Asian Journal of Transfusion Science最新文献

The objective of this study is to determine the perinatal outcome in pregnancies with hydropic fetuses. The study was a retrospective evaluation of data on intrauterine transfusion (IUT) done in hydropic fetuses for correction of severe anemia from December 2017 to August 2021 in AIIMS Jodhpur. The retrospective case series involves five cases that underwent IUT for severe fetal anemia. All had a sign of hydrops at the time of presentation. Out of five cases, four were of alloimmunized pregnancies while one was of hydrops fetalis secondary to parvovirus infection. The presence of severe hydrops at the time of presentation is a poor prognostic factor affecting fetal survival post-IUT therapy.

Background and objective: Septic transfusion reactions due to bacterial contamination in platelet concentrates (PCs) are continually reported to hemovigilance (HV) programs. Worldwide, blood centers use different systems to avoid transfusion-associated bacterial sepsis in PCs. Herein, national HV data were gathered to compare bacterial protection systems and to assess the risk of bacterial contamination.

Materials and methods: HV data with definite transfusion-associated bacterial sepsis in PCs were obtained from Australia, Canada, the United Kingdom (U. K.), and Switzerland between 2006 and 2016. These data were reviewed to evaluate bacterial protection systems including early small-volume (ESV), early large-volume (ELV), and delayed large-volume (DLV) bacterial culture screening and pathogen inactivation (PI) treatment.

Results: Implementation of DLV bacterial culture screening in the U. K. and PI treatment in Switzerland resulted in significant reductions (P < 0.05) in transfusion-associated bacterial sepsis for the period of 2011-2016 compared to the prior 4 years (2006-2010). Approximately 1.86 million DLV bacterial culture-screened PCs and 0.21 million PI-treated PCs were issued with no reported septic fatalities nor cases of life-threatening sepsis. In Australia, two life-threatening septic transfusion reactions (1.923 per million) were reported out of almost 1.04 million ELV bacterial culture-screened PCs, and no septic fatalities were reported. Meanwhile, in Canada, four life-threatening septic transfusion reactions (3.6/million) and one fatality (0.9/million) were observed in about 1.11 million ESV bacterial culture-screened PCs.

Conclusion: DLV bacterial culture and PI treatment significantly reduced the incidence of septic reactions. The advantages and disadvantages of both systems merit further investigation before implementation.

A 68-year-old male known follow-up patient of nonalcoholic steatohepatitis and carcinoma stomach was admitted to hospital for further management. The patient was planned for radical gastrectomy and required two units of packed red blood cell (PRBC), due to low hemoglobin of 6.6 g/dl. The patient blood grouping and antibody screening (ABS) were done. Patient ABS was positive. On antibody identification, using eleven-cell identification panel, resolve Panel A (Ortho Clinical Diagnostics, Johnson and Johnson, USA), "anti-f" alloantibody was identified in the patient sample. Select cells, from another resolve panel were used to rule out remaining antibodies. Anti-f antibody is produced due to the exposure of "f antigen." Anti-f antibody can cause hemolytic disease of fetus and new-born and possible hemolytic transfusion reactions. At our center, we successfully transfused two units of anti-human globulin compatible and "c-negative" units, to the patient without any adverse reactions. Thus, the patient having anti-f antibody can be managed by transfusing "c-negative" or "e-negative" PRBC units or units lacking both the "c" and "e" antigens.

Background and objectives: Discrepancy between forward and reverse ABO grouping could be due to several reasons including genetic mutations of the alleles encoding group specific transferase. The healthy donors found with weak A antigen were investigated to ascertain the allele responsible for variation.

Materials and methods: Standard serological methods were employed using commercial antisera. The molecular sequencing was performed on DNA with enrichment library prep kit and a custom designed overlapping probe panel. Binary alignment mapping files, generated on board the Illumina MiSeq instrument and aligned to the GRCh37/Hg19 reference genome, were uploaded to the QIAGEN CLC genomics workbench software (version. 20) where variant call files were generated and analyzed.

Results: Red blood cells (RBCs) of six healthy donors, showing weak mix-field agglutination by anti-A and anti-A, B and plasma with absence or weakly reacting anti-A, were investigated serologically. The RBCs incubated with anti-A yield positive elution and their saliva lacked A but possessed H antigen thereby classifying as a historical known phenotype A_end. Family study on 4 probands showed inheritance of the trait. Molecular studies revealed presence of ABO*A allele carrying rare novel variant referred to as c.106delinsGG in line with HGVS recommendation that was thought to be responsible for the variant of A.

Conclusion: Six cases serologically defined as A_weak were found to be associated with novel allele ABO*A (c.106delinsGG). The A_weak phenotype with the novel allele has not been displayed on International Society of Blood Transfusion database, though c.106delinsGG is listed in the UCSC genome browser under rs782544248.

Introduction: The rate of discarded blood components or "wastage rate" reflects on the whole process, preparation, and production of blood and its quality control. It is the ratio of blood and blood components discarded to the total number of collections. The discard or unusability of blood products are many, and the ones that can be monitored and regarded as indicators to be improvised on are QC failure rate, transfusion-transmitted infection (TTI) positivity, and component discards (other than TTI), including those that caused transfusion reactions. These were studied over four intervention cycles to see if they could be improved.

Materials and methods: This was a clinical audit and quality improvement study. The clinical audit was conducted over four cycles over 16 months. Each cycle included three stages wherein the data required for calculating those key performance indicators (KPIs) of the blood center were studied and analyzed, and causes for the poorly performing ones were identified; a corrective plan was drawn and implemented, followed by data collection and interpretation of the same in the next cycle for improvement. The data were compiled using a Microsoft Excel spreadsheet and analyzed using SPSS version 19 (IBM Corporation, New York, USA).

Results: The overall discard rates due to all cumulative causes mentioned were at about 5% at the start of the first cycle. The various factors comprising preparatory, preparation, and the management of inventory and issue were analyzed, and corrective interventions were performed in every cycle. The discard rates were reduced to about 3% by the end of the four cycles. The difference was statistically significant, with a P < 0.05.

Conclusion: The implementation of Corrective and preventive action measures can rectify the deviations in KPIs. The blood center director, staff, and doctors should be responsible for maintaining and continuously improving the quality indicators.

Introduction: Granulocyte transfusion is one of the best therapeutic modalities in prolonged neutropenic patients with severe bacterial/fungal infections. Granulocyte harvest using conventional acid citrate dextrose (ACD) anticoagulant (ACD-A) by apheresis is not satisfactory in comparison to the use of hydroxyethyl starch (HES), but the latter is associated with various adverse events, especially with high-molecular-weight HES.

Aims and objective: This study aimed to assess the beneficial impact of the use of medium-molecular-weight (MMW)-HES and trisodium citrate combination over ACD-A in granulocyte apheresis when using Spectra Optia.

Materials and methods: This was a retrospective study comparing granulocyte harvest results with the use of ACD or HES and trisodium citrate combination. All the donors in both the groups received single 600 μg of granulocyte colony-stimulating factor subcutaneous injection followed by 8 mg of dexamethasone tablet 10-12 h and omnacortil 60 mg orally 3 h before harvest. A number of adverse incidents, if any, were observed and noted. Donor/procedure parameters were compared using Mann-Whitney U-test/unpaired t-test.

Results: Granulocyte yield (mean: 3.29 × 10¹⁰/unit vs. 4.5 × 10¹⁰/unit in the ACD and HES groups, respectively, P ≤ 0.0001) was significantly better in the HES group. The collection efficiency was also better in the HES group (mean: 15.86% vs. 26.70% in the ACD and HES groups, respectively, P ≤ 0.0001) in the ACD and HES groups, respectively. There was no significant adverse event noted in any of these two groups.

Conclusion: In our study, granulocytes with optimum yield can be easily harvested with Spectra Optia cell separator using 6% HES (MMW) and trisodium citrate combination with standard 12-h interval gap between mobilization and harvest. This strategy can also have no or minimal extra cost burden to patients.

Donor lymphocyte infusions (DLIs) are often recommended products after allogeneic hematopoietic stem cell transplant to increase graft - versus - leukemia effect. More success rate of DLI has been reported in relapsed posttransplant chronic myeloid leukemia. Whatever the indication for DLI, mortality related to post-DLI infusion is 5%-20%, and more than one-third of patients will develop acute and/or chronic graft versus host disease (GVHD) after DLI. We report two cases where DLIs were used for residual disease after posttransplant. Both of DLI went uneventful. None of the patient's developed signs of GVHD postinfusion. Although both patients expired with different causes, none were related to DLI infusion. Information from published literature suggests that DLI should be administered early after relapse or as a prophylactic strategy in patients receiving T-cell-depleted grafts, and patients with aggressive diseases may benefit from disease reduction before DLI. However, further evidence is required to evaluate its efficacy, especially in relapsed or residual hematological malignancies.

Introduction: The regulations in India mandate a blanket deferral period of 12 months for donors from the time of acquiring a tattoo. The rationale is that using nonsterile needles, the same dyes for many persons, and other unhygienic practices result in the transmission of blood-borne infections. However, currently, autoclavable tattoo equipment, professional tattoo gun, single-use dye, and needle for tattooing have come up and are known to be devoid of the risks mentioned above. Hence, this study was designed to assess if the seroprevalence of transfusion-transmitted infections (TTIs) among tattooed blood donors was higher than in other nontattooed donors.

Methodology: This cross-sectional comparative study was conducted in the Department of Transfusion Medicine at the tertiary care teaching hospital in Pondicherry from September 2017 to May 2019. The study group included blood donors in the age group of 18-60 years with one or more tattoos, and the control group was chosen among blood donors of the same age without a tattoo. The sampling technique was consecutive. The serological prevalence of the two groups was compared for HIV, hepatitis B virus, hepatitis C virus, Syphilis, and Malaria.

Results: A total of 368 donors were recruited for the study, 184 donors with tattoos and 184 donors without a tattoo. The detected seroprevalence of TTI among the tattooed and nontattooed groups was 3.8% and 4.3%, respectively. There was no significant association found between tattooing and seroprevalence of TTI. About 60% of the ones who got a tattoo had obtained it from a licensed tattoo parlor.

Conclusion: We found that the seroprevalence of TTI among tattooed donors was similar to that of nontattooed donors. However, the seroprevalence among donors who had undergone more than one tattooing experience was higher than those who had a single tattooing event.