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

How Do I Forestall Platelet Stockpiling? Experience from a Tertiary Care Center

Background:Among all the blood products, platelets had been reported to have a high rate of outdates due to its unpredictable demand and short shelf life of only 5 days. Researchers have applied techniques of management science and inventory theory to develop a model for inventory management. However, they failed to be implemented due to the variations in the demand and supply and complex computational models.Aims:To analyze the utilization pattern of platelet concentrates and discuss the method of optimal inventory management.Methods:We conducted a prospective observational study on platelet inventory practice at our center from January to December 2014. The number of units to be prepared is decided on daily basis by the transfusion medicine faculty or the resident. The utilization, wastage, expiry and the day’s cover are calculated for the study period. Future requirement is estimated based on the usage in the previous quarter, discard rare, average increase in usage and an additional 1% for managing disasters. Results:During this period a total of 6241 and 5706 units of platelet concentrates were prepared and issued respectively. The wastage rate was 5.1% and expiry rate was 3.5%. The average day’s cover of platelet units at our center was found to be 3 days using average monthly stock available and issued platelets. We observed that holding a stock of 45 units of platelets per day we had a cover for about 3 days for issue. Calculation of future requirement(6309) gave a high prediction when compared to the actual platelets prepared(6241).Conclusions:Understanding and regularly monitoring the inventory, setting up an optimum inventory level, follow of first in first out policy and to have an alternate management plan in times of shortage, like usage of apheresis products are some of the strategies which would benefit in best inventory practices.

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

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

Effect of therapeutic phlebotomy on plasma volume in polycythemia patients

Background: Therapeutic phlebotomy (TP) helps in reducing the red cell mass thereby whole blood viscosity to improve tissue perfusion and oxygen delivery in polycythemia patients. We aimed to determine the plasma volume changes in polycythemia patients undergoing TP. Materials and Methods: We studied TP procedures in 134 patients undergoing 236 episodes prospectively. Patient clinical details were recorded to assess improvement in symptoms after the procedure. Plasma volume changes were calculated based on the difference between the pre- and postcollection blood volume. The influence of frequency of blood collected on plasma volume was analyzed. Results: A progressive reduction in hematocrit (1.7 ± 2.6 %) and hemoglobin (0.78 ± 0.5 g/dL) in relation to volume removed and frequency was observed . The mean blood removed during TP in these patients was 304 ± 58.1 mL. There was a progressive increase in plasma volume with respect to the frequency of TP (2.51 ± 1.58 mL/kg). Conclusion: Symptomatic improvements following TP were noted in 60% of patients. TP though commonly performed for reducing red cell mass in polycythemia had poor compliance from patients, resulting in failure to achieve desired levels

A rare case of haemolytic disease of newborn with Bombay phenotype mother

We are reporting a rare case of severe hemolytic disease of newborn (HDN) with Bombay phenotype mother. A retrospective study of a case with severe haemolytic disease of newborn with Bombay phenotype mother was done. Blood grouping, antibody screening, and lectin study was done on the blood sample of the baby and mother to confirm the diagnosis. Hematological and biochemical parameters were obtained from the hospital laboratory information system for the analysis. Blood group of the baby was A positive, direct antiglobulin test was negative. Blood group of the mother was confirmed to be Bombay phenotype, Hematological parameters showed all the signs of ongoing hemolysis and the bilirubin level was in the zone of exchange transfusion. Due to the unavailability of this rare phenotype blood unit, baby was managed conservatively. Anticipating the fetal anemia and HDN with mothers having Bombay phenotype and prior notification to the transfusion services will be of great help in optimizing the neonatal care and outcome