The spectrum of hemolytic disease of the newborn has changed over the last few decades. With the implementation of Rhesus D immunoprophylaxis, hemolytic disease due to ABO incompatibility and other alloantibodies has now emerged as major causes of this condition. Though in developing countries, anti D is still a common antibody in pregnant women, many Asian countries have identified alloantibodies other than anti D as a cause of moderate-severe hemolytic disease. The most concerned fact is that, some of these have been described in Rh D positive women. It appears that universal antenatal screening in all pregnant women needs to be initiated, since Rh D positive women are just as likely as D negative women to form alloantibodies. Many developed nations have national screening programs for pregnant women. This is necessary to ensure timely availability of antigen negative blood and reduce effects on the newborn. Although universal screening seems justified, the cost and infrastructure required would be immense. Developing countries and under resourced nations need to consider universal antenatal screening and frame guidelines accordingly.

Advances in science and technology have revolutionized medical services in the last two decades. Medical education in the undergraduate and postgraduate courses has tried to keep pace with the changes and several curriculum modifications have taken effect. One of the commonly seen changes include active participation in "communication skills" training and implementation of the same in practice. This article discusses the practical issues one would face in day-to-day medical communication and highlights the necessity of the same in the Indian setting, with a focus on transfusion medicine.

Background and Aim: Platelets are routinely isolated from whole blood and stored in plasma for 5 days. The present study was done to assess the in vitro function of random donor platelets stored for 7 days in composol platelet additive solution at 22°C. Materials and Methods: The study sample included 30 blood donors of both sex in State Blood Bank, CSM Medical University, Lucknow. Random donor platelets were prepared by platelet rich plasma method. Whole blood (350 ml) was collected in anticoagulant Citrate Phosphate Dextrose Adenine triple blood bags. Random donor platelets were stored for 7 days at 22°C in platelet incubators and agitators, with and without additive solution. Results: Platelet swirling was present in all the units at 22°C on day 7, with no evidence of bacterial contamination. Comparison of the mean values of platelet count, platelet factor 3, lactate dehydrogenase, pH, glucose and platelet aggregation showed no significant difference in additive solution, whereas platelet factor 3, glucose and platelet aggregation showed significant difference (P < 0.001) on day 7 without additive solution at 22°C. Conclusion: Our study infers that platelet viability and aggregation were best maintained within normal levels on day 7 of storage in platelet additive solution at 22°C. Thus, we may conclude that in vitro storage of random donor platelets with an extended shelf life of 7 days using platelet additive solution may be advocated to improve the inventory of platelets.

Introduction : Storage of red cells causes a progressive increase in hemolysis. In spite of the use of additive solutions for storage and filters for leucoreduction, some amount of hemolysis is still inevitable. The extent of hemolysis, however, should not exceed the permissible threshold for hemolysis even on the 42 ^nd day of storage. Study Design and Methods: Eighty units of packed red cells, 40 stored in SAGM post leucoreduction and 40 in ADSOL without leucoreduction filters, were evaluated for plasma hemoglobin by HemoCue Plasma Hemoglobin analyzer on the day of collection and on the 7 ^th , 14 ^th , 21 ^st , 28 ^th , 35 ^th and 42 ^nd days thereafter. The hemoglobin and hematocrit were also noted for all these units by the Beckman and Coulter analyzer. Percentage hemolysis was then calculated. Observations: Hemolysis progressively increased with the storage period in all the stored red cell units (SAGM as well ADSOL). However, on day 42 ^nd of storage, free hemoglobin in all the red cell units was within the permissible level (which is 0.8% according to the Council of Europe guidelines and 1% as per the US FDA guidelines). The mean percentage hemolysis was slightly higher in the SAGM-containing bags with an integral leucoreduction filter as compared to the bags containing ADSOL. However this difference was marginal and not statistically significant. Conclusion: Hemolysis of the red cells increases with storage. However, maximum hemolysis does not exceed the permissible limits at any time thereby indicating the effect of optimum processing and storage conditions on red cell hemolysis.

Introduction : Containers for the storage of platelets are made using polyvinyl chloride plasticised with di, (2-ethyl hexyl) phthalate, n-butyryl, tri (n-hexyl) citrate and tri (2-ethyl hexyl) mellitate or using special poly olefins without plasticiser. Of these, the first two have disadvantages such as plasticiser leaching and impairment of platelet function. Polyolefin bags cannot be HF welded or steam sterilized. Mellitate plasticised bags can store platelets well for five days but they are not completely phthalate free. Research and Development: We have developed a new generation of containers made of PVC plasticised with the non DEHP, non aromatic plasticiser,1,2- Cyclohexanedicarboxylic acid, diisononyl ester (Hexamoll DINCH) which can store platelets without loss of function for at least six days. Observation: The present studies show that DINCH plasticised PVC bags (TPL-167) are well suited for the storage of platelet concentrates for more than five days. Conclusion: The present studies show that the PVC plasticised with the non phthalate, non aromatic, non toxic plasticiser DINCH is a viable alternative to other existing containers for the storage of platelets for more than five days.

Introduction : Hepatitis C virus (HCV) is the etiological agent for the majority of cases of non-A, non-B hepatitis. As a blood-borne virus, HCV is widely recognized as a major causative agent of post-transfusion non-A, non-B hepatitis. The prevalence of HCV and the distribution of HCV genotypes in Sri Lanka in comparison with the rest of Asia are not well known. Materials and Methods: The blood samples collected from healthy blood donors at the National Blood Transfusion Centre of Sri Lanka were screened to determine the prevalence and the genotypes of HCV among blood donors in Sri Lanka. Results: HCV antibodies were found in 53 of 4980 blood donors. However, of the 53 only 8 positive results were confirmed by Reverse Transcription-PCR, which suggests frequent false-positive results or viral clearance. The PCR positive samples were genotyped by DNA sequencing of the Core/E1 regions of HCV genome, and all the HCV viruses belonged to genotype 3, of which 7 were 3a and 1 was 3b. Conclusion: HCV is relatively rare among blood donors in Sri Lanka and only genotype 3 was detected in the studied group.

Background : Voluntary non-remunerated repeat blood donors are perceived to be safer than the first time blood donors. This study was planned for follow-up of previous hepatitis C virus (HCV) test results of anti-HCV enzyme-linked immunosorbent assay (ELISA) reactive repeat blood donors. The aim was to suggest a protocol for re-entry of the blood donors who are confirmed HCV negative by nucleic acid test (NAT) and recombinant immunoblot assay (RIBA). A group of repeat voluntary donors were followed retrospectively who became reactive on a cross sectional study and showed HCV reactivity while donating blood regularly. Material and Methods: A total of 51,023 voluntary non remunerated blood donors were screened for anti-HCV ELISA routinely. If anybody showed positivity, they were tested by two ELISA kits (screening and confirmatory) and then confirmed infection status by NAT and or RIBA. The previous HCV test results of repeat donors reactive by anti-HCV ELISA were looked back from the records. Data of donors who were repeat reactive with single ELISA kit (in the present study) were analyzed separately from those reactive with two ELISA kits (in the present study). Results: In this study, 140 (0.27%) donors who were reactive by anti HCV ELISA were included. Out of them, 35 were repeat voluntary donors and 16 (11.43%) were reactive with single ELISA kit. All 16 donors were reactive by single ELISA kit occasionally in previous donations. Their present ELISA positive donations were negative for HCV NAT and RIBA. A total of 19 (13.57%) donors were reactive with two ELISA kits. In their previous donations, the donors who were reactive even once with two ELISA kits were consistently reactive by the same two ELISA kits in their next donations also. Conclusion: Donor sample reactive by only single ELISA kit may not be considered as infectious for disposal as they were negative by NAT and or RIBA. One time ELISA positivity was found probably due to ELISA kit specificity and sensitivity. Donors reactive with two ELISA kit should be discarded as there is a high positivity with NAT/ RIBA. However, donors reactive by two ELISA kits and negative by NAT and RIBA should be followed up and may not be deferred permanently.

Background: Lamivudine is an analog nucleoside used for the treatment of chronic hepatitis B virus (CHV) infection. Studies showed that prolonged therapy could induce lamivudine resistance hepatitis B virus (HBV) variants (YMDD motif). In this study, the rate of YMDD motif mutants is determined in lamivudine-treated CHV patients in Iran. Materials and Methods: Thirty-three serum specimens of patients with chronic hepatitis who had been treated with lamivudine were included in the study. Serum samples of patients were tested by PCR flash and RFLP as well as tested for HBeAg, HBsAg, and liver enzymes (ALT and AST). Results: Out of the 33 patients enrolled in this study, 82% were male and 18% female, respectively. Mean ALT levels were between 20 and 100 IU/1. HBeAg was positive in 76% of the patients whereas HBs was positive only in 61% of the patients. Furthermore, in 28 patients liver biopsy grade was between 2 and 17 having the stage of 1-6. Moreover, HBsAg negative and HBeAg positive were observed in 30% of the patients. Conclusion: During therapy, it was found that patients with lamivudine incidence YMDD mutation were approximately 14%. The ALT levels were also reduced in these patients. This study revealed that there was a significant difference between HBeAg, grade, and YMDD mutation whereas no significant different was observed between HBsAg and HBV DNA PCR. Conclusively, it was found that a significant difference exists between YMDD mutation and lamivudine therapy (17% of patients were HBsAg negative and PCR positive).

General Objective: To assess the practice of blood conservation. Specific Objectives: To determine the methods of blood conservation in use, to assess the lower limit for hemoglobin for elective procedures, to determine transfusion trigger point in practice, to find out limitations in practice and ways to improve clinical practice. Materials and Methods: This was conducted in February 2009. Self-administered questionnaires were distributed among the surgeons and anesthetists in practice at the University of Nigeria Teaching Hospital, Enugu State University Teaching Hospital, Ebonyi State University Teaching Hospital and National Orthopaedic Hospital, Enugu. The data gathered was analyzed using the SPSS software. Results : Of participants who agreed to fill the questionnaires, more than 50% were males. The most prevalent specialty was general surgery (24.2%), followed by orthopedics (22.6%), obstetrics and gynecology (20.7%), and anesthesia (17.7%). The lowest hemoglobin limit before the patient was allowed into the theatre for elective procedures was 10 g/dl while individual transfusion trigger points ranged from hemoglobin of 6 to 10 g/dl. Majority of the doctors would avoid homologous blood transfusion in order to avoid transfusion-related diseases and reaction. Regarding knowledge of blood conservation methods and means of avoiding homologous blood, the use of diathermy was highest (12.33%), followed by preoperative blood donation (11.87%), use of hematinics (10.96%), and tourniquet 10.5%. Also, in practice, diathermy was the most frequently used (18.69%), followed by preoperative blood donation (16.16%), use of tourniquet (15.15%), while the Ovadje cell saver was least with 0.01%. Suggestions from respondents on the ways of limiting transfusion-related problems included optimization of patients (24.5%), improvement of standard of living (17.7%), and personnel training (13.3%). Conclusion: There is an agreement with the global trend geared toward minimizing the use of homologous blood by doctors in these hospitals. However, our practice must continually be refined by continuing medical education in order to keep everyone informed of changes in practice. The Government must improve the quality of service by the provision of unavailable infrastructure.

Background: Alloantibodies of clinical importance can cause transfusion reactions or hemolytic disease of the fetus and newborn (HDFN). The frequencies of these antibodies have not been reported in our locality. Aims: To determine the frequency of occurrence of alloantibodies among pregnant women in Port Harcourt, Nigeria. Settings and Design: This is a prospective study, which was carried out in the Braithwaite Memorial Specialist Hospital, Port Harcourt, Nigeria. Materials and Methods: Screening and identification of red blood cell alloantibodies was done on the sera of 500 pregnant women using the DiaMed, DiaCell, and DiaPanel reagents (Cressier, Switzerland). ABO and Rh blood groups were done using antisera bought from Biotec (Ipswich, UK). Results: Alloantibodies were identified in the serum of 17 of the 500 (3.4%) pregnant women. The specificity of the antibodies was as follows: anti-C 6 (1.2%), anti-E 3 (0.6%), anti-Jsb 3 (0.6%), and anti-K 5 (1.0%). No anti-D was identified despite 8.6% of the study population being Rhesus D (Rh D) negative. The distribution of the antibodies was found to be independent of the blood groups of the participants (x ² = 4.050, P = 0.670). Blood group O constituted the highest percentage (48.0%). Conclusion: This study has identified the presence of non-Rh D antibodies to the proportion of 3.4%. Rh D antibody was absent in this population irrespective of the relatively high percentage of Rh D negative women. There is a need to determine the actual risk these antibodies may pose to the antenatal women and to include antibody screening and identification in routine antenatal care.

Background: Red blood cell (RBC) alloantibodies may be formed following exposure to RBC antigens. In most cases, the alloimmunization develops during pregnancy or from previous blood transfusions. The RBC antigens and their alloantibodies vary among different human populations and ethnic groups, and they do have a clinical significance for their adverse immunological reactions. Aims: This study aimed at studying the prevalence of RBC alloantibodies at the Blood Transfusion Unit of Hospital Raja Perempuan Zainab II in Kota Bharu, Malaysia. Patients and Methods: A cross-sectional study was performed utilizing data obtained in the years 2007 and 2008. Data of antibody screening tests from 5719 patients were examined. Results and Discussion: The overall prevalence of alloimmunization was 65 (1.13%). The majority of these had a single alloantibody (76.9%), whereas the remaining 23.1% had multiple antibodies. The anti-E antibody comprised the most common alloantibody (24.6%) followed by the anti-Lewis (a) antibodies (18.5%) and the anti-M antibody (13.8%). There were more female recipients than males. Conclusions: It was concluded that the findings of this work have been comparable with other published works, and that the main factors associated with alloantibody formation were multiple transfusions and pregnancies. The study also emphasizes the necessity for carrying out immunohematology studies prior to every blood transfusion especially in cases that require multiple transfusions for a long period of time such as in thalassemia patients.

Background : ABO incompatibility in maternal-fetal relationship has been shown to cause hemolytic disease of the newborn (HDNB); a survey which is not yet done in this locality. Aim: Frequency of ABO blood group maternal-fetal incompatibility, maternal iso-agglutinins, and immune agglutinins quantitation was carried out in Osogbo, Osun State, South-West of Nigeria. Settings and Designs : A total of 260 subjects comprising 130 postpartum mothers within the age range of 22-35 years having good obstetrics history and normal delivery, with their 130 neonate babies were used for the study. Materials and Methods : ABO cell and serum groupings were carried out on the subjects using standard antisera and cells with appropriate controls. Direct Coomb's Test was carried out on neonate red cells. Antibody quantitation by double dilution on the maternal serum using red cells containing corresponding antigen to the antibody was determined. A titer, which is the reciprocal of the highest dilution showing agglutination by Indirect Coombs Test, was determined. Another batch of sera was pretreated with 2-mecarptoethanol before determining the titer. Statistical Analysis: The distribution study results obtained were compared in percentages, whereas the antibodies quantitation was expressed as titers using the mode of the titers for compariso-agglutininsn. Results and Conclusions : Thirty-eight percent (50) mothers were ABO incompatible with their babies, whereas 62% (80) mothers were compatible. The distribution of blood groups in the compatible population showed blood group O (45%); A (30%); B (20%); and AB (5%). Mothers O, A, and B carrying incompatible babies had a frequency of 24% each, whereas mothers AB had 28%. Serologist differences occur in maternal ABO antibodies of corresponding incompatible baby ABO antigens. A high incidence of ABO maternal-fetal incompatibility observed without detection of immune agglutinins is indicative of a rare incidence of HDNB due to ABO incompatibility in the population studied.

Introduction : Similar to other developed countries, only 3% of the total population in Hong Kong donate blood (Hong Kong Red Cross Blood Transfusion Service 2003). More than 20% of annual donations come from youngsters aged 18-25. However, this category of donors has decreased gradually from 24.6% in 2004 to 22.9% in 2008. This study aims to examine the characteristics and intention of young blood donors versus nondonors in Hong Kong; and to explore the factors that may influence Hong Kong young people's donation behavior. Materials and Methods: This is a cross-sectional study using questionnaire to solicit information from young people including both blood donors and non-donors. Results: It showed that more non-donors were underweight (26%) than blood donors (16.9%). Blood donors demonstrated to have more knowledge on the usage of donated blood (87.2%). Nearly half of youngster admitted that they made use of donation as a means for blood testing (53.1%) or free physical check-up (47.3%). Conclusions: Recruitment strategies should focus on the enhancement of health education programs related to blood and blood donation for young people to increase their awareness of blood and alleviate their misconceptions about blood donation.

Background: The minimum hemoglobin cutoff for blood donation in India is 12.5 gm% for both male and female donors and the minimum donation interval is 3 months. Donation of one unit of blood results in decrease in hemoglobin by 1 gm% and loss of 200-250 mg of iron. Donor deferral due to anemia is one of the major reasons of temporary rejection of blood donors. In the absence of further workup or advise, it results in loss of valuable donor base. Aim and Objective: To provide baseline information regarding the prevalence and spectrum of anemia in prospective blood donors to help plan a future strategy for donor management. Materials and Methods: Hemoglobin testing of donors was performed using Hemocue and Copper sulfate specific gravity method. Ethylene diamine tetraacetic acid sample of all the donors who failed either or both the screening tests was tested on automated analyzer for evaluation of hemoglobin and red blood cell indices. Results: Of all the donors, 15.5% were deferred due to anemia. Prevalence of anemia in prospective blood donors was 1.8%. It was significantly higher in female donors compared with male donors (34.2% vs 1.2%). The most common type of anemia was normocytic normochromic.