
==== Front
Asian J Transfus Sci
Asian J Transfus Sci
AJTS
Asian J Transfus Sci
Asian Journal of Transfusion Science
0973-6247
1998-3565
Wolters Kluwer - Medknow India

AJTS-18-28
TRANSCON 2023: E-Poster Abstracts
TRANSCON 2023: E-Poster Abstracts
8 2024
21 8 2024
18 Suppl 1 S28S55
Copyright: © 2024 Asian Journal of Transfusion Science
2024
https://creativecommons.org/licenses/by-nc-sa/4.0/ This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
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pmcP 1: Administrative challenges in obeying blood centre guidelines

Rinku Shukla, Kruti Dumaswala

Surat Raktadan Kendra and Research Centre, Surat, Gujarat, India

Aims and Objectives: The main objective of the study is to point out the problems faced related to administrative issues in the blood centre in past years which may be helpful in continuous improvement.

Methods: Surat Raktadan Kendra & Research Centre was NABH accredited in 2010, since then internal audits, external audits and Blood Centre Inspections by Central Drugs Standard Control Organization (CDSCO) at regular intervals have been taken. During these audits number of non-compliances were reported which was difficult to obey as per the guidelines. These administrative issues as per guidelines are reported in the present study. As a reference material The Drug and Cosmetics Rule, 1945 with its amendments over years and NABH standards were used.

Results: Administrative issues pointed out in the study included appointment of FDA approved technicians, number of technicians in the blood donation camps, medical officers in the camps, appointment of counsellor or Medical Social Workers, Calibration of instruments, use of CDSCO approved TTI kits, Quality Control of empty bags, Controls of Haematolgy analyser, Fire safety guidelines, confidentiality of information, validation of computer software, training of clinicians by standalone blood banks, infrastructure of the blood centres and component laboratories.

Conclusion: Handling of such administrative issues helps us in continuous improvement and shall be helpful to other blood centers too.

P 2: Donor feedback serving as internal audit in the blood centre of a tertiary care hospital

Rimple Khatri, Richa Gupta, Manisha

Regional Blood Bank, Guru Teg Bahadur Hospital, Delhi, India

Aims and Objectives: An integrated strategy for blood safety is required for the provision of safe and adequate blood. Efforts are needed to strengthen voluntary blood donation at all levels, including educating and motivating more individuals to be involved in blood donation process. An internal audit in the form of donor feedback might help in improving current practices thus moving towards goal of 100% voluntary donation. The present study was undertaken to assess the experience and feedback of donors in the blood centre of a tertiary care hospital.

Methods: A structured, simple and validated questionnaire was prepared and responses were recorded by a trained counsellor from donors donating blood at our centre. The questionnaire was given during post donation rest period. In a five-year period from 2017- June 2023, response was recorded from a total of 2243 blood donors.

Results: Among these, 1134 (50.55%) were first time donors while 1109 (49.44%) had donated blood previously also. Furthermore, only 114 (5%) were voluntary donors and rest 2129 (95%) were replacement donors. 2239 (99.8%) donors felt that proper information was communicated to them during counselling which appears skewed attributing to lack of awareness and accurate knowledge for blood donation. 10 (0.4%) donors found the blood donation room uncomfortable citing reasons like unclean bedsheets, hygiene, improper lighting etc. Although most of the people 2181 (97.8%) were satisfied with the post donation care provided, 49 (2.1%) complained about the lack of proper refreshment and uncomfortable donor recovery area. A large population of first time donors indicates the need for further donor education and motivation. Donor feedback analysis helps to increase donor retention and improve the standard of blood donation services.

P 3: Analysis of pre- and post-donation hematological parameters in plateletpheresis donors at tertiary care hospital of central India

Reena Patel, Ramesh Chandrakar

Department of Transfusion Medicine and Blood Bank, AIIMS, Raipur, Chhattisgarh, India

Aims and Objectives: To compare the pre and post hematological parameters (within 30 min and after 48-72 hours) in healthy plateletpheresis donors.

Methods: Plateletpheresis was performed on 50 eligible donors using the spectra optia cell separator over a period of 18 months. Hematological parameters were assessed pre and post-procedure, with blood samples collected in EDTA vacutainers. The sysmex S1 analyzer measured hemoglobin, hematocrit, platelet count, RBC count, WBC count, MPV, and PDW. Paired t-tests compared mean pre- and post-plateletpheresis values (p < 0.05, significant).

Results: Significant transient increase in hemoglobin was observed with mean values (pre: 14.402 (SD=0.8484), post 30 min: 14.934 (SD=1.0813), post 48-72 hrs: 14.028 (SD=0.7964); p < 0.000011). Platelet counts significantly decreased with mean values (pre: 272.8 (SD=54.6872), post 30 min: 204.56 (SD=49.2553), post 48-72 hrs: 239.36 (SD=52.9041); p < 0.00001).

Conclusion: Understanding the impact of plateletpheresis donation on the hematological parameters of donors is crucial for ensuring their well-being and the safety of the donated platelets.

Reference

Khurshid I, Jan A. Analysis of changes in pre- and post-donation haematological parameters among plateletpheresis donors at SKIMS blood bank – A hospital based study. JMS Ski 2020;23 (Suppl 1).

P 4: Changes in pre- and post-donation platelet indices and serum ionised calcium in plateletpheresis donors

Gajender Singh, Deepshikha

Pt. B.D. Sharma, PGIMS, Rohtak, Haryana, India

Aim and Objectives: To evaluate changes in pre and post donation platelet indices and serum ionized calcium in plateletpheresis donors. To assess post donation changes in Hb, WBC’s, and RBC’s. To observe any adverse reactions, post plateletpheresis.

Materials and Methods: A prospective study on 78 plateletpheresis donors over a span of one year was conducted. Donors were selected as per criteria of DGHS, MHFW, GOI and DRUG AND COSMETIC ACT, 1940. Preprocedural blood samples were taken for complete blood count and blood grouping. Plateletpheresis procedure was performed on Multiprocedure COM.TEC apheresis machine of Fresenius Kabi. For haematology parameters pre and post donation blood samples were taken and analysed on Automatic Hematology Analyser BC 5800 Mindray and for biochemical parameters, besides pre and post donation blood samples, and additional sample was taken 30 minutes after start of the procedure and were analysed on COMBILINE machine.

Results: Present study demonstrated the significant post procedural decrease in haemoglobin, hematocrit and platelet counts but none of the donors had implications of clinical anemia or thrombocytopenia. Serum ionised calcium was also decreased significantly but only 7.69% donors manifested mild symptoms of hypocalcemia.

Conclusion: Plateletpheresis is a safe procedure for donors. Though a significant decrease in post procedural haematological and biochemical parameters were noticed but no significant clinical manifestations were observed.

P 5: Automated RBC exchange transfusion in a 10-year-old female child with sickle cell beta thalassemia: A case report

Melvin Mathew, Seema Gupta, Prasad Kulkarni

Department of Transfusion Medicine, D. Y. Patil School of Medicine, Navi Mumbai, Maharashtra, India

Introduction: A complicated hemoglobinopathy known as sickle cell beta thalassemia is caused by the interaction of sickle cell trait and beta thalassemia gene mutations. From mild to severe anemia, hemolysis, and vaso-occlusive consequences, this illness can present with a wide range of clinical symptoms. RBC exchange transfusion have been the treatment for Ischemic stroke due to sickle cell crisis in known case of sickle cell beta thalassemia. An innovative and successful treatment strategy that offers precise control over hematocrit and hemoglobin levels while limiting iron overload is automated RBC exchange transfusion using therapeutic apheresis.

Objectives: The aim of this case is to present the successful application of automated RBC exchange transfusion via therapeutic apheresis in a 10-year-old female child diagnosed with Ischemic stroke due to sickle cell crisis in known case of sickle cell beta thalassemia.

Methods: We present a case study of a 10-year-old female child diagnosed with Ischemic stroke due to sickle cell crisis in known case of sickle cell beta thalassemia, who underwent automated RBC exchange transfusion via therapeutic apheresis. The procedure involved the simultaneous removal of a calculated volume of sickle-affected RBCs and the replacement with healthy donor RBCs. Close monitoring of vital signs, hematocrit, and hemoglobin levels was performed throughout the procedure to ensure patient safety.

Results: The 10-year-old female child with sickle cell beta thalassemia underwent the automated RBC exchange transfusion procedure successfully. We were able to lower the proportion of sickle hemoglobin and lower the risk of vaso-occlusive events by maintaining the patient’s hematocrit and hemoglobin levels within the desired target range through multiple transfusion sessions. The patient tolerated the procedure well with no complications.

Conclution: To manage sickle cell crisis in pediatric patients, automated RBC exchange transfusion via therapeutic apheresis offers a secure and efficient therapeutic option. Reducing the burden of sickle hemoglobin and lowering the risk of vaso-occlusive complications are two benefits of being able to precisely control hematocrit and hemoglobin levels. The 10-year-old female patient with sickle cell beta thalassemia responded well to the automated RBC exchange transfusion in this case, demonstrating the procedure’s potential as a beneficial therapeutic option.

P 6: Therapeutic plasma exchange in G6PD deficient patient complicated with acute hepatitis a causing hemolysis: A case report

Rituparna Bhattacharya

Department of Immunohematology and Blood Transfusion, B.J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India

Introduction: Glucose-6-phosphate dehydrogenase is an enzyme that protect the erythrocyte against oxidative damage. G6PD deficiency is the most common enzyme deficiency of red blood cells which can present with hemolytic anemia and acute renal failure after exposure to oxidative triggers such as drugs, infection or some foods like fava beans. We report a case highlighting the role of plasma exchange in a G6PD deficient patient presenting with hepatitis A related acute liver failure and concomitant acute renal failure.

Case Report: A 23-year-old G6PD deficient male patient presented with complaint of fever, vomiting followed by abdominal pain, yellowish discoloration of sclera and skin, dark coloured urine since last 10 days. On physical examination pallor and jaundice was present. High serum Total bilirubin, indirect bilirubin, LDH, serum creatinine and reticulocyte count suggestive of intravascular hemolysis. Anti HAV IgM antibody was positive. Peripheral smear showed Normocytic normochromic RBCs with anisopoikilocytosis (blister cells, bite cells and some RBCs showed Heinz bodies). Therapeutic plasma exchange (TPE) procedures were performed on three consecutive days using a Spectra Optia cell separator. There was continuous improvement in patient’s general condition, hemolytic parameters and renal function after each cycle of TPE.

Conclusion: Although supportive therapy is enough in mild cases, TPE might be lifesaving in complicated cases. Clinicians treating G6PD deficiency patient should be aware about the TPE option for the management of complication related to hemolysis.

P 7: Investigating the correlation between blood types in COVID-19 convalescent plasma donors and anti-SARS-CoV-2 IGG antibody levels: A retrospective study

Shweta Ranjan, Rakesh Kumar, Bankim Das, Neha Singh, Saurabh Lahare

Department of Transfusion Medicine and Blood Bank, AIIMS, Patna, Bihar, India

Aim and Objectives: The primary aim of this to investigate the potential association between ABO blood groups of COVID-19 convalescent plasma (CCP) donors and the levels of post-infection anti-SARS CoV-2 IgG antibodies. The secondary objectives were to compare the antibody levels among different ABO blood groups and to analyse the antibody level during stratified post-infection periods.

Materials and Methods: From September 2020 to May 2021, a total of 404 CCP donors were included in the study. Donor samples were tested for anti-SARS-CoV-2 IgG antibody levels (S/CO value) using the VITROS Anti-SARS-CoV-2 IgG chemiluminescence immunoassay, which is a qualitative assay. The study compared the number of donations with low (S/CO=1.0-4.42), medium (S/CO=4.62-18.45), and high levels (S/CO >18.45) of the antibody using the Chi-square test. Additionally, antibody levels during three stratified post-infection periods (0-60 days, 61-120 days, and >120 days) in different blood groups were compared using the Kruskal-Wallis ANOVA test, while inter-blood group comparisons of antibody levels were performed by independent t-tests.

Results and Conclusion: The mean anti-SARS CoV-2 IgG antibody levels were found to be the lowest in the O blood group (17.22±9.2), followed by A (17.59 ± 11.4), B (18.21 ± 10.7), and AB (19.91 ± 9.7) groups. However, the analysis of antibody levels according to blood groups did not show statistically significant differences (p value >.05). Similarly, antibody levels during the stratified post-infection periods based on blood groups and inter-blood group comparisons of antibody levels were also not found to be significant.

Conclusion: AB blood group showed the highest but statistically non-significant anti-SARS CoV-2 IgG antibody levels among CCP donors. Nevertheless, our findings indicate that ABO blood groups do not significantly influence antibody levels in CCP donors, regardless of the post-infection period. Further research may be required to explore additional factors that could potentially impact the antibody levels in CCP donors.

References

Jessy SJ, Beegum MS, Genga S, Bindu G, Chintha S, et al. Prevalence of SARS CoV-2 infection among health care workers of a hybrid tertiary COVID-19 hospital in Kerala. [doi: 10.1101/2021.07.19.21260792].

Žiberna K, Jež M, Jazbec K, Mali P, Potokar UR, Rožman P. ABO blood group does not influence the level of anti-SARS-CoV-2 antibodies in convalescent plasma donors. Transfusion 2022;62:556-62.

P 8: A study on blood utilization practices in cardiac surgeries

B Megala, R Krishnamoorthy, A Ashwin, Sampath

Department of Transfusion Medicine, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India

Introduction: Blood transfusions plays a major role in the resuscitation and management of surgical patients and utilization of blood is a common practice in cardiac surgeries.

Aim and Objective: To estimate the blood utilization indicator (Crossmatch to transfusion ratio C/T, Transfusion probability T%, Transfusion index TI) in cardiac surgery patients in a tertiary care hospital.

Methods: This study was conducted retrospectively for the period of February 2023 to April 2023 (3 months’ period). We analyzed 172 cardiac surgery patients, 669 blood units were crossmatched and 206 units were transfused. The data was collected from blood requisition forms, OT register, issue registers of blood bank.

Results: We had received 177 patient blood requisition for whom 669 blood units were cross matched and 206 units were transfused to 104 patients. The overall blood utilization rates in our hospital crossmatch to transfusion ratio C/T-3.2, Transfusion probability T%-60%, Transfusion index TI-1.2 respectively.

Conclusion: Blood transfusion quality indicators such as crossmatch to transfusion ratio (C/T), Transfusion probability (T%) and transfusion index assesses the efficiency of blood product utilization. All patients undergoing cardiac surgeries do not have an equal risk of bleeding and may not require blood transfusion. To reduce the excessive blood wastage, blood Centres need appropriate blood conserving policies such as maximum surgical blood order schedule, which would lead to better utilization of blood products.

References

Vibhute M, Kamath SK, Shetty A. Blood utilisation in elective general surgery cases: Requirements, ordering and transfusion practices. J Postgrad Med 2000;46:13-7.

Yazdi AP, Alipour M, Jahanbakhsh SS, Gharavifard M, Gilani MT. A survey of blood request versus blood utilization at a university hospital in Iran. Arch Bone Jt Surg 2016;4:75-9.

Marcondes SS, Carrareto AR, Zago-Gomes MD, Orletti MD, Novaes AC. Evaluation of the use of blood in surgeries as a tool to change patterns for requesting blood product reserves. Clinics (Sao Paulo) 2019;74:e652.

Mangwana S, et al. Optimization of blood transfusion services: Analysis of blood requisition and utilization practices in cardiac surgical patients in a tertiary care hospital, India. Glob J Transf Med 2017;2:47.

P 9: Performance evaluation of leukoreduction filters for packed red cells in a tertiary care oncology centre

N Arunkumar, S Ojha, S H Sumathi, S Saha, D Madkaiker, K M Chavan

Department of Transfusion Medicine, ACTREC, Navi Mumbai, Maharashtra, India

Aims and Objectives: For performance evaluation and comparison of two different leukoreduction filters for PRBCs prepared using 350 ml and 450 ml blood collection bags.

Materials and Methods: A prospective evaluation of leucoreduction (LD) filters from two different companies (Macopharma Leucolab & Fresenius BioR) was conducted at our tertiary care oncology center for a period of one year from Januay 2022 to December 2022. Pre and Post hematological parameters like WBC count, RBC count, Hb, HCT, MCV, MCHC, MCH, RDW & Platelet count of leukoreduced PRBC units were compared to analyze quality control of the procedure using Wilcoxon Signed Ranks Test & Mann-Whitney U Test as statistical analysis.

Results: Out of a total analyzed 248 LD PRBC units, 142 PRBC units and 106 PRBC units were processed using Macopharma & Fresenius LD filters respectively. The time taken for LD processing was significantly (p<0.001) less in Macopharma whereas volume loss (p=0.006) & red cell loss (p=0.067) were less in Fresenius. Additionally, among the analyzed LD-PRBC units, 147 and 101 LD-PRBC units were obtained from 450 and 350 ml bags respectively. The mean time taken of LD-PRBC was lower in Fresenius for both 350 ml & 450 ml bags whereas the mean Volume loss & RBC loss were lower in Macopharma for both blood bags.

Conclusion: Overall Leucoreduction was achieved in both type of filters for both bags as per the regulatory standards. The overall time taken was significantly lower for Macopharma with volume loss & percentage red cell loss being lower in Fresenius.

P 10: Implementation of platelet additive solution for all platelet concentrates at a tertiary care hospital

Deepak Kumar, Amit Bisht, Tarun Kumar, Rahul Katharia

Department of Transfusion Medicine, Amrita Institute of Medical Sciences, Faridabad, Haryana, India

Aims and Objectives: To access the quality of platelet concentrates prepared with PAS.

Methods: A total of 348 Single donor platelet concentrate were prepared using T PAS + (65% PAS + 35% Plasma). All components were tested for indices (Red cell & platelet). The products were check for changed in ABO titres of IgM & IgG (Anti A & Anti-B). A prior consent taken before procedure.

Results: A total of 348 Single donor platelet concentrate were prepared using T PAS + (65% PAS + 35% Plasma) Group Non-Specific (261) & Group Specific (87) - 25%. The ABO distribution was A – 27% B – 30% O – 32% AB – 11% ABO mismatch between the donor and patient was 75%. Implementation of PAS has reduced the donor deferral based on ABO group. The Mean RBC count in pre were 5.05 ± 2.1 vs 0.28 ± 0.32 in post (P<001). The yield of platelets concentrate were comparable with plasma and PAS ( 3.2 ± 1.2 x 1011 vs. 3.6±1.3 x 1011/bag. There is no loss. The Mean WBC count in pre were 6.35 vs 0.05 in post (P<001). There was a significant reduction in Anti A & Anti B titre (IgM Mean Pre Post -1:32 vs 1:4, IgG Mean Pre & Post-1:32 vs 1:2 One patient had allergic reaction (case of BMT and she has transfused more than 60 unit of blood & blood component).

Conclusion: This facilitates the ABO incompatible SDP transfusion and helps in inventory management. The risk of allergic transfusion reaction decreases after reducing the amount of plasma from SDP units. Using PAS-SDP certainly improve the inventory management for platelets with no compromise on clinical and laboratory efficacy.

References

Transfusion Medicine Technical Manual. 3rd ed.; 2022.

AABB. Guidelines. 19th ed. AABB; 2020.

P 11: Achieving optimum platelet yield in RDP by comparing different methods of preparation of platelet rich plasma and analysing reproducibility when applied to different donors

Muzaffar Khan Alam Khan, M Sintha, Sudharsan

Department of Immuno Hematology and Blood Transfusion, Madurai Medical College, Madurai, Tamil Nadu, India

Aims and Objectives: (1) To establish the quality and greater quantity of platelets by ensuring efficient separation and preservation of platelets. (2) To compare four different methods of preparation by changing optimal settings and to find out which method yields highest concentration of platelets without compromising quantity. (3) To enhance platelet purity and recovery without compromising the risk of platelet activation or damage by following recommended protocols.

Methods: The prospective study was conducted in Department of Immunohematology and Blood Transfusion Government Rajaji Hospital, Madurai Medical College, Madurai from March-2023 to June-2023 using Thermo scientific Cryofuge-16. The process involves subjecting the whole blood, resulting in the formation of platelet concentrates by two step process. However, the quality and quantity of platelets prepared from Cryofuge 16 can be influenced by various factors. We compared 4 different methods of preparation by considering the following factors Centrifugation speed, centrifugation time, temperature, brake settings.

Results: Our method shows reproducibility when applied to different donors. The procedure resulted in increase in platelet concentration from 3.2 (12.8%) to 5 (20%) fold above 5.5*10^10 establishing quantity. The RBC contamination as low as 0.03x10^6/ul and leucocytes as low as 0.18x10^3/ul present in the final platelet product which showing quality, platelet purity and recovery.

Conclusion: Achieving optimal platelet yield requires careful consideration of various factors, Understanding and optimizing these factors are crucial for ensuring the availability of high-quality platelet products for transfusion, ultimately improving patient outcomes.

Reference

National Blood Transfusion Council, Ministry of Health and Family Welfare. Available from: https://nbtc.naco.gov.in/index.php?/page/bloodbankstandard/.

P 12: Therapeutic blood components in the tribal district of Palghar, Maharashtra

Mukund Khandelwal, Yogini Patel

Vedantaa Institute of Medical Sciences, Palghar, Maharashtra, India

The tribal area of Palghar District has a high incidence of sickle cell and Thalessemia patients ranging between 3-5% of the population, also amidst the forests, there is a need for therapeutic blood components like fresh frozen plasma and cryoprecipitate for bleeding patients due to Snake bite, insect bites and Disseminated Intravascular Coagulation (DIC) patients. While, lots is being integrated on achieving international standards for Transfusion Therapy in India, it is necessary to monitor the FDA and NBTC mandates in the Tribal zones amidst the interiors of India. This paper describes the means to facilitate therapeutic value blood component requirements for patients in Palghar district, following all regulatory norms.

P 13: Knowledge, attitude and practice of blood donation among medical students at entry level

Minal Wasnik

Department of Transfusion Medicine and Blood Bank, AIIMS, Raipur, Chhattisgarh, India

Aims and Objectives: (1) To assess knowledge, attitude, and practice regarding blood donation in medical students at entry level. (2) To create awareness about blood donation.

Methods: Data was collected from 1st and 2nd year medical students through self-administered questionnaire. Written-informed consent was taken. An awareness-session on blood donation was also conducted. Data collected was entered into excel sheets and proportions calculated.

Results: Out of 200, 157 (78.5%) responded; 62.4%-males; 37.6%-females. Mean age: 19.36 ± 1.15 years. 95.5% knew their blood group. 89.8% knew minimum age for donation. 54.8% & 39.5% knew minimum weight & hemoglobin respectively. Overall, 47.8% had adequate knowledge. 96.2% considered blood donation a noble act and 89.2% knew voluntary donation as best source. 73.2% visited blood bank previously and 8.3% donated voluntarily. 59.9% motivated others for blood donation. To help even the unknown at time of need was reason cited by all donors. Among non-donors, most common reason for not donating was fear of weakness/ anemia followed by fear of infection & needle. Willingness for donation improved from 83.4% to 93% following awareness-session.

Conclusion: Participants had good knowledge and favourable attitude towards blood donation. However, practice was less as they were new to donor pool. Conducting regular blood donation camps in institute, improving nutritional status & regular health check-ups for students, including them in donor motivation activities and making awareness-sessions part of existing curriculum will encourage them for blood donation. Regular motivational activities to eliminate misconceptions and reinforce positive attitude are needed even for health-care staff.

P 14: The front line warrior model of blood donor motivation: An innovative idea

Puneet Sachdeva

Department of Transfusion Medicine, Paras Hospitals, Panchkula, Haryana, India

Aims and Objectives: To increase voluntary blood donations through a new innovative model.

Methods: We adopted a new front line warrior model developed by us for increasing the voluntary blood donations at our blood centre. In a private hospital based blood centre people usually hesitate to donate blood unless required for their patient. We observed that there are many attendants (potential donors) who accompany their patients for OPD consultation. We tried to convert these attendants to our voluntary blood donors. We trained our front line staff which included front office executives, nurses, billing, hospital attendants, housekeeping staff etc. to interact with these attendants and just ask them if they would like to donate blood. We called them as front line as they are the first ones to receive the patients and interact with them on regular basis. They were our warriors as they fought for the cause of increasing blood donations. We regularly keep sensitizing them so that they do not become lax and stop asking the attendants.

Results: To our surprise we observed a significant increase in blood donations as compared to previous months. There was a gradual increase to the extent of 37% in the number of blood donations during the last 3 to 4 months when this new model was implemented than in the months before that.

Conclusion: We concluded that this new innovative model of front line warriors proved significantly effective in increasing voluntary blood donations.

P 15: To study the effect of motivation lectures on voluntary blood donations among young blood donors

Rishi Raj Sinha, Pratul Sinha1, Vilasini Patil1

Department of Transfusion Medicine, AIIMS, New Delhi, 1Department of Transfusion Medicine, AIIMS, Bhopal, Madhya Pradesh, India

Aim: To evaluate the effect of program involving motivational lecture in the year preceding 18th birthday of individuals followed by a reminder on 18th Birthday and observation of the incidence of blood donation on or around 18th birthday.

Objectives: (a) To study the effect of motivational lectures on incidence of voluntary blood donation. (b) To evaluate the experience of blood donations in young blood donors. (c) To estimate the prevalence of serological markers of Transfusion Transmissible Infections (TTI) in voluntary blood donors in this study and to compare it with other donor groups.

Materials and Methods: (a) Type of study: Community based prospective study. (b) Study design: Community based interventions involving motivation lectures. (c) Study population: Students in the final year (Standard 12th) of school from schools in Bhopal, Madhya Pradesh. (d) Inclusion criteria: Students in the final year (Standard 12th) of school from schools in Bhopal, Madhya Pradesh. Giving consent for participating in the study. (e) Exclusion criteria: Completed 18 years before date of motivational lecture. (f) Study setting: Secondary schools of Bhopal. (g) Study duration: 15-18 months after approval from ethical committee. (h) Sample size: 250 students. (i) Place of study: Department of Transfusion Medicine and Blood Bank, AIIMS Bhopal, Madhya Pradesh and Schools (j) of Bhopal, MP.

Methodology: After receiving the LOP on 27th November 2020 from the Institutional Human Ethics Committee, the study was conducted from the date of approval to May 2022. Class 12th students from various schools in Bhopal were approached in the study. Government schools were the preferred target for the study. Due to on-going COVID pandemic and subsequent lockdown during the study period, most of the schools were closed. Hence motivational lectures of available class 12th students were taken in online/offline mode as per the consent granted by the principal of the schools. Consent was sought from the students and their parent/guardian for participation in the study as per approved research protocol. Nine lectures were conducted in various schools of Bhopal and total 728 students participated in the study. Mode of lecture was didactic as well as interactive. Each lecture was conducted for duration of 15-20 minutes. In Online mode, various online applications and software like Zoom online class, Google classroom were used. Google form was framed and link was shared after the online motivation lecture was delivered and the answers were recorded via link. In offline mode, survey sheet was distributed to students in classroom. All queries raised by the students were answered and clarified. Proper confidentiality was maintained during the whole study. The Participant students were contacted on their 18th birthday through their preferred mode of contact like phone calls, SMS, WhatsApp & emails. They were informed about their eligibility for blood donation and asked about their plans for blood donation. A reminder contact was made after 3 months of the 18th birthday of these participant students to know about their experience & plan towards blood donation. Data was secured by using password protected files having access to only investigator. It was also ensured that the database was well maintained by performing regular audit for the quality of data transfer. Data was entered in Microsoft Excel.

Results: As per the preference opted by these students, the participants were contacted through phone calls, messages and emails on their 18th birthday and their attitude towards blood donation were noted. As per the preference 270 students (47.41%) opted to contact via phone call/WhatsApp messages and 299 students (52.58%) opted to contact via mail. Thus 569 students were contacted through phone calls/WhatsApp/SMS/Email and their attitude towards blood donation were noted. A total 299 students opted for contact via email but there was no response obtained from any one of them. Thus, there was a loss of 52.55% of participants who had been motivated for blood donation. The reason for no response could be due to infrequent access to the emails, email address belongs to the parents which resulted in failure of parents to convey it to the students. Of 270 students, who were contacted through phone calls/WhatsApp/SMS, 62.65% expressed their willingness to come soon for donation. 15.66% students reported that they had no plan for blood donation, 12.04% were suffering from health issues and 6.02% students required parents’ permission for blood donation while 3.61% students informed their inability as they were out of station. Though 62.6% students agreed to donate blood, it was found that none of these students turned up for blood donation at our centre or any other blood centres in Bhopal within three months of this call. Total 9 schools were approached & 36 lectures were taken time to time. Due to COVID pandemic, out of 36, only 12 lectures were conducted offline in the school & remaining 24 were conducted online. Maximum strength of students was limited to range of 20-30 students in 1 class. Total 728 participants were enrolled. 378 students attended online lectures & 350 students attended offline lectures. Few students of standard 11th also showed their interest for attending the motivational lectures. But were later excluded based on the exclusion/inclusion criteria approved by the study. Total 569 students were contacted on their 18th birthday through their preferred mode of contact. 62.65% replied that they will come soon for donation. 15.66% students reported that they had no plan for blood donation, 12.04% were suffering from to health issues, 6.02% students required parents’ permission for blood donation while 3.61% students were out of station. A reminder contact was made to above 569 students after 3 months of their 18th birthday. On second reminder 54.5% students replied to donate soon, 11.1% would donate after getting parents’ consent and 10.1% were suffering from ill health.

Conclusions and Recommendations: (1) Motivational lectures thus help to bring a positive attitude in the student towards blood donation. However, only giving the didactic motivational lecture doesn’t have a significant impact on actual blood donation. So, parents influence is equally needed to add more impact on such intervention programmes. Hence, Parents counselling should be done simultaneously along with such implemented programmes. (2) Though motivational lectures in the final year of school (class 12th students) creates awareness towards blood donation in young donors, assessment of such programmes should be done in the first year of institutes where more exposure towards blood donation camps is also done. (3) Regular visits to the blood bank should be planned by the schools as an education tour to and donation camps for parents in the schools should be organize frequently to make the students more aware about the blood donation.

References

Dhingra N. Expert Consensus Statement on achieving self-sufficiency safe blood and blood products, based on voluntary non-remunerated blood donation (VNRBD). Vox Sang 2012;103:337-42.

Oswalt RM, Hoff TE. The motivations of blood donors and nondonors: A community survey. Transfusion 1975;15:68-72.

Waheed U, Azmaat M, Zaheer HA. Knowledge, attitude and practices towards blood donation in Pakistan: A nationwide survey. Hematol Transf Int J 2015;1:4.

Zanin TZ, Hersey DP, Cone DC, Agrawal P. Tapping into a vital resource: Understanding the motivators and barriers to blood donation in Sub-Saharan Africa. Afr J Emerg Med 2016;6:70-9.

Garg S, Mathur DR, Garg DK. Comparison of seropositivity of HIV, HBV, HCV and syphilis in replacement and voluntary blood donors in western India. Indian J Pathol Microbiol 2001;44:409-12.

Marshall DA, Kleinman SH, Wong JB, AuBuchon JP, Grima DT, Kulin NA, et al. Cost-effectiveness of nucleic acid test screening of volunteer blood donations for hepatitis B, hepatitis C and human immunodeficiency virus in the United States. Vox Sang 2004;86:28-40.

National AIDS Control Organization, Ministry of Health and Family Welfare. An Action Plan for Blood Safety 2003. India: Government of India; 2007.

Jemberu YA, Esmael A, Ahmed KY. Knowledge, attitude and practice towards blood donation and associated factors among adults in Debre Markos town, Northwest Ethiopia. BMC Hematol 2016;16:23.

Lownik E, Riley E, Konstenius T, Riley W, McCullough J. Knowledge, attitudes and practices surveys of blood donation in developing countries. Vox Sang 2012;103:64-74.

Amatya M. Study on knowledge, attitude and practice of blood donation among students of different colleges of Kathmandu, Nepal. Int J Pharma Biol Arch 2013;4:424-8.

World Health Organization. Towards 100% Voluntary Blood Donation: A Global Framework for Action. World Health Organization – International Federation of Red Cross and Red Crescent Societies.

P 16: A study to assess about the awareness, perception, and concepts of voluntary blood donation

P Kiruthika, K Anbu Lenin

Department of IHBT, Vinayaka Mission’s Kirupananda Variyar Medical College and Hospitals, VMRF (Du), Salem, Tamil Nadu, India

Aim and Objective: To assess awareness, perception, and concepts of voluntary blood donation.

Materials and Methods: This is a cross-sectional study conducted at VMKVMCH, Salem from June to July 2023 among medical students and health care professionals using structured questionnaire containing five sections covering various aspects of blood donation including socio-demographic profile, General knowledge, Donor selection, Blood collection & storage and Donor reactions. Medical students and Healthcare professionals who gave their consent were included in the study. Results obtained were recorded and analyzed using SPSS version 24.

Results: Among 320 participated, 129 (40.3%) were males, 192 (60%) were females. Age of participants ranged between 17 - 75 years. 251 (78.43%) did not donate previously. 214 (66.8%) did not know that donors with heart disease are deferred from donation. 195 (60.93%) did not have knowledge on remuneration. 191 (59.68%), 164 (51.25%), 162 (50.65%), 124 (38.75%) and 114 (35.62%) were not aware of age criteria, interval between successive donation, volume of blood collected, hemoglobin level and body weight requirement for voluntary blood donation respectively.

Conclusion: The level of voluntary blood donation among students and healthcare professionals remains very low. They lack knowledge on hemoglobin requirement, age criteria, donation interval, deferral criteria, and remuneration. Thus, to promote blood donation it is necessary to reinforce the importance of blood donation by increasing the awareness towards blood donation by conducting CME and awareness camps as well as with the help of existing social medias and educational networks.

P 17: Evaluation of donor experiences and barriers to blood donation in the blood centre of a tertiary care hospital

Debasrita Banerjee, Sourav Chowdhury, Sourav Mukherjee, Sudipta Sekhar Das

Department of Transfusion Medicine, Apollo Multispeciality Hospitals, Kolkata, West Bengal, India

Aim: Here we performed a questionnaire-based survey to analyze the donors’ experiences and understanding related to their blood donation in our blood center.

Materials and Methods: The prospective study was conducted for a period of 60 days after taking due consent from the prospective donors. A simple bilingual questionnaire was developed to understand their blood donation experiences and concerns. The data generated were analysed using online statistical tools.

Results: A total of 256 healthy donors participated in the study of which 233 (87.1%) were males. Most donors were in the age group 21-30 years (34%) and 140 (54.7%) of the 256 donors were undergraduates in qualification. We observed that donors with low education level found the survey questionnaire difficult to understand or read or write (p=0.00001) when compared to the educated donors. A total of 233 donor (91%) disliked the refreshment or found it inadequate. The reading and comprehension of visual aids & IEC were found to be associated with the donor educational status. Higher level of comprehension and understanding were observed among educated donors (p=0.0000032). A 96% of donors were pleased with blood center’s hygiene and sanitation but a total of 44% of donors were dissatisfied with the phlebotomy service.

Conclusion: The study shades light on the fact that donor forms and IEC materials should be lucid and available in understandable languages. Good donor experiences during blood donation play an important role in donor retention which in turn optimizes the blood donor pool.

P 18: Delayed adverse reactions in blood donors

Sunil Kumar, Tulika Chandra, Archana Solanki, Ashutosh Singh

Department of Transfusion Medicine, King George’s Medical University, Lucknow, Uttar Pradesh, India

Background: Blood donor experiences both early and delayed adverse reactions. A higher percentage of delayed adverse reactions were reported1, hence donor follow-up after the donor has left the donation site is important. A telephonic interview was used to evaluate the incidence and characteristics of delayed adverse reactions.

Aims and Objectives: To analyze the frequency of delayed adverse reactions in blood donors. To correlate the frequency of donor reactions with donor profile in whole blood donors and in plateletpheresis donors.

Materials and Methods: The study was conducted over one year for blood donations at a tertiary care centre. Donors were selected according to the guidelines laid down by the Drugs and Cosmetics Act 20202. Donors were contacted four weeks after donation, to inquire about their general well-being and particular delayed adverse reactions in compliance with an international standard format (International Society of Blood Transfusion).

Results: The incidence of delayed adverse reactions was 8.16%, of 3.32 fatigue followed by 2.21% bruise and 1.60% painful arms. A significant association of frequency of donation was found with delayed adverse reactions such as fatigue (p=0.001) and bruise (p=0.033). More proportion of bruise was observed in first-time donors while fatigue in repeat donors.

Conclusion: Post donation follow-up has provided a thought into donor experiences and can be used as a valuable tool in donor hemovigilance. This will help to improve donor retention and promote voluntary donation in future.

P 19: Does blood group affect hemoglobin levels among blood donors in India: A retrospective observational study from a tertiary care center

Kommineni Sai Sreeja, Namala Vivekanand1, Puneeth Babu Anne1

Departments of IHBT and 1Transfusion Medicine, KAMSRC, Hyderabad, Telangana, India

Aims and Objectives: A recent study by Kronstein-Wiedemann et al.[1] reported a significantly higher hemoglobin in blood Group B compared to Group A donor in Germany owing to more lineage specific progenitors in B group. The aim of this study is to find if there is any such difference in the Indian donors.

Methods: A retrospective study based on donor records was carried out from January to June 2023. The data from 857 donors was included & analysed using Microsoft Excel & JASP for age, gender and Hemoglobin (pre donation).

Results: In this study 170 A group donor, 271 B, 369 O and 44 AB group donors were included. Most of our donors were in the age group of 18-30 years (62%). The mean Hemoglobin for the 857 donors was 14.4 g/dl. The mean (+/- 1 SD) of Hemoglobin for A group is 14.44 g/dl (13.37 - 15.57), 14.43 (13.3 - 15.56) for B group, 14.59 (13.44 – 15.74) for O group and 14.47 g/dl (13.29 – 15.65) for AB group. There was no statistically significant difference among the donors of different blood groups with and without age adjustment.

Conclusion: The present study concludes that there is no statistically significant difference among hemoglobin ranges of different blood groups. However, small sample size and inclusion of only healthy donors may affect the outcomes.

Reference

Kronstein-Wiedemann R, Blecher S, Teichert M, Schmidt L, Thiel J, Müller MM, et al. Novel evidence that the ABO blood group shapes erythropoiesis and results in higher hematocrit for blood group B carriers. Leukemia 2023;37:1126-37.

P 20: ABO and Rh (D) blood group distribution and gene frequency among blood donors in central Bihar, India

Nishith Nayan, Shweta Ranjan, Bankim Das, Rakesh Kumar, Neha Singh, Saurabh Lahare

Department of Transfusion Medicine and Blood Bank, AIIMS, Patna, Bihar, India

Aims: The aim of the study was to present data regarding gene frequency and distribution of ABO and Rh blood groups among blood donors in Central Bihar, India.

Objectives: (1) To find out the most and least common ABO and Rh (D) phenotype present in the blood donors populations in central Bihar. (2) To prepare a database containing frequencies of the IA, IB and IO alleles present in the blood donors populations in central Bihar.

Methods: Study was conducted on 45,732 healthy blood donors from April-2018 to July-2023. Blood group was determined by forward and reverse methods by commercially available standard column agglutination technique and monoclonal antisera by test tube in required cases. Using the maximum likelihood method, the frequencies of the IA, IB and IO alleles were calculated and tested according to the Hardy Weinberg law of Equilibrium.

Results: The most common blood group was B (36.45%) followed by O (33.06%), A (21.61%), while the least prevalent blood group was AB (8.88%). Rh positivity was 94.73%, rest were Rh negative (5.27%). The calculated gene frequencies were 0.1644 for IA (p), 0.2607 for IB (q) and 0.5749 for IO (r).

Conclusions: The most common blood group was B positive and least common was AB negative. The study provides information about the relative distribution of various alleles in central Bihar region. This vital information may be helpful in planning for future health challenges, particularly with regards to transfusion and organ transplant services at tertiary care centres.

References

Blaney K, Howard P. Basic and Applied Concepts of Blood Banking and Transfusion Practices. 3rd ed. Mosby, Elsevier Inc.; 2013.

Sharma DC, Sunita R, Iyenger S, Jain B, Sao S. Prevalence and distribution of ABO and Rh-D antigens along with its subgroups & rare types in greater Gwalior region. Open J Blood Dis 2013;3:69-73.

Raja KA, Dobariya GH, Unagar CA, Pandya AN, Patel JN, Wadhwani SN. Frequency and distribution of ABO and Rh blood groups among blood donors in tertiary care hospital of South Gujarat, India. Int J Res Med Sci 2016;4:5377-81.

P 21: Adverse reaction in whole blood donors: An experience in a rural tertiary care hospital

K Eswar, K Anbulenin

Department of IHBT, Vinayaka Mission’s Kirupananda Variyar Medical College and Hospitals, Salem, Tamil Nadu, India

Aims and Objectives: This Prospective study was conducted to analyse the Incidence and type of adverse events occurring during Whole Blood Collection.

Methods: This was a cross sectional study conducted among 6385 whole blood donors in hospital setup and camps from January 2020 to June 2023. Various adverse reactions that occurred during voluntary blood donation were recorded and analysed using SPSS version 24. 6276 (98.2%) were male donors and 109 (1.7%) were female donors. Data’s are collected for the 80 (1.2%) Adverse reaction voluntary donors.

Results: Among 6385 donors, 6276 (98.2%) were males and 109 (1.8%) were females. 80 (1.25%) donors had adverse reactions of which 52 (65%) were first time donors, 75 (93.75%) were males and 48 (60%) were below 30 years. Dizziness was the most common reaction observed among 36 (45%) donors. Other reaction were weakness (18.75%, n=15), Hypotension (17.5%, n=14), Vomiting (13.75%, n=11), Anxiety (2.5%, n=2) and convulsion (2.5%, n=2).

Conclusion: Good blood collection technique by well-trained phlebotomist along pre-donation counselling and newer preventive measures like pre-donation hydration and applied muscle tension will reduce the incidence of donor adverse reactions.

P 22: Miraculous growth in voluntary blood donation among the tribals in Maharashtra

Mukund Khandelwal, Bhushan Laddha, Yogini Patel

Blood Centre, Vedantaa Institute of Medical Sciences, Palghar, Maharashtra, India

The tribal area of Palghar District has a high incidence of sickle cell and Thalessemia patients. 40% of the women visiting the hospital for labour have a haemoglobin (Hb) level with an average ranging between 5-7 gms%, 10% belong to an age group of 14-19 years, 3% have associated hemoglobinopathy like sickle or Thalassemia or both. The women (apparently healthy) have an average Hb level of 7-9 gms%. Men in this region although lean and timid looking are much healthier and 90% of them pass the donor screening mandates for blood donation. This paper describes the way and means to promote Voluntary blood donation in the tribal Palghar where blood donation is a taboo. We detail the means to not only motivate these males into blood donation but also forming marketing and motivating groups for donor awareness. This verbatim shares an overview of blood component status in the tribal district of Palghar, keeping all prevailing hurdles in mind. Modalities to maintain the quality aspects of blood components with special reference to blood donation, component preparation, preservation and transfusion of blood components for therapeutic use in the available circumstances are streamlined. Combating with the shortage of therapeutic blood in palghar district is a challenge for the medical practitioners.

Materials and Methods: Blood donation is almost considered a taboo among the tribal population, as majority of the population comprises of hardworking farmers with a small fragile structure. On screening, we observe, most of these timid donors are actually healthier and better than the city donors. Compassionate counselling of the patient’s relatives for donation not only helps to overcome the shortage of blood but also motivates them to form donor groups that help each other for blood requirement due to their tribal bonding.[3] City Blood banks have near access to corporate offices and collages where the blood donation camps are in the vicinity, and can easily transport the collected blood for timely component separation to the blood centre. Most blood centres in Palghar district separate only plasma for the corporate fractionation institutes. A medical institute, can form an in-house voluntary donor team of undergraduate and post graduate students, along with the local donor groups that make fresh blood available to prepare blood components.[4-6] In India, there is a need of about 8 million units of blood every year out of which only about one-third are obtained from voluntary donors.[7] Replacement donors or family donors are people who donate blood to their family, friends, and relatives in time of need and account for approximately 45% blood donations in India.[7] The WHO stresses the fact that replacement blood donation needs to be discouraged and replaced by voluntary, nonremunerated blood donation. Paid/professional blood donation has been banned in India since January 1998.[8]

Clinical Use of Blood: Unnecessary transfusions and unsafe transfusion practices expose patients to the risk of serious adverse transfusion reactions and transfusion-transmissible infections. Unnecessary transfusions also reduce the availability of blood products for patients who are in need. WHO recommends the development of systems, such as hospital transfusion committees and haemovigilance, to monitor and improve the safety of transfusion processes.[9]

In this Regard:

We need to follow national guidelines on the appropriate clinical use of blood

Transfusion committees need to monitor blood transfusion therapy

Systems for reporting adverse transfusion events need to be implemented

A sub central haemovigilance team is needed for the district.

Manpower: Timely component separation along with parallel testing for infectious markers and red cell serology result in therapeutic quality of component yield. Trained manpower, well calibrated equipment and quality reagents are responsible for the quality of blood component. It is a challenge to get trained and qualified manpower starting from housekeeping level staff to the blood bank in charge among the tribal habitats. FDA mandates on qualification can be shorted at appointment level, while training and grooming them becomes a question. Expatriate staff in tribal regions are costly. Well trained experts even though costly work out to be economically viable and can monitor the responsibilities of all subordinates into multi-tasking various sections of the blood centre. This not only regulates, a uniform work culture for staff hailing from different background, but also sets quality protocols on processes in a smooth amicable monopoly.[10]

Equipments: Equipment in these tribal areas need to be sturdy and have good performance output with uninterrupted power supply (ups). Fluctuating/resurrecting breakdowns of electric supply is a major problem in the tribal areas as they can damage the vital spare parts like equipment compressors and motherboard ICs. Commuting to remote tribal location of blood banks is challenging and demotivating for service engineers for prompt correction of the equipment. A well trained in-house biomedical team leader eases 90% equipment problems for proper blood component yield. A well calibrated and validated equipment generates 98-100% perfection in product yield, e.g. micro pipettes.[11]

Reagents: Reagents used should be branded with valid quality reports/certificates (QC/potency report) and retested in-house with every new/different batch received. Cold chain transport should be well monitored in remote tribal location. As fluctuating temperature reduces the potency of the reagent used for testing resulting in substandard production of the components. All reagents including the distilled water used for preparing simple reagents like wash buffer, normal saline should be purchased from proper vendor source, as local vendors may use short cuts for easy profit margins.[12]

Medical Monitoring: Having shorted the blood bank variables in general, the centre should focus on actual requirement of blood components, preservation, and issue, following all transfusion protocols as per FDA and NABH protocols. Medical practitioners in these regions try to use cost effective conservative means for treating the patients. Proper therapeutic blood components should be prepared prescribed and transfused.[13,14] There is a need for saline washed packed cells for patients requiring transfusions like thalassemia sickle cell anaemia and leukaemia.This product can be made available by a proper nodal regional blood centre (RBTC). An immunohematology reference centre to identify atypical antibody screening for these multiply transfused patients.[14,15]

Training and Science: Blood bank staff should be well aware with the haematology triggering the component requirement. This detail comes in a properly filled the component requisition which includes Haemoglobin level and patient illness like- chronic anaemia, thalassemia, sickle cell anaemia, patient in labour, thrombocytopenia, DIC, leukaemia, renal failure, tuberculosis, other type of illness, surgery for emergency appendicitis, RTA accident or planned correction etc. It helps the technical staff to issue timely components.

Documentation: Proper and regular update of all mandatory forms formats and registers reflect a vain to vain clarity of the blood centre. These forms formats and register entries not only reflect the working of blood centre, but are instrumental in double checking the process mistakes (if any) at every stage which protects the centre from any dramatic eventuality leading to medico legal issues.[16]

EQAS: Successful results for participation of national/international external Quality Assurance Programs (EQAS) by and large, confirm proper working of the blood centre and implementation of all FDA and NABH mandates.[17]

Bed Side Hemovigilance: Hemovigilance, bed side pre transfusion quality practice and post transfusion feedback forms work as a feather in the cap of the blood centre. Palghar District needs to have at least one such nodal reference centre,that can used for guidance and reference and can make blood components like Platelets, FFP and Cryo available to the ailing needy patients visiting all the government PHCs and private hospitals/nursing homes.[18,19]

References

Colah RB, Mukherjee MB, Martin S, Ghosh K. Sickle cell disease in tribal populations in India. Indian J Med Res 2015;141:509-15.

Mohanty D, Mukherjee MB, Colah RB, Wadia M, Ghosh K, Chottray GP, et al. Spectrum of hemoglobinopathies among the primitive tribes: A multicentric study in India. Asia Pac J Public Health 2015;27: P562-71.

Uma S, Arun R, Arumugam P. The knowledge, attitude and practice towards blood donation among voluntary blood donors in Chennai, India. J Clin Diagn Res 2013;7:1043-6.

Chauhan R, Kumar R, Thakur S. A study to assess the knowledge, attitude, and practices about blood donation among medical students of a medical college in North India. J Family Med Prim Care 2018;7:693-7.

Amatya M. Study on knowledge, attitude and practice of blood donation among students of different colleges of Kathmandu, Nepal. Int J Pharm Biol Achiev 2013;4:424-8.

Kowsalya V, Vijayakumar R, Chidambaram R, Srikumar R, Reddy EP, Latha S, et al. A study on knowledge, attitude and practice regarding voluntary blood donation among medical students in Puducherry, India. Pak J Biol Sci 2013;16:439-42.

Fordham J, Dhingra N. Towards 100% Voluntary Blood Donation: A Global Framework for Action. Geneva: WHO; 2010.

Garg S, Mathur DR, Garg DK. Comparison of seropositivity of HIV, HBV, HCV and syphilis in replacement and voluntary blood donors in Western India. Indian J Pathol Microbiol 2001;44:409-12.

WHO. Safe Blood and Blood Products: Manual on the Management, Maintenance and Use of Blood Cold Chain Equipment. WHO.

Report of Expert Working Group DGHS-Review and Recommendations of Manpower Norms for Blood Banks in India: Objective IV. NBTC Policy; 2002.

Blood Bank Equipment. CDC QMS Training Manual-NACO CDC CMAI-QMS BB.

Acker JP, Marks DC, Sheffield WP. Quality assessment of established and emerging blood components for transfusion. J Blood Transfus 2016;2016:4860284.

Available from: https://NBTC.naco.gov.in/assets/resources/training/26.pdf.

WHO: Fact Sheet: Blood Safety and Availability; 2023.

Arya RC, Wander G, Gupta P. Blood component therapy: Which, when and how much. J Anaesthesiol Clin Pharmacol 2011;27:278-84.

Guidelines on hospital blood bank documentation and procedures. British Committee for Standards in Haematology, Blood Transfusion Task Force. Clin Lab Haematol 1990;12:209-20.

Chaudhary R, Das SS, Ojha S, Khetan D, Sonker A. The external quality assessment scheme: Five years experience as a participating laboratory. Asian J Transfus Sci 2010;4:28-30.

McClelland B, Love E, Scott S, Williamson LM. Haemovigilance: Concept, Europe and UK initiatives. Vox Sang 1998;74 Suppl 2:431-9.

Bisht A, Singh S, Marwaha N. Hemovigilance program-India. Asian J Transfus Sci 2013;7:73-4.

P 23: Donor deferral pattern in a tertiary care hospital

Simran Chowdhary, Ramesh Chandrakar

Department of Transfusion Medicine, AIIMS, Raipur, Chhattisgarh, India

Aims and Objectives: To study the frequency of different reasons for Donor Deferral.

Methods: We performed a retrospective analysis on the donor deferral pattern in the past three months (April to June). All the data that was present in the already maintained at the Blood Centre. The data was segregated based on low hemoglobin (<12.5), high hemoglobin (>16.5), hypertension, history of jaundice, others (donor safety), others (patient safety) and high-risk behaviour.

Results: Of the total donors deferred (748) during the months of April, May and June, 31% were due to low hemoglobin, 12% were due to high hemoglobin, 14.9% due to hypertension, 3.7% due to history of jaundice, 13.3% due to other (donor safety), 24% due to others (patient safety) and 0.4% due to high risk behaviour.

Conclusion: The pattern of donor deferral is an important tool for blood safety and also provides a key focus for the formulation of regional policies.

Reference

Agnihotri N. Whole blood donor deferral analysis at a center in Western India. Asian J Transfus Sci 2010;4:116-22.

P 24: Distribution of ABO and Rh(D) blood groups in central India

Sushant Kumar, Ashok Yadav, Ramu Thakur, Amrita Tripathi, Nidhi Sharma

Department of Transfusion Medicine (IHBT), M. G. M Medical College and M. Y. Hospital, Indore, Madhya Pradesh, India

Aims and Objective: Retrospective analysis to determine the frequency of ABO blood groups among blood donors in central India from March 2022 to February 2023.

Methods: During the period of March 2022 to February 2023 there were 40,390 blood donors (both voluntary and replacement) in our Centre. Blood grouping was done using conventional tube method by sample collected in the EDTA tube after the donation.

Results: Among the 40390 donors, 8813 (21.81%) were of A Positive, 14034 (34.74%) were of B Positive blood group, 12185 (30.16%) were of O Positive blood group, 3352 (8.29%) were of AB Positive blood group, 447 (1.10%) were of A Negative blood group, 711 (1.76%) were of B Negative blood group, 684 (1.69%) were of O Negative blood group and 164 (0.40%) were of AB Negative blood group.

Conclusion: From this study it is found that the most common blood group in central India is B (36.50%) followed by O (31.86%), A (22.90%) and AB (8.70%). The Rh(D) Positives are 95.03% and the Rh(D) Negatives are 4.96%.

P 25: Confirmation of RPR reactive samples using specific test (TPHA)

Keyuri Jariwala, Rinku Shukla, Kruti Dumaswala

Surat Raktadan Kendra and Research Centre, Surat, Gujarat, India

Background: Syphilis infection among Voluntary Blood Donors were increased in recent years. It is important to analyze the Sero –positive Donor and help to recruit donors from low –risk Population.

Aims and Objective: The aim of this study was to Compare two methods RPR (Rapid Plasma Regain) and TPHA (Treponema Palladian Hema agglutination Assay) for syphilis detection, to evaluate the suitability of commercially available non treponemal test like RPR and tremonemal test like TPHA.

Methods: A Study was conducted among blood donors in Surat Raktadan Kendra and Research Centre from January 2021 to December 2022. All blood donors sample were screened by RPR method as mandatory test and those syphilis positive were counseled and the samples were recollected and tested with two kits one RPR and second kit Syphicheck for TPHA as confirmatory test.

Results: Total 48429 blood samples were collected in the study during 2021 to 2022. From January 2021 to December 2021, 12 (0.05%) cases were detected syphilis positive out of 23357, Follow up was done for 7 cases counseling and retesting result positive by both the test RPR and TPHA. From January, 2022 to December 2022, 25 (0.01%) cases were detected syphilis positive out of 25072, Follow up was done for 15 cases were counseling and retesting result 15 positive by RPR and 12 Positive by TPHA. Total 22 Syphilis positive 22 (100%) cases were positive by RPR and 19 (86.36%) positive by TPHA, 3 cases were false positive and 19 cases were true positive.

Conclusion: For Syphilis testing TPHA method is best for confirmation.

P 26: Incidence and analysis of blood donor adverse reactions

Amanpreet Kaur, Rajesh Kumar1

1Department of IHBT, Dayanand Medical College and Hospital, Ludhiana, Punjab, India

Aims: Study Incidence and Analysis of Blood Donor Adverse Reactions.

Objectives: Blood donors are the essential pillars for safe blood transfusion service. But immediate adverse reactions experienced during donation decrease return rates among blood donors. This study aimed to analyse the spectrum of blood donor adverse reactions (ADR) and design strategies for their prevention.

Materials and Methods: A prospective study was conducted in period of IHBT over six months on voluntary and aphaeresis donors who were selected as per the national guidelines.

Results: All adverse events were recorded in a specifically designed form. The adverse events occurring during or after the donation were classified as vasovagal reactions, citrate toxicity or local events. A total of 14534 whole blood donations and 564 apheresis donations were done (14354 - males and 180 - females). Total 281 adverse reactions (related to 1.87% of all donations) in whole blood donations were recorded out of which Vasovagal reactions, mostly of mild intensity, were the most commonly observed and were 209 (1.39%) Local reactions 54 (0.36%) 102 adverse donor reactions were reported in apheresis donors of which vasovagal reactions were 18 (0.12%) Citrate toxicity was reported in 52 of apheresis donations (0.35%) Local reactions 32 were observed (0.22%).

Conclusion: The results of our 6-month survey document that apheresis and blood donation are safe procedures for the donor with a low incidence of adverse reactions; the adverse reactions that did occur were mostly mild and resolved rapidly.

P 27: Analysis of adverse donor reactions in whole blood donors at a tertiary care medical institute of North India

Milan Jaiswal, Aakriti Baijal, Pragya Bhardwaj

Department of Immunohematology and Blood Transfusion, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India

Aim and Objectives: The aim of this study was to observe the incidence and severity of adverse donor reactions (ADR) in whole blood donors; and further to evaluate the strength of association of donor characteristics with the occurrence of ADR.

Materials and Methods: This retrospective observational study was conducted over a period of 2.5 years on 17951 whole blood donors, from January 2021 to June 2023 at a Tertiary Care Institute of North India. Incidence of ADR was observed with respect to donors’ age, gender, weight, hemoglobin, donor category [Voluntary/Replacement/Family replacement], first time or repeat and severity. Frequency distribution of ADR with respect to place and time of occurrence, pre-donation anxious/relaxed state, meal and sleep adequacy status and history of previous reaction. Strength of association of adverse reactions with respect to donor characteristics was evaluated using Chi-square test and odds ratio, wherever possible. Results were considered statistically significant at p<0.05 and 95 % confidence interval.

Results: The overall ADR rate was 0.59% with severity grade of 1 in 93.58%. Vasovagal reaction was the most common comprising 95.41%. ADR was 2.76, 2.23 and 2.20 odds higher in females than males (1.56% vs 0.57%), in <40 years than >40 years (0.64% vs 0.29%) and in first time donors than repeat donors (0.69% vs 0.31%), respectively. No statistically significant association was observed with donor weight, hemoglobin and donor category. Onset of ADR was mostly after donation in phlebotomy room. Most of the donors who experienced ADR were relaxed, had adequate sleep and meals pre-donation and no history of previous donor reaction.

Conclusion: Blood donation is a safe procedure; however, it is not completely without risks. Identifying the at-risk population and factors contributing to adverse reactions will enable health care facilities to implement mitigation strategies; thereby preventing their occurrence and facilitating donor retention.

P 28: Analysis of pattern of blood donor deferral in tertiary care hospital in North India

Deepshikha Sharma

Department of IHBT, GMC, Jammu, Jammu and Kashmir, India

Background: Blood transfusion services is a vital part of health care system which saves many lives across the globe. Therefore, blood donor selection is a cornerstone for blood transfusion to safeguard the health of both donors and recipients. Donors may get deferred due to temporary or permanent causes. Our study was done to understand causes of deferral in our blood bank and in turn provide safe blood.

Aim: The aim of study is to evaluate different causes of blood donor deferral in tertiary care hospital.

Methods: A retrospective cross sectional study was conducted over 1-year period from August 2022 to July 2023 at Government Medical College, Jammu to analyse the donor deferral rate.

Results: During the study period, the total donation was 21134, among which male donors were 20115 and female donors were 1019 in number. A total of 3.6% (774) donors were deferred, among which male deferral was 3.3% (672) and female deferral was 10% (102). 29.45% (228) were voluntary donors and 70.55% (546) were replacement donors. Temporary deferrals were 90.69% (702) and permanent deferrals were 9.30% (72). Among temporary deferrals, the most common cause was anemia (29.06%), tattooing (17.57%) and recent antibiotic treatment (12.01%). Most common cause in permanent deferrals was hypertension associated with heart disease (44.44%), uncontrolled diabetes on insulin therapy (29.16%). Also majority of deferrals were temporary deferrals in age group of 18-30 years (61.08%) followed by in age group 30-40 years (32.7%).

Conclusion: Most of the deferral donors were young adults. Temporary deferred donors were higher than permanent deferred donors. It is important to determine rate and causes of donor deferral to guide the recruitment efforts for safe blood transfusion.

P 29: A case report of blood group discrepancy leading to health insight

Abhra Barman, Suman Sudha Routray, Nirupama Sahoo, Sukanta Tripathy

Department of IHBT, KIMS, Bhubaneswar, Odisha, India

Aims and Objectives: Blood group discrepancies resulting from inconsistencies between forward and reverse typing in blood grouping are common, particularly in the context of various disease states. However, instances where such discrepancies serve as indicators of underlying health conditions are infrequent.

Case Study: This paper presents a comprehensive case study involving a 38-year-old male afflicted by chronic kidney disease and renal dysfunction. Initial forward typing revealed a “B” positive blood group, while reverse typing revealed an unexpected reaction involving both ‘B’ and ‘O’ cell (forward-reverse ABO blood grouping card, matrix gel system). Conventional tube technique (CTT) validation corroborated a Type III discrepancy. Subsequent Polyspecific Direct Antiglobulin Test (DAT) yielded negative results. Antibody screening using commercially available three-cell panel (Reacell I-II-III, Tulip Diagnostic) by column agglutination technique, yielded negative reactions. Positive auto control (AC) reactions were evident (Grade: 2+) at 4°C, 22°C, and 37°C but remained negative during the AHG phase. Suspecting presence of Rouleaux, a saline replacement technique was done, which resolved the discrepancy. Further investigation for paraproteinemia was carried out on the patient, following valuable input from the Immunohaematology laboratory led to a diagnosis of multiple myeloma. The instance presented herein serves as a noteworthy example of how blood group discrepancies can offer valuable insights into hitherto undetected health issues, thereby guiding healthcare practitioners towards timely intervention and improved patient care.

P 30: A review on the impact of COVID-19 pandemic on blood transfusion services and blood donation activity in Pune

Shankar Madhavrao Mugave

The COVID pandemic was rapidly increased patients in India during 2020-21. Total corona cases 183934913 confirmed and 3985022 confirmed deaths. To overcome the challenge of spreading corona virus, Indian government was announced nationwide lockdown which adversely affected the blood transfusion and blood donation activities. The COVID pandemic had not only affected on the blood transfusion activity but also affected on the recruitment of blood donors and blood supply chain all over India. As a significant element of health are system blood banks were one of the most affected services due to COVID pandemic. Majority of blood banks in India reported a huge reduction in blood donation during COVID pandemic. The present study has assessed the consequences of COVID-19 pandemic on the blood transfusion and blood collection activities of Regional Blood Bank, Sassoon General Hospital situated in Pune. The study is also focuses on the various measures taken by the Sassoon Hospital Blood Bank.

Objectives: (1) To understand the various problems/challenges faced by the Regional Blood Bank, Sassoon General Hospital, Pune during COVID pandemic era. (2) To understand the various measures taken by the Regional Blood Bank, Sassoon General Hospital, Pune to overcome the challenges and problems raised due to COVID pandemic.

Keywords: Blood donation, blood transfusion, COVID-19 pandemic

P 31: Significance of blood component transfusion to progression free survival and overall survival in multiple myeloma patients undergoing chemotherapy

Sourav Chowdhury, Sudipta Sekhar Das, Anupam Chakrapani1, Sourav Mukherjee, Debmalya Bhattacharyya1

Departments of Transfusion Medicine and 1Hemato-Oncology, Apollo Multispeciality Hospital, Kolkata, West Bengal, India

Aim and Objective of the Study: Evaluation of blood component transfusion as a prognostic factor in progression free survival and overall survival in multiple myeloma patients undergoing chemotherapy.

Materials and Methods: The disease and clinical event end points, Revised Multiple Myeloma International Staging System (R-ISS) score, disease progression and relapse, were evaluated using criteria from International Myeloma Working Group.[1] The laboratory and clinical event data were reviewed from hospital medical records and discharge certificate. The demographic and clinicopathological data were compared between <5 units and ≥5 units blood component transfusion groups. Chi-square test for categorical variables and t-test for continuous variables were used to compare these two distinct groups.[2] The overall survival (OS) and progression free survival (PFS) were analyzed using the Kaplan-Meyer statistical method. The log-rank test was used to determine the significance of differences among these survival curves. Cox regression models were used for analysis of multivariate analyses with adjustment for significant prognostic factors according to univariate analysis. All statistical analysis was done using the latest SPSS tool. A p-value of <0.05 was consider statistically significant.

Results: The total number of patients who met the inclusion criteria of the study was 44. Patients (n=20) who were transfused ≥5 units blood components were older in age (≥50 years) with lower serum albumin level (<3.5 gm/dl). In addition, this cohort of patients showed statistically significant (p<0.05) variations in β2 microglobulin level (≥5.4), R-ISS score, and disease relapse. We observed that patient receiving thalidomide as maintenance therapy required more blood component transfusions when compared with those administered with pomalidomide (p=0.089). Among patients who received ≥5 units of transfusions had higher percentage of recipients of single protocol chemotherapy (p=0.028). The log rank survival analysis showed that the group who needed lesser (<5 units) blood transfusion had higher PFS (p=0.025) and higher mean OS (430.4 vs 409.7days) (p=0.243).

Conclusion: The study concludes that patients of multiple myeloma undergoing chemotherapy who received less than 5 units’ blood component transfusions have higher progression free survival.

References

International Myeloma Working Group (IMWG) Criteria for the Diagnosis of Multiple Myeloma. International Myeloma Foundation. Available from: https://www.myeloma.org/.

Fan L, Fu D, Zhang J, Huang H, Wang Q, Ye Y, et al. Prognostic significance of blood transfusion in newly diagnosed multiple myeloma patients without autologous hematopoietic stem cell transplantation. Biomed Res Int 2017;2017:5462087.

P 32: A case report of suspected case of transfusion-related acute lung injury in severe acute ulcerative colitis patient

S Manigandan, Tulika Chandra, Archana Solanki, Ashutosh Singh

Department of Transfusion Medicine, KGMU, Lucknow, Uttar Pradesh, India

Background: Transfusion-related acute lung injury (TRALI) is a rare but potentially fatal complication of blood product transfusion. Transfusion-related acute lung injury (TRALI), is a clinical syndrome in which there is acute, noncardiogenic pulmonary edema associated with hypoxia that occurs during or after a transfusion.[1]

Aims: To evaluate a potential case of TRALI and to differentiate from other diagnosis.

Methods: A 30 yrs old male suffering from acute severe ulcerative colitis underwent subtotal abdominal colectomy and end ileostomy with distal mucus fistula on 7/6/23 but due to bleeding in surgical site patient went for re-exploration on 13/6/23. During the re-exploration patient was transfused with 1-unit PRBC, 2-unit FFP and 2-unit RDP. Within 6 hrs after transfusion patient developed dyspnoea and Acute respiratory distress features.

Results: Patient on examination had pulse-91/min, GCS-E4VTM6, SPO2-81 % on VT, blood pressure-125/88 mmHg, chest auscultation- bilateral crepitation present, no neck veins distention, chest x-ray showed bilateral patchy infiltrations and on blood investigations showed BNP of 9623 pg/ml, TLC of 60600 cells /mm3, LFT in normal range, procalcitonin of 23.81 ng/ml.

Conclusion: The increased BNP level and absence of leukopenia suggest against TRALI, the patient was given diuretics and showed no response for diuretics, there is no hypertension, no distended neck veins which suggest against TACO. The TLC count is elevated since before surgery and increased much more since then. Patent is on continuous antibiotics which suggest the absence of fever, procalcitonin level elevation and other features shows the possibility of sepsis.

References

Cho MS, Modi P, Sharma S. Transfusion-related acute lung injury. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022-2023.

Keifer JC, Kingsley CP, Roth MT, Abt AB, Romano PJ. Transfusion-related acute lung injury (TRALI) complicating colectomy for ulcerative colitis. Anesthesiology 1998;89:1020-3.

P 33: Predictors of large volume blood transfusion and related complications during peri-operative period in patients of open aortic aneurysm repair

Punkesh Patel, Vinu Rajendran, P Shivanesan1, R Amita, Debasish Gupta

Department of Transfusion Medicine, SCTIMST, 1Division of Vascular Surgery, SCTIMST, Thiruvananthapuram, Kerala, India

Aims and Objectives: Open aortic aneurysm (OAA) repair is a complex cardio-vascular procedure, often (39%) requires large volume blood transfusions (LVBT). Limited data are available in the literature on the predictors of LVBT and the transfusion support in OAA repair especially in low- middle-income countries. This study aimed to identify the peri-operative predictors of LVBT in OAA repair. We extended our objectives to determine the transfusion requirement and the correlation between LVBT and complications of acute kidney injury (AKI), coagulopathy in OAA repair.

Methods: This was a single-centre retrospective case-control study to include data of patients who underwent OAA repair in the last one year. Patients with incomplete data, age less than 18, and ruptured aneurysm were excluded. Patients who received LVBT and who didn’t receive LVBT were cases and controls respectively. Pre-operative variables, transfusion requirements, surgical factors and post-operative complications were collected and analyzed for co-relation using DATA tab 2023.

Results: Out of 34 patients, 47% (n=16) received LVBT. Low Hb, Low BMI, and High platelet count have significant association (p<0.05) with LVBT. Association of LVBT with age, gender, PT, aPTT, Tranexamic Acid, Heparin, and ACT were not significant (p>0.05). Intra- operatively, average transfusions were RBC: 3.7±2.9; FFP: 3.1±2.6; CRYO: 2.4±2.3; PLT: 1.9±2.5. Post-operatively, LVBT was significantly associated with higher mortality, prolonged PT and low platelets. AKI, hospital stays and re-exploration were not found significant with LVBT.

Conclusion: Low Hb, Low BMI, and High platelet count are found to be predictors of LVBT in OAA repair. Transfusion requirement in OAA repair was found to be 4 units, 3 units, 3 units and 2 units respectively for RBC, FFP, CRYO and PLT. Larger multi-center studies may be conducted to explore the further predictors of OAA repair.

References

Pieri M, Nardelli P, De Luca M, Landoni G, Frassoni S, Melissano G, et al. Predicting the need for intra-operative large volume blood transfusions during thoraco-abdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg 2017;53:347-53.

Ho P, Ting AC, Cheng SW. Blood loss and transfusion in elective abdominal aortic aneurysm surgery. ANZ J Surg 2004;74:631-4.

Lowe E, Quarmby J. Are we cross-matching too much blood for elective open abdominal aortic aneurysm repair? SAGE Open Med 2017;5:2050312116688843.

P 34: Unveiling infiltration: Exploring patterns, complications, and expected interventions in patients experiencing blood infiltration during PRBC transfusion

Pallavi Singh, K Revathy Nair, Akshay Batra

Tata Memorial Centre (MPMMCC and HBCH), Varanasi, Uttar Pradesh, India

Introduction: Infiltration is unintentional leakage of blood or blood components from a blood vessel into the surrounding tissues during a transfusion.

Aim: To Analyse the risk factors of infiltration and provide recommendations for healthcare professionals on strategies to minimize its occurrence.

Methods: A retrospective case series design was used to investigate infiltration incidents during packed red blood cell (PRBC) transfusions. Qualitative data from medical notes and descriptions of clinical outcomes were subjected to thematic analysis.

Results: Two patients, a 45-year-male with periampullary carcinoma and a 67-year-female with carcinoma colon, experienced infiltration after receiving PRBC transfusions during surgery. In both cases, the infiltration caused patchy discoloration in the affected area; there was associated pain in first case. The lesions persisted for several days, but the patients expired of other causes. Laboratory investigations ruled out hemolytic transfusion reaction. The two patients experienced a common but non-life-threatening complication of PRBC transfusion. The complication did not contribute to their deaths.

Conclusion: Infiltration is a rare but serious complication of PRBC transfusion. It is important to be aware of the risk factors for infiltration and to take steps to minimize its occurrence. These include careful cannulation, using the correct size and type of cannula, and monitoring the patient during the transfusion. If infiltration does occur, it is important to stop the transfusion immediately and change cannula site. Topical heparin jelly can be used for management. There should be reporting of such cases to raise awareness of infiltration and to improve patient safety.

P 35: An interesting case report which highlighted the clinical significance of “multiple alloantibodies” in a complex haematologic case of aplastic anaemia with paroxysmal nocturnal hemoglobinuria

Amit Kumar Biswas, Anoop Sharma

Department of Immunohaematology and Blood Transfusion, Armed Forces Medical College, Pune, Maharashtra, India

Introduction: In multiple transfused patients & multigravida females, alloimmunization poses a great challenge to blood transfusions especially with red cell antigen(s). This case report illustrates the difficulty which was encountered in providing compatible packed red blood cells (PRBC) units to a patient of AA with PNH with multiple alloantibodies.

Case Discussion: Our Patient (57-year male) was admitted as a case of pancytopenia & was subsequently, based on bone marrow biopsy & flowcytometry, was diagnosed as a case of AA with PNH, whose blood group was found to be A RhD negative. Multiple PRBC & component transfusion were been carried out as per clinical requirement. But 02 weeks after the last transfusion, multiple units were found to be incompatible. On immunohaematological workup, Indirect Coombs Test (ICT) came positive. Antibody identification was done subsequently, which detected both anti-Lewis (anti-Leb) & anti-Duffy (anti-Fya) antibodies. A total of 19 units were cross matched and compatible unit was found using Hardy-Weinberg law.

Conclusion: The antibodies which had developed against his corresponding antigen after multiple transfusion were high frequency antigen, with a prevalence of 85% and 68% respectively in Indian population. Anti-Duffy being predominantly IgG antibody, is clinically significant in causing Acute Hemolytic Transfusion Reaction than anti-Lewis, which is of IgM subtype.

P 36: Rifampicin induced hemolytic anemia: A case report

Dipshikhaa Ravi, R Krishnamoorthy, A Ashwin, Niranj Ratnan

Department of Transfusion Medicine, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India

Introduction: Difficult to distinguish from other causes of anemia is drug induced hemolytic anemia (DIHA), which is rare and therefore diagnosis and treatment is quite often delayed. Certain common drugs administered in standard doses like ceftriaxone and piperacillin can cause DIHA.

Case Presentation: A 65-year-old female, had presented with complaints of yellowish discoloration of eyes, decreased appetite, and shortness of breath. On admission, her lab parameters were Hb- 4.2 g/dl, TC-8660 and MCV- 105. Peripheral smear showed evidence of hemolytic anemia with leukocytosis. She had previously underwent an excision and biopsy (in view of a right supraclavicular lymph node) probable TB lymphadenitis, hence started on RIFAMPICIN, after which she developed the above complaints. Hb showed a declining trend from 8.3 (before starting the drug) to 4.2 g/dl. Liver Function test (LFT) were indicative of hepatitis with hyperbilubinemia, ANCA was negative and LDH was 1707, suggesting hemolysis. Direct Coomb’s Test was negative and Indirect Coomb’s Test was positive. Hematologist opinion was obtained and G6PD deficiency was ruled out and Haptoglobin was <0.781 (levels within the normal limits for both). Rifampin was withheld, and started on other ATT Drugs-Streptomycin, Levofloxacin, Ethambutol and also T. Wysolone. Two compatible units of PRBCs was transfused. Post transfusion values were 7.2 g/dl and 7.9 g/dl. LFT recovered and was started on Isoniazid which she was able to tolerate and was later discharged with Hb-7.9 g/dl.

Conclusion: DIHA is often difficult to differentiate from other autoimmune anaemias, a thorough history and serological workup needs to be done. Withdrawal of the inciting drug is curative in the majority of cases.

References

Garbe E, Andersohn F, Bronder E, Klimpel A, Thomae M, Schrezenmeier H, et al. Drug induced immune haemolytic anaemia in the Berlin case-control surveillance study. Br J Haematol 2011;154:644-53.

Garratty G. Immune hemolytic anemia associated with drug therapy. Blood Rev 2010;24:143-50.

Hill QA, Stamps R, Massey E, Grainger JD, Provan D, Hill A, et al. Guidelines on the management of drug-induced immune and secondary autoimmune, haemolytic anaemia. Br J Haematol 2017;177:208-20.

Arndt PA, Leger RM, Garratty G. Positive direct antiglobulin tests and haemolytic anaemia following therapy with the beta-lactamase inhibitor, tazobactam, may also be associated with non-immunologic adsorption of protein onto red blood cells. Vox Sang 2003;85:53.

Go RS, Winters JL, Kay NE. How I treat autoimmune hemolytic anemia. Blood 2017;129:2971-9.

Oğuz A, Kanra T, Gökalp A, Gültekin A. Acute hemolytic anemia caused by irregular rifampicin therapy. Turk J Pediatr 1989;31:83-8.

P 37: Real time data on immunohematology practices at various blood centers across India: A survey-based prospective assessment

Rashmi Sood

Introduction: Immunohematology branch of transfusion medicine studies antigen-antibody reactions and analogous phenomena.

Aims: Assessment of current immunohematology practices in India recommendations thereafter for improvement.

Methods: Prospective unique study of its kinds conducted for period of 6 months after taking due consent from participants. Online survey questionnaire prepared. Sent to special interest group through email WhatsApp platforms. Questionnaire separated into two parts, multiple choice answers, focusing on various aspects of immunohematology practices. Online inputs received incorporated in data sheet analyzed using statistical tools.

Results: Total 99 blood centers around country participated in survey. Of blood centre doctors, 50.5% specialized in pathology 34.3% in transfusion medicine. Of total, 37.3%, 35.3% and 27.2% blood centres were charitable, government and private centers respectively. Total of 77 (77.7%) centers have separate immunohematology facility (p value 0.27). While both doctors and technicians perform tests in 55 (55.5%) centers; only technologist driven immunohematology testing observed in 40 (40.4%) centers. Total of 18 (27.7%) centers use both automation and manual techniques for various immunohematological testing. Mono- specific DAT, elution-adsorption technique, titration study performed by 61%, 44.1% and 88.2% blood centers respectively. Antibody screening done by 56.3% centres.

Conclusions: Smaller centers may collaborate higher centers for advanced immunohematology practices. Areas of interruptions need to be sorted out by individual blood centres. Inadequate efforts and knowledge in immunohematology practices may affect patients in terms of improper reporting miss diagnosis and maltreatment.

P 38: Management of acute hemolytic transfusion reaction in a E-beta thalassemia through rare blood donors

P Dutta, P Bhattacharya, C Maity, S Pandey

Department of Immunohematology and Blood Transfusion, Medical College and Hospital, Kolkata, West Bengal, India

Introduction: Nontransfusion dependant thalassemia (NTDT) has higher alloimmunization incidence than transfusion dependant thalassemia (TDT) revealed by various studies.

Aims: In the present case we are reporting an occurrence of multiple alloimmunization against high incidence antigens in NTDT E-β thalassemia child.

Case: 11-year-old E β thalassemia female was admitted in paediatric ward as she deteriorated due to acute transfusion reaction. She was transfused 4 units PRBC first time in life in a peripheral hospital 2 months ago. On examination she looked pale, icteric with splenomegaly (8 cm). Laboratory examination- CBC (Hb 4 gm/dl, TLC 5300/mm³, Plt 1 lakh), urea 104 mg/dl, creatinine 2.2 mg/dl, UB 7.5, LDH 4189 U/L, Serum ferritin 216 ng/ml.

IH work-up: On physical verification cell was non hemolysed but plasma was icteric. Saline control, Direct antiglobulin test, Autocontrol was negative. On antibody screening (3 cell) the possible alloantibodies were against C, e, Jkb, Fy, Kell antigen. Antibody identification (11 cell) was panreactive.

Management: Though we had limitation to phenotype the RBCs due to h/o recent transfusion, she was transfused with two compatible units obtained from rare donors in consecutive two weeks which resulted in marginal Hb rise upto 5.5 gm/dl. She was adviced for restricted daily performance and hydroxyurea was started. 3 weeks after the biochemical parameter returned normal. We could perform her RBC phenotype at an interval of 4 weeks of post transfusion and it was R2R2, (K – k+), Fy (a- b+), Jk (a+ b-).

Conclusion: Screening and Phenotyping is contemplated prior to transfusion initiation in hemoglobinopathy patients. Unless this is feasible, emergency immunohematology service can be saviour to mitigate this situation.

P 39: An analysis of red cell alloimmunization versus age of initiation of transfusion in thalassaemia patients: A retrospective study from Eastern India

Sumita Pandey, Prasun Bhattacharya, Chikam Maity

Department of Immunohematology and Blood Transfusion, Medical College and Hospital, Kolkata, West Bengal, India

Introduction: The development of alloantibodies against nonself red cell antigen remain a major problem in thalassaemia patients.

Aim: Overall prevalence of alloimmunization in Thalassaemia patients and its relation with first transfusion and with types of thalassaemia.

Materials and Methods: Total 409 Thalassaemia patients who were presented with non-increment of hemoglobin despite of repeated transfusions, currently increased transfusion frequency, recurrent transfusion reactions, their blood samples were immunohematologically evaluated in the Department of Immunohematology and Blood Transfusion (IHBT) since January 2020 to December 2022. The antibody screening and identification were performed with commercially available panel cells [ID-Dia Panel, Bio-Rad, Switzerland] by column agglutination method.

Statistical Analysis: Comparison in various categorical data was analyzed by 2*2 contingency table using Chi square with Yates correction on Graph Pad Prism version 9.

Results: Demography and characteristics of patients: 409 Thalassaemia patients were reviewed. There were 212 males and 197 females. Male to female ratio 1.073: 1. Out of 409 patients, 198 had beta thalassaemia major (BTM), 204 had E-beta thalassaemia, rest 3 had BTM with delta beta mutation, 2 had sickle B thalassaemia, 1 had HbE disease and rest 1 had S/d double heterozygosity. Blood group distribution: Most common ABO blood group encountered B>O>A>AB. Alloimmunization rate: Out of 409 patients, 65 had developed alloantibody (15. 8%). In B-thalassaemia major total 14/198 (7%) patient had developed alloantibody and in EBT total 48/204 (23.5%) patients had developed alloantibody. This association was considered statistically significant using Chi-square 2*2 contingency table (P value 0.0001). We divided BTM and EBT into two groups as per their age of first transfusion (<2 years and >2 years). In BTM and EBT patients with 1st transfusion <2 years, alloimmunization rate was 5.23% and 11.47% and >2 years 1st transfusion group, alloimmunization rate was 57.14%and 28.67% respectively. Alloantibody specificity: Vast majority of alloantibody irrespective of thalassaemic types were Anti E, anti K [(17/65) (26%)], followed by Anti E, anti c, antiK [(15/65) (23%)], Anti Jkb, anti K [(4/65) (6%).

Conclusion: We observed that with increasing age of initial transfusion the development of alloantibody is more common. So, with extended RBC phenotyping prior transfusion can minimize future alloimmunization and transfusion with respective antigen negative donor cell can reduce this complication.

References

Al-Riyami AZ, Al-Muqbali A, Al-Sudiri S, Murthi Panchatcharam S, Zacharia M, Al-Mahrooqi S, et al. Risks of red blood cell alloimmunization in transfusion-dependent β-thalassemia in Oman: A 25-year experience of a university tertiary care reference center and a literature review. Transfusion 2018;58:871-8.

Datta SS, Mukherjee S, Talukder B, Bhattacharya P, Mukherjee K. Frequency of red cell alloimmunization and autoimmunization in thalassemia patients: A report from Eastern India. Adv Hematol 2015;2015:610931.

P 40: Antibody screening and identification in the general patient population at a standalone blood centre

Hetal Patel, Ripal J Shah V Harimoorthy

Prathama Blood Centre, Advanced Transfusion Medicine Research Foundation, Ahmedabad, Gujarat, India

Background and Objectives: The development of alloantibodies can significantly complicate transfusion therapy and results in difficulties in cross-matching of blood due to alloimmunization. Alloimmunization is refers to an immune response to foreign antigens from another human, most commonly occurring after pregnancy or blood transfusions. Alloimmunization may result in serious complications. This study was aimed at assessing the frequency and type of unexpected red cell antibodies in the general patient.

Methods: A total of 54312 antibody screening tests carried out on patients, from January 2021 to June 2023 were analyzed. The clinical and transfusion records were reviewed. The data were collected from blood Centre’s software. Antibody screening done by Column agglutination technique using Gel card method. A total of 54312 (26940: 49.60% Male) and (27372: 50.39% Female) patient were screened for the presence or absence of unexpected antibodies. Antibody screening was positive in 344 patients (0.6%).

Results: Among all positive patients only 41 patients were subjected for antibody identification. Antibody identification was performed by automated Blood grouping system (Qwallys by Diagast, France). Antibodies against the Rh system were the most frequent (61.6%). The most common alloantibody identified was anti D (n=15, 25%). Other antibodies were also detected. They were Anti C (n=10, 16.6%), Anti c (n=3, 5%), Anti E (n=7, 11.6%), Anti Cw (n=2, 3.3%), Anti Kell antibody (n=5, 8.3%), Anti M (n=8, 13.3%), Anti N (n=1, 1.6%), Anti S (n=4, 6.6%), Anti JKa (n=1, 1.6%) Anti Fya (n=2, 3.3%) and Anti Lea (n=2, 3.3%).

Interpretation and Conclusions: The current practice for providing compatible blood to patients in cases of alloimmunization is still reliant upon random cross-matching of available units in the inventory. Since clinically significant antibodies are frequently detected in our patient population, antibody screening and if required, identification is the need of the hour. Since antibodies against the common Rh blood group antigens are the most frequent, provision of Rh matched red cells may be of protective value. Since clinically significant antibodies are frequently detected in our patient population and cross-matching is not fully effective as a procedure of ensuring absence of the antigen to which the patient is immunized, this practice is neither safe nor cost-effective. Antibody screening and if required identification, combined with at least Rh-Kell phenotyping donors and may be patients to provide a supply of antigen negative blood is necessary for safe transfusion.

Keywords: Alloimmunization, antibody identification, antibody screening, immunohematology, phenotype, unexpected red cell antibodies

P 41: Blood donor antibody screening: A must

Hiral Marakana, Monali Valera, Nishith A Vachhani, Sanjiv Nandani

Department of Red Cell Serology, Life Blood Centre, Rajkot, Gujarat, India

Introduction: Blood transfusion practice involves multiple steps to ensure selection of safe blood component for transfusion. There are two types of irregular red cell antibodies: Alloantibodies and autoantibodies. The red cell antibodies present in healthy blood donors can cause severe hemolytic transfusion reaction, especially in massive blood transfusion recipients and pediatric patients.

Aim: The present study aims to assess the prevalence of red cell antibodies in healthy blood donors at a stand-alone blood centre in Rajkot, Gujarat, India.

Materials and Methods: This is 5.5-year retrospective observational study conducted at stand-alone blood centre from Rajkot, Gujarat from January 2018 to June 2023. A total of 74566 healthy blood donors: 72836 (97.67%) males and 1730 (2.33%) females donated at the centre. Antibody screening was performed by Solid Phase Red Cell Adherence (SPRCA) method (pooled cells) on fully automated immunohematology analyzer. Positive tests were further confirmed using ready screen (4 cell panel/3 cell-CAT). Antibodies identified by using 11 cells panel-CAT.

Results: Out of 74566 donors, we got 212 (0.28%) donors with red cell alloantibodies. The frequency of alloimmunization was 0.26% in male and 0.018% in female. Anti-M (1.89%), Anti-E (1.42%), Anti- Cw (0.94%), Anti-Lea (0.47%), Anti-D (0.47%), Anti-P1 (0.47%) were most frequently identified alloantibodies at our blood center.

Conclusion: The prevalence of red cell antibodies in healthy blood donors is low, but it is important to screen all donors. The detection of red cell alloantibodies can help to ensure that blood transfusions are compatible and also reduces the risk of complications from incompatible blood transfusions.

References

Garg N, Sharma T, Singh B. Prevalence of irregular red blood cell antibodies among healthy blood donors in Delhi population. Transfus Apher Sci 2014;50:415-7.

Makroo RN, Rajput S, Agarwal S, Chowdhry M, Prakash B, Karna P. Prevalence of irregular red cell antibody in healthy blood donors attending a tertiary care hospital in North India. Asian J Transfus Sci 2018;12:17-20.

Pahuja S, Kushwaha S, Sethi N, Pujani M, Jain M. Screening of blood donors for erythrocyte alloantibodies. Hematology 2012;17:302-5.

Myhre BA, Greenwalt TJ, Gajewski M. Incidence of irregular antibodies occurring in healthy donor sera. Transfusion 1965;5:350-4.

P 42: A study on the rarest Aend subgroup detected at stand-alone blood centre from Rajkot, Gujarat

Sudha Chauhan, Manali Ramoliya, Spruha Dholakiya, Sanjiv Nandani

Department of Red Cell Serology, Life Blood Centre, Rajkot, Gujarat, India

Introduction: When the cell grouping and serum grouping mismatch the blood group discrepancies occur. These discrepancies can arise due to variations in erythrocyte antigen expressions caused by allelic heterogeneity, leading to the existence of subgroups. Weaker subgroup of A blood group that have been reported so far include A3, Aend, Ax, Am, Ay, and Ael. We report an incidentally detected case of Aend blood type in a 31-year-old male blood donor.

Case Report: A 31-year-old male donor donated blood at the Life Blood Centre. Blood grouping was performed using the SPRCA and CTT method, revealing a discrepancy between cell and serum grouping. The donor’s red cells gave weak reaction with Anti-A & Anti-AB, negative with Anti-B & Anti-A1 and Anti-H, Anti-D showed 4 + reactivity in forward grouping. In reverse grouping, B cell gave 3 + reaction, whereas A cells & O cell were negative. Reaction pattern was same at 37°C, RT & 4°C.The blood-grouping pattern shows a Type II blood group discrepancy, probably a weaker subgroup of A. Adsorption and elusion confirmed the presence of A antigen. The donor was found to be secretor of H substances only in saliva. These findings were consistent with the reactivity pattern of the Aend subtype.

Conclusion: The Aend subgroup is a very rare phenotype of blood, often mislabelled as group “O,” which can lead to potentially dangerous haemolytic transfusion reactions. To avoid this, cell & serum groping must be done meticulously.

References

Cohn CS, Delaney M, Johnson ST, Katz LM, editors. Red cell typing methods: Method 2-2. Determining ABO group of red cells and serum-tube test. In: Technical Manual. 20th ed. Bethesda, MD: AABB; 2020.

Thakral B, Saluja K, Bajpai M, Sharma RR, Marwaha N. Importance of weak ABO subgroups. Lab Med 2005;36:32-4.

Heier HE, Namork E, Calkovská Z, Sandin R, Kornstad L. Expression of A antigens on erythrocytes of weak blood group A subgroups. Vox Sang 1994;66:231-6.

Nair R, Gogri H, Kulkarni S, Gupta D. Detection of a rare subgroup of A phenotype while resolving ABO discrepancy. Asian J Transfus Sci 2019;13:129-31.

P 43: Anti-M antibodies, interfering with compatibility testing: An exasperating nuisance for transfusion physicians

Akarshan Gupta, Pandeep Kaur, Davood Bava, Amit Kumar Chatterjee, Amit Kumar

Department of Immuno-Hematology and Blood Transfusion, National Institute of Medical Sciences and Research, Jaipur, Rajasthan, India

Aims and Objectives: (1) To report three cases of anti-M antibodies interfering with compatibility testing. (2) To discuss how to approach and resolve such scenarios.

Methods: We report 3 cases with anti-M alloantibody detected at our centre during routine compatibility testing. The clinical details are taken from patient’s file and the lab results were extracted from the hospital information system. Blood grouping was performed by Conventional Tube Testing (CTT); Direct Antiglobulin Test (DAT), auto control, Indirect Antiglobulin Test (IAT), antibody screen, identification, and AHG crossmatching were done by Column Agglutination Technique (CAT).

Results: The patients included a 54-year male with alcoholic hepatitis and cholelithiasis; a 21-year multiparous female at labour and a 26-year nulliparous female with acute gastroenteritis. The blood groups were B, A and O Rh D positive respectively. There was a history of blood transfusion 1 month back for the male patient who was the only one with a positive DAT (2+). There were varied strengths of reactions in screening and identification. M-antigen negative PRBC units were prepared for all patients, and transfused to one uneventfully; two of them didn’t require transfusion and were managed conservatively.

Conclusion: Anti-M, if reactive at 37 degrees Celsius can lead to hemolytic transfusion reactions. As the prevalence of M antigen in the Indian population is pretty high (88.7%), finding an M-antigen negative PRBC unit can be tedious. Establishing and maintaining a red blood cell (RBC) antigen phenotyped donor registry shall ensure quick provision of antigen-negative blood for transfusion in emergency situations.

P 44: Rare weak D type 8: Molecular analysis

Anurag Singh, Tulika Chandra1, Archana Solanki1, Ashutosh Singh1, Swati Kulkarni2, Garima Mishra2

1Department of Transfusion Medicine, King George’s Medical University, Lucknow, Uttar Pradesh, 2National Institute of Immunohaematology, KEM Hospital Campus, Mumbai, Maharashtra, India

Aim: To analyse weak D type 8 on a molecular basis.

Methods: Donors Donated blood according to DCA Act after which WEAK D was performed on the Diagast France machine. Following this Rh extended phenotyping was done. And samples were sent to NIIH Mumbai. DNA was prepared by the Chloroform method, after which multiplex PCR was done, followed by QMPSF and Sanger Sequencing.

Results: Around 120,000 samples were tested out of which 7895 came out to be Rh D negative out of which 28 were WEAK D Positive and one came to be WEAK D TYPE 8.c.919G>A was the nucleotide change seen. R1r was the phenotype that appeared. The allele where it was present was 6.

Conclusion: A serological weak D phenotype is the expression of an amino acid substitution in the RhD protein or RHD-RHCE-D gene conversion. One of the difficulties in clinical transfusion practice is avoiding anti-D allo- immunization. Patients with incomplete D phenotypes are at risk of producing anti-D. Matching rare Rh antigens at the haplotype and genotype levels should be implemented in practice. A clinical benefit should be demonstrated.

P 45: Distribution of ABO blood group antigens along with the subgroups of A and AB in a blood center of Northern India

Irm Yasmeen

Department of Blood Transfusion Medicine, GMC and AH, Rajouri, Jammu and Kashmir, India

Aims and Objectives: Aim of this study was to determine the prevalence of ABO blood group antigens along with the subgroups of A and AB i.e A1, A2, A1B and A2B and Bombay blood group.

Materials and Methods: This was a cross-sectional study conducted over a period of one year from April 2022 to March 2023. Blood samples were received from blood donors, blood recipients, OPD and IPD patients. The ABO blood groups and subgrouping were determined by the antigen-antibody agglutination method by the test tube method using commercially prepared monoclonal antisera anti-A, anti-B, anti AB, anti-D, anti-A1 lectin and anti-H for forward grouping. The data was calculated and presented in tabulated form.

Results: Out of 15527 ABO blood grouping done in the blood centre, 4164 (26.8%) were blood group A, 4834 (31.13%) were blood group B, 5059 (32.58%) were blood group O and 1470 (9.46%) were blood group AB. Out of 4164 A blood groups, frequency of A1 blood group was 94.09% (3917), and A2 was 5.93% (247). Out of total 1470 AB blood groups, A1B was 85.5% (1257) and A2B was 14.48% (213). It was found that A2 in AB blood group was more frequent in occurrence than A2 in A blood group. The blood samples were also typed for anti-H to know the frequency of Bombay blood group. No case of Bombay blood group was found during the study period.

Conclusion: Though subgroups of A and AB are rare but they can cause severe transfusion reactions which can be life threatening.

P 46: Lewis system antibodies – Unravelling the silent threat: A case report

Rajat Bansal, Saptarshi Mandal, U B Davood, Arya V Nair

Department of Transfusion Medicine and Blood Bank, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

Introduction: Lewis-antibodies are typically considered clinically-insignificant because they don’t react at 37°C. However, in rare instances it can be clinically-significant and can cause severe HTRs.

Case Summary: A 16-year-old-female, with h/o fever, cellulitis, septic shock and severe anemia (Hb - 1.9 g/dl) was admitted in the AIIMS Paediatric Emergency. There was no previous transfusion history. In pre-transfusion testing, there was no discrepancies or incompatibilities. Three blood-group matched and AHG crossmatched PRBCs were transfused in over 48 hours which was uneventful and hemoglobin improved to 7.1 g/dl. She was planned for BKA as MRI s/o high-grade Osteosarcoma left distal tibia. This time, Pretransfusion-testing showed incompatibility with group matched PRBC-units at AHG-phase. Antibody-screening and identification was positive by CAT and was s/o Anti-Lewis B (Leb) antibodies. DAT and Auto-control were negative. However, Antibody screening and identification in saline neutral cards were negative. The units came incompatible were phenotyped and was found to be Leb-positive. Two units negative for Leb antigen came compatible at AHG phase which were transfused uneventfully later. Patient serum was also crossmatched with cord-blood-cells & came compatible. Phenotype of pretransfusion sample of the patient was Le (a+b-).

Discussion: Even though antibodies against Lewis antigens exhibit minimal clinical significance due to their reactivity at lower temperatures, in rare cases, these antibodies may react at 37°C and lead to hemolytic reactions. The hemolytic capacity of Lewis antibodies is attributed to their capability to fix complement and individuals with pre-existing Lewis antibody are recognized to display an anamnestic response following a transfusion with antigen-incompatible blood.

Conclusion: The results of this study emphasize the importance of assessing the thermal amplitude of Lewis antibodies by laboratory personnel. Regardless of the antibody class, it is crucial to provide antigen-negative crossmatch compatible blood units to prevent HTRs.

References

Gayathri AM, Gupta D. Case series investigation on the Lewis system antibodies encountered during a routine screening in a tertiary care hospital-based blood center. Asian J Transfus Sci 2020;14:54-6.

Subramaniyan R. Serological characteristics of Lewis antibodies and their clinical significance – A case series. Hematol Transfus Cell Ther 2023;45:159-64.

P 47: Frequency of subgroups of “A” and “AB” in patient population at tertiary healthcare center

Shailesh Kucha, Nidhi Bhatnagar, Sangita Shah, Kamini Gupta

Department of IHBT, B.J. Medical College, Ahmedabad, Gujarat, India

Introduction: ABO Blood group system was discovered by Karl Landsteiner in the year 1900 who classified the blood groups into A, B and O. Further, in the year 1911, Von Dungern and Hirszfeld divided the Group A into A1 and A2 hence total of 6 blood Groups A1, A2, B, A1B, A2B, O were known at the time. A1 and A2 are two main subgroups of A blood group system.

Objective: To find out the frequency of subgroups of A and AB Blood groups.

Methods: This is retrospective analytical study from Jan to June 2023 in Tertiary Health Care Center. Primary blood grouping were performed by Erythrocyte magnetized technology (Diagast). Further testing performed by Conventional Tube Technique using the commercially available Lectin Anti A1 (Tulip diagnostics). Group A red blood cells which agglutinate with Anti A1 lectin are classified as subgroup A1, whereas which do not agglutinate are classified as A2. Other subgroups of A are rarely found and cannot be serologically differentiated.

Results: Out of total 51185 patient sample, 12332 belonged to Group A and 5021 constituted Group AB. The percentage of A1 amongst the A blood group is 93.2% (11494) and A2 is 6.8% (838). The percentage of A1B amongst the AB blood group is 93.8% (4711) and A2B is 6.2% (311).

Conclusion: The frequency of A1 subgroup is more in comparison to A2 in both A and AB blood groups amongst the patients.

P 48: Comparative evaluation of three different methods for titration of anti-A and anti-b antibodies in ABO incompatible renal transplant patients

A Joseph, P Agarwal, D Khetan

Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Aims and Objectives: Titration of ABO isoagglutinins in renal transplant patients is of paramount significance in case of ABO incompatible donors. Hence the study was aimed to evaluate three different techniques for estimation of titre of Anti-A & Anti-B antibodies (IgM & IgG).

Methods: This study was a prospective, observational study conducted in the department of Transfusion Medicine at SGPGIMS, Lucknow. 100 patient serum samples each for titration of Anti-A and Anti-B were included. Both Anti-A and Anti-B were titrated for IgM & IgG antibodies in Conventional Tube Technique (CTT), Column Agglutination Technique (CAT) and Solid Phase Red Cell Adherence (SPRCA) method. Descriptive analysis was done using SPSS.

Results: The titer results of Anti-A by SPRCA [IQR, mean: 16-1, 15.99 (IgM); 128-16, 95.06 (IgG)] were more than by CAT [16-1, 15.63 (IgM); 64-8, 75.37 (IgG)] and CTT [8-1, 8.13 (IgM); 32-8, 29.06 (IgG)]. Same trend is seen in Anti-B (IgG) also. But for Anti-B (IgM), titer result by CAT [IQR, mean: 8-1, 11.04] were more than SPRCA [8-0, 9.37] and CTT [4-0, 6.14].

Conclusion: Our evaluation concluded that there are differences in estimation of the ABO antibody titer by different techniques. SPRCA and CAT method were more sensitive than CTT. Consistent and uniform application of a better sensitivity method for titration is highly essential throughout the treatment of an ABO mismatch kindey transplant patient.

P 49: Comparison of anti-Rh(D) titre performed using gel and conventional tube test techniques in Rh(D) negative females

Lakhvinder Singh, Mohammed Abubacker Sithik, Ashish Jain, Ratti Ram Sharma

Department of Transfusion Medicine, PGIMER, Chandigarh, India

Aims and Objectives: (1) To determine the prevalence of alloimmunization in Rh(D) negative pregnant females. (2) To compare the conventional test tube technique and column agglutination technique for performing Anti-D titre in Rh(D) negative alloimmunized pregnant female.

Methods: It was a prospective study conducted on Rh(D) negative pregnant females over a period of 12 months. Blood grouping and antibody screen was performed on all the samples. If antibody screen was positive, the antibody identification was done. In patients with anti-D antibody, antibody titres were performed using the tube technique and gel technique and were compared for any correlation. Further, the antibody titres were correlated with the ultrasonographic findings (MoM) in the patients.

Results: A total of 345 Rh(D) negative pregnant females were recruited. The frequency of maternal alloimmunization due to anti-D in Rh(D) negative females was 41.45%. The frequencies of other antibodies identified were anti-C (14.5%), anti-M (1.36%), anti-E (0.29%), anti-S (0.29%). Samples of 111 ICT positive females were tested to compare the tube and gel anti-Rh(D) titres. The titre level by gel technique was higher than tube technique with an average of 4.91 dilution with a grouped median of 5. Considering tube titres >16 to be critical titre for diagnosing HDFN, The gel technique at titre >256, >512 and >1024 was 100% sensitive but the specificity was low. We found that at gel titre of 512, there is only 75.51% chances that patient will requires similar intervention as required by patient with tube titre of 16. On comparing the tube titres with MoM value on ultrasound, the tube titres >32 are more specific than titres >16. Hence titres >32 should be used as the critical titre.

Conclusion: Rh(D) alloantibodies remain the most common cause of HDFN in Rh(D) negative females. According to our study, titres >512 on gel can be used as equivalent titres to >16 by tube technique. However, it is associated with high chance of false identification of patients with risk of developing HDFN remains.

P 50: Data banking of Rh and kell phenotype frequencies in blood donors in South India

G Deepthi Krishna, K S Prabhakaran, K Thameemunisa, Deepti Sachan

Department of Transfusion Medicine, Dr. Rela Institute and Medical Centre, Chennai, Tamil Nadu, India

Introduction: Rh antigens are highly immunogenic, and most of the Rh antibodies should be considered as potential causes of hemolytic transfusion reactions and Hemolytic disease of the newborn (HDN). Routine blood typing for RhD status in both blood donors and transfusion recipients has reduced the incidence of transfusion reactions caused by anti-D. But sensitization to other Rh antigens can still be a problem, particularly in multi-transfused patients.

Aim: To study the distribution and frequency of principal Rh blood group antigens (D, C, c, E, and e) and their phenotypes in the local blood donors.

Methodology: This study was conducted from March 2022 to June 2023. A total of 2248 samples were processed for Rh kell phenotyping. Donor samples were tested for blood grouping & typing along with donor antibody screening using a fully automated immunohematology system (IH-500, Bio-Rad, Cressier, Switzerland) by Column agglutination technology (CAT). Only DAT negative samples were included. The Rh and Kell phenotyping (C, c, E, e and K) was performed on the selected O Blood group samples using the Diaclon Rh-subgroups +K phenotyping cards.

Results: A total of 2248 donors were typed for Rh (C, c, E and e) and K antigens. Of these, 2083 (92.6%) donors were D+ and the remaining 165 (7.33%) donors were D-. In order of prevalence of Rh antigens, apart from D antigen, e antigen was the most prevalent antigen (2224, 98.9%) followed by C (Capital) antigen 1903 (84.6%), small c -1305(58.05%), E - 353(15.7%).

Among the Rh antigens, the e antigen was found to be the most prevalent antigen, with a frequency of 98.8% and 100% among the D+ and D- donors, respectively. The C antigen in D+ donors & D- donors were 91.1% vs. 2.4% respectively. The c antigen was expressed by 100% of D- donors, & only in 50.7% D+ donors. The E antigen was found in 15.6 % and 0.6% of D+ and D- donors, respectively. The R1R1 phenotype was the most frequent phenotype (944, 45.3%), followed by the R1r (759, 36.4%) and R1R2 (23.1, 11.1%). Among D- donors, rr phenotype (160, 97%) was observed to be the most frequent, followed by the r’r (4, 2.4%). Phenotype r”r was noted in one donor (0.6%).With respect to the Kell blood group system, the K antigen was present in 16.5% of the donor samples were processed.

Conclusion: Red cell phenotyping of the local blood donor population helps in handling emergency needs for patients with alloimmunization and in resource constraint settings atleast phenotyping of the major Rh and kell antigens.

References

Dean L. The Rh blood group. In: Blood Groups and Red Cell Antigens. Ch. 7. Bethesda (MD): National Center for Biotechnology Information (US); 2005.

Gundrajukuppam DK, Vijaya SB, Rajendran A, Sarella JD. Prevalence of principal Rh blood group antigens in blood donors at the blood bank of a tertiary care hospital in Southern India. J Clin Diagn Res 2016;10: C07-10.

Sachan D, Gundrajukuppam DK, Shanmugam N, Rajalingam R, Rela M. R2R2 phenotype blood requirements for liver transplantation surgery in a child with multiple Rh antibodies: Meeting needs and changing Indian scenario. Glob J Transfus Med 2023;8:82-5.

Sachan D, Rajakumar A, Krishna GD, Rajalingam R, Rela M. Living donor liver transplantation in an alloimmunised patient: Immunological challenges and management in Indian settings. Transpl Immunol 2023;79:101854.

P 51: Alloimmunization in multitransfused liver disease patients: Impact of underlying disease

Pankaj Jain, Meenu Bajpai, Apoorva Maheshwari

ILBS Hospital, New Delhi, India

Aims and Objectives: To study the effect of underlying liver disease on alloimmunization in multitransfused patients.

Objectives: (1) To study the impact of underlying diagnosis on alloimmunization in liver disease patients. (2) To study the correlation between blood groups of patients and frequency of alloimmunization. (3) To study the effect of gender on alloimmunization. (4) To correlate frequency of alloimmunization in liver disease patients with age.

Methods: A retrospective analysis of antibody screening and identification in liver disease patients was done at the Department of Transfusion Medicine from 2014 to 2022. The data on clinical diagnosis, frequency of alloimmunization and history of transfusions was collected and statistically analysed.

Results: A total of 26,085 patients were screened during the study period out of which 588 (2.25%) were positive. Allo-antibodies were identified in 338 (1.29%) patients which included 194 (57%) males and 144 (42%) females. Alloimmunization was highest in patients of Chronic liver disease (0.92%) followed by Acute on chronic liver disease (0.06%). Most common antibody identified was against the Rh system (55.6%) followed by MNS (16.2%), Lewis (13%), Kell (6.29%), Duffy (4.6%) and Kidd (2.9%).

Conclusion: Our findings suggest that underlying disease etiology has an impact on red cell alloimmunization in multitransfused patients. Giving Rh kell matched blood and following patient blood management protocols are the key to reduce frequency of alloimmunization.

P 52: Unraveling the mysteries of blood group discrepancies: Causes, implications, and solutions

Rajat Bansal, Archana Bajpayee, Arya V Nair, Vasanth Asirvatham

Department of Transfusion Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

Aim: Retrospective observational analysis of Blood-Group (ABO) Discrepancies in blood donors by CTT.

Objective: ABO discrepancies occur when the reactions in forward grouping are not corroborative to those in the reverse grouping due to weak subgroups of A and/or B, missing or weak ABO antibodies or unexpected alloantibodies. We aimed to determine the prevalence of ABO discrepancies in our donor population and to know the causes by using a standard classification.

Methods: It was a retrospective study on donor samples from 1st January 2021 to 31st July 2023. All the data were analysed on Excel sheet. For all the discrepant samples, the ABO and RhD grouping was repeated using tube technique. Adsorption–elution testing was done for detecting weak subgroups of A and B.

Results: During this time period, 20,886 Blood Donors have donated their blood. Out of 20,886 donors, 20,010 (96%) were male donors and rest 876 (4%) were females. As per SOP, ABO Grouping was done by CTT (Conventional-Tube-Technique). Out of 20,886 Blood Groupings, 58 (0.28%) ABO discrepancies were found in CTT. 47 discrepancies were Group-1 discrepancy (weak/missing antibodies) and rest 11 were Group 2 discrepancies (weak expression of antigens/missing antigens). Those discrepancies if done on slide, would have been missed. All the discrepancies were solved by Thermal Amplitude and further serological work-up along with detailed clinical and past history.

Conclusion: Blood grouping should not be done by slide technique as it may result in false interpretation and miss clinically significant antibodies. Any grouping discrepancy between cell and serum grouping, thermal amplitude should be done as a first step apart from other serological techniques as it is very simple and cost-effective technique. Apart from serological work-up, clinical history of the apparently healthy blood donor is very important. All blood donors with discrepancies should be informed appropriately about their blood group as a blood donor or blood recipient.

P 53: From ABO/Rh typing to the point of diagnosis: A single case study of warm AIHA

Bhanupriya Mujhalda, Ashok Yadav, Yogesh Pawde, Khushboo Likhar

Department of Transfusion Medicine, M. G. M. Medical College, Indore, Madhya Pradesh, India

Case Presentation: A 16-year-old female patient was admitted in general ward with the provisional diagnosis of megaloblastic anaemia. Her Hb was 4.4 gm/dl, Hct 12.3%, reticulocyte count 4.5%, serum LDH 773.45 U/L, Vitamin B12 – 78 pg/ml and had no history of previous blood transfusion. For correction of severe anaemia, blood requisition form for PRBC was received at Department of Transfusion Medicine.

Results: Blood discrepancy was observed, forward grouping showed O Rh(D) positive and reverse grouping showed agglutination in A, B and O cells. Antibody screen was performed using 3 panel which showed 0 reaction in all three-screening cell at immediate spin and IAT phase. Both polyspecific (IgG + C3d) and monospecific (IgG) DAT showed 2+ reaction. Indirect antiglobulin test was positive at immediate spin phase with 2+ reaction and at IAT phase with 3+ and autocontrol positive with 2+ reaction. Autoantibody was found to be IgG type most probably warm type of auto antibody. She was not showing any improvement with treatment. She was administered steroid and her symptoms improved, this proved that she was misdiagnosed with megaloblastic anaemia, after one week she was discharged with Hb 10.2 gm/dl.

Conclusion: DAT and IAT is mentioned to be useful in diagnosis of several situations that include: autoimmune hemolytic anemia. Immunohematology testing is important for guidance in both diagnosis and patient management. Proper communication between blood Centre and clinical team is essential for patient management.

Reference

Arays R, Shmookler AD. Educational case: Warm autoimmune hemolytic anemia. Acad Pathol 2020;7:2374289520968228.

P 54: Are all men created equal: The analogy of red cell antibodies behaviour through flowcytometric phagocytosis assay

M Divya, Snehil Kumar, Neha Seth, Tulasi Geevar, Rutvi Dave, K C Gayathri, John Gnanaraj, Ramya, Sam Arul Doss, Amal Raj, Sukesh C Nair, Dolly Daniel

Department of Transfusion Medicine and Immunohematology, Christian Medical College, Vellore, Tamil Nadu, India

Aim and Objectives: Senescent, damaged or antibody (IgG) coated RBCs are removed in the RES by phagocytic cells through Fc receptors via a process called Erythrophagocytosis. This study aimed to demonstrate the erythrophagocytosis assay using flowcytometry and to analyse the differential behaviour between auto and alloantibodies as well as among various group of alloantibodies.

Materials and Methods: Our study included 69 frozen plasma samples containing red cell antibodies. The combination of two fluorescence markers were used: PKH26 dye for staining red cells and CD14 FITC for monocytes. Plasma samples were incubated with red cells with relative phenotype, and following sensitization, incubated with monocytes in CO2 environment. The percentage of erythrophagocytosis, measured by double positive events (staining for both CD14 and PKHGL26 dye) and MFI ratio of PKH26 staining in monocytes were assessed.

Results: Out of 69 samples, 67/69 were alloantibodies and 2/69 autoantibodies. The profile of alloantibodies included: anti D (38, in various titres), anti M (12), anti E (10), anti S (3), anti C (2), anti Fya (1) and anti Leb (1). The trimmed mean percentage of phagocytosis of antibodies studied ranged from anti D (>1:32 - 4.44%), anti S (3.50%), anti D (<1:32 - 2.1%), anti E (2%), anti M (1.38%) to remaining overall antibodies anti C, Leb and Fya (1.88%). In the context of various anti D titres, the percentage of phagocytosis and MFI ratio had a low correlation with phagocytic activity, r=0.36 and r=0.48 respectively. On comparing mean percentage of phagocytosis between allo and autoantibodies, the latter had higher phagocytic activity (17.84%) compared to (2.67%). When anti D titres of same strength showed variable percentage of phagocytosis, the higher percentage of phagocytosis correlated well with IgG1/IgG3 co-positivity.

Conclusion: Our study showed that in the setting of red cell antibodies (auto and allo), the phagocytosis process is clearly implicated in the pathophysiology of red cell destruction by RES. Additionally, there exists differential behaviour among various set of alloantibodies with anti D of titre >1:32 showing the highest percentage of phagocytosis and also between IgG1/IgG3 subtypes of anti D antibodies. The demonstration of erythrophagocytosis on Flowcytometric platform appears to correlate well with the laboratory parameters previously described to impact clinically.

P 55: Seroprevalence and trends in transfusion transmitted infections in voluntary and replacement blood donors: A 2-year experience in a tertiary care hospital

Gulinder Singh, Rajesh Kumar

Department of Immunohematology and Blood Transfusion, Dayanand Medical College and Hospital, Ludhiana, Punjab, India

Aims and Objectives: Transfusion of safe blood remains a great challenge for blood centres, especially in developing countries. Restricted resources and budget constraints add to the problem in developing countries. Different populations and regions carry different frequency and type of disease burden. Knowledge of prevalence of TTIs is essential to monitor safety of blood transfusion by ensuring better practices of collection and processing of blood components.

Methods: A retrospective cross sectional study was performed from 2021 to 2022 in a tertiary care hospital. The study analyzes all voluntary and replacement blood donations. The testing methods used were CLIA (chemiluminescence immune assay) and NAT (Nucleic acid amplification test).

Results: A total 52,368 blood donations were enlisted in the study which included both voluntary (43030) as well as replacement donors (9338) comprising of 82.16% and 17.83% of the total donation respectively. Seroprevalance for HCV was 1.23%, Syphilis was 0.73%, HBsAg in total donors was 0.46% HIV was 0.13%. Co-infection of HIV and HCV was found in 20 cases (0.038%) and for HIV and syphilis was positive in 10 cases (0.019%).

Conclusion: Incidence of HCV was the highest among blood donors of this particular region followed by syphilis and HBV. Results show a lower rate of TTI positivity as compared to other studies in the Indian sub-continent. An effective donor selection, screening criteria and adequate medical examination can reduce TTI seropositivity rates and make blood transfusions to patients safer.

P 56: To evaluate clinical and serological correlation of positive direct antiglobulin test

Sonal Sonu, Rajesh Kumar

Department of Immunohematology and Blood Transfusion, Dayanand Medical College and Hospital, Ludhiana, Punjab, India

Aims and Objectives: The direct antiglobulin test (DAT) determines whether the red blood cells (RBCs) circulating in the bloodstream are sensitized with antibodies. The antibodies that bound to the surface of the RBCs are responsible for the RBC destruction. The aim is to evaluate the clinical and serological correlation of positive DAT and categorize the class and subclass of antibodies.

Methods: The prospective observational study was performed on samples from all the concerned areas and all DAT requests received during the study period of six months i.e., 1st January to 30th June. The DAT was performed on blood samples by the CAT using LISS Coombs ID card “DAT IgG/C3d.” In patients with positive DAT further, it was performed using monospecific LISS Coombs ID card. DAT positivity was graded (1+ to 4+) in each patient. The clinical details were recorded including clinical examination, transfusion history, drug history, and other laboratory parameters.

Results: Total of 1123 DAT requests were received. Out of them, 174 patients were DAT positive. Among 174 patients, 112 were males and 62 were females. Maximum number of patients 72 of 174, belonged to liver diseases (alcoholic and nonalcoholic hepatic cirrhosis), which constituted 41.3% of the total. 14.3% patients belonged to autoimmune disease group, among them 9 patients had underlying SLE, while 16 had rheumatoid arthritis. The chief infectious conditions associated with DAT positivity were hepatitis B (18/28), fungal infections (10/28). Out of 174 positive patients, 85 (48.8%) had in vivo hemolysis and 89 (51.1%) did not had hemolysis.

Conclusion: Various number of diseases can result in a DAT positive test regardless of the presence of hemolysis. Therefore, it becomes important to corelate positive DAT results clinically as well as serologically.

P 57: Unveiling dual antibody action: Anti-JKA Allo-antibody and underlying autoantibody in EVANS syndrome

Nilasish Pani, Smita Mahapatra, Binay Bhusan Sahoo, Pallabi Dash1

Departments of Transfusion Medicine and 1Medicine, SCB Medical College and Hospital, Cuttack, Odisha, India

Background: Evans syndrome represents a group of immune cytopenia that may be primary or secondary to other autoimmune diseases. Clinical symptoms could be related to haemolysis and thrombocytopenia. Even though the first-line treatment of Evans syndrome is intravenous corticosteroids or intravenous immunoglobulins yet majority of supportive management is being done by transfusion of blood products. This case report highlights development of alloantibodies as a result of such supportive transfusions.

Case History: An 18-year-old female presented with heavy menstrual bleed for 6 months and was diagnosed and treated as a case of EVANS Syndrome. Patient had severe anaemia and thrombocytopenia not responding to Methyl Prednisolone pulse therapy. There was history of multiple A Rh D Positive Blood transfusions over the past six months.

Investigation and Results: When PRBC and RDP transfusions were needed, crossmatching revealed incompatibility with all A Rh D Positive Donor unit, despite confirming the patient’s blood group to be A Rh D Positive. An extensive immunohematological work up revealed the presence of anti-Jka alloantibody resulting in a delayed Haemolytic Transfusion Reaction in the context of EVANS Syndrome.

Conclusion: This study illuminates the role of Jka antibody in causing delayed haemolytic transfusion reaction in a patient with history of multiple transfusions, a fact which has already been corroborated by several studies. Hence with the help of this report we aim to emphasize the need for vigilant antibody screening and identification in such cases.

P 58: Hemolytic disease of fetus and newborn due to secretory antibody in a primigravida pregnant mother: A case report

Tunu Bhatria, Smita Mahapatra, Binay Bhusan Sahoo

Department of Transfusion Medicine, SCB Medical College and Hospital, Cuttack, Odisha, India

Background: HDFN occurs due to antigenic difference between mother and fetus and mainly due to ABO, Rh and other antibodies.In developing countries Rh HDFN is common due to anti D antibody in case of second pregnancy. Here we found lewis antibodies in a primigravida pregnant mother.

Case History: A newborn female child born from a mother in her first pregnancy was admitted at NICU in Pediatric Department of, SCB MCH, Cuttack for hyperbilirubinemia and anaemia. Jaundice had developed within 24 hours of birth. Despite intensive Phototherapy bilirubin level did not decrease. They had requested 400 ml of blood for double volume exchange transfusion.

Results: Blood group of mother and baby was AB positive and B positive respectively. On crossmatching blood was incompatible with mother but compatible with baby. Since mother sample was incompatible we go for immuno haematological work up like DCT of baby and antibody screening of mother. Baby’s DCT and mother’s antibody screening was positive. On antibody identification antibody found was Lewis antibody.

Conclusion: We conclude that antibody screening should be accepted universally at antenatal period irrespective of their gravida and Rh positive or negative status.

P 59: Haemolytic anemia due to anti-C incompatibility in the newborn period: A case report from tertiary care centre

Bhavikaben Khunt, Farzana Kothari

Department of Immuno-Haematology and Blood Transfusion, S. S. G. Hospital and Medical College, Baroda, Gujarat, India

Background: Hemolytic disease of the fetus and newborn is a disease that is caused by maternal alloantibodies to the fetus. The frequency of hemolytic disease of the newborn due to Rh (D) sensitization decreased inversely with the increase in the use of anti-D gammaglobulin.[1] Minor blood group incompatibility due to blood groups other than Rh(D), although an uncommon cause of neonatal hyperbilirubinemia, has the potential to cause severe hyperbilirubinemia and its sequelae in infants, if left undiagnosed and untreated.[2] In this case study, we present a patient with hemolytic anemia due to anti-c antibody incompatibility. The aim of this study is to prevent HDN by performing Advance Immunohaematology work up in Rh (D) positive antenatal mother.

Case Report: Male child with birth weight of 2.2 kg, cried immediately after birth, was admitted at 2nd Hour of life. On admission, baby was euthermic and euglycemic, Saturation was 35% on nasal prongs, severe pallor and jaundice was present. Routine investigations along with advance immunohaematological workup in baby and mother shows Severe haemolytic anemia, with complete match for Anti-c antibody in this case. Baby expired at 3rd day of life. Minor blood group incompatibility due to blood groups other than Rh(D) requires routine antibody screening during pregnancy.

Keywords: Anemia, anti-c antibody incompatibility, newborn

References

National Library of Medicine. Ilkay Ozmeral Odabasi 2020;54:502-4.

National Library of Medicine. 2020;9:43-7. [doi: 10.5582/irdr.2019.01094].

P 60: Analysis of various aspects of blood donor profile in all Government blood centers at Prayagraj

Priyanka Roy, Ravi Rani Mishra1, Vatsala Misra2

Departments of 1IHBT and 2Pathology, Motilal Nehru Medical College, Prayagraj, Uttar Pradesh, India

Aims and Objective: To study the general blood group profile of blood donors at Prayagraj region to maintain inventory of our blood centres and to study prevalence of Transfusion transmitted infection (TTI) among blood donors.

Methods: It is a retrospective study for which data was collected from eRaktKosh portal from April 2022 to March 2023 and proper statistical analysis done.

Results: Total blood donations were 25762; among them 22082 voluntary and 3680 are replacement donors. Most common blood group among donors was B positive. Total number of TTI was 147. Hepatitis B was the most common TTI and most common blood group associated with TTI was B positive.

Conclusion: By doing the analysis of blood donor profile at Prayagraj region we can maintain inventory of blood centres more efficiently. As observed in our study TTI is more common in replacement donors so we can take proper measures to promote voluntary blood donation in our region.

P 61: Blood transfusion: A double edge sword!

Omshubham Asai, Soumya Das1

Departments of Anesthesiology and Critical Care and 1Transfusion Medicine, AIIMS, Nagpur, Maharashtra, India

Introduction: Blood - “Elixir of Life”; Blood Transfusion – performed on day-to-day basis; considerably safe. Massive blood loss & replenishing the loss with rapid transfusion has remained a great strategy to prevent the deaths but with a unique set of complications on its own – TRALI/TACO.

Case History: 31-year-old female, C/O ruptured ectopic operated for exploratory laparotomy (POD 02); referred to our hospital with dyspnea requiring NIV support with high PEEP & 100% FiO2. On admission patient had tachypnea, tachycardia, hypoxia and dyspnea onset of symptoms 4 hrs after the surgery, she was immediately transferred to Surgical ICU. History of 12 blood products transfusion intraoperatively. Suggesting Pneumonia.

Height – 121 cm, Weight – 34 kg, BMI – 23.2, IBW – 21.5 kg, TBV – 2210 ml

On admission	
	
	HR	BP	RR	SpO2	RS	CVS	
Vitals	130	135/90	42	65 % (NIV support)	Finea and Coarse Crepts	NAD	
	
	WBC	Platelet	Pro BNP	ABG	CXR	PCT	
	
Investigation	2000	70,000	>12,000	P/F <100	Severe ARDS (Figure)	>0.5 ng/mL	
WBC=White blood cell, BP: Blood pressure, HR: Heart rate, SpO2: Oxygen saturation, Non-invasive ventilation, ARDS: Acute respiratory distress syndrome

A diagnosis of TACO/TRALI was made and patient was started with supportive treatment.

Discussion: Massive Blood Transfusion - Replacement of 50% of total blood volume (TBV) within 3 h. Transfusion-associated circulatory overload (TACO) and transfusion-related acute lung injury (TRALI) are acute respiratory distress syndromes which occur within 6 hours of a blood transfusion and associated with high mortality. Treatment of TACO and TRALI is largely supportive but intubation with pharmacologic pressure support may be required. Prone ventilation – strong recommendation in severe ARDS. Strategies to prevent TACO include screening transfusion recipients for occult cardiac insufficiency and reducing the volume and rate of transfusions. Strategies to prevent TRALI include increased donor HLA antibody screening, using male only plasma donors, and donor deferral based on history of transfusion. Anaesthesiologists and other acute care physicians should be well versed in the current concepts in the management of massive blood loss and transfusion.

P 62: Audit on usage of fresh frozen plasma and effect on international normalized ratio and prothrombin time among surgical patients – A retrospective study

Junith Thomas, Athira Sasidharan, Nithya M Baiju, Aboobacker Mohammed Rafi, Ramesh Bhaskaran

Department of IHBT, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India

Aims and Objective: (1). To audit the usage of FFP in surgical departments. (2). To study the effect of FFP on the pre and post transfusion PT and INR.

Methodology: This is a retrospective observational study conducted in the Department of Immunohematology and Blood Transfusion, during April to June 2023. Medical records of 117 consecutive surgical (General Surgery and Neurosurgery) patients who received FFP were retrospectively studied. Pre-and post-transfusion INR were recorded and the effect of FFP on the pre-transfusion INR and PT were studied. FFP usage was classified as appropriate or inappropriate based on the guidelines by the Kerala State Transfusion Policy.

Results: Total 388 units were issued for 117 patients (males (68.3%) and females (31.6%). The mean age of study population was 57 years. 73% of patients who were transfused with FFP had PT/INR <1.5 times the normal value. Prophylactic FFP transfusion was given to 18% of patients irrespective of PT, INR ratio. Patients with profuse bleeding (27%) were transfused with FFP even though they had normal coagulation profile. A total of 63 (53.8%) patients with abnormal PT and INR were transfused and post transfusion improvement of both PT and INR was noted significant in patients (68%) who had pretransfusion INR >1.5 times the normal. The mean improvement in pretransfusion INR was 0.9.

Conclusion: Patients with a high pre-transfusion PT INR are more likely to be benefited with FFP transfusion. These observations bring to our attention to refine the institutional policies regarding FFP usage.

P 63: Efficiency and significance of blood transfusion practices in central India’s blood centre

Yogesh D Pawar, Ashok Yadav, Sachin Sharma, Yogesh Pawde

Department of IHBT (Transfusion Medicine), MGM Medical College, Indore, Madhya Pradesh, India

Aims and Objective: To determine the crossmatch to transfusion ratio to evaluate the efficacy of requisition of blood and its product during the period of 1st May 2022 to 30th April 2023 at State of Art Model Blood Bank, Department of IHBT (Transfusion Medicine), MGM Medical College, Indore. C/T ratio determines efficient or inefficient use of Blood product whereas Transfusion Index TI index determines whether the Blood Utilisation is significant or not.

Methods: All the data of crossmatch and issue was obtained from the departmental record.

Results: During the period of 1 year from 1st May 2022 to 30th April 2023. Total crossmatch done: 58630. Total Transfusion done: 49272. Total Number of Patients Transfused: 37100. C/T Ratio: 1.19. TI index: 1.32.

Department of Gynaecology, Surgery, Orthopaedics and Medicine had the highest utilization of the blood and blood product with more than 50% of the total transfusion. The C/T Ratio for Gynaecology Department was highest with 1.4. Department of Paediatrics including Thalassemia and Bone Marrow Transplant unit, Oncology and Super Speciality had relative low utilization Except Thalassemia Ward which alone had 10% of the total transfusion and low C/T ratio of around 1.1.

Conclusion: C/T ratio <2.5 is indicative of efficient Blood usage. TI index (number of units transfused/number of patients crossmatched). >0.5 is indicative of significant blood utilisation. A C/T ratio of 1.19 and TI index of 1.32 at State of Art Model Blood. Bank, Indicates efficient as well as significant blood transfusion practices.

P 64: Experiences of a tertiary care centre of Western India in therapeutic plasma exchange for paediatric population: A case series

Ujjwal Dimri, Sujay Bhowmik, Amit Ajay Pawar, Amit Kumar Biswas1

Department of Immunohematology and Blood Transfusion, Armed Forces Medical College, Pune, Maharashtra, 1Command Hospital (Central Command), Lucknow, Uttar Pradesh, India

Aim and Objective: The aim of this case series was to investigate safety, clinical indications, and results of therapeutic plasma exchange (TPE) in critically ill pediatric patients in our setup.

Materials and Methods: Patients who underwent TPE between July 2022 and June 2023 in our setup were included in the study. Demographic, clinical, and laboratory data of patients were obtained. Indications were categorized as per American Society for Apheresis (ASFA). A venous catheter was placed into subclavian, femoral, or jugular veins. Cell separators used were Hemonetics MCS + and Fresenius COM.TEC. Red cell priming of kit prior to TPE was required in 04 patients due to low blood volume and hematocrit. Procedural details of TPE were noted. The number of plasmapheresis sessions for each patient was determined by observing the course of the disease and clinical improvement. Patients were monitored for vital signs during the plasmapheresis process. Complications directly associated with TPE were recorded.

Results: During the 1-year study period, 33 TPE sessions were performed in 07 patients (04 males/03 females). The median age was 9 years (4.5–12), and the median body weight was 22 kg (9.2–36). The indications were Febrile Infection Related Epilepsy Syndrome (02), Guillain-Barré syndrome (02), Acute Liver Failure (Wilson’s Disease) (01), Autoimmune encephalitis (01) and Supra Refractory Status Epilepticus (SRSE) (01). Barring 01 episode of hypocalcemia, no other procedure related complications were observed. All patients except SRSE showed good clinical improvement post TPE. Premature discontinuation of the procedure was not seen due to complications. Complications were treated with symptomatic therapy.

P 65: Two cases of anti-neutrophil cytoplasmic antibody-associated vasculitis associated with diffuse alveolar haemorrhage: Managed with plasmapheresis and immunosuppressants

Jayagowri Karthikeyan, Mohit Chowdhry

Department of Transfusion Medicine, Blood Centre, Indraprastha Apollo Hospitals, New Delhi, India

Introduction: The anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a systemic disorder characterised by necrotising pauci-immune inflammation of small and medium blood vessels due to antibodies directed against leukocyte proteinase 3 (PR3-ANCA) and myeloperoxidase (MPO-ANCA). Diffuse Alveolar Haemorrhage (DAH) is a serious, devastating, fatal complication of AAV. We report case series of two cases of Granulomatosis with Polyangiitis (GPA) associated with DAH which were managed with plasmapheresis.

Case Description: Patient 1: A 56-year- old rheumatoid arthritis female, was referred with azotaemia, recurrent episodes of vomiting, abdominal discomfort, joint pains, dizziness, hematemesis. Initial workup revealed azotaemia, microscopic haematuria, absolute neutrophilia, positive acute phase reactants, crescentic glomerulonephritis, DAH and PR3-ANCA positivity suggesting GPA. She was managed with antibiotics, pulse steroids, cyclophosphamide and plasmapheresis. The effects of treatment were evident by improvement in oxygen saturation, urine output, fall in serum creatinine, serum urea and TLC levels. Patient 2: A 47-year-old diabetic male, presented with chest pain, fever, joint pain, haemoptysis and shortness of breath. Initial examination revealed drowsy, difficult mobilisation, conjunctival haemorrhage, oral ulcers, reduced air entry, palpable purpura, pedal oedema and hypotension. Investigations revealed microcytic hypochromic anaemia, abnormal coagulation profile, azotaemia, elevated HbA1c and positive acute phase reactants. Bilateral lung infiltrates, DAH and PR3-ANCA positivity inferred GPA. He was managed with insulin, antibiotics, pulse steroids, cyclophosphamide and plasmapheresis. Laboratory parameters showed significant improvement in terms of urea, electrolytes, haemoglobin and TLC.

Conclusion: This case series depicts the usefulness of plasmapheresis alongside immunosuppressants to manage patients of DAH associated with GPA.

P 66: Therapeutic plasma exchange in a rare case of hemophagocytic lymphohistiocytosis coexisting with thrombotic thrombocytopenic purpura and sepsis: A case report

Aparupa Sen Gupta, Dheeraj Khetan1, R K Chaudhary1

Departments of Transfusion Medicine and 1Transfusion, SGPGIMS, Lucknow, Uttar Pradesh, India

Introduction: HLH is a rare condition that is triggered by sepsis and leads to multiorgan dysfunctions due to excessive immune activation.[1] TTP is another uncommon fatal condition characterised by the ‘pentad’ features of microangiopathic haemolytic anaemia, fever and thrombocytopenia with renal and central nervous system involvement.[2] Therapeutic Plasma Exchange (TPE) is a category I and III indication in TTP and HLH respectively[3] has a major role to play. There are only few case reports stating the evidence of these disorders coexisting.[4,5] Here we share our successful experience of performing TPE in a 20-year-old female dealing with the above condition.

Case: Thirteen cycles of TPE were performed daily on a 20-year-old female admitted in the Critical Care Unit with the diagnoses of sepsis-induced HLH and TTP based on abnormal haematological and clinical parameters along with the disease-specific scoring systems, exchanging 1.5 times the patient’s total plasma volume with Cryo-poor plasma with a ‘target’ platelet counts >150,000/µL, near-normal LDH for two-three consecutive days and clinical improvement. During the course of TPE, her clinical status drastically changed showing neurological, respiratory and renal improvements. Though the ‘target’ haematological parameters couldn’t be attained immediately, the peripheral blood smear was now negative for HLH-TTP features. She continued to improve after TPE, being discharged in a stable condition on day 76 with Hb-7.9, TLC-10.8 x 10 9 /L and Plt-3.34 x 103/µL.

Conclusion: A timely diagnosis of this complex constellation of diseases with the appropriate utilisation of TPE in the patient is crucial to achieving great clinical outcomes in such patients.

References

Henter JI, Horne A, Aricó M, Egeler RM, Filipovich AH, Imashuku S, et al. HLH-2004: Diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis. Pediatr Blood Cancer 2007;48:124-31.

Tsai HM. Untying the knot of thrombotic thrombocytopenic purpura and atypical hemolytic uremic syndrome. Am J Med 2013;126:200-9.

Connelly-Smith L, Alquist CR, Aqui NA, Hofmann JC, Klingel R, Onwuemene OA, et al. Guidelines on the use of therapeutic apheresis in clinical practice – Evidence-based approach from the writing committee of the American Society for Apheresis: The ninth special issue. J Clin Apher 2023;38:77-278.

Li Y, Li W, Li Z, Ma F, Xu B. A case report: Hemophagocytic lymphohistiocytosis and thrombotic thrombocytopenic purpura in an otherwise healthy woman. Medicine (Baltimore) 2023;102:e33803.

Verma DP, Dandu H, Yadav G, Verma SP. Complicated case of COVID-19 disease with overlapping features of thrombotic thrombocytopenic purpura and haemophagocytic lymphohistiocytosis. BMJ Case Rep 2021;14:e242202.

P 67: Role of therapeutic plasma exchange in complementary and alternative medicines induced liver injury-experience of a tertiary care centre

Preeti Paul, Aarushi Sahni, Rekha Hans, Divjot Singh Lamba, Ajay Duseja1, Sadhna Bhasin Lal2, Ratti Ram Sharma

Departments of Transfusion Medicine and 1Hepatology, PGIMER, 2Division of Paediatric Gastroenterology and Hepatology, PGIMER, Chandigarh, India

Introduction: Complementary and alternative medicines (CAM) are a known cause of drug induced liver injury (DILI). The severity of DILI in these patients varies from mild serum aminotransferase elevations to the development of severe liver injury that can progress to acute liver failure resulting in death in absence of liver transplantation within days of onset. Chronic liver injury that persists for more than 6 months after onset of liver injury is also recognized in these patients.

Aims and Objectives: (1) To assess the efficacy of plasma exchange in improvement of biochemical parameters and clinical scores in CAM associated liver failure. (2) To assess the safety of the procedure in these patients.

Materials and Methods: We did retrospective analysis of records of patients with history of CAM associated acute liver injury who were referred to Department of Transfusion Medicine and underwent therapeutic plasma exchange (TPE). Patients with chronic liver disease with acute exacerbation due to CAM exposure were also selected. Bedside procedures were done for paediatric or sick patients using Cell separator Optia Spectra, Terumo BCT, Lakewood, USA. The stable adult patients were shifted to the Department of Transfusion Medicine for the procedures. One to 1.5 times plasma volume was exchanged using fresh frozen plasma, and normal saline as replacement fluid in ratio of (Normal saline: FFP as 20:80) and 1% calcium gluconate infusion was given during procedures. Pre procedural clinical scores and biochemical parameters were recorded. Follow up for any improvement was done at time of discharge, 1 month, and 6 months after discharge. Adverse reactions during procedures were noted.

Results: A total of 10 patients underwent plasma exchange procedures over a period of 3 years out of which 50% (n=5) were adult patients and 50% were paediatric. 80% of adult patients were having chronic liver disease excavated by CAM exposure presenting as ACLF. One patient had subacute liver failure. All paediatrics patients had acute liver failure. Total sixty-three procedures were done for ten patients. The median plasma volume exchanged in these procedures was 2715 ml (1979-4266 ml) and median ACD used in procedures was 335 ml (239-537 ml). We observed a significant decline in total serum bilirubin levels, total protein and liver enzymes (Aaminotransferase and Aspartate aminotransferase) levels (p<0.05). However, there was no statistically significant change in serum albumin levels from baseline. In coagulation profile, activated partial thromboplastin time (aPTT) improved significantly (p< 0.05) with no change in prothrombin time (PT). There was no significant change in clinical scores (APASL ACLF Research Consortium- AARC score for acute on chronic liver failure, Model for End-Stage Liver Disease (MELD) score and Paediatric End-Stage Liver Disease (PELD). Out of these, 20% patients suffered adverse reaction during plasma exchange of which one was mild vasovagal reaction and the other had allergic reaction to replacement fluid. We observed 60% in-hospital and 30-day mortality in these patients with 90% mortality at 6 months of discharge. All pediatric patients suffered in hospital mortality.

Conclusion: Plasma exchange can be considered as bridging supportive intervention for liver transplant candidates but lack of liver transplantation services results in high mortality rates in CAM associated liver failure.

P 68: Adverse reactions of therapeutic plasma exhange by centrifugation technique in a tertiary care centre

S Sudharsan, M Sintha, A Muzaffar Khan

Department of IHBT, Madurai Medical College, Madurai, Tamil Nadu, India

Aim and Objective: Therapeutic plasma exchange (TPE) Constitutes an important therapy for hematological, neurological, immunological and nephrological diseases. Aim of the study is to observe the Complications during TPE sessions by centrifugation technique in a tertiary care centre.

Materials and Methods: We conducted a prospective study of all patients who underwent Therapeutic Plasma Exchange between January 2023 and June 2023 at Govt Rajaji Hospital, Madurai. TPE sessions using the centrifugation technique by continuous flow were performed by dedicated trained team. The patients were monitored and observed for adverse reactions.

Results: In total, 123 TPE sessions perfomed on 56 patients were analyzed. Hypotension occurred during 6 sessions (4.87%), Hypocalcemia occurred during 7 sessions (5.69%), Allergic reactions occurred during 5 sessions (4.06%), Nausea/Vomiting occurred during 6 sessions (4.87%), Shivering occurred during 2 sessions (1.62%).

Conclusion: Therapeutic Plasma Exchange (TPE) is a safe therapy. Adverse effects were not so frequent and mostly not serious and can be managed. Therefore, TPE can be used in a wide variety of clinical conditions where it is recommended.

Keywords: Allergic reaction, centrifugation, hypocalcemia, hypotension, therapeutic plasma exchange

P 69: A case report on therapeutic plasma exchange in a pregnant lady with acute liver failure of viral etiology

Ashish Jain, Aswin K Mohan, Om Kumari1, Anand Sharma2

Departments of Transfusion Medicine, 1Obstetrics and Gynaecology and 2Gastroenterology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

Introduction: TPE has a role in removing the pathogenic substances and can be initiated if indicated in pregnancy with proper precautions and multidisciplinary approach.[1] We report a case of acute liver failure in a pregnant woman with viral hepatitis and hepatic encephalopathy, which was successfully resolved with TPE procedures.

Case Presentation: A 30-year-old woman, G3P2L2, 18 weeks POG presented with intermittent fever, progressively worsened jaundice and altered sensorium (GCS of E1V2M2). In view of fulminant acute liver failure associated with Hepatitis A and B virus, grade IV hepatic encephalopathy and coagulopathy therapeutic plasma exchange was planned.

Materials and Methods: An initial course of five exchanges was planned daily after multidisciplinary discussion, in which 1-1.2 volume of exchange was performed using Terumo BCT Spectra Optia Apheresis System. FFP was used as replacement fluid with inlet speed of 30-40 ml/hour, 1:13 ratio of anticoagulant, along with adequate calcium replacement. Special precautions were taken for pregnancy including left lateral positioning and right jugular vein access to lessen the possibility of IVC compression. Low inlet flow rates, fetal heart rate monitoring using Doppler USG and adjustment in plasma volume calculation using the Nadler’s formula was done. Patient’s ONSD (from 6.4 to 4.5 mm) and biochemical parameters gradually decreased after the procedures. Post 5 procedures, on day 7 of admission the patient’s GCS improved to E3V3M6 and was extubated. The condition of the fetus was satisfactory.

Conclusion: TPE can be used safely as a treatment modality in pregnancy if adequate precautionary measures are taken.

References

Wind M, Gaasbeek AG, Oosten LE, Rabelink TJ, van Lith JM, Sueters M, et al. Therapeutic plasma exchange in pregnancy: A literature review. Eur J Obstet Gynecol Reprod Biol 2021;260:29-36.

Connelly-Smith L, Alquist CR, Aqui NA, Hofmann JC, Klingel R, Onwuemene OA, et al. Guidelines on the use of therapeutic apheresis in clinical practice – Evidence-based approach from the writing committee of the American Society for Apheresis: The ninth special issue. J Clin Apher 2023;38:77-278.

P 70: To study the level of agreement between 3rd and 4th generation ELISA in the detection of HIV in blood donors in a tertiary care hospital in South India

Purshotam Paudel, Dibyajyoti Sahoo1, B Abhishek1, Rakesh Singh2

Departments of 1Transfusion Medicine and 2Microbiology, Puducherry, India

Aims and Objectives: To assess the level of agreement between 3rd and 4th generation ELISA in the detection of HIV in blood donors.

Methods: It was an epidemiological, cross-sectional analytical study conducted from November 2021 to May 2023. During the study, a total of 25,231 blood donor samples were processed in the Department of Transfusion Medicine as a part of routine donor blood testing. Out of those samples, 59 samples that were initially reactive (positive as well as grey zone) with 4th generation ELISA were included. Each batch of the positive sample (92 wells in each batch) were repeated with 3rd generation as a negative control and also duplicated in 4th generation ELISA. So, the total number of samples that were repeated in both generations of ELISA was 5428 (92 x 59). All data were analyzed using SPSS 22 with a p-value <0.05 as significant.

Results: Out of 59 positive samples that were initially reactive with 4th generation ELISA, on repeat testing only 15 were positive. The number of samples that were positive in 3rd generation ELISA was 17. The prevalence of HIV by the 4th generation was found to be 1.08%, whereas, with the 3rd generation, it came out to be 0.31%. The level of agreement between 3rd and 4th generation ELISA came to be 0.18 by Kappa statistics which is a slight level of agreement.

Conclusion: The study found that 4th generation ELISA is 100% sensitive but specificity is less. False positives due to 4th generation ELISA can lead to a greater number of discards of blood products.

P 71: Association of ABO and Rh blood group system with hepatitis B infection in blood donors: A single centre retrospective prevalence study from tertiary care hospital

P Sriraman, Shahida Noushad, Dibyajyoti Sahoo

Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

Aims and Objectives: The study aimed at determining the association of ABO and Rh D antigens with Hepatitis B virus (HBV) infection as well as it’s prevalence among blood donor population in and around Pondicherry, which has not yet reported till date.

Methods: The samples were collected retrospectively from 37,595 donors for 2 years (2021-2022) who were screened for TTI testing by ELISA and if reactive, were confirmed by eCLIA. ABO and Rh D status were done by tube technique. Statistics were analysed using STATA version 15.1.

Results: In this study, the prevalence of HBV infection among blood donors was 0.87% (328) with males 0.88% & females 0.37%. Combining the ABO and Rh blood group systems, negative association (Odd’s ratio (OR) 0.65; p>0.05) was found to exist between B negative blood group and HBV infection (B neg < B+ < AB+ < O+, O neg < A+ < A neg). Of all factors assessed, female donors have lower risk (OR 0.33; 95% Confidence interval (CI) 0.11-0.99; p<0.05) than males for HBV infection. Doctors and nurses also have lower risk (OR 0.05, 95% CI 0.03-0.82; p<0.05) in-comparison with other occupations. Based on univariate analysis, occupation has been dichotomised into high-risk and low-risk by strength of association (p<0.2) where high risk (daily labourers, farmers, textiles, carpenter, tailors, employees & not working groups) had OR 2.92; 95% CI 1.35-6.63; p<0.05 than low-risk occupational groups.

Conclusion: Presence of B antigen without Rh D is negatively associated with HBV infection. Doctors, nurses, and female gender also have low risk.

P 72: Seroprevalence of TTI’s among blood donors: A single institute study

Ratnadeep Rawat, Ashok Yadhav, Ramu Thakur, Khushboo Likhar

Department of Transfusion Medicine, MGM Medical College, M. Y. Hospital, Indore, Madhya Pradesh, India

Aim and Objective: A study to find out current trend of TTI in blood donor and evaluating the current screening procedure.

Methods: A study from January 2021 to June 2023 in Department of Transfusion Medicine, M. Y. Hospital, Indore. A Serology Screening Data of all blood donor who were accepted for blood donation according to selection criteria by FDA. From January 2021 to June 2023, 95771 blood donor were estimate for Hep B, HCV, HIV, VDRL and Malaria by using 3rd generation ELISA or rapid assays. Data entered in Microsoft excel spread sheet and analysed using R source software.

Results: From January 2021 to June 2023, 1325 are reactive in TTI screening from 95771 blood donor. Prevalence of TTI in 2021 is 1.3% (HBV 1.03%, HCV 0.05%, HIV 0.9%, VDRL 0.14%) and Prevalence of TTI in from January to June 2023 is 1.4% (HBV 1.13%, HCV 0.08%, HIV 0.4%, VDRL 0.11%). Percentage of Voluntary Donor and Replacement Donor reactive for TTI is 1.04% and 4.03% for in 2021 and Voluntary Donor 1.18% and Replacement Donor 4.2% for in 2022.

Conclusion: Prevalence of HBV is increase, HCV decrease, HIV decrease from 2021 to June 2023. Proper donor screening of donor can decrease prevalence of TTI.

Reference

Farshadpour F, Taherkhani R, Tajbakhsh S, Gholizadeh Tangestani M, Hajiani G, Sharifi N, et al. Prevalence and trends of transfusion-transmissible viral infections among blood donors in South of Iran: An eleven-year retrospective study. PLoS One 2016;11:e0157615.

P 73: Blood donation screening of transfusion-transmissible viral infection using two different nucleic acid testing platforms: A single tertiary care oncology centre experience

Amardeep Pathak, Devasis Panda1, Manushri Sharma2, Narender Tejwani1, Anurag Mehta1

Departments of Transfusion Medicine and 1Laboratory Medicine, Rajiv Gandhi Cancer Institute and Research Center, 2Department of Biochemistry, Sir Ganga Ram Hospital, Delhi, India

Background: Nucleic acid testing (NAT) is used to screen transfusion transmittable infections (TTIs) in donated blood samples and provide an additional layer of blood safety. In this study, we describe our experience in screening viral TTIs using two formats of NAT: cobas® MPX2 polymerase chain reaction- based minipool NAT (PCR MP-NAT) and Procleix Utrio Plus transcription-mediated amplification based individual donor-NAT (TMA ID-NAT).

Materials and Methods: Data routinely collected as a part of blood bank operations were retrospectively analysed over a period of 70 months for TTIs. Blood samples were initially screened for HIV, HBV, HCV, syphillis by chemiluminescence and malaria by Rapid card test. In addition to serological testing, all samples were further screened by TMA-based ID-NAT (Procleix Ultrio Plus Assay) during January 2015–December 2016, and by PCR-based MP-NAT (Cobas® TaqScreen MPX2) during January 2017–October 2020.

Results: A total of 48,151 donations were processed over 70 months, of which 16,212 donations were screened by Procleix Utrio Plus TMA ID-NAT and 31,939 donations by cobas® MPX2 PCR MP-NAT. Replacement donors and male donors outnumbered voluntary donors and female donors respectively. The overall NAT yield rate of MP-NAT was 1:2281 compared to 1:3242 with ID-NAT, during the respective time period. ID-NAT detected 5 HBV infections missed by serology, whereas MP-NAT detected 13 HBV infections and 1 HCV infection missed by serology. The proportion of donations that were both seroreactive and NAT reactive was higher with MP-NAT (59.8%) compared to ID-NAT (34.6%).

Conclusion: Cobas® MPX2MP-NAT had higher overall NAT yield rate compared to ProcleixUtrio Plus IDNAT and confirmed a higher proportion of seroreactive donations. Due to the ease of operation, simple algorithm, cobas® MPX2 PCR based MP-NAT can be an effective solution for blood screening in India.

Keywords: Minipool, NAT, transfusion transmitted infection

Disclaimers: The identity of the patient is not disclosed here in this case. The authors state that there is no conflict of interest present.

References

Pathak S, Chakraborty T, Singh S, Dubey R. Impact of PCR-based multiplex minipool NAT on donor blood screening at a tertiary care hospital blood bank in North India Int J Med Sci Curr Res 2021;4:570-5.

Hans R, Marwaha N. Nucleic acid testing-benefits and constraints. Asian J Transfus Sci 2014;8:2-3.

Safic Stanic H, Babic I, Maslovic M, Dogic V, Bingulac-Popovic J, Miletic M, et al. Three-year experience in NAT screening of blood donors for transfusion transmitted viruses in croatia. Transfus Med Hemother 2017;44:415-20.

Chatterjee K, Coshic P, Borgohain M, Premchand, Thapliyal RM, Chakroborty S, et al. Individual donor nucleic acid testing for blood safety against HIV-1 and hepatitis B and C viruses in a tertiary care hospital. Natl Med J India 2012;25:207-9.

P 74: Cost effectiveness cannot be measured by money alone: Value of SAB monitoring in deceased donor workup

S Stephen, Sam Aruldoss, John Gnanaraj, Dolly Daniel

Department of Transfusion Medicine and Immunohaematology, Christian Medical College, Vellore, Tamil Nadu, India

Aim and Objectives: The study aims to demonstrate the value addition of interval based Anti HLA antibody monitoring in deceased donor transplantation using the Luminex single antigen bead assay (SAB).

Materials and Methods: All patient who underwent deceased donor renal transplant between January 2022 and July 2023 were included in our retrospective study. Results of their HLA typing, sequential SAB assay and serological and flow cytometric crossmatch results done at the time of transplant were reviewed. As per institutional protocol, along with CDC and FCXM, SAB is repeated at the time of transplant in the event of any recent sensitisation history or if the previous SAB was more than 6 months prior.

Results: A total of 56 patients were registered for initial cadaveric transplant workup, of which 24 (42%) patients were transplanted with deceased donors during the study period. Clearing for transplant requires a negative CDC and, FCXM at the time of transplant. However, 4 of these patients had a positive CDC, 3 contributed by an IgM antibody and one with an IgG antibody. The consistent negativity of the SAB assay prior and during the day of the transplant helped rule out the possibility of a clinically significant antibody. Serial SAB assays at 6 monthly intervals or as clinically indicated contribute significantly in facilitating decision making in the presence of what appears to be non-specific positivity on serological platforms.

Conclusion: Performing SAB at regular intervals helps in important decision making during cadaveric transplantation workup thereby impacting cost and graft longetivity in the long run.
