Asian Journal of Transfusion Science最新文献

Several weaker subgroups of B have been described (e.g. B3, Bx, Bm, and Bel) which are very infrequently encountered. These subgroups show weaker and variable serologic reactivity with the commonly used human polyclonal antisera, thus causing group discrepancy and dilemma to resolve these problems and mismatch blood transfusion. Here, we present a case of weak B subgroup detected in a 40-year-old male voluntary blood donor. His red cells showed weak agglutination with anti-B and anti-AB, and in his serum, there were potent anti-A and weak anti-B which were not detected at 37°C. After adsorption with anti-B, an eluate was prepared from the patient's cells which agglutinate with B and AB cells but did not agglutinate with A or O cells. His probable blood group is Bx. With special serological testing, a rare group is detected and decision is made to provide blood to the right patient at the right time.

Autoimmune hemolytic anemias (AIHAs) are not very common, and autoimmunity is an important cause of hemolytic anemia, especially in female population. Some primary AIHAs are cold or warm agglutinin mediated anemia. Autoimmune reaction leads to macrophage activation as well as conversion of normal RBCs into spherocytes leading to their destruction and causing hemolysis leading to anemia. Rarely autoimmune phenomena can lead to agglutination however Cold agglutinin disease or Warm agglutinin disease have specific tests which are diagnostic for them. Here, we highlight a known case of Grave's disease who was admitted to the emergency and on sampling the peripheral blood repeated agglutination/clumping of RBCs occurred on glass surface but nothing happened in the plastic EDTA tube. This to the authors was extremely puzzling phenomena which occurred even on repeat sample for the case, Hence the authors warranted a need to discuss this.

Introduction: Pretransfusion testing is an essential and important investigation to provide safe and fully compatible packed red blood cell (PRBC) unit to the recipient to prevent the fatal hemolytic transfusion reaction. Type and screen (T and S) procedure is one of the effective approaches in pretransfusion testing in which antibody screen (AS) negative recipients are transfused with an immediate saline phase compatible PRBC unit. In order to explore the feasibility of implementing T and S protocol in our institute, this study was carried out. The main aim of our study was to compare the T and S protocol in AS-negative recipients with anti-human globulin (AHG) phase crossmatch in patients requiring PRBC under elective protocol.

Materials and methods: Our study was a cross-sectional analytical study carried out in all the elective blood samples with a history of transfusion or pregnancy. In our study, 849 elective blood samples were subjected to antibody screening by reagent 3 red cell screening panel and AS-negative blood samples were subjected to immediate saline phase crossmatch, and compatible units were issued to the patients. The same samples were subjected to AHG phase crossmatch for validation.

Results: Among 14,705 elective requests for PRBC 849 patients had a history of transfusion or pregnancy. Of 849 patients, no case was found to be positive for antibody screening. Totally around 1028 PRBC units were saline crossmatched and totally 677 PRBC units were issued to the patients under T and S protocol. Not even a single case where AHG crossmatch was incompatible when antibody screening was negative. There was a perfect agreement between T and S method and AHG phase crossmatch. Crossmatch transfusion ratio was reduced from 2.1-1.5 with the implementation of T and S protocol.

Conclusion: This study validated and showed that there was a perfect agreement between T and S protocol and AHG phase crossmatch. All blood requests under elective protocol, the T and S method can be implemented for better utilization of technical workforce and better inventory management.

Aim: To explore the association of ABO blood groups with COVID-19 severity, mortality, hospital stay, and their clinical indices.

Methods: Retrospective clinical data from 185 COVID-19 patients were stratified into four-time points based on their survival status and length of hospital stay (<8> days). Chi-square tests, two-way ANOVA, multinomial logistic regression analyses, and multivariate logistic regression analyses were used to study their associations, strengths, and risk.

Results: The frequency distributions of blood groups among COVID-19 patients were A (19.45%), B (26.48%); AB (7.02%); and O (47.02%), respectively. Even though patients in the O-blood group had the highest infection rate (47.02%), patients in the AB blood group had the maximum severity and mortality and patients in the A-blood group had the most negligible mortality. The mean overall survival time among different blood groups was O (23), A (19), B (24), and AB (17) days. Mean platelet count (%), aggregate index of systemic inflammation (AISI), Platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and hospital stay were increased (P < 0.005) in the AB blood group among survivors >8 days. Total leukocyte count (TLC) cells/mm³ levels were increased among nonsurvivors in <8 days in the AB blood group (P < 0.005). Lactate dehydrogenase U/L was increased (P < 0.005) in A blood group of nonsurvivors of <8 days.

Conclusions: Even though O blood group patients had the highest infection rate, AB group patients had the most severe disease accompanied by the least survival. Higher (AISI, PLR, SII, and higher TLC) were associated among the survivors of the AB blood group.

Background: Hemolytic disease of the newborn (HDN) was more common due to Rh incompatibility. Its prevalence has decreased due to introduction of Immunoglobulin G (IgG) prophylaxis against RhD antigen. HDN due to ABO incompatibility has become more common.

Aim: The aim of this study was to study the predictive value of umbilical cord serum and maternal serum anti-A and anti-B antibody titer for the occurrence of significant hyperbilirubinemia in newborns.

Settings and design: This was a prospective cohort study which included 139 "O" blood group mothers and their offspring with A or B blood groups.

Materials and methods: We analyzed the IgG anti-A, and anti-B antibody titers from cord blood and maternal serum and correlated them with features of significant hyperbilirubinemia. Positive predictive value (PPV), negative predictive value (NPV), sensitivity and specificity were calculated.

Results: Twenty-eight newborns out of 139 (20 %) developed significant hyperbilirubinemia and required phototherapy. One newborn required immunoglobulin infusion. Out of these 28 newborns' maternal serum, 22 (79%) newborns' maternal serum had IgG antibody titer of ≥128. Cord blood serum IgG antibody titer was 1:2 in all newborns, which was not significant. The direct Coombs test was positive in six (4%) newborns with maternal IgG antibody titer ≥128.

Conclusion: Maternal IgG antibody titer was ≥1:128 and can predict significant hyperbilirubinemia in newborns with a sensitivity of 53.5%, specificity of 98.2%, PPV of 88%, NPV of 89%, and P value (P > 0.001).

Thalassemia is a genetic blood condition and one of the emerging global public health concerns in the world, with an estimated prevalence of 300,000,000. The genes controlling hemoglobin production are affected, leading to an anemia of variable severity. Carriers of this hereditary anemia are found globally, but a high frequency is observed around the Mediterranean basin, in the Middle East, in the Indian subcontinent, and in Southeast Asia, so called the thalassemia belt. This article aims to review the history and factors of spreading of thalassemia, to identify the burden of the disease on individuals, population, and public health, and the issues that thalassemia patients have experienced during the pandemic of COVID-19. Online literature and previous studies on the disease are used to prepare this article. We identified various factors that have contributed to the spread of thalassemia in the last decades and affected the health condition of individuals and population. The recent worldwide pandemic of COVID-19 worsened the situation and made it more complicated for most patients, especially in the emerging countries.

Introduction: Massive hemorrhage calls for massive transfusions (MTs) to maintain adequate hemostasis. Massive transfusion protocols (MTPs) are the appropriate treatment strategy for such patients replacing conventional use of crystalloids. These help in standardizing and optimizing the delivery of blood components in a well-balanced ratio.

Aim and objectives: The aim of the study is to propose an ideal ratio of blood components for MTP after assessing relationship between ratios of blood components transfused and mortality.

Methodology: MT was defined as receiving >4 packed red blood cell (PRBC) units within 1 h with the anticipation of continued need for blood products. All MT patients above 13 years of age regardless of cause of bleed were included in the study from December 2015 to October 2017 accounting for a total of 61 patients. Subgroup categorization of study population was done, and physician-driven ratios of the blood components were calculated for each case. The ratios were grouped as high (>1), equal (=1), and low (<1) ratios of fresh frozen plasma (FFP):PRBC and platelet: PRBC, and the relationship of these ratios to the clinical outcome in terms of mortality was examined.

Results and discussion: Sixty-one patients underwent MT of which the overall hospital mortality rate was 8.1% with 100% mortality among patients with penetrating trauma followed by 25% with gastrointestinal bleed. Emergency admission was an independent risk factor for mortality. Hypotension before the initiation of MT was detrimental for survival. Efficient communication existed between the treating physicians and transfusion. Majority of survivors received equal ratios of FFP: PRBC and platelet: PRBC, and all nonsurvivors received low ratios of FFP: PRBC. Analysis was statistically indicating better survival with 1:1:1 ratio of PRBC: FFP: platelet.

Conclusion: The need of the hour is to establish an institutional MTP and ensure compliance with the same. A prospective randomized controlled trial needs to be done to overcome the limitations and confounders of the present study and establish a universal protocol.

Introduction: Neuromyelitis optica (NMO) is an idiopathic demyelinating disorder characterized mainly by optic neuritis and myelitis, causing gradual loss of vision and deterioration of neurological function. The underlying pathogenesis mainly involves antibodies against aquaporin 4. The effectiveness of therapeutic plasma exchange (TPE) has been shown by many studies across the globe but are only a few from India. We studied ten cases of NMO retrospectively to find out the safety and efficacy of plasma exchange and to know the outcome of those patients who underwent the procedure.

Materials and methods: We retrospectively analyzed ten cases of NMO who underwent TPE from January 2017 to July 2021. Out of 153 patients on whom plasma exchange procedures were done during this period, ten cases of NMO were diagnosed and managed with TPE.

Results: In our study, we found that 6 of our patients (60%) had a marked improvement noticed clinically with an increase in baseline power of limbs from 0-2/5 to 3-5/5. However, two patients expired after despite TPE. The other two did not show any improvement. Four of our patients started showing clinical improvement after the 2^nd-3^rd cycles of treatment. TPE was initiated early (within 5 days). There were no notable events in most of the procedures except in one procedure where the patient developed hypotension, her saturation started to drop, and the procedure had to be aborted.

Conclusion: Our study supports the effectiveness of timely initiation of plasma exchange to improve the overall mortality rate of the patients.