Indian Journal of Hematology and Blood Transfusion最新文献

Despite many technological improvements and therapeutic advances in interventional cardiology, contemporary percutaneous coronary intervention (PCI) is still associated with cardiovascular thrombotic events, increased risks of bleeding, and red blood cell (RBC) transfusion. This narrative review describes the shortage of RBC packages for transfusion in hospital blood banks. Blood donations have significantly diminished mainly because of decreasing number of qualified donors. Moreover, there is compelling evidence indicating that RBC transfusion is excessive and sometimes unnecessary, leading to blood banks depletion. Although, alternatives to RBC transfusion and other treatment options exist, they are seldom utilized. Evidently, there is a necessity to implement a wiser utilization of RBC transfusion to diminish its unnecessary use. It was demonstrated that one unit of RBC transfusion in the PCI setting is significantly associated with immediate and long-term adverse outcomes, including increased infection, myocardial infarction, stroke, renal failure, prolonged ventilation and hospital stay, atrial fibrillation, multi-organ failure and death, as well as, increased overall hospital healthcare costs. There is a clear medicine based evidence of the shortcomings of RBC transfusion in PCI. The evidence that RBC transfusion carries significant risks points out to avoid it when possible. Therefore, it is paramount to better comprehend the rationale for a better management of blood supply and a wiser utilization of RBC transfusion. This is a significant warning to the medical community, and a scientific motivation to perform a conscious revision of our routine medical practice towards a better utilization of RBC transfusion in contemporary PCI.

Vitamin B12 deficiency poses significant health care challenges. Its deficiency is an important cause of nutritional anemia in children, next to iron deficiency. Though macrocytic/ megaloblastic anemia due to deficiency of vitamin B 12, is the common presentation, a significant proportion of patients develop pancytopenia. As vitamin B12 has a significant role in synthesis of myelin, its deficiency also leads to several neurological manifestations. This may have long term implications as neurological complications do not completely resolve if treatment is delayed. Recently, role of vitamin B12 in somatic growth is being highlighted. This review highlights the prevalence, causes, diagnostic approach and treatment of Vitamin B12 deficiency. Possible reasons for increasing incidence and prevalence of vitamin B12 deficiency across the globe are also briefly discussed.

Acute myeloid leukemia (AML) is one of the most prevalent types of acute leukemia in adults, markedly impacting the quality of life, especially in the elderly. The clinical effectiveness of decitabine and the cytarabine, aclarubicin, and granulocyte colony-stimulating factor (GAC) regimen alone in AML patients is limited, and current research on the application of decitabine combined with CAG in AML patients is relatively scarce. This study aimed to analyze the differences in the therapeutic efficacy of CAG regimen alone and in combination with decitabine in patients with AML. A retrospective analysis was conducted on 150 patients with AML who underwent treatment in our hospital from July 2018 to March 2023. They were categorized into two groups based on the differences in their treatment regimens: the CAG group (n = 61, treated with the CAG regimen) and the D-CAG group (n = 89, treated with decitabine in combination with the CAG regimen). Patients of both groups were compared in terms of the therapeutic efficacy, changes in T lymphocyte subsets before and after treatment, differences in IL-4 levels before and after treatment, and occurrences of adverse reactions and toxic side effects during treatment. A 12-month follow-up was conducted for both patient groups, and the cumulative incidence of relapse and cumulative survival rate were compared. The overall response rate of patients in the D-CAG group was 93.26%, which was significantly higher than the 60.66% response rate in the CAG group (P < 0.05). Starting from the 4-month follow-up, the relapse rate in the D-CAG group was lower than that in the CAG group (P < 0.05). After the 12-month follow-up, the cumulative survival rate in the D-CAG group (93.26%; 83/89) was higher than in the CGA group (75.41%; 46/61) (P < 0.05). Except for leukopenia, there were no significant differences in the incidence of toxic side effects between the two groups (P > 0.05). After chemotherapy, patients in the D-CAG group exhibited superior immune markers and inflammatory cytokine levels compared to those in the CAG group (P < 0.05). Compared to the CAG regimen alone, the combination of decitabine and CAG regimen enhanced the therapeutic efficacy in AML patients without significantly increasing adverse reactions or toxic side effects, demonstrating commendable safety. Furthermore, the combined treatment regimen may improve immune function to some extent, potentially playing a positive role in controlling AML progression.

Currently, the anti-Xa assay is the "gold standard" for monitoring heparin activity; however, dextran sulfate (DS) addition to analytical reagents can lead to overestimated heparin activity following unfractionated heparin (UFH) reversal by protamine (Pr), often leading to improper UFH management. We investigated the impact of DS on anti-factor Xa assay outcomes after UFH was reversed by excessive Pr. Normal pooled plasma samples were spiked with UFH and Pr to prepare samples with varying Pr to UFH (P: H) ratios of different UFH concentrations. A chromogenic method was used to detect anti-Xa activity using two reagents: HemosIL liquid anti-Xa with DS (HemosIL) and STA liquid anti-Xa without DS (STA). When the P: H ratio was ≥ 1.0, i.e., Pr was equal or in excess, anti-Xa activity was detected by the HemosIL reagent, and did not decrease as expected, with dose-dependent effects with increasing UFH concentrations, while anti-Xa activity using STA reagent was almost undetectable. Meanwhile, both APTT and TT were within reference ranges, indicating that UFH had been completely neutralized. Therefore, when using HemosIL reagent (with DS) to detect anti-Xa activity from UFH reversal by excessive Pr, clinicians must be aware of potential DS interference and consider alternative monitoring strategies to accurately assess anticoagulant status.

Supplementary information: The online version contains supplementary material available at 10.1007/s12288-025-01971-7.

The year 2024 marks the 20th year since when free cART was introduced in India. This study reports the clinicopathologic profile and outcomes of people living with HIV (PLHIV) who were diagnosed with lymphoma from Northern India. We also review the outcomes of HIV-associated lymphoma in India reported over the past 2 decades. This study included all PLHIV of age ≥ 12 years who were diagnosed with lymphoma and treated at our center between June 2009 and June 2022. Demographic profile, lymphoma subtype, stage and CD4 count at lymphoma diagnosis, and treatment outcomes were analysed. Forty-eight PLHIV patients were diagnosed with lymphoma during the study period of which 31(64.5%) were diagnosed with AIDS Defining Lymphoma (ADL) while 17 (35.4%) were diagnosed with Non-AIDS Defining Lymphoma. Extra-nodal disease was more common in ADLs as compared to NADLs (87% vs. 23%; p < 0.001). 58% (n = 28) patients were previously known HIV, 42% (n = 20) were diagnosed to have HIV concurrent with lymphoma diagnosis. DLBCL was the most common subtype, diagnosed in 45.8% patients. 79% (38/48) patients received a definitive treatment regimen for lymphoma. The median overall survival of the cohort was 26 months. 5-year OS for patients who received definitive lymphoma therapy was 55.2 ± 9%. On multivariate analysis, the receipt of lymphoma directed therapy (HR:5.6 {95% CI:1.34-23.37}, p value:0.018) and a baseline CD4 count of ≥ 200cells/µL (HR:3.5 {95% CI:1.09-11.26}, p value: 0.035) were predictors of overall survival. The lack of lymphoma-directed therapy and a CD 4 count < 200 cells/µL continue to be a significant factors negatively impacting survival in the contemporary cART era in India.

Supplementary information: The online version contains supplementary material available at 10.1007/s12288-024-01927-3.

There is a growing interest in pre-operative optimization and decreasing intra/post-operative allogeneic transfusion requirements in cardiac surgeries. This is a retrospective analysis of blood component utilization in pediatric cardiac surgeries at a newly established pediatric cardiac surgery department at a free-standing tertiary care pediatric hospital in India. All pediatric (less than 18 years) cardiac surgery cases between 2018 and 2021 were included. Demographic description, primary diagnosis, type of surgery, estimated total blood loss, total blood utilization for the entire hospitalization since the surgery, blood components transfused, length of hospital stay and mortality were captured. A total of 101 pediatric cardiac surgeries (M:F = 61:40); age distribution: < 1-year 25.7% (26/101), 1-5 years 38% (39/101) and 35.6% > 5 years (36/101) were included. Of these, 83.1% (84/101) were open-heart surgeries [acyanotic CHDs (n = 46); cyanotic CHDs (n = 34) and acquired CHDs (n = 4)] and 16.8% (17/101) were closed-heart surgeries. Of the 101 surgeries, 6 did not need any transfusions. The remaining 95 surgeries utilized a total of 700 units of blood components (mean 7.3 ± 5.3 units/surgery); with a significantly higher number of transfusions in open-heart pediatric surgeries (total 677 units; mean 8 ± 5.2units) as compared to closed-heart surgeries(total 23 units, 1.3 ± 1.5 units) p-value < 0.0001. Blood utilization was significantly higher during the post-operative phase (85.8% of all usage; 601/700 units; mean 5.3 ± 5.9 units per surgery) than intra-operatively (0.9 ± 1 units/surgery), p < 0.01 and in patients who died (n = 27); total 439 units (mean 9.6 ± 8units/surgery) as compared to non-deceased patients (5.9 ± 3.7 units/surgery). In this single institutional experience, the transfusion requirement varied depending on the underlying CHD physiology, and a significant difference seen in transfusion requirements during different phases of the surgery (Intra versus post-operative) and based on survival outcomes of the surgery.

Iron deficiency anaemia is the most common cause of anemia among pregnant and lactating women. Personalised management and precision in anemia diagnosis requires ferritin estimation. The current laboratory-based serum ferritin tests are a bottleneck for further management of anemia. The study aimed to assess the diagnostic accuracy of the point-of-care testing (POCT) device for serum ferritin estimation among people in different age groups in a secondary care health facility in India, compared to the gold standard laboratory-based enhanced chemiluminescence-based immunoassay. A sample of 40 participants attending the 50-bed secondary healthcare facility in Faridabad, Haryana, was included. Venous blood samples were collected to estimate serum ferritin levels using the POCT device and the laboratory-based enhanced chemiluminescence-based immunoassay (gold standard). Sensitivity, specificity, positive and negative predictive values, accuracy, and Lin's concordance correlation coefficient were calculated to assess diagnostic accuracy. This study enrolled 40 participants between the ages of 5 and 45 years, with the majority being females (67.5%). Based on hemoglobin estimation using the Hemocue 301, 50% were anemic. The POCT device demonstrated a sensitivity of 73.3% (95% CI: 49.9-92.2), specificity of 96.0% (95% CI: 79.6-99.9), and diagnostic accuracy of 87.5% (95% CI: 72.1-93.3) compared to the laboratory-based enhanced chemiluminescence-based immunoassay. The mean percent difference (S.D.) based on Bland Altman analysis was 35.9% (37.8) (95% C.I. 23.9-48.1%), with lower and upper limits of agreement as -38.0%, and 109.9% respectively. Lin's concordance correlation coefficient was 0.95 (95% CI: 0.92 to 0.98). The ferritin POCT device's high specificity and moderate sensitivity make it suitable for diagnosing iron deficiency. Its ability to provide rapid turnaround of test results can facilitate the early initiation of appropriate treatment, leading to improved clinical outcomes. Further research, including validation studies, should be undertaken.

Supplementary information: The online version contains supplementary material available at 10.1007/s12288-024-01943-3.