Fresh frozen plasma utilization pattern in tertiary care hospital of North Western India

Background: Fresh Frozen Plasma (FFP) is mainly used in treatment of coagulation derangements; trauma emergencies. It is the most inappropriately used blood component. Since the guidelines for FFP use in a clinical setting are not well defined, this study aims at defining the appropriateness of use of FFP in the light of its risks and adverse effect. Audit of institute FFP usage with specific aim of assessing appropriate use, based on clinical indications and laboratory parameters in requisition form.Methods: Retrospective analysis of 10,753 FFP supplied in 3072 patients from June 2016 to December 2016 in SMS Hospital, Jaipur, Rajasthan, India was done in Department of Immunohaematology and Transfusion Medicine, SMS Hospital, Jaipur, Rajasthan, India. Detailed analysis of clinical indication, INR value, specialty, age, gender of patient was done.Results: 10,753 FFP was supplied to 3072 Patients. 6990 FFP was supplied to 1995 males. 3763 FFP was supplied to 1077 females. Clinical use of FFP for medical and surgical conditions was highest seen in Blood Cancers (13%) and Cardiosurgery (22.3%). 15.2% was available from Emergency Department. 1.9% of FFP was returned back. Patients with Deranged Coagulation Profile (DCP) require maximum transfusion (49.3), Bleeding patients (37.6%), DIC (3.3%). FFP used for plasmapheresis (2.6%). No information available about diagnosis (7.2%) was available from Emergency Department.Conclusions: FFP is most inappropriately used blood component (39.57%) and should be used judiciously. Regular audit of blood components serves as tool for accomplishment of quality tools and to understand clinical transfusion practices

Analysis of vitamin D level among asymptomatic and critically ill COVID-19 patients and its correlation with inflammatory markers

COVID-19 is characterized by marked variability in clinical severity. Vitamin D had recently been reviewed as one of the factors that may affect the severity in COVID-19. The objective of current study is to analyze the vitamin D level in COVID-19 patients and its impact on the disease severity. After approval from Ethics Committee, M.L.B Medical College the current study was undertaken as continuous prospective observational study of 6 weeks. Participants were COVID-19 patients of age group 30–60 years admitted during the study period of 6 weeks. Study included either asymptomatic COVID-19 patients (Group A) or severely ill patients requiring ICU admission (Group B). Serum concentration of 25 (OH)D, were measured along with serum IL-6; TNFα and serum ferritin. Standard statistical analysis was performed to analyze the differences. Current Study enrolled 154 patients, 91 in Group A and 63 patients in Group B. The mean level of vitamin D (in ng/mL) was 27.89 ± 6.21 in Group A and 14.35 ± 5.79 in Group B, the difference was highly significant. The prevalence of vitamin D deficiency was 32.96% and 96.82% respectively in Group A and Group B. Out of total 154 patients, 90 patients were found to be deficient in vitamin D (Group A: 29; Group B: 61). Serum level of inflammatory markers was found to be higher in vitamin D deficient COVID-19 patients viz. IL-6 level (in pg/mL) 19.34 ± 6.17 vs 12.18 ± 4.29; Serum ferritin 319.17 ± 38.21 ng/mL vs 186.83 ± 20.18 ng/mL; TNFα level (in pg/mL) 13.26 ± 5.64 vs 11.87 ± 3.15. The fatality rate was high in vitamin D deficient (21% vs 3.1%). Vitamin D level is markedly low in severe COVID-19 patients. Inflammatory response is high in vitamin D deficient COVID-19 patients. This all translates into increased mortality in vitamin D deficient COVID-19 patients. As per the flexible approach in the current COVID-19 pandemic authors recommend mass administration of vitamin D supplements to population at risk for COVID-19