Perioperative normovolemic hemodilution in a case of leiomyomatous erythrocytosis

A 66-year-old female patient presented with complaints of abdominal discomfort, pigmentation and numbness of both lower limbs for 3 years duration. On examination, she had erythema of the face and palms. Investigations revealed high hemoglobin (Hb), hematocrit (Hct) and erythropoietin. Ultrasonography abdomen showed large uterine fibroid. As there are increased tendencies of thromboembolic episodes in patients undergoing surgeries with such high Hb and Hct, a target to achieve a Hb of 15g/dl and Hct of 45 was set in the patient. Repeated phlebotomies were done over 10 days with oral hydration only and the Hb was brought down to 18 g/dl on the day prior to surgery. On the day of surgery, pre-operative phlebotomy was done so as to remove 2 units of 350 ml blood and was transfused intraoperatively to combat blood loss. Post-operatively Hb was 12.4 g %. Patient was discharged on the 10 th post-operative day with further follow-up evaluations being uneventful

Surrogate markers and their correlation to bacterial contamination and other quality parameters in random-donor platelets by platelet-rich plasma method

Introduction: Bacterial contamination in platelet concentrates (PCs) occurs more frequently than other blood components because of several factors such as storage in oxygen permeable blood bags at 20°C–24°C with continuous agitation which facilitates bacterial growth compared to other blood components which are kept frozen or refrigerated which inhibits bacterial proliferation in them. The purpose of the study was to assess the incidence of bacterial contamination of random-donor PCs and factors associated with its contamination and see how well the surrogate markers such as pH and swirling correlate with the same. Methodology: This was a cross-sectional study which included randomly chosen 500 random-donor platelets (RDPs) in blood bank prepared by platelet-rich plasma method. The samples chosen for the study were from the RDPs on the 5th day of storage after their preparation. pH, platelet count, and swirling in platelets, which act as surrogate markers for bacterial contamination, were checked on the RDP units. About 1–3 ml of PCs was inoculated from the RDP units into labeled culture bottles (BD Bactec Peds Plus/F). Results: Among a total of 499 random-donor PCs that were cultured in the automated BACTEC system for the study, none of them were culture positive. Thirty RDP units in the study were visibly lipaemic whereas 93 RDP units were visibly reddish in appearance. PCs having volumes 70 ml did not affect the swirling, pH, and platelet counts. There was a statistically significant difference between mean pH with RDP units having swirling Grade 2 and 3 and platelet counts with RDP units having swirling Grade 1 and 2. Conclusion: Bacterial contamination though poses a significant risk is a very rare event in a meticulously prepared and stored PCs. Surrogate markers though useful in resource-constrained settings does not correlate optimally with the quality indicators

Olfactory function and its association with ABO blood group in adults: A cross-sectional study

Background: The effect of blood group antigens in human olfactory performance has not been established yet. This study was designed to find out the association if any of blood groups ABO of a person with the olfactory performance by some simple standard established olfactory tests. Materials and Methods: Olfactory threshold testing and olfactory identification testing were performed using the standard “i-smell” test using the common household items such as asafoetida (heeng), camphor, cardamom, clove oil, cumin seeds, lemon, and Vicks. The results were compared to see for association with ABO blood groups. The statistical analysis was done using IBM SPSS Statistics for Windows, Version 21.0., 2013 (Armonk, NY; IBM Corp.). Results: Among the 329 individuals participated in the study who were age and sex matched, there was an equal representation of all ABO blood groups. There was no statistically significant difference between the ABO groups either with olfactory threshold testing or with olfactory identification testing. Conclusion: Blood group is not proximally associated with olfactory function of an individual. A more objective test which may include complex or invasive studies in controlled environment with bigger sample may be planned for

Improving turnaround time for the issue of blood components in case of emergency

Background and Objectives: During a surgical or medical emergency, the timely issue of crossmatched blood is crucial for efficient and satisfactory patient revival. Turnaround time (TAT) is the duration taken from the time blood requests, and samples are received in the blood center until the blood is crossmatched and available for blood transfusion. The study aimed to audit the TAT in our center, analyze and study the factors delaying TAT, and formulate plans to improve it by implementing corrective measures. These actions would directly or indirectly impact the outcomes of the delivery of patient care in emergency services. Methods: A record-based prospective study was performed in a tertiary care teaching hospital with trauma and all emergency services in Southwestern India. TAT was calculated for all emergency blood requests received over 16 months in a systematic sampling method. Cases with prolonged TATs, where the product issue TAT exceeded the internal policy and quality indicator standards (15 min for emergency packed red blood cells issue), were further evaluated for causes of delay and analyzed at frequent intervals. Results: The mean TAT at the start of the study was 17.1 min (standard deviation [SD] 1.05 min), gradually reducing to 14.9 min (SD 0.62 min) by the end of the study, and it was statistically significant with P = 0.01. Conclusion: It is essential to deduce the causes for delayed TAT and work on those variables amenable to modifications based on priority to improve the TAT regarding pretransfusion testing and the issue of blood products, which is crucial in emergency services

Recipient hemovigilance at a tertiary care hospital in Southern India: A cross-sectional study

Introduction: Information on incidence of various transfusion reactions could help in early recognition as well as management and could also help to institute adequate measures to make blood transfusion as safe as possible. The primary objective of the present study was to determine the frequency and types of adverse transfusion reactions in patients who required blood component transfusion. Methodology: This was a cross-sectional, observational study conducted over a period of 22 months from September 2014 to June 2016 in the Department of Transfusion Medicine, JIPMER. All patients admitted to the wards of various specialty departments who were transfused with blood components and reported to have transfusion reaction during or after transfusion of blood components were included in the study. Results: A total of 90,758 components were issued during the study period, and 137 transfusion reactions were reported which accounted for 0.15% of total transfusions. Febrile nonhemolytic transfusion reaction (46.7%) was the most common reaction followed by allergic reaction (31.3%). Among different blood components, packed red blood cells (82%) were most commonly associated with transfusion reactions. Conclusion: Transfusion reactions unless serious are grossly underreported either due to lack of attributing the adverse event to transfusion or because the milder reactions are usually managed and unreported as the staff are too often used to having them, especially in chronically transfused patients

Steroid-Resistant immune thrombocytopenia: Challenges and solutions

Immune Thrombocytopenic purpura (ITP) is an autoimmune disorder characterized by a platelet count of <100 × 109/L in the absence of other underlying causes of thrombocytopenia and increased risk of bleeding. Glucocorticoids are the mainstay drugs of treatment for ITP. The response rate to steroids is around 60%–70% in adults, but only 10%–15% of these patients will have a durable response. If patients do not respond to steroids by 4 weeks, they are considered to have steroid-resistant ITP. Some patients though they respond, need frequent courses of steroids to maintain a platelet count above 30 × 109/L or to avoid bleeding and are considered nonresponders to steroids. A number of potential mechanisms for this resistance to steroids have been suggested, including receptor downregulation by glucocorticoid exposure and negative inhibition by the beta-isoform of the glucocorticoid receptor. The available treatment options for these patients include various drugs including rituximab, thrombopoietin receptor agonists, fostamatinib, danazol, immunosuppressive drugs, and biological therapies including intravenous immunoglobulin, Rh immunoglobulins, and immunoadsorption. Splenectomy has been performed surgically, by radiation, or chemoembolization. Supportive treatment includes screening for osteoporosis and management, vaccination, and platelet therapy. Newer therapies such as veltuzumab, belimumab, and toralizumab which deplete B-cells have been tried. Nearly 70% of adult chronic ITP patients failing to respond to splenectomy still achieve stable remission with additional therapies

Hypercoagulability in pediatric autologous hematopoietic progenitor cell collection – Is it the time to reconsider screening? – A case report

Peripheral blood hematopoietic progenitor cell harvest by apheresis in pediatric patients, a double-edged sword, has advantages and disadvantages over conventional bone marrow transplantation. The effect of granulocyte colony-stimulating factor (G-CSF) mobilization on hemostasis in literature is very scarce. A 3-year-old female child with metastatic neuroblastoma planned for autologous transplant. Following G-CSF mobilization (75 mg; 4 days), the procedure was performed with all default parameters in Spectra Optia with an acid citrate dextrose (ACD) flow rate 1:12, assuming 3-total blood volume (TBV) to be processed with 150 ml of expected collection with target yield of 6 × 106 CD34 cells/kg. Despite normal coagulation laboratory parameters, it was abandoned for reasons such as low-flow alarms and thrombi in the kit tubings. In the subsequent procedures, the ACD to whole blood ratio was decreased to 1:16, and used bolus of heparin was followed by continuous heparin infusion throughout the procedure. Despite using heparin anticoagulation, a long thrombus was aspirated at needleless port. The procedure was completed with continuous low-flow alarms. A cumulative dose of 5.67 × 106 CD34 cells/kg was achieved over four procedures, but the cause of hypercoagulability was unknown. All the coagulation parameters were within normal limits before and after the procedure. The exact cause for hypercoagulability remains elusive. There are no studies or case reports in the pediatric population on hypercoagulability following apheresis procedure after G-CSF mobilization, but evidence is available for adults, with lack of explanation. It can also be due to low draw flow from the patient side or embolization of thrombi developed in the anticoagulant unprimed site in the kit tubings. More extensive studies are required to explain the mechanism of hypercoagulability during apheresis procedures in the pediatric population