Background and Objectives: Blood transfusion is a widely accepted treatment modality in modern medical practice and it has no substitute. Therefore, blood is a scarce resource, and proper management of bloodstock is essential. Transfusion service is responsible to maintain an adequate blood stock to ensure the supply of blood for hospitals while minimizing blood wastage due to postexpiry. To achieve efficient bloodstock management, the pattern of blood collection should be identified. This study was designed to establish a time series model for monthly blood collection of Sri Lanka. Methods: Data on monthly blood collection of Sri Lanka were collected from the year 2010 to 2020 and time series models were developed using “R” statistical software. Results: Time series data clearly exhibited an increasing trend with seasonality in blood collection. Therefore, seasonal time series models were fitted and the best seasonal autoregressive integrated moving average (ARIMA) model was selected as ARIMA (0, 1, 1) (0, 1, 2) (12) which showed the lowest Akaike information criteria value. Conclusion: It is suitable for forecasting the monthly blood collection.
{"title":"Analysis of blood collection of national blood transfusion service, Sri Lanka: A time series analysis","authors":"S. Senavirathna, N. Abeynayake","doi":"10.4103/gjtm.gjtm_92_22","DOIUrl":"https://doi.org/10.4103/gjtm.gjtm_92_22","url":null,"abstract":"Background and Objectives: Blood transfusion is a widely accepted treatment modality in modern medical practice and it has no substitute. Therefore, blood is a scarce resource, and proper management of bloodstock is essential. Transfusion service is responsible to maintain an adequate blood stock to ensure the supply of blood for hospitals while minimizing blood wastage due to postexpiry. To achieve efficient bloodstock management, the pattern of blood collection should be identified. This study was designed to establish a time series model for monthly blood collection of Sri Lanka. Methods: Data on monthly blood collection of Sri Lanka were collected from the year 2010 to 2020 and time series models were developed using “R” statistical software. Results: Time series data clearly exhibited an increasing trend with seasonality in blood collection. Therefore, seasonal time series models were fitted and the best seasonal autoregressive integrated moving average (ARIMA) model was selected as ARIMA (0, 1, 1) (0, 1, 2) (12) which showed the lowest Akaike information criteria value. Conclusion: It is suitable for forecasting the monthly blood collection.","PeriodicalId":52961,"journal":{"name":"Global Journal of Transfusion Medicine","volume":"9 1","pages":"40 - 45"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74400990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A sole emphasis on the increase in whole blood donations. Is it advisable in Iran?","authors":"M. Dehshal, A. Pourfathollah, K. Shamsasenjan","doi":"10.4103/gjtm.gjtm_64_22","DOIUrl":"https://doi.org/10.4103/gjtm.gjtm_64_22","url":null,"abstract":"","PeriodicalId":52961,"journal":{"name":"Global Journal of Transfusion Medicine","volume":"37 1","pages":"107 - 107"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74720358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tejal Ahuja, N. Bhatnagar, Shital Soni, Mamta Shah, Sangita Shah
Hemoglobinopathies are the most common hereditary disorders in India and pose a major health problem. Both beta-thalassemia and structural hemoglobin (Hb) variants are relatively common in North-Western India. Here, we report a case of a 26-year-old female (caste-Lohana) who came to us for premarital screening hemoglobinopathy. A complete blood count was done on automated cell counter. Hb analysis was carried out using high-performance liquid chromatography (HPLC) Bio-Rad VARIANT II Hb Testing System. HPLC analysis showed a peak in the unknown window with retention time (RT): 4.72 min and area: 18.9% and S-window with RT: 4.33 min and area: 0.5%, which was suggestive of Hb Q India. Further workup was done on other family members also. And found that the mother and sister of the patient also had similar findings (Hb Q India) and the father of the patient was positive for beta-thalassemia trait. Hb Q India is a rare hemoglobinopathy, which presents in mostly heterozygous form. The inheritance of Hb Q India is autosomal dominant.
{"title":"A rare case of Hb Q India- An uncommon hemoglobin variant","authors":"Tejal Ahuja, N. Bhatnagar, Shital Soni, Mamta Shah, Sangita Shah","doi":"10.4103/gjtm.gjtm_95_21","DOIUrl":"https://doi.org/10.4103/gjtm.gjtm_95_21","url":null,"abstract":"Hemoglobinopathies are the most common hereditary disorders in India and pose a major health problem. Both beta-thalassemia and structural hemoglobin (Hb) variants are relatively common in North-Western India. Here, we report a case of a 26-year-old female (caste-Lohana) who came to us for premarital screening hemoglobinopathy. A complete blood count was done on automated cell counter. Hb analysis was carried out using high-performance liquid chromatography (HPLC) Bio-Rad VARIANT II Hb Testing System. HPLC analysis showed a peak in the unknown window with retention time (RT): 4.72 min and area: 18.9% and S-window with RT: 4.33 min and area: 0.5%, which was suggestive of Hb Q India. Further workup was done on other family members also. And found that the mother and sister of the patient also had similar findings (Hb Q India) and the father of the patient was positive for beta-thalassemia trait. Hb Q India is a rare hemoglobinopathy, which presents in mostly heterozygous form. The inheritance of Hb Q India is autosomal dominant.","PeriodicalId":52961,"journal":{"name":"Global Journal of Transfusion Medicine","volume":"23 1","pages":"96 - 98"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83758289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The management of massively bleeding patients has undergone paradigm shift. With the evolution of bundle of care in form of damage control resuscitation, early blood-based resuscitation has emerged as one of the pillars of treatment; focused at preventing shock, coagulopathy, and thrombocytopenia. Military has always relied on low-titer O whole blood (LTOWB) to provide balanced hemostatic resuscitation for bleeding patients in combat casualties. Good results from military practice have led to questioning of practices followed in civilian bleeding trauma patients. With the realization that cold-stored platelets are functionally superior for immediate hemostasis, there is renewed interest in role of LTOWB in providing early hemostatic resuscitation to massively bleeding patients. Not only does LTOWB provide all the components but it also has an advantage of simplifying resuscitation logistics by providing all the components in one bag instead of three, in situations where delay of every minute leads to increased mortality. It can provide blood-based resuscitation in scenarios where it may not otherwise be possible. It can be used across all blood groups. This review explores the concerns regarding the use of LTOWB, historical perspective, advantages, and disadvantages. Several studies have shown that LTOWB is noninferior, as compared to components, and is a safe practice, without significant transfusion-related adverse events. The use of LTOWB in bleeding patients needs further studies to explore its efficacy and safety versus component therapy.
{"title":"Low-titer O whole blood in management of massive bleeding","authors":"S. Pahuja","doi":"10.4103/gjtm.gjtm_38_22","DOIUrl":"https://doi.org/10.4103/gjtm.gjtm_38_22","url":null,"abstract":"The management of massively bleeding patients has undergone paradigm shift. With the evolution of bundle of care in form of damage control resuscitation, early blood-based resuscitation has emerged as one of the pillars of treatment; focused at preventing shock, coagulopathy, and thrombocytopenia. Military has always relied on low-titer O whole blood (LTOWB) to provide balanced hemostatic resuscitation for bleeding patients in combat casualties. Good results from military practice have led to questioning of practices followed in civilian bleeding trauma patients. With the realization that cold-stored platelets are functionally superior for immediate hemostasis, there is renewed interest in role of LTOWB in providing early hemostatic resuscitation to massively bleeding patients. Not only does LTOWB provide all the components but it also has an advantage of simplifying resuscitation logistics by providing all the components in one bag instead of three, in situations where delay of every minute leads to increased mortality. It can provide blood-based resuscitation in scenarios where it may not otherwise be possible. It can be used across all blood groups. This review explores the concerns regarding the use of LTOWB, historical perspective, advantages, and disadvantages. Several studies have shown that LTOWB is noninferior, as compared to components, and is a safe practice, without significant transfusion-related adverse events. The use of LTOWB in bleeding patients needs further studies to explore its efficacy and safety versus component therapy.","PeriodicalId":52961,"journal":{"name":"Global Journal of Transfusion Medicine","volume":"440 1","pages":"4 - 9"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82911268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Sachan, Deepthi Gundrajukuppam, N. Shanmugam, R. Rajalingam, M. Rela
Red cell alloimmunization often poses challenge for transfusion support during surgery. As transfusion needs are unpredictable in liver transplant recipients, it requires well-equipped immunohematology laboratory for timely antibody identification and good coordination with other blood centers, for the arrangement of compatible units in case of rare phenotypes. We present a case of child with multiple Rh antibodies (Anti-C & anti-e) requiring rare R2R2 phenotype blood units for liver transplantation. With no antigen negative units available in inventory, various blood centers in India were approached individually and through social media. Eleven R2R2 units were transferred by air from three blood centers from North India (New Delhi) to South India (Chennai) with the help of Courier services maintaining cold chain over 24 h with data logger facilities. The patient underwent LT with 2 units (R2R2 phenotype) transfused intraoperatively and 3 units in postoperative period. The patient was discharged on postoperative day 18 with Hb 8.0 gm/dL. The case highlights the need for national/zonal database of rare phenotype blood donors to timely fulfil the blood requirement of patients in need.
{"title":"R2R2 phenotype blood requirements for liver transplantation surgery in a child with multiple Rh antibodies: Meeting needs and changing Indian scenario","authors":"D. Sachan, Deepthi Gundrajukuppam, N. Shanmugam, R. Rajalingam, M. Rela","doi":"10.4103/gjtm.gjtm_86_22","DOIUrl":"https://doi.org/10.4103/gjtm.gjtm_86_22","url":null,"abstract":"Red cell alloimmunization often poses challenge for transfusion support during surgery. As transfusion needs are unpredictable in liver transplant recipients, it requires well-equipped immunohematology laboratory for timely antibody identification and good coordination with other blood centers, for the arrangement of compatible units in case of rare phenotypes. We present a case of child with multiple Rh antibodies (Anti-C & anti-e) requiring rare R2R2 phenotype blood units for liver transplantation. With no antigen negative units available in inventory, various blood centers in India were approached individually and through social media. Eleven R2R2 units were transferred by air from three blood centers from North India (New Delhi) to South India (Chennai) with the help of Courier services maintaining cold chain over 24 h with data logger facilities. The patient underwent LT with 2 units (R2R2 phenotype) transfused intraoperatively and 3 units in postoperative period. The patient was discharged on postoperative day 18 with Hb 8.0 gm/dL. The case highlights the need for national/zonal database of rare phenotype blood donors to timely fulfil the blood requirement of patients in need.","PeriodicalId":52961,"journal":{"name":"Global Journal of Transfusion Medicine","volume":"47 1","pages":"82 - 85"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89068492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background and Objectives: The contribution of blood establishments (BEs) on Research, Development, and Innovation (R + D + I) is minimally addressed in the literature. Herein, we present an analysis of key indicators of R + D + I in BEs and discuss the impact of their R + D + I interests and priority areas, resources, and outcomes on the delivery of quality health products and services. Methods: Data from a worldwide representation of BEs were collected and analyzed in 2020. We assessed R + D + I areas studied, budget allocations, collaborations with other institutes, number of research staff available, and scientific production of BEs. Results: Details of 15 BEs from four continents were included in the study. All of them conducted R + D + I on a better understanding of their products and product safety. Other areas focused on were donors and donations (87%), bone marrow transplantation (80%), transfusion practices (80%), and immunogenetics (80%). 1%–11% (median of two points five %) of staff and 35–238 (median of 70, n = seven) in number, were involved in R + D + I. In 2018–2019, the budget allocated for R + D + I varied from € two point 6 to €13.7 million (median €seven point 6 million, n = 8) and it was zero point eight–10.5% (median of two points one %) of the total budget of BEs. Twelve (80%) and 11 (73%) BEs collaborated with academic institutes and hospitals, respectively. All centers generated publications and conference presentations, whereas only 4 (27%) hold patents. Conclusion: Research is an essential component in BEs that further potentiates R + D + I by partnering with research centers and universities as well as establishing specialized networks. A strong commitment to allocate resources and establish dedicated facilities or strategic alliances may generate world-class innovations in this ever-growing field.
背景和目的:血液机构(BEs)对研究、开发和创新(R + D + I)的贡献在文献中很少提及。在此，我们分析了BEs的R + D + I关键指标，并讨论了他们的R + D + I兴趣和优先领域、资源和结果对提供优质卫生产品和服务的影响。方法:在2020年收集并分析了来自全球代表性的BEs的数据。我们评估了研究的R + D + I领域、预算分配、与其他研究所的合作、可用的研究人员数量和生物多样性的科学产出。结果:研究纳入了来自四大洲的15名BEs的详细信息。他们都进行了R + D + I，以更好地了解他们的产品和产品安全。其他重点领域是献血者和捐赠(87%)、骨髓移植(80%)、输血做法(80%)和免疫遗传学(80%)。1%-11%(中位数为2.5%)的员工和35-238(中位数为70,n = 7)的人数参与了R + D + I。在2018-2019年，分配给R + D + I的预算从2.6欧元到1370万欧元(中位数为760万欧元，n = 8)，占BEs总预算的8.10.5%(中位数为2.1%)。分别有12家(80%)和11家(73%)的BEs与学术机构和医院合作。所有中心都发表了出版物和会议报告，而只有4个(27%)拥有专利。结论:研究是BEs的重要组成部分，通过与研究中心和大学的合作以及建立专业网络，进一步增强R + D + I。一个坚定的承诺，分配资源和建立专门的设施或战略联盟可能会产生世界级的创新在这个不断发展的领域。
{"title":"Analysis of key indicators of research, development, and innovation in blood establishments and their impact on the delivery of improved quality health products and services","authors":"G. Manchanayake, J. García-López, J. Vives","doi":"10.4103/gjtm.gjtm_48_22","DOIUrl":"https://doi.org/10.4103/gjtm.gjtm_48_22","url":null,"abstract":"Background and Objectives: The contribution of blood establishments (BEs) on Research, Development, and Innovation (R + D + I) is minimally addressed in the literature. Herein, we present an analysis of key indicators of R + D + I in BEs and discuss the impact of their R + D + I interests and priority areas, resources, and outcomes on the delivery of quality health products and services. Methods: Data from a worldwide representation of BEs were collected and analyzed in 2020. We assessed R + D + I areas studied, budget allocations, collaborations with other institutes, number of research staff available, and scientific production of BEs. Results: Details of 15 BEs from four continents were included in the study. All of them conducted R + D + I on a better understanding of their products and product safety. Other areas focused on were donors and donations (87%), bone marrow transplantation (80%), transfusion practices (80%), and immunogenetics (80%). 1%–11% (median of two points five %) of staff and 35–238 (median of 70, n = seven) in number, were involved in R + D + I. In 2018–2019, the budget allocated for R + D + I varied from € two point 6 to €13.7 million (median €seven point 6 million, n = 8) and it was zero point eight–10.5% (median of two points one %) of the total budget of BEs. Twelve (80%) and 11 (73%) BEs collaborated with academic institutes and hospitals, respectively. All centers generated publications and conference presentations, whereas only 4 (27%) hold patents. Conclusion: Research is an essential component in BEs that further potentiates R + D + I by partnering with research centers and universities as well as establishing specialized networks. A strong commitment to allocate resources and establish dedicated facilities or strategic alliances may generate world-class innovations in this ever-growing field.","PeriodicalId":52961,"journal":{"name":"Global Journal of Transfusion Medicine","volume":"112 1","pages":"57 - 61"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84009984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Soumya Das, Manisha Karaskar, Sandeep Dabhekar, R. Khot, K. Prathipati, Vijay Bidkar, B. Shrikrishna, S. Kumbhalkar
Since the advent of the pandemic, ABO blood group has a role in the immunopathogenesis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Disagreement between forward and reverse typing leads to ABO discrepancy which arise either due to intrinsic problems or from the technical errors in performing the test. Here, we document the two cases of transient absence anti-A and anti-B antibodies among two COVID patients proved by serological techniques, with the photographic representation of their immunohematological workups. SARS-CoV-2 viral envelop proteins mimicking as A and B antigen expressed on red blood cells (ABOs) and anti-A and anti-B antibodies acting as viral neutralizing antibodies, possible explanation for appearance of such phenomenon among patients. The ABO blood grouping of such discrepancy patients should be cautiously reported and advised to repeat once after full recovery. Transfusion center should be prepared appropriately in case of blood component support needed among such patients.
{"title":"Transitory absence of ABO antibodies during severe acute respiratory syndrome coronavirus 2 infection","authors":"Soumya Das, Manisha Karaskar, Sandeep Dabhekar, R. Khot, K. Prathipati, Vijay Bidkar, B. Shrikrishna, S. Kumbhalkar","doi":"10.4103/gjtm.gjtm_95_22","DOIUrl":"https://doi.org/10.4103/gjtm.gjtm_95_22","url":null,"abstract":"Since the advent of the pandemic, ABO blood group has a role in the immunopathogenesis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Disagreement between forward and reverse typing leads to ABO discrepancy which arise either due to intrinsic problems or from the technical errors in performing the test. Here, we document the two cases of transient absence anti-A and anti-B antibodies among two COVID patients proved by serological techniques, with the photographic representation of their immunohematological workups. SARS-CoV-2 viral envelop proteins mimicking as A and B antigen expressed on red blood cells (ABOs) and anti-A and anti-B antibodies acting as viral neutralizing antibodies, possible explanation for appearance of such phenomenon among patients. The ABO blood grouping of such discrepancy patients should be cautiously reported and advised to repeat once after full recovery. Transfusion center should be prepared appropriately in case of blood component support needed among such patients.","PeriodicalId":52961,"journal":{"name":"Global Journal of Transfusion Medicine","volume":"15 1","pages":"62 - 64"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82480122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 52-year-old male repeats voluntary blood donor donated at our blood center for the first time. Historical blood group was O, Rh (D) positive. Initial blood grouping was done on the fully automated immunohematology analyzer using column agglutination technique (CAT). Discrepant results (forward as group O and reverse as group B) were observed while performing the ABO blood grouping by CAT. Repeat testing by conventional tube technique showed the same discrepancy. Antibody detection test and direct antiglobulin test results were negative. After adsorption-elution, the eluate reacted only with group B red cells. Saliva testing for secretor status shows the presence of B and H substances. Finally, it was classified as a case of Bm (now called Bweak) phenotype. As a precautionary measure, the donor was recalled and a special blood group card was issued with a clear mention of his respective donor and recipient status. This case showed the importance of ABO subgroup determination that can help blood centers to establish defined transfusion protocol and prepare an elaborate rare blood donor registry.
{"title":"A rare case of Bm (Bweak) phenotype detected in a healthy blood donor from Eastern India","authors":"M. Reddy, S. Basu, Debapriya Basu, S. Datta","doi":"10.4103/gjtm.gjtm_53_22","DOIUrl":"https://doi.org/10.4103/gjtm.gjtm_53_22","url":null,"abstract":"A 52-year-old male repeats voluntary blood donor donated at our blood center for the first time. Historical blood group was O, Rh (D) positive. Initial blood grouping was done on the fully automated immunohematology analyzer using column agglutination technique (CAT). Discrepant results (forward as group O and reverse as group B) were observed while performing the ABO blood grouping by CAT. Repeat testing by conventional tube technique showed the same discrepancy. Antibody detection test and direct antiglobulin test results were negative. After adsorption-elution, the eluate reacted only with group B red cells. Saliva testing for secretor status shows the presence of B and H substances. Finally, it was classified as a case of Bm (now called Bweak) phenotype. As a precautionary measure, the donor was recalled and a special blood group card was issued with a clear mention of his respective donor and recipient status. This case showed the importance of ABO subgroup determination that can help blood centers to establish defined transfusion protocol and prepare an elaborate rare blood donor registry.","PeriodicalId":52961,"journal":{"name":"Global Journal of Transfusion Medicine","volume":"77 1","pages":"79 - 81"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83876932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Sahoo, P. Sriraman, A. Basavarajegowda, S. Noushad, Esha Toora, Rajendra Gurunath Kulkarni
The ideal way to screen for the presence of alloantibodies is by antibody screening panels which represent all clinically significant antigens in appropriate dosage. Most centers use pooled O-cells for antibody screening as it has antigens of non-ABO blood group systems that are prevalent in a representative population. Pooled O-cells sometimes fail to detect antibodies to less prevalent red blood cell antigens with reduced expression or show a dosage phenomenon. Despite pooling 4 to 5, O-donor segments, sometimes, it is difficult to detect clinically significant antibodies. False-negative indirect Coombs test by pooled O-cells may delay getting a compatible unit for elective cases where type and screen policy is used. Donor units with weak antigenic expression or units showing dosage can come compatible despite being antigen positive and lead to a hemolytic reaction. We report two cases where antibody screening by pooled O-cells was negative; still, cross-match was incompatible. Antibody screening with a three-cell panel was positive. Antibody identification with 11-cell panels confirmed the alloantibody to be anti-E. The present cases emphasize the importance of three-cell panels over pooled O-cells.
{"title":"Is indirect coombs test by pooled cells sufficient for antibody screening? An eye-opening case series","authors":"D. Sahoo, P. Sriraman, A. Basavarajegowda, S. Noushad, Esha Toora, Rajendra Gurunath Kulkarni","doi":"10.4103/gjtm.gjtm_74_22","DOIUrl":"https://doi.org/10.4103/gjtm.gjtm_74_22","url":null,"abstract":"The ideal way to screen for the presence of alloantibodies is by antibody screening panels which represent all clinically significant antigens in appropriate dosage. Most centers use pooled O-cells for antibody screening as it has antigens of non-ABO blood group systems that are prevalent in a representative population. Pooled O-cells sometimes fail to detect antibodies to less prevalent red blood cell antigens with reduced expression or show a dosage phenomenon. Despite pooling 4 to 5, O-donor segments, sometimes, it is difficult to detect clinically significant antibodies. False-negative indirect Coombs test by pooled O-cells may delay getting a compatible unit for elective cases where type and screen policy is used. Donor units with weak antigenic expression or units showing dosage can come compatible despite being antigen positive and lead to a hemolytic reaction. We report two cases where antibody screening by pooled O-cells was negative; still, cross-match was incompatible. Antibody screening with a three-cell panel was positive. Antibody identification with 11-cell panels confirmed the alloantibody to be anti-E. The present cases emphasize the importance of three-cell panels over pooled O-cells.","PeriodicalId":52961,"journal":{"name":"Global Journal of Transfusion Medicine","volume":"39 1","pages":"86 - 88"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77190909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Pahuja, R. Chauhan, Geetika Sharma, Deeksha Singh, Manisha Singh, R. Yadav
Background and Objectives: Alloimmunization can lead to difficulty in arranging compatible, antigen-negative blood units for the patients. Alloimmunization by coexisting “c” and “E” antibodies, though common, is frequently missed. Both “c” and “E” antigens are highly immunogenic and have the potential to cause hemolytic disease of newborn and hemolytic transfusion reactions. The objective of this study is to discuss different clinical scenarios of concomitant and singular presence of anti-c and anti-E along with the diagnostic approach and transfusion management in resource-limited settings. Methods: Column agglutination gel technology in low ionic strength solution phase was used for initial antibody identification. Detailed immunohematological workup was done by the use of select cells (c+, E− and c−, E+) and adsorption elution studies using a commercially available acid elution kit. Results: Out of 16 patients, detailed immunohematological workup was available for 14 patients, whereas two patients were lost to follow-up. Among 14 patients, 12 had CCDee (R1R1) phenotype, whereas two patients had CcDee phenotype (possible R1r) with anti-E antibody. In 12 patients with R1R1 phenotype, 6/12 (50%) had dual coexisting anti-c and E, whereas 3/12 (25%) had only anti-c and 3/12 (25%) had only anti-E. In R1R1 patients having anti-E, coexisting anti-c was found in 6/9 (66.66%) of patients. Conclusion: The study emphasizes the use of both “c” and “E” negative red cells (R1R1) in R1R1 patients having either anti-c or anti-E. Thus, in India, there is a need to develop our own red cell panels having an adequate representation of indigenous antigens and phenotypes.
背景和目的:同种异体免疫可能导致难以为患者安排相容的抗原阴性血液单位。同时存在的“c”和“E”抗体的同种免疫虽然很常见，但经常被忽略。“c”和“E”抗原都是高度免疫原性的，有可能引起新生儿溶血性疾病和溶血性输血反应。本研究的目的是讨论在资源有限的情况下，抗-c和抗- e同时存在和单独存在的不同临床情况，以及诊断方法和输血管理。方法:采用低离子强度溶液柱凝集凝胶技术进行抗体初始鉴定。通过选择细胞(c+， E -和c -， E+)进行详细的免疫血液学检查，并使用市售的酸洗脱试剂盒进行吸附洗脱研究。结果:16例患者中，有14例患者进行了详细的免疫血液学检查，2例患者没有随访。14例患者中，12例为CCDee (R1R1)表型，2例为CCDee表型(可能为R1r)伴抗e抗体。在12例R1R1表型的患者中，6/12(50%)的患者同时存在抗c和E, 3/12(25%)的患者仅存在抗c, 3/12(25%)的患者仅存在抗E。在有抗- e的R1R1患者中，6/9(66.66%)的患者存在共存的抗-c。结论:本研究强调在抗c或抗E的R1R1患者中同时使用c和E阴性红细胞(R1R1)。因此，在印度，有必要发展我们自己的红细胞小组，使其充分代表本土抗原和表型。
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