Asian Journal of Transfusion Science最新文献

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.

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.

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.

Para-Bombay blood group is a rare blood group typically characterized by the absence of H antigens on red blood cell and the presence of ABH substances on secretion. It can be easily missed and often mistaken as blood group O without extended testing. Detection is important as it significantly affect transfusion management. We report two cases of Para-Bombay A blood group in a teaching hospital in a North-Eastern state of Malaysia.

Red cell exchange is important to treat acutely ill sickle cell patients, but it is time-consuming. An automated red cell exchange technique using cell separators developed by different manufacturers helps in removal of sickled hemoglobin and improving blood viscosity. The use of these cell separators permits automated red cell exchange to be performed safely and smoothly with the isovolemic hemodilution. The retrospective analysis of seven cases for automated red cell exchange was performed in IMS and SUM Hospital from September, 2019 to July 2021. One procedure was performed on COBE Spectra Apheresis System and the rest six using Spectra Optia Apheresis System. These procedures were performed on the patients and the decision to perform these procedures was based on clinical indications for red cell exchange following the ASFA guidelines 2019. After only one procedure, all the patients have their sickle hemoglobin reduced to a safe level. End hematocrit was observed to be 33% in three cases, 31.9% in one case, and 30% in the rest three. A total number of red blood cells (RBCs) transfusion in all the cases were 7, 6, 8, 5, 6, 7, and 7 with an average hematocrit of 55%, 56%, 54%, 56%, 55%, 51.7%, and 52.2%, respectively. All the patients partially phenotypically matched, leukoreduced, gamma-irradiated, fresh packed RBCs were provided. Automated red cell exchange came out to be successful in reducing the symptoms along with the improvement in laboratory parameters. New-generation automated apheresis equipment like Spectra Optia, the case series provides better monitoring and also reduces apheresis-related complications.

Background: High titers of anti-A and anti-B are considered to be one reason for hemolytic transfusion reactions and ABO hemolytic disease in fetus and neonates. There is no consensus for critical ABO antibody titers to guide transfusion or transplant decisions. Implementation of ABO titer measurement can favor reduction in transfusion reactions in nongroup "O" recipients.

Aims: This study aimed to understand the trend and quantification of anti-A and anti-B antibody titers in Group "O" donors in this geography.

Subjects and methods: A prospective study was conducted in 218, Group "O" blood donors in the year 2021, during the COVID-19 pandemic. Immunoglobulin (Ig) M antibody titers were measured by hemagglutination and IgG titers by solid-phase red cell adherence. Antibody titers ≥128 for IgG and ≥64 for IgM were considered "high titers." Epi Info 7.1 software was used for statistical analysis, with P < 0.05 significant.

Results: About 96.75% of blood donors were male with a median age of 33.16 ± 8.8 years. ABO antibody titers ranged from 0 to 1024. The prevalence of titers of <128 for IgG anti-A and anti-B was 79.36% and 86.24%, respectively, and 88.53% for both anti-A and anti-B IgM (<64). High IgG anti-A antibody titers were exhibited in 20.64% and anti-B titers in 13.76% of donors. None of the recipients showed any hemolytic reactions.

Conclusions: The donor population showed predominance of low isoagglutinin titers. Defining critical titers will help formulate institutional guidelines on ABO-incompatible platelet transfusions and transplants. The use of automation in ABO titer assays removes interobserver variations and offers precise, reproducible, and less labor-intensive assays in resource-constrained settings.