Asian Journal of Transfusion Science最新文献

We report the case of a 5-year-old girl with a rare P-null phenotype who presented for a neurosurgical procedure at our center. The case is unique as this patient was one of the two P-null phenotype cases reported in India and we report how we could successfully arrange a rare blood unit for her. As it was challenging to find a donor for her, autologous blood was collected. Despite iron supplementation and erythropoietin injections, her hemoglobin remained low and the required number of autologous units could not be collected. As a consequence of the search initiated with the international and regional rare donor registries, a donor was identified in a remote village in India. Despite the logistic hurdles due to the COVID pandemic, the blood could be transported safely for performing the surgery. A centralized database of rare donors needs to be established to meet such requirements.

Background: Transfusion is an integral part of supportive care in patients undergoing aggressive chemotherapy for acute myeloid leukemia (AML). As transfusion induces immune modulation, the objective of the study was to assess whether the intensity of red blood cell (RBC) and platelet (PLT) transfusion during induction chemotherapy influences complete remission (CR) and overall survival (OS) in newly diagnosed AML patients.

Methods: Details of the number of RBC units and PLT events transfused from diagnosis till completion of induction chemotherapy were collected. Patients were stratified as high or low intensity for transfusion based on median RBC units and PLT events transfused per week. The influence of transfusion intensity on CR and OS was estimated using multivariate analysis and log-rank test, respectively.

Results: Among 90 patients analyzed, the median RBC unit required was 1.7 units/week and PLT transfused was 1.5 events/week. Patients requiring transfusion at disease presentation had significantly higher intensity of RBC and PLT transfusions. Only high intensity for RBC transfusion (P = 0.016) appeared among prognostic factors for achieving CR. The OS was not affected in patients requiring high intensity of RBC (P = 0.314) and PLT (P = 0.504) transfusions.

Conclusion: Transfusion support was higher in patients with a high disease burden at diagnosis. The lower intensity of RBC transfusion goes along with the response to chemotherapy in terms of CR but not OS.

Introduction: Blood banks are responsible for notification and counseling of the reactive donors besides screening for transfusion-transmitted infections (TTIs). Donor notification and counseling is essential to protect the health of the donor by early clinical intervention and to prevent secondary transmission of infection.

Aim: The aim of this study was to determine the effectiveness of human immunodeficiency virus (HIV)-reactive donor notification and counseling in a tertiary care center.

Materials and methods: An audit of the records of HIV-reactive donors over 2 years was conducted. The response rate of HIV-reactive donors on notification about reactive HIV status for one-to-one counseling was evaluated. Their attendance at an integrated counseling and testing center (ICTC) and compliance at an antiretroviral therapy (ART) clinic were also assessed.

Results: Out of 60,907 total donations, 124 (0.2%) donors were HIV reactive. One hundred and eleven were informed about their reactive status and the rest 13 could not be informed due to wrong demographic details in donor registration form. Eighty-seven (78%) reactive donors were informed by phone and the rest 24 (22%) were informed by confidential letter. Of the 111 informed donors, 62 (55.8%) came for one-to-one counseling (responders). Fifty-one (82.2%) responders visited ICTC after postdonation counseling. Over 6-month follow-up, 20/62 (32.2%) reactive donors were undergoing ART.

Conclusion: The response rate of the donors to the notification and further receiving treatment is low in developing countries. Predonation screening and counseling by a trained counselor should be strengthened upon. Education of the donors about the TTIs can improve their knowledge and allay their anxiety.

Background: Hepatitis E virus (HEV) stands out as a significant transfusion-transmissible infection, yet it is not included in the screening protocols of many countries. The present study was conducted to assess the cost-benefit implications of incorporating HEV screening among blood donors which is one of the preventive strategies in reducing transfusion transmissible HEV.

Methodology: A decision tree model was prepared to assist the cost-benefit analysis. The serological screening cost of HEV was estimated based with fixed and variable cost. The cost of illness was estimated with direct and indirect cost. Net present value (NPV) and benefit-cost ratio (BCR) was used to measure the economic variability of screening HEV among the blood donors.

Results: The unit cost of HEV IgM antibody screening is 1000 INR, and the unit cost of illness due to HEV infection is INR 80,122. The NPV and BCR is INR 6,73,001 and 1.7:1 for the probable transfusion-transmitted HEV infection that was averted by the screening of HEV among the blood donors.

Conclusion: Considering the risk of probable HEV transmission through blood transfusion, the study suggests that screening HEV among the blood donors is beneficial in averting transfusion-transmitted HEV infection.

Introduction: There are scarce data on Indian blood donors with respect to blood group phenotypes using molecular diagnostic modalities. Hence, we planned to estimate frequencies of blood group alleles/phenotypes using DNA microarray analysis in the north Indian RhD-negative blood donor population. With this initial pilot study, we plan to expand it to our entire donor population.

Methodology: The cross-sectional prospective study was conducted on 50 Indian blood donors (O RhD negative), to study the blood group genotype frequency. Genotyping for the most relevant red blood cell antigens (Rh, Kell, Duffy, Kidd, MNS, Lutheran, and Dombrock) was done using Bioarray Precise Type^HM Human Erythrocyte Antigen BeadChip kit containing probes directed to polymorphic sites.

Results: In the Rh system, the most common alleles were RHCE*e/RHCE*e (98%) and RHCE*c/RHCE*c (80%). Phenotype K-k+ (genotype- KEL*02/KEL*02) was seen in 98% of samples, Js(a-b+) (KEL*02.07/KEL*02.07) was detected in 98% (49/50) of the samples tested. Jk(a + b+) (JK*01/JK*02) was the most common phenotype (48%) in the Kidd blood group system. In MNSs system, M+N+ (GYPA*01/GYPA*02) 44% and S+s+U+ (GYPB*03/GYPB*04) 34% were the most common phenotypes detected.

Conclusion: This pilot study shows the feasibility of genotyping a Northern Indian donor population. To the best of our knowledge, it is the first study on molecular blood grouping in Indian blood donors using the Bioarray platform.

Anti-M antibody is one of the causes of severe fetal anemia and intrauterine death despite its relatively low frequency. A G3P2 26-year-old pregnant woman referred to our hospital at 29 weeks gestational age (WGA) with fetal hydrops. Her second pregnancy results in intrauterine fetal death at 35 WGA due to fetal hydrops. From ultrasound exam, we found singleton live fetus with ascites, cardiomegaly, and pericardial effusion. The peak systolic velocity in the fetal middle cerebral artery (PSV-MCA) was 1.44 multiples of the median corresponding to fetal anemia. The patient's blood group was B RhD+M- N+. A reactive IgG anti-M antibody was detected at 37°C. Fetal hemoglobin (Hb) from the first cordocentesis was 2.2 g/dl and we perform multiple intrauterine transfusions and cesarean section at 34 WGA. The postdelivery Hb level was 10.2 g/dl and infant need three times packed red blood cell transfusions after delivery.

Background: Ideal blood inventory management involves guaranteeing maximal availability of blood while minimizing wastage. Benchmark for the guidance of O (Rh) D-negative red blood cells (ONEG RBCs) is not widely available. In this study, we aimed to identify the areas of improvement in blood center inventory of ONEG RBCs through a clinical audit.

Materials and methods: During April 2017 to March 2018, patients who received ONEG RBCs units were studied for their demographics, primary reason for admission, location, and clinical condition. Data were collected from computerized blood center information system, online integrated laboratory data (Integrated Laboratory Management System), and patients' medical record charts. Children at ≤18 years were included in the pediatric population as per our institutional criterion while a female between 15 and 49 years was considered as having childbearing potential according to previously published data.

Results: Overall, 807 units (2.8%) of ONEG RBCs were transfused during 577 transfusion events with a median (inter quartile range) of 2 (1-3) units per patient in each transfusion event. Recipients of ONEG RBCs were 221 unique patients including 91 females (41%) and 130 males (59%) and only 44 (20%) females had child-bearing potential. Overall, 72 of 807 red cell units (8.9%) were transfused to young females of O/non-O negative/unknown group and were classified as "obligatory." Neonates, pediatric patients, chronically transfused, and bone marrow transplant recipients received 337 of 807 (42%) units and were marked as "acceptable." Transfusion of 398/807 units (49%) to females of nonchildbearing potential and adult males could have been saved for those with a mandatory transfusion requirement of ONEG RBCs.

Conclusions: This clinical audit showed that 409 of 807 of ONEG RBCs (51%) were transfused according to the guidelines while 398 of 807 of these (49%) could have been saved for other mandatory requirements. Appropriate policies, planning, education of physicians, and regular clinical audits are needed to bring the desired change in transfusion practices.

Introduction: Weak D red cells were defined as having a reduced amount of D antigen (formerly called "Du") that required an indirect antiglobulin test (IAT) for detection. Weakly reacting D is those which give <2+ reactions on routine methods. The present study is sharing our experience on weak D and weakly positive anti-D in various methods.

Materials and methods: All the blood sample of patients and blood donor, which were RhD negative, were included in the study. Furthermore, RhD positive sample <2+ was included. We repeated blood grouping of all these samples by gel card (Tulip), tube method (two different antisera), slide method, and Solid Phase Red Cell Adherence (SPRCA) (Immucore, USA).

Results: A total number of samples were 27,245. RhD negative found out to be 945 (3.46%). Out of all, 929 (98.3%) samples were Rh D negative in gel card and IAT negative, while 16 (1.7%) were weak D positive. Rh D typing with these samples by different antisera at four platforms showed that 14 were weakly positive (<2+) in any of the four platforms. Similarly, out of 26,300 Rh D Positive samples, 21 samples (0.079%) were serologically weak (<2+). Repeat Rh D typing was done with different antisera in all four platforms. Result showed more than 50% were Rh D negative in any of four platforms.

Conclusion: Above observation showed that serological tests at various platforms failed to distinguish weak D from weakly reacting D. Thus, we propose that weakly reacting D should be treated equal as weak D unless they are distinguished by genotyping.

Context: Hemoglobinopathies are the most common heterogeneous group of monogenetic disorder in the world and its prevalence varies with geographical regions. India is developing country and many studies show a significant burden of hemoglobinopathies in India.

Aims: The aim of the present study was to check the prevalence of various hemoglobinopathies in anemic subjects using high-performance liquid chromatography (HPLC) method in Pune region which has multiple ethnic population groups from all parts of India.

Settings and design: The present study was conducted at the department of IH and BT on anemic patients referred from different outpatient department and Wards of the hospital and informed consent were taken from all participants.

Subjects and methods: The present study included a total of 2698 individuals' age ranging from 1.5 to 67 years. The HPLC test was performed using Bio-Rad D-10 analyzer once a week.

Results: Out of a total of 2698 cases, we found 543 (20.12%) cases with abnormal hemoglobin fractions and 2155 (79.88%) cases free from hemoglobinopathies. Out of the total hemoglobinopathies detected 250 (46%) were male and 293 (54%) were female. The major abnormality detected was beta-thalassemia trait (BTT) with 425 (15.75%) cases, followed by sickle cell disorders 58 (2.15%), HbE 38 (1.41%), hereditary persistence of fetal hemoglobin 6 (0.22%), HbD Punjab 13 (0.48%), HbD Iran 2 cases and 4 cases of compound heterozygous for HbS beta-thalassemia. Forty (1.48%) cases were detected as borderline with HbA2 level ranges from 3.6% to 3.9%.

Conclusions: In our study, we found a high prevalence of hemoglobinopathies among anemic subjects. The most common disorder detected was BTT. Most of the hemoglobinopathies found in our study could be accurately quantified by HPLC which is a rapid, sensitive, and reproducible method for the detection of different hemoglobinopathies.

Introduction: Hemoglobin (Hb) estimation in blood donors is conducted using capillary samples on portable hemoglobinometers, representing measurement methods in practice. The reference standard is conducted using a venous sample on a hematology analyzer, representing the mentor measurement method or the true value. The correction involves the calculation of the secondary adjustment factor (SAF) to mitigate the difference between the two values.

Material and methods: A cross-sectional study enrolled 187 blood donors after approval from the institute's ethics committee. On each donor, capillary Hb was performed on the first drop and the second drop of blood using the hemoglobinometer (HCC-1 & 2) and venous Hb using the hemoglobinometer (HC-V) and hematology analyzer (HA-V) consecutively. The secondary adjustment factor was derived from the slope of the regression equation by calculating the ratio of change in HA-V to the corresponding change in HCC -1 & 2.

Results: The Hb on HCC-1 & 2 was 15.02 ± 1.30 g/dL & 15.03 ± 1.34 g/dL, whereas the Hb on HC-V & HA-V was 15.00 ± 1.24 g/dL & 14.41 ± 1.19 g/dL respectively. No difference in means of Hb between HCC-1 & HCC-2 was observed. The equation to calculate SAF was HA-V = 3.25 + 0.74 × HCC-1 and HA-V= 3.58 + 0.72 × HCC-2 respectively.

Conclusion: The study highlights the need for Hb cut-off for blood donors specific for the type of sample, the drop of blood in case of capillary sample and use correction with secondary adjustment to strengthen quality assurance.