Indian Journal of Hematology and Blood Transfusion最新文献

Nutritional anaemias are on the rise in India despite several control programs. Haemoglobin synthesis needs iron, vitamin B12, folic acid, and a source of complete protein (containing all essential amino acids). While we were focusing on iron deficiency only, in reality, one or more nutrients needed for haemoglobin synthesis may be missing from the diet due to lack of awareness, empowerment, and marginalisation issues. Therefore, nutritional anaemias represent the tip of the iceberg of clinical and subclinical malnutrition in our scenario, in a vast majority of patients. There are several myths on nutrition and a balanced diet, rooted in cultural, religious, and regional factors. In the developed countries, these nutritional deficiencies are more often due to physiologically or pathologically increased need or due to malabsorption or increased losses of the nutrients involved or blood loss, which are equally important concerns in our scenario too. To make a beginning, we need to work on creating awareness on a balanced diet, removing false beliefs and wrong practices related to food items. Equally important for a sustainable solution is to empower the people through social, economic, and agricultural reforms, and policy changes, for consuming a balanced diet.Other social aspects of malnutrition, including poor management of human and financial resources, wrong influences on the people by advertisements, and the growing fast-food culture, need to be addressed. Patients of anemia need to be evaluated with proper investigations in an algorithmic approach, especially when nutritional supplementation is producing sub optimal results. Other causes of anemia including hemoglobinopathies, malnutrition associated, anemia of chronic disease need to be investigated. For iron deficiency, treating the underlying cause of excessive blood loss is essential. All this will go a long way to achieve the goal of anaemia-free India.

To analyse the trends in drug susceptibility patterns (DSP) of gram- negative bacilli (GNB) in setting of febrile neutropenia in hematology-oncology patients. This retrospective study (done from April 2019-April 2024) compares clinical (Charlson co-morbidity index [CCI], Sequential organ functional assessment [SOFA] score, Pitts bacteraemia score, and all cause 30 day mortality) parameters and trends in DSP of GNBs isolated from blood cultures of hematology-oncology patients. Various AMS activities, including restriction on use of high end antibiotics, cessation of antibiotics in patients with pre-neutropenic fever, involvement of an infectious diseases physician for management of multi-drug resistant (MDR) infections and improvement in diagnostics, among others, were done during this time period. In 535 patients, 601 different GNB bacteraemia episodes were identified. Time series analysis showed that carbapenem resistance in Klebsiella pneumoniae and Escherichia coli decreased from 90.3 to 48.1% (r = -0.961, p = 0.0006) & 54.5-27.7% (r = -0.882, p < 0.001) respectively, DTR (difficult to treat) rates in Pseudomonas aeroginosa fell from 83.3 to 10% (r = -0.716, p- 0.036). This study provides evidence that resistance in GNB can be curtailed by AMS activities even in highly vulnerable population like hematology-oncology.

Purpose: Assessment of the effect of cytotoxic chemotherapy on the indices of iron homeostasis to elucidate the aetiology of anaemia in breast cancer.

Methods: Forty-two newly diagnosed breast cancer patients with Hb > 10 g/dL were recruited. Iron indices were estimated before and after neoadjuvant chemotherapy (NACT). Anaemia of chronic disease (ACD) and anaemia of chronic disease + iron deficiency anaemia (IDA) were identified by sTfR, sTfR index, and algorithm by Skikne et al.

Results: Anaemia was 52% at the presentation time, which increased to 93% at the end of NACT. Among the anaemic breast cancer patients, 75% belonged to the group of ACD + IDA, and only 25% belonged to the group of ACD at the time of presentation. After NACT, the number of patients in the ACD + IDA group significantly increased to 93%, while the members of the ACD group significantly reduced to 7%. Ferritin, Hepcidin, Transferrin, sTfR, and sTfR index increased after NACT.

Conclusion: The primary aetiology of anaemia among Indian breast cancer patients is a combination of ACD and IDA. Indian breast cancer patients were more vulnerable to developing iron deficiency anaemia when compared to anaemia of chronic disease during NACT.

Anemia is a common problem encountered by patients hospitalized in the intensive care unit (ICU). However, the relationship between transfusion and mortality has not been clearly determined. We aimed to investigate the effects of a restrictive transfusion practice on patient outcomes in the ICU. We enrolled 143 patients who were hospitalized in the ICU between August 2018 and August 2019. Patients were categorized by whether they had received transfusion during their stay. Transfusions were performed according to a restrictive transfusion policy with a hemoglobin (Hb) threshold of < 7 g/dL. Transfusion was required for 43% of the patients with a median of 3 units used. Transfused patients were older (79.3 vs. 74.6 years; p = 0.034), had greater length of stay (LOS) in the ICU (LOS-ICU: 51 vs. 9.5 days; p = < 0.001), were under invasive mechanic ventilation (LOS-IMV: 20 vs. 7.5 days; p = 0.026), and higher mortality rates (68.9% vs. 37.8%; p = < 0.001) than those who did not. Age (odds ratio [OR]: 1.03), sepsis or septic shock (OR: 2.74), placement of central venous catheter (OR: 6.36), and LOS-ICU (OR: 1.01) were defined as predictors of transfusion. However, after hierarchical logistic regression analyses, mortality rates were not associated with transfusion. The need for vasopressor use (OR: 17.3) and IMV (OR: 38.3) were predictors of mortality. Although transfused patients were more severely ill, whether they underwent transfusion or not did not correlate with increased mortality rates. Selecting a restrictive transfusion policy and shortening LOS-ICU might provide better patient outcomes. While this study supports restrictive transfusion policies, it primarily contributes region-specific data rather than novel or generalizable findings.

Estimation of haemoglobin (Hb) plays an important role in the medical examination of prospective blood donors. Various tests to estimate Hb are available in the market to screen for donor Hb with their own set of advantages and disadvantages. Each Blood centre chooses their test based on the availability of funds / resources, manpower and number of donations. Like any other test, Hb estimation tests also have various factors resulting in erroneous results. Identifying and preventing such factors is crucial in maintaining the safety of donor and the patient. This short research communication dwells upon such common factors influencing Hb estimation in the routine blood donor screening and what can be done to prevent such errors.

This study explores a novel sensitive and accurate method for the quantitative determination of red blood cells (RBCs) agglutination in clinical laboratory. Natural antibodies (Anti-B) were selected and diluted as 1:2, 1:4,1:8 and 1:16 to react with healthy blood group RBC-B, using normal saline as a control group. All the sample tubes were incubated at 37 °C for 30 min. On other hand, tube method was also used and the degree of agglutination was graded. The strongest agglutination was observed in the 1:1 dilution, but as the serum was serially diluted from 1:2 to 1:16, the agglutination strength decreased. In contrast, no agglutination was found in the control group. Furthermore, we plotted the logarithm of serum dilution on X-axis coordinate while the index of agglutination (IAG) on Y-axis coordinate, which showed that there is a good linear relationship existed between IAG and serum (Anti-B) Concentration (r = 0.979 and P = 0.004). A serum stability test conducted over 10 consecutive days showed a coefficient of variation (CV) of 2.26%, indicating good stability of the test results. Our study concluded that the flow cytometry method (FCM) was most reliable, accurate and sensitive tool for the detection of RBCs agglutination in clinical settings.

Most primary Ebstein-Barr Virus (EBV) infections are asymptomatic, with up to 35% developing infectious mononucleosis (IM). After the initial primary infection (PI), EBV can undergo lytic replication and cause secondary manifestations like chronic active EBV, autoimmune diseases, or tumorigenesis. We aim to highlight the hematological spectrum of EBV and discuss its management. This is a retrospective case series of five adults (> 20 years) with confirmed EBV infection by quantitative polymerase chain reaction (QPCR) in peripheral blood. Case one showed a delayed PI with EBV in a 37-year-old female with generalized lymphadenopathy and spontaneous resolution. Case two was a complicated PI with severe nasal obstruction requiring steroids. Case three was EBV-induced Natural killer / T cell lymphoma with a complete response to modified SMILE therapy and radiation. Cases four and five demonstrate post-allogeneic hematopoietic stem cell transplant (alloHSCT) scenarios of EBV viremia and role of pre-emptive therapy. EBV infection can mimic lymphomas and should be tested in all adults with fever and lymphadenopathy. Although self-limiting, some EBV PI may need steroids. Early EBV QPCR monitoring can aid in prognostication and diagnosis. Post-alloHSCT EB viremia needs monitoring from four weeks to 12 months, especially with ongoing immunosuppression.

Purpose: We aimed to determine the effectiveness of platelet transfusions in the presence of thrombocytopenia in late-onset neonatal sepsis (LONS) caused by gram-negative bacteria in preterm neonates. Methods: The newborns, who received platelet transfusions, were divided into two groups: those with bleeding and those without bleeding. Results: The median gestational age and birth weight of the newborns were 29 (26-31) w and 1100 (865-1470) g, respectively. Of the 72 neonates, 50 (69.5%) did not bleed and 22 (30.5%) bled. The time for the platelet count to exceed 50,000/µL was similar between the groups: 5 (3-10) days in the bleeding group and 4 (3-7) days in the non-bleeding group, and the median number of transfusions was two in both groups. In the transfused group, the mortality rate in patients with bleeding was significantly higher compared to those without bleeding (27.3% vs. 8%, p = 0.0001). Conclusion: Although platelet transfusion was performed in the presence of severe thrombocytopenia in gram-negative LONS, the platelet counts exceeded 50,000/µL not immediately after transfusion, but in approximately four days, and repeated platelet transfusions were generally required. The mortality rate was higher in those who bled compared to those who did not bleed.

Supplementary information: The online version contains supplementary material available at 10.1007/s12288-024-01916-6.