACKGROUND: Mononuclear cells (MNCs) are considered equivalent to hematopoietic stem cells, and differential count using peripheral smear was routinely practiced to enumerate MNC. Flow cytometry plots used for CD34 enumeration assay can also be used in MNC enumeration as it counts more WBC events than manual methods. The aim was to determine the relationship and degree of agreement between peripheral smear and flow cytometry in MNC enumeration of peripheral blood stem cell (PBSC) products. METHODS: In 63 patients, 73 PBSC products were collected between January 2017 and September 2019. The differences in MNC count estimated by peripheral smear method and from flow cytometry plots used for CD34 enumeration were analyzed using Mann–Whitney test. Agreement between the two methods for MNC enumeration was determined by regression analysis. Receiver operating characteristic curve was performed to determine MNC threshold in peripheral blood and PBSC product for adequate mobilization and harvest. RESULTS: There was no difference in enumeration of median MNC count between peripheral smear and flow cytometry (52% vs. 59%, P = 0.185) in PBSC product. However, regression analysis indicated a constant and proportional difference between the methods with r = 0.52. Cumulative sum test for linearity showed deviation from linearity (P = 0.04). MNC counts in peripheral blood failed to achieve discrimination capacity in predicting adequate CD34+ yield/kg body weight in product. CONCLUSION: Peripheral smear estimated lower MNC counts than flow cytometry with weaker agreements between the two methods. Hence, MNC count derived from flow cytometry plot can substitute peripheral smear method for MNC dose calculations. MNC dose at 3.4 × 108/kg consistently predicted >2 × 106/kg CD34+ cells collected.
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Utilization of red cell concentrate from storage centers of South Gujarat p. 157
Yogesh Panchal, Keyuri Jariwala, Kanjaksha Ghosh
DOI:10.4103/ajts.AJTS_118_18  
INTRODUCTION: Blood storage centres in remote areas of the country was started to serve the patients in those locations. Present study analyses the the utilisation of blood from such storage centres under one regional transfusion centre in south Gujrat. MATERIALS AND METHODS: In this retrospective study amount of blood requested, utilised, major reasons for utilisation were studied from available records and analysed. RESULTS: 20 storage centres serving almost 2 million population per year was studied. 2197 - 3089 units of blood were requested from these centres per year with utilisation rates of 100 – 134 units/centre/year. Severe anaemia, Antenatalcare, operations and postpartum. Haemorrhage were important causes for red cell transfusion. DISCUSSION AND CONCLUSION: The storage centres are functioning reasonably well but utilisation of around 2500 - 3500 units packed red cell per year for 2 million population suggests under utlisation of the facility.
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Autoimmune hemolytic anemia in children: Clinical presentation and treatment outcome p. 160
Satyam Arora, Seema Dua, Nita Radhakrishnan, Savitri Singh, Jyotsna Madan, Devajit Nath
DOI:10.4103/ajts.AJTS_31_20  
BACKGROUND: Autoimmune hemolytic anemias (AIHA) are characterized by the destruction of red cells following the production of autoantibodies directed against them. Although AIHA in children is usually self-limiting, many still succumb to the illness due to delay in the diagnosis and treatment. AIHA in children may be secondary to autoimmune diseases, drugs, or immune deficiencies. Early diagnosis and appropriate immunohematological evaluation can aid in the diagnosis and treatment. OBJECTIVE: To analyze the evaluation, treatment, and outcome of AIHA in children. METHODS: Prospective data of patients aged 0–18 years diagnosed with AIHA between June 2017 and May 2019 were collected. INTERVENTION: Prednisolone was the first-line agent in all; second-line agents included cyclosporine and rituximab. Red cell transfusion was given in those with severe anemia with cardiac decompensation. RESULTS: Eleven patients were diagnosed during the study period. Hemoglobin ranged from 1.2 to 9 g/dl. The initial presentation was severe anemia in 8 children and moderate anemia with thrombocytopenia in 3. The trigger was infection in 5. Polyspecific direct coomb's test (DCT) was positive in 10 patients. 2/10 polyspecific DCT-positive cases on further evaluation had immunoglobulin G (IgG) and C3d positivity, whereas rest 8 had only IgG. One infant was diagnosed with DCT-negative immunoglobulin A-mediated AIHA. 4/11 attained remission following the short course of prednisolone. Cyclosporine was used as the second-line agent in 2 and rituximab was used in 3. Seven children are in sustained remission and off medication. One died within 12 h of diagnosis. CONCLUSION: AIHA is not an uncommon problem in children and can vary in its clinical severity. Early and correct diagnosis helps in deciding appropriate treatment.
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Donor notification and counseling: Experiences and challenges from a private multi-specialty hospital in South India p. 166
P M Bala Bhasker, Anamika Aluri
DOI:10.4103/ajts.AJTS_123_19  
BACKGROUND: Donor notification and counseling plays a vital role in both blood safety and comprehensive donor care. This process informs donors about their status as to transfusion-transmitted infections (TTI), modes of transmission of such infections and helps prevent secondary transmission of these infections in the community. AIMS AND OBJECTIVES: This study was initiated to see the response rate of notified reactive donors for counseling and to propose useful recommendations that could probably improve the response rate. MATERIALS AND METHODS: Total of 17025 donations was screened for TTIs, namely, human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and syphilis, by serology. All TTI reactive donors were retested and notified of their status by telephone and called for repeat testing followed by face-to-face counseling and referral for treatment. RESULTS: We evaluated 183(1.07%) donors with reactive screening test results, i.e., 106(57.9%) HBV, 38(20.7%) HCV, 29(15.8%) HIV, and 11(0.6%) were syphilis reactive and all (100%) were from replacement blood donations. Only 58.4%(107) of donors could be personally communicated over telephone and only 49 (45.79%) of them returned for counseling. Three (6.1%) among the reactive donors knew their results earlier and 11(22.4%) donors had history of high-risk behavior. CONCLUSION: In spite of strict donor screening and self-exclusion option, donors conceal their high-risk behaviors or their reactive status and continue to donate blood. It reflects the need to implement thorough predonation counseling to extract the history of high-risk factors from the donors.
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Irradiating stored blood and storing irradiated blood: Is it different? - A study of serial changes in biochemical parameters of red blood cell units p. 172
Pramanya Balasubramanyam, Abhishekh Basavarajegowda, Nandeesha Hanumanthappa, Vir Singh Negi, KT Harichandrakumar
DOI:10.4103/ajts.ajts_71_21  
INTRODUCTION: Gamma Irradiation of blood products accentuates biochemical changes in the blood stored at 4°C. This study tried to compare the changes in potassium, sodium, glucose, lactate, and lactate dehydrogenase (LDH) levels in packed red blood cell (PRBC) units irradiated at various time points and then stored versus those stored for a particular period then irradiated. METHODOLOGY: One hundred and eighty units of RBCs were randomly assigned equally to be irradiated or not. Eighteen units each were irradiated by gamma irradiator using cobalt 60 (BI 2000) on day 1, 7, 14, 21, and 28 of their storage, respectively, in the irradiation group. All the units were assessed for their plasma levels of potassium, sodium, glucose, LDH, and lactate by clinical chemistry auto analyzer Beckman coulter AU680 weekly. The values were documented and analyzed by SPSS. RESULTS: Baseline values on day 1 for studied biochemical parameters were comparable between irradiated and nonirradiated groups. Mean values of potassium, lactate and LDH were higher in irradiated than nonirradiated PRBC bags. In contrast, Sodium and Glucose mean values were lower than baseline values. Maximum cumulative mean values were noted in day-21 irradiated bags when the parameters were measured on day-28 for potassium and lactate levels. This was followed by day 14 irradiated bags, followed by day 7 irradiated bags. CONCLUSION: The study indicates that irradiation of red cells later in their storage period had comparatively more detrimental changes in relation to potassium and lactate than irradiation in earlier days. Consideration of irradiation to be performed as close to the issue as possible to reduce a lesser number of days of storage postirradiation is to be explored.
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Frequency of hepatitis B virus-DNA among hepatitis B surface-Ag negative, anti-hepatitis B core antibody-positive blood donors in Yazd, Iran p. 179
Mahtab Vaziri, Hayedeh Javadzadeh Shahshahani
DOI:10.4103/ajts.AJTS_155_18  
BACKGROUND: The diagnosis of hepatitis B infection in most blood transfusion centers is based on hepatitis B surface (HBs) antigen detection by an enzyme immunoassay method. This study aimed to determine the frequency of hepatitis B core (HBc) antibody, HBs antibody, and hepatitis B virus (HBV) DNA among HBs antigen-negative healthy blood donors of Yazd province, Iran. MATERIALS AND METHODS: This cross-sectional study was conducted on 1500 healthy blood donor samples negative for HBs antigen, hepatitis C virus antibody, human immunodeficiency virus antigen/antibody, and rapid plasma regain tests. All samples were screened for HBc antibody test. HBs antibody and real-time polymerase chain reaction were performed for HBc antibody-positive samples. RESULTS: HBc antibody was positive in 74 (4.9%) samples and 11 (14.9%) of 74 positive samples for HBc antibody were negative for HBs antibody. Sixty-three (85.1%) positive samples for HBc antibody had HBs antibody titer over 10 IU/L, and 43 (58.1%) had HBs antibody titer over 100 IU/L. There was no hepatitis B DNA-positive sample in the present study. CONCLUSIONS: The study results suggest that there is a very low risk for transmission of HBV through blood donors of Yazd, Iran.
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Risk factors associated with human immunodeficiency virus infection in blood donors in Iran: A case–control study p. 183
Fariba Seighali, Nasim Sadat Hosseini Divkolaye, Negar Rezaei, Masumeh Kangarloo
DOI:10.4103/ajts.AJTS_47_18  
BACKGROUND: Despite setting the stringent criteria for the selection of safe donors, some human immunodeficiency virus (HIV)-positive volunteers manage to give blood. Considering the window period of screening tests, this could endanger the safety of blood supply. MATERIALS AND METHODS: A frequency match case–control study was conducted on HIV-positive and negative blood donors in Iran from 2007 to 2008. Overall, 61 HIV-positive and 224 HIV-negative blood donors were selected as cases and controls, respectively. Two groups were matched for confounding factors. An identical questionnaire was used to assess risk factors. Univariate regression analysis for calculating crude odds ratio (OR) and 95% confidence interval (CI) was used for detecting eligibility of risk factors to enter the final model. The exposures with P < 0.1 were entered in the logistic regression model. Adjusted ORs with P < 0.05 and 95% CIs were reported for statistically significant variables. RESULTS: Significant effects were detected for the following variables: education, job, tattoo, intravenous (IV) drug abuse, imprisonment, and risky sexual behavior. However, based on multiple analyses, education, IV drug abuse, imprisonment, and risky sexual behavior remain significant. CONCLUSION: The majority of our findings are in parallel with the other studies performed in other countries. To increase blood safety, special attention should be paid to illiterate, first-time blood donors who are in the 25–40 age range. In addition, having the history of IV drug abuse, imprisonment and risky sexual behaviors put the blood donors more at risk of infecting HIV.
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Regulated upon activation, normal T cells expressed and secreted (CCL5) in platelet concentrate: Role of mode of preparation and duration of storage p. 189
Rinku V Shukla, H Mody, Snehalata C Gupte, Kanjaksha Ghosh
DOI:10.4103/ajts.AJTS_107_18  
BACKGROUND AND OBJECTIVES: Platelet concentrates (PCs) can be prepared in several different ways, and they can be stored over few days before the use. Regulated on activation, normal T cells expressed and secreted (RANTES) levels in these concentrates may vary depending on the type of preparation and duration of storage of this component. We measured RANTES levels in platelet supernatants in different preparations and with different storage duration. MATERIALS AND METHODS: Fifteen PCs were prepared by platelet-rich plasma (PRP) and buffy coat (BC) method each. Forty-two single donor platelets (SDPs) were prepared using cell separators Cobe Spectra, Trima Accel, and Amicus. Filtered PCs were prepared using labside and bedside filters. The supernatants were collected after 1, 18, 65, and 112 h of preparation. SDP samples were taken on the 0 day, 3rd day, and 5th day. In filtered PC, pre- and post-filtration samples were taken, and aliquots were frozen at − 56°C for the measurement of RANTES. RESULTS: RANTES at 1 h was 1210 ± 560 pg/ml in PRP-PC, 1384 ± 463 pg/ml in BC-PC. At 112 h, 1617 ± 451 pg/ml and 1949 ± 134 pg/ml, respectively. In SDP, 0-day level was 1850 ± 278 pg/ml and >2000 pg/ml on 5th day. In prestorage, filtered PC RANTES was 1035 ± 496 pg/ml, and in the poststorage sample, it was 310 ± 508 pg/ml. With bedside filters, presample showed 1243 ± 832 pg/ml and postsample showed 556 ± 748 pg/ml. CONCLUSION: The concentration of RANTES increased continuously from 1 h to 5 days of storage in all PCs. After 65 h, BC-PC showed higher levels of RANTES compared to PRP-PC. Filtered PRP-PCs appear to be the best in terms of low RANTES to prevent allergic reactions and cultures negative.
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Reducing split-thickness skin grafting donor site agony; faster healing and decreased pain-role of platelet-rich plasma p. 195
Rakesh Kumar Jain, Ghisulal M Choudhary, Gajendra Gupta, Aditya N Patil, Gautam D Prakash, Ayush K Jain
DOI:10.4103/ajts.AJTS_39_17  
INTRODUCTION: The split-thickness skin graft harvested donor site is associated with prolonged healing, discomfort, and pain. Platelet-rich plasma (PRP) contains platelet-derived growth factors and has been widely used in chronic wounds and skin graft donor sites. PRP application is known to accelerate wound epithelialization rates, and also reduce postoperative wound site pain. MATERIALS AND METHODS: We assessed 20 patients admitted to our hospital service who underwent split-thickness skin grafting (STSGs) with proximal half of the donor site treated with PRP. The dressing was conducted on postoperative day 7, 14, and 21. The donor site healing was assessed with serial photographs and donor site pain measured by numerical rating scale. RESULTS: Complete healing of wounds (epithelialization) was present in 12 (60%) patients dressed with PRP. Pain on opening dressing was an average of 3.5 in PRP dressed wounds and 6.35 in control wounds. Patients dressed without PRP, none of them had complete epithelialization. All patients had partial healing and were less than the donor site dressed with PRP. Based on these results, skin graft donor site with PRP showed accelerated healing and reduced pain and discomfort compared to control without PRP. CONCLUSION: PRP is a beneficial adjunct for reducing donor site pain and increased healing of donor site following STSG harvest.
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Analysis of red blood cell irradiation practices from South India p. 199
Mohandoss Murugesan, Merline Augustine, Sangeetha Keloth Nayanar
DOI:10.4103/ajts.ajts_60_21  
INTRODUCTION: Age of red blood cell (RBC) units at the time of irradiation is important and prolonged storage of preirradiated units is detrimental. The objectives were to determine RBC age at irradiation, days from expiry (DFE), and percentage of late transfusions of irradiated RBC. To estimate the concordance on expiry of irradiated RBC units with present American Association of Blood Banks (AABB)/Directorate General of Health Services (DGHS), New Delhi over British Committee for Standards in Hematology (BCSH) and Council of Europe (CE) guidelines. METHODS: All the RBC units irradiated for a 1 year period were included. Retrieved data included date of collection, irradiation, revised expiry, and issue of blood. Late transfusions are units transfused in the last 2 week of RBC's shelf-life and wastage due to expiry was determined. Chi-square and Kruskal–Wallis test were used for comparisons between the guidelines. RESULTS: Out of 1303 RBC units irradiated, the median age for irradiation was 2 (0–36) days and 99.3% units irradiated within day +14. Median DFE for these units transfused was 26 (0–28) days. 2.8% units expired as per local standards. Late transfusions happened in 121 (9.3%) units transfused. AABB/DGHS practice was not concordant with CE standards for 86 (6.6%) units and with BCSH 94 (7.2%) units. Overall discordance between the present practices was CE and BCSH was seen in 130 (10%) events. CONCLUSION: Median RBC irradiation age and DFE was two and 26 days respectively at our center. Only 90% concordance was observed between AABB/DGHS and CE/BCSH guidelines with 9.3% units transfused as late transfusions. Restricting late transfusions of irradiated RBC can act as surrogate to improve the quality of units transfused through an inexpensive strategy.
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REVIEW ARTICLES Top

A review of legal, regulatory, and policy aspects of blood transfusion services in India: Issues, challenges, and opportunities p. 204
Joy John Mammen, Edwin Sam Asirvatham, Charishma Jones Sarman, Varsha Ranjan, Bimal Charles
DOI:10.4103/ajts.AJTS_65_20  
Background: Blood transfusion services (BTS) in India have progressed significantly during the last three decades. However, there is still inequity in the availability and access to blood due to various demand and supply-side issues. Appropriate laws, regulations, policies, and guidelines are critical to ensure universal access to blood. Aims and Objectives: This article aims to review the evolution and current status of legal, regulatory, and policy framework and analyses the issues, challenges, and opportunities for improvement of BTS in India. Methods: This article is based on an extensive review of currently available literature and government documents. Results: The review highlights the gaps and challenges in terms of licensing, safety and quality, voluntary blood donations, the organization of BTS, access to services, and regulatory bodies. The findings emphasize the need for a coordinated response by either the National Blood Transfusion Council or a newly established autonomous “National Blood Authority” consisting of technical, administrative, and legal experts which must be exclusively responsible for regulating the BTS. As adherence to quality management systems in blood banks is not a mandatory requirement, it recommends a legal measure to ensure mandatory quality assurance in blood banks and storage centers. Towards ensuring efficiency and universal access to blood, this article recommends evidence-based criteria for establishing new blood banks to avoid skewed distribution of blood banks, component separation facilities, and blood storage centers. Conclusion: The review emphasizes the need for periodic reviews and updates of the legal, regulatory and policy framework, considering the rapid developments and technical advancements with increasingly complex systems and processes in transfusion medicine.
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Molecular and serological markers of human parvovirus B19 infection in blood donors: A systematic review and meta-analysis p. 212
Mohammad Farahmand, Ahmad Tavakoli, Saied Ghorbani, Seyed Hamidreza Monavari, Seyed Jalal Kiani, Sara Minaeian
DOI:10.4103/ajts.ajts_185_20  
BACKGROUND: Human parvovirus B19 (B19V) is one of the blood-borne viruses. The virus can be transmitted to susceptible individuals by blood or blood products. The virus is not associated with significant disease in general population, while people with underlying problems such as immunodeficiency can cause anemia and arthritis. The current systematic review and meta-analysis aimed to estimate the overall prevalence of B19V DNA, anti-B19V IgG, and anti-B19V IgM antibodies in blood donors worldwide. METHODS: A systematic search was carried out in online databases for relevant studies from inception until March 30, 2019. Study selection was performed based on predesigned eligibility criteria. The proportion of B19V DNA, anti-B19V IgG, and anti-B19V IgM antibodies were pooled using the inverse variance method. All statistical analyses were performed using the R version 3.5.3, package “meta.” RESULTS: According to the random-effects model, the pool prevalence of B19V DNA, anti-B19V IgM, and anti-B19V IgG among blood donors was calculated to be 0.4% (95% confidence interval [CI] =0.3%–0.6%), 2.2% (95% CI = 1.3%–3.7%), and 50.1% (95% CI = 43.1%–57.1%), respectively. CONCLUSION: For the transmission of B19V through blood, the presence of the virus genome is required, and the present study showed that the prevalence of the virus genome in blood donors is <1%. Therefore, there is no need to screen donated blood for B19V infection.
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CASE REPORTS Top

Anti-Emm, a rare specificity to the high-incidence antigen Emm in an Indian patient defining the new blood group system EMM (ISBT042) p. 223
Ripal J Shah, Snehal B Senjaliya, V Harimoorthy, Anna Burgos, Sunitha Vege, Christine Lomas-Francis, Connie M Westhoff, Sanmukh Ratilal Joshi
DOI:10.4103/ajts.ajts_59_21  
A transfusion recipient lacking a high-incidence antigen (HIA) and has corresponding alloantibody pose a problem in providing compatible blood unit. We encountered a patient with an antibody to an HIA that required identification to assess if compatible blood could be organized. A 65-year-old male was posted for coronary artery bypass grafting surgery. His blood specimen collected in EDTA was referred to the blood bank to provide blood for transfusion. The patient, grouped AB RhD+, had an antibody reacting in saline and antiglobulin phases. It agglutinated all the red blood cells (RBCs) of the 11-cell panel and random donors, indicating specificity to an HIA, though one of his siblings was compatible. After ruling out specificity to HIAs such as H, Inb, and INRA (IN5), the specimen was referred to the New York Blood Centre for further work-up. The antibody reacted with examples of red cells lacking HIA, except those with the Emm− phenotype. The patient's RBCs were typed as Emm−. Anti-Emm in the patient appeared to be naturally occurring as there was no history of transfusion. Naturally occurring alloantibody to an HIA, identified as anti-Emm in phenotype Emm−, is rare and the first of its kind to be reported from India. The case was instrumental in recognizing the Emm as the new blood group system assigned with the symbol ISBT042.
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Patient blood management in a neurosurgical patient with anti-e antibody p. 226
Sreethu Chand, Anila Mani, R Amita, Debasish Gupta
DOI:10.4103/ajts.ajts_30_21  
The successful application of patient blood management approach in a 48-year-old neurosurgery patient planned for meningioma excision and requiring transfusion is described. The patient had multiple past immunizing events and developed antibody against a high-frequency antigen “e” of the Rh blood group system. With the joint effort from transfusion medicine specialist, anesthesiologist, and surgeon, the patient was successfully managed using the preoperative autologous blood donation program.
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Case report and strategies to mitigate passive hemolysis with platelet transfusions in children p. 229
Merline Augustine, Mohandoss Murugesan, Kaduveettil Gopinathan Gopakumar, TK Jithin
DOI:10.4103/ajts.ajts_25_21  
Mismatched platelet concentrate transfusion due to inadequately maintained inventories is relatively common and in most instances do not cause any untoward event in adults. The cases of passive hemolysis following a mismatched apheresis platelet transfusion are common but are relatively rare with platelet concentrates. We report here a case of a nine year old boy who received three units of mismatched platelet concentrates(PC) followed by acute hemolysis. On further investigation, one of the donors of the PC, who was typed as O positive, found to have high anti-A and anti-B titres of 1:128. This highlights the importance of matched platelet transfusions or modifying the product in pediatric setting, who are susceptible for passive hemolysis.
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Coomb's negative cold agglutinin disease: A rare report of an incidentally detected case p. 233
K V Vinu Balraam, Adnan Masood, Nidhi Garg, Venkatesan Somasundaram
DOI:10.4103/ajts.AJTS_78_20  
Cold agglutinin disease (CAD) is a rare type of autoimmune hemolytic anemia which usually results due to production of immunoglobulin M-type autoantibody against the I/i and H antigens on red blood cell membrane. They can be idiopathic or may be due to underlying lymphoproliferative disorders or atypical infections. It can have a varied presentation ranging from being incidentally detected to being totally transfusion dependent for a longer or shorter duration. Several factors play a role in determining the ability of cold agglutinins in inducing hemolysis such as antibody concentration and temperature. Here, we present a 54-year-old patient, a known case of chronic obstructive pulmonary disease who was admitted to our hospital in the winter months as a case of alcohol withdrawal syndrome. During the course of the stay, the patient developed respiratory insufficiency and went into Type II respiratory failure and hematological investigations revealed features of CAD.
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Surgical management of endometriosis in a severe Hemophilia A female patient and the role of transfusion medicine specialist: A case report with review of literature p. 237
Sanooja Pinki, Ganesh Mohan, Divya Venugopal, Susheela J Innah
DOI:10.4103/ajts.ajts_6_21  
Hemophilia A is an X-linked recessive bleeding disorder occurs due to deficiency of factor VIII (FVIII). The disease manifests exclusively in males though it rarely occurs in females due to complex pathophysiological mechanisms. We present a rare case of female hemophilia due to skewed X-inactivation which adversely affected the quality of patient life. She presented with recurrent abdominal pain and was diagnosed with severe endometriosis and underwent total abdominal hysterectomy with left salpingo-oophorectomy and appendicectomy. She was infused recombinant factor VIII both prophylactically and postoperatively as per the World Federation of Hemophilia guidelines. Recombinant Factor VIII was supplemented every 12th hourly and Factor VIII activity levels were monitored daily. She was discharged uneventfully on the postoperative day 21 after screened negative for acquired inhibitors.
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A case series of hemorrhagic neurological complications of sickle cell disease: Multiple faces of an underestimated problem! p. 241
Sangita D Kamath, Manish Ganesh Pai
DOI:10.4103/ajts.AJTS_101_18  
Sickle cell disease (SCD) is a group of hemoglobinopathies that vary in severity, the most severe form, homozygous sickle cell anemia, is more commonly associated with neurologic complications. These are attributed to the vaso-occlusion and micro-obstruction in the circulation of the central nervous system. The incidence of various neurologic complications in SCD ranges from 6% to 30% in various series. The commonly reported in literature include silent cerebral infarction (SCI), ischemic stroke, transient ischemic attacks (TIAs), headaches, seizures and neurocognitive impairment. However, hemorrhagic complications like subarachnoid hemorrhage (SAH), hemorrhagic stroke, extradural and subdural hematomas, especially in absence of trauma are rarely thought of. We report three uncommon spontaneous hemorrhagic manifestations of sickle cell anemia – one case of parenchymal (intracerebral) bleed who presented with acute onset of parkinsonism and two cases of extradural hematoma (EDH) of which one patient had recurrent EDH at the same site which is hitherto not reported in the literature.
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Blood group discrepancy in mixed-type autoimmune hemolytic anemia in a pediatric patient p. 247
Minal Wasnik, Saurabh Lahare, Tushar Jagzape, Ramesh Kumar Chandrakar
DOI:10.4103/ajts.AJTS_74_19  
Autoimmune hemolytic anemia (AIHA) is characterized by the presence of antibodies directed against self-antigens on red blood cells (RBCs) leading to progressive RBC destruction along with reduced red cell survival. Mixed-type AIHA is characterized by the presence of both warm and cold-autoantibodies. These autoantibodies may cause blood-group discrepancy or cross-match incompatibility leading to delay in arranging suitable blood unit for transfusion. The detection of autoantibodies by monospecific-direct antiglobulin test showing positive reaction on immunoglobulin G and C3d and presence of cold-agglutinins leads to the diagnosis. We report a rare case of mixed AIHA in a 15 years female showing severe anemia, blood group discrepancy, and cross-match incompatibility. She received transfusion of least incompatible packed RBCs without any untoward effect.
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A successful booster umbilical cord blood transplantation for a 10-year-old patient with beta-thalassemia major in India p. 250
Vijay Ramanan
DOI:10.4103/ajts.ajts_109_20  
Beta-thalassemia major is characterized by a genetic deficiency in synthesis of beta-globin chains, resulting in reduced levels of functional hemoglobin. It is characterized by anemia, hepatosplenomegaly, and iron overload due to repeated blood transfusion. Hematopoietic stem cell transplantation is currently the only known curative treatment. We present a case of a 10-year-old girl with beta-thalassemia major who was successfully cured with allogeneic booster umbilical cord blood (UCB) transplantation with outcome data after 3 years of transplantation, in India. Postdiagnosis, she was on regular once-a-month blood transfusion until the age of 10 years, with no improvement. No serious adverse events occurred in the patient post-UCB transplantation. Chronic graft versus host disease was limited and was managed by medicines. Signs of primary graft rejection were also not seen.
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SHORT COMMUNICATION Top

A rare case of mistaken identity - Historical blood group saved the situation p. 253
Anand Deshpande, R Basavanna
DOI:10.4103/ajts.ajts_68_21  
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LETTERS TO THE EDITOR Top

Clinical relevance of hepatitis B core total antibody in the detection of occult hepatitis B infection in patients with liver disease and blood donors p. 256
Vijeta Bajpai, Ekta Gupta, Aashish Chaudhary, Meenu Bajpai
DOI:10.4103/ajts.AJTS_77_18  
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Positive/external control of rapid diagnostic tests: A step forward in malaria screening p. 258
Rasika D Setia, Mitu Dogra, Anil Handoo, Prerna Sachdeva
DOI:10.4103/ajts.AJTS_103_17  
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2006 - Asian Journal of Transfusion Science | Published by Wolters Kluwer - Medknow
Online since 10th November, 2006