Asian Journal of Transfusion Science最新文献

Introduction: Macrothrombocytopenia is a combination of thrombocytopenia and giant platelets (PLTs). It can be found asymptomatically with several genetic polymorphisms/mutations. This study aimed to assess the prevalence of macrothrombocytopenia in blood donors and to identify its geographic variation.

Materials and methods: A cross-sectional observational study was conducted in blood donors in the East, West, North, and South zones of India. Donors not eligible for blood donation were excluded. Blood was collected and analyzed by hematology analyzer. Samples with low PLT count (<1.5 lakhs/mm³) and mean PLT volume >11.5 fl were identified, and a peripheral blood smear was prepared, stained, and screened for giant PLTs. The data were analyzed using MS Excel (Microsoft 365), RStudio (Version: 2023.03.1 + 446), and IBM SPSS Statistics 27.

Results: A total of 2574 donors were screened at four centers of different geographic zones of India. The mean age was 34.81 ± 9.32 with male: female of 34.75:1. Overall macrothrombocytopenia was found in 102 (4%) with significant zonal variation: 88 (86.3%), 4 (3.9%) in East and South, respectively, and 5 (4.9%) each in West and North regions. The peripheral smears revealed giant PLTs in all cases of macrothrombocytopenia in the South and North, 76% and 80% in the East and West, respectively. The most common blood group showing macrothrombocytopenia was B positive 41 (40.2%).

Conclusion: Macrothrombocytopenia shows significant zonal variation, with a maximum number of cases identified in the East zone of India. Screening and awareness of this condition are essential to counsel donors for bleeding tendencies.

Introduction: Multiple blood transfusions with one or more nonself, genetically mismatched donor red blood cells (RBCs) may result in the production of alloantibodies, complicating future transfusions and increasing patient morbidity. This could be averted if adequate prophylactic measures are implemented in the vulnerable group. Due to the paucity of data in our region, we planned this study to identify the alloimmunization pattern in relation to clinical and demographic patient factors.

Materials and methods: A prospective observational study was carried out in a newly developed Medical Institution of National importance in Northern India, for 1 year. The red cell antibody screening and identification were done for 770 patients receiving two or more transfusions. The patient and transfusion-related factors were statistically compared between alloimmunized and nonalloimmunized cases.

Results: The overall seroprevalence of RBC alloimmunization among the multi-transfused patients was 4.02% (31/770). Thirty-six alloantibodies were identified in the 31 alloimmunized patients, which comprised 13 different alloantibody specificities. Most of them belonged to the Rh system (38.8%), followed by MNS (25%) and Lewis (27.7%) blood group systems. On Multivariate logistic regression analysis, the highest risk was found to be associated with recipients having more than three transfusions with an odds ratio of 8.4.

Conclusions: The highest alloimmunization risk was found in multi-transfused patients receiving more than three transfusions and with female gender. Rh blood group system was found to be predominating the alloantibody specificity pattern. This highlights the need for the provision of extended Rh (DCcEe) matched packed red cells for susceptible patients.

Background: Donor physiognomic characteristics play a critical role in determining the quality of packed red cell units (PRBCs), which directly impacts transfusion outcomes. This retrospective study aimed to evaluate the influence of donor physiognomic factors on PRBC quality at a tertiary care transfusion center.

Methods: A retrospective analysis was conducted on 250 randomly selected blood donors from January 2015 to August 2018. Donor age, gender, weight, and predonation hemoglobin (PHB) levels were assessed, along with PRBC parameters including volume (350 ml vs. 450 ml), processing method, PRBC age, and percent hemolysis during storage. Subsequent evaluations included hematocrit, per unit total hemoglobin (UTHB), and red cell mass.

Results: The mean weight among donors aged 18-28 years was 69.8 kg, compared to 74.46 kg in higher age groups. Lower PHB levels (12.5-13.0 g/dL) were associated with decreased UTHB. PRBCs prepared using the buffy coat method exhibited lower mean UTHB compared to other methods. A significant correlation (P = 0.01) was observed between PRBC age and hemolysis in all units.

Conclusions: Donor PHB significantly influences the quality of PRBCs prepared, with lower PHB levels correlating with decreased UTHB. PRBCs prepared using the buffy coat method showed inferior UTHB, and older PRBC units displayed higher red cell hemolysis. However, donor gender, age, and weight did not significantly affect PRBC quality in this study. Larger sample sizes are necessary to confirm these findings. These results highlight the importance of donor screening and selection to optimize PRBC quality and enhance transfusion therapy outcomes.

Erythroblastosis fetalis is one of the leading causes of death among newborns and fetuses in India. This condition is characterized by maternal immunoglobin G antibodies destroying the red blood cells (RBCs) of the neonate or fetus, resulting in potentially life-threatening consequences. When a mother with an Rh-positive blood group has a fetus with an Rh-negative blood group, the fetal RBCs trigger maternal antibodies against Rh-antigens. Anti-D antibodies are activated as a result of this process, which is known as isoimmunization. As a result of the antibody reaction, all of the erythrocytes are destroyed, resulting in hemolysis, bilirubin release, and anemia. Intravascular transfusions and intraperitoneal transfusions are examples of antenatal therapies that potentially avoid dangers to the fetus in the early stages of pregnancy. Phototherapy, exchange top-up transfusions, and intravenous immunoglobulin (IVIG) injections are examples of postnatal therapies (IVIG). IVIG therapy is highly recommended since it has a low risk of adverse medication responses and a wide range of survival rates. To avoid isoimmunization, anti-Rh D therapies are indicated. Noninvasive identification of the fetal human platelet antigen 1 genotype using cell-free fetal DNA obtained from maternal blood is one example of progress. This is still in the early stages of research as preventive medicine, the platelet equivalent of Rho (D) Immune Globulin Human (RhoGAM). The erythroblastosis fetalis is highly preventable when it is diagnosed at its early stages. Regular screening of all the patients with ABO incompatibility is necessary to prevent the risks of erythroblastosis fetalis.

Background and objectives: In vitro serological reactions due to antibodies in the presence of certain chemicals are rare occurrences. Although such antibodies are often considered harmless, their innocuous nature requires verification. We investigated a pan-agglutinating antibody that reacted in the presence of BLISS used in the gel card device.

Materials and methods: The gel cards used for serological compatibility tests were of commercial sources (Ortho Diagnostics, USA and Tulip Diagnostics, India), soluble antigens used for antibody neutralization tests were locally obtained, and certain antibiotics and dialysis bags were procured from the local market. Serological workup was carried out by standard methods.

Results: A 13-year-old female cancer patient with a pan-reacting autoantibody showed mixed-field agglutination in serological tests. It reacted only on a gel card system that uses BLISS-containing antibiotic co-trimoxazole. Autoantibody was identified as anti-Sd^a by hemagglutination inhibition test using guinea pig urine.

Conclusion: The autoantibody with anti-Sd^a specificity was detected on the gel card only in the presence of the antibiotic co-trimoxazole in BLISS.

Graft-versus-host disease is a critical posttransplant complication, particularly affecting individuals with compromised immune systems. Patients undergoing bone marrow transplants, neonates receiving intrauterine transfusions, and those recipients of blood from first-degree relatives are vulnerable to this condition. The significance of efficient lymphocyte inactivation has driven the widespread adoption of Gamma Irradiation Chambers (GICs) utilizing radiation sources such as Cesium-137 (Cs-137) or Cobalt-60 (Co-60). However, the effective operation of these chambers is contingent on navigating a complex regulatory landscape (Cs-137 or Co-60 is commonly used as the source of gamma rays. The usual dose is 25 Gray [Gy] to 35 Gy [1 Gy = 100 rads], this dosage inactivates 85%-95% of lymphocytes in the blood components without any adverse effect on other cellular components of the blood). GIC unit mainly houses either Co-60 or Cs-137as radiation sources (model no BI-2000, BI-5000 mfr. by Board of Radiation and Isotope Technology with typical radioactivity ranging from tens to hundreds of terabecquerel. These units are also used in research institutions, hospitals, blood center, etc. A review of legal, regulatory, and policy aspects of the operation of GIC in India regarding its issues, challenges, and opportunities. We aimed to prepare a standard guidance document for GIC for a smooth process of the Atomic Energy Regulatory Board (AERB) licensing and equipment purchasing. The present article was written based on the experience of applying for GIC with AERB and recurrent support extended to colleagues in the fraternity. The documents prepared for licensing and various procedural steps involved in the same are included. Many documents and many days are required from procurement to the receipt of the license for operation GIC. At the same time, with very few user institutes and less number of experienced people in the country, it becomes difficult to find a proper method to approach the national government body. If blood center/radiological safety officer are properly trained as per the guidelines available, this can reduce man-days and facilitate the earliest operations.

Background: Blood transfusion services were seriously affected during COVID-19 not only due to limited availability of blood components but also due to gap in the clinical knowledge about the need for transfusion in COVID-19 patients. However, understanding the transfusion needs is essential for inventory management. We analyzed the utilization of blood components in hospitalized COVID-19 patients and recorded the outcome of the patients who were transfused.

Materials and methods: The study included all COVID-19 patients who underwent transfusions over a time period. Patient details included demographics, clinical condition, comorbidities, laboratory parameters, and outcome. Details of transfusion were collected from the blood bank and patient records.

Results: Of 3052 hospitalized COVID-19 patients, 395 (12.9%) were transfused blood components and were included in the study. Comorbidities were identified in 85% of these patients. Red blood cell (RBC) was transfused in 348 (11.4%) with a mean of 2.3 units/patient. Similarly, platelets and fresh frozen plasma were transfused in 3.3% of patients (mean 6.2 units) and 3% (mean 4.9 units), respectively. Transfusion triggers were largely restrictive in nature. Patients with haemato-oncologic conditions required significantly higher numbers of RBCs and random donor platelets. RBCs transfusion were also higher in patients requiring intensive care unit care and ventilatory support. Blood components usage was not affected by severity of COVID-19 disease, comorbidity index, or coagulopathy.

Conclusion: Blood utilization in COVID-19 patients is typically low. Blood components were mainly required by patients with preexisting comorbidities, or those requiring critical care. RBCs were the predominant blood component transfused. Coagulopathy associated with COVID-19 did not necessitate transfusion.

Background: In the maintenance of this important application, it is very important to ensure safety and to prevent complications. Therefore, it must be careful in the transfusion of blood and blood component.

Aim: The aim of the study was to define nurses' blood transfusion-related knowledge levels and applications.

Study settings and design: The study sample consisted of nurses who worked in a medical faculty hospital, two education and research hospitals and two state hospitals in Turkey. The study was performed with 116 nurses.

Materials and methods: "Nurse Information Form", "The Blood Transfusion Knowledge Questionnaire" and "The scenario form and a video taken on the errors and drawbacks related to blood transfusion" were used as data collection instruments.

Statistical analysis used: The statistical analysis was performed using SPSS for Windows version 17.0. The sociodemographic data obtained from the study were assessed by numbers frequency and percentage distribution. The blood transfusion knowledge scores of the independent variables and, the relationship between knowledge scores and units were analysis by chi-square, Mann Whitney-U and, Kruskal-Wallis tests.

Results: The nurses' mean scores for the blood transfusion knowledge level were 61.81 ± 10.18 (ranging between 0 and 79) for the overall scale. There was a significant relationship between the clinics and questions on pre-transfusion patient preparation knowledge and their mean total knowledge score. The nurses' mean scores for the blood transfusion-related scenario knowledge levels were 36.42 ±15.42 for the overall scenario scores.

Conclusions: Based on this, the nurses' knowledge levels about blood transfusion are partly adequate in terms of their mean knowledge scores, and insufficient in terms of their mean scenario knowledge scores.

Introduction: Beta-thalassemia trait (BTT) and iron-deficiency anemia (IDA) are the most common causes of microcytic hypochromic anemia (MHA). Concomitant presence of both BTT and IDA can cause a more severe form of anemia that may increase morbidity and mortality. Therefore, the present study was conducted to check the prevalence and assess the impact of IDA on various hematological parameters in BTT subjects.

Subjects and methods: The present study was conducted at the department of immunohematology and blood transfusion after taking ethical clearance and written informed consent from all the participants. One hundred and sixty-eight known cases of BTT were included in this study. Out of these, 88 were females and the remaining 80 were males with ages ranging from 9 to 65 years. Blood samples collected in ethylenediaminetetraacetic acid and sterile vacutainers were assessed for complete blood count, serum iron, total iron-binding capacity (TIBC), and ferritin. All the data were analyzed using IBM SPSS Statistics software version 28.0.1.1 (15).

Results: The majority of the patients had MHA on peripheral blood smears. Thirty-nine (23.21%) out of 168 BTT subjects were found to have IDA. Hemoglobin, mean corpuscular volume, mean cell hemoglobin, and mean cell hemoglobin concentration levels were significantly reduced in patients of Group I (BTT with IDA) when compared to Group II (BTT without IDA). The mean (± standard deviation) value of serum iron, total TIBC, and ferritin showed significant differences between the two groups.

Discussions and conclusion: High prevalence of IDA in patients of BTT in the current study suggests that there is a need for careful evaluation in the differentiation and diagnosis of BTT and IDA, especially in females, as IDA is more common in females. Moreover, IDA has a significant impact on various hematological parameters in BTT subjects.

Background: Blood transfusion is an integral part of the health-care system. A healthy donor is important for safe blood transfusion. Donors are selected based on the deferral criteria given by the Drugs and Cosmetics Act 1940 and amended thereof. Coronavirus disease 2019 (COVID-19) vaccination became mandatory after the spread of COVID-19 pandemic and was included in the deferral criteria.

Objective: The objective was to study and analyze the impact of COVID-19 vaccination on the deferral pattern in blood donors.

Materials and methods: A retrospective study was carried out in the Department of Immunohematology and Blood Transfusion for pre-COVID period from January 2019 to December 2019 for the most common reason of deferral before COVID-19 and for comparison for donor deferral with COVID-19 period. Then, a retrospective study was carried out over a period of 12 months from February 2021 to January 2022. The demographic details of donors such as age, gender, voluntary or replacement donation, and temporary and permanent reasons for deferral were recorded. The data were entered in the MS Excel sheet and descriptive statistics were calculated.

Results: The total numbers of registered donors were 7064. Six thousand two hundred and sixty-four donors were accepted for donation, of which voluntary donations were 4478 (71.48%). The deferred donors were 800 (11.3%). Seven hundred and thirty-eight (92.26%) deferred donors were male; the most common cause of temporary deferral was COVID-19 vaccination 179 (22.37%), followed by low hemoglobin 162 (20.25%). The common causes of permanent deferral were high blood pressure 36 (5.17%) and history of unknown jaundice 10 (1.43%).

Conclusion: COVID-19 vaccination had a significant impact on the pattern of donor deferral. However, this was only a temporary situation till the pandemic is over. The loss of potential donors has adversely impacted the transfusion services.