Asian Journal of Transfusion Science
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   Table of Contents - Current issue
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January-June 2022
Volume 16 | Issue 1
Page Nos. 1-157

Online since Saturday, July 30, 2022

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ORIGINAL ARTICLES  

Outcome of type and screen versus crossmatch in cardiovascular surgery patients: A comparative study Highly accessed article p. 1
Anupa Pokhrel, Ashish Jain, Neelam Marwaha, Rana Sandip Singh
DOI:10.4103/ajts.AJTS_21_19  
BACKGROUND: The need for an anti-human globulin (AHG) cross-match (XM) when the antibody screen (ABS) is negative is debatable and a matter of policy. AIM: (1) To compare the outcomes of type and screen (T and S) method versus the AHG-XM in terms of posttransfusion alloimmunization and hemolytic reactions. (2) Calculation of XM transfusion ratio in both groups. MATERIALS AND METHODS: The study included 200 patients undergoing elective cardiovascular surgery. Group I patients (n = 100) were issued packed red blood cell units after ABO and RhD typing, an ABS followed by an immediate spin XM (T and S protocol), while Group II (n = 100) patients by an AHG-XM. In Group II patients, if incompatibility was found, then an ABS and identification were performed. A posttransfusion ABS and a direct antiglobulin test (DAT) was done on the 4th day. The XM, ABS (3-cell panel) and DAT were done using the gel technique (Bio-Rad, Switzerland). Thus, the outcomes of T and S method versus the AHG-XM in terms of posttransfusion alloimmunization and hemolytic reactions was measured. The XM transfusion ratio was also calculated in both groups. RESULTS: In each of Groups I and II, 99 patients (99%) were transfused. There was no significant difference between the two groups based on previous transfusion (P = 0.621) or combined history of transfusion and pregnancy (P = 1). In Group I, all the patients were negative for ABS. In Group II, an AHG-XM was incompatible for 1 patient (1%) due to anti-c and anti-E alloantibodies and had a history of pregnancy as well as transfusion. In both the groups, none of the patients had any adverse transfusion reaction and the posttransfusion ABS and DAT were negative. CONCLUSION: ABS is a better tool than AHG-XM in detecting alloantibodies in patients having the previous history of transfusion and/or pregnancy.
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Plerixafor use in autologous hematopoietic stem cell mobilization: Experience from a single center in Southern India Highly accessed article p. 7
Soumya Das, Smita Kayal, Biswajit Dubashi, Abhishekh Basavarajegowda, Nanda Kishore Pasupala, Rajendra Kulkarni, Krishnappa Dhanraju, Chinmaya Kumar Pani
DOI:10.4103/ajts.ajts_106_21  
BACKGROUND: Plerixafor is used for patients at risk of Stem cell mobilization failure based on clinical factors or low peripheral blood CD34 count. It is also added upfront to any mobilization irrespective of risk factor, but the cost-effectiveness of the approach is an issue. Data on plerixafor in different settings of autologous hematopoietic stem cell (HSC) collection from India are scant. We are hereby reporting the experience of failure/success of mobilization rate and few important significant variables (CD34+ dosage, failed collection) between plerixafor and granulocyte colony-stimulating factor alone groups among autologous hematopoietic stem cell transplantation (aHSCT) at our institute. METHODS: This was a record-based single-center study on patients who underwent aHSCT from January 2013 to June 2019 at a tertiary care hospital. Descriptive statistics were used for baseline characteristics, transplant-related factors, and peritransplant outcomes. All statistical analyses were performed at the 5% significance level. RESULTS: During the study duration, a total of 96 patients had undergone autologous hematopoietic stem cell collection (aHSCC), all by peripheral blood stem cell harvest, requiring 131 apheretic collections. Of the total 131 collections in 96 patients, plerixafor was used in 63 apheresis collections (48% of total pheresis) in 40 patients. Among the 40 patients who were administered plerixafor to augment the collection, 34 patients had upfront use of plerixafor. We did not observe any significant adverse event related to plerixafor use. CONCLUSION: A rational utilization of plerixafor can facilitate the process and logistics of aHSCC outcome.
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Seroprevalence of anti-severe acute respiratory syndrome coronavirus 2 antibody among healthy blood donors in a hospital-based blood center in Eastern India during the COVID-19 pandemic p. 15
Sudipta Sekhar Das, Subhas Chandra Bera, Rathindra Nath Biswas
DOI:10.4103/ajts.ajts_123_20  
BACKGROUND: Few international studies have reported the prevalence of anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies in healthy, asymptomatic blood donors. These findings have definitely raised queries regarding blood safety and transfusion-transmitted coronavirus disease (COVID)-19. We conducted this first anti-SARS-CoV-2 seroprevalence survey among the healthy blood donors in Eastern India. MATERIALS AND METHODS: The study included 611 healthy blood donors who donated whole blood (WB) in our blood center. For detailed analysis, social and demographic details of all donors like gender, age, weight, occupation, and place of residence were included. Donor eligibility criteria for WB donation were followed as per existing national guidelines. Residual serum samples leftover after screening the mandatory infectious markers were tested for the presence of anti-SARS-CoV-2 IgG directed against domain S1 and S2 of the SARS-CoV-2 spike protein using automated enhanced chemiluminescence technology following the manufacturer's instructions. RESULTS: The mean overall seroprevalence of anti-SARS-CoV-2 antibody in blood donors was observed to be 4.4% (95% confidence interval 3.8–4.9) with a monthly increasing trend. Seroprevalence adjusted for sensitivity and specificity of the assay was 4.1%. The mean S/Co values of reactive donor samples were observed to be 2.99 and 3.42 in June and July 2020, respectively (P = 0.013). No significant variation in seroprevalence rate was observed among donor variables like donor age, gender, profession, and educational qualification. A higher significant prevalence of antibody was observed among voluntary donors and donors residing in suburban areas (P < 0.05). Among the ABO blood groups, no statistical significance of seroprevalences was observed among the various ABO blood groups. CONCLUSION: We conclude that despite many limitations in the current study, we found 4.4% seroprevalence of anti-SARS-CoV-2 antibody in the asymptomatic, healthy, epidemiologically, and medically screened blood donors. These data are definitely the tip of an iceberg and signify much higher seroprevalence in the normal population and indicate that protective measures like masking and social distancing should remain implemented for a long term.
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Strengthening quality management system: An assessment of awareness and knowledge in trainees in blood bank p. 22
Manisha Shrivastava, Nehal Shah, Seema Navaid, Shweta Mishra
DOI:10.4103/ajts.AJTS_154_18  
OBJECTIVES: The objective of this study was to assess the changes in knowledge concerning quality management system (QMS) among the participants before and after attending a QMS training. METHODS: After obtaining the ethical approval, a retrospective study was designed to evaluate the effectiveness of QMS. Fifty participants from district blood banks of three different states participated in the study organized at two different periods. After obtaining informed consent, the participants were subjected to set of questionnaire containing 45 questions (35 multiple choice and 10 subjective questions) as pretest on quality standards and were again subjected to posttest questionnaire containing the same set of questions after 5 days of workshop. Twenty minutes were granted to solve the questions. Each question was given one mark. There was no negative marking. An assessment of knowledge gained during training was evaluated by comparing the scores of pre- and post-assessment. RESULTS: Of the total 50 delegates, 29 were trained in the month of July (Training I) and 21 were trained in the month of November (Training II). There were 96% (n = 48) males and 4% (n = 2) females. In both the training sessions, that is, Training I and II, the mean scores of objective questions in pretest were 13.629 ± 6.58 and 9.34 ± 5.74, and after the training, the posttest scores increased significantly to 17.77 ± 7.05 and 14.34 ± 7.09, respectively. Paired Student's t-test was applied which showed statistically significant increment in knowledge (P = 0.001). CONCLUSIONS: There was a significant positive change in the knowledge of the participants after attending QMS workshop.
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Alterations in blood component utilization in a tertiary care hospital in eastern India in the COVID-19 pandemic p. 36
Sudipta Sekhar Das, Rathindra Nath Biswas
DOI:10.4103/ajts.AJTS_122_20  
BACKGROUND: With shortages of blood globally in the COVID-19 pandemic, many hospitals and blood centers have successfully implemented blood conservation strategies and strategies to maintain blood donations and blood inventory. Here, we reported our experience of utilization of blood components for transfusion in the current COVID-19 pandemic and discussed the patient blood management (PBM) methods and importance of judicious blood usage in any pandemic. MATERIALS AND METHODS: The retrospective study of 8 months was divided into pre-COVID and COVID periods. Parameters that included number of blood requisitions, blood components reserved and transfused, clinical speciality wise blood usage in both the periods were analysed. Blood utilization indices were computed using recommended equations. RESULTS: We observed an unusual pattern of blood utilization with significant disruption on blood supply and demand chain in this pandemic. A mean drop of 50.7% blood requisitions was observed in the COVID period. The period observed transfusion of 3608 units of blood components with a mean drop of 49.7% when compared to pre-COVID period. Mean drop of 46.6%, 54.4%, 53.4% and 52.7% were observed in packed red blood cell, fresh frozen plasma, platelet concentrate and cryoprecipitate transfusions in the COVID period. Blood component utilization was significantly reduced in most clinical specialities. The mean cross match to transfusion ratio in the COVID period was 1.28 with a mean increase in transfusion probability and transfusion index by 18.2% and 22.2% respectively. CONCLUSION: Although a constant transfusion support was needed in few clinical specialities throughout the pandemic, strict adherence to PBM protocols and practice of first in, first out method of blood dispensing helped the blood centre to support all patients needing blood transfusion.
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Factors associated with vasovagal reactions in whole blood donors: A case–control study p. 41
Aaditya Shivhare, Abhishekh Basavarajegowda, KT Harichandrakumar, Pragya Silwal, Pruthvi Raj
DOI:10.4103/ajts.ajts_90_21  
BACKGROUND: Vasovagal reactions to blood donation though generally mild and account for about 1% of donations, causes embarrassment/injury to the donors, lower likely return rates for future donations etc. The workforce hours devoted to attending to those who reacted can also affect the efficiency of the blood centre. There are various factors, both modifiable and nonmodifiable, involved in the causation of such reactions. OBJECTIVES: This study sought to identify the factors associated with vasovagal donor reactions in a case–control study. MATERIALS AND METHODS: This was a descriptive comparative study between donors who had VVRs (cases) and those who did not (controls) during or after blood donation from a single center in southern India. All the biophysical and demographic variables were collected from the donor records. In addition, a questionnaire was administered to the donors after donation within half an hour, addressing the psychosocial variables. All the data were captured in Microsoft Excel and analyzed using SPSS for Windows version 20. RESULTS: A total of 178 donors who had donor reactions were included in the study with an equal number of controls who were age and sex-matched. Donors who had VVRs had an odds of 4.1 (95% confidence interval [CI]: 2.4–7.7) of admitted anxiety for blood donation. They also had an odds of 4.4 (95% CI: 2.8–6.9) of disturbed sleep the night before blood donation. Having an accompanying person to the blood center was detrimental, with an odds of 0.32 (95% CI: 0.2–0.6). Donors with local complications such as hematoma, double prick, or delayed collection had an odds of 21.2 (95% CI: 1.8–159.8) of developing VVR. CONCLUSION: The psychosocial factors such as fear of the needle, the sight of the blood, state of mind, and quality and duration of sleep seem to have an association, adversely impacting the donors resulting in VVRs after/during blood donation.
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RHCE*E and RHCE*e genotype incompatibility in a southern Thai Muslim population p. 50
Poonyapa Tanwarawutthikul, Kamphon Intharanut, Supattra Mitundee, Oytip Nathalang
DOI:10.4103/ajts.AJTS_10_20  
CONTEXT: The formation of red cell alloantibodies resulting from both transfusion and pregnancy can cause adverse effects from allogeneic blood transfusions. Alloanti-E is commonly detected among Thai and Asian populations. AIMS: This study aimed to determine RHCE*E and RHCE*e genotype incompatibility in a southern Thai Muslim population and to compare it with those previously reported for other populations. SUBJECTS AND METHODS: Nine hundred and twenty-seven DNA samples obtained from 427 unrelated healthy blood donors from southern Thai Muslims and 500 samples from Central Thais were included. Samples were genotyped for RHCE*E and RHCE*e using an in-house polymerase chain reaction with the sequence-specific primer technique. RESULTS: Significant differences were found when we compared the allele frequencies of the RHCE*E and RHCE*e between southern Thai Muslims and Central Thais: RHCE*E 0.162 versus 0.197 and RHCE*e 0.838 versus 0.803 and also found in Chinese, American native, Japanese, Korean, Alaskan native, Hawaiian, South Asian, Brazilian Japanese-descendant, and Malay Malaysian populations (P < 0.05). In addition, the E/e incompatibilities among southern Thai Muslims and Central Thais were 24.23% and 26.71%, respectively. CONCLUSIONS: This study was the first to determine the RHCE*E and RHCE*e genotype incompatibility among southern Thai Muslims, enabling the estimation of their potential alloimmunization risk. These data could be useful to provide safe blood transfusions across ethnic populations.
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Determinants of voluntary blood donation in the city of Bahir Dar: A case–control study p. 56
Berhanu Elfu Feleke
DOI:10.4103/ajts.AJTS_115_17  
BACKGROUND: In a normal adult, the volume of blood needed to maintain physiological needs ranges from 5 liters to 6 liters. Disease and traumatic conditions may decrease this volume. Medically, this condition can be treated safely by blood transfusion. However, residents of the city of Bahir Dar have a low rate of volunteering to donate blood. No study has examined this situation, and therefore, this study was designed to fill this gap. AIM: The aim of this study is to identify the determinants of voluntary blood donation in the city of Bahir Dar. SETTING AND DESIGN: An unmatched case–control study design was used. METHODS AND MATERIALS: The sample size was calculated using Epi-Info Software, 109 cases and 218 controls were included in the study. Data were entered into the computer using Epi-Info and were analyzed using SPSS. STATISTICAL ANALYSIS USED: Logistic regression was used. Adjusted odds ratios (AOR) and 95% confidence interval (CI) were used to identify the determinants. RESULTS: In this study, voluntary blood donation was more among male donors (AOR: 2.66; [95% CI: 1.03–6.88]), health professionals (AOR 18.56; [95% CI, 6.26–55.09]), negligence (AOR 0.12; [95% CI, 0.05–0.31]), lack of information (AOR 0.24; [95% CI, 0.1–0.58]), a convenient place (AOR 11.36; [95% CI, 3.61–35.73]), fear (AOR 0.26; [95% CI, 0.12–0.61]) and lack of opportunity (AOR 0.23; [95% CI, 0.1–0.52]). CONCLUSION: Decision-makers in the area of blood collection should work hard to create awareness on voluntary blood donation. High-level decision-makers and the other partners should endeavor to make blood collection locations more convenient.
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Assessing safety and efficacy of therapeutic plasma exchange in pediatric patients: A single-center experience p. 61
Mohit Chowdhry, PJ Mutjhukamaravel, Soma Agrawal, Shiva Prasad Gajulapali, Uday Kumar Thakur
DOI:10.4103/ajts.AJTS_25_20  
INTRODUCTION: Therapeutic plasma exchange has been widely employed by clinicians for removal of the toxic constituents from plasma by filtration of whole blood and subsequent removal of plasma and reinfusion of cellular components along with a replacement fluid. It has become an accepted therapeutic modality in paediatric patients for numerous indications including but not limited to renal transplant, haemolytic uremic syndrome and Guillain Barre Syndrome. But, data on safety and efficacy are mainly derived from studies in the adult population with very limited data available in the paediatric age group. However, it is technically challenging in children due to their small circulating volume. This study discusses the clinical indications, efficacy, and safety of therapeutic plasma exchange in paediatric population. METHOD: We retrospectively reviewed the data of children (up to 18 years of age) who underwent TPE between January 2017 and March 2019 at our Hospital. Main features of the TPE procedures i.e. frequency of TPE, site of vascular access, type of replacement fluid used, instrument used, plasma volume processed, priming of the circuit, adverse events if any and outcome of the patients were analysed. RESULTS AND CONCLUSION: A total of 114 procedures were performed on these 24 patients. Fifteen patients with Category I indication showed good clinical outcome in terms of attainment of target ABO titre and/or decrease in the donor specific antibody. TPE is an effective therapeutic option in selected paediatric disorders. Our series of data on TPE procedures from paediatric perspective has shown safety and efficacy of the therapy.
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Assessment of dengue virus inactivation in random donor platelets using amotosalen and ultraviolet A illumination p. 67
Ankit Kumar, Aseem Kumar Tiwari, Satendra Kumar, Ashutosh Biswas, Gurpreet Singh, Kabita Chatterjee, Sourit Chakroborty, Sujatha Sunil
DOI:10.4103/ajts.AJTS_108_19  
OBJECTIVES: The study objective was evaluation of amotosalen and ultraviolet A (UVA) illumination-based inactivation of dengue virus (DENV) in blood platelets. MATERIALS AND METHODS: Whole blood was collected from healthy donors and platelet concentrates were prepared at a tertiary care hospital in Gurugram, India. Platelet units collected from five blood group matched individuals were pooled and spiked with DENV. The spiked platelet units were subjected to amotosalen treatment followed by UVA illumination, to evaluate the efficiency of this method for viral inactivation. The treated platelet units were evaluated for the presence of infectious DENV. Amotosalen levels were quantified in the treated samples using high-performance liquid chromatography. RESULTS: The presence of replicating DENV was not observed in spiked platelet units treated with amotosalen and UVA illumination, whereas untreated units contained actively replicating DENV. Amotosalen levels were found to be in the permissible range after photochemical inactivation. CONCLUSIONS: Amotosalen/UVA pathogen inactivation treatment showed efficient inactivation of DENV in platelet components. Therefore, it seems to be a promising method for mitigating the risk of dengue transmission through transfusion of potentially contaminated platelet components in dengue-endemic countries such as India.
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Prevalence of irregular red cell antibody in transfusion recipients vis-a-vis healthy blood donors attending a tertiary care hospital in North India p. 73
Abhilasha Yadav, Gaurav Raturi, Bhardwaj Aparna
DOI:10.4103/ajts.AJTS_118_19  
CONTEXT: Alloimmunization by foreign red cell antigens is a matter of concern as it may lead to hemolysis in transfused patients as well as fetus of pregnant females. AIMS: This study aimed to perform a comparative analysis of prevalence and type of irregular antibodies in healthy donors, vis-a-vis blood transfusion recipients. SETTINGS AND DESIGN: Blood samples of 4000 individuals comprising healthy donors, exposed patients, and nonexposed patients were collected and were analyzed for irregular antibodies. MATERIALS AND METHODS: Commercially available three-cell antigen panel was used for the antibody screening. The samples positive in antibody screen were further subjected to an extended 11-cell panel for antibody identification in low-ionic strength saline with and without enzyme. STATISTICAL ANALYSIS: Statistical analysis was done using SPSS for Windows 15.0 program. Chi-square test was used for detecting statistical significance of exposure to red blood cell antigens in the formation of alloantibodies. RESULTS: Of the 4000 samples, antibodies were identified in 105 (2.6%) samples. Overall, nonexposed group showed a seropositivity of 0.36%, while the exposed group showed a seropositivity of 9.4%. Anti-D was the most common antibody found in 38 patients (33.3%). Anti-E was the most common antibody in males, while anti-D was the most common antibody in females. CONCLUSIONS: Since the risk of alloimmunization is more common in multitransfused patients, it is advisable to screen at least those cases for irregular antibodies.
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Comparison of efficacy of filter paper cyanmethemoglobin method with automated hematology analyzer for estimation of hemoglobin p. 78
Lalit Kumar, Ranjit Kangle
DOI:10.4103/ajts.AJTS_135_16  
BACKGROUND: Screening of hemoglobin (Hb) before blood donation is one among the vital tests. It is performed to select a blood donor to prevent the collection of blood from an anemic person. However, no accurate, cost-effective, reliable, and standardized method is available to estimate Hb. OBJECTIVE: The aim is to evaluate the efficacy of filter paper cyanmethemoglobin (FPCH) method with the automated hematology analyzer in the estimation of Hb concentration for screening of a suitable donor. METHODOLOGY: This was a cross-sectional study in which the blood samples of 2000 patients visiting KLE's Dr. Prabhakar Kore Charitable Hospital, Belagavi, were collected in vials and directly estimated for Hb using automated hematology analyzer. To evaluate the efficacy of FPCH, 20 μL of blood sample was transferred onto Whatman filter paper and dried at room temperature. After drying, it was placed in 5 mL of Drabkin's solution for 30 min. Optical density was estimated by measuring the absorbance. Data were analyzed using SPSS version 20. The correlation coefficient, paired t-test, and difference between the means of both the methods were calculated. RESULTS: The mean Hb estimated by FPCH was 11.25 g/dL and automated hematology analyzer gave 11.35 g/dL. The difference in the means of both the methods was 0.1 g/dL. Paired t-test was done to test the level of significance and the result was 8.151 (95% confidence interval: 0.08–0.13 g/dL, P < 0.001). The correlation coefficient was found to be 0.976 (P < 0.001). CONCLUSION: FPCH is an efficient method, which is comparable to the automated hematology analyzers for Hb estimation. It could be used as an alternative screening tool for detection of Hb in a blood donation camp.
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Type and screen method and Coombs crossmatch method for pretransfusion testing: A prospective comparative study in a tertiary care hospital in Delhi p. 83
K Devi Anu, Sangeeta Pahuja, Geetika Sharma
DOI:10.4103/ajts.ajts_138_20  
BACKGROUND: The aim of pretransfusion testing (PTT) is to prevent the immune-mediated hemolytic reaction by the transfusion of incompatible donor red cells. The methods of PTT have evolved over the years and a new method of type and screen (T and S) was introduced, in which only ABO grouping, Rh typing, and antibody screening would be carried out with omission of routine Coombs crossmatch. Although T and S is an accepted method for PTT in developed countries, only a few studies in literature have evaluated its efficacy in India. AIM AND OBJECTIVE: The aim of the study was to compare T and S method with conventional Coombs crossmatch method for PTT. MATERIALS AND METHODS: Two thousand and fifty samples were randomly selected from the samples received in blood bank for requisition of blood transfusion after taking informed consent. ABO blood grouping and Rh typing were performed for each recipient's sample. “T and S” and “Coombs crossmatch” were done simultaneously by two different persons without knowing the result of each test. A commercially available three cell panel was used for antibody screening, in which the recipient's plasma was reacted with red cells in the low ionic strength solution Coombs Gel card at 37°C by column agglutination technology. RESULTS: Antibody screening was positive in 29 (1.41%) patients and negative in 2021 (98.59%) patients. Out of 29 patients, 27 had alloantibodies and 2 had autoantibody. Most common alloantibody found in our study was anti-D. Other antibodies found were anti-K, anti-C + D, anti-E, anti-C, anti-c, anti-Jka, and anti-Mi (a). Crossmatch on first attempt was compatible in 2028 (98.93%) patients and incompatible in 22 (1.07%) patients. Out of 29 patients who were positive for antibody screening, crossmatch was incompatible in nine patients. Crossmatch was compatible in twenty patients, who had positive antibody screen. However, crossmatch compatibility in these patients, reflect either absence of corresponding antigen or antigen present in low dose (heterozygous) in donor blood. On the other hand, out of 22 patients incompatible on first crossmatch, antibody screening was negative in 13 patients and was positive in only nine patients. Hence, 13 patients with antibody would have been missed by antibody screen alone. Kappa statistics was used to compare the efficacy of “type and screening” and “Coombs crossmatch.” It showed κ =0.445 (P < 0.001) implying moderate agreement between the two variables of “T and S” and “Coombs crossmatch.” CONCLUSION: T and S is a scientifically better method but needs to be implemented with caution. We need to develop our own cell panels having adequate representation of indigenous antigen (including In, Mi (a), etc.,). Large-scale studies need to be done in India with indigenous screening cells to evaluate efficacy and safety of T and S method.
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Reappraisal of screening strategy in hepatitis B surface antigen-negative blood donors: Correlation with hepatitis B virus-DNA quantification p. 89
Md Sohrab Alam, Tushar Samdani, Md Sawkat Hassan
DOI:10.4103/ajts.AJTS_157_18  
BACKGROUND: In spite of screening for hepatitis B surface antigen (HBsAg), transfusion-associated hepatitis B virus (TAHBV) infection remains a serious public health problem due to transmission of HBV in window period and occult HBV infection. To avoid TAHBV infection, some health-care facilities have started Hepatitis B core antibody test along with HBsAg, but this leads to a lot of potential donor rejection who are not HBV infected. Our aim is to find a new protocol of donor screening to prevent TAHBV without compromising blood availability. MATERIALS AND METHODS: A total of 88 HBsAg-negative anti-HBc total positive blood donors were included in this study. All samples were also tested for anti-HBs by enzyme immunoassay and for the presence of HBV-DNA viral load by real-time polymerase chain reaction. RESULTS: A total of 88 HBsAg negative and anti-HBc, total positive blood donors were tested for anti-HBs and HBV-DNA (Qn.). Among them, 76 donors (86.4%) (males 73 and females 3) were found to be positive for anti-HBs, while rest 12 (13.6%) showed no detectable antibody against HBsAg. HBV-DNA was found to be positive in 4 (7.7%) donor samples among 52 (60%) who have anti-HBs level <100 mIU/ml, while 36 (40%) donor samples were found to have >100 mIU/ml anti-HBs antibody with no detectable HBV-DNA. CONCLUSION: HBV-DNA should be implemented as a screening test of the blood donors to prevent TAHBV infection without potential donor rejection.
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A cross-sectional study on thrombopoietin levels in immune thrombocytopenia and its correlation with platelet count, megakaryocytes, and treatment response p. 95
Gurleen Oberoi, Mili Jain, Shankar Madhav Natu, Rashmi Kushwaha, Anil Kumar Tripathi, Ashutosh Kumar
DOI:10.4103/ajts.AJTS_65_17  
INTRODUCTION: Thrombopoietin (TPO) being the major regulator of megakaryopoiesis is expected to show a compensatory increase in immune thrombocytopenia (ITP), however, it is not so observed. This study was undertaken to measure TPO levels in ITP and assesses its association with platelet count, megakaryocytes, and response to steroid therapy. MATERIALS AND METHODS: A total of 41 cases of ITP and twenty controls with normal platelet count were enrolled in this prospective study. Complete blood count, bone marrow examination, and ELISA for serum TPO were measured. Response to steroid therapy was evaluated for thirty cases. RESULTS: The TPO levels were increased in 80.5% of patients in comparison to the controls. The degree of rise, however, was variable. On analyzing low, normal, and high TPO levels with reference to platelet and megakaryocyte count no statistically significant difference was observed. Raised TPO levels were seen with significant lowering of functional megakaryocytes. The mean TPO levels in nonresponders were higher than responders but highly variable and statistically nonsignificant. CONCLUSION: Quantitative alterations in TPO are in a way regulated by qualitative efficacy of megakaryocytes rather than platelet or megakaryocyte count. Nonresponders with markedly increased TPO levels (due to qualitative megakaryocyte injury) are less likely to respond to TPO receptor agonist.
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Transfusion-transmitted infections, its risk factors and impact on quality of life: An epidemiological study among β-thalassemia major children p. 99
Bijit Biswas, Narendra Nath Naskar, Keya Basu, Aparajita Dasgupta, Rivu Basu, Bobby Paul
DOI:10.4103/ajts.AJTS_74_18  
BACKGROUND: Multi-transfused thalassemic children are at higher risk of acquiring transfusion-transmitted infections (TTIs). There are limited data available on TTIs among thalassemic children, especially on its impact on their quality of life (QoL). AIM: The aim of this study is to find out the proportion of multi-transfused β-thalassemia major (β-TM) children suffering from TTIs, its risk factors and impact on QoL. METHODS: This was a hospital-based, analytical observational study, cross-sectional in design, conducted among 328 β-TM children and their caregivers attending thalassemia day care unit of a medical college during May 2015–April 2016, with a structured schedule. Data were analyzed with appropriate statistical methods using the Statistical Package for the Social Sciences. RESULTS: Two-fifth (39.9%) of them were found to have TTIs with hepatitis C being the most common (34.5%), followed by hepatitis B (4.5%) and human immunodeficiency virus (1.8%). In the multivariable model, place of residence (adjusted odds ratio [AOR] – 2.23 [1.19–4.17]), per capita monthly family income (AOR – 1.84 [1.10–3.07]), and blood transfusion frequency (AOR – 1.19 [1.10–1.29]) were significant predictors of TTIs adjusted with their age, age at diagnosis, last pretransfusional hemoglobin level, size of spleen, and caregivers knowledge regarding the disease. The study participants with TTIs had a lower QoL compared to others as there were significant differences in between the total QoL scores ([49.9 ± 15.6 vs. 57.4 ± 15.5], P ≤ 0.001) and its various domains. CONCLUSION: There was high burden of TTIs among multi-transfused β-TM children and it has significant negative impact on their quality of lives.
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Therapeutic plasma exchange in HELLP syndrome: A life savior p. 106
Mohit Chowdhry, Soma Agrawal, Shiva Prasad Gajulapalli, Uday Kumar Thakur
DOI:10.4103/ajts.ajts_176_20  
BACKGROUND: HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome occurs in about 0.5%–0.9% of all pregnancies, but its prevalence is higher in patients with severe preeclampsia, accounting for a substantial maternal and perinatal morbidity and mortality. According to the latest American Society for Apheresis guidelines, Therapeutic plasma exchange (TPE) performed for postpartum cases and antepartum HELLP syndrome cases fall in Categories III and IV, respectively. MATERIALS AND METHODS: Retrospective analysis was done at our tertiary care center from January 2014 to June 2019 for patients diagnosed with HELLP syndrome. Clinical data for age, gestational age at the time of diagnosis, type of delivery, outcome of pregnancy, history of preeclampsia /eclampsia, hemoglobin levels, AST, ALT, LDH, platelet counts, prothrombin time, activated partial thromboplastin time, international normalised ratio, complete blood count, was obtained from patients' electronic medical records. The TPE was initiated within 24 hrs of diagnosis. All TPE was done on Spectra Optia apheresis system (Terumo BCT, Inc, USA). Statistical testing was conducted with the statistical package for the social science system version SPSS 20.0 and R-3.2.0. Continuous variables were expressed as mean±SD and were compared between Pre and Post TPE records of patients by using the paired T test. RESULTS: Nine patients fulfilled the criteria of HELLP syndrome. Seven (77.8%) were diagnosed in the postpartum period and 2 (22.2%) during the second trimester. Out of the total nine patients, two patients (22.2%) recovered completely and were discharged on day 15 ± 7 days, whereas 4 (44.4%) patients were discharged on day 21 ± 7 days with the advice of hemodialysis. Two (22.2%) patients had an intrauterine death and were discharged 3–4 days after the demise. In all these patients (except one), the TPE was initiated within 24 h of the diagnosis. A significant increase in platelet count and decrease in the lactate dehydrogenase levels (P < 0.05) was observed post TPE. CONCLUSION: Our data showed that TPE improved the treatment outcome in patients with HELLP syndrome despite being a Category III and IV indication among postpartum and antenatal females, respectively. However, a timely diagnosis and management are of paramount importance for a favorable outcome. TPE needs to be performed within 24 h of the diagnosis postdelivery when the patient is not responsive to the usual therapies, especially in class I HELLP syndrome.
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REVIEW ARTICLE Top

Prevalence and specificity of red blood cell alloantibodies and autoantibodies in transfused Iranian β-thalassemia patients: A systematic review and meta-analysis p. 111
Hosein Rostamian, Ehsan Javandoost, Mozhdeh Mohammadian, Abbas Alipour
DOI:10.4103/ajts.AJTS_39_20  
BACKGROUND: Repeated allogeneic blood transfusions in thalassemia major patients stimulate the patient's immune system to generate antibodies against foreign erythrocyte antigens. This study was carried out to systematically review the findings of available studies about the prevalence of alloantibodies and autoantibodies, as well as the type of causative antigens among transfusion-dependent thalassemia patients in Iran. METHODS: Electronic search was conducted on Medline, PubMed, Cochrane, EMBASE, ScienceDirect, and Persians databases. All relevant articles published from January 1990 to July 2018 were included. Abstracts of conference booklets which that been published in the last 5 years were also included in the meta-analysis. The search language was restricted to English and Persian. The quality of studies was evaluated according to a checklist developed by authors, and Cochrane Risk of Bias Assessment Tool was used to evaluate the risk of bias. RESULTS: Twenty-three relevant articles met all the inclusion criteria. The prevalence of alloimmunization was 13%. Our study showed that anti-D (25%) and anti-K (25%) were most prevalent among Iranian β-thalassemia patients. Data analysis shows the autoantibody prevalence to be 1% among 3787 patients. Meta-regression revealed that the prevalence of alloantibodies increases with each year as the average age of the study population increases. CONCLUSION: The prevalence of red blood cell (RBC) alloantibodies in transfused Iranian β-thalassemia patients was high. Appropriate preventive strategies such as RBC phenotyping for patients before beginning transfusion and using extended RBC donor–recipient matching, specifically for Rh and Kell system, could be implemented to avoid complications in thalassemia patients.
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CASE REPORTS Top

A case report on non-D HDFN: Highlighting the role of antibody screening in RhD positive antenatal women p. 121
Bharat Singh, Rajendra Chaudhary, Preeti Elhence, Jyoti Kala Bharati, Anubha Srivastava
DOI:10.4103/ajts.ajts_108_21  
The widespread use of anti-D immunoglobulin has resulted in a relative increase in the importance of non-D alloimmunization as a cause of hemolytic disease of the fetus and newborn (HDFN). Non-D alloantibodies that are capable of causing severe HDFN include anti-K, anti-E, and anti-c. Anti-c is clinically the most important Rh system antibody after anti-D. Here, we report three cases of neonates presenting with anemia and hyperbilirubinemia with strongly positive direct antiglobulin test who required phototherapy and neonatal exchange transfusion due to non-D antibody in RhD positive antenatal women. Anti-c was common in all the three cases while two cases have one additional non-D antibody. Due to faulty practices, antenatal antibody screening was not done for any case considering the mother's RhD positive status. Hence, antenatal antibody screening should be performed routinely, in all RhD positive pregnant women to reduce the delay in diagnosis and the management of HDFN occurring due to non-D antibodies.
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Effect of leukapheresis on pain reduction in leukemic priapism p. 124
Shahida Noushad, Dibyajyoti Sahoo, Abhishekh Basavarajegowda, Esha Toora, Purshotam Paudel
DOI:10.4103/ajts.ajts_160_21  
Priapism is a rare presentation of Chronic Myeloid Leukaemia (CML). It is also considered a medical emergency as delay in treatment may lead to impotence. Prompt medical and surgical interventions such as hydroxyurea, analgesia, phenylephrine injection and aspiration, open surgical shunting, and local radiation therapy are essential. Leukapheresis effectively reduces leukocyte count rapidly and effectively, thereby an important therapy along with other standard of care in CML-induced priapism. In the present case, priapism was the presenting symptom of CML. The same was managed with various modalities such as hydroxyurea, allopurinol, antibiotics, analgesics, sedatives, phenylephrine injection, and aspiration but failed to reduce priapism pain. With a single cycle of leukapheresis, priapism pain could be reduced significantly.
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Successful management of Methemoglobinemia and G6PD deficiency in a patient posted for surgical excision of branchial cyst p. 128
VJ Arun, Anuradha Deorukhkar, Aboobacker Mohamed Rafi, Deepak Charles, Rati Devendra, Susheela J Innah, Prabhakar Kedar
DOI:10.4103/ajts.ajts_152_20  
A 27-year-old female patient who came for branchial cyst excision was found to have cyanosis and a saturation gap during preanesthetic check-up and hence she was referred to haematology for further workup. She had a Hb of 9 gm% with all other baseline tests as normal. Blood samples were sent for methaemoglobin estimation and related work up to the National Institute of Immunohematology (NIIH) Mumbai. She was diagnosed as a case of Methemoglobinemia with a methaemoglobin level of 68.7% with NADH cytochrome B5 reductase activity of 10.82 IU/g Hb. The drug of choice for treatment is Methylene blue and hence G6PD deficiency had to be ruled out prior to initiating therapy. She was found to have a concurrent existence of G6PD deficiency. The blood sample was further sent to NIIH for genetic confirmation. We avoided methylene blue and other precipitating factors that could trigger a haemolysis. She was further consulted by the Patient blood management team to optimize her erythropoiesis and avoid unnecessary transfusions. Anaesthetic consultation and planning were done to avoid drugs that could induce haemolysis. She was started on Vitamin C, Niacin, hematinic and advised to follow up after a month. She was symptomatically better. Cyanosis had reduced, and Hb improved to 12 gm%. She was taken up for surgery with all precautions. The surgery and the post-operative period were uneventful. She was discharged on postoperative day 4 with an advice to continue Vitamin C & Niacin and to follow-up in Haematology OPD after a month.
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Detection of a weaker subgroup of A in ABO blood group system p. 132
Gurika Chopra, Manpreet Kataria, Arshpreet Kaur Batra, Gurkiran kaur, Rajesh Kumar
DOI:10.4103/ajts.ajts_66_21  
Testing to detect ABO incompatibility between a donor and potential transfusion recipient is the foundation on which all other pretransfusion testing is based. Sometimes, weak agglutination reactions may be obtained with reagent antibodies due to weak expression of A and B antigens on red blood cell (RBC) surface which may cause a discrepancy in blood group typing. Here, we report a patient showing discrepancy between RBCs (forward) and serum (reverse) typing. After doing detailed analysis, the blood type as a variant of blood Group A revealed. Subgroups of A are very rare phenotype of blood. Weaker subgroups of A blood group reported so far are mainly A3, Aend, Ax, Am, Ay, and Ael. We are reporting a case of a 35-year-old patient whose RBCs showed a discrepancy between cell and serum grouping during initial testing. Serological investigation included absorption elution tests and saliva tests after performing initial blood grouping. The serological characteristics of the patient's red cells were similar to A3 subtype. The patient was a secretor and A and H substance was present in the saliva. Serum did not show any presence of anti-A1. The weak A phenotype identified had serological characteristics similar to A3.
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Passenger Lymphocyte Syndrome as a rare cause of hemolysis in a patient after small intestine transplantation, A case report and review of the literature p. 135
Edalat Zarei, Mojtaba Shafiekhani, Nazanin Azadeh, Alireza Shamsaeefar, Mahnaz Lotfi, Mahbube Ahrami, Amirhassan Rabbani, Hamed Nikoupour
DOI:10.4103/ajts.ajts_18_21  
Passenger lymphocyte syndrome (PLS) is a well-described phenomenon causing immune hemolytic anemia, mostly in non-ABO identical transplantations. The syndrome occurs when donor lymphocytes produce antibodies against the recipient's red blood cells. Although the syndrome is usually self-limited, further management with blood transfusions, immunosuppression, or plasmapheresis might be needed. A 23-year-old female with AB+ blood group underwent small intestine transplantation from a deceased donor with O+ blood group. She received rituximab, thymoglobin, and methylprednisolone as immunosuppressive induction. In the 9th postoperation day, she developed hemolysis which was primarily managed with blood transfusions and finally ceased by plasmapheresis and intravenous immunoglobulin. Few cases of PLS have been previously described in intestinal transplantation recipients. Correct diagnosis and management prevents severe hemolysis outcomes. Previous cases have been successfully treated with a combination of immune suppression, plasma exchange, and transfusions.
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Effect of cryoprecipitate transfusion without ABO group consideration: A nightmare experience p. 140
Dibyajyoti Sahoo, Pragya Silwal
DOI:10.4103/ajts.ajts_83_21  
The cryoprecipitate is an essential blood product as they are rich in factor VIII, fibrinogen, von Willebrand factor, factor XIII, and fibronectin, and their volume is too small. They play a significant role in the management of massive transfusion nowadays. Usually, they are used without ABO group consideration. We here report a case in which immunohematological problems arose due to out-of-group transfusion of cryoprecipitate. We suggest that the possibility of incompatibility subsequently is to be kept in mind during transfusion of large quantity cryoprecipitate, and ABO group compatible may be preferred.
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Maternal allo anti-M antibody-induced hemolytic disease of newborn p. 144
Ashly Monson Mathew, Sangita Shah, Nidhi Bhatnagar, Mamta Shah, Tarak Patel, Truptee Thakkar
DOI:10.4103/ajts.ajts_109_21  
Hemolytic disease of the fetus and newborn is a syndrome associated with immune destruction of the fetal and newborn red cells by maternal red cell alloantibodies. The detection of anti-M in antenatal screening can be responsible for neonatal red cell aplasia. A 32-h-old full-term neonate admitted with inconsolable cry and mild fever. Laboratory tests revealed progressive anemia and hyperbilirubinemia on day 3. The peripheral blood smear showed evidence of hemolysis and reticulocyte count was reduced. Intensive phototherapy and antibiotics were started after ruling out other causes of hyperbilirubinemia. Blood group typing and advanced red cell serology workup were done. Antibody screening and identification was suggestive of the presence of anti-M antibody in both mother and baby. Intravenous immunoglobulin and red blood cell transfusions were given. Anti-M is capable of causing hemolytic disease of the fetus and newborn and prolonged anemia. Newborns with anemia should be evaluated for all the possible causes to establish a diagnosis.
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SHORT COMMUNICATION Top

Illustration: Thromboelastography – A useful tool to monitor COVID-19-associated coagulopathy p. 148
Ashwinkumar Vaidya, Bemma Paonam, Ganesh Mohan, Shamee Shastry
DOI:10.4103/ajts.ajts_73_21  
COVID 19 is caused by Severe Acute Respiratory Syndrome Corona Virus-2 which results in wide range of manifestations. Systemic hypercoagulation is a typical feature of COVID-19. We present a case of COVID-19 in whom TEG was performed on admission and hypercoagulability was diagnosed and hence patient was started on Enoxaparin sodium 6000 IU twice daily. TEG was repeated after 5 days which showed normal coagulation status and the patient was discharged without any thrombotic complications.
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Prevalence of C, c, E, e, K, and k antigens in RhD-negative blood donors in and around Puducherry p. 150
Sridhar Gopal, Rajendra Kulkarni, Abhishekh Basavarajegowda
DOI:10.4103/ajts.AJTS_94_21  
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LETTER TO THE EDITORS Top

Antihuman globulin test reactivity in SARS-CoV-2 infection-positive patients p. 152
Sheenam Thakkar, Swarupa Bhagwat, Jayashree Sharma
DOI:10.4103/ajts.ajts_168_21  
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AINT blood group: A case report on rare subtype of blood group A p. 154
Minal Wasnik, Saurabh Lahare, Ramesh Kumar Chandrakar, Sankalp Sharma
DOI:10.4103/ajts.AJTS_126_18  
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SHORT COMMUNICATION Top

Refrigerated centrifuge calibration for maximum platelet and plasma yield in a blood bank p. 156
R Loganathan, B Abhishekh
DOI:10.4103/ajts.ajts_56_19  
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2006 - Asian Journal of Transfusion Science | Published by Wolters Kluwer - Medknow
Online since 10th November, 2006