
==== 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-18-2
TRANSCON 2023: Oral Paper Abstracts
TRANSCON 2023: Oral Paper Abstracts
8 2024
21 8 2024
18 Suppl 1 S2S27
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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pmcA 1.1: Documents to procure gamma irradiation chamber and license for operation in blood centre

Rakesh Kumar Luhar, Kishore Maheshwar, Ripal J Shah, V Harimoorthy

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

Background: Viable lymphocytes present in blood can be responsible for Graft-Versus-Host Disease (GVHD) in the recipient. The resulting disease has serious consequences like fever, skin rashes, hepatitis, diarrhea, bone marrow suppression and infection. All of them can progress to mortality. Severely immune suppressed or Immune compromised recipient, such as bone marrow transplant patients, neonates who have receive intrauterine transfusion and exchange transfusion, and persons who are recipient of blood from first-degree relatives are at risk of developing Graft-Versus-Host Disease. Gamma irradiation can inactivate lymphocytes present in the blood. Cesium-137 (137 Cs) or Cobalt-60 (60 Co) is commonly used as the source of gamma rays. The usual dose is 25 Gray (Gy) to 35 Gy (1 Gray=100 rads), This dosage inactivates 85 to95% of lymphocytes in the blood components without any adverse effect on other cellular components (red cells, platelets and granulocytes) of the blood, In India, for procurement of irradiator, permission from Atomic Energy Regulatory Board (AERB) is mandatory. The AERB. was constituted on 15 November 1983 by the President of India by exercising the powers conferred by Section 27 of the Atomic Energy Act, 1962 (33 of 1962) to carry out certain regulatory and safety functions under the Act. The regulatory authority of AERB is derived from the rules and notifications promulgated under the Atomic Energy Act, 1962 and the Environmental (Protection) Act, 1986. The headquarters is in Mumbai. eLORA: (e-Licensing of Radiation Applications), an e-Governance initiative by AERB, is a web-based application (seen the fig 2) for automation of regulatory processes for various Radiation Facilities in India. The objective of the project is to enhance efficiency and transparency in the regulatory processes of AERB. The system is aimed at achieving paperless licensing of Radiation Facilities implementation in July 2015 start. Gamma Irradiation Chamber (GIC) unit mainly houses either Co-60 or Cs-137as radiation sources (model no BI-2000, BI-5000 mfr. by BRIT (Board of Radiation and Isotope Technology) with typical radioactivity ranging from tens to hundreds of TBq (Terabecquerel). These units are also used in research institutions, hospital, blood centre etc.

Figure 1 AERB website page

Figure 2 e-LORA login page

Aims and Objectives: A review of legal, regulatory, and policy aspects of operation of Gamma Irradiation Chamber in India regarding to its issues, challenges, and opportunities. We aimed to prepare a standard guidance document of Gamma Irradiation Chamber for smooth process of AERB licensing and equipment purchasing. The steps for the licensing and its details are taken from website of AERB [www.aerb.gov.in as show Figure 1]. Though it is available on website of AERB, it is difficult to prepare a detailed documentation in absence of on call guidance, this article is prepared.

Methods: The present article was written based on the experience of applying for GIC with AERB and recurrent support extended to colleagues in the fraternity. The documents prepared for licensing and various procedural steps involved in the same are included.

Results: Atomic Energy Regulatory Board (AERB) safety Guide on “Security of Radioactive Sources in Radiation Facilities” the Competent Authority for radiation protection in the country (As per the requirements specified in section 4.5.1), the security plan needs to be registered with the District Law and Enforcement Authority. For procurement of an indigenously manufactured GIC unit, applicant should submit the application in the prescribed format to the Competent Authority for obtaining the consent after ensuring that the manufacturer/supplier of the GIC unit is in possession of valid Type Approval certificate issued by the Competent Authority. For first time import of any GIC model, the supplier should obtain ‘No Objection Certificate (NOC)’ from the Competent Authority by submitting the application in prescribed format. Upon import and installation of the equipment in the country, the supplier shall demonstrate Type Approval testing of the equipment to AERB. Based on the satisfactory demonstration of Type Approval testing, Type Approval certificate for such equipment shall be issued by the competent authority. Only type approved GIC equipment shall be used in the country. The applicant shall not operate the GIC unit without obtaining the Licence for Operation from the Competent Authority. Intimation of Receipt of the Gamma Irradiation Chamber The receipt of GIC unit with source should be submitted with full details of radioactive source pencil nos. as soon as the GIC received by the institute. Procurement permission shall be obtained through the on-line portal, www.aerb.gov.in/e-LORA [Figures 1 and 2 are seen]. In general, the following minimum documents have to be submitted along with the application form.

i) Application Form: Employer Details: Full Name, Date of Birth, Document/card for proof of identity and date of birth, Document/Card No, E-mail (O) and mobile no.

ii) Proof of Employership: (i) Appointment Letter of Employer, (ii) Board Resolution, (iii) Any Govt./PUC document substantiating proprietorship (iv) Partnership deed (notarised), PAN of Institute o TAN of Institute o Registration with State/Central/Local Government Authority

iii) Two copies of duly signed and stamped document on layout plan(scale 1:100) of GIC installation room indicating the following:

iv) Adequate room size for installation: 4M x 4M x 4M

v) Thickness of the walls and shielding material details: Location of entrance door 1.2M clear width X 2M height, position of windows along with height from ground level, door lock and key arrangement for preventing access by unauthorized person

vi) Pit size: 35cm dia X 70cm depth in the floor, Occupancy in the immediate vicinity of the installation room

vii) Floor loading capacity:10MT per sq.mtr

viii) Copy of certificate of approval of sealed source (including Serial No.), classification and leak test certificates as per applicable national/international standard

ix) Copy of the AERB Type Approval certificate for the GIC (valid 1 year)

x) Copy of the document of the institution registration with the local/state/central Government authorities

xi) Security plan for the facility as per AERB Safety Guide on ‘Security of Radioactive Sources in Radiation Facilities’ (AERB/RF-RS/ SG-1) and AERB Safety Guide on ‘Security of Radioactive Material during Transport’ (AERB/NRF-TS/SG-10)

xii) A copy of the undertaking furnished by the supplier of the source to take back the disused/decayed source

xiii) Nomination of personnel in the standard format of application form for training in radiation safety aspects of GIC (in case the personnel trained in radiation safety are not available).

The applicant is required to comply with the requirements for availability of manpower and safety infrastructure as stated below:

(a) Radiological safety officer (R.S.O.)

(b) Personnel monitoring devices (e.g. Thermoluminesent Dosimeter TLD)

(c) Radiation monitoring devices (e.g. radiation survey meter).

Other requirements are

(a) The employer/licensee should ensure that suitable radiation measuring instrument should be available in working condition to carry out radiation protection survey of GIC unit

(b) The radiation survey meter: should be periodically calibrated, at least once in two years and records are maintained. The calibration of a radiation survey meter should be traceable to the national/international standards laboratory

(e) Security plan for the facility: Description regarding GIC facility, Map Layout Plan, Police Verification of Employer, Certificate of RSO, Trustworthiness certificate of staff, Emergency Response plan, SOP, Log book & log sheet of Irradiation Machine, Log book of Key Control Register, Undertaking of Sensitive Information Protection, Training records of Radiation worker, sweeper & Security Guard, Security Agency Registration Letter etc. Above all documents are filed and sent to District Law and Enforcement Authority for registration. After document sent physical verification by police officer all clear the document then issue the letter. Then after registration, soft copy of “Registered Security Plan” is sent to AERB by using eLORA system. AERB then issue security plan approved letter.

After complete installation, institution will send online application (via e-LORA thru) for authorization for commissioning and operation blood irradiator. Then after AERB team inspect all documents, staff, equipment etc. Then AERB will issue the first fresh license and is valid for 5 years then after renewal license with 3 years’ validity.

Conclusion: Many documents and many days are required from procurement to the receipt of license for operation gamma irradiation chamber. At the same time, very few user institutes and less number of experienced person in the country, it become difficult to find a proper method to approach the national government body. If blood centre/RSO are properly trained as per the guidelines available, this can reduce man-days and facilitate the earliest operations.

Keywords: Atomic energy regulatory board, gamma irradiation chamber, graft-versus-host disease, radiological safety officer

References

Available from: https://www.britatom.gov.in/product/radiation-technology-equipment. [Last accessed on 2023 May 27].

Available from: https://www.aerb.gov.in/hindi/regulatory-facilities/radiation-facilities/application-in-medicine/blood-irradiators. [Last accessed on 2023 May 27].

Available from: https://elora.aerb.gov.in/ELORA/populateLoginAction.htm. ([Last accessed on 2023 May 27].

Atomic Energy Act; 1962.

Atomic Energy (Radiation Protection) Rules; 2004.

Atomic Energy (Safe Disposal of Radioactive Wastes) Rules; 1987.

Guide on Security of Radioactive Sources in Radiation Facilities No. AERB/RF RS/SG-11; 2011.

Security of Radioactive Material (RAM) during Transport No. AERB/NRF-TS/SG-10; 2008.

Other Applicable Regulatory Documents Issued by AERB.

Director General of Health Services Transfusion Medicine Technical Manual Second Edition.

A 1.2: Analysis of ABO discrepancies in voluntary blood donors in a tertiary care centre, South India

Rajeswari, M. Sintha, B Anandeeswari

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

Aim and Objective: Aim of the study is to analyse ABO discrepancies in voluntary blood donors to prevent ABO mismatch transfusion.

Methods: This prospective study includes all voluntary blood donors from January 2023-June 2023 in the department of IHBT. Among 3107A donors, 5082B donors and 1191AB donors, 4 donor samples were detected with ABO discrepancy excluding technical errors. All tests are done by conventional tube method. 4 samples which shows Discrepancies between forward and reverse grouping, subjected to further tests. Discrepancies existed even after increase in incubation period to 30 minutes at room temperature but weak reactivity was with anti-B and anti-AB at 4°C for 2 samples and weak reactivity with anti-A and anti-AB at 4°C for 2 samples. DAT of all 4 samples were negative. These 4 samples were subjected to adsorption-elution techniques, 2 sample shows 4+ reactivity in elution with anti-B and 2 samples shows 4+ reactivity in elution with anti-A respectively. 4 donor samples subjected to saliva testing, shows 1donor with A&H substances, 2 donors with B&H substances and 1 donor with A,B,H substances.

Results: 4 donor samples with ABO discrepancy were found. B3 subgroup of 2B donors, Am subgroup of 1A donor and A3 subgroup of 1AB donor were identified.

Conclusion: In our donor population, incidence of weak ABO subgroup was 0.042%. Hospital transfusion service identified these weak subgroups in a timely manner thus preventing haemolytic transfusion reaction and reduced RBC survival post transfusion. These donors were informed in person clarifying their donor and recipient status.

A 1.3: Assessment of iron deficiency and anemia in antenatal females in Western India

Mallika Agarwal, Charusheela Gore, Parag Ratnakar

Introduction: Anemia is the most common nutritional deficiency disorder affecting pregnant women in developing countries affecting 52% of pregnant women. Although iron requirements are reduced in first trimester but they rise steadily.

Aims and Objectives:

To estimate the prevalence of anemia in antenatal females

To estimate the prevalence of iron deficiency in anemic antenatal females

To analyze the response of iron deficiency anemic antenatal females to the treatment.

Methodology: A retrospective observational study was done on 119 pregnant women with Hb less than 11 g/dl who came to Obstetrics and gynecology OPD during October 2022 to July 2023 was conducted in Department of Pathology in Dr. D.Y Patil medical college hospital and research, Pune. Antenatal females Hb less than 11 gm% were subjected to complete blood, RBC indices, iron profiler and the grade of anemia was defined as mild, moderate and severe On the next antenatal visit, repeat hemoglobin was done to note change in hemoglobin levels after taking the supplements judiciously.

Results: The antenatal females showed mild, moderate and severe anemia in 54.6%, 33.6% and 6.72 % respectively. The prevalence of anemia was 74.6% with iron deficiency in 64.6%. Serum Iron, ferritin and transferrin were decreased with high TIBC. Prevalence of anemia increased with pregnancy duration. Supplementation with iron showed improvement of Hb to 52.7% in mild anemia, 30.9% with moderate anemia and 4 3.6% with severe anemia.

Conclusion: Prevalence of Anemia in Western India is 74% with iron deficiency in 64.6%. Anemia increases with increasing age of gestation. Majority antenatal females have mild iron deficiency anemia which can be corrected by iron supplementation at early gestational age and make delivery safer.

A 1.4: A study of donor deferral patterns of whole blood and single donor platelet donors in a tertiary care hospital

Harshita, B Shanthi1, Sudhir Kumar1, Mahesh Kumar1

Departments of Transfusion Medicine and 1Immuno-hematology and Blood Transfusion, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India

Aim and Objectives: To analyse the pattern of whole blood and single donor platelet donor deferral, its characteristics and reasons in a tertiary care hospital to provide safe and healthy blood transfusion.

Materials and Methods: The study is done from January 2021 to May 2023. Blood donors were screened as per NACO guidelines. Pre-donation screening was done using a questionnaire followed by a physical examination & Haemoglobin estimation. Data was collected from the Donor deferral registry. The donor deferral causes were categorized as temporary and permanent, and data was recorded in an excel sheet.

Results: A total of 47520 donors screened, 46407 were for blood donation and 1113 were for SDP. Of 46407 donors, 44579 donated blood, while 1828 (4.1%) were deferred. Of 1113 SDP donors, 990 donated, while 123 (11.05%) deferred. Out of 1828 blood donor deferrals, 1665 (91.08%) were males and 163 (8.91%) females. In SDP, 123 donors deferred, all were males. Among the blood donors, 1687 (92.28%) deferred for temporary reasons and 141 (7.71%) for permanent. In SDP, 102 (82.92%) were deferred for temporary reasons and 21 (17.07%) for permanent. Majority of donors deferred were young (18-29 years), 61 SDP and 878 WB donors.

Conclusion: The common cause of blood donor derferral is anemia and for SDP high haemoglobin and low platelet count. The pattern of donor deferral is an important tool for blood safety and donor safety as well. Determining a donor deferral pattern by categories can aid in donor retention. Donor deferral can be reduced by creating awareness and educating donors about blood donation.

References

Drugs and Cosmetic Act.

Standards for Blood Banks & Blood Transfusion Services, National AIDS Control Organization, Ministry of Health and Family Welfare, Government of India, New Delhi; 2007.

Mangwana S. Analysis of blood donor deferral pattern: Scenario in a tertiary health care hospital in India. Asian J Transfus Sci 2013;7:160-1.

Sharma T, Singh B, Bhatt GC. Profile of deferral of blood donors in regional blood transfusion center in North India. Asian J Transfus Sci 2013;7:163-4.

A 1.5: Blood donor satisfaction and intention of future donation by post-donation feedback analysis: A study from an oncology centre in Eastern India

Najla Haneefa Basheela, Suvro S Datta, Soumitra S Datta, Somnath Roy

TATA Medical Center, Kolkata, West Bengal, India

Aims and Objectives:

To understand and evaluate blood donor satisfaction and motivation concurrently at the time of donation.

To find correlation between donor satisfaction and motivation for future donation.

Methods: This was a prospective study where donors were approached by a blood centre counsellor in the refreshment area to complete a brief, anonymous, self-administered feedback survey and rate their satisfaction with the donation process over a period of 42 months (2019-2022). Questions included basic demographics, satisfaction at each step, motivation for the current donation and intent to return for future donation. Responses were recorded on 10-point Likert-type scales. Chi-squared and Fisher’s tests were used to assess bivariate associations between demographic and blood donation variables. Stratified analysis was used to address potential confounding in the bivariate associations. Associations at p <0.05 level were considered significant.

Results: Out of the 2197 donors studied; 77% were males with an age of 40 ± 22.5 years. More than 95% of donors rated the overall donation process at 9 or 10 on a scale of 10 with no difference observed among gender and age groups. 63.4% were repeat donors, majority were graduates and above (77.5%). For the current donation, 65.5% donors rated altruism as major motivation. The blood centre being at a cancer hospital, has influenced 55.9% donations.

Conclusion: Blood donor satisfaction and level of education is positively correlated with the intent to return for future donation. Although altruism and oncology setup influenced majorly, voluntary donations should be encouraged to balance blood inventory and blood utilization.

A 1.6: Analysis of the causes for deferral in blood donors at a tertiary health care centre in Northern India

Kislay Mishra, Tulika Chandra, Ashutosh Singh, Archana Solanki

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

Background: Healthy Blood Donors form the backbone of any Blood Centre. To provide good quality blood components to patients, screening of donors acts as a first line of defence against poor blood quality. Various causes for the deferral of donors needs to be understood for advocating appropriate donor recruitment and retention strategies that may vary according to different areas. This study aims at analysing the most common causes for donor deferral at our centre catering to patients from all parts of UP which is the most populous state in India.[1,2]

Aim and Objective: Analyse the causes for deferral in blood donors at our centre.

Methods: This is a retrospective study conducted during the period from 01/01/2018 to 30/06/2023 (5.5 years) in which the causes for the deferral in blood donors were segregated and analysed to find out the most common ones. DCA guidelines were used to screen the donors.

Results: 3,03,940 donors were evaluated during the period of 5.5 years averaging around 55000 donors per year. Of this, 38725 (12.5%) donors were deferred in which 95.4% were temporary deferrals and 4.6% were permanent deferrals. Anemia was the most common cause for temporary deferrals (42.2%) followed by medications (20%), donor not wishing to donate (11.7%), low weight (6.7%) and recent alcohol consumption (3.6%). History of liver disease was the most common cause for permanent deferral (0.9%) followed by high risk behaviour (0.8%) and medical causes (0.6%).

Conclusion: The study indicates that the blood donor deferral can have variations based on regional aspects that should be considered when national policies are developed. Results of UP, being the most populous state of India, can be indicative of the similar findings for the rest of the country.[3]

References

Shrivastava M, Shah N, Navaid S, Agarwal K, Sharma G. Blood donor selection and deferral pattern as an important tool for blood safety in a tertiary care hospital. Asian J Transfus Sci 2016;10:122-6.

Gonnade N, Bajpayee A, Elhence A, Lokhande V, Mehta N, Mishra M. And using cord blood for transfusion Azikiwe University Teaching Hospital. 2017;12:105-11.

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

A 1.7: A comparative interventional study to know the effect of pre-donation water hydration and applied muscle tension among blood donors in a tertiary care hospital

Ramini Sheetal, B Shanthi, V Sudhir Kumar, K Mahesh Kumar

Department of Immunohematology and Blood Transfusion, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India

Aims and Objectives: 1. To determine the actual Vasovagal reaction incidence rate, severity among blood donors and the associated risk factors for vasovagal development. 2. To compare the incidence, severity of vasovagal reactions for both hydration and non-hydration group. 3. To assess Blood Donor Reaction Inventory (BDRI) 4 item score post donation for both hydration and non-hydration group. 4. To know the effect of leg exercise prior to venipuncture.

Methodology: A comparative interventional study was done from 1st May 2022- 31st May 2023. A total of 23620 healthy blood donors aged from 18-65 years old are divided into 2 groups. Group A consists of 13473 donors with no water intake prior to donation, Group B consist of 9527 donors consuming 250 ml water before 20 minutes of donation. 620 donors who were instructed to do leg exercise prior to donation were also analysed. Donors were assessed with BDRI 4-item score post donation. Severity of vasovagal reactions were classified according to DGHS.

Results: The incidence of Vasovagal reactions among all blood donors was 488 (3.6%). Hydration group showed significantly lower vasovagal incidence 108 (1.1%) compared to donor with applied muscle tension 9 (1.5%) and non-hydration group 380 (2. 8%).Younger age, low weight, females, lower estimated blood volume were associated with vasovagal reaction incidence. The BDRI score were significantly lower in hydration group compared to donors with leg exercise prior to donation and non-hydration. According to DGHS guidelines, mild group – 307 (63%), moderate – 116 (23.96%), severe – 63 (13%), very severe-2 (0.04%).

Conclusion: Potential benefits of donor interventions such as predonation water hydration and applied muscle tension were effective in reducing vasovagal reactions incidence among blood donors and also associated with increased donor retention.

References

France CR, Ditto B, France JL, Himawan LK. Psychometric properties of the Blood Donation Reactions Inventory: A subjective measure of presyncopal reactions to blood donation. Transfusion 2008;48:1820-6.

Eder AF. Improving safety for young blood donors. Transfus Med Rev 2012;26:14-26.

A 1.8: Blood donor deferral pattern at a tertiary care hospital blood centre

G Archana, J Ravishankar

Department of Immunohaematology and Blood Transfusion, Tirunelveli Medical College and Hospital, Tirunelveli, Tamil Nadu, India

Introduction: As blood is a precious source, it is necessary to ensure its safety before transfusion. Donor deferral is common during the stringent process of donor selection.

Aim and Objective: To describe the blood donor deferral pattern among blood donors at a tertiary care hospital blood centre.

Materials and Methods: This was a retrospective cross sectional study conducted by analysing 6 months’ data (January 2023 - June 2023) in one month (July 2023) at the Department of Immunohaematology and Blood Transfusion, Tirunelveli Medical College Hospital, Tirunelveli, Tamilnadu, India. Details of donors (demographic details, previous donation history, reasons for deferral) were retrieved from donor deferral register. Data was entered and analyzed in Microsoft excel. Descriptive data were given in summary statistics.

Results: Of the 6839 donors registered, 5461 had donated with a deferral rate of 20.15% (n=1378/6839). While 93.32% (n=1286/1378) were temporarily deferred, 6.67% (n=92/1378) were permanently deferred. Most of the donors were in 18-30 age group (67.27%, 927/1378). 83.89% (n=1156/1378) were males. Most common reasons for temporary deferral were low hemoglobin (17.42%, n=224/1286), inadequate sleep (12.13%, n=156/1286) and tattooing within 12 months (10.96%, n=141/1286), while the most common reasons for permanent deferral were uncontrolled diabetes on insulin (38.04%, n=35/92), thyroid disorders (36.96%, n=34/92) and epilepsy on treatment (8.69%, n=8/92).

Conclusion: Females deferred due to low hemoglobin can be encouraged to take iron rich diet and supplements. Inadequate sleep was common in males and addressed with change in sleep pattern. Such measures could help the blood centres to retain donors who were deferred temporarily.

Key words: Blood donor deferral, donor selection, low hemoglobin, permanent deferral, temporary deferral.

References

Shrivastava M, Shah N, Navaid S, Agarwal K, Sharma G. Blood donor selection and deferral pattern as an important tool for blood safety in a tertiary care hospital. Asian J Transfus Sci 2016;10:122-6.

Bahadur S, Jain S, Goel RK, Pahuja S, Jain M. Analysis of blood donor deferral characteristics in Delhi, India. Southeast Asian J Trop Med Public Health 2009;40:1087-91.

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

A 1.9: Therapeutic plasma exchange as a bridge to liver transplantation in Wilson disease (pediatric age group) practical approach

Purnima Rao, Smita Joshi, Ashwini Bhilare, Snehavardhan Pandey

Acute liver failure (ALF) can be a primary presentation of Wilson disease (WD) with high mortality rate. Wilson’s disease (WD) is a lethal metabolic disease in childhood ranges from asymptomatic liver disease, acute liver failure to cirrhosis. Therapeutic plasma exchange (TPE) in pediatric age group is technically challenging because of low blood volume, difficult venous access & usually patient’s poor cooperation. TPE is a procedure used for removal of copper & circulating autoantibodies and provides a bridge for liver transplantation. Presenting herewith “A case study of a 5-year-old child having WDALF treated by TPE followed by liver transplant for quality life”.

Material: A 5-year-old female child admitted with H/o high grade fever for a day, decreased oral intake & reduced urine output. Cearuloplasmin Levels were low with high LFT & 24 hours Copper level in urine was high & mild abdominal distension with ++ icterus. Patient was given higher antibiotics, antipyretics & other supportive treatment by which the fever was settled. On investigations, it was diagnosed as Wilson’s disease. She underwent total 9 sessions of plasma exchange along with supportive treatment, hence the decision for ABO group specific liver transplantation was taken as her bilirubin was high but without any other infection. Liver transplant was successfully performed & patient was discharged with post-transplant medications to prevent organ rejection for life.

Results: This patient was timely diagnosed & treated with TPE & liver transplantation & went home with good prognosis.

Conclusion: WDALF children can survive and recover with plasmapheresis which proved to be a boon “A bridge “for liver transplantation.

A 1.10: A study of indications, clinical applications, and effects of therapeutic phlebotomy at a tertiary care hospital Navi Mumbai

Sonal Gupta, Damayanti Dey, Shweta Dhote

Department of Immunohaematology and Blood Transfusion, MGM Medical College and Hospital, Navi Mumbai, Maharashtra, India

Aim: To study the effects on Lab parameters of therapeutic phlebotomy among patients in MGM Medical College Navi Mumbai.

Objectives:

To categorize the indication of Therapeutic phlebotomy

To analyze the effects on Lab parameters of Therapeutic phlebotomy among patients.

Methods: It’s a 5-year Retrospective study and was conducted in department of Immunohematology and Blood transfusion, method of analysis was - Patient name, age, sex, diagnosis, height, weight, vitals, and Lab parameters.

Results: In the study, of 150 patients most common indication is Polycythemia, 97% were Male and 3% Female, most common age group is 41-50 yrs. (27%). 4% were JAK 2 mutation positive.

Conclusions: Therapeutic Phlebotomy is an essential part of the treatment of various diseases especially those with iron overload, it is safe and cost effective treatment. Further studies are needed to improve the treatment guidelines for therapeutic phlebotomy.

References

Effect of therapeutic phlebotomy on plasma volume in polycythemia patients. Glob J Transfus Med 2018;3:117.

Kim KH, Oh KY. Clinical applications of therapeutic phlebotomy. J Blood Med 2016;7:139-44.

A 2.1: Evaluation of hematological and hormonal parameters in plateletpheresis donors

Pradeep Kr Maurya, Tulika Chandra, Archana Solanki, Ashutosh Singh, Wahid Ali

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

Introduction: Single-donor platelets are collected by centrifuging a fixed volume of whole blood. Citrate (ACD) anticoagulants inhibit the calcium-dependent clotting cascade. As ionized calcium levels fall due to chelation by citrate, calcium mobilization secondary to increased PTH secretion during apheresis is seen. TPO is the principal regulatory body of thrombopoiesis and increases output by stimulating thrombocyte synthesis in donors.

Aims and Objectives:

To study the alteration in hematological parameters in plateletpheresis donors

To study the alteration in serum Thrombopoietin (TPO) levels in plateletpheresis donors

To study the alteration in serum Parathormone (PTH) levels in plateletpheresis donors.

Materials and Methods: Donors were selected as per guidelines laid down by the Drugs and Cosmetics Act, 2020.[1] Sampling was done for ABO and Rh grouping and transfusion transmissible infections. Plateletpheresis procedures were performed on COM.TEC, Fresenius Kabi, Germany®. On day 0, a complete hemogram and serum parathormone (PTH) levels were evaluated before and after plateletpheresis. Evaluation of serum TPO levels was done before plateletpheresis on day 0 and after plateletpheresis on day 3.

Results: WBC count, RBC count, Hb, Hct, MCV and platelet count showed statistically significant (p<0.001) fall in values post plateletpheresis. PTH showed statistically significant rise (p<0.001) while TPO showed statistically not significant rise (p>0.05) after plateletpheresis. The correlation between Platelet count and TPO level was found to be r = 0.243, which was positive but weak.

Conclusion: A statistically significant drop in hematological parameters was seen postplateletpheresis. With the continuous infusion of ACD, symptoms of hypocalcemia were observed and postplateletpheresis PTH levels were found to be raised significantly, as well as postplateletpheresis TPO levels were found to be raised to increase the reduced platelet counts.

Reference

Drugs and Cosmetics Act, 2020. The Gazette of India: Extraordinary. CG-DL-E-11032020-218602. No. 142; 2020.

A 2.2: The purpose of this study is to determine the role of TPE in Ratol paste (3% yellow phosphorus) poisoning

Kiruthika, K Anbu Lenin1

1Department of IHBT, Vinayaka Mission’s Kirupananda Variyar Medical College and Hospital, VMRF (DU), Salem, Tamil Nadu, India

Aims: The purpose of this study is to determine the role of TPE in Ratol paste (3%yellow phosphorus) poisoning.

Materials and Methods: This was a descriptive period study conducted from November 2022 to July 2023. Eight consecutive Ratol paste poisoning patients were included in the study. Liver function tests such as total bilirubin, direct bilirubin, SGOT, SGPT and Coagulation profile including prothrombin time, activated partial thromboplastin time, and international normalized ratio were recorded at the time of admission and after each TPE session. Results obtained were analysed by using SPSS version 24.

Results: A total of 8 cases who underwent 26 cycles of Therapeutic plasma exchange were included in this study. Out of all, 2 (25%) underwent 5 cycles each, 1 (12.5%) underwent 4 cycles, 2 (25%) underwent 3 cycles each and 3 (37.5%) underwent 2 cycles of TPE each. The mean value before and after TPE for the patients underwent 5 cycles of TPE for total bilirubin, direct bilirubin, SGOT, SGPT, PT, APTT, INR were 2.6 mg/dl, 0.69 mg/dl, 31U, 19.5U, 21.95 sec, 40.5 sec, 1.77 and 1.6 mg/dl, 0.45 mg/dl, 25U, 16U, 15.3 sec, 27.85 sec, 1.22 respectively.

Conclusion: All the patients who underwent five and four cycles of TPE showed significant improvement in the liver function tests and coagulation profile and hence TPE could potentially bridge the gap between medical management and liver transplantation in cases of Ratol paste (3% yellow phosphorous) poisoning.

A 2.3: Therapeutic plasma exchange in various clinical settings at a tertiary health care centre: A retrospective analysis

Kolahalam Venkata Sai Kiran, Nidhi Bhatnagar, Sangita Shah, Mamta Shah

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

Aim: Therapeutic plasma exchange (TPE) was first described as an extracorporeal blood purification technique. According to ASFA 2023 guidelines, TPE is considered first-line treatment in many clinical conditions and can be lifesaving at times.

Objectives:

To determine the frequency of different clinical indications for performing TPE.

To analyze the variations in plasma volume exchanged.

Methodology: This is a retrospective observational study of all the TPE procedures performed in our department of IHBT between 1st January to 31st December 2022. Patient parameters were enumerated and frequency of indications was calculated. Patient’s plasma volumes were calculated and corresponding exchanged plasma volumes were noted. Statistical relationship was calculated using IBM SPSS Statistics 26.

Results: Within the study period, a total of 723 TPE procedures were performed on 181 patients. The frequency distribution: Neurological (83.4%) – Majority being GBS (62.5%), Transverse myelitis (11%); Immunological disease and Vasculitis (14.4%) – Majority being Myasthenia gravis (11%), TTP (1.2%). The calculated plasma volume was significantly higher in patients with immunological diseases and vasculitis (2728 [2491-3148] ml) compared to patients with neurological disorders (2376 [2078-2872] ml) [p value - <0.01]. Moreover, the mean exchanged plasma volume was lower than recommended in both the strata being 0.92 (0.72-1.1) in neurological diseases and 0.77 (0.69-0.82) in immunological diseases and vasculitis (p value <0.01).

Conclusion: The majority of the patients that received TPE had neurological conditions, single major indication being Guillain-Barré Syndrome. Patients with high body weight and lower hematocrit did not receive recommended exchange volume.

A 2.4: Effectiveness and safety of therapeutic plasma exchange in neurological disorders: Measuring the response to treatment by using modified Rankin scale

Shubham Gupta, Aseem K Tiwari, Geet Aggarwal, Sunil Golia, Samruddhi Pawar

Introduction: Therapeutic plasma exchange (TPE) is commonly used as treatment modality in various neurological disorders. The main objective of TPE is removal of “pathological antibodies”, responsible for disease progression and provide relief to patient. However, such response to TPE in these neurological disorders is usually noted in “subjective” terms. We, therefore, measured response to treatment, objectively, using Modified Rankin’s Scale (MRS).

Methods: This was an observational prospective study in patients diagnosed with autoimmune neurological disorders who underwent TPE. This study was carried at tertiary care Centre, within the span of one year. Data collected included age, gender, neurological diagnosis, days of ICU and in-patient stay, number of TPE sessions, volume processed, replacement fluid, response to treatment and adverse reactions, if any. The response to treatment was assessed by applying disability scale called Modified Rankin Scale (MRS), in overall eight neurological disorders, before (pre-TPE) and after TPE (post-TPE). Pre- and post-TPE clinical condition were compared using Wilcoxon matched-pairs signed-ranks test.

Results: Fifty-four patients were included, with 15 females and 39 males, who had mean age of 39.5 years. Eight different autoimmune neurological disorders were; myasthenia gravis (MG; n = 11), Guillain–Barre syndrome (GBS; n = 18), neuromyelitis optica spectrum disorders (NMOSD; n =6); chronic inflammatory demyelinating polyneuropathy (CIDP; n = 5); autoimmune encephalitis (AE; n = 6); Transverse myelitis (TM; n= 6); Multiple sclerosis (MS; n= 1); Subacute Sclerosing Panencephalitis (SSPE; n=1). Patients received median of 5-cycles of TPE and mean 1.5 plasma volume was exchanged. Out of 54 patient, ten (18%) admitted in ICU had median stay of 11 days. Out of these ten patients four patients were moved to in-patient ward, upon improvement in clinical condition. Rest 44 (81%) patients were in-patients, with median of 12 days in-patient stay. The improvement in MRS score was significant when post-TPE scores were compared with pre-TPE scores. Most common adverse reaction was shivering (n=10; 37%). Adverse events were managed clinically.

Conclusion: TPE proved as an effective and safe treatment modality in providing relief to the patients with neurological disorders.

A 2.5: Outcomes of therapeutic plasma exchange: A study at tertiary care hospital, Indore

Piyush Kumar Sharma, Ashok Yadav, Khushboo Likhar, Ramu Thakur

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

Aims and Objectives: The aim of this study is to assess the effectiveness of therapeutic plasma exchange in improvement of patients of neurological and non-neurological disease.

Methods: A retrospective analysis of TPE procedures was done for a period of 5 years from 2019 to 2023 at MGM Medical College, Indore. A total of 286 TPE procedures were performed in 73 patients between 15 to 60 years of age. Patients underwent at least 3 to 5 cycles of TPE session with Spectra Optia and/or Haemonetics MCS plus on alternate day. ACD solution was used for anticoagulation.1-1.5 plasma volume was planned for exchange during every cycle. Data analysis was performed using SPSS software 25.0 (trial version).

Results: Total 73 patients were indicated for TPE procedure. Neurological cases accounted to 79.4% (59), in which 72.8% (43) cases of GBS followed by the 11.8% (7) cases of MG, 6.7% (4) Cases of NMO and 8.4% (5) others. Out of 73 cases non-neurologic cases accounted to 19.1% (14), in which 35% (5) cases of atypical HUS followed by 28% (4) of TTP and 35% (5) others. Out of 73 patients, clinical and functional improvement was noted in 69 patients.

Conclusion: Therapeutic plasma exchange is a nearly risk-free and effective adjuvant therapy for a variety of neurological and non-neurological disorders. Major complications were uncommon & minor complications were fever chills and hypotension that were effectively managed during the procedure cycle.

References

Padmanabhan A, Connelly-Smith L, Aqui N, Balogun RA, Klingel R, Meyer E, 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 eighth special issue. J Clin Apher 2019;34:171-354.

Bobati SS, Naik KR. Therapeutic Plasma Exchange - An Emerging Treatment Modality in Patients with Neurologic and Non-Neurologic Diseases. J Clin Diagn Res 2017;11: C35-7.

Paternostro-Sluga T, Grim-Stieger M, Posch M, Schuhfried O, Vacariu G, Mittermaier C, et al. Reliability and validity of the Medical Research Council (MRC) scale and a modified scale for testing muscle strength in patients with radial palsy. J Rehabil Med 2008;40:665-71.

A 2.6: A retrospective study of changes in platelet parameters of plateltpheresis donors after COVID-19 infection

S Akhtar, D Setya, A Malhotra1, S Sharma1

Departments of Transfusion Medicine and 1Hematopathology, Manipal Hospital, Jaipur, Rajasthan, India

Aims and Objectives: Platelet parameters like plateletcrit (Pct), platelet distribution width (PDW), platelet-large cell ratio (P-LCR) and mean platelet volume (MPV) are readily available in laboratory using cell counters. During COVID-19 pandemic, these parameters were studied for association with severity of disease. It was observed that patients with the infection had thrombocytopenia. However, impact was not studied in donors coming for donation who had suffered from the infection. The aim of this study was to assess changes in platelet parameters after COVID-19 infection in repeat plateletpheresis donors coming for plateletpheresis.

Materials and Methods: This was a retrospective, observational study conducted in department of Transfusion Medicine at a tertiary healthcare facility from January 2023 to June 2023. All plateletpheresis donors who had donated before COVID-19 pandemic i.e. between January 2019 to March 2020 who also came for donation after recovering from laboratory proven COVID-19 infection between August 2020 to June 2022 were included in the study. Values of platelet parameters of included donors was compared and a statistical analysis of pre and post COVID-19 values was performed.

Results: During the study duration, a total of twelve such donors were identified using inclusion and exclusion criteria. All twelve were male donors with a mean age of 39 ± 6 years. Out of twelve, two donors had history of severe infection requiring hospital admission. Before COVID-19, mean platelet count was 228±46 x 103/µL, mean Pct was 0.35±0.15%, mean PDW was 15.6±4 fL, mean P-LCR was 35.3±6% and average of MPV was 11±1.2fL. After COVID-19, mean platelet count was 192±23 x 103/µL, mean Pct was 0.28±0.4%, mean PDW was 19.1±2 fL, mean P-LCR was 41.7±3% and average of MPV was 14.2±0.9fL. A statistically significant difference was observed in all platelet parameters.

Conclusion: Though there are confounding factors like change in lifestyle during COVID-19 pandemic, a significant difference was observed in all platelet parameters before and after COVID-19 infection in plateletpheresis donors.

B 1.1: Buffy coat pooled platelets – A cost-effective alternative to single donor apheresis platelets for hemato-oncology patients in Indian scenario: A randomized cross-over study

Prateek Srivastava, Hari Krishan Dhawan1, Ratti Ram Sharma1, Pankaj Malhotra2

Department of Transfusion Medicine, Medanta Hospital, Lucknow, Uttar Pradesh, Departments of 1Transfusion Medicine and 2Clinical Haematology and Medical Oncology, PGIMER, Chandigarh, India

Aim: Since Buffy Coat Pooled Platelets (BCPP) have recently been licensed for clinical use in India, this study was conducted with an aim of determining the feasibility of its preparation, and comparing it with Single Donor Apheresis Platelets (SDAP) in terms of efficacy, safety, and cost.

Methods: Five ‘O’ positive buffy coats were pooled and suspended in Platelet Additive Solution. In a randomized cross-over study design, 93 non-refractory, hemato-oncological patients were assigned either BCPP or SDAP as their first transfusion product. For subsequent requisition, the other product was transfused to the same patient. Corrected count increment (CCI) and Percentage Platelet Recovery (PPR) were calculated one hour after each transfusion. For cost analysis, all resources consumed during BCPP and SDAP preparation were considered.

Results: Multivariate analysis established that the estimated difference in outcomes of BCPP and SDAP for CCI was -549.3 (95% CI: -1129 to -30), for PPR was -1.62 (95% CI: -3.02 to -0.21), for platelet increment was 6202 (95% CI: 4742 to 7661), and for inter-transfusion interval was 35.0 (95% CI: 10.5 to 59.5), showing that the results were statistically significant. No transfusion reactions were reported. Total cost of one unit SDAP and BCPP was found to be Rs.10,498 and 4,063 respectively.

Conclusion: In non-refractory, hemato-oncological patients, BCPP is non-inferior to SDAP in terms of post- transfusion CCI and PPR, and superior in terms of post-transfusion platelet increment and inter-transfusion interval. Since BCPP costs significantly lesser than SDAP, it can act as a good alternative to SDAP in resource-constrained settings.

B 1.2: To study prevalence of bacterial contamination in blood and blood components

Nirali M Desai, Rinku Shukla, Kruti Dumaswala

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

Aim and Objective: To study the prevalence of bacterial contaminations in whole blood and blood components.

Materials and Methods: This study was conducted from January 2023 to May 2023. In total, 168 blood and blood components like Red cell concentrates and Platelet concentrates were processed for sterility testing manually using Brain Heart Infusion medium and a Sodium thioglycolate medium. The blood bags were thoroughly mixed before sampling. Segment used as a sample were inoculated aseptically. The bacterial growths were identified by their colonial morphology, grams reactions, and biochemical tests, and MALDI-TOF Mass Spectrometry (Matrix- Assisted Laser desorption/Ionization Time-of Flight).

Results: Out of 168 samples, 3 samples were tested positive for sterility testing Bacterial contamination was not observed in the whole blood where as it was observed in one RCC and 2 PC components and they were found to be sterility positive at half-life. The contaminant found in RCC and PCs was Bacillus cereus.

Conclusion: Total 168 blood and blood components were checked for sterility testing and the prevalence rate was found to be 1.7 %. Bacillus cereus can be present as the environmental contaminant and possibilities while component separation or while storage.

B 1.3: Should Cryo be prepared from fresh frozen plasma prepared beyond standard time interval: Factor VIII and fibrinogen assessment in fresh frozen plasma

Shubhi Yadav, Tulika Chandra, Archana Solanki, Ashutosh Singh

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

Background: Fresh frozen plasma (FFP) is plasma separated from whole blood, frozen within 6-8 hours after collection, and stored at -20 degC or below.[1] Typically, 170-200 mL of FFP is separated from standard donation of whole blood (350 mL), containing more than 70-80 units/dl of factor VIII, factor. IX, von Willebrand factor, and other plasma clotting factors.[1] Quality analysis of FFP, 1% of all the units prepared or 4 units per month are tested for stable coagulation factors (200 Units of each factor); Factor VIII - 0.7 Units/mL and Fibrinogen levels 200-400 mg/dl.[2]

Aims: Assessment of Fibrinogen levels and factor VIII levels in the same FFP unit at 4, 6, 8, 10 hours from the time of collection of whole blood.

Methods: In this study following procedures were done: -Donors who fulfilled the criteria of donation according to Drugs and Cosmetic act 2020 were allowed to donate. Phlebotomy was done under all aseptic precautions, in a single prick and blood was collected within 6-8 minutes after that. These units were prepared within 4 hours of collection and then it was assessed at different time intervals namely 4, 6, 8 and 10 hours. (From the time of collection of whole blood). All the FFPs were prepared using refrigerated centrifuge and heavy spin (3150 rpm) at a temperature of 22 deg c for 11 minutes.

Results:

On assessment of fibrinogen at different time intervals, mean value at 4 hours is found to be 279.06 which is maximum out of all and the mean values at 6, 8 and 10 hours which is 272.32, 276.36 and 274.82 respectively. All the values are within the normal range (200-400 mg/dl)

Factor 8 levels on assessment at 4, 6, 8 and 10 hours is also found to be maximum at 4 hours (124.42) out of all and the levels at 6, 8 and 10 hours are 123.28,122.1 and 118.8 respectively, all the values are within normal range (70 units/dl).

Conclusion:

The fall in levels of both the factors (fibrinogen and factor 8) is significant only from 8 hours to 10 hours but the mean values of the factors in every sample irrespective of the time at the assessment are within normal range

So the time taken for preparation of FFP should be within 6 to 8 hours but in case of any huge camps crediting a larger number of donated units where there might be delay in freezing of FFP because of already occupied deep freezers, the period between extraction and freezing can be increased, thus the total time of preparation can be within 10 hours (from the time of collection).

B 1.4: A prospective study on acute adverse reactions following transfusion of blood and blood products in tertiary health care center AIIMS, Raipur

Srilaxmi Srangi, Minal Wasnik

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

Aims and Objectives: To analyze the frequency and nature of acute transfusion reactions following blood and blood product transfusion reported in AIIMS, Raipur.

Methodology: This was a prospective study conducted in blood bank of Department of transfusion medicine AIIMS, Raipur. All acute transfusion reactions reported to the blood bank over a period of 12 months (July 2022 to June 2023) were reviewed and analyzed. Data were analyzed in SPSS version 21 software. P< 0.05 was considered significant.

Results: Out of 21,155 units transfused, 23 patients (0.10%) ATRs during or after transfusion within 24 hours. The incidence of FNHTR was maximum observed in 13 (56.5%) patients, followed by Allergic Transfusion Reaction in 6 (26%) patients) followed by transfusion-associated hypotension (8.6%) followed by TRALI observed with FFP and hemoglobinuria with PRBC (4.3%) each. Of all the reported ATRs, 21 (91.3%) occurred with PRBC, 1 (4.3%) with PLT, while FFP transfusions were responsible for 1 (4.3%) and 0 % with WB and CPP.TRALI is observed in 1 patient transfused with FFP (4.3%).

Conclusion: We observed acute transfusion reaction in 0.1% of transfusion, definite attribution to components transfused. Majority of the reactions observed were FNHTR followed by allergic reactions followed by Transfusion associated hypotension, TRALI, and Hemoglobinuria.

B 1.5: Study of acute nonhaemolytic transfusion reactions in patients receiving blood components

V Neeharika, B Shanthi, K Mahesh Kumar

Department of Immunohematology and Blood Transfusion, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India

Aims and Objectives: To study the clinical features of acute non-hemolytic transfusion reactions [ANHTRs], and to determine effect of gender on transfusion reaction.

Methods: This is a retrospective study done between February 2022 to July 2023. Patients age, sex, disease, history of previous transfusions, pregnancy, clinical features of transfusion reaction were obtained from transfusion reaction reporting form and hospital information system. Post-transfusion Samples were obtained from physicians, blood bag. Transfusion reaction workup was done. Severity of ANHTR was evaluated and classified into 7 types: Allergy, Anaphylactoid, Anaphylaxis, Febrile, Sepsis like, TRALI and Dyspnoea.

Results: 29 patients with ANHTR reported in NIMS hospital, 19 [65.5%] females and 10 [34.4%] male patients got ANHTR after 24 h of Transfusion. Among them, TRAR were 12 [43.4%], anaphylactic were 3 [13.04%], anaphylaxis were 2 [8.69%], febrile were 3 [13.04%], sepsis-like were 2 [8.69%], TRALI were 1 [4.34%], Dyspnoea were 1 [4.69%]. Patients with age <25 were [12], <50 were [15], <70 were [2]. Patients with positive blood cultures were 2, Patients with history of previous transfusions were 11. Among them 5 were from haemato- oncology, 1 from cardiothoracic surgery, 2 from general medicine, 3 from medical oncology.

Conclusions: The incidence of ANHTRs is high in females than in male patients. Incidence of allergic transfusion reactions were high among both the groups followed by febrile, anaphylactiod, sepsis-like, anaphylaxis. Beneficial strategies to avoid allergic reactions include judicious use of blood components, identifying high risk patients.

References

Imoto S, Araki N, Shimada E, Saigo K, Nishimura K, Nose Y, et al. Comparison of acute non-haemolytic transfusion reactions in female and male patients receiving female or male blood components. Transfus Med 2007;17:455-65.

Combs MR, Drew MJ, Goodnough LT, et al. Non-infectious complications of blood transfusion. In: Brecher ME, editor. AABB Technical Manual. 14th ed. Bethesda, Maryland: American Association of Blood Banks; 2002. p. 585-612.

B 1.6: Study of complications of therapeutic plasma exchange according to patients’ demography and variations in procedure

Jyoti Bharti, Tulika Chandra, Archana Solanki, Ashutosh Singh

Department of Immunohematology and Blood Transfusion Medicine, King George Medical University, Lucknow, Uttar Pradesh, India

Aims and Objectives: To observe a correlation between a patient’s demography profile and procedural variation with complications after Therapeutic plasma exchange during the procedure, after 24 hr, at 1 week, and at 1 month.

Materials and Methods: Observed complications in 150 patients in one year during therapeutic plasma exchange during the procedure, after 24 hr, at 1 week and at 1 month.

Results: TPE was done on 150 patients, 78 were female and 72 were male, aged 10 – 89 years. 40 (26.67%) and 46 (30.6%) patients had complications, during the procedure and within 24 hr after the procedure respectively. Complications seen during the procedure were allergy, nausea, cough (8.0%), allergy (6.67%), hypothermia (5.33%), itching and nausea (2. 67%), and tingling sensation all over the body (1.33%). Complications seen within 24 hr after the procedure were abdominal discomfort (8.0%), cough, mild bipedal edema and hypothermia (5.33%), severe bipedal edema (2.67%), death (2.6%), vomiting (1.33%). After 1-week, during follow up only out of 54 patients [04 (07.41%)] patients reported abdominal discomfort, followed by bipedal edema [08 (5.33%)]. Maximum mean age (32.50±12.50) and maximum mean BMI was observed (34.61±3.09) with Abdominal Discomfort. Only 02 (8.70%) female and 08 (25.81%) males were observed with complications. After 1 month during follow-up only out of 39 total patients [02 (5.13%)] patient having lower back pain, 02 (10.00%) females were observed with complications, 19 (100%) males were observed without complications.

Conclusion: As the time durations increased complications were minimized.

B 1.7: An insight into quality control of blood components: A step towards safe and efficient supply of blood components

B Anandeeswari, Dr. M. Sintha(HOD), Dr.S. Rajeswari

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

Aims and Objectives:

To ensure the supply of safe and efficient blood components through periodical Internal QC Programmes.

To study the Volume, Appearance, Sterility of all Blood units meant for QC.

To study PCV in PRBC units and Whole blood, Platelet count, RBC contamination & WBC contamination in SDP and RDP units meant for QC.

Methods: Study design - Retrospective Analytical study. Study period - 4 years from January 2019 to December 2022 in the Department of IHBT, Madurai Medical College. Volume, Appearance, Sterility for all units, PCV for PRBC & Whole Blood units, Platelet count, RBC contamination, WBC contamination for RDP & SDP units were analysed.

Results: A total of 87,327 units Whole Blood were collected in 4 years. 79, 159 Packed Red Blood Cells, 79,384 FFPs, 49,605 RDPs, 12 SDPs processed. 727 PRBCs, 414 RDPs, 12 SDPs were sent for QC analysis. In our study, 96.87% of PRBCs, 96.4% of RDPs, 100% of SDPs fulfilled the quality requirements.

Conclusion: Good Manufacturing Practice, Quality Control, Audit Programmes are closely interlinked together with the management of Errors and Incidents in a Blood Centre.

References

Das SS, Biswas RN, Sardar TP, Safi M. An insight to the internal quality control of blood components separated using the latest whole blood collection and processing systems: Experience from a tertiary care hospital blood transfusion service in Eastern India. Asian J Transfus Sci 2022;16:194-200.

Arora R. IP J Diagn Pathol Oncol 2022.

B 2.1: Analysis of thrombocytopenia in blood donors in Uttar Pradesh

Rajeev Kumar, Tulika Chandra, Ashutosh Singh, Archana Solanki

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

Background: Thrombocytopenia is a common haematological disorder, characterised by platelet count <150000/ul. The aetiology of thrombocytopenia is multifactorial.[1] Platelet are disc-shaped cell fragments whose function is to react to blood vessel injury by clumping to initiate the formation of a blood clot. Thrombocytopenia increases the risk of bleeding, however, most cases of thrombocytopenia are detected on as Routine complete blood count (CBC).

Aim and Objective: The study determined the prevalence of thrombocytopenia in blood donors in various region of Uttar Pradesh.

Methods: We conducted prospective study at Dept. of transfusion medicine at KGMU. We screened blood donor for platelet count by using a standardised Medonic M20M GP cell analyser a new 3 – part cell counter with 20 parameters.

Results: During 3-month study period 1500 blood donors were screened for thrombocytopenia at dept. of transfusion medicine KGMU. The prevalence of Thrombocytopenia in Uttar Pradesh comes as 40.4%. According to mapofindia.com Uttar Pradesh divided into 4 different regions. Prevalence of Thrombocytopenia in these region: in east up is 39.3%, in west up 50%, in central up 40.2% and in Bundelkhand is 36.4%.

Conclusion: The prevalence of Thrombocytopenia in Uttar Pradesh is 40.4% and in different region of Uttar Pradesh prevalence is different. This can be used in blood centre for screening of blood donor for thrombocytopenia and it will be useful in blood centre to increase the quality of Random donor platelet where blood component are prepared.

B 2.2: The least incompatible/best matched PRBC transfusion by biological in vivo compatibility test

Manoj Kumar Dubey, Tulika Chandra, Ashutosh Singh, Archana Solanki

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

Background: Biological in vivo compatibility test is an essential serological test in patients who’s crossmatched PRBC not showing compatibility.

Aim and Objective: This study aimed to determine the safety and efficacy of the least incompatible/best matched PRBC transfusion through the biological in vivo compatibility test.

Methods: This is a prospective observational study conducted at Dept. of Transfusion Medicine at KGMU. Till now 5 patients are included in our study, for whom appropriate red blood cells (RBC) could not be found. Total 11 best matched PRBC units transfused by applying the “in vivo compatibility test” patients were observed during and after the transfusion with respect to acute hemolytic reactions that could develop. The biochemical parameters (S.LDH, S. Bilirubin, HCT, Retic count, Hb) of hemolysis were examined before and after at 24 hrs. of transfusion.

B 2.3: Intrauterine transfusion as a measure of fetal salvage – In a case of very high titre material anti D >2048 along with other multiple alloantibodies

Sumita Pandey

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

Introduction: Intra uterine transfusion (IUT) is a lifesaving therapy in fetal anemia specially in Rh all immunization.

Case: 22 years old apparently healthy lady with no comorbidities married for 5 years G4P1+2 was referred at 22 weeks of her gestation for routine maternal alloantibody screening and titration. Her blood group was ARhD negative, RBC phenotype rr. Indirect coomb test was positive, 2+ in strength, alloantibody against D, C, E antigen. Her anti D titre was on increasing trend (>2048). She had a h/o 2 episodes of spontaneous abortion one at 24 weeks (3 years ago) and another at 28 weeks (2 years ago). Her husband’s blood group was A+ve, RBC phenotype R1R1. In doppler study fetal MCA-PSV was>1.5Mom. A decision was made to perform IUT on the basis of ultrasound finding and increasing rise of anti D titre. At the time of 1st IUT, gestational age was 24 weeks 3 days.

Preparation of RBC for IUT: O RhD negative, C, E negative, <5 days old collection, leukoreduced, irradiated (25Gy of gamma irradiation to the central portion of bag), with 75% hematocrit, bag volume 170 ml.

3 episodes of IUT procedure was performed at a interval of average 13 days. 1st pretransfusion hct was 28% and after last procedure post transfusion hct was 46%.

Post-partum Life: Baby girl was born at 32 weeks of gestation by LSCS. Birth weight 1.5kg, crying at birth, APGAR Score was 7 out of 10. She was needed 2 times of double volume exchange transfusion due high bilirubin and 3 times of top up transfusion. For every transfusion <5 days collected, leukoreduced, irradiated, Anegative, C, E antigen negative compatible with both mother and baby’s plasma [Baby blood group was A positive, DAT 3+]. The baby was discharged from SNCU at age of 42 days of her life with a hemodynamically stable condition.

Conclusion: Prompt decision making for IUT and selection of proper PRBC for every procedure as well as in post partum period can save a life.

Reference

New HV, Berryman J, Bolton-Maggs PH, Cantwell C, Chalmers EA, Davies T, et al. Guidelines on transfusion for fetuses, neonates and older children. Br J Haematol 2016;175:784-828.

B 2.4: Impact of notification and counselling of reactive blood donors in a tertiary care hospital in South India

M Deepika, A Divya

Department of Transfusion Medicine, Vinayaka Missions Kirupananda Variyar Medical College, Salem, Tamil Nadu, India

Background: Donor notification and counseling represents a crucial role in blood safety and reducing transfusion transmitted infections. TTI reactive donors were requested to follow up in blood centre for further counseling. The aim of this study was to determine the response rate of notified reactive donors and implement useful recommendations to improve the response rate amongst them.

Materials and Methods: This was a prospective study conducted in the blood centre by the Department of Transfusion Medicine, Vinayaka Missions Kirupanandha Variyar Medical College & Hospital, Salem from July 2022 to June 2023. A total of 1945 donations were screened for TTI‘s i.e. HIV, HBV, HCV, Syphilis & Malaria by rapid card tests and ELISA.[1] All TTI reactive donors were retested, informed of their status via telephone, called for re-testing, in-person counseling and referral for treatment.

Results: Out of 32 (1.65 %) donors with reactive TTI screening test results i.e. 12 (37.5 %) HBV, 10 (31.3%) HCV, 7 (21.9%) Syphilis, 3 (9.4 %) HIV and 0 Malaria were from replacement blood donations. Amongst these, 25 (78.13%) donors responded to phone call and remaining 7 (21.88%) did not pick up the call. Amongst the responders, 10 (40%) returned to hospital for re-testing, counseling and referral for treatment. Remaining 15 (60%) donors did not come for counseling or treatment. A total of 7 (21.88%) TTI reactive donors were non-responders as they could not be contacted by 3 telephonic calls with an interval of 2 weeks between.

Conclusion: Reducing TTIs through donor notification only is an impossible task. A centralized data system connecting all blood centers is the need of hour.

Reference

Sachdev S, Mittal K, Patidar G, Marwaha N, Sharma RR, Duseja AK, et al. Risk factors for transfusion transmissible infections elicited on post donation counselling in blood donors: Need to strengthen pre-donation counselling. Indian J Hematol Blood Transfus 2015;31:378-84.

B 2.5: E-ratio as criteria for further referral in asymptomatic donors with HCV infections

Niharika Yadav, Atul Sonker

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

Aim: The main aim of this study is to use E- Ratio as criteria for further referral in Anti HCV antibody positive asymptomatic blood donor population at our center.

Objective: Comparison and analysis of the demographics and history of high risk factors for HCV transmission in Anti HCV antibody positive blood donors, with respect to their E-ratios.

Methods: The study was conducted at Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute for medical sciences, Lucknow, over a period of one year. In this study, we have taken a total of 90 donors whose samples were reactive for Anti-HCV. We have used third generation ChLIA HCV (VITROS, ORTHO-CLINICAL DIAGNOSTICS) to screen the donor samples for Anti-HCV antibody. Donors with co-infection of HBV or HIV, and those who could not be contacted over the telephone were excluded. As a part of donor notification we contacted these 90 donors over the telephone and interviewed to obtain their demographics, education level and HCV risk factors. All the statistical analysis was performed on SPSS version 20. Qualitative variables are presented as proportions, and age as mean and standard deviation. Association between Anti-HCV antibody level and categorical variables was done using appropriate statistical tests. Differences were considered significant at p values of less than 0.05.

Results: Out of total 26548 donors, 90 came out to be Anti HCV Antibody positive. The mean age for donors with E-ratio more than one was 33 years. Out of 47 donors with E-ratio more than 10, 15 gave history of previous blood transfusion, 10 had history of previous surgery or invasive procedure done, 6 had history of recent tattoo (they denied this history when questioned at the time of blood donation), while rest had history of unsafe sex or drug abuse.

Conclusion: Among Anti-HCV antibody blood donors, those with E-ratio between 1-5 had no significant history of HCV risk factors whereas those with E-ratios more than 10 had significant history. Therefore, donors with E-ratio more than 10 should be referred for further supplementary testing for viremia.

Reference

Contreras AM, Tornero-Romo CM, Toribio JG, Celis A, Orozco-Hernández A, Rivera PK, et al. Very low hepatitis C antibody levels predict false-positive results and avoid supplemental testing. Transfusion 2008;48:2540-8.

B 2.6: Is prevention better than cure? The impact of NAT in a tertiary blood centre in South India: A 6 years experience

R K Abirami, P Amalraj, Dolly Daniel

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

Aims and Objectives: To assess the prevalence of NAT yield over a 6 years period in tertiary referral centre and assess number of potential events that have been prevented. To assess if the prevalence of NAT yield varies between replacement and voluntary donors. To study if these NAT yield samples were positive on the Q-PCR system.

Materials and Methods: This was a retrospective study where NAT yield data during the period 2017-2022 were collated. Subsequently performed Q-PCR samples were also collected, positivity in replacement and voluntary donors were assessed.

Results: A total number of 1,73,975 donors were tested in this 6 years. Of these 1,40,626 were replacement donors and 33,349 were volunteers. The overall NAT yield was 81, of which 80 being HBV and 1 being HCV yield. Of the 81 NAT yield 68 were noted in replacement (0.48% of all replacement donors) and 13 in volunteers (0.38%of all voluntary donors). 53 of 81 NAT yields were confirmed on a Q-PCR, while 28 were reported negative.

Conclusion: The NAT yield in total donor population was 0.046% with no significant difference between replacement and voluntary donor population. Considering that we are 100% component based, potential 243 cases of TTI’s were averted by this added layer of safety. The 35% donor not confirmed by Q-PCR ideally should have been followed up for seroconversion / negativity.

B 2.7: Appropriateness of fresh frozen plasma transfusion: A retrospective analysis

M Manimozhi

Tirunelveli Medical College and Hospital, Tirunelveli, Tamil Nadu, India

Aims and Objective: Every blood component carries inherent risk of adverse transfusion reactions and transfusion transmitted infections (TTI). As Fresh frozen plasma (FFP) is one of the commonly used blood component, appropriate and rational use is necessary for patient safety. The objective of the study was to evaluate the appropriateness of FFP utilization in clinical practice.

Methods: This retrospective study was conducted at the Department of Immunohematology and Blood Transfusion, Tirunelveli Medical College and Hospital, Tirunelveli, Tamilnadu, India in June, 2023. Blood Request Forms with request for FFP transfusion between December 2022 and May 2023 were analysed. Data entry and statistical analysis was performed using Microsoft Excel sheet.

Results: 631 patients received 1798 FFP units (mean = 2.85 units), 16.1% of transfusions were in the age group of 31- 40 years (n = 291/1798), 53.6% were in males (n=963/1798), 27.5% were issued to the Department of General medicine (n=495/1798). 65.1% of transfusions were appropriate (n= 1171/1798), the most common indication being therapeutic plasma exchange. Inappropriate transfusion indications were volume replacement, improve wound healing and prophylactic use during surgeries.

Conclusion: As FFP is involved more in adverse transfusion reactions like allergy and Transfusion related acute lung injury, inappropriate indications can be reduced significantly with continuous education of end users by regular CMEs, interactive sessions, discussion in Hospital Transfusion Committees and prospective audits, to ensure the optimal use of scarce resource and to reduce transfusion related adverse events.

Keywords: Appropriateness, fresh frozen plasma, transfusion reactions

References

Yadav A, Tiwari P, Sheemar AK. An audit on usage of fresh frozen plasma in a tertiary care hospital in north western part of India. Int J Res Med Sci 2020;9:106-11.

Lingegowda JB, Jeyakumar JD, Muddegowda PH, Pitchai R, Gopal N, Sinha P. An audit of requests for fresh frozen plasma in a tertiary care center in South India. J Lab Physicians 2016;8:41-4.

Kumar S, Kushwaha N, Tomar A, Philip J, Biswas AK. A retrospective audit to evaluate the appropriateness and rationalization of fresh frozen plasma usage in a tertiary care hospital. Med J Armed Forces India 2022;78: S226-31.

B 2.8: Performance validation of a new NAT platform for detecting transfusion-transmitted infection

R Shaikh, R Salgaonkar, M Rane, R Sawant

Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India

Aim and Objectives: It is essential to choose sensitive assays capable of detecting TTI, ensuring complete blood safety. In this context, this validation study was conducted to compare performance of cobas 5800 NAT platform for detecting HBV, HCV and HIV in blood donors. It is a PCR based nucleic acid testing system designed for low-to- medium throughput labs.

Materials and Methods: Blood donor screening was done using serology and NAT. Serological testing of samples was done by CLIA based assay. Cobas MPX PCR based MP-NAT, Procleix Ultrio Plus TMA-based IDNAT and NATSpert PCR based ID-NAT was used to test blood donor samples. 21 parallel samples were tested in same time period.

Results: For HIV detection, all 3 NAT platforms had comparable results. However, 1HIV NAT yield was picked by MP-NAT but missed by both ID-NAT. For HBV detection, there were 3 discordant results between MP-NAT and ID-NAT. Cobas MPX PCR MP-NAT on new 5800 NAT platform had better sensitivity and could detect 3 HBV infections missed by both UltrioPlus ID-NAT and NATSpert ID-NAT platforms. Further, MP-NAT on 5800 system was also able to pick up 1 co- infection (HBV+HIV) which was non-reactive on both ID-NAT platforms. Follow-up of discrepant samples was done to confirm true positivity. The samples were reported seropositive on follow-up. For HCV detection, NAT yield results were comparable between 3 NAT platforms.

Conclusion: Occult HBV infections are commonest TTI infections often missed by serology. MP-NAT on cobas 5800 system was found to have better sensitivity in detecting TTIs and occult hepatitis B infections compared to TMA-based and PCR based ID-NAT platforms.

B 3.1: Donor notification and counselling: Where we stand?

Suman Sudha Routray, Sukanta Tripathy, Gopal Krushna Ray, Nirupama Sahoo

Department of IHBT, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, 1Department of IHBT, AIIMS, Guwahati, Assam, India

Aims and Objectives: Post- donation counselling (PDC) in donors reactive for transfusion transmitted infections is an integral tool promoting individual and community health. However, the response of donors and the efficacy of the counselling procedure in them are ambiguous and must be addressed.

Study Design: This prospective study, conducted between April 2023 and July 15, 2023, evaluated the response of repeat reactive donors to telephone calls and follow-up calls made within 15 days of PDC and referral to a designated centre. SPSS version 20 was used to analyse all responses and donor demographics.

Results: During this time period, 3068 units of blood were donated, of which 87 were found to be reactive for HBV (n=42), followed by syphilis (n=20), HCV (n=15), and HIV (n=8). Two of the donors with positive syphilis test results were infected with HIV and HCV, respectively. On repeated testing, 73.6% (n=64) of the 87 initially reactive units were found to be repeat reactive. Within forty-eight hours of test results, 52.9% of reactive donors were notified. The PDC was attended by 64% of the donors who had been notified. Donors with HCV (12/13) and HBV (16/23) were excellent responders, whereas donors with syphilis (9/20) were poor responders. Only 11 donors are receiving therapy. Twenty-two donors (53.6%) didn’t attend the referral centre. Eight donors were retested outdoors and received negative results.

Conclusion: The response rate of notified donors to the referral centre is quite low. Policy development to address these concerns is of critical importance.

B 3.2: Turnaround time for issuing blood components in routine and emergency: A prospective study

M Saranya Maruthayee, J Ravishankar

Department of Immunohematology and Blood Transfusion, Tirunelveli Medical College and Hospital, Tirunelveli, Tamil Nadu, India

Aims and Objectives: Turnaround time (TAT) is one of the quality indicators of blood bank. The aim of this study was to evaluate and compare TAT for the issue of blood components in emergency and routine situations.

Methods: This was a prospective cross-sectional study done at the Department of Immunohematology and Blood Transfusion, Tirunelveli Medical College Hospital for one month (June 2023). The data collected was entered in Microsoft excel and analyzed. For routine request, crossmatch was done by both immediate spin (Tube method) and Antiglobulin phase (Gel card technique) and for emergency blood component request, crossmatch was done by immediate spin.

Results: Out of 92 blood components observed, range of TAT during emergency issue was, 11-30 mins for packed red blood cells (PRBC), 31-40 mins for Fresh frozen plasma (FFP), 21-30 mins for platelet concentrate (PC) and range in routine issue was, 36-90 mins for PRBC, 36-62 mins for FFP, 31-35 mins for PC. Mean TAT in emergency issue (46 patients) for PRBC was 18.60±3.32 mins, FFP was 37.36±1.85 mins and 26.40±1.14 mins for PC, while mean TAT in routine issue (46 patients) for PRBC was 45.76±9.15 mins, FFP was 40.63±7.27 mins and 32.80±1.48 mins for PC.

Conclusion: TAT observed for both emergency and routine cases were comparable with other studies. Reasons for prolonged TAT was incompatible crossmatch, time to thaw FFP and multiple component request. Preparation of suspension of few donor PRBC units at the start of day can be used for cross match, to reduce TAT during emergency issue.

Keywords: Antiglobulin crossmatch, immediate spin crossmatch, turnaround time

References

Subash S, et al. A prospective observational study on turnaround time for issue of blood components on emergency request in a tertiary care teaching hospital. IJMSIR 2018;3:329-35.

Ramanathan T, et al. Turnaround time for issuing blood products in emergency: A prospective real time study in a regional blood transfusion centre. IJCMR 2017;4.

Sharma M, et al. Analysis of turnaround time for issuance of blood products in emergency, a prospective study in a tertiary care centre in Jammu. JMSCR 2018;6.

B 3.3: Turnaround time for issuing blood components in routine and emergency: A prospective study

M Pratheeba, Sam Arul Doss, John Gnanaraj, M Divya, Tamilarasi, Dolly Daniel

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

Aim: Alloimmunisation is an immune response to foreign antigens following pregnancy, transfusion and/or transplant. The aim of our study is to demonstrate the incidence of alloimmunization among the HLA and red cell antigens following a sensitizing event.

Materials and Methods: This retrospective study was performed in the department of Transfusion medicine and Immunohematology. The study population included haploidentical matched pairs. Anti HLA antibodies were identified using Luminex single antigen bead assay. Simultaneously the patients were screened for the presence red cell antibody, positive samples were further analyzed.

Results: A total of 46 patients were included in the study group. Of these 39 (85%) patients had a sensitizing history of transfusion and the remaining 7 (15%) patients had no history of sensitization. Anti HLA antibodies were identified in 13 (33%) patients, of which 7 patients had antibodies against HLA class I and the remaining 6 patients had antibodies against both HLA class I and II. Only one of the 46 patients had a red cell alloantibody identified as anti E. This patient also had a co-existing anti HLA antibody.

Conclusion: The differential response of the HLA and red cell system following a sensitizing event such as transfusion is evident from the data derived from our study. With such a significantly greater response in the production of anti HLA antibodies as compared to red cell alloantibodies while being challenged by the same sensitizing events, suggests that the mechanisms of allorecognition and subsequent responses might differ between these two antigen systems.

B 3.4: Probability of identifying a human leukocyte antigen matched related donor within a family by next generation sequencing

Manisha Tambe, Selma Z D’Silva, Jyoti Rajak, Andrea S Pinto, Meenakshi Singh

Aim: The process of finding an unrelated HLA matched donor within a registry is lengthy and unpredictable; hence the aim of the present study was to evaluate the probability of finding a HLA matched family donor.

Methods: The present study included a total of 535 leukemic patients along with their sibling donors (n=960). 30 ng/ul of genomic DNA was used for amplifying 6 HLA Loci, followed by library preparation using the NGSgo kits (GenDx, The Netherlands). 1.1 pM library was loaded on Illumina MiniSeq system using the MiniSeq mid-output reagents (Illumina, USA). Analysis was performed using GenDx NGSengine software v2.26.1.

Results: It was observed that 214/535 (40%) patients had a full HLA matched family donor. This probability varied with the number of siblings in each family 31.14% for families with 1 sibling, 41.57% for 2 siblings, 52.94% for 3 siblings, 70.58% for 4 siblings, and 81.81% for 5 sibling families.

Conclusions: As per Mendelian inheritance a patient with four siblings is expected to have a 25% chance of finding a full matched HLA family donor. However, our data suggests that this percentage is much higher especially in families with 2 or more siblings. This can be attributed to the fact that HLA alleles and haplotypes are conserved in a population due to different castes practising endogamy which results in unchanged genetic makeup within a particular region. This results in higher prevalence of conserved HLA haplotypes and hence a higher chance of finding a full matched HLA family donor.

B 3.5: Impact of antibodies to human leucocyte antigens and their association with blood product exposures in Haplo identical transplant setting

R Sam Arul Doss, John Gnana Raj, Dolly Daniel

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

Aim and Objectives: The study aims to assess the association of previous allogenic blood product exposures with the formation of anti HLA antibodies and determine if Leucodepleted blood components pose a lesser risk of developing antibodies.

Methods: This retrospective study includes 46 patients who were worked up for Haplo identical transplant. Anti HLA antibodies were detected by Luminex Single Antigen Bead assay and Flow cytometric crossmatch as a part of our routine protocol and the results were correlated against the different blood products.

Results: Of the total 46 patients, 24/46 (52.17%) had Leucocyte reduced red blood cells (LRRC) in which 8/24 (33%) had shown anti HLA antibodies detected on Flow cytometric crossmatch and Luminex single bead antigen assay and remaining 16 were negative. 10/46 (21.7%) patients had Packed red blood cells (non leukoreduced) transfused. 6/10 (60%) had shown anti HLA antibodies and remaining one sample had shown negative. The difference between the above two groups is statistically significant (P value 0.002). There were 4 (8.6%) patients who had received transfusions elsewhere and the nature of the product are unknown in which 3 patients had shown anti HLA antibodies. Of 7 patients (15.12%) who had nil transfusion, 4 patients had anti HLA antibodies and remaining 3 were negative. One patient had a combination of multiple transfusions and showed anti HLA antibodies in both Flow crossmatch as well as the Luminex Single Antigen assay

Conclusions: Leucodepleted blood products offer a clear advantage in terms of reduced allo immunization to HLA in patients requiring transfusions and awaiting transplant. Considering the negative impact of preformed donor specific antibodies in a transplant setting the choice of strategies such as leucoreduction may be worthwhile.

References

Cruz-Beltran S, Lane A, Seth S, Miller K, Moore RH, Sullivan HC, et al. Antibodies to human leukocyte antigens and their association with blood product exposures in pediatric patients undergoing cardiac transplantation. Paediatr Anaesth 2021;31:1065-73.

Rossano JW, Morales DL, Zafar F, Denfield SW, Kim JJ, Jefferies JL, Dreyer WJ. Impact of antibodies against human leukocyte antigens on long-term outcome in pediatric heart transplant patients: An analysis of the United Network for Organ Sharing database. J Thorac Cardiovasc Surg 2010;140:694-9, 699.e1-2.

B 3.6: Assessment of engraftment on ABO incompatible allogenic hematopoietic stem cell transplant

Imlimenba Walling, Ashok Yadav, Sachin Sharma, Amrita Tripathi, Nidhi Sharma

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

Aims and Objectives:

To assess the impact of ABO compatibility and incompatibility on Engraftment in HLA fully matched Bone Marrow transplant patients.

Methods: This was a retrospective study conducted at the Department of Transfusion Medicine, M.G.M. Medical College, Indore. Only paediatric patients who underwent stem cell transplant at our BMT Unit with bone marrow as source and HLA fully matched related donor were evaluated. A total of 47 patients with different haematological diseases were studied and classified into four groups: ABO compatible, Major mismatch, Minor mismatch and Bidirectional transplant. The data was recorded and analysed using appropriate statistical test.

Results: Out of 47 patients, there were 26 (55.31%) ABO matches, 6 (12.76%) major, 11 (23.40%) minor and 4 (8.51%) bidirectional ABO mismatches. Median day for neutrophil engraftment in ABO match, major, minor and bidirectional mismatch transplant was 16, 20, 16 and 22 respectively. Similarly, median platelet engraftment day was 18, 22, 19 and 24 respectively. No significant association (p=0.09) in outcome and duration of hospital stay was observed with reference to ABO incompatibility status and engraftment pattern.

Conclusion: ABO incompatibility does not have a significant impact on the engraftment and overall outcome on HLA matched allogeneic bone marrow transplant. ABO group should not be a distinctive barrier when selecting allogeneic HPC donor with a different ABO group than the recipient.

Reference

Ciftciler R, Goker H, Buyukasık Y, Karaagac T, Aksu S, Tekin F, et al. Impact of ABO blood group incompatibility on the outcomes of allogeneic hematopoietic stem cell transplantation. Transfus Apher Sci 2020;59:102597.

B 3.7: Parabombay phenotype: A case report from a tertiary care hospital in South Tamil Nadu

G Vaidesh, V Bala Vignesh1

Department of Immunohematology and Blood Transfusion, Tirunelveli Medical College, Tirunelveli, 1Department of Immunohematology and Blood Transfusion, Government Virudhunagar Medical College, Virudhunagar, Tamil Nadu, India

Background: Identification of rare blood group phenotype is important as its incidence is very low and it is important to detect them in routine blood banking so that we can ensure safe and appropriate transfusion.

Case Report: A 48-year-old male blood donor, who has donated more than 10 times, donated whole blood at a blood donation camp conducted by a Peripheral Government Hospital. His historic blood group was O Rh D Positive. The blood unit was transferred to our Blood center. On performing routine ABO grouping and Rh typing of the donor, forward grouping showed the group as “Bombay O” Rh D positive, and reverse grouping wasn’t found complimentary. Further testing with secretor study and adsorption and elution confirmed that the donor’s blood group was Para-Bombay A (Ah) Rh D positive.

Conclusion: The Para-Bombay phenotype is very rare, and only a few cases have been reported in India. This blood group is characterized by the absence of A, B, and H antigens on red blood cells (RBCs) with the presence of ABH substances in secretions or by the weak expression of A, B, and H antigens on RBCs with the absence or presence of ABH substances in body secretions. This rare phenotype can be mislabeled as the “O” group if all detailed investigations are not performed.

Keywords: H antigen, Para-Bombay, secretor status

References

Cohn CS, et al. Technical Manual. 20th ed. Bethesda, Maryland: AABB; 2020.

Harmening D. Modern Blood Banking & Transfusion Practices. 7th ed. Philadelphia, Pa: F.A. Davis Company; 2019.

B 3.8: Utilizing the institutional rare blood donor registry to manage three children immunized with antibodies of anti-m specificity having a wide thermal amplitude

Manish Raturi, Yashaswi Dhiman, Basanta Khatiwada, Dushyant Singh Gaur

Department of Immunohematology and Blood Transfusion, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India

Aim and Objectives: Predominately anti-M antibody is an IgM type with narrow thermal amplitude. However, sometimes, an IgG component may be involved. Anti-M antibody with an IgG component reacting at 37°C, interferes with pre-transfusion testing such as blood grouping and crossmatches eventually making it difficult to find fully compatible blood within the short, stipulated time. Herein, we highlight the spectrum of the anti-M encountered in three children and having an institutional blood donor registry helped us find compatible blood units for all of them.

Methods: Red cell typing for ABO and Rh (D) was performed using reagents (Resolve Antisera, Tulip Diagnostics (P) Ltd, Goa) and supplies following the manufacturers’ instructions. Pre-transfusion workup was performed according to our department’s standard operating procedures [SOP]. We also performed the direct anti-globulin test [DAT] using a poly-specific (anti-IgG, -C3d) column agglutination test [(CAT); Ortho Clinical Diagnostics, Pvt Ltd., Mumbai, India]. Serologic crossmatches and antibody screening were performed by the same CAT method using low-ionic-strength saline (BLISS) at the anti-human globulin (AHG) phase per our department SOP.

Results: Three children [M: F= 2:1 with a mean age (in years) of 2.5 ± 2.1 (1-5)] were involved. Since there was no history of the transfusion, and the antibody reacted at 37°C and the AHG phase, we deduced that the anti-M antibodies detected were naturally occurring with an IgG component. All three of them were timely managed using M-antigen negative PRBC other than the standard treatment offered in the hospital. This was possible due to an already established O-typed blood donor registry of donors serologically phenotyped for 21 erythrocyte antigens.

Conclusion: Currently, all children are doing well.

Keywords: Alloimmunization, anti-M, blood transfusion services, blood transfusions, immunizing, immunohematology, naturally occurring antibodies, Uttarakhand

C 1.1: The effect of hematocrit of reconstituted whole blood on total serum bilirubin, hemoglobin and hematocrit of neonates undergoing exchange transfusion

Shivam Azad, Tulika Chandra, Ashutosh Singh, Archana Solanki

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

Background: Exchange transfusions are used primarily to remove high levels of unconjugated bilirubin and thus prevent kernicterus. The most common indication for exchange transfusion in neonates is hyperbilirubinemia caused by Haemolytic disease of foetus and newborn (HDFN). Other indications for exchange transfusion are Severe sepsis, severe anaemia causing cardiac failure and to eliminate circulating toxins.

Aims: To compare the change in Haemoglobin, Haematocrit and Bilirubin of neonates, and assess complications during exchange transfusion.

Methods: This is a prospective study which included 14 neonates undergoing exchange transfusion for neonatal hyperbilirubinemia. Sample size was divided into two groups. Group A was supplied whole blood with haematocrit 45-52% and Group B with haematocrit 53-60%. Both groups were compared on the basis of haemoglobin, haematocrit, total serum bilirubin, electrolytes and platelet count.

Results: Total 14 cases were divided into two groups. Groups A and B consists of 7 cases each who were given whole blood with haematocrit in the range of 45-52% and 53-60% respectively. Group A showed mean increment in haemoglobin by 30.35% and haematocrit by 29.4%. Group B showed mean increment in haemoglobin by 94.14% and haematocrit by 91.35%. Groups A and B showed mean decrement in total serum bilirubin by 41.9% and 42.9% respectively and mean decrement in platelet count by 59% and 58.4% respectively. Mean change in Sodium, Potassium and Calcium for Group A were +0.67%, -13.44%, -17.08% respectively and for group B were -0.91%, -20.3%, -10.52%.

Conclusion: Reconstituted whole blood with the haematocrit in range of 53-60% is more effective in correcting the anaemia in neonates as compared to that with the haematocrit in range of 45-52%. But both are equally effective in reducing the Total serum bilirubin. Both are equally safe for exchange transfusion as the change in electrolytes is approximately equal and insignificant. Both causes significant reduction in platelet count post exchange transfusion.

References

Carneiro De Lima A. Antigen-Antibody Characteristic Chart.

Transfusion A. Technical Manual.

Greinacher A. Rossi’s principle of transfusion medicine. Eur J Haematol 2010;84:462.

Article O. Effect in Newborns; 2017.

Shakur A, Garba N, Ahmadu I, Apollos D, Wada A, Abdullahi S, et al. Effect of exchange blood transfusion on oxygen saturation of neonates with severe neonatal jaundice by pulse oximetry. J Acute Dis 2021;10:112.

Mayssara A, Abo Hassanin Supervised A, Munawarah SH, Misnaniarti M, Isnurhadi I, Komunitas JK, et al. Paper Knowledge: Toward a Media History of Documents. 2019;7:1-33. Available from: https://www.bertelsmannstiftung.de/fileadmin/files/BSt/Publikationen/GrauePublikationen/MT_Globalization_Report_2018.pdf%0Ahttp://eprints.lse.ac.uk/43447/1/India_globalisation%2C societyandinequalities%28lsero%29.pdf%0Ahttps://www.quora.com/What-is-the.

Chacham S, Kumar J, Dutta S, Kumar P. Adverse events following blood exchange transfusion for neonatal hyperbilirubinemia: A prospective study. J Clin Neonatol 2019;8:79.

Sharma DC, Rai S, Mehra A, Kaur MM, Sao S, Gaur A, et al. Study of 25 cases of exchange transfusion by reconstituted blood in hemolytic disease of newborn. Asian J Transfus Sci 2007;1:56-8.

Patel KA, Raja KA, Patel JN, Pandya AN, Unagar CA, Wadhwani SJ. Study of exchange transfusion by reconstituted blood in hemolytic disease of fetus & new born. Int J Contemp Med Res (IJCMR) 2019;6:1-5.

Joshi I, Sharma A. Sex-wise changes in haematological and biochemical parameters before and after exchange transfusion in neonatal hyperbilirubinemia. Int J Res Med Sci 2019;7:3704.

C 1.2: Gregg with Oneg!!! Utilisation of O RhD negative red blood cells: An analysis at a trauma tertiary care centre in Himalayan state of North India

Priyanka Rathod, Daljit Kaur, Gita Negi, Aswin Mohan, Ashish Jain

Aims and Objective: This study aims to evaluate the appropriateness of O RhD negative red blood cell utilisation at a tertiary care centre.

Methods: The issuance of O RhD negative Red blood cell units were reviewed retrospectively from June 2022 to July 2023. For each unit issued, patient’s age, gender, department of admission, indication of transfusion, blood group and transfused red blood cell unit details were retrieved from the Blood Bank Management Software.

Results: During the study period, a total of 20,023 blood units were collected and O RhD Negative blood type donors constituted 2% (n=420). A total of 426 units of O RhD negative packed red blood cell (PRBC) units were issued and out of which 203 units (47.65%) were issued to patients with ‘Other ABO RhD type’ and 223 units (52.34%) were issued to patients with O RhD negative blood type only. Forty-three (43) O negative PRBCs were issued for Double volume exchange transfusion and 04 for Intrauterine transfusion. The remaining 156 units were transfused to patients with other indications. The distribution of O RhD negative PRBCs ranged from emergency release to trauma patients, women with postpartum hemorrhage, patients with massive UGI bleed, pediatric patients, Surgical patients, and intensive care patients.

Conclusion: We analysed that around 44.5 % of O RhD negative PRBC transfusion can be avoided for patients with ‘Other ABO RhD type’ where drawing blood sample is feasible and specific ABO RhD blood type can be issued. Effective communication, awareness, and education of the treating team of resident doctors and nursing staff regarding utilisation of this precious resource can help in optimizing the usage and allowing availability for the ones highly indicated.

References

Moiz B, Ali A, Qadir H, Khalid A. A clinical audit on the utilization of group O-negative red cells and the lesson learnt. Asian J Transfus Sci 2022. [doi: 10.4103/ajts.ajts_170_21].

Ilmakunnas M, Salmela K, Kivipuro T, Sareneva H, Sainio S. Use of O RhD-negative red blood cells: A nationwide, prospective audit. Vox Sang 2022;117:1279-86.

Available from: https://www.aabb.org/docs/default-source/default-document-library/resources/association-bulletins/ab19-02.pdf. [Last accessed on 2023 Jul 20].

C 1.3: Force field analysis of accelerating and restraining factors influencing the implementation of patient blood management in obstetrics: Time to take giant strides towards obstetrics PBM

Daljit Kaur, Gita Negi, Zikra Syed, Ashish Jain, Priyanka Rathod, Latika Chawla1, Jaya Chaturvedi1, Shalini Rajaram

Departments of Transfusion Medicine and 1Obstetrics and Gynecology, AIIMS Rishikesh, Rishikesh, Uttarakhand, India

Aim: To implement PBM as Standard of care in Obstetrics at a medical institution of national importance

Objectives: 1. To address the first pillar of PBM by correcting anemia, prevalent among antenatal women or preconceptionally. 2. To minimize the allogenic blood component transfusions by adopting multidisciplinary approach during pregnancy for medical and surgical strategies addressing the second and third pillar of PBM.

Methods: A Mixed Method study was conducted using audit of the transfusion practices for a subset of pregnant women followed by Focus Group Discussion. A Force Field Analysis was done which yielded various restraining and driving factors to work towards implementation of PBM for evidence-based transfusion practices in Obstetrics. The study was conducted for a period of one year at a tertiary care hospital.

Results: A total of 200 antenatal women with anemia were studied where around 70% of them were of age group 20-30 years. Most of them had moderate anemia (124, 62%) followed by severe (51, 25.5%) and mild anemia (25, 12.5%). Around 35% of multigravida and 27% of primigravida women had moderate anemia. The severity of anemia varied depending upon the gravida status of women. Severe anemia and mild anemia were observed in 20.5% and 3.5%. A Force Field Analysis was conducted involving various stakeholders from the Departments of Transfusion Medicine, Obstetrics & Gynecology and Nursing for the status and awareness of PBM in the obstetric setting. Around 32 Driving and Restraining forces were identified for the existing challenges for future consideration and smooth accomplishment of PBM at our hospital.

Conclusion: There is an immediate concern of management of the nutritional anaemia as prevalent among the antenatal women visiting our hospital. Education of all the concerned stakeholders including the beneficiaries would play a significant role in managing the anemia and preventing the related complications. A multidisciplinary approach can further aid in managing all the three phases of pregnancy with PBM Strategies.

References

Surbek D, Vial Y, Girard T, Breymann C, Bencaiova GA, Baud D, et al. Patient blood management (PBM) in pregnancy and childbirth: Literature review and expert opinion. Arch Gynecol Obstet 2020;301:627-41.

Hofmann A, Spahn DR, Holtorf AP, PBM Implementation Group. Making patient blood management the new norm(al) as experienced by implementors in diverse countries. BMC Health Serv Res 2021;21:634.

Zdanowicz JA, Surbek D. Patient blood management in obstetrics – Review. Transfus Apher Sci 2019;58:412-5.

C 1.4: Formulating a data driven maximum surgical blood ordering schedule, its implementation and outcome analysis in a tertiary care hospital in Eastern India

Milind Agrawal, Santosh Kumar Mishra1, Aditi Khanna2, G N Kanungo2

Department of Immunohaematology and Blood Transfusion, Lady Hardinge Medical College, New Delhi, 1JP Hospital, Rourkela, 2IMS and SUM Hospital, SOA (Deemed to be University), Bhubaneswar, Odisha, India

Aims and Objectives:

To evaluate the ordering and utilization of blood in different elective surgical procedures.

To formulate MSBOS based on analysis of this data.

To implement MSBOS and analyse the outcome.

Methods: This prospective observational study was conducted at Department of Transfusion Medicine, IMS and SUM Hospital, Bhubaneswar from October 2019 to September 2021. Data of patients admitted for elective surgeries to different departments and requiring blood transfusion was analysed and MSBOS was formulated. Type of crossmatch was decided on the cut-off of transfusion index (0.5) and transfusion probability (30%). Statistical analysis was done by Chi square and Unpaired T-test using IBM SPSS version 25.0.

Results: A total of 1787 patients were enrolled in the study. A significant reduction was observed in the number of units crossmatched after MSBOS was implemented. It was also observed that C:T ratio decreased with increase in transfusion probability and transfusion index. 66.72% patients were marked for “type screen and cross-match” while 34.27% patients had only “type screen and hold”.

Conclusion: Implementation of MSBOS helped in achieving an optimal C: T ratio, blood transfusion probability and transfusion index resulting in better utilization of blood and resources of blood centre. Overordering of blood was reduced thereby avoiding wastage of blood. Among the developing countries, blood typing (Type and Screen) protocol is not widely practised even though it has significant role in decreasing non-essential crossmatches and facilitating efficient blood usage in planned surgeries.

C 1.5: A comparison of the effectiveness of RDP and SDP on platelet increment

Peddinti Tejaswani, Sankalp Sharma

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

Aims and Objectives: To compare platelet increment between RDP and SDP transfusions using quantitative analysis.

Methods: We performed a retrospective analysis on 100 transfusion episodes (75 RDP, 25 SDP) given to Hematology and Oncology patients, with an average age of 36.29 years, over two months. Data was collected from issue registers and the patient laboratory information system. The RDP transfusion group consisted of transfusions with four or more RDPs. Platelet increment was determined using the formula: API = Post-transfusion Platelet count – Pre-transfusion Platelet count. A p-value was calculated using an independent T-test.

Results: RDP transfusions had a mean volume of 228.94 ml (SD=40.2187), while SDP transfusions had a mean volume of 213.48 ml (SD=65.14095). The mean API was 5.5333 X 10-9/L for RDP (SD=15.6941) and 31.12 X 10-9/L for SDP (SD=28.787). The t-value is - 5.61795. The p-value is <.00001, which is significant (p<0.05).

Conclusion: SDP transfusions yield higher post-transfusion platelet increments than RDP transfusions. SDPs, with reduced donor exposure and leukoreduction, are considered superior. However, affordability and accessibility challenges exist in resource-constrained developing countries.

Reference

Sabha S, Makhdoomi RH. Effect of single donor versus random donor platelet concentrates in thrombocytopenic patients at SKIMS Blood Bank: A hospital-based study. JMS Ski 2021;24 Suppl 1.

C 1.6: Mastering the trio: Patient blood management in a case of juvenile nasopharyngeal angiofibroma

Rajat Bansal, Archana Bajpayee, Amit Goyal1, Vidhu Sharma1

Departments of Transfusion Medicine and 1ENT (Otorhinolaryngology), All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

Introduction: PBM is a patient-specific, multimodal, multidisciplinary evidence-based approach to improve patient outcomes. It’s based on 3 pillars: management of anemia, minimizing blood loss and evidence based allogenic blood transfusion.

Case Summary: 18-year-male patient c/o Juvenile Nasopharyngeal Angiofibroma with recurrent episodes of nasal-bleed was posted for elective Surgical Excision. While routine-investigations for PAC, hemoglobin was found to be 8.4gm/dl. Optimization of hemoglobin to minimum 10 gm/dl was advised by the anesthesiologist since the patient was at high risk of bleeding. We assessed the patient as a reference was received for pre-operative anemia correction by transfusion. CBC showed low MCV, MCH and MCHC which was s/o microcytic and hypochromic anemia. As a part of anemia evaluation, iron profile and PBF advised which showed severe iron deficiency. As its elective, clinicians were advised to optimize Hb by I.V. Iron therapy. Four doses of I.V FCM was given in one month period after which Hb was increased to 14.6 gm/dl. Two units of whole blood was collected during ANH. Intra-operative blood-loss was approximately 1L. No allogenic transfusion was required in the peri-operative period. Post-operative Hb after was 11.2 g/dl. Patient was discharged on POD-3.

Discussion: 3 pillars of PBM were implemented in this case - pre-operatively by I.V. iron-therapy, intra-operatively by ANH and I.V. Tranexamic Acid, post-operatively by vigilant monitoring and avoiding secondary hemorrhage.

Conclusion: Implementing PBM strategies in surgical settings like pre-operative anemia correction by Hematinic agents, intraoperatively using autologous transfusion, employing techniques to minimize blood loss, using hemostatic agents, allogenic transfusion based on evidence-based guidelines and proper postoperative care can help optimize patient outcomes, reduce the need for blood transfusions, and improve overall patient care.

Reference

Longacre MM, Seshadri SC, Adil E, Baird LC, Goobie SM. Perioperative management of pediatric patients undergoing juvenile angiofibroma resection. A case series and educational review highlighting patient blood management. Paediatr Anaesth 2023;33:510-9.

C 1.7: Breaking the time barrier: Analyzing the possibility for extended platelet storage – A cross-sectional study

V Soundharya, Hariharan Annadurai, Suresh Iyyappan, Natesan Hemamalini, Vinod Kumar Panicker

Department of Transfusion Medicine, Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India

Aim: To Evaluate the feasibility of Storing Platelets beyond 5 days without any detrimental effects by performing Quality assessment of Outdated RDPs prepared by Platelet-rich Plasma (PRP) method.

Objectives: To Analyse the Quality and Bacterial contamination of Outdated RDPs on day-7 and day-10 of their preparation by PRP method. To determine the possible extension of Platelet shelf life without the addition of Platelet additive solution (PAS).

Methodology: This was a Cross-sectional study which included randomly chosen 72 RDPs prepared by PRP method. The samples were subjected for analysis on day-7 and day-10 of their preparation stored in Oxygen permeable blood bags at 20- 24ºC with continuous agitation. Platelet count, MPV, PDW, WBC, RBC counts were assessed using automated analyser. Bacterial culture was performed by inoculating 1-3 ml of RDPs over Solid media. Daily pH measurements were done using digital pH meter. Grades of swirling by visual inspection.

Results: Among 72 RDPs, none of them were culture positive on day-7 and day-10. On day-7, the Mean Platelet count (3.6 x 1010/uL), MPV (9.3 fL), PDW (11.5 fL), WBC (5.6 x 107/uL), RBC (0.2 ml), pH (6) were found to be within normal limits. On day-10, the Standard quality parameters for Platelet concentrates were not met. Thus, through Optimal Storage conditions, Platelet shelf-life can be prolonged upto 7-days from the current storage (5-days).

Conclusion: By determining the Quality of outdated RDPs on seventh and tenth day, Platelet shelf life can be extended from day-5 to day-7 without the addition of PAS. Thus, increasing the Platelet supply and better Inventory management.

References

Dwivedi P, Basavarajegowda A, Sastry AS. Surrogate markers and their correlation to bacterial contamination and other quality parameters in random-donor platelets by platelet-rich plasma method. Glob J Transfus Med 2019;4:33-8.

Mokhtar MB, Hashim HB, Joshi SR. Assessment of quality of platelets preserved in plasma and platelet additive solution: A Malaysian experience. Asian J Transfus Sci 2016;10:84-7.

C 1.8: Blood utilization review in the department of obstetrics and gynaecology (OBG) in a tertiary care center

Saurabh Lahare, Bankim Das, Rakesh Kumar, Neha Singh, Shweta Ranjan, Nishith Nayan, Ankita Sinha, Surbhi Kumari, Pritu Garhewa, Nagendra Pratap, Shweta Anand, Saurabh Kumar

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

Aims and Objective: Transfusion Indices calculation for the Department of OBG.

Methods: This was a retrospective study conducted in the department of Transfusion Medicine and Blood Bank. Last one-year data of blood utilisation was reviewed for the Department of OBG from the blood requisition forms: -Crossmatch to Transfusion ratio (CT ratio) =Total no. of units crossmatched/No. of units transfused. Transfusion Probability (%T) =No. of patients transfusedx100/No. of patients crossmatched. Transfusion Index (TI)=No. of units transfused/No. of patients transfused.

Results: i) No. of units crossmatched= 1338 ii) No. of units Transfused=900 iii) No. of patients Transfused=513 iv) No. of patients crossmatched=919 v) No. of units Transfused=1093, CT ratio= 1.49, %T= 55.8%, TI=2.13

Conclusion: CT ratio should be ideally less than 2.5, (1.49 in our case) which shows too much crossmatches in comparison to actual transfusion. Transfusion probability should be <30% (55.8% in our case), a value >30% shows a significant blood utilisation and Transfusion Index should be <0.5 (2.13 in our case), a value >0.5 shows a significant blood utilisation. So in our case two ratios were high showing a significant blood utilisation in the Department of OBG. Department of Transfusion Medicine should implement Patient Blood Management with the Department of OBG to reduce unnecessary transfusions.

Reference

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.

C 1.9: Massive transfusion protocol: Need of the hour

Gloriya Cheriyan, Vanamala*, Shanthala Devi

Department of Transfusion Medicine and Immunohaematology, St. John’s Medical College Hospital, Bengaluru, Karnataka, India

Aim:

To review the indications of activation of Massive transfusion protocol (MTP).

To review the blood component utilization patterns in these cases of massive haemorrhage.

Methods: The MTP indications were reviewed in our blood Centre for MTP from July 2019 to December 2022. All requests clinically indicative of massive transfusion were included in the study.

Results: A total of 146 requests for MTP were received. Of these, majority of requests were received from ICUs accounting for 105 (71.9%) and 38 (26%) from the emergency ward. 3 (2.05%) cases were received from wards (OB & cardio thoracic). Indications for activating MTP were, mainly haemorrhage and trauma accounting for 93 cases (63.6%). Bleeding from GI tract was the 2nd most common indication accounting for 26 cases (17.8%). Obstetric bleeds accounted for 6 (4.1%) and septic shock for 9 cases (6.16%). Other miscellaneous indications including surgical bleeds, haemophilia bleed & coagulopathy accounted for 12 (8.2%) cases. The male: female ratio was 3.4:1. The Mean Pre transfusion Hemoglobin was 7.7 gm%. A Total of 1667 units were used for these 146 MTP requests. Of these, 584 units were PRBCs (accounting for 4 units/ patient on average), 554 units were FFPs (3.7 units/patient on average), 477 units were platelet concentrates (3.26 units/ patient on average) and 52 units were cryoprecipitate (0.35 units/patient on average). The highest number of units consumed for a patient was 94. The requests for MTP categorised into < 10 PRBCs and those > 10, were n= 137 (93.8%) & n= 9 respectively (6.16%). 15 patients (10.27%) expired.

Conclusion: MTP is requested commonly in the setting of haemorrhage. It was a lifesaving multidisciplinary intervention for most patients, when MTP was activated with appropriate clinical indication and prompt evaluation of need.

Keywords: Blood components, indications, massive transfusion protocol

C 1.10: Bacterial detection in platelets with and without platelet additive solution: Experience at a hospital blood centre

Karen Gonsalves, Samir Shrivastava, Dr. Tanvi Yardi, Dr. Rajesh B Sawant

Department of Transfusion Medicine, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India

Aims and Objectives: To assess the extent of bacterial contamination in apheresis and pooled platelets and to understand the effect of Platelet Additive Solution (PAS) on results of bacterial screening.

Materials and Methods: Blood bags with diversion pouches and inline filters were used for blood collection. Closed system was maintained during addition of PAS. BacT/ALERT pediatric aerobic culture bottles were inoculated with platelet sample at 24 hours after collection. Results were interpreted after 14 days of incubation. If any growth was detected, supernatant plasma from same unit was sampled for bacterial detection. Bacterial testing data was compiled and analysed separately for platelets with and without PAS.

Results: 4/2983 platelets without PAS (0.12%) were positive for bacterial growth which was detected at mean 9 days after incubation. 16/6167 (0.26%) with PAS were positive for bacterial growth. 13/16 (81%) bacterial species identified were commensals. Mean detection time was 3 days. Supernatant plasma from these units showed no growth in all but one.14/16 platelet units were transfused prior to detection of bacterial growth and none of the recipients presented with clinical sepsis.

Conclusion: Bacterial contamination was detected significantly early and in greater proportion in platelets with PAS. Any pre-analytical and analytical factors affecting these results need to be studied further.

C 1.11: Assessment of quality indicators defined by NABH in blood centre of a tertiary care hospital: A cross sectional analytical study

R Arthi, I Suresh Kumar, A Hari Haran, N V Hemamalini, Vinod Kumar Panicker

Department of Transfusion Medicine, Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India

Aim: To assess the quality indicators defined by the National Accreditation Board for Hospitals and Healthcare Providers (NABH) in a blood center of a tertiary care hospital.

Objectives: To audit the quality of standards and practices in our blood centre as advocated by NABH Key performance indicators (KPI). To perform root cause analysis and implement corrective and preventive action for achieving the benchmark values of various quality control parameters.

Methods: This is a cross sectional analytical study done at Department of transfusion medicine, Saveetha medical college and hospital, Chennai. All data were obtained from records maintained at the blood centre from June 2022 to May 2023. Values observed were compared with benchmark data. Root cause analysis of all non-conformance parameters were done. Problems were identified, and actions were taken to achieve benchmark values.

Results: Out of the ten KPI’s which were studied, more than 75% meet the quality standards. The ones which did not meet the benchmark were TTI-syphilis 0.17%., platelet wastage 46.06%, donor deferral rate 12.05% and % of components from whole blood which was 99.9%. After corrective and preventive action were implemented there was a significant improvement towards achieving the benchmark values.

Conclusion: This study has provided us valuable insights into the adherence to NABH quality indicators. It has helped us identify areas of excellence and areas that require attention and improvement. However, these guidelines are not mandatory for a blood centre to be operational, achieving these parameters will establish a comprehensive safety starting from donor vein to patient vein.

References

Gnanaraj J, Kulkarni RG, Sahoo D, Abhishekh B. Assessment of the key performance indicator proposed by NABH in the blood centre of a tertiary health care hospital in Southern India. Indian J Hematol Blood Transfus 2023;39:308-16.

Anagbo CC. Quality indicators in transfusion medicine: The building blocks. ISBT Sci Ser 2011;6:35-45.

C 2.1: Cold agglutinin induced hemolysis in systemic lupus erythematous patient: A case series

Ashwini Garhewal

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

Introduction: Systemic Lupus Erythematous (SLE) is a well-known autoimmune chronic inflammatory disease. Hemolytic anaemia has been known to occur in <10% of SLE patient. They are usually mediated by warm antibodies. Only few cases have been reported of cold antibody mediated hemolytic anaemia associated with SLE. We present a series of 3 cases of SLE who presented with severe anaemia with cold agglutinin disease. Request for transfusion of was received at blood centre. All these blood samples were proceeded for Blood grouping, cross matching, antibody screening, DAT, IAT. DAT and IAT were positive. Cold autoantibody was identified in each case using monospecific AHG gel cards by column agglutination method. (C3d).

Conclusion: CAD is an autoimmune hemolytic Anaemia, rarely associated with SLE. Diagnosing the subtype of AIHA precisely for the choice of therapy. Management should focus on treating the underlying cause. Patient responded to methyl prednisolone and rituximab. PRC transfusion can safely be given in CAD with appropriate precaution.

C 2.2: Rare anti-CW alloantibody in patient: A case series

Priya Kalavadiya, Sangita Shah, Nidhi Bhatnagar, Kamini Gupta

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

Introduction: Anti-CW is an antibody against CW antigen which is a low incidence antigen of Rh system. Providing compatible blood for transfusion is not a problem, if the patient has antibody to low incidence antigen. However, it is necessary to identify such antibodies to assess their potential to cause haemolytic transfusion reaction and haemolytic disease of new born. We are presenting a series of 3 cases having incompatible crossmatch performed by AHG column agglutination technique during pre-transfusion testing.

Case 1: A 18-year-old female, known case of Thalassemia Major.

Case 2: A 32-year-old female patient with crush injury.

Case 3: A 40-year-old female patient with severe anaemia with past history of multiple transfusion. Further work up was done to identify the cause of incompatibility. All three cases were having anti- Cw alloantibody.

Conclusion: This cases illustrates that work of a transfusion service does not end with providing compatible blood as work up of incompatible cross match led us to detection of antibody to low frequency antigen in the patient’s serum and prompted us to study the antigen frequency in our region.

C 2.3: Retrospective analysis of frequency of ABO, Rh (D, C, c, E, e) and Kell blood group antigens in blood donors at a tertiary care hospital in North West India

Somya Chahar, Tulika Chandra, Archana Solanki, Ashutosh Singh

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

Aim and Objective: To study the frequency of ABO, Rh, Kell blood group antigens and their phenotype in northwest Indian donors.

Methods: Retrospective study of 4 months from March 2023 to June 2023 was done. This included a total of 17464 donors attending a tertiary care blood centre. the frequency of different blood group antigens was analysed with the help of diagast – duolys.[2]

Results: A total of 17464 blood donors were included in 4 months retrospective study. maximum donors were of B blood group followed by O, A and AB. The most common Rh antigen found was D (95.2%) followed by C (89.6%), c (53.6 %), E and e both (17.3 %), Kell present in 1.91 % of donors In order of descending frequency most common phenotypes were – DCcEe (8.7%), DccEe (5.14 %), DCCEe (3.35 %).

Conclusion: D antigen is the most common antigen in our study population. most common phenotype is DCcEe Knowledge of major antigens and their frequency in donor population helps in selecting antigen negative compatible blood for alloimmunised patients.[3]

C 2.4: Molecular mechanism of D negativity in large cohort of RhD negative Indians

Garima Mishra, Swati Kulkarni, Manisha Madkaikar

ICMR-National Institute of Immunohaematology, Mumbai, Maharashtra, India

Aim and Objectives: To overcome the limitations of serology, D negative samples should be screened using a DNA-based approach to exclude RhD variants to prevent immunization. Genotyping requires knowledge about the molecular mechanism causing D negativity in a given population. The percentage distribution of different mechanisms varies with the population. The aim of the study is to determine the molecular basis of D negativity in apparently RhD negative Indians.

Methods: A total of 2988 RhD negative samples were screened for RHD exon 5, 10 and weak D type 150 using indigenous multiplex PCR. In all samples the entire RHD gene was also screened by QMPSF to calculate the copy number. Sequencing was performed on uncharacterized samples.

Results: None of the RhD negative samples were D variant. Among the 2% of the sample harboring RHD exons, of which 1.74% carried the gene in RHD-CE-D hybrids form and 0.23% showing single nucleotide variance. The data were also analyzed as RhD negative with presence/absence of C/E antigen. All samples with the rr phenotype showed complete deletion of the RHD gene as the only mechanism responsible for D negative phenotype. Among the D Negative C/E positive samples, around 23% of the sample carried one or more RHD exons.

Conclusion: Six different molecular mechanisms causing D negative phenotype (RHD Deletion, RHD-CE (3-9)-D, RHD- CE (3-8)-D, RHD-CE (4-9)-D, RHD(T148R) and RHD 702 (delG) were identified in the Indians. Based on the data generated, we will develop a diagnostic genotyping strategy for correct RhD typing in Indians.

C 2.5: Are the gaps worth it: Comparison of an ‘O’ pooled in-house IAT and a 3-cell antibody screening panel

P Amalraj, Gnanaraj John, Daniel D Institution

Christian Medical College, Vellore, Tamil Nadu, India

Aims and Objectives: To assess the efficacy of alloantibody detection using a commercial 3-cell screen versus an in-house phenotyped pooled ‘O’ cell (IAT).

Methods: This is a retrospective study over a period of 6 months from February to July 2023. All Red cell antibody screening results performed using the commercial antibody 3-cell screen (3 cell Bio-rad ID DiaCell-I-II-III Asia) during the study period were reviewed. As per institutional protocol, a positive antibody screen had a reflex testing using the in-house phenotyped pooled ‘O’ cells (In-house IAT) and results of the latter were also reviewed. Antibody identification using 11-cell panel (Biorad ID-DiaPanel, Switzerland) was done on all samples with the positive screen/IAT. (Biorad LISS/Coombs AHG cards). Results were collated and compared.

Results: During the study period, a total of 6,688 samples had a 3-cell screen performed. Of these, 220 (3.28%) were positive. All 220 samples had an IAT, of which only 200 were positive. Of the 220 antibody identifications performed using a 11-cell panel, 146 (66.36%) antibodies were identified while the remaining 74 (33.3%) showed patterns suggestive of probable Miltenberger antibody which could not be confirmed using our panels. However, all the 20 samples which showed a discrepancy between the 3-cell screen and in-house IAT had definitively identified antibodies. These included antibodies to the following blood group systems respectively: MNS (6), Lewis (7), and Rh (7).

Conclusion: Despite using phenotyped ‘O’ pooled cells for antibody screening, our data clearly highlights the advantage in using the commercial 3-cell screen. The gaps observed are probably attributable to dosage/pooling and emphasizes the need to use a 3-cell panel at the minimum for alloantibody detection in patients.

C 2.6: The battleline between good and bad: The different avatars of Daratumumab

P Tamilarasi, M Divya, John Gnanaraj, K C Gayathri, Amal Raj, Dolly Daniel

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

Aims and Objectives:

1) To demonstrate the effect of Daratumumab (DARA), a monoclonal anti-CD38 antibody on pre transfusion testing.

2) Subsequently demonstrating its potential impact on likely delay in blood availability and turnaround time.

Materials and Methods: The study included three patients, diagnosed with relapsed Multiple Myeloma requiring packed red cell transfusion in view of anemia. On receiving the request for packed red cell, we performed the routine pre-transfusion testing that included ABO/Rh blood grouping, antibody screening, DAT, IAT and crossmatching.

Results: All three patients showed pan positive reaction with 3 cell antibody screening panel, 11 cell panel and compatibility testing. This was in sharp contrast with negative antibody screen and crossmatch in the previous workup. Retrospective examination of clinical records revealed that these patients had received one dose of DARA prior to the latest cross match request. To negate the DARA’s interference, the RBCs were treated with dithiothreitol (DTT), a reducing reagent that resulted in negative antibody screening and cross match compatibility. This resulted in a time delay of about 2-3 hours in ensuring issue of safe blood for transfusion.

Conclusion: Daratumumab and other anti-CD38 Monoclonal Antibodies cross-react and interfere with compatibility testing, leading to misinterpretations and delay in issuing blood for transfusion that affect patient care. Time-consuming special techniques are needed to nullify the drug’s interference. Appropriate communication between health-care professionals and the transfusion medicine department regarding clinical details before starting on DARA therapy will ensure minimal adverse impact when dealing with DARA.

C 2.7: HLA pharmacogenetic markers associated with drug reactions in Indian population

G Vivek, John Gnana Raj, Sam Arul Doss, Snehil Kumar, K C Gayathri, Sukesh Chandran Nair, Joy Mammen, Darshini, Dolly Daniel

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

Aims and Objectives:

To study the prevalence of different HLA pharmacogenetic markers associated with severe adverse drug reactions in a cohort of Indian patients previously HLA typed in the laboratory

To look for any difference in the prevalence of HLA Alleles in different regions of India divided based on mother tongue and place of origin

To perform high-resolution NGS based typing to identify the prevalence of HLA-B*15 subtypes in a subset of patients who are HLA-B*15 positive based on low resolution typing.

Materials and Methods: Data of individuals/patients who underwent HLA high-resolution typing for various reasons in the hospital over 3 years was taken and segregated into North, South, East, Northeast and West regions of India based on mother tongue and place of origin. Prevalence of high-risk HLA alleles implicated in drug hypersensitivity were analyzed and extrapolated into different regions. NGS-based high-resolution typing was performed on subpopulation (n=31) who are recently positive for HLA-B*15 on low resolution typing and statistical analysis was done by calculating the percentage of individuals who have the allele. Homozygous alleles were considered only once.

Results: Out of total 2178 individuals, majority are from South India (n=1187). Overall, HLA-A*24:02 was highly prevalent with 27.5% (599/2178) and with a high prevalence of 32% (389/1187) in South India. HLA-B*15:02 showed 6.6% (145/2178) with high prevalence of 13.6% (18/132) in Northeast India and lowest of 4.2% (50/1877) in South India. NGS-based high-resolution typing revealed 45% (14/31) patients with HLA-B*15:02 among other HLA-B*15 positive alleles.

Conclusion: Overall, HLA-A*24:02 showed highest prevalence and the HLA alleles associated with Carbamazepine hypersensitivity shows highest prevalence. Analysis of ethnicity differences revealed a pattern of alleles associated with Allopurinol hypersensitivity showing the highest prevalence in North India followed by carbamazepine and Phenytoin. In all the other regions, Carbamazepine is more prevalent. High resolution HLA typing performed on a subset of patients tested for HLA-B*15 showed almost half of the patients positive for HLA-B*15:02. However, barring about a fifth of the patients tested, the remaining showed alleles which have been described to be implicated in Carbamazepine hypersensitivity.

C 3.1: Unravelling the unusual - do only beta blockers exist? ‘D’ blockers do exist

J C Livingston Raja, John Gnanaraj, K C Gayathri, Amal Raj, Dolly Daniel

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

Background: Haemolytic disease of the foetus and Newborn (HDFN) occurs when there is destruction of foetal or neonatal RBCs by Ig G antibodies produced by the mother. We reported here the case of blocked D in a neonate sample in a suspected case of Rh D-HDFN which was detected in our hospital.

Case Report: A 26-year-old lady G2P1L1 at 30 weeks of gestation was admitted with pain abdomen and proceeded as preterm labour. Her first pregnancy was uneventful and delivered a term female neonate. Baby’s blood group was ‘A’ positive. The status of Rh(D) immunoglobulin administration was unknown. No history of blood transfusion in the past. In the current pregnancy, Immunohaematology work up for the mother showed blood group as ‘A’ negative with Antibody screen being positive (4+), ICT was Positive and DCT was negative. Antibody was identified as Anti-D with titre of 1024. She delivered a girl baby with Birth weight of 1.8 kg by emergency Caesarean section (indication: foetal distress). Baby was shifted to NICU for preterm care. Blood investigations of the baby showed Hb 6g%, Retic count 8%, TB-8 mg/dl, DB-0.6 mg/dl, peripheral smear-anisocytosis, polychromasia, spherocytosis which is suggestive of Haemolytic anaemia. So proceeded with immunohaematological workup of the baby. The baby red cells were typed for ABO and Rh by conventional tube technique and gel technique which showed ‘A’ negative. The direct antiglobulin test gave Positive (4+) which indirectly indicates the foetal red cells were heavily coated by some antibody. So, we proceeded with EDTA -Glycine elution technique (for removal of bound antibodies from red cells). Antibody screen and identification using eluate was identified as Anti-D antibody. Repeating blood grouping of the baby was done on Eluted red cells which showed Rh positive (4+).

Blocked D Phenomenon: It has been reported that if a neonate’s red blood cells are heavily coated by anti-D antibodies, Rh D typing with anti-D reagent will give false negative result. So while performing Rh typing, there won’t be any D antigen site for the antisera to bind which results in false negative reaction. It’s due to the binding od maternal Anti-D antibodies to D-antigen sites in fetal RBCs making it unavailable for antisera to bind thus gives false negative reaction.

Conclusion: A possibility of blocked D phenomenon should be considered in a clinical scenario where baby has features of HDFN in intrauterine life with high titre Rh-alloimmunised Mother.

C 3.2: Indigenously developed multiplex PCR assay for genotyping common antigens of RH, MNS, Kell, Kidd, and Duffy blood group systems

Pooja D Kshirsagar, Manisha Madkaikar, Swati S Kulkarni

ICMR- National Institute of Immunohaematology, Mumbai, Maharashtra, India

Aims and Objectives: Haemagglutination is a gold standard method for antigen typing however in multitransfused patients; it fails to phenotype the patient’s antigens due to donor-derived erythrocytes from previous transfusions. DNA typing can provide the accurate blood group antigen profile. Which will help to reduce alloimmunization caused by blood transfusion. The aim of the study was to develop a Multiplex PCR assay for blood group genotyping to predict presence/absence of common antigens of RH, MNS Kell, Kidd, and Duffy blood group systems.

Methods: A multiplex PCR assay was developed for typing 14 RBC antigens (C, c, E, e, M, N, S, s, K, k, Jka, Jkb, Fya, Fyb) in two reaction mixes. The assay includes following alleles: MNS1, MNS2, MNS3 and MNS4; KEL1, KEL2, FY1, FY2; JK1 and JK2; RH2, RH3, RH4, RH5. The assay was validated using 100 well characterized DNA samples by serology and other molecular methods.

Results: Multiplex PCR was performed using 100 DNA samples found to be concordant with phenotyping and genotyping results. The results of Multiplex PCR were reproducible. The sensitivity of the multiplex PCR assay was evaluated using positive and negative DNA controls and found to be 100%.

Conclusion: This multiplex PCR assay is cost effective, easy to perform with short turnaround time. This PCR can be utilized in Indian blood centres to know extended blood group antigen profile in multitransfused patients and donors, so that antigen-matched blood can be provided to recipients. For alloimmunized patients, it will help in antibody identification and selecting antigen-negative blood units.

C 3.3: Effectiveness of acute nonmonomeric hemodilution in reducing perioperative allogeneic blood transfusions in cardiac thoracic vascular surgery patients

Devesh Chandra Dubey, Babita Raghuwanshi

Department of Transfusion Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India

Objective: This study aims to evaluate the efficacy of Acute Nonmonomeric Hemodilution (ANH) in reducing the need for perioperative allogeneic blood transfusions in cardiac thoracic vascular surgery (CTVS) patients.

Methods: A 27-year-old male patient underwent surgical resection of a right atrial myxoma at a tertiary care hospital in central India. Preoperative hemoglobin levels were 14.8 g/dL and were maintained at 12.2 g/dL after ANH. Prothrombin time (PT), activated partial thromboplastin time (APTT), and platelet counts were within normal ranges. Preoperatively, The mean value of blood withdrawn in the patient was two units of 450 ml. This was replaced simultaneously with an equal volume of normal saline to maintain normovolemia. Hematocrit decreased significantly as compared to preoperative values. There were no changes in heart rate or mean blood pressure. The amount of blood collected during and post-surgery in suction bottles and, chest tube drainage was 80 ml. Acute normovolemic hemodilution (ANH) was performed to a target hematocrit of 33% before the start of surgery. Patients were bled from arterial or venous cannula with simultaneous infusion of Normal Saline in the contralateral arm so as to maintain normovolemia. Blood was collected into standard blood collection bags containing 49ml of CPDA. The volume of the blood collected was determined by the following formula (7):

V = EBV × Hi – Hf

Hav

Where V = Volume of blood collected,

EBV = Patient’s estimated blood volume (70ml kg-1), Hi = Patients initial Hematocrit,

Hf = Patient’s final (Desired) Hematocrit after hemodilution (30%), and Hav = Average of initial and final Hematocrit.

The bags were sequentially labeled and stored at room temperature. Retransfusion was started once the main surgery was over and hemostasis achieved. However, it was planned that in the event of excessive blood loss, autologous transfusion would be started early, and if the blood loss exceeded the autologous blood donation, homologous blood would be also given. The autotransfusion was performed in reverse order of collection i.e. first unit collected was transfused last. However, the homologous blood was not required.

During surgery, monitoring included ECG, heart rate, arterial blood pressure, central venous pressure, oxygen saturation, temperature, urine output and blood loss by gravimetric method. Blood collected in suction bottles and drapes was also included in the total calculated blood loss. Arterial blood gas and serum electrolytes were measured hourly during surgical procedure. Preoperative hemoglobin, hematocrit, electrolytes were recorded as baseline values. These were measured again after blood drainage, hemodilution, at maximum surgical blood loss and after retransfusion.

Results: Post-surgery the patient’s hemodynamic stability was monitored, and there were no complications. The postoperative day 1 (POD 1) hemoglobin level was 10 g/dL. The patient was transferred to the ward on POD 4 and discharged on POD 8 without any perioperative complications or allogeneic blood transfusions.

Conclusion: ANH is a safe and effective alternative to allogeneic blood transfusions in CTVS patients. Acute normovolemic hemodilution up to a target hematocrit of 30% is safe and effective in reducing the need for homologous blood in surgical patients. It proved to be a valuable measure in patient blood management. Successful implementation of ANH requires collaborative planning among surgeons, anesthesiologists, and transfusion specialists, emphasizing its potential benefits in developing countries like India and southeast Asia where the prevalence of Hepatitis is high. Acute normovolemic hemodilution has been employed from limited to extreme degree of dilution. Hemodilution up to 27 to 30% hematocrit value is called moderate hemodilution and it is the acceptable value for elective surgery of ASA grade I patients even without hemodilution.[1] It reduces blood viscosity and hence improves blood flow in the macro as well as microcirculation, improves tissue perfusion and oxygen supply.[2] This could be beneficial especially in patients undergoing surgery.

References

Messmer KF. Acceptable hematocrit levels in surgical patients. World J Surg 1987;11:41-6.

Messmer K. Hemodilution – Possibilities and safety aspects. Acta Anaesthesiol Scand Suppl 1988;89:49-53.

C 3.4: Interdepartmental transfusion error reporting in a tertiary care hospital in North India

Pradip Banerjee, Gita Negi, Chanchi B Khiamniungan, Daljit Kaur, Ashish Jain

Department of Transfusion Medicine and Blood Bank, AIIMS Rishikesh, Rishikesh, Uttarakhand, India

Introduction: Incident reporting and follow up is an important tool in maintaining quality in blood transfusion services. Implementation and follow up of specific corrective and preventive actions ensure continuous quality improvement and safe transfusion practices.

Aims and Objectives: To analyze the interdepartmental errors reported at our blood centre, classify them according to root cause and department involved and review the corrective and preventive actions taken.

Methods: A retrospective analysis of all incidents reported at our blood centre from January 2018 to June 2023 was done. All incidents where other departments were involved and had the potential of an adverse outcome in the recipient were included. In this study, data was retrieved from the incident reporting system and was analyzed with regard to root cause, department involved and corrective and preventive actions taken.

Results: A total of 91 incidents were reported during the study period out of which other departments were involved in 21 (23.1%) incidents. Among all interdepartmental incidents, maximum involvement was from Obstetrics and Gynecology (n=6, 28.6%) followed by Pediatric Medicine (n=4, 19.1%). The most common root cause was ‘improper patient details on forms and reports’ (n=5, 23.8%) followed by ‘wrong blood in tube’ (n=4, 19.1%). Corrective and preventive actions were reviewed to check compliance. A total of 9 near miss events were detected and proper corrective actions prevented an adverse outcome.

Conclusion: Interdepartmental collaboration is necessary for detection and mitigation of errors which have the potential of an adverse outcome. Identification and reporting of common errors and its sources prompt a more vigilant approach from the stakeholders of transfusion. Proper corrective actions can prevent near miss events from having an adverse outcome whereas preventive actions thwart recurrence of such errors.

C 3.5: Review of 57 non obstretic massive transfusions in a tertiary care centre

Bonagiri Shanthi, Manisha Agrawal1

Departments of Immunohaematology and Blood Transfusion and 1Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India

Aims and Objectives: To study the criteria for massive transfusion protocol implemented in our institute in different clinical settings and the ratios used for massive transfusions.

Methods: This study was performed as a retrospective audit of all transfusion orders constituting a massive transfusion for patients admitted from January 2022 to April 2023. For the purposes of this study, massive transfusion was defined as patients receiving criteria I->10 PRBC IN 24 HR, criteria II-4 TO 5 PRBC in 24 HR, III->ONE BLOOD VOLUME IN 24 HR, criteria IV-50%OF BLOOD VOLUME IN 4 HR. All patients in the study population were, who required a massive transfusion for excessive haemorrhage for both trauma and surgery-induced haemorrhage.

Results: Total 57 patients were analysed for demographic details, blood groups, types of blood products used, males 38/57, critera I MTP received by 6/57, critera II MTP received by 31/57, critera III MTP received by 7/57, critera IV MTP received by 10/57. Majority of the patients received during major cardiac surgeries, fixed ratio used were predominantly 1:1:1 based on laboratory parameters.

Conclusion: Massive Transfusions are needed to change the patient outcome in massive bleeding state, we need to regularly audit our Massive Transfusion Protocols to improve the performance as well as to optimize the use of precious blood and blood products.

Reference

O’Bryan LJ, Slater RJ. An audit of the incidence of over-transfusion at a quaternary centre. Anaesth Intensive Care 2022;50:407-9.

C 3.6: Evaluating the in vitro efficacy of platelets and plasma after pathogen reduction

Rishabh Agarwal, Rashmi Kushwaha, Tulika Chandra, Wahid Ali, V K Singh

Introduction: The safety of blood transfusion is still evolving and threatened by infections with various pathogens like virus, bacteria, parasite etc. There are numerous variety of known pathogens and emerging pathogens which are not feasible to test for each and every organism. A novel pathogen reduction technique known as Mirasol pathogen reduction inactivates all these infections. It is being done first time in Indian settings to evaluate the efficacy of platelets and plasma after treatment with riboflavin and UV radiation. This study will help us to assess the efficacy of platelets and plasma being supplied to the patients after proposed pathogen reduction.

Aims and Objectives:

To assess the platelet counts, functions, pH and biochemical parameters before and after pathogen reduction

To assess coagulation activity, biochemical parameters of fresh frozen plasma before and after pathogen reduction

To correlate the preparation time of platelets and plasma with in vitro efficacy of pathogen reduction.

Methodology: A pilot study on 40 units of platelets and 40 units of plasma was done in Department of Pathology and Transfusion Medicine, KGMU. Pooled random donor platelets and pooled fresh frozen plasma supplied to patients of liver and renal transplants were tested before and after preparation for counts, functions, ph and biochemical levels for platelets and coagulation profile and protein content for plasma. Correlation was done with the time of preparation of pooled platelets and plasma with efficacy of final units.

Results: Platelet counts and aggregration were slightly diminished in the final product but remained within normal range. Sodium, glucose, Lactate, protein and albumin levels were slightly decreased but within normal range. Potassium and chloride increased marginally with processing. Ph was almost constant. Pooled platelets prepared within 4 hrs showed a higher efficacy as compared to those within 6 hrs. In Plasma PT and APTT was prolonged slightly and the difference was insignificant. Factor 8 and fibrinogen showed a diminution but the p value was insignificant. Protein and albumin levels were marginally decreased. Pooled plasma prepared within 4 hrs showed a higher efficacy as compared to those within 6 hrs. Pooled plasma within 6 hrs had a higher efficacy than mixed (4 and 6 Hrs) pooled units.

Conclusion: The plasma and platelets pathogen reduced with UV radiation and riboflavin technology showed insignificant changes and the efficacy of these products in vitro was maintained. It is advisable to pool the products prepared within 4 hours than 6 hours.

C 3.7: Bridge therapeutic plasma exchange to manage non-alcoholic steatohepatitis related liver transplant patient with graft rejection: Evidence based case report

Lincy Jacob, Aditi Garud, Seema Yadav, Prajakta Joshi

Department of Transfusion Medicine and Immunohaematology, Dr. L H Hiranandani Hospital, Mumbai, Maharashtra, India

Aims and Objectives: To manage a NASH related chronic liver disease patient using Therapeutic Plasma Exchange (TPE) as bridge therapy, between a failed Live Donor liver transplant (LDLT) and a prospective wait for same group Deceased Donor liver transplant (DDLT).

Methods: 43-year-old male was listed for DDLT after a failed same group graft following a LDLT. Laboratory parameters were monitored for Thrombotic Thrombocytopenic Purpura (TTP) with daily platelet count, Schistocyte%, Immature Platelet Fraction (IPF) & LFT. Supportive transfusions were given to maintain platelet and hemoglobin levels. Six Bridge TPE were performed, 4 consecutively and 2 on alternate days. Post DDLT, again six TPE were performed, 3800 ml processed during each procedure. Patient response following each was noted and analysed.

Results: TPE was started on Day 3 of LDLT in view of graft failure and TTP. Six TPE procedures were performed as bridge therapy and helped patient remain clinically stable until the second transplant. On Day 6 of DDLT patient developed convulsions and TPE was started again in view of suspected immune related TTP. Significant improvement was noted by third TPE with improved platelet count (27,000 to 74,000), Schistocytes (3% to 0%), LDH (606 to 356) and SGPT (1046 to 43). No adverse events were noted during all 12 TPE procedures. Patient was discharged on DDLT Day 17 with stable vitals and improved graft function.

Conclusion: TPE can be used as an effective bridge therapy in patients with graft rejection to support the failing liver until potential DDLT; to reverse immune related TTP and improve the overall acceptability of transplanted liver.

C 3.8: Red blood cell exchange in sickle cell disease: A single center experience

Ankita Sharma, Mohit Chowdhry, Soma Agrawal, S Minu Lekshmi

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

Background and Objectives: Red cell exchange (RCE) is a therapeutic apheresis procedure aimed at removing the deformed red blood cells of a patient and replacing them with those obtained from healthy donors. It is a commonly used yet underutilized procedure for the treatment of sickle cell disease (SCD). The objective of the study is to study and understand the efficacy of RCE in the management of patients with SCD.

Methods: This is a retrospective study carried out over a period of 7 years. All the RCEs were performed on Spectra Optia apheresis. Patients of all age groups and sexes were included. RBC units used were compatible, TTI nonreactive, 3 log leukoreduced, HbS negative, and <7 days old from the date of collection. Prior blood grouping and screening for red cell antibodies were done.

Results: A total of 12 exchanges were performed in 9 patients. The targeted hematocrit and the final fraction of red cell (FCR) remaining values were kept at 30%. One patient who was planned to undergo autologous stem cell harvest (SCT), the procedure was aborted midway due to multiple clot formation in the tube circuit. An automated RCE was performed on the patient the next day. An effective FCR of 23% and a reduction of 85.3% in HbS were achieved. In another SCT patient, an automated RCE was done prophylactically. Also, 3 of these 9 patients had undergone the procedure twice. Two out of the 9 patients were found to be antibody screen positive. Corresponding antigen-negative units of packed red cells were issued for these patients.

Conclusion: RCE is a safe and effective therapeutic treatment modality for patients with SCD. RCE provides immediate relief in acute complications and is also advantageous when performed prophylactically to augment the plausibility of a successful primary procedure directed towards treating the underlying disease entity.

C 3.9: Aid of leukapheresis in leukemic priapism: A case report

Priyanka Devi, Gita Negi, Pradip Banerjee, Daljit Kaur, Ashish Jain

Department of Transfusion Medicine, AIIMS Rishikesh, Rishikesh, Uttarakhand, India

Introduction: Priapism is a rare presentation of Chronic Myeloid Leukaemia (CML). It is also considered a medical emergency as delay in treatment may lead to impotence. Prompt medical and surgical interventions are essential. Leukapheresis effectively reduces leukocyte count rapidly and effectively, thereby an important therapy along with other standard of care in CML-induced priapism.

Case Report: 23-year-old male was brought to emergency department who is a known case of CML on irregular treatment with chief complaints of painful erection for 5 days and generalized ache for 1 month. His Vitals was stable without any abnormality in general and systemic examination. Local examination confirmed the presence of painful erection. Urology and haemato-oncology opinion was taken. All baseline investigations sent and USG doppler resulted ischemic priapism with bone marrow aspirate and peripheral smear suggesting CML in Chronic Phase (CP). The WBC at the date of admission was 438.51x103/ ul. Hydroxyurea, Allopurinol, Dasatinib were started. Thereafter, 2 sessions of leukapheresis were done. The post procedure WBC was 257.83 103/ul. And then, winter shunt procedure was done and low dose sub-cutaneous Cytarabine was given following which patient condition was improved and discharged with WBC 9.73 103/ul and painful priapism resolved.

Conclusion: The present case has shown that leukapheresis might be a helpful adjuvant therapy in the management of priapism by rapidly decreasing the leukocyte count and pain. However, the treatment of priapism in CML remains a multidisciplinary approach, including haematology, urology, transfusion medicine, and emergency medicine.

References

Noushad S, Sahoo D, Basavarajegowda A, Toora E, Paudel P. Effect of leukapheresis on pain reduction in leukemic priapism. Asian J Transfus Sci 2022;16:124-7.

van der Velde MG, Tiellemans SM, de Lil H, Nieuwenhuizen L. The value of leukapheresis for treatment of priapism as presenting feature of chronic myeloid leukemia: Case report and review of literature. EJHaem 2022;3:1100-15.
