Asian Journal of Transfusion Science最新文献

Introduction: With the advent of different technologies, multiple manufacturers are producing blood bag systems with different salient features. It is important for transfusion services to select a blood bag system with the best features and quality. This requires an objective evaluation with emphasis on the donor and user experience. Based on a validated questionnaire, this study aimed to design a system for the objective evaluation of two or more blood bag systems from different manufacturers.

Subjects and methods: A case-control observational study was conducted over a period of 1 month at a tertiary care center involving regular repeat voluntary whole blood donors, phlebotomists, and technical staff. A questionnaire was designed based on focused study group discussions and was validated. The new blood bag system comprised the case arm (n = 30), while the routinely used blood bag system comprised the control arm (n = 30). Responses were recorded for both arms and analyzed.

Results: Needle prick was reported as painful by 83% of study donor population (P < 0.005). Eighty-nine percent of the phlebotomists reported that needle penetration force was more for the novel blood bag system (P < 0.005).

Conclusions: The novel blood bag system had certain limitations about the phlebotomy and needle characteristics which may affect the donor and phlebotomist's experience. The blood components did not deviate in quality parameters as per the guidelines of national standard bodies. A similar evaluation of any newly procured reagent and supply item should be done before introduction to the blood transfusion services.

ABO hemolytic disease of the fetus and newborn (HDFN) generally occurs due to transplacental passage of maternal IgG ABO antibodies causing fetal and newborn red cell hemolysis. Preterm, premature neonates born to O blood group mothers with a high titer of anti-A and/or anti-B antibodies are more prone to developing ABO HDFN. This is a case of ABO HDFN in a preterm, premature, and low birth weight B-positive baby of an O-positive, HbE-beta thalassemic mother. The mother had a very high titer of anti-B antibodies, leading to ABO HDFN. The mother was also allo-immunized with anti-Jk (a) antibodies from past packed red blood cell (PRBC) transfusions she received for thalassemia. This anti-Jk (a) antibody was not detected in the antenatal period, probably due to the low titer of the antibody. The mother had an anamnestic response to the PRBCs provided in the antenatal period, and thus, the anti-Jk (a) became identifiable during the pretransfusion workup for the baby. Even if the baby was Jk (a) antigen positive, the baby developed HDFN mostly due to ABO incompatibility. The baby was managed with a double-volume exchange transfusion with reconstituted whole blood and phototherapy. During the postnatal period, the mother developed a delayed hemolytic transfusion reaction (DHTR) due to the anti-Jk (a) antibodies, as she had received Jk (a) antigen-positive PRBC transfusions in the antenatal period. Later, the mother responded well to the Jk (a) antigen-negative PRBC transfusions and conservative management for the DHTR.

Preanalytical variables play a key role in the correctness of laboratory test results. We report a false reactive result for hepatitis B surface antigen (HBsAg) on serological testing with a relatively low OD. The pilot sample was collected in yellow top BD Vacutainer^® (SST™ II Advance 5 mL tube) with separator gel and was marked for serological testing. It was centrifuged at 7000 rpm for 30 min. Serological testing was performed by chemiluminescence on Abbott Architect Plus i1000SR with Abbott kits for HBsAg, anti-HIV, and anti-HCV. This particular sample tested reactive for HBsAg with S/CO of 1.91, S/CO for HBsAgQ2NC (Negative kit control) being 0.19 and that of HBsAgQ2PC (Positive kit control) being 3.65. Repeat testing from the same Vacutainer was also reactive for HBsAg with S/CO of 2.10. Nucleic acid testing was performed and was found to be nonreactive. We repeated serological testing with a sample from fresh frozen plasma of the same donor unit. It was nonreactive. Cross contamination was ruled out by repeat testing of two serial samples before and after this unit number. The serum showed an unusual appearance on visual inspection after centrifugation. By exclusion, we concluded that the gel probably got partially dislodged into the serum, giving a relatively low reading and false reactive result for HBsAg. This highlights the possibility of inert gel not always being inert, the importance of repeat testing from a different sample in case of low reading, the importance of visual inspection, a need for manufacturers and laboratory personnel to consider such preanalytical variables which, though not much mentioned in literature, can affect test results. These results have a multi-fold impact on the donor or patient's mindset, treatment outcome and/or fate of blood donation. These are definitely preventable if more such guidelines are made available for handy reference in handling such results.

[This corrects the article on p. 350 in vol. 18, PMID: 39822678.].

Context: Transfusion medicine is critical for patient care, yet its knowledge among house officers remains under-researched. Adequate training and confidence in prescribing blood products and managing acute transfusion reactions are essential for improving patient outcomes.

Aims: This study aims to assess the level of transfusion medicine knowledge among house officers and explore influencing factors such as demographic characteristics and confidence in clinical practice.

Settings and design: A cross-sectional study was conducted from April 2020 to May 2021 at both a teaching hospital and a tertiary hospital in Kelantan, Malaysia.

Subjects and methods: Validated assisted self-administered questionnaires were used to collect data. The questionnaire was divided into three sections: demographic characteristics, transfusion medicine knowledge, and confidence levels. A total of 393 house officers participated in the study.

Statistical analysis used: Descriptive statistics, including mean and percentages, were used to summarize the data. Logistic regression was employed to determine the association between continuous medical education (CME) and transfusion medicine knowledge, calculating odds ratio (OR) and 95% confidence interval (CI).

Results: Of the 393 house officers surveyed, 61.6% were female, with an average service duration of 12.52 months. Most (60.3%) had attended CME, and 57.3% had donated blood. Only 28.5% demonstrated good knowledge in transfusion medicine, with the highest proficiency in understanding transfusion risks (45.3%). House officers who attended three or more hours of cumulative CME were significantly more likely to possess good transfusion medicine knowledge (adjusted OR: 17.31; 95% CI, 6.35-47.19; P 0.001).

Conclusions: There is a notable deficit in transfusion medicine knowledge among house officers. Intensive CME throughout housemanship can effectively address these knowledge gaps, enhancing medical expertise and patient care.

Context: Institute specific protocols are needed to reduce unnecessary cross matches. Type and screen policies for surgical procedures which does not require blood and maximum surgical blood order schedule (MSBOS) for procedures which require blood units are the two protocols in use currently.

Aim: To compare the effect of maximum surgical blood order schedule in neurosurgery between pre- and post-implementation.

Settings and design: It is a study of 5 years' duration (4 years retrospective and 1 year prospective) conducted at the departments of transfusion medicine, neurosurgery and neuroanesthesia.

Subjects and methods: The patients above 18 years for whom blood requisition were sent were included, whereas those who underwent emergency procedures, massive transfusion, or had underlying bleeding disorders were excluded. The MSBOS was developed based on 4 years' retrospective data and the new protocol was followed for 1 year. The transfusion indices were compared between preimplementation and postimplementation.

Results: A total of 2462 patients were included in the retrospective period, whereas it was 746 in the prospective group. Overall, reduction of crossmatch to transfused ratio from 3.6 to 2.4 and increase of blood utilization from 27.40% to 41.55% was observed. The patients for whom type and screen were performed increased from 18% in the retrospective period to 75% in the prospective period. Eighteen out of 30 common procedures were managed with T and S and seven of them did not require even a single unit of red blood cells intraoperatively.

Conclusions: Our study highlights the importance of including both diagnosis and procedure to formulate MSBOS and the use of modified formulas "transfusion index for type and screen and transfusion probability for type and screen" for revision of MSBOS.

Background: Extracorporeal membrane oxygenation (ECMO) is a mode of therapy initiated for patients with cardiac and/or respiratory failure. Blood transfusion plays a significant role in the management of ECMO patients. In this study, pediatric patients were all cyanotic and transfusion requirements of cyanotic patients differ from other critically ill patients. This study has been conducted to assess the daily transfusion requirements of such group of patients to frame future transfusion policies.

Aims and objectives: This study was undertaken to assess the daily transfusion requirements of ECMO patients with various indications for ECMO initiation. Our aim was to formulate institutional transfusion policies for paediatric and adult patients on ECMO.

Materials and methods: A three years retrospectivTable study was undertaken with 20 study participants. Transfusion requirements were analyzed with regard to the number of days on ECMO support and indications for ECMO initiation. Iatrogenic blood loss/day was assessed among paediatric age group.

Results: Maximum transfusions with PRBC, FFP, and platelet concentrates occurred during the initial 7 days on ECMO. The median packed red cell requirement and FFP requirements for pediatric age group was 1260 ml (IQR = 360-3580) and 900 ml (IQR=150-4650) ml respectively. The median platelet and cryoprecipitate requirements were 450 ml (80-1610) and 120 ml (0.00-600) respectively. The median survival was 8 days (IQR=5.961-10.039).

Conclusion: Transfusion requirements would largely depend upon the clinical status of the patient and therefore, with a smaller number of participants it is difficult to make generalised recommendations. However, the present study could help us to frame institutional-based transfusion support policies for ECMO patients.

Background and objectives: ABO antibodies have implications in platelet transfusions, solid organ, and bone marrow transplants. The study aimed at measuring the immunoglobulin G (IgG) and immunoglobulin M (IgM) ABO antibody titers in A, B, and O blood group blood donors and correlating the titers with age, gender, and blood group of donors.

Settings and design: A prospective observational study was performed over 3 years at a tertiary care blood center.

Materials and methods: Equal number of A, B, and O group blood donor samples chosen by random sampling were evaluated for titers by doubling dilution using tube method. IgM titers were determined at room temperature. IgG titers were tested at 37°C with anti-IgG antiglobulin reagent after inactivating IgM antibodies by dithiothreitol. The titers were correlated with age, gender, and blood group.

Statistical analysis: Mann-Whitney U-test, Kruskal-Wallis test, and Bonferroni correction were employed for various correlations using IBM SPSS v26 (Statistical Package for the Social Sciences) software. A two-tailed P < 0.05 was considered statistically significant.

Results: A total of 870 samples (290 of each of A, B, and O blood groups) were tested for IgG and IgM antibody titers. IgG anti-A and anti-B titers were significantly higher in blood group O as compared to blood groups B and A. Anti-B IgM titers in group A were significantly higher than anti-A IgM titer in B. The antibody titer showed decreasing trend with age. There was no correlation with gender.

Conclusions: The study will help hospitals and blood centers in formulating policies regarding ABO antibody titer estimation in platelet donors and renal transplant recipients in the context of out-of ABO group platelet transfusions and ABO-incompatible renal transplants, respectively.

Inherited factor X (FX) deficiency is a rare autosomal recessive bleeding disorder, presenting with various bleeding manifestations ranging from nonspecific bruising to life-threatening intracranial hemorrhage. It is often misdiagnosed as hemorrhagic disease of the newborn. It is characterized by prolonged prothrombin time, as well as activated partial thromboplastin time, and needs FX level assay for definitive diagnosis. Here, we describe a case of a newborn with FX deficiency who presented with frank umbilical stump bleeding.

Introduction: Different generations of ELISA have evolved over the years. With the introduction of the fourth-generation ELISA, there is a claim of higher sensitivity over the third-generation HIV ELISA kits. However, few literatures suggest false positive issues. The present study aimed to assess the seroprevalence of HIV and to see the level of agreement between the third- and fourth-generation ELISA for HIV detection.

Methodology: Prospective cross-sectional study conducted in a tertiary care hospital from November 2021 to May 2023. All positive samples by either the third- or fourth-generation ELISA were included in the study. If any sample was positive in one generation, and the same whole batch was repeated in another generation ELISA. All positive samples were subjected to molecular testing by polymerase chain reaction. Cohen's kappa coefficient was used to see the level of agreement between the thrid and fourth-generation HIV ELISA.

Results: Seventeen samples were positive by the third-generation ELISA versus 50 samples were positive by the fourth-generation ELISA. The prevalence of HIV was found to be 0.9% by the fourth-generation ELISA and 0.3% by the third-generation ELISA. There was a fair level of agreement between the third- and fourth-generation HIV ELISA. Both generations have a sensitivity of 100%, whereas specificity with the third generation was 91% and the fourth was 24%.

Conclusion: Both the fourth- and third-generation ELISA are highly sensitive; however, the specificity of the fourth-generation kit is less, leading to more false positive results.