Are we missing out something in donor notification?

Background: Donor notification is an integral part of any blood collection facility. But regarding DAT positive donors there are no standard guidelines to notify them or to refer them to any clinician. Aim of this study was to suggest possible ways to manage DAT positive donors. Material and Methods: This was a retrospective study extended over past 5 years from 2013-2017 in a tertiary care health center. All whole blood donations were tested for ABO Rh, irregular antibody, HIV, HBV, HCV, SYPHILIS, and Malaria parasite. At the time of blood request if crossmatch came incomnpatible and antibody screen was negative we do DAT of the unit and if it comes positive then DAT work up was done. Result: Of total 55,310 donations, Twenty-two (0.04%) donors were DAT positive. From DAT positive donors, in 72% of cases IgG alone was responsible for DAT positivity of the unit, and in 18% of cases, involved IgG was subtyped as I gG1/IgG3. Conclusion: With the evidence of a significantly increased risk of cancer, especially hematologic malignancies, among blood donors with a positive DAT, donor notification is suggested. There should be a standardized protocol across the country about donor notification to avoid confusion and variations seen in different blood collection facilities

Transfusion-related adverse reactions: From institutional hemovigilance effort to National Hemovigilance program

Aims: In this study we have evaluated the various adverse reactions related to transfusion occurring in our institution as a pilot institutional effort toward a hemovigilance program. This study will also help in understanding the problems faced by blood banks/Transfusion Medicine departments in implementing an effective hemovigilance program. Materials and Methods: All the adverse reactions related to transfusion of whole blood and its components in various clinical specialties were studied for a period of 1 year. Any transfusion-related adverse event was worked up in accordance with guidelines laid down by the Directorate General of Health Services (DGHS) and departmental standard operating procedures. Results: During the study period from November 1, 2011 to October 31, 2012, 45812 components were issued [30939 WB/PRBC; 12704 fresh frozen plasma (FFP); 2169 platelets]. Risk estimation per 1000 units of red cells (WB/PRBC) transfused was estimated to be: 0.8 for febrile nonhemolytic transfusion reaction (FNHTR), 0.7 for allergic reaction, 0.19 for acute hemolytic transfusion reaction (AcHTR), 0.002 for anaphylactoid reactions, 0.1 for bacterial sepsis, and 0.06 for hypervolemia and hypocalcemia. 0.09 is the risk for delayed transfusion reaction and 0.03 is the risk for transfusion-related acute lung injury (TRALI). Risk estimate per 1,000 units of platelets transfused was estimated to be 1.38 for FNHTR, 1.18 for allergic reaction, and 1 in case of bacterial sepsis. Risk estimation per 1,000 units of FFP was estimated to be 0.15 for FNHTR and 0.2 for allergic reactions. Conclusions: Factors such as clerical checks at various levels, improvement in blood storage conditions outside blood banks, leukodepletion, better inventory management, careful donor screening, bedside monitoring of transfusion, and documentation of adverse events may decrease transfusion-related adverse events. Better coordination between transfusion specialists and various clinical specialties is the need of the hour and it will help in making the whole transfusion chain safe and effective. There is a need for a hemovigilance program at the national level so that true incidence and the spectrum of adverse events due to transfusion are known and policies formulated to minimize the risks associated with it

Daratumumab (Anti-CD38) interference with serological testing: An emerging challenge for blood banks in developing countries

Daratumumab (DARA), a monoclonal anti-CD38 antibody, belongs to the new generation of immunotherapy in refractory relapsed multiple myeloma. CD38 is weakly expressed on human erythrocytes. By its intrinsic anti-CD38 activity, DARA also interferes in routine pretransfusion compatibility testing such as antibody screening for red blood cells (RBCs) alloantibodies and compatibility testing. Treating RBCs with dithiothreitol eliminates the DARA interference. We report two cases of serological interference of DARA in pretransfusion testing and how timely information before starting the second patient on DARA prevented the delay in pretransfusion compatibility testing and blood availability