Asian Journal of Transfusion Science最新文献

Introduction: Massive hemorrhage calls for massive transfusions (MTs) to maintain adequate hemostasis. Massive transfusion protocols (MTPs) are the appropriate treatment strategy for such patients replacing conventional use of crystalloids. These help in standardizing and optimizing the delivery of blood components in a well-balanced ratio.

Aim and objectives: The aim of the study is to propose an ideal ratio of blood components for MTP after assessing relationship between ratios of blood components transfused and mortality.

Methodology: MT was defined as receiving >4 packed red blood cell (PRBC) units within 1 h with the anticipation of continued need for blood products. All MT patients above 13 years of age regardless of cause of bleed were included in the study from December 2015 to October 2017 accounting for a total of 61 patients. Subgroup categorization of study population was done, and physician-driven ratios of the blood components were calculated for each case. The ratios were grouped as high (>1), equal (=1), and low (<1) ratios of fresh frozen plasma (FFP):PRBC and platelet: PRBC, and the relationship of these ratios to the clinical outcome in terms of mortality was examined.

Results and discussion: Sixty-one patients underwent MT of which the overall hospital mortality rate was 8.1% with 100% mortality among patients with penetrating trauma followed by 25% with gastrointestinal bleed. Emergency admission was an independent risk factor for mortality. Hypotension before the initiation of MT was detrimental for survival. Efficient communication existed between the treating physicians and transfusion. Majority of survivors received equal ratios of FFP: PRBC and platelet: PRBC, and all nonsurvivors received low ratios of FFP: PRBC. Analysis was statistically indicating better survival with 1:1:1 ratio of PRBC: FFP: platelet.

Conclusion: The need of the hour is to establish an institutional MTP and ensure compliance with the same. A prospective randomized controlled trial needs to be done to overcome the limitations and confounders of the present study and establish a universal protocol.

Introduction: Neuromyelitis optica (NMO) is an idiopathic demyelinating disorder characterized mainly by optic neuritis and myelitis, causing gradual loss of vision and deterioration of neurological function. The underlying pathogenesis mainly involves antibodies against aquaporin 4. The effectiveness of therapeutic plasma exchange (TPE) has been shown by many studies across the globe but are only a few from India. We studied ten cases of NMO retrospectively to find out the safety and efficacy of plasma exchange and to know the outcome of those patients who underwent the procedure.

Materials and methods: We retrospectively analyzed ten cases of NMO who underwent TPE from January 2017 to July 2021. Out of 153 patients on whom plasma exchange procedures were done during this period, ten cases of NMO were diagnosed and managed with TPE.

Results: In our study, we found that 6 of our patients (60%) had a marked improvement noticed clinically with an increase in baseline power of limbs from 0-2/5 to 3-5/5. However, two patients expired after despite TPE. The other two did not show any improvement. Four of our patients started showing clinical improvement after the 2^nd-3^rd cycles of treatment. TPE was initiated early (within 5 days). There were no notable events in most of the procedures except in one procedure where the patient developed hypotension, her saturation started to drop, and the procedure had to be aborted.

Conclusion: Our study supports the effectiveness of timely initiation of plasma exchange to improve the overall mortality rate of the patients.

Background and objective: Blood transfusion is an essential component of health care. However, several issues can hamper the promotion and sustainability of voluntary blood donation programs. This article is about a hackathon in the field of transfusion medicine that was designed to stimulate original ideas to promote voluntary blood donation.

Materials and methods: The transfusion medicine hackathon was conducted as a joint project of an educational institute, the Asian Association of Transfusion Medicine, and the Innovation Center. It was conducted in eight main phases, which included planning and preparation, choosing the problem statement, participant recruitment and registration, launch, and mentoring as the first steps. Participants presented their ideas in the ideation phase, and the top five teams were selected for the prototyping phase. Selection was based on innovation/originality (10 points), feasibility (10 points), and social impact (5 points). In the prototype phase, two teams were selected as winners and were awarded by the organizers.

Results: A total of 36 multidisciplinary teams representing various parts of India pitched innovative ideas. The majority have proposed new strategies for the retention of blood donors to maintain the donor pool and teams came up with novel ideas aimed at enhancing the overall blood donation experience. One of the winning teams completed the project and launched the product.

Conclusion: Health-care hackathons promote interdisciplinary education and innovation. This is a first-of-its-kind effort from the field of transfusion medicine to explore a hackathon platform to promote voluntary blood donation.

Objective: The objective of the study is to assess the satisfaction level of doctors regarding their competence in the blood transfusion process and their reflection on training at the undergraduate level.

Background: Transfusion errors due to suboptimal knowledge and lack of training can lead to grave outcomes. Therefore, to optimize patient care, a thorough understanding of transfusion medicine basics is highly imperative for all medical graduates.

Methodology: This survey was conducted online through Google forms with a questionnaire consisting of 15 questions. 8 medical colleges (4 government and 4 private) were selected by random cluster sampling technique. Data were analyzed with SPSS version 23.

Results: Of 502 participants, 53.8% were females and 69.9% were graduates of public medical colleges. About 84.6% did not receive any formal training on transfusion during graduation. Almost 82% felt that the current curriculum is not designed to meet their practical needs of blood transfusion and 52% agreed that knowledge of transfusion medicine is required for undergraduates. The survey also revealed that 70.5% of participants believed that whole blood is required for most patients and 49.8% did not feel confident to manage transfusion-related complications by themselves.

Conclusion: Our survey showed that our undergraduate curriculum is not aligned with the practical transfusion needs of a young doctor. As transfusions are being carried out by these young doctors, this needs to be addressed by revising the current curriculum and incorporating teaching and hands-on training to our medical graduates.

Blood is a life saver in many emergencies like accidents or for the patients suffering from deadly diseases such as cancer and thalassemia. Conventionally, blood collection is done in five steps, i.e., recruitment, screening, physical examination, collection, and postdonation care. The huge demand of blood requires the implementation of smart approaches in the field of blood donation, which allows specific, measurable, achievable, and timely outcomes. This paper throws light on various smart approaches to motivate and attract people for blood donation. Gamification, social media, short message service, mobile applications, and other web-based applications are some of these approaches reviewed in this article. A number of platforms are also highlighted where one can seek potential donors or blood banks easily during urgency, avoiding the complex steps followed in traditional blood donation systems.

Background: Although ABO and RhD are the clinically significant blood group antigens that are routinely tested for, other blood group antigens may become important in multiply transfused patients due to risk of alloimmunization. Knowledge of antigen prevalence in a population is important in the context of alloimmunization and antigen matching. This study aims to do the same in a population of voluntary blood donors of a center in South India.

Aims and objectives: To study the ABO, Rh (D, C, c, E, and e), and Kell (K) antigen and Rh phenotype prevalence in whole blood donors donating at the blood bank of a tertiary care hospital in South India.

Materials and methods: One thousand and two hundred eligible whole blood donors were chosen by random sampling between November 2017 and April 2019. After administration of informed consent and routine testing for ABO grouping, RhD typing, and indirect antiglobulin test, Rh and Kell typing was done on appropriate gelcards and the data were analyzed to arrive at phenotypes.

Results: 97.6% of the donors were male and 2.4% were female. They were divided into 7 different categories based on the regions of origin: Kerala, Andhra Pradesh, Tamil Nadu, Karnataka, West Bengal, North India, and others with the largest number of donors hailing from Karnataka (38.5%). The ABO distribution, in descending order, was as follows: O (38%), B (34.5%), A (20.6%), and AB (6.8%). The prevalence of the Rh antigens was as follows: D: 93.4%, C: 87.9%, c: 55.6%, E: 19.3%, and e: 98.8%. K was present in 1.4% of the population. Since genotyping has not been done, the most common "presumed" Rh phenotype among RhD-positive donors was R₁R₁ (46.4% of total donors and 49.5% of RhD-positive donors). The most common phenotype among RhD-negative donors was rr (5.9% of total donors and 92.2% of RhD-negative donors). The order of prevalence of the ABO, Rh, and K antigens and the Rh phenotypes remained the same irrespective of gender, ABO group, and region of origin.

Conclusion: This population-based study analyzes a donor population as a whole and separately as per regions of origin and shows that antigen prevalence and thereby risk of alloimmunization does not vary markedly among the different population subsections. Hence, even where extended phenotyping and antigen matching cannot be done, risk of alloimmunization may be low. Limiting antigen matching to specific patient subsets like in multiply transfused patients with uncommon phenotypes may, therefore, be an efficient and cost-effective approach.

With the use of Anti-D prophylaxis for rhesus D-negative pregnant women, other Rh and non-Rh allo-antibodies have become relatively more important. The index case reports severe hemolytic disease of the newborn due to anti-E antibody in a full-term baby boy born to a COVID-19-positive mother. The antibody screening of the mother performed during Booking of pregnancy at 9^th week of gestation was negative. Subsequently the mother was lost to follow-up till delivery due to COVID pandemicity. At birth, the baby was icteric but non-hydropic, his direct antiglobulin test (DAT) was strong positive (4+ by column agglutination technology) and required top-up transfusion and phototherapy at Neonatal Intensive Care Unit. Elution of DAT-positive red cells rendered anti-E which could have formed as "late developing" red cell allo-anti-E in the pregnancy. A repeat antibody screening around 28^th week gestation is of prime importance to detect any underlying allo-antibody in a multigravida and thus enabling close monitoring of fetus and initiation of early management as desired.

Background and objectives: The blood collection agencies (BCAs) employ two major logistical modes of conduct for outdoor blood collection. First, the collection agency walks to the donor's preferred location for routine blood donation drives. Second, the drive is conducted using a heavy-duty vehicle having all the facilities for blood donation in it - Blood Donation on Wheels - hereinafter referred to as mobile blood drive (MBD). The study aimed to review the role of MBDs during the coronavirus disease 2019 (COVID-19) pandemic.

Materials and methods: This was a retrospective analysis of data concerning the blood collection at the outdoor blood donation drives such as the number of drives, blood donations in voluntary (total outdoor), routine blood drive (RBD), and MBDs during the COVID-19 pandemic with respect to referent data.

Results: There was a trend in the increase in MBDs (43.3% in 2020 vs. 35.6% in 2019), with odds of 1.38 (confidence interval [CI]: 0.99-1.9), P = 0.05, during the pandemic. There was a statistically significant increase in contribution in terms of blood donations from MBDs (25.8% in 2020 vs. 19.5% in 2019), with odds of 1.43 (CI: 1.4-1.5), P < 0.05, during the pandemic. There was a statistically significant reduction in the rates of vasovagal reactions in blood donors donating blood at voluntary blood drives, RBD, and MBDs during the pandemic, in comparison with the referent data.

Conclusion: The blood donation on wheels compliments the public outreach efforts of the BCAs, both in terms of the organization of the outdoor blood donation drives and the blood donations obtained thereof.