Asian Journal of Transfusion Science最新文献

Introduction: Blood transfusion is an integral part of health-care system and there is no complete suitable substitute for human blood till date. Thus, every unit of blood and its products is precious and should be used judiciously. There is a steady increase in demand for blood and its components and thus to maintain balance between demand and supply, rational use of blood and its components is the need of the hour. This study was conducted to analyze different reasons for discarding blood and its components in a tertiary trauma center so that proper recommendations can be adopted to minimize the discard rate.

Materials and methods: A retrospective analytical study was carried out in Sanjay Gandhi Institute of Trauma and Orthopaedics, Bengaluru; a Tertiary Trauma Care Centre for 5 years from January 2015 to December 2019. Details of whole blood collected and blood products prepared were collected from donor register. Reasons for discard were retrieved in detail from discard register. Discard rate for each is calculated as ratio between blood and component collected to the total number of collections and it is expressed as percentage.

Results: Out of 22,401 total units of whole blood and its components, 1310 units were discarded accounting for 5.85%. Platelet concentrate (PC) was commonly discarded component (18.3%) followed by whole blood (6.1%), Packed red blood cells (3.64%), and fresh frozen plasma (FFP) (2.92%). The main cause for discarding is expired shelf life (675/1310, 51.53%) followed by transfusion-transmitted infection (12.75%) and suboptimal collection (9.7%). PC was the common component discarded due to the expiry of shelf life (83.21%). FFP was discarded due to damaged blood bags commonly.

Conclusion: From our observation, we conclude that strict donor selection criteria, predonation counseling, continuous regular training of technical staff involved in blood collection and processing, and adopting newer techniques such as apheresis and first-in and first-out policy will reduce the overall discard rate.

Background: Crossmatch test for neonate transfusion is performed on maternal serum.

Aim: The aim of this study was to investigate whether an alloantibody to a high-frequency antigen (HFA) in the mother may pose a problem in finding compatible blood for transfusion.

Materials and methods: Blood grouping reagent antisera, red cell panel, papain enzyme, and 2-aminoethyl isothiouronium bromide powders were obtained from a local supply and were used according to standard protocol. Clinical details were obtained from the patient's records.

Results: A 5-day-old male with rising serum bilirubin at 24 mg/dL was planned for exchange transfusion. The blood samples of the baby and his mother were referred to get compatible blood. While the baby and his mother both were typed A, RhD+, no blood unit was compatible with mother's serum due to pan-reactive alloantibody against some HFAs. The physician adopted an alternative strategy of phototherapy in combination with Intravenous immunoglobulin (IVIG) as treatment. Meanwhile, the antibodies were identified as anti-In^b reacting at 37°C, which is innocuous with regard to neonatal jaundice. The baby's red blood cells were tested as glucose-6-phosphate dehydrogenase (G6PD) deficient, and he was administered Vitamin K at birth, which explained clinical hemolysis.

Conclusion: An alloantibody to an HFA in the mother posed a problem in finding compatible blood for transfusion. Severe hyperbilirubinemia was due to drug-induced hemolysis in the baby with G6PD deficiency and was successfully treated by phototherapy and IVIG.

Background: In Sri Lanka, blood collection is purely from voluntary, nonrewarded, nonremunerated blood donors. To cope with the rising demand, the donor pool, which is at threat of declining, has to be safeguarded. Therefore, knowledge of Post donation satisfaction (PDS) is essential to retain regular safe blood donors.

Aim: The aim of this study was to determine the PDS and its associated factors among blood donors attending donor clinics of the National Blood Center (NBC), Colombo.

Materials and methods: A cross-sectional descriptive study was conducted among 423 blood donors who attended outdoor donor clinics of NBC, Colombo. Participants were selected by a systematic sampling method. A pretested interviewer-administered questionnaire was used. The prevalence of "high" PDS and associated factors with odds ratio (OR) and 95% confidence interval (CI) was determined.

Results: Blood donors were more likely to be young, male, educated up to advance levels, from religious/ethnic majorities, and employed with an average low monthly income. The majority were repeated, nonregular, nonloyal, and unlikely to be retained. Donor clinic-related particulars were adequate for the majority of donors. The prevalence of "high" PDS was 33.3% (95% CI = 29%-38%). The PDS was associated with donor loyalty (OR = 3.4, 95% CI = 2.1-5.3), adequacy of publicity for donor clinic (OR = 7.2, 95% CI = 4.4-11.8), accessibility (OR = 6.8, 95% CI = 4.1-11.3), environment of location (OR = 9.2, 95% CI = 5.4-15.7), convenience of time/duration (OR = 10.8, 95% CI = 6.3-18.8), provision of refreshments (OR = 11.6, 95% CI = 5.9-23.2), and sanitary and other facilities (OR = 12.2, 95% CI = 6.6-22.6).

Conclusions: Blood donors with "high" PDS were low. Regularizing and updating the available guidelines on outdoor donor clinics would improve the availability of donor clinic-related particulars, enhancing PDS.

Antigens of the Gerbich (Ge) blood group system are highly prevalent proteins that are expressed on the glycophorin C and glycophorin D of the human erythrocytes. Three phenotypes of Ge-negative red blood cells (RBC) have been identified serologically and genetically. Alloantibodies against Ge antigens are extremely rare and their identification can be clinically significant. The persistence of Ge alloantibodies in the patients' blood has not been well investigated. Herein we report a case of a patient with osteosarcoma showed anti-Ge alloantibodies by serology testing following blood transfusion. This case has been further genetically tested and showed a Yus phenotype by molecular analysis. The formed anti-Ge alloantibodies disappeared after 9 months of induction. This case has been successfully managed with compatible Ge2-negative frozen packed RBC. This case reports an extremely rare finding in the Palestinian population characterized by the presence of anti-Ge antibodies and highlights the need for establishing a registry of rare blood groups antigens in Palestine.

Autoimmune myasthenia gravis (MG) is sometimes associated with thymic abnormalities. Thymectomy is performed in cases of MG with a thymoma or general MG that is resistant to medical therapy. The aims and objectives of the study are to assess the survivability and response to plasma exchange in patients planned for thymectomy in unstable disease activity status of MG. Plasma exchange is indicated before and after thymectomy in unstable disease activity status. Here, we are presenting case summary of five patients undergoing plasma exchange for unstable disease activity status. The outcome was poor in patients having Masoka staging III and Iva, respectively. The survival rate was 60% during an unstable state of MG with thymoma in our study.

Aim: The aim of this study was to find out the incidence of seizure recurrence among blood donors who developed vasovagal reaction (VVR).

Settings and design: A prospective survey-based study conducted at the department of transfusion medicine of a tertiary care referral hospital in southern India.

Subjects and methods: All donors who were diagnosed with VVR and loss of consciousness with or without convulsions during 3½ years study period were telephonically contacted to a maximum of 3 times. Whether they experienced a repeat episode of convulsions during 6-month follow-up period irrespective of blood donation was enquired.

Results: Out of 66 donors who were included in the study, 45 (68%) donors could be successfully contacted. One donor out of 45 (2.22%) had developed a repeat episode of seizure 5 months postdonation. However, she also had a previous history of seizures which was not revealed during the medical examination.

Conclusions: Our study shows that the VVR with convulsions during blood donation can trigger a secondary episode if the donor had convulsions in their past before donation. We did not find any donor who developed a new seizure episode without a past history of seizure. However, more studies are needed to confirm the same.

Background: Dry eye disorder in Sjogren's syndrome (SS) is very debilitating to the patients as it affects their day-to-day activities, sleep quality, and overall well-being. To date, there is no known cure for dry eye disorder. The conventional treatment options available so far, such as artificial tears, are ineffectual in symptom relief and are not economically feasible for a long time. Hence, the Autologous plasma prepared and used as eye drops was considered a logical therapeutic option in such a chronic debilitating condition.

Materials and methods: Sixteen patients diagnosed with primary SS with dry eye were included. This was a single arm before and after the interventional study. They were given autologous plasma prepared as eye drops (20% dilution as 5 ml bottles to be used six times a day for 3 months). The outcomes were measured subjectively and objectively as Standard Patient evaluation of Eye Dryness (SPEED) and Dry Eye WorkShop score. The comparison of these categorical variables in the group before and after the intervention was carried out using the paired Wilcoxon test.

Results: None of the patients reported any adverse events following the installation of the serum eyedrops. There was a statistically significant improvement in dryness, soreness, burning/watering, and eye fatigue postintervention. Signs such as corneal staining and superficial punctate keratitis, tear fill breakup time, and Schirmer's score showed improvement postintervention compared to preintervention, but it was not statistically significant.

Conclusion: Our study showed the beneficial effects of autologous plasma eye drops on symptom relief and objective improvement at the end of 3 months. Hence, autologous plasma eye drops can be considered a therapeutic option in patients with SS dry eye disorder.

Introduction: Frequent and regular blood donation is associated with iron deficiency and iron depletion in apparently healthy individuals. However, besides iron, water-soluble vitamins and folate play a significant role in regulating hemoglobin erythropoiesis. Hence, the determination of the prevalence of these supplementary micronutrient deficiencies in regular blood donors can contribute as an additional blood donor safety measure.

Materials and methods: In this study spanning from 2014 to 2020, we assessed ferritin, folate, and Vitamin B12 status in a total of 1722 healthy voluntary Indian blood donors. We further correlated these findings to donor physiognomic parameters such as gender and dietary habits. In addition, we have compared the hematological parameters in donors deficient and nondeficient for the three micronutrients.

Results: Total blood donors included 1360 males and 362 females with the median age for donors of 30 years in both sexes. A higher prevalence of Vitamin B12 and folate deficiency was observed in males (P = 0.0001). However, ferritin deficiency was observed to be more common in female donors (P < 0.0001). Based on the dietary preferences, Vitamin B12 deficiency was observed to be higher in vegetarian donors (P = 0.001), while folate deficiency was more prevalent in nonvegetarian donors (P = 0.005). No such statistically significant correlation was observed in food habits for ferritin deficiency (P = 0.4). Mean corpuscular volume and total red blood cell count were observed to be significantly lower in ferritin-deficient donors compared to nondeficient (P < 0.0001).

Conclusion: Evaluation of micronutrient deficiencies such as Vitamin B12, folate, and ferritin should be routinely incorporated in the blood donor investigation profile in addition to the regular screening tests, especially for repeat donors, thus enhancing the blood donor safety.

Background: Red blood cell (RBC) transfusion is a challenge in autoimmune hemolytic anemia (AIHA) patients due to pan reactivity and crossmatch incompatibility. Apprehensions about the safety and efficacy of least incompatible (best-matched) red cells are common among treatment providers.

Aim: A primary objective was to study the effect of RBC transfusion on hemolysis parameters (hemoglobin [Hb], serum bilirubin, serum lactate dehydrogenase [LDH], and reticulocyte count) in AIHA patients.

Settings and design: This was a hospital-based prospective observational study conducted on 40 AIHA patients attending the department of internal medicine from January 2020 to July 2021 who received RBC Transfusions.

Methodology: Blood samples were collected for evaluating hemolysis parameters: Hb, reticulocyte count, serum bilirubin, and serum LDH before transfusion and compared with the same parameters within 12 h after transfusion.

Statistical analysis: Analysis was done by SPSS software Version 16. Paired t-test was used to find the effect of RBC transfusion on hemolysis parameters and independent t-test was used to compare the effect of compatible and incompatible RBC transfusions.

Results: The median age at presentation was 42 years with a female preponderance (67.5%). Majority of the patients belong to warm AIHA (73%) and Secondary AIHA (60%). Compatible RBC units could be provided to 57% of cases and 43% were transfused with the least incompatible units. The mean pretransfusion Hb in AIHA was 4.3 mg/dl and showed a statistically significant increase after transfusion (P < 0.001). A significant difference between reticulocyte levels of compatible and incompatible transfusions was noted with a P = 0.025. No statistically significant difference noticed in Hb, serum LDH, serum bilirubin levels between compatible and incompatible RBC transfusions.

Conclusion: RBC transfusions in AIHA patients provide Hb increment similar to other anemic patients. RBC transfusions should not be denied in AIHA patients in view of hemolysis and best-matched units also may be transfused in indicated cases.

Background: Rhesus D (RhD) negative is considered a rare blood group in Asian country including Malaysia. Thus, the red blood cell (RBC) alloimmunization among RhD negative is considered significant because the blood's availability and rarity makes it more challenging to find compatible blood. The aims of the study are to determine the prevalence, specificities of alloantibodies, and associated factors of RBC alloimmunization among RhD-negative patients admitted to our center.

Methods: This cross-sectional study involved 562 RhD-negative patients who were admitted to Hospital Universiti Sains Malaysia from January 2011 to December 2019. Demographic, clinical, and transfusion data were collected from patients' records and laboratory information system retrospectively. The blood samples were subjected to the standard immunohematological procedure for RBC antibody screening and identification using Diamed ID gel microtyping system. Pearson's Chi-square and Fisher's exact test were used for statistical analysis and P < 0.05 was considered statistically significant.

Results: The mean age of patients was 41-year-old, with the majority being female (71.4%), Malay (87.5%), blood group O (40.2%), and rr phenotype (64.1%). The main reason for admission was pregnancy related (48.6%) and trauma (18.7%). The prevalence of RBC alloimmunization was 3.6% (n = 20). Most of the alloimmunized patients had a single alloantibody (n = 18) and belonged to Rh antibody (n = 16). The most common alloantibody specificity was anti-D (n = 14) followed by anti-Le (n = 4). The significant associated factors with RBC alloimmunization were the history of blood transfusion (P = 0.049) and Rh phenotype (P = 0.047).

Conclusion: The rate of RBC alloimmunization in RhD-negative patients was low. Nevertheless, it is still mandatory that there should be one standard universal protocol to identify RhD-negative patients and screening for antibody especially anti-D, which is clinically significant.