Asian Journal of Transfusion Science
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TRANSCON 2020 CHENNAI Table of Contents   
Year : 2021  |  Volume : 15  |  Issue : 3  |  Page : 5-16
OP Transcon 2020 Abstracts Compilation



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Date of Web Publication29-Apr-2021
 

How to cite this article:
. OP Transcon 2020 Abstracts Compilation. Asian J Transfus Sci 2021;15, Suppl S1:5-16

How to cite this URL:
. OP Transcon 2020 Abstracts Compilation. Asian J Transfus Sci [serial online] 2021 [cited 2021 Oct 26];15, Suppl S1:5-16. Available from: https://www.ajts.org/text.asp?2021/15/3/5/315255



   45th National Annual Conference of Indian Society of Blood Transfusion and Immunohematology, Chennai, Tamilnadu Chapter Top



   Free Papers: OP 1 Top



   Vein assessment tool improves outcomes in double platelet product apheresis collections Top


Merline Augustine, Mohandoss Murugesan, Sangeetha K Nayanar, Maya Padmanabhan

Malabar Cancer Centre, Kannur, Kerala, India

Background: Vein selection is one of the principal factors determining the outcome of platelet donations. Double Platelet Product (DPP) collections (target yield ≥6x1011 platelets) by apheresis require longer procedure time than single dose collections. Vein assessment tool (VAT) was adopted in the past for whole blood donations.

Aims: To determine the phlebotomy and procedural outcomes using vein assessment tool and cubital vein patterns in Double Platelet Product collections.

Methods: Donors consented for DPP donation by institutional policy was included. VAT was based on assessing vein visibility, vein palpation and vein size with maximum score of 12 and the least being 0. The scores were graded: 0-7 (poor), 8-9 (fair) and 10-12 (good). Vein-viewer was used to illuminate the veins against the dark background for studying patterns (type 1 to 5). The arm selected for phlebotomy was based on the conventional method and was independent of the results obtained by VAT. Phlebotomy outcome was defined based on need for re-puncture. Procedural outcomes in terms of target yield attained and RBC reinfusion completed. Chi square test and Mann- Whitney U test used to assess the vein score and pattern against phlebotomy and procedural outcome.

Results: Out of 200 DPP collections, the phlebotomy outcome was successful in 183(91.5%) donations and 17 requiring re-puctures. Procedural outcome was successful in 184 (92%) donations. In 12 donations, procedure was terminated and RBC not re-infused. Among the re-punctures, 47% had poor and 35% had fair grades. There were significant difference in phlebotomy outcome (p=0.038) and procedural outcome (p<0.01) with respect to the grading of veins by VAT. Among the vein patterns, significance was observed only to procedural outcomes (p=0.05) and not to phlebotomy outcomes (p=0.095). Hematoma was most common complication in the donations requiring re-puncture (n=15). Re-punctures rates were lesser in repeat donors as compared to first time donors (4.7 vs. 11.4% p=0.124).

Conclusion: Adopting vein assessment tool will help reduce vascular complications and thereby improving the phlebotomy and procedural outcomes in double product platelet collections.


   OP 2 Top



   Insights from analysis of blood donor deferral in pursuit of donor and patient safety Top


Divjoth Singh Lamba, Suchet Sachdev, Rekha Hans, Hari Krishan Dhawan, Ratti Ram Sharma, Neelam Marwaha

PGIMER, Chandigarh, India

Background: Blood donor deferral is part and parcel of this commitment to assure the safety of the health of the blood donor as well as the recipient of the blood. The deferral has a negative impact on the psyche of temporarily deferred donor in terms of the return for blood donation.

Methods: A retrospective analysis of deferral amongst blood donors who presented at the blood centre over a span of nine years (2011-2019). The donors were selected in accordance with the Drugs and Cosmetics Act of 1940 and the rules therein as amended from time to time. The reasons were classified into four categories, i.e. donor safety, patient safety, donor and patient safety, and miscellaneous reasons.

Results: Overall 14.6% of prospective donors were deferred from donating blood. Majority (87.7%) donors were temporarily deferred. Almost equal number of donors (49.1 % & 48.5%) were deferred for donor safety and patient safety reasons respectively. Overall, low hemoglobin (21.6%), hypertension (11.4%) and history of jaundice of unknown origin (9%) were the three most common reasons for deferral. In donor safety, low hemoglobin (43.4%), hypertension (22.9%) and low blood pressure (4.5%), and for patient safety, history of jaundice of unknown origin (18.6%), common cold (15.8%), and high-risk behavior (8.8%) emerged as the three most common reasons for deferral respectively. In males, low hemoglobin (14.5%), hypertension (12.7%), history of jaundice of unknown origin (10%), and in females, low hemoglobin (76.8%), menstruation (2.7%), underweight (1.9%) emerged as the three most common reasons for deferral respectively. In donors above 40 years of age, low hemoglobin (23.6%), hypertension (21%) and history of jaundice of unknown origin (5.6%) emerged as the most common reasons for deferral. Notably, high-risk behavior (4.4%) is consistently observed a common reason for deferral in donors less than 50 years age.

Conclusions: Health initiatives towards fortification of diet with iron, school health programs like mid-day meal for provision of protein in diet, and screening for early detection of iron deficiency, hypertension and education about high-risk behavior would be the foundation pillars for the realization of better health for all and will help in provision of a safe and sustainable blood supplies.


   OP 3 Top



   Retrospective analysis of effectiveness of therapeutic plasmapheresis procedures in tertiary care hospital, Hyderabad Top


Murali Krishna Bogi, Shanthi Bonagiri, Sudhir Kumar Vujhini, Mahesh Kumar Kandukuri

Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India

Background: Therapeutic Plasmaphersis (TP) is used primarily in various immunological and other clinical conditions, in which the patient's blood is collected in to an apheresis machine and separated into plasma, and other cellular components (RBC, WBC &platelets etc).The cellular components are returned back to the patient and removed plasma is replaced by colloids/crystalloids. It primarily removes auto antibodies, immune complexes, high molecular weight proteins such as protein bound toxins. The present study was undertaken to study the various aspects of therapeutic plasma exchange in a tertiary care hospital in Hyderabad.

Aims: To study the effectiveness of therapeutic plasma exchange in neurological disorders

Methods: The present study, a retrospective analysis of TP was done for a period of one year from January 2020 to December 2020. Patients admitted with neurological disorders such as myasthenia gravis, guillain-barre syndrome, demyelinating disorders, myeloradiculopathies etc were requested for therapeutic plasmapheresis by the clinicians and as per the request we have done TP. Patients clinical laboratory data was collected from the case records before doing the procedure. We have replaced the plasma with Gelatine solution, albumin and normal saline.

Results: A total of 301 TP procedures were performed on 69 patients. Out of 69 patients 34 were females, 35 were males. Myasthenia gravis accounts for majority of the cases (18/69) followed by Guillain barre syndrome (11/69). Remaining 40 cases were contributed by Longitudinal extensive transverse myelitis, neuromyelitis optica, demyelinating disorders. Among 69 patients total of 301 procedures were done with minimum of one cycle to maximum of 7 cycles for one myasthenic patient. No severe adverse reactions were noted. 55out of 69 cases were improved in our study.

Conclusions: TP effectively removes immunoglobulins and other antibodies which are acutely toxic to the patient. TP is a safe and effective treatment which is cost effective in most neurological cases.


   OP 4 Top



   Blood donation by repeat voluntary blood donors in the age group 61-65 years and their contribution to the blood supply- Three years experience at a tertiary care hospital Top


Amena Ebadur Rahman, Rasika Dhawan Setia, Mitu Dogra, Ankita Sharma, Ramesh Yadav, Gokhula Prasath Thangavel

Dr. B. L. Kapur Hospital, New Delhi, India

Background: As per 2016 report by Ministry for Statistics and Programme Implementation, India had 103.9 million people above age 60 (8.5% of total population). Due to increase in older population, elderly blood donation is becoming necessary to maintain adequate blood supply. Prevalence of cardiovascular and cerebrovascular diseases increase with age which accounts for cautious approach by transfusion services in accepting older donors, who may theoretically be less able to tolerate sudden hemodynamic changes on donating a unit of blood.

Aims: We initiated a retrospective study from January 2018 to December 2020 and analyzed data of donors between 61-65 years, at a blood bank in a tertiary care hospital at New Delhi, India to assess:

  1. Whether raising upper age limit from 60 to 65 years has helped in overall gain
  2. In number of blood donations
  3. Was there increased incidence of adverse donor reactions in the elderly?
  4. What was the average hemoglobin (Hb) in this subgroup?
  5. Any additional clinical observations necessary?


Methods: We retrospectively collected and analyzed donor data, adverse donor reactions, donor deferral rates and Hb of donors in 61-65 years over three year period (January 2018-December 2020) and did comparative analysis with donors of age 18-60 years.

Results: Total 38424 whole blood donors were screened from January 2018 till December 2020 and 32998 donations done.177 (0.46%) of screened donors were in 61-65 years {163(92.09%) males and 14(7.9%) females}. Out of 177, 125(70.6%) were accepted and 52 (29.37%) were deferred mainly due to medical reasons as compared to 5767 (15.09%) in 18-60 years group. Mild vasovagal reaction was recorded in only 1 (0.84%) donor when compared to 278 (0.85%) in 18-60 years group. Average Hb in elderly group was 14.07g/dl when compared to donors in 18-60 years (14.65g/dl).

Conclusions: Despite higher donor deferral rate in 61-65 years, older donors could donate without undue health or safety risk to themselves. Adding donors beyond 60 years has been an added benefit to increase our donor pool by marginal 0.46%, which is significant if compared to percentage of donors at entry level in 18-19 years (0.46%). Considering these findings, donations by elderly should be encouraged as much as with younger group donors.


   OP 5 Top



   Tackling wastage in apheresis platelets inventory during normal and unprecedented times Top


S Usha, E Manikanda, K Yabesh V Ramakrishnan, Vikas Hegde

Apollo Speciality Hospitals, Chennai, Tamil Nadu, India

Background: Apheresis platelets are precious, costly and short-lived components. Being a Centre supporting high volume of Haematopoietic Stem Cell Transplant and oncology cases, storage of these platelets is practised to support patients with these much sought-after critical components. The demand for these platelets is sudden, unpredictable and variable - paediatric patients less than 30kg require only “half” unit. .Reviewing their wastage can guide towards better inventory management.

Aims:

  1. To explore the scope of minimizing wastage of apheresis platelets due to expiry
  2. To study the effect of “lockdowns”.


Methods: Data was collected retrospectively from Blood Centre Discard Records from Jan 2019 to Dec 2020 at Apollo Speciality Hospitals Blood Centre, Chennai.

Results: Overall wastage of apheresis platelets due to expiry was 4.34% of collection (151.5 of 3485). Of the total wastage, 95 were “full” units (62.70%) & 56.5 were “full unit equivalents” (37.29%) (n=113 “half” units). Wastage was 16.34% more in year 2020 than in year 2019. Notably, from Mar'20 to Aug'20, wastage as “half” units was double the number (n=41) observed during the same period in year 2019 (n=20).

Conclusion: There is scope for minimizing wastage by reducing the wastage of “half” units. These are left-over components with no takers subsequently, as there are no current regulations/guidelines for issuing them to adult patients. Issuing “full unit equivalents” to adults would reduce wastage and lessen the pressure on donor arrangements, not only in general, but also during unprecedented times like “lockdowns”. Frequent interruptions in the services cause loss of these short shelf-life products atleast 1.5 times more than that can be expected in the normal times.


   OP 6 Top



   A comparative study of iron status in first time donors and regular repeat blood donors at a tertiary care centre in Jammu division Top


Lubna Naseer, Vijay Sawhney, AS Bhatia, Ritika Basnotra, Salve Sharma

GMC, Jammu, Jammu and Kashmir, India

Aims: The purpose of study was to evaluate and compare the iron status of first time donors and regular repeat donors using hematological and biochemical parameters. To assess the influence of frequency of blood donation on iron stores of the donor.

Methods: This 1 year Prospective, Cross-sectional study was conducted on 413 donors in Immuno-haematology &Transfusion Medicine Department, GMC Jammu. Donors were divided into First time donors (n=109) Repeat donors (n=304).

Repeat donors were further sub grouped:

1: On the basis of frequency of donation

Group A (n=160)1 to 5 donations in last 2 years.

Group B (n=79)6 to 10 donations in last 3 years.

Group C (n=51)11 to 15 donations in last 4 years.

Group D (n=15)15 donations

2: On the basis of inter-donation interval

Group 1,2,3,4 with inter donation interval of 3 months, >3 – 6 months, >6-9 months, >9 months respectively.

Results: First time donor group showed significantly higher hemoglobin content (13.57 ± 0.58) compared to repeat donor group (13.20 ± 0.55). Also, first time donor group showed significantly higher MCV, MCH, MCHC (85.54 ± 3.12, 28.53 ± 0.81, 33.63 ± 1.22 respectively) compared to repeat donor group (82.10 ± 5.86, 27.70 ± 1.91, 33.35 ± 1.21 respectively) p <0.0001. Serum iron, serum ferritin, Transferrin saturation in the first time donors (131.06 ± 10.18, 197.76 ± 24.19, 37.44 ± 3.49) was significantly higher compared to repeat donors (83.99 ± 18.53, 72.97 ± 27.23, 23.17 ± 5.40) while TIBC level in first time donors (350.74 ± 18.49) was significantly less (p value <0.0001) in comparison to repeat donors (369.77 ± 31.66). The ferritin level was highest in Group A (91.27 ± 15.19) followed by Group B (69.06 ± 12.95) and lowest in Group D (17.88 ± 3.97) difference was statistically significant. The serum ferritin and iron was highest in Group 4 (102.81 ± 17.24, 102.00 ± 15.30 respectively) followed by Group 3 (97.63 ± 10.29, 101.88 ± 8.54 respectively) and lowest in Group1 (59.17 ± 23.85, 59.17 ± 23.85 respectively) difference was statistically significant.

Conclusions: Increased blood donation frequency and decreased inter donation interval affect iron stores significantly. Hemoglobin measurement alone is not enough to evaluate donor suitability.


   OP 7 Top



   Evaluation of hematological and biochemical changes during storage in packed red blood cell unit: A prospective study in a tertiary care hospital Top


Jagannath Sahoo, Pankaj Parida, Sabita palai, Binay bhusan Sahoo

SCB Medical College, Cuttack, Odisha, India

Background: Packed Red blood cells units are the most transfused blood components worldwide. It can be stored upto six weeks at 2 to 6°C.Despite recent advances in improvement in blood storage conditions, a wide variety of harmful molecular,biochemical and physical alterations have been identified during storage that are collectively referred to as storage lesions.

Aims: To evaluate and compare the hematological and biochemical parameter changes in the packed red blood cell unit on different days of storage in preservative solution of CPDA and SAGM.

Materials and Methods: This prospective study was conducted in the Department of Transfusion Medicine SCB MCH,Cuttack between October 2018 to September 2020. A total of 100 prepared packed red blood cell units have been included in this study, 50 units each preserved with CPDA and SAGM. The study parameters included hematological parameters such as hemoglobin, hematocrit, plasma hemoglobin and biochemical parameters like supernatant sodium, potassium and pH which were measured on 0, 7, 14, 21, 28 and 35 days of storage.

Results: The evaluation showed a progressive decrease of mean hemoglobin and mean hematocrit in both the groups but CPDA units showed a lower decrease at the end of storage period. The mean percentage of hemolysis showed gradual increase in both the units, but, CPDA units showed a higher increase in the value of mean percentage of hemolysis .The Mean Supernatant sodium level showed a continuous decrease and mean supernatant potassium level increased markedly during storage in both CPDA as well as SAGM units but on day 35 CPDA units showed higher value of potassium as compared to SAGM units. The mean pH value gradually declined in both CPDA as well as SAGM units throughout the storage period.

Conclusions: This study reveals the hematological parameters of red cells are within the acceptable limits but the biochemical changes are significant which may contribute to adverse transfusion effects.


   OP 8 Top



   Quality assessment of platelet concentrates prepared by platelet-rich plasma, buffy coat, and apheresis methods in a tertiary care hospital in south India – A cross-sectional study Top


Esha Toora, Rajendra G Kulkarni, Apurba Sankar Sastry, M Prabhu

JIPMER, Pondicherry, India

Background: Recent advances in diagnosis and treatment of various diseases has led to an increased demand for specific blood component therapy. After Packed red blood cell the most commonly used blood component is Platelet concentrate which is prepared by different methods each having its own advantages and disadvantages. Tertiary care hospital like ours requires platelet products in large numbers .We prepare platelet products by different methods. The quality of platelet products prepared plays an important role in their therapeutic outcome.

Aims: Assess quality of platelet concentrates prepared by platelet-rich plasma, buffy-coat, and apheresis methods.

Methods: This is a cross-sectional study done in a tertiary care hospital in South India. A total of 760 platelet concentrates (PC) were prepared by 3 different methods – Viz., platelet-rich plasma (PRP), buffy coat (BC) and apheresis methods (PRP- PC, BC-PC and apheresis-PC: 124, 176 and 460 units respectively.) In-vitro quality of platelet concentrates were assessed by observing volume, swirling, platelet count, WBC count per bag, RBC count per bag, pH and sterility (RDP's only). Statistical analysis was performed using SPSS version 22.0.

Results: The mean volume of PRP-PC, BC-PC and apheresis-PC was 59.48± 6.84ml, 60.59±3.29 ml and 395.04± 32.72 ml and ranged from 30-75 ml, 42-69 ml and 116-402 ml, respectively. The mean platelet concentration of PRP-PC, BC-PC, and apheresis -PC were 4.48± 1.33×1010/ unit,4.56± 1.25×1010 it, and 5.71± 1.1×1011/unit and ranged from 0.8-8.7×1010/ unit, 1.3-9.8×1010/unit and 0.78-9.38×1011/unit, respectively. The mean pH was 6.51± 0.31 (range: 6.0-7.2).Comparison between PRP-PC, BC-PC shows not much difference in yield.

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. All the platelet concentrates units had pH well above the recommended norm. More than 84% of PCs prepared by all the three methods were within the acceptable quality standards as per Indian drugs and cosmetic act and other guidelines.


   OP 9 Top



   Buffy coat pooled platelet concentrate: A new age platelet component Top


Hari Krishan Dhawan, Rakesh Kumar, RR Sharma, Jyotdeep Kaur

PGIMER, Chandigarh, India

Background: Buffycoat pooled platelet concentrate (BCPP) is a new blood component mainly used in Europe and is recently included as a new blood component for clinical use in our country as per the drugs and cosmetics (Second Amendment) Rules, 2020.This blood componenthave good attributes of both conventional platelets (Random Donor Platelets and Apheresis Platelets) as they are available at low cost, contain large number of platelets, can be leukoreduced and be made available in emergency conditions.

Aims: The study was done to compare quality parameters and biochemical activation markers among buffycoat pooled platelets (Non-leucoreduced vs Leucoreduced vs Leucoreduced with Platelet Additive Solution [PAS]) and apheresis platelet concentrate (AP-PC) to establish the quality and safety of this new blood component during storage.

Methods: We prepared three different preparations of BCPP non-lecoreduced (BCPP Part A), Leucoreduced (BCPP Part B) and Leucoreduced with PAS (BCPP Part C) using a pool of 15 ABO matched buffycoats in each experiment to avoid any donor related variations. Ten such experiments were done. As the pool of 15 was divided into three parts, virtually each BCPP unit was equivalent to 5 buffycoat units. Ten apheresis platelets were also taken as control.Serial samplings were done from these platelet components on day 0,3 and 5 of collection and were assessed for following parameters:Volume, platelet count, WBC Count, swirling, pH, Sterility, glucose, lactate, soluble p-selectin, Intelukin-6, Interlukin-1β and TNF-α.

Results: BCPP part C (Leucoreduced with PAS) maintained the best quality control parameters and platelet activation markers in terms of maintenance of pH, least lactate accumulation, least sP-selectin levels and least accumulation of inflammatory mediators (Intelukin-6, Interlukin-1β and TNF-α) than the other groups i.e. BCPP part B, AP-PC and BCPP part A. On day 5 of storage pH for BCPP Part A, Part B, Part C and AP-PC was respectively: 6.33, 6.42, 6.64 and 6.29 and Soluble p-selectin (ng/ml) were 201.04±21.69, 186.66±10.6, 149.07±17.9, 200.03±23.3 respectively. BCPP part B and AP-PC had comparable quality control parameters and platelet activation markers. BCPP part A (Non-leucoredued) had the maximum platelet activation and accumulation of inflammatory mediators out three variations and are comparable to random donor platelets.

Conclusions: This study concludes that Buffycoat pooled platelets have comparable and even better quality control parameters (specially Leucofiltered with PAS) than conventional platelet preparations and are good alternative for meeting platelet transfusion requirements of critical patients during emergency hours. As BCPP recently got listed for use in India, thisdata will provide some scientific evidence to promote the use of this product in our country.


   OP 10 Top



   Red blood cell alloimmunization among recipients of blood transfusion in India; A systematic review and meta-analysis Top


Shamee Shastry, Deepika Chenna, Abhishekh Basavarajegowda, Soumya Das, Rajendra Chaudhary

Kasturba Medical College, Manipal, Karnataka, India

Background: Clinically significant alloantibodies can lead to serious transfusion reactions or hemolytic disease of the newborn. There is limited knowledge on the most prevalent RBC antibodies in the Indian population. This knowledge gap is taken as the main review question to study the commonly found red cell antibodies among Indians receiving red cell transfusion.

Methods: The review was planned and conducted following the PRISMA guidelines. We have searched the MEDLINE, SCOPUS, CINAHL, EMBASE, and Google Scholar bibliographic databases with no restriction in search dates. All the original articles in the English language on alloimmunization among recipients of blood transfusion conducted on the Indian population were included for the review. Both the studies conducted on pediatric and adult age groups were considered. Studies on alloimmunization among antenatal cases without a history of blood transfusion and the animal studies were excluded. A standardized data extraction form was used to extract data from the studies included for evidence synthesis. Extracted information included the study setting, study population, participant demographics, and baseline characteristics, details of case and control conditions, study methodology, and outcomes. The risk of bias was assessed independently by two study authors.

Results: A total of 372 articles were identified in the search process. After the removal of duplicates, 330 articles were processed for title and abstract screening following which 68 articles were included for full-text screening. A total of 44 full-length articles fulfilled the inclusion criteria and qualitative data extraction and meta-analysis was performed. The overall proportion of alloimmunization rate was 0.052% (95% confidence interval 0.024-0.08). Concerning antibody specificity, anti- D (24%) was most common followed by anti-E (22%), anti-c (10%), anti-K (8%), and anti-M (6%). Heterogeneity between studies was high mainly because of inconsistencies in study population and study duration.

Conclusion: This review provides an insight into the extent of alloimmunization among recipients of blood transfusion in the Indian population. Apart from matching for D antigens, if we practice matching for 'E', 'c', and 'K' antigens as a part of pre-transfusion testing, we will be able to reduce the development of alloantibodies by 73% in the Indian population.


   OP 11 Top



   Quantitative assessment of alpha (α) and beta (B) haemolysin antibodies incidence among blood group 'O' healthy volunteer donors Top


Deva Japa Ajith, Sanjeeth Peter

GMCCC and R Society Bloodbank, DDMM Heart Institute, Nadiad, Gujarat, India

Background: Blood group- O individuals can have potent high titer anti-A and anti-B antibodies (haemolysins) in the serum. As a rule, all group O blood red cells that are intended for use against ABO blood group barrier in blood group A, B and AB individuals must be tested for high titre anti-A and B haemolysins. The shortages have resulted in the increasing transfusion of group O blood Type as -Universal donors to non group O individuals.

Aims: Only those that are negative should be used for group A, B and AB recipients? What is the frequency in our population.To determine the incidence of ά and β haemolysins in healthy blood group O donors in the Blood Bank Unit.

Methods: Blood samples (5mls) was collected from each subjects by venepuncture into 2 tubes; EDTA anticoagulated tube (3 mls) and plain tubes without anticoagulant (3mls). One volume of donor serum and one volume of absorbed fresh blood group O serum was added each into 3 test tubes labelled A, B and O. The absorbed fresh blood group O serum was added to provide a source of complement. The ability of serum to lyse red cells with the group specific antigens is dependent on the presence of complement. The complement content of plasma tend to diminish on storage. To each tube was added 1 volume of 5% suspension of red cells of group A, B, and O respectively. The O cells were used as negative control because blood group O individual do not have ABO blood antigens (A and/or B) on their red cells. The tubes were then incubated at 37 0 C for 1 hour. All tubes were centrifuged lightly post incubation at 1,000 rpm. They centrifuged tube were then examined microscopically without distortion of the red cell button for signs of haemolysis microscopically. Haemolysis was graded as follows; 3+ (complete haemolysis), 2+ (partial with more than 50% but not complete haemolysis), 1+ (trace haemolysis) and negative (no visible haemolysis). All donor serum samples showing haemolysis were then titrated for anti-A and anti-B haemolysins using standard A and B cells respectively. A critical titre of ≥64 was considered a positive test. In summary, titration was carried out by adding 2 millilitres of each test serum in a tube. The serum was then double and serially diluted in saline up to 256. Equal volume (0.5 mls) of each serum dilution was added into 3 tubes labelled A, B and O. Subsequently, 0.5 mls of absorbed fresh group O serum were added to each of the 3 tubes. To each tube was than added 0.5 mls of 5% standard A, B and O cells respectively and the mixture was incubated at 37 0C for 1 hour. Post 1 hour incubated samples were examined for haemolysis microscopically and the least titres at which show a confirmed microscopic were recorded as the critical titres. Haemolysis was graded as follows: 3 + : complete, 2 + : partial (more than50% but not complete), 1 + : trace, Negative: no visual visible haemolysis.

Study Design: This was a prospective case study designed to evaluate the prevalence of high titre alpha and beta haemolysin among blood donors of O Group.

Results: This study comprised of 110 Voluntary donors whom Alpha and Beta haemolysin was done in GMCCC&R Society Blood Bank, Nadiad, Gujarat over a period of three months from 7th November 2019- 30th January 2020.The study showed the voluntary donors mean age was 32.77±9.02 which is a quality indicator that blood bank focused on young blood donors. In this study majority of the donors are regular donors i.e. 61.82% which is a good indication for the quality and safety of the recipients whereas 38.18% of the donors are first time donors. The study revealed Alpha Haemolysin A is negative in only 79.4% and 76.2% of the regular and first time donors respectively while remaining showed from trace to partial level. Study revealed 27.9% showed trace to partial haemolysin for Beta haemolysin and 2.4% showed highest haemolysin. Our study showed α and β absent in the 67.3%, α haemolysin seen in 15.5%, β haemolysin seen in 10.9%.

The overall prevalence of Alpha and Beta haemolysin was seen in 5.5% and 10.9% of the donors and while that of donor having both Alpha and Beta haemolysin in their sera was 15.5%.

Conclusion: This study has shown that the quantitative assessment of Alpha and Beta haemolysin is higher particularly among blood group O donor in GMCCC & R Society Blood Bank, Nadiad. We recommend that all group O donor be screened routinely for titer Alpha and Beta haemolysin and that blood group O red cell intended for use as universal donor unit must be screened and found negative for high titer Alpha and Beta haemolysin. Study confirms that titration of Alpha and Beta haemolysin in blood bank will increase safety in non-identical ABO transfusion and transplant.


   OP 12 Top



   Understanding molecular mechanisms responsible for rhd negative phenotype in Indians Top


Garima Mishra, Manisha Madkaikar, Swati Kulkarni

ICMR- National Institute of Immunohematology, Mumbai, Maharashtra, India

Background: RhD status remains ambiguous in some individuals due to the presence of RhD variants. Based on the type of antisera used, these variants can be classified as RhD positive or negative. Thus, in some developed countries molecular typing of all RhD negatives is mandatory. To design genotyping strategy, the molecular basis of RhD negativity in a given population must be known. The commonly observed mechanisms causing RhD negative phenotype in different ethnic groups include entire RHD deletion, RHD-CE-D hybrid formation and various SNPs. However, knowledge of the molecular mechanisms responsible for RhD negativity in Indians is not known.

Aims: This study was aimed to determine the molecular basis of RhD negativity in Indians.

Methods: Rh phenotype in 1123 apparently RhD negatives samples was determined by different clones of anti-D( P3x61+MCAD6, LDM1/ESD1M),anti-C(MS-24),anti-c(MS-33),anti-E (MS- 80 + MS-258)and anti-e(MS-16 + MS-21 + MS63) reagents. Rh genotyping was performed by RHD quantitative multiplex PCR of short fluorescent fragments (QMPSF) for all exons of RHD gene. In absence of few RHD exons further characterization by RHCE QMPSF was done. Samples showing presence of all RHD exons were further characterized by Sanger's sequencing.

Results: Six samples were identified as RhD variants. The most common RhD negative phenotype was rr (90.2%) followed by r'r (8.1%), r”r (1.1%) and r'r' (0.6%). In one sample the rare r'r” phenotype was identified. Molecular characterization revealed the presence of RHD-CE (3- 8)-D, RHD-CE (3-9)-D, RHD-CE (1-9)-D and RHD-CE (4-9)-D hybrids in 19.8% RhD negative samples with C/E antigens. In four samples, the entire RHD gene was identified. Complete deletion of the RHD gene was detected in 96.6% RhD negative samples.Two SNPs, 443C>G and 701delG also detected in samples with all RHD exons.

Conclusions: The presence of RhD variants (0.5%) among RhD negative samples emphasizes the necessity of having an RhD typing strategy. Deletion of the entire RHD gene was found to be a predominant mechanism in RhD negative Indians. However, 25.2% of samples with C/E positive antigens showed the presence of one or more RHD exons. These findings will now fill the lacunae and help in designing an Indian specific RhD typing strategy.


   OP 13 Top



   Red cell alloimmunisation and its significance – 2 year study in regional referral center Top


T Varnisha, P Arumugam, Swathandran Hamsavardhini

The Tamil Nadu Dr. M.G.R. Medical University, Chennai, Tamil Nadu, India

Background: It is well established that unexpected red blood cell alloantibodies can cause hemolytic transfusion reactions, discrepancies in compatibility testing, HDFN and may complicate HSC and solid organ transplant.

Aims: In this study, the prevalence of different red cell alloantibodies found in general patient population and in antenatal mother were analysed.

Methods: The clinical data and the results of the Immunohematological workup of blood samples received between January 2019 and December 2020 at The Tamil Nadu Dr.MGR Medical University were retrospectively analyzed.

Results: Out of 150 samples received, Alloantibodies were identified in 57 patients (38%). The types of antibodies detected are listed in [Table 1]. Of 60 alloantibodies identified, the rate of alloimmunization in general patient population and antenatal mothers were 41% (n=25) and 59% n=35) respectively. Among general patient population, Anti-M (10/25;40%) seems to be the most common alloantibody followed by Rh antibodies, anti-c (6/25;24%) and anti-E (3/25;12%). Of 35 alloimmunized antenatal mother, anti-D was the most common alloantibody (22/35; 62.8%), followed by anti-C (5/35;14.2%) and Anti-E (4/35;11.4%). In general population, the history of multiple transfusion for hematologic pathologies such as aplastic anaemia, myelodysplastic syndrome, thalassemia, sickle cell anemia, Paroxysmal nocturnal hemoglobinuria was the main reason for alloimmunization. Other causes includes Chronic kidney disease with hemodialysis, Dysfunctional uterine bleeding and Proinflammatory conditions like Diabetic foot ulcer with Anemia.
Table 1: Prevalence of red cell antibodies in general population and antenatal mothers

Click here to view


Conclusion: In our study, prevalence of alloimmunization was common among antenatal mother than general patient population, which emphasis on need for proper antenatal antibody screening and timely administration of RhIg Immunoprophylaxis. Judicious transfusion of phenotypically matched RBCs at least for Rh and Kell antigens will be a preventive strategy for alloimmunization in patients with multiple transfusions.


   OP 14 Top



   Comparison of syphilis testing by reverse algorithm and conventional method among blood donors in a tertiary care center Top


Athira Sasidharan, Susheela J Innah, Chithra Valsan, Nithya M Baiju, AM Rafi

Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India

Background: Traditional testing algorithm for syphilis begins with screening non-treponemal test such as RPR, followed by confirmatory treponemal test such as fluorescent antibody or treponema pallidum particle agglutination assay (TPPA) /TPHA. Reverse algorithm first screens with a treponemal test; reactive samples are then tested by RPR which is used to assess disease activity. Discordant syphilis IgG and RPR results are resolved by a second treponemal test (TPPA/TPHA), as recommended by the Centers for Disease Control and Prevention laboratories. This study was performed to investigate the performance analysis of reverse and traditional algorithm in syphilis infection among blood donor population in a tertiary care center.

Aims: To evaluate the analytical performance of reverse algorithms in syphilis infection among donors in comparison with conventional methods.

Methods: This was a cross sectional study done in the department of transfusion medicine from January 2019 to February 2020. The study population comprised 8635 blood donors. All the donors who consented for the study were accepted for blood donation. After blood collection all the blood samples in the red tubes were subjected for TTI screening of syphilis. As per the study, samples screened for syphilis using chemiluminescent immunoassay (Vitros syphilis TPA assay) in Vitros 3600 EQ/ECIQ immunodiagnostic system and RPR (omega RPR test kit) irrespective of each other's result. Whenever chemiluminescence immunoassay or RPR turns positive, the samples were sent for TPHA (Immutrep TPHA test kit). TPHA is considered as the gold standard method in the present study and thus for comparing the results in both methodologies, additional samples were also taken which were negative in TPHA and compared with other RPR and TPHA.

Results: Among 8635 samples tested, seroreactivity of CLIA (Vitros syphilis TPA assay) was 0.25 % whereas for traditional algorithm 0.13%. Sensitivity, specificity and accuracy of reverse algorithm in comparison with traditional was 100 %, 70.6%, 78.3% and 36.4% ,75% and 65.1% respectively. In comparison with TPHA, Vitros TPA assay in reverse algorithm showed moderate agreement (k=0.56, p=0) which was statistically significant whereas RPR showed slight agreement (k=0.11, p=0.47). Negative predictive value of CLIA was 100% (p=0) which was statistically significant. Positive predictive value of reverse algorithm was 54.5% and 33.3% for traditional algorithm (p=0.04).

Conclusion: Performance analysis of reverse algorithm using Vitros TPA assay as a first line screening is superior to traditional algorithm even though false positive rate is high to ensure safe issue of blood.


   OP 15 Top



   Pre donation counseling for transfusion transmitted infections: Are we doing enough? Top


Tanvi Sood, Ravneet Kaur, Kshitija Mittal, Paramjit Kaur

Government Medical College and Hospital, Chandigarh, India

Background: Pre-donation counseling provided to prospective blood donors enables them to self-defer if they recognize themselves unsuitable to donate blood due to presence of risk factors.

Aims: To analyse risk factors among blood donors reactive for various transfusion transmitted infections.

Methods: The study was conducted over a period of 18 months. Blood donor samples were screened for HIV1&2, anti HCV, HBsAg and RPR using approved fourth generation, third generation ELISA and RPR kits respectively as per manufacturer's instructions. The seroreactive donors were notified. Data regarding socio-demographic characteristics and other relevant history was obtained from donor record form and post donation counselling register.

Results: Of total 33,550 blood donations, 354 (1.06%) donations were seroreactive for HIV 1&2, anti HCV, HBsAg and RPR. Of these 354 donors, the seroreactivity was 20 (5.7%), 150 (42.4%), 130 (36.7%) and 54 (15.2%) for HIV 1& 2, anti HCV, HBsAg and RPR respectively. Majority of the donors (98.6%) were males and 50% were below 30 years of age. HIV: Seventy percent (n=14) of HIV reactive donors reverted back and 12 of them (85.7%) revealed history of risk factors in form of high risk sexual behaviour(n=9) or prolonged hospitalization and blood transfusion (n=3). HCV: Eighty nine out of 150 (59.3%) HCV reactive donors who responded, majority (n=87) gave history of one or other risk factor (10 donors gave history of I/V drug abuse, 54 donors gave history of instrumentation and 23 of jaundice in themselves or in their family). HBsAg: Of 130 HBsAg reactive donors, 74 (56.9%) donors reverted back to the department. All but one revealed one or the other risk factor (11 were known cases, 15 revealed high risk sexual behaviour history, 29 donors gave history of instrumentation, 5 of blood transfusion and 13 of jaundice in themselves or in their family) RPR: Out of 54 RPR reactive donors, 37 (68.5%) donors responded. Three were known cases while in 23 donors history of high risk sexual behaviour could be elicited.

Conclusion: The present study emphasizes on the need to strengthen pre donation counselling and screening for risk factors in outdoor voluntary blood donation camps.


   OP 16 Top



   Seroprevalance of hepatitis 'E' among healthy blood donors in a tertiary care hospital in southern India Top


P Sunantha, B Abhishekh, Rahul Dhodapkar

JIPMER, Pondicherry, India

Background: There is a recent rise noted in the number of transfusion transmitted Hepatitis E virus (HEV) infection. Asymptomatic infections of HEV have been found in blood donors. HEV seroprevalence in immunocompetent individuals is 1%–5%. The predilection of HEV for young adults, who are also eligible donors, increases the risk of transmission of the virus through blood transfusion.

Aims: To determine the Seroprevalence of HEV and associated sociodemographic features in Southern India.

Methods: This is a cross- sectional descriptive study done in a tertiary care hospital in South India. After getting informed consent a total of 920 samples collected after blood donation for routine TTI screening tests in the blood were tested using Dia.Pro HEV IgM kit (Diagnostic Bioprobes Srl, Milano, Italy). The antigen used for coating are four synthetic peptides with conservative epitopes of ORF2 and ORF3 in genotypes 1, 2, 3, and 4. Statistical analysis was performed using SPSS version 22.0.

Results: Out of 920 samples tested, 13 samples were found to be reactive. (1.41%) 95% CI: 0.75%-2.40%. Among the tested samples which were reactive, 7 donors were Replacement donors (53.8%) and 6 donors were voluntary donors (46.2%).12 male donors (92.3%) and 1 female donor (7.7%) were found reactive. 9 donors were at the age of 18-30 (69.2%) years. 7 donors belong to lower middle economic class (53.9%) followed by upper middle (38.5%). 2 donors had family history of jaundice (15.4%), 2 donors had chronic illness suffering in their family (15.4%) and one donor had family member with recent onset illness (7.7%). None of them were reactive for other routine TTI infections.

Conclusions: Seroprevalence of HEV obtained from this study is 1.41 %. These results were in concordance with few studies from North India. Systematic studies from different geographical areas are required to quantify the HEV burden and the impact of implementing HEV testing as a part of routine TTI screening of blood donors.


   OP 17 Top



   Effect of therapeutic plasma exchange on anca antibodies in patients of anca associated rpgn Top


M Arun, Archana Bajpayee, Nitin Bajpai, Aasma Nalwa

AIIMS, Jodhpur, Rajasthan, India

Background: ANCA associate vasculitis is due to ANCA specific for myeloperoxidase (MPO-ANCA) or proteinase 3 (PR3-ANCA). The rationale behind Therapeutic plasma exchange is to lower the titers of antibodies involved in the pathogenesis of ANCA. The present study aims to monitor the titer of ANCA antibodies after the TPE sessions and their correlation with the patient's clinical outcome.

Aims: To evaluate the clinical effectiveness of TPE in ANCA associated RPGN. To monitor the effect of TPE on ANCAs titers in ANCA associated RPGN.

Methods: TPE was performed in patients of ANCA positive RPGN, as indicated, based on guidelines. Baseline blood samples were collected, and renal biopsy was done before initiating plasma exchange. A follow-up sample was collected at the end of the last plasma exchange session. Samples are collected and stored at -80° C. The collected samples have been tested for ANCA by ELISA.

Results: A total of 20 patients with ANCA-positive vasculitis were selected between January 2019 to December 2020; 6 patients were excluded as per non-eligibility criteria (no renal involvement). A total of 14 patients are finally included in the study, in which six patients underwent TPE and standard care treatment. The remaining eight patients are in the control group, in which the only standard of care treatment is given. Death from any cause or ESRD occurred in 3 of 6 patients (50%) in the plasma exchange group and 4 of 8 patients (50%) in the control group (Fisher's exact; P =0.9). Renal function recovered in 2 of 6(33.3%) patients in the plasma exchange group and 2 of 8(25%) patients in the control group (Fisher's exact; P =0.9). Post-procedure ANCA titer is not significantly reduced compared to Initial pre-procedure ANCA titer in patients samples who underwent plasma exchange (p=0.109). There is no association between IFTA score, ANCA titer and kidney function test.

Conclusions: Among patients with severe ANCA-associated vasculitis, the use of plasma exchange did not reduce the incidence of death or renal recovery. The plasma exchange is not significantly decreasing the ANCA titer in the current study.


   OP 18 Top



   Effect of therapeutic leukapheresis in acute leukemia patients with hyperleucocytosis Top


Linda John, Veena Shenoy

AIMS, Kochi, Kerala, India

Background: Hyper-leucocytosis occurs when the peripheral blood leucocyte count increases more than 1 lakh/microlitre.The morbidity and mortality is due to capillaries getting blocked by leukemic blast cells.Tumour lysis syndrome is a major concern in such patients. Therapeutic leucapheresis followed by cytoreductive chemotherapy would be the most effective immediate management. In this study, we analysed the effect of therapeutic leucocyte apheresis on hematological parameters in hyperleucocytic patients and the procedure related factors affecting the collection efficiency.

Aims:

  1. To determine the effect of therapeutic leucocyte apheresis on hematological parameters in hyperleucocytic patients
  2. To evaluate the procedure related factors affecting the collection efficiency.


Methods: This Retrospective cohort study over a period of 2 years and 8 months (June 2018 to February 2021) included the leucapheresis procedures performed in the department of transfusion medicine at a tertiary care hospital in South India.The procedures were performed with COBE Spectra and spectra optia apheresis .Central venous access was used for the procedures. All the procedures were performed after obtaining written informed consent from patient/ patient's relatives. The volume of the blood processed during the procedure was based on the patient's weight, height, hematocrit.

Results: A total of 20 procedures were performed for 14 patients. 6 patients underwent two procedures. Mean age, weight, height were 46.5±22.7yrs,66±14.8kg,166±12.8cm respectively. Male: female ratio was 4:1.Median pre procedural counts of WBC, Platelet were 303k/μl (IOR:174-388),50.5k/μl (IQR:34-72) respectively. Mean pre procedural and post procedural Hb was 8.79±2.25, 8.96±2.77 respectively. Median post procedural counts of WBC, Platelet were 138.5k/μl (IOR:102-206),33k/μl(IQR:27-50) respectively. Median reduction in WBC, platelet, HCT, Hb after the procedure was 50.7%,24% ,1%,1.5% respectively. There was significant difference between pre and post procedure WBC count (p value:0.05) and platelet count (p value :0.001).Blood transfusions were required in 15% patients before the procedure and 45 % patients after the procedure. There is positive intermediate correlation of product volume with collection efficiency (p value: 0.05, r = 0.439).

Conclusions: In hematological malignancies where leukostasis is anticipated leukapheresis should be combined with other supportive measures to avoid untoward complications.


   OP 19 Top



   Thrombocytopenia in pediatric ICU and HDU: Incidence, transfusion requirement and ITS prognostic value Top


Lavanya Bandaru, Sadhana Mangwana, Pradeep Sharma

Sri Balaji Action Medical Institute, New Delhi, India

Background: Prevalence of thrombocytopenia varies in various Intensive Care Units, ranging from 13% to 58% depending on disease profile of patients. Platelet count is now considered a predictor of outcome. Conservative transfusion policies save transfusion recipients from inherent risks of transfusion adverse reactions.

Aims: To evaluate the incidence of thrombocytopenia, transfusion requirement, outcome and prognostic value of platelet count.

Methods: A prospective study was conducted between October 2018 and December 2019. Total 450 children of age >1 month and <18 years in level III Paediatric Intensive Care Unit (PICU) & level II High Dependency Unit (HDU) were included. Patients' complaints, complications, laboratory data, length of stay, severity score, transfusion requirement and outcome were noted.

Results: Patients' age varied from 4 months to 15 years with male preponderance. Incidence of thrombocytopenia was 24%; 20.22% patients presented at admission and 3.78% patients developed thrombocytopenia during hospital stay. Fever, shock and bleeding manifestations were found in 70.44%, 5.77% and 9.11% cases respectively; more in thrombocytopenia than in non-thrombocytopenia patients. Circulatory failure and shock were found in 17.59% thrombocytopenic and 2.04% non-thrombocytopenia patients. Coagulopathy was found in 27.78% of thrombocytopenia patients. Kidneys were affected in 61.11% patients in thrombocytopenia. Single & multi organ failure were more in thrombocytopenia patients (34.25% & 12.96% respectively) than non-thrombocytopenia patients. Severity score, using PRISM III score, was high (>8) in 14% thrombocytopenia patients. Length of stay of >10 days was more in thrombocytopenia cases (4.62 % vs. 2.33%). Outcome was favorable; 99.89% patients discharged and 1.11% had unfavorable prognosis. Mortality rate of 3.7% & 0.29% in thrombocytopenia and non-thrombocytopenia patients respectively support that thrombocytopenia is a good prognostic indicator for outcome. 4.44% patients required transfusion; 2.78% in non-thrombocytopenia and 10.98% in thrombocytopenia category. 2.77% thrombocytopenia patients required multiple component transfusion and 0.92% cases only platelet transfusion reinforcing conservative transfusion policies.

Conclusions: In this prospective study, severe or life threatening bleeding was not present in thrombocytopenia patients. There was less number of Thrombocytopenia Associated Multiple Organ Failure and very less transfusion requirements reinforcing that various clinical practice international guidelines for platelet transfusions should be adhered and patients be treated for underlying causes and monitored closely.


   OP 20 Top



   Qualitative changes due to gamma irradiation on apheresis platelets resuspended in platelet additive solution Top


Gokhula Prasath Thangavel, Rasika Setia, Mitu Dogra, Anil Handoo, Raj Kumar Kapoor, Ankita Sharma, Ramesh Yadav, Amena Ebadur Rahman

Dr B L Kapur Memorial Hospital, Ludhiana, Punjab, India

Background: Transfusion Associated Graft Versus Host Disease (TAGVHD) occurs due to the presence of donor WBCs in blood products. TAGVHD is almost always fatal. It can be prevented only by irradiation of blood products.

Aims: To find if pre-storage gamma irradiation affect the in-vitro storage parameters of apheresis platelets re-suspended in platelet additive solution (PAS) by comparing on day 1 and day 5.

Methods: Apheresis platelets were collected from 50 eligible donors on Day 0. The platelets were re-suspended in autologous plasma:PAS in a ratio of 30:70. A sample (control) was collected before irradiation. Another sample (test) was collected after irradiating with a dose of 25 Gy. Both samples were stored along with apheresis platelets in a platelet agitator at 22±2 °C. On Day 1 and Day 5, both control and test samples were subjected to a battery of biochemical (pH, Na+ , K+ , HCO3- and lactate) and flowcytometric (activation marker: CD62P – P-selectin and apoptosis marker: Annexin V) tests. A comparative analysis between nonirradiated and irradiated samples was made using paired t-test.

Results: The in-vitro storage parameters were within acceptable range throughout the storage period in both groups. On Day 1, viable population (p = 0.718), CD62P expression (p = 0.608), cell count (p = 0.819), pH (p = 0.404) and bicarbonate (p = 0.388) were slightly lower while apoptotic population (p = 0.387), lactate (p = 0.774), sodium (p = 0.602) and potassium (p = 0.335) were slightly higher in the test group compared to control group. On Day 5, apoptotic population (p = 0.301), cell count (p = 0.523), pH (p = 0.229) and lactate (p = 0.657) were slightly lower while viable population (p = 0.392), bicarbonate (p = 0.769), sodium (p = 0.155) and potassium (p = 0.996) were slightly higher in the test group compared to control group. But the differences between both groups were not significant (p >0.05).

Conclusions: Our data demonstrate that pre-storage irradiation had no impact on the quality of platelets. In view of these findings, we recommend universal platelet irradiation policy in speciality hospitals dealing with transplant patients with high risk of TAGVHD.


   OP 21 Top



   Effectiveness of goal directed therapy vs massive transfusion protocol in a tertiary care centre Top


VJ Arun, Ramesh Bhaskaran, Aboobacker Rafi, Susheela J Innah, Divya Venugopal

Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India

Background: Massive blood transfusion refers to the replacement of a large volume of blood with blood products over a short period to a patient with uncontrolled hemorrhage. ROTEM is a viscoelastic hemostatic assay which is being increasingly used in the diagnosis of coagulopathy as goal-directed therapy and aids in hemostatic resuscitation. Various ROTEM parameters could identify acute traumatic coagulopathy, Post-partum hemorrhage, and predict the need for massive transfusion faster and more accurately. They also can provide rapid and accurate detection of hyperfibrinolysis. The current study aims to assess the utilization of the blood component of goal-directed therapy against protocol based massive transfusion.

Aims: To compare the blood component utilization, morbidity & mortality in patients managed by an institutional massive transfusion protocol (MTP) versus goal-directed therapy (GDT) using Rotational thromboelastometry (ROTEM).

Methods: A comparative study was done, wherein the retrospective data was collected from the institutional MTP registry and compared with prospective data of patients managed by GDT using ROTEM. Massive transfusion was defined as per standard guidelines. Goal-Directed therapy was as per the temogram from ROTEM, Which shows clear indication for transfusion of FFP, Platelet, or cryoprecipitate. Red cell transfusion is based on clinical and other lab parameters. Data pertaining to patient demographics, mode of admission, indication for massive transfusion, blood component usage, Morbidity, and mortality were collected and analyzed.

Results: The study population comprised a total of 122 patients (61 in each protocol). The mean age of patients managed by MTP & GDT was 33.36 & 46.52 years respectively. There was no statistical difference in gender, criteria of admission among the comparison groups. MTP was activated for PPH, Trauma & surgery at a rate of 45%, 36.1% & 11.5%. Goal-directed Therapy was initiated mainly for Trauma, surgery, PPH & snake bite at a rate of 42.6%, 23%, 19.7%, 4.9% respectively. There was a significant reduction in blood component utilization for PRBC, FFP & platelet (p<0.05) in GDT, but cryoprecipitate utilization remained the same. There was a significant reduction in length of hospital stay (Sig=0.038) for patient managed by GDT (9.39 days) in comparison to those managed by MTP (17.05 days). There was no statistical difference in mortality among the comparison groups.

Conclusions: Goal-directed therapy shows a significant reduction in blood component utilization & morbidity without a significant change in mortality among patients in this study. GDT has the potential to impact the care of critically ill patients in many ways, but current evidence for their use is limited. Further high-quality research, including randomized controlled trials are needed to elucidate the role of GDT.


   OP 22 Top



   Intrauterine fetal transfusion and maternal red cell alloimmunization Top


D Kaur, G Negi, S Mandal, A Jain, L Chawla

AIIMS, Rishikesh, Uttarakhand, India

Background: Maternal red blood cell alloimmunization is the main cause of fetal anemia. Timely recognition of the implicated antibodies through screening, identification and titration by indirect antiglobulin test alongwith ultrasound monitoring forms the basis of surveillance for severe anemia before development of hydrops fetalis. The survival rates after intrauterine transfusion (IUT) in view of red cell alloimmunization have been reported to be 80.5 to 93.5%.

Aims: To assess the efficacy of Intrauterine transfusions provided to Rh-isoimmunized antenatal mothers visiting a recently developed tertiary care centre.

Methods: IUT preparation begins with the arrival of a written requisition from the Obstetrics unit mentioning date and time of requirement, desired volume and hematocrit of PRBC unit, Indirect Antiglobulin Test (IAT) status of mother, middle cerebral artery peak systolic artery velocity (MCA-PSV), estimated fetal weight (if performed) along with blood sample of mother. One O RhD negative, Rh and Kell phenotype matched PRBC unit identical with the mother, specific red cell antigen negative and crossmatch compatible in anti-human globulin phase with maternal plasma, is leuco-filtered and centrifuged to get a desired hematocrit between 75% to 85%. Once the IUT bag passes quality control criteria, it is further subjected to Irradiation and subsequently released to Obstetrics for transfusion. Fetal sample is asked for confirmation of blood group, Pretransfusion Hb and DAT if feasible to obtain during cordocentesis.

Results: Five Rh-isoimmunised multigravida women (G3 to G10) with anti-D titers ranging from 64 to 256 presented to our hospital during second and third trimester of gestation and a total of 16 IUTs were performed. 60% (n=3) of the fetuses survived after receiving IUTs and were discharged in a healthy state while 40% (n=2) had already developed hydrops fetalis at presentation to the hospital. One fetus was lost at 28weeks due to Intrauterine death and was delivered vaginally by a Gravida 7 mother while the other born to a Gravida 10 ,expired after birth due to severe anemia despite resuscitation.

Conclusions: The survival rate of the neonates utilizing IUT is higher among those with severe anemia but without features suggestive of hydrops fetalis. Rh isoimmunised mothers having high gravida status but presenting late to a tertiary care centre with facility of IUT are at higher risk of poor neonatal outcome.


   OP 23 Top



   Comparison of hematocrit change in preterm neonates with birth weight based versus formula based packed red blood cell transfusion: A randomized control trial Top


Rajbir Kaur, Ravneet Kaur, Suksham Jain, Deepak Chawla Gagandeep Kaur

Government Medical College and Hospital, Chandigarh, India

Background: Conventionally the packed red blood cell (PRBC) transfusion volume given to neonates is 10 ml/kg to 20 ml/kg. The weight based formulae underestimate the volume of PRBC required to achieve a target hematocrit (Hct) in preterm neonates.

Aims: The study was done to compare the rise in Hct after transfusing PRBC volume calculated either based on body weight or using formula considering Hct of bag and Hct of preterm neonates.

Methods: This prospective study included a total of 68 preterm neonates requiring transfusion for first time having ≤ 34 weeks of gestational age. Neonates were randomized using block randomization, to receive 15 ml/kg of PRBC transfusion (Group A) or transfusion based on formula (group B). Primary outcome of interest was post transfusion rise in Hct. Secondary outcome was effect of transfusion on neonatal morbidities in terms of retinopathy of prematurity, broncho-pulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis and death.

Results: Baseline variables (birth weight, gestation age, APGAR score and Score of neonatal acute physiology) pretransfusion hemodynamics and hematocrit of the bag were comparable in both groups. Mean volume of PRBC in group A was 18.8±4.9 ml, whereas in group B it was 29.6±7.3 ml, p=0.0001. Group B transfusions had statistically significant change in 24 hrs post transfusion hematocrit. Secondary outcomes were comparable in two groups. Four neonates died in each group.

Conclusions: Post transfusion rise in Hct of patient in group B was significant as compared to group A but the need for re-transfusion was not decreased in group B despite transfusion of more volume of blood.


   OP 24 Top



   Seroprevalence of SARS-COV-2 among potential convalescent plasma donors and analysis of their deferral pattern: Experience from tertiary care hospital in western India Top


Romesh Jain, MV Mallya, Sangeeta Amoncar, Sachin Palyekar, Harshat Popat Adsul

Goa Medical College, Goa

Background: Seroprevalence estimation of COVID-19 is quite necessary for controlling the transmission of SARS-CoV-2 infection. Seroprevalence rate in recovered COVID-19 patients help us to identify individual with anti-SARS-CoV-2 antibodies and its protective nature.

Aims: To find out seroprevalence of SARS-CoV-2 among potential convalescent plasma donors and analysis of their deferral reasons.

Methods: A total 400 potential convalescent plasma donors were enrolled over four-month period for this study. Inclusion criteria were lab confirmed COVID-19 recovered patients, 14 days of symptoms free period and presence of IgG antibody of COVID-19. All prospective plasmapheresis donors were tested for IgG SARS-CoV-2 antibody through chemiluminescent microparticle immunoassay, CBC, serum protein, blood grouping along with other required test for normal blood donation as per Drugs & Cosmetics Act. After final eligibility 500 ml COVID-19 convalescent plasma (CCP) was collected by plasmapheresis (Spectra Optia USA) after getting written informed consent. If the donor was not found to be eligible for plasmapheresis, then the donor was deferred after proper counselling. Seroprevalence rate was calculated by positive IgG antibody test results among the potential plasma donors.

Results: Seroprevalence rate was 87% for IgG SARS-CoV-2 antibodies in prospective convalescent plasma donors (recovered COVID-19 patients). It was observed that antibodies against SARS-CoV-2 were present in repeat plasma donors for more than 60 days with the longest persistence of 111 days in one of the participants. Most common reason for their deferral was absent IgG SARS-CoV-2 antibodies (12.5%) followed by absenteeism of eligible screen donors (6.7%), low Hb (1.7%) and poor veins for plasmapheresis (1.7%).

Conclusion: 13% recovered patients did not develop IgG antibodies after SARS-CoV-2 infection. Once developed these (SARS-CoV-2 IgG) antibodies persist for quite some time (varying period) and provide protection against reinfection. More long-term serology studies are needed to understand better antibody response kinetics and duration of persistence of IgG antibodies.


   OP 25 Top



   Association of anti-SARS-COV-2 virus IGG antibody levels in COVID-19 recovered individuals with computerised tomography severity index Top


C Ravi kanth, B Suresh babu, R Arun, KV Sreedhar babu, C Keerthi

Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India

Background: The continued spread of corona virus disease 2019 (COVID-19) has prompted widespread concern around the world. Currently, the antibody responses against SARS-CoV-2 remain poorly understood and the clinical utility of serological testing is unclear.

Aims: To estimate anti-SARS-CoV-2 IgG antibodies in recovered COVID-19 individuals and its association with Computerised Tomography (CT) severity index.

Methods: This cross sectional observational study was done in the department of Transfusion Medicine from April 2020 to June 2020. Anti-SARS-CoV-2 IgG antibodies were measured by Enhanced chemiluminiscence technology in individuals recovered from COVID-19 infection. Reactive light units of more than 1 were considered as positive. CT severity index was calculated from the report available in the hospital information system. CT severity index was classified into mild (1-10), moderate (10-15) and severe (15-25). The collected data and the demographic details were entered in Microsoft excel and analyzed using SPSS 21.0. Continuous data was analysed by student t-test/Mann Whitney U test as appropriate. Categorical data was expressed as percentages and was analyzed using chi-square/Fisher's exact test. A 'P' value of less than 0.05 was considered statistically significant.

Results: A total of 46 recovered participants were tested for anti-SARS-CoV-2 IgG antibodies. The median age of study participants was 47years (IQR, 25-69) of which males were 33 (72%) and female were13 (28%). Out of 46 participants, 19 individuals showed positive for anti-SARS-CoV-2 IgG antibody. The median antibody level was 7.71 with Inter quartile range of 1.16 to 12.1. Of these 19 individuals, 14 had mild CT severity index, 3 moderate and 2 severe CT changes. We found that there is a significant association between the anti-SARS-CoV-2 IgG antibodies and CT severity index (P value is 0.008). We didn't find any significant association between anti-SARS-CoV-2 IgG antibodies and age (P value 0.330), gender (P value 0.425), and blood group (P value 0.255). Logistic regression analysis showed a positive correlation with CT severity index.

Conclusions: As the CT severity index increases, there is a significant rise in anti-SARS-CoV-2 IgG antibodies and those recovered patients with increased CT severity index can be tested for anti-SARS-CoV-2 IgG antibodies for them to become as convalescent plasma donors instead of testing all COVID-19 recovered patients. This may help to decrease the screening time and to have a better component quality.


   OP 26 Top



   SARS COV-2 antibody screening among health care workers in a quartenary care centre, south India- A pilot study Top


Deepthi Krishna, Deepti Sachan, G Shanthi

Dr. Rela Institute and Medical Centre, Chennai, Tamil Nadu, India

Background: Health care workers (HCWs) is a well-known risk group and they account for a significant proportion of Corona virus (COVID-19) infections worldwide. The protection of HCWs is of paramount importance in protecting the population.

Aims: To assess the prevalence of covid antibodies (SARS Cov) among COVID-19 recovered HCWs, to counsel them and to assess their eligibility for Convalescent plasma donation and the deferral reasons.

Methods: At our Blood centre, Prevalence of SARS Cov antibodies in HCWs and eligibility for plasma donation was analyzed from May 2020 to October 2020 for a period of 6 months. All the HCWs were requested to go for antibody testing after 28 days of recovery from the Covid infection (RTPCR positive with either symptomatic or asymptomatic) at our blood centre.

Their serum samples were obtained after informed consent and tested for SARS Cov IgG antibodies using chemiluminescent immunoassay on Architect, Abbott, USA [C/O ≥ 1.4 OD are considered Positive]. HCWs who turned out to be positive were screened for history of symptoms (fever/ cough/chest pain etc/ medications/ history of transfusion and eligibility as per donor selection guidelines and counseled for plasma donation and deferral factors were analyzed among the HCWs.

Results: A total of 130 HCW who were RT PCR positive for COVID-19 were included during study period. Of which 91 were males and 39 were females. The HCW groups affected were staff nurses (30.7%,n=40), followed by Doctors(n=18) and paramedical staff (n=18) with each 13.84% both in Covid and non covid wards & other supporting staff of various departments 23.8%(n=31). Most of the HCWs were symptomatic with overlapping symptoms; fever (33.73%) being the most common symptom followed by cough, breathlessness (28.6%), myalgias (24.6%) and asymptomatic (13%). Mean days of testing is 32.7 days (17d to 76 days). Out of total, 79 (60.7%) symptomatic HCWs were counselled and consented to give samples for serosurvey. In that 79, 87.3% (n=69) were IgG positive (21 in between 1.4 to 4 OD; 39 between 4 to 8 OD and > 8 OD in 9. Higher OD did not correlate with the area of work or symptoms present. 90.7% were in the age group of 18-45 yrs. 16.5% (n=16) of HCWs donated convalescent plasma out of total plasma donations (n=97). 32 HCWs (24.6%) were deferred, the main reasons being Covid antibody negative (n=10, 7.7%); females with pregnancy history (n=8, 6.15%); females with anemia even though antibody positive (n=7,5.4%). Around 23% (n=30, though eligible) of HCW denied plasma donation for various reasons like fear of donation or covid reinfection, unwillingness and COVID duties or nonavailability during requirements.

Conclusions: This study highlighted the high seroprevalence of SARS-CoV-2 antibodies among HCWs in our hospital setting, indicating that HCWs represent a population at considerable risk of contracting COVID-19, for which the primary reason being indirect reflection of the disease burden in the general population and other reason is our centre being a covid treating facility.


   OP 27 Top



   Are we missing the appropriate method for enumeration of residual WBC during quality control of single donor apheresis platelets?-A comparative prospective study of three different methods Top


Nasir Nabi Naikoo, Deepak Kumar Mishra, Sabita Basu, Suvro Sankha Datta

Tata Medical Center, Navi Mumbai, Maharashtra, India

Background: The need for quality control of leucoreduction of blood products has led to the development of various methods to count low levels of residual leucocytes (rWBCs) in blood components. Unfortunately, the concentration of rWBCs in leucoreduced blood components is below the level of accurate detection by standard hematology analyzers and presents a technical challenge.

Aims: To compare use of Nageotte hemocytometry, Flow cytometry and standard hematology analyzer for enumeration of rWBCs in single donor apheresis platelets (SDAP) as a part of quality control process.

Methods: A prospective, observational study was conducted in a tertiary care oncology center during January'20 to March'20. A total of 36 single donor platelets collected by apheresis from healthy blood donors were subjected to testing by Nageotte hemocytometer, flow cytometry and hematology analyzer for enumeration of rWBC. All tests were performed within 24 hours of collection and according to manufacturers' recommended methods. Results of Nageotte hemocytometer was obtained by: rWBC/μl = [Cells counted X Dilution/ Gridded area volume (50μl)] and flow cytometry calculation was performed by: rWBC/μl = [Total beads X Number of Leukocyte Events/ Total Beads Acquired X Total Sample Volume (μl)].

Results: Mean age of donor was 32 years (Male: 33, Female: 3) and mean volume of SDAP was 262 mL (260-270 mL). Number of rWBC detected by flow cytometer was between 0.1 WBC/μl and 8 WBCs/μl whereas that detected by Nageotte's chamber were between 0.3 WBC/μl and 6.2 WBCs/μl. The range of rWBC detected by hematology analyzer was 10 WBC/μl to 270 WBCs/μl. No correlation was observed between the results of hematology analyzer with any of the other two methods. The concordance correlation coefficient between three methods was measured by kappa analysis and found 0.7 between Nageotte hemocytometry and flow cytometry. The kappa value was zero between hematology analyzer and flow cytometry.

Conclusions: Flow cytometry followed by Nageotte hemocytometry is a better method compared to the standard hematology analyzer for enumeration of rWBCs in SDAP. To manage the cost of flow cytometry a centralized quality monitoring system for leuco-reduced blood components could be considered in India.


   OP 28 Top



   Requirements as per part XB and schedule F part XIIB of drugs rules 1945 and common non-compliances in blood centres Top


C Saravanan, M Pharm

Drugs Inspector, CDSCO, South Zone, Chennai, Tamil Nadu, India

Background: The operation of a blood centre in India is regulated under Schedule F Part XIIB read with Part XB of Drugs Rules 1945.

Aims: To describe the role of Technical personnel such as medical officer, Technician, Technical Supervisor, Registered Nurse & Counsellor for efficient functioning and operation of a blood centre and to satisfy the regulatory requirements.

Methods: Many non-compliance were observed during the regulatory inspections such as in Forms, Records, Registers, Labels, SOPs, Facility, QC of Blood and Blood Components, QC of grouping and cross matching reagents, Unavailability of emergency medicines, improper storage of pilot samples and out-door blood donation camps, etc.,

Results and Conclusion: Awareness about the legal requirements for efficient functioning and operation of a blood centre among the technical personnel needs to be increased for better compliance.

Disclaimer: Views & Opinions expressed here are personal and not connected with the present organization.



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