|Year : 2011 | Volume
| Issue : 1 | Page : 63-109
|Abstract of 37 th Annual Conference of Indian Society of Blood Transfusion and Immunohematology (ISBTI)
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|Date of Web Publication||21-Jan-2011|
|How to cite this article:|
. Abstract of 37 th Annual Conference of Indian Society of Blood Transfusion and Immunohematology (ISBTI). Asian J Transfus Sci 2011;5:63-109
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. Abstract of 37 th Annual Conference of Indian Society of Blood Transfusion and Immunohematology (ISBTI). Asian J Transfus Sci [serial online] 2011 [cited 2015 May 29];5:63-109. Available from: http://www.ajts.org/text.asp?2011/5/1/63/76033
12-14 th November 2010, Hyderabad
Free Papers and Posters
Blood Donation/Donor Motivation/Apheresis
Efficacy of counseling for seropostive donors
Dr. MGR Medical University, Chennai, Tamilnadu, India
Background : Transfusion transmitted infections (TTI) is a major challenge to the blood transfusion service all over the world. The problem of TTIs is directly proportional to the prevalence of infection in the blood donor community. Currently the prevention of TTIs depends upon proper predonation selection followed by proper serological testing. This results in assuring safety of transfusion of blood and blood components and minimizing the actual loss of blood units. Post donation care involves proper follow up of the donor's if they found to be positive for TTI. It makes them self-informed that they are deferred in future so as to increase the safety of blood.
Aim : To determine the efficacy of post donation counseling of seropositive voluntary donors
Methods : This is a retrospective study carried out in our department from 2007 to 2010. Voluntary donor's showing seropositivity in TTI screening (those given consent for knowing the TTI results) will be called for counseling.
Result : Total numbers of voluntary donors from 2007 to 2010 were 8882. A total of 113 donors were found to be seropositive for TTI. Ninety one donors were seropositive for hepatitis B, fourteen for HCV, four for HIV and four donors were reactive for syphilis. When they were called for counseling, only 70 donors responded and 43 donors did not respond. Of the 70 donors, only 50 donors came to the department for counseling. HbsAg and HCV positive donors were sent to SGE clinic for further management. HIV and syphilis positive donors were sent to ICTC for reconfirmation and treatment
Conclusion : Nearly fifty percent of the seropositive donors were aware of the importance of TTI. So proper donor education regarding TTI is essential to provide safe blood and blood products. Post donation counseling would help seropositive donors mentally prepared for further course of action; moreover their complete data help us to understand the profile of other healthy voluntary donors.
Evaluation of individuals deferred from blood donation for medical reasons
Pandey HC, Chaudhary R, Elhence P, Verma A,
Agarwal P, Sonkar A Katharia R.
Transfusion Medicine Department, SGPGIMS, Lucknow, India
Introduction : Whole blood (WB) donors are deferred for several reasons, either permanently or temporarily. It is well known that quite a large number of apparently healthy donors are not able to donate blood successfully because of varied reasons.
Aim : To analyze the rate and the various reasons for deferrals.
Material and Methods : A retrospective analysis of records of the donors, for 2 years from July 2008 to July 2010 was done. Deferred donors were also analyzed according to gender and age.
Results : A total of 50,495 donors registered for whole blood donation, of which 4907 (9.7%) donors were deferred for various reasons. Of the total donors registered, 5.3% were females. The common causes for deferral were low Hb 17.1 % followed by low body weight (13%), H/O of fever (6.5%), abnormal blood pressure (4.8%), Active infection (4.2%), and jaundice (4.0%). Female donors were deferred more frequently than male donors (35.1% vs. 12.7%, p<0.0001). In female donor the most common reason for deferral was low Hb and low body weight, whereas for male it was under weight followed by low Hb. The deferral rates were different in different age group. For age group of 18-25 years, most common cause for deferral was low hemoglobin level
Conclusion : Deferrals lead to loss of precious whole blood donors and blood units available for transfusion purposes. Our deferral rate as observed study is 9.7% which is similar to the published data (4%-17%), less restrictive criteria can be used for donor selection without compromising donor safety to increase the donor pool. Knowledge of rate and causes of donor deferral can guide the recruitment strategy for whole blood donation.
Finding prevalence and period of transient antigenemia in blood donors after hepatitis B vaccination
Aseem Kumar Tiwari, Vimarsh Raina, Prashant Kumar Pandey, Surbhi Dixit, Praveen Kumar
Medanta- The Medicity, Gurgaon, Hariyana, India
Introduction : Individuals recently vaccinated for hepatitis B may test positive for HBsAg and become permanently disqualified as blood donors. No deferral period is defined, after vaccination with Hepatitis B vaccine, in Transfusion Medicine Technical Manual, in India. This has never beeen studied in Indian blood donors. If HbsAg does comes reactive, temporarily, after vaccination, blood banks might have to consider temporary deferral of potential donors who received hepatitis B vaccine, recently.
Aims and objectives : This study aims to find the prevalence and period of transient antigenemia in blood donors after hepatitis B vaccination in India.
Materials and Methods : Healthcare delivery personnel especially blood bank and laboratory personnel with zero anti-HBs titers and no previous history of HbsAg vaccination are administered Hepatitis B vaccine as part of routine bio-safety protocol. Around 100 such personnel would be recruited after informed consent. Samples (seven) collected at the time of consent taking, on day 0, 1, 3, 7 and 14 and one month after the six-month immunization would be evaluated for HbsAg by chemiluminescence tests. The observations for duration of antigenemia would help find the right deferral period for a blood donor receiving Hepatitis B vaccine.
Results : Anti-HBs was performed in 160 personnel. 24 were found to have zero titre. Of these 24 personnel only 16 gave written consent for being part of the study protocol. All these 16 personnel (prospective donors) recruited so far have been tested after vaccination on day 0, 1, 3, 7 and 14. None of these donors have been tested positive for HbsAg.
Conclusion : With the data available so far, it seems that detectable transient antigenemia doesn't happen in blood donors and we need not defer donor because of HbsAg vaccination.
Donor vigilance at NIMS
Mohd Samiuddin, G Ramashastry, Sandip VS
Nizam Instt. of Medical Sciences, Hyderabad, AP, India
Aims and Objectives : We have initiated Donor Vigilance to record, report, analyze and check the facts about what contribute to donor reaction.
Introduction : Inspite of following Standard Operating Procedures and stringent donor recruitment criteria Donor Reaction are reported. Most of the Western and European studies have shown Donor Reactions and complications of around 3-7%.
Material and Methods : 10,000 units were collected (from January 2010 to July 2010) Pheresis Donors excluded. After undergoing Standard Donor Questionery and Medical Examination and Lab Test (like HB%, Blood Grouping). Only fit to donate were accepted for Blood Donation. The data is analyzed and we observed them for sweating, giddiness, loss of consciousness, fainting and vomiting. We also look into the time period - during the donation, after the donation (5 to 45 minutes) or delayed.
- The Maximum numbers of Donors were Replacement type (patient's family friends) and first time donors.
- About 3.5 % of donors had Reactions.
- Maximum number of donors had giddiness, Loss of Consciousness, sweating few associated with vomiting.
- Donors had Reactions from 5 to 45 minutes after Blood Donations and few had immediate Reactions (during donation) and some had developed Delayed Reactions
- Majority of Donors after subsequent questionery revealed sleepless nights, late night journey.
- Majority of the Donors Reactions resolved in Blood Bank by putting them in Head low position with proper ventilation and providing adequate liquids.
- Donor Reactions are more in the morning and afternoon when the donors have come to donate blood with a gap of 2 to 3 hours after their Breakfast /Lunch.
Conclusion : We conclude that Donors Questionary and proper counseling needs to be done in Donor Complex prior to bleeding procedures /phlebotomy. Staff working in post recovery room needs to be sensitized and little more vigilant and alert in handling donor after donations. This will avoid an unpleasant experience to the donors and embarassment to the staff and other donors observing this episode. This can be an important impact factor for the future Donor Recuitment and Retention program.
Adverse reactions of blood donation in voluntary donors
TN Dr. MGR Medical University, Chennai, TN, India
Background : Hemovigilance is a set of surveillance procedures covering the complete transfusion chain. Particularly, adverse events occurring during blood donation are an important part of hemovigilance. Blood donation from voluntary blood donors is sometimes associated with some unwanted reactions during or after the donation process.
Aim : This retrospective study summarizes the data on adverse reactions related to blood donation during the last two years in our centre.
Methods : Adverse reactions were analyzed retrospectively on voluntary blood donors during 2008 and 2009. Reactions were written on donor forms during the process of blood donation.
Results : Total number of blood donors during 2008 and 2009 were 5383. Adverse reactions were noted in 60 donors. Following reactions were observed in donors. Vasovagal reaction is seen in 36 donors (60%), hematoma in 5 donors (8.33%), vomiting in 15 donors (25%), convulsions in 2 donors (3.33%), hyperventilation and tetany in 2 donors (3.33%). Among 60 reactions, 38 occurred during 2008 and 22 in 2009. Most of these reactions occurred in first time donors who were more apprehensive. Vomiting was more common in those donors, who had heavy meals just before donation. Volume of blood collection did not play a role in causing reactions except in females where there were more reactions, when 450ml bag was used. All cases resolved themselves with minimal resuscitation. All donors were sent after they felt comfortable.
Conclusion : Vasovagal reaction was the most common type of adverse reaction in this study. Because of our strict donor criteria and proper pre donation donor counseling, donor education, the incidence of adverse reaction came down in the subsequent years. Post donation care of blood donors (donor resuscitation, counseling) made us to alleviate the negative effects of donation thereby making the donor satisfactory and to become a regular donor. Post donation reaction notification and counseling are important aspect of hemovigilance, thereby contributing to blood safety and donor retention.
Adverse events associated with apheresis procedures: Incidence and relative frequency
Col J Philip, Col R S Sarkar, Lt Col Satish Kumar, Amardeep Pathak
Arms Forces Medical College, Pune, India
Introduction : Apheresis procedures are usually well tolerated, but occasionally Adverse Events (AEs) of variable severity may occur during or after the procedure. AEs that occur in Donors/Patients are divided into local reactions and systemic reactions. Local reactions are mainly related to venous access, which includes haematomas, pain, hyperaemia and swelling at the phlebotomy site. Systemic reactions include pallor, sweating, dizziness, nausea/vomiting, hypotension, and Bradycardia. Citrate reaction in Apheresis is because of anticoagulants such as acid-citrate-dextrose (ACD) used during the procedure which leads to hypocalcaemia, characterized by episodes of paresthesia of the lips, oral cavity and limbs. Rarely, Tremor, Muscle spasms, Tachycardia, Arrhythmia, Convulsions and Tetany can occur.
Aim and Objective : To evaluate incidence of the AEs related to Apheresis procedures on two different cell separators (Baxter CS 3000 and Haemonetics MCS+).
Study Design and Methods : A total of 2,767 Apheresis procedures were performed over a 09 year period, out of which 1,277 were on Baxter CS 3000 and 1,490 were on Haemonetics MCS+ cell separators. Donor and procedural variables were compared among uneventful procedures and those that resulted in various types of AEs, including Venipuncture related Vascular injuries (VIs), Citrate reactions (CR), Presyncopal/Syncopal (PS) episodes, and reactions with both components (PS + CR).
Results : A total of 76 AEs occurred among 2,767 procedures (2.74%), including 45 VIs, 29 CR, 02 PS, and Nil PS + CR. VIs may be associated with smaller Total Blood Volume (TBV), small veins etc. Older age, smaller TBV may be associated with CR.
Conclusion : Apheresis procedures performed on cell separators are safe with a low incidence of significant AEs. Various types of AEs have different predisposing factors. Apheresis may be safer option for donors with risk factors for PS reactions associated with whole blood collections, such as younger age, female sex, and small TBV.
Life threatening adverse blood donor reaction incidence during blood donation camp at sir J. J. Mahanagar Raktapedhi
Sameer Sarvankar, Hitesh Pagare
R J.J. Mahanagar Raktapedhi, Mumbai, Maharashtra, India
Introduction : Post blood donation many mild reactions due to vasovagal attacks tend to occur and noted commoner in first time voluntary donors.
The incidence is case report in which severe life threatening severe reaction was noted in a voluntary donor at an outdoor Blood Donation Camp.
Case Description : 30 years old resident of Bhiwandi Thane district. Qualified the pre donation medical examination and the Hb test for donation. His weight was 55kg, Hemoglobin level - 16gm%, P-74/min, BP-140/90mm of Hg. No major illness in past or present. After consent the donor registration was done, 350ml of whole blood was collected in triple bag SAGM under all aseptic precaution by the Phlebotomist. The entire procedure of blood donation went uneventfully.
He was asked to take rest for 5 min and after taking refreshment, certificate and thank you card was handed over. After 10 minutes the donor started complaining of difficulty in breathing and chest pain. Head low position was given on examination P-110/min, BP-100/80mm of Hg. The staff nurse and B.T.O. gave initial treatment, Inj. Atropine, Inj. Adrenaline, Inj. Hydrocortisone and intravenous fluid was started.
Still the condition of the donor deteriorated; then he was shifted to J.J.Hospital where he was admitted in I.C.U. Differential diagnosis of massive Myocardial infarction against Pulmonary Thromboembolism was made. X-Ray chest and contrast enhanced chest CT-Scan showed the evidence of Pulmonary Thromboembolism however Cardiac enzymes were normal.
The donor was put on ventilatory support for 3 days and was started on Thrombolytics. The coagulation profile was done in which most of the parameters were normal. Only D-dimer was raised, PTT was prolonged.
The donor was in I.C.U. for 7 days the recovery was prolonged due to lung infection.
After undergoing several investigation the donor was diagnosed to have Pulmonary Thromboembolism after receiving treatment he was discharged.
Discussion : This was a rare type of severe life threatening donor reaction. The reasons for the pulmonary Thromboembolism was not identified it may be due to air Embolism or Thromboembolism probably from puncture site. Proper preparation of Phlebotomy site, proper technique of Phlebotomy procedure must be followed, manipulation of the needle after prick should be strictly avoided.
Therapeutic thrombocytapheresis: An effective management approach to essential thrombo-cythemia induced coronary thrombosis in patient undergoing coronary artery bypass grafting
Sudipta Sekhar Das, Satyajit Bose, Ashok Kumar Parida
The Mission Hospital, Durgapur, West Bengal, India
Introduction : A 73 year old gentleman presented with acute chest pain and shortness of breath suggestive of unstable angina. A cardiac investigation revealed cardiomyopathy and coronary artery thrombosis and elective coronary artery bypass graft was planned. To our surprise routine investigation revealed a pre-operative platelet count of 2650x 103/΅l with other parameters within normal. Subsequent bone marrow and genetic study confirmed the diagnosis of high risk essential thrombocythemia (ET) that might have triggered the onset of coronary thrombosis.
Aims and Objectives : Owing to critical condition of the patient and failure of platelet lowering drugs we planned acute reduction of platelet to < 400 x 103/΅l by Therapeutic Platelet Reduction (TPR) procedures using the latest Aphaeresis Technology.
Material and Methods : Three TPR procedures were carried out on alternate days using the cell separator Haemonetics MCS+ and TPR dedicated closed system disposable kit. Whole blood volumes between 1826 and 2920 ml were processed with ACD-A usage between 188 and 264 ml without any adverse effect.
Results : Patient platelet count was reduced to 367 x 103/΅l at the end of 3 procedures. Surgery was done with no complications and patient was discharged stable after 14 days with oral hydroxyurea and regular platelet monitoring. Counts between 210-284 x 103/΅l were maintained at follow-up.
Conclusion : TPR reduces platelet count rapidly in ET and relieves patients of acute symptoms. However TPR should be performed meticulously in ET with underlying cardiac disorder.
Role of therapeutic plasma exchange in renal allograft rejection
Makroo RN, Aggarwal DK, Arora B, Chowdhry M,
Bhatia A, Rosamma NL
Indraprastha Apollo Hospitals, New Delhi, India
Introduction : Therapeutic Plasma Exchange (TPE) is a first line treatment modality for many clinical conditions such as Thrombotic Thrombocytopenic purpura, Myasthenia Gravis etc. It has resulted in excellent clinical remission in these patients. The role TPE in renal transplant rejection is however probationary. The American Society for Apheresis (ASFA) ranks it as a category IV treatment, whereas it is not ranked as a treatment modality by the American Association of Blood Banks (AABB).
Aims and Objective : This study was undertaken at Department of Transfusion Medicine, Indraprastha Apollo Hospitals, New Delhi from January 2008 till April 2010 to evaluate the clinical efficacy of TPE in prolonging renal allograft survival.
Material and Methods : All the TPE procedures in patients of Chronis Renal Disease who had undergone kidney transplantation at our centre were retrospectively analysed. All procedures were done using an automated cell separator- MCS plus (Hemonetics, USA) and single use, sterile disposable set, REF 981E (Hemonetics, USA). 1 to 1.5 volume exchange was done depending on the patients' vital parameters and the plasma volume that was determined using patient's body weight and hematocrit. Fresh Frozen Plasma or Albumin and Normal Saline were used as replacement fluids for the procedures. Renal parameters- Serum Creatinine and Blood Urea were evaluated as measures of improvement in graft function.
Results : A total of 21 patients were treated at our institution with 154 TPE procedures, average being 6.69 procedures per patient. In 7 (33.3%) patients the renal parameters normalized (Blood Urea <50 mg/dl and Serum Creatinine= 0.7-1.3 mg/dl) after completion of TPE sessions. This cohort primarily comprised of patients with accelerated rejection, vascular rejection and antibody mediated rejections. In 9 (42.8%) cases appreciable decrease in renal parameters was noted, although absolute normal levels were not attained. Five patients (23.8%) did not show a favourable response to therapy, and renal profiles continued to be deranged. It was observed that patients with accelerated rejections, vascular rejections and antibody mediated rejections showed
Conclusion : TPE is an effective modality of treatment in the setting of renal transplant rejection and its use should be encouraged to prolong graft survival.
Therapeutic plasma exchange for acute Guillian Barrι syndrome
A.Yashovardhan, Chaitanya Kumar. I.S, Pratul Sinha, K.V. Sreedhar Babu
Sri Venkateswara Institute of Medical Sciences, Tirupati, AP, India
Introduction : Guillian Barrι syndrome (GBS) is an acquired demyelinating polyradiculo-neuropathy with postulated auto-immune pathogenesis. Therapeutic Plasma Exchange (TPE) has been reported to be useful in these patients. It is classically a disease with ascending paralysis; occurs initially in lower limbs and gradually leads to complete paralysis. Autonomic disturbances, respiratory muscle paralysis are some of its complications. Upto 10% patients may die inspite of intensive care.
Aims and Objectives : To evaluate the beneficial effects of TPE in patients with Acute GBS.
To note any adverse effects of TPE.
Materials and Methods : This study is a retrospective and prospective study. The case records of patients diagnosed as GBS by the neurology unit of SVIMS, based on characteristic clinical history, neurological examination, spinal fluid profile etc., between 2009 and June 2010 were retrieved and analyzed.
In the prospective cases, factors like disability scale, need for ventilation etc., were recorded. In patients with severe disability and with symptoms less than 2 weeks duration, unable to walk independently were planned for TPE, after obtaining an informed consent. Patients with mild symptoms or unwilling to undergo TPE were excluded.
Following premedication, a central venous access was obtained. TPE was done using Fresenius-Kabi Automated cell separator and replaced by Fresh Frozen Plasma(FFP), 20percent Human Albumin and saline. The vital signs of the patient were carefully monitored. Ventilatory support was given to patients when necessary. Any adverse reactions treated. Approximately 3-5 cycles of TPE were done for each patient and the outcome recorded.
Results : Of 78 patients, diagnosed as GBS, 50 (64.10percent) were males and 28(35.90percent) were females. In 24(30.77percent) severe cases, TPE was done.
All patients who underwent TPE showed early recovery.
Conclusion : Further controlled clinical studies are warranted to establish the efficacy of TPE in GBS patients.
One year experience of single needle plateletpheresis procedures - study of 70 procedures
Amruta Chindarkar, Nidhi Mehta
Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
Aim : To demonstrate the collection efficiency and the post-platelet count estimation accuracy following single needle platelet procedures on Amicus.
Materials and Methods : 70 successful single needle plateletpheresis procedures were performed on the Amicus Blood Cell Separator of Fenwal in the past one year.
Donor Selection Criteria : The standard donor selection criteria were applied for selection of apheresis donors. The minimum weight of the donors being 55kgs and hemoglobin was 12.5 gm% and above.
Only for donor platelet count, the minimum count was taken as 200 x 103/uL.
The pre-procedure hemogram and TTI testing of each donor was performed.
The average target yield was 4 x 1011. Of the 70, 4 procedures were double dose procedures, with a target yield of 6 x 1011.
Following the procedure, the product was rested for an hour and a representative sample collected after proper mixing. The platelet sample was tested for platelet count and WBC contamination. The actual yield and the collection efficiency were calculated for each product.
Following the procedure, the donor sample was collected for post procedure platelet count. This was compared with the estimated post count was displayed on the machine.
Data of 70 procedures was studied. (n=70)
Average Pre-procedure Platelet count 271 x 103/uL
Average Target yield for single dose 4 x 1011
Actual yield achieved 4.4 x 1011
Target yield for double dose 6 x 1011
Actual double dose yield achieved 7 x 1011
Post-procedure donor platelet count 186 x 103/uL
% of platelets removed from the donor 32%
Collection efficiency 81.6%
Our procedures on Amicus demonstrated a high collection efficiency averaging about 82%, as against the documented efficiency of 75%, as mentioned in various scientific studies. 14 procedures showed an efficiency of over 90% and efficiency of 100% and more was achieved in 7 procedures. In only 2 procedures, the actual yield was less than the target yield, with the highest being a yield of 9.4 against the target of 5. The decrease in the donor's platelet count following the procedure was 32%, well within the acceptable limits of 30-35%. sThe estimated post-procedure count demonstrated by the machine was compared with the actual post counts measured from the donor's samples. The findings were comparable.
There was a difference of +/-10 in the post-count values between the machine and the actual sample. This is not statistically significant.
Conclusion : Our data of 70 procedures demonstrates that Amicus is a highly efficient machine for Single donor plateletpheresis. At our center, we achieved a very good collection efficiency of over 80%, higher the established efficiency of 70-73%, without compromising on donor platelet count or donor comfort.
Also, the machine is fairly accurate in its post-platelet count estimation, removing only 32% of the donor platelets.
Effect of two different sampling sites and machines on hemoglobin estimation
Tendulkar. A. A, Thakkar. R, B. Ganesh
Tata Memorial Hospital, Parel, Mumbai, India
Introduction : Hemoglobin estimation is an essential criteria for blood and platelet donor selection. However, the logistics are different in platelet as compared to blood donors. Platelet donors undergo many screening tests (viz. Hb, Platelet count, Anti-HIV, Anti-HCV, HBsAg, VDRL, MP) before they can actually donate the platelets. Platelet donor's hemoglobin estimation involves two steps. In the first step, a capillary sample is tested on a portable hemoglobin analyzer and if Hb>12.5, the donor is eligible for further testing on the same day. In the 2nd step, a venous blood sample is collected and tested on an automated cell counter (gold standard). Thus different blood sampling sites and different machines are utilized in both these steps of screening.
Objective : Our aim is to compare hemoglobin estimation of the same platelet donors tested by (1) a portable hemoglobin analyser (capillary sample) and (2) Automated cell counter (Venous sample)
Materials and Methods : A detailed medical history and blood sample testing for cell counts and serology decides eligibility for the platelet donation. Donor selection criteria are as per DGHS (Directorate General Health services, India) guidelines for platelet donation. A random selection of blood samples from the routine pool of tested donors is done. The donors whose blood samples are tested on the same day by both the methods are included in the study. The donor is tested for hemoglobin by a capillary blood sample on a portable hemoglobin analyzer (Hemocontrol). A venous blood sample is collected from this group of eligible donors whose hemoglobin value is >12.5 g/dl. The venous sample is tested on the automated cell counter on the same day.
Observations : t test will be applied to test the significance.
Is it essential to inform the positive donor? - A two year study at a tertiary care hospital
Febe R. Suman, Krishnamoorthy R, Vinod K. Panicker, Alexander S, Ida S
Sri Ramachandra University, Chennai, India
Introduction : In India, screening of blood for HIV, HBsAg, and HCV are mandatory before issue, but the donors are often not informed of their positive status. Though the revised national policy states that the HIV positive donors may be offered post-test counseling, this is not a routine practice in all the transfusion centers. The HBsAg and HCV positive donors are always kept in dark. Is it essential to inform the positive donor? It is a debate still.
Aim : To study the results of post test counseling of donors to assess the outcome of the program.
Materials and Methods : Sri Ramachandra Blood Bank, Chennai took the challenge of post testing counseling of blood donors from June 2008. Blood collected from donors were screened for HIV, HBsAg, and HCV. The blood is discarded when it is positive by ELISA I for any one of the above. The donors of the blood which are positive by two different ELISA for any of the above tests were sent a letter of calling respecting their rights and maintaining confidentiality. Responded donors were given counseling and offered information about confirmation, evaluation, consultation, early treatment, follow-up and contacts testing and transmission prevention. The results were analyzed for the period of two years from June 2008 to May 2010.
Results : Among the 22,573 donors 355 (1.7%) were found to be positive in the screening tests. Letters of calling were sent to 309 (87.04%) donors. 234 (65.7%) donors with 7 (87.5%) HIV, 199 (68.85%) HBsAg, and 12 (92.31%) HCV positivity responded. None of the responded donors knew their status earlier. 82 (35%) of them were repeat donors with 201 earlier donations at various blood banks.
Conclusion : Post test counseling of positive donors is very essential for the health of the donor and his family, prevention of diseases, improving blood bank economy, reducing exposure to health care workers. All blood banks may undertake the responsibility of post-test counseling not only to HIV Positive donors but also to HBsAg, and HCV positive donors.
Does preliminary blood grouping during donor screening have any existence in modern blood banking?
Prashant Pandey, Aseem Tiwari, Ajay Kumar, Surbhi Dixit, Vimarsh Raina
Medanta the Medicity, Gurgaon, Gurgoan, India
Introduction : Transfusion of ABO-incompatible blood can lead to serious complication of transfusion. Manual method of slide grouping is an incomplete method of blood grouping associated with poor reproducibility and interpretation is subjective. Slide method of blood grouping (SMBG) is never a confirmatory test but can be performed during donor medical examination.
Aims and Objectives : 1) the advantages and disadvantages of SMBG 2) the sensitivity, specificity, positive and negative predictive value (PPV, NPV) of SMBG against the fully automated column agglutination technique(CAT) method of blood grouping.
Materials and Methods : This prospective observational study is conducted at the dept of transfusion medicine, Medanta-The medicity. Healthy blood donor between the ages of 18 - 60 (with their informed consent) were selected for study. Blood grouping through slide and automated technique (column agglutination technique, CAT-Autovueinnova, Ortho Clinical Diagnostics) were performed as per the standard operating procedure (SOP). For slide grouping during medical examination capillary blood from the puncture of finger tip was used. Blood grouping through autovue was performed in serology lab on EDTA sample collected during blood collection. In case of any discrepancy b/w slide grouping and autovueInnova, tube segment from the blood bag was used for grouping.
Results : 3800 samples were tested during the period of study. sensitivity, specificity, PPV and NPV of SMBG were found to be 99.9%, 80%, 99.9% and 80% respectively.30% of blood donor were unaware of their blood group. SMBG during medical examination proved to be very useful at our blood center. For example, selection of group specific apheresis donors became easy, inventory management (archiving and marking) of FFP became stream lined. Last but not least it provided an opportunity for the registry of Rh negative/rare blood donors. We observed a slightly increased duration of donor medical examination.
Conclusion : We recommend SMBG during donor medical examination.
Evaluation of the reasons for pre-donation deferral of prospective donors at a tertiary care hospital in Mumbai
Kokilaben Ambani hospital and Research Center, Mumbai, India
Whole blood donors deferral, either temporarily or permanently is an important step in improving the safety of blood transfusion.
A retrospective study of pre-donation deferral of prospective blood donors at a tertiary care hospital in Mumbai was conducted. Records of all pre-donation deferrals over a 12-month period from April 2009 to March 2010 were studied. Total 4004 donors were registered and screened for blood donation and all pre-donation deferral of prospective blood donors (n= 490) were analyzed. Data was collected from the database of all blood donor record forms and computer software.
Majority of donors were temporarily deferred and only few were permanently deferred. The most common reason for deferral was low hemoglobin count (26.93%), and closely followed by medication.
Details of statistics will be discussed.
Performing blood bank internal audits and reviewing statistics are vital tools for a successful blood transfusion service.
Monitoring and evaluation of deferral rates and reasons could be used as guide to modify the policy of recruitment and retention of blood donors and local regional and national levels.
Hepatitis B virus vaccination of voluntary blood donors to immunize them and prevent transfusion associated HBV infection transmission to patients through safe donors
Singh RP, Harimoorthy V, Maheswari K, Vaidya K.
Prathama Advanced Transfusion Medicine and Research Centre, Vasna, Ahmedabad, India
Introduction : Prevention of HBV transmission is still a big challenge in India due to limited availability of HBV testing facilities, trained manpower and on the other hand bad clinical practices by practitioners e.g., re usage of syringes and HBV contaminated surgical equipment. We planned to prevent this deadly disease through vaccination of our blood donors and rendered them immunized for HBV, and on the other hand made available HBV infection free blood to the patients with negligible cost involvement.
Aims and Objectives : To assess the effectiveness of hepatitis B vaccination in voluntary blood donors to immunize and prevent them from accidental acquiring HBV infection as well as made available HBV infection free blood to the patients.
Material and Methods : A total of 4036 voluntary blood donors were studied, of which 587 donors completed all three HBV vaccination doses and 894 received 2 doses and 2555 donors received 1 dose, among them 3990 were male and 46 were female. These were non reactive for HBsAg antigen tested by Biorad ELISA kits, France and among them 446 donors were also tested for HBV DNA by using COBAS s201, Roche, USA by Taqscreen MPX test kit and were negative for HBV DNA. Recombinant Hepatitis B Vaccine of Bharat Biotech international limited, Hyderabad (India) was used and one dose of 1 ml which contains 20 ug of HBsAg particles was given as intramuscular injection. The 2 ml blood sample was collected in plain BD vacutainer to test Anti HBsAg antibody titer by microparticle enzyme immunoassay (MEIA), AXYSM AUSAB, Abbott, Germany for quantitative determination and titer was done on limited number of blood donors those who completed all 3 HBV vaccination doses.
Results : Out of 4036 donors 587 has got all three doses of HBV vaccination and for anti HBs antibody and those donors' shows anti HBs antibody titer equal or more than 100 mIU/ml, considered as immunized.
Until now 40 samples were collected and tested for anti HBs antibody titer, of these 38 sample (95%) were of >1000 mIU/ml anti HBs antibody titer, but 2 sample (5%) had very low titer (one with 1.4 mIU/ml and other with 10.4 mIU/ml), were recalled and vaccinated. All of these samples were collected between 1-3 months of last (3rd) dose of hepatitis B vaccination.
Conclusion : Till the more sophisticated services are available for e.g., trained manpower, automated/semi-automated ELISA techniques, HBV screening by anti HBc IgM antibody along with HBsAg, or NAT facility which is still a distant dream due to cost barrier and unavailability in India at all the blood banks and on the other hand safe clinical practice among the doctors, HBV infection transmission is a huge challenge.
Immunization to HBV by vaccination of all blood donors serve two purposes; one is render them safe and immunized to fight against accidental exposure and secondly minimizes the risk of HBV transmission to the patients.
The long term benefit of this approach looks promising in preventing HBV infection transmission in general donor population as well as in patients by implementing simple HBV vaccination with minimal cost and expertise requirement.
Efforts to meet the challenges of 100 percent voluntary blood donation
Chaitanya Kumar I.S, A. Yashovardhan, Anju Verma,
D.S. Jothi Bai
SVIMS, Tirupati, AP, India
Introduction : In order to have a safe and sufficient blood supply, it is necessary to rely on solid voluntary blood donor base. While the World Health Organization recommends countries to develop strategies for 100% Voluntary blood donation (VBD), only 5 states in India seem to have come nearer to this by achieving more than 80%; One of them being our neighbouring state Tamilnadu with 91.1% (Chadhuri SR, 2010).
Aims and Objectives : To assess the frequency of VBD in our SVIMS Blood Bank, during the past 4 and1/2 years
To evaluate the results of the efforts taken for donor satisfaction and loyalty.
To identify the challenges and plan the strategies for achieving 100%VBD.
Materials and Methods : The donor records of all persons who donated blood at SVIMS Blood Bank from 2006 to June 2010 were analyzed and observations tabulated.
The demographic profiles of Voluntary Blood Donors were reviewed; the status of recent years compared with that of the VBD status prior to the year 2008.
Results : The VBD rate at our Blood Bank is slowly but steadily rising from 8.82% in 2006 to 27.16% in 2010. The number of voluntary donors donating blood at the blood bank has increased from 93 in 2006 to 862 during 2009.On the whole, the number of VBDs at the Blood bank was observed to be more, compared to that at the mobile camps. Male donors accounted for 92.66% of all VBDs while female donors were only 7.34%.
Conclusion : There is an increasing response for VBD, particularly at the Blood Bank itself, possibly due to the evolution of the Department of Transfusion Medicine and additional efforts taken for donor satisfaction and motivation.
Details of the efforts taken and the strategies proposed towards 100% VBD are discussed.
Blood donation experience key to donor retention
Ravi Shanker; Rajneesh Bakshi and Kamini Mehta
Prathama Blood Centre, Vasna, Ahmedabad, India
Introduction : Positive or favorable blood donation experience is key to retain voluntary blood donors. The encouragement to voluntary donations is enhanced when the blood donation service is careful about these matters (donor screening, selection, handling and comfort), as the donation of blood basically depends on the goodwill of the population served.(Woodfields 2009). Memorable blood donation experience will make the donor to repeat the donation. A blood bank has to develop and deliver practices that leave lasting impression. This paper studies donor experiences that influence favorably or unfavorably to repeat their donation.
Aims and Objectives : To study blood donor's donation experience and reasons for their repeat donation with blood centre.
Material and Methods : From the 2009 data base of Prathama Blood Centre 204 repeat donors are randomly selected and calls are placed to solicit their response on donation experience. Responses were recorded and compiled for analysis. Literature review set the contextual background on donation experience to voluntary blood donation call.
Results and Conclusions : Those respondents (70%) satisfied with their blood donation experience referred to prompt services of blood centre. Adherence to quality, good facilities and ambiance, staff behavior, donor care and recognition were sited as part of good donation experience. 37% respondents repeated their donation because they felt the blood bank is good and working for good cause. Those who are not satisfied (14%) but still continued to donate said that the staff behavior was not good at times. Frequent delays in services, donor reaction, and refreshment related issues were part of not good donation experience. They however continued because they felt the blood bank is good and working for good cause. Others (16%) expected special provisions for blood donors when they need blood.
Building donor loyalty
Prathama Blood Centre, Vasna, Ahmedabad, India
The call for 100% voluntary blood donation has been echoing in India for many years. Major challenge is insignificant increase in the number of repeat donors, reason behind is lack of donor loyalty. The management of blood bank requires continued efforts, substantial resources as well as special studies in order to establish the appropriate approach in building donor loyalty.
First and foremost step required is to become "Donor Centric Organization". Donor relationships shall be made a core organizational value to ensure long-term growth. Donor cultivation must be embraced as an objective by every department, staff member, and board member.
Donor loyalty is achieved by responding to donors with, active cultivation, careful consideration and respectful appreciation. For this complete database of donors is required. We at Prathama Blood Centre realized the importance of the same and with data available of more than 2 lac donors, started "Donor Recall Centre". Today, 48% of the total donor population of Prathama is of repeat donors.
Donor cultivation strategy plays a vital role in building donor loyalty. To implement strategy of building donor loyalty, Prathama followed basic techniques of donor cultivation.
Regular communication with donors by Donor Recall Centre Executives. Blood Bank at donors door step - Blood Mobile Vans. Excellent donor care and pleasant atmosphere Organizing events regularly. Update donors every time they donate.(TTI test results). Always thank donors for their generosity. Recognize donors in ways that they approve of. A loyal donor base delivers significant benefits including: A lower operating cost. Increased safety. Improved, sustainable growth. Improved inflow of blood and service
Optimizing donor loyalty is the key to a sustainable blood service. In fact, excellence in donor loyalty is a business imperative within the major blood systems.
High donor motivation and retention with administration of hypodermic local anesthesia (inj.Xylocain1%) during phlebotomy among first-time blood donors.
M. Soren, R.R. Panda, U. Das
Ispat General Hospital, SAIL, Rourkela, India
Introduction : Challenge to recruit and retain 100% VNRBD for blood centers to achieve 'Safe, low-risk, Blood. Huge money and energy are pumped in organizing promotional and extensive donor motivational programmes, but results are not encouraging. If, there will be 2% of highly motivated donors retained for blood centers, Nation will never face threat of shortage of blood.
Numerous demotivating factors are prevailing across the demographic population and one of the major factors is apprehension and fear for pain (Algophobia). It is a fact that, first time blood donors withdraw from blood donation because of 'Algophobia' and results poor retention.
Aim : 'Algophobia' can be eliminated from mindset of people and highest numbers of first time blood donors can be retain for repeat blood donation.
Materials and Methods : 1000- First time blood donors of both sexes, aged 18-60 years were taken for the study over a period of 12 week. Donors were divided into equal two- group. Group (A,n=500) with local anesthesia by hypodermal inj.1% xylocain over phlebotomy site and other group(wA, n=500) without anesthesia.
Anonymous, self administered (modified LSI) questionnaires were used to access the blood donor's motivation-satisfaction status during pre and post donation. Evaluation of the result was derived from the pre and post-donation questionnaires response sheet.
Results : More than 96.6% of first-time blood donor have rated overall satisfaction and motivation score(score 9-10 on scale of 10), who received local anesthesia and reported back for blood donation after 12 weeks. On the other hand only 40% of them reported for repeat-donation, who (scored 6-7 on scale of 10).
Conclusion : This simple, cheap modified phlebotomy procedure in first time blood donors has demonstrated high satisfaction, motivation and return for repeat donation. It is possible because local anesthesia have helped eliminating demotivating factor like 'Algophobi' among group (A). Whereas among group (wA) poor satisfaction and demotivating factors prevailed. "Z" Statistic (Proportion test) applied, p-value is <0.001, which is considered to be statistically significant.
Introduction of this simple procedural-tool can enhance in achieving high satisfaction, motivation and effective retention among first time blood donors.
Plateletpheresis procedure management: Need for a voluntary platelet donor program
Daksha A, Sahjid M, Rajesh S
Rajkot Voluntary Blood Bank, Rajkot, Gujarat, India
Background : Donor recruitment and their availability during emergencies for platelet donation is a major challenge today.
Aim : To form a in-house voluntary platelet donor registry and evaluate various aspects of platelet-apheresis protocol at our centre.
Material and Methods : Brochures of information regarding apheresis procedures were prepared in local and English language. Repeat voluntary blood donors of various blood groups were approached for enrolment into the platelet donor pool and were tested for TTI's. A motivation program for platelet donors was implemented. Simultaneously clinicians were aggressively approached and educated about plateletpheresis procedures. Procedures performed over a period of one year were retrospectively studied with reference to the donor parameters, plateletpheresis procedure details and product quality.
Results : 75% of platelet donors were regular blood donors. Pre-plateletpheresis platelet count ranged from 1.8 to 3.5 x 103/cumm. 90% procedures were performed on the Haemonetics MCS Plus and 10% on MCS 3P (all were single needle procedures).The average time taken for single unit collection was 80 minutes and 98 minutes respectively. Procedural interruptions occurred in 37% procedures. Average blood volume processed was 3650 ml 3625 ml respectively. 7% donors experienced mild to moderate reactions during donations. 97% of the SDP's had platelet content of > 3X 1011. Residual WBC content was 1x108 and 0.23X109/ unit respectively. 25% of plateletpheresis procedures were performed on weekends and holidays. The mean collection efficiency was 58.9% and 55%. Post- plateletpheresis platelet count did not fall below 1 x 103/cumm in any of the donors. The turn-around time for plateletpheresis procedures reduced from 7.5 hours to 3 hours after the implementation of this program.
Conclusion : Platelet yield was independent of the cell separator used. Ongoing monitoring of plateletpheresis procedure performance is essential to establish apheresis program in a new setup. Having pre-tested volunteers available for apheresis -platelet donation reduced the turn-around-time for plateletpheresis procedures significantly.
Impact of blood donation on voluntary donors
Uma S, Arumugam P
TN Dr.MGR Medical University, Chennai, TN, India
Background : A safe and sufficient blood supply is essential for modern Medicare. Donor research studies can be regarded as `the foundation of a healthy blood supply'. It is vital that efforts be made to educate the public about the importance of blood donation and encourage more people to become regular donors by devising successful recruitment and retention strategies. Positive experience is important for donor retention and the factors such as good donor care, short waiting time, physical comfort during donation and post donation are likely to foster donor return. Especially, comfortable first time donation experience remains ever in the memory of an every donor, which not only makes him or her to be a regular donor, but also helps in sharing their experience with neighbors and friends, who are potential donors, thereby encouraging voluntary blood donation.
Aims : The aim of the study is to assess the impact of voluntary blood donation on donors.
Methodology : Using a questionnaire, 530 donors were questioned about the impact of blood donation on them.The answers were considered as effects perceived by themselves.
Results : Among 530 donors, 493 donors were males and 37 donors were females. Exclusively positive effects were reported by 476 donors (86.6%), negative effects were exerted by 18 donors (3.41%) and mixed effects, where they had both positive and negative effects, were reported by 36 donors (6.82%). Among positive effects, 'feeling of satisfaction' was predominant and among the negative effects 'dizziness' was predominant than the other effects.
Conclusion : The effect elicited by blood donation on blood donors were mostly positive effects with few mixed effects and very meager negative effects. The finding of high frequency of positive effects may be of importance for the recruitment and retention of new blood donors as it may make blood donation less frightening and more attractive.
Voluntary blood donor's recruitment and retention: Futuristic approach
Ranjani P, Ravikumar Mantri, Panicker V.K, Febi R.S, Krishnamoorthy R, Alexander S
Sri Ramachandra University and Hospital, Porur, Chennai, India
Introduction : The main aim of Blood Transfusion Services (BTS) is to maintain the adequacy of blood supply from Non-remunerated and truly altruistic blood donors from the low risk population. Blood transfusion services would encounter blood demand increasingly by 27% in the next 20-25 years. Therefore continued effort should be made to maintain the donor pool sufficient to meet the local blood demand. But, donor recruitment and donor retention is not an easy task in blood services because of the dynamic nature of the socio-economic environment and the human factors involved.
Aim of the study : To study the effect of continued motivation in retaining voluntary blood donors.
Materials and methods : This study was conducted at Sri Ramachandra Blood Bank, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra University, Porur, Chennai during the period January 2009-July 2010.Donors were enquired over the phone about the blood donation experience the day following the blood donation. Greetings were sent to all donors on their respective birthday. An appeal for repeat blood donation was made after 3 months of their previous donation by sending SMS to their mobile numbers.
Results : Motivation of donors is directly proportional to the literacy rate of the population. Out of 19,720 during the period January 2009-July 2010, 69% of the donors were educated and 31% of the donors had no formal school education and these 31% required continued motivation. The literate population just needed to be reminded of the eligible date for the next donation and the need for blood.
Conclusion : To get the truly altruistic voluntary donors to donate regularly the first and foremost requirement is continued motivation. If motivator is not involved fully, the major problem faced is the retention of blood donors. Successful donor motivation and retention depend on experience of donating blood for the first time, how comfortable and convenient it has been, how efficiently the records are maintained, recalling of donors, reminding them how much they are needed, thanking them for their contribution and assuring them proper utilization of their donated blood.
Establishing donor loyalty: An experience in a rural blood bank
Deva Japa, Dorothy Lal, Maphedkar, Sanjeeth Peter
DDMM Heart Institute, Mission Road, Nadiad, Gujarat, India
Introduction : Blood banks depend on voluntary blood donors who are willing to come forward and donate blood as a gift to those in need. Even in rural areas, the demand for blood has increased; therefore there is a need to increase the donor pool to meet this demand. There are various incentive schemes initiated by blood banks to enhance donor loyalty. The strategy to retain the first time donors (maiden donors) is different depending on the type and location of the blood bank. The experience at blood banks mainly plays a role in the decision of these donors to donate a second time as walk-in donors. There are very limited studies about educating donors to build donor loyalty.
Aims and Objectives : To build donor loyalty and a donor base using education and interaction with maiden donors, in response to emergency call.
Material and Methods : All persons donating blood from July 2009 to July 2010 were analysed. There were 1199 donations, of which 407 were maiden donors responding to an emergency call, communicated through cable TV, notice boards in colleges, offices and word of mouth. The average time taken for blood donation is 40 minutes, which includes screening, tapping and refreshments. This time is utilized to educate the donors about the importance of blood and the fact that it cannot be replaced or manufactured, safety of blood donation, blood components and its utilization -where and when and clarifying doubts.
Results : Of the 407 maiden donors, 334 (82%) donors came back for a second time and 114 (34%) for a third time as walk-in donors. 80% of the donors were males between 20 - 40 years.
Conclusion : Emergency situations often elicit a generous response from the public. We should focus on the humanitarian response of this group and recruit them to the donor pool. Education gives birth to an ocean of difference in developing positive attitudes towards voluntary blood donation in true life practice among the general mass.
Back to basics -A little more attention to unrelated replacement donor
Shaiji P.S, Maria M. Baby, K.C. Usha
Medical College, Trivandrum, Kerala, India
Introduction : It is a matter of no dispute that blood safety is largely dependent on recruiting more and more voluntary non renumerated blood donors into the donor pool. Replacement donors are considered to be less safe and efforts are targeted towards converting the replacement donors into regular voluntary donors by effective counselling. Replacement donors can be divided into related and unrelated donors. Our study compares thedemographic and serological profiles of unrelated donors with voluntary blood donors as well as related blood donors. We hypothesise that unrelated replacement blood donors are safer than related blood donors and more easily converted into a regular blood donor.
Aim and Objectives : To examine the demographic profiles and TTD screening status of unrelated replacement donors.
To compare the profiles and TTD status with voluntary donors and related replacement donors
Materials and Methods : The study was done in blood donors presenting to medical college trivandrum from 2009 september to 2010 July. study subjects were divided into 3 groups- non related replacement donors, related replacement donors and voluntary nonremunerated blood donors, consisting 2000 donors in each. Each donor was separately interviewed. Age, sex, educational status, occupation, other charitable activities, involvement in social service, willingness to donate for another person etc were noted. TTD Status and blood group also was noted. Return rate was also compared. Data was analysed in SPSS ver.16
Results : Majority (79%) of unrelated replacement donors were young (<30yr) males.57% were students and 52% were associated with some social organisations. When asked about donating to another patient than the patient for whom he came for, 88%agreed which was much higher than the response from related donors (33%). TTD positivity was significantly lower in unrelated donors (p=0.01) compared to related donors and not much significantly different from voluntary donors.
Conclusion : The better TTD status and altruistic spirit of unrelated replacement donors should not be unseen and even though these donors cant replace the importance safe voluntary blood donors,attempts can be done to convert them into regular voluntary donors by counselling and appreciation which is a simple and no-cost step that can be adopted in all the blood banks.
Donor rights and expectations
Rotary Blood Bank, New Delhi, India
The importance of high quality donor care and positive staff attitudes towards blood donors. It shows how the quality of the service being provided affects the recruitment and retention of voluntary, non-remunerated donors who are regular, committed and low risk. It offers practical approach to donor service, with suggestions for improving the interaction between staff and donors.
- An Attitude of good customer service to your blood donors.
- Introduction of effective procedures to improve the service to your donors.
- A system to ensure the continuous evaluation and improvement of your service to donors.
Delivering Excellent Customer Service:
Our own expectations of how we like to be treated by people are probably no different from those of our customers, the donors.
Customer service skills are vital. Customer service needs to be very visible, with policies addressing the perspectives of all the people affected by it. This not only includes all categories of donor, but also external contacts and staff. Regular training and practice in customer service skills should be encouraged for all levels of staff.
Every donor customer has two basic needs that must be satisfied in order to provide exceptional service:
- Personal needs.
- Practical needs.
Your life on the job is never dull. Many everyday situations become opportunities to provide extraordinary service. Donors demand and deserve the best and, if you want them to return, that is what you must provide. The angry, skeptical, unhappy or difficult person creates a unique and demanding situation for even the most experienced office staff. The following skills will help you to deal with a dissatisfied donor:
- Hear them out.
- Take Responsibility for action.
Customer relation skills are as important to the effective running of a blood programme as traditionally valued clinical and clerical skills.
Donor rights and expectations
H. L. Bansal, K. M. Singal
Blood Donors Council, Rampura Phu, Punjab, India
National Guide Book on Donor Motivation brought out by Ministry of Health and Family Welfare, Govt. of India strongly recommends recognition of blood donors and voluntary organisations for promoting this humanitarian movement. Blood donation is a divine act. Mother Teresa has eulogised blood donation as 'Helping God'. Blood Donors donate blood for saving precious human lives. When they make this donation, they enjoy supreme bliss. They are Ambassadors of Goodwill and Universal Brotherhood.
Inspite of all this a voluntary blood donor has certain rights and expectations. The most important factor that will encourage him to donate blood again and again is the treatment meted out to him by the blood bankers and camp organizers. He/She expects that he/she is welcomed properly, tested according to rules, bled with upto date instruments. Sweet words spoken during his donation will definitely boost him.
Secondly, it is natural and humanitarian right of the blood donor that whenever he or all his family members need blood, he gets blood immediately without any hesitation. We have the experience at Rampura Phul in this matter. "We see to it that they get blood without any difficulty whenever and wherever needed. We love our blood donors. We strongly feel that when a blood banker accomodates a blood donor smilingly, he moves and motivates him to the maximum extent". As a result, there are hundreds of blood donors who are donating blood regularly.
An another expectation, we feel 'a right of the blood donor' is recognition of his services. It is a hard fact that the wish to be recognised is a basic human instinct. When we recognise the services rendered by an individual or organisation, it inspires him to continue his efforts. Almost in all spheres, awards are given. The Nobel Prize has inspired thousands of scientists and social workers to do their best in their respective spheres. So whereas the award, honour or recognition inspires the workers getting the honour, it also prompts thousands of others to emulate the shining example set by him. Therefore, awards and incentives are integral part of blood donor motivation.
In all most all the countries, several states in India, Indian Red Cross Society and Indian Society of Blood Transfusion honour the blood donors / organisations. So the conclusion is that recognition plays an immensely motivational role in the domain of blood donation and fulfils the expectations of blood donor.
Implementation of pre and post donation counseling for donors in the blood bank: Observations made and lessons learnt
Mitali Rajpopat, Siddharth Herma, Kalpesh Vala, Sahjid Mukhida, Rajesh Sawant
Rajkot Voluntary Blood Bank, Rajkot, Gujarat, India
Background : Blood banks which do not conduct NAT for transfusion transmitted infection (TTI) testing have to rely largely on effective donor screening protocols for the identification of low-risk voluntary blood donors. We have implemented pre and post- donation counseling for all in-house donors since 1st December 2009.
Aim : To understand psychology of donors regarding blood safety and high risk behavior with the implementation of the donor counseling program.
Materials and Methods : A donor informed consent form and questionnaire on blood safety with series of medical, behavioral and general questions was prepared. While pre-donation screening, the donors were offered an option for knowing the test results of TTIs screened in the blood bank. Donor answered the blood safety questionnaire during both pre and post- test counseling sessions. Confidentiality was maintained throughout the process.
Results : Out of the total 3957 in-house donors during the study period, 3870 (97%) donors were offered pre-donation counseling. 14% donors were first time donors and 70% were married. 15% donors accepted high risk behavior in pre-donation counseling session. 853 (22%) donors returned for post-donation counseling. The TTI reactivity rate amongst indoor donors was 0.9%. All the above donors had opted for knowing their test results and only 20 (54% of reactive donors) reported back for post donation counseling. Most of the reactive donors were in 30-40 years age group. 56% donors knew about HIV infection, but 96% donors were unclear about the concept of window period. 4 out of 3957 donors(0.1%) had opted for the CUE option. Difference in acceptance of high risk behavior during the pre vs post-test counseling, indicative of test-seeking behavior was observed in 35(4%) of donors.
Conclusion : Lack of knowledge regarding blood safety, window period transmission and importance of altruism was observed in a high proportion of donors. Counseling skills should be improved with focus on strategies to increase the return rate of donors for post-test counseling.
Is it rational to double check blood donors for hemoglobin; preserving the blood supply of rare blood and single donor platelet units and also as sentinels of general population health
Atul Sonker, Anju Dubey, Rahul Katharia,
Rajendra K. Chaudhry
Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
Background : Blood donor suitability criteria represent procedures to provide safety for both donors as well as recipients. Donors are deferred for multiple reasons. Losses related to disease marker rates are well established. Donor and donation losses for other reasons, like low hemoglobin, however, have not been extensively studied in developing country like India.
Aims and Objectives : To evaluate impact of double checking the hemoglobin on Rh (D) negative packed red cell and SDP inventory by prevention of false deferrals. To raise health awareness among blood donors, deferred on the basis of anemia.
Material and Methods : Extensive detailed analysis of pre-donation Hb assessment by copper sulphate specific gravity method and further by rapid quantitative method HemoCue (M/S DiaMed) method for allogeneic whole-blood donations as well as platelet apheresis (as per departmental SOP), was done. The donors found to be anemic were given proper referral.
Results : During the study period of three years (Aug 2007 to Jul 2010), total of 64985 donors were subjected to primary Hb screening by copper sulphate specific gravity method. 1705(2.62%) did not pass Hb check and out of these 1554 donors were further tested by Hemocue, 186 (12%) passed and were allowed to donate blood or undergo platelet apheresis procedure. By these blood donations, our inventory received additional 8 SDP and 178 whole blood units including 11 Rh negative units.
Conclusion : Loss of precious blood and SDP units due to false deferral on the basis of low hemoglobin was prevented by using a quantitative second check. Positive impact of quantitative hemoglobin estimation was found to be a sentinel of general blood donor population health.
Analysis of voluntary blood donors deferral data at Sir J. J. Mahanagar Raktapedhi
Ms. Vidula Kothamkar, Hitesh Pagare
Sir J. J. Mahanagar Raktapedhi, Mumbai, Maharashtra, India
Introduction : Proper selection of voluntary donors is one of the pre-requisite of any blood transfusion services.
The acceptance of any voluntary donor therefore depends on their satisfying certain criteria designed to protect both donor and recipient.
Aims : To analyze the reasons for which donors were defered
Materials and Methods : The data was collected at Sir J. J. Mahanagar Raktapedhi from 1st March 2009 to 28th Feb 2010. The entries of the donor forms were made in donor deferral register and the data obtained was analysed.
Hemoglobin was tested using Hemocue -301 by rapid photometry method.
Results and Discussion : Total 20,043 donors were screened out of which 17996 donated and 2047 were rejected which is 11.6% of total donors.
The percentage of Temporary Deferral was 87.4% of all the deferred donors.
All the donors were rejected under 33 causes. Commonest cause was low Hb which constituted to 53.98% of total donor rejected out of which 71% were female donors in their reproductive age group. Second cause of rejection was donor under medication for fever which included antibiotics was 13%. 12.6% of donors were deferred permanently high BP was amongst the highest deferral cause followed by asthma and diabetes on insulin. Rejection due to H/O Malaria and H/O Jaundice was 3% and 1.42% respectively.
Study of factors that motivate and hinder the blood donation decision among the younger population of Jammu city
Sonam Kumari, T.R. Raina
Government Medical College, Jammu, J&K, India
Background : To achieve the target goal of 100% Voluntary Non Remunerated Blood Donation in India, factors influencing the blood donation decision needs to be investigated. These factors influence the donation efficiency, safety, retention, collection number and diversity of the donor pool.
Aim : The aim of the study was to investigate the factors responsible for donating blood and the factors responsible for not donating blood among the younger population of Jammu City.
Material and Methods : The study involved 1520 College Students of 18 - 26 years age group. Donor questionnaire proforma was distributed among all the students that contained questions regarding blood donation, reasons for donating blood and the reasons for not donating blood.
Results : Out of the 1520 students involved in the study 210 (13.81%) were known blood donors and 1310 (86.18%) were non blood donors. Main reasons for voluntary blood donation were "Altruism", doing good to others, 'Sense of social responsibility", and "For helping friends and relatives". Main reasons for not donating blood were "Fear of needle/ Fear of sight of blood", "Fear of illness / ill effects", " Objection from elders", and " Never been asked for Blood Donation".
Conclusions : In this study "Sense of social responsibility" was the commonest reason for voluntary blood donation while "Fear of illness" and "never been asked for blood donation" were the main reasons for not donating blood. To increase the blood donation, younger population must be counselled so that all the myths and the false beliefs regarding blood donation can be mitigated. Specific campaigns targeting the youth, motivating them to become Regular Voluntary Non - Remunerated Blood Donors should be conducted.
Innovative approaches in blood donor motivational programmes
l.K. Dadhich, V.P. Gupta
Krishna-Rotary Blood Bank, Kota, Rajasthan, India
Introduction : Blood donor motivational programmes are very important activities from the point of view of Blood Donation Camps, which are normally organized by blood donor turned motivator, who knows about all the intricacies and the needs related to the blood banks. Since, a motivator is himself a blood donor he has in him a self developed capacity of turning a person to be a blood donor. He also knows that the retention of previous donors and the recruitment of new donors is a serious challenge for many blood donation services in their effort to prevent blood shortages. More and more services make use of some sort of donation incentives. However, the use of (material) incentives to motivate blood donors is fiercely controversial, and there is a longstanding (ethical) debate about whether it should be allowed that donors receive material rewards. Interestingly, this debate is dealt with in almost complete absence of systematic empirical evidence on the effectiveness of material incentives in encouraging people to donate.
Aims : The aim of this study was to establish which motivational and socio-demographic factors are important for the development of a long-term commitment as a safe, voluntary, non-remunerated blood donor.
Material and Methods : A cross-sectional sample survey of active blood donors in Kota, Rajasthan was conducted. Donors filled in a self-administered questionnaire during donation. Data on motivation were analyzed using factor analysis and were shown to potential blood donors for motivation and knowledge as feed forward.
Results : The blood donors' socio-demographic characteristics were found to be similar to those of the population as a whole. The single, most important, recruitment channel was the influence of active blood donors. Five dimensions of blood-donor motivation as known to many volunteers working for blood donation camps, campaigns and movements were identified with factor analysis. These were: altruism and empathy; social reasons (such as the influence of friends and family); strengthening of one's self-esteem; positive experiences associated with donation; and a moral obligation to donate. Support for statements on altruistic motives for donation was strong and similar in long-time and short-time donors. In contrast, short-time donors were more likely to be motivated by factors related to self-esteem than were long-term donors.
Conclusion : In this article, we present that the discussion on what is ethical in motivating blood donors should be enriched with empirical evidence based on field experiments. We confront the Titmuss controversy with grass root movement RAKT KRANTI 2010 an experiment administering Rural motor vehicle rally as a motivation device in order to take up a neglected phenomenon in the study of blood donors. Many non donors are not principally against donating blood; they have just never made up their mind about becoming active blood donors. We propose active decisions as a mechanism to transform latent pro social preferences into actual pro social behavior. The 'good habit' of continued blood donation seems not to be exclusively linked to a high degree of reported other-regarding ('altruistic') reasons, but also to a combination of motives, including some modestly self-regarding motives experienced by this innovative movement supported by many blood donors, motivators and the camp Organizers.
Evaluation of the Sensitivity and Specificity of Enhanced Chemiluminescence VITROS ECi Vs ELISA in the detection of Hepatitis C Viral infection in Blood Donor using Confirmatory RIBA HCV
Transfusion Transmitted Infections
Seroepidemiology of hepatitis 'A' in voluntary blood donors from Pune, India
Smita Joshi, Purnima Rao, Madhuri Joshi,
Shobha D. Chidambar
Sahyadri Speciality Hospital, Pune, India
Introduction : Previously Hepatitis `A` virus was considered to be the sole causative pathogen for Hepatitis. Infection with ` Hepatitis `A` being self limiting and was never a fatal disease But still a virus like Hepatitis A is involved it concerns of more importance and hence earlier it was referred as infectious hepatitis. Because of unhygienic conditions in India it is a major Public Health problem as more than 2 million cases are noticed each year. Prevalence of Hepatitis `A is inversely related to socioeconomic status. Hepatitis A is a disease of paediatric age group in developing countries and disease of adults in developed countries. Hepatitis `A` is usually mild in children but the disease is more serious and prolonged in adults.
Aim : Hepatitis `A` virus (HAV) is a single stranded and non enveloped RNA virus. It is usually transmitted by faeco- oral and blood transfusion routes. Hence this study was taken up.
Objective : The objective of this study was to find the prevalence of HAV among voluntary blood donors.
Material and Methods : Sera of 124 blood donors who were negative for anti HIV, HBsAg and anti HCV were tested for total anti HAV antibodies (IgG + IgM) by Elisa using commercial kits available at National Institute of Virology. (NIV)
Result : The prevalence of total anti HAV antibodies in blood donors was very high i.e 96.8%. That means these 120 donors were either immunized or infected in childhood.
In conclusion we must note following points.
- Blood donors selection must be performed carefully.
- India is experiencing transition in the epidemiology of Hepatitis A.
Both hyper and intermediate prevalence co-exist even in the same city.
- Formulation of National policy for the control of Hepatitis A is desirable by vaccination programme.
- Explosive outbreaks likely.
To study the correlation between reactive anti-HCV ELISA tests and HCV NAT and or riba in voluntary blood donors
Sunita Tulsiani, Priti Desai 1 , Ripal Shah 2 , Ankit Mathur 3 , V. Harimoorthy 4 , N. Choudhury 5
Jeevan Jyoti Blood Bank, Nagpur; 1 Tata Memorial Hospital, Mumbai; 2 GSCBT, Ahmedabad; 3 Rotary Blood Bank, Banglore; 4 Prathama Blood Centre, Ahmedabad; 5 Tata Medical Sciences, Calcutta, India
Introduction : In India, most of the blood banks do test for HCV by ELISA (Enzyme Linked Immunosorbent Assay) method, which may give high false positive results. There is a need for a more standardized approach to the screening of blood donors with the aim of minimizing the number of false reactive test results.
Aim : This study was conducted to assess if the blood donors who were reactive on ELISA were confirmed positive by NAT (Nucleic Acid Testing) and /RIBA (Recombinant Immunoblot Assay). It also correlated the results of samples reactive by single ELISA vs those by two ELISA kits with NAT and/ RIBA results. Correlation between Sample- to- cut- off ratio (S/CO) of ELISA results with NAT and RIBA was also done.
Material and Methods : A total of 68,951 blood units were screened by two anti-HCV ELISA kits over a period of 15 months at three blood banks in Ahmedabad. The total 140 anti-HCV ELISA reactive samples were tested by NAT. The NAT negative samples were tested by RIBA. Analysis of samples reactive in only single ELISA kit (87) vs. those reactive by both ELISA kits (53) was done. Correlation of S/CO with NAT/RIBA results was done.
Results : Out of 140 anti-HCV ELISA reactive samples, a total of 16 (11.43%) were positive by NAT. Of the 124 NAT negative samples, RIBA was positive in 6 (4.84%), negative in 92 (74.19%) and indeterminate in 26 (20.97%) samples. None of the sample which was reactive in only single ELISA kit was positive by NAT or RIBA. A significant association was observed between low S/CO ratio and negative NAT and RIBA results.
Conclusion : Only a minority of donors with repeatedly reactive anti-HCV screening tests is positive by confirmatory testing, but all these reactive blood units are discarded as per existing legal provisions. Efforts should be made to retain these donors and also donor units.
Evaluation of various techniques for sero-diagnosis of syphilis in blood donors
Deepti Sachan, Anupam Verma, R K Chaudhary
SGPGIMS, Lucknow, India
Introduction : In India, it is mandatory that blood banks screen every donation for syphilis. There are currently a large number of different commercial treponemal and non-treponemal tests available for syphilis screening in blood donors. Rapid plasma regain (RPR), the most common screening tests has disadvantage of false positive reactions. Apart from this particle gel immunoassay (PaGIA) and solid phase immunochromatographic test are also currently available as specific assays for syphilis. The confirmatory assays include treponemal tests such as TPHA and ELISA which are rarely used in blood bank settings.
Aim : This study was planned to evaluate the performance of various techniques for sero-diagnosis of syphilis in blood donors visiting SGPGI.
Methods : RPR was performed on sera collected from blood donors during a period of 18 months (Oct 2008 to Jan 2010) and titer was determined on RPR positive samples. Further all the sera were tested by ELISA (Treponostika, BioMιrieux, France), TPHA (Omega diagnostics, UK), PaGIA gel immunoassay (Diamed, Switzerland) and a rapid immunochromatographic assay (SD diagnostics, Gurgaon). TPHA was taken as gold standard technique.
Results : Out of 28,544 donors screened for syphilis by RPR method, 132 donors were found to be RPR reactive with 0.46% seropositivity. RPR titer was found <4 in 50% (n=66) donors and >8 in 35.6% (n=47) donors. TPHA was positive in 64.4% (n=85), negative in 34.8% (n=46) while 1 was indeterminate at a dilution of 1:80. ELISA and TPHA showed 95.5% concordant results and 04 samples were TPHA negative and ELISA positive. Rapid immunochromatographic tests showed positive in 86 (65.2%) with 100% sensitivity and 97% specificity while PaGIA showed 100% sensitivity and 92% specificity. The correlation of RPR titer with other methods was also found significant.
Conclusion : Rapid immunochromatographic test shows an excellent sensitivity and specificity compared to PaGIA and RPR. It can be used as a rapid treponemal test for screening of blood donors especially in resource poor countries. ELISA can be used for further confirmation of syphilis.
Incidence of HIV reactivity and co-infection among voluntary blood donors (2003-2008): Case of Rotary blood bank, Delhi
Anju Verma, Asha Bazaz, Surjit Singh Dabas,
Rotary Blood Bank, New Delhi, India
Introduction : Blood transfusion has been contributing about 2 to 10 percent HIV transmission in India and blood safety measures have been adopted throughout the country to combat HIV spread. Since 1988, it has been made mandatory to screen all collected blood for HIV in the country. Considering the importance, Government of India announced National Blood Policy in April 2002, and the policy statement spells out an integrated strategy for collection of voluntary blood, screening of all donated blood for essential transfusion-transmitted infections.
Methods : Year-wise of Rotary Blood Bank from 2003 to June 2008 was collected and analysed for calculating the HIV incidence and co-infection. A total number of 207556 units of blood were collected during the period.
Results : The voluntary donations with Rotary Blood Bank have increased substantially since 2003. The total number of donors were 29084 during 2003, which increased to 31094 during 2004. The number of donors increased to 37201 units during 2008 by organizing 501 camps in National Capital Region (NCR). The rate of HIV incidence among donors during 2004 was 0.17 percent, which increased to 0.33 percent during 2008. Analysis also reveals that incidence of co-infection was found to be higher among men compared to women.
Conclusion : The increase in the HIV incidence among voluntary donors is a matter of great concern. It is hereby suggested to have a uniform testing policy for blood banks, to ensure safe blood supply. A centralized reference system, for confirmatory test for the virus after screening HIV reactive, is also the need of the hour.
Keywords: HIV, incidence, blood safety, voluntary donation, transfusion.
Role of anti HBC screening in blood donors to reduce post transfusion hepatitis B in India
Reeta Rai, M. Chandrashekhar
Max Super Speciality Hospital, Delhi, India
Introduction : The Screening test for hepatitis B infection for Blood donors is Hepatitis B surface antigen but inspite of mandatory screening for HBsAg transfusion transmitted Hepatitis B infection continues to be a problem in our country. Anti HBc test is an useful marker to indicate resolved HBV infection in remote past, low grade chronic infection or occult HBV infection with a mutant strain of HBV.
Aim : To evaluate whether anti HBc test can be added as screening test for Hepatitis B Virus in addition to HBsAg.
Materials and Methods : 1138 donors were screened from June 2008 to November 2008 for HBsAg and anti HBc using Vitros Eci system. 62 Positive sample of Anti HBc antibody was tested for anti HBs.
Result : Out of 1138 donor samples tested 88 (7.7%) were reactive for anti HBc only and 15 (1.3%) samples reactive for both HBsAg and anti HBc. Only 62 samples of HBsAg negative and anti HBc reactive tested for anti HBs. 38 (61%) donor samples were reactive for anti HBs with levels >12 mIU/mL and 24 (38%) were non reactive for anti HBs and potentially infectious to transmit Hepatitis B infection.
Conclusion : Approximately 9% of donor population is anti HBc reactive and there is high incidence of post transfusion hepatitis B in our country. Anti HBc test can help to prevent Hepatitis B virus infection transmitted through HBsAg negative donors. It is likely that anti HBc testing helps in reduction of Hepatitis B infectious units entering donor pool. Although this test has potential benefit it may have high false positive results leading to high discard rate. Anti HBs testing is helpful as it is a marker of recovery and protective immunity. We propose that anti HBc testing may be added to pretransfusion screening and units reactive for anti HBc should be tested for anti HBs. Units non reactive for anti HBs should be discarded and units reactive for anti HBs added to inventory, as donor samples reactive for anti HBc and anti HBs are presumed non infectious and safe for transfusion.
This may be a good strategy to improve the safety for HBV transmission although not fool proof. NAT testing for HBV-DNA would be ideal but due to cost constraint this strategy can be applied for the country as a whole.
Low Prevalence of Transfusion Transmitted Infection at tertiary care hospital in Mumbai
Low prevalence of transfusion transmitted infection at tertiary care hospital in Mumbai
Manoj Gupta, Nidhi Mehta
Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
Background : Blood transfusion is the most widely used medical procedure for the clinical care of critically ill patients. The aim of the study was to assess the prevalence of transfusion-transmissible infections among blood donors.
Methods : During the period of April 2009 to July 2010 total of 5954 blood donors presented to our department. 669 donors were deferred due to multiple reasons. The male donors (96.56%) were significantly higher than the female donors (3.43%).
A total of 5285 blood units collected were tested for transfusion transmitted infection markers i.e. HIV 1 and 2 (Ag/Ab Combo), HBV, HCV, Syphilis and Malaria as per the Drug and Cosmetic Act of India. Virology testing is done by CMIA technique; Syphilis is tested by Rapid Plasma Reagin method and Malaria by rapid immunochromatographic test.
Results : The sero-prevalence of HBV was 56 (1.05%), for HCV 10 (0.18%), for HIV 1 and 2 11 (0.20%), for Syphilis 10 (0.18%) and 1 (0.018%) positive for Malarial parasite. 2 (0.037) donors tested positive for syphilis as well as HIV.
Conclusion : TTI marker especially for HBV and HCV is very low as compared to National data.
Low sero-positivity for diseases in our study could be attributed to proper pre-donation counseling of blood donors, the stringent donor selection criteria and self rejection criteria.
The extended grey zone phenomenon
Dilliram Silpakar, Sanjana Dontula, Ankit Mathur,
Rotary TTK Blood Bank, Bangalore, India
Background : The sensitivity of the screening tests for Transfusion Transmissible Infections is an important factor in ensuring blood safety. For ELISA based assays, as per kit criteria, the Initially Reactive (IR) samples, i.e. with Optical Density (OD) greater than Cut Off (CO), and those less than CO but within the 10% 'Grey Zone' (GZ), are to be retested in duplicate. All others are considered Non Reactive (NR) and fit for transfusion.
We observed that some samples had an OD less than GZ, but much higher than the other non-reactive samples of that run. These samples are considered negative as per kit criteria. However, we termed the samples in the 30% range below CO as "Extended Grey Zone" (EGZ) and retested them in duplicate. A few of these EGZ samples tested repeat reactive.
If these EGZ were not retested then false negative blood units would have been transfused with serious consequences to the patient.
Aim : To evaluate EGZ samples to improve blood safety.
Methods : The study was conducted at Rotary Bangalore-TTK Blood Bank, Bangalore Medical Services Trust, Bangalore from the period Jan 2007 - July 2010.
All blood samples at our centre are tested with the 3rd / 4th generation EIA kits for HBs Ag, anti HIV 1 and 2 and anti HCV. In addition to the IR samples, EGZ samples were also retested in duplicate. All Repeat Reactive (RR) units were considered not fit for transfusion and discarded.
Results : The number of blood units screened by ELISA from January 2007 to July 2010 was 76156.
Of the 44 EGZ samples for anti HIV, 3 were RR. Of the 40 EGZ samples for HBsAg, 3 were RR and of the 67 EGZ samples for anti HCV, 9 were RR.
Conclusion : There may be several reasons that could give rise to this phenomenon such as technical discrepancies, or low antibody titer. The kits used are manufactured in countries outside India and therefore may not detect viral variants prevalent in the Indian population. This was a retrospective study and the 15 EGZ samples, which were RR, were not issued to patients. Due to resource constraints, confirmatory tests could not be performed on these samples hence we do not know if these samples were false reactive. We hope to continue the study and do confirmatory testing to test the validity of the EGZ phenomenon.
In developing countries where Nucleic Acid Testing is not mandatory, this extended grey zone criteria can be an additional layer of safety in blood transfusion centers. Nevertheless, if indeed such Extended Grey Zone samples are confirmed positive, the question then arises, is the 10% below CO criterion to define the Grey Zone for ELISA assays, adequate to ensure blood safety
Prevention of hepatitis B virus transmission through HBV vaccination of voluntary blood donors
Kishore M., Jayshree S., Ravindra P., Krupali V.
Prathama Blood Centre, Vasna, Ahmedabad, India
Hepatitis B virus vaccination of voluntary blood donors to immunize them as well as prevent transfusion associated HBV transmission through safe population.
Introduction : Transfusion transmitted HBV infection is real challenge in developing countries including India especially in Gujarat by reusage of contaminated syringes. Exposure to blood through injections with nonsterile equipment or transfusion of contaminated blood products is a common and preventable cause of hepatitis B virus infection.
Aim : In this study we aimed to assess the efficacy of hepatitis B vaccination in voluntary blood donors to immunize and prevent HBV infection transmission through blood transfusion and increase the immunized population to prevent them from accidental acquiring HBV infection.
Material and Methods : The blood donors are selected which are non reactive for HBsAg antigen had sensitivity of 0.2 ng/ml tested by Biorad ELISA kits on automated EVOLIS system, Biorad. Anti HBs antibodies titer were done on limited number of blood donors those who completed all 3 HBV vaccination doses. Recombinant Hepatitis B Vaccine of Bharat Biotech international limited, Hyderabad (India) was used and single dose of 1 ml containing 20 ug of HBsAg.
Results : A total of 2648 repeat voluntary blood donors were studied, 994 donors completed all three doses, 1769 received 2 doses and all 2648 donors received 1 dose. All are HBsAg non reactive for HBV tested by BIORAD HBsAg ELISA kits. 10 donor's 2 ml blood sample tested for anti HBs antibody titer to assess immunization status. All shows anti HBs antibody titer equal or more than 10 mIU/L considered as immunized.
Conclusion : Almost all adequately vaccinated individuals have shown evidence of immunity in the form of persisting anti-HBs and/or in vitro B-cell stimulation. Safe blood procurement is encouraging by promoting voluntary blood donations and further safety is added by vaccination of the population against hepatitis B virus.
Comparison of ELISA, rapid and nat testing in aphaeresis blood donor screening
R N Makroo, Mohit Chowdhry, Aakanksha Bhatia,
Richa Gupta, Minimol
Indraprastha Apollo Hospitals, New Delhi, India
Introduction : Screening for infections like Hepatitis C, Hepatitis B and HIV is an important step towards blood safety. Although ELISA is the mandatory test for infectious marker screening, recently Nucleic Acid Testing (NAT) has been incorporated at various centers in order to improve blood safety. The rapid tests, although easy to perform and provide faster results, concerns about the sensitivity and accuracy of these kits still exist.
Aims and Objective : This study aims at comparing the three commonly used techniques for infectious marker screening, i.e. the ELISA, Rapid and NAT for infectious marker screening in aphaeresis blood donors.
Methods : This study was conducted over a period of 6 months on 1090 aphaeresis donors coming to the Department of Transfusion Medicine, Indraprastha Apollo Hospitals. Samples collected from these donors were subjected to screening by all three techniques i.e. ELISA (Monolisa HbsAg ULTRA/ BIORAD, Murex anti HCV/ABBOTT murex, Genscreen plus HIV Ag- Ab/ Biorad), Rapid test kits for HIV (HIV Tridot/JMitra), HBsAg (Virucheck/Orchid) and HCV (HCV Tridot/JMitra) and ID-NAT (Procleix Ultrio/Chiron). All the reactive samples were tested further by confirmatory tests including Western Blot (New Lav Blot I/ Bio-Rad) and Polymerase Chain Reaction (cobas amplicor).
Results : A total of 1090 donors were tested of whom 22 donors were reactive by at least by one of the three techniques. Out of these 14 were reactive for hepatitis B, 2 for HIV and 6 for HCV. 17 donors were reactive by all the three techniques. The yield by NAT (NAT positive; Rapid and ELISA negative) was one (HCV). Four donors showed positivity only with ELISA (3 for HCV, 1 for HIV). Further testing using confirmatory tests identified these cases to be false positive.
Conclusion : Although ELISA and rapid screening tests appeared comparable, variable false positivity was observed with the former. NAT testing picked up one additional infection in HCV in the study. Thus, incorporation of NAT testing in screening of blood donors will help in improving blood safety.
Correlation between ELISA and nucleic acid testing in blood donor screening-SRMC experience
Ravikumar Mantri, Ranjani P, Panicker V.K, Febi R.S, Krishnamoorthy R, Alexander S
Sri Ramachandra University and Hospital, Chennai, India
Introduction : Blood safety remains an issue of major concern in transfusion medicine due to growing pandemic and an increasing trend of positivity for HIV and Hepatitis markers among blood donors. Sensitivity and specificity of serological (ELISA) and molecular (NAT) techniques used in blood donor screening has an impact on blood safety.
Aims and Objectives : To study the correlation between serology and Nucleic Acid Testing (NAT) for HBV, HCV, and HIV on blood donor samples.
Methodology : This study was conducted at the Sri Ramachandra Blood Bank, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra University, Porur, Chennai, during the period January 2009-July 2010. In addition to the mandatory TTI screening tests, which include screening for HBsAg, anti-HCV, anti-HIV 1 and 2 by ELISA, all blood donor samples were subjected to core antibody testing (AHBc ELISA) and Individual Donor Nucleic Acid Test (ID-NAT) for HBV, HCV, and HIV. NAT was done by Transcription-Mediated Amplification (TMA) technology using multiplex and discriminatory testing.
Results : Out of 19,720 samples screened both by ELISA and NAT 19 were found be reactive for HIV both by ELISA and NAT ; 19 cases were anti-HCV ELISA reactive out of which only 17 were NAT reactive and 2 were non reactive by NAT. 286 samples were HBsAg positive by ELISA of which 32 were Non-reactive by NAT. 11 samples that were initially reactive by multiplex NAT gave non-reactive results on doing a discriminatory assay.
Conclusion : In our view, ELISA still remains the gold standard for blood donor screening. However, alternate NAT technologies need to be evaluated.
Six year study of prevalence of blood transfusion transmitted diseases in blood donors at blood bank of C. U. Shah Medical College and Hospital, Surendranagar
Parekh Malay, A.S. Agnihotri, Dhiren Kapupara
C. U. Shah Medical College and Hospital, Surendranagar, Gujarat, India
Background : Transfusion-transmissible infectious agents such as hepatitis B virus (HBV), human immunodeficiency virus (HIV), hepatitis C virus (HCV) and syphilis are among the greatest threats to blood safety for transfusion recipients and pose a serious public health problem. The outcome of measures designed to improve transfusion safety can be assessed by evaluating the prevalence of TTDs at Surendranagar situated in Gujarat and enjoys one of the best health care facilities including Blood transfusion services in region.
Material and Methods : An analytical study was carried out to study seroprevalence for HIV, HBsAg, HCV and VDRL among 15,570 healthy blood donors for a period of six years from Jan'03 to Dec'08 at blood bank, C. U. Shah Medical Medical College and Hospital, Surendranagar was done. WHO guidelines for selection of blood donors are strictly followed.
Result : There were 2,896 (18.6%) voluntary donors and 12,674 (81.4%) replacement donors. Seropositivity rate of HIV, HBsAg, HCV and VDRL is 0.29%, 1.13%, 0.096% and 1.149% respectively. Prevalence rate of TTDs in replacement donors (2.95%) is higher as compared to voluntary donors (1.45%).
Conclusion : TTDs are of prime importance for safe blood banking. However taking in to account the lower seropositivity among voluntary donors more efforts should be done to encourage voluntary donation to replace replacement donation as per national policy. Safe donation depends on the expansion of donor selection criteria, standardized testing facilities for TTDs and promotion of voluntary donation.
Seroprevalance and risk factors of hepatitis C virus, hepatitis B virus and human immunodeficiency virus in multiply transfused recipients in a tertiary care blood bank
Lt Col Satish Kumar, Col R S Sarkar, Col J Philip, Sumathi S H
Armed Forces Medical College, Pune, India
Introduction : The worldwide prevalence of and trends in transfusion-transmitted viral infections (TTIs) have been documented extensively. Transfusion transmitted hepatitis continues to be a problem in many parts of the world, especially where population prevalence of the parenterally transmitted hepatitis is high.
The blood supply in developed countries is very safe; in contrast, TTIs remain a significant public health problem in developing countries. The probability of contacting infection is further increased in developing countries like India where diagnosis of the underlying disease is late and blood-banking practices are poorly developed. Few reports have measured the prevalence of and risk factors for acquired blood-borne infections in individuals requiring multiple transfusions. Patients with ί thalassemia, hemato-oncology disorders and chronic renal failure, who receive multiple transfusions of blood or blood products, are at an increased risk of transfusion transmitted infections. The safety of the blood supply is an important factor in maintaining a low rate of TTI. Several risk factors, such as demographics and medical status, are related to blood transmitted infections, and patients receiving chronic transfusions are at high risk for TTI.
Aims and Objectives : The purpose of this study was to assess the prevalence of blood-transmitted infections in multiply transfused patients and to identify the current risk factors associated with these illnesses in a tertiary care setting.
Materials and Methods : A cross-sectional descriptive survey was done and 100 multi-transfused patients were recruited from tertiary care blood bank of Armed Forces Medical College and the attached tertiary care Command Hospital (Southern Command) Pune. The medical records of the included patients were examined to obtain the clinically relevant data. Peripheral blood samples were obtained from all patients and serum was subjected to detect serologic markers for Human Immunodeficiency virus (HIV), Hepatitis B Virus (HBV) and Hepatitis C virus (HCV) using commercial detection kits according to the manufacturers' instructions. The presence of these viruses and demographic, behavioural and medical factors influencing their prevalence were assessed. Statistical analysis and differences in proportions were compared by a two-tailed chi-square test or two-tailed Fisher's exact test and P value of 0.05 or less was considered significant for all tests.
Results : A total of 100 male and female multiply transfused patients were studied. The prevalence was 12.0% for HCV, 2% for HBV, and 2% for HIV infections. Patients with thalassemia had the highest prevalence for HCV and HIV infections, and haemato-oncology patients for HBV infection. The risk factors related to acquired HIV and HCV were thalassemia and also more number of hospitalizations. The main risk factors for HBV were having hemato-oncology disorders.
Conclusions : This study showed that HCV infection was more frequently identified than HBV and HIV infections in multiply transfused patients. Additionally, several risk factors which are associated with acquired TTI's in multi-transfused patients require continued vigilant attention. Better blood safety procedure is warranted to deal with acquired TTI's, which continue to represent a public health problem.
Transmission of leptospirosis: Is it possible by blood transfusion?
KK Sharma, Madhavi Latha P, Usha Kalawat,
D S Jothi Bai
Sri Venkateswara Institute of Medical Sciences, Tirupati, AP, India
Introduction : Blood is considered as drug used for treating patients, so it is mandatory that blood or blood products should be free from all the ill effects, either infectious or non infectious. In India we screen blood for HIV, HCV, HBV, malaria and syphilis. But we have no idea about the other infectious diseases prevalent in that area. Leptospirosis is common infectious disease prevalent in south India. There are several reports of leptospirosis from the other parts of the country also.
Aim : We tried to know whether leptospires can be transmitted by blood transfusion or not.
Materials and Methods : We randomly selected 4 blood donor samples in the beginning of rainy season from blood bank to know the status of leptospirosis in those 4 blood sample. Samples were tested by Dark Field Microscopy (DFM), Microscopic Agglutination Test (MAT) and IgM ELISA for leptospirosis and culture was done in EMJH liquid and semisolid media.
Results : All the samples were negative for Microscopic Agglutination Test (MAT) and IgM ELISA for leptospirosis. Two blood samples were positive for dark field microscopy and became culture positive after 3 weeks of incubation at 30oC.
Conclusion : It is very small study. This observation needs further detailed study. How long leptospires survives in blood at 4oC? We have to follow the blood and blood product recipient and donor. There are so many questions are unanswered.
Viral inactivation of blood and blood components
Medical College, Trivandrum, Kerala, India
The need for effective methods of viral inactivation of blood and blood components arises due to many reasons
- Existence of window period
- Tests for a number of pathogenic viruses are not included in current screening protocol
- Possibility of emerging unknown transfusion transmissible viruses
An ideal viral inactivation method should be cheap, non toxigenic and should be able to inactivate all viruses irrespective of whether enveloped, nonenveloped, intracellular or extracellular.
Currently used methods are discussed separately for RBCs, plasma and platelet products
a) Solvent Detergent Process -in this plasma is subjected to treatment with 1%tri n butyl phosphate and non ionic detergent triton X 100.plasma protein recovery>80% and all tested enveloped viruses are destroyed. Disadvantage is that its ineffective on nonenveloped ones.
b) S-59+UV A
Synthetic psoralen causing DNA/RNA adducts in presence of light. Effective on intra cellular and enveloped viruses. Good factor recovery.
Produce oxidative damage to guanine. Has a favourable toxicology profile. Primary photoproduct is lumichrome which is not much toxic. Good recovery for clotting factors other than factor V
d) Methylene blue +light
intercalative binding causing damage. Factor 1 and C1 activator more susceptible. Not toxic
2. Packed Red Cells
FRALE Compounds-Frangible Anchor Linker Effector compounds which Consists of an anchor, effector alkylating agent and a linking moiety. Some anchors are mutagenic.
Azridine compounds and photosensitisers like DMMB are used
R.F and light, Psoralen and UV
In summary although various compounds are under trial, research to produce a better agent which is broader acting and non toxic is warranted.
Association of seropositivity for TTD's in blood donors with socioeconomic and education status
Kala, K.C. Usha
Medical College, Trivandrum, India
Introduction : Transfusion transmitted HIV rose rapidly from first occurrence in 1978 to a peak in late 1982. After that there was a decline which was directly attributable to increased awareness, donor education and deferral measures by blood bank.
Aims and Objective : To determine the percentage of seropositivity for transfusion transmitted diseases among donors and to find out association with the socioeconomic and education status if any.
Methodology : A retrospective study was done in the Department of transfusion Medicine, Medical College, Trivandrum during the year 2010. The serological results were taken from the records and the education and socioeconomic status from the donor registration forms.
Results : Percentage of positivity for any of the 5 TTD's namely HIV, HBV, HCV, malaria, syphilis was 8%. 78% of the donors who were positive for any of these diseases had an education below graduation whereas among the highly qualified or the professionals it was as low as 4%. The donors belonging to a poor socioeconomic status had a seropositivity of 68% whereas in the donor of the upper strata it was only 4%.
Inference : The data illustrates the dramatic effectiveness on education and socioeconomic status of the donors pointing out the target population wherein recruitment and retention strategies to be directed for a safer blood product.
HIV and hepatitis B co-infection amongst blood donors of Kolar
Subhasish Das, Harendra Kumar M. L, Lakshmaiah
Sri Devaraj Urs Medical College, Tamaka, Karnataka, India
Introduction : Co-infection with hepatitis virus (HBV) and Human Immunodeficiency Virus (HIV) is common, because of shared modes of transmission.
Aim : To determine the co prevalence of HBV and HIV among blood donors
Materials and Methods : We screened 11,995 units of blood from both volunteer and replacement blood donors of Kolar by standard ELISA method. The statistical significance of the Co prevalence of infections was obtained by using Chi square (x 2) test.
Results : The co prevalence of HBV and HIV was 0.029 percent (3 /11,995) among total blood donors. 4 individuals (3 males and 1 females) were found to be co infected with HBV and HIV. The association of HBV and HIV infection was tested and found statistically significant (p<0.05).
Conclusion : HIV co-infection in HBsAg positive cases among healthy looking individual was 2.7% routine screening of all these parameters may be useful in preventing transmission of disease through transfusion.
Key words : HIV, HBsAg, Co - infection, ELISA, Screening, Blood donors
Evaluation of a fully automated chemiluminiscence immunoassay (vitros ECIQ) for the screening of transfusion transmitted diseases
Aseem Tiwari, Prashant Pandey, Ganesh Singh,
Surbhi Dixit, Vimarsh Raina
Medanta-The Medicity, Gurgaon, Hariyana, India
Introduction : The performance of the fully automated Vitros EciQ (Ortho Clinical Diagnostics) was evaluated for the detection of HbsAg, anti-HIV, and anti-HCV in serum samples of the blood donors. Vitros EciQ is a continuous random access immunodiagnostic system utilizes enhanced chemiluminiscence as the detection technology.
Aims and Objective : This study was carried out with the aim to assess the the suitability of Vitros EciQ for the screening of blood donors based on their sensitivity, specificity, positive predictive value(PPV) and negative predictive value(NPV).
Materials and Methods : This prospective observational study is conducted at the dept of transfusion medicine, Medata-The medicity. As per the departmental policy a blood unit from a healthy blood donors is subjected to 2 tiers of infectious markers testing before taking in finished good inventory. The first tier of testing is Vitros EciQ which is performed on donors serum sample. EDTA blood sample of healthy blood donors is subjected to individual donor nucleic acid testing(ID-NAT) for HBV, HCV and HIV. ID-NAT was done using the Procleix Ultrio Assay which is based on the principle of Transcription Mediated Amplification(TMA). Samples that were reactive by the ultrio assay were subjected to a discriminatory assay.
Results : 4000 samples were tested during the period of study. The sensitivity, specificity, PPV and NPV for HIV were found to be 80%, 99.84%, 40% and 99.97% respectively. The sensitivity, specificity, PPV and NPV for HBV were found to be 94.1%, 99.8%, 69.6% and 99.97% respectively. Similarly, the sensitivity, specificity, PPV and NPV for HCV were found to be 83.3%, 99.4%, 17% and 99.97% respectively.
Conclusion : Vitros EciQ for screening of blood donors is a highly specific method. The low positive predictive value and low sensitivity may be due to small sample size.
Sub-clinical arboviral infections in voluntary blood donors from Pune
Purnima S. Rao, Smita R. Joshi, Kishor R. Kshirsagar, Madhuri S. Joshi
Shayadri Specialty hospital, Pune, India
Introduction : Arboviral infections have been reported to be endemic throughout India. This infections is globally transmitted by mosquito vectors Health care- related transmission, including transmission by blood products, has also been documented.
Emerging infections diseases pose treat to general human population, including recipients of blood transfusion.
Aim and Objective : There was epidemic of Dengue and chikunguniya in city of Pune. Hence this study was taken up where screening of Japanese Encephalitis (JE) Dengue and Chikungunya virus infections by Elisa technique developed at National Institute of Virology
Results : None of the samples showed positively for JE IgM antibodies. Where as presence of antibodies for Dengue IgM and chikungunya IgM was observed in one specimen each.
Interpretation : In spite of strict scrutinizing the donors for selection (by pre-donation questionnaire) was carried out. Still we could get the positive result with 2 donors as stated above.These units packed cells were already issued to the patients as there was delay in receiving these results. Fresh frozen Plasma (FFP) was taken by NIV for further study. No. post transfusion infections noted or intimated to blood bank. Hence it was overlooked, but this should not be the status as that HIV and HCV.
Conclusion : Blood Transfusion related (specially when PCV`s is transfused) dengue will represent only a small proportion of its cases in endemic countries. Patients cannot be totally protected from mosquitoes, hence one cannot really come to conclusion that post transfusion Dengue or Chikanguniya is through blood transfusion or mosquito bite. Further studies are needed to establish the magnitude of the threat that dengue poses to blood safety in countries where it is endemic. Proper FDA licensed kit must be easily available and cost effective per product against the risk of infection rather than going of NAT testing - An expensive affair.Policies will also be influenced by economic resources available and healthcare priorities of a country / regions as mosquitoes are seen all round the year and not only seasonal. Last but not the least the presence of anti dengue and anti chikunguniya IgM antibodies indicated that sub- clinical infection and possibility of horizontal transmission of viruses is possible.
Preparation of ELISA positive control, and it's application in internal quality control program - Our experience
Neena Doshi, Megha Yadav, Anjana Patel, Monica Gupta
BD Gorwara Blood Bank, Karamshad, Vadodara, Gujarat, India
Introduction : The three lines of defense in Enzyme Linked Immunosorbent Assay (ELISA) for Transfusion Transmitted Infections are use of kit Positive and Negative Controls, application of Internal Quality Control, and participating in External Quality Program.
Aim : The aim of the study is to establish ELISA Internal Quality Control by preparing in-house ELISA Positive Control Reagent, plotting Levey-Jennings chart, and applying Westgard rules.
Materials and Methods : Serial dilutions of serum of ELISA positive donor for Transfusion Transmitted Infection are prepared. Each serial dilution is run in duplicate in ELISA reader and mean Optical Density is calculated. Thereafter, E ratio (Optical Density/Cut Off value) is calculated for each dilution and plotted on a graph to obtain sigmoid curve. An appropriate dilution is selected to prepare ELISA Positive Control. The Control is run every time an ELISA is run. Mean and Standard Deviation of ELISA Positive Control are calculated from twenty sequential runs, and a Levey-Jennings chart is made. Westgard rule is thereafter, applied on every run.
Results : When the "Warning Westgard Rule" is violated, the run is accepted, however, corrective action is taken. When "Rejection Westgard Rule" is violated, the run is rejected. Root cause analysis is done, corrective action is taken and samples are re-run.
Conclusion : ELISA should be able to detect the lowest reported concentration of Transfusion Transmitted Infection, to minimize false-negative results. All Blood Banks should thus, establish their own ELISA Positive Control Reagents, whose Optical Density is close to cut off value. Levey-Jennings chart and Westgard rules allow a quick visual assessment of quality performance; which help to analyze 'Random Errors', affecting the reproducibility or precision of test, caused by variations in line voltage, contamination, volume dispensed, etc.; and 'Systematic Errors' affecting the accuracy, caused by temperature changes, reagent lot changes, etc.
Dual testing strategy to enhance the safety of blood for transfusion
Gethziyal, Marimuthu, Anburaja, Rema Menon
Apollo Hospitals, Chennai, India
Introduction : Safe blood, free from transfusion transmitted diseases (TTD), remains a major concern in transfusion medicine. To enhance the safety of blood transfusion and to ensure that blood and blood products are free from TTD agents, we at Apollo Hospitals, Chennai advocate dual testing strategy. We use two sensitive methods in screening blood donors for the Transfusion Transmitted Disease (TTD) markers: 1) A highly sensitive serology testing based on enhanced chemiluminescence technique (ECLIA) and2) Nucleic Acid Testing (NAT)
Aims and Objectives : This study was carried to evaluate the sensitivity and specificity of both ECLIA and NAT for the screening of HIV, HBV and HCV infection in donors.
Materials and methods : A total of about 33000 donors attending the blood bank at Apollo Hospitals, Chennai during the period of June 2008 to August 2010 were screened for TTD markers by both NAT and ECLIA. NAT for HIV, HBV and HCV were was done using Chiron's Procleix Ultrio Assay and Discriminatory assay kits. VITROS ECiQ based on enhanced Chemiluminescence method was used for sero-screening for aHCV, aHIV and HBsAg.
Results and Discussion : We have observed some discrepant results from both the testing methods.NAT assay failed to detect viral sequences in patients who are truly infected with HBV and HCV. This study showed that serology testing based on ECLIA is highly sensitive in detection of Hepatitis infection when compared to NAT in blood donors, based on comparison of incidence of false negative results. It is therefore conclusive to say that NAT testing cannot be a replacement for serology testing. This is because some percentage of Antigen / Antibody positive donors have been tested negative by NAT tests. It is obvious that neither of the sensitive methods can be used in isolation for ensuring blood safety but in combination give us the advantage of "X-TRA" blood safety.
Evaluation of the repeat reactive of anti-HIV I and II test results of the blood donors at Sir. J. J. Mahanagar Raktapedhi
Bhavna Patil, Hitesh Pagare
Sir J. J. Mahanagar Raktapedhi, Mumbai, India
Introduction : Sir. J. J. Mahanagar Raktapedhi managed by SBTC has been functioning since March 2009, we have collected 17996 Blood Units from voluntary non-remunerated donors through Out-door camps and In-house collection. It is mandatory to screen all the donor samples for Anti-HIV I and II HBsAg, Anti-HCV, VDRL and Malaria.
Aim : To evaluate the repeatability of reactive results of the Anti-HIV I and II test performed on the Blood Donor samples.
Material and Methods : Period of study March 2009 to Feb 2010
Total no of donors screened 17996
Anti HIV. I and II Elisa Assay was done on Evolis 4PS completely Automated system using 4th generation BioRad Kits.
The protocol of 1st Elisa Reactive, unit should be discarded was followed.
Repeat test was done on the 1st time reactive samples using the same kit.
Result : Total no. of units tested 17996 out of which positive were 120.
31 units were repeat negative and 2 units readings was in grey zone which was negative after repeat
Percentage positivity for Anti HIV - I and II - 0.66%.
Discussion : 70.25% was repeat positive. Which were true positives. False positive results obtained was - 29.75% which was repeat negative. As the sensitivity of the kit increased with generation there are more chances of false positive cases which are safe for Blood Bank.
Conclusion : As the generations of Elisa increased the window period for Anti HIV - I and II has shortened tremendously which is 11days very close to NAT testing thus helping us to issue safe blood to the patients. The screening test for Anti HIV - I and II by Biorad when used in population showing low incidence of HIV. Tend to detect more false positive results which may vary with procedure and users.
By doing repeat test we are more confidents in reporting on the results of the donors.
Evaluation of the sensitivity and specificity of enhanced chemiluminescence vitros ECI vs ELISA in the detection of hepatitis viral infection in blood donor using confirmatory RIBA HCV
Anju Verma, Asha Bazaz
Rotary Blood Bank, New Delhi, India
Introduction : The objective of the study was to evaluate sensitivity of screening assays in Transfusion Medicine for weeding out all possible infectious/unsafe blood donors in the first instance and to assess the specificity of the low reactive results on the aHCV assays for qualifying the rejects of blood donors.
Materials and Methods : In the study, all low reactive donor samples (less than S/C ratio of 8 as recommended by CDC) on VITROS ECi were tested in parallel by both an ELISA method (VIRONOSTIKA ELISA aHCV) and confirmatory testing by RIBA HCV. A total of 42,000 samples were tested within a span of a year (2008-2009), of which the initial reactivity rate was 5.95 in 1000 samples. Out of the 250 reactive samples, 27 donor samples were low reactive. These 27 samples were tested by above said methodologies.
Results : False negative rate on ELISA was 4 out of 27 samples tested. The projected incidence rate of false negative in total pool of 42000 donors is equal to 0.088%, i.e. 9 samples missing detection per 10,000 donor samples in ELISA as compared to VITROS ECi chemiluminescence technoloy. Five of 27 low reactive donor samples were confirmed positive and 11 of 27 showed indeterminate results on RIBA HCV.
Conclusion : It can be concluded from the study that VITROS ECi has excellent sensitivity with uncompromised specificity. This enables blood banks to detect infection earlier than ELISA in routine practice and therefore enhance safety of transfused blood
Quality systems for ELISA testing in blood bank
Jyoti Bhatt, Darshana Khandhedia, Nayana Andipara, Rajesh Sawant
Rajkot Voluntary Blood Bank, Rajkot, Gujarat, India
Introduction : ELISA testing is being used in Blood banks for screening donors for various markers of TTI. For validation of an ELISA assay, it is necessary to have in-house quality assurance system especially for implementation of post-test counseling of donors in the blood bank.
Aim : To examine the feasibility of implementing quality systems for ELISA testing in a regional blood transfusion centre. We share our experience in the preparation of External Positive Control and plotting of a Levy-Jennings graph.
Materials and Methods : Sera reactive for HIV, HCV and HBV were serially diluted and run in duplicate along with routine samples. The mean absorbance was plotted on a graph with E- Ratio against dilution which gave a sigmoid curve. The dilution with absorbance just above the cut off was taken and prepared in large batch. Its homogeneity and stability was assessed before storing in 1ml aliquots at -20C. EPC was thawed and used in each assay. The E-Ratio, Mean, +2SD were calculated after deriving data of 25 days and plotted against day run. Westgard rules were applied for interpretation.
Results : The time involved was 2 extra working shifts by two technologists. 54 microwells were utilized. The cost was marginal for each assay. The EPC were stable and integrity was maintained upto 3 months. All results were within +2SD limits except two occasions when the e-ratio value was above +2SD limit. A systematic error due to improper functioning of the ELISA reader could be identified. Corrective action was taken promptly and tests repeated. The EPC thawed and stored at 4-6oC were used upto day 3 gave OD within 95% confidence limit of the original value. The batch variation of kits did not affect the EPC OD values.
Conclusion : Levey-Jennings chart ensures the reliability and accuracy of each assay. No extra man power and equipment were required.
Immunohematology and Compatibility
ABO and rhesus blood groups in potential blood donors at Urgapur steel city of the district of Burdwan, West Bengal
Ipsita Nag, Sudipta Sekhar Das
The Mission Hospital, Durgapur, West Bengal, India
Introduction : Blood groups are genetically determined and incidence of ABO blood groups and Rh subgroups vary in different parts of the world.
Aim and objective : The aim of this prospective and observational study was to document the frequency of ABO and Rh subgroups among the blood donors of Durgapur city, West Bengal.
Materials and Methods : The study group includes a total of 1000 healthy blood donors between 18 to 60 years age. All donations were done in the department of Transfusion Medicine, The Mission Hospital, Durgapur, in 2009. Blood grouping was carried out by the conventional tube method using commercially available antisera following the departmental SOP.
Result : The most common ABO blood group was O (34.8%) which is followed by B (33.6%), A (23.9%) and AB (7.7%). Among the Rhesus blood group, Rh D positive and negative comprised of 94.7% and 5.3% respectively. The most frequent ABO blood group linked with Rh D is O positive (33%), followed by B positive (32%) and the least prevalent was AB negative (0.1%). Among the Rhesus blood group the most common antigen was antigen e(98%) followed by D(94.7%), C(88.4%), c (47.9%), E (17.4%) and d(5.3%). Phenotype R1R1 (49.4%) was found to be most common among the Rh positive donors and Rzr" (0.1%) being the least prevalent. Among the Rh negative donors, the most prevalent probable phenotype is rr (4.3%) and 6 out of 1000 donors have the uncommon Rh phenotypes.
Conclusion : We observed that the most common blood group in Durgapur is O positive followed by B positive. Among the Rhesus subgroups the commonest probable phenotype R1R1 is seen. Knowledge of the distribution of ABO and Rh blood group in a particular demography is important for effective transfusion services.
A study to prepare a registry of red cell phenotyped Indian voluntary donors
Bibek Gautam, Ankit Mathur, Sanjana Dontula, Dilliram Silpakar, Latha Jagannathan
Rotary Bangalore TTK Blood Bank, Bangalore, India
Introduction : Alloimmunization to red cell antigens is a significant risk in chronically transfused patients like Thalassemia and other diseases like cancer, leukemia and complicated pregnancies. Incidence of alloimmunization to some clinically significant minor antigens viz Rhesus, Kell, Duffy, MNSs and Kidd system is 5 to 23.6%. In order to provide safe antigen matched blood for such patients, we require a panel of Repeat, Regular Voluntary donors phenotyped for all clinically significant Major as well as Minor antigens. The project is planned to develop a panel of 2000 voluntary donors extensively typed for all red cell antigens. As a pilot study here the data of 168 phenotyped donors is presented.
- To evaluate the presence of different red cell antigens in Indian voluntary donors
- To prepare a registry of red cell phenotyped voluntary donors.
Material and Method : Voluntary blood donors are counseled and educated about the study. Only O positive and O negative donors are selected. Along with the donor form additional consent form is taken from them for phenotyping. The blood sample is first tested for HIV, HBsAg, HCV, malaria, syphilis and DAT and only samples which are non reactive and negative, used for phenotyping. Phenotyping is done by using column agglutination technique.
Result : A total number of 168 voluntary donors were typed for their Phenotype over the period of April 2010 to August 2010. Out of 168, 159 were D pos and 9 were D negative. For other Rh antigens, like C 24 (14.3%) were Negative and 144 (87.5%) were Positive; c 71 (42.3%) were Negative and 97 (57.7%) were positive; E 128 (76.2%) were Negative and 40 (23.8%) were Positive; e 2 (1.2%) were Negative and 166 (98.8%) were Positive.
For Kell system K 2 (1.2%) found positive and 166 (98.8%) donors found negative. For k 166 (98.8%) donors found positive and 2 (1.2%) were found negative.
For MNSs system, M 23 (13.7%) were negative and 145(86.3%) were positive; N 65(38.7%) were negative and 103 (61.3%) were positive; S 76(45.2%) were negative and 92 (54.8%) were positive; s 19(11.3%) were negative and 149(88.7%) were positive.
For Duffy, Fya 19 (11.3%) were negative and 149 (86.7%) were positive; Fyb 70 (41.7%) were negative and 98 (58.3%) were positive.
For Kidd blood group, 149 (88.7%) are Jka negative and 19 (11.3%) are Jka positive. For Jkb 99 (58.9%) are positive and 69 (41.1%) are negative.
Conclusion : This is an on going study to phenotype at least 2000 voluntary donor in order to make a registry of phenotyped Indian voluntary donors. Extended phenotype matched blood transfusion will prevent alloimmunization in thallassemia and other multiply transfused patients. Antigen matching, by decreasing the likelihood of alloantibody development, may significantly facilitate long-term management while decreasing morbidity.
Frequency of ABO blood group system in northern India
Aseem Tiwari, Prashant Pandey, Nixon P. Joseph,
Surbhi Dixit, Vimarsh Raina
Medanta - The Medicity, Gurgaon, India
Introduction : The abo blood group system was discovered in 1901 and since it is of major importance in medicine. There are racial and ethnic differences in blood type and composition. The frequency of four main blood group systems varies in population throughout the world and even in different parts of country.
Aims and Objectives : The aim of this study is to find out the frequency of abo blood group system in northern part of india.
Materials and Methods : This study was conducted at the department of transfusion medicine, medanta-the medicity, gurgaon, haryana from december 2009 to july 2010. Data were collected from the hospital information system and blood bank grouping records. Blood grouping (forward and reverse) was performed as per the departmental standard operating procedure (sop). All blood samples processed during the period of observation (donor sample+patient sample) were included in study.
Results : During the period of observation the number of groupings performed on patient's samples were 10014 and the number of blood groupings performed on donor's sample were 8338. The frequency of blood group b in our population was 37.3% (34.8 % b rh(d) positive and 2.5 % b rh(d) negative). The frequency of blood group o in our population is found to be 31.2% (29% o rh(d) positive and 2.2% o rh(d) negative). The frequency of blood group a in our population was 22.2% (20.7 % a rh(d) positive and 1.5 % a rh(d) negative). The frequency of blood group ab in our population was found to be 9.4% (8.7% ab rh(d) positive and 0.7 % o rh(d) negative).
Conclusion : Every transfusion center should have a record of frequency of blood group system in their population. It helps a lot in inventory management. The commonest blood group in our population was found to be B.
Hematype segment device: A 3 year experience at SPS apollo hospitals, Ludhiana
SPS Apollo Hospitals, Ludhiana, Punjab, India
Introduction : The use of scissors for cutting segments from blood component units is the prevalent technique for obtaining blood/ plasma samples to type, cross-match and screen for specific blood group antigens and antibodies. 'Segment Sampling' can pose a risk of exposure to blood-borne pathogens for the blood bank technicians. It can cause blood to splatter on the work surface and can come in contact with the skin, eyes, mucosal surface or clothing of the technician. There is also potential risk of percutaneous injuries from sharp pointed scissors. The use of improper scissor technique can also be associated with cross contamination of samples from segments resulting in erroneous results. These problems associated with 'segment sampling' can be obviated by implementation of single-use segment sampling devices.
Aims and Objectives : To use and evaluate the performance and safety of Hematype Segment device.
Material and Methods : The scissor technique was used for segment sampling from September 2005 to February 2007. The Hematype Segment Device (HSD) was used from March 2007 and its performance was evaluated till March 2010 using following quality indicators -
- Number of blood spills on the work surface
- Number of blood spills on the technical personnel
- Number of percutaneous injuries to the technical personnel
- Number of repeat tests because of errors in sampling
Results : A total of 14527 and 25675 segment samplings were done using scissor technique and HSD respectively during their respective periods. No incidence of blood spill, percutaneous injuries or repeat test was seen using Hematype Segment Device and the difference between the two techniques was found to be significant.
Conclusion : Hematype Segment Device is a safe and easy to use device for segment sampling. It eliminates the use of scissors and the potential risks associated with its use. It also avoids the risk of undesirable liabilities arising out of accidental injuries and illnesses at work place.
Incidence of RH antigens, phenotype and probable genotype in the population of Gwalior and its surrounding area
D C Sharma, S. Rai, S. Iyenger, Bharat Jain,
G.R.Medical College, Gwalior, MP, India
Introduction : RhD antigen was discovered in 1940 by Karl Landsteiner and Wiener. In later years, because of its immunogenecity, along with ABO grouping RhD antigen testing was made mandatory before issuing a compatible blood. Presently there are five major antigens (D, C, E, c and e) in Rh Blood group system. Rh antigens are highly immunogenic in the following order D > c > E > C > e.
Aim and Objective : To know the distribution of major Rh antigens, its phenotype and proposed genotype in the population of Gwalior and its surrounding areas in M.P, U.P and Rajasthan (central India).
Material and Methods : The study was conducted in Blood Bank, Department of Pathology, G.R. Medical College, Gwalior. The distribution of Rh antigens, its phenotype and proposed genotype was studied in 600 individuals between the ages of 18-60 years. In this study, blood samples were collected from voluntary donors, blood recipients, outdoor and indoor patients and were tested for ABO antigens and five major antigens of Rh system by testtube agglutination method, using monoclonal commercial antisera i.e. Anti-A, B, D, C, c, E, and e and supported by gel technique.
Results : Out of 600 individuals studied, the antigen D was 91.6% and only 8.4% cases shows absence of D antigen. Antigen C, E, c and e was 84%, 25.6%, 58.3% and 78.5% respectively. Most common phenotype in RhD positive cases were DCCee (41%) and in RhD negative it was dccee (5.6%). Eleven cases (1.83%) were negative for antithetical antigens E and e. Most common probable genotype in order of frequency was DCe/DCe (41%), DCe/Dce (25.5%) and dce/dce (5.6%).
Conclusion : As in various previous studies, our study also showed that there is a wide range of distribution of the phenotype and genotype of Rh antigens amongst the various populations studied.
Mcleod syndrome: Report of an Indian family with phenotypic heterogeneity
Prasun Bhattacharyand, A Chakravarty, D Banerjee 1 ,
P Bhattacharya, and S Mukherjee 2
Medical College, Calcutta and AMRI Hospitals, Kolkata; 1 Vivekananda Institute of Medical Sciences, Kolkata, 2 AMRI Hospitals, Kolkata, India
The present report deals with the clinical phenomenology of three members (brothers) of one family with McLeod syndrome (MLS). In two, the clinical pictures were of choreiform disorders with amyotrophy which were found to be neurogenic in origin by detailed electrophysiological study. The index case had peripheral acanthocytosis; immunohematological and molecular genetic studies confirmed diagnosis of McLeod syndrome. However, one brother only had a slowly progressive motor neuron disease like picture but no abnormal movement disorder. He had peripheral acanthocytes as well. The inheritance most likely is X-linked recessive in nature. The affected family members exhibited much phenotypic heterogeneity.
Prevalence of subgroup A2 and A2B in voluntary donors at regional blood transfusion centre Shimla
M.L. Kaushal, Sandeep Malhotra, Nishi Jaswal
I.G Medical College Shimla, HP, India
Background : A and AB blood groups have been divided into subgroups A1, A2, A1B and A2B depending upon the reaction with anti-A1 Lectin, the extract from the seed of lectin Dolichos biflorus, or human Anti-A1 serum. Anti A1 agglutinates A1 and A1 B cells but not A2 and A2B cells. About 20% of the persons with A antigens in the A or AB group are A2 or A2 B. Anti A1 occurs in the serum of 1-8% of A 2 group and 22-30 % A 2B persons. Anti A 1 causes discrepancies between ABO cell and serum grouping and also cause cross matching incompatibility. Any patient of group A2 or A2B having antiA1 reactive at 37°C should be given A2 or A2B group blood.
Methods : The study was planned to find out the Prevalence of subgroup A2 and A2B in voluntary donors as no such study has been conducted in this region. In the present study 235 samples of blood group A and AB were tested for subgroup A2 and A2 B by standard procedure using anti A1lectin over a period of six months w.e.f. January to June 2010 in the Regional Blood Transfusion Centre of Indira Gandhi Medical College Shimla. The samples were collected from voluntary blood donors who came for blood donation in the voluntary blood donation camps. The ABO cell and serum grouping was done by standard tube technique i.e. saline at room temperature. Further identification of subgroups A2 or A2B was done by using anti A1 lectin. Testing for the detection of anti-A1 was done using the standard technique at room temperature.
Results : Out of 250 samples 170 (68%) were of group A and 80(32%) were of AB group. Subgroup A 1 was found in 6 (2.4%) and A2 B was found in 7 (2.8%) voluntary blood donors which is very low as compared to the national prevalence of about 20%. Anti A 1 was not found in any of the donors of subgroup A2 and A2B.
Conclusion : The present study concludes that the prevalence of A 2 and A 2 B is very low in this region of the country, however, further study is required on a larger donor base. Since anti A1 was not detected in any of the A2 or A2 B subgroup donors it is not necessary to classify group A and AB patients or donors as A1, A2, A1B or A2B in routine. It is only when the individual's serum contains anti A1, reactive at 37°C, further sub grouping for A2 or A2B group is required to select the appropriate blood for transfusion.
Phenotyping of rare blood group antigens
TN Dr. MGR Medical University, Chennai, TN, India
Background : The prevalence of blood group antigen in the local population will help to detect the presence of irregular antibodies. So it is necessary to have information on the distribution of rare blood groups in our population.
Aim : Detection of rare blood groups in regular voluntary blood donors in our department.
Methodology : A total of 100 regular voluntary donors of 'o' blood group were included. Red cell antigen typing was done by gel technology using rare antisera for rh (d, c, e, c, e) kell (k),(k),jk(a), jk(b), fy(a), fy(b), m, n, s, s, lu(a), lu(b).
Result : Out of 100 'o' group blood donors 96% were rh d positive. Among other rh antigens, e (94%), c (80%), c (48%), e (20%), in kell blood group system, k (3%), k (100%). In lutheran system, lu(a) 0%, lu(b) 80%.in kidd and duffy blood group systems jka 2%, jkb 1%, and fya 38%, fyb 20%. In the mns blood group system, m (1%), n (2%), s (1%), s (10%) was present. So in our population the most common antigens were d, e, c, k, lu (b).
Conclusion : Knowledge of red cell antigen phenotype helps in providing antigen negative compatible blood to patients with multiple alloantibodies. It helps in creating a rare donor data for preparation of indigenous cell panels for screening irregular antibodies in our population.
Insertion of Kode™ peptide constructs into red cell membranes: Artificial blood group antigens found on MNS hybrid glycophorins
Robert Flower, Damien Heathcote 1 , Steve Henry 2
Australian Red Cross Blood Service, Queensland, 1 CSL Biosciences, Victoria, Australia, 2 Kiwi Ingenuity, Auckland, New Zealand, India
Antibodies against hybrid MNS glycophorin antigens (often designated Mi(a) antigens) cause transfusion reactions and Haemolytic Disease of the Newborn (HDN). Hybrid glycophorins are the result of complex genetic changes and are often found in mixtures with several different specificities. Peptide ELISA was used to determine epitope specificity of antibodies to hybrid MNS glycophorin antigens from patients of various ethnic groups including Indians from Malaysia. KODE™ technology was used to convert vMNS antigen-negative red cells into antigen-positive red cells displaying single epitopes found on hybrid glycophorins suitable for serological analysis. This is an example of application of research effort to new ways of manufacturing reagent red cells for use in pre-transfusion testing.
Significance of quantitation of autoantibodies in eluate of sensitized red cells in warm autoimmune hemolytic anemia
Sudipta Sekhar Das, Rajendra Chaudhary
Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
Concentrated autoantibodies obtained by elution can be subjected for total serological characterization including their quantitation. We perform elution routinely in all suspected patients of autoimmune disorders and the present study was performed to correlate the quantity of immunoglobulin (Ig) G (IgG) autoantibodies in eluate with direct antiglobulin test (DAT) reactivity and markers of in vivo hemolysis in warm autoimmune hemolytic anemia (WAIHA). Detailed autoantibody characterization was performed on 34 samples with regards to antibody class, IgG subclass, DAT dilution and quantification study on eluate. Hemolysis in a patient was documented as per the previous guidelines. Cold acid elution was performed on the DAT positive red cells and quantitation of IgG in eluates was done using ELISA. Number of IgG molecules eluted per RBC was calculated using Avogadro's number. We observed a significant correlation between the concentration of IgG in eluate and DAT strength (r = 0.53, P = 0.014), hemoglobin (Hb)(r = -0.41, P = 0.04), serum bilirubin (r = 0.67, P = 0.000) and serum lactate dehydrogenase (LDH) (r = 0.50, P = 0.02). The number of IgG molecules/RBC also correlated significantly with the DAT strength (r = 0.69, P = 0.001) as well as DAT dilutions (r = 0.53, P = 0.004). We conclude that immunohematological laboratories with no facilities of high sensitive methods may quantify autoantibodies in eluate to labelling the severity of an autoimmune disorder and plan appropriate management.
HLA in transfusion medicine
Krishnamoorthy R, Panicker V.K, Febe R.S, Alexander S, Senthilmurugan B
Sri Ramachandra University, Chennai, TN, India
Introduction : Transfusion medicine is a multispecialty that encompasses transplantation science. Human Leukocyte Antigens (HLA) are implicated in Graft versus host disease (GVHD) and HLA alloimmunisation. Kidney transplantation requires a HLA crossmatch to be performed (before the transplantation) between the recipient serum and donor lymphocytes to ensure graft survival.
Aim : To estimate the incidence of positive HLA crossmatch among prospective kidney transplant recipients.
Materials and Methods : This study was conducted in the Department of Transfusion Medicine, Sri Ramachandra University, Chennai during the period January 2009 to June 2010. Prospective Kidney transplant recipients (and their prospective donors) were the subjects in this study. Lymphocytes were separated from heparinised whole blood samples of the prospective donor using Ficoll Hypaque. Complement mediated cytotoxic crossmatch between Patient's Serum and Donor Lymphocytes was done using microtitre plates by the conventional method. Rabbit serum was used as the source of complement. A mixture of Ethidium Bromide and Acridine orange was the fluorescent dye used. An inverted fluorescence microscope was used to read the results.
Results : Out of 228 HLA crossmatches performed, 2.2 % (n=5) had a positive HLA crossmatch indicating the presence of preformed antibodies (in the recipient) against donor lymphocytes. 80% (n=4) of the subjects with a positive HLA crossmatch were males and 20% (n=1) were females. These subjects had a history of blood transfusion / pregnancy or both. HLA crossmatch was negative in the remaining 97.8 % (n=223).
Conclusion : Presence of preformed antibodies (indicated by a positive HLA crossmatch) could cause hyper-acute rejection of the transplanted kidney. HLA alloimmunisation could be a cause of platelet refractoriness in patients who have had multiple platelet transfusions. Such patients would require HLA matched donor platelets obtained by Apheresis. HLA plays a significant role in transfusion medicine. Doing a flow cytometric HLA crossmatch would be an added advantage due to its higher sensitivity and specificity.
Importance of reverse blood grouping in RH negative Bombay blood group multipara a case report
Deepa Devi G, Arumugam P
TN Dr. MGR Medical University, Chennai, TN, India
Case Report : An antenatal mother was referred from a tertiary care hospital to our department as 'O' Negative with IAT positive and requested for IAT titer. She had previous history of one live birth followed by one abortion. She was not aware whether Rh anti-D was given after first pregnancy and after the abortion. The first baby and her husband blood group were B positive.
The patient grouping was done which showed as O Negative with reaction in O pooled cells in the reverse grouping. So we expected some irregular antibodies. Rouleaux formation and cold antibodies were ruled out. Then, to rule out Bombay blood group, patient's blood was checked with Anti-H lectin, which was found to be negative. So it was confirmed to be Rh negative O Bombay phenotype. Since, antibody screening with 3 cell panel would show pan reactivity due to the presence of anti-H in the patient's serum, to avoid the interference of Anti-H, the serum was adsorbed with O cells and the antibody screening was done using the adsorbed serum, which showed no reaction. Hence the presence of irregular antibodies was ruled out. The blood group of the patient was thus confirmed as O Bombay phenotype with Rh negative without any alloantibodies.
Conclusion : The presence of O Bombay phenotype could be suspected only if reverse blood grouping is done and the same can be confirmed by Anti-H lectin. This emphasizes on the importance of reverse blood grouping and use of Anti -H lectin, in confirming O Bombay phenotype. We present this case because had we not been reconfirmed the blood group, we would not have proceeded further and reached the final interpretation.
External quality assessment scheme in red blood cell serology-our experience
Arun R, Arumugam P
TN Dr.MGR Medical University, Chennai, TN, India
Background and Aim : Quality Assurance involves all measures that can be taken to improve Blood Bank's efficiency and its effectiveness with a maximum benefit to the society. It provides competent external Proficiency testing to improve the existing standards of diagnostic services in Transfusion Medicine. External Quality Assessment is a very important component of a quality system for blood transfusion services. It is also used to monitor Blood Bank's continual performance and improvement. In our center, EQAS is in place since 2008 in order to improve the quality level and decrease the errors in blood banking.
Materials and Methods : Since 2008, EQAS samples were evaluated for ABO grouping, Rh typing, cross matching, DAT, antibody screening and identification thrice yearly under the EQAS- Transfusion Module, CMC, Vellore. All tests were performed using conventional tube technique.
Results : There was 100% concordance in ABO and Rh typing, DAT, antibody screening and identification scoring. But we got a negative scoring while evaluating one sample for cross matching. This negative scoring was mainly due to incomplete/improper filling of the report in the prescribed format.
Conclusion : EQAS appears to be an important tool that contributes to safer blood supply. Evaluation of our laboratory was satisfying. Clerical errors were identified as the main reason for negative scoring. EQAS assisted us to identify and minimize errors and recommend corrective measures. It gives us an objective impression of our accuracy and precision with reference to other blood banks. Hence, taking part in EQAS program is the prerequisite of every blood bank to ensure safe and quality blood consistently. QUALITY IS NEVER AN ACCIDENT; IT IS ALWAYS THE RESULT OF INTELLIGENT EFFORT.
Importance of routine antenatal antibody screening in Rh(D) positive females
Reeta Rai, M. Chandrashekhar
Max Super Speciality Hospital, Delhi, India
Introduction : Hemolytic disease of fetus and newborn is a condition that results in destruction of fetal and newborn red cells by maternal alloantibody specific for inherited paternal red cell alloantigens. The red cells destruction occurs most commonly by IgG antibodies produced by mother due to blood group incompatibility between mother and fetus. The most common cause of HDN is Rh system and in 95% of these cases D antigen is responsible. Rarely c, C, and E antigens have been implicated. Other antigens kell, kidd and duffy have also been rarely involved. We report a case of HDN due to development of Anti E and Anti c in a multigravida woman.
Aim : To discuss the importance of routine antenatal antibody screening even in Rh (D) positive females.
Materials and Methods : A request was received in Blood Bank to arrange two units of whole blood for exchange transfusion of a 6 day old baby admitted with neonatal hyperbilirubinemia (30 mg/dl at the time of admission). Mother had no history of blood transfusion. Blood grouping of both mother and baby was done using DiaMed gel card. Antibody screening of mother using DiaMed 3 cell panel and Direct Coombs test of baby was done using Newborn Blood Grouping Card.
Result : Blood Group of both mother's and baby's was 'A' Positive. The Antibody screening with DiaMed three cell panel and in house prepared O Positive pooled cells was positive on the mother's blood sample. Direct Coombs test of baby was strong positive both on tube and gel method. We got only two Coombs compatible units and one unit was issued for exchange transfusion. Bilirubin level reduced to 12.5 mg/dl after phototherapy and exchange transfusion. 11 Cell commercial panel (ID Dia Panel) from DiaMed was put up for Antibody identification. Papainized 11 cell panel was also used for identification of antibody. Reaction pattern showed presence of anti E and Anti c (in developing phase).
Conclusion : Anti E and Anti c although uncommon antibody to cause severe HDN has been occasionly reported to cause the same. This case highlights the importance of routine antenatal antibody screening in Rh (D) positive females also. Detection of antibody at early stage will help in appropriate intervention, as antigen negative compatible blood can be provided for exchange transfusion, if required.
ABO blood group discrepancy-a case report
Reeta Rai, M. Chandrashekhar
Max Super Speciality Hospital, Delhi, India
Introduction : ABO Blood group discrepancy exists when the result of red cell tests do not agree with serum tests, usually caused by unexpected negative or unexpected positive results in either the forward or reverse grouping. Discrepancies can be due to weak/missing red cell or serum reactivity, extra red cell or serum reactivity and technical error. Resolution of ABO discrepancies is must for providing appropriate blood for transfusion. Saliva testing may help to resolve ABO discrepancy, molecular testing is a great tool to resolve discrepancy but expensive and not available everywhere. We report a case of ABO discrepancy due to absence of expected B antigen found in our blood bank.
Aim : To identify and resolve ABO discrepancy correctly for providing safe blood to the patients.
Materials and Methods : A request was received in blood bank for 4 units of FFP and 2 units of packed cells for a 49 years male admitted with dyspnoea, patient was a follow-up case of motor neuron disease with urethral injury. Patient blood grouping was done with DiaMed gel card and and tube method also.
Result : Patient typed A on forward grouping whereas reverse grouping showed AB Positive. Result was same in tube method also. Antibody screening with DiaMed 3 cell panel was negative. Tubes and gel card were incubated at 4°C for 30 minutes then centrifuged. But result was same. Blood grouping was done using polyclonal antisera also but result was same. Cross matching with plasma of A donors was also done, that showed negative reaction. As patient was admitted in emergency two units O Positive packed red cells and four units of FFP was issued. Transfusion was uneventful.
Conclusion : Result of ABO discrepancy in this particular case shows either B antigen substance is absent from the red cells or present in very low amount. Confirmation of this group discrepancy would require molecular analysis. If the discrepancy is not resolved and transfusion is required urgently group O RBC component and AB plasma product should be given.
RHD typing strategy for discrepant cases
Swati Kulkarni, K. Vasantha, Kanjaksha Ghosh
National Institute of Immunohaematology, Parel, Mumbai, India
Background : RhD variants are classified for clinical purposes into partial D and weak D variants. Partial D variants lack some epitopes of D antigen, and in weak D variants generally all D epitopes are present but in reduced quantities. Partial D variants have the potential to make allo anti-D antibodies whereas the chances are less in weak D variants. Partial D variant red cells are known to give discrepant results with different monoclonal anti-D reagents which are routinely used in laboratories. Hence it is clinically important to determine the correct RhD status of an individual.
Objectives : To develop a preliminary diagnostic strategy for the correct determination of RhD status while dealing with RhD blood group discrepant cases.
Material and Methods : Forty five samples referred to the Institute for discrepancy in RhD grouping were tested for Rh phenotyping with monoclonal anti-C, anti-c, anti-D, anti-E, anti-e antisera. The samples were then tested with ALBAclone Advanced Partial RhD typing kit by Indirect antiglobulin test (a panel of twelve monoclonal anti-D). The kit can identify and classify weak D type 1 and 2 and partial D variants (DII and DNU, DIII, DIV, DVa, DCS, DVI, DVII, DOL, DFR, DMH, DAR, DHK and DAU-4, DBT and Rohar).
Results : Forty three out of the forty five RhD discrepant samples could be classified with ALBAclone Advanced Partial RhD typing kit. Sixty one percent of these samples belonged to DFR and DOL partial D category. Forty four samples showed presence of "C' antigen. The cell line LHM 174/102, LHM 70/45 and LHM 59/19 showed negative reaction with majority of the RhD discrepant cases, while cell lines LHM 76/59, ESD-1 and LHM 76/55 showed positive reaction with all RhD discrepant cases studied.
Conclusions : This Advanced partial D typing kit is very useful in confirmation of RhD status when different commercial anti-D reagents give discrepant results. Based on this study we have tried to develop a preliminary diagnostic strategy to determine the correct RhD status in our population.
Red cell alloimmunization amongst pregnant women in Delhi: A hospital based study
Sangeeta Pahuja, Santosh K Jain, Mukta Pujani,
Lady Hardinge Medical College and Assoc. Hospitals, New Delhi, India
Introduction : Alloimmunization during pregnancy leading to Hemolytic disease of fetus and new born is a major challenge to Obstetricians and blood transfusionists. After introduction of Rh(D) prophylaxis, various other non D Rh and non Rh antibodies have come into limelight. However, despite the guidelines, screening for irregular erythrocyte antibodies (IEA) in all Rh(D) pos and Rh(D) negative women is not practised universally.
Study Design : The prospective study was conducted to assess the prevalence of alloimmunization in all multiparous women, (irrespective of Rh(D) status) attending the antenatal clinic of Lady Hardinge Medical College and Assoc. Hospitals, New Delhi. Primigravidas and women who had received anti (D) prophylaxis were excluded. Detailed obstetric history and history of transfusion was taken. Antibody screen was done for all the patients using commercially available 3 cell panel. Antibody identification was done in cases of positive antibody screen.
Results : Total of 3577 women (Rh (D) pos: 3183; Rh (D) neg: 394) were screened for presence of red cell alloantibodies. 51 antibodies were detected in 45 women making overall prevalence of alloantibodies to be 1.25%. Prevalence of irregular erythrocyte antibodies in Rh (D) neg group was 10.4% whereas in Rh (D) pos group was 0.125%. 92.5% of antibodies belonged to Rh system including Anti D, Anti DandC, Anti c. Other non Rh antibodies detected included Anti K, Anti M, Anti S.
Discussion and Conclusions : Despite prophylaxis, Anti D alloimmunization is still a very significant concern. Other non D antibodies are also frequently being encountered. Limited literature is available on alloimmunization in pregnancy from India. Large scale comprehensive studies need to be undertaken to evaluate and address the concerns of alloimmunizations in pregnant women of India.
Distribution of ABO and Rh blood group- A population based study from north India
Pushpanjali Crosslay Hospital, Ghaziabad, UP, India
Introduction : ABO and Rh blood groups are most important blood group in human beings. ABO blood group system was discovered by Landsteiner in 1901 and Rh blood group system was discovered by Weiner in 1930. ABO system is specific as its antibodies are naturally occurring in blood and as they are most antigenic most of the workup in blood bank is based on its compatibility. These antigens show a specific distribution in population. ABO antigen expression varies with age, race, genetics and disease state of the individual. On world wide basis O group is most prevalent followed by B and then A. AB is the least prevalent group overall.
Rh antigen is the second most antigenic structure on RBC. Anti Rh antibodies do not occur naturally in the blood. Its antibodies are produced through exposure of foreign cells as either by transfusion or pregnancy. Rh incompatibility is the most common cause encountered in haemolytic disease of newborn.
Aims and Objectives : To identify distribution of ABO and Rh blood group antigens in a donor population from a tertiary care hospital from north India.
Materials and Methods : Study Site: Study was conducted, in Department of Transfusion Medicine, in Pushpanjali Crosslay Hospital, Ghaziabad. Study Design: Retrospective Study. Case Definition: Persons who had donated blood as replacement donors and as voluntary donors in blood bank of Pushpanjali hospital, in between Jan 2010 to July 2010
Procedure : Data were retrieved from records and computer.
Following were the methods used in our blood bank for determination of Blood groups -
- ABO Blood group was detected by using commercially available Anti A and Anti B sera. Forward grouping was done by Slide method.
- It was reconfirmed by tube method with forward and reverse grouping
- Rh antigen detection was done by slide method using Anti Rh (D type) sera. It was reconfirmed by tube method. Du testing was done for all negative cases.
Result : Out of 1119 donors, 1016 (90.8%) donors were replacement donors and 103 (9.2%) were voluntary donors.
Total male donors were 1074(95.98%) and female were 45(4.02%).
Most common blood group was found to be B (433; 38.7%) followed by O (361; 32.3%) and A (238; 21.27%). rarest was AB (87; 7.8%).
Total Rh positive were 1061 (94.82%) and Rh negative were 58 (5.18).
Conclusion : The commonest blood group detected in the study was B followed by O and A.
Distribution of Rh positive was more than those Rh negative case
Removal of antibodies from dat positive red cells: Comparison of three elution methods
Katharia R, Chaudhary R.
SGPGIMS, Lucknow, UP, India
Introduction : The direct antiglobulin test (DAT) commonly detects immunoglobulin G (IgG) molecules or complement fragments on the red blood cell surface. To phenotype these DAT positive red cells elution procedures are done.
Aim : Objective of the study is to compare three methods for elution of antibodies from DAT positive cells.
Material and Methods : Antibody coated red cells; either by in-vivo or in-vitro sensitization, were used to assess the outcome of three elution methods. For In-vivo sensitized red cells DAT was performed on 230 patient's samples out of which 93 samples were positive by gel cards. 17 alloantibodies (Anti D: 6, Anti D+C: 3, Anti E:2, Anti Jka:2, Anti M:2, Anti Fya:1) were used for in-vitro sensitization of red cells. On these DAT positive red cells elution was performed by three methods, glycine-HCl/ EDTA (acid/EDTA), chloroquine diphosphate and heat elution.
Results : Out of 93 DAT positive samples, 64 (68.8%) showed reduction in strength of reaction, of which 28 samples became DAT negative after treatment whereas in 29 samples there was no change in strength of reaction. Glycine-HCl/EDTA elution showed decrease in reaction in 59 samples (p<0.0001) of which 22 samples became DAT negative. After Heat Elution there was decrease in strength of reaction in 36 samples of which 11 samples became DAT negative where as for chloroquine diphosphate only 29 samples showed decrease reaction which included 6 DAT negative samples. In 17 in-vitro sensitized red cells, Glycine HCl/ EDTA treatment made 12 samples completely negative whereas after heat elution and chloroquine diphosphate treatment 9 samples and 6 samples became DAT negative, respectively. Decrease in strength of reaction was seen in 2 samples for glycine-HCl/EDTA, 3 samples each for heat elution and chloroquine di phosphate.
Conclusion : On comparing the three elution methods, Glycine-HCl/EDTA appears to be better and can be used for typing red cells coated with antibodies.
Clinico-laboratory profile of ABO Haemolytic disease of the newborn
Sabita Basu, Gagandeep Kaur, Ravneet Kaur,
Government Medical College, Chandigarh, India
Introduction : ABO haemolytic disease of the newborn (HDN) results from transplacental passage of maternal anti A and anti B antibodies resulting in hemolysis of fetal / neonatal red cells. We reviewed ABO HDN cases at our centre and describe some interesting observations.
Aims : To determine the frequency of ABO HDN as compared with Rh HDN and to evaluate the clinico-laboratory features of ABO HDN
Materials and Methods : All cases diagnosed as HDN at our centre, during the period January 2007 to December 2009 were reviewed. The maternal blood group, neonate blood group and the DAT reactivity were noted in all cases. The maternal antibody titer and elution studies were evaluated where available. Details of management ie. exchange transfusion and / or photo therapy, and the use of IVIG were also assessed.
Results : Out of a total of 74 cases of HDN diagnosed during this period, there were 35 cases of ABO-HDN. The maternal blood group was 'O' Rh D positive in 33 cases and was 'O' Rh D negative in 2 cases. In these latter two cases, there was no maternal alloimmunisation to the Rh D antigen.The neonate blood group was 'A' in 19 cases. The DAT was positive in all but 2 cases. In both of them DAT was negative(tube technique), but red cell elution showed presence of antibodies. Maternal antibody titers could not be done in all cases, however titers as high as 1024 were noted. Besides photo therapy, the babies were also managed using exchange transfusion and IVIG.
Conclusion : Maternal-fetal ABO incompatibility was responsible for almost half of the cases of haemolytic disease of the newborn. Early detection is necessary, as severe HDN requiring exchange transfusion is not uncommon. Besides, in the appropriate clinical setting, red cell elution must be performed, as the DAT may be negative with red cell elution positive for antibodies.
Frequency of irregular red cells antibodies in thalassemia patients
Chaurasia R, Chaudhary R, Elhence P.
SGPGIMS, Lucknow, India
Introduction : Multiple transfusions are frequently associated with various complications which also include formation of irregular red cell antibodies. Transfusion therapy in thalassemia is a major life saving modality, though; it can lead to complications such as alloimmunization.
Aim : We studied the frequency of alloimmunization and autoimmunization among the multi transfused thalassemia patients coming for regular transfusion at our centre.
Material and Methods : A total of 244 thalassemia patients receiving transfusion were analyzed for the formation of auto and alloantibodies. Direct antiglobulin test was performed on all patients to detect autoantibody while antibody screening (using 3-cell panel) and antibody identification (11-cell panel) were carried out to detect the presence of alloantibody. All patients received ABOand Rh(D) mated transfusion.
Results : In these 244 thalassemia patients, irregular red cell antibodies were found in 20 (8.2%) patients, whereas auto antibodies were detected in 4 (1.6%) patients. Out of the 20 patients with alloantibodies 4 patients had more than one antibody. The alloantibodies identified were Anti E: 10, Anti K: 8, Anti Jka: 2, Anti C: 2, Anti D, c, N: 1 patient each.
Conclusions : For decreasing the rate of alloantibody formation, we should perform an extended phenotype matched cross match, in addition to major blood groups from the start of transfusion.
Weak ABO subgroups in donors of a Delhi blood bank
ESI Hospital Basaidarapsur, New Delhi, India
Introduction : The ABO system is the most important blood group system in transfusion medicine. Majority of the people are clearly typed by red cell (forward) and serum (reverse) group. The extremely weak A (and B) subgroups are infrequently encountered and are usually recognized by apparent discrepancies between red cell and serum grouping.
Aims and Objectives : To analyze the prevalence of extremely weak ABO subgroups in the blood donors
Material and Method : Prospective Study of blood groups of donors from January 2004 to Jun 2010.The blood groups were done by tube test; forward group using monoclonal anti-A and anti-B and reverse group using freshly prepared pooled A1 and B cells prepared in-house. The degree of red cell agglutination was noted. In case of less than 2+ agglutination / discrepancy in forward and reverse group, the tests were repeated with anti-A1, anti-AB, and anti-H for forward group and A1, A2, and O cells for reverse group. An auto control was also included. Adsorption elution studies and Saliva test for A, B and H contents were also done for confirmation of subgroup. Guidelines given in Clinical Practice of Transfusion Medicine by Petz were followed for classification of weak ABO subgroup.
A1 and A2 subgroups are not included in the study.
Results : The number of donors during the study period was 29468. Total 8 subgroups were detected. Out of these 5 belonged to A group, 2 to B group and 1 could not be fixed into any group. Distribution of different weak subgroups was A -1, A3B-3, Ax-1 and Bm -2.
Conclusion : Attention must be given to degree of red cell agglutination to detect weak ABO subgroups. Subgroups of A are more common than B. However the study revealed that less reported subgroups of B are prevalent in our population.
Special procedures required for confirmation of weak subgroup include serum transferase levels, molecular techniques and family studies. Such facilities should be made accessible to blood centres for problem solving Multicentric study for determining frequency of subgroups in Indian population must be undertaken.
Incidence and relative frequency of red cell alloantibodies in Indian blood donors, blood transfusion recipients and antenatal cases by gel centrifugation technique - A pilot study from India
Lt. Col Alok Sen
AFTC Delhi Cantt, New Delhi, India
Introduction : In India, pre-transfusion screening for red cell alloantibodies is not done in majority of the blood banks. Red cell alloantibody screening in antenatal cases, though extremely important to prevent hemolytic disease of the newborn (HDN), is not being done as a routine test in a large number of hospitals in India.
Aims : To determine the incidence and relative frequency of RBC alloantibodies in Indian blood donors, blood transfusion recipients and antenatal cases using gel centrifugation techniques and to evaluate whether red cell alloantibody screening should be adopted as a routine screening test
Methods : Sera from 15,514 blood donors, 10,049 blood transfusion recipients and 1,924 antenatal cases were evaluated for the presence of red cell alloantibodies using a 3 cell screening panel (DiaMed ID DiaCell I-II-III) and the antibodies in the positive sera were identified using an 11 cell identification panel (DiaMed ID DiaPanel).
Results : Red cell alloantibodies were detected in 5 of the 15,514 blood donor samples (0.032%), 33 of the 10,049 blood transfusion recipient samples (0.328%) and 28 of the 1,924 antenatal samples (1.455%). A total of 69 antibodies were detected in the 66 cases. Blood transfusion recipients showed a positivity of 0.3 - 0.4% while the antenatal cases showed an overall positivity of 1.45% with the Rh -ve antenatal cases positivity being as high as 7.2%. The most frequently detected antibody was anti D followed by anti E and anti C.
Summary/Conclusions : Data of this investigation clearly indicates that screening of red cell alloantibodies plays an important role in the pre-transfusion work up of blood transfusion recipients and in antenatal cases. The incidence of red cell alloantibodies in the donors is considerably lower. In view of this, we recommend that red cell antibody screening by gel technique should be adopted as a routine test in the pre-transfusion work up of blood transfusion recipients and screening of antenatal cases and should be optionally done for blood donors if the cost permits.
An analysis of ABO discrepancies in a tertiary care hospital
Gagandeep Kaur, Ravneet Kaur Sabita Basu
Govt. Medical College, Chandigarh, India
Introduction : The ABO system is the most important of all blood group systems in transfusion practice. ABO grouping is a simple, accurate and precise procedure and to be considered valid, the results of cell grouping and serum grouping should agree. Correct typing of a donor or a patient is crucial in transfusion practice since the naturally occurring IgM anti-A and anti-B antibodies can readily activate complement which lead to acute hemolysis and death.
Materials and Methods : We analysed blood group discrepancies reported in our department between Jan'2009 to June' 2010.
Results : 23 blood group discrepancies were detected in a total of 20,119 donors samples and 25,242 patients samples. The most common cause of these discrepancies was ABO subgroups. Low titer of anti- B in serum samples, presence of naturally occurring cold agglutinins in sera and rouleaux formation were other reasons in this regard.
Conclusion : It is important to recognize discrepant results and resolve them. Correct blood typing and labeling of an individual is essential to prevent ABO incompatibility.
Screening for red cell antibodies in blood donors and recipients in saurashtra region with the automated SPRCA technology
Rajesh Sawant, Chandani Karia, Jyoti Bhatt,
Bhanumati Radadia, Maitrik Dave
Rajkot Voluntary Blood Bank and Research Centre, Rajkot, Gujarat, India
Introduction : Antibody screening for donors and patients is performed at very few centres in India. Many patients currently receive only saline cross-matched blood due to lack of proper Antibody screening protocols.
Aim : To determine the extent of red cell antibodies in donor and patient population in Saurashtra region.
Materials and Methods : 34,827 blood donors and 14209 patients blood samples were screened for presence of red cell alloantibodies using a 2 cell panel with the (Galileo) PRCA technology. All positive cases were further tested for antibody identification with the 11 cell panel (Diamed ID Diapanel)
Results : 0.12% (43 of 34827) donors and 0.73% (104 of 14209) patients showed presence of red cell alloantibodies. The occurance of antibodies in female donors (0.35%) significantly higher than in males (0.11%). 16.2% donors had a positive DAT. Positive antibody screening results were observed in 0.87% of female patients and 0.64% of male patients. Thalassaemia (21%), non hemolytic Anemia (12.5%) and AIHA were the most common clinical conditions (10.5%) associated with irregular red cell antibodies. The most common antibodies identified were anti-e, anti-E, Anti-D and Anti- K.
Conclusion : Presence of red cell alloantibodies is detected in significant number of patient population especially those with hemolytical disorders. Screening protocols for red cell allo-antibodies shall remain a challenging task for future.
A case of mild HDN as a result of production of anti-RHD antibody in mother with the weak d type del (ivs3+1g>a) hyland,
Catherine Gardener 1 , Glenn Millard 2 , Glenda O'Brien 1 , Helen Flower 1 , Robert 1
1 Australian Red Cross Blood Service, Brisbane, Australia and 2 Mater Health Service, Brisbane, Australia
Background : Women who have weakened D expression, are usually managed according to protocols devised for Rh(D) negative women. Diagnostic laboratories commonly use serology reagents that type weak Rh(D) variants as Rh(D) negative. In contrast, blood donors of partial or weak Rh(D) types are identified as Rh(D) positive to avoid transfusion and sensitisation of Rh(D) negative recipients.
Results : In a pregnancy in which the mother of the very weak D type, RHDEL (IVS3+IG>A) production of anti-Rh(D) was detected and mild HDN in the baby following delivery managed by phototherapy.
Summary and Conclusion : There are a limited number of reports of detection and evaluation of clinical significance of anti-D in patients with DEL phenotypes. Molecular genotyping provides a basis for identification of the specific weak D type cases and as a result there is an expanding data base of clinical experience in management of pregnancies in mothers with weak Rh(D) positive phenotypes. Increased availability of molecular typing promises a systematic approach to detection of these pregnancies and to more precisely link clinical outcome with appropriate evidence-based management.
Evaluation of the incompatible cross-match test results at Sir J. J. Mahanagar Raktapedhi
Pravin Kamble, Lloyd D'souza, Hitesh Pagare
Sir J. J. Mahanagar Raktapedhi, Mumbai, India
Introduction : The purpose of pre transfusion testing is to select the blood components that will have acceptable survival when transfused and will not cause harm to the recipients. Compatibility testing is done to ensure safe transfusion. The Objective of the study is to identify the cross-match which were incompatible due to various clinical conditions of patients and basis on which blood units were issued.
Material and Methods : Period of study from March 2009 to Feb 2010 cross-match was done on completely automated system Techno Twin station by Diamed. Results obtained using poly specific cards coomb's and saline were categorized in to positive and negative. First positive test was repeated with same sample and IAT was performed simultaneously on all the samples.
Results : 11,364 cross-matches were performed to issue 11160 units.; 370 cross-match were incompatible found in 200 patients; 85 of there were males 115 were females; 32.4% cross-match which were incompatibility was seen in case of auto immune Hemolytic anemia; 20% of the cases belong to hematological disorder
Thalessemia children constituted to 16.2%; 158 patients were IAT positive.
Discussion : In case of Auto - Immune haemolytic -
Anemia (AIHA) auto antibodies are developed which interfer in cross-matching techniques. Patients with Multiple transfusion also should these problems so repeat multiples cross-match were done.
In case of emergency least incompatible units were issued by doing dilutional cross-match to the patient after request from the physician.
Conclusion : Column agglutinations techniques very sensitive method. We had incompatible units detected due to various clinical conditions, the antibody identification using screening cells and panel cells was done at referral center, by analyzing this data we felt the need to started, Antibody screening and Identification at our center to issue compatible units to our patients.
Assessment of extended shelf life of random donor platelets stored at lower temperatures
Tulika Chandra, Ashish Gupta, Ashutosh Kumar
C.S.M Medical University, Lucknow, India
Introduction : Platelets are routinely isolated from whole blood, concentrated and stored in plasma for use in transfusion therapy. According to guidelines of blood bank, random donor platelets are stored for five days at 20 to 24 0 C.
Aim and Objectives : The objective of the present study was to assess the shelf life of random donor platelets stored for 7 days at lower temperature. Lower temperature may minimize chances of bacterial proliferation while maintaining platelet functions at optimum level.
Material and Methods : The study sample included 55 blood donors of both sex in State Blood Bank, Chhatrapati Shahuji Maharaj Medical University, Lucknow. Complete history of donors was taken to exclude any infection and disease. The random donor platelets were prepared by platelet rich plasma (PRP) method. The whole blood (350 ml.) was collected in anticoagulant Citrate Phosphate Dextrose Adenine (CPDA) triple blood bags. Random donor platelet concentrates were evaluated for platelet functions and bacterial contamination on day 0, day 5 and day 7 at temperatures of 22 0C, 18 0C and 16 0C
Results : Platelet swirling was present in all the units on day 7. Out of 55 samples, 2 showed bacterial contamination on day 7 only at 22 0C. Comparison of the mean values of platelet count, PF 3, lactate dehydrogenase, pH and glucose showed no significant difference at 22 0C and 18 0C while PF 3, pH and glucose level were markedly different on day 7 at a temperature of 16 0C.
Conclusions : Our study infers that platelet functions are maintained within normal levels with no evidence of bacterial contamination on day 7 only at 18 0C. Thus we may conclude that extended storage of random donor platelets can be done at 18 0C for seven days.
Effect of gamma irradiation with 30 gy on the coagulation system in fresh frozen plasma
Col R S Sarkar, Col J Philip, Lt Col Satish Kumar,
Prathip Kumar B R
Arms Forces Medical College, Pune, India
Introduction : Fresh Frozen Plasma (FFP) is a blood component prepared from whole blood or from apheresis donation. It contains plasma proteins, coagulant factors, anticoagulant factors, complement factors and immunoglobulins in a functional state. Clotting factors are the main constituents for which FFP is demanded. Donor leukocytes including lymphocytes are present in FFP in significant numbers inspite of freezing. These WBCs can proliferate in patient circulation following transfusion causing complications including Transfusion associated graft versus host disease (TA-GVHD). This warrants for irradiation of FFP. The only currently effective (approved) method available for preventing TA-GVHD is by gamma irradiation of blood component before transfusion. Studies till date suggest there is no clinically significant change immediately after irradiation of cellular components. There is limited data available regard changes in FFP after irradiation in respect to coagulation parameters.
Aim and objective : To study the effect of gamma irradiation with 30 Gy on the coagulation system in FFP.
Study Design and Methods : 75 units of FFP that have been prepared at our centre were analysed. After thawing of FFP a small aliquot was made under sterile conditions and one more after irradiating the product. In both the parts variables of hemostatics system were measured using automated coagulation analyzer Diagnostica stago (STA Compact France). Activated partial thromboplastin time (APTT), prothrombin time (PT) and with it the international normalized ratio, thrombin time and the activities of the coagulation factors FI, FII, FV, Vwf Ag, and D-dimer were measured.
Results : Irradiation with 30 Gy resulted in alteration of PT, APTT, TT and in coagulation factors FI, FII,FV and D -dimers and Vwf Ag.
Conclusion : Gamma irradiation of FFP with 30 Gy resulted in a significant but very weak alteration of coagulation system in FFP.
Detection of bacterial growth in blood and blood components using oxygen consumption as surrogate marker
Preeti Chavan, S B Rajadhyaksha, Shashank Ojha,
ACTREC, Navi Mumbai, Maharastra, India
Introduction : Bacterial contamination, one of the earliest recognized complications of stored blood, remains an important cause of transfusion related morbidity and mortality. In USA, bacterial contamination is the most common infectious source of morbidity and mortality related to transfusion. In fact, risk in Random Donor Platelets and Single Donor Platelets was found to be 300-fold higher than the risk of either HIV or HCV.
Aim and Objectives : This retrospective study was done to evaluate the rate of bacterial contamination in Random Donor Platelets (RDPs), Single Donor Platelets (SDPs), and Packed Red Blood Cells (PRBCs) using oxygen consumption as a surrogate marker.
Materials and Methods : During a period from October 2008 till July 2010, a retrospective evaluation of the rate of bacterial contamination in RDPs, SDPs and PRBCs, meant to be transfused to patients undergoing bone marrow transplantation was done. For this purpose Pall eBDS system (M/S PALL Life Sciences) was used which detects bacteria by measuring oxygen consumption. Results are interpreted by the system as PASS or FAIL based on the level of oxygen consumption after 30 hours of incubation.
Results : Out of 258 RDPs tested, 3 RDPs (1.16 %) failed the test after 30 hrs incubation. Similarly, out of 246 SDPs and 272 PRBCs, 2 SDPs (0.81 %) and 8 PRBCs (2.94%) respectively, failed the test after 30 hr incubation. The failed units and all of their respective components were discarded.
Conclusion : The above system is quite useful in screening blood and blood components meant for transfusion in patients with low immunity, especially Bone Marrow Transplantation patients, who are more susceptible to get transfusion transmitted bacterial infection.
Quality control of random donor platelets
Sundar Periyavan, Sebastin L, Shivanna N
NIMHANS, Bangalore, India
Introduction : For every blood transfusion services it is necessary to carry out reliable quality control including Random platelet concentrates (RDP),
Aims and Objectives : The aim of the study was to determine whether patients transfused with RDPs, in our center, get adequate therapeutically useful amount of platelets.
Materials and Methods : The study was conducted at transfusion medicine center, NIMHANS, Bangalore, on 200 RDPs, randomly, over a period of 5 months June to September. 2009. The platelet concentrates were prepared from whole blood using the PRP method. The quality control procedures were carried out after 24 hours of preparation for volume, Ph, total platelet count/bag, red cell contamination and morphology. The volume was measured by electronic weighing scale in ml. Ph of the platelet concentrate units was checked by the use of dipsticks. The results were correlated with Ph meter. Platelet count was done by automated method using Hematology analyzer and manual method. The appearance of RDPs was checked to determine whether there was red cell contaminated by visual inspection. The appeared colors were light straw, light pink, pink and red.
Results : Volume 90% of the RDP was weighing between 50 to 70 ml, 4% below 50 and 6% above 70 ml. The count correlated well in both the methods and 85% of RDP had a count of above 5.5 x 1010, 15% had below 5 x 1010. Ph: 56% of the RDP had of 6.3 to 6.5, 33% had 6.6 to 7.0 and 6% at 6.2 and 5% above 7.0. Appearance: 86% was light straw colored, 3% light pint, 6% pink and 5% red.
Conclusion : Doing quality control is essential and it is not only valuable in itself but also helps in identify trouble shooting of the procedures. In conclusion more than 95% of the RDPs prepared meet the standard.
Evaluation of platelets for bacterial contamination using the EBDS system-a pilot study
Rajesh Sawant, Aboli Marathe, Amol Tirlotkar, Vimal Sathyan, Kalpesh Chawan
Rajkot Voluntary Blood Bank and Research Centre, Rajkot, Gujarat, India
Introduction : Bacterial contamination of blood components has been a major concern worldwide recently. Currently, the extent of bacterial contamination in platelet units in Indian scenario is not known.
Aim : To estimate the extent of bacterial contamination in platelet units and evaluate the sensitivity, specificity and practical feasibility of use of the eBDS system.
Materials and Methods : Platelet units (N=10) were spiked with 5 to 100 cfu/ml of ATCC strains of most commonly implicated species of bacteria and stored at 240c for 5 days. All units were tested in parallel with eBDS and Bactec 9050 systems at specific intervals. Further, random donor platelets (N=3000), Apheresis platelets (N= 150) and pooled platelets (N=50) were tested for pH and bacterial contamination on Days 1, 3 and 5 with both the systems.
Results : Percentage positivity rate was 0.3% for random donor platelets and 2.6% for apheresis platelets. The sensitivity, specificity, PPV and NPV of eBDS with reference to the Bactec system was better when results obtained at 48 hours compared to those at 24 hours were considered. Coagulase negative Staphyllococcus, nutritionally variant Streptococci and Bacillus subtilis were the commonly isolated bacteria. Bacterial contamination was detected most commonly on Day 3 of storage and there was no significant correlation (P=0.12) of fall in pH with bacterial contamination.
Conclusion : Extent of bacterial contamination of platelets is considerably high in our scenario. eBDS system has a high sensitivity and specificity at 48 hours and was easy to implement into routine use.
Validation of manual method of counting WBCS in Nageotte chamber
Vedanta, The Medicity, Gurgoan, Haryana, India
Introduction : Quality control standards of leucodepleted blood components require less than 5 X 106 White Blood Cells (WBC) in Red Cells, according to American Association of Blood Banks (AABB) technical manual (14th Edition). This number is so small that it is below the detection limits of an electronic cell counter. The only possible ways of counting such small number of WBC is either Nageotte chamber (detection limit=1WBC/μl) or flow-cytometer (detection limit=0.1 WBC/μl). Since Nageotte chamber was available, it was decided to validate the manual method of counting WBC in Nageotte Chamber before its routine use for Quality Control of leuco-depleted blood products.
Aims And Objectives : Validate the manual method of counting WBCs in Nageotte Chamber.
Materials and Methods : 30 samples containing known concentrations of WBC (measured by calibrated Electronic Cell Counter) were prepared by diluting (dilution1: 1000) 1-day-old EDTA blood on thirty different working days. Same operator did the manual counts using the standard method described in Dacie and Lewis Practical Haematology (10th edition).
Results : The manual counts were compared with known concentrations of WBC and the variations in manual counts were within two standard deviations.
Conclusion : The manual method of counting WBCs in Nageotte Chamber was validated. However the process of validation was lengthy and cumbersome with the technician spending two hours every day on an average.
Clinical Transfusion Practices
An audit on completeness of transfusion request in a tertiary care oncology centre
Sujata Malankar, Priti Desai, SB Rajadhyaksha
Tata Memorial Hospital, Parel, Mumbai, India
Introduction : Judicious use of blood depends on appropriate ordering practices and audit of transfusion requests.
Aim : To study appropriateness and completeness of Transfusion Requests
Materials and Methods : The various details in the Transfusion Request form were evaluated for completeness of the request in all respects. A total of 1000 requests across all specialties, including indoor and outdoor (Day Care) patients over a period of one month were examined.
Results : The salient findings are being presented in this paper.
Conclusion : The findings of this audit will help improve ordering practices for blood and blood products and ensure better blood utilization.
Transfusion in disasters: Shift in focus from whole blood to blood components and frozen blood: Armed forces scenario
Tata Main Hospital, Jamshedpur, Jharkhand, India
Introduction : The blood requirement during disasters is unpredictable. It is vital that we seriously consider Frozen Red blood cell reserves as a supplement to liquid stored blood and use of blood components in place of whole blood for disaster scenarios and avoid overzealous collection of liquid blood and its wastages due to mass media appeal to donate during disasters.
Aim : To maintain adequate inventory of screened blood components in addition to daily usages and to establish Frozen red cell programme for armed forces in particular for disasters to save life and limb.
Materials and Methods : Whole blood is collected from healthy male and female volunteer donors in 350/450 ml triple plastic blood bags with CPDA-I anticoagulant as per guidelines on the subject. For liquid stored blood, 100 percent blood collected is converted into packed red cells, fresh frozen plasma and platelet concentrate within 6-8 hours of blood collection and transported and stored at requisite temperatures in respective storage cabinets at disaster site. Three times the daily usage is collected and screened to ensure adequate preparedness for disasters. For frozen red cell reserves, 100 units of packed red cells has been collected in 450 ml plastic bags and glycerolized using 40% w/v glycerol using Hemonetics ACP 215 equipment and stored at minus 80o C. Deglycerolization using the same equipment has been carried out within its shelf life and the product evaluated at three monthly intervals for one year.
Results : Quality assurance of liquid stored blood is being carried out as per FDA guidelines on the subject. The deglycerolized product is being evaluated in terms of sterility, ph, hemolysis, osmolality and viability to see if it complies with the international regulations and guideline before the frozen red cell programme could be put into use without any untoward effect.
Conclusion : Blood components both in liquid state and stored frozen at minus 80o C can effectively meet any disaster situation in terms of blood transfusion requirement and thus help reduce morbidity and mortality.
Role of blood transfusion services in disaster management
Dhinesh Kumar C, Panicker V.K, Krishnamoorthy R, Febe R.S, Alexander S
Sri Ramachandra University, Chennai, India
Introduction : Blood transfusion services (BTS) should be geared up to tackle the situation in case of disasters. As of now there is no pre-planning done to tackle emergency crises- either natural (Earthquakes etc) or man-made (Terrorist attacks, Rail accidents etc).
Aim of the study : To provide an insight about the role of BTS in disaster management.
Methodology : Preparedness, mitigation, response and recovery are the phases of a disaster management plan. Disaster Plan should be designed in such a way that the Government Bodies, Private Agencies and Voluntary services co-ordinate together so that the whole system is streamlined and immediate measures are taken. In the event of a disaster, the Media (Radio and TV) play a major role in bringing together the spirit of the people and appealing for blood donations. Care must be taken to streamline the donation process so that all donors would not land in the same collection centre. Shifting of blood from the collection point to the lab and re-shifting of such huge quantities of blood to the transfusion site should be properly planned. Wastage of blood and its products is to be avoided.
Results : Based on previous experiences, it is always better to manage the situation initially with the existing blood bank inventory, rather than relying only on blood donations after the disaster strikes. Patients who truly require blood and who would benefit from transfusion must be triaged. Security of the BTS and blood supply should be ensured.
Conclusion : Regular blood donors' registry should be maintained so that in the event of a disaster they can be called upon to donate blood. Like door to door population census, if a blood census is taken region wise and country wise it would be the best and most valuable data in the event of a disaster.
Planning for disaster management in BTS-need of the hour
V S Minhas
HP State AIDS Control Society, Simla, India
Introduction : Emergencies and disaster situations require a rapid and timely response by the health services, development of activities to reduce vulnerability of the health sector to disasters, to strengthen emergency and disaster preparedness plans and timely provision of safe blood.
Aims and Objectives : Keeping in view the highly specific functions of Blood Transfusion Services, the blood banks should have low vulnerability to disasters, probability of the system being significantly damaged should be as low as possible, if damage does occur, it should not disrupt the operational capacity and if damage occurs, recovery can take place in a reasonable amount of time.
Discussion : The disaster puts partial or total loss to health facilities at the time of increase demand of these services and leads to disruption of social networks and operational aspects of Health Services. BTS must be prepared to mitigate and reduce vulnerability by restoring and reorganizing BTS services and ensuring community participation in disaster. The preparedness must be ensured by determining the physical and organizational vulnerability of the system by considering structural, non- structural, functional elements and proper management of human resources including training etc. and ensuring organizational and institutional responses to the disaster and effective communication with the community based organization for provision of safe blood. The Blood Transfusion Services should have identified alternate blood bank services, inventory of blood and its components, trained blood bank personals, testing facilities, transportation facilities available and list of community based organizations with list of donors. The simulation exercises to access the preparedness of the services to provide the safe blood at the time of disaster must be conducted in regular intervals. During disaster, the need of the blood units to be released should be assessed immediately by taking into account the blood units available and that can be transported from other alternate sources. The community organizations with area specific blood donor list (as communication may be broken) should be contacted and appeal for donation should be issued, only if urgent, to avoid panic. The regular donors should be preferred and camps be organized in less congested areas. Critical post emergency analysis must be done to access effectiveness of the disaster management plan.
Conclusion : Blood Transfusion Services (BTS) are the backbone of any disaster management plan as provision of safe blood is of utmost importance during crisis. Effective disaster management plan can ensure safe and timely blood to the patient and tilt the balance in his favour.
Process improvement to minimize the discard of blood units
Tata Memorial Hospital, Mumbai, India
Introduction : There are several reasons for the discard of blood units other than sero-reactivity. Continuous monitoring of procedures, corrective actions whenever required during collection of blood unit, processing of blood components, issue of blood units and other process can reduce the number of discards in the blood transfusion services
Aim : To identify the areas for process improvement and formulate the strategies to minimize the number of discards of blood units in the transfusion services.
Materials and Methods :
- A retrospective analysis of data of discarded blood units for the year 2009 was done. Various reasons leading to the discard of blood units were listed
- Different factors responsible for discard of blood units were studied.
- Various possibilities and precautionary measures which will help to reduce the discard of blood units were identified.
Results : During study period of one year, out of 16569 blood donations 472 (2.84%) units were discarded for various reasons which include sero-reactivity, variation in volume, leakage, presence of clot, problems during processing, lipemic unit, altered LFT, returned after issue, CUE etc. Total 347 (2.09%) units discarded due to sero-reactivity. About 125 (0.75%) units were discarded due to other reasons.
Conclusion : Present practices of transfusion services leave much scope for improvement. Every effort to identify the critical areas of blood transfusion services and processes should be done to reduce the number of discard blood units.
An audit of transfusion of blood components in a tertiary care hospital in Gujarat
Pritesh Rajani, Jignesh Jambukiya, Mamta Shah, Nidhi Bhatnagar, M.D. Gajjar
Dept of IHBT, Civil Hospital, Ahmedabad, India
Background : Audit in blood bank is an effective management tool for rationalizing blood usage and forms an important part of quality assurance program.
Rational usage of blood means providing the right blood product in the right quantity for the right patient at the right time.
Aims and Objectives : The objective of this study is audit of blood and blood component utilization by different specialities using the cross match/ Transfusion ratio C/T= No. of units cross matched/No. of units transfused, non usage probability (%) = (No. of patients transfused/No. of patients cross matched) X 100, transfusion index = No. of units transfused/No. of Patients Cross matched as a guide to achieve effective transfusion practices. A C/T ratio of >2 and Transfusion Index of > 0.5 are taken as cut-off for deciding the rational usage of blood components.
Material and Method : A retrospective study was conducted in Civil Hospital, Ahmedabad in the department of Immuno Haematology and Blood Transfusion regarding transfusion of blood components in the various departments of the hospital for the year 2009 (January to December).
The number of units cross matched, issued and cancelled and the numbers of patients admitted in each department were obtained from the computerized data and CT ratio, Non usage probability and TI were calculated.
Results : From the data collected the following results were obtained -
For whole blood usage, for the department of Urology, Dental and ENT, the C/T ratio was more than 2 and the non usage probability (%) was more than 50%.
For Red cell concentrate the C/T ratio for department of Urology and ENT exceeded 2.
For Platelets, FFP, CPP and Cryoprecipitate, the products were issued on immediate requirement basis, so the non usage probability (%) was reduced to a minimum.
As far as transfusion index value for most of the department goes it exceeded 0.5.
Conclusion : Whole blood and red cell concentrate were the components that were used irrationally by some of the departments as cited by the figures which indicate the extra workload and expenses borne by the department.
Proper planning of surgeries (in cases of planned operation) and planning the demands in view of clinical diagnosis and clinical examination can not only reduce workload borne by the department but can also help maintain stock for the urgent demands.
Trends in issue and discard of blood and blood components at Sir. J.J. Mahanagar Raktapedhi
Pravina M. Bhalgamiya, Hitesh Pagare
Sir J. J. Mahanagar Raktapedhi, Mumbai, India
Introduction : Sir J. J. Mahanagar Raktapedhi has been fully functional Since March 2009. Total collection is from voluntary non-remunerated donors Blood Bags collected are subjected to 100% component separation.
Aim of study is to find out the trends in issue and discard of Blood Components at our center.
Material and Methods : Data collected from the issue Registers of Packed Red Blood Cells, Platelet- Concentrate, Fresh Frozen Plasma, Cryoprecipitate and Single donor platelet and Sales Receipt during Year 1st March 2009 to 28th February 2010.
Discard records on monthly basis noted from discard register.
Total collection during the period was 17996
Total No. of components separated was - 51470
Total No. of Blood and blood components issued - 45322
PC-14358, Platelet - 13936, FFP - 11330
Total No. of blood components discarded - 516 reactive discard 2.8%.
Total No of Packed cells discarded outdated - 123 - 0.85%
Total No of Platelets discarded outdated - 921 - 6.6%
- 14358 packed cells were issued, out of which 2.5% to organizer, 1.7% against Voluntary donor card.
- 66.8% of platelet was issued to the Government Hospitals, while 6.6 % were discarded.
- 38.4 % of fresh frozen Plasma was issued to Government Hospitals, 35% was sent for fractionation.
- 73.6% of total cryoprecipitate was issued free to the Hemophilia patients.
- 12.4% of the Blood components were issued free of cost.
Conclusion : Maximum issue of Platelets was in month June 2009.
Inventory management in blood bank
Seth G.S. Medical College and K.E.M. Hospital, Mumbai, India
An effective hospital blood inventory management system can reduce the inventory that a hospital needs to keep on hand as well as contribute to lower blood outdate rates.
The minimum and desired inventory levels that meet the need of patient population should be determined. The inventory should be rotated ensuring the shortest outdate units in front of the refrigerator/ freezer.
If computer systems are available in a hospital, the hospital transfusion service computer system should generate a daily report of "soon to outdate" blood components. The report should be posted on the front of the storage refrigerator / freezer to remind staff to utilize these components first. Whenever possible, only ABO identical red blood cells and plasma products should be provided to patients for transfusion. This will conserve group O red blood cells and AB plasma products for emergency situations.
To minimize RBC outdates, transfusing "Soon to outdate" Rh negative RBCs to Rh positive patients should be considered. Smaller hospitals should consider an arrangement to transfer "Soon to outdate" RBCs to a larger hospital with a higher demand for RBCs. Packing procedures must ensure that the RBCs are maintained at appropriate conditions during transport. A regular inventory count should be done with prompt resolution of the inventory discrepancies. For hospitals with a transfusion service computer system, this may involve comparing the computer inventory count to a manual inventory count.
MSBOS- Maximum Surgical Blood Order Schedule should be established which is based on the hospital's past surgical blood use and serves as a guideline for future surgical blood requests.
Group and screen policy should be considered for patients where red blood cells are ordered but are unlikely to be required for transfusion. This will minimize the red blood cell inventory that is cross matched/ labeled for patients and is unavailable for use by other patients.
There should be a cancellation policy that returns red blood cells to an "available" inventory as soon as the potential need for a transfusion is passed. Cross match to transfusion (C: T) ratios should be monitored. A target C: T ratio of less than 2 is considered acceptable. Guidelines for autologous blood donation should be established.
If hospital routinely transfuses platelets, an inventory of platelets in hand should be maintained. This may assist in minimizing the need for orders from outside the hospital. If a hospital is at a significant distance (>1-2 hours drive) from the blood supplier, and the hospital's patient population includes patients that require platelets in urgent situations, it is advisable to keep a dose of platelets in hand. Inventory management for blood platelets is a challenging task due to platelet's extremely short product life cycle, high unit production cost, limited pool of platelet donors, and high demand uncertainty.
Emergency and disaster situations require a rapid and timely response by the transfusion services. There should be timely provision of safe blood and inventory of blood bank personnel should be maintained. Monsoon related illnesses like Leptospirosis, Malaria and Dengue require platelet transfusions due to thrombocytopenia and bleeding. Hence, the requirement for platelets increases during monsoons. All the Blood Transfusion Services should maintain adequate stock of platelets during monsoons so that it can be given to any patient and not just restrict to in-house hospital patients. However, when the demand for platelets is less, platelets units may outdate i.e. expire without being transfused, due to mismatches between supply and demand. Hence, it is essential to optimize platelet inventory management.
In case of disaster, an inventory of blood bank personnel should be maintained. The communication systems of the blood bank and transfusion services should be well organized. It should be ensured that the information is transmitted about the need for and inventory of immediately available blood and blood components. Blood collection should be planned in accordance with the needs.
Effective inventory management-PBC experience
Prathama Blood Centre, vsan, Ahmedabad, India
Aim : Prathama was started in Nov, 2000 with the specific objective of promoting 100% voluntary blood donations and componentization without any room for whole blood inventory. Initially there were several hiccups between PBC and medical fraternity while promoting the use and advantages of blood components. Later, after seeing the advantages and efficacy of the blood components, the same medical fraternity has been responding exceedingly well in utilizing the components. Then the pressure on inventory management to meet the demands of the doctors came up
Method : During the initial years with the blood collections around 2000/p.m, there was chronic and acute shortages of RBCs and platelets. Then it was realized that this was due to less than expected blood collections and very little base line blood inventory level i.e 25 units each of all D positive groups and 2-3 units of negative groups except AB negative.
With the active promotion of Donor Insurance Programme (DIP) and the engagement of donor motivation team, the blood collections started increasing dramatically. The blood collections have gone up to 4000 per month. Then, we revised our policy of inventory management.
We started with the base line stock or the Safety Stock Level of 1500 units of RBCs of all groups put together and keeps replenishing the stock based on demand and the supply chain has become smoother. Our Re-call centre helps us to a great extent in replenishing the stocks especially for D-negative groups and platelets.
Results : With the excellent response from voluntary blood donors and the medical fraternity, PBC is able to meet 50% of the City's blood component requirement. Maintenance of Safety Stock Levels has helped us to meet all critical requirements for blood and blood components. Forecasting of platelet preparation through our IBBMS software has helped us to reduce the expiry rate of platelets from 15 to 9%. PBC is not experiencing any hiccups due to shortages for last few years. Last year, the total component distribution has reached more than 1,15,000.
Conclusion : PBC experience shows that the Effective Inventory Management of blood components through software help to maintain adequate and safe stock levels to meet the demand during critical periods and minimize the wastage of components due to outdating.
After 100% component separation only 6.6% of total platelets were discarded. However the discard rate of Packed Cells 0.85% and 0.2% for Fresh Frozen Plasma was very low due to maximum utilization.
Analysis of the partial units issue at Sir J.J Mahanagar Raktapedhi
Shreya Shevade, Hemangi Paradkar, Hitesh Pagare
Sir J. J. Mahanagar Raktapedhi, Mumbai, India
Introduction : The Partial units issue by Aliquots is mostly indicated in neonates in which the volume required for transfusion is around 50-100ml. as per the patients weight. Instead of issuing the entire bag, the required volume to be transfused, should be aliquot and issue. This will also help in inventory management
Aim of the study : To analyze the issue of partial unit data.
Materials and Method : The period of study from March 2009- Feb 2010.
Total number of cross match done 11364 to issue 11160 units.
Aliquot was done using sterile connecting device by Terumo Penpol which is closed system, Hence the expiry date remains the same which is 42 days from date of collection entries were made in aliquot issue register.
Result : Total number of partial units issued 371 which 2.5% of total issue.
Commonest group for which aliquot was done is 'O' Positive (37.73%).
Minimum and Maximum Volume was 10cc and 240cc respectively.
Maximum number of partial units was issued in month of August 2009.
The remaining Blood volume of the mother bag if not used was issued to other patient after doing cross match was 4.8%.
Discussion : 'O' Positive group partial units were maximum issued, as 'O' positive units were compatible with Mother and Baby's samples.
Depending on the weight of the neonates the volume of aliquots can be prepared thus remaining blood volume which used to be discarded after 24 hours due to open system can be reduced is Sterile Connecting device is used. The issue of total Blood units was maximum in the month of August hence partial unit issue also increased.
Conclusion : By issuing partial units to the neonatal and infants using sterile connecting device, helps to maintain the same expiry as that of mother bag and thus helping us to manage our blood inventory.
In-process leukocyte depletion: Need of the multi-transfused patients
Rajkot Voluntary Blood Bank, Rajkot, Gujarat, India
Introduction : The use of LD blood components has become the standard therapy for multi-transfused patients during past few years, as measures to reduce the frequency of alloimmunization and post-transfusion complications.
Aims and Objectives : To evaluate Pall leukotrap RCPL inprocess filter system, UK as per AABB standards and compare incidence of NHFTR and platelet refractoriness in renal dialysis and hematology patients between LD and non LD pRBC and PC recipients.
Material and Methods : The study was conducted in Riyadh Medical Complex, KSA from January 2006 to November 2007. A total of 70 Pall Leukotrap RCPL in-process double red cell and platelet leukocyte filter 450 ml quadruple blood bags with SAGM were evaluated. The incidence of NHFTR in pRBC and PC and platelet refractoriness in PC of non LD and LD recipients were compared. A total of 1826 (male-1553; female-273) patients received non LD-pRBCs (n=1917) and PCs (n=3972) while 2168 patients received LD-pRBCs (n=3262) and LD-PC (n=5916) units during study period.
Results : The mean whole blood WBC count was 4.03X109/unit. Mean post LD WBC count in LD-pRBC unit was 3.3X105/unit [>99.99 WBC removal; 4log10] and in LD-PC unit was 4.9X105/unit [99.8% removal; 3log10] respectively. The mean platelet count in post LD-PC units was 8.2X1010/unit.
The incidence of NHFTR in non-LD-PCs 3.7% (158/3977) and pRBCs 2.04% (39/1907) recipients were compared with LD-PCs 0.028% (17/5916) and LD-pRBCs 0.35% (8/2262) recipients (p<0.001). Platelet refractoriness in non LD recipients were 4.7% (187/3972) compared to LD-PCs 0.24% (17/6916) recipients (p<0.001).
Conclusion : The systematic use of LD components decreases threat of WBCs associated post transfusion complications which allow better supportive care and more aggressive approaches in multi-transfused patients care.
Utilization of blood and blood components in liver transplantation - An experience of medanta - the medicity
Prashant Pandey, Aseem Tiwari, Divyajyoti Srivastava, Surbhi Dixit, Vimarsh Raina
Vedanta the Medicity, Gurgaon, Haryana, India
Introduction : Massive blood loss during surgery and preexisting hypo-coagulopathy create a challenge to transfusion services. Liver transplantation is done in patients of end stage liver disease (failure) who have coagulation deficiencies and thrombocytopenia. Despite of dramatic improvement in live transplant technique to reduce blood loss and use of pharmacological alternatives of blood, still liver transplantation procedures require the most blood components.
Aims and objectives : The objective of this study is to analyze the data for the mean blood component usage in liver transplantation at our center.
Materials and Methods : This prospective observational study was conducted at the dept of transfusion medicine, Medata-The medicity. Data were collected for the period of 2 months (June 2010 to july 2010). Data for the peri-operative utilization of blood and blood components were collected through the hospital information system (HIS) and in some of the cases data were retrieved physically through the blood bank issue record.
Results : Total number of live donor liver transplant procedures performed during the period of observation were 45. the mean age of liver transplant recipients was 37 years(range 3 years- 60 years). The mean number of components used during the period of observation were 8.3 (Range= 2-23) leuko-depleted red cell concentrates in additive solution,7.4 units of FFP (Range=1-19) and 1.7 (Range= 1-7) units of single donor platelets. In none of the patients cryoprecipitate and random donor platelets were used.
Conclusion : Although the blood utilization has steadily declined over the years in last decade but still a successful liver transplant program frequently requires a large number of blood units peri-operatively.
Platelet transfusion practice during dengue fever
Red Cross Blood Bank, Nellore, AP, India
Introduction : Dengue fever and its complications have emerged as a public health problem in our country particularly in Nellore and surrounding districts. Bleeding in Dengue is one of the dreaded complications and is associated with high mortality. The exact indications for platelet transfusion trigger vary greatly in different clinical settings.
Aim : The present study has been designed to perform a retrospective analysis of platelet transfusions during the three months period among patients with suspected dengue fever with Thrombocytopenia, those cases are analyzed for pre and post transfusion platelet count, platelet dose, and increment.
Methods : The study included all patients who were admitted in the emergency ward with suspected Dengue fever with Thrombocytopenia.
Result : During the three months period 1043 patients of suspected dengue fever with Thrombocytopenia, received 5143 units of Platelet concentrates units.
Dengue viral serology was done in less than half of these cases. Details of bleeding manifestations were not available on the requisition form and had to be retrieved from case files. In 11 percent of cases platelet transfusion trigger was 20,000/΅l for most of patients. Correlation of platelet count with clinical history, platelet transfusion dose and platelet count increment will be evaluated wherever possible.
Conclusion : Since large number of platelet transfusions were given with Pre-transfusion count around 20,000/΅l. There is need for development and implementation of uniform guidelines for optimal utilization of platelets.
Close interactive and Co-ordination between clinician and transfusion medicine specialist is required to ensure adherence to formulated guidelines. Blood Bank must have efficient inventory management and ensure prompt issue of platelets and new technology of Plateletpheresis, Pooled Platelets should be.
Evaluation of red cell transfusion practices in patients undergoingelective surgical procedures at a superspeciality center
Agarwal N., Agarwal P., Chaudhary R.K.
SGPGIMS, Lucknow, India
Introduction : There is a great tendency in most departments of surgery to request more units of blood for elective procedures than is actually required. Many units of blood routinely ordered by surgeons are not utilized but are held in reserve and thus are unavailable to needy patients. Therefore, it is necessary to streamline blood ordering and transfusion practices. Continuous monitoring of transfusion activity as well as implementation and optimization of transfusion strategies may help to improve transfusion practice and reduce or eliminate this large variability across transfusion practices.
Aim of study :
- To assess pattern of red cell transfusion support in patients undergoing elective surgery at our institute.
- To assess blood ordering practices in surgical departments.
Material and Methods : This study was an audit of blood usage for patients who underwent elective surgery at our institute between Nov 2007 and Oct 2009. Clinico-pathological and laboratory data for these patients was obtained from the Hospital Information System (HIS) as well as patient's medical records. C/T ratios, Transfusion Probability and Transfusion Index were calculated for each surgery.
Results : A total of 834 patients were included in the study, out of which 69% were males and 31% were females. A total of 2217 units were crossmatched for 834 patients, of which only 907 (40.9%) PRBC units were utilized while remaining 1310 (59.1%) units were received back unutilized. All the 3 indices used showed cardiac surgeries like CABG, septal repair and valve surgeries used blood optimally without much wastage. Same pattern of blood usage was observed in other surgeries like Gastrectomy, Whipple's procedure, Exploratory laparotomy and Nephrectomy. As per the transfusion indices, any one out of three indices showed that blood was not used optimally in surgeries like Thyroidectomy, PCNL, Prostatectomy, Craniotomy and TURP. However, surgeries like laparoscopic Cholecystcetomy, Genitoplasty, VVF repair utilized blood inefficiently as indicated by all transfusion indices with TP< 30,TI < 0.5 and CTR>2).
Conclusion : Enormous variability still exists in the use of blood for surgical procedures and overordering is a common occurrence. There is a great need to develop clinically useful criteria to assess transfusion need and blood should be ordered according to a MSBOS for operations with higher transfusion requirements.
Clinical transfusion practices: Uses and misuses of FFP audit of fresh frozen plasma usage in tertiary care centre
Jayashree Sharma, Swarupa Bhagwat, Prakash Dive, Charusmita Modi
Seth G.S. Medical College and K.E.M. Hospital, Mumbai, India
Introduction : Demand for Fresh Frozen Plasma (FFP) is constantly increasing due to increased therapeutic use in surgeries and liver diseases. Because of this significant increase in FFP transfusions, it is very essential to audit FFP collection, storage, quality, ordering practices and clinical outcome of FFP transfusions.
Aims and Objectives : To assess usage of FFP in various clinical settings; To assess proper indications for usage of FFP in various clinical settings; To establish FFP Transfusion guidelines
Materials and Methods : A prospective audit of 8699 FFP transfusions in 8 months, total 85 indoor patients admitted under all specialities in a tertiary care centre during 2008-2009 was performed. Using the clinical records of the patients, all the required data was collected like demographic details, clinical and laboratory diagnoses, indications for FFP transfusions, number of FFP transfused to patients, coagulation profile of the patients pre and post transfusion.
Results : The audit of FFP transfusion showed that there are large numbers of inappropriate transfusion requests from the consultants for FFP resulting in inappropriate use. Out of 85 observed transfusions, total of 408 units of FFP, 158 units were inappropriately requested i.e. 39% of total requests.
Conclusion : There is an urgent need to limit the inappropriate transfusion episode by active intervention from the providing Department. Active prospective monitoring of the requests can help in reduction of inappropriate transfusion.
Continual medical education of the clinical consultants, resident doctors, and nursing staff should be done and put to assessment periodically. Transfusion guidelines should be followed.
Clinical transfusion practice- Use and misuse of FFPS, FFP utilization at a tertiary care liver disease hospital
Meenu Bajpai, Monika Kocchar
Institute of Liver and Biliary Sciences, New Delhi, India
Aim and Objectives : Rational use of blood and blood components is the need of the hour in view of perennial shortage and safety issues surrounding this precious resource. The Institute of Liver and Biliary Sciences is a tertiary care institute focusing on liver diseases, most patients have some degree of coagulopathy therefore FFP is the major component used. In this retrospective study we have analyzed component utilization patterns over a period of six months from Sept. 2009 to March 2010.
Materials and Methods : We carried out a retrospective analysis of 447 request orders for 1207 units of fresh frozen plasma (FFP), for 171 patients during the study period. The request forms were analyzed for indications for transfusion, patients laboratory indices such as coagulation screen, and compared with the standard guidelines and the clinical transfusion practice was assessed.
Results : A total of 447 requests were received for FFP in these coagulation screening had been performed in 81.4% of the cases and of these 22 (4.92%) had normal prothrombin time and International normalized ratio. Ongoing upper GI bleed with deranged coagulation screen and deranged coagulation screen per se were the most common indications (36.1% and 13.70% respectively) for FFP transfusion.
Conclusions : There is extensive use of FFP in liver disease patients due to coagulopathy associated with liver diseases. As liver disease patients have lower levels of both pro-coagulant and anti-coagulant factors, PT and INR are not always the best indicators to determine risk for bleeds. There is a need to evaluate the efficacy and adverse effects of plasma, both in bleeding and non-bleeding patients with liver disease to understand whether the presumed benefits outweigh the real risks. In addition new hemostatic tests that better define the risk of bleeding are the need of the hour and require validation.
Transfusion in thalassemics - Emerging problems and future strategies
Richa Gupta, Bharat Singh, Usha Rusia
University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
Aims and Objectives : To evaluate the magnitude of red cell alloimmunization in regularly transfused patients with thalassemia major and analyse factors which may be responsible for development of antibodies.
Materials and Methods : This cross sectional study was conducted on 116 thalassemics receiving regular transfusions. All the patients underwent antibody screening. Patients with positive antibody screen were further tested for antibody identification. The data was analysed to find out the frequency, pattern and factors influencing red cell alloimmunization secondary to multiple transfusions.
Results : Mean age of the patients was 14 years (range - 1.5 to 27 years). Red cell alloantibodies were found in 11 patients (9.48%). In four (36%) patients first transfusion was given before 6 months of age and in seven (64%) patients, first transfusion was given after two years of age. The interval between consecutive transfusions varied from 18 to 30 days. The most common antibody was Anti-E found in 4 (36.4%) patients, followed by Anti-K (three patients, 27.2%), Anti-Kpa (two patients, 18.2%) and Anti-Cw (two patients, 18.2%). The interval from first transfusion to antibody development varied from 1.5 to 14 years. None of the eight out of 116 patients, who underwent splenectomy showed any antibody development.
Conclusion : The rate of red cell alloimmunization was found to be 9.48% in thalassemics receiving regular transfusions. The incidence of alloantibody development was higher if first transfusion was received at more than 2 years of age. Early institution of red cell transfusions and Rh and Kell phenotyping followed by provision of matched blood could prevent alloimmunization.
Thalassemia screening programme: Prathama's experience
Prathama Blood Center, Vasna, Ahmedabad, India
Introduction : Thalassemia is a haematological disorder which is inherited as a recessive mode. Overall prevalence of carrier is between 8 to 10 percent. Screening of general population is the best way to detect the carrier state. Screening of communities with high prevalence is also productive in detecting the carrier state and overall prevention of birth of child with Thalassemia major.
Aim : To screen the general population in Ahmedabad with the traditional screening test and to determine the sensitivity and specificity of available screening test.
Material and Methods : Total n=1041 individual were screened from September 2009 to April 2010. Following tests were performed on the collected whole blood EDTA samples (2 - 3 ml).
- Naked eye single tube osmotic fragility test: done with 0.36 percent unbuffered saline
- Complete Blood Count on automated cell counter (sysmax)
- Capillary zone electrophoresis by Sebia capillary's as confirmatory test
Screening indices were calculated from complete blood count and sensitivity, specificity, positive predictive value and negative predictive value were determined.
Results and Observation : Out of 1041 individual, 132 (12.68%) samples were sent for capillary electrophoresis on bases of positive Osmotic Fragility test or abnormal Complete blood count or abnormal screening indices. 30(2.88%) were confirmed as Thalassemia minor trait by capillary electrophoresis (Sebia). Two individuals were found to be positive for HbS and two individuals were positive for high fetal haemoglobin. Sensitivity of MCH/RBC, MCV/RBC,RBC*10/HB,(MCV)2*RDW/HB100 and MCV-(5HB+RBC+K)K=3.4 were 80.00%,86.66%,86.61%,23.33% and 30.55% respectively while specificity were 97.23%,97.23%,96.93%,93.86% and 90.50% respectively. Positive predictive value of the above mentioned indices were 42.85%,49.05%,45.61%,10.14% and 10.28% respectively while negative predictive value were 99.39%, 99.59%, 99.50%, 97.63% and 97.96% respectively.
Conclusion : Screening test with high sensitivity and specificity results identification of carrier state in regions with limited health resources. Complete blood count with various screening indices for beta Thalassemia trait/minor has reasonable sensitivity and accuracy.
Transfusion load of sickle cell patients: Experience at model blood bank, Raipur
Renuka, Gahine R, Sudarshan V, Kapse V, Hussain N, Chandrakar R
Pt. JNM Medical College, Raipur, India
Introduction : Sickle cell anaemia is the most common inherited hematologic disorder in Chhattisgarh. This is a novel study as studies on trends of transfusion in patients with sickle cell anaemia in this region are not available. In this report, we present our experience of blood transfusion in sickle cell patients and try to determine the frequency of transfusion and to establish its pattern.
Aim : To assess the blood transfusion requirement of patients diagnosed with sickle cell anaemia coming to Dr. BR Ambedkar Hospital and Model Blood Bank, Raipur. Data was retrieved from the records and analyzed.
Material and Methods : The retrospective analysis was carried over a period of two years from July 2008 to June 2010. The blood utilization by patients with sickle cell anaemia was calculated as percent utilization of total units issued.
Results : A total of 28424 blood units were issued during this period. Out of these 4.6% of blood units were issued to patients with sickle cell anaemia with an average of 2.49 units per patient. Majority of these units were supplied to pediatric department both on emergency and regular basis. Majority of the patients were males. O blood group constituted the maximum number of units issued.
Conclusion : In short, generation of simple database of blood transfusion requirement of sickle cell patients, not only provides data about the load on blood bank but also provides a forewarner of future burden of disease. Such studies need to be carried and verified at different District blood banks in our state to guide future blood donation practices.
Reporting and analysing near miss events: A step towards blood safety
Ravneet Kaur, Gagandeep Kaur, Sabita Basu
Govt. Medical college, Chandigarh, India
Introduction : In Transfusion Medicine safety and reliability are of utmost importance as even a small error can lead to serious consequences. Errors in blood transfusion services are the result of mistakes occurring in a complex process. Near miss event is an error that does not result in injury or damage but has the potential to do so. Reporting and analysis of near miss events allow detection of weakness of the system, provide a chance for correction and prevent recurrence of such errors.
Material and Methods : Near miss events reported in our department between November 2009 to July 2010 were analysed.
Results : A total of nine miss events were reported. Majority of them originated in the blood bank. Of great concern was the issue of a wrong blood group unit to a patient, due to incorrect identification of the patient sample in the blood bank laboratory. Other causes were error in sample collection in pilot tubes after phlebotomy (4/9), mislabeled samples of the patients from the ward (2/9), incorrect marking of blood units (3/9) and issue of lysed blood bag on the day of expiry of blood unit. No serious adverse patient outcome occurred despite these events. Adequate corrective steps were taken to prevent such errors from occurring in future.
Conclusion : Reporting of near miss events should be done in transfusion centres as analysis of these events provide an opportunity to identify areas where resources need to be targeted in order to prevent harm to the patients, improving the overall safety of transfusion.
A retrospective study of blood transfusions in patients receiving cancer chemotherapy
Deepak Kumar Singh, Richa Gupta, Shefali Gupta, Manisha, Bharat Singh, Jyotika Jain, RK Grover
GTB Hospital and UCMS, Delhi, India
Aims and Objective : The clinico-pathologic factors contributing to blood transfusions in patients with malignancy are not well documented. Our aim was to analyze oncology patients receiving chemotherapy to determine 1) prevalence of anemia, 2) frequency of transfusions, and 3) factors necessitating more frequent transfusions.
Materials and Methods : In this retrospective study, consecutive patients presenting to our oncology department and receiving chemotherapy from August 2009 to October 2009 were included. Case files of all patients were reviewed and age, diagnosis, hematologic investigations, transfusion history, chemotherapy regimen, and prior treatment was recorded. For each subject, data collection ended 4 weeks after the last cycle of chemotherapy or after 32 weeks of starting chemotherapy.
Results : Out of 670 patients receiving chemotherapy, 247 (36.86%) patients received blood transfusions. The average hemoglobin at first transfusion was 8.3 g/dl. Average numbers of transfusion were 2.9 per patient. Transfusion was required in 207 (83.8%) patients for anemia, in 23 (9.3%) patients for thrombocytopenia and in 17 (6.9%) patients for coagulation abnormalities. Of all patients with solid tumors; those with renal cell carcinoma, carcinoma ovary and lung cancer had the highest rate of transfusions. On multivariate analyses, platinum (OR = 6.69) and anthracycline (OR = 4.27) chemotherapy and baseline hemoglobin (OR = 0.97) were statistically significant contributors. Patients with anemia who received chemotherapy were more likely to be transfused.
Conclusion : Red blood cell transfusions were required in about one-third of oncology patients. Patient groups at high risk of transfusion can be identified with platinum-based chemotherapy being the most significant contributing factor. Patients with renal, ovarian and lung cancer, and/or prior anemia have higher transfusion rates and may benefit from therapies such as recombinant human erythropoietin. The information obtained from this study may prove helpful in developing supportive care guidelines for the management of chemotherapy-related anemia requiring transfusion.
Drug induced immune hemolytic anemia - Case studies in Apollo Hospitals, Chennai
Apollo Hospitals, Chennai, TN, India
Introduction : The main feature of the immune hemolytic anaemia is the destruction of the red blood cells by its own immune system There are three main types of immune hemolytic anaemia: autoimmune, alloimmune, and drug-induced. Certain drugs can cause a reaction that develops into hemolytic anaemia. These include penicillin and related drugs, acetaminophen, quinine and other antimalarials, NSAID and levodopa.
Objectives : Presence of anti red cell antibodies is one of the major challenges in transfusion therapy. It is important to detect the presence of red cell antibodies prior to transfusion as these antibodies may complicate transfusion therapy. In Drug- induced Immune hemolytic patients the antibodies are "PAN Reactive" that react with all donor cells and it will be time consuming and futile to identify a compatible blood for transfusion. In this study we will discuss three cases of Drug Induced Immune Hemolytic Anemia and the management of such cases.
Materials and Methods : The blood samples received for pre-transfusion compatibility testing are all screened for red cell antibodies using Ortho's Surgiscreen (3 cell panel) in a fully automated Ortho AutoVue Innova IH system. Compatibility testing is also done using Column Agglutination technology by using AHG Polyspecific cassettes. The complete medical history of the patients showing the presence of PAN reactive antibodies and incompatibility in AHG cross-match was collected from the clinicians for the better understanding of the problem.
Results and Conclusion : Three pretransfusion blood samples out of 25846 samples screened for the presence of red cell antibodies from July 2008 to August 2010 showed the presence of PAN reactive antibodies; showing positive reaction with all the three cells in the panel. The case history showed that all these three patients had Rheumatic Heart disease (RHD) and were under prophylactic oral penicillin therapy after stopping Injection Penidure for 6 to18 month prior to admission for valve replacement surgery. In such cases, red cell antibodies develop in response to either a normal red cell component or to a "drug - red cell" complex and this leads to pre-mature destruction of the red cells. They were advised to stop the oral penicillin therapy and the samples were retested at regular intervals from 4 weeks to 12 weeks after stopping penicillin. The titer of red cell antibodies was reduced to undetectable levels and compatible red cell concentrates could be issued for the surgery. All the three cases had an uneventful post operative period.
Rational use of blood and components in a tertiary care hospital
Col R S Sarkar, Col J Philip, Lt Col Satish Kumar, Pramod Yadav
Armed Forces Medical College, Pune, India
Introduction : Blood banks are the backbone of all the tertiary care hospitals. Blood transfusion is an indispensible part of various treatment protocols. Blood and blood components must be transfused keeping in mind certain precautions because, like drugs, blood and its components have the propensity to cause side effects such as introduction of donor antigens in the recipients, transfusion reactions or exposure to various transfusion transmissible diseases. The clinicians must keep themselves upto date regarding these potential hazards to the recipients of the blood products.
Aim and Objectives : To study the utilization of blood and blood components in various disease conditions and its relevance in the quality management of transfusion practices in a tertiary care hospital.
Material and Method : In a retrospective study details of whole blood and blood components transfused were noted and correlated with the patient's diagnosis and indications for transfusion during 06 months.
Results : The blood units supplied were approximately 2,000 per month. Packed red cells were the most utilized component followed by platelets. Least utilized product was whole blood. The supply of blood and blood components was maximum to the cardiothoracic centre.
Conclusion : The use of blood and components must be reviewed periodically to monitor the correct and efficient use of these products. To prevent misuse or overuse of blood and blood components educational sessions and seminars should be regularly held. Irrational use of blood and blood components leads to undersupply of these to patients who are in great need of these products.
Evaluation of pattern of single unit transfusions in I G Medical College, Shimla H.P.
Sandeep Malhotra, M.L. Kaushal, Nishi Jaswal
Indira Gandhi Medical College, Shimla, India
Background : Single unit blood transfusions are discouraged in adults by WHO and it has also been considered as an unhealthy practice by many countries. Blood is often unnecessarily given to raise a patient's Hb level before surgery or to allow earlier discharge from hospital. These are rarely valid reasons for transfusion since there is a big gap between demand and supply of the blood apart from various risks associated with transfusion of blood.
Methods : Evaluation of pattern of single unit transfusions was carried out retrospectively in the superspeciality hospital of Indira Gandhi Medical College, Shimla from July 2009 to September 2009. The scrutiny of blood transfusion request forms was done and available socio-clinical information was recorded. The details of the patient recorded were age, sex, haemoglobin level, the indication of transfusion and the blood / blood component ordered for transfusion including whole blood, fresh whole blood or components (PRBC). Since the blood units crossmatched for transfusion are generally kept in the blood bank and issued only when required for transfusion so it was presumed that the blood units issued were transfused.
Results : Total number of 2700 requisition forms were scrutinized and out of these 541 (20%) were single units and the blood was issued to 91% of these patients. The mean age was 40 yrs. The numbers of infants were only 11 where the single unit transfusion was justified keeping in view the low blood volume. The male to female ratio was 49:51.In most of these patients whole blood transfusion was given. The departments sending single unit requisition were general surgery, cardiothoracic surgery, obstetrics and gynecology, urology, radiotherapy, orthopaedics, medicine, pediatrics and ENT. Out of 541 single units, the requests from surgical branches were 386 (71.34%).which includes 183 (47.4%) from general surgery and from medical stream 155 (28.65%). Most commonly single units were requested for cholecystectomy, BPH and renal calculus. The patients with hemoglobin levels less than 7g/dl were 64(11.77%) where transfusion was justified. Haemoblobin between 7-10 g/dl were 294 (54.40%) wherein the single unit might have been avoided with the use of safer alternatives. There were 75 (13.8%) of patients where haemoglobin levels were more than 10 g/dl and in these cases there was no justification for single unit transfusion. In 108 (20.03 %.) patients the haemoglobin levels were not mentioned so it was assumed that haemoglobin values were same as in those patients whose haemoglobin values were available
Conclusion : In 1980s and early 1990s hospital based transfusion committees reviewed single unit transfusions and it indicated that for most patients more restrictive transfusion is warranted. WHO also recommends appropriate and rational use of blood/blood components to ensure their availability to needy patients as well as to avoid the unnecessary risk of transfusion-transmitted diseases. Since the whole blood is a raw material consisting of red cells, platelets, white cells and more than 200 proteins and exposes the recipient to various risks associated with transfusion. Therefore the use of single units transfusions is strongly discouraged and should be used only when really indicated. It is also suggested that more awareness programmes / CMEs should be organized for clinicians regarding the appropriate use of blood and blood products.
Transfusion reactions reported in Dr. RML Hospital, New Delhi over the last two and half years
Shalini Trivedi, Veena Doda
Dr RML Hospital, New Delhi, India
Background : Transfusion reaction is defined as any unfavourable transfusion related event occurring in a patient during or after transfusion of blood or blood products. Transfusion Reactions can be attributed to incompatible red cell antigens, irregular antibodies in donor blood, HLA antibodies on white blood cells, cytokines in wbcs and plasma proteins. Also recipient's lymphocyte can also mount an immunological reaction and good number of non immunological factors (Excess citrate, Volume overload) can also be responsible for reactions. The spectrum of donor reactions is quite varied depending on the time of presentation; it can be acute or delayed. Despite all the necessary steps taken by the blood transfusion services transfusion reactions do occur. The analysis of records of transfusion reactions is utmost important as we can derive information regards the causation. Hence take necessary corrective actions when indicated.
Aims and Objective : To analyse all the suspected transfusion reactions reported to our Blood transfusion services with respect to type and cause, to provide a better insight for areas of improvisation.
Materials and Methods : This is a retrospective (Post facto) study of transfusion reactions reported to blood transfusion services of Dr. RML Hospital in last two and half year. In this study we have categorised the reactions into mild, moderate and Severe according to the signs and symptoms reported by the clinicians according to WHO guidelines for the recognition and management of acute transfusion reactions. Also analysed the data with regards to clinical diagnosis which increase the incidence of multiple transfusions.
Results and Discussion :
1) We have derived various conclusions that most of the transfusion reactions are reported in multiply transfused patients. Thallasaemics had 11.60% incidence, CRF patients 25.50%, Hemato oncology patients 6.9%, Severe Anaemia patients 16.20%, Oncology patient 2.3%, Obstetric and Gynaec patients 6.9%, surgical patients 9.3%, Chronic liver disease 11.60% and Orthopaedics patients 9.3% incidence respectively.
2) Out of all reactions reported Allergic reactions were-88.3% (38/43), anaphylactic reactions were2.30% (1/43), febrile non haemolytic transfusion reactions were 4.6% (2/43), acute haemolytic transfusion reactions were2.3% (1/43) and 2.3% (1/43) were delayed haemolytic transfusion reactions.
3) On grading the severity of transfusion reactions based on the WHO guidelines for the recognition and management of acute transfusion reactions 39.5 %(17/43) were mild, 46.5% (20/43) were moderate and 11.65% (5/43) were severe reactions.
4) In the month of August and September 2008 there were maximum reactions, on investigating this it was inferred that it was blood from an out station camp that was responsible for maximum reactions. It could have been due to failure to maintain cold chain during transportation.
5) The number of reactions has drastically come down after June 09; it approximately coincides with introduction of Leucodepleted packed red cells for Thallasaemics and increased use of leucoreduced packed red cells for multiply transfused patients like CRF and Hemato oncology patients.
Conclusions : It was inferred that multiply transfused patients were at greatest risk of transfusion reactions. Hence these patients should be transfused with Leucodepleted packed red cells, if not possible at least leucoreduced packed red cells or saline washed packed cells. Comprehensive compatibility testing including antibody screening, identification and issue of antigen negative units (if required) should be carried out for multiply transfused recipients. Clerical errors are the most common errors encountered in any blood transfusion services; hence multiple levels of checks are indicated. Also the variables like maintaining the cold chain from vein to vein are essential to ensure the well being of recipient
Hyperhaemolysis in a patient with beta thalassemia major
P Rajani, J Jambukiya, P Patel, J Bhatt, M Shah, N Bhatnagar, M D Gajjar
Dept. of IHBT, Civil hospital, Ahmedabad, India
Introduction : The term hyperhaemolysis is applied when the post transfusion Hb level is less than the pre transfusion Hb level suggesting destruction of both the patients own red blood cells and the transfused of rbcs. The mechanism of hyperhaemolysis is not well understood although it has been well described in patients with sickle cell disease. Transfusion of antigen negative cross match compatible rbcs doesnot prevent hyperhaemolysis. Serologic studies of post transfusion and follow up samples may show a negative or a positive(complement only) direct antiglobulin test and usually no rbc antibodies leaving the haemolysis unexplained. In the mild form the option is to stop transfusion to avoid exacerbating the haemolysis. In severe forms, further transfusions have been successfully given with concurrent iv Ig and iv steroid therapy. Recurrent hyperhaemolysis is fortunately rare and unpredictable.
Case Report : A 3 year old patient Varun Bharatkumar, diagnosed with Beta Thalassemia major on Hb electropheresis was transferred to the civil hospital, Ahmedabad after developing the complaint of reddish brown coloured urine after the transfusion of 1 unit of blood. The patient had been transfused 2 units earlier.
Patient's Hb on arrival was 7.2 with a total count of 10,900 and platelet count of 1.01 lakhs with raised indirect bilirubin 5.8. Patients Hb was falling continuously with subsequent days testing showing values of 3.9 following which 120cc of cross matched least incompatible blood was given. Patient continued to haemolyse with post transfusion Hb 4.2 which again fell back to 3.9. Pt was put on iv antibiotics and antimalarial drugs.
Patient showed both direct and indirect antiglobulin test to be positive with auto control positive with EDTA sample showing autoclumps. Patient also showed enlarged liver and spleen on abdominal sonography.
Patient had been put on iv methyl prednisolone following which successive transfusion of 100 cc of least incompatible saline washed pcv had been tried with no significant improvement in haematological or clinical picture. After 2 days of steroid therapy increment in Hb values from 3.4 to 4.8 to 5.9 was seen. After 5 days of steroid therapy patient was put on oral cyclophosphamide following which 4 units of 120cc PCV were transfused with no significant haemolysis.
Serologica6l investigations :
Interpretations of Monospecific reactions:
The results obtained with the monospecific reagents may help to define a clinical condition. Patients with warm antibody autoimmune haemolytic anaemia (WAIHA) most often have IgG coating their RBCs however C3 complement components may also be detected in about 24% of WAIHA patients. Less commonly complement alone may be demonstrated on the RBCs (about 7%). IgM and/or IgA immunoglobulin may also be present.
In Cold Agglutinin Disease (CAD), the most common result is the detection of complement alone coating the RBCs, but the IgM and/or Ig A may be detected simultaneously. Paroxysmal Cold Haemoglobinuria (PCH) is usually demonstrated initially by coating the RBCs unless the RBCs are washed with cold (4c)saline, when IgG autoantibody may also be detectable. The Donath Landsteiner test is used to differentiate between CAD and PCH. In mixed type AIHA, both IgG and C3 are usually demonstrated. It is important to note that a positive DAT can be due to other phenomenon and that the patient's clinical condition, medical history and other laboratory data must be considered in parallel with DAT results.
Antibody Screening- Positive in Coombs and Enzyme phase.
Antibody identification-Positive in Coombs and Enzyme phase.
Antibody screening afterelution of red cells of patient using dicedal kit- Positive.
Remarks : Positive DAT and antibody screening of the elute after elution shows the presence of autoantibody/antibodies, because of autoantibodies presence of underlying alloantibody could not be ruled out, if any.
The DAT is positive and the plasma is reactive against all the screening and identification cells. We tried to ascertain the specificity of the antibodies (autoantibodies) attached to the RBCs. We carried out elution and then tested the eluate against the screening and identification panel. Even the eluate was reactive
This suggests that the autoabtibody is reacting against a red cell antigen/structure present on all the red cell. The pan positive with the antibody screening and identification panels is seen commonly with the autoimmune antibodies. This identification process can be repeated after 2-3 weeks of steriod/immunosuppresent therapy after (DAT becomes negative or weaker). At that point the specificity of the autoantibody/alloantibody may be clear.
Discussion : A case of hyperhaemolysis causing severe anaemia in a patient with Beta Thalasemia major who continued to haemolyse even after use of washed least incompatible units. The exact pathogenesis of hyperhaemolysis is complex and poorly understood. It involves destruction of both transfused and autologous RBCs.
The patients response to cyclophosphamide suggests that cyclophosphamide can be used in patients with hyperhaemolysis where transfusion is unavoidable due to other assciated medical conditions.
Evaluation of non-infectious post-transfusion reaction
Surekha S Kadadi
Damani Blood Bank, Solapur, Maharashtra, India
Background : Blood Transfusion is a life saving measure but it is associated with risks as well. No blood is 100% safe in spite of stringent blood measures but Incidence of Post transfusion reactions can be reduced by Leucodepleted blood components.
Aim : To study the frequency of acute non-infectious Transfusion Reactions after blood/blood components transfusion.
Material and Methods : The study was carried out at the Smt. Gopabai Damani Blood Bank, Solapur (Maharashtra) from April 1 st 2005 to 31st March 2010. Acute non-infectious Transfusion reactions that were reported to the blood bank following transfusion of blood/blood components were analyzed.
Results : Incidence of acute non-infectious transfusion reactions for whole blood was (0.13% - 50 out of 36,833), Pack cells (0.042% - 29 out of 68,981), Leucoreduced Pack cells (0.016%,1 out of 5,900), F.F.P (0.012%, 4 out of 32,546) R.D.P. (0.019%, 5 out of 25,842), S.D.P. (0% No reactions reported out of 2699)
Febrile non-hemolytic transfusion reaction (FNHTR) was the most common transfusion reaction encountered.
Conclusions : Incidences of Non-infectious post transfusions reactions are less with blood components compared to whole blood. Again incidences of non-infectious post transfusion reactions are less with leucoreduced components like leucoreduced pack cells (prepared from Quadruple bags) and S.D.P. Leucodepletion is the need of the hour.
Correlation of birth weight of infants with umbilical cord blood derived cd34+ cell concentration
Tulika Chandra, Sheeba Afreen, Ashutosh Kumar,
C.S.M Medical University, Lucknow, India
Introduction : Human cord blood has been successfully used as an alternative source of haematopoitic stem cells suitable for transplantation. A number of factors such as gestational age, new born sex, baby weight and placental weight can influence the amount of CD34+ cells, which are considered as immature and capable of proliferation.
Aim and Objective : The aim of this study was to assess the association between birth weight of full term infants with umbilical cord blood derived CD34+ cells concentration.
Material and Method : 205 umbilical cord blood samples were obtained from both vaginal and cesarean deliveries from the Department of Obstetrics and Gynecology. Processing was done in the Department of Transfusion Medicine, State of Art Model Blood bank, CSMMU, Lucknow. Complete medical history of pregnant women was taken to exclude any infection or disease. The cord blood was collected in anticoagulant Citrate Phosphate Dextrose Adenine (CPDA) triple blood bag. It was processed and mononuclear cells were isolated from it. CD34+ count was done on them and findings were analyzed and correlated with birth weight of baby.
Results : The mean of the high birth weight baby and low birth weight baby were 3.25 and 2.4 kg respectively. The percentage of CD34+ cells were compared in both the groups. The absolute number of CD34+ cells were significantly higher in high birth weight babies.
Conclusion : This study concludes that higher the birth weight of the baby better is the yield of CD34+ cells.
Prestorage leukodepletion reduces transfusion associated immunomodulation
Prashant Kumar Pandey
Medanta - The Medicity, Gurgaon, Haryana, India
Introduction : Transfusion of blood causes significant changes in recipient's immune response. Down-regulation of recipient's cellular immune response caused by transfusion of allogenic blood is defined TRIM.
Aims and Objectives : Estimation of TRIM by measuring quantitative changes in cytokines after one time blood transfusion in neurosurgery patients.
Materials and Methods : Forty patients undergoing neurosurgery were randomly allocated into four transfusion groups:(a)no-transfusion, (b)allogeneic non-leukodepleted (c)prestorage-leukodepleted and (d)autologous transfusion. Samples collected before surgery (day 0) and postoperative days 1, 7, and 14. IFN-? and IL-10 production capacity was measured in supernatant after whole blood culture and serum FasL levels in patients' sera using commercially available ELISA kits (picogram/ml). Change in ratios (cytokine value after phytohemagglutinin stimulation/control value) of IFN-? and IL-10 and percentage change from baseline for serum FasL levels across different transfusion groups were calculated.
Results : There was an increase in IL-10 production in patients receiving allogeneic non-leukofiltered transfusion on days 1 and 7 (mean ratio 2.22 (? 2.16), 4.12 (? 1.71), 4.46 (? 1.97) on days 0, 1, and 7, respectively). Similarly there was a significant (P<0.05) decrease in IFN-? production in patients who received allogeneic non-leukodepleted red cell transfusion on post-op days 1, 7, and 14 (mean ratio 6.88 (? 4.56), 2.53 (? 0.95), 3.04 (? 1.38) and 2.58 (? 1.48) on day 0, 1, 7, and 14, respectively). Serum FasL production was increased across all patients till 7th day except for 'no transfusion' group and this increase was most significant in the non-leukodepleted group
Conclusion : One time transfusion leads to quantitative changes in levels of these cytokines largely through interplay of Th2/Th1 pathways in allogeneic nonleukodepleted transfusion; however, soluble mediators like FasL which are also present in autologous and leukodepleted blood products may contribute toward minor immunologic effect.
Use of platelet concentrate in a tertiary care centre
Medical College, Trivandrum, India
Introduction : The distribution of platelet usage varies from centre to centre.Baseline information regarding platelet usage in individual centre is crucial for coordination of clinical and transfusion service.
Aim and objectives : To describe the pattern of platelet usage in Medical college,Trivandrum.
Materials and Methods : Case records of patients transfused with random donor platelet concentrate transfusion in Medical college Trivandrum from 2009 June-2010 June was reviewed
Results : A total of 11200 units of platelet concentrate were transfused to 5241 patients.The average number of transfusions per patient was 2.14.The mean pretransfusion platelet count for the medical services was about 20.0 X 10(9)/L, compared with 100.5 X 10(9)/L for the cardiovascular service. An increment in platelet count 24 hour after transfusion was noted with 78% of the transfusions.Wastage rate of RDPs were 11%. 73% of platelets were transfused prophylactically to patients. Rest was therapeutic. 88% of prophylactic platelet transfusions were appropriate as per the recommended BCSH guidelines.
Indications for prophylactic platelet transfusion were fever with thrombocytopenia 27%(19%adult,8%pediatric)chronic haematological conditions-16%, neonatal4%, CABG12%, DIC5%, Other surgical services 4%, Miscellaneous 5%
Conclusion : Since a large proportion of platelets are used for diseases with infectious etiology,Prompt antibiotic therapy and better control of infection may help in reducing the transfusion requirements of platelets.
Hemoglobin based oxygen carriers
Raj Bharath R
The TN Dr MGR Medical University, Chennai, India
The need for blood is ever increasing day by day. Though various screening procedures are done to detect infectious diseases, there is no guarantee that the blood is 100% safe. So there is a necessity for alternative sources of blood. Red blood substitutes refer to oxygen carrying solutions that can both expand the blood volume and deliver oxygen to tissues. An ideal blood substitute should have a high efficacy (high capacity for oxygen and carbon dioxide transport and delivery), safety and logistics. Hemoglobin based oxygen carriers is one of the alternative way for the replacement of RBC.
Hemoglobin was initially used without a RBC membrane but it caused a variety of deleterious effects such as nephrotoxicity and vasoactivity. Various type of modification to hemoglobin was done such as intramolecular cross linking, intramolecular stabilization and surface conjugation to increase the plasma half life and eliminate nephrotoxicity. The main sources for the hemoglobin were outdated units of RBC, bovine RBC and recombinant hemoglobin. Some of the hemoglobin based oxygen carriers which uses human hemoglobin are polyheme, hemolink and hemassist. The bovine based are hemopure and polyethylene glycol hemoglobin. Micro encapsulated hemoglobin is another product in which phospholipids in combination with cholesterol is used to encapsulate hemoglobin which confers flexibility and stability to the membrane. These substances have an oxygen equilibrium curve similar to that of blood and have an intravascular half life of 24 hours.
There have been cases where the patient (Jehovah witness) has refused blood or its components during a surgery where hemoglobin based oxygen carriers have played a vital role in saving lives. Polyheme has been tested in trauma resuscitation and was able to maintain adequate hemoglobin levels despite loss of RBC hemoglobin due to hemorrhage. Trials have been successfully conducted where these products have demonstrated efficiency comparable to that of blood. These products could be used in a wide area of application like in surgery, trauma and other conditions.
Review of platelet transfusions in a tertiary care hospital
Sitalakshmi Subramanian, Siddhi GSK
St. John's Medical College Hospital, Bangalore, India
Introduction : Allogeneic platelet transfusions play a major role in the management of thrombocytopenia. The ready availability of platelet concentrates has made a major contribution to support the development of intensive treatment regimens accounting for the substantial increase in the use of platelets over the last two decades. Although considerable advances have been made, several areas of controversy continue to exist with regard to the optimal approach to the use of platelet transfusions.
Aim : This study is an attempt to review the platelet transfusion practices in a tertiary care hospital
Material and Methods : The details of platelet transfusions over a period of 11 months were obtained from the blood bank records of St. John's Medical College Hospital, Bangalore
Results : The total number of 1953 platelet transfusions was reviewed over a period of 11 months. The utilization of platelet has been increased over the last decade. Data on the usage of platelets for hematological and non hematological conditions, intensive care and non intensive care situations, pediatric and adult transfusions, random donor platelets and single donor platelets, use of ABO and Rh mismatched platelets, number of platelet transfusions in each case, prophylactic vs therapeutic transfusions were obtained. It was observed that 20-25% of the platelet transfusions were for hematological conditions of which acute leukemias and aplastic anemias were the common indications accounting for 10-12% each. 6.34% of the transfusions were for dengue hemorrhagic fever. The other indications were sepsis, DIC, cardiac surgeries and postoperative conditions In 58.73% of the transfusions, the specific indication for platelet transfusion was not available on the request form.
Conclusion : The review indicates that there are still many questions regarding the practices that are routinely used. There is a need for continuous audit of the use of blood components as therapy. Results provide good opportunities and strategies for improvement
Key words: Platelet transfusion practices, review, audit
Usage of FFP in a tertiary care hospital in Himachal Pradesh
M L Kaushal
I.G Medical College, Shimla, India
Background : The indications for transfusing FFP are very limited as it can cause unpredictable adverse effects such as allergic reactions, anaphylaxis, TRALI, haemolysis etc. besides the risk of transmitting infections as with whole blood or other blood components. The use of FFP has increased substantially over the past few years but this component of the blood is more often misused than used which is largely due to misconceptions regarding its haemostatic effectiveness and inadequate knowledge of the situations in which its use is inappropriate. The use of FFP is now reserved for conditions requiring therapy in which replacement of multiple plasma constituents are needed or for which the specific constituents are not available in the purified injections or transfusion form.
Methods : A retrospective and cross-sectional audit was carried out at the tertiary care hospital at Indira Gandhi Medical College Shimla (H.P) between January 2010 to May 2010 over a period of five months. We evaluated all the FFP transfusion request forms to assess the rational usage of FFP and classified them as appropriate, inappropriate and clinically appropriate.
Results : Total numbers of 670 FFPs were supplied to 338 patients. The department wise distribution of the FFP is as per [Table 1].
Out of 670 units supplied 74 (11.04%) were judged appropriate, 76 (11.34%) clinically appropriate and 520 (77.62%) were totally inappropriate as shown in [Table 2].
Conclusion : This study reveals the pitfalls in the use of FFP among clinicians and in a country like India with limited resources the FFP usage is generally inappropriate which reflects the lack of knowledge as well as non adherence to standard guidelines. Every clinician must weigh the benefits of FFP transfusion over the risks associated with it.
The utility of pre test clinical scoring for clinical diagnosis of Heparin Induced Thrombo-Cytopenia in cardiac surgery patients
Deepti Sachan, Nirmal Gupta, Prashant Agarwal, Rajendra Chaudhary
SGPGIMS, Lucknow, India
Background : Heparin induced thrombocytopenia (HIT) should be diagnosed clinically as well as by laboratory assays for timely recognition, prevention and management of complications. We evaluated the clinical utility of pretest clinical scoring system with two immunoassays for the diagnosis of HIT in cardiac surgery patients.
Material and Methods : 100 consecutive patients undergoing cardiac surgery were monitored for platelet counts during postoperative period. Clinical thrombocytopenia was defined as more than 50% fall of platelet counts from baseline or count <100,000/ml. was found postoperatively in 42 patients in which pretest clinical scoring was done. Two antibody assays i.e. Heparin -PF4 ELISA and Particle gel immunoassay (PaGIA) were performed.
Results : Out of total 100 patients, clinical thrombocytopenia was found in 42 patients. In these patients, low T score was observed in 6 patients, intermediate in 28 and high score in 8 patients. Out of these 42 patients, 19 patients (45.2%) were positive by H-PF4 ELISA and 10 (23.8%) by Particle gel immunoassay (PaGIA) for Heparin-PF4 antibody. The difference in incidence of clinically significant HIT antibodies in the three categories was statistically significant. A good correlation was also observed with ELISA Optical density (OD) and T scoring.
Conclusion : Pretest clinical scoring correlated well with development of H-PF4 antibodies which are incriminated in the causation of thrombotic complications in patients with HIT. We also proposed a protocol for diagnosing patients with clinical suspicion of HIT using pretest clinical scoring and immunoassay.
Laboratory evaluation of Hemophilia patients along with estimation of factor VIII inhibitors: SGPGI experience
Anju Dubey, Anupam Verma, R K Chaudhary
SGPGIMS, Lucknow, India
Introduction : The development of inhibitors to factor VIII is one of the most serious complications in hemophilia therapy and is an important challenge in hemophilia care. It is therefore imperative that the complications, if present, be detected at the earliest and managed appropriately.
Aims and Objectives : To study the coagulation profile and detect the presence of factor VIII inhibitors in hemophilia patients registered at our hospital and also to determine the presence of TTI markers and clinically significant red cell alloantibody in these patients.
Materials and Methods : aPTT, factor assay and inhibitor screening (mixing study) were done on citrated plasma using semi-automated coagulation analyzer. Quantification for factor VIII inhibitors was done by Bethesda assay on samples positive on screening. Blood grouping, TTI testing (ELISA) and red cell alloantibody detection was done using EDTA sample as per the departmental SOP.
Results : Out of 114 patients evaluated 98 (86%) had hemophilia A and remaining 16(14%) had hemophilia B. In hemophilia A patients, median value for aPTT was 89.8sec (range 43-120 sec) and median value for factor VIII level was 5.6 % (range 1.5- 76.1%). Five (5.1%) patients were positive on inhibitor screening. On Bethesda assay, 1 patient was high responder (14.4 BU/mL) and rest 4 were low responders (<5BU/mL). Overall, 19 patients were positive for TTI markers and 2 had clinically significant red cell alloantibody (Anti E and Jkb).
Conclusions : The department of Transfusion Medicine at SGPGI has initiated coagulation testing for hemophilia patients, free of cost. This is probably first comprehensive study from our state on laboratory testing for hemophiliacs including factor VIII inhibitor quantification. The overall prevalence of inhibitors in our hemophilia A patients was 5.1%, which is less as compared to majority of published studies.
Viveka Priyadharshni S, Krishnamoorthy R,
Panicker V.K, Febe R.S
Sri Ramachandra University, Chennai, TN, India
Introduction : The definition of massive transfusion is arbitrary. Replacement of the patient's blood volume with donor blood within 24 hours is generally considered as massive transfusion. The dramatic improvement in survival can be attributed to many factors including an improved understanding of consequences of massive resuscitation, increased use of damage control techniques, improved trauma systems, improved transfusion practices during resuscitation and improved blood banking techniques.
Aim : To determine the outcome of patients who have been massively transfused.
Methodology : This study was conducted in the Department of Transfusion Medicine, Sri Ramachandra University on patients who received massive transfusions for either major traumatic injury with increased blood loss, intra operative blood loss, post partum hemorrhage or liver disease during the period August 2009 to July 2010. Blood products such as packed red blood cells, platelet concentrates, fresh frozen plasma and cryoprecipitate were used for transfusion depending upon the clinical status of the patients.
Results : During the study period, massive transfusion was advocated in 53 patients for the following indications: trauma-17%(n=9), surgeries-24.5%(n=13), post partum hemorrhage- 3.7%(n=2), massive UGI bleed-7.54%(n=4), sepsis-13%(n=7), liver disease-15.09%(n=8), others including kidney disease-18.8%(n=10). Among the massively transfused, 50% of patients recovered and 50% of patients did not survive.
Conclusion : Massive transfusion can be life saving if undertaken judiciously. Co-morbid conditions should be treated accordingly and complications specific to massive transfusions like hypothermia, electrolyte disturbances should be taken care of.
Role of blood transfusion service in tissue banking
Arun R, Arumugam P
Dr. MGR Medical University, Chennai, India
Objective : Each year thousands of patients benefit from donated tissues like bone, cartilage, tendons, cornea and skin. Because of a lack of centralization in tissue procurement, there could be inadequate records of storage conditions and recipient identification. With the rapid growth in all areas of tissue banking industry, there has been an increasing need for accountability and measures that ensure safe, quality tissues for clinical use. At present, there are no proper standards or system to monitor tissue banking. So it needs a system with well established capabilities to monitor its service. It is imperative to discuss about the role of blood transfusion service in tissue banking.
Tissue banking depends on donor recruitment, donor eligibility determination, collection, processing, storage and distribution of various tissues. Tissue banking is a rapidly growing service throughout the world. It reflects the widening availability of transplantable tissue and its clinical indications in various fields. Public altruism and the willingness of persons to be tissue donors form the foundation of the tissue banking. A major impediment to the procurement of tissues has been the failure of health care professionals to inform the next of the kin, the option of tissue donation.
So tissue banking needs an effective organization for its further growth. Blood banks have the physical and administrative resources as well as the processing and distributing capabilities to operate a tissue bank. The blood bank has the capacity, experience and skills to act as a central depot and distribution point for all tissues. It will ensure that distribution records are well maintained. Blood centers, with expertise in donor recruitment, counseling, donor eligibility determination and cellular cryopreservation, are ideal for providing tissue transplantation services.
The risks of disease transmission by tissue transplantation are similar to those for blood transfusion and the majority of tissues are grafted during procedures that are not life saving. The danger of disease transmission needs introduction of legislation. Creating a new organization to monitor tissue banking is very difficult in countries like India. Blood transfusion services in developed countries have extended their roles to include tissue banking under them. In India, blood banks have readily available capabilities and experience with an established infrastructure, compliant with Good Manufacturing Practice, placing them in an ideal position to provide this service safely and cost-effectively.
Conclusion : Most of the basic guidelines for tissue banking activities fall within the guidelines of Blood Transfusion Services, like those that apply to care and selection of blood donors, quality systems, quality assurance and to testing of donors. As technology in this area continues to expand, blood banks will play an increasingly important role in co-coordinating and supporting tissue banking.
Administration and IT
Study of common preventable errors in blood banking
Rekha Hans, R R Sharma, Neelam Marwaha
PGIMER, Chandigarh, India
Introduction : Human errors in medical field are a known fact and well documented in literature. Errors in relation to blood transfusion may lead to a fatal event of mismatched transfusion. So, these errors in transfusion practice need to be identified and prevented.
Aim : To identify different types and sources of errors with the aim of reducing them and preventing their recurrences.
Materials and Methods : Study was conducted in blood bank services of a tertiary care hospital in North India (Postgraduate Institute of Medical Education and Research, Chandigarh).The errors noted by blood bank staff (clerical and technical) and residents taking care of the patients were recorded. Also an active search for errors in blood/component requisition and reaction forms was made. These errors were noted over a period of 9 months from Nov 2009 to July 2010. These errors were then analyzed and classified as per their site of occurrence.
Results : A total of 419 errors were recorded over a period of 9 months (from Nov 2009 to July 2010 study being conducted for one year till Oct 2010). Of the total errors, 407 (97.13%) occurred outside the blood bank. Most common error seen outside the blood bank was labelling error (55.13%) in form of wrong details of patient identification followed by errors due to inadequate previous transfusion history (27.20%), in transit errors (5.90%), non uniform identification number and near- miss events (2.60% each), wrong blood/component transfusion (0.70%) and miscellaneous errors (2.80%). Only 2.87% errors were noted inside blood bank.
Conclusion : Errors occur mostly outside the blood bank and the most common error was labeling error. Hence, caution in filling the form, labelling patient's sample properly and matching patient's details with the unit received for transfusion may prevent a major bulk of these errors.
Current challenges in transfusion medicine with a focus on Indian scenario
Prathama Blood Centre, Vasna, Ahmedabad, India
India is moving ahead to join the league of developed countries. Corresponding blood collection needs to grow from current 0.7% of the population to 5% of the population as per WHO and statistics of developed countries. Currently about 2500 blood banks collect about 7 million units of blood at an average of just 3000 units p.a. per blood bank. Such small blood banks, a few profiteering, come into play as blood is in short supply. Bulk of Indian blood is used as whole blood as it needs simpler economic facilities. Blood Safety is a question mark and the source is frequently the replacement donation. Technical facilities and the drive to make blood components is absent in majority of the Blood Centres.
The main challenges for the slow growth of Transfusion Medicine in India are:. Uneconomical size of blood banking in India. This leads to insignificant financial surplus to expand their infrastructure and capabilities. Blood banks attached to the hospitals. Blood banks attached to private hospitals do not get permission to do blood drives, so are always be depended upon replacement donors. All hospital based blood banks never grow beyond the requirement of the hospital. Fragmented policy framework Replacement Blood donations. Replacement blood donations are addictive and make blood banks lethargic. Lack of incentives to attract financial donations and contributions in blood banking There is no one big reason why donors from public sector should donate money to put up a modern "not for profit" blood bank in their cities. Lopsided organization structure and lack of management systems in blood banks. At most blood banks, the organization structure is lopsided towards medical and technical side and there is a vacuum towards the management functions.
IT solution in transfusion medicine
Prathama Blood Centre, Vasna, Ahmedabad, India
Blood Banking is a complex organization where every unit of blood is to be treated like batch. Creating and managing data for 50,000 units/p.a. or above 1,25,000 blood components at Prathama would be a nightmare without significant automation.
Manual handling of various operations from donors to patients can results in clerical error, data mix up, labeling error, sample mix up etc. It is cumbersome to track these errors and rectify them, putting the data in numerous registers and retrieving the data in certain form to get clarity and make professional decisions.
With the help of Information and Technology, it reduces the burden of routine, error prone activities and provides efficient, fast and quality service to donors, patients and hospitals.
At Prathama, we designed and implemented our own ERP-Software from day one of our operation. It networks all blood banking functions with use of barcode systems and its multi-faceted data capture and data sharing mechanism. It has core modules viz. Blood Collection and testing; Component Processing and Inventory; Component Reserve and Issue; Raw Material; Societal Marketing; Human Resources - Daily Activity; Financial Accounting; Quality Control; MIS; Vehicle Movement
Conclusion of our ERP-Software:
- Donor database management is initiated with each donor being assigned a unique barcode number. All information collected about the donor and donation is maintained on this number.
- The software links up the blood testing machines with donor database, product database and patient database. Through this integration, large number of TTD screening and blood grouping is performed accurately and efficiently. It has taken away the fear of mistakes and infused high confidence in the medical team with its fault free performance.
- The composite labels and blood issue labels are auto generated intelligently by assimilating relevant information from different sources. This totally eliminates the chances of error.
- It supports integrated Stock maintenance for multiple locations, online stock statement, stock ledger and inventory evaluation. It can auto generate purchase orders, Good Received Note (GRN) etc.
- It maintains all employee information and records training, leave, loan information along with salary registers, pay structures, P.F.forms and medical insurance details. Management can evaluates daily activity with KRA (Key Resources Area).
- The finance module contains all major entities like a traditional finance system like ledger, and voucher maintenance. It can segregate cost centre wise financial information generate trial balance, profit and loss, fixed asset monitoring and reconciliation.
- Our repeat donors are reaching 43% due to Recall Centre module.
- The software auto produces more than 100 different kinds of reports for efficient running of the blood bank. This includes all FDA required reports.
- QC module / Blood drive planning module / SOP and Policy module are coming shortly.
Identification of sampling error resulting into blood group discrepancy
P Desai, S B Rajadhyaksha, S K Jathar
Tata Memorial Hospital, Mumbai, India
Introduction : There are many critical steps in the blood transfusion chain from ordering blood for transfusion to administration of blood. One of the critical steps is the preanalytical stage of collection of blood sample from recipient. Any error occurring at this step of sample collection can lead to selection of wrong blood for the recipient. There should be a well defined system to identify and prevent such errors.
Aims and Objectives :
- To identify the non-technical causes of blood group discrepancy.
- To do root cause analysis of sampling errors occurring at the time of sample collection for blood grouping and crossmatching.
- To emphasize on adherence to standard procedures to prevent such errors.
Material and Methods : All cases of blood group discrepancy due to non-technical reasons were identified during the period March 2010 to July 2010 and root cause analysis was done. The non-technical reasons are mix up of samples or wrong labeling of sample. It is the hospital policy to send one blood sample for blood grouping preferably at the time of first outpatient visit. Another separately collected sample has to be sent along with crossmatch requisition of blood for the patient. Blood transfusion services in turn check the records as well as repeat the blood group prior to issue of blood. In case of discrepancy the clinicians are notified, and a fresh properly labeled repeat sample is requested and tested. Emphasis has been given on adherence to standard procedures by all the staff to ensure recipient safety.
Results : There were 6 incidents of blood group discrepancies during above mentioned period. It was found that the standard procedures were not followed resulting in sampling errors. On further analysis it was also found that amongst the staff for sample collection there were new recruits.
Conclusion : Effective orientation program and training are the essential areas affecting largely the outcome of various procedures; it needs proper attention for successful implementation of quality management program. To identify any deviation in entire process, continuous monitoring should be done; corrective and preventing action should be taken in the interest of patient safety.
Process excellence and performance enhancement: Beyond technical and design excellence
Artimis Hospital, Gurgoan, Haryana, India
Background : Blood Transfusion Services (BTS) are unique in nature in being a crucial link between blood donor and patient through manufacturing of safe blood components. Various aspects are taken into consideration to fulfill the "safe" blood components for current Good Manufacturing Practices (cGMP) and design excellence to optimize the manufacturing of the components to make sure, that desired outcome is achieved among patients with blood transfusion therapy. Statistical process control helps in reducing errors and improving patient outcomes. Implementation of six sigma and lean strategies helps in optimizing the resources so as to give efficient BTS.
Aim : Overall assessment of BTS was done to improve the donor retention by streamlining donor flow, improving the TAT of the blood groups and issuing of components, and have a uniform pattern for component preparation and transfusion transmitted infection screening and be achieved. The study is the first phase of implementation of "lean" i.e. reduction in non value added activities, in a hospital based tertiary care blood transfusion service.
Method : The first phase of implementation of lean was done throughout the BTS, covering all functional areas done over 3 months (June 2009 to August 2009), followed by maintenance and regular audits. Baseline data was collected over 3 working days (29 th march to 31 st march 2009) including busiest days and weekends, so as to have an overall picture of the dept. workflows during initial phase of the "lean". Major bottlenecks were recognized in manner of manpower deployment, equipment placements and methodologies of sample flow pattern and processing stages. Area specific strategy was designed to improve the process excellence within the dept.
Results : The outcome included a reduction in turn around time of whole blood donor to target time, of 45 min. to 60 min. stay in blood bank, in more than 95% of donors. Infection screening was achieved in 99% collections in less than 120 min of blood collection through process flow and optimum use of equipments capable of random access sampling. Recovery of Buffy coat recovered platelet concentrate was achieved within 4 hours of blood collection in more than 99% collections. Blood group report turn around time was reduced from 6 hours to 3 hours by bringing the changes in sample flow pattern. A simultaneous reduction in wastages, of time and reagents, was observed. Overall improvement in the reproducibility of the outcome was also observed.
Conclusion : The lean implementation to reduce the non value added activities plays a significant role in improving the performance of blood transfusion services. The clinical application of the lean and six sigma can prove to be quite beneficial.
Documentation- Back bone for TQM
IMA Blood Bank of Uttarakhand, Dehradun, India
Introduction: Documentation plays a pivotal role in all aspects of medical health care particularly in blood banking where legal issues and quality service both are involved. At the time of performing any procedure, all steps would be documented and performed as per documentation- this is basic of SOP. Whenever any particular activity is performed as per documentation, its very easy to trace all steps (audit) to maintain vein to vein transparency.
Documentation can be done by 2 ways- Manual and Software based. ERP software based is a costly technique but worthwhile. Manual documentation though cheap but is error prone. At IMA Blood Bank, Dehradun we are keeping hard copies of all necessary documents as per FDCA norms as well as all entries from donor to patient in ERP based software. All vein to vein transparency can be obtained by simple click within few seconds. ERP software is password protected and particular rights are given to authorized persons maintaining confidentiality.
The common problem in a large Blood centre is management of sample, data and information. There are high chances of sample mix-ups, testing mix-ups and the results can be wrongly attributed to a different patient. Blood Banking job is highly monotonous, requiring lot of paper work. Single mistake at issue counter may lead to mismatch transfusion bringing patient and Blood Bank Management into great trouble. ERP software which has its interface with robotic machines and barcodes is essential to integrate and automate all the functions of a blood bank.
Statutory requirements of maintaining the Data for a long time can be extremely tough if maintained only on Paper. Processing Data in to important information is possible only if it is stored in proper software. Retrieving any particular detail in a short time is possible only through good data base software.
Manual operation like labeling of Blood bags is extremely error prone. And those apart hand written labels are not only dirty and messy but can also be illegible. Knowing stock of Blood at shortest possible time and proper implementation of FIFO policy at large blood centre is impossible without automation.
Six sigma in transfusion medicine
Alexander S, Krishnamoorthy R, Panicker V.K,
Sri Ramachandra University, Chennai, TN, India
Introduction : Human blood is a scarce and precious resource. A Blood Transfusion Service (BTS) can function optimally by maximising the utilisation of resources (including man power) and minimising wastage. Six Sigma is a Quality management tool and involves professionalizing of quality management. Quality Management (QM) is an important aspect of any operation. Blood transfusion services that have a total control over their processes will be able to attain their full potential.
Aim of the study : To determine whether improvement in BTS operations can be achieved by implementing Six Sigma as a quality management tool.
Methodology : This study was conducted in the Department of Transfusion Medicine, Sri Ramachandra University, Chennai during the period July 2009 to June 2010. The DMAIC model (Define, Measure, Analyse, Improve, Control) of Six Sigma was used as the assessment tool. Quality indicators that were used in this study were: Sample rejection rate (Benchmark: less than 0.8%), Transfusion reaction rate(Benchmark: less than1.0%), Blood utilization rate(Benchmark: more than 95.0%), Blood wastage rate(Benchmark: less than 5.0%), Donor adverse reaction (Benchmark: less than 1.0%), Donors' feedback and Physicians' feedback and Turn Around Time (TAT). Whenever performances were not satisfactory, a Root Cause Analysis (RCA) was done and Corrective and Preventive Action (CAPA) were implemented.
Results : Implementation of Six Sigma in the BTS helped in elucidating customers' (Physicians) expectations, measuring current performances and identifying factors that affect processes within the BTS. The initiative resulted in implementation of the latest technology within the BTS, appropriate blood utilisation by the Physicians and decreased wastage thereby helping in cutting down on the cost and delivering a quality blood product.
Conclusion : Six Sigma is a rigorous process improvement tool that identifies and eliminates defects and reduces process variation over time. Quality Management is truly a team effort.
Hospital transfusion committee- A boon for quality blood transfusion services
Sandeep Malhotra, M.L. Kaushal, Nishi Jaswal
Indira Gandhi Medical College, Shimla, India
Background : The Hospital Transfusion Committee (HTC) is responsible for developing and implementing quality assessment protocols designed to improve patient care and substantiate that high level of care is being achieved. HTC evaluates and takes corrective action for each instance which did not meet preapproved criteria, starting from sending requisition to transfusion of blood or blood components.
Aim : The present study was planned to assess the role of HTC in improving the blood transfusion practices prevalent before the constitution of HTC and for better coordination between Blood Transfusion Department and various clinical departments using blood and blood components in a tertiary care hospital of I.G. Medical college Shimla.
Material and Methods : The present study was conducted over a period of five years since the constitution of HTC of Indira Gandhi Medical College Shimla in 2005 to June 2010. The main issues which were taken up for assessment are:
- Blood requisition forms as the forms were usually filled with incomplete information.
- Blood sample quantity and labeling as the sample quantity was usually inadequate with incomplete information on labels.
- Warming of blood /components as the existing practice was to keep the blood for warming before transfusion.
- Time frame for receiving back the issued blood units as there was no time frame for returning the unused blood to the blood bank.
- Storage of blood after issue from blood bank as the blood units were kept outside the refrigerators for many hours before transfusion.
During the period of study four meetings were held and all the parameters as mentioned above were addressed and corrective measures initiated as per the recommendation of HTC.
Results : Review of the main issues which were taken up for assessment showed significant improvement in terms of practices of blood requisition forms, blood sample quantity and labeling, warming and transfusion practices of blood/components and storage of blood awaiting transfusion. The receive back policy was formulated which resulted in marked improvement in early return of unutilized blood units.
Conclusion : Periodic meetings and review of the issues addressed in the HTC created a considerable awareness in the blood users and brought significant changes contributing to blood safety. After initial teething troubles a regular interaction among the members was established. Now it is a regular feature to discuss the various issues associated with blood transfusion. An active HTC acts as a boon for providing quality transfusion services to achieve the ultimate goal of safe transfusion. We suggest that all the hospitals having blood transfusion facility must have its own HTC.
Haematopoietic stem cell processing: Quality and regulatory scenario of ASEAN countries
Inno Bioventures Sdn. Bhd., Malayasia
For over 50 years, patients have been receiving haematopoietic stem cell transplants as part of their treatment for many haematological disorders Most clinical transplant units have, by necessity, established their own stem cell processing units or, in the case of smaller units, used facilities provided by larger transplant centers or local blood bank facilities. Most of these units have tended to be a mixture of research and clinical service, and this has been reflected in the backgrounds and training of the staff involved . Few, if any of these have been managerially independent of the end user, the transplant physicians. In most centers the processing has been conducted within classII microbiological safety cabinets in conventional laboratories with little or no cGMP/GTP issues. Over the past 10-15 years, cellular therapies have evolved, and now encompass gene therapies, immune-therapies, and stem cell therapies for metabolic and structural repair of neurologic, cardiovascular, haematologic, pancreatic, hepatic, renal, musculo-sketal and even ophthalmologic disorders. The cells and tissues used in these increasingly advanced and novel therapies are prepared in correspondingly complex ways, including sophisticated cell selection processes, ex-vivo cell expansion, genetic modification, and cell activation. USFDA and other regulatory agencies responded to the evolution of advanced cell therapies by establishing a risk-based regulatory structure, in which more rigorous controls are required for products that have been more extensively manipulated, or are thought in other respects to pose increased risk. This structure is described in the USFDA guidance documents and the GTP's and GMP's. Allogenic cord blood and unrelated donor peripheral blood stem cell/progenitor cells for transplant are subject to these regulations as well.
The advent of the Code of Practice for Tissue Banks has led to the requirement of quality systems to be established in all laboratories involved in the production or processing off all cellular tissues to be used therapeutically. The quality system is all encompassing from process validations and quality assurance to the standard of facilities and staff training. This seems self-evident to those working within the transfusion field but is a relatively novel concept to many hospital laboratories preparing transplant products such as bone marrow or peripheral blood derived haematopoietic stem cells.
Regulations governing cord blood and other cellular therapies in ASEAN countries, 21CFR 1271, FAHCT and other related quality guidelines and standards shall be discussed during the oral presentation.
Roadmap to achieve the quality standards and getting external accreditation for all government medical college blood banks in Gujarat
Ripal Shah, N. Choudhury, Pradeep Kumar, J L Meena
Gujarat State Council for Blood Transfusion, India
Introduction : Blood Transfusion services (BTS) scenario is changing day by day. BTS are aiming towards quality standards. Third party certification by accreditation gives a distinctive mark of quality, recognition nationally and that gives an external recognition of the commitments to quality. National Accreditation Board for Hospitals and Healthcare Providers (NABH) initiated blood bank accreditation since 2007. The end users (donor and patients) benefit from accreditation because through the process the blood bank has committed to raising the performance of the services offered.
Aims and Objective : To achieve the NABH accreditation for all 6 Government Medical College associated Blood Banks in Gujarat which was initiated by Gujarat State Council for Blood Transfusion (GSCBT).
Material and Method : NABH is the one of the external accreditation systems available to Indian BTS. Since the inception of the NABH standards in 2007, many blood banks started preparation for the accreditation. In Gujarat, the efforts have been initiated by GSCBT to obtain accreditation in six Government Medical College associated Blood Banks (GMCBB). Approximately 29 steps starting from sensitization and orientation of key personnel to awarding of the accreditation were pre structured by experts from GSCBT. A panel of resource persons was mobilized and one GMCBB was allotted to one resource person for regular monitoring and hand holding. Review meetings were organized for all quality managers, hospital administrators and in-charge of blood banks centrally for regular updating. All technical guidance was provided by the panel of experts and GSCBT.
Result : This strategy for accreditating GMCBB showed excellent result. Out of 6, 1 blood bank was awarded accreditation within 6 months and 3 more have submitted application within 10 months of starting of the process. Remaining 2 blood banks are changing premises and requiring more time which will be completed in another 6 months This is the first time in the country when 4 government GMCBB are in the process of awarding accreditation and 2 are in the final preparation.
Conclusion : With all the efforts by GSCBT and Government of Gujarat, 1 GMCBB already achieved accreditation and other 5 are expected to be awarded by March 2011. This is for the first time in the country where all GMCBB are accreditated within a very short span of 18 months. Ultimately, quality of blood transfusion services in the state has improved substantially.
Hospital blood transfusion committee - A tool for ensuring rational use of blood and blood components: The experience of a rural tertiary care teaching hospital
Monica Gupta, Faruq Mulla, Neena Doshi, Megha Yadav
A.D. Gorwala Blood Bank, Pramukhswami Medical College and Shree Krishna Hospital, Karamsad, Gujarat, India
Introduction : The importance of a Hospital Blood Transfusion Committee has been emphasized by various national and internationally acclaimed institutions in the field of transfusion medicine. In addition to formulating policies to effect the rational use of blood and blood products, the committee is also an effective tool for auditing the blood transfusion practices in a hospital.
We are presenting our experience of eighty two Blood Transfusion Committee Meetings from year 2003 to 2010.
Material and methods : The Shree Krishna Hospital is a 550-bedded general hospital with fully equipped ICUs, a Cancer centre and a Cardiac centre. The hospital is affiliated to the Pramukhswami Medical College. The Hospital Blood Transfusion Committee was established in 2003. Since then 82 meetings have been held. The following parameters are studied in the meeting.
- Single unit transfusion of blood and blood products
- Rapid tests
- Reactions forms received back in the blood bank
- Cross match Transfusion ratio
- Collection and Dispatch of whole blood and components
- Number of voluntary blood donation camps, voluntary and replacement donation
- Ratio of incomplete requisition forms
The data of these meetings was compiled, and trends over the past 7 years, are studied.
Results : Transfusion reaction forms received back at the blood bank has increased from 60-65% in 2003 to more than 90%. The rate of single unit transfusion has come down from more than 5% in 2003 to 1.6% in the current year. An analysis of the justifications provided reveal that many of these cases have received single units only because the patients have either left the hospital against medical advise or in some instances expired. The rate of rapid test which had previously stayed within 10%, has increased in the past two years. This is related to two factors, when donors have to be called for platelet concentrates and when blood has to be collected in emergency. The rate of voluntary blood donation has increased from 41% in 2003 to 93 % in 2009. Once component separation was started, our blood bank has issued only components.
Conclusion : The Hospital Blood Transfusion Committee is an effective tool for ensuring rational use of blood and blood products and implementation of best practices in Transfusion medicine especially in a teaching hospital.
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2]
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