B Subgroup: Bx blood Group in a Patient : A Case Report

This is a report of a case of B Sub Group: Bx, first ever detected in Bangladesh, while doing compatibility test of a sample of a patient undergoing cardiac surgery. The patient was referred to the transfusion medicine department of Bangabandhu Sheikh Mujib Medical University to do cross-match with 8 proposed donors of same ABO group prior to cardiac surgery. His red cells showed weak agglutination with anti-B, anti-AB and in his serum there was potent Anti-A and weak anti-B which was not detected at 370C. After adsorption with anti-B an elute was prepared from patients cells which agglutinate with B and AB cells but did not agglutinate with A or O cells. The patient could be transfused with B blood but in this situation of cardiac surgery, as he should have to be kept in hypothermic condition, we transfused him with O washed red cell with AB plasma during operation. Patient was released from hospital without any complication. The weak B subgroups are: B3, Bx & Bel. B3 shows a mixed field of agglutination with anti B. Bx shows a weak agglutination and weak anti-B is found in the serum. Bel is not agglutinated with anti-B but is only adsorbed anti-B. With meticulous attention, cell & serum grouping of recipient and proposed donor/s to be done along with 3 phase cross-matching (Saline phase at room temp, at 4 and 37 degree Celsius temp, Indirect Coombs Test phase) to ensure right blood to the right patient at right time.DOI: http://dx.doi.org/10.3329/bsmmuj.v5i1.11032 BSMMU J 2012; 5(1):81-82

The Incidence of Vaso-vagal Reactions Among Whole Blood Donors During or Immediately After Donation

Background: The incidence of vaso vagal reaction among the whole blood donors are common. Few percent of these reaction may progress to syncope. Objectives: To evaluate the incidence of vaso-vagal reaction (VVR) among whole blood donors. Methods: This prospective, observational study was done in the department of transfusion medicine in Bangabandhu Sheikh Mujib Medical University from 01-04-2008 to 31-03-2009. Total 19553 blood donors were observed for vaso-vagal reaction. Results: The incidence of vaso-vagal reaction was 0.37%, in male 0.33% and in female it was 0.67%. Female donors were significantly more prone to develop vasovagal reaction (p=0.001). 78.8% of donors were first time donor and 28.8% were repeat donor. The clinical character of the symptoms according to frequency was- Sweating (86.3%), Nausea/ Vomiting (80.8%), Pallor (67.1%), Dizziness (39.7%), Loss of consciousness and fainting, increased rate of respiration (30.1%), anxiety presented (16.4%) and vertigo (1.4%). Conclusion: Although the incidence of vasovagal reactions in our study is lower than other studies, it is important to follow strict donor selection criteria and ensure careful monitoring during and immediate after the donation process to avoid the fatal consequences. Key words: Vaso-vagal reaction; donor reaction; blood donation. DOI: http://dx.doi.org/10.3329/bsmmuj.v4i2.8640 BSMMU J 2011; 4(2):106-10

External beam radiotherapy and intracavitary brachytherapy is an acceptable treatment for locally advanced carcinoma of the uterine cervix

Background: Cervical carcinoma is the second most common neoplasm in women worldwide and is the most frequent cancer among women in Bangladesh. In recent years, High Dose Rate (HDR) brachytherapy in combination with External Beam Radiotherapy (EBRT) has been popular in the management of cancers of uterine cervix.Objectives: To evaluate the effectiveness and acute toxicity of four fractions high dose rate intracavitary brachytherapy following pelvic external beam radiotherapy in the treatment of locally advanced cervical carcinoma. Methods: Bangabandhu Sheikh Mujib Medi­cal University & NICRH chosen as a research place for EBRT and HOR brachytherapy. A typical radiotherapy treatment involves daily inadiation for several weeks. Whole pelvis was treated with total dose of SO Gy in 5 weeks. Patients were treated once a day, 5 days a week with a daily fraction size of 2.0 Gy. EBRT: Pelvic radiotherapy dose is 50 Gy in 25 fractions (2.0 Gy per fraction) over 5 weeks. HDR brachytberapy dose is 7 Gy per fraction, total 4 fractions, each in a week over 4 weeks. Results: Ninety-eight patients were entered in the study. Three patients were excluded due to active non-malignant diseases. One patient had active tuberculosis, two patients had severe skin reactions and two patients withdrew following the first HDR application. The remaining Ninety patients were analyzed. Ninety patients completed the prescribed treatment and were evaluated. Eighty had complete response with relief of symptoms, negative Pap-smear and no clinical signs of persistence disease at 3 months. Ten patients had a positive Pap-smear with clinical signs of persis­tence disease. Patients were evaluated before statting treatment with EBRT and before starting treatment with HDR ICBT. Conclusion: It can be easily concluded that 4 fractions of HDR ICBT, 7 Gy each weekly and pelvic EBRT can effectively and safely control locally advanced carcinoma of the uterine cervix. So that EBRT and HDR ICBT is an acceptable treatment for locally advanced carcinoma of the uterine cervix. Careful attention to normal tissue doses such as the rectum, bladder, and small bowel is important in the treatment of locally advanced cervical cancer

External beam radiotherapy and intracavitary brachytherapy is an acceptable treatment for locally advanced carcinoma of the uterine cervix

Background: Cervical carcinoma is the second most common neoplasm in women worldwide and is the most frequent cancer among women in Bangladesh. In recent years, High Dose Rate (HDR) brachytherapy in combination with External Beam Radiotherapy (EBRT) has been popular in the management of cancers of uterine cervix.Objectives: To evaluate the effectiveness and acute toxicity of four fractions high dose rate intracavitary brachytherapy following pelvic external beam radiotherapy in the treatment of locally advanced cervical carcinoma. Methods: Bangabandhu Sheikh Mujib Medi­cal University & NICRH chosen as a research place for EBRT and HOR brachytherapy. A typical radiotherapy treatment involves daily inadiation for several weeks. Whole pelvis was treated with total dose of SO Gy in 5 weeks. Patients were treated once a day, 5 days a week with a daily fraction size of 2.0 Gy. EBRT: Pelvic radiotherapy dose is 50 Gy in 25 fractions (2.0 Gy per fraction) over 5 weeks. HDR brachytberapy dose is 7 Gy per fraction, total 4 fractions, each in a week over 4 weeks. Results: Ninety-eight patients were entered in the study. Three patients were excluded due to active non-malignant diseases. One patient had active tuberculosis, two patients had severe skin reactions and two patients withdrew following the first HDR application. The remaining Ninety patients were analyzed. Ninety patients completed the prescribed treatment and were evaluated. Eighty had complete response with relief of symptoms, negative Pap-smear and no clinical signs of persistence disease at 3 months. Ten patients had a positive Pap-smear with clinical signs of persis­tence disease. Patients were evaluated before statting treatment with EBRT and before starting treatment with HDR ICBT. Conclusion: It can be easily concluded that 4 fractions of HDR ICBT, 7 Gy each weekly and pelvic EBRT can effectively and safely control locally advanced carcinoma of the uterine cervix. So that EBRT and HDR ICBT is an acceptable treatment for locally advanced carcinoma of the uterine cervix. Careful attention to normal tissue doses such as the rectum, bladder, and small bowel is important in the treatment of locally advanced cervical cancer

Frequency of ABO and Rh-D blood groups in cervical cancer

There is much evidence that the ABO blood group system may play a role in the pathogenesis of the disease. The relationship between ABO and Rhesus blood groups and cancer risk has been demonstrated in many research works. However, concerning gynaecological malignancies, these findings are inconsistent. This study aimed to evaluate the frequency of ABO and Rh-D blood groups in patients with carcinoma cervix. This cross-sectional study was conducted in the Department of Transfusion Medicine, Department of Gynaecological Oncology and Department of Pathology of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. A total of 110 clinically suspected cervical cancer patients were included in this study. Pap smear tests was done in all cases and the patients were divided into case (Pap test positive) and control group (Pap test negative). A total of 55 patients were included in each group. Blood groups (ABO & Rh-D) of all the patients were recorded. A higher number of the patients in the cervical cancer group were multiparous than in the control group. Almost in two-thirds of the population, the age of marriage was <18 years in the cervical cancer group compared to 34.5% in the control group. More than one-third population had “O” blood group in the case group, while it was 31% in the control group. The almost equal number had Rh D+ve in the case and control (92.7% vs. 94.5%). The differences between the blood group and Rh D were not statistically significant between the two groups. Nearly half (40.0%) of the participants had used a hormonal contraceptive in the case and 61.8% in control. The differences in hormonal contraceptives use were statistically significant within the two groups. The distribution of “O” blood group and Rh D +ve cases was found to be higher in patients with cervical cancer than in non-cancer patients although the difference was not statistically significant. BSMMU J 2022; 15(2): 70-7

Daycare transfusion service: Two-year experience in a daycare transfusion unit of a licensed private blood transfusion center in Dhaka City of Bangladesh

Background: Establishment of daycare blood transfusion service in a licensed blood transfusion center of Dhaka city for patients needed blood transfusion is a milestone for improving blood service of Bangladesh. Aim: The aim of this study is to assess the daycare blood transfusion service of a licensed blood transfusion center in Dhaka city and evaluation of patients receiving blood transfusion and to determine the pattern of blood groups of the patients. Materials and Methods: This cross-sectional study was done in a licensed blood transfusion center in Dhaka city. The study reveals that 383 patients of various modalities of ailments had their blood transfusion from August 2012 to January 2014. The patient age, sex, diagnosis, and levels of hemoglobin were taken into consideration. The patterns of their blood groups were determined for the study. Results: This cross-sectional study revealed that among 383 patients, 148 were male and 235 were female. With the age range of 14–80 years, mean age was 53.9 ± 2.77 years. Among them, most (148) were in the age range of 55–64 years. Among the patients, 47.00% (180) were suffering from anemia according to severe, moderate, and mild anemia with various diseases. Out of 383 patients, 31.33% (120) were suffering from carcinomas. Among those carcinomas, breast, colon, lung, larynx, tongue, stomach, and esophagus carcinoma and cholangiocarcinoma were prevalent. Others such as chronic kidney disease and leukemia 7.31% (28) were next to take transfusion. Maximum of them, i.e. 235 (61.36%), were in the hemoglobin range of 5.81–7.80 g/dl range and 60 (15.67%) had their hemoglobin level at 3.81–5.80 g/dl range. Out of them, 160 were of A group, 106 were B group, 88 were O group, and 29 were AB group. Conclusion: Although daycare transfusion centers are very few in licensed blood transfusion centers, the need for daycare transfusion is increasing gradually. We recommend establishing more daycare transfusion services for the transfusion needed patients

Social, economic and legal dimensions of tobacco and its control in South-East Asia region

This paper examines the social, cultural, economic and legal dimensions of tobacco control in the South-East Asia Region in a holistic view through the review of findings from various studies on prevalence, tobacco economics, poverty alleviation, women and tobacco and tobacco control laws and regulations. Methods were Literature review of peer reviewed publications, country reports, WHO publications, and reports of national and international meetings on tobacco and findings from national level surveys and studies. Tobacco use has been a social and cultural part of the people of South-East Asia Region. Survey findings show that 30% to 60% of men and 1.8% to 15.6% of women in the Region use one or the other forms of tobacco products. The complex nature of tobacco use with both smoking and smokeless forms is a major challenge for implementing tobacco control measures. Prevalence of tobacco use is high among the poor and the illiterate. It is higher among males than females but studies show a rising trend among girls and women due to intensive marketing of tobacco products by the tobacco industry. Tobacco users spend a huge percent of their income on tobacco which deprives them and their families of proper nutrition, good education and health care. Some studies of the Region show that cost of treatment of diseases attributable to tobacco use was more than double the revenue that governments received from tobacco taxation. Another challenge the Region faces is the application of uniform tax to all forms of tobacco, which will reduce not only the availability of tobacco products in the market but also control people switching over to cheaper tobacco products. Ten out of eleven countries are Parties to the WHO Framework Convention on Tobacco Control and nine countries have tobacco control legislation. Enforcement of control measures is weak, particularly in areas such as smoke-free environments, advertisement at the point of sale and sale of tobacco to minors. Socio-cultural acceptance of tobacco use is still a major challenge in tobacco control efforts for the governments and stakeholders in the South-East Asia Region. The myth that chewing tobacco is less harmful than smoking tobacco needs to be addressed with public awareness campaigns. Advocacy on the integration of tobacco control with poverty alleviation campaigns and development programs is urgently required. Law enforcement is a critical area to be strengthened and supported by WHO and the civil society organizations working in the area of tobacco control