Asian Journal of Transfusion Science最新文献

Multi-system inflammatory syndrome in children associated with COVID19 (MIS-C) is a unique clinical syndrome characterised by fever, gastrointestinal symptoms, skin and oral rash and or neurological symptoms in the presence of raised acute phase reactants and coagulopathy. Ferritin is an acute phase reactant which is used as a marker of inflammation. Diagnosis of MIS-C in the background of transfusion dependent thalassemia with iron overload needs a strong clinical suspicion. Early diagnosis and prompt treatment are necessary to ensure a rapid uneventful recovery. A three-year-old male child born to non-consanguineously related parents reported to pediatric emergency with difficulty breathing and pain abdomen for one day. The child was a diagnosed case of Beta thalassemia major since the age of one year and was on regular transfusions and was on iron chelation for past eleven months with deferrasirox. Initial clinical examination showed a sick and irritable child with tachypnea tachycardia and hypoxia. Initial investigations showed raised acute phase reactants along with severe anemia. The child was investigated for MIS-C because of unexpected rise of serum ferritin from 1980 ng/mL (October 2020) to 6686 ng/mL (in January 2021) despite being on regular chelation. Antibody titre for SARS COVID-19 was positive. The patient was treated with intravenous corticosteroids and improved with the same. The advent of COVID19 pandemic saw most children having a mild disease with no or minimal symptoms. Some kids however presented with more serious delayed symptoms of MIS-C. To diagnose same in multi transfused patients a strong clinical suspicion and just judgement based on the clinical and laboratory findings should be done. Unexplained rise in ferritin levels, typical symptoms and high probability of exposure to COVID19 helped in clinching diagnosis.

Introduction: In human beings, there are 45 blood group systems and 360 antigens currently recognized by ISBT (July 2023). The Rh blood group system has 56 antigens, out of them 5 antigens D, C, c, E, and e are clinically significant antigens. The Kell blood group system has 25 highly immunogenic antigens. Cases have been reported where IgG-type of antibodies against Rh and Kell antigens are found which are responsible for transfusion reactions and hemolytic disease of newborn.

Aims and objectives: To study the prevalence of Rh-Kell phenotype in voluntary blood donors, To provide Rh and Kell antigen-matched blood products to patients to prevent alloimmunization, To make a donor directory of Rh and Kell phenotyped donors for further use.

Mateials and methods: The antigen typing for Rh antigens (D, C, c, E, and e) and Kell (K) was performed on the collected ethylenediaminetetraacetic acid samples from 1014 voluntary donors. The test was performed by Erythrocyte Magnetic Technique using a microplate (DuoLys) in a fully automated immunohematology system (Diagast Qwalys Evo 3 instrument).

Results: From 1014 phenotyped donors, the most common antigen frequency was of "e" (98.6%) followed by "D"(96.2%),"C"(89.4%), "c"(54.8%), and "E"(18.6%). The frequency of the "K" antigen was (1.38%). The most common Rh phenotype from the study population was R1R1(CDe/CDe) (45%) and the rarest was r'r' (Ce/Ce) (0.1%).

Conclusion: Knowledge of the phenotype frequency in the local population is helpful in making a donor directory, In situations where clinically significant alloantibodies are found in patient's serum, antigen-negative blood unit can be arranged using a donor directory.

Simulation in medical education has made significant inroads in most of the specialties in some form or the other. Transfusion medicine, as a branch, being a new specialty, is imbibing a few things from the world of simulation and provides immense scope for its utilization, given its broad applicability as well as necessity. In the current Indian scenario of transfusion medicine, wherein the transfusion process has undergone significant changes involving critical steps, with fewer but can be serious complications arising due to the transfusion process, it is desirable for students and the staff involved to practice on the simulators to attain the desired level of competency as it allows the practice of hands-on invasive procedures before performing the actual process. The principles, pedagogies, and educational strategies with their modalities used in health care simulation like case-based scenarios, physical models, computer systems, standardized patients, mannequins, virtual reality, and integrated simulators are all being used and the scope for improvisation is always in the fore with technical advancements. The transfusion and related activities include significant risks, so regular training is essential. The costs are also reasonably high, and focusing on being time-efficient is essential as many scenarios need immediate attention and management. Simulation in transfusion medicine has farsighted returns wherein there is the possibility of defining goals and objectives and ensuring that they could be adjusted to the individual learners as per their knowledge and skill level. The simulations can be set up that can train as well as assess cognitive, affective, and psychomotor domains simultaneously in transfusion using multiple modalities.

Introduction: Patient blood management (PBM) is outlined as evidence-based medical and surgical concepts with a multidisciplinary method.

Aims and objectives: The aim of this article is to review the PBM implementation and analyses the issues, challenges, and opportunities.

Methodology: In this article, we have an overview of PBM implementation in literature and our experience in one hospital in Iran. We used databases including Embase, CINAHL, Scopus, Google Scholar, Google, Science Direct, ProQuest, ISI Web of Knowledge, and PubMed to attain the related literature published in the English language.

Results: There are different barriers and challenges of implementation of PBM, such as hospital culture confrontation, reduced staff with restricted time, lack of interdisciplinary conversation, change of practice, the lack of experience with PBM, the feasibility to integrate PBM, electronic documentation and schedule budget for required instruments, resources, and personnel. Hospitals differ globally in the aspect of infrastructure, personnel and properties, and it is necessary to individualize according to the local situation.

Conclusion: The review highlights the importance of PBM and its implementation for obtaining patient safety. PBM establishing in hospitals as a complex process have different challenges and barriers. Sharing experiences is essential to success in the PBM programs. Cooperation between countries will be useful in PBM spreading.

In the absence of specific antisera and molecular typing technique, selection of P antigen-negative red cell unit is a challenge. This article explains a new technique that can be used in emergency situations to screen P antigen-negative red cell unit for the transfusion of patients with paroxysmal cold hemoglobinuria tested positive for Donath-Landsteiner antibody. The technique is based on the theory behind the Donath-Landsteiner test, and it can be performed even in a transfusion laboratory with minimum facilities.

Background: Rh-DEL type is not detected on routine serology and requires specialized adsorption elution methods which are laborious. Identifying the DEL phenotype in blood donors is important to prevent alloimmunization in transfusion recipients. The present study aimed to determine the frequency of DEL phenotype in RhD-negative North Indian blood donors and correlate the results with Rh Cc/Ee phenotype.

Materials and methods: In this prospective descriptive cross-sectional study, a total of 205 blood donors with historic blood group RhD-negative were enrolled. All samples were subjected to blood grouping using a fully automated immunohematology analyzer and samples that typed as RhD negative by two different anti-D antisera were tested for Weak D. Weak D-negative samples were subjected to adsorption and elution for DEL phenotype. All samples were also tested for extended Rh phenotype for C/c and E/e antigens.

Results: Of the total 11934 donors during the study, 6.2% (n = 743) donors were RhD negative. Of the 205 donors enrolled in the study, two donor samples were serologically weak D positive. None of the remaining 203 donors tested positive for the DEL phenotype. The extended Rh phenotype performed for these donors showed that 6.83% (n = 14) donors were positive for RhC antigen and 1.46% (n = 3) were positive for Rh E antigen. Both weak D-positive donors were also positive for the Rh C antigen.

Conclusion: The prevalence of DEL phenotype is low in the Indian population and studies with larger sample sizes are required to determine the effectiveness of routine C/E typing as a strategy to identify DEL-positive individuals.

Background: Red blood cell (RBC) units undergo metabolic, structural, and biochemical changes known as "storage lesions" that can reduce the survival and quality of RBCs. The use of antioxidants such as α-tocopherol may help to improve the quality of RBC units by reducing oxidative stress. The aim of this study was to determine the antioxidant effect of α-tocopherol in RBC units containing citrate-phosphate-dextrose solution with adenine (CPDA1) stored at 1°C-6°C for 35 days.

Materials and methods: Four RBC units containing CPDA1 were divided into four equal satellite bags. Three bags were supplemented with 0.125, 0.625, and 3.125 mM concentrations of α-tocopherol as test groups. One bag was supplemented with ethanol (0.5%) as a control group. They were stored at 1°C-6°C for 35 days. Malondialdehyde (MDA) concentration, total antioxidant capacity (TAC), and hemolysis index (HI) were measured on days 0, 7, 14, 21, 28, and 35.

Results: In all groups, MDA concentration and HI increased and TAC decreased (P < 0.05). MDA concentration and HI in the 3.125 mM of the α-tocopherol group had a lower increase compared to the other test and control groups. Supplementation of RBC units with α-tocopherol resulted in a significant increase of TAC in all three groups compared to the control group (P < 0.05) and had a lower reduction during storage.

Conclusion: Supplementation of RBC units with α-tocopherol improves the quality of RBC units by decreasing lipid peroxidation and hemolysis and by increasing TAC. Among the mentioned concentrations, 3.125 mM of α-tocopherol had a significantly more antioxidant effect.

Introduction: Apheresis is practiced widely to collect single donor platelets (SDPs). This procedure utilizes an anticoagulant acid citrate dextrose to prevent clotting of blood in the extracorporeal circuit which chelates divalent ions like calcium. This alters the calcium homeostasis resulting in hypocalcemia causing acute adverse events.

Aim: The study aimed to know the calcium homeostasis in apheresis platelet donors.

Materials and methods: This cross-sectional study was conducted from January 2020 to December 2020 in the department of transfusion medicine. The sample size was 50. Donors who walk in for voluntary SDP donation were selected. Total and ionized calcium, pH, and serum albumin for all the donors at baseline and ionic calcium at the end of the procedure and 30 min after the procedure were measured.

Results: According to statistical analysis of the ionic calcium level at pre procedure, immediate post procedure and 30 minutes post procedure, there was decrease in the value immediate post procedure and values returned to baseline within 30 minutes. The levels of pH change were analyzed. On comparing the preprocedure and immediate postprocedure values, there was a significant lowering of pH value from the baseline (P = 0.5), indicating acute lowering of pH immediate postprocedure. Hence, most of the citrate metabolism can be achieved within 30 min after completion of the apheresis procedure.

Conclusion: SDP collection is essentially a safe procedure with minimal adverse effects. Toxicity of citrate is not much pronounced. Recovery of calcium levels is within 30 min of completion of plateletpheresis.

Anti-P1 is immunoglobulin M type and occurs naturally; it is often detected as a weak- and cold-reactive antibody. However, in rare cases, it is reactive at 37°C or shows hemolytic transfusion reactions. The presence of high thermal amplitude of anti-P1 cannot be ignored and requires cross-match compatible red blood cells for transfusion. In the present study, we report three cases with ABO discrepancy due to anti-P1 that was identified as a cold-reacting antibody with high thermal amplitude.

Context: COVID-19 usually presents with mild symptoms. No cases of transfusion - transmission of COVID-19 had been reported. Assessing the prevalence of viral infections among blood donors is essential to frame blood safety strategies.

Aim: The main aim of this study is to assess the seroprevalence of SARS-CoV-2 antibodies among healthy and asymptomatic voluntary blood donors by enzyme-linked immunosorbent assay (ELISA).

Setting and design: This cross-sectional study was conducted among voluntary blood donors using a consecutive sampling technique in the Department of Transfusion Medicine, the Tamil Nadu Dr. M.G.R. Medical University, Guindy, Chennai, for 18 months.

Methods: Adhering to COVID-19 pandemic guidelines and donor eligibility criteria, blood samples collected from 500 asymptomatic unvaccinated voluntary blood donors were tested for SARS-CoV-2 (IgG + IgM + IgA and IgG) antibodies by ELISA. Adding IgA to a conventional IgM and IgG serological test improves sensitivity.

Statistical analysis used: The collected donor data were analyzed with IBM SPSS Statistics software. Pearson's Chi-square test and Fisher's exact test were used. P = 0.05 was considered statistically significant.

Results: IgG seropositivity among the donors was 58.8%, and IgM + IgA seropositivity was 29.6%. There was no statistically significant difference in the COVID-19 IgG/IgM + IgA seropositivity status with age, gender, blood group, occupation, or socioeconomic status. The IgG and IgM/IgA/IgG ELISA kits showed a difference of 13 cases which could be attributed to the higher sensitivity of IgG alone ELISA kit. This increased the seroprevalence by 3%.

Conclusion: The majority of donors were either IgG or IgM and IgA positive, despite remaining asymptomatic. The seropositivity rate coincided with the COVID-19 surge among population.