Pattern of blood component cross-matching and their utilization in a tertiary care hospital of Jammu region

Background: Transfusion of donated blood remains the mainstay of treatment for a wide range of medical and surgical conditions. Although it can save life, but transfusion of blood is not without risk. Clinicians should cautiously assess the appropriateness of indications before requesting various blood components thereby preventing misuse of blood and unnecessary exposure of patient to various transfusion transmitted infections and antibodies production. This study was conducted to determine the pattern of whole blood (WB) and blood component cross-matching and their utilization and to minimize the inappropriate use of blood and its components.Methods: This cross-sectional prospective study was performed at SMGS Hospital Blood Bank, Jammu from April 2016 to September 2016. The requisition forms were analysed at the reception counter and inside the pre-transfusion testing laboratory for any error. The department wise utilization of blood and its components, Crossmatching to transfusion (C/T) ratio, transfusion probability (T%) and transfusion index (TI) were calculated.Results: A total of 14376 requests for cross-matching of blood and its components were received. All the units were cross-matched. Out of these, 12766(88.8%) units of blood and its components were issued to various departments. The most common indication for using packed red cells and whole blood was anemia and bleeding (APH/PPH/Trauma). The total C/T Ratio, transfusion probability (T%) and Transfusion index(TI)  of various blood components were 1.12:1, 88.8% and 0.88 respectively.Conclusions: Our study indicates efficient usage of blood and its component. However, awareness is still needed amongst the clinicians and residents to ensure the appropriate use of blood and its components in the future as well. Hospital transfusion committee has to develop transfusion guidelines and subsequent implementation of such guidelines to assure effective blood utilization. MSBOS (maximum surgical blood ordering schedule) should be formulated for elective procedures with regular auditing, feedback, and modifications to improve blood ordering and utilization

Study of seroprevalence of antibodies to SARS-COV-2 among the healthy blood donors of Jammu region

Background: SARS‑CoV‑2 emerged in China and spread throughout the world due to its rapid transmission. The exposure rate in the healthy population is unknown, mainly in resource‑limited countries. Herein, we estimated the seroprevalence of anti‑SARS‑CoV‑2 antibodies and risk factors among blood donors at our blood bank and to describe some characteristics of those that test positive. The objective of the study was to measure the levels of IgG antibodies targeting the SARS-CoV2 during the peak period of the COVID-19 pandemic in Jammu State, India to know the magnitude of SARS-CoV-2 exposure, the prevalence of herd immunity in the population.Methods: This is prospective observational study of COVID-19 seroprevalence among blood donors that complied with blood donation protocol. Participation in study was voluntary after taking proper consent on the consent form.Results: A total of 750 random blood donors who voluntarily participated, were enrolled in this study after obtaining their proper consent on the consent form. Out of 750 donors, 287 (38.2%) were positive for IgG antibodies and 463 (61.7%) were negative for IgG antibodies. In our study, male donors (745) outnumbered the female donors but on the other hand female donors showed a higher prevalence of covid antibodies i.e., 60% as compared to male donors i.e., 38% which is a statistically significant difference (p<0.005).Conclusions: A high prevalence of SARS-CoV-2 antibodies was detected among blood donors which indicated a high level of exposure to the virus within the population and development of innate immunity against the virus. This could help us to introduce a protocol of antibody testing in the screening of blood donors to enhance the number of plasma donation cases for the treatment of serious COVID patients

Distribution of RH and Kell (K) blood group antigens among blood donors in a tertiary care hospital of Jammu region, India

Background: Knowledge about the frequency of red cell antigen phenotype is very important for the creation of donor data bank and to minimize the risk of alloimmunization. This requires the determination of immunological characteristics of blood products and blood recipients by performing phenotyping of clinically significant blood group antigens. The aims and objectives were to study the distribution of Rh and Kell (K) antigen among blood donors of different ethnic groups in a tertiary care hospital.Methods: This was prospective observational cross sectional one-point analysis study which was carried out over a period of one year with effect from November 2015 to October 2016 in the Postgraduate Department of Immunohematology and Blood Transfusion Medicine, Shri Maharaja Gulab Singh (SMGS) Hospital, Government Medical College, Jammu and Kashmir, India. It comprised of voluntary and replacement donors and categorized into different ethnic groups i.e Dogras, Gujjar Muslims, Non-Gujjar Muslims, Kashmiri Pandits, Sikhs and Christian. Donors selection criteria was as per Drug and Cosmetic Act.Results: A total of 500 (Five hundred) blood samples from the donors of all blood groups were typed for the presence of Rh (D, C, E, c, e) and Kell (K) antigens. Out of these 500 samples, 420 were antigen typed by conventional tube technique and 80 samples were typed by column agglutination technique using glass beads. As per ethnicity, maximum donors were Dogras (74%) followed by Non-Gujjar Muslims (9.4%), Gujjar Muslims (9%), Sikhs (5.6%), Kashmiri Pandits (1.4%) and Christians were the least in frequency (0.6%). On phenotyping for Rh and Kell antigens ‘e’ antigen have the ubiquitous distribution and was found to have the highest frequency 486 (97.2%) followed by ‘D’ antigen 472 (94.4%), ‘C’ antigen 426 (85.2%), ‘c’ antigen 320 (64.0%) and ‘E’ antigen 103 (20.6%). Overall frequency of Kell (K) antigen was 2.6%.Conclusions: Knowledge of red cell antigen phenotype frequencies in a population with different ethnic groups can help in creating donor data bank and database for the distribution of blood groups for preparing inhouse cell panels and providing proper antigen compatible blood for patients with multiple alloantibodies and also reduce the risk of RBC antigen alloimmunization along with their complications

Donor notification in reactive donors and their response to communication

Background: Blood transfusion is associated with the risk of transmitting transfusion transmissible infections (TTI) even after the thorough mandatory TTI screening of blood units. To prevent disease transmission, it is important to inform, notify and counsel the donors about their seroreactive status at the blood centre. The present study determines the response of various TTI reactive donors for post donation counselling after notification and their persistence in society as reactive donors.Methods: It was a retrospective study conducted at tertiary care center from 1May2015 to 30April2017. Re-active donors were called to the blood bank by telephonic call and letters. Reactive donors on complying at center were retested, counselled and referred to appropriate centre for further management.Results: There were 34,204 blood donations over period of two years, out of which 375[1.09%] were reactive donors. Of these HBV reactive comprises of 166/34204(0.48%), HCV were 40/34204(0.11%), HIV reactive donors comprises of 26/34204(0.07%), Syphilis 138/34204[0.40%] and there were five cases of co-infection, two for HIV+ HCV, two cases HIV+HBV and one case of co-infection with HBV+ Syphilis. A total of 375 TTI reactive donors were identified, out of which (227/375) 60.5% contacted by tele-phone calls and letters and remaining (148/375) 39.46% cannot be contacted. Out of 227 contacted donors only 117 donors reported for post donation counselling i.e. response rate of 51.54%.Conclusions: Donor notification is efficient method of curtailing TTI but undermined by communication failure with donors, resulting in persistent load of blood transmissible infectious risk

Impact of COVID-19 outbreak on the blood donation and utilization and strategies adopted to combat it in a tertiary care center of Jammu province

Background: The COVID-19 pandemic has major implications for blood transfusion. There are uncertain patterns of demand, and transfusion institutions need to plan for reductions in donations and loss of crucial staff because of sickness and public health restrictions. A range of strategies need to be planned to maintain ongoing equitable access to blood for transfusion during the pandemic, in addition to providing new therapies such as convalescent plasma. The main role of transfusion institutions during this period, is the monitoring of supply and demand so that sufficient blood stocks are maintained to support ongoing critical needs. The main aim of our study was to study the impact of COVID-19 outbreak on blood transfusion services (BTS) and to identify the challenges faced by our blood center and mitigation strategies adopted to combat it.Methods: Total number of donations and total number of blood and its components issued were noted from the donor and issue registers respectively, both during the pre-COVID and COVID-19 pandemic and the results were compared thereafter. Various strategies were adopted during the COVID pandemic in order to maintain balance between demand and supply of blood and its products.Results: There has been sudden decrease in the number of blood donations in the month of April 2020 (35%) in the COVID pandemic as compared to pre-COVID time with percentage difference of 65%. This was followed by gradual decrease in the no. of donations in COVID pandemic when compared with donations in the pre-COVID time. The percentage difference in blood donation gradually improved over a period of time from 65% in April 2020 to 7% in April 2021. Similarly, no. of blood units issued also decreased from 1147 in April 2019 to 553 units in April 2020.Conclusions: The BTS need to provide an uninterrupted blood supply, and this stays true even in the face of a pandemic. The plan of action has to be started early so that the supply can be maintained and monitored effectively. Health-care workers being one of the main pillars in the fight against COVID-19 have to be supported and protected.

Audit of fresh frozen plasma usage, prospective study: a report from department of immunohematology and transfusion medicine, government medical college Jammu, Jammu and Kashmir, India

Background: Fresh frozen plasma is commonly used in tertiary care hospitals. These are used to manage conditions such as coagulation derangements. Unnecessary use of fresh frozen plasma (FFP) is known to increase the risk of side effects in plasma transfusing patients like anaphylaxis, transfusion related acute lung injury (TRALI) and risk of transfusion transmitted infections etc. So judicious use of plasma is extremely important where its benefits outweigh its potential risks.Methods: Prospective observational study conducted over a period of six month. The following data were collected; provisional clinical diagnosis, indication of FFP’S, coagulation profile and gender of the patients. We evaluated all FFP transfusions, classified them as appropriate or inappropriate according to fresh frozen plasma transfusion guidelines of Directorate general of health services (DGHS).Results: A total of 808 FFP units were issued (474 units to males and 334 units to females) over a period of 6 months. Out of these, 15% (122 units) of  FFP’s were issued to intensive care unit (ICU) patients, 12.87% (104 units) to paediatrics ward, 12.25%  (99 units) to emergency ward which include patients with upper GI bleed and lower GI bleed , 6.8% (55 units) to obstetrics patients, 6.18% (50 units) to orthopaedics, 4.45% (36 units)  to road traffic accident patients, 4.20% (34 units) to Hepatic failure patients, 3.09% (25 units) to Cardiothoracic and vascular surgery (CTVS), 2.97% (24 units) to oncology patients, 2.47% (20 units) to snake bite patients, 1.23 % (10 units) to dengue patients, 1.11% (9 units)  to Haemophilia  patients, 27.38% units were issued to the patients were indication for FFP transfusion was not known.Conclusions: study showed that 66.44% were appropriate and 33.56% were inappropriate use of FFP’s in patients. This highlights the pitfalls in use of FFP among clinicians and for that matter there is need of awareness and understanding the transfusion medicine by clinicians

Effectiveness of buffy coat leucoreduced packed red blood cells in decreasing febrile non-hemolytic transfusion reactions in thalassemic patients

Background: Blood transfusions have always been associated with a number of adverse outcomes which have steadily decreased over years owing to new discoveries and technical advancements. Thalassemic patients are more prone to transfusions related complications owing to repeated transfusions. Study of these reactions and correlating them with the leucodepletion status of the transfused packed red blood cells (PRBCs) reduces transfusion complications due to the transfused leukocytes.Methods: This is a prospective study carried out on 1750 transfusions in 138 thalassemic patients at our institute between August 2015 and March 2016. The total transfusions were classified into four categories depending on the leucodepletion status of the PRBC’s. The clinical records and the reaction workup done to rule out the hemolytic reactions were recorded.Results: Reactions were recorded in 17 (0.97%) out of a total of 1750 transfusions. 14 (4.1%) reactions were recorded on transfusions of non-leukoreduced PRBCs whereas only 2 (0.16%) reactions were recorded in leucoreduced (buffy coat) PRBCs. 1 (0.8%) reaction was recorded on transfusion of leucodepleted PRBCs done by bedside filter. No reaction was documented when buffy coat leucoreduced PRBCs were used along bedside filter.Conclusions: Elimination of WBCs from donor packed cells results in reduction of adverse reactions following blood transfusion. Various methods of leucoreduction have been successfully employed in the past and shown to reduce transfusion reactions in multi transfused thalassemic patients. In resource limited settings, leukoreduction using the buffy-coat method is an effective intervention in reducing the transfusion reactions

Study of red blood cell alloimmunization in multitransfused thalassemic children of Jammu region

Introduction: Thalassemia is one of the most common genetic disorder of hemoglobin synthesis in Jammu region. Although RBC transfusion is life saving for these patients, it may be associated with some complications like RBC alloimmunization. Thus, the aim of this study was to determine the frequency of alloimmunization and the most common alloantibodies involved. Material and Methods: This was a descriptive study involving a total of 70 thalassemic patients in the age range of 2-17 years receiving regular blood transfusions, registered at SMGS Blood Bank, Jammu. Relevant clinical and laboratory data was collected with reference to age at the start of transfusions, total number of transfusions received and splenectomy status. Antibodies screening, antibody identification, and cross matching was done on allpatient samples included in the study, during the period between November 2009 and October 2010. Results: In this study, a total of six alloantibodies six patients (8.5%) and one autoantibody (1.42%) was detected. All identified alloantibodies belonged to Rh system (i.e. anti-E, in 3 patients (50%), anti D, in one patient (16.66%)) and Kell system (anti-K, in two patients (33.34%)). Higher frequency of alloimmunization was found, with increase in number of transfusions and in those who received transfusions after 1 year of age. Alloimmunization was not significantly associated with gender and splenectomy status (P-value > 0.05). Conclusion: Red cell alloantibodies developed in 8.5% of thalassemic patients and 1.42% had autoantibodies. The most common alloantibodies identified were anti Rh system antibodies (anti-E and anti-D) present in 50% and 16.66% of patients respectively. Alloimmunization is not an uncommon problem faced by blood banks and finding compatible units for regularly transfused thalassemic patients may become very difficult. In order to reduce alloimmunization, a policy for performing extended red cell phenotyping of these patients is essential and at least antigen E and Kell negative blood should be provided for transfusion to these patients

Report on errors in pretransfusion testing from a tertiary care center: A step toward transfusion safety

Introduction: Errors in the process of pretransfusion testing for blood transfusion can occur at any stage from collection of the sample to administration of the blood component. The present study was conducted to analyze the errors that threaten patients′ transfusion safety and actual harm/serious adverse events that occurred to the patients due to these errors. Materials and Methods: The prospective study was conducted in the Department Of Transfusion Medicine, Shri Maharaja Gulab Singh Hospital, Government Medical College, Jammu, India from January 2014 to December 2014 for a period of 1 year. Errors were defined as any deviation from established policies and standard operating procedures. A near-miss event was defined as those errors, which did not reach the patient. Location and time of occurrence of the events/errors were also noted. Results: A total of 32,672 requisitions for the transfusion of blood and blood components were received for typing and cross-matching. Out of these, 26,683 products were issued to the various clinical departments. A total of 2,229 errors were detected over a period of 1 year. Near-miss events constituted 53% of the errors and actual harmful events due to errors occurred in 0.26% of the patients. Sample labeling errors were 2.4%, inappropriate request for blood components 2%, and information on requisition forms not matching with that on the sample 1.5% of all the requisitions received were the most frequent errors in clinical services. In transfusion services, the most common event was accepting sample in error with the frequency of 0.5% of all requisitions. ABO incompatible hemolytic reactions were the most frequent harmful event with the frequency of 2.2/10,000 transfusions. Conclusion: Sample labeling, inappropriate request, and sample received in error were the most frequent high-risk errors