Asian Journal of Transfusion Science最新文献

Anti-C^w (C Willis) is a low-frequency immunoglobulin against red cell antigen C^w in the Rhesus (Rh) blood group system. Anti-C^w can either be naturally occurring or develop as a result of red blood cell sensitization through transfusion or during pregnancy, and is rarely associated with clinically significant hemolytic disease of the fetus and newborn. However, anti-C^w, being a low-frequency antigen, is not always included in the commercial antibody screening panels and also not phenotyped for in-house pooled red cells used for single-cell indirect antiglobulin testing for blood donors in various blood centers. Here, we report a case of a whole blood donor who was identified with an anti-C^w antibody.

Splenic infarction is a rare entity in pediatric population and is associated with predisposing conditions, i.e., hematological and oncological or infections. Among hematological conditions, only few cases associated with autoimmune hemolytic anemia (AIHA) have been reported so far. We encountered a 12-year-old female who presented with left upper quadrant pain and was diagnosed as AIHA with splenic infarction. Further workup revealed decreased protein S levels -63% (normal: 74%-146%); no laboratory parameters were suggestive of any clinical condition, leading to decreased protein S levels. Few cases of protein C deficiency with splenic infraction have been reported in patients with leukemia, hereditary spherocytosis, and Epstein-Barr virus infection, but to the best of our knowledge, no one has reported AIHA with splenic infarction with protein S deficiency so far.

Background: Buffy coat pooled platelets (BCPP) have recently been licensed for clinical use in India and have merits of both the conventional platelet concentrates, i.e., random donor platelets and single-donor apheresis platelets (SDAPs). Repeatedly, finding a ABO-matched donor for hemato-oncology patients is a challenge.

Aim: This study aimed to evaluate feasibility, efficacy, safety, and cost-effectiveness of BCPP in nonrefractory, hemato-oncological patients in comparison to SDAP.

Methods: In a randomized cross-over study design, 93 hemato-oncological patients were assigned either BCPP or SDAP as their first transfusion product. On subsequent requisition for the same patient, the other platelet product was issued for transfusion. Corrected count increment (CCI) and percentage platelet recovery (PPR) were calculated 1 h after the transfusion. Intertransfusion interval, posttransfusion platelet increment, and signs of any adverse transfusion reactions were also noted. A cost analysis was also done.

Results: Mean posttransfusion platelet increment was observed to be 37043/μL for BCPP and 30839/μL for SDAP. The mean CCI and PPR 1 h after transfusing was 15003 and 36.42% for BCPP and 15554 and 38.04% for SDAP. The median intertransfusion interval was 96 h after BCPP and 72 h after SDAP transfusion. Multivariate analysis shows that the BCPP is noninferior to SDAP for CCI (-549, 95% confidence interval [CI]: -1129--30), PPR (-1.62, 95% CI: -3.02--0.21), superior for platelet increment (6202, 95% CI: 4742-7661), and for intertransfusion interval (35, 95% CI: 10.5-59.5). No transfusion reactions were reported in any of the patients enrolled. BCPP costs 61% less than the SDAP in our setup.

Conclusion: This study suggests that in nonrefractory, hemato-oncological patients BCPP is noninferior to SDAP in terms of 1-h posttransfusion CCI and PPR. BCPP costs significantly less and can act as a good alternative to SDAP in resource-constrained settings.

Introduction: Therapeutic plasma exchange (TPE) is commonly used as a treatment modality in varying neurological disorders. Response to TPE in neurological disorders is usually noted in "subjective" terms. We, measured response to treatment, objectively, using Modified Rankin Scale (MRS).

Materials and methods: This was an observational prospective study in patients diagnosed with autoimmune neurological disorders (AND) who underwent TPE, in addition to intravenous immunoglobulin, and/or prednisolone. This study was carried out at a tertiary care center. Demographic data, procedure details including adverse reactions, and clinical responses were collated. Clinical response was assessed by applying MRS, in different neurological disorders, before (pre-TPE) and after TPE (post-TPE). Pre- and post-TPE clinical conditions were compared using the Wilcoxon matched-pairs signed-ranks test.

Results: Fifty-three patients were included, with 15 females and 38 males, who had a median age of 48 years. Seven different AND were; myasthenia gravis (n = 11), Guillain-Barre syndrome (n = 18), neuromyelitis Optica spectrum disorders (n = 6); chronic inflammatory demyelinating polyneuropathy (n = 5); autoimmune encephalitis (n = 6); transverse myelitis (n = 6); and multiple sclerosis (n = 1). Patients received a median of 5 cycles of TPE and a mean 1.5 plasma volume was exchanged. The improvement in the MRS scale was significant when post-TPE scores were compared with pre-TPE scores. The most common adverse reaction was shivering (n = 5; 1.85%), which was managed conservatively.

Conclusion: TPE was shown to be an effective and safe treatment modality in providing relief to patients with neurological disorders.

Transfusion therapy remains the main stay of treatment for patients with sickle cell anemia for several years. However, repeated transfusions might result in iron overload and alloimmunization in sickle cell disease (SCD) patients. Automated red cell exchange (RCE) is a therapeutic procedure, in which deformed red blood cells of the patient were separated, removed, and exchanged with normal red blood cells of blood donor through a dedicated apheresis machine. It is an evolving and effective procedure in reducing the sickle cell load and its associated complications. Sickle cell crisis is a life-threatening and an emergency condition encountered in SCD patients, which requires prompt intervention and management. We would like to report our experience with one such case of SCD with acute bone pain crisis, in whom therapeutic automated RCE was initiated. This successful intervention promptly reduced the patient symptoms and also effectively decreased the Hemoglobin S concentration from 74% to 18%, which highlights the importance of RCE procedure.

Background: As is widely known, blood group antigens are found in varying proportions in individuals of different races and geographical places. The aim of this study is to determine and compare the distribution of red blood cell (RBC) phenotypes in blood donors between the major ethnic groups in Peninsular Malaysia, Sabah, and Sarawak based on the Malaysian population.

Materials and methods: A total of 1213 voluntary blood donors were randomly recruited among those who donated in the National Blood Centre and 10 other different blood banks in state hospitals or their mobile blood donation sessions from January 2021 to December 2021. All donors were typed for blood group systems: ABO, Rh, Kidd, Duffy, MNS, and Kell by automated system using the Galileo Neo Analyser.

Results: The comparison of the prevalence of the RBC phenotypes among the different ethnic groups as analyzed by Fisher's exact test, showed significant differences (P < 0.05) for Rh, Kidd, Duffy, MN, and Ss blood group antigen. The rare phenotypes: CCDEE (RZRZ) was found in three Malay, Jk (a-b-) in one Chinese, and two Murut, and SS in 8 donors.

Conclusion: The mapping of RBC phenotypes among major ethnic groups in blood donors in Peninsular, Sabah, and Sarawak, Malaysia, can aid in strengthening the database for the Rare Blood Donor Registry based on the Malaysian population. This study's finding can also be used to expedite the provision of antigen-negative blood for the transfusion of patients with unexpected red cells antibodies. This will improve the quality and effectiveness of transfusion services in Malaysia.

Context: Total knee arthroplasty (TKA) is associated with blood loss and allogeneic blood transfusion (ABT).

Aims: The present study aimed to determine the predicting factors for ABT in patients undergoing TKA.

Setting and design: This was a retrospective cohort study, performed from 2003 to 2021 in Kashani hospital (a tertiary referral center) in Isfahan, Iran.

Subjects and methods: Patients who underwent TKA during the period of the study were included in the study. Demographic data including age, sex, marital status, and place of living were extracted. Surgery-related factors, including the day of admission and surgery, indication for surgery, and the American Society of Anesthesiologists score, were recorded. Data about ABT during and after surgery, hemoglobin (Hb), creatinine (Cr), platelet (Plt) level before the surgery and past medical history including comorbidities and drug history were also evaluated.

Statistical analysis used: Independent sample t-test and Chi-square were used for the comparison between study groups and logistic regression model on an as-needed basis.

Results: During the study period, 889 patients underwent TKA and were included. Three hundred and seven (34.53%) patients received ABT. In the univariate analysis, factors including asthma, anemia, antihypertensive drug consumption, preoperative Hb and Plt, and Cr had a significant relation with transfusion. Among these factors, preoperative Hb and Plt level had a significant association with transfusion in the logistic regression analysis.

Conclusion: We deduce that preoperative Hb and Plt can predict the probability of transfusion in patients undergoing TKA. We suggest routine blood preservation before the surgery in hospitals with a high rate of transfusion.

Alloimmunization is a significant complication of blood transfusion, especially in sickle cell patients, and may lead to a delayed hemolytic transfusion reaction (DHTR). DHTR is defined as evident hemolysis and a positive direct antiglobulin test (DAT) 24 h to 28 days posttransfusion with either a positive eluate or a newly identified alloantibody in the plasma. Hyperhemolysis syndrome (HS) is a fatal form of DHTR in which the posttransfusion hemoglobin (Hb) level is less than the pretransfusion Hb level. In this case series, we have reported three cases of alloimmunized sickle cell disease patients with clinically significant DHTR. The second case is typical of HS. All three cases were DAT positive, alloimmunized with multiple alloantibodies, and had substantial hemolysis posttransfusion. In this series, we have provided an algorithmic approach to resolve such complex immunohematological problems and have highlighted some of the limitations of serology methods. High-dose corticosteroid and intravenous immunoglobulin prove to be an effective treatment for DHTR.

Introduction: Asymptomatic hepatitis E virus (HEV) infections have been found in blood donors. Posttransfusion hepatitis E has been reported and raises concern due to cases of HEV-related mortality in patients with underlying cirrhosis or immunocompromised patients. This study aimed to determine the seroprevalence of HEV-associated sociodemographic parameters, awareness about feco-oral transmitted diseases among healthy blood donors attending a tertiary care teaching hospital blood center.

Materials and methods: This was a cross-sectional study done for 1 year from January 2019 to January 2020. Our study included a sample size of 920 blood donors attending for donation at a single center. All the samples were tested using HEV IgM kit with the antigen used for coating were four synthetic peptides with conservative epitopes of ORF2 and ORF3 in genotypes 1, 2, 3, and 4. An open-ended questionnaire regarding awareness of the feco-oral transmission of diseases was administered; data regarding clinical, epidemiological, and demographic characteristics were collected from the donors by a structured data collection proforma. The responses were recorded.

Results: Our study results showed a seroprevalence of 1.41%. All the reactive donors were asymptomatic during our routine screening procedures. Most of the donors (457 donors), i.e., 49.7%, belonged to the lower middle class; the mean age of the study population was 28.6 years (standard deviation 8.9).

Conclusion: This study reflects the burden of HEV in the local population, and this result can be considered a preliminary step in quantifying the risk of transfusion-transmitted HEV. Cost-effectiveness in implementing HEV screening as a part of routine TTI screening to be considered.