Transfusion Science

Haemovigilance programme of India: Comparative analysis of transfusion reactions reported over a 5-year period through two reporting formats and key recommendations for blood safety Akanksha Bisht, Neelam Marwaha, Ravneet Kaur, Debasish Gupta, Reba Chhabra Asian Journal of Transfusion Science 2020 14(2):103-116

Coronavirus disease-2019 pandemic: Maintaining an adequate and safe supply of blood and blood products Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava Asian Journal of Transfusion Science 2020 14(2):117-118 The coronavirus disease-2019 (COVID-19) pandemic has influenced all the dimensions of human lives and the functional pattern of the health care establishments as the caseload continues to rise at an alarming speed. Even though, the possibility of transmission of infection through blood is negligible, it is important to take into account that the ongoing pandemic is going to impact the supply of blood and blood products via reduction in the practice of voluntary blood donation, and the entire range of activities pertaining to the blood system. This calls for the need to assess the situation, plan for remedial measures and respond adequately to the existing problem. In conclusion, in the battle against the COVID-19 infection, it is of utmost importance that the supply of blood and its products needs to be continually maintained, and the most effective approach will be to integrate the various elements of the blood system within the public health care delivery system.

Distribution of antenatal alloimmunization in the southern districts of West Bengal and its significant associated factor Archana Naik, Prasun Bhattacharya, Palash Das, Krishnendu Mukherjee, Partha Mukhopadhyay Asian Journal of Transfusion Science 2020 14(2):119-125 Objectives: Detection of maternal irregular antibodies against red blood cell antigen is vital in the management of hemolytic disease of fetus and newborn. There are no uniform guidelines related to antenatal antibody screening and identification in the developing Country like India. This study was aimed to identify such alloimmunization and its associations. Materials and Methods: This prospective study was conducted on antenatal mothers at a tertiary care center. The mothers having a history of anti-D administration, blood transfusion, and autoimmune disorders were excluded from the study. Initial indirect antiglobulin test (IAT) was performed in all blood samples by conventional tube technique (CTT) to identify alloimmunization. IAT-positive samples were screened for irregular antibody by column agglutination technology (CAT). Antibody screen-positive samples were further analyzed in 11-cell panel by CAT. Antibody strength was measured by serial double dilution by CTT. The source of isoimmunization was identified by extended Rh phenotype of women, husband, and newborn. Results: A total of 12 (2.3%) women out of 530 were positive for IAT and antibody screen. Antibody could be identified in 11 women, of which anti-D (5) was the most common, followed by anti-C + anti-D (4), anti-C + anti-E (1), and anti-C (1). All four cases of anti-D + anti-C were distinguished from anti-G by differential adsorption and elution. There was a significant association with alloimmunization versus increased gravid status, antepartum hemorrhage, and past history of newborns with neonatal jaundice. Conclusion: All pregnant women with history of antepartum haemorrhage, newborn with neonatal jundice should be screened for alloantibody for early detection and better management of HDFN.

Reporting transfusion-related acute lung injury cases Farheen Karim, Huma Mansoori, Anila Rashid, Bushra Moiz Asian Journal of Transfusion Science 2020 14(2):126-130 Background: Transfusion-related acute lung injury (TRALI) is a rare but potentially fatal complication of blood product transfusion. It is felt worldwide that TRALI is an underrecognized and underreported entity because of lack of awareness. Aim: The purpose of this study was to report all cases of TRALI diagnosed in a tertiary care hospital over a 5-year period. Materials and Methods: This is a retrospective review of all TRALI cases reported from January 2011 to December 2015. All TRALI cases were identified from a manual review of reported transfusion reaction forms. For detailed information of all TRALI cases, medical record charts of patients were reviewed. The record of donors implicated in TRALI cases was derived from blood bank system. Statistical Analysis Used: The rate of TRALI cases per 1000 blood products transfused was computed by dividing the transfusion reactions by total number of all blood units transfused. Results: Total number of transfusions during the study was 291,041. Six cases of TRALI were reported during this period. Rate of TRALI per 1000 units transfused was 0.02%. The mortality associated with TRALI was 33.3%. TRALI occurred following the transfusion of fresh-frozen plasma in one patient, packed red blood cells in two patients, and a mixture of blood components in three patients. In all cases, the donors were male. Conclusion: The rate of TRALI reported to our blood bank was found to be 0.02%, which is very low as compared to international data. This is the first comprehensive study on TRALI from the country and a step forward to create awareness about the importance of diagnosing and reporting TRALI.

Modeling predonation testing strategies in platelet donations - Approach from low throughput apheresis blood center from India Mohandoss Murugesan, Maya Padmanaban, Riyas Malodan, Gayathiri K Chellaiya, Sangeetha K Nayanar Asian Journal of Transfusion Science 2020 14(2):131-136 Background: Hospital-based blood centers in India adopt pre-donation testing for transfusion-transmitted infections (TTI) before plateletpheresis donations. However, the WHO emphasizes on TTI tests be performed on samples collected during the donation process. The study objective was to determine whether cost implications by adopting product testing along with predonation testing or only product testing strategy in platelet donation in Indian blood centers. Materials and Methods: Cross-sectional study on registered plateletpheresis donors, strategy-1 with predonation testing using rapid tests and product testing using chemiluminescence (CLIA) were compared with alternate models: Strategy-2 (predonation test using CLIA and product testing with rapid test) and strategy-3 (product testing). For strategy-1 and 2, donors wait for predonation test to complete or visit blood center twice, while strategy-3 donors donate plateletpheresis immediately. The cost implications of these strategies were compared among registered plateletpheresis donors. Results: Out of 560 donors registered with strategy-1, three donors were reactive in predonation tests and six platelet units were discarded at product testing. After modeling, for strategy-2, nine donors would be identified as sero-reactive at pre-donation test only, while in strategy-3, nine units would be discarded in product testing. Only 506 donations were completed in strategy 1 after donor attrition. Recoverable costs was greater for strategy-3 (INR 5,146,500) than strategy-2 (INR 5,120,000) and strategy-1 (INR 5,069,000). Conclusion: Strategy-3 appears cost-effective but requires regulatory changes in the Indian setting. Testing apheresis procedures using Strategy 2 had greater cost recovery, and also prevents infectious donations and thereby enhances blood safety with the present guidelines.

Assessment of rhesus and kell blood group antigens, phenotypes, and their allelic frequencies in North Indian blood donors Sangeeta Pahuja, Sonal Jain, Manupriya Nain, Ruchika Goel, Shivali Sehgal, Manjula Jain Asian Journal of Transfusion Science 2020 14(2):137-141 Background: Prevalence of rhesus (Rh) and Kell antigens in a population vary with race, ethnicity, and geographical location. With advances in immunohematology, non-D antigens, and their corresponding antibodies are increasingly being found to be culprits for alloimmunization. Materials and Methods: Assessment of the phenotype of Rh and Kell blood group antigen in the healthy donor population from North India was done, and estimation of the frequencies of these alleles in our population was performed. Results: The most common antigen in the North Indian donor population was “e” (95.6%) followed by “C” (89.6%), “c” (57.7%), and “E” (17.29%) in that order. The most prevalent phenotype in the Indian population was found to be “CDe” followed by “CcDe” and “CcDEe.” “K” antigen was found to be positive in 1.81% of the population. Discussion: Knowledge of the Rh antigen profiles in a given population can be very helpful in formulating transfusion guidelines specific to a particular population with an aim to minimize the cost and maximize the benefits. With this aim in mind and considering the problems encountered in developing countries like ours, we conducted Rh and Kell antigen profiling of donors. Comparative analysis with other population studies and implications for transfusion protocols is evaluated. Conclusion: Assessment of Rhesus antigen profile of a particular population is useful to develop cost effective ways of providing maximum benefits of blood transfusion with least resources.

Role of plasma exchange in management of patients clinically diagnosed of postpartum thrombotic microangiopathies: A retrospective observation from a tertiary health-care center Prashant Kumar Pandey, Anil Prasad Bhatt, Vijay Kumar Sinha, Nitin Agarwal, Gyanendra Agrawal Asian Journal of Transfusion Science 2020 14(2):142-148 Introduction: Diagnosis of postpartum thrombotic microangiopathies in pregnancy is a challenge, but plasma exchange (PE) is life-saving in such cases. This study was conducted with the aim to find the result of the early start of PE in such patients. Materials and Methods: There were a total of seven clinically diagnosed cases of post partum thrombotic microangiopathies (PP-TMA) where PE was done. The diagnosis of PP-HUS and decision to start PE in such cases were based on the classical triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure. All the PE procedures were done using fully automatic COM.TEC (Fresenius Kabi, Germany). Results: Immediately before the start of PE, the mean platelet count and serum lactate dehydrogenase (LDH) and hemoglobin (Hb) were 53.1 × 109/L, 10,943 IU/L, and 6.4 gm%, respectively. After seven sessions of PE, platelet count improved to 158 × 109/L and LDH dropped to 609 IU/L, and Hb improved to 10.3 gm% (P < 0.05). We got a positive renal response in four patients in whom serum creatinine value reached within normal range while in the remaining three patients, no positive renal response was obtained and serum creatinine remained above normal range. Thus, the response of PE was shown to be inadequate in three patients. Compliance to PE was good. Patients were discharged after 20 days (mean) of hospital admission. Conclusion: PE is life-saving in PP-HUS. High degree of clinical suspicion to it and early start of PE were crucial for successful outcome in our patient population.

Depleted iron stores in voluntary blood donors: A three-center cross-sectional study in Ghana Patrick Adu, David Bennin, Richard Ato Edzie, Ama Gyasiwaah Owusu-Poku, Toniah Umar Hakeem, Glory Obadiah Baba, Emmanuel Kobina Mesi Edzie Asian Journal of Transfusion Science 2020 14(2):149-157 Background: Blood donation is frequently associated with iron deficiency. Although iron deficiency is endemic in Ghana, there is a scarcity of data on iron stores in blood donors to inform donor recruitment policy. This study determined the prevalence and factors predictive of depleted iron stores in blood donors. Materials and Methods: This cross-sectional study recruited 287 blood donors from three regions in Ghana. Venous blood samples were collected for estimation of C-reactive protein, full blood count, and serum ferritin. Questionnaires were used to capture sociodemographic data. Data were analyzed using SPSS or GraphPad Prism. Multivariate logistic regression and receiver operator characteristics (ROC) analyses were, respectively, used to determine the factors associated with depleted iron stores or sensitivities of calculated red cell indices in predicting depleted iron stores in the participants. Results: Whereas 27.4% of the blood donors had depleted iron stores (ferritin <15 ng/dL), only 11% took iron supplementation. While ferritin levels significantly increased with age, 49.5% of the blood donors were aged 20–29 years. Whereas 39.5% of participants had never donated blood, 24.9% had donated ≥3 units of whole blood in the past 2 years. Female (adjusted odds ratio [aOR]: 7.407, P = 0.005), multiple previous donations (1–2 [aOR: 1.846, P = 0.431]; ≥3 [aOR: 6.297, P = 0.016]), no iron supplementation (aOR: 17.553, P = 0.078), or platelet count ≥150 × 109/L (aOR: 2.689, P = 0.354) significantly associated with iron depletion. ROC analyses showed that whereas mean cell hemoglobin (MCH) density (area under the curve [AUC]: 0.735, P < 0.01), MCH (AUC: 0.772, P < 0.01) or Shine and Lal (AUC: 0.736, P < 0.01) fairly predicted iron depletion, combined cell index (AUC: 0.660, P < 0.01) or Green and King (AUC: 0.603, P < 0.01) indices poorly predicted iron depletion. Conclusions: More than quarter of voluntary blood donors suffers postdonation sideropenia. Calculated red cell indices should be investigated in different settings to validate usefulness in detecting iron depletion.

Platelets transfusion in Greece: Where, when, why? A national survey Serena Valsami, Abraham Pouliakis, Maria Gavalaki, Aspasia Argyrou, Evagelia Triantafillou, Evagelia Arvanitopoulou, Fotios Girtovitis, Virginia Voulgaridou, Aggeliki Megalou, Paraskevi Chronopoulou, Andreas Papachronis, George Sakellarakis, Eleftheria Zervou, Christina Batsi, Kalliopi Fountouli, Aggelos Athanasopoulos, Elias Kyriakou, Afrodite Cheropoulou, Anastasia Livada, Konstantinos Lebessopoulos, Maria Papakonstantinou, Anthi Gafou, Despina Katopi, George Martinis, Ioanna Dendrinou, Hrysanthi Katharopoulou, Marianna Politou, Margarita Papadopoulou, Paraskevi Papadopoulou, Ekaterini Manaka, Konstantina Paneta, Chrissoula Alepi, Christos Damaskos, Nikolaos Garmpis, Konstantinos Stamoulis, Elisavet Grouzi Asian Journal of Transfusion Science 2020 14(2):158-166 Background: Platelet transfusion is among the most useful therapeutic tools in modern clinical settings which mean that ensuring an adequate supply is of paramount importance. Aim: The aim of our study was to record the use and wastage of platelet concentrates (PCs) in Greece, so as to come up with evidence-based interventions. Methods: The study was conducted during May and June 2015. We evaluated the use of random-donor platelets (RDPs) and single-donor apheresis platelets (SDPs). We analyzed such parameters as hospital department and diagnosis, indication for transfusion, PCs' age at the time of transfusion, and wastage rate. Results: We used data from 21 hospitals across the country. A total of 12,061 RDPs and 1189 SDPs were transfused, with an average of 4.84 (±2.72) and 1.12 (±2.73) units per episode, respectively. Most patients had been admitted to the internal medicine and hematology departments. The transfusions were mostly given prophylactically, usually in cases of acute leukemia, and mostly on the day before expiration. Wastage rate was 16.75% for RPDs and 2.70% for SDPs, primarily because of the expiration of the use-by date. Conclusions: This is the first national survey regarding platelet transfusion in Greece. Since most patients were admitted in internal medicine and hematology departments, we recommend that the staff of the abovementioned departments should undergo training on contemporary transfusion guidelines. Platelet discard rate could further be lowered through the centralization of inventory management along with the extension of the lifetime of PCs by means of emerging technologies.

Evaluation of serum natural autoantibodies reaction in different hematological disorders with prospective view to their probable utilization in predictive medicine Maryam Mosaed, Ali Akbar Pourfathollah, Mostafa Moghadam, Mir Hadi Jazayeri, Amir Reza Safdarian Asian Journal of Transfusion Science 2020 14(2):167-171 Background: There are some antibodies which are present in healthy individuals without any former exposure to foreign antigens; they are known as natural autoantibodies (NAAbs). In recent years, it was shown that they probably contribute to the homeostasis of the whole body and might be present before beginning of some diseases. Thus, as new biomarkers, they are promising factors to diagnose diseases. Materials and Methods: In this study, we drew upon samples of 924 individuals (600 controls and 324 cases) with underlying diseases of anemia, polycythemia, leukocytosis, thrombocytopenia, thrombocytosis, and pancytopenia. For detection of NAAbs against red blood cell, plasma samples were incubated with their own red cell suspension in 4°C for 18 h. Then, positive samples were evaluated for antibody screening and titration. Results: Fifty-two (8.6%) controls and 58 (17.9%) cases showed positive reaction (Pv < 0.001). The prevalence of positive antibody screens among auto-positive controls was 53% and 100% among cases; moreover, strength of antibody screen reaction had a mean rank of 22.5 in controls and a mean rank of 38.5 in cases (Pv < 0.001). A significant relation was also observed between ABO blood group and prevalence of NAAbs in controls but not in cases (Pv < 0.05). Conclusion: The prevalence and potency of NAAbs increased along with hematological changes; moreover, the antibody reactions' pattern and titration showed significant differences between the two groups and these may be useful as biomarker for monitoring and prediction of some hematological diseases.

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Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,

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