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

Efficiency of blood utilization and characteristics of patients receiving blood transfusion at an associated hospital in North India

Background: Blood is the liquid connective tissue composed of cells and plasma. It is the most precious and unique gift that one person gives to another. Blood banks are not the manufacturing factories. It can only be available on replacement basis. Periodic review of blood components usage is essential to assess the blood utilization pattern in hospitals. This study was conducted to analyse the efficiency of blood utilization and to minimize the inappropriate use of blood.Methods: A retrospective cross-sectional study was conducted in the department of blood transfusion and immunohematology, government medical college and associated hospital, Rajouri for a period of one year with effect from November 2019 to November 2020. Data was collected using blood bank record. Blood utilization was calculated using crossmatch to transfusion ratio (C/T), transfusion probability (T%) and transfusion index (TI) indices.Results: A total of 974 patients were requested to prepare 1270 crossmatched units. Of these 1141 blood units were transfused for 664 patients. The total donations during that period were 1197. 998 donors were replacement donors and 199 were voluntary non-remunerated blood donors donated at various blood donation camps. The overall values of C/T, T% and TI were 1.1:1, 68.1% and 1.1 respectively.Conclusions: Blood utilization indices show efficient usage of blood. However, a blood ordering policy (MSBOS) must be developed to guide the clinicians regarding blood usage which can decrease overordering of blood thereby reducing unnecessary usage of reagents, manpower and also wastage of blood due to outdating.

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

Seroprevalence of markers of transfusion transmissible infections among blood donors at a tertiary care hospital blood bank: a 5 year retrospective study

 Background: Transfusion transmitted infections (TTIs) can be caused by various microorganisms present in the blood of apparently healthy donors. The recipient may get infected after being transfused with the unsafe blood. It is mandatory to screen the blood for HIV 1 and 2, HBV, HCV, Syphilis and Malaria. This study was undertaken to investigate the seroprevalance of Transfusion transmitted infections among blood donors at our tertiary care centre and to compare our study with other studies conducted at different hospitals of the country as well as outside.Methods: A retrospective review of blood donor records was made over a period of 5 years with effect from January 2014 to December 2018 at blood bank, department of Blood Transfusion and Immunohaematology, SKIMS, Soura, Srinagar. Both voluntary and replacement blood donors were selected after taking proper history and examination were included in the study. Serum samples were screened for HIV 1 & 2, HBV (HBsAg) and HCV using ELISA with 3rd generation kits.Results: A total of 56325 blood donors were screened. Out of total 55346 (98.2%) were males and 979 (1.73%) were females. Among them 38969 (69.1%) were replacement donors and 17356 (30.8%) were voluntary donors. The seroprevalance of HBV (HBsAg), HCV and HIV 1and 2 was 0.24%, 0.17% and 0.01% respectively and overall seroprevalance of TTIs was 0.43%.Conclusions: Continuous improvement and implementation of newer techniques like NAT and chemilumenescence for testing of blood for TTIs will reduce the risk of acquiring these infections.lanc

Analysis of cross matching to transfusion ratio of blood components in blood bank SKIMS, Soura: a prospective one year study

Background: Blood requisitions received in blood bank for elective and emergency procedures from surgery, trauma, Obstetrics and Gynaecology Department are often associated with excessive demand for cross matching of blood which is often more than the required blood and blood components. In this study, our goal was to use the blood stocks more efficiently and reduction in the wastage due to over dating and to prevent injudicious pre-operative cross-matching and utilization of blood.Methods: This was a prospective study conducted in the Department of Blood Transfusion and Immunohematology of Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Soura, Srinagar over a period of one year with effect from September 2017 to August 2018. Source was requisition forms and blood bank records of patients who underwent elective procedures in the hospital. For the purpose of analysis, departments were categorized into surgical and allied branches i.e Cardiovascular Surgery (CVTS), Neurosurgery, General Surgery and Obstetrics and Gynaecology. Department wise utilization of blood Components cross matching to Transfusion ratio (C/T), transfusion probability (T%) and Transfusion Index (TI) were calculated. Data was entered and analyzed using Microsoft excel window 2010. The obtained data was evaluated and presented in the tabular and diagrammatic forms.Results: A total of 3940 requests for cross matching of blood and its components were received for 3072 patients. Out of these, 2048 units were transfused. The total C/T Ratio, Transfusion Probability (T%) and Transfusion Index (TI) was 1.92, 42.5% and 0.6 respectively.Conclusions: To reduce the injudicious usage of blood, blood transfusion services need to adopt blood conserving policies. Efforts should be made to adopt more conservative transfusion thresholds, periodic feedback to improve blood ordering, conduct regular auditing, handling, distribution and utilization practices of this scarce resource

Socio-demographic profile and mode of attempt of suicide among suicide attempters in Kashmir: a hospital-based study

Background: Suicide is an important and serious public health problem. It is one of the major emergencies in psychiatry. This study was carried out to assess the socio-demographic profile and mode of attempt of suicide among suicidal attempters attending emergency.Methods: This study was a cross sectional, observational study conducted at Institute of Mental Health and Neurosciences-Kashmir, an associated hospital of Government Medical College Srinagar, among the suicide patients attending the outpatient service and inpatient services fulfilling inclusion and exclusion criteria over a period of one and a half year. Each patient was informed about the purpose of interview; his/her consent was obtained in a simple and easily understandable unambiguous language.Results: A total of 221 cases who had been admitted following unsuccessful suicide attempts to the emergency and psychiatry department were taken up for the study. Out of which 161 (72.9%) were females and 60 (27.1%) were males, the mean age was 24.61±8.9 years. Lower middle and upper lower classes occupied an equal percentage of 34.4% of the suicide attempters, while 24% belonged to upper middle class and only 5.9% belonged to lower class .The least no. of cases (1.4%) were from the upper classes. The most common mode adopted was poisoning whereas the least common mode was self- immolation. Poisoning and self-mutilation were proportionally high in females as compared to males with a significant p value.Conclusions: There should be a robust system in place which takes care of future management and follow up of this group of population.

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