Laboratory work-up and its translational significance in cold agglutinin syndrome

Autoimmune hemolytic anemia (AIHA) is characterized by the presence of agglutinins directed against autologous erythrocytes causing their reduced survival. Approximately 20% of AIHA are associated with cold-reactive antibodies. About half of patients are termed idiopathic without any underlying causes. Secondary cases are associated with underlying diseases or with certain drugs. We report herein a case of idiopathic cold autoimmune hemolytic anemia in a 65 year old lady without any underlying cause who presented with grouping discrepancy and responded well to treatment. Blood transfusion was completely avoided by keeping her warm and other conservative management including hematinic. At the time of discharge from the hospital her haematocrit reached 24%. Patient now is being followed as an outpatient and she continues to work daily albeit acro-cyanosis occurs sometimes on exposure to cold water. To our knowledge a careful communication between the transfusion services and clinicians can avoid unnecessary blood transfusions in such cases especially in clinically responding patients

Response Rate of Sero-reactive Blood Donors to Notification and Counselling

Background. Sero-reactivity disclosure to blood donors is an important issue of public domain. The sensitivity of situation demands both confidential as well as trust laden atmosphere while notifying them. Our aim was to assess and analyze the response rate of sero-reactive donors towards post-donation notification and counselling.Material and methods. Donors reactive for any transfusion transmitted infections were notified of their results and called to blood bank for counseling (January 2016 to December 2017). The notification process included one postal and two telephonic communications. Their privacy was maintained throughout the whole process. Responders were counseled by the medical officer and subsequently referred to the concerned specialty for further management.Results. Among 30,343 voluntary blood donors (96% males) 65.2% (n = 19 784) were repeat donors. Total 0.42% (n = 129) cases with reactive screening test results (0.30% HBV; 0.06% HIV; 0.006% HCV; 0.04% syphilis and 0.006% malaria) were evaluated. Prevalence of HBV and HIV were higher among first time donors (0.61% and 0.12%) than in repeat donors (0.14% and 0.02%) respectively (p = 0.002). Overall 58% (n = 75/129) donors responded to notification and counseling. Response among repeat donors (67.5% [n = 27/40]) versus first time donors (54.0% [n = 48/89]) was better and statistically significant (p = 0.05). The response rate for Malaria, HIV, Syphilis, HBV and HCV was 100%, 78%, 77%, 51% and 50%, respectively. Inaccurate donor demographics (wrong address and phone number) resulted in our inability to notify 11.6% (n = 15) cases. Major factors hindering the response rate were donors’ inability to be present for a post-test discussion either due to far distance (> 100 miles) and/or their busy schedule.Conclusion. Good response was noted among repeat blood donors. Donor education and repeated attempts to communicate with the sero-reactive donors would improve the response rate

Zastosowanie kliniczne świeżo mrożonego osocza w szpitalu referencyjnym w Indiach

Background. Increased utilization of fresh frozen plasma (FFP) over the last decade hascaused a rising trend in its unjustified usage exposing recipients to both infectious and non--infectious hazards. The aim of the study was to observe the pattern of clinical use of plasmaat a tertiary care hospital from India.Material and methods. Prospective analysis of all the requests raised for plasma was carriedout. Indicators namely homogeneity of the requisition forms, patient demographics, indicationsfor transfusion, dosage, pre-transfusion coagulation parameters and adverse events werenoted. Appropriateness was defined based on compliance to both national and internationalstandards. Data was analyzed using SPSS version 20 (IBM, USA).Results. Total nine hundred ninety eight patients (Males: 66%) received 4991 units ofplasma at an average of two episodes per patient. Majority were adults 83.6% (n = 835).Primary users were internal medicine (32%) and plastic surgery (17%) respectively. Mostcommon indication was bleeding with coagulopathy seen in 41% (411/998) patients. Averageplasma volume administered was 456.2 ± 287.4 (17 to 2800) mL per episode. Pre--transfusions INR value was available in only 63.2% (n = 1317) episodes. Overall, 56% (n= 1169) episodes were deemed appropriate. Total 0.28% plasma related adverse reactionswere seen and reported to the national hemovigilance database. Mortality in the study groupwas 7.2%.Conclusion. Existing transfusion practices for plasma use were moderately compliant withthe standards. Commonest indications for inappropriate FFP use were for low protein statesand prophylaxis without any evidence of bleeding.Wstęp. W ciągu ostatniej dekady znacznie zwiększyło się zużycie świeżo mrożonego osocza(fresh frozen plasma, FFP), co spowodowało rosnącą tendencję do nieuzasadnionego stosowaniaFFP, a tym samym narażenie pacjentów na ryzyko związane z zakażeniami i niezakaźnymi powikłaniami. Badanie przeprowadzono w celu zaobserwowania, w jaki sposób stosuje sięFFP w referencyjnym szpitalu w Indiach.Materiał i metody. Przeanalizowano w sposób prospektywny wszystkie przypadki zamówieńosocza. Stosowano jednorodne formularze zamówienia i odnotowano dane demograficznechorych, wskazania do transfuzji, dawkę, parametry krzepliwości krwi przed transfuzją orazzdarzenia niepożądane. Prawidłowe stosowanie definiowano jako zgodność z krajowymi i międzynarodowymistandardami. Do analizy danych użyto oprogramowania SPSS, wersja 20(IBM, Stany Zjednoczone).Wyniki. Ogółem 998 chorym (66% mężczyzn) podano 4991 jednostek osocza, a średnia liczbatransfuzji na pacjenta wynosiła 2. Większość stanowiły osoby dorosłe (83.6%; n = 835).Największą grupę stanowili pacjenci internistyczni (32%) i osoby poddające się zabiegom z zakresuchirurgii plastycznej (17%). Najczęstszym wskazaniem było krwawienie z koagulopatiąobserwowane u 41% (411/998) chorych. Średnia objętość podanego osocza wynosiła 456,2± 287,4 (17 do 2800) ml na transfuzję. Wartość INR przed transfuzją była dostępna tylkow 63,2% (n = 1317) epizodów. Ogółem, 56% (n = 1169) epizodów uznano za prawidłowe.W 0,28% przypadków zaobserwowano działania niepożądane i zgłoszono je do krajowej bazynadzoru hematologicznego. Odnotowano 72 przypadki zgonów (7,2% chorych).Wnioski. Stosowana praktyka dotycząca transfuzji osocza była umiarkowanie zgodna ze standardami.Najczęściej stwierdzanymi nieprawidłowościami było stosowanie FFP w przypadkuniedoborów białkowych i w ramach profilaktyki przy braku jakichkolwiek oznak krwawienia

Cumulative quality assessment for whole blood-derived platelets: A compliance review

Background and Objectives: Quality control (QC) results of platelet-rich plasma and buffy coat-reduced platelet concentrates (PCs) are presented with the goal to assess their compliance with published guidelines and corrective action taken for any process deviation during their manufacture. Subjects and Methods: Retrospective QC of in-house prepared whole blood-derived platelets (2009–2013) was conducted. Their cumulative results were compared to the published quality standards given by the American Association of Blood Banks, Council of Europe, and Indian guidelines. Data was analyzed using SPSS Statistics version 20. Results: A total of 36,053 PCs were prepared during the study period, and 1.43% (n = 516) was subjected to QC. The aggregate five years mean ± standard deviation (range) of product per bag were volume 58.4 ± 9.5 (37–90) mL, platelet yield 5.89 ± 1.28 (3.1–8.7) × 1010, residual leukocyte count 1.5 ± 1.2 (0.02–5.5) × 107, pH 6.67 ± 0.48 (6.0–7.3), and erythrocyte contamination 0.29 ± 0.2 (0.03-2.0) mL. Swirling was present in all the units. None of the bags showed any microbial growth. Against volume, yield, and erythrocyte contamination 90.0%, 94.3%, and 87.0% units showed compliance to the Indian standards, respectively. All the PCs had pH and leukocyte counts well within the recommended norms. Conclusions: Quality of our platelet product although suboptimal to International standards was well within the national requirements

Preponderant use of fresh-frozen plasma in children despite weaker evidence

BACKGROUND: Considering the higher use of fresh-frozen plasma (FFP) in our hospital, we desired to determine the pattern, prevalence, and potential complications of its utilization in new-born and children with the primary aim to observe its effect on the conventional coagulation screening (CCS) parameters. SUBJECTS AND METHODS: Patients' demographics, clinical indications, and pre- and posttransfusion CCS parameters such as the prothrombin time, the international normalized ratio (INR), and partial thromboplastin time were observed over a period of 10 months. Any improvement observed in the laboratory parameters after FFP transfusion was noted. RESULTS: We studied 433 episodes, where 499 FFP units were utilized in 184 patients. Mean age in years was 6 ± 0.16 (new-born to 17). Diagnoses-wise majority had diffuse intravascular coagulation with sepsis 25% (46/184) followed by febrile illness 23% (42/184). Around 46% (84/184) patients had bleeding episodes of which four had known family history of bleeding (three factors IX and one factor XI deficiency). Mean doses of FFP utilized (mL/kg) in children and infants were 12.6 ± 6.3 (n = 297 episodes) and 14.4 ± 6.3 (n = 136 episodes), respectively (P = 0.006). Mean change in INR in the cohort with deranged coagulation parameters against the overtly bleeding cohort was 0.85 versus 0.40 (P = 0.006). CONCLUSION: The study elicits minimal evidence in correcting the coagulation parameters, especially in the infants, whenever FFP was transfused prophylactically. Joint-decision making of the pediatricians and transfusion medicine physician would promote judicious use in children

Bank to bedside: A reliable and efficient transportation of blood by pneumatic tube system

Background: Turnaround time (TAT) is an important quality indicator in blood banking. This study evaluated the effectiveness of the pneumatic tube system (PTS) to reduce TAT and its effect on the quality of the blood products. Materials and Methods: The PTS (Swisslog GMBH, Germany) which connects to 29 stations was installed at our 2032-bedded tertiary care referral center. The system transports the carrier at an average speed of 25 feet/s (7.6 m/s). Acknowledgment slips were sent along with the blood components through this carrier system to know the time of receipt. Quality control parameters were checked before and after PTS transport in 10 bags of each of the blood components (packed red blood cells [PRBC], platelet concentrate, and fresh frozen plasma [FFP]). Data were analyzed using IBM SPSS Statistics 20. Results: PTS was used for 220 events to deliver 69% PRBC (n = 152), 15% FFP (n = 34), 14% platelets (n = 30), and 2% cryoprecipitate (n = 4), respectively, to 11 destinations. The average transport time by PTS was 1.36 ± 0.34 min and for human-based transport, it was 7.92 ± 1.40 min and this difference was found to be statistically significant (P < 0.001). The mean latent time was 5.85 ± 4.39 min. Conveyance in the PTS did not reinforce any negative changes on the quality of any blood component. Conclusion: PTS is rapid and reliable for the transport of the blood products to bedside

Cellular mimicry in kleihauer–betke assay

The Kleihauer–Betke (KB) test is a time-consuming test with a lot of variables which affect the calculation of the extent of fetomaternal hemorrhage (FMH). There have been several formulae proposed by various authors to calculate FMH using KB test. In this article, we propose a simple mathematical alteration to accommodate the correction for some of the factors that lead to falsely high estimation of FMH