Asian Journal of Transfusion Science
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   2009| July-December  | Volume 3 | Issue 2  
    Online since July 17, 2009

 
 
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ORIGINAL ARTICLES
Quality assessment of platelet concentrates prepared by platelet rich plasma-platelet concentrate, buffy coat poor-platelet concentrate (BC-PC) and apheresis-PC methods
Ravindra P Singh, Neelam Marwaha, Pankaj Malhotra, Sumitra Dash
July-December 2009, 3(2):86-94
DOI:10.4103/0973-6247.53882  PMID:20808653
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.
  18,752 853 24
Quality evaluation of four hemoglobin screening methods in a blood donor setting along with their comparative cost analysis in an Indian scenario
Rashmi Tondon, Anupam Verma, Prashant Pandey, Rajendra Chaudhary
July-December 2009, 3(2):66-69
DOI:10.4103/0973-6247.53874  PMID:20808648
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.
  11,915 572 10
Alloimmunization among transfusion-dependent thalassemia patients
Mohammad Hadi Sadeghian, Mohammad Reza Keramati, Zahra Badiei, Mehrangiz Ravarian, Hossein Ayatollahi, Houshang Rafatpanah, Mohammad Khajeh Daluei
July-December 2009, 3(2):95-98
DOI:10.4103/0973-6247.53884  PMID:20808654
Background: Thalassemia is a common hemoglobin disorder in Iran and one of the major public health problems. Although blood transfusions are lifesavers for thalassemia patients, they may be associated with some complications especially erythrocyte alloimmunization. The purpose of this study was to investigate the prevalence of red blood cell alloantibodies and to determine types of these antibodies among multiple-transfused thalassemic patients. Materials and Methods: A total of 313 thalassemia patients in the northeast of Iran, who received regular blood transfusion, were included in this study. Screening of antibodies was performed on fresh serum of all patients and then antibodies were identified in patients' serum that had positive antibody screening test using a panel of recognized blood group antigens. Results: We identified 12 alloantibodies in 9 patients (2.87%) that all were against Rhesus (Rh) blood group antigens (D, C, E). Three patients developed 2 antibodies, and others had one antibody. The most common alloantibodies were Anti-D (88.88%) and followed by Anti-C and Anti-E. Higher frequency of alloimmunization was observed in female, Rh negative and splenectomized patients. Conclusion: This study showed that evaluation of the packed cells for Rh (C, E) from the start of transfusion can be helpful in decreasing the rate of alloantibody synthesis.
  7,060 365 28
Comparing prevalence of Iron Deficiency Anemia and Beta Thalassemia Trait in microcytic and non-microcytic blood donors: suggested algorithm for donor screening
Aseem K Tiwari, Iva Chandola
July-December 2009, 3(2):99-102
DOI:10.4103/0973-6247.53883  PMID:20808655
Background: The prevalence of microcytosis in donors and Iron Deficiency Anemia (IDA) and Beta-Thalassemia trait (BTT) in microcytic and non-microcytic donors has not been studied in India. The present study aims at finding the same. Materials and Methods: Initially 925 donor samples were evaluated on cell-counter. Of these, 50 were found to be microcytic. These were subjected to Ferritin and HbA2 determination. Subsequently, an additional 51, age-and-sex matched non-microcytic donor samples were selected to serve as controls. These were subjected to the same tests. Results: The prevalence of microcytosis was 5.4% (50/925). Among the microcytic donors, 52% were IDA, 36% BTT, 8% both, and 4% none. In case of non-microcytic donors 29.4% were IDA, 3.9% BTT, and 66.7% none. Conclusions: The study revealed a high prevalence of IDA and BTT in blood donors and a higher probability of finding these in the microcytic samples. This prompted authors to suggest an algorithm for screening of blood donors for IDA and BTT. The algorithm recommends doing an hemogram on all donor samples, routinely. Ferritin could be done only in microcytic samples. At levels lower than15 ng/ml, it is diagnosed as IDA, and therefore, HPLC is performed only for non-IDA samples with Ferritin levels higher than 15 ng/ml. By employing this algorithm, a substantial number of IDA and BTT could be diagnosed while keeping the number of Ferritin tests small and the number of HPLC tests even smaller and thus making it cost efficient.
  6,395 385 5
Bedside practice of blood transfusion in a large teaching hospital in Uganda: An observational study
JD de Graaf, I Kajja, GS Bimenya, MJ Postma, C Th. Smit Sibinga
July-December 2009, 3(2):60-65
DOI:10.4103/0973-6247.53872  PMID:20808647
Background: Adverse transfusion reactions can cause morbidity and death to patients who receive a blood transfusion. Blood transfusion practice in Mulago Hospital, Kampala, Uganda is analyzed to see if and when these practices play a role in the morbidity and mortality of patients. Materials and Methods: An observational study on three wards of Mulago Hospital. Physicians, paramedics, nurses, medical students and nurse students were observed using two questionnaires. For comparison, a limited observational study was performed in the University Medical Centre Groningen (UMCG) in Groningen, The Netherlands. Results: In Mulago Hospital guidelines for blood transfusion practice were not easily available. Medical staff members work on individual professional levels. Students perform poorly due to inconsistency in their supervision. Documentation of blood transfusion in patient files is scarce. There is no immediate bedside observation, so transfusion reactions and obstructions in the blood transfusion flow are not observed. Conclusion: The poor blood transfusion practice is likely to play a role in the morbidity and mortality of patients who receive a blood transfusion. There is a need for a blood transfusion policy and current practical guidelines.
  6,002 531 8
Hyperbilirubinemia in normal healthy donors
Veena Arora, RK Kulkarni, Susan Cherian, Raji Pillai, M Shivali
July-December 2009, 3(2):70-72
DOI:10.4103/0973-6247.53875  PMID:20808649
The present study was carried out in B.A.R.C. Hospital Blood Bank over a span of five years, and includes 2734 donors. All the bags were screened for HIV, HBsAg, HCV and VDRL and the plasma in the pilot tubes of the blood bags was observed to detect any abnormality in color. In 27 cases plasma was found to be icteric and liver function tests were carried out on these samples. Two donors showed higher SGPT level, and were excluded. No significant increases in liver enzymes were recorded in the others. Causes of icteric plasma in these apparently healthy donors are discussed. Differential diagnosis includes Gilbert's disease, hemolytic anemia, drug-induced anemia and other hepatic causes of hyperbilirubinemia, of which Gilbert's disease is most probable cause with a prevalence of 0.91% in our population. As there are no studies to document the safety of the recipients receiving such abnormal colored plasma as well as to document the hazards in its transfusion, the question arises whether to transfuse such units or not. This study highlights this dilemma. A reassessment of existing policies and regulations is merited.
  5,327 320 3
EDITORIAL
Management in Indian blood banking system: True reality
N Choudhury
July-December 2009, 3(2):57-59
DOI:10.4103/0973-6247.53871  PMID:20808646
  5,112 503 5
ORIGINAL ARTICLES
Comparison of plateletpheresis on three continuous flow cell separators
Anita Tendulkar, Sunil B Rajadhyaksha
July-December 2009, 3(2):73-77
DOI:10.4103/0973-6247.53877  PMID:20808650
Introduction: Platelet concentrate (PC) remains one of the most important support measures in thrombocytopenic patients. An efficient cell separator is a prerequisite for an optimally functioning apheresis setup. Donor blood count may undergo a temporary reduction after the procedure. Aim: The aim was to find the extent of reduction in donor blood count (hemoglobin, hematocrit, white blood cell, and platelet) after plateletpheresis and to evaluate the cell separator for collection efficiency, processing time, and leukoreduction. Study Design and Methods: Two hundred and thirty seven procedures performed on the Amicus (N = 121), Fenwal CS-3000 Plus (N = 50) and Cobe spectra (N = 66) in a one year period were evaluated. The procedures performed on the continuous flow centrifugation (CFC) cell separators and donor blood counts (pre and post donation) done were included in the study. Results: The percent reduction in hemoglobin (HB), hematocrit (HCT), white blood cell (WBC) and platelet count ((PLT ct) was 2.9, 3.1, 9, 30.7 (Mean, N = 237) respectively after the procedure. The post donation PLT ct reduced to <100x109/L (range 80-100) in five donors (N = 5/237, Amicus). The pre donation PLT ct in them was 150-200x109/L. Collection efficiency (percent) of Amicus (79.3) was better as compared to the other two machines (CS: 62.5, Cobe: 57.5). PC collected on Cobe spectra had <1x106 WBC. The donor pre donation PLT levels had a positive correlation to the product PLT yield (r = 0.30, P = 0.000). Conclusion: Monitoring donor blood counts helps to avoid pheresis induced adverse events. A cautious approach is necessary in donors whose pre donation PLT ct is 150-200x109/L. The main variable in PLT yield is donor PLT ct (pre donation). High collection efficiency is a direct measure of an optimally functioning cell separator.
  5,321 246 12
BOOK REVIEW
Introduction to Blood Transfusion Technology - ISBT Science Series
Dipika Mohanty
July-December 2009, 3(2):112-112
  4,736 230 -
REVIEW ARTICLE
The evolution of immunohematology in South Asian countries
Graeme Woodfield
July-December 2009, 3(2):103-107
DOI:10.4103/0973-6247.53881  PMID:20808656
Many factors have resulted in the slow development of transfusion services in some South Asian countries. Despite difficulties, there have been some excellent developments and the outlook for the future is very positive. The biggest problems relate to the availability of the truly voluntary altruistic blood donors and considerable work is still needed to upgrade this aspect of the work. Screening for transfusion transmissible diseases is now widespread although there is still a requirement to enhance quality assurance procedures and to improve statistical definitions and collection. Other factors that have affected the evolution of immunohematology are outlined and there is now optimism for the future.
  4,678 256 -
ORIGINAL ARTICLES
Evaluation of knowledge of healthcare workers in hospitals of Zabol city on proper methods of blood and components transfusion
Ali Reza Piri, Vahed Aziz Shahraki, Abbas Ali Moien, Hamuleh Marjan Mardani, Mohammad Reza Taghavi
July-December 2009, 3(2):78-81
DOI:10.4103/0973-6247.53878  PMID:20808651
Background and Aims: Blood and components are more frequently used in surgery and non-surgical procedures. In medical procedures blood transfusion is important and needs adequate expertise and practice, thus adequate knowledge in healthcare workers of this procedure is essential. Materials and Methods: This descriptive study is designed to assess the knowledge of healthcare workers about proper methods of blood transfusion, and how to promote their knowledge for proper performance if their knowledge is inadequate. Data were collected with aimed questionnaire and analyzed by statistics software. Result: The study population mainly comprised 122 healthcare workers (HCWs). The main findings from this study showed that 26.2% of healthcare workers (HCWs) had low-level knowledge, 22.1% moderate and 51.6% acceptable knowledge. We did not find any significant correlation between knowledge of HCWs and years in profession, participation in training, number of blood transfusions per day, age, gender, etc. ( P < 0.05). Discussion and Conclusion: Results strongly emphasized the need for a curriculum to promote knowledge of HCWs about blood transfusion because we found low and moderate level of knowledge in approximately half our samples and on the importance of blood transfusion procedure, suggesting that more attempts should be made to build up knowledge about blood transfusion.
  4,671 244 9
COUNTRY REPORT
Blood transfusion services in Bangladesh
Muhammad Badrul Islam
July-December 2009, 3(2):108-110
DOI:10.4103/0973-6247.53880  PMID:20808657
  4,381 280 7
ORIGINAL ARTICLES
Use of blood components in critically ill patients in the medical intensive care unit of a tertiary care hospital
RN Makroo, RK Mani, Raina Vimarsh, Sudha Kansal, Kumar Pushkar, Sandeep Tyagi
July-December 2009, 3(2):82-85
DOI:10.4103/0973-6247.53879  PMID:20808652
Background: The art of fluid administration and hemodynamic support is one of the most challenging aspects of treating critically ill patients. Transfusions of blood products continue to be an important technique for resuscitating patients in the intensive care settings. Concerns about the rate of inappropriate transfusion exist, particularly given the recognized risks of transfusions and the decreasing availability of donor blood. We investigated the current transfusion practice in the critically ill patients at our hospital. Materials and Methods: A total of 1817 consecutive critically ill patients admitted between January 2006 and December 2006 were included in this retrospective study. The blood request forms of the patients were analyzed, and their pretransfusion investigations, indications for transfusions, etc. were studied. Results: Nine hundred and eleven (50.1%) critically ill patients, comprising 71.6% males and 28.4% females, received blood/blood components. About 43.8% patients were administered packed red cells (PRC), 18.27% fresh frozen plasma (FFP) and 8.4% transfused platelets. Among those receiving PRC, 31.1% had a pretransfusion Hb below 7.5g%, 34.4% had Hb between 7.5 and 9g%, while 21.4% had Hb above 9g%. Among those receiving FFP, 14.5% had an international normalized ratio INR < 1.5, and 19% had a pretransfusion platelet count above 50,000/cumm. During the study, there were 7% of the patients who received red cells and FFP, 2% of the patients received red cells and platelets, 1% of the patients received platelets and FFP, and 5% of the patients had received all the three components, i.e., red cells, FFP and Platelets. The baseline investigations and/or clinical indications were not mentioned in 13.1% of patients receiving PRC, 57% receiving FFP and 49.7% receiving platelets. Conclusion: About 21.4% of PRC, 14.5% of FFP, and 19% of platelets were inappropriately indicated. Clinicians in our centre were conservative in keeping with recent transfusion guidelines. A significant number of blood request forms were still incomplete with baseline investigations not mentioned in the request forms.
  4,147 275 1
LETTER TO THE EDITOR
Attitude and willingness toward blood donation in Iranian students
Reza Afshar, Suzan Sanavi, Siamak Afshin-Majd, Sayeh Sanavi
July-December 2009, 3(2):111-111
DOI:10.4103/0973-6247.53876  PMID:20808658
  2,982 188 -
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