Asian Journal of Transfusion Science
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ABSTRACT Table of Contents   
Year : 2015  |  Volume : 9  |  Issue : 3  |  Page : 11-44
39 th ISBTI Annual Conference, TRANSCON 2014, Patiala



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Date of Web Publication14-May-2015
 

How to cite this article:
. 39 th ISBTI Annual Conference, TRANSCON 2014, Patiala. Asian J Transfus Sci 2015;9, Suppl S1:11-44

How to cite this URL:
. 39 th ISBTI Annual Conference, TRANSCON 2014, Patiala. Asian J Transfus Sci [serial online] 2015 [cited 2019 Sep 19];9, Suppl S1:11-44. Available from: http://www.ajts.org/text.asp?2015/9/3/11/157018



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A study of critical control points in the blood transfusion chain

Amruta Indulkar, Rakhi Malvankar, Rajesh Sawant, Anand Deshpande


Department of Transfusion Medicine, P. D. Hinduja Hospital & MRC, Mahim, Mumbai, Maharashtra, India

Background: Haemovigilance includes various measures planned to ensure that the transfusion process is effective and further monitoring, evaluation and analysis of these systems to ensure maximum efficacy. We developed and analysed the turn around time (TAT) for issue of blood components and transfusion time for various components in our hospital.

Aim: To analyse the utility of turn around time (TAT) for blood component issue and transfusion time for various components as quality indicators.

Materials and Methods: As a part of a pilot programme, a system was made to document the exact time when the request for issue was raised at the patient care area upto the time when the corresponding transfusion process was implemented. This includes the request transfer time (RTT) (time taken for request raised by nursing staff to reach the blood bank), the component issue time (CIT) (time taken by the blood bank staff to complete the formalities and issue the component). We also analysed the actual transfusion time (ATT) (actual time from the start till the end of transfusion). The data was manually captured and analysed on a monthly basis for 17 months. Acceptable limits for various steps were defined based on local acceptance and standard guidelines, as applicable. Compliance was monitored and root cause analysis performed for outliers.

Results: In a 17 months period, 19821 blood components were issued of which 9532 (48%) were packed red blood cells (PRBC), 6488 (33%) were platelets, 3473 (18%) were fresh frozen plasma (FFP) and 828 (2%) were cryopreciptate. Mean RTT was 25 min (4 min-5 hrs). The mean CIT was 4 min (2 min-6:35 hrs). CIT was highest in case of cryoprecipitate with mean of 8 min (3 min-2:15 min) followed by FFP with mean of 7 min (2 min-3 hrs) and platelets with mean of 7 min (2 min-6:35 hrs) while it was lowest in case of PRBC's with mean of 2 min (1 min-3:20 hrs). However ATT was highest in case of PRBC's with mean of 2:49 hrs (15 min-5:27 hrs), followed by platelets 52 min (09 min-1:23 hrs) and FFP with 34 min (15 min-1:46 min). Compliance with the set standards for RTT and CIT was met with in 97.9% of the cases.

Conclusion: Monitoring the TAT for blood component issue and transfusion time for various components helped us to identify the areas for improvement in transfusion process at our hospital. Switching over from manual to electronic processes and more focus on training of nurses in safe blood administration practices has now been planned to enhance transfusion safety.

Turn around time (TAT) for emergency blood issue: A quality indicator

T Ramanathan, KC Usha


Department of Transfusion Medicine Govt. Medical College, Trivandrum, Kerala, India

Background: Quality indicators in transfusion medicine are necessary for patient safety and customer satisfaction. The turnaround time for issuing blood products has emerged has a quality indicator but it is not an established benchmark. So establishing an appropriate TAT for issuing blood units in response to stat request with regular monitoring important for Quality management. We examined the TAT from receiving the blood request to the components exited the blood bank. Objectives: 1. To analyse the turnaround time (TAT) in issuing blood units using Immediate Spin Cross-Match (ISCM). 2. To identify the factors leading to prolonged TAT.

Materials and Methods: TAT was defined time of request received (start time) to when components exited the blood bank (stop time). Cases where PRCs units issued after immediate spin cross-match and FFP & PC issued for emergency cases are included in the study. Start & stop times are recorded by the TEAM. TAT was recorded at different shifts - FORENOON 8 am-1 pm, AFTERNOON 1 pm-6 pm, NIGHT 6 pm-8 am. Reason for delay is noted in cases of prolonged TAT. Observations: In total of 125 cases, mean TAT in forenoon, afternoon and night shift are 30.02, 30.32, 32.46 respective standard deviations are 14.212, 17.890 and 16.246. One way ANOVA was done to compare average TAT recorded at different shifts shows NO SIGNIFICANT DIFFERENCE (i.e. P value = 0.863). Mean TAT of whole day in our study is 30.933 minutes which was almost same as the standard TAT (30 minutes). Main Reasons for prolonged TAT identified in our study are sample labelling issues, non-availability of staff, multiple requests overloading.

Conclusion: Standards for TAT currently do not exist within the field of transfusion medicine. This study serves as a starting point for establishing a benchmark for TAT of blood products. Strategies like education, improving work force distribution, re-assigning technician duties on demand will improve the quality of blood bank services.

Audit of blood donation and utilization of blood products at a tertiary care hospital (Sri Guru Ram Das Institute of Medical Sciences & Research (SGRDIMSAR), Vallah, Amritsar): 1 year study

Harjot Kaur, Mohit Paul, Mridu Manjari


Department of Pathology, Sri Guru Ram Das Institute of Medical, Sciences & Research (SGRDIMSAR), Vallah, Amritsar, Punjab, India

Aim: To analyse patterns in blood donation and blood utilization. Introduction: For optimal functioning of any transfusion services, it is essential to study the patterns of blood collection and audit blood utilization practices.

Materials and Methods: A retrospective study from January 2013 to December 2013 was undertaken at a tertiary care hospital blood bank centre of a 775 bedded hospital. Blood collection data was analyzed on the basis of voluntary/replacement donors, male/female donors, ABO blood grouping prevalence and sero-reactivity. Blood utilization trends were analyzed and was calculated using necessary statistics.Transfusion probability and Index were also calculated.

Results:

  • Total blood units collected = 6065
  • Prevalence of Blood Groups - B>O>A>AB
  • Voluntary/Replacement donors - 2015/4050
  • Male/Female donors-5992/73 = 82:1
  • Total blood bags issued = 9159
  • Total blood bags discarded = 1319
  • Bags issued to in house patients = 8150
  • Bags issued outside hospital = 1009


Blood utilization statistics

  • No. of blood units cross matched = 9509
  • No. of patients cross matched = 6723
  • No. of blood units transfused = 9159


Conclusion: Performing blood bank internal audits and reviewing statistics are vital tools for a successful blood transfusion service. Implementing policies such as type and screen and the maximum surgical blood ordering schedules will lead to more effective blood utilization and monetary savings.Drives for enhancement of volunteer blood donors are recommended.

Quality indicators in transfusion medicine

Alexander Singh, Radha Krishnamoorthy, Vinod Kumar Panicker


Department of Transfusion Medicine, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra University and Hospital, Chennai, Tamil Nadu, India

Background: Blood banking involves Blood donor selection, collection, processing, storage and issue of blood and/or blood components after compatibility testing. Indicators are necessary to assess the quality of blood bank and transfusion services.

Materials and Methods: This study was done at Sri Ramchandra Blood Bank (AABB Accredited), Department of Transfusion medicine, Sri Ramachandra Medical College & Research Institute, Sri Ramachandra University & Hospital, India during the period April 2013 to March 2014. The following were the quality indicators used for assessment: Transfusion reaction rate, Donor adverse reaction rate, Blood utilization rate, Blood discard rate, Turn around time and Donor and Physician feedback. The observed data were compared with the benchmark for each quality indicator as per Joint Commission International (JCI) and National Accreditation Board for Hospitals & healthcare providers (NABH) recommendations every month.

Results: On assessing our data with the recommended bench mark every month, it was observed that our department functioned efficiently as per JCI & NABH recommendations which was as follows: Transfusion reaction rate 0.3% (Benchmark 1%), Donor adverse reaction rate 0.4% (Benchmark 0.5%), Blood utilization rate 96.9% (Benchmark >95%), Blood wastage rate 3.1% (Benchmark <5%), Turn around time 2.5% (Benchmark <5%) and feedback from blood donors and Physicians was very much satisfactory.

Conclusion: Assessing the performance of any department becomes easier when quality indicators are formulated and observations made every month, so that whenever there is a drop in performance a cause and effect analysis can be done to correct the deviation.

Rate of component preparation and it's demand with expiry of blood & it's component as a quality indicator in transfusion practice at rural hospital

Raviraj Bhoknal, Kinjal Vaishnani, Nand Kishor Angarkar, Ravinder Rao Sabih Karle


Pravara Institute of Medical Sciences, Pravara Rural Hospital, Loni, Maharastra, India

Introduction: Blood transfusion is safe, life saving but with minimum risk. Implimentation of quality systιm & continous evaluation of all activities of the Transfusion services can help to achieve the maximum quality and quantity of safe blood.

Aim and Objectives: Aim of study is to determine the rate of discard of blood and it's component with reasons.

Materials and Methods: A four year retrospective data from Jan. 2010 to Dec. 2013 of the total blood collection & their components with the reason for discard of whole blood & components is obtained & compair with the C:T ratio, assesed for their mean annual trends. The reason for discard of blood & blood components units,whether infectious or non infectious were analysed.

Result: Total number of blood units collected were 12,765 of which 7176 were whole blood. 208 whole blood bags were discarded out of these 76 (1.0.5%) were discarded because of seropositivity and 132 (1.83%) were discarded because of expiry. The total 5589 components were prepared in which 812 components were discarded. In these platelets are most common units which are discarded due to expiry 25.0%) because of non utilisation followed by, seropositivity of PCV (1.6%), leakage of FFP (3.1%), expiry of PCV (1.3%), less quantity (0.3%). The total discard rate was 7.5%. C:T ratio was 26429:17859 (67.5%).

Conclusion:

  1. Proper demand and utilisation policies will help to reduce expiry of blood and it's components.
  2. Proper counseling of the donor, list of permenantly defereal donors will help to minimize the rate of discard from collected units.
  3. These discarded bags due to non utilization are both financially as well as socially harmful to the blood bank.


Quality control of platelet rich plasma/platelet concentrate

Arunpreet Kaur, Neetu Kukar, Ram Niwas Maharishi, Harkiran Arora


Department of Immunohematology and Blood Transfusion (IHBT), Guru Gobind Singh Medical College and Hospital (GGSMCH), Faridkot, Punjab, India

Introduction: Platelet transfusions are the primary therapy for thrombocytopenia due to various causes. Thrombocytopenia may be due to qualitative defect i.e. defect in platelet function or quantitative defect i.e. decreased platelet count. The first successful attempt to raise the platelet count in thrombocytopenic patients by transfusion of whole blood was described by Duke in 1910. General improvement of the technique to separate platelets from whole blood and availability of plastic bags in blood banking revolutionized the field of component therapy. The in-vitro platelet quality can be assessed by using certain parameters e.g. swirling, volume, platelet count and WBC count per bag, and pH.

Aim: Aim of the present study was to analyze the quality of platelet rich plasma/platelet concentrate prepared by PRP method as per the recommended quality norms.

Materials and Methods: In this study, quality control of PRP/PC was done. Platelet concentrates were prepared from whole blood using PRP method. The quality was assessed using the following parameters:

  1. Qualitative parameters: Swirling, volume of platelet concentrate and pH.
  2. Quantitative parameters: Platelet count and WBC count per Bag.


Results: A total of 72 PRP/PC were enrolled in this study. The mean volume of PRP was 150 ml and that of PC was 50 ml. The mean platelet count of PRP/PC was 5.2 × 10 10 /unit. The mean WBC count was 1.1 × 10 8 /unit. The mean pH was 6.5. Swirling was reported in 85% of units.

Conclusion: 79% of the total units tested fulfilled the desired quality control criteria.

Knowledge, attitude and practices on blood donation among college students of different disciplines in Bhubaneswar, Odisha, Eastern India

Babita Raghuwanshi, Somnath Mukherjee, Sonu H Subba


All India Institute of Medical Sciences, Bhubaneswar, Odisha, India

Background: The intention to donate blood is determined by positive or negative attitude, social and peer pressure and altruism. India has a potential of young, healthy blood donors. Therefore in this study we decided to assess the knowledge attitude and practices of students of different streams towards voluntary blood donation.

Aim: To determine the knowledge, attitude and practices about blood donation among college students of various streams.

Materials and Methods: A cross-sectional study was conducted on 399 students. A pre-designed questionnaire consisting of sections on knowledge, attitude and practices was formulated to collect data. Statistical analysis was done by SPSS version 21.

Result: 399 college students participated in this study, which included 185 (46.36%) students from medical field and 214 (53.63%) students from nonmedical field. 228 (57.1%) students had adequate knowledge and 171 (42.9%) had less than adequate knowledge on various aspects of blood donation. Among these, 152 (82.2%) of medical stream had adequate knowledge which was significant (P < 0.001). 268 (67.17%) students felt temporary weakness and fainting as the commonest fear associated with donation. 163 (40.9%) students donated blood as a sense of social responsibility, of which 132 belonged to medical stream. Significant difference in attitude between students of medical and nonmedical streams was observed (P < 0.001). 221 students (55.38%) had donated blood one or more times. 300 students (75.18%) declined to be paid for becoming a regular voluntary donor. 286 (71.67%) students took parental permission before donation. 233 (58.39%) students would donate for altruistic reasons and when called in emergency 320 (80.20%). 299 (74.9%) students consented to become a regular voluntary donor. However, 361 (90.5%) students agreed arranging transport to donation venue would help them become a regular voluntary donor.

Conclusion: The study assessed that there was a significant difference observed in knowledge and attitude between students from medical and nonmedical stream. A positive attitude of parents was a determining factor as most students took parental permission before donation. A negative attitude towards paid donors was observed in the study. Interventional strategies like arranging transport to donation venue and reminder call were found to be strong motivating factors for blood donation.

New strategy succeeded for retention of voluntry blood donors at GMC Patiala

Kusum K Thakur, Hardeep Singh Sanor, Kanchan Bhardwaj


Department of Transfusion Medicine, Govt. Medical College, Patiala, Punjab, India

Introduction: Recruitment of donors becomes one of the most important aspects of Blood Transfusion Services. Any healthy adult males can donate every three months while females can donate every four months. According to NACO guidelines, efforts should be directed towards encouraging & retaining adequate number of repeat donors. Prefixed venue, time and dates help donors to plan their donations. This study was planned two years back with fixed dates (5 th and 20 th ) every month, fixed venue (blood bank) and fixed time (9-12 AM) for blood donation and after donation a reminder card be given to donor with next date of donation. Follow-up was done for repeat donations.

Aim/Objective: To retain donors for blood safety.

Materials and Methods: A reminder card was designed in Punjabi language depicting fixed dates, time and venue. Publicity was done in hospital premises & outdoor camp sites. Study started with effect from 5 th May 2012. Observations: Till 20 th August 2014, fifty five (55) such camps were held with total 988 donations and 142 repeat donors. Out of 142, three donated seven times, eleven donated six times, eight donated five times, twenty six donated four times, thirty six donated three times and rest fifty eight donated two times.

Conclusion: An innovative thought of camps with fixed venue, time & dates with reminder card has born fruits and in short span of about two years and three months, 142 (14.4%) donors have become repeat donors. In future journey will go on and more and more repeat donors with full blood safety and hence patient safety.

Implementation of pre-donation counseling in the camps: Impact and effectiveness

Mitali Shihora, Kaplesh Vala, Kirit Bhatt, Jignasa Gami, Kamlesh Dharajiya


Rajkot Voluntary Blood Bank & Research Centre, Rajkot, Gujrat, India

Background: Effective donor screening protocol is the best path for the identification of the low risk voluntary blood donors. Gujarat is leading in voluntary blood donation and majority of blood comes from the outdoor blood collection sites. TTI is a major challenge to the blood transfusion service all over the world, especially at campsites. We have implemented pre-donation counseling at the campsites since 2012.

Aim: To determine the impact of pre donation counseling at the outdoor blood donation campsites.

Materials and Methods: A donor informed consent form has been prepared. While the pre-donation screening in the camp, the donors were counseled about TTI risks and were made aware about blood safety for the patient's benefit. This retrospective study was conducted from 2011 to 2014 (July) outdoor camp site donors of our center. Other area of study about the geographical data of the sero-reactive donors in the region.

Result: Total 73825 donors were studied. Out of this 46824 donors from camps. Out of this 91.2% donors were male and 8.7% were female. Before the implementation of the pre-donation counseling our sero-reactive rate was 0.87% for in-house collection and 1.18 % for outdoor camp collection and after implementation the sero-reactivity the rate was 0.47% for in-house and 0.88% for outdoor camps.

Conclusion: Sero-reactivity rate is decreased on a notification mode due to the implementation pre-donation counseling in the in-door as well as the outdoor camp donors. TTI risk can be decreased by pre-donation counseling and blood donation awareness in blood donors till 100% safe testing method is invented.

Response rate for counselling of blood donors who were seroreactive for transfusion transmissible infections

Rimpreet Singh Walia, Kulbir Kaur 1 , Madan Gopal, Suresh Kumar


Lifeline Blood Centre, Patiala, 1 Department of Pathology & Transfusion Medicine, Punjab Institute of Medical Sciences Jalandhar, Punjab, India

Background: Each unit of donated blood is tested five Transfusion Transmissible Infections (TTIs): HIV, Hepatitis B (HBV), Hepatitis C (HCV), Syphilis and Malaria. Donors whogive prior consent for disclosure of their test results and are seroreactive, are requested to visit the blood bank personally.

Aims: This prospective study was undertaken to determine the turn out rate of seroreactive blood donors for counselling.

Materials and Methods: This study included donors who donated blood at Life Line Blood Centre, Patiala, Punjab from 1 st April 2013 to 30 th June, 2014. All samples were analyzed to detect anti-HIV (I & II), Hepatitis B surface antigen (HBsAg) and anti-HCV by Enzyme Linked Immuno-sorbent Assay (ELISA) test. Screening for malaria was done with rapid test and for syphilis by the Rapid Plasma Reagin (RPR)/dipstick/card test. Seroreactive blood donors were asked to visit the blood bank. Donors who came to the blood bank were repeat tested with a fresh blood sample, informed of their test results, counselled and were referred.

Observations: Among the 6589 blood donors, the total number of seroreactive cases was 98 (1.49%). Only 88 (88.8%) of the seroreactive donors could be contacted telephonically and a mail was sent to the remainig 10 donors. Out of these, only 37 (37.76%) donors came for counseling.

Conclusion: Post test counselling of seroreactive donors is important to provide early treatment and prevent further transmission of disease. However, the turnout rate of such donors for counselling is very low.

Fear factor in donors for blood donation coming from rural area in Bihar

Rakesh Kr Ranjan, Shamsheer Ahmad, Santanu Kumar


Department Transfusion Medicine, Paras HMRI Hospital, Patna, Bihar, India

Background: There is a lack of Awareness in the People about Blood Donation coming from Rural Areas of Bihar. Mostly they have a lot of queries about Blood Donation. Proper Donor Counseling before Donor Registration is very important to increase the number of Donor.

Aim: The aim of this study is to provide Awareness about Blood Donation and increasing the Blood Donation in the Blood Bank to manage proper stock of Blood and its component.

Materials and Methods: A study is conducted between the voluntary donors and Patient Attendants and their friends reported in Blood Bank for blood arrangement for their patient and 3000 attendants are counseled before donor registration.

Observation: In 3000 attendants only 79 Peoples are coming for voluntary Blood Donation and they are aware about Blood Donation. Around 1000 Donors are from the main City Patna. They have knowledge about Blood Donation also they were ready for replacement Donation. 1921 donors are from rural areas of Bihar. They have lack of Awareness about Blood Donation. They have a lot of fear factors about Blood Donation like they have weakness after donation, loss of blood, weight loss, don't want to Donate for relatives. All these donors are counseled before donor registration for donation. We make donors aware about the benefits of Blood Donation. After counseling only 1500 attendants donated Blood and 421 attendants refuses donation.

Conclusion: Awareness about Blood donation is very important in the people leaving in rural areas. We have increased our monthly donation more than 600 by donor counseling before donor registration. Donors are also motivated for a repeat voluntary donation.

Knowledge, attitude and practices of blood donors towards blood donation

Suchet Sachdev, Karobi Das 1 , Geetanjli 1 , Baljeet Kaur 1 , Charan Inder Singh 1 , Daiamonlang Nongbri 1


Department of Transfusion Medicine, 1 National Institute of Nursing Education (NINE), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Haryana and Punjab, India

Aim: To assess the knowledge, attitude and practices of blood donors towards blood donation and to find out association of knowledge and attitude with selected demographic variables.

Materials and Methods: A total of sixty (60) subjects were selected using purposive sampling technique. The knowledge, attitude, and expressed practice questionnaire, was devised and construct and content validated before usage. The study was conducted at the Department of Transfusion Medicine of a tertiary level Institute from northern India during the year 2011-2012. Paper and pencil technique was used to collect the data.

Results: Analysis of data collected revealed that 23 (38.4%) of the participants had good knowledge, 21 (35%) had average knowledge, 12 (20%) had excellent knowledge and only few 04 (6.6%) had poor level of knowledge regarding blood donation. Mean of the knowledge score was 6.21 ± 2.3 and the mean percentage was 51.80. Assessment of attitude revealed that majority of the participants had a strongly favorable attitude towards blood donation. Assessment of practices showed that majority 45 (75%) of the donors had donated blood for almost five times. Nearly half 28 (46.7%) of the donors donated blood only when they were asked for and more than half 32 (53.3%) of donors started donating blood when they were in age group of 21-30 years. Regarding reasons for blood donation, exactly half 30 (50%) of them donated due to altruism, and all the donors (100%) were willing to do so in future. The demographic variables like age, education and occupation were found to be associated with level of knowledge and attitude towards blood donation.

Conclusion: The findings of the study revealed that blood donors had good knowledge and a positive attitude towards blood donation but majority of individuals were not donating blood regularly as volunteers.

Role of blood mobile in voluntary blood donation

Aditi Sharma, Raman Sharma 1 , Neeraj Sharma, Adarsh Sahni


Departments of Transfusion Medicine and 1 Medicine, Government Medical College, Amritsar, Punjab, India

Voluntary blood collection is the foundation for safe and quality blood transfusion service as the blood collected from healthy strongly motivated donors belonging to low risk population is the safest. The family/replacement donors have been found to be associated with a significantly higher prevalence of Transfusion Transmissible Infections (T.T.Is.). Secondly to wipe off the scarcity of blood and ensure the availability of safe and quality blood it is desirable to approach sufficient number of donors who are healthy and are ready to donate blood voluntarily whenever required. Blood Mobile plays an important role in achieving the goal.

Aims and Objectives: The aim of the study is to analyze the impact of blood mobile on the voluntary blood donation.

Materials and Methods: Data is collected for the blood collected through voluntary blood donation camps for the last three years from January, 2011 to December, 2013 and analyzed for the increment in the blood units collected and additions in the donor data base.

Observation: In the period January to December, 2011 a total of 127 voluntary blood donation camps were organized and total units collected were 11158 in comparison to the period January to December, 2010 where the total VBD camps were 67 and blood collected was 7771 units when there was no mobile bus facility with the Department of Transfusion Medicine, Govt. Medical College, Amritsar. Similarly, in the year 2012 a total of 117 VBD camps were organized and blood units collected were 13292 and in the year 2013 from January to December, the total VBD camps were 142 and units collected were 18147.

Conclusion: Blood Mobile Bus plays a substantial role in voluntary blood donation.

Platelet audit: Assessment and utilization in a tertiary care hospital of Punjab

Abha Singla 1 , Kanchan Bhardwaj 2 , Manjit Singh Bal 1 , Harpal Singh 1 , Aradhana Sharma 2

1 Department of Pathology, 2 Department of Transfusion Medicine, Govt. Medical College, Patiala, Punjab, India

Background: Blood component therapy has benefitted many patients by meeting their specific transfusion needs from a single blood donation. Non compliance to various guidelines of platelet transfusion therapy is frequently seen. There is a need for rationale use of platelet transfusions. So, audits are important to reduce inappropriate transfusions.

Materials and Methods: This study was done to audit the usage of platelet transfusions in blood bank, Rajindra Hospital, Patiala. British Committee for Standards in Haematology (BCSH) Guidelines was followed to know the appropriateness for platelet transfusions. Platelet concentrates prepared from random donor platelets (RDPs) were included.

Results: 1580 units of RDP's were audited for appropriateness of transfusion. The appropriate use of platelet transfusions were 1232/1580 (77.9%). Maximum number of transfusions were in Medicine Department, 1002 (63.4%), in patients of Dengue, Alcoholic Liver Disease, Aplastic Anaemia followed by Surgery, 231(14.6%), pre and post operatively in patients of major surgeries. Maximum number of appropriate transfusions were in Gynae (98%), followed by Surgery (90.3%). Overall, 77.9% were appropriate.

Conclusions: The importance of internal audit and sensitizing clinicians for proper usage of platelet transfusions, for the patients with severe and life threatening bleeding.

Fresh frozen plasma in medical care setting in a tertiary care hospital of north-west India

Sanjay Goyal, Harnoor Singh Bhardwaj, Gurkirat Kaur Gill, Bachan Lal Bhardwaj, Kanchan Bhardwaj 1


Departments of Medicine and 1 Transfusion Medicine, Government Medical College, Patiala, Punjab, India

Background: Fresh frozen plasma (FFP) is used in bleeding with abnormal coagulogram. The definitive indications of FFP usage in a medical care setting is replacement of a factor deficiency where factor concentrate is not available; disseminated intravascular coagulation (DIC), in massive transfusion, liver diseases, cardiopulmonary bypass surgery etc.

Aims and Objectives:

  1. To study usage of FFP in medical care setting in Rajindra Hospital, Patiala.
  2. To carry out the audit of appropriateness of FFP usage with reference to international guidelines.


Materials and Methods: 100 cases where FFP was transfused in the medical and surgical wards of Rajindra hospital were taken. Data including their clinical presentation, pre-transfusion and post-transfusion coagulation profile, units transfused and the final outcome was studied. Analysis of indications and pattern of usage of FFP was done according to the guidelines by College of American Pathologists (CAP). FFP was separated from whole blood in 6 hrs of collection at 4 ° C in a refrigerated centrifuge and frozen at <-30 ° C for 1 yr. The dose of FFP is 10 ml/Kg body wt. Post transfusion assessment of APPT, PT, INR and fibrinogen was done for monitoring the effect of FFP. ABO compatible Plasma but not group specific was transfused.

Results: Most of the cases were from surgery followed by medicine department. Main indication of FFP transfusion in medicine ward was chronic liver disease followed by DIC whereas in surgical specialty derangement of coagulation parameters prior to invasive surgery was the main reason which was followed by peri-partum hemorrhage. Appropriate dosage of 4 units of FFP was given at one time in 66% cases only. The mean change in a PTT was from 44 ± 9.1 to 41.8 ± 9.17 with P < 0.001 while mean change in INR was from 2.35 ± 1.04 to 2.10 ± 0.97 with P < 0.001. Appropriate requests of FFP were done in 71% where as inappropriate were 29%. Of these requests, majority of the appropriate requests were from medicine department whereas majority of inappropriate requests were from surgical department.

Conclusion: FFP usage results in clinical and lab parameter improvement. There is need for educating the clinical specialists about the appropriate use of FFP.

Audit of whole blood and its components

Sonima Sharma 1 , Kanchan Bhardwaj 2 , Manjit Singh Bal 1 , Anil Suri 1 , Kusum Thakur 2 , Shikha Aggarwal 1

1 Department of Pathology, 2 Department of Transfusion Medicine, Govt. Medical College, Patiala, Punjab, India

Background: Blood and its components are an important part of patient management treatment protocols and like drugs have property to cause adverse reactions in the recipients. To maximize the effectiveness, safety and utility clinicians and intravenous therapists should be knowledgeable about the potential risk of blood component therapy. Therefore the clinician should keep in mind the appropriate indication for ordering blood components, thereby avoiding misuse and unnecessary exposure of the recipient to various infectious and non infectious complications. Hence, regular audit of blood and its component usage is essential to access the blood utilization pattern and set Ideal policies in all the blood using specialties. In spite of the sophisticated blood banking services worldwide; indiscriminate use of blood components with either no indication or inappropriate indication continues.

Aims and Objectives: The aim is to access the utilization pattern of 5000 units of blood and blood components and its appropriateness of the transfusion in each situation.

Materials and Methods: Study was done from 1 st January 2014 to 31 st July 2014 to audit the usage of whole blood and its component in blood bank Rajindra hospital Patiala. 5000 fgilled requisition forms were studied with its indications to know its appropriateness/inappropriateness according to accepted criteria.

Results: Out of total 5000 units whole blood used were 1925 (38.5%), packed cell were 1380 (27.6%), fresh frozen plasma were 1083 (21.66%), random donor platelets were 520 (10.4%),Platelet rich plasma were 72 (1.44%), single donor platelets were 20 (0.4%). Maximum number of transfusions were from gynaecology and obstetrics, followed by medicine and surgery. Overall 3260 transfusions were found to be appropriate (65.6%) and 1740 (34.4%) were inapproriate.

Conclusion: The importance of internal audit and sensitizing clinicians for the proper usage of whole blood and its components.

Evaluation of the quality and extension of shelf life of platelet concentrates: A prospective study

Pothipillai Arumugam, Swathandran Hamsavardhini, Munuswamy Sri Devi, Madhu Chitra


The Tamilnadu Dr. MGR Medical University, Guindy Chennai Department of Transfusion Medicine

Introduction: In blood transfusion service, the primary goal is "Transfusion of Safe Blood". A failure in the quality of blood collected or screening of donated blood unit can result in fatal consequences. Good quality control measures help us to attain minimal accepted standard limits.

Aim: To ensure that platelet concentrate units prepared, consistently meet requirements for quality, safety and potency and find out the possible extension of shelf life.

Materials and Methods: Fifty units of platelet concentrates, prepared by platelet rich plasma method were tested on 0, 3, 5, 7 days for the following parameters: Volume, pH, platelet count, WBC count, RBC contamination, bacterial culture and swirling which were evaluated as per DGHS, AABB and WHO guidelines.

Results:

  • Volume, pH, platelet count, WBC count, RBC contamination were within normal range.
  • Bacterial culture on day 3 and 5 showed one unit each positive. On day 7, 5 units were found positive.
  • Swirling phenomenon was observed in all units on day 0 (100%), gradually decreased to 98% on day 3, 90% on day 5 and 0% on day 7.


Conclusion: Our study on evaluation of the quality of platelet concentrates in a consecutive scheduled time period within fixed and slightly extended shelf life revealed adherence to various parameters. However, the study of various quality parameters evaluated on extended storage period of platelet concentrates showed non-compliance to the standardized quality control. Hence extension of the shelf-life of platelet concentrates from 5 to 7 days would not be possible but may be prolonged with additive solutions.

Comparison of the intermediate flow versus continuous flow cell separator: Effect on donor services

Yogesh Domadiya, Daksha Akbari, Dinesh Gami, Sahjid Mukhida, Kamlesh Dharajiya


Rajkot Voluntary Blood Bank & Research Centre, Rajkot, Gujrat, India

Background: Cell separator facility is a necessary requirement for blood banking. Most of blood banks use intermediate and/or continuous flow cell separator. Our blood bank has both types of cell separator facilities. We have compared both of the instruments for donor service.

Aim: To compare intermediate flow and continuous flow cell separator for the platelet donors to improve the services of the blood bank.

Materials and Methods: In this retrospective study, we analyzed cell separators, Hemonetics MCS+ for intermediate flow and TRIMA Accel for the continuous flow. We analyzed the last one year data of 151 plateletpheresis procedures on cell separator.

Results: 69.53% procedures and 30.46% procedures were performed on the MCS+ and TRIMA. The average time taken for a single unit collection on MCS+ and TRIMA were 76 minutes and 51 minutes respectively. Average blood volume processed was 2786 ml with MCS+ and 2114 ml with TRIMA procedures respectively. Average ACD volume used was 339 ml with MCS+ and 234 ml with TRIMA. 2% and 1% donors experienced mild to moderate reactions on MCS+ and TRIMA.

Conclusion: Plateletpheresis procedures can be performed successfully with the continuous-flow and intermittent-flow blood cell separators, but continuous flow cell separator gave more satisfaction to the donors. Most of the continuous flow instruments are double needle, that's why most of the donors avoid to donate plateletpheresis on continuous flow cell separator. But TRIMA is a single needle continuous flow cell separator. TRIMA is a satisfactory single needle cell separator with less time consuming for the donors. Less ACD volume used is more beneficiary for the donors and operators to avoid Citric Toxicity and less chances of donor reaction.

An audit of fresh frozen plasma (FFP) usage in a rural tertiary care centre

Jyoti Sharma, Naseeb Chand Khabra


Department of Pathology, Maharishi Markandeshwar Institute of Medical Sciences and Research (MMIMSR), Ambala, Haryana, India

Introduction: Fresh frozen plasma is a blood component prepared from whole blood or collected by apheresis, frozen within time limits and at a temperature such as to preserve the labile clotting factors adequately.

Aims and Objectives:

  1. To analyse usage of FFP in our institute,
  2. To classify usage of FFP as appropriate or inappropriate based on standard guidelines (National Health and Medical Research Council And Australian Society For Blood Transfusion)
  3. To study the effect of FFP on pretransfusion International Normalised Ratio (INR) in patients who appropriately received FFP.


Materials and Methods: This was a prospective study undertaken in M.I.M.S.&R, Mullana, Ambala for duration of one year (Aug 2013 to July 2014). A total of 50 consecutive case records of patients, who received FFP were retrieved and studied. FFP usage was classified into appropriate and non-appropriate based on guidelines issued by NHMRC and AASBT. The pre and post transfusion INR were recorded in all patients who received FFP. Post transfusion INR was analysed in patients who received FFP units with appropriate indications.

Results: A total of 204 units of FFP were issued for 50 patients (29-males, 21-females) A total of 104 units in 23 patients were appropriately transfused. INR was calculated after and before the transfusion. 15 out of 23 patients showed significantly improved results after the transfusions.

Conclusion: Percentage of inappropriate usage of FFP is significantly high.

An audit of platelet utilization in a tertiary care mutispeciality hospital

Vidya Patne, Shweta Gupta, Rajesh Sawant, Anand Deshpande


Department of Transfusion Medicine, Medical Research Centre (MRC), PD Hinduja Hospital, Mumbai, Maharashtra, India

Background: There has been a major increase in the utilisation of platelets as a means of heamotological support in cancer patients as well as in outbreaks like dengue, malaria and leptospirosis. Monitoring the patterns of platelet use on a continuing basis in the form of audits provides a means for evaluating the impact of existing strategies and a basis for suggesting additional or alternative approaches to optimize use of this precious component.

Aim: To analyse the appropriateness of platelet transfusion against published guidelines in our set-up.

Materials and Methods: All the requests for platelet transfusion received at our blood bank during 11 months period were analysed for appropriateness against the ASCO guidelines for oncology patients and the NIH consensus guidelines for non-oncology patients. Platelet utilization patterns were analysed with respect to the type of platelet preparation used, ABO group and transfusion threshold.

Results: 1000 platelets transfusion requests including 780 (78%) for Random donor platelets (RDPs) and 220 (22%) Single donor platelets (SDPs) were studied. 83% of the platelets were transfused to oncology patients and 17% to non-oncology patients. ABO identical platelets were issued in 62.5% of cases (63% in case of RDP transfusion and 59.5% in case of SDP transfusion) and ABO non-identical platelets issued in 37.5% cases (37% in case of RDP transfusion and 40.5% in case of SDP transfusion). The overall mean transfusion threshold for platelet was platelet count of 30,207/cumm. 183(18.3%) patients were transfused at thresholds <10,000, 270 (27%) patients at platelet count between 10,000 to 20,000 and 547 (54.7%) at platelet count above 20,000/cumm. 10% of the total platelet transfusions were for therapeutic purpose.

Conclusion: The current pattern of platelet transfusion as well as potential areas for improvement could be identified with this audit at our institution. Prospective monitoring of transfusion request may help us in optimizing the platelet transfusions further.

Platelet transfusion in thrombocytopenic patients

Sharad Jain, Dharam Pal Lokwani 1 , Dilip Tripathi

Departments of Transfusion Medicine, Netaji Subhash Chandra Bose (NSCB) Medical College, Jabalpur, Madhya Pradesh, 1 Madhya Pradesh Medical Science University, Jabalpur, Madhya Pradesh, India

Background: Thrombocytopenia is a common condition observed in clinical practice. There are several causes to produce thrombocytopenia. There are few cases of thrombocytopenia showing bleeding others do not. There is always a possible risk of impeding bleeding due to thrombocytopenia. Clinicians do not wish to take any chance and risk of bleeding. They transfuse Platelets empirically.

Aims and Objectives: This study is aimed to assess thrombocytopenia, their probable cause with platelet count, related possible complication of bleeding, clinical and investigatory probabilities of the thrombocytopenia, clinical evaluation and decision regarding Platelets transfusion.

Materials and Methods: The study was carried out on 76 cases, between year 2009-year 2011. Study covered various age groups showed thrombocytopenia with bleeding or without bleeding hemophilia excluded. Coagulation profile was performed. Random donor platelets transfusion was carried out by clinicians in thrombocytopenia cases.

Results: 76 cases of thrombocytopenia cases platelets transfusion was carried out. 69 cases platelets were empirically (prophylactic) transfused. 7 cases therapeutic platelets transfused. In all platelets transfused cases showed rise in platelet count with change in coagulation profile. In two cases ABO incompatible poled platelets were transfused with no evidence of reaction immediate or delayed.

Conclusion: Platelets provides first line defense during haemostatic process. In most of the thrombocytopenia condition there is always a risk of impending bleeding. Clinicians transfuse platelets prophylactic in spite of knowing the risk of Platelets transfusion reaction as Trali, Septicemia. With Platelet transfusion change are observed in Platelets count and bleeding time. There is no other change observed in any haemostatic parameters. Platelet transfusion along with anti snake venom in snake bite case showed beneficial effect in bleeding diathesis. Cases with Chemotherapy and radiotherapy induced thrombocytopenia there is a beneficial effect of Platelets transfusion.

Transfusion support to thalassemic patients in a resource poor setting: Still a long way to go

Rakesh Kumar, Kshitija Mittal, Ravneet Kaur, Tanvi Sood, Gagandeep Kaur, Paramjit Kaur


Department of Transfusion Medicine, Government Medical College and Hospital, Chandigarh, Haryana and Punjab, India

Background and Objectives: Alloimmunization to erythrocyte antigens is one of the major complications of regular blood transfusions. The study was planned to estimate the frequency of alloimmunization against red cell (RBC) antigens and the various factors in β-thalassaemia major and intermedia patients.

Material and Methods: A total of 79 patients who received regular blood transfusions at our institute were included in the study. Crossmatching and antibody screen were performed by microcolumn gel technique. ABO, Rh (D, C, E, c, e) and Kell matched blood was provided. In case of a positive result on initial screen, antibody was identified and antigen negative blood was provided. An autocontrol was also put simultaneously to exclude the presence of autoantibody.

Results:0 Seventy five patients had β-thalassaemia major (40 males and 35 females) while 4 (2 males and 2 females) had β-thalassaemia intermedia. Six (7.59%) patients with β-thalassaemia major developed alloantibodies. The most common antibody identified was anti Kell (n = 4) followed by anti E (n = 1). One of the patients developed autoantibodies along with alloantibodies (anti E, C). Age at which first transfusion was started was more than 1 year in 5 patients (83.33%).

Conclusion: Framing of uniform policies and guidelines for the appropriate management of these patients is the need of hour.

Transfusion 0 in major orthopedic surgery: a0 n 0 experience of tertiary care hospital of North India

Ravisha Bhardwaj, Randhir Singh Boparai


Department of Orthopedics, Government Medical College, Guru Nanak Dev Hospital, Amritsar, Punjab, India

Background: Post-operative anaemia occurs in major orthopaedic surgeryin 90% of patients. Blood transfusion (BT) is the most frequently used measure for treating acute intra- and post-operative anaemia.

Objectives:

  1. Study role of BT in major orthopedic surgery.
  2. Compare results in non-transfused with patients undergoing transfusion.


Materials and Methods: Randomized observational study on 100 cases in orthopedics ward of GNDH, GMC Amritsar on whom major surgery was done. The cases were divided into 2 groups, group A-in which BT was given and group B in which BT was not given. Clinical diagnosis, type of surgery, pre-operative and post-operative Hb, fall in Hb, length of hospital stay, number of units of blood transfused, mortality at 30 days, age, sex and co-morbidities were compared in two groups.

Results: Mean age for group A and B were 46.54 ± 19.51 yrs and 36.11 ± 15.81 yrs respectively and differed significantly (P < 0.001). Male to female ratio in group A was 48:17 while in gp B was 21:14. Mean preoperative Hb significantly differed (P < 0.001) in group A 9.86 ± 1.58 gm/dl and in group-B 10.92 ± 1.40 gm/dl. While mean post-operative Hb in group A 9.95 ± 0.80 gm/dl did not differ significantly from the group B 9.66 ± 1.07 gm/dl. Mean fall in Hb in group A was -0.10 ± 1.75 gm/dl and 1.2 6 ± 0.78 gm/dl in group B, extremely significant difference (P < 0.001). Average units of PRBCs/WB transfused were 2.75 in gp A. Hospital stay was 29.12 ± 25.21 12.94 ± 7.14 days for group A and group B, extremely significant difference (P < 0.0003). The maximum number of PRBCs/WB units transfused was in case of diabetic foot amputation with hospital stay 90 days. Longest stay in hospital was 120 days. Associated co-morbidities were more in gp A 22 (33.84%) as compared to gp B 9 (25.71%). In gp A CVS disease 9 (40.9%), infections 6 (27.27%), DM 4 (18.18%), HT 2 (9.1%) and chronic alcoholic 1 (4.5%), while in gp B maximum cases were having CVS disease and infection 2 (2.22%) each followed by DM, HT and drug addict 1 (11.11%) case each.

Conclusions: Patients with Co-morbidities who undergo major orthopedic surgery had significant fall in Hb, received BT, had longer hospital stay as compared to those who were not given BT. Co-morbidities should be managed before surgery to lessen the need for BT.

The study of usage of blood/blood components in medical care setting

Richa Bansal, Bachan Lal Bhardwaj, Kanchan Bhardwaj 1 , Harnoor Bharadwaj, Ashish Bhagat, Rajni Bassi 1

Departments of Medicine and 1 Transfusion Medicine, Government Medical College, Patiala, Punjab, India

Introduction: Blood transfusion services is the vital part of medical care system without which efficient medical care is impossible. Objectives: To study usage & appropriateness of blood components transfusion in Medical Care Setting at Rajindra Hospital, Patiala.

Materials and Methods: The prospective study conducted from Oct, 2012 to July 2014 on 500 cases where Blood components were transfused in Medical Care Setting at Rajindra Hospital, Patiala. The need for blood component requirement was assessed by clinical and laboratory parameters.

Results: 278 (55.56%) patients received Packed red blood cells (PRC) transfusion (mean 1.87 ± 1.051) out of which appropriateness was 59.4%. 119 (23.8%) patients received Platelet (PC) transfusion (mean 5.02 ± 1.682) out of which appropriateness was 60.5%. 126 (25.2%) patients received FFP transfusion (mean 2.58 ± 1.046) out of which appropriateness was 65.9%.

Conclusion: Appropriateness of transfusion of blood/blood components needs to be improved warranting sensitisation of the clinicians about usage of blood/blood components to rationalise its use.

Clinico-hematological evaluation of patients presenting with thrombocytopenia

Dishvin Bajwa, Sanjay Bedi, NC Mahajan


Department of Pathology, Maharishi Markandeshwar Institute of Medical Sciences and Research, Ambala, Haryana, India

Introduction: Thrombocytopenia is deficiency of platelets in the blood stream. It is a common clinical problem found in laboratory results during health examination. Platelets play essential role in hemostasis, thrombosis and coagulation of blood. Thrombocytopenia may be congenital or acquired. Acquired form is more common especially in elderly. It may result from use of certain drugs such as NSAIDS, quinine, quinidine etc.

Aims and Objectives: To study the clinico-hematological correlation and classify various underlying disorders causing thrombocytopenia.

Materials and Methods: It is presented a study which contained a no. of 40 cases of thrombocytopenia selected during year 2013. Platelet morphology was checked on peripheral blood film. Final diagnosis was listed under two categories neoplastic and non-neoplastic. Observation and

Results: The most common neoplastic condition was acute leukemia followed by aplastic anaemia and non-neoplastic condition was idiopathic thrombocytopenic purpura followed by megaloblastic anaemia. Out of 40 cases, acute leukemia was reported in 20 cases, ITP in 10 cases, Megaloblastic anaemia in 6 cases and Aplastic anaemia in 4 cases.

Conclusions: We concluded that thrombocytopenia is not a disease but it is an entity which can be seen in no. of clinical problems including neoplastic and non-neoplastic diseases. We also found that bleeding is not very common manifestation in thrombocytopenia and moreover few patients with very low platelet count had no bleeding manifestation.

A retrospective analysis of platelet usage in dengue fever patients at Government Medical College and Hospital Jammu

Naveen Akhtar, Meena Sidhu, Vijay Sawhney


Department of Transfusion Medicine, Government Medical College and Hospital, Jammu, Jammu & Kashmir, India

Background and Objective: The study was done in the Department of Transfusion Medicine Govt. Medical College and Hospital, Jammu during first ever reported Dengue Fever Epidemic in Jammu region in 2013. The aim of the study was to analyze the appropriateness of use Platelets in patients diagnosed with Dengue Fever and to formulate proper guidelines to prevent irrational Platelet use. Due to limited supply and short shelf life Platelets needs to be used in a rational and adequate manner.

Materials and Methods: A retrospective study was done in the blood bank of SMGS Hospital, Department of Transfusion Medicine GMCH Jammu during the dengue fever epidemic from 1 st September 2013 to 30 th November 2013. Seropositive dengue cases were included in the study. Clinical data, platelet count and platelet transfusion was assessed in these patients. WHO guidelines for platelet transfusion in dengue patients were taken as a standard to compare the platelet transfusion.

Results: Among the 479 serologically positive patients, 382 (79.75%) were thrombocytopenic (platelet count <100,000/cumm) and 28 (5.84%) patients had bleeding manifestations in the form of petechiae, gum bleeding, upper GI bleed, malaena, epistaxis etc. Out of 479 patients 116 (24.2%) patients received platelet transfusion. Of 116 who received platelet transfusion 53 (45.68%) patients had a platelet count <20,000/cumm, 46 (39.66%) had platelet count in the range of 21000-40,000/cumm and rest 17 (14.66%) had platelet count between 41000-100,000/cumm. Out of 63 patients with a platelet count >20,000/cumm, 9 patients had bleeding manifestations which necessitated platelet transfusion. The remaining 54 patients with platelet count >20,000/cumm and with no bleeding manifestation were transfused with platelets. Transfusion of platelets to these 54 (46.55%) dengue patients was inappropriate.

Conclusion: In order to prevent irrational platelet transfusion among dengue patients in such epidemics, the study emphasizes the need to formulate specific guidelines by our hospital, constant updating of knowledge and co-ordination between clinicians and transfusion specialists.

Efficacy and safety of therapeutic plasma exchange in pediatric atypical hemolytic uremic syndrome patients

Rekha Hans, Ratti Ram Sharma, Neelam Marwaha


Department of Transfusion Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

Background: Therapeutic Plasma Exchange (TPE) in atypical Hemolytic Uremic Syndrome (HUS) is considered as first line treatment as per current ASFA guidelines. In pediatric age group TPE procedure is difficult to perform. There is very limited data available in literature regarding efficacy and safety of TPE procedures in pediatric patients of atypical HUS.

Aim: To access the safety and efficacy of Therapeutic Plasma Exchange in pediatric patients with atypical HUS.

Materials and Methods: We did retrospective analysis of all TPE procedures done in pediatric patients below 13 years of age over a period of 13 years (2001-2013) for clinically diagnosed atypical HUS.TPE procedures were done on cell separators (CS 3000 plus, Fenwal USA and Cobe spectra, Caridian BCT Lakewood, Colorado) daily or on alternate days depending on clinicial condition of the patient. Adverse events if any, were noted and analysed. Pre and post procedural laboratory profiles were analysed to assess the response to TPE therapy and patients were catagorised accordingly.

Results: A total of 169 TPE procedures (range 1-22/patient with an average of 7.6 procedures/patient) were done for 30 pediatric patients. More than three TPE procedures were done in 24 patients. Complete response was observed in 16 patients, partial response was observed in 5 patients and 3 patients did not show any response. In remaining 6 patients, only 1-2 TPE procedures could be done due to patient's non compliance due to financial constraints. Adverse events (allergic reaction, hypotension, return line blockage, hypocalcemia and vasovagal reaction) were observed in 13 (7.69%) procedures. One patient succumbed to the disease.

Conclusion: Therapeutic Plasma Exchange is safe and effective therapeutic modality in pediatric HUS if instituted early in the course of disease with a minimum of 4 to 5 plasma exchange procedures.

Nucleic acid technique: Adding an extra layer of safety

Apra Kalra


Department of Transfusion Medicine, Fortis Hopsital, Mohali, Punjab, India

Background: Nucleic acid testing (NAT) is a molecular technique for screening blood donations to reduce the risk of transfusion transmitted infections (TTIs) in the recipients, thus providing an additional layer of blood safety. NAT technique is highly sensitive and specific for viral nucleic acids. NAT is a highly sensitive and advanced technique which has reduced the window period of HBV to 10.34 days, HCV to 1.34 days and HIV to 2.93 days but it is highly technically demanding, involving issues of high costs, dedicated infrastructure facility, equipments, consumables and technical expertise.

Aims and Objective: Our study was aimed to know the seroprevalence of TTIs among the blood donors of a tertiary care centre and the need for newer technologies like nucleic acid testing (NAT).

Materials and Methods: A total of 7759 samples were tested by chemiluminiscence technique, out of which 7587 sero-negative samples were tested simultaneously by Roche mpx Assay for early detection of HIV-1 and 2, HCV, and HBV.

Observations: Of the 7759 samples tested, 172 (2.21%) were seroreactive by chemiluminiscence technique. Out of the remaining sero negative 7587 samples which were tested by NAT technique, 3 samples (0.039%) were found to be reactive which were negative by serological tests.

Interpretation and Conclusions: Our observed NAT yield for all three viruses was 3 in 7587 (0.039%). In conclusion, our findings showed that NAT allowed rapid detection of three prevalent viruses that cause serious infections.

Comparison of analytical sensitivity of screening assays for anti-HIV, HBsAg and anti-HCV by serial dilution method

M Laxmi, S Velaye, S Rajadhyaksha, P Desai


Department of Transfusion Medicine, TATA Memorial Hospital, Mumbai, Maharashtra, India

Background: Analytical sensitivity is the highest dilution of a strong positive serum in which the analyte is no longer detected. Though seroconversion panels are ideal for evaluating sensitivity of screening assays it is not feasible for blood banks to use them. Serial dilution is one of the methods to evaluate analytic performance of the assay.

Aim and Objectives: To test analytic capability of different immunoassays by detecting the dilutional endpoint.

Materials and Methods: Kits chosen for the study included Microparticle Enzyme Immunoassays (MEIA), Microplate Elisa and Rapid Immunoassays. A true reactive sample (reactive by all types of available testing methods), one each for anti-HIV, HBsAg and anti-HCV was selected. Each sample was serially diluted using negative sera (1:2 dilution method) up to 1:65536. The dilutions were run into their respective assays as per manufacturers' instructions and seroreactivity up to the highest dilution was noted.

Observations:

Reactivity seen in highest dilution was as follows:



The Microparticle Enzyme Immunoassays (Axsym) showed reactivity in the highest dilution amongst various assays studied.

Conclusion: The highest analytic capability was observed with the MEIA based assays. Serial dilution is a practical technique for blood banks to evaluate analytic performance, which is one of the factors for choosing an immunoassay.

Seroprevalence of HBV, HCV, HIV and syphilis among blood donors at a tertiary care teaching hospital in Southern India

R Pitchai


Department of Transfusion Medicine, Vinayaka Missions Kirupananda Variyar Medical College, Salem, Tamil Nadu, India

Aims: This study is conducted to evaluate the sero-prevalence of HBV, HCV, HIV and syphilis among blood donors in Vinayaka Missions Kirupananda Variyar Medical College hospital along the duration of two years. All blood units received from replacement as well as voluntary blood donation at our setup in Salem, Tamil Nadu State, India during the period from June 2012 to June 2014 were selected for the study.

Materials and Methods: HBV, HCV and HIV were tested by ELISA methods approved by NACO in voluntary as well as replacement blood donors. VDRL was carried out for screening of syphilis.

Results: The seroprevalence of HIV, HBV, HCV and syphilis was found to be 0.035%, 0.662%, 0.179% and 0.501% in voluntary blood donors.

Conclusion: Voluntary blood donors have been found to be safer than replacement blood donors vis-à-vis markers for HIV, HBsAg, syphilis but HCV shows an increasing prevalence in our study over two years. This may be reflective of changing life style and more open social norms. More detailed history regarding sexual exposure of blood donors is also advocated.

Sero-prevalence and changing trends of transfusion transmitted infections among blood donors in a tertiary care hospital

Sonia Gupta, Rajesh Kumar, Amarjit Kaur, Aikaj Jindal


Department of Immunohematology and Blood Transfusion, Dayanand Medical College and Hospital, Ludhiana, Punjab, India

Background: Safe blood is a critical component in improving health care and in preventing the spread of infectious disease. But the quality and safety of blood transfusion is still a concern for health-care personnel's.

Objectives: The aim of the study was to know the sero-prevalence and changing trends of Transfusion Transmitted Infections (TTIs) among blood donors in a tertiary care hospital.

Materials and Methods: Blood donations collected over a 6-year period were screened for HIV (4 th generation), HBsAg, HCV (3 rd generation), Syphilis and Malaria. All reactive samples were retested before being labeled as seropositive.

Results: Of the 187575 donors, 134391 (71.6%) were replacement and 53184 (28.4%) voluntary donors%. Of all the blood donors there were 8577 (4.57%) seroreactive cases which included 492 (0.26%) of anti HIV, 1937 (1.03%) of HBV, 2867 (1.53%) of anti HCV, 3270 (1.74%) of VDRL and 11 (0.006%) of malaria. The overall seropositivity for various TTIs are more in replacement donor i.e. (3.8%), where as it was only (0.7%) among voluntary blood donors.

Conclusion: Voluntary donations are safer as compared with replacement ones and need to be encouraged. The screening of blood donors is the corner stone in assuring the safety of blood transfusion.

Seroprevalence of HIV, hepatitis B, hepatitis C and syphilis co-infections among donors in tertiary care blood bank, Punjab

Mohit Madhukar, Harjot Kaur, Mridu Manjari, Jang Bhadur


Department of Pathology, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India

Background: Blood transfusion is life saving intervention and millions of lives are saved each year globally through this procedure. Unsafe blood remains a major threat for the global spread of transfusion transmissible infections (TTI). Measures for safe transfusion services include donor selection criteria donor interviews, donor deferral, and serological tests for infective disease markers. There is lack of available data in the Indian literature regarding co infections among donors in Punjab.

Aim: To study the seroprevalence of HIV, Hepatitis B, Hepatitis C and Syphilis co-infections in blood bank of Sri Guru Ram Das Institute Of Medical Sciences And Research Institute, Amritsar.

Materials and Methods: This was a retrospective study done on blood donors at Sri Guru Ram Das Hospitals in Amritsar, Punjab. Blood bank records were retrieved to calculate no of cases of coinfections over a period of 13 years (2001 to 2013).

Observations/Results: A total of 81574 donors were screened of which 2606 (3.19%) donors had seroprevalence for TTI's. Total no of cases of coinfections were 27 for which various combinations was (HBV and VDRL), (HCV and VDRL), (HCV and HIV), (HBV and HCV), (HIV and VDRL). One case was reported having three infections (HBV, HCV and VDRL).

Conclusion: Data on prevalence of these coinfections is limited, hence the prevalence of coinfections needs to be studied on a larger scale for better understanding of the impact on clinical outcome and treatment response. Due to a similarity in risk factors and routes of transmission, public awareness and education would go a long way in curbing the prevalence of these infections and increasing blood safety.

Seroprevalence of transfusion transmitted diseases in voluntary and replacement blood donors: A retrospective analysis

Sajith V


Department of Transfusion Medicine, Government Medical College, Thrissur, Kerala, India

Introduction: Each unit of blood carries 1% chance of transfusion associated problems including Transfusion Transmitted Diseases (TTD's). As per NACO guidelines, five mandatory TTD tests (Hepatitis B, C, HIV, Syphilis and Malaria) should be carried out in all collected units. Blood is collected from both voluntary and replacement donors.

Aim and Objective: To compare the Seroprevalence of TTD's among voluntary and replacement blood donors in Kerala, thereby assessing the blood safety in both groups.

Materials and Methods: A five year retrospective data of 30000 randomly selected donors (15000 donors from each group) was collected and statistically analysed.

Results: Among replacement donors, 10020 (66.80%) aged from 18 to 29 years, 3870 (25.80%) from 30 to 39 years, 1032 (06.88%) from 40 to 49 and 78 (00.52%) were in the 50-65 years age group. Among voluntary donors, 12884 (85.62%) aged from 18 to 29 years, 1476 (09.84%) from 30 to 39 years, 568 (03.79%) from 40 to 49 and 112 (00.75%) were in the 50-65 years age group. Out of 30000 blood donors, 633 (02.11%) were tested reactive for TTD's. Out of this 323 (01.08%) fell in replacement group and 310 (01.03%) fell in voluntary group. Thus 51.03% and 48.97% of detected TTD's fell in replacement and voluntary groups respectively. The prevalence for Hepatitis B was 01.00% (299 cases) in total donors, more in replacement (167 donors-00.56%) as compared to voluntary (132 donors-00.44%). The prevalence for Hepatitis C was 00.78% (235 cases) in total donors, more in voluntary (137 donors-00.46%) as compared to replacement (98 donors-00.32%). The prevalence for HIV was 00.19% (57 cases) in total donors, more in replacement (34 donors-00.11%) as compared to voluntary (23 donors-00.08%). The prevalence for Syphilis was 00.08% (24 cases) in total donors, more in replacement (13 donors-00.043%) as compared to voluntary (11 donors-00.037%). The prevalence for Malaria was 00.06% (18 cases) in total donors, more in replacement (11 donors-00.037%) as compared to voluntary (07 donors-00.023%).

Discussion: On analysis the prevalence of Hepatitis B and C among replacement and voluntary donors was significantly higher with P-values 0.0481 and 0.0128 respectively. Most common infection in both groups was Hepatitis B followed by Hepatitis C, HIV, Syphilis and Malaria. Increased HCV prevalence among voluntary donors requires further investigation.

Conclusion: The replacement donors' carries an increased risk for HBV, HIV, Syphilis and Malaria. But voluntary donors carry an increased risk for HCV. Elaborate donor selection criteria's, service of social workers and counsellors and effective awareness sessions should be implemented for both voluntary and replacement donors attending blood banks and outdoor camps.

Trend of Hepatitis B virus infection among blood donors at M.M.I.M.S and R, Mullana

Jyoti Sharma, Naseeb Chand Khabra, NC Mahajan


Department of Pathology, Maharishi Markandeshwar Institute of Medical Sciences and Research (MMIMSR), Ambala, Haryana, India

Background: Hepatitis B virus infection, acquired through the therapeutic blood transfusion process is a most important universal health problem in transfusion medicine. It is the common cause of serious liver diseases particularly, cirrhosis and hepatocellular carcinoma.

Aim: To determine the prevalence of Hepatitis B virus infection among blood donors at M.M.I.M.S and R, mullana.

Materials and Methods: This is a reterospective and prospective study carried for a period of 5 years from 2009 to 2013. Physically fit donors aged between 18 to 65 years were included. Blood donors with previous history of transfusion transmitted infections, donors below 18 years weighted less than 45 kg, having anemia and history of jaundice within past six months, high risk behavior of drug use, unsafe intercourse and donated blood within past three months were excluded. After complete physical examination of the donors, venous blood samples were taken under aseptic conditions for testing HbsAg. 4 th generation Hepalisa was used for detection of Hepatitis B Surface Antigen.

Results: Total blood donations were 10641, in which 9679 (90.39%) were replacement and remaining 962 (9.61%) were voluntary donors. In 2009-there were 7 (.065%) positive cases, 2010-4 cases (0.037%), 2011-29 cases (0.27%), 2012-22 cases (0.20%), 2013-30 cases (0.28%) which showed an increase in trend of prevalence of Hepatitis B virus infection.

Conclusion: Pre-donation counselling and donor self-exclusion will be effective in decreasing the Hepatitis B virus infection and practice of autologus blood transfusion should be encouraged.

Evaluation for senstivity of 4 th generation Elisa assays for detection of HIV 1 and 2 and HCV vs. mini pool nat

Deepak Kumar, Rashmi Sood, Sushil Pawar, Vijay Kumar Parewa


Department of Transfusion Medicine (Blood Bank), Saket City Hospital, Delhi, India

Introduction: India is the second most populated nation in the world with a population of more than 1.2 billion that includes 2.5 million HIV, 43 million Hepatitis B and 15 million Hepatitis C infected person. HIVtest made mandatory in 1990 and HCV in June 2001.Test is mandatory for all blood bank in India. The 4 th generation Bio-Rad GS HIV Combo Ag/Ab EIA was developed to improve sensitivity and specificity of detection of HIV-1 for p24 antigen and antibodies to HIV-1 and/or HIV-2 with the goal to significantly reduce the serological detection window HIV infection.HCV Ag -Ab ULTRA assay is a qualitative enzyme immunoassay for the detection of HCV infection, based on the detection of capsid antigen and antibodies associated with an infection by Hepatitis C virus in patient serum or plasma. HCV NAT was first introduced between 1999 and 2001 in blood banks across France, Germany, Italy, Spain, Switzerland and the United Kingdom presumably as it was already mandatory for plasma screening in these countries. NAT detects -in the pre-seroconversion window phase, infected with immunovariant viruses or a non-sero -converting chronic carrier.

Materials and Methods: Study was carried out in a tertiary care hospital situated at Mandir Marg Saket New Delhi. Blood Bank licence was received on 12 th July 2013. ELISA testing was done for HIV 1 and 2, HCV, HBsAg and HB Core total from Biorad. 4 th generation of ELISA kit of HIVI and II and HCV are used. For further send to Minipool NAT (ROCHE) at another tertiary care Hospital situated at Saket New Delhi. Above test are doing by ELISA method on semi-automated system PR40 micro plate washer and PR 4100 Reader of BIORAD. 10% grey zone policy is followed.

Results: NAT started at this tertiary care center since 23 rd Nov 2013. Total test (n = 1148) done from 23 rd Nov 2013 to 24 th June 2014. Since five months Biomeriux 4 th Gen kit for HIV I and II was used instead of Biorad HIV kit due to non-availability. Till the date ELISA and NATare performed in parallel for 1148 units. It didn't show any single NAT yield.

Discussion/Conclusion: The study showed sensitivity and specificity of 4 th Generation ELISA kit of HIV and HCV is reliable as compared to Minipool NAT. It is reliable and suitable fortesting the sample and can be easily adapted to automated platform, have high stability. It also indicates that it is relatively less expensive than NAT and easy to perform in blood banks to ensure complete blood safety.

Anti H study in superspeciality hospital based blood bank in South Delhi

Sushil Pawar, Vijay Kumar Parewa, Rashmi Sood, Deepak Kumar, Tarun Kumar, Sushma Rani


Department of Transfusion Medicine (Blood Bank), Saket City Hospital, Delhi, India

Introduction: The H antigen is a basic blood group antigen present in human beings. There is considerable variation in the H antigen content in different individuals of the same ABO group. Human red blood cells that do not agglutinate with Anti-H Lectin are classified as Bombay Phenotype (Oh). The Bombay Phenotype is more common in India than other parts of the world and the estimated genefrequency of Oh Phenotype in Bombay is 0.0066%. The Bombay Phenotype was first reported by Bhende 1952 in Bombay, India. Anti-HLectin is a purified extract from seeds of Ulex Europeans in a buffered medium. The reagent contains a phytohaemagglutunin which is virtually specific for the H antigen on human red Blood cells. Anti-H Lectin is used to demonstrate the presence of H antigen on human red blood cells and in assessing the H secretor status of group "O'' individuals

O secretor H only

A secretor A and H

B secretor B and H

AB secretor A, B and H

Non secretor None

Significance in blood transfusion: Bombay people would be incompatible when crossmatched with red cells of all normal ABO groups (groups O, A, B and AB).

Aim and Objective: The aim of this study is to highlight the importance of Anti-H in routine practice.

Materials and Methods: Study was carried out in a tertiary care Saket City Hospital (A unit of Gujar Mal Modi Hospital Research Centre for Medical Sciences) situated at Mandir Marg Saket New Delhi. We perform Anti H in routine donor blood samples.

Study was carried out from 12 th July 2013 to July 2014

  1. Total Number of sample tested- 707.
  2. Total Male-678 (96 %).
  3. Total Female-29 (4%).


Tube Test

  1. Prepare a 5% suspension of the red cells to be tested in isotonic saline.
  2. Place one drop of Anti-H Lectin into a test tube.
  3. Pipette into the test tube, one drop of the test red cell suspension and mix well.
  4. Centrifuge for 1 minute at 1000 rpm.
  5. Gently suspends the cell button, observing for agglutination macroscopically.


Results:





Conclusion:

Significance in blood transfusion: Bombay people would be incompatible when crossmatched with red cells of all normal ABO groups (groups O, A, B and AB). During study we didn't find any Bombay Blood Group. But for safer sides we continue perform Anti H for donors in routine practice.

Prevalence of ABO and Rhesus blood group in Salem, Tamil Nadu, India

Anumanthan RR


Department of Transfusion Medicine, Vinayaka Missions Kirupananda Variyar Medical College, Salem, Tamil Nadu, India

Background: The ABO blood group system was the first human blood group system to be discovered by Landsteiner in 1900. The second type of blood group is the rhesus system. There are only two Rh phenotype such as Rh positive and Rh negative, depending on whether Rh antigen is present on the red cell or not. The frequency of ABO and Rh phenotypes in different populations has been extensively studied. The present study was done to assess the prevalence of blood groups in different categories of Salem, Tamil Nadu, India and to compare our results with other studies conducted in India and elsewhere in the world and its multipurpose future utilities for the health planners.

Materials and Methods: A retrospective study was carried out on 6,012 blood donors during a period of one year from 1 st January to 31 st December 2013. The Blood samples were obtained by standard procedures of venupuncture and subjected to determination of ABO and Rhesus blood group using antisera by combined slide and test tube method. Each sample of donors was tested for ABO and Rhesus status.

Results: The blood group B (34.23%) was the commonest group prevalent in donors followed by group O (32.3%), A (20.09%) and AB (4.34%).

Conclusion: The commonest ABO blood group was group B in Northern India with Rh negativity at only 8.05%.

Effect of gamma irradiation on red cell antigenic sites per RBC by flow cytometer

Priyanka Viresh Shah, Keyuri Farasram Jariwala, Avani Padmesh Shah, Snehalata Chandrakant Gupte

1 Khatodra Health Centre, Surat, Gujarat, 2 Surat Rakat Daan, Kendra & Research, Gujarat, India

Background: Irradiation of RBC increases extra cellular potassium due to alterations in red cell membrane. Therefore it is possible that blood group antigen sites may be reduced. Antigens of ABO and Rh systems are more potent than other antigens like 'Fy a' , 'Fy b' , 'M' and 'N' which are easily destroyed by enzymes.

Aim: To investigate if there is reduction in red cell antigen sites after gamma irradiation.

Materials and Methods: For the study of 'A','B', 'D', 'Fy a' , 'Fy b' , 'M' and 'N' antigens,10 units of whole blood and red cell concentrates for each antigen were selected. Gamma irradiation was done at 25 Gy on Blood Irradiator (BI 2000). Antigenic sites per RBC of non-irradiated and irradiated RBC were checked at storage time interval of 0, 7, 14, 21 and 28 th days by flow cytometer.

Results: Antigenic sites/RBC was calculated by using median fluorescence intensity (MFI).The value of MFI or antigenic sites/RBC on day zero was considered as normal. The criterion for reduction in antigenic sites/RBC was the MFI value below mean minus one SD. There was no significant difference observed between MFI values of non-irradiated and irradiated samples for any antigen on different days of storage of whole blood and RCC.

Conclusion: The quantitative analysis of 'A','B', 'D', 'Fy a' , 'Fy b' , 'M' and 'N' antigens by flow cytometer did not show significant changes in antigenic sites/RBC during cold storage or after gamma irradiation process. Thus it can be concluded that the antigenic sites reduction is not aggravated by gamma irradiation process.

Prevalence of Rh and Kell phenotypes in voluntary blood donors of Delhi/NCR

Poonam Shrivastava, Shikha Gupta, Rajesh Yadav


Lions Blood Bank, Delhi, India

Background: Rh is the most important blood group system after ABO. The five principal Rh antigens -D, C, c, E, and e and K (KEL1) are responsible for the majority of clinically significant antibodies resulting in haemolytic disease of foetus and newborn (HDFN) or hemolytic transfusion reactions. There is little data available for prevalence of these in Indian population.

Aims: To determine the frequencies of Rh antigens in voluntary blood donors of Delhi.

Materials and Methods: The study was carried out by Lions Blood bank, a Standalone RBTC blood bank in Delhi. All the 14280 donor units collected between 1.1.14 to 13.8.14 were phenotyped. The antigen typing of each donor's red blood cells was performed on NEO (Advanced fully automated Immunohaematology Analyser) Immucor, Rodermark, Germany that uses the microplate haemagglutination technique by using six standard antisera i.e anti-D, anti-C, anti-c, anti-E, anti-,e and anti-K. Agglutination of red blood cells at 37 C incubated phase of testing indicates the presence of appropriate antigen and no agglutination indicates a negative test.

Results: The prevalence of various phenotypes in voluntary blood donors is as follows D+ 94.34%, D- 5.66%, e + 98.13%, e- 1.87%, C + 85.95% C- 14.05%, c + 55.52%, c- 44.48%, E+ 20.30%, E- 79.7 %, K + 2.26% and K- is 97.74%.

Conclusion: The prevalence of Rh and K antigens is derived from a large cohort of more than 14000 donors and would be helpful in calculating the number of units that would need to be tested to find the desired antigen combinations when providing blood for a patient with antibody/ies in NCR Delhi.

Antigen negative red blood cell inventory of Indian blood donors

Swati Kulkarni, K Vasantha, Kanjaksha Ghosh


National Institute of Immunohaematology, Mumbai, Maharashtra, India

Background: Crossmatching with ABO and RhD matched donors is performed routinely for providing compatible blood to patients. However, it is difficult to obtain compatible donors for patients who have produced alloantibodies against common antigens of clinically important blood group systems (Rh, Kell, Kidd, Duffy and MNS). Screening the donor population for these antigens and creating a database of phenotyped donors will eliminate the tedious task of large scale screening for antigen negative units.

Aim: To identify donors lacking common antigens or a combination of common antigens to establish antigen negative inventory.

Materials and Methods: Blood samples of 1221 regular donors were phenotyped for common antigens of Rh, Duffy, Kell, Kidd and MNS blood group system using standard tube technique.

Results: The clinically important antigens of common occurance in our study were Fya, Jka, D, C, e, k and s. 199 donors (16.3%) lacked a combination of above common antigens (except RhD negative donors lacking only C and D antigens). About half of these lacked two common antigens (one Rh antigen and one other blood group system antigen). Of these 3.2% lacked Fya and Jka antigens, 1.96% Fya and s, 1.88% Jka and s antigen. Four donors lacked three common antigens and were considered very rare donors.

Conclusion: An antigen negative inventory of donors who lack a single common antigen or a combination of common antigens was prepared from regular donors which will prove useful for efficient management of transfusion therapy in patients with multiple antibodies against common antigens.

Molecular genotyping of Indian blood group system

Harita Gogri, Swati Kulkarni, Kanjaksha Ghosh


National Institute of Immunohaematology, Mumbai, Maharashtra, India

Background: The Indian blood group system discovered by Badakere et al. (1973), consists of two antithetical antigens ('In a ' and 'In b ') and two high-incidence antigens ('INFI' and 'INJA'). In a is a low frequency antigen found in approximately 10-12% of Arabs and Iranians, 3% of Indians and <1% in Caucasians. In b is a high frequency antigen expressed in all populations. Antibodies to Indian blood antigens are clinically significant. However, reliable antisera to detect Indian blood group antigens are difficult to obtain. As the single nucleotide polymorphism (SNP) associated with In a and In b antigens are determined (G252C in CD44), DNA based methods can be used to genotype these antigens.

Aims and Objectives: To genotype the IN*A and IN*B alleles using sequence specific primers by polymerase chain reaction (PCR-SSP) and to measure their frequencies among blood donors in Mumbai.

Materials and Methods: The DNA samples were genotyped for IN*A(In a ) and IN*B(In b ) alleles using PCR-SSP.

Observations: Among 214 regular donors, six were heterozygous i.e. In(a+b+). No In a homozygotes were found. The In a antigen positivity was confirmed serologically, using in-house absorbed anti-In a (human origin) and the serological typing was concordant with the genotyping results.

Conclusion: The frequency of In a (2.9%) is comparable to that found in Indian population 30 years ago. DNA based methods will play an important role in defining rare alleles like IN*A in large number of donors, circumventing the need of rare antisera. Also, In a positive reagent red cells will help to identify clinically significant antibodies to Indian blood group antigens.

Adverse transfusion reactions after blood and its components transfusion in a tertiary care centre: A step towards hemovigilance

Shikha Aggarwal, Kanchan Bhardwaj 1 , Manjit Singh Bal, Manjit Kaur Mohi 2 , Kusum Thakur 1 , Rajni Bassi 1


Department of Pathology, 1 Department of Transfusion Medicine, 2 Department of Obstetrics & Gyane, Government Medical College, Patiala, Punjab, India

The goal of haemovigilance is to increase the safety and quality of blood transfusion. Like any other drug, therapeutic use of blood and its components has its own side effects, adverse reactions and risks involved.

Aims and Objectives: To determine the type and frequency of adverse transfusion reactions reported to the blood bank of Rajindra Hospital, Patiala between November 2013 and August 2014.

Materials and Methods: In case of blood/ blood component transfusion reaction, the duly filled reaction reporting form along with used bag with attached BT set and 2 blood samples (1 EDTA sample and 1 in plain vial) taken from the limb of opposite side and 1 st posttransfusion urine specimen were sent to the Department of Transfusion Medicine for work up. On the basis of reported signs and symptoms by the treating physician accompanied by the blood bank workup and the compilation of reports of various tests done by respective departments, the reactions were classified and analysed.

Observations: The frequency of adverse transfusion reactions was 0.4%. Out of the total transfusion reactions reported during the study period, febrile non haemolytic transfusion reactions were observed in 69% cases followed by allergic reactions in 27% cases. A single case of bacterial contamination was found.

Conclusion: Identification of the adverse reactions will help in taking appropriate steps to reduce their incidence and making blood transfusion process as safe as possible.

Acute transfusion reactions in intensive care unit: A retrospective study

Manvi Gupta, Rajesh Kumar, Amarjit Kaur


Department of Immunohaemotology & Blood Transfusion, Dayanand Medical College and Hospital, Ludhiana, Punjab, India

Background: Blood transfusion is a frequent and integral part of critical care. It can occasionally be unsafe and result in a spectrum of adverse events. Acute transfusion reactions (ATRs) are probably under diagnosed in critically ill patients due to confusion of the symptoms with the underlying disease.

Aim: To analyze the incidence and spectrum of acute transfusion reactions occuring in critically ill patients.

Materials and Methods: This was a retrospective review conducted from 1 st April 2011 till 31 st March 2013. The acute transfusion reactions in the patients admitted in various intensive care units were recorded, analyzed and classified on the basis of their clinical features and laboratory tests.

Results: During the study period 98651 blood components were issued. Out of these 21971 were issued to various intensive care units and a total of 225 transfusion reactions were reported from these critical care departments. The most frequent were febrile non hemolytic transfusion reactions 136 (60.4%), allergic reactions 70 (31.2%), hemolytic reactions 1(0.4%) and non specific reactions 18 (8%). The incidence of ATRs in our study was found to be 1.09% in adult ICUs and 0.36% in pediatric ICUs.

Conclusions: Blood transfusion is a vital therapeutic procedure with a potential risk to already critical patients. So a strict vigilance has to be kept and each transfusion has to be monitored carefully with prompt recognition and treatment of acute transfusion reactions. A rational use of these products considering their deleterious effects can decrease transfusion related morbidity and mortality in the critically ill patients.

Comparison of plateletpheresis using amicus and trima accel cell separators

Deepti Sachan, J Rajeswari


Department of Transfusion Medicine, Global Health City, Chennai, Tamil Nadu, India

Background: The demand of platelet concentrates have grown steadily in India in recent years. Optimizing the yield of plateletpheresis, by increasing the collection efficiency can benefit by providing high dose of platelets to patients, multiple doses, as well as lesser the duration of donation.

Aims and Objectives: To compare two cell separators (Fenwal Amicus version 3.2 (A) and Trima Accel Version 5 (T) and their products with regard to procedure time, white blood cell content, platelet (PLT) yield, No. of doses, collection efficiency(CE), collection rate (CR) and 1-hour corrected count increment (CCI).

Materials and Methods: 150 healthy voluntary donors between January to May 2013, who met the criteria for apheresis, were included in this study. The pre procedure demographic and hematological parameters were examined. After informed consent, 75 plateletpheresis was performed in each of the cell separator devices. Operational parameters (procedure time, blood volume processed, target yield, ACD volume used, volume product) PLT yield, CE, CR, no of units per donation were recorded. 1-hour CCI was compared for selected 32 patients with end stage liver disease.

Results: The demographic and baseline hematological parameters were similar in both the groups. The mean PLT yield and mean number of PLT donation per donor was significantly higher for T compared to A (4.8 vs 3.4 × 10 11 /bag and 1.56 vs 1.16 respectively; both P < 0.001) inspite of similar procedure time (62 vs 61 minutes respectively). Although the mean blood volume processed was significantly higher in T (2975 ml vs 2625 ml; P < .0.5), ACD-A consumption was lower compared to A (312 ml vs 355 ml; P < 0.001). The Mean collection efficiency and collection rate were also significantly higher in T compared to A (82.6% vs 69.9% and 0.08 vs 0.056 × 10 11 /min; both P < 0.001). Both cell separators produced consistent leucoreduced components (<5 × 10 6 ). In selected ESLD patients, 1-hour CCI of 50 T- PLTs were comparable with those of 50 A- PLTs (14,260 vs 13225; P = 0.280).

Conclusion: Both instruments collected platelets efficiently with consistent leukoreduction. Trima produced higher PLT yield per donation and higher number of double and triple products despite shorter duration and lower consumption of citrate. Both T and A products showed good and comparable 1-hour corrected count increment.

Distribution of beta-thalassemia mutations and its variance in ethnic groups of Saurashtra region, Gujarat

Jignasa Gami, Heena Kasyani, Kamlesh Dharajiya


Rajkot Voluntary Blood Bank & Research Centre, Rajkot, Gujrat, India

Background: β-thalassemia is one of the commonest health problems in India. More than 200 mutations described worldwide for β-thalassemia but frequency very in different geographical and ethnic groups. In west India, occurrence of this monogenic disorder is extreme in few ethnic groups of Gujarat,especially in Saurashtra.

Aim: To study spectrum of mutations causing β-thalassemia and to understand diversity of mutations among different communities of Saurashtra.

Materials and Methods: In present study, β-thalassemia mutations characterized in 594 thalassemia cases from Jan-2002 to July-2014. Known Hb mutations analyzed by Reverse Dot-blot Hybridization, Amplification Refractory Mutation System (ARMS) and PCR-Restriction enzyme analysis, where as Direct Sequencing of Amplified DNA, Southern-Blotting for deletions using specified gene probe used for unknown mutations. The mutation data analyzed statistically.

Results: Hb variances, IVS1-5 (G > C) (44.98%), 619 bp deletion (11.51%), FS codon 41/42(-CTTT) (7.95%), IVS1-1 (G > T) (6.90%) and FS codon8/9 (+G) (6.49%) were significant and accounted 75.73% of studied mutant alleles. Other 14 mutations founded. Mutation at codon 1-5 (G > A) and codon5 (-CT) also notable, 4.88% each. The most affected community was Patel (21.16%); interestingly there was no case of 619 bp deletion, 41/42(-CTTT) and codon 8/9(+G). The second most affected community was Lohana (18.34%) were all common mutations were present. However IVS1-5 (G > C) was present in almost all communities.

Conclusion: Appropriate knowledge of spectrum of β-thalassemia mutations is the pre-requisite for successful prenatal diagnosis. Information on prevalent mutations in ethnic groups will help in prenatal molecular diagnosis and genetic counseling specifically to couples at high risk of β-thalassemia in Saurashtra region.

Role of ThalCare.In: A web based application in enhancing the role of blood transfusion services in thalassemia management

Amit Sedai 1 , Ankita Kumari, Sunil Dhimal, Rakesh Dhanya, Lalith G Parmar, Prabha Gowda, Rajat K Agarwal


Jagriti Innovations, 1 Sankalp India Foundation, Bangalore, Karnataka, India

Introduction: Thalassemia management requires extensive support from a quality oriented blood transfusion services (BTS). Setting up a mechanism to track the demand, supply and quality parameters is essential to identify gaps and take corrective actions. ThalCare.In is a web based application developed by Sankalp India Foundation with Jagriti Innovations for thalassemia management in use for last 3 years. Our study shares the impact of using ThalCare.In.

Materials and Methods: ThalCare.In, was built to covers data recording, analysing, and reporting for all areas of thalassemia management. The web based application was used for tracking blood availability, suitability of components being transfused, time taken to process blood components, track delays in transfusion because of stocks, managing donors, demand for replacements, special processing of blood products, transfusion associated reactions, TTI etc.

Results: ThalCare.In enabled detailed monitoring of BTS. The average time taken for processing blood units was 1.4 hours (SD 1.6). Blood was available in the in-house blood bank 81% of the time. Blood units transfused were 4.71 days old (SD: 3.3 days). All units were leuko-reduced using saline washing. The patient returned without blood 5 out of 6431 (0.08%) times. The average pre-transfusion HB rose from 6.8 gm/dl to 8.5 gm/dl. 2 patients were identified with irregular antibodies. No replacement blood was requested. In all 5 patients were detected with TTIs. In last 1 year 20 transfusion reactions were identified.

Conclusion: ThalCare.In enabled was effectively used to identify gaps in the blood transfusion services, ensure availability of adequate and suitable blood components.

Calculation of Haemopoietic cell dose mid-procedure in Bone-marrow harvest by Total Leucocyte Count (TLC) and it's comparison with actual CD34 counts in the harvest

Background: Haematopoietic stem cell transplantation is used as curative therapy for various clinical conditions and Bone Marrow is used as a source for few paediatric indications where it is preferred. The calculation of volume to be harvested is tricky and the adequacy is measured mid-procedure and the length of harvest procedure (volume) decided upon with the donor in an Operation Theatre under General Anaesthesia. Since the recipient and donor are generally young children the second harvest is difficult. Therefore the calculation of Haematopoietic cell dose mid-procedure in Bone-marrow harvest by TLC is quite crucial. We studied the accuracy of one such formula in comparison with the actual CD34 counts in the harvest.

Materials and Methods: Five HLA- matched (6/6) family donors were taken for BM harvest for various clinical conditions like Pure Red Cell Aplasia, Fanconi's anaemia, Osteopetrosis. Etc

All harvests were done from posterior superior iliac spine under General Anaesthesia (GA). The required dose was between 3 to 5 10 6 cells/Kg and therefore the "target" for the harvest was set at 5 10 6 cells/Kg. Mid-harvest sample was taken for TLC. Another 2 ml was taken from the final product for determination of total CD34 harvested.





The CD34 analysis was done by flow cytometer.

Result: Average CD 34 dose in BM harvest achieved was 4.3 million per kg (Range=3.39 to 6.42) which was 85.7% of targeted dose.

Conclusion: Volume of marrow to be collected can be decided based on TLC based formula in lieu of CD34 counts.

A study on dermatoglyphics in thalassemia

Paul Gultaj, Gurdeep Singh Kalyan, Usha Chhabra, Harsimarjit Kaur


Department of Anatomy, Government Medical College, Patiala

Dermatoglyphics (from ancient Greek derma = "skin", glyphe = "carve") is the scientific study of fingerprints. Fingerprint is a multifactorial trait. Large number of genes play their role along with environmental influence. Chromosomal aberration affect these genes and produce variation in dermatoglyphic pattern in various chromosomal syndromes. Thalassemia is the world's most common hereditary hemoglobinopathy. The present study was conducted in the Department of Anatomy, Government Medical College and Rajindra Hospital, Patiala and is based on digital dermatoglyphics of 100 Thalassemic patients from Thalassemia Ward of Rajindra Hospital, Patiala hailing from North-western region of India. The control group comprises of 50 individuals of similar origin. Fingertip dermatoglyphic patterns of both hands of Thalassemia patients and control group were recorded by INK method. The data so obtained was compiled and analysed statistically. The fingertip pattern type was recorded by using Henry's classification method. It was found that whorls were most frequent pattern on digit IV in patients and controls, with statistical significance in both hands, right hand (P value .042) and left hand (P value .010). Ulnar loops had preponderance over other patterns on digit V in both the groups but the difference was statistically significant in left hand (P value .033). The mean digital ridge count was generally reduced in patients as compared to control group in both the hands and statistically significant difference was found for digit V of left hand (P value .001) and digit II (P value .043), digit IV (P value .007) and digit V (P value .001) of right hand. The mean total finger ridge count (TFRC) was lower in the patients than controls and the difference was statistically significant (P value .009). From our study it can be concluded that dermatoglyphics can prove to be an extremely useful tool for the preliminary investigations into conditions with a suspected genetic base and dermatoglyphic abnormalities should prove of considerable value in preliminary mass screening.

Role of insulin resistance in glucose metabolism abnormalities in thalassemia children

Sumita Sharma, Gurdeep Kaur Bedi, Chittranjan Vij, Shashi Prabha 1 , Anil Vij 2 , Karanpreet Kaur


Departments of Biochemistry, 1 Blood Transfusion and 2 Medicine, Government Medical College and Hospital (GMCH), Patiala, Punjab, India

Thalassemia is a common cause of hereditary hemolytic anemia in northern India. The use of regular and frequent blood transfusions in thalassemia has improved the span and quality of life of the patients, but it leads to chronic iron overload which frequently causes endocrine problems especially diabetes mellitus. Insulin resistance due to iron overload or liver dysfunction is thought to play a key role in the abnormalities of glucose metabolism in thalassemia children. The present study was conducted in 60 chronically transfused non diabetic thalassemia children to study insulin resistance. 30 age and sex matched children were taken as controls. Insulin resistance index was significantly higher (P < 0.0001) in the study group (mean ± SD = 1.296 ± 0.55) as compared to the control group (mean ± SD = 0.87 ± 0.203) and it correlated well with indicators of iron overload i.e. total units of blood transfused (r = 0.5438, P < 0.0001) and mean serum ferritin levels (r = 0.7689, P < 0.0001). So, it is concluded that insulin resistance plays an important role in the development of glucose metabolism abnormalities in thalassemia children.


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Analysis of discard of blood and its components as a quality indicator of blood utilisation in SGRDIMSAR, Vallah, Amritsar

Harleen Kaur, Harjot Kaur, Mridu Manjari


Department of Pathology, Sri Guru Ram Das Institute of Medical, Sciences & Research, Vallah, Amritsar, Punjab, India

Introduction/Background: The need for blood transfusion has increased in recent years. Blood utilisation rate and blood discard rate are quality indicators for a blood transfusion service. Adequate units of blood and components should be made available in blood banks to ensure availability to needy patients. Considering the fact that human blood is a precious resource which should not go waste, blood discard rate should ideally be near zero, but in practice, it is not so.

Aim of the study: The present study was undertaken to study the discard rate, various causes of discarding blood and its components in the past 2 years and to implement effective strategies to prevent wastage.

Materials and Methods: A retrospective study from Jan 2012 to Dec 2013 was undertaken in the Blood bank, SGRDIMSAR, Amritsar. The blood bank records were reviewed and analysed. Discard of blood components were recorded everyday in the "Blood Discard Register" with the reason for discard.

Observation and Results: The discard rate for the individual blood components are as follows:

Whole blood: Seropositive: 7.5%.

Paediatric units used and expiry 2.52%

PRBC: Seropositive: 6.46%

Paediatric units used and expiry: 1.92%

FFP: Seropositive: 6.46%

Leakage and Red cell contamination: 3%

RDPC: Short expiry: 62.56%

Thus the most common reason cited for discard of PRBCs and Whole blood was seropositivity, followed by paediatric discard and expiry .FFP discard was commonly attributed to seropositivity followed by leakage of bags and contamination with Red cells.Because of the short shelf life, platelets had the highest discard rate.

Conclusion: Blood and its components are a very important resource and hence should be used in a justifiable manner. Continuous monitoring through standard quality indicators of a quality management system will improve the blood transfusion services. Appropriate ordering and use of blood contribute towards filling up of the gap between demand and supply.

ASSAY of coagulation factors in FFP and cryoprecipitate

Paramjit Kumar Sehgal, Rama Goyal, Rajeev Sen 1 , Bimla Rathi, Jyoti 1


Department of Blood Transfusion Medicine, 1 Department of Pathology, Pt. B.D. Sharma, PGIMS, Rohtak, India

Introduction: With the availability of techniques for separation of blood components in closed system, the patient could be administered specific replacement therapy. Blood contains coagulation factors for maintaining normal haemostasis.Coagulation factors can be replenished in body by way of FFP, cryoprecipitate, prothrombin complex concentrate and other factor concentrates. Fresh Frozen plasma is used for treating multiple coagulation factor deficiency.

Materials and Methods: The present study was conducted in Pt. B. D. Sharma, PGIMS, Rohtak. Study was planned to measure concentration of coagulation factors in FFP and cryoprecipitate, using automated coagulation analyzer and to compare the results, of factor assay between FFP and cyroprecipitate. The concentration of coagulation factor VIII, IX and fibrinogen were measured in the sample from units of FFP. Similarily, concentration of factor VIII, IX and Fibrinogen was measured in cryoprecipitate.

Summary: On statistical analysis it was observed that fall in concentration of factor VIII in cryoprecipitate was highly significant in comparison to concentration in FFP.

Conclusion: Our study deduces that FFP is effective upto 180 days but concentration of factor VIII reduces with duration. Although factor IX and fibrinogen show decline but not to the extent of factor VIII. Cryoprecipitate is effective upto 365 days.

Donor demographic and single donor platelet yield

Poojitha Datla, Suryatapa Saha, Prathiba L, Shasi, Prakash HM


Department of Transfusion Medicine, Vinayaka Mission Kirupananda Variyar Medical College, Salem, Tamil Nadu, India

Background: Platelet transfusion are essential to prevent morbidity and mortality in patients who are severely thrombocytopenic and are at risk of spontaneous bleeding. Platelets are currently obtained either by fractionation of whole blood or platelet apheresis. The quality of signal donor platelets (SDP) in terms of yield influences platelet recovery in the recipient and follows prolonging intervals between transfusions.

Materials and Methods: Donor demographic and laboratory data were analyzed prior to performing plateletpheresis to identify donor factors that influence platelet yield. The study was conducted on 52 healthy, first time plateletpheresis donors over a period of 1 year. The plateletpheresis procedures performed were performed using Hemonetics MCS plus separator.

Results: The mean platelet yield was 3.55 ×10 11 per unit. Platelet yield was more in the age group of 21 to 30 yrs.

Conclusion: Donor predonation platelet count and donor age influence platelet yield. Young healthy donors with a high platelet count and better BMI can give a better platelet yield in the SDP.

Discolored blood and blood components: A dilemma for transfusion specialists

Tanvi Sood, Ravneet Kaur, Kshitija Mittal, Gaurav Raturi


Department of Transfusion Medicine, Government Medical College and Hospital, Chandigarh, India

Background and Objectives: It is not uncommon in transfusion practice to see blood/components with abnormal colored plasma. The present study was conducted to identify and determine the etiology of blood and/or blood components showing altered color.

Materials and Methods: The present study was conducted in Department of Transfusion Medicine, Government Medical College and Hospital, Chandigarh over a period of seven months. All the blood units/components having an abnormal appearance were segregated as:

  1. Green discoloration
  2. Yellow discoloration
  3. Bright cherry red color
  4. Lipemic plasma


The donor's history was carefully evaluated and relevant investigations were done depending on discoloration.

Results: Seventeen units out of 7370 (0.23%) donations showed discoloration. In 3 units the plasma was green, 5 units were yellow, in 3 units PRBC/WB unit was bright cherry red and in the remaining 6 units the plasma was lipemic. Total bilirubin of all the 5 donors with yellowish plasma ranged from 1.6-2.3 mg/dl. The hemoglobin and hematocrit of two out of three donors with cherry red discoloration of PRBC/WB were low. All the donors with lipemic plasma gave history of intake of fatty meal prior to donating blood.

Conclusion: The existing rules prohibit issue of blood and blood components if the plasma is abnormal in color. Our study showed that many of the discolored units could have been safely transfused but further larger studies are required to confirm the safety of recipients receiving such units.

Standardization of hemoglobin estimation in blood donors at GMC Patiala

Kusum K. Thakur, Sonima Sharma 1 , Shikha Aggarwal 1 , Kanchan Bhardwaj, Satpal Singh


Department of Transfusion Medicine, 1 Department of Pathology, Government Medical College, Patiala, Punjab, India

Introduction: Pre-donation hemoglobin screening is among first and foremost tests done for blood donor selection with the main intention of preventing blood collection from an anemic donor. Despite the wide range of methods available for hemoglobin estimation, no single technique has emerged as the most appropriate and ideal for blood donors. Cyanmethemoglobin method is recommended by International Council for Standardization in Hematology.

Aim/Objective: To compare three hemoglobin testing methods to ascertain the accuracy of traditional copper sulfate method for screening of hemoglobin of blood donors.

Materials and Methods: This prospective study was conducted on 200 blood donors at our centre, one sample daily from January to September 2014. The sample showing hemoglobin more than 12.5 gms% which is cut off value for donor fitness, with copper sulfate method was subjected to hemoglobin estimation with, Sahli's and cyanmethemoglobin methods and results were compared.

Observations: 193 (96.5%) samples showed hemoglobin more than 12.5 gms% with all three methods. 9 (4.5%) samples tested with Sahli's method showed hemoglobin less than 12.5 gms% as compared to copper sulfate method but with little variation of 0.1 to 0.5 gms% only. Same is case with cynmethhemoglobin method. 7 (3.5%) samples showed hemoglobin less than 12.5 gms% with both Sahli's as well as cynmethhemoglobin method with little variation of 0.1 to 0.5 gms%.

Conclusion: Study shows that CuSO 4 method still stands the test of time and this can be retained as screening method for blood donors. It also shows that technique of copper sulphate method at our centre is accurate.

Estimation of haemoglobin in potential female donors with borderline haemoglobin values: Comparison of Hemocue 301 with automated haematology analyser

Vimal Sathyan, Shashank Ojha, Vidya Patil, Sunil Balkrishna Rajadhyaksha 1


Department of Transfusion Medicine, Tata Memorial Centre, Advanced Centre for Treatment, Research and Education in Cancer, Kharghar, Navi Mumbai, 1 Department of Transfusion Medicine, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India

Background: Determination of the haemoglobin (Hb) level of prospective blood donors is a well established requirement. Portable hemoglobinometer are wildly used for estimating capillary Hb and the reliability of these devices in discriminating potential female donors with borderline haemoglobin values are conflicting. We present our findings with a modified version HemoCue 301; with a reagent-free cuvette for routine use.

Aim: To compare the performance of HemoCue 301 with automated haematology analyser (Sysmex KX21) in potential female donors with borderline haemoglobin values.

Materials and Methods: Capillary finger stick samples were assayed by hemocue by lancing a finger tip of prospective female blood donors for a period of seven months (n = 102). Concurrent venous samples were tested using both hemocue and Sysmex KX21. The values given by the latter was taken as reference. Data was analysed statistically using SPSS software version 21.

Observations: Capillary Hb values were greater than venous hemocue value, which in turn were greater than venous Hb values by Sysmex KX21.The capillary hemocue value didn't correlate with venous hemocue and venous reference. Blant Altman plot showed capillary blood sample was overestimated by 5.32 when compared with venous measurement by reference method. Interclass correlation coefficient <0.30 indicates poor discrimination of borderline haemoglobin values.

Conclusion: Hemocue overestimates Hb levels in capillary blood sample and consequently more donors were included in the donation group than there would have been with reference method. Accuracy can be improved by appropriate validation and collection staffs' performance. Blood collection facilities must balance the need to ensure donor safety with their need to maintain an adequate blood supply.

Quality of red blood cells collected from fixed vs mobile blood collection facilities: A comparative study

Anumole Jose, Krishnakumariama Chakrapani Usha


Department of Transfusion Medicine, Government Medical College, Trivandrum, Kerala, India

Background: Primary goal of any blood bank is to promote high standards of quality in all aspects of patient care, related products and services. Stringent quality control measures and adherence to Good Manufacturing Practices (GMP) helps to achieve this goal in the setting of a fixed blood collection centre. But voluntary blood donation camps present special challenges.

Objectives: 1.To compare the quality of red blood cells collected from fixed blood collection centre Vs voluntary blood donation camps in a tertiary care setting 2. To assess the adherence to Good Manufacturing Practices at voluntary blood donation camps.

Materials and Methods: Voluntary blood donors (satisfying DGHS criteria) from 4 peripheral blood donation camps held between 11 th and 21 st of July 2014 by Department Of Transfusion Medicine, Govt Medical College, Trivandrum and voluntary blood donors from Blood Bank, Government Medical College, Trivandrum on the corresponding days were included in the study. Systematic sampling was performed and every 5 th donor at the peripheral voluntary blood donation camp and blood bank was included

  • Adherence to Good Manufacturing Practices was evaluated using a prepared checklist. Component separation protocols, storage temperature and other storage settings were standardized for all units. On Day 14 the following quality parameters assessed for the Packed Red Cell units collected from the study subjects of the two groups: Hemolysis, Volume of blood collected in ml, Hb, Total WBC Count, Platelet Count, Haematocrit, RBC Count and pH.


Observations: Independent T test was used to compare Quality control parameters of PRC from blood bank and VBD camp donor units.

Conclusions: The present study, documents no significant difference in quality parameters between the PRC units collected from blood bank and VBD camps. Adherence to Good Manufacturing Practices was satisfactory in the VBD camps. A Voluntary Blood Donation camp checklist based on Good Manufacturing Practices should be formulated and made mandatory by all blood banks.

Discard rate of whole blood/PRBC at Government Medical College Patiala (PB)

Kusum K. Thakur, Shikha Aggarwal 1 , Sonima Sharma 1 , Yogesh Kumar Gupta 2 , Amardeep Garg, Kanchan Bhardwaj


Department of Transfusion Medicine, 1 Department of Pathology, 2 Department of Medicine, Government Medical College, Patiala, Punjab, India

Introduction: Blood transfusion is the easiest transplant to save life. Blood banks in India face shortage of blood to about 30-40%. There is a proportion of discarding of blood that is avoidable and is called wastage. The rate of discard of blood can be used as a quality indicator to monitor the efficiency of the transfusion services. In order to decrease wastage there is a need for better recruitment strategies, production methods, inventory management, and recipient selection.

Aims/Objectives: To know the discard rate of blood in our centre, reasons for discard and to develop strategies to avoid wastage of this precious commodity and hence its shortage.

Materials and Methods: Available records from 1/9/13 to 31/8/14, analysed for the number of blood units donated, number of whole blood/RCC units discarded and the reasons for discarding these units was carried out.

Observation: The total number of blood units collected during the study period were 17964 units. Total discard rate is 7.48%. Hemolysis was the most important cause for discarding blood. The important causes for discarding whole blood/RCC besides hemolysis were seroreactivity, expiry, insufficient collection and leakage.

Conclusion: Identifying and managing the reasons for avoidable wastage of blood/RCC can go a long way in improving the efficiency of blood transfusion services. Effective training of technical staff, effective counselling and self deferral of donors with high risk behaviour can reduce the collection of blood from sero-reactive donors, watchful stock management system can reduce the wastage of red cell due to expiry and computerization with software on blood management system can notify the expiry of blood units before hand and will go a long way in preventing unnecessary wastage of blood.

Turbid blood unit: A second look

Gaurav Raturi, Kshitija Mittal, Tanvi Sood, Ravneet Kaur


Department of Transfusion Medicine, Government Medical College and Hospital, Chandigarh, India

Introduction: Visual examination of blood and blood components is a very important aspect of quality check in Transfusion Medicine. It helps us to identify hemolysis and/or microbial contamination, blood clots, alteration in plasma color either due to turbidity or hyperbilirubinemia. We hereby report a case of hyperlipidemia detected on visual examination of whole blood unit.

Case Report with Results: The donor, 43 year male, 68 kg donated blood for the first time. Turbidity was noticed in the blood unit at the time of receiving of blood in the department and bag was quarantined. Complete lipid profile was performed on the sample from blood unit. Serum triglycerides (TG, 988 mg/dl, normal: 10-190 mg/dl) and serum cholesterol (453 mg/dl, normal: 120-230 mg/dl) were found elevated while other fractions were within normal limits. Donor was called subsequently and detailed lipid profile (fasting sample) along with liver function tests (SGOT, SGPT), renal function tests (RFTs, serum creatinine, blood urea), fasting blood sugar and complete blood count (CBC) were performed on fresh sample. Serum TGs were highly elevated (1364 mg/dl) along with raised cholesterol (550 mg/dl). SGOT and SGPT were mildly deranged (75 IU/L, normal: 5-40 IU/L; 111 IU/L, normal: 5-35 IU/L respectively). RFTs, fasting blood sugar and CBC were within normal limits. His blood pressure was slightly on a higher side (150/92). Dietary history revealed history of regular intake of rich fatty meals. Serum lipoprotein (a) levels could not be done due to financial constraints. Donor was referred to physician and was started on medication for increased triglycerides and cholesterol. Ultrasound examination of abdomen showed mild fatty change of liver. Blood unit was discarded.

Conclusion: Visual screening of blood units is not only an important quality control tool but can also help to detect donor disease and provide them an opportunity to receive an early medical or dietary intervention.

Discard rate of blood and blood components at blood bank GGS MC, Faridkot

Ram Niwas Maharishi, Neetu Kukar, Harkiran Arora


Department of Immunohematology and Blood Transfusion, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India

Introduction: The transfusion of blood and its components has become an integral part of patient management in modern medicine. Therefore, the Blood Transfusion Services (BTS) plays an important role in blood safety. Implementation of quality system and continuous evaluation of all activities of the BTS can help to achieve maximum quality of safe blood. Aims and Objectives: Present study was done to analyse the discard rate and reasons of discarding blood and its components in the last one year. To follow good practice for rational use of blood. Materials and Methods: This is a retrospective study involving the analyses of discarded blood and its components from the data maintained at Department of IHBT, GGSMCH Faridkot from June 2013 to May 2014.

Observations and Results: Total Blood units collected were 11332. Out of them, 4476 (39.49%) units were Whole Blood and 6856 units were Packed RBCs (60.51%). Following are the discard rate of individual blood component:

Whole Blood: Seropositive 4.3%, Expiry 1.7%.

Packed RBC: Seropositive 3.8%, Expiry 1.05%

PC/PRP: Seropositive 3.8%, Expiry 37.15%.

FFP: Seropositive 3.7%, Expiry 2.7%, Leakage 4.5%, RBC contamination 0.53%.

Major cause of discarding whole blood and Packed RBC was seropositivity. But the highest discard rate of PRP/PC was due to short shelf life. The difference in the discard rate of FFP due to Leakage over seropositivity was 0.8%. Conclusion: Blood is precious and a scarce resource. To minimize the discard rate proper donor selection and planned production of blood components should be mandatory.

An analysis of completeness of transfusion request form in an independent blood bank

Gopal Kumar Patidar


Adlakha Medical Centre, Amritsar, Punjab, India

Background: Completeness of transfusion request form shows logically use of blood and blood component.

Aims: 1. An analysis of completeness of the transfusion requests. 2. Impact of change in the request form and introduction of CME for staff in completeness of request form.

Materials and Methods: A total of 2422 request forms received in the month of July and August 2014 at Blood Bank Adlakha Medical Centre, Amritsar were evaluated for completeness of various fields and also analysed for improvement after introduction of new request form and CME for hospital staffs in August 2014.

Observations: (1) A total of 71.96%of the requests were incomplete in which 81.12% in month of July while 62.78% in month of August 2014. (2) Only 8.07%) of request form had second identification either in form of CR No. or Patients' Father/Husband Name in month of July 2014 and it improved to 80% in August 2014. (3) History of previous transfusion and adverse transfusion reaction (80.21%) was the most common incomplete field, and followed by phlebotomist signature (75.27%) in month of July 2014. (4) In month of August 2014 after introducing new request form and CME of staff there was a total of 18.34% improvement in completeness.

Summary:
Continuing education of hospital staff and audit of transfusion requests will help improve provision of requisite details during ordering for blood.

Discard rate of blood and blood components in the department of transfusion medicine, Govt Medical College, Amritsar

Jasmine, Aditi Sharma 1 , Neeraj Sharma 1 , Amarjeet Singh, Raman Sharma 2 , Adarsh Sahni 1


Departments of Pathology, 1 Transfusion Medicine and 2 Medicine, Government Medical College, Amritsar, Punjab, India

Background: The transfusion of blood and blood components has become an integral part of patient management in modern healthcare. Blood is an expensive and scarce resource. But due to various reasons, blood has to be discarded. These include disproportionate rate of collection and rate of utility, improper storage of blood, reactive blood units, prick failure cases, rare blood groups, polycythemia, autologus blood, bacterial contamination, any leakage of the bag.

Aim: The aim of the study is to analyse the rate and causes of discard of blood and blood components.

Materials and Methods: Statistical data collected and analysed for number of blood/component units collected, issued, kept in the inventory and discarded in the period from 1 st April, 2013 to 31 st march, 2014.

Observation: Out of total collection of 25463 blood units, 18117 were collected as voluntary blood donation and 7346 as replacement donors. The overall number of discarded blood units were 1118 (4.3%). Out of the total discarded blood units, 707 units (63%) were reactive due to HIV, HbsAg, HCV, syphilis and malaria and 248 blood units (22%) were discarded due to small autologus blood units, prick failure and polycythemia cases. Out of total 7221 Random donor platelet concentrates prepared, 3156 (43.7%) were issued and 4065 (56.3%) were discarded. Out of the total discarded units, 17% were discarded due to being reactive and 83% due to overdated reasons. Out of the total 11738 FFP units prepared, 8502 units were issued and 2440 units (20.7%) were discarded.

Conclusion: Strategies should be framed to minimize the discard of blood.

Role of quality indicator in blood bank

Deepak Kumar, Rashmi Sood, Vijay Kumar Parewa, Sushil Pawar


Department of Transfusion Medicine, (Blood Bank), Saket City Hospital, Delhi, India

Introduction: Quality indicators used to monitor and evaluate the quality of the therapeutic transfusion process or compliance with clinical guidelines. Quality indicators are a Quality Management System (QMS) tool that are instituted in an organization with intent on not just providing this much needed proof of the level of quality performance tenable in the organization, but they are also intent on utilizing the information gained to seek improving the quality of performance in the organization. There are two types of indicators: Internal and external. Indicators are only one tool for evaluating practice. However, if used in the right way indicators may be an efficient and tool for improving the quality of the therapeutic transfusion process.

Material and Methods: Study was carried out in tertiary care hospital located at Saket, New Delhi. Specialized in - Cardiac sciences, Neurosciences, Orthopaedics and Joint Replacement, Pulmonology and Critical Care, Urology Sciences, Obstetrics and Gynaecology, Minimally Access and and Bariatric Surgery, Gastroenterology and Internal Medicine.

Role of quality indicator of blood bank according to guidelines/standards and own departmental set indicators. (Includes -Structure indicators, Process indicators and Outcome indicators):

  1. Number of out-dated/wasted units
  2. Crossmatch: Transfusion Ratio
  3. Incidence of transfusion reactions
  4. Number of surgical procedures cancelled due to non-availability of blood.
  5. Number of emergency requisitions received and met and average time taken.
  6. Number of blood units transfused per bed in a year.
  7. Number of patients given the whole blood vs. those given packed cells
  8. Number of autologous transfusions given
  9. Statistics for assessing over/under utilization of the infrastructure available.

    1. Maximum stock stored vis a vis the storage capacity
    2. Total number of units received, processed, issued in a year.
    3. Average number of units transfused per patient.


Results: Based on above analysis, performance, quality indicator of blood bank was analyzed. For e.g. Target to achieve to collect 100% transfusion follow-up form from wards, OT and ICUs. Exercise was done to collect every day follow-up from nursing station and sensitized them to do the same. That exercise was done on day to day basis with nursing dept., and quality team. At the end of result within 3month 75-84% transfusion follow-up form were received which was 37-60% earlier.

Transfusion Follow-up form data from 12 th July 2013 to May 2014



Discussion/Conclusion: Blood is a scarce resource and demand is always more than the supply. It needs Continuous monitoring through standard quality indicators of a quality management system which improve the blood transfusion services. Appropriate ordering and use of blood and blood components contribute towards filling up of the gap between demands and supply.

Positive response was obtained after proper Quality indicator analysis. It is a key factor for any performance in blood bank. Transfusion follow up form is one of the quality indicators for end product process. Role of Quality Indicator is mandatory as per JCI, NABH and NABH Blood Bank.

Improvement of response rate of donors for post donation counseling

Kusum K. Thakur, Shikha Aggarwal 1 , Sonima Sharma 1 , Jaspreet Kaur 1 , Kanchan Bhardwaj 1


Department of Transfusion Medicine, 1 Department of Pathology, Government of Medical College, Patiala, Punjab, India

Introduction: Counseling is an essential part of quality system in blood donor management. Prevention of Transfusion Transmissible Infections (TTIs) depends upon proper pre-donation counseling, selection of donors and proper screening tests done. If found positive for any TTIs, bags are discarded and donors are called back to department for post test counseling. Proper follow up of donors, with extended services of BTS in form of referral to ICTC/special clinics, increases the blood safety as there will be self deferral by them in future.

Aims and Objectives: To know improvement in response rate of donors for post donation counseling.

Materials and Methods: A retrospective analysis of records of donors for one year from September 2013 to August 2014 was done. Donors who had given consent and who were positive after screening tests, were called for further follow up.

Observations: Total number of donors during one year 2013-2014, were 17964. Total positive for TTIs after screening tests were 299 (1.6%) as compared to 237 (1.4%) in 2011-2012 but only 134 (49%) reported for post donation counseling as compared to 82 (35%) in 2011-2012 and were sent to special clinics for further management with advise that if confirmed positive should self deferral themselves for future blood donations.

Conclusion: Response rate of donors increased from 35% in year 2011-12 to 49% in 2013-14 which shows that counseling methods have improved in our center with more faith of donors in our counseling services.

Donor deferral pattern in the blood centre at Indira Gandhi Medical College Shimla

Manohar Lal Kaushal, Sandeep Malhotra


Department of Immunohaematology & Blood Transfusion, Indira Gandhi Medical College Shimla, Himachal Pradesh, India

Background: The availability of healthy and safe blood donors is always a matter of concern for the blood banks all over the country. Stringent donor screening criteria are designed to include only safe and healthy donors. There is also a wide gap between demand and supply of blood in our country. As per National Blood Policy of Govt. of India the aim is to achieve 100% blood collection through voluntary donation which presently is about 83.1% as per NACO data 2011-2012. However, significant number of voluntary blood donors are deferred during the process of donor screening which is essential to obtain safe and quality blood.

Aim: To find out the main reasons of donor deferral.

Materials and Methods: A retrospective analysis of data of blood donors who visited our blood centre was done at BCSU of Indira Gandhi Medical College Shimla over a period of one year w.e.f. January 2013 to December 2013. During this period the voluntary donors who came for blood donation in the blood donation camps and in the blood centre were screened as per the standard guidelines. The donors found unfit for donation were deferred and the reasons for deferral recorded.

Results: The study revealed that out of 6328 voluntary donors who came for donation 245 (3.9%) donors were deferred. Out of these 186 (75.9%) were males and 59 (24.1%) were females. The commonest cause of donor deferral was low hemoglobin level. Out of 245 donors rejected 42 (17.1%) were due to low hemoglobin level comprising of 28 (66.6%) female and 14 (33.4%) male donors. The next common cause of deferral was donors taking medication which was found in 41 (16.7%) donors and most of these were under antibiotic therapy. The underweight donors was the third common cause for donor deferral which was present in 30 (12.2%) donors. H/o jaundice was the next reason which resulted in the deferral of 18 donors (7.3%). In 12 (4.8%) donors the reason for deferral was donation interval less than three months. Due to other miscellaneous reasons 102 (41.6%) donors were deferred which includes h/o typhoid fever, ear piercing, alcohol intake, anti rabies vaccination and epilepsy etc.

Conclusion: Out of the total donors deferred a significant number of donors i.e. 17.1% were deferred due to low hemoglobin levels which is a treatable condition. It is followed by h/o medicine intake and low body weight of the donors respectively leading to temporary deferral. These donors should be followed up and encouraged to donate blood as soon as they are fit for donation as they are already self motivated and will be helpful in increasing the donor pool to meet the demand of safe and quality blood.

The evaluation of blood donor deferral causes in a tertiary care hospital

Prathiba L


Department of Transfusion Medicine, Vinayaka Mission Kirupananda Variyar Medical College, Salem, Tamil Nadu, India

Background: Blood safety is the major issue all over the world in transfusion medicine. For this donor selection is necessary in addition to screening of blood bags for infectious disease. Deferrals lead to loss of precious blood or blood components available for transfusion. For preventing this, evaluation of causes of deferrals and their frequencies is essential.

Materials and Methods: In this study, causes of donor deferral were evaluated retrospectively from January 2012-December 2013 in blood bank of Vinayaka Mission Medical College and Hospital, Salem, Tamil Nadu.

Results: Analysis of the deferral showed that temporary deferral (82.97%) was more common than permanent deferral (17%). Most common cause of permanent deferral was HbsAg positive (25%), and among temporary deferral, it was anaemia due to Hb <12.5 gm% (17.94%).

Conclusion: It is important to determine the rate and causes of whole blood donor deferral to guide the recruitment and retention efforts as it helps medical personnel and doctors to be more focussed in donor screening especially of those who are having high frequency of deferral.

Whole blood donor deferral analysis in a tertiary care hospital in Hyderabad, Telangana, India

Sudhir Kumar Vujhini, Pandu Ranga Rao Sanagapati


Department of Transfusion Medicine, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India

Background: A blood transfusion is a life-saving procedure in many instances. An adequate supply of safe blood is ensured by exercising donor deferral criteria and screening for Transfusion Transmitted Infections (TTI). The aim of this paper is to study the profile of blood donors and reasons for donor deferral in a tertiary care hospital, Hyderabad.

Materials and Methods: The study was conducted at a tertiary care hospital in Hyderabad. All those who donated between 1 January 2013 and 30 June 2014 were included in the study. Data was collected using a pre-tested semi-structured proforma and analysed using SPSS version 11.5.

Results: Donors were predominantly male (98.60%). More than three-quarters of the donors (81.61%) were replacement donors. Total donors deferred were 1399 (4.88%).Most of the deferred donors were under the age of 18-25 years (39.52%). The main reasons for deferral were low haemoglobin (87.07%), followed by high haemoglobin (3.61%), drug intake and alcohol consumption (1.42%) each. Among the TTIs identified, most samples were positive for Hepatitis B surface Antigen - HBsAg (63.44%), followed by positive for Anti-Hepatitis C (HCV antibodies) (13.34%) and HIV (11.49 %).

Conclusion: From the study it was concluded that the majority of the deferral donor population was young. The reason for donation was mainly replacement rather than voluntary. Most common cause for deferral was low haemoglobin. Most common sero-positivity among the TTI's was HBsAG.

Evaluation of donor deferral causes in whole blood collection in 2000 cases in Rajindra Hospital, Patiala

Aradhana Sharma, Sonima Sharma 1 , Shikha Aggarwal 1 , Poonam Rani 1 , Yogesh Kumar Gupta 2 , Kanchan Bhardwaj


Department of Transfusion Medicine, 1 Department of Pathology, 2 Department of Medicine, Government of Medical College, Patiala, Punjab, India

Background: Blood banking is one of the pillars of modern medicine but simultaneously it carries potential risk of transmitting lethal infectious diseases. Hence proper pre-screening of blood donor is essential to ensure quality of donor and to avoid risk of transfusion transmitted diseases to the recipient. Various efforts have been made for ensuring a safe blood donor selection through screening and education. By the process of screening, donors are deferred for several reasons related to the donor as well as recipient safety. It is very essential to study and analyse the reasons for such deferrals among prospective donor in order to categorise them into temporary and permanent deferrals. The objective of this study is to assess the current rate and reason for donor deferral so that temporarily deferred donors with corrective reasons can be identified, properly informed and guided to improve their quality and thus later on continuous blood supply can be maintained.

Aims and Objectives: The aim of study is to find out the incidence and cause for deferral in whole blood collection and also to categorise and analyse the various causes of deferral.

Materials and Methods: A retrospective study is done at Department Of Transfusion Medicine Government Medical College and Hospital, Patiala over a period of one month in march in 2000 donors. Based on history and physical examination findings, all blood donors coming to blood bank were classified as fit for donation or as a deferred donation. They were categorized according to type of donation, sex, temporary or permanent deferral and the cause of deferral. National guidelines were followed for the above categorization.

Results: Total 2000 predonation screening interviews were conducted in Department of Transfusion Medicine, Government Medical College and Rajindra Hospital Patiala out of which 1754 were found fit for donation. Total 246 (12.3%) donor were found unfit for various reasons and were deferred. Among deferred 222 (90.2%) were males and 24 (9.8%) were females. Majority were due to temporary reasons (72.8%). Commonest causes were low haemoglobin for females (35%), uncontrolled blood pressure for males (23.8%) and others.

Conclusion: One of the most important step in improving the safety of blood and blood component is donor selection. Insight into the reasons of donor deferral is very important to avoid the permanent loss of donor as blood donation programme is the life force of any blood bank in hospital.

Prevalance of adverse reactions in 10,000 blood donors of Rajindra Hospital Patiala

Rajni Bassi, Mayankjot Sharma 1 , Kanchan Bhardwaj, Bachan Lal Bhardwaj


Department of Transfusion Medicine, 1 Department of Medicine, Government of Medical College, Patiala, Punjab, India

Aims and Objectives: To find out the prevalence of adverse reactions in whole blood donors.



Observation for Reaction: All donors were observed before, during and after blood donation for any signs or symptoms suggestive of any adverse reaction. Proforma (attached as Annexure 1) was filled for any immediate donor adverse reaction. Vasovagal reactions were classified as mild, moderate and severe reactions. Statistics Applied:

Chi-square test (χ2 test)

Yates Statistics

Observations: 45% of the total reactions were present in the age group of 20-29% followed by 10-19 years age group with 32% of reactions. In total 77% reactions were seen in donors below 29 yrs of age which is a significant finding. The overall percentage of reactions was 6.07% with mild reactions at the highest percentage of 4.63%. Moderate reactions were found to be occurring in 0.57% donors. Amongst the local reactions the prevalence of hematoma was higher at 0.64% and bruise at 0.23%. There were no reports of arm soreness after the donation. No donor in this study had severe adverse reaction before, during or after blood donation.

Amongst the reactions: 76% were Mild, 11% Hematoma, 9% Moderate, 4% Bruise. 7% donors donating blood in camps had reactions as compare to 4% in indoor donations. Donor Care and Motivation Strategies:

Pure voluntary recruitment strategy.

Social persuasion based recruitment strategy.

Usage of platelet transfusions in medical care setting in a tertiary care hospital

Deep Inder Singh, Harnoor Singh Bhardwaj, Kandhan Bhardwaj 1 , Kamaljeet Kaur Boparai, Manpreet Kaur, Bachan Lal Bhardwaj


Department of Medicine, 1 Department of Transfusion Medicine, Government of Medical College, Patiala, Punjab, India

Introduction: Platelet utilization, during the last two decades, has increased all over the world more than the use of any other blood component.

Objectives: The present study was conducted to study the pattern of usage of platelet transfusion and its appropriateness in medical care setting in Rajindra Hospital, Patiala.

Materials and Methods: It was a prospective study, conducted at Rajindra Hospital, Patiala between January 2012 and June 2013. 100 patients receiving platelet concentrate transfusion in medicine indoor were evaluated. British Committee for Standards in Haematology guidelines (2003) were used to study the appropriateness of platelet transfusions.

Results: Out of 100 patients, 55 (55%) were males and 45 (45%) were females and the median age was 40.48 ± 14.20 years. Out of 100 platelet concentrate transfusion, 39 (39%) transfusions were prophylactic and 61(61%) were therapeutic. Most common indication for prophylactic transfusion was in patients on chemotherapy (30.76%) and in patients of dengue (30.76%). Out of 39 prophylactic transfusions, 17 (43.58%) were inappropriate. The most common indication of therapeutic transfusion was bleeding in patients of dengue. Single Donor Platelets (SDP) were given to 11 patients only. Platelet refractoriness was not observed in any patient.

Conclusion: There is need to promote the optimum use of platelet concentrates. The use of SDP platelets also need to be increased.

Red cell exchange in malaria: Study of two cases

Suryatapa Saha


Department of Transfusion Medicine, Vinayaka Mission's Kirupananda Variyar (VMKV) Medical College, Salem, Tamil Nadu, India

Background: Plasmodium falciparum malaria is the most dangerous form of malaria with high mortality, secondary to high parasitemia and complications. In malaria, red cell exchange (RCE) offers a rapid approach to treat acute, severe cases of malaria. RCE is a medical procedure involving removal of abnormal red cells from blood of a patient and replacing it by normal donor red cell components using an automated cell separator.

Aim: To have a better understanding how red blood cell exchange transfusion can be used as an adjunct treatment for severe falciparum malaria, using Automated Procedure.

Materials and Methods: We report 2 cases of falciparum malaria that were initially treated with intravenous anti-malarial therapy,with no clinical improvement. RCE Transfusion has been done using MCS Haemonetics Plus.

Results: Among 2 cases, first case presented with 10% infestation rate. Along with antimalarials, RCE was done which led to drop of infestation rate to 7% during first exchange and 5% during second exchange. 3 units top up transfusion were given as Post Exchange and Hb% improved from 10 to 12 gm%. The second case was a Patient who presented with 11% infestation rate. He was started on antimalarials and RCE. Infestation rate drop to 6% was seen on day 1. But patient expired due to delayed initiation of treatment.

Conclusion: We conclude that using automated RCE as an adjunctive treatment for the severe case of Plasmodium falciparum malaria and establishing the correct diagnosis early in the clinical course may improve prognosis.

Therapeutic plasma exchange in patient of Alport syndrome

Raju Singh, Pritesh Rajani, Meenu Bajpai


Department of Transfusion Medicine, Institute of Liver and Biliary Sciences, New Delhi, India

Background: Alportsyndrome is a genetic disorder characterized by glomerulonephritis, end-stage kidney disease, hearing loss and visibly bloody urine is common.

Aim: We report here on treatment with TPE of a patient who presented with findings suggestive of Alport syndrome due to auto antibodies against collagen type IV.

Materials and Methods: A 15 yr old male with chronic renal disease on hemodialysis presented with fever, hearing loss, difficulty in breathing since 2-3 days. Patient had bilateral pneumonia with alveolar hemorrhage, anemia, hypertension, ejection fraction 30% suggestive of uremic cardiomyopathy. The findings were suggestive of Alport syndrome. Patient's hemoglobin 8.3 g/dl, serum creatinine 8.33 mg/dl, blood urea 127 mg/dl weight was 53 kg; volume exchange of 2406 ml using fresh frozen plasma as replacement fluid over duration of 2 hrs 35 mts on an apheresis machine (MCS+, Haemonetics, Hong Kong Ltd. Hong Kong). After I st session patient's Hb-9.0, BUN-7 mg/dl serum creatinine-5.11 mg/dl. IInd session of TPE was done on next day; with a hemoglobin 7.8 g/dl BUN-142 mg/dl, serum creatinine 7.4 mg/dl volume exchange of 2400 ml using fresh frozen plasma as replacement fluid over duration of 1 hr 35 mts on the same apheresis machine. After II nd session patient's Hb 8.8 g/dl, BUN 69 mg/dl serum creatinine 4.79 mg/dl.

Result: The patient was then seen to recover from the illness, bilateral pneumonia also resolved there after the patient was managed symptomatically and discharged a week later.

Conclusion: The case suggests the role of TPE in successful management of the patient with Alport syndrome most likely due to auto-antibodies.

Therapeutic plasma exchange in treatment of pemphigus vulgaris: A case report

Aikaj Jindal, Rajesh Kumar, Amarjit Kaur, Sonia Gupta


Department of Immunohematology and Blood Transfusion, Dayanand Medical College and Hospital, Ludhiana, Punjab, India

Background: Pemphigus vulgaris (PV) is an autoimmune disease caused by antibodies directed against both desmoglein 1,3 resulting in the loss of cohesion between keratinocytes in the epidermis leading to extensive flaccid blisters and muco-cutaneous erosions.

Objective: The aim of case report is to assess the role of Therapeutic Plasma Exchange (TPE) in severe PV which was resistant to treatment.

Materials and Methods: TPE was performed using a single volume plasma exchange with intermittent cell separator (Haemonetics MCS plus, kit 980/790) machine by femoral access. It was scheduled on alternate-day intervals for five cycles. Replacement fluids used were isotonic sterile saline, 4% purified human albumin and Fresh Frozen Plasma.

Results: After TPE, Nikolsky sign became negative and no new lesions appeared. The exudation from the lesions reduced drastically. The lesions showed 60-70% re-epithelisation and 90% healing after the last cycle and oral lesions also healed completely.

Conclusion: TPE is a useful intervention in patients with PV who are not responding to standard therapy or who require unacceptably high doses of steroids or immunosuppressant. It may be considered as treatment option especially in developing countries like India as it is less costly and effective procedure for the management of severe PV.

Immune thrombocytopenic purpura in pregnant patient managed with plasmapheresis: Case report

Dhara J Ardeshana, Sweta Upadhyay, Jitendra Vachhani


Department of Immuno Hematology and Blood Transfusion (IHBT), MP Shah Government Medical College, Jamnagar, Gujarat, India

Introduction: Immune thrombocytopenic purpura (ITP) known as Idiopathic thrombocytopenic purpura, is an acquired disorder. Immune mediated destruction of platelets and inhibition of platelet release from megakaryocyte. In adult, it is usually chronic disease. It is characterised by mucocutaneous bleeding and low platelet count with normal peripheral blood smear usually.

Case Report: Female patient, 22 years old, 36 kg weight, 7 months Primigravida, presented with bleeding gums ,haematuria, petechia for two days. She admitted in medical ward GGH, Jamnagar. She had stable vitals at that times.

Discussion: On regular ANC, Initially Hb-8 gm%, TC-9900, Platelets-3000/cumm, PSCM-Severe thrombocytopenia, dimorphic anemia, predominant macro-ovalocyes, PT-12sec, APTT-28 sec, LFT and RFT-Normal. She was given PCs and PCVs for thrombocytopenia and anaemia. No improvement after this. Repeat inv: Hb-7, Platelets-1500/cumm. She was not improved after methyl prednisolone inj. Again platelet-1000/cumm, ANA-++++, ANA Profile-only SS-A and RO-52 are positive, USG: Borderline splenomegaly, USG ANC: Live fetus, 25 weeks with asymmetrical IUGR of 4 weeks with 2 nd degree heart block. 2D echo: Normal, Bone marrow: Increased no of megakaryocytes with mature and young form many showing bluing of cytoplasm. Normal erythroid and myeloid series S/O ITP. She was given Inj. Dexona, tab. Azathioprine, IVIG-2 g/kg*5 days, but not improved, she diagnosed as REFRACTORY ITP. Finally 6 Cycles of plasmapheresis done: Total WB processed-17374ml, Total Plasma volume removed-7493 ml, Replacement fluid given [NS, Albumin (50 ml of 20%), FFP]-10510 ml.

Conclusion: Finally after plasma pheresisplatelet count-1.2 lac, LSCS done, a male live baby of 1.05 kg delivered died after 2 days due to CHB. No any intra and postpartum maternal complications.

Role of platelet transfusion in the management of dengue fever in a tertiary care centre in North India

Kulwinder Lal, Harnoor S. Bhardwaj, Kanchan Bhardwaj 1 , Bachan Lal Bhardwaj, Rajni Bassi 1 , Jasbir Kumar, Ashish Bhagat, Sanjay Goyal


Department of Medicine, 1 Department of Transfusion Medicine, Government of Medical College, Patiala, Punjab, India

Background: Dengue fever is a global health problem and its incidence has increased in the recent years. Dengue fever (DF), Dengue hemorrhagic fever (DHF) and Dengue shock syndrome (DSS) are different modes of its presentation. So early management with fluid/platelet is required to prevent fatal complications.

Aims and Objective: To study the role of platelet transfusion in the management of dengue fever.

Materials and Methods: Observational study that includes 70 patients (mean age was 27 yrs) admitted between 1 st of September to 30 th of October 2013 in the Department of Medicine at Rajindra Hospital, Patiala, who were either dengue NS1 Ag positive or had the presence of the IgM or IgG antibodies or both positive.

Results: Among 70 serologically confirmed dengue patients with platelet count <100,000/μl, haemorrhagic manifestations were present in 25 (35.71%) patients. Platelet transfused were Random donor platelet (RDP) in 36 (51.42%) and Single donor platelet (SDP) in 11 (15.70%) patients. Mean Post-transfusion platelet increment (PTPCI) was 41237/μl at 1 hr and 38000/μl at 24 hr. Mean Corrected Count Increment (CCI) was 13717 at 1hr and 11644 at 24 hour respectively. One patient (1.42%) with baseline platelet count >30,000/μl who was responder to platelet transfusion progressed to WHO grade 3 bleeding. Two patients (2.86%) were poor responders as they had CCI <7500. Conclusion: Platelet transfusion in dengue fever is overemphasized, so it should be used judiciously.

Clinical use of plasma apheresis in prevention and treatment of bleeding episodes in patient with Glanzmann's thrombasthenia

Sirat Kaur, Rajesh Kumar, Amarjit Kaur


Department of Immuno Heamatology & Blood Transfusion, Dayanand Medical College (DMC), Ludhiana, Punjab, India

Background: Glanzmann's Thrombasthenia (GT) is a rare autosomal recessive platelet disorder manifested by lack of glycoprotein II B-III A complex in the platelet membrane. Platelet aggregation is impaired in the absence of this integral membrane complex which holds the receptor for fibrinogen. The platelet count may be normal but there is abnormal platelet function. The disorder is characterised by a prolonged bleeding time and severe haemorrhagic mucocutaneous diasthesis.

Aim: We present a case of 41 year old female with GT who came to the hospital for elective hysterectomy.

Materials and Methods: The patient was a known case of GT diagnosed in childhood. Post hysterectomy patient continued to bleed and pass clots per vaginum. Patient was transfused two units of packed red blood cells, six units of random donor platelets and still patient continued to bleed. She was then administered two units of apheresis plasma (500 ml each). Patient stopped passing clots and oozing from surgical site markedly reduced. Haemostasis was maintained by giving one more plasma apheresis and Fresh Frozen Plasma.

Conclusion: Risks of post operative bleeding and haemorrhage are very high in patients of GT. An alternative effective agent is therefore needed for management of GT patient particularly those who are refractory to platelet transfusion and who live in areas where platelets are not readily available. Single donor plasma which is rich in Factor VII and fibrinogen proves to be a better alternative in such patients.

The study of usage of blood component transfusoin in medical care setting at SGRRIMHS Dehradun

Lovedeep Saini, Sumeet Pal Saini, Amit Varma, Satya Prakash Singh


Department of Medicine, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun Uttrakhand, India

Objective: To study the utility of blood component transfusion in medicine wards of SGRRIMHS/SMI Hospital.

Materials and Methods: It was a randomized observational study on 50 cases in medicine wards of SGRRIMHS/SMI Hospital Dehradun who were found to be having severe anaemia and thrombocytopenia. the rise in haemoglobin and platelet counts were observed after the prbc and platelet concentrate transfusion.

Result: 30 patients out total no. of 50 recievied PRBC transfusion for severe anaemia and 20 patients recieved platelet concentrate transfusion. an average rise of 1.2 grams in haemoglobin was observed after one unit of blood transfusion and average rise of 5000 platelets was observed after one unit of platelet concentrate transfusion.

Conclusion: Blood component transfusion is an important part of medical therapy. With the rising number of patients who need prbc and platelet transfusions, the clinicians should make a judicious use of this therapy to achieve maximum benefits and favourable patient outcomes.

Prevalence of Transfusion transmissible infections in blood donors of southeastern Punjab

Rimpreet Singh Walia, Kulbir Kaur 1 , Gopal Bahadur, Surinder Pal, Gurdeep Kaur, Ripu Daman Sharma


Lifeline Blood Centre, Patiala, Punjab, 1 Department of Pathology & Transfusion Medicine, Punjab Institute of Medical Sciences Jalandhar, Punjab, India

Background: Blood transfusion is a life saving intervention, however, it carries an inherent risk of spread of transfusion transmissible infections (TTI's).

Aims: The present study was undertaken to analyse the seroprevalence of markers of TTIs viz. Human Immunodeficiency Virus (HIV), Hepatitis B virus (HBV), Hepatitis C virus (HCV), Syphilis and Malaria among blood donors.

Materials and Methods: A retrospective analysis of the TTI marker status of 6589 blood donors who donated blood at Life Line Blood Centre, Patiala, Punjab from 1 st of April 2013 to 30 th of June 2014, was undertaken. The donor samples were examined for various markers of infection including those of HIV, HBV, HCV, Syphilis and Malaria. All the samples were analyzed to detect anti-HIV (I and II), Hepatitis B surface antigen (HBsAg) and anti-HCV by Enzyme Linked Immuno-sorbent Assay (ELISA) test. Screening for malaria was done with rapid test and for syphilis by the Rapid Plasma Reagin (RPR)/dipstick/card test.

Observations: Among the 6589 blood donors, 6464 (98.10%) were males and 125 (1.9%) were females. The total number of seroreactive cases was 98 (1.49%). The number of cases found seroreactive for markers of HIV, HBV, HCV, Syphilis and Malaria was 1 (0.02%), 52 (0.79%), 37 (0.56%), (0.12%) and 0 (0%) respectively.

Conclusion: Among theseblood donors, the highest seroprevalence was found to before HBsAg followed by markers for HCV, Syphilis and HIV respectively. None of the donors were positive for malaria during this period.

Evaluation of sensitivity of VITROS enhanced chemiluminiscence immunodiagnostics syphilis assay for the detection of syphilis in donors

Hitish Narang


Department of Transfusion Medicine, Satguru Partap Singh (SPS) Apollo Hospitals, Ludhiana, Punjab, India

Background: Syphilis is a sexually transmitted bacterial disease caused by the spirochete Treponema pallidum. The infection may be passed congenitally from mother to unborn child, causing birth defects or fetal death. The VITROS Syphilis TPA test is performed using the VITROS ECi/ECiQ Immunodiagnostic Systems, VITROS 3600. Immunodiagnostic System and VITROS 5600 Integrated System using Intellicheck ® Technology. An immunometric immunoassay technique is used, which involves the reaction of IgG, IgM or IgA antibodies present in the sample with a biotinylated TP antigen and a horseradish peroxidase (HRP)-labeled TP antigen conjugate. The antibody-antigen complex is captured by streptavidin on the wells. Unbound materials are removed by washing. The bound HRP conjugate is measured by a luminescent reaction. A reagent containing luminogenic substrates (a luminol derivative and a peracid salt) and an electron transfer agent is added to the wells. The HRP in the bound conjugate catalyzes the oxidation of the luminol derivative, producing light. The electron transfer agent (a substituted acetanilide) increases the level of light produced and prolongs its emission. The light signals are read by the system. The bound HRPconjugate is directly proportional to the concentration of anti-TP antibody present.

Objective: To study the significance of using sensitive Assay in donor screening, minimizing false negative results due to low level of antibodies or use of Non- Treponemal test for Syphilis screening.

Protocol: In this study a total of 1280 blood donors were tested for commercially available Syphilis screening Assays in parallel during the period of 1 st May 2014 to 31 st Aug 2014 on RPR(Bensphera RPR Test), Syphilis Card Test(Quickvue Syphilis card Test) and VITROS Immunodiagnostic Syphilis Test. All discordant samples were tested on TPHA Technique from Reference Laboratory. 8 samples were found discordant within Assays, out of which 6 were found positive and 2 found Negative on TPHA. The detection limit at lower concentration of Syphilis antibody was evaluated by serial dilution of the Syphilis sero-reactive sample and tested in both VITROS ® Syphilis TPA assay and Syphilis RPR assay and the results were compared for the highest dilution sensitivity.



All discordant samples were tested on TPHA from reference Lab shows concordant results with VITROS Syphilis Assay



Dilutional Sensitivity: A reactive sample having cutoff ratio of 35.4 is diluted with a non-reactive specimen of 0.05 cutoff to ensure no matrix change. The samples were then tested in parallel.



Conclusion: The VITROS Syphilis Assay enabled with Enhanced Chemiluminescence has excellent sensitivity and avoids any False Negative.

  • In comparison with RPR (Bensphera RPR Test), Syphilis Card Test (Quickvue Syphilis card Test) and VITROS Immunodiagnostic Syphilis Test, VITROS Immunodiagnostics Syphilis Test with Enhanced Chemiluminescence is found to be more sensitive.
  • As per the study Assays with inadequate sensitivity should not be used for screening.


Seroprevalence of HBsAg and HCV in 7000 blood donors at Rajindra Hospital, Patiala

Jasraj B. Panwar, Harnoor S. Bhardwaj, K M Prasad, Bachan Lal Bhardwaj, Kanchan Bhardwaj 1 , Ashish Bhagat


Departments of Medicine and 1 Transfusion Medicine, Government Medical College, Patiala, Punjab, India

Introduction: Hepatitis B and HCV infection, and associated sequelle of these infection is of major public importance worldwide. Blood transfusion is an important mode of transmission of HBV and HCV infection to recipients.

Aims and Objectives: To access the seroprevalence of HBV and HCV, and possiblerisk factors among blood donors, donating blood at Department of Transfusion Medicine, GMC, Patiala.

Materials and Methods: Study was conducted on 7000 blood donors, donating blood in Department of Transfusion Medicine, GMC, Patiala. Screening and selection of blood donors was done as per guidelines of, Director General of Health Services, Ministry of Health, Government of India. 5 ml of blood sample was taken from blood bags or after phlebotomy from each donor and preserved at 4-6 C. Testing for HBV and HCV was carried out by using 3 rd generation ELISA technique.

Results: Among the blood donors, 77.85% (5450) were voluntary and 22.15% (1550) were replacement donors. Majority of blood donors were males in both group, comprising 92% and 98.12% respectively. Seroprevalence of HBsAg and HCV was markedly higher in replacement group than voluntary group, 1.35% v/s 0.79% (HBSAG) and 1.22% v/s 0.72% (HCV). HBsAg and HCV was higher in rural for both groups. [1.64% v/s O.27% and 1.35% v/s 0.55% (HBsAg) and 1.40% v/s 0.30 %. and 3.46% v/s 0.28% (HCV)]. HBSAG and HCV seropositivity was higher in age group 31-40 years. HBsAg and HCV seropositivity higher in skilled worker. According to socio economic status, maximum HBsAg and HCV seropositivity was observed in lower class in both group, 1.17%v/s 2.02% and f 1.32% v/s 1.35% respectively. According to high risk behaviour, HBsAg seropositivity was maximaum in donors having extra marital relation in both group (5.12% v/s 6.25%), followed by in donors with drug abuse, 54% v/s 4.76%) and history of surgery and injections in past (4.9% v/s 2.31%).Anti HCV seropositivity was maximum in drug abuse donors from both group,(1.63% v/s 3.17%), followed by extra/pre marital sexual realtions.

Conclusions: HBsAg and HCV has more prevalence in urban area, in age group 31-40 years, in skilled workers, lower economic status and in high risk behaviors.

Seroprevalance of HIV and HCV in 500 blood donors at Bhagat Phool Singh Government Medical College for Women, Khanpur Kalan (SONEPAT)

Paritev Singh, Sukhwinder Singh


Department of Pathology, Bhagat Phool Singh, Government Medical College for Women, Khanpur Kalan (Sonepat) Haryana, India

Introduction: Transfusion Transmissible infections such as HIV, HEPATITIS C are among the greatest threats to blood safey for the recipient.

Aims and Objectives: To determine the seroprevelance of these viral markers in relation to the voluntry/replacement donation and number of donations in 500 blood donors at Bhagat Phool Singh Government Medical College, Khanpur Kalan.

Materials and Methods: Study was conducted on 500 blood donors in deptt of Blood Transfusion and at the outreach of voluntry donation camps. Screening and selection of the patient was done as per guidelines provided by DGHS, MHFW, New Delhi. Blood units were screened by 4 th generation ELISA for these 2 viral markers. Chi square test and chi square analysis was done.

Results: Out of 500 donors tested 84.2% donors were voluntary donors and 15.8% were replacement donors. 96.3% were males and 3.7% were females. Mean age in present study was 30.42 + 10.2 yrs. Maximum number of blood donors were in the age group of 21-30 yrs in both voluntry 50.6% and replacement group 53.3% followed by 31-40 yrs with voluntry donors as 27.8% and replacement donors as 27.2%. Seropositivity was more in first time donors in both voluntry 1.7% and replacement 2.5% donors. Incidence of HIV was 0.2% in replacement donors and 0.1% in voluntry donors. In HCV incidence was 1.4% in replacement donors and 1.2% in voluntry donors. Conclusion: Voluntry blood donation is more safe than replacement donation where high incidence opf TTI's was observed, hence advocated.

Prevalence of Hepatitis B surface antigen, HCV and liver function test in thalassaemia children

Vaishali, Aditi Sharma 1 , Kamal Sachdev, Neeraj Sharma 2 , Amarjeet Singh, Raman Sharma 1

Department of Pathology, 1 Department of Medicine, 2 Department of Transfusion Medicine, Government Medical College, Amritsar, Punjab, India

Background: Thalassaemia is a group of congenital anaemia in which there is deficient synthesis of one or more polypeptide globin chains of haemoglobin. It is a progressive haemolytic condition with usually manifests during the I st 6 months of life. Majority of thalassaemic children require regular blood transfusions to prevent development of anaemia. Repeated blood transfusions expose these children to blood borne infections of which most common are HBV, HCV, HIV. The transfusional iron overload and hepatitis B virus infection contributes to high incidence of chronic liver disease.

Aims: The aim of the study is to find the prevalence of Hepatitis B virus infection in thalassaemic children by using HBSAg is a viral marker and to estimate biochemical evidence of viral hepatitis using liver function tests.

Materials and Methods: The study was conducted on 100 thalassaemic children. HBSAg testing was done using micro ELISA method and LFTs were performed on semi-automated analyser.

Observations: Age and sex distribution, age of children at the time of diagnosis, distribution of cases according to blood transfusions received, cases with elevated serum bilirubin, SGPT, SGOT, ALP decreased albumin, prevalence of HBSAg and anti HCV antibody was observed.

Conclusion: Reduction in incidence of post transfusional hepatitis can be achieved by routine screening of all blood donors for HBSAg using 3 rd generation methods like ELISA and by adopting 100% volunteer blood donor programme. All thalassaemic children should be vaccinated for HBV and HCV infection and leukofiltered blood should be preferred.

Trends in HIV seroprevalence among blood donors

Shelly Jetly, Amardeep Garg, Sonia Bawa, Kusum Thakur, Kanchan Bhardwaj


Department of Transfusion Medicine, Government Medical College, Patiala, Punjab, India

Introduction: Transmission of HIV through transfusion of blood is the greatest threat to the blood safety of recipient. Amongst the undesirable complications arising out of transfusion of blood and blood products transmission of HIV is most significant for long term detrimental side effects.

Aim: To study the trends in prevalence of HIV among blood donations at Blood Bank Govt. Medical College Patiala.

Materials and Methods: All the blood donors (including voluntary and replacement donors) coming to donate either at blood bank GMC Patiala or various blood donation camps organized by blood bank were included in the study. Serum samples from the above donors were tested for prevalence of HIV by third generation ELISA or rapid tests.

Observations: A total of 148197 samples were tested for HIV from January 2006 to 15 th September 2014, out of which 170 serum samples were reported to be HIV positive (0.114%). The results of initial sero reactive samples were repeated and verified to exclude false positive results.

Results: Though there was a steady decline in prevalence of HIV from 2006 to 2012 but there is increase in prevalence of HIV since 2013.

Conclusion: Increase in seroprevalence may be reflective of changing life style and more open social norms. A more detailed history regarding social exposure is advocated.

Inadvertent cell suspension preparation leading to blood group discrepancies

Ravishankar Jairaj


Department of Transfusio on Medicine, The TN Dr. MGR Medical University, Guindy, Chennai, Tamilnadu, India

Background: Each and every step is important in Immunohematology workup to prevent serious hazards to patients. Steps as simple as cell suspension preparation, can lead to grouping discrepancies which requires extensive rework up and loss of valuable time.

Case 1: On one occasion, when blood grouping analysis was done on donor samples, all samples which were supposedly 'B' group in forward grouping gave weak results (2+) with 'A' cells in reverse grouping.

After rechecking every step, the fault was found to be in 'A' cell suspension which was pooled without checking their subtypes, which turned out to be 'A 2 ' cells. When repeated with A 1 cells, it gave strong reaction (4+).

Case 2: On another occasion, blood grouping was done for antenatal mother (who came for IAT testing), which showed strong reaction (4+) with O pooled cells (Oc) while supposedly B group in Forward grouping. Retesting with tube technique, DAT, autocontrol, prewarming and antibody screening did not resolve the discrepancy. Entire procedure, starting from preparation of cells for reverse grouping, was checked and the problem was due to the unnoticed error of taking 'A' pooled cells in both Ac and Oc tubes in reverse grouping. The tests were repeated with fresh O positive cells, which gave negative reaction. Conclusion: Whenever in-house reagent cell suspension is prepared, points like correct labeling of test tube, taking correct pooled samples in the labeled test tube are important and every step in the Standard Operating Procedure should be followed diligently.

Warm reacting anti Le a : Case report

Sushama D, Krishnakumariama Chakrapani Usha


Department of Transfusion Medicine Govt. Medical College, Trivandrum, Kerala, India

Background: Clinically significant antibodies are associated with HDFN,HTR or with notably decreased survival of transfused red cells. Antibodies reactive at 37 ° C or in AHG test phase are more likely to be clinically significant. Antibodies like A1,H,Le a ,Lutheran,M,N,P1 and Sd a are not clinically significant unless reactive at 37 ° C.

Materials and Methods: A 46 year old known Type 2 diabetic on treatment (Type 2DM) admitted in Medicine department due to fever with rigors & chills, fatigue, nausea & a single episode of malena. Examination and Investigations suggested acute viral fever with Iron deficiency anemia (Hb-3.5 gm%) and uncontrolled diabetes. Blood grouping by tube method did not exhibit any grouping discrepancy. Blood group was found to be O positive. Cross match with O+ve PRC in Saline, IS phase was compatible, but was incompatible in LISS Coombs gel card @ 37 ° C. ICT was positive, DCT-negative. Autocontrol was negative at all temperatures. Antibody screening and identification was done using Biorad ID DIa cell panels.

Results: Identified an antibody of Anti-Le a specificity which reacted in Liss-coombs phase, but failed to react at 4 ° C and 22 ° C. Enzyme treatment showed enhancement. Phenotyping and neutralization couldn't be performed, as antisera was not readily available. O +ve PRCs cross-matched in coomb's gel card were given on D3, D4 and D5 along with other treatments. Hb-3.5;8.8 gm%. Patient became symptomatically better and was discharged.

Conclusion: Anti Le a are at times clinically significant. Risk arises if Le (a+) group O red cells are selected for patient whose serum contains potent anti-Lea; here, Le (a-) PRC can be transfused.

Specificity of blood group antibodies in patients and donors

Keyuri Farasram Jariwala, Snehalata Chandarkant Gupte


Surat Rakat Daan, Kendra & Research, Gujarat, India

Background: Patients may develop irregular red cells antibody from previous transfusion, pregnancy or sometimes even without such apparent stimulus. It is therefore important to make the transfusion safer by identifying specificity of antibody in donor and patient and corresponding antigen negative blood is provided.

Aim: To screen and identify the specificity of unexpected antibodies in multi-transfused patients, patients referred from different hospitals, pregnant women and donors.

Materials and Methods: In our blood bank routinely donors and patients are screened for atypical antibodies. Often discrepant cases are referred to us for Immunohaematology studies. Donor's blood grouping, saline phase and IAT antibody screening is carried out on Diagast machine. Every patient's blood samples are screened either on Diagast or manually. All antibody positive samples are screened at 4Ί C, 22Ί C and 37Ί C temperature in saline and 22% BSA phase, and by IAT. Specificity is identified by using Matrix (Tulip) three cells panel and also on Diagast at 37Ί C temperature. Further identification is done by using eleven cells panel.

Result: Among blood donors eight had anti-H. Three donors developed anti-Lu b . Red cell alloimmunization was found in 28 patients. Out of 28, ten developed anti-D, five anti-c, three anti-E, two anti-K, one anti-Fy b , two anti-I, one anti-N, one Jk b and one Le b . In remaining patients specificity was unknown. 36 patients had auto-antibodies. Five patients were of Bombay phenotype. Family studies of one Bombay group patient and donor were done.

Conclusion: Our results reveal that detection and identification of blood group antibodies in donors and patients is essential to prevent hemolytic transfusion reaction.

Cold agglutinin disease: A rare entity

Harkiran Arora, Neetu Kukar, Ram Niwas Maharishi,

Arunpreet Kaur


Department of Immuno Hematology and Blood Transfusion, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India

CAD is typically characterized by the presence of IgM antibodies directed against antigens on the red blood cell surface reacting at 4°C. The most common cold agglutinins are designated anti-I. It has most commonly been reported following viral infections, mycoplasma pneumonia, and infectious mononucleosis. It is diagnosed by presence of severe anaemia (normocytic normochromic), reticulocytosis, indirect hyperbilirubinemia, raised lactate dehydrogenase (LDH) level and positive Direct Coombs Test.

Case 1: A 16 year old male patient, admitted with complaints of continuous high grade fever associated with chills and rigors, yellowish discoloration of urine and eyes, vomiting and generalized weakness. Severe autoagglutination in the sample at room temperature so there was difficulty in the cell and serum grouping. Blood grouping was confirmed to be AB+ve by washing the red cell with warm saline 8-10 times. DCT and autocontrol was positive. He was found to have cold agglutinins. So, 3 units of washed PRBCs were transfused.

Case 2: A 60 year old male k/c/o Ca oesophagus, admitted with complaints of dysphagia, showed severe autoagglutination in the EDTA sample. Blood grouping was done by washing the red cells by warm saline 8-10 times and confirmed by Gel method to be O+ve. DCT and autocontrol was positive. He was found to have cold agglutinins.

Conclusion: Cold agglutinin disease is an autoimmune disease in which antibody directly agglutinates red cells at temperature below body temperature and maximally at 0 to 4. Titer more than 1:64 is clinically significant. So in presence of clinically significant cold agglutinin, thermal amplitude should be quantified.

Managing bombay phenotype patient of 2.5 month old with ano-rectal surgery: A challenging case study

Jignasa Gami, Chandani Karia, Ekta Pankhaniya, Dinesh Gami, Kamlesh Dharajiya


Rajkot Voluntary Blood Bank & Research Centre, Rajkot, Gujrat, India

Background: Bombay blood group is a rare autosomal recessive phenotype (Oh) -homozygous for non-functional H(hh).The unique aspect of Bombay phenotype is that red cells are not agglutinate by antisera A, B and H. Occurrence of Bombay blood group is rare about 0.0004% of the human population, yet in Mumbai it is 0.01% (1 in 10,000) of inhabitants and 1 in a million people in Europe. It is very difficult to get safe compatible blood/blood components for transfusion for Bombay group. Here we report management of a case of blood request for 2.5 years old baby admitted in local hospital.

Case Study: In Rajkot Voluntary Blood Bank and Research Centre, a request for one unit of RCC received for 2.5 years old baby admitted in a local hospital for ano-rectal surgery. HisHb was 8.6 gm/dl and had history of one unit "O" positive WB transfusion during his Infancy. While testing blood group of patient, we found 3+ reactivity with "O" pooled cells during reverse grouping and 3-cell antibody screening was positive. The sample was tested by H lectin. It was Bombay phenotype and the treating surgeon informed immediately. As our center, neither stock of Bombay group blood-unit nor registered blood-donor available at that time. Fortunately compatible blood unit was arranged for the blood transfusion. Baby got discharged after successful surgery without any complications.

Discussion: To detect Bombay group successfully, blood banks must perform grouping test with Anti-H Lectin. Individuals with Bombay phenotype must be managed either with pre-deposit autologous blood transfusion whenever possible or with blood from other Bombay phenotype individuals.Here the patient was managed successfully with Bombay phenotype blood unit.

DAT positivity in blood donors: A perplexing scenario

Ajay S. Praveen, Ravneet Kaur, Kshitija Mittal, Tanvi Sood


Department of Transfusion Medicine, Government Medical College and Hospital, Chandigarh, India

Introduction: The direct antiglobulin test (DAT) is a simple test used to determine if red cells have been coated in vivo with immunoglobulin, complement, or both. We hereby report a case of a DAT positive donor with no clinical and laboratory evidence of hemolysis.

Case Report with Results: A blood request was received for 70 year male patient suffering from chronic obstructive pulmonary disease with anemia. One unit was found incompatible in AHG phase. Patient's antibody screen, indirect antiglobulin test, DAT and auto control was negative. DAT of donor unit was positive with anti IgG gel card and negative with C3d reagent along with positive auto control. Donor was 30 year male with no history of blood transfusion and medication with no evidence of hemolysis.

Conclusion: There are no clear cut guidelines and established policy for deferral of DAT positive donors and referral of such donors to physician. Donors with positive DAT should be deferred, notified and referred to physician but further studies are required.

Frequency and distribution of ABO and Rh blood groups among the blood donors of a tertiary care hospital blood bank in Hyderabad, Telangana

Pandu Ranga Rao Sanagapati, Sudhir Kumar Vujhini


Department of Transfusion Medicine, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India

Background: ABO and Rh blood groups are most important blood groups in human beings. The frequency of four main blood group systems varies in population throughout the world and even in different parts of a country.

Aims and Objectives: The aim of this study was to identify distribution of ABO and Rh blood group system.

Materials and Methods: The study was conducted in an urban tertiary care hospital from January 2013 to June 2014. Data was collected from Blood Bank grouping records. All donor blood samples processed during the above period of observation were included in the study.

Results: During the period of observation, the total number of donors was 28,659. Donors were predominantly male (98.60%). More than three-quarters of the donors (81.61%) were replacement donors. The frequency of blood group O in our population was 41.29% (38.50% O Rh positive and 2.79% O Rh negative). The frequency of blood group B in our population was 32.79% (30.91% B Rh positive and 1.87% B Rh negative) followed by blood group A was 19.42% (18.19% A Rh positive and 1.22% A Rh negative) and blood group AB was 6.44% (6.10% AB Rh positive and 0.34%AB Rh negative) and 11 Bombay blood group donors (00.03%). Rh positive were 26,859 (93.71%) and Rh negative were 1,789 (6.24%).

Conclusion: O positive blood group is significantly high in our population. Incidence of Bombay phenotype is high in our study when compared to studies in literature. The present study of ABO and Rh grouping was compared with other studies in literature and was in agreement with most of the studies.

Clinically significant anti-m antibodies-report of two cases

Kondareddy Sindhuja, Shridhir Babu KV, Arun Rajendra, Deepti Krishna, Suresh Basu


Shri Venkateshwar Institute of Medical Sciences, Tirupati, Andhra Pradesh, India

Background: Each and every step is important in Immunohematology workup to prevent serious hazards to patients. Steps as simple as cell suspension preparation, can lead to grouping discrepancies which requires extensive rework up and loss of valuable time.

Case 1: On one occasion, when blood grouping analysis was done on donor samples, all samples which were supposedly 'B' group in forward grouping gave weak results (2+) with 'A' cells in reverse grouping.

After rechecking every step, the fault was found to be in 'A' cell suspension which was pooled without checking their subtypes, which turned out to be 'A 2 ' cells. When repeated with A 1 cells, it gave strong reaction (4+).

Case 2: On another occasion, blood grouping was done for antenatal mother (who came for IAT testing), which showed strong reaction (4+) with O pooled cells (Oc) while supposedly B group in Forward grouping. Retesting with tube technique, DAT, autocontrol, prewarming and antibody screening did not resolve the discrepancy. Entire procedure, starting from preparation of cells for reverse grouping, was checked and the problem was due to the unnoticed error of taking 'A' pooled cells in both Ac and Oc tubes in reverse grouping. The tests were repeated with fresh O positive cells, which gave negative reaction.

Conclusion: Whenever in-house reagent cell suspension is prepared, points like correct labeling of test tube, taking correct pooled samples in the labeled test tube are important and every step in the Standard Operating Procedure should be followed diligently.

Anti- IH cold autoantibody mimicking as alloantibody: A case report

Deepti Sachan, Aswin Kumar


Department of Transfusion Medicine, Global Health City, Chennai, Tamil Nadu, India

Background: Cold agglutinin disease is a form of autoimmune hemolytic anemia caused by cold-reacting auto-antibodies. Most cold reactive auto-antibodies have anti-I specificity. Anti-IH cold autoagglutinins have complex ABH-Ii antigens specificity and reacts opatimally with cells that are rich in both I and H antigens. We present here a case of Anti-IH cold auto-antibodies mimicking alloantibody detected during pre liver transplant immunohematological workup.

Case Report: A 9 years old male child, a case of metabolic liver disease, planned for liver transplant presented with mild anemia (Hb -10.2 gm/dL, retic- 6.2). During pre transplant immunohematological workup, ABO discrepancy was found during blood grouping using gel technology (Biorad). The forward grouping showed A positive while reverse grouping was showing 4+ reactions with B cells, 2+ with O cells and negative with A-cells. The Direct and Indirect coombs test were performed using polyspecific LISS/coombs card and three cell panel (Diacell, Biorad Switzerland) and were negative. Cold antibody test was performed using both tube method as well as using gel technology and were found to be 4+ panreactive with pooled O cells, Diacell panel as well as ID- Panel but were not reactive with Autologous cells giving suspicion of cold alloantibody. Donath- Landsteiner test was negative for biphasic hemolysins. Cold antibody titer was 1:32 and they were reactive from 4 ° C to 22 ° C but nonreactive above 30 ° C. The weaker reactions with A 1 cells gave suspicion of Anti-IH antibody. Saline crossmatch showed compatible results with A 1 Positive units while 2+ incompatibilities with all O+ units and A 2 units confirmed the presence of Anti-IH antibody; all were compatible at AHG crossmatch. Patient was advised to transfuse only A 1 compatible and group specific units only and not O or A 2 during liver transplant.

Discussion: Anti-IH antibody distinguishes among cells of various ABO groups. Group O and A2 cells reacts best because they have most H substance. Because of the low levels of H antigen expression on the RBCs, anti- IH did not react with autologous A 1 cells and mimicked alloantibodies. Usually harmless, these cold autoagglutinins have rarely been implicated in hemolytic transfusion reactions.

An evaluation of adverse blood transfusion reactions at a tertiary care teaching hospital I.E. SVIMS, Tirupati, Andhra Pradesh

Kondareddy Sindhuja, Shridhir Babu KV, Arun Rajendra, Deepti Krishna, Suresh Basu


Shri Venkateshwar Institute of Medical Sciences, Tirupati, Andhra Pradesh, India

Background: An adverse reaction is an undesirable response or effect in a patient or recipient, temporarily associated with administration of whole blood or blood components, some complication risk depends on the patient status, some on the specific transfusion quantity involved. Identification of such adverse reactions will help in taking appropriate steps to reduce their incidence and to improve overall transfusion safety in the institute.

Aim: To assess the frequency and type of transfusion reactions occurring in patients, reported to the blood bank at our institute.

Materials and Methods: It is a retrospective analysis done during the period from January 2014 to June 2014. All the adverse events related to transfusion of blood and blood components were evaluated and classified on the basis of their clinical features and laboratory reports.

Results: During this 6 months period, a total of 8242 blood and blood components were issued by our blood bank. A total of 8 adverse reactions were observed during the study period. The frequency of adverse reactions is 0.09%. Majority of the reactions (4 out of 8) occurred in neurosurgery patients (50%). All the reactions are of allergic type only. Of all the transfusion reactions reported 50% (n = 4) occurred with whole blood, 25% (n = 2) with packed cells, 25% (n = 2) with fresh frozen plasma. Overall 0.07% of packed cells, 0.2% of whole blood, 0.09% of fresh frozen plasma issued from the blood bank during the study period were involved in causing transfusion reactions. The incidence of reactions is equal in both males and females.

Conclusion: The frequency of adverse reactions is 0.09% which is similar to a study conducted by Kumar et al. (0.05%).This may be due to effective screening and leucoreduction, proper blood storage conditions and good practices during component preparation. It may also be due to under estimation of the incidence of reactions because of under reporting.

Acute transfusion reactions encountered in patients at a tertiary care centre in Punjab

Manvi Gupta, Rajesh Kumar, Amarjit Kaur


Department of Immunohematology and Blood Transfusion, Dayanand Medical College and Hospital, Ludhiana, Punjab, India

Background: Blood transfusion is a life saving procedure, which can occasionally be unsafe and result in a spectrum of adverse events.

Aim: To determine the characteristics and type of acute transfusion reactions occurring in hospitalized patients at a tertiary care centre.

Materials and Methods: A retrospective study was conducted at the Department of Immunohaematology and Blood Transfusion, Dayanand Medical College and Hospital, Ludhiana. All the acute transfusion reactions reported to the department from 1 st Jan 2012 till 31 st march 2013 were evaluated. All the adverse reactions were recorded, analyzed and classified on the basis of their clinical features and laboratory tests.

Results: During the study period 45092 blood components were issued from the department. A total of 190 transfusion reactions were reported. The most frequent were febrile non hemolytic transfusion reaction (54.2%), allergic reactions (36.3%), hemolytic reactions (1%) and non specific reactions (8.5%). The incidence of reactions in our study was 0.42%.

Conclusion: Transfusion of blood and its products is a vital therapeutic procedure but with potential risks for the recipient. Strict vigilance has to be observed at the time of collection, component preparation, storage, cross-match and release of the blood unit. Each transfusion has to be monitored carefully with prompt recognition and treatment of acute transfusion reaction to decrease transfusion related morbidity and mortality. Data from a well functioning hemovigilance system can be used as a quality indicator for monitoring blood transfusion safety and contribute significantly to evidence based transfusion medicine.

Transfusion related lung injury (TRALI)

Raminderpal Singh Sibia, Amith Kumar


Department of Medicine, Government of Medical College, Patiala, Punjab, India

Introduction: Transfusion Related Acute Lung Injury (TRALI) is a rare, but not uncommon, yet under reported complication of transfusion of blood or blood products. The lack of awareness among physicians results in frequent misdiagnosis of a rather potentially fatal reaction towards blood transfusion.

Case Report: 45 year old female, who presented with fever and thrombocytopenia, developed sudden onset respiratory distress following a single unit platelet rich plasma transfusion. Rapid clinical deterioration was noted with a low oxygen saturation (81%), tachycardia (120/min), tachypnea (40/min), and fever (102 o F). arterial blood gas analysis showed PaO2/FIO2 ratio of 168. Blood pressure was recorded to be 110/70 mm of Hg and there was no cyanosis or other signs of respiratory failure. Analyzing results of hematological, biochemical and radiological investigations, a diagnosis of Transfusion Related Acute lung Injury was made, excluding other causes of acute lung injury. Patient was managed conservatively, her symptoms improved over next four days and was discharged in satisfactory condition.

Conclusion: The diagnosis of TRALI relies on a high index of suspicion and awareness from the part of the physician. Other causes of acute lung injury following blood transfusion, such as sepsis, volume overload, cardiogenic pulmonary edema, have to be sequentially excluded using clinical and laboratory aids. Treatment is essentially supportive, with the outcome being better than most of the other causes of acute lung injury.

Awareness of thalassemia among medical students

Gunjit Singh Walia, Kusum K. Thakur, Kanchan Bhardwaj


Department of Transfusion Medicine, Government Medical College (GMC), Patiala, Punjab, India

Introduction: Awareness is the key to prevent thalassemia. Few small countries in the world have been able to control it very well by using premarital counseling, carrier screening, marital counseling and prenatal diagnosis. This is possible only if doctors are aware about all this. A study was conducted on final year MBBS, they were given written test of 50 MCQ's on all aspects of thalassemia. It was found that medical students are not fully aware of this preventable disease. So more such awareness programmes are needed.

Aims/Objectives: To make medical students fully aware of thalassemia and encourage them to spread the message where ever they go to prevent this disease.

Materials and Methods: After lot of advertisement, 160 participated in the written test of 50 MCQs on thalassemia under supervision of faculty from department of blood transfusion. Answer sheets were evaluated and results analyzed.

Observations: 62(34%) students knew only 40% about thalassemia, about half of them knew only 40-60% and rest 18(11%) knew 61-80%. No one knew 100% about the disease.

Conclusions: Need for more awareness programmes among medical students regarding thalassemia as it will really help to prevent birth of thalassemia major children which are financial and psychological burden on family, society and nation.

Knowledge, attitude and practices of parents of thalassemic children undergoing treatment at thalassemia day care centre of pediatrics department

Jaswir Singh, Kanchan Bhardwaj 1 , Kamaldeep, Vajinder Singh, Jaspreet Kaur


Department of Pediatrics, 1 Department of Transfusion Medicine, Government Medical College, Patiala, Punjab, India

Introduction: β-thalassemia is an autosomal recessive single gene disorder characterized by defective production of Hb and excessive destruction of RBCs. The defect causes an abnormal development of RBCs and ultimately anemia.

Aims and Objectives: This study attempted to explore the knowledge of the parents of thalassemic children, their attitude towards the prevention of birth and practices followed by them in relation to the treatment adherence.

Materials and Methods: This study was conducted on parents of 100 patients of thalassemia who were coming regularly for blood transfusion in thalassemia day care centre at Rajindra Hospital, Patiala from January 2011 to Nov 2012. The parents were interviewed regarding their knowledge about the inheritance and types of thalassemia, prenatal diagnosis and various treatment options available and practices followed by them on a pre-designed questionnaire.

Results: The variables were compared by Chi square test and were analyzed using SPSS version 15 and 'P' value was calculated. Difference in knowledge of the parents regarding type of disease (P = .006), inheritance (P = .007), 3 types of thalassemia (P = .002), role of consanguinity (P = .027), prenatal diagnosis (P = .002), curability of disease (P = .000), need for blood transfusion (P = .013), important ferritin levels (P = .000), role of chelation therapy (P = .003), splenectomy (P = .000) was found statistically significant relation to their socioeconomic status.

Conclusion: Knowledge of the parents of thalassemic children was inadequate as only 21% parents gave correct answers regarding knowledge.

To study the clinico-hematological spectrum of pancytopenia

Ragini Singh, Pratap Singh Ghalaut 1 , Manisha Sharma 1 , Jatinder Pehalajani 1 , Joginder Duhan 1 , Hament Dahiya 1 , Naresh Gaur 1 , Arvind Chahal 1


Department of Pathology, 1 Department of Medicine, Pt. B.D. Sharma, PGIMS, Rohtak, Haryana, India

Introduction: Extensive studies have been conducted for the different etiological factors of pancytopenia like megaloblastic anemia, aplastic anemia, leukemia, myelodysplastic syndrome. However, there is limited number of comprehensive studies in this subject. The incidence of aplastic anemia quoted from the west is 10-25%. However, the studies in Indian sub continent shows different causes of pancytopenia. We have planned to review the clinico-hematological spectrum of pancytopenia in Indian patients.

Materials and Methods: This study was conducted at Pt. B.D. Sharma, PGIMS, Rohtak on 100 patients of pancytopenia of age group 14-65 years. The patients were evaluated for clinico-hematological spectrum of pancytopenia. All patients having hemoglobin <12 g/dl, total leukocyte count (TLC) <4000/micro L and platelet count <1,00,000/micro L with age between 14-65 yrs were included in the study.

Observation and Results: The study population consisted 57 male patients and 43 female patients with male to female ratio 1.3:1. Most common age group was of 56-65 years of age. Most common symptom was generalized weakness and fatigue (100%) followed by fever, shortness of breath, palpitations and bleeding menifestations. On examination, pallor (100%), hepatomegaly (31%) and splenomegaly (27%) were predominant findings followed by icterus and lymphadenopathy. Severity of anemia and leucopenia was moderate and of thrombocytopenia was mild in most of the case. Most common picture on peripheral blood film was dimorphic (54%) followed by macrocytic (25%). Bone marrow was hypercellular in 64 cases and hypocellular in 31% cases. Isolated vitamin B 12 deficiency in megaloblastic anemia was more common (69.23%) than isolated folate (12.82%) or combined deficiency (7.69%). Most common cause of pancytopenia in Indian population is megaloblastic anemia (39%) attributed to nutritional cause in 35% cases. Second common cause was aplastic anemia (29%) which is the commonest cause of pancytopenia in other countries. Aleukemic leukemia constituted 3 rd most common cause of pancytopenia (15%). Other causes included lymphoma, multiple myeloma, MDS, myelofibrosis, infections, hypersplenism and SLE (17%). In western countries most common cause was aplastic anemia followed by neoplastic conditions such as leukemia.

Conclusion: The present study on 100 patients of pancytopenia seen at PGIMS Rohtak demonstrated that megaloblastic anemia was the most common cause of pancytopenia constituting 39% of cases. This could be due to higher prevalence of nutritional deficiency in our country.

Nitro blue tetrazolium dye reduction test and myeloperoxidase activity on peripheral blood film examination in patients of chronic granulomatous conditions

Priyanka Goyal, Ramesh Kumar Kundal, 1 Bachan Lal Bahrdwaj


Departments of Pathology and 1 Medicine, Government Medical College (GMC), Patiala, Punjab, India

Introduction: Chronic granulomatous conditions are group of diseases which are manifested when neutrophils are unable to kill and digest the microbial agents by oxygen dependent mechanisms resulting in increased susceptibility to severe infections which can be assessed by Nitroblue tetrazolium dye reduction test and myeloperoxidase score.

Aims and Objectives: To assess the phagocytic activity of neutrophils by Nitroblue Tetrazolium Dye reduction test in various diseases. To assess Myeloperoxidase deficiency in various diseases. To study relationship between Nitroblue Tetrazolium Dye reduction test and Myeloperoxidase activity. To compare NBT dye reduction and Myeloperoxidase activity in chronic granulomatous conditions, non granulomatous bacterial infections and healthy controls.

Materials and Methods: The present study was conducted on 200 cases, divided into 3 subgroups, received in various OPDs of Rajindra Hospital Patiala, as Group ' A ' 100 cases already diagnosed as chronic granulomatous conditions. Group ' B ' 50 cases of non granulomatos bacterial infections. Group ' C ' 50 healthy blood donors to act as control. Percentage of NBT positive cells and MPO score calculation was done in all patients.

Results: NBT positivity between healthy controls and non-granulomatous bacterial infections showed that it was significantly higher (P < 0.001) in non-granulamatous bacterial infection than in healthy adults. The difference of MPO score was also significant statistically (P < 0.05). On comparing the control and granulomatous groups there was seen a highly significant relation for both %age of NBT positive cells and MPO score (P < 0.001). Comparison between the infectious and granulomatous groups showed that there was seen a highly significant relation for both between %age of NBT positive cells and absolute NBT cell count and no significant relation for MPO score.

Conclusions: It is of useful means in differentiating certain types of bacterial infection from non-bacterial diseases and viral infections. Myeloperoxidase deficient neutrophils display normal phagocytic activity yet kill the ingested bacteria at a subnormal rate.

Molecular blood group genotyping in patients with Thalassemia

Swati Kulkarni, Bhavika Choudhary, Kanjaksha Ghosh


National Institute of Immunohaematology, Mumbai, Maharashtra, India

Background: In multi-transfused thalassemic patients, hemagglutination fails to phenotype the patient's blood group antigens due to donor derived erythrocytes from previous transfusions or positive direct antiglobulin test. DNA technology has overcome the limitations of haemagglutination assays. Accurate determination of blood group antigen status will facilitate the procurement of antigen matched blood in patients who have not produced antibodies as well as in identification of appropriate antigen negative RBCs for transfusion in alloimmunised patients requiring regular transfusion.

Aim: To screen multitransfused thalassemic patients for clinically important blood group antigens(C, c, D, E, e, Fy a , Fy b , Jk a , Jk b , K, k) by serological and molecular methods. Materials and Methods: Presence of RHD, RHC, RHc, RHE, RHe, JK1(Jk a ), JK2(Jk b ), FY1(Fy a ), FY2(Fy b ), KEL1(K), KEL2(k) alleles were determined in fifty seven multitransfused beta-thalassemia patients by PCR and compared with the hemagglutination method.

Observations: Genotype and serological phenotype of 57 Thalassemic patients was compared for eleven antigens of four clinically significant blood group systems. 87% of multitransfused Thalassemic patients gave discrepant results by serological (due to presence of donor red cells) and molecular methods. The antigens c and E showed maximum and k and e showed no discrepancy between genotyping and serologic typing in the patients tested.

Conclusion: Blood group genotyping has vital importance in management of chronically transfused patients especially if patients were not phenotyped before starting the initial transfusion. The true blood group genotype determined by DNA typing will be helpful for selecting antigen-negative RBCs for transfusion dependent patients.

Assessment of haematological parameters and serum ferritin levels in anaemic pregnant women at MMIMSR, Mullana: A prospective study of 100 cases

Jyoti Sharma, Naseeb Chand Khabra, NC Mahajan


Department of Pathology, Maharishi Markandeshwar Institute of Medical Sciences and Research (MMIMSR), Ambala, Haryana, India

Background: Haematological parameters are definitive evidence of anaemia in pregnancy and Serum Ferritin test is regarded as the most sensitive test for assesing iron status as it is not affected by the physiological changes of pregnancy.

Aims and Objectives: 1. To grade the severity of anaemia in pregnant women. 2. To asses serum ferritin levels in anaemic pregnant women. 3. To find out the morphological types of anaemia.

Materials and Methods: Study was conducted on pregnant women attending out -patient department of Obstetrics and Gynaecology, M.M I.M.S.R, Mullana. Patients with haemoglobin levels <11 g/dl were included and patients suffering from maternal infections were excluded. Blood samples were collected under aseptic conditions. Haematological investigations (Hb, TLC, DLC, Platelet count, PBF) and Serum Ferritin test by (ELISA method) were performed.

Results: Out of 100 cases, 37 had (Mild anaemia), 52 (Moderate anaemia), 11 (Severe anaemia). Serum ferritin levels were below 15 μg/l-72 cases, 15-30 μg/dl-24 cases and >30 μg/dl -4 cases respectively. PBF findings-67% (Microcytic hypochromic anaemia), 18% (Normocytic hypochromic), 7% (Dimorphic), 5% (Macrocytic) and 3% (Normocytic normochromic).

Conclusion: Present study revealed maximum cases with moderate degree of anaemia. Showing Microcytic hypochromic blood picture and Serum ferritin levels below 15 μg/l indicating predominance of Iron deficiency anaemia in pregnant women.

Prevalence of hepatitis B and hepatitis C virus infections among the patients undergoing gastrointestinal endoscopic procedures

Ashish Bhagat, Sanjay Goyal, Harnoor Bharadwaj, Bachan Lal Bhardawaj, Jasbir Kumar


Department of Medicine, Government Medical College, Patiala, Punjab, India

Introduction: Hepatitis B and Hepatitis infection are endemic in India and have an important etiological role in chronic liver diseases. These diseases cause significant mortality, and morbidity along with financial burden both for the patient and the country. Studies in blood donors in different parts of the country have shown the prevalence of HBV to be around 2-3% and for HCV to be around 1% Gastrointestinal endoscopic procedures are commonly done for diagnostic and therapeutic reasons. These procedures have potential of transmitting various pathogens as same equipment is used on different patients although after stringent sterilization measures. We are assessing the prevalence of hepatitis B and hepatitis C in patients undergoing endoscopy for various reasons. This study aims to strengthen the already existing data of prevalence of hepatitis B and hepatitis c infections in India. Prevalence of these pathogens in this population will predict the chances of transmission of these pathogens during endoscopic procedures.

Materials and Methods: We retrospectively studied one thousand patients who underwent gastrointestinal endoscopic procedures for different reasons during the period of January 2013 and July 2014 at our hospital. We studied the presence of HBsAg and anti HCV antibodies among these patients.

Results: Out of 1000 patients 648 (64.8%) were males and 352 (35.2%) were females. Mean age of the patients was 48 years. Ninety five (9.5%) patients were positive for anti HCV antibodies and twenty six (26%) were positive for HBsAg. No case of HCV/HBV co-infection was found.

Discussion: Gastrointestinal endoscopies are commonly performed in modern healthcare. Like other invasive procedures it has potential of transmitting various pathogens among patients. There is no vaccine available for hepatitis C virus infection; great stress must be laid on preventive measures such as screening of blood, proper sterilization of instruments, proper disposal of contaminated materials and safe sexual practices. Fortunately effective vaccination is available for hepatitis B virus infection. In addition to aforementioned measure for hepatitis C; immunization of population at risk is required. Potential of transmission of hepatitis B and hepatitis C during endoscopic procedures have been reported earlier. Chances of transmission are likely to higher if prevalence of Hepatitis B and Hepatitis C is high in population undergoing endoscopic procedures. In our study prevalence of Hepatitis B is 2.6 % and prevalence of hepatitis C is 9.5 %. In various studies in normal population, prevalence of hepatitis B is 4.7 % and hepatitis C is 0.48% to 1.85%. In case of hepatitis C infection it is much lower than what we are reporting in our study. Prevalence of hepatitis is also significantly high. The reason could be that patients referred for endoscopy are likely to have higher chances of having liver related illnesses. High prevalence of hepatitis C in this population may have significant implication. Considering the prevalence of hepatitis B and hepatitis C among patients undergoing endoscopy, it is suggested that all patients undergoing endoscopy procedures should be screened for these pathogens. To minimize the chances of transmission of these pathogens, we further recommend use of dedicated endoscopic equipment (in addition to standard sterilization) for patients infected with these pathogens. Similar studies may be carried out at other endoscopy centers to corroborate our observations. This data might help policy makers in taking preventive measures for these diseases. These measures may help efficient use of financial and other recourses.

Conclusion: Hepatitis B hepatitis C infections put major burden on our health care resources. Dedicated data for these diseases will limit their transmission, and effective use of available resources.

Neoplastic and non-neoplastic lesions of prostate

Hinna Bansal, NC Mahajan


Department of Pathology, Maharishi Markandeshwar Institute of Medical Sciences and Research, Ambala, Haryana, India

Introduction: Worldwide, diseases of prostate gland are responsible for significant morbidity and mortality among adult males. Prostate cancer is the most common malignant tumor in men all over the world and is the second important cause of cancer related deaths. Most frequently encountered disease affecting prostate are prostatitis, benign prostatic hypertrophy and prostatic cancer.

Aims and Objectives: 1. To evaluate prostatic specimens and categorise them into neoplastic and non-neoplastic lesions. 2. To grade and score all malignant lesions.

Materials and Methods: It is presented a study which contained a number of 30 cases of prostatic lesions selected during year 2013. We described histopathogical aspects both neoplastic and non neoplastic lesions.

Observation and Results: There were total 30 cases of prostatic lesions reported in histopathology. Out of 30 cases, 4 cases were of Benign Prostatic Hypertophy, 21 cases were of benign adenomyomatous prostatic hyperplasia, 3 cases were of carcinoma prostate, 1 case of prostatic abscess, 1 case of chronic prostatitis.

Conclusion: This study shows the experience of prostatic lesions in a medical college hospital in North india showing the incidence of neoplastic and non neoplastic lesions of prostate.

Histopathological spectrum of mucosal response in cholecystectomy specimens with correlation to gall stones

Jyoti Sharma, Naseeb Chand Khabra, NC Mahajan


Department of Pathology, Maharishi Markandeshwar Institute of Medical Sciences and Research, Ambala, Haryana, India

Background: Cholelithiasis produces diverse histopathological changes in gall bladder namely acute inflammation, chronic inflammation, glandular hyperplasia, granulomatous inflammation, cholesterosis, dysplasia and carcinoma.

Aims and Objectives: To study the host mucosal response in gall bladder to gall stones. To study the correlation between various stone characteristics with type of mucosal response in gall bladder.

Materials and Methods: Present study was conducted on 300 cholecystectomy specimens with complete gall stones, submitted for histopathological examination in Department of Pathology, M.M.I.M.S and R. Cholecystectomy specimens without gall stones were excluded. Grossly, dimensions, outer surface, wall thickness, and mucosa of specimens were noted and gall stones were examined for weight, size, volume, number and morphological type. Microscopically, diagnosis was established on the basis of routine H&E staining of sections.

Observation and Results: Out of total 300 cholecystectomy specimens, Mixed stones were seen in 170 specimens, Combined-80, Pigment-28, Cholesterol-22. Chronic cholecystitis was diagnosed in-230 specimens, Cholesterosis-30,Acute on chronic cholecystitis-6, Xanthogranulomatous-6, Follicular-2,Mucocele-2. Cholecystitis with hyperplasia -10 were of adenomatous type and 6-Adenomyomatous.Adenocarcinoma was reported in 8 cases respectively.

Conclusion: As the weight, volume, size of the gall stone increases, the histopathological changes in gall bladder mucosa varies from cholecystitis, hyperplasia, metaplasia, dysplasia to carcinoma.

NHL and CML simultaneously in a patient: A rare occurance

Pratap Singh Ghalaut, Sudhir Atri, Jatinder Pehalajani, Arvind Chahal, Hament Dahiya, Joginder Duhan, Isha Pahuja


Department of Medicine, Pt. B.D. Sharma, PGIMS, Rohtak, Haryana, India

Background: Chronic myeloid leukaemia (CML) is a clonal stem cell disorder characterized by the acquisition of an oncogenic BCR/ABL fusion protein and by proliferation of granulocytic elements at all stages of differentiation. Patients with CML in CP PHASE has Lymph nodes palpable in around 60 to 70% but rarely they are more than 1 cm in largest diameter. NHL patient usually presents with lymphadenopathy with hepatosplenomegaly, the peripheral blood picture may shows anaemia and pancytopenia due to bone marrow involvement. NHL and CML have different etiopathogenesis so the finding of both the disease in same patient simultaneously is highly unlikely.

Materials and Methods: We came across a patient. 43 year male patient presented with complaints of generalised weakness since last three months which was also associated with mild grade fever associated with significant weight loss. Patient also noticed a small lump in his bilateral axilla and neck region.

Observation: Examination revealed mild pallor and generalised lymphadenopathy, rest general physical examination was normal. on abdominal examination patient was having liver Palpable 2 cm below right costal margin with a span of 13.5 cm patient also has spleen palpable around 3 cm below left 9 th costal cartilage, rest systemic examination was normal. Lymph node biopsy was done which showed NHL, mixed small and large T-cell types CD-3 and CD-5 positive. On his routine investigation haemogram showed Hb 8.2 g/dl, TLC showed 23,000 myelocyte metamyelocyte promyelocte in peripheral blood film. In view of this Patient was investigated for Myeloproliferative disorder, to our surprise Bcr-Abl positive was in 100% cells by Rt-Pcr.

Conclusion: Thus patient was diagnosed as a case of NHL with CML. Patient was given CHOP regimen with Imatinib therapy patient's lymphnode regressed after 2 weeks of first cycle. Simultaneous presence of two haematological malignancies are rare so this case is being presented here.

Sarcoidosis presenting as pancytopenia and hepatosplenomegaly: A rare presentation

Pratap Singh Ghalaut, Mohini, Jatinder Pehalajani, Arvind Chahal, Hament Dahiya, Ashima Mittal, Naresh Gaur


Department of Medicine, Pt. B.D. Sharma, PGIMS, Rohtak, Haryana, India

Background: Sarcoidosis is a multisystem inflammatory disease of unknown etiology that manifests as noncaseating granulomas, It predominantly involves the lungs and intrathoracic lymph nodes. The presentation in sarcoidosis varies with the extent and severity of organ involvement. Patients usually presents with fever, anorexia, dyspnea on exertion, cough, chest pain, and hemoptysis. Pancytopenia is a rare presenting feature of sarcoidosis.

Materials and Methods: We came across with a 50 year old female, presented with chief complaints of fever on and off and generalised weakness for one and half years, on examination pallor was present with hepatosplenomegaly. Patient was investigated for Myeloproliferative disorders, multiple myeloma and granulomatous disorders.

Observations and Conclusion: Patient was having pancytopenia with raised calcium level and phosphate level, with raised alkaline phosphate, serum ACE level was moderately raised, Paratharmone harmone level was normal. Ultrasonography of abdomen shows liver 20 cm with grossly altered echotexture and portal vein diameter was 15 cm. Spleen was 24 cm with normal echo pattern. Viral markers were negative, Liver biopsy was done which showed multiple small epetheloid cell granulomas with langhans giant cells without caseous necrosis compatible with hepatic involvement of sarcoidosis, bone marrow biopsy showed decreased trilineage hematopoesis. There was no evidence of granuloma or amyloidosis. Final diagnosis was kept as sarcoidosis with pancytopenia, patient was given steroid therapy and patient responded after 3 month of therapy.

Preneoplastic and neoplastic lesions of urinary bladder

Dishvin Bajwa, Sanjay Bedi, NC Mahajan


Department of Pathology, Maharishi Markandeshwar Institute of Medical Sciences and Research, Ambala, Haryana, India

Introduction: Urinary bladder cancer is seventh most common cancer worldwide with estimated 2,60,000 cases occurring each year in men and 76,000 in women. It accounts 3.2% of all cancers worldwide and is common in males than females (3.5:1).

Aims and Objectives: To study the morphological pattern in various pre-neoplastic and neoplastic lesions of urinary bladder.

Materials and Methods: It is presented a study which contained a no. of 23 cases of bladder lesions selected during year 2013. We described histopathological aspects corresponding to growing pattern, tumoral differentiation and invasion depth, as well as associated lesions, especially those of urothelium adjacent to tumors.

Observation and Results: There were total of 23 cases of bladder lesions reported in histopathology. Out of 23 cases, 3 were of in which few atypical cells, reactive urothelium was seen; 1 was of polypoidal cystitis; 1 was of in which fungal hyphae were seen; 6 were of Papillary Urothelial Neoplasm of Low Malignant Potential (PUNLMP); 3 were of Low Grade Papillary Urothelial Carcinoma and 9 were of High Grade Papillary Urothelial Carcinoma, out of these 9 cases 1 case was of High Grade Urothelial Neoplasm with Sarcomatoid component.

Conclusions: This study shows the experience of Urinary bladder tumors in a Medical college hospital in North India showing the incidence of premalignant and malignant conditions of urinary bladder. It shows the frequency of malignant lesions in the overall disease burden of urinary growths in our hospital.

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Source of Support: None, Conflict of Interest: None


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2006 - Asian Journal of Transfusion Science | Published by Wolters Kluwer - Medknow
Online since 10th November, 2006