Asian Journal of Transfusion Science最新文献

Introduction: In blood banking and transfusion medicine, it is of paramount importance to improve transfusion safety and provide a higher quality of product to maximize the therapeutic outcomes and minimize the risk of developing transfusion-associated complications for patients receiving a blood transfusion.

Materials and methods: This was a cross-sectional study conducted at the department of transfusion medicine in a tertiary care hospital of South India from February 2019 to December 2020. The primary objective of the study was to assess the quality of platelet concentrates (PC) prepared by platelet-rich plasma (PRP), buffy-coat (BC), and apheresis method. A total of 760 PCs were subjected to quality assessment, among which 124 were PRP-PC, 176 were BC-PC, and 460 were single donor platelet (SDP).

Results: The total percentage of platelets meeting all the six quality control parameters in PRP, BC and SDP was 78.23%, 81.81%, and 89.96%, respectively. Apheresis PCs showed a significantly higher platelet concentration per µL on comparison with whole-blood-derived platelets. BC-PCs were found to be better than PRP-PC with regard to lower white blood cell (WBC) contamination (P < 0.05) and red blood cell (RBC) contamination (P < 0.01). No statistically significant difference was found with regard to platelet yield, volume, swirling, and pH.

Conclusion: Ex vivo quality of PCs prepared by BC-PC, PRP-PC, and apheresis-PC fulfilled the desired quality control parameters. BC-PC was better than PRP-PC in terms of lesser WBC and RBC contamination and comparable in terms of volume, platelet yield, swirling, and pH. Apheresis PCs showed a higher platelet concentration per microliter on comparison with whole-blood-derived platelets; hence in a blood center where facilities for collection of apheresis product are available, SDPs should be the choice of platelet transfusion.

Background: One of the complications of chronic transfusions in thalassemia is the development of red cell alloimmunization.

Aims: The aim of the study was to determine the frequency, specificity of red cell alloantibodies, and factors influencing alloimmunization in multiply transfused thalassemia patients.

Materials and methods: The study was carried out prospectively on beta-thalassemia patients over 10 months. Plasma samples were used for antibody screening and identification using the column agglutination technique. Patients' clinical, laboratory, and transfusion details were obtained from hospital information system and patient files.

Statistical analysis: Continuous variables were reported as median and quartile, whereas categorical variables were provided as numbers and proportions. P < 0.05 was considered statistically significant.

Results: Out of 255 patients, 17 (6.6%) patients developed alloantibodies. Alloimmunized patients had significantly higher median ages at their first transfusions (1 year vs. 0.5 years; P = 0.042) than nonalloimmunized patients. Alloimmunized patients had significantly higher conjugated bilirubin (P = 0.016) and serum ferritin (P = 0.007). The majority of alloantibodies had specificity toward K antigen, followed by E, C, D, JKa, and JKb antigens. Alloimmunized patients received more units per year than nonalloimmunized patients (median, 30 vs. 24 units; P < 0.001). The average transfusion interval time between two successive transfusions showed a significant difference (P < 0.001).

Conclusions: The prevalence of alloimmunization in thalassemia patients in North India is relatively low. Since most of the alloantibodies belong to Rh and Kell blood group system, extended phenotype-matched blood for Rh and Kell will be helpful in further preventing or decreasing the development of alloantibodies in multiply transfused thalassemia patients.

Blood Centres in India lack infrastructure to investigate immunohematology problems. Reference Testing Center (RTC) was established in 2014 to investigate Immunohematological problem as it is not possible for small blood centers to go for complete immunohematology work up due to lack of financial and technical resources in remote and rural areas. Objective of this study is to share our experience as RTC of past 6 years so that more RTC are established across Indian subcontinent. 1456 Discrepant samples received from various hospitals of South India for Immunohematology problems were analysed in 6 years. Maximum requisitions obtained in 2014 were more than 40 years of age and then 21-40 years of age group in 2015 and same was observed till 2020.75% of total samples received were for antibody identification followed by blood group discrepancy resolution, investigation of positive DAT, red cell phenotype and pre-natal evaluation & antibody titration. Single allo-antibodies were identified in 773 cases whereas multiple allo-antibodies were found in 118 cases. Most common single and multiple antibody found was anti D and Anti-D+C. Weak D subgroup was the most common blood group discrepancy.22 cases & 4 cases of Bombay and para-bombay were also investigated.

The International Society of Blood Transfusion (ISBT) 128 is an internationally endorsed, electronically readable labeling standard that provides a convenient and accurate means of identification, traceability, publication, and storage of information for blood and blood products. The authors' center recently registered with the International Council for Commonality in Blood Banking Automation (ICCBBA) and progressed to ISBT 128 labeling standard. This manuscript was written with the objective of sharing the authors' experience with respect to the implementation of ISBT 128 standards for whole blood donations and integration of ISBT 128 standards with Indian licensing regulations. The authors explore the process of implementation of ISBT 128 standards through a step-by-step journey that included facility registration with International Council for Commonality in Blood Banking Automation (ICCBBA), allotment of facility identification number, development of four-quadrant label for blood components, and integration of local regulatory requirements in the final "composite" label. Acknowledging the lack of any published report from India on ISBT 128 standards implementation, the authors wish to attempt help their peers in understanding and implementation of this global standard at their respective facilities.

A positive direct antiglobulin test (DAT) is of diagnostic feature for the patient with autoimmune hemolytic anemia (AIHA). However, on rare occasions, for obscure reasons, it is found among healthy blood donors. The present report is aimed to elucidate serological and immunological characteristics of such autoantibody in a healthy donor aged 62 years found with positive DAT. There was no history of Leishmaniasis, nor having a significant illness. His red blood cells (RBCs) showed incompatible cross-match results with every recipient tested in the antiglobulin phase. He was found to be DAT+. As his plasma had very little presence of autoantibody, hence was augmented by elution from his in vivo sensitized RBCs for the study. Autoantibody with immunoglobulin IgG showed predominant specificity of anti-Ce. It is certainly a rare case of autoantibody to RhCe compound antigen yet being innocuous in a healthy blood donor with a positive DAT.

Background: Red blood cell (RBC) group systems are depicted by antigens on the surface of RBCs, which when transfused to a recipient that lacks them, can result in alloimmunization. Thus, transfusion of matched RBC components to the recipient is recommended, especially for the more immunogenic blood group antigens, such as Rh (E, e, C, and c), Kell, Kidd, Duffy, and MNS.

Aims: The aim of this study was to perform the blood group genotyping from blood samples of 12 polytransfused patients whose phenotyping was inconclusive or incomplete.

Methods: The amplicons were amplified by polymerase chain reaction-sequence-specific primers for the following alleles: RHCE (RHCE * C, RHCE * c, RHCE * E, and RHCE * e), KEL (KEL * 01 and KEL * 02), FY (FY * 01 and FY * 02), and KID (JK * 01 and JK * 02), in addition to the GATA1-mutated gene (FY * 02N.01).

Results: Discrepancies were found in the Rh (E) and Kidd systems, in addition to cases of Fyb antigen silencing attributed to the GATA mutation, which was present in all individuals with Fy (a-b-) phenotype. The technique also solved the inconclusive phenotyping caused by mixed-field agglutination.

Conclusion: The results show the contribution of blood group genotyping in complex immunohematology cases, optimizing the delivery of RBC components suitable for transfusion safety, and expanding the number of compatible donors for patients with the Fy (a-b) phenotype related to the FY (02N.01) allele.

Background: Coagulation factors are essential to maintain normal hemostasis. Plasma for transfusion can be obtained from whole blood donation or plasma apheresis. Plasma obtained from whole blood donation is termed as fresh frozen plasma (FFP). The quality of FFP can be influenced by several factors including donor variables (such as age, gender, diet, genetic profile), environmental factors, collection methods, processing methods, storage temperature, etc. This study was done to assess the association of donor characteristics such as donor age, blood group, and smoking with coagulation factor levels in FFP units.

Materials and methods: The screening of donors for collection of whole blood units was done as per the national guidelines. A total of 144 FFP units were assessed for coagulation factors. The FFP units were tested for prothrombin time (PT), activated partial thromboplastin time, fibrinogen, coagulation factor VIII, and coagulation factor IX (CF IX) on coagulation analyzer.

Results: A total of 144 FFP units were tested for coagulation parameters. The value of PT was highest in units prepared from donors in more than 45 years of age group. The value of CF IX was significantly lower in O blood group as compared to non-O blood group. The value of fibrinogen was significantly higher in smokers as compared to nonsmokers.

Conclusion: The findings of the present study further add evidence to the fact that donor factors such as age, blood group, and smoking have an impact on coagulation factor levels in FFP units.

Background: The new cell separators make it simple to collect single donor platelets (SDP), although the platelet yield may vary depending on the cell separator used and donor-related clinical and laboratory variables.

Aims: This study aims to study the factors affecting SDP yield and corrected count increment (CCI).

Materials and methods: This retrospective study was carried out at a tertiary care facility in northern India, over 4 years (May 2017-April 2020), data were retrieved and analyzed.

Statistical analysis: Categorical variables were presented as proportions, while continuous variables were presented as mean with standard deviation, P < 0.05 was considered significant.

Results: We found a positive correlation between predonation platelet count and yield (r = 0.243, P = 0.000). No such significant correlation was found with Hb concentration (r = 0.025, P = 0.720), age (r = 0.016, P = 0.820), sex (r = -0.038, P = 0.584), and weight (r = -0.025, P = 0.714). Maximum platelet yield and minimum time were seen with Trima. Only 39.3% (33/84) meet the 24 h CCI. The majority of patients did not meet the desired CCI could be due to the patients' clinical condition. On logistic regression, we found a significant association of 24 h CCI with product yield (odds ratio [OR] = 0.168, P = 0.015) and posttransfusion platelet count (OR = 0.454, P < 0.05).

Conclusion: The only donor-related factor that influences yield is predonation platelet count, whereas 24 h CCI may depend on the clinical status of the patient and yield.

Background: Cold agglutinin disease (CAD) is relatively rare and has primarily been reported as retrospective case series.

Aim: We reviewed our experience with CAD to shed light on this disease.

Study settings and design: This was a retrospective review of all patients with CAD managed at our institution between 2007 and 2018.

Materials and methods: The study was approved by our institutional review board. We extracted patients' demographic, clinical, and laboratory data, blood transfusions, and outcomes from their electronic medical records.

Statistical analysis used: Statistical analysis was performed using SPSS version 17. The method of Kaplan-Meier was used to plot survival curves.

Results: Forty-eight patients fulfilled the inclusion criteria for CAD. The median age of patients was 73.1 (range, 43-99) years; 36 (75%) were female. The majority (n = 38; 79.2%) of patients were Caucasians. Most patients (n = 25, 52.1%) presented with symptomatic anemia. Eight patients were asymptomatic. The median hemoglobin level was 8.6 g/dL (range, 3-12 g/dL); 7 (14.6%) patients had concurrent thrombocytopenia. Lactate dehydrogenase was elevated in 40/47 (85.1%) patients and haptoglobin was below normal in 35/46 (76.1%) patients. Coagulopathy was observed in 19 (52.8%) of 36 patients. Sixteen (33.3%) patients required blood transfusion during admission at the time of diagnosis with a median number of 3.5 red blood cell units. Twenty-five (52.1%) patients were alive after a median follow-up of 50.1 months. The 5-year and 10-year survival was estimated at 58.2% and 30.8%, respectively.

Conclusion: CAD poses considerable burden on patients and health-care systems. Patients vary widely in their disease severity and course.

There are many challenges to obtain antigen-negative, crossmatch compatible blood for a patient with multiple alloantibodies. We present a case report of a 31-year-old female patient with a recurrent pontine cavernoma who was to undergo a neurosurgical procedure. We identified alloantibodies anti-Fy^a and anti-c in her blood sample. To meet her intraoperative blood requirement, we attempted with autologous blood transfusion using both predeposit autologous donation and acute normovolemic hemodilution. Autologous blood alone was sufficient despite anticipating surgical blood loss and a postoperative surgical site infection.