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2007| January-June | Volume 1 | Issue 1
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Role of platelet transfusion in the management of dengue patients in a tertiary care hospital
RN Makroo, V Raina, P Kumar, RK Kanth
January-June 2007, 1(1):4-7
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.
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.
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.
Red cell antigens: Structure and function
January-June 2007, 1(1):24-32
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.'
Harvesting, processing and inventory management of peripheral blood stem cells
Aleksandar Mijovic, Derwood Pamphilon
January-June 2007, 1(1):16-23
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.
Evaluation of single unit red cell transfusions given to adults during surgery
Snehalata C Gupte, Amarnath Shaw
January-June 2007, 1(1):12-15
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.
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.
Surgery patients are receiving inappropriate transfusions. Continuous awareness programmes are needed to achieve judicious use of blood.
Platelet audit: Assessment and utilization of this precious resource from a tertiary care hospital
K Saluja, B Thakral, N Marwaha, RR Sharma
January-June 2007, 1(1):8-11
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.
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.
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.
Road blocks in achieving a 100% voluntary blood donation rate in the South Asian region
January-June 2007, 1(1):33-38
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.
Birth of a new journal
January-June 2007, 1(1):3-3
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