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

Making type and screen policy an essential component of pretransfusion testing: Need of the hour in India

Introduction: “Type and screen” policy involves the prior determination of patient blood group and antibody screening at the time of admission irrespective of the need of the blood transfusion to the patient. Materials and Methods: As a part of our retrospective analysis, we have evaluated our data from January 2014 to June 2016. Blood grouping was done by column agglutination technology (CAT) using DiaClon ABO/D+ Reverse Grouping cards (BIO-RAD, Switzerland). Antibody screening and identification were done using three cell panels (ID-DiaCell I-II-III Asia panel by BIO-RAD, Switzerland) and 11 cell panels (ID-DiaPanel-P by BIO-RAD, Switzerland) on CAT with LISS/Coombs cards. Results: A total of 17,896 patients requests for “type and screen” were received by the department during the study. Out of which 201 (1.12%; 1 in 89 patients) patients were found to have positive antibody screen. Out of 201 patients (132 females; 69 males); mean age group of 45.6 years (range: 1 day–85 years). Out of 201, 145 patients developed single antibody, 15 patients had double antibody, and in 41 positive antibody screens the specificity of alloantibodies were not identified either due to an interfering autoantibody (n = 10) or the specificity was not resolved on extended panels (n = 31) even with enzymes. Conclusion: “Type and screen” policy helps in timely blood group typing of the patients and providing enough time for the blood bank to arrange for blood. Our analysis shows the presence of an alloantibody in every 89 requests received for “type and screen.

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

Treosulfan-Thiotepa-Fludarabine–Based Conditioning Regimen for Allogeneic Transplantation in Patients with Thalassemia Major: A Single-Center Experience from North India

AbstractHematopoietic stem cell transplantation (HSCT) is the definite treatment for patients with thalassemia major. A busulfan (Bu) and cyclophosphamide (Cy)–based regimen has been the standard myeloablative chemotherapy, but it is associated with higher treatment-related toxicity, particularly in patients classified as high risk by the Pesaro criteria. Treosulfan-based conditioning regimens have been found to be equally effective and less toxic. Consequently, we analyzed the safety and efficacy of treosulfan/thiotepa/fludarabine (treo/thio/flu)-based conditioning regimens for allogeneic HSCT in patients with thalassemia major between February 2010 and September 2012. We compared those results retrospectively with results in patients who underwent previous HSCT with a Bu/Cy/antithymocyte globulin (ATG)–based conditioning regimen. A treo/thio/flu-based conditioning regimen was used in 28 consecutive patients with thalassemia major. The median patient age was 9.7 years (range, 2-18 years), and the mean CD34+ stem cell dose was 6.18 × 106/kg. Neutrophil and platelet engraftment occurred at a median of 15 days (range, 12-23 days) and 21 days (range, 14-34 days), respectively. Three patients developed veno-occlusive disease, 4 patients developed acute graft-versus-host disease (GVHD), and 2 patients had chronic GVHD. Treatment-related mortality (TRM) was 21.4%. Two patients experienced secondary graft rejection. We compared these results with results in patients who underwent previous HSCT using a Bu/Cy/ATG-based conditioning regimen. Twelve patients were treated with this protocol, at a median age of 7.2 years (range, 2-11 years). One patient had moderate veno-occlusive disease, 2 patients developed acute GVHD, 2 patients had chronic GVHD, and 2 patients experienced graft rejection. There was no TRM in this group. We found no significant differences between the 2 groups (treo/thio/flu vs Bu/Cy/ATG) in terms of the incidence of acute GVHD, chronic GVHD, TRM, and graft failure, although a trend toward higher TRM was seen with the treo/thio/flu regimen