This study was aimed to review and establish the practice of exchange transfusion (ET) with reconstituted blood in neonates and to observe fall of bilirubin and its comparison with related studies. Twenty-five neonates diagnosed as hemolytic disease of newborn (HDN) were selected for this study, in which exchange transfusion was carried out as one of the treatments for hyperbilirubinemia. Out of the 25 cases, 15 were of Rhesus (Rh) HDN, while ABO and other blood groups constituted 6 and 4 HDN cases respectively. First, the neonates' and mother's blood samples were subjected to relevant investigations. After that, for neonates having Rh HDN, O Rh negative cells suspended in AB plasma were given, O Rh positive cells suspended in AB plasma were given to ABO HDN; and O positive cells, which were indirect Coomb's cross-matched compatible with neonates' and mother's serum / plasma, suspended in AB plasma were given to the neonates having HDN because of other blood group antibodies. The exchange transfusion (ET) was carried out taking all aseptic precautions by Push-Pull technique with double-volume exchange transfusion method. The average post-exchange fall in serum indirect bilirubin was (52.01%) in all 25 cases, which was found to be more significant than the previous studies. Looking into the superiority of the exchange transfusion in HDN by reconstituted blood, the reconstituted blood can be modified and supplied as per the requirement and conditions.

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Background and Objective: While medical fraternity globally recognizes the role of platelet transfusion in the management of hospitalized dengue patients the exact indications and situations in which these are to be transfused may vary. Since there is inherent risk associated with the transfusion of blood/blood-component, it is imperative for each institution (or country) to lay their own criteria for transfusion of these blood components. The present study was conducted to lay precise criteria and transfusion trigger for platelet transfusion in our set-up. Materials and Methods: The present study was conducted on 225 serologically confirmed dengue patients admitted at Indraprastha Apollo Hospitals between 1st of August to 30th of November 2005. Clinical data, reports of hematological investigation, platelets requirements and data obtained from daily follow-up were analyzed. The clinicians followed the guidelines issued by the Directorate of Health services, NCT of Delhi. Results: In the serologically confirmed cases, the prevalence of thrombocytopenia (count less than 100,000/cumm) was 84.88% on admission and bleeding was recorded in 22 (9.7%) patients. About 96 (42.6%) patients of dengue cases received platelet transfusion. Among them 47 (20.88%) patients had a platelet count <20,000/cumm, 43 (19.11%) had a platelet count in the range of 21-40,000/cumm while 6 (2.66%) patients had the platelet count in between 41 and 50,000/cumm. Out of 49 patients with a platelet count >20,000/cumm, 18 patients had haemorrhagic manifestations such as petechiae, gum-bleeding, epistaxis, etc., which necessitates the use of platelet transfusion. However, 31 patients received inappropriate platelet transfusion. Conclusion: This study suggests that bleeding occurs more often in patients with severe thrombocytopenia. High-risk patients having platelet count <20,000/cumm and risk of bleeding require urgent platelet transfusion. Patients with platelet count 21-40,000/cumm are in moderate risk and require platelet transfusion only if they have any haemorrhagic manifestations and other superadded conditions.

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Landsteiner and his colleagues demonstrated that human beings could be classified into four groups depending on the presence of one (A) or another (B) or both (AB) or none (O) of the antigens on their red cells. The number of the blood group antigens up to 1984 was 410. In the next 20 years, there were 16 systems with 144 antigens and quite a collection of antigens waiting to be assigned to systems, pending the discovery of new information about their relationship to the established systems. The importance of most blood group antigens had been recognized by immunological complications of blood transfusion or pregnancies; their molecular structure and function however remained undefined for many decades. Recent advances in molecular genetics and cellular biochemistry resulted in an abundance of new information in this field of research. In this review, we try to give some examples of advances made in the field of 'structure and function of the red cell surface molecules.'

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Hepatitis B virus (HBV) can be classified into nine immunological subtypes or eight genotypes. The most prevalent genotypes in Asia are genotypes B and C. HBV is transmitted parenteraly and can produce either asymptomatic or symptomatic disease. Although the consequences of acute hepatitis B can be severe, serious sequelae are associated with chronic infections. HBV seroprevalence ranges from intermediate (2%-7%) to high (≥8%) levels in Asia. Several strategies for the control and prevention of HBV infection have been found to be efficacious. They include vaccination and the administration of HBIG, interferon-a and nucleoside/nucleotide analogues. However, these procedures also apply selective pressures on HBV in infected individuals leading to the generation and accumulation of mutations in the S gene. Most of these mutations occur in the major hydrophilic region (MHR) of the S gene. These mutations create public health concerns as they can be responsible for reactivation of hepatitis B and occult hepatitis B infection. The inability to detect occult infections means that these individuals may become blood donors. This suggests that new strategies for donor evaluation and selection may need to be developed to protect the blood supply.

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Introduction: Apart from the visual assessment, measurement of plasma hemoglobin in the supernatant from red cell units provides an objective measure of the extent of hemolysis during storage. Study Design and Methods: Packed red cells (N=50), 25 units each in triple (CPD-A1 and SAGM) and quadruple (CPD-A1 and ADSOL) blood bags were evaluated for plasma hemoglobin by the tetramethylbenzidiene (TMB) method on day 1, 7, 14, 21 and 28 of collection. The hemoglobin, hematocrit, MCV, LDH and potassium levels were also noted. Whole blood units (N=25) were used as controls. Results: Hemolysis increased in all the stored red cell units. Plasma hemoglobin increased significantly in the first week of storage. The hemolysis, LDH and potassium levels were found to be significantly higher in the red cell units harvested from the triple blood bags. However, on day 28 of storage, free hemoglobin in all the red cell units was much below the 0.8% hemolysis. Conclusion: Hemolysis of the red cells increases due to processing and during storage and is maximum during the first week. Adequate process control and proper storage facilities should be ensured to minimize the hemolysis of red cells during processing and storage.

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By 2003, 97% autologous transplants and 65% of allogeneic transplants in Europe used mobilised peripheral blood stem cells (PBSC). Soon after their introduction in the early 1990's, PBSC were associated with faster haemopoietic recovery, fewer transfusions and antibiotic usage, and a shorter hospital stay. Furthermore, ease and convenience of PBSC collection made them more appealing than BM harvests. Improved survival has hitherto been demonstrated in patients with high risk AML and CML. However, the advantages of PBSC come at a price of a higher incidence of extensive chronic GVHD. In order to be present in the blood, stem cells undergo the process of "mobilisation" from their bone marrow habitat. Mobilisation, and its reciprocal process - homing - are regulated by a complex network of molecules on the surface of stem cells and stromal cells, and enzymes and cytokines released from granulocytes and osteoclasts. Knowledge of these mechanisms is beginning to be exploited for clinical purposes. In current practice, stem cell are mobilised by use of chemotherapy in conjunction with haemopoietic growth factors (HGF), or with HGF alone. Granulocyte colony stimulating factor has emerged as the single most important mobilising agent, due to its efficacy and a relative paucity of serious side effects. Over a decade of use in healthy donors has resulted in vast experience of optimal dosing and administration, and safety matters. PBSC harvesting can be performed on a variety of cell separators. Apheresis procedures are nowadays routine, but it is important to be well versed in the possible complications in order to avoid harm to the patient or donor. To ensure efficient collection, harvesting must begin when sufficient stem cells have been mobilised. A rapid, reliable, standardized blood test is essential to decide when to begin harvesting; currently, blood CD34+ cell counting by flow cytometry fulfils these criteria. Blood CD34+ cell counts strongly correlate with the apheresis yields. These are, in turn, predictive of the speed of haemopoietic recovery after transplantation, which has helped establish the adequate cell dose for transplantation. Following collection, PBSC may be transfused unmanipulated, processed to select specific cell subtypes, or stored for future use. Cryopreservation techniques allow long term storage of stem cells without significant loss of viability. Increasingly demanding calls for safety led to introduction of vapour phase storage, separate storage of infected material, and mandatory quality control measures at all stages of the cryopreservation process and subsequent thawing and transfusion. At the same time, safety of the personnel working in stem cell processing and storage laboratories is safeguarded by a set of regulations devised to minimize the risk of infection, injury or hypoxia. Requirements for quality and safety have been shaped into a number of documents and directives in Europe and USA, emphasising the importance of product traceability, reporting of adverse reactions, quality management systems (standard operating procedures, guidelines, training records, reporting mechanisms and records), requirements for cell reception, quarantine, process control, validation and storage. Establishments that collect, process and store stem cells must be accredited or licensed by appropriate national or international authorities on a regular basis. These regulatory measures have recently become law across the European Union.

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Three quality systems that can be used in blood establishments are briefly explained. The Pyramid model is described as a tool to manage the quality systems. Finally, some experiences in other countries are given to prove the validity of the system.

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Aim : The study was designed to find out the incidence of thrombocytopenia in leptospirosis and to correlate thrombocytopenia with other parameters like renal failure, hepatic failure and bleeding manifestation like adult respiratory distress syndrome and to assess the role of platelet transfusion. Materials and Methods : 50 cases of leptospirosis during the month of July and August 2005 were retrospectively analyzed. Criteria for selection were Lepto Tek Dri - dot test positive cases of the clinically suspected cases of Leptospirosis. Degree of thrombocytopenia was categorized as severe, moderate and mild. Presence of thrombocytopenia was clinically correlated with parameters like renal dysfunction, hepatic dysfunction and hemorrhagic manifestations (mainly ARDS). Role of platelet transfusion was assessed with reference to presence and degree of thrombcytopenia and hemorrhagic manifestations. Results : Out of total 50 patients 26 were male and 24 were females. Major bleeding manifestation in the form of ARDS was seen in 15 (30%) of patients. 28 (56%) patients had thrombocytopenia and 22 (44%) patients had normal platelet counts. Total number of patients with renal dysfunction was 24 (48%). Only four (18.18%) patients with normal platelet counts had renal dysfunction while 20 (71.42%) patients with thrombocytopenia had renal dysfunction. Only two (9.09%) patients with normal platelet counts and 48 (46.42%) patients with thrombocytopenia had hepatorenal dysfunction. Total number of patients with ARDS was 15 (30%). Of these two (13.33%) had normal platelet count while 13 (86.6%) patients were thrombocytopenic. Total 47 units of platelets were transfused to 12 patients in our study. Of these seven patients with severe thrombocytopenia required total 28 units, two patients with moderate thrombocytopenia required total seven units and patients with mild thrombocytopenia were transfused total 12 units of platelets. Conclusion : It is important to anticipate and recognize thrombocytopenia early in the course of leptospirosis so that appropriate steps can be taken to prevent it and to treat it with platelet transfusion when it develops

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Background: Autologous, and in some cases allogeneic, hemopoietic stem cells (HSC) are stored for varying periods of time prior to infusion. For periods of greater than 48 h, storage requires cryopreservation. It is essential to optimize cell storage and ensure the quality of the product for subsequent reinfusion. Methods: A number of important variables may affect the subsequent quality of infused HSC and therapeutic cells (TC). This review discusses these and also reviews the regulatory framework that now aims to ensure the quality of stem cells and TC for transplantation. Results: Important variables included cell concentration, temperature, interval from collection to cryopreservation, manipulations performed. They also included rate of freezing and whether controlled-rate freezing was employed. Parameters studied were type of cryoprotectant utilized [dimethyl sulphoxide (DMSO) is most commonly used, sometimes in combination with hydroxyethyl starch (HES)]; and storage conditions. It is also important to assess the quality of stored stem cells. Measurements employed included the total cell count (TNC), mononuclear cell count (MNC), CD34+ cells and colony-forming units - granulocyte macrophage (CFU-GM). Of these, TNC and CD34+ are the most useful. However, the best measure of the quality of stored stem cells is their subsequent engraftment. The quality systems used in stem cell laboratories are described in the guidance of the Joint Accreditation Committee of ISCT (Europe) and the EBMT (JACIE) and the EU Directive on Tissues and Cells plus its supporting commission directives. Inspections of facilities are carried out by the appropriate national agencies and JACIE. Conclusion: For high-quality storage of HSC and TC, processing facilities should use validated procedures that take into account critical variables. The quality of all products must be assessed before and after storage.

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Anti-M is a fairly common naturally occurring antibody with rarely causing hemolytic transfusion reactions or hemolytic disease of the newborn. Most anti-M are not active at 37 ^o C and can generally be ignored in transfusion practice. However, we did not find this antibody to be fairly common and detected only two cases of anti-M in the past three years. We describe these two cases; one 'immunizing' type and other 'naturally occurring' and review the literature. The immunizing type was reactive at 37 ^o C as well as AHG phase of testing with IgG component, and showing dosage effect while the other was 'naturally occurring' reactive well below 37 ^o C. Though rare, sometimes these antibodies can be of clinical significance when the antibody detected is reactive at 37 ^o C and AHG phase. When the antibody is active at 37 ^o C, M antigen negative cross match compatible red cell unit should be given.

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ABO and Rhesus (Rh) blood group antigens are hereditary characters and are useful in population genetic studies, in resolving medico-legal issues and more importantly in compatibility test in blood transfusion practice. Data on frequency distribution of ABO and Rh-D in Niger-Delta region of Nigeria are not available; hence we made an attempt to retrospectively analyze the records on the blood donors, transfusion recipients and patients attending antenatal care or some other medical interventions. Over a twenty-year period between 1986 and 2005, a total of 160,431 blood samples were grouped for ABO and Rh-D at the blood bank of the University of Benin Teaching Hospital, Benin City, Nigeria. Blood group distribution among these samples showed phenotypes A, B, AB and O as 23.72%, 20.09%, 2.97% and 53.22%, respectively. The Rh-D negative phenotype was found among 6.01% of the samples tested.

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Background and objective: The ready availability of blood in Surat city has resulted in its liberal use. Surat Raktadan Kendra and Research Centre (SRKRC) is 30 years old blood bank having license to supply blood components. In spite of publishing quarterly bulletin and organizing seminars to update clinicians' knowledge still we have not achieved rational use of blood. Present study has evaluated the use of single unit as well as whole blood transfusion for adult surgery cases. Materials and Methods: A total of 8470 surgery cases in the age group of 19 years to 95 years receiving 13070 units of whole blood and 3761 units of red cell concentrate (RCC) during surgery were analyzed on the basis of incidence of single unit and whole blood transfusions, sex and Hb values using Microsoft Excel. Results: Analysis revealed that 38.9% cases received single unit and 77.7% whole blood transfusions. Females more frequently received single unit transfusion than males (p<0.001). The highest incidence of single unit (62.2%) and whole blood transfusion (95.2%) was observed for urogenital surgeries. The lowest incidence (22.9%) of single unit transfusion was for cancer surgeries. There was no significant difference in the mean Hb level at which male and female cases, received single unit transfusion (p>0.5). Mean Hb concentration was about 10.0 g/dl for patients receiving single unit of whole blood and 8 g/dl for those who received single unit of RCC. Conclusion: Surgery patients are receiving inappropriate transfusions. Continuous awareness programmes are needed to achieve judicious use of blood.

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Background: To assess the appropriate utilization of platelet transfusions [random donor platelets (RDP) and single donor platelets (SDP)]; a six-month retrospective audit was carried out in a tertiary care hospital. Materials and Methods: A six-month retrospective platelet audit was carried out from May to October 2005 to estimate its preparation, appropriate utilization and wastage rate. Patient's demographics, transfusion triggers and episodes and ABO and Rh (D) group specific or non-group specific transfusions were also assessed. Results: About 5525 units of platelets [PRP-PC, 3,813 (69%); BC-PC, 983 (17.8%); PRP, 648 (11.7%) and SDP 81 (1.5%)] were prepared and transfused to 853 patients (RDP to 814 patients and SDP to 39 patients) in 2,093 transfusion episodes. Adult and pediatric hemato-oncology were the main user specialties utilizing 39.1 and 87.6% of the RDPs and SDPs prepared. Of the patients receiving RDPs, 95% were transfused ABO and Rh (D) group specific platelets whereas 100% SDPs transfusions were of group specific platelets. 88% of prophylactic platelet transfusions were appropriate as per the recommended BCSH guidelines. However, 12% of the prophylactic platelets were transfused inappropriately in cardiopulmonary bypass (CPB) surgeries with normal platelet counts and no evidence of bleeding related to platelets. Out of 5,444 RDPs prepared 1,585 (29.11%) units were not utilized. Conclusions: Regular audit of blood and blood components is a must so that necessary remedial measures can be taken to maximize appropriate and judicious utilization of each component.

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Cell separators in India are routinely used for plateletpheresis, peripheral blood stem cell collections and therapeutic plasma exchange. Therapeutic leukapheresis, particularly as an emergency procedure, has been uncommonly performed and reported. Here, a case of a 53-year-old male, diagnosed with acute myeloid leukemia subtype M5 (AML M5) with hyperleukocytosis, who underwent emergency leukaphereis, is reported. After two procedures, there was a decrease of WBC count by 85%, which enabled cytotoxic therapy to be initiated.

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Voluntary blood donation rates are not high in the South Asian region, except in a few countries. The reasons for this are outlined and the roadblocks for improvement of the situation noted. The need for increased planning, both regionally and nationally, is emphasized and some factors that inhibit voluntary blood donation are mentioned. There is a real need to move from a system of reliance on 'replacement' donors to a fully nonremunerated voluntary blood donation system, and the examples and lessons from successful countries should be carefully studied.

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Removal of leucocytes from various blood products has been shown to minimize Febrile nonhemolytic transfusion reactions, HLA alloimmunization, platelet refractoriness in multitransfused patients and prevention of transmission of leukotropic viruses such as EBV and CMV. Rapidly growing size of hemato-oncological patients in our country requiring multiple transfusion of blood and components during the course of their management pose a great challenge to transfusion services to provide them red cell and platelet antigen matched products in alloimmunized subjects. Thus removal of leucocytes below a certain threshold, ≤ 5 x 10 ⁶ in a blood component certainly helps in prevention of alloimmunization and associated risks in these patients. Currently the best Leucoreduction can be achieved with the help of 3rd and 4th generation leukofilters, both in laboratory and patient bed side, and state of the art apheresis devices. The present article briefly reviews the current literature for pros and cons of leucofilteration and its scope of implementation in the cost constrained settings.

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Background: Platelet rich plasma-platelet concentrate (PRP-PC), buffy coat poor-platelet concentrate (BC-PC), and apheresis-PC were prepared and their quality parameters were assessed. Study Design: In this study, the following platelet products were prepared: from random donor platelets (i) platelet rich plasma - platelet concentrate (PRP-PC), and (ii) buffy coat poor- platelet concentrate (BC-PC) and (iii) single donor platelets (apheresis-PC) by different methods. Their quality was assessed using the following parameters: swirling, volume of the platelet concentrate, platelet count, WBC count and pH. Results: A total of 146 platelet concentrates (64 of PRP-PC, 62 of BC-PC and 20 of apheresis-PC) were enrolled in this study. The mean volume of PRP-PC, BC-PC and apheresis-PC was 62.30±22.68 ml, 68.81±22.95 ml and 214.05±9.91 ml and ranged from 22-135 ml, 32-133 ml and 200-251 ml respectively. The mean platelet count of PRP-PC, BC-PC and apheresis-PC was 7.6±2.97 x 1010/unit, 7.3±2.98 x 1010/unit and 4.13±1.32 x 1011/unit and ranged from 3.2-16.2 x 1010/unit, 0.6-16.4 x 1010/unit and 1.22-8.9 x 1011/unit respectively. The mean WBC count in PRP-PC (n = 10), BC-PC (n = 10) and apheresis-PC (n = 6) units was 4.05±0.48 x 107/unit, 2.08±0.39 x 107/unit and 4.8±0.8 x 106/unit and ranged from 3.4 -4.77 x 107/unit, 1.6-2.7 x 107/unit and 3.2 - 5.2 x 106/unit respectively. A total of 26 units were analyzed for pH changes. Out of these units, 10 each were PRP-PC and BC-PC and 6 units were apheresis-PC. Their mean pH was 6.7±0.26 (mean±SD) and ranged from 6.5 - 7.0 and no difference was observed among all three types of platelet concentrate. Conclusion: PRP-PC and BC-PC units were comparable in terms of swirling, platelet count per unit and pH. As expected, we found WBC contamination to be less in BC-PC than PRP-PC units. Variation in volume was more in BC-PC than PRP-PC units and this suggests that further standardization is required for preparation of BC-PC. As compared to the above two platelet concentrates, all the units of apheresis-PC fulfilled the desired quality control criteria of volume. Apheresis-PC units showed better swirling and platelet count than PRP-PCs and BC-PCs. All the platelet concentrates units had pH well above the recommended norm.

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Background: Our blood bank is a regional blood transfusion centre, which accepts blood only from voluntary donors. Aim: The aim is to study iron status of regular voluntary donors who donated their blood at least twice in a year. Materials and Methods: Prior to blood donation, blood samples of 220 male and 30 female voluntary donors were collected. Control included 100 each male and female healthy individuals in the 18- to 60-year age group, who never donated blood and did not have any chronic infection. In the study and control groups, about 10% subjects consumed non-vegetarian diet. After investigation, 85 males and 56 females having haemoglobin (Hb) levels above 12.5 g/dl were selected as controls. Donors were divided into ≤10, 11-20, 21-50 and >50 blood donation categories. Majority of the donors in >50 donation category donated blood four times in a year, whereas the remaining donors donated two to three times per year. Haematological parameters were measured on fully automatic haematology analyzer, serum iron and total iron-binding capacity (TIBC) by biochemical methods, ferritin using ELISA kits and transferrin using immunoturbidometry kits. Iron/TIBC ratio × 100 gave percentage of transferrin saturation value. Statistical Analysis: Statistical evaluation was done by mean, standard deviation, pair t -test, χ² and anova ( F -test). Results: Preliminary analysis revealed that there was no significant difference in the iron profile of vegetarian and non-vegetarian subjects or controls and the donors donating <20 times. Significant increase or decrease was observed in mean values of various haematological and iron parameters in donors who donated blood for >20 times ( P < 0.001), compared to controls. Anaemia, iron deficiency and depletion of iron stores were more prevalent in female donors ( P < 0.05) compared to males and especially in those male donors who donated their blood for more than 20 times. Conclusion: Regular voluntary blood donors should receive iron supplementation to prevent iron deficiency and depletion in iron stores.

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Background: Despite the wide range of methods available for measurement of hemoglobin, no single technique has emerged as the most appropriate and ideal for a blood donation setup. Materials and Methods: A prospective study utilizing 1014 blood samples was carried out in a blood donation setting for quality evaluation of four methods of hemoglobin estimation along with cost analysis: Hematology cell analyzer (reference), HCS, CuSO4 method and HemoCue. Results: Mean value of HemoCue (mean ± SD = 14.7 ± 1.49 g/dl) was higher by 0.24 compared to reference (mean ± SD = 13.8 ± 1.52 g/dl) but not statistically significant ( P > 0.05). HemoCue proved to be the best technique (sensitivity 99.4% and specificity 84.4%) whereas HCS was most subjective with 25.2% incorrect estimations. CuSO4 proved to be good with 7.9% false results. Comparative cost analysis of each method was calculated to be 35 INR/test for HemoCue, 0.76 INR /test for HCS and 0.06-0.08 INR /test for CuSO4. Conclusion: CuSO4 method gives accurate results, if strict quality control is applied. HemoCue is too expensive to be used as a primary screening method in an economically restricted country like India.

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Splenectomy has been the conventional surgical treatment for patients with Immune Thrombocytopenic Purpura (ITP). Aim: To define response to surgical therapy, pre operative factors influencing outcome and tolerability of surgery in adult patients undergoing splenectomy for ITP. Method: We analyzed prospectively maintained data of 33 patients who were diagnosed as ITP and underwent splenectomy over the last 10 years. The age, presenting complaints, bleeding manifestations, clinical details and other investigations were noted. Details of immediate pre-operative administration of blood transfusions, platelet transfusions and other forms of therapy were also recorded. Operative details with regards to blood loss and the presence of accessory spleens were obtained. Postoperative course in terms of clinical improvement, rates of complications and platelet counts was also noted. Results: Skin petechiae and menorhhagia were common presenting symptoms in patients (mean age 26.5±10.5 yrs) with ITP. Eighteen patients underwent splenectomy for failure of therapy and fifteen for relapse on medical treatment. Mean platelet bags transfused in immediate pre-operative period were 2.8±0.8. Mean intra-operative blood loss was 205±70.5 ml. Accessory spleens were removed in 1 case (3.03%). The immediate postoperative response was complete in 19 cases (57.58%) and partial in 13 cases (39.39%). The platelet counts increased significantly from 23142±12680/ µL (Microliter) (mean ± SD) preoperatively to 170000±66000/µL (Microliter) within 24-48 hours after splenectomy ( P < 0.05). The mean platelet count was 165000+66000/µL (Microliter) at the end of one month when steroids were tapered off gradually. Four patients (12.12%) had complications (one each of wound hematoma, wound infection, splenic fossa collection and upper GI hemorrhage) in postoperative period but all responded to therapy. One relapsed patient was detected with accessory spleen and responded after re-surgery. Response to splenectomy was better in young patients and in those patients who had higher immediate post-splenectomy thrombocytosis. Conclusions: Splenectomy is safe and effective therapy in ITP patients with no response to steroids and relapse after medical therapy. Response to splenectomy was more in young patients and in those patients who had higher immediate post-splenectomy thrombocytosis.

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Background: In spite of the progress made in the prevention of transfusion transmitted infections over the last few years, transmission of HBV infection through transfusion of HBsAg negative blood has been documented. Objectives: To assess the frequency and clinical significance of anti-HBc in multitransfused hemodialysis patients. Materials and Methods: One hundred and forty-three hemodialysis patients who had been receiving blood regularly with an average of 39.4±7.579 months on hemodialysis were enrolled in this study. HBV markers (HBsAg, anti-HBc, anti-HBs) were measured in these patients and in 100 healthy controls by the ELISA technique. The following data were obtained for all patients: socio demographic data, number of blood transfusions and some laboratory investigations. Results: In our patients, anti-HBc was positive in 9%, anti HBs in 7%, coexistant HbsAg/anti-HBc in 2.8% and anti HBc /anti HBs in 18.9%, meanwhile no patients were positive for HBsAg alone. In patients with only positive anti-HBc, the levels of anti-HBc were significantly related to abnormal results of liver function. In patients with positive anti-HBs/anti-HBc (n = 27), 18 patients had abnormal liver function, and 9 patients had normal liver function with no significant difference between them. Conclusions: This study suggests that hepatitis B prevalence in our multitransfused hemodialysis patients is far in excess of that anticipated on the basis of HBsAg prevalence. Absence of HBsAg in the blood of hemodialyzed patients may not be sufficient to ensure lack of circulating HBV, and isolated positivity of anti-HBc may be a possible indicator of active hepatitis B infection.

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A case is described here of drug-induced immune hemolytic anemia (DIIHA) due to cefotetan administered to a post-partum woman who received the drug for infection prophylaxis at the time of caesarean section. Renewed fatal hemolysis occurred when the drug was given a second time 12 days after the first dose. The initial immunohematologic findings included a positive direct antiglobulin test (DAT) due to IgG and complement coating of the patient's RBCs as well as an eluate that did not react with RBCs in the absence of drug. The antibody was drug-dependent, reacting with both drug-coated RBCs as well as when the drug was added to a mixture of her serum and donor RBCs. Cefotetan has been a common cause of this uncommon problem. The clinical features of cefotetan DIIHA, classification of drug-induced antibodies, and the differential diagnosis of a positive DAT are briefly discussed.

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

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