Poster Abstracts

eP001: Blood Components: Comparative study for measurement of quality parameters in leucoreduced RBC prepared by three different methods

B. Visali, Farzana Kothari

Background and Objectives: Leucoreduced RBC are Red cell components from which WBC’s are removed. It prevents Febrile Non hemolytic Transfusion Reaction, HLA Alloimmunisation in multitransfused patients and Transfusion of leucotropic viruses especially CMV. Also it improves the invivo 24 hour red cell survival by removing the metabolically active cells.

1. To differentiate the efficacy of leucoreduction by buffy coat method and during prestorage RBC leucofiltration compared to post storage RBC leucofiltration.

2. To evaluate the leucoreduction carried out by different methods and finally to establish the best method to prepare leucoreduced RBC.

Materials and Methods: In this Retrospective study, 60 units of blood were divided into three groups of 20 each. Now two groups were subjected to leucoreduction using two types of filtration methods ie., prestorage and poststorage PRBC filtration. Leucoreduction by buffy coat method was applied to 3rd group.

Results: For prestorage pRBC means post filtration residual leucocyte count range from 0.01 to 0.03 x 10*3 with leucofilteted bags showing log 3 leucoreduction. For poststorage PRBC Mean post filtration residual leucocyte count range from 0.02 to 0.04 x 10*3 with leucofilteted bags showing 3 log leucoreduction. For Buffy coat leucoreduction, post filtration residual leucocyte count range from 2.1 to 6.6 x 10*3 with leucofilteted bags showing 1 log leucoreduction.

Conclusion: This study suggests that leucofiltration (both pre and post storage) is preferable over Buffy coat method. We recommend selective log 3 leucodepletion using prestorage filtration for patients with specific indication.

eP002: Blood Components: Are the factor 8 levels in group O plasma too low? It’s time to reevaluate the dose of group O plasma

Safnasafeer, Ashish Jain, Priyanka Rathod, Dixa Kumari, Daljit Kaur, Gita Negi

Introduction: The structural differences between the antigens of the ABO blood group system can have an impact on the levels of coagulation factors in different blood components.

Materials and Methods: A cross-sectional study took place in the Department of Transfusion Medicine of a tertiary care hospital from March 2023 to February 2024. Blood grouping was done, and factor 8, fibrinogen, PT, APTT, and INR levels were measured.

Results: Blood group B was the prevailing type, accounting for 38.29%. The activity of coagulation factor 8 was highest in blood group B (mean = 236.44% and blood group O had significantly lower activity (mean = 134.51%) (p value = 0.014). Blood group A had the highest mean level of fibrinogen at 411.01 mg/dl and group O had the lowest mean level at 332.78 mg/dl. The PT values were lower in blood group AB (mean = 11.511 sec) and lowest in group A (mean = 12.15 sec). The APTT values were found to be lower in blood group AB (mean = 25.992 sec) and higher in O (mean = 28.531 sec). The INR levels were found to be lower in blood group AB (mean= 0.9877) and higher in group O (mean = 1.007).

The average factor 8 levels in an O group FFP was 254 IU / unit, while in group B it is 448.4 IU/unit. A patient weighing 70 kg and with a hematocrit of 40 needs 2900 IU of factor 8 to achieve a 1% increase which is achieved after 11 group O plasma transfusions as opposed 7 group B plasma transfusions.

Conclusion: It has been observed that blood group O tends to have lower levels of factor 8 and fibrinogen. Therefore, it may be worth considering adjusting the dosage of FFP in patients of the O blood group who require a transfusion.

eP003: Blood Components: Evaluation of serum biochemical markers of skeletal muscle damage during hypobaric hypoxic stress

Richa, Geetha Suryakumar

Background and Objectives: High altitude stress leads to several pathophysiological conditions, one of them is hypobaric hypoxia induced skeletal muscle atrophy. Skeletal muscle is the key factor for physical performance and endurance. It has been reported that chronic hypobaric hypoxia exposure leads to decrease muscle loss with compromised physical performance. Nevertheless, data about changes in muscle damage enzymes in serum are sparse. Therefore, the present study was planned to search out possible serum biomarkers which changed due to hypobaric hypoxia induced skeletal muscle damage.

Methods: Ten rats were exposed to hypobaric hypoxia exposure for 0 and 7 days. After exposure, a serum level of biochemical markers of muscular damage was elucidated. Skeletal muscle cross sectional area (CSA) was also quantified.

Results: A significant increase in serum CPK, LDH, myostatin and myoglobin was observed in 07d HH exposed rats. Ergo, a significant positive correlation analysis between HH exposed skeletal muscle CSA and muscle damage markers were established.

Conclusion: Our study could demonstrate relevant hypobaric hypoxia induced muscle injury was accompanied by significant increase in CPK, LDH, myostatin and myoglobin in serum. Further, the validation in large sample size is required to establish the same.

eP004: Blood Components: The efficacy of platelet-rich plasma in treatment of ligament injuries and its potential in regeneration and healing

R. Praveen Shankar, B. Latha, G. Kavitha

Background: Platelet concentrates like Platelet-rich Plasma (PRP) and Platelet-rich Fibrin are autologous biological blood-derived products used to enhance Tissue and Ligament repair.

Aims and Objectives: To evaluate patient reported outcomes, Physical examination findings of various ligament injuries following treatment with a intra-articular injection of PRP compared to a control group.

Methods: Ligament injuries like ACL tear, Medial Meniscal Tear of Knee and Supraspinatus tendon tear from period of March 2024-July 2024 were treated non-operatively and were prospectively evaluated after 2 months. PRP was prepared by Platelet-rich plasma method. Patients were treated with single intra-articular injection of PRP along with specific Physical therapy Protocol. Control group were given only specific Physical therapy protocol.

Results: A total of 25 patients were included, 11 treated with PRP injection and rest control. Patient reported outcomes evaluated by Visual Analog Scale (VAS), Numerical rating scale (NRS) and Physical examination like Tegner activity Scale and failure rate (patients with clinical instability at follow-up who needed subsequent ligament repair).

Conclusion: All evaluation parameters showed mild to moderate clinical improvement for the patients who received single dose PRP than the control group.

eP005: Blood Components: Critical analysis of quality control standards of fresh frozen plasma in India as given by DCA and DGHS manual

Aishwarya Sharma, Hari Krishan Dhawan, Suraj Pardhan, Sheetal Malhotra, Ratti Ram Sharma

Background and Objectives: Quality standards of Fresh frozen plasma (FFP) are included in Drugs and Cosmetic act (DCA, Second Amendment) 2020 and Directorate General of Health Services (DGHS) Manual 3rd edition 2022. Objective of this study to analyse the quality control data for FFP done at our centre during last one year based on these standard and critically analyse the Indian standards ( specially for the volume and Factor VIII content of the bag for FFP) and compare these standards with international Standards.

Methods: Quality Control data of 234 FFP units (109 from 350 ml and 125 from 450 ml collection) was analysed for volume Factor VIII and Fibrinogen content of the bags. QC criteria for of volume: 180-220 ml from 350 ml bag, 220-300 ml from 450 ml bag, Factor VIII : at least 70 IU/ bag and Fibrinogen 200 to 400 mg /bag were taken as given in DCA and DGHS Manual.

Results: 62 out of 109 (57%) FFP prepared from 350 ml bags and 16/125 (13%) prepared from 450 ml bags passed the QC criteria for volume. If we take 350 ml bags where PC was not prepared and only FFP was prepared 60 out of 82 (73%) of the bags passed the QC criteria for volume. This shows that the newer QC criteria for volume does not count for 50 to 70 ml PC prepared from the 350 ml bags along with FFP. This is why FFP prepared from most of 450 ml bags failed the volume QC criteria as PC is always prepared along with FFP from these bags. For Factor VIII, the earlier QC criteria was 0.7 IU/ml which is same as given by European union, as per this criteria 181 out of 234 FFP (77.3%) pass the QC criteria. In DCA 2020 Amendment, Factor VIII QC criteria is lowered to 70 IU/ per bag, as per the newer criteria 225 out of 234 (96%) of FFP pass the QC criteria. QC criteria of 70 IU/ per bag for FFP looks inappropriate as criteria for Cryoprecipitates which are prepared from FFP is 80 IU/ per bag.

Conclusion: A relook needs to be done in DCA QC criteria for FFP specially for volume and factor VIII content so that these criteria can measure the quality of FFP prepared in a blood centres appropriately.

eP011: Blood Donation and Donor Apheresis: Experience of follow up of TTI reactive donors at our centre

Abhay G. Jhaveri, Kruti Dumaswala

Background and Objectives: It is important to inform and counsel initial TTI reactive donors for confirmation of result; and take appropriate measures for health of self, family and persuade not to donate again. We tried to evaluate follow up rate of TTI reactive donors for retesting and counselling.

Methods: Data of follow up of TTI reactive donors from January 2020 to June 2024 was analysed in MS Excel every month. We tried to contact initial TTI reactive donors by phone or courier and persuade them to come for retesting and counselling. Total 2608 calls were made (average 4 calls/donor). As per guidelines, we made at least three calls to each donor (one week apart). 176 couriers were sent.

Results: Total 644 (0.61%) units out of 108549 total collections from January 2020 to June 2024 were found reactive. Out of these 355 (51.96%) were HBV, 105 (15.81) were Syphilis, 81 (12.20%) were MP, 80 (11.90%) were HCV, and 43 (6.48%) were HIV reactive. We succeeded in tracing overall in 397 (61.65%) cases. Success rate was 70.59% in 2021, 61.94% in 2022, 52.84% in 2023 and 60.56% in 2024 (till June). We counselled them at our centre and referred to appropriate place for confirmatory tests and treatment. We convinced the donors not to donate again. Common causes for failure were 1) wrong or incomplete contact number/correspondence address, 2) living at a faraway place, 3) working in industries or offices where mobile phones are not allowed and 4) Correspondence address is given of a large enterprise where thousands of workers are employed.

Conclusion: If we follow up the donor properly, we do succeed in counselling the TTI reactive donors and prevent them to donate again. We must take care to collect correct and complete contact details during registration especially in mega camps.

eP013: Blood Donation and Donor Apheresis: Insights into availability and exploring the unavailability factors in unrelated blood stem cell donors

M. P. Dechamma, R. Chandrashekar, Nitin Aggarwal, Patrick Paul, Alexander Schmidt

Background and Objective: DKMS is a global non-profit organization founded by Mr. Peter Harf (1991) to provide as many blood cancer and blood disorder patients with a second chance at life. We have a global presence in 5 continents, 7 countries, 13 entities with a Life-Saving Impact of Over 115,00 blood stem cell donations. This retrospective study aims to investigate the availability of potential blood stem cell donors and to identify the reasons contributing to their unavailability for donation in India.

Methods: The retrospective data was gathered for a period of 2.7 years (Jan 2022 - July 2024). A thorough analysis of the data resulted in categorizing the reasons for a better understating of the donor unavailability in India.

Total Availability = (Total Number of Successful cases/Total Requests Received) ×100

Results:

Total Potentially Matched Donors – 1602

Total Availability – 431 (27%)

Total Unavailability – 1171 (73%) – (Temporary Unavailability (TU) – 510 + Permanent Unavailability (PU) – 661)

Donor Unavailability:

Reasons:

Family -TU:43% ; PU:25%

Personal -TU:41% ; PU:56%

Abroad-TU:5% ; PU:2%

Medical -TU:6% ; PU:7%

Recent Blood Donation-TU: 0.4% ; PU: NA

Pregnancy / Breast Feeding-TU:4% ; PU: NA

Unable to Contact-TU: NA ; PU:10%

Conclusion:

• Every 17 seconds, someone somewhere in the world is diagnosed with Blood Cancer, Sickle Cell Disease or Thalassemia and currently, more than 10 million people worldwide are affected. Unfortunately, only 1% of the worldwide population is registered as a blood stem cell donor and hence a dire need to increase their availability is necessary.

• Our study reflects two major reasons that affect unavailability: unexplained personal circumstances and lack of awareness in general public that leads to family concerns and denial of permission to donate.

• To increase our availability, we have measures in place that build trust among our donors (Ex: patient–donor meet-ups, counselling sessions and many more).

eP014: Blood Donation and Donor Apheresis: Whole blood donor deferral in a tertiary care centre in Maharashtra

Vineeth Pynadath

Background: Blood donor deferral is a critical issue that affects the availability of blood supplies, especially in countries like India where demand frequently outstrips supply. Understanding the reasons for donor deferral is essential for developing strategies to optimize donor recruitment and retention, ensuring a safe and adequate blood supply.

Objective: This study aims to analyse the patterns and reasons for whole blood donor deferral in a tertiary care centre in India, providing insights into improving donor selection criteria and reducing deferral rates.

Methods: A retrospective cross-sectional study was conducted at a Bharati Hospital in Maharashtra India. Data from all prospective whole blood donors who visited the blood centre of the hospital between 01/01/2023 and 01/12/2023 were reviewed. Donors were categorized into eligible and deferred groups based on the standard selection criteria. Deferred donors were further classified according to the reason for deferral, such as low haemoglobin levels, medical history, or lifestyle factors.

Results: A total of 6500 prospective donors were screened, of which 560 were deferred. The most common reasons for deferral included low hemoglobin levels, recent medication use, fungal infection, tattoo, Male donors were predominantly deferred due to hypertension, surgical history and recent infections. and hypertension, while female donors were more often deferred for low hemoglobin and recent pregnancy.

Conclusion: This study highlights that low hemoglobin is a leading cause of deferral among both male and female donors. Strategies to address this issue, such as targeted pre-donation counselling and nutritional support, may help in reducing deferral rates. Understanding local deferral patterns can guide recruitment strategies and improve donor retention, ultimately enhancing the blood supply chain in the region.

eP015: Blood Donation and Donor Apheresis: Understanding blood donor deferral: A comprehensive review

Jyoti R. Shetty, Vishvas Amin, Jhalak Patel, Emmanuel Christian, Bharat Parmar, Akib Mansuri, Palak Panchal

Background and Objectives: Voluntary Blood Donors are the main stay for safe blood. These blood donors often go through negative experience of donor rejection due to screening criterias. These donors are highly enthusiastic and motivated. This study of analysis of donor deferral will help us in evaluating the different reasons of deferral and thereby forming various strategies to redefine their experience. The objective of this study is to evaluate the reasons for deferral amongst potential blood donors.

Materials and Methods: This is the retrospective study done at Indian Red Cross Society, Ahmedabad Blood Centre from period of January 2023 to December 2023. The Donor deferral reasons are evaluated and categorized into temporary and permanent deferrals and its distribution gender wise.

Results: A total of 77,467 voluntary blood donors came to donate blood out of which 59,701 (77.07%) were accepted for blood donation and 17,766 (22.93%) were deferred in which 7,329 were female and 10,437 were males having low haemoglobin to be main reason for temporary deferral with various other reasons like hypertension, underweight, medical causes etc.

Conclusion: The knowledge of this study will help us in identifying the reasons of deferral amongst the potential blood donors and help us in forming donor recruitment strategies. Voluntary blood donation recruitment through these strategies will lead to safe donor pool.

eP016: Blood Donation and Donor Apheresis: Causes of whole blood donor deferral in a tertiary care hospital

Sharon Joy, N. Sasikala, V. L. Kala

Introduction: Blood transfusion is a vital lifesaving procedure in current medical and surgical fields for which adequate safe blood supply must be maintained, for this sufficient supply of blood components is necessary. Donor deferral means that an individual is not eligible to donate blood based on current requirements. Donors are given a predonation counselling and medical examination before acceptance/deferral. Deferred donors can be mainly temporarily deferred or permanently deferred donors.

Aims: To study the cause of donor deferral in a tertiary care hospital.

Materials and Methods: Retrospective study of 9 months duration (January 2024 to September 2024). Data was taken from donor deferral registry maintained in blood centre. Donors who came to blood centre as well those attended voluntary blood donation camps were included. Out of 20642 registered 19764 (95.75%) were males and 878 (4.25%) were females.

Results: Out of 20642 donors registered 18493 (89.59%) were found to be fit for donation and 2149 (10.41%) were deferred. Prevalence of deferral is 10.41%. Out of 18493 donated 18210 (98.47%) were males and 283 (1.53%) were females. Out of 2149 deferred 1582 (73.6%) were males and 567 (26.4%) were females. 2059 were deferred due to temporary (95.8%) and 2 (4.2%) were deferred due to permanent causes. Most common cause for deferral was lack of sleep ((16.6%) followed by anaemia (15.6%). Other causes for temporary deferral were regular medication intake for various diseases, hypertension, rashes at phlebotomy site, underweight, dengue within 6 months. Reasons for permanent deferral were high risk behaviour, using inhaler, diabetics on insulin.

Conclusion: This study shows lack of sleep and anaemia as major causes of donor deferral. This shows the need to teach the general population about the need of proper sleep, iron supplementation as well as the need to do regular screening of vitals and intake of proper medications.

eP017: Blood Donation and Donor Apheresis: Assessing whole blood donor deferrals in eastern India: Insights from a tertiary care hospital

Bhavyaa Beriwal

Background: Whole blood collection is a critical component of blood transfusion services, ensuring the safety of both donors and recipients. Donor screening and deferral, coupled with stringent blood bag testing, are essential to maintain the quality of donated blood. While deferrals are necessary to mitigate risks, they can also lead to a loss of potential donors. Analysing donor deferral patterns is crucial for optimizing blood collection practices and maximizing the availability of safe blood products.

Aim and Objectives: To determine the deferral rate and categorize the reasons for blood donor deferrals. To develop evidence-based recommendations for reducing donor deferrals.

Methods: This study was conducted in the Department of Transfusion Medicine and Blood Bank of AIIMS Patna using the donor deferral records of 6 month from January 2024 to June 2024. National guidelines laid by Drug and Cosmetic Act 1940 (amendment 2020) were used for donor deferral criteria.

Results: Of 11774 total registrations, 10169 donations were accepted and 1605 prospective donors deferred. Males had a higher deferral rate of 82.05%. The total deferral rate 13.63% and major reason was low hemoglobin (24.23%), hypertension (21.37%), inadequate sleep (11.4%). Other causes are underweight (6.72%), medical cause (6.66%), tattooing (3.17%), alcohol (3.3%), typhoid (3.11%), tachycardia (1.49%), bradycardia (0.12%), fungal infection (1.12%), dengue (2.28%), vaccination (1.74%), underage (1.8%), hypotension (0.31%), Miscellaneous (11.4%).

Conclusion: Blood donor deferral serves as a crucial quality marker in the donor selection process. In this study, anemia and hypertension were identified as the leading causes of deferral. To address these issues, targeted interventions such as fortifying commonly consumed foods with iron and encouraging individuals with hypertension to seek timely medical intervention can help improve donor eligibility. Temporarily deferred donors should receive proper counselling regarding their deferral reasons and the necessary steps for requalification.

eP018: Blood Donation and Donor Apheresis: Adverse donor reactions in platelet pheresis donors

Aifa Hashim, Meena Sidhu, Naveen

Background: Despite significant technical advancements in automated cell separators, more emphasis has been placed on the quality of platelet concentrates rather than on donor safety. We designed this prospective study to investigate donor safety by analyzing adverse events in healthy plateletpheresis donors, focusing on the occurrence of such events during nearly 175 apheresis procedures conducted over 2 year period in a hospital-based program.

Study Design and Methods: The study involved 175 healthy plateletpheresis donors, consisting of 125 first-time and 50 repeat donors, all of whom provided informed consent. Procedures were conducted using the Spectra Optia Terumo BCT apheresis machine , during which adverse events were documented and categorized. Donors’ hematological profiles were assessed using an automated cell counter and serological testing using ELISA. Data were collected apheresis adverse event registers. Adverse events were analyzed in several categories, including complications like hatoma formation, machine errors, citrate toxicity, hypotensive or vasovagal episodes.

Results: A total of 20% (n = 35) of the plateletpheresis donors experienced adverse events, with 8% related to hematoma formation, 5.7% related to tingling sensations, followed by vasovagal reactions (4%), and kit-related events (2.3%). Multivariate analysis indicated that factors such as first time donors and donors within age group 30-45 years were substantially related to adverse donor reactions.

Conclusion: Identifying donors at risk for complications can help modify the apheresis procedure to minimize adverse events. Increasing public awareness about the ongoing need for blood and blood products is essential. Common adverse events in plateletpheresis donors include hematoma formation, tingling sensations, vasovagal reactions and kit related events which can be mitigated through pre-donation education and adjustments to machine configurations. However, further prospective studies are needed to develop guidelines for donor safety in apheresis and to evaluate donor suitability, particularly with the rising trend of double product apheresis collections.

eP019: Blood Donation and Donor Apheresis: Decoding deferral patterns: A 9-year retrospective study from a tertiary care center of North India

Sangeeta Kumari, Divjot Singh Lamba, Preeti Paul, Rekha Hans, Ratti Ram Sharma

Background and Objectives: Platelet donor selection criteria should be periodically evaluated to modify any criteria to maintain balance between safety and sufficiency. To analyze demographic profile of deferred donors and attribution of different causes of donor deferral.

Materials and Methods: Retrospective study of platelet donor deferral was conducted over 9 years (2012-2020). Donors for SDAP were screened as per SOP based on donor selection criteria in the Drug and Cosmetic Act of 1940 & Rules of 1945 and its time-to-time amendments.

Results: Out of 24505 screened platelet donors, 23.9% were deferred. 23.6% males and 55.3% females were deferred. Maximum (62.9%) deferred donors were of ≤30 years age group and replacement donors were (62%). Most donors were deferred temporarily (81.6%). Significant odds of being temporarily and permanently deferred were following-

1.3 and 0.9 times respectively in 41-50 years as compared to age ≤30 years.

1.2 and 0.85 times respectively in replacement as compared to voluntary donors.

1.4 and 0.72 times respectively in repeat as compared to first-time donors.

Maximum (37.1%) donors were deferred for the safety of both donors and patients. Most common categories for deferral were abnormal lab investigations (24.6%), physiological conditions (23.6%), and risk of TTI (20.7%). Poor venous access (15.5%), jaundice (13.6 %), low platelet (11.7 %), and low hemoglobin (8.8%) were individual most common causes.

Conclusion: This comparative analysis of donor deferral underscores importance of strict adherence to donor selection guidelines to maintain a safe SDAP supply. Educating temporarily deferred donors about deferral period, treating causes of temporary deferral, and encouraging them to return can expand the donor pool. Comprehensive multicentric studies on donors with platelets ranging from 150 to 140 × 10^9/L and Hb 12.5-11.5 gm/dl are required to assess any additional health risks and frequency limits for these donors to ensure donor health and product quality.

eP020: Blood Donation and Donor Apheresis: Analysis of adverse reactions among whole blood donors at a tertiary care hospital

Lalmalsawmsanga, J. Ravishankar

Background and Objectives: Blood donation is a very low risk procedure and donors usually tolerate blood donations very well. Adverse reaction can occur any time during or after donation, which are usually mild and does not pose much effects on the health of the individual, but may dissuade or deter donors from future donations. The aim of this study was to describe the incidence, severity, grade and pattern of adverse reactions among whole blood donors at a tertiary care hospital blood centre.

Methods: This was a retrospective observational study conducted during August 2023 – July 2024 at the Department of IH & BT, Tirunelveli Medical College and Hospital. Demographic details of donors, previous donation history and grade of adverse reaction were retrieved from donor adverse reaction register. Data was entered and analysed in Microsoft excel. Descriptive data were given in summary statistics.

Results: Of the 11180 total donors, 7090 were repeat donors (63.42%) and 10,752 were male donors (96.17%). Adverse donor reaction rate was 0.71% (n= 79/11180) with male to female ratio of 25:1. 97.47% (n=77/79) were Grade 1 severity of which vasovagal reaction was 89.61 % (n=69/77) and hematoma 10.38% (n=8/77). 2.53% (n=2/79) developed Grade 2 severity: vasovagal syncope requiring IV hydration. There was no Grade 3/4/5 reaction during this study period. Majority of reactions (78.48%, n=62/79) were seen in donors ≤30 years and in first time donors (55.69%, n=44/79). Incidence of adverse reaction in First time donors was 1.07% (n=44/4090) and in female donors was 0.70% (n=3/428).

Conclusion: Analysis of adverse donor reactions helps in identifying the donors at risk and in adopting better strategies like pre donation counselling, reassurance & post donation monitoring until adequate hemodynamic recovery that ensures prevention of adverse reaction.

eP021: Blood Donation and Donor Apheresis: Hematological impact of plateletpheresis on donor hemoglobin levels

Dondeti Pavan Kumar, Y. Divya Prafulla

Kamineni Institute of Medical Sciences, Nalgonda, Telangana, India E-mail: pavan.dondeti@gmail.com

Background and Objectives: Plateletpheresis is critical in transfusion medicine for platelet supply, but it can lead to reductions in donor hemoglobin (Hb) levels. This study evaluates Hb reductions in plateletpheresis donors, specifically those experiencing decreases of 0.8 gm to 1.5 gm, to assess the hematological impact.

Methods: A prospective study was conducted on 15 plateletpheresis donors. Pre- and post-procedure Hb levels were measured. Data collection spanned six months, and analyses were performed to evaluate Hb level changes and identify influencing factors.

Results: Of the 15 donors, 10 exhibited Hb reductions of at least 0.8 gm, and 5 showed reductions of 1.5 gm. The mean Hb reduction was significant, with donor age, initial Hb levels, and donation frequency influencing the extent of reduction.

Conclusion: A substantial proportion of plateletpheresis donors experience significant Hb reductions, with some up to 1.5 gm. Monitoring Hb levels and revising donation guidelines may enhance donor safety.

eP022: Blood Donation and Donor Apheresis: Impact on whole blood donor deferral criteria during pre and post covid pandemic: A retrospective analysis

Poonam Saini, Saroj Rajput, Tathagata Chatterjee, Sumit Barik, M. S. Bindra

Background and Objective: Healthy blood donors are crucial for maintaining safe and adequate blood transfusion services, which are vital for patients undergoing surgeries, trauma care, or managing chronic conditions like anemia and cancer. Understanding the reasons for donor deferral is essential for improving recruitment, retention, and ensuring blood safety. This study aims to analyze the deferral patterns of whole blood (WB) donors and comparing the periods before and after the COVID-19 pandemic. By identifying the primary causes of deferrals and any significant shifts due to the pandemic, the study seeks to inform future strategies to optimize donor recruitment and ensure a stable and safe blood supply.

Methods: This retrospective comparative study analyzed WB donor deferral patterns at a tertiary care institute in northern India. Data were collected from donors who were deferred from donating blood during both the pre-COVID and post-COVID periods. The variables studied included the sex of the donor, donor type (voluntary or replacement), type of deferral (temporary or permanent), and reasons for deferral. All data were systematically recorded using a standardized proforma.

Results: A total of 13,457 donors donated blood during the study period, which was divided into two phases: pre-COVID and post-COVID. Of these, 2,026 donors were deferred, resulting in an overall deferral rate of 15.05%. Pre-COVID Deferrals Were 640 donor and the majority of deferrals were temporary, with anemia (24.21%) being the most common cause, followed by high haemoglobin. Post-COVID Deferrals Were 1386 donors were deferred after the pandemic. Similar to the pre-COVID period, anemia remained the primary cause of deferral. Across both periods, 87.79% of deferrals were temporary, allowing for the possibility of future donations and 12.21% were permanent deferrals.

Conclusion: COVID-related deferral criteria (recent illness, vaccinations, exposure) temporarily affected eligibility but did not significantly alter overall deferral patterns. Anemia remained the primary cause of deferral before and after the pandemic, highlighting its ongoing impact on donor eligibility. The study concludes that while pandemic-related challenges existed, medical deferral criteria remained stable.

eP023: Blood Donation and Donor Apheresis: Pre-donation transfusion transmitted infection screening in single donor apheresis platelet (SDP) donor: Prevalence and psycho-social issues

Ansuman Sahu, Somnath Mukherjee, Satya Prakash, Debasish Mishra

Background and Objectives: Pre-donation Transfusion Transmitted Infection (TTI) screening (PDS) is vital in Transfusion Medicine, particularly in high endemic areas, to improve blood transfusion safety and cost-effectiveness. While PDS is commonly performed in whole blood donation settings in other parts of the world, it is regularly conducted before single donor platelet (SDP) collections in India either by chemiluminescence or other serological methods. However, the prevalence of TTIs in SDP donors using chemiluminescence remains unreported, as does the psychological impact on donors with reactive results. The objective of the study is to determine the prevalence of TTIs in SDP donors using chemiluminescence.

Materials and Methods: A retrospective study was conducted to trace the PDS results of SDP donors over five years in the Department of Transfusion Medicine at AIIMS Bhubaneswar. When a platelet transfusion is indicated, the patient’s representative must bring a donor to the department. The donor completes a pre-donation questionnaire, undergoes a physical examination, and is assessed for vein suitability. Blood grouping and a complete blood count (CBC) for platelet count and haemoglobin levels are performed. If the donor meets all eligibility criteria, PDS is performed using chemiluminescence-based serology. If results are non-reactive, platelet collection through apheresis is carried out, and donors are counselled and referred if reactive. The prevalence percentage was calculated by dividing the total number of reactive by the total number of PDS multiplied by 100.

Results: A total of 893 prospective donors were screened for TTIs. Among these donors, all were male except for one female. Platelet donations increased from 36 in 2020 to 335 by September 2024. Three individuals tested reactive for TTIs during PDS: two for HBsAg and one for syphilis, resulting in a prevalence rate of 0.36%. HBsAg reactive donors were referred to the Gastroenterology OPD, and the syphilis reactive donor was referred to the Venereology and Dermatology OPD.

Conclusion: We found that the prevalence of TTI in PDS was 0.36%, which is much less when compared to post-donation screening of whole blood donors. While PDS in SDP donation offers economic benefits by preventing product discard, it also presents challenges such as regulatory compliance issues, extended donor waiting times, potential psychological impacts to the donor due to the complexities involved in result disclosure, and the risk of patients being deprived of timely platelet transfusions. Additionally, highly sensitive testing methods increase the likelihood of false positives. To address these challenges, voluntary SDP collection should be instituted, while smaller centres should maintain a group-wise stock reserve and ensure proper inventory management.

eP024: Blood Donation and Donor Apheresis: Descriptive analysis of therapeutic phlebotomy procedures in a tertiary care center

Shallu, Ashish Jain, Gita Negi, Daljit Kaur, Dixa Kumari, Safna Safeer

Background and Objective: Therapeutic phlebotomy is a blood-drawing procedure used to treat conditions like hemochromatosis, polycythemia vera, and secondary erythrocytosis. By reducing blood volume or concentration, it helps alleviate symptoms and prevent complications associated with these disorders.

Methods: A retrospective study was conducted from January 2022 to August 2024 in the Department of Transfusion Medicine, examining patients who underwent therapeutic phlebotomy. Data on demographics, diagnoses, and indications for the procedure were collected. The procedure’s effectiveness was assessed by analyzing hematological parameters, frequency of procedures per patient, and symptom-free periods. Safety was evaluated based on recorded adverse events.

Results: In total, 264 therapeutic phlebotomy procedures were performed on 161 patients, 125 males and 36 females. Among them, 104 had single procedure while 57 required multiple procedures. The most common indications were primary polycythemia vera (95 patients) and secondary polycythemia (66 patients). Of the secondary polycythemia cases, 10 were related to heart diseases and 72 to respiratory conditions. Heart conditions included 3 cases each of Tetralogy of Fallot (TOF), Transposition of the Great Arteries (TGA), and congenital heart disease, plus 1 case of congestive heart failure. Respiratory cases consisted of 68 with Chronic Obstructive Pulmonary Disease (COPD), 2 with Pulmonary Arterial Hypertension (PAH), 1 with Ischemic Heart Disease (IHD), and 1 with bronchiectasis. One patient had hereditary hemochromatosis. Out of the 95 patients with primary polycythemia, 89 were JAK2 positive, while 6 were JAK2 negative. The age distribution of the patients was: 12 between 0-15 years, 28 between 15-30 years, 51 between 31-45 years, 47 between 46-60 years, and 23 over 60 years with hemoglobin levels between 17 g/dL and 23 g/dL and hematocrit between 50% and 73%. Following one phlebotomy session, hemoglobin decreased by 1-2 g/dL and hematocrit by 3-5%. Fluid replacement done using normal saline in admitted patients. No adverse events were reported following the procedure.

Conclusion: This descriptive analysis showed that primary polycyethemia with JK2+ and secondary polycyethemia with respiratory indication are the common indication for therapeutic phlebotomy. Based on the changes in the hemoglobin and haematocrit after the procedure, patients showed improvement after the procedure.

eP025: Blood Donation and Donor Apheresis: Analysis and evaluation of adverse donor reaction in a tertiary care blood centre – Enhancing safe blood donation practices

Bharti, Ravi Rani Mishra

Introduction: An untoward feeling by the blood donor before, during or after blood donation is known as adverse donor reaction, these reactions can compromise donor safety and the efficiency of blood collection. Appreciating the nature and frequency of the reactions is essential for improving donor management and enhancing the overall blood donation experience.

Objective: To analyse and evaluate the frequency, incident, types and risk factors associated with these adverse donor reactions which is important for safe blood donation practices.

Methods: This is a retrospective study conducted at our tertiary care centre from December 2022 to July 2024.

Results: A total of 13958 Donation happened in the duration of 20 month

Replacement donors were 1413

Family donors were 9638

Voluntary donors were 2904

Total no of donors who experienced adverse donor reactions were 313

Majority were mild reactions which doesn’t need any action, most common reaction was mild vasovagal attack f/b nausea/ vomiting f/b hematoma at needle site.

Conclusion: The study summarises the ADR reported during blood donation. We concluded that younger age, first time and female donors are more prone to ADR. Participation of blood centres in donor vigilance is a very positive step towards safe blood donation practices. CMEs can be conducted to increase awareness among blood centres as well as donors. There is a psychological element to most reactions, So a friendly cheerful atmosphere can reduce donor anxiety and perhaps reduce adverse reaction.

eP026: Blood Donation and Donor Apheresis: Deferrals of blood donors in Northern India

Vijay Pratap, Tulika Chandra, Archana Solanki, Ashutosh Singh

Background: Pre donation screening is important for safe donor selection and blood collection. Deferral is also an integral part of donor screening to ensure safe blood.

Objective: To analyse and study the various causes of pre donation deferral and rate of deferral in Northern India.

Methodology: Retrospective study of various causes of deferral at our center for a period of one year from Sept 2023 to Sept 2024. The data collected was statistically analysed.

Results: Total 82522 donations were done, 7512 donor were were deferred among which 7371 (98.12) were males, 141 (1.87) were females. Temporary deferred donors were 6730 (89.58) and permanently deferred were 782 (10.41). Male deferrals were (48.32%) with a count of 3537 due to anemia, followed by 1311 (17.79%) on medication, alcohol 719 (9.82), unwilling to donate 610 (8.27%). Permanently deferred were 782 because of liver diseases, HIV, Syphilis. Among 151 female donors 84 (59.57) were anemic, 39 (27.65%) were deferred for some sort of medication and 18 (12.76%) donors were underweight.

Conclusion: The deferral rate is 9.10% at our center. The temporary deferred donors were educated about deferral period and counsel them to donate in future. Motivation and awareness among women’s and in rural areas must be done for blood collection. The highest factor for deferral was Anemia hence awareness and counselling regarding of prevention of anemia should be done at priority.

References

1. Soundharya V, Arthi R, Haran AH, Suresh Kumar I, James S. Analysis of blood donor deferral pattern at a tertiary care hospital in Chennai: A cross-sectional retrospective study. Cureus 2024;16:e67541.

2. Malhotra S, Negi G. Analysis of reasons of blood donor deferral at a tertiary care institute in India and its reflections on community health status. Asian J Transfus Sci 2023;17:48-52.

eP042: Clinical Transfusion Therapy and Patient Blood Management: Evaluation of blood utilization practices in urology patients at tertiary care center from southeastern part of Rajasthan

Arifa Bano, Hargovind Meena, Rashmi Parashar

Department of IHTM, GMC, Kota, Rajasthan, India

Background: In developing countries, blood transfusion was decided by treating physicians. Development of Maximum surgical blood ordering schedule (MSBOS) for surgical procedure can mitigate over-ordering of blood. Implementation of MSBOS can cause cost reduction because of unnecessary compatibility tests.

Aim: This study aimed to assess the practices of blood requisite and transfusion in Urology patients.

Methods: An institutional-based prospective study was conducted from October 2023 to March 2024, in Govt. medical college and hospital, Kota, Rajasthan. Socio-demographic data like age, sex, type of anesthesia, and type of surgeries were taken preoperatively. The number of cross-matched and transfused data were collected from blood center record. Efficacy of blood utilization was evaluated using the following indices like cross-match to transfusion ratio (C/T ratio), transfusion probability (%T), and transfusion index (TI); a ratio of 2.5 and below, A value of 30% and above, and values of 0.5 or more respectively were considered indicative of significant blood usage.

Results: In all procedures, among cross-matched blood units, 78.7% were unutilized. The overall blood transfusion indices result was C/T ratio, %T, and TI and utilization rate was 4.69, 24.3%, and 0.30, 21.3% respectively.

Conclusion: Preoperative grouping, screening, and hold (GSH) are sufficient for elective surgical procedures to decrease the wastage of valuable supplies.

Keywords: Blood transfusion indices, blood utilization practices, C/T ratio, maximum surgical blood ordering schedule, transfusion index, transfusion probability

eP043: Clinical Transfusion Therapy and Patient Blood Management: Patient blood management (PBM) in obstetrical cases in ESI tertiary care model hospital Delhi

Bharat Singh, Surubhi Srivastava, Radha, Hanisha Jain

Aims and Objectives:

1. To study the pattern of blood demand in obstetric cases

2. To minimize the demand for blood & Blood components in the obstetrical cases.

Introduction: Patient blood management (PBM) is relevant in all patients requiring blood transfusion, more so in elective surgical procedures Patient blood management is evidence based multidisciplinary approach to optimize the care of patient who needs blood transfusion. PBM covers the entire stay of patients in the hospital, before the admission to the hospital, treatment and outcome.

Materials and Methods: It is a prospective study in the department of immunohematology and blood transfusion, the duration of study was six months from October 2023 to March 2024. Every blood request raised by obstetricians was reviewed and analyzed daily. The accelerated request was noted, and the obstetrician was communicated by personal meeting and through WhatsApp message and advise to raise justified demand for blood.

Results: The monthly demand for PRBC in the first month of study (October-23) was 673 units whereas the blood unit’s utilization 105 units. It was just 15% of the demand raised. Similarly, for FFP the utilization was 28% and for platelet it was 23%. After multiple intervention with the clinicians via talks on rational used, WhatsApp messages in the last month of study (March 24 the utilization % was 41%, 43% and 53% for PRBC, FFP and platelets respectively.

Discussion: Multiple intervention through lectures, seminar discussions and WhatsApp message and using mass multimedia with consultant, senior residents and the post graduate students we could reduce the unjustified raise of request for blood and blood components. The utilization has increased from 15% to 41% for PRBC, 28% to 43% for FFP and 23% to 53% for platelet concentrate.

Conclusion: Multiple interventions like meeting, seminars and use of multimedia helps in achieving rational utilization of blood & Blood products. Role of HTC is crucial in spreading the information to clinicians and resident doctors.

eP044: Clinical Transfusion Therapy and Patient Blood Management: Assessment of transfusion reaction to fresh frozen plasma in surgical patients

Rajeev Kumar, Tulika Chandra, Archana Solanki, Ashutosh Singh

Introduction: Fresh frozen plasma (FFP) is the fluid portion of a unit of whole blood frozen in a designated time frame, usually within 8 hours. Fresh frozen plasma contains all coagulation factors except platelets. Fresh frozen plasma contains fibrinogen, albumin, protein C, protein S, antithrombin, and tissue factor pathway inhibitors. The judicious use of FFP can significantly impact surgical outcomes, reducing intraoperative and postoperative complications associated with excessive bleeding. However, their administration is not without risks. The adverse effects of fresh frozen plasma administration are similar to those that pertain to whole blood and all blood components.

Aims and Objectives:

1. To assess the frequency and characteristics of transfusion reactions to FFP in surgical patients.

2. To assess the impact of standard transfusion practice in the prevention of adverse transfusion reactions and clinical outcomes.

Methodology: This prospective study was conducted at the Department of Transfusion Medicine, KGMU, in collaboration with surgical departments. Surgical patients who received FFP transfusions were included in this study. Data on demographic characteristics, surgical procedures, clinical history, transfusion practices, and any documented transfusion reactions were collected. Transfusion reactions were classified according to standard criteria.

Results: In this study, 230 patients were included who were admitted to surgical departments for surgical procedures. The adverse reaction rate during the transfusion was minimal, with 94.3% of patients reporting no reactions. A small percentage experienced itching (3.1%) and fever (2.6%). The most common adverse reaction was mild allergic reaction. No cases of transfusion reactions of TRALI and TACO were reported in the present study. The majority of reactions were managed with standard protocols, resulting in favourable patient outcomes.

Conclusion: The incidence of transfusion reactions to FFP in surgical patients is relatively low, with allergic reactions being the most common. Awareness of potential risk factors can help optimise transfusion practices and improve patient management.

eP045: Clinical Transfusion Therapy and Patient Blood Management: Managing post transfusion hyperhemolysis in E-β-thalassemia with multiple red cell alloantibodies and subsequent support without transfusion – A case study

Suchismita Paul, P. Bhattacharya, C. Maity, B. Talukder, A. Das, S. Pandey, P. Dutta

Background and Objectives: Hyperhemolysis syndrome is a lifethreatening complication of blood transfusion. We report a successful management of an adult female with E-beta thalassemia and multiple alloantibodies who developed hyperhemolysis syndrome.

Methods: A 43 years old female was referred to the transfusion medicine (TM) clinic due to crossmatch incompatibility with history of infrequent transfusion frequency of 1-2 unit per year for last 22 years since her first pregnancy. However, in last six months, her transfusion requirements increased to 1 U/week.

Presentation: Initially hemoglobin (Hb) was 3.3 g/dL. A fully compatible unit was transfused initially. Extended phenotype was done of this unit.

She was admitted after 3 weeks with Hb 3.7 g/dL. A best-matched unit, phenotypically same as previously compatible unit, was transfused, resulting in delayed hemolytic transfusion reaction (DHTR) and hyperhemolysis syndrome.

Laboratory Results: Post-transfusion Hb dropped to 2.7 g/dL, LDH: 2965 U/L.

Management: She was treated with IV Methylprednisolone (500 mg) & immunoglobulin (2 g/kg) and addressed for uncompensated heart failure and intravascular hemolysis related organ damage.

Results: Patient was discharged with single HbF inducer i.e. thalidomide and oral corticosteroids along with anti-heart failure measures. One month later, her Hb was 3.5 g/dL, and she received phenotype-matched packed red blood cells (PRBCs). Her Post-transfusion Hb remained stable.

Second HbF inducer, hydroxyurea was introduced. Subsequent follow-up showed:

1 Month Later: Hb 4.9 g/dL

2 Month Later: Hb 5.2 g/dL

3 Month Later: Hb 7.5 g/dL

Conclusion: Complicated DHTR has to be managed aggressively. Non transfusion measure like HbF inducer can help to bypass complicated transfusion situation. The use of HbF inducers played a crucial role in stabilizing hemoglobin levels and in enhancing the patient’s quality of life.

eP046: Clinical Transfusion Therapy and Patient Blood Management: Evaluating blood usage efficiency in obstetrics and gynaecology: Charting a path for patient blood management at a tertiary care center

Priyanka Rathod, Daljit Kaur, Safna Safeer, Deepali Chauhan, Ashish Jain, Gita Negi

Background and Objectives: Effective blood management is crucial in obstetrics and gynaecology due to the potential for significant blood loss during procedures and childbirth. This study aims to assess blood usage efficiency within a tertiary care center which can further help in developing strategies for improving patient blood management.

Methods: In a retrospective observational study spanning from August 2023 to July 2024, the Department of Transfusion Medicine focused on patients from the Department of Obstetrics and Gynaecology (OBGYN) who required blood components, including Packed red blood cells (PRBC), fresh frozen plasma (FFP), Random donor platelets (RDP), Single donor platelets (SDP), and Cryoprecipitate (CRYO). Detailed patient information, including diagnoses and clinical indications, was meticulously extracted from blood requisition forms and the Hospital Information System database. Additionally, blood utilization data was obtained through the blood bank software, allowing for a comprehensive analysis of transfusion practices within this specific patient population.

Results: A total of 2,665 blood requisitions for 2,424 patients were received from the Department of OBGYN during the study period. Of the 3,714 PRBC units crossmatched, 937 were issued to 738 patients, resulting in an average cross-match to transfusion ratio (C/T ratio) of 3.9. The Transfusion Probability (T%) was 38%, and the Transfusion Index (TI) was 0.38. Following PRBC, RDP were the second most common component transfused, with 128 patients receiving 319 units, while 282 units of FFP were transfused to 86 patients. SDP and CRYO were notably underutilized among OBGYN patients. The most common indication for transfusion was severe anaemia in antepartum phase followed by Emergency LSCS, Hysterectomy, Obstetrical Haemorrhage and others.

Conclusion: Our study showed underutilisation of blood in terms of Cross-match to transfusion ratio and Transfusion Index while Transfusion Probability was appropriate. The common indication of transfusion was severe anaemia in pregnant females which can be corrected in prepartum phase and subsequently reduce need for transfusion.

eP047: Clinical Transfusion Therapy and Patient Blood Management: Analysis of blood transfusion practices during chemotherapy in acute myeloid leukemia patients in a tertiary care oncology centre

S. Priya, Priti Desai, Anisha Navkudkar, Abhaykumar Gupta

Background and Objectives: Blood transfusions are important in managing patients with Acute Myeloid Leukemia (AML). The objective of this study was to analyse the blood transfusion practices among AML patients undergoing chemotherapy.

Methods: This retrospective study was conducted over a period of 8 months (January to August 2024). A total of 107 AML patients who received different blood components transfusion were included. Data was retrieved from Electronic Medical Records and departmental records. The parameters analysed were age, gender, pre-transfusion hemoglobin count and platelet count, type and number of blood components transfused, adverse reactions etc by using appropriate statistical tools.

Results: During study period, 107 AML patients (70 males, 37 females) with mean age of 36 years (range 25-48) received total of 3812 blood components, 27.5% were Random Donor Platelets (RDP), 35% Single Donor Platelets (SDP), 26.5% Packed Red Blood Cells (PRBC), 8.5% cryoprecipitate, 2% Fresh Frozen Plasma (FFP) and 0.5% Granulocyte. These patients received a mean of 9 (4-14) PRBC, 12 (4-17) RDP, 13 (5-18) SDP, 21 (3-44) Cryoprecipitate, 12 (2-48) FFP over an average period of 60 days. More than 75% of patients were undergoing the induction phase of chemotherapy. Additionally, 23 patients received granulocyte products. Mild transfusion reactions occured in 5 (4%) patients. Low pre-transfusion platelet counts (<20,000/µL) predicted higher platelet transfusions which was statistically significant (p<0.001). For PRBC transfusions, 55 patients were transfused with pre-transfusion hemoglobin (<7 g/dL). FFP and cryoprecipitate were transfused to patients experiencing active bleeding with deranged coagulation profile. More than 92% of transfusions were found to be appropriate as per institutional guidelines.

Conclusion: The transfusion patterns among AML patients showed that platelets were required more frequently than other blood components probably due to chemotherapy induced thrombocytopenia. Anticipating transfusion needs of AML patients during chemotherapy induction phase will aid in resource allocation and planning which will positively impact the patient services and care.

eP048: Clinical Transfusion Therapy and Patient Blood Management: Is PBM the need of time in current era? – CTVS surgeries experience from a tertiary care hospital

Para K. Trivedi, Archana Bajpayee, S. Sathish

Background and Objectives: Patient blood management (PBM) is a patient-focused, evidence-based and systemic approach to optimize the management of patients and transfusion of blood products for quality and effective patient care. It is not blood in the blood center that is managed but the patient’s own blood that is taken good care of and managed in accord with the physiology of blood management. This study is conducted to understand where PBM stands in this modern era with multiple available modalities in cardiac surgery.

Methods: The study was done from starting of July to end of September 2024. It is a retrospective observational study. Data was collected and analyzed from the Department of CTVS surgery and transfusion medicine, AIIMS Jodhpur. Lab results were collected from CDAC.

Results: Total number of surgeries conducted in 3 months were 132 out of which 57 (43.18%) were CABG. 72 (55%) patients were allogeneically transfused. 13 (9.85%) patients had autologous transfusion in form of ANVH out of which 3 (2.27%) patients had additional allogeneic transfusion. Pre-operative anemia incidence was 64.39%. Patients undergoing on pump CABG required a greater number of transfusions compared to off pump CABG. Transfusion probability was 85% and transfusion index was 1.8 suggesting significant blood utilization.

Conclusion: All efforts should therefore be made to detect and treat preoperative anemia and to prevent blood loss during and after surgery. Patients having preoperative anemia should be preferred for off pump CABG. Even with the availability of drugs and biocompatible bypass machines, without basic correction of anemia will predispose patient to unnecessary transfusion and lower survival rates. A reduction in the use of blood products will be the earliest and clearest result, and maybe the only one directly measurable in the short term.

eP049: Clinical Transfusion Therapy and Patient Blood Management: Effect of hematocrit and storage time of reconstituted blood on serum bilirubin, hemoglobin and hematocrit of neonates undergoing exchange transfusion

Shivam Azad, Tulika Chandra, Archana Solanki, Ashutosh Singh, Mala Kumar

Background and Objectives: Exchange transfusion is the use of whole blood or equivalent to replace the neonate’s circulating blood and simultaneously removing bilirubin and maternal antibodies. Reconstituted blood for exchange is prepared by mixing RBCs (compatible with maternal serum or neonates’ serum) and AB plasma. Objective is to compare the differences of pre and post exchange parameters on the basis of different hematocrits and storage time of blood units.

Methods: On receiving the request for reconstituted whole blood for exchange transfusion, both mother’s and baby’s samples were tested and reconstituted blood was prepared by mixing O negative PRBC with AB plasma. Total no. of patients were divided into two groups on the basis of target hematocrit of reconstituted whole blood:-

1. GROUP A (hematocrit 45%-52%)

2. GROUP B (hematocrit 52.1%-60%)

They were also divided into another two groups on the basis of storage time of RBCs.

1. GROUP C (PRBC 0-5 days old)

2. GROUP D (PRBC 6-10 days old)

Results: For bilirubin levels, a significant difference in mean percentage change was observed between Group A and Group B (t-value = -2.40, p = 0.027). For sodium levels, a significant difference in mean percentage change was observed between Group C and Group D (t-value = -4.83, p < 0.001). Additionally, for glucose levels, a significant difference in mean percentage change was observed between Group C and Group D (t-value = 3.11, p = 0.005).

Conclusion: These findings suggests that in case of hematocrit of the reconstituted blood, higher hematocrit is better as is it associated with better reduction in serum bilirubin. In case of storage time of reconstituted blood, O negative units less than 10 days old should be used.

eP050: Clinical Transfusion Therapy and Patient Blood Management: Optimizing perioperative and postoperative management: Harmonizing the use of allogeneic blood components in liver transplantation

M. S. Veshika Abinaya, B. Latha, G. Kavitha

Background: Despite advancements that have significantly reduced the necessity for blood components, Liver Transplantation remains a complex procedure often requiring substantial allogeneic blood transfusions due to the significant blood loss.

Objectives:

1. To assess the perioperative and postoperative utilization of allogeneic blood components.

2. To identify preoperative parameters that predict the requirement for allogeneic blood components in Liver transplant recipients.

Methods: A retrospective study on utilization of allogeneic blood components were analyzed for a total of 11 Liver Transplant Procedures performed between February 2023 and September 2024 at a tertiary care hospital. The data on utilization of perioperative and postoperative (up to 48 hours) blood components were collected from Blood Bank Records.

Results: The data were analyzed for a total of 11 patients who utilized allogeneic blood components during Liver Transplantation and the first 48 hours of Intensive Care Unit (ICU) stay. The common indications were Alcoholic Cirrhosis and Chronic Liver Disease related to Viral disease (Hepatitis B Virus).

Intraoperative Utilization:

81.8% (n=9) of patients received Red Cell Concentrate when their Hemoglobin levels were less than 8 g/dl.

Pooled Cryoprecipitate and Fresh Frozen Plasma were transfused to patients with abnormal Rotational Thromboelastometry (ROTEM) test results.

72.7% (n=8) of patients received Single Donor Platelets (SDP) when their Platelet count was less than 75×103/microliter.

Postoperative Utilization:

54.5% (n=6) of patients required Red Cell Concentrate when their Hemoglobin levels were less than 10 g/dl.

18.2% (n=2) of recipients did not require any allogeneic transfusion.

Conclusion: Point of care testing particularly ROTEM, preoperative Hemoglobin level and Platelet Count assessments play a critical role in anticipating perioperative and postoperative transfusion needs. This allows healthcare professionals to better manage transfusion strategies, optimize resource allocation and improve patient outcomes in liver transplantation.

eP051: Clinical Transfusion Therapy and Patient Blood Management: Management of massive transfusion in postpartum hemorrhage – Formula based approach versus goal based massive transfusion

Hadhiya Thahir, Shiffi Fazal, S. Greeshma

Introduction: Obstetric-Haemorrhage is the major cause of Maternal-mortality/morbidity. With transfusion------blood-component-therapy------as an important indicator of Obstetric-morbidity, there is a need to initiate Quality-improvement by reviewing cases of postpartum-haemorrhage (PPH) with management. Massive-Transfusion have been advocated as an essential tool in managing PPH. The most accepted/tested strategy is the Formula-based-approach. But due to the overexposure to blood-components;Point of care testing–TEG/ROTEM is now being employed widely. Below are two cases of Atonic PPH- one managed by Formula-based-approach and other using ROTEM and is meant to compare and identify the advantages and limitations of each.

Aims and Objectives: To analyse two cases of Postpartum-Haemorrhage: one managed by Formula-based-approach and other by Goal-based-Massive-Transfusion.

Methodology: Following are two-cases of Atonic-PPH------one managed by formula-based-approach and other using ROTEM.

Case 1:

24-Year-old-female------G3P2L1NND1

Atonic-PPH (following-vaginal-delivery)

Vitals:

- Pulse:120/min BP-90/50 mmHg

Laboratory-Parameters:

- Hb:6 g% Platelet count:1.1 Lakhs PT/INR:40.3/3.39 Fibrinogen:80 mg%

MTP-activated.

Total of 8 unitsPRCs, 8 Units FFP, 6 units Platelet-concentrate, 10 units Cryoprecipitate transfused

Patient-HemodynamicallyStable.Laboratory-parameters-----within normal-limits

Case 2:

29-year-old-Female; weighing 70 kg-----G3P1L1A1, presented with Atonic-PPH

Vitals:

- Pulse: 110/min BP-90/60 mmHg.

Laboratory-Parameters:

- Hb: 9 g% Platelet count: 2.1 Lakhs PT/INR: 31.3/2.39 aPTT: 47.4s Fibrinogen: 80 mg%

Transfused-----4 unitsPRC, 2 unitsFFP

Bleeding-still persisting.ROTEMdone.

ROTEMFindings-----EXTEM:

• CT-215 seconds (38-79)

• CFT-849 seconds (34-159)

• A5-10 (34-55)

• A10-17 (43-65)

• A15-21 (48-69)

• α-angle---23 (48-69)

• MCF-20 (50-72)

Fibtem:

• CT-59 (38-62)

• A5-5 mm

• A10-5 (7-23)

• MCF-5 (9-25)

According to evidence-based ROTEM-A5-PPH-Algorithm (2019), 10 units-Cryoprecipitate, 5 units FFP-Transfused.

Patient----Stable. No further bleeding-episodes. Laboratory values---within normal limits.

Results and Discussion: Formula-based-approach have been advocated as an essential-tool for facilitating early transfusion of sufficient volume and types of blood products for patients with massive-obstetric-haemorrhage. Its implementation shown to improve the timeliness of transfusion and cost-effective.

Disadvantage: May lead to

• Unwanted exposure to blood-components

• Increased risk of acute-respiratory-distress-syndrome, sepsis and multiple-organ-dysfunction.

• Wastage of BloodProducts.

According to Goal-Based-Massive-Transfusion, instead of “One size fit all” rule, Management is according to physiological-status of patient. There is individualised patient care-better patient-management. Early achievement of haemostasis----earlyFibrinogen-replacement.

Disadvantages:

• Difficult to validate and standardise.

• Patient-to-Patient-variability

• Inter-user-variability.

• DifficultQuality-Assurance.

Conclusion: Further studies should be conducted to assess whether, Formula-Based-Approach or Goal-based-Massive-Transfusion-therapy, is better in improving-MaternalOutcome inPPH and to comment on the superiority of one over-the-other.

eP052: Clinical Transfusion Therapy and Patient Blood Management: Transfusion management in a toddler with sickle cell anaemia for a major neurosurgery procedure: A case report

M. K. Sajimol, N. Sasikala

Introduction: In sickle cell anaemia, there is abnormal form HbS for majority of Hb. Preoperative red cell transfusions can reduce the complications during & postsurgery.

Case Report: A 1 yr 8 m old female child with sickle cell anaemia, Lumbosacral Lipomyelocele, admitted for corrective surgery Neurosurgery unit. The first child, term AGA from FTND, B W 2.5 kg, uneventful other than, received phototherapy for 6 hrs in neonatal period. No previous hospital admission/ past transfusions. Mother & maternal grandmother known case of sickle cell anemia. At the age of 1 yr mother noticed gait abnormality when the baby started walking. On admission child weight: 9.5 kg, alert, moving all four limbs. Her HbS was 72%, Hb electrophoresis suggestive of homozygous for HbS with hereditary persistence of HbF. Sickling Test was Negative. Cardiac Echo was normal.

Blood Group: O Rh pos, DAT, IAT -Neg, Autocontrol-Neg Antibodyscreening – Negative, Extended Phenotyping of the child -Neg-c, E, K & positive for s, P1, Fya, k. We decided to issue crossmatch compatible c, E negative Leucoreduced Fresh PRC unit.

Management: Selected c, E negative O rh positive donor from the Extended phenotype Registry pool. We traced locally available 3 donors from our registry. Screened and reserved the units and simple transfusion of the PRC unit in alliquots. Transfusion done in 10-15 ml/kg in 4 hrs. Her Hb level improved, HbS percentage reduced to 40% after 3 successive transfusions of 120 ml. Intra-0peratively 120 ml PRC and surgery was uneventful without any complications. Child discharged on the 7th day.

Conclusion: This was a multidisciplinary approach and a team work, concluded in a successful major neurosurgical operation with sickle cell disease. From our effort of Extended Phenotype Donor Registry, we were able to do our task in a swift way planned approach and concluded into a success story.

eP053: Clinical Transfusion Therapy and Patient Blood Management: Audit of single donor platelet in a tertiary care center in South India

Rutvi Modh, N. Preethi

Background and Objectives: To assess the appropriate utilization single donor platelets (SDP); a six-month retrospective audit was carried out in a tertiary care hospital.

Materials and Methods: A six-month retrospective platelet audit was carried out from March to August 2024 to estimate its preparation, appropriate utilization. Patient’s demographics, diagnosis, Underlying condition & transfusion triggers assessed.

Results: About 355 units of single donor platelets were prepared and transfused to 355 patients. Adult Critical care unit patient (CCM) & High dependency unit (HDU) were the main user utilizing 39.1 and 78.4 % of SDPs prepared. 24 % SDPs transfusions were of group specific platelets. 63% of prophylactic platelet transfusions were appropriate as per the recommended BCSH guidelines. However, 37% of the prophylactic platelets were transfused inappropriately with normal platelet counts and no evidence of bleeding related to platelets.

Conclusions: Regular audit of blood and blood components is a must so that necessary remedial measures can be taken to maximize appropriate and judicious utilization of each component.

eP066: Hemovigilance: Error analysis in transfusion service: A tool for quality improvement

Suman Sudha Routray, Sukanta Tripathy, Nirupama Sahoo, Devi Prasad Acharya

Introduction: Errors in the blood transfusion process significantly contribute to adverse events, highlighting the need for identification and mitigation.

Methodology: A retrospective analysis of documented errors was conducted from Jan to June 2024 at KIMS blood centre, categorizing them by type and location within the transfusion chain. Significant errors underwent root cause analysis (RCA), with statistical calculations of percentages and trends and severity classified as minor, moderate, or major.

Results: A total of 144 errors were recorded, primarily in the cross match laboratory (59%, n = 85). Mislabelling errors (55.2%) and missing records (20%) were most frequent, with blood grouping errors at 2 per 1000 tests. Among 11,057 samples, 10 (1 in 1105) had wrong blood in tube (WBIT), with six identified pre-releases. Moderate harm occurred in two WBIT cases, while two others resulted in minor harm. Component lab errors included outdated platelet inventory (3.4%, n = 6) and storage failures (0.6%, n = 1). Donor section errors involved mislabelled blood bags (6.9%, n = 10) and donor screening errors (3.4%, n = 5). The TTI screening section had 11 near-misses. Most errors were internal, with nine affecting external incidents, leading to five minor and two moderate harm cases. RCA indicated that 81.4% of mislabelling and documentation errors occurred during afternoon shifts, suggesting uneven workforce distribution. Emergency night requests were linked to missing records, while WBIT errors stemmed from nursing non-compliance with standard operating procedures (SOPs).

Conclusion: The study identifies critical error areas—mislabelling, WBIT, and inventory mismanagement—necessitating targeted interventions. The correlation between error rates and workforce distribution underscores the need for an improved duty schedule. Recommended actions include schedule adjustments, retraining, and further automation for sustained improvement.

eP067: Hemovigilance: Prevalence of adverse transfusion reaction and its temporal association in a tertiary care center

Umesh Kumar Singh, Daljit Kaur, Dixa Kumari, Gita Negi, Ashish Jain

Background and Objectives: Blood transfusion is an underappreciated medical procedure worldwide. Even a minor mistake in any one of this multi-step process covering vein to vein transfusion could be fatal for the patients. Hence, the study was aimed to identify any correlation between Adverse Transfusion Reactions (ATR) and the time (routine vs non-routine) of blood components transfusion.

Methods: A retrospective observational study was conducted in Department of Transfusion Medicine of a tertiary care center. The data for the study was collected from the ATR records for a period of 1 year from April 2023 to March 2024. The time duration between 8 PM to 8 AM was considered as non routine hours and all the blood components issued during this time period was assessed. A comparison was done for ATRs on the units issued during routine and non-routine hours.

Results: During the study period total number of components issued to patients were 50,463 units, out of which 31,611 (62.64%) units were issued during routine and 18,852 (37.35%) units during non-routine hours. A total of 108 ATRs were reported during the study period out of which 63 (58.33%) occurred during routine hours where 45 (41.66%) were reported during non-routine hours. ATRs as observed to the number of units issued during routine hours accounted to 0.19% and during non-routine hours to 0.23%. The most frequent ATRs occurring during routine and non-routine hours was FNHTR (57.14%; 48.88% ) (febrile non hemolytic transfusion reaction) followed by Allergic (22.22%; 37.77%), TAD (6.34%; 4.44%) (transfusion associated dyspnea), TACO (4.76%; 6.66%) (transfusion associated circulatory overload) and TAH (3.17%; 2.22%) (transfusion associated hypotension).

Conclusion: The study demonstrated a higher number of ATRs were associated with non-routine hour transfusions as compared to routine hour transfusions. Hence regular audits of non-routine hour transfusions should be conducted by all the institutes to curtail the unnecessary non-routine hours transfusions.

eP068: Hemovigilance: Bedside transfusion audit: Manual monitoring versus RFID system

Deepak Kumar, Rahul Katharia, Swati Pabbi, Tarun Kumar, Amit Bisht, Omprakash Mandal, Ashok Kumar, Shivam Dwivedi

Background and Objectives: Traceability from blood unit to patient is crucial to ensure the availability and the quality of blood products transfusion. RFID based system would help in optimization of transfusion process with fast and contact less communication with real time traceability and monitoring on the ongoing bed side transfusions. To assess the utility of RFID based system for bedside monitoring.

Methods: RFID based inventory as well as bedside transfusion monitoring was implemented in March 2023. A total number of 6200 Packed Red Blood Cell and 2700 platelet requisition were assessed for completion of transfusion details. The units are tagged with RFID from Biolog-id. Ethical clearance has taken the from the institute ethical committee.

Results: A total of 8900-blood component requisition were analysed. Transfusion follow-up forms which were received within 12 hours were 8374 (94.1%) versus form which were not sent back within 12 hours were 523 (5.9%). On comparison of RFID system verses manual data capture of transfusion, 87 % (n=7607) had concurrence. Whereas 13% (n=1137) of requisition there was mismatch of transfusion timing details. We also observed that there was incomplete data capture on RFID system amounted up to 11% (n=). There were 9.2% (n=819) request were only start time was captured verses 1.79% (n=160) request where only end time was entered.

Conclusion: There was no mismatch transfusion reported, it was suggested for regular training of staff would help to reach 100% compliance from 87%. Similar result were also observed by Clive Hohberger et al, 2011.

References

1. Transfusion Medicine Technical Manual. 3^rd ed; 2022.

2. Good Blood Transfusion Practices –Guidance for Rational Use of Blood; 2022.

3. AABB Guidelines. 19^th ed; 2020.

4. Basic & Applied Concepts of Blood Banking and Transfusion Practices. 5^th ed; 2020.

eP150: Transfusion Transmitted Diseases (Including NAT): Seroprevalance, risk factors and sero-positive donor compliance response rate among blood donors in corporate hospital

Nandini Raval, Prabhat Sharma, Vikram Shah

Background and Objectives: High risk population of blood donation increase the prevalence of transmission of blood borne diseases & thus it leads to compromised blood safety. Objective of this study is to investigate the sero-prevalence of syphilis, syphilis seropositive donor compliance response and assessing the risk factors on syphilis among blood donors & thus analyzing the donation status of high risk population.

Methods: Present study is a retrospective study and data is taken from Jan-2021 to Dec 2023 and analyzed for seropositivity to T. Pallidum and Donor Compliance Response Rate and history given by syphilis positive donor after councelling.

Results: Out of 5247 blood donors screened for TTIs , 42 donors have been found sero-reactive for syphilis from Jan-2021 to Dec 2023 , among them 6 were 1st time donors & 36 were repeat donors with syphilis sero-positive donor compliance response rate of 13.79%, 1.72% and 20.68% for donors responded & come, donors not responded and given wrong phone no. & donors responded but talk over telephone respectively.

Conclusion: Positive donors were more likely to have multiple sexual partners & positive travelling history with unsafe sex with commercial sexual workers. Health consultation and screening of high risk groups before blood donation is one of the important aspect to improve blood transfusion service. In addition , syphilis positive donors need councelling as the majority of syphilis positive donors did not turn upto collect the reports & receive treatments. All blood bank staff should be trained to identify high risk behaviour through proper history taking while giving the confidence to the donor regarding confidentiality.

eP151: Transfusion Transmitted Diseases (Including NAT): Seroprevalence of cytomegalovirus among voluntary blood donors

monali Valera, Yogesh Domadiya, Nishith Vachhani, Meera Kangad, Sanjiv Nandani

Background: Cytomegalovirus (CMV) is a Herpes virus that usually causes mild symptoms like flu or glandular fever in healthy individuals but can remain in the body for life. The virus can reactivate and is often present without symptoms in bodily fluids such as nasopharyngeal secretion and urine. Serious illness can occur in fetuses, new-borns, and people with weakened immune systems, such as those undergoing immunosuppressive treatments. Most adults have been exposed to CMV and develop an immune response marked by the presence of CMV IgG antibodies. CMV can spread through direct contact with body fluids and from mother to child during pregnancy or breastfeeding. In immunocompromised individuals, disease can result from reactivation of the virus or new infections. This study aimed to assess the prevalence of CMV antibodies among blood donors to understand the risk of transfusion-transmitted CMV (TT-CMV), particularly in vulnerable populations like low birth weight infants and immunocompromised patients.

Methods: A prospective study was conducted to screen 54 voluntary blood donors for CMV IgG antibodies, following the necessary consent procedures.

Results: Of the 54 blood donors, 51 (94.44%) were found to be seropositive for CMV IgG, indicating prior exposure to the virus. Only three (5.56%) of the donors were seronegative.

Conclusion: The high prevalence of CMV antibodies in blood donors poses a risk for TT-CMV. To improve blood safety, it is recommended to use leucodepleted blood components, which reduce white cells and are considered ‘CMV safe’. These components should be used for high-risk patients, as leucodepletion is as effective as using CMV IgG negative blood. This practice can help prevent TT-CMV in vulnerable recipients.

eP152: Transfusion Transmitted Diseases (Including NAT): Economic impact of nucleic acid testing in the blood transfusion services in a developing country: An economic modelling study

Angel Mary Sam, Rakhal Gaitonde, Debasish Gupta

Background and Objectives: Around the world, more than 53 million units of blood are screened with Nucleic Acid Testing (NAT). Latest WHO data depicts that 55 countries across the globe carry out NAT on donated blood units mandatorily. NAT testing of collected blood started in India around late 2000s and was subsequently implemented by only a few centres across India. This study aims to understand the importance of NAT of donated blood by mapping out the economic impacts of transfusion transmissible viral infections (HIV, HBV and HCV), to perform a costing of outcome pathways with and without NAT and to project the long-term economic savings by implementing NAT.

Methods: An economic modelling study was carried out by analysing 5-year data obtained from a blood centre in a tertiary care centre in South India. Serological screening reports were compared with nucleic acid testing. The key steps involved were:

Step 1: A protocol map showing the blood donor pathway in various scenarios was developed

Step 2: Cost analysis

a) Imputed costs from Indian literature were applied to the protocol.

b) Costs for provision for NAT testing in this institute was calculated

Step 3: The experience from our blood centre was applied to create an economic model.

Results: Out of the 50,731 donors who registered, 33,578 donors donated blood. Seroreactivity was seen in 165 units while NAT was reactive for 71 units only. A NAT yield of 6 (1 in 5596) was obtained. Sensitivity analysis revealed 2.6% false positive testing using serological testing alone. Expenses for NAT testing was INR 5,12,83,500 (US$ 6,12,669). Lifetime total expenses incurred if these 6 donations took place leading to TTI was INR 10,95,67,250 (US$ 13,08,969).

Conclusion: NAT should be made a mandatory test in India, at least by Government intervention to perform centralized blood testing in each state as it is more cost-effective than the lifetime expenses incurred in transmission of HIV, HBV and/or HCV via blood transfusion. If NAT is made mandatory, testing costs can subsequently be reduced.

eP153: Transfusion Transmitted Diseases (Including NAT): Review of donor testing algorithms: Ethical dilemmas

U. Arjun, Rahul Chaurasia, Gopal Kumar Patidar, Hem Chandra Pandey, Poonam Coshic

Background and Objectives: Screening of Transfusion-transmitted diseases (TTIs) is an essential step to ensure safety of blood components. Notification of TTI status among the reactive donors’ aids in early diagnosis and management of infected donors. It also helps in preventing reactive donors from future donations and further transmission of the incriminated infectious agent. However, notification of indeterminate and false positive reactive status can lead to emotional and social distress amongst the donors. Thus, it is imperative to review the TTI testing, prior to notification.

Methods: A retrospective study was conducted over a period of 6 months, to review the donor testing algorithms of HIV, HBV and HCV by both serological (Chemiluminescence) and Nucleic acid amplification testing (NAT), prior to donor notification. The data was collected from blood bank information software (BIS) and descriptive analysis was done using Microsoft Excel.

Results: A total of 30675 donors were assessed during the study period. Amongst these, 797 (2.6%) donors were found initially reactive for either of the tested infectious markers. This included 355 (1.16%) concordant reactivity (serology-reactive and NAT-reactive), and 442 (1.44%) discordant reactive (394 (1.28%) Serology-reactive but NAT-nonreactive and 48 (0.16%) serology-non-reactive and NAT-reactive). All discordant reactive samples were repeat tested in duplicate (both serology and NAT) using fresh sample from plasma units to ascertain its reactive status. It was found that 189 (42.76% of 442) donors showed reactivity in repeat testing whereas 253 (57.24% of 442) donors showed non-reactive status for both serology and NAT.

Conclusion: Reactive blood donors with concordant TTI results can be notified in appropriate and timely manner, whereas notifying donors with non-reactive repeat testing, further warrants confirmatory testing and their follow-up. It also raises serious concerns, for false yet permanent deferral of such donor, which can lead to serious emotional and social distress among such blood donors.

eP154: Transfusion Transmitted Diseases (Including NAT): Cost-benefit analysis of implementing nucleic acid amplification testing for transfusion transmissible infections: 6.5-year experience from a tertiary care centre

Akshay Kumar Chopra, Shamee Shastry, Ganesh Mohan, Deepika Chenna

Introduction: Despite safety measures, the risk of Transfusion Transmissible Infections (TTIs) remains due to testing limitations. Nucleic Acid Testing (NAT) improves transfusion safety by reducing both residual risk and the window period for detection. The cost-benefit of NAT is assessed by comparing its costs to the economic benefits of preventing infections and related morbidity.

Objectives: To perform the cost-benefit analysis of universal NAT screening for HIV, HBV, and HCV by comparing the costs of NAT to the economic benefits of preventing infections.

Methodology: This retrospective study at a tertiary hospital from June 2017 to December 2023 reviewed donor data, serological screening, and NAT results for HIV, HBV, and HCV. MiniPool (6 samples) PCR-based NAT was performed using Cobas s201 (Roche Diagnostics). The additional infections detected by NAT that were missed by serology represent the NAT yield. A cost-benefit analysis, using value of statistical life in India, assessed the infections prevented relative to cost of NAT.

Results: A total of 102,929 donors were screened - 93.23% males and 6.77% females. 61.5% aged 18-32. The serological reactivity rate was 0.79%, while the NAT reactivity rate was 0.114%. The NAT yield was 0.0136%, detecting 13 HBV, 1 HIV, and no HCV cases. In total, 42 TTIs were averted, with residual risks of 0.0029 for HIV, 0.027 for HBV, and 0.00043 for HCV. Investing 600 rupees in NAT-tested blood products saves each recipient about 15 lakhs in treatment costs and prevents 7 DALYs. For tertiary care centres, NAT enhances blood safety and reduces legal implications from TTI, underscoring the benefits of advanced testing for better health outcomes and lower costs.

Conclusion: NAT is a cost-effective tool for TTI screening in tertiary hospitals. The cost-benefit analysis shows that it reduces TTI incidence and healthcare costs, underscoring its value in enhancing blood safety and saving lives.

eP155: Transfusion Transmitted Diseases (Including NAT): Seroprevalence of cytomegalovirus among voluntary blood donors

Monali Valera, Yogesh Domadiya, Meera Kangad, Nishith Vachhani, Sanjiv Nandani

Background: Cytomegalovirus (CMV) is a Herpes virus that usually causes mild symptoms like flu or glandular fever in healthy individuals but can remain in the body for life. The virus can reactivate and is often present without symptoms in bodily fluids such as nasopharyngeal secretion and urine. Serious illness can occur in fetuses, new-borns, and people with weakened immune systems, such as those undergoing immunosuppressive treatments. Most adults have been exposed to CMV and develop an immune response marked by the presence of CMV IgG antibodies. CMV can spread through direct contact with body fluids and from mother to child during pregnancy or breastfeeding. In immunocompromised individuals, disease can result from reactivation of the virus or new infections. This study aimed to assess the prevalence of CMV antibodies among blood donors to understand the risk of transfusion-transmitted CMV (TT-CMV), particularly in vulnerable populations like low birth weight infants and immunocompromised patients.

Methods: A prospective study was conducted to screen 54 voluntary blood donors for CMV IgG antibodies, following the necessary consent procedures.

Results: Of the 54 blood donors, 51 (94.44%) were found to be seropositive for CMV IgG, indicating prior exposure to the virus. Only three (5.56%) of the donors were seronegative.

Conclusion: The high prevalence of CMV antibodies in blood donors poses a risk for TT-CMV. To improve blood safety, it is recommended to use leucodepleted blood components, which reduce white cells and are considered ‘CMV safe’. These components should be used for high-risk patients, as leucodepletion is as effective as using CMV IgG negative blood. This practice can help prevent TT-CMV in vulnerable recipients.

eP156: Transfusion Transmitted Diseases (Including NAT): Rising syphilis positivity in blood donors: A review of our experience and strategies for mitigation

Vidhi Jain, Devanshi Gosai

Introduction: Syphilis is treatable bacterial infection caused by Treponema Pallidium. Various epidemiological studies report a diminishing prevalence of syphilis including other bacterial STIs and a rising incidence of viral STIs. However, a resurgence of syphilis has been observed and reported. The aim of our study was to find out the trends of syphilis among blood donors in Vadodara region of Gujarat.

Materials and Methods: This study was carried in a blood centre, attached to the Medical College in Vadodara, Gujarat. This was a retrospective study. A total of 11,924 blood donors were screened for syphilis during 5 years (from 2019 to 2023) by Syphicheck Rapid Dipstick test (Modified Treponema pallidum hemagglutination assay) and data was analyzed with respect to sero-reactive cases.

Results: Out of 11,924 blood donors screened for transfusion transmitted infections, 47 donors were sero-reactive for syphilis, while one donor had syphilis with human immunodeficiency virus (HIV) infections. Prevalence of syphilis was more in replacement donors than voluntary donors and was in raising trend.

Conclusions: Prevalence of syphilis among blood donors was in raising trends in last five years, especially last year in this region and was more in replacement donors. To mitigate this trend, we recommend enhance screening, serological testing, donor education, and collaboration with public health authorities. We also purpose strategies for early detection, prevention, and control of syphilis transmission through blood transfusion.

eP157: Transfusion Transmitted Diseases (Including NAT): A multifaceted approach to hepatitis B screening: The role of anti-HBc and anti-HBs in blood transfusion safety

Ramesh Kumar, S. Shanmugam

Background and Aim: Transfusion transmitted hepatitis B has always been with incidence of increased transmission through donated blood. The screening test for hepatitis B infection is detection of HBsAg, that does not rule out the risk of transmission of hepatitis B as the donor may be in the ‘window period’. The presence of antibody to the hepatitis B core antigen (anti-HBc)- Total in serum usually means a past infection of the hepatitis B virus (HBV). Therefore, the present study was undertaken to find the possibility of obviating the need of screening of Anti HBc Total with Anti HBc-IgM and Anti HBs so as to optimize the resource.

Materials and Methods: Between January 2023 and December 2023, a total of 5,540 blood donor samples were collected and tested for anti-HBc Total, Anti HBc-IgM, Ant HBs and HBsAg using the chemiluminescent microparticle immunoassay (CMIA) method. All anti-HBc Total reactive samples were subsequently tested for anti-HBs. Among the anti-HBc Total reactive and anti-HBs negative samples, anti-HBc-IgM was also tested.

Results: Of the 5,540 samples, 1.99% (110) were reactive for HBsAg, while 10.1% (560) were reactive for anti-HBc Total. In the 450 anti-HBc Total reactive samples that were negative for HBsAg, 386 were reactive for anti-HBs (≥10 IU/ml), and 64 were negative (<10 IU/ml). Among those anti-HBs negative samples, only 4 were reactive for anti-HBc-IgM.

Conclusion: Routine screening for anti-HBc Total is not mandatory in India; however, the high incidence of anti-HBc necessitates careful evaluation. Unlike Western countries, where positive units can often be discarded, this is not feasible in India. Testing for anti-HBs and anti-HBc-IgM can reduce blood discard rates while enhancing the safety of the blood supply. Our findings support a strategic approach to screening that optimizes resource utilization while ensuring transfusion safety

eP158: Transfusion Transmitted Diseases (Including NAT): Study of major transfusion transmitted infections (TTI)

Faisal, Sohail Malik

Background: Major Transfusion Transmissible Infections (TTI’s) as human immune-deficiency virus (HIV-I/II), hepatitis B virus (HBV), Hepatitis C virus (HCV), Malaria parasite (MP) and syphilis can spread through blood or blood products These TTI are a threat to blood safety. The objective of a BTS is thus to ensure safe and efficient supply of blood at all levels. Efforts to increase blood supply through family/replacement donations can lead to dangerous outcomes in patient care.

Aim: Study aims to find out the prevalence of transfusion transmitted infection (TTI) in blood Donors in a government tertiary care hospital and formulate strategies.

Materials and Methods: A Retrospective Cross Sectional study was done on 5168 donors from 2021 - 2023 in Department of Immuno haematology and Blood Transfusion Medicine at SKIMS, MCH, Jammu and Kashmir India. The donors were properly screened as per blood donor selection criteria and guidelines laid down by NACO and Drug and Cosmetic Act 1940.

Results: Out of 5168 donors comprising of both voluntary and replacement donors. Males comprised of 4861 (94.06%) and females 307 (5.94%) donations. Male to female blood donor ratio is 15:1. 3676 i.e. (71.13 %) of total donors were on replacement basis 2020 – 23. In this study the total number of male donors 4861 (94.06%) exceeded than female donors 307 (5.94%). Replacement blood donors 3676 (71.13%) comprised two thirds of blood donations in comparison to voluntary donations 1492 (28.87%). Overall seroprevalence of TTI was found to be 39 (0.75%). Prevalence of HIV, HBsAg, HCV and Syphilis (VDRL) was 0%, 0.25%, 0.48% and 0.04% respectively.

Conclusion: A relatively low prevalence of TTI was found.

eP159: Transfusion Transmitted Diseases (Including NAT): A retrospective analysis of co-infection patterns and prevalence among blood donors at a tertiary care centre in Southern India (2008–2023)

M. Pushpaja, B. Shanthi

Background and Objective: Blood is a potential source of infections like HIV, HBV, HCV, malaria, and syphilis. Despite improved detection through molecular techniques, transfusion-transmissible infections (TTIs) remain a significant risk, especially with coinfections that can worsen disease outcomes.

Materials and Methods: A retrospective analysis of all blood donors during the study period from January 2008 to December 2023 was done. From 2008 to 2014, blood donors were screened using the 4th generation Enzyme-Linked Immunosorbent Assay (ELISA) and from 2015 to 2023, by using the Chemiluminescence Immunoassay (CLIA) method for anti-HIV I and II, HBsAg, and anti-HBC and for Malaria and syphilis by using ELISA. Donors were grouped as mono-infected and co-infected.

Results: During the study period from 2008 to 2014, a total of 118188 donors screened by using, ELISA 4th generation out of which, 3433 (2.9%) donors were serologically reactive, with 3393 (2.87%) having mono-infections and 40 (0.033%) showing co-infections. From 2015 to 2023, a total of 159885 donors screened by using CLIA, 3278 (2.05%) donors were reactive, with 3227 (2.018%) mono-infections, and 51 (0.0318%) co-infections. Throughout the entire study period from 2008 to 2023, 91 (0.0327%) donor samples exhibited co-infections. The most common combinations HIV and syphilis in 28 donors, HBV and HCV in 21 donors, HIV and HBV in 17 donors, and HBV and syphilis in 15 donors. Additionally, there were 4 cases each of HCV and syphilis, and HIV and HCV, 1 case of malaria and syphilis, and 1 case of HIV, HBV, and syphilis. The mean age of donors was 30.49 years, with 95.8% being males.

Conclusion: We conducted a first-time assessment of co-infection patterns among blood donors at our tertiary care centre. Since co-infections impact disease progression, future prospective studies are needed to rule out cross-reactivity and potential false-positive results.

Keywords: Blood donors, co-infections

eP073: Immunohematology: Beyond “dangerous O”: Anti-A and anti-B titers in A, B and O whole blood donors

Amit Kumar Chatterjee, Amit Kumar Chatterjee, Pandeep Kaur, Davood Bava, Akarshan Gupta, Amit Kumar, Anuneet Tripathi, Ankita Nigam

Background and Objectives: Despite advancements in component preparation and cross-matching reducing hemolytic transfusion reactions, concerns remain, particularly with apheresis-derived platelets, which can still cause hemolytic responses if transfused to an ABO-incompatible patient due to high titer anti-A and anti-B antibodies. This study aimed to determine the prevalence of high anti-A and anti-B titer among A, B, and O blood group donors and to explore factors associated with high titers.

Methods: A cross-sectional observational study was conducted over 18 months, enrolling 978 participants from a tertiary care teaching hospital in Western India. Anti-A and anti-B titers were determined by Serial 2-fold doubling dilutions using the Conventional Tube Technique. Samples with IgM titers ≥64 and IgG titers ≥128 were labeled as high titer. Statistical analysis assessed correlations between high titers and demographic factors.

Results: Among the participants, majorities were males (98.8%), with an age range of 18-60 years (mean: 28.9 years). Blood group distribution was A: 26.1%, B: 39%, and O: 34.9%, with 90.6% being RhD positive. The prevalence of “dangerous O” was 14.1%. High antibody titers were observed in 3.52% of A group donors and 10.5% of B group donors. For anti-A, 12.2% had high IgM titer and 2.5% had high IgG, In case of anti-B, high IgM was found in 2.3% of donors, while high IgG titer were seen in 0.2%. High IgM titers correlated with younger age, female gender, and vegetarian diet. High IgG titers were linked to female gender, vegetarian diet, and O RhD-positive blood group.

Conclusion: The study sheds additional light and provides supplementary information regarding the prevalence and correlation of high anti-A and anti-B titers among O, A and B blood donors. Understanding these factors is crucial for optimizing transfusion safety protocols, including selective screening of platelet units and tailored transfusion strategies based on donor characteristics.

eP074: Immunohematology: Antigen and phenotype frequencies of Rh and kell blood groups among 500 donors at a tertiary care center in Punjab

Rajarshi Chatterjee, Vaneeta Bhardwar, Maninder Kaur

Background and Objectives: Karl Landsteiner & Weiner discovered the Rh blood group system. Due to the immunogenicity of the Rh antigen, Rh D antigen testing was mandated in the pre-transfusion testing along with A & B antigen. The most important irregular red blood cell alloantibodies are directed towards Rh (Anti D, C, c, E, e) & Kell (Anti K & k) blood group antigens. The study aims to determine the phenotype frequencies of the Rh & Kell blood group antigens among voluntary blood donors attending the blood center, PIMS, Jalandhar, Punjab. The prospective cross-sectional study was conducted on 500 voluntary blood donors attending the blood center from August 2023 till June 2024.

Methods: The antigen typing was carried out using the Galileo fully automated immunohematology analyzer (Immucor, Germany) which uses the microplate hemagglutination technique for antigen typing. The Rh (D, C, c, E, e) & Kell (K) antigen typing was done using IgM monoclonal antisera from Immucor.

Results: Out of 500 donors, 491 (98.2%) were male & 9 (1.8%) were female donors. 88 (17.6%) donors were first-time donors & 412 (82.4%) were non first-time donors. e antigen was most common (98.2%) followed by D (96.8%), C (88%), c (57%), E (12.4%), and K (1.8%). In order of descending frequency, the phenotypes were DCCee (42.4%), DCcee (38%), DCcEe (7%), Dccee (4%), dccee (3.2%), DccEe (3%), DccEE (1.8%), and DCCEe (0.6%).

Conclusion: This study aimed to determine the antigen & phenotype frequencies of Rh & Kell blood group systems & also the most probable genotype of the Rh blood group system among voluntary blood donors.

eP075: Immunohematology: Evaluation of presence of anti-D antibody in breast milk of Rh D negative mothers

Kshitija Mittal, Ravneet Kaur, Harshita Agarwal, Paramjit Kaur, Gagandeep Kaur

Background and Objectives: The objective was to identify anti-D antibody in breast milk of Rh D negative mothers.

Methods: The descriptive observational study was conducted over 8 months. Sixty-four RhD negative pregnant mothers with gestational age ≥ 34 weeks were enrolled. Two ml breast milk and 5 ml blood sample in an EDTA vaccutainer were obtained within 7 days of delivery. ABO grouping and Rh D typing on maternal plasma and reverse grouping on breast milk samples was performed using tube technique. Indirect Antiglobulin test (IAT) was performed using microcolumn gel technique on both samples. If IAT was positive, antibody screen, identification and doubling dilution titers of antibody identified were performed. ABO grouping, RhD typing, and Direct Antiglobulin Test (DAT) was performed on neonate sample within 24 hours of delivery. Neonate was followed up for requirement of phototherapy, double volume exchange transfusions (DVET) or for PRBC transfusions during hospital stay.

Results: Of 64 mothers, majority (n=41, 64.1%) were multigravida. Anti-A and anti-B antibodies in breast milk corresponded to respective maternal blood groups. IAT was positive in 22 (34.4%) maternal plasma samples with anti-D in 21 and anti-D along with anti-C antibody in 1 sample. Among 22 mothers with anti-D antibody, 13 (59.1%) had received Rh immunoprophylaxis and alloanti-D was seen in 9 (40.9%) cases. Anti-D titers due to Rh immunoglobulin ranged from 1:1 to 1:2 and due to alloanti-D from 1:4 to 1:32. IAT was positive only in 17 (26.6%) breast milk samples with anti-D antibody identified in all samples. Anti-D titers due to Rh immunoglobulin ranged from negative to 1:1 and due to alloanti-D ranged from 1:1 to 1:4. DAT was positive in 7 neonates. Phototherapy was required in 4 neonates and phototherapy plus DVET in 2 neonates.

Conclusion: Our study demonstrated presence of anti-D antibody in breast milk.

eP076: Immunohematology: The least incompatible crossmatched prbc transfusion by biological in vivo compatibility test

Manoj Kumar Dubey, Tulika Chandra, Ashutoh Singh, Archana Solanki

Background: Biological in vivo compatibility test is an essential serological test in patients who’s crossmatched PRBC not showing compatibility.

Aim and Objective: This study aimed to determine the safety and efficacy of the least incompatible/best matched. PRBC transfusion through the biological in vivo compatibility test.

Methods: This is a prospective observational study conducted at Dept. of Transfusion Medicine at kgmu. Till now 25 patients are included in our study, for whom appropriate red blood cells (RBC) could not be found. Total 36 best matched PRBC units transfused by applying the “in vivo compatibility test” patients were observed during and after the transfusion with respect to acute hemolytic reactions that could develop. The biochemical parameters (S.LDH, S.Bilirubin, Hct, retic count, Hb) of hemolysis were examined before and after at 24 hrs. of transfusion.

Results: Most of the transfusion were completed successfully with no complication or symptom observed. Some of them got mild increase in body temp. urticaria and palpitation but transfusion were completed. Only in two case symptoms found mild to moderate along with dysnea after that unit were dicarded and another selected unit transfused successfully. A statistically significant increase in hematocrit (~2.7) and hemoglobin (~0.9), Retic count (~1.4), And significant decrease in serum bilirubin total (~0.3), S.LDH (~13.1) was seen post transfusion.

eP077: Immunohematology: Detection of unexpected antibodies in blood donors and patients – A prospective study

Abhipsa Shrotriya, J. Philip, R. Mallhi, R. Basnotra

Introduction: Unexpected red cell antibodies pose a significant threat in providing safe blood. These antibodies can be categorized into alloantibodies and autoantibodies, arising from pregnancy, transfusion, transplantation, or occurring naturally. Detecting clinically significant antibodies in pretransfusion testing is crucial to prevent immune haemolytic transfusion reactions. This study assesses the prevalence of unexpected antibodies among blood donors and transfused patients.

Aim: To detect unexpected antibodies in blood donors and patients.

Materials and Methods: This prospective study was conducted over a period of 18 months. Indirect antiglobulin tests (IAT) was done for all donors and for those patients with incompatible crossmatches. These IAT positive donor and patients, were further analysed by Direct Antiglobulin Test (DAT) and Auto-control with antibody screening and identification.

Results: During the period of study 11,726 donor and 69,667 patients were evaluated for all abnormal antiglobulin test results. Among the blood donors, 22 were found to have unexpected antibodies, with the distribution as follows :13 donors tested positive only for IAT, 5 only for the DAT, and 1 for both IAT and DAT,1 for IAT and Auto-control, and 2 for all three tests. Among the patients, 27 were identified with unexpected antibodies, The distribution among these was: 21 tested positive only for IAT, 1 for both IAT and DAT, 2 for both IAT and Auto-control and 3 for all three tests. The commonly identified antibodies were anti-M followed by anti-c, anti-E and anti-D.

Conclusion: Our findings indicate a notable prevalence of unexpected antibodies, underscoring the critical need for thorough pre-transfusion testing. Many of the antibodies detected are clinically significant and have potential to cause harm to the patient. Therefore, the screening for unexpected red cell antibodies in both donors and recipients should be reinforced as a routine practice.

eP078: Immunohematology: Antibody identification in general patient population at tertiary care hospital in Haryana for safe blood transfusion

Akash Ghansham Gore, Saroj Rajput

Background and Objectives: Ensuring transfusion safety necessitates not only the exclusion of infectious agents but also the averting of haemolytic episodes due to alloimmunization against erythrocyte antigens. Although antibody screening is customary in certain regions, it remains under-implemented in India. The objective of this study is to determine the prevalence and frequency of allo immunization in the general patient population, focusing on a gap in existing data that primarily covers multi transfused individuals.

Methods: This retrospective study was conducted in the tertiary care centre of North India. All patients between (Jan-Dec 2023) with a positive indirect antiglobulin test (IAT) regardless of age, gender and number of prior transfusions were included in this study. Transfusion and clinical records of these transfused patients were analyzed. The variables analyzed were ABO group, Rh system, IAT, direct antiglobulin test (DAT) and autoantibodies.

Results: In a cohort of 1936 patients, 148 (7.6%) were positive for antibodies. Of these, 87 (58.8%) were females and 61 (41.2%) were males. A single alloantibody was detected in 129 (87.2%) cases, while 19 (12.8%) had multiple alloantibodies. Alloimmunization occurred in 141 (95.3%) previously transfused patients (p < 0.01), and 66 (75.9%) of the 87 allo immunized women had a history of pregnancy (p < 0.01). Rh system antibodies were the most prevalent, detected in 118 (79.7%) cases (p < 0.05), with anti-D (68/148, 45.9%), anti-E (20/148, 13.5%), and anti-C (14/148, 9.5%) being the most frequent. MNS system antibodies were found in 16 (10.8%) cases, mainly anti-M (9/148, 6.1%). Other antibodies included Lewis (8/148, 5.4%), Kidd (3/148, 2%), and Kell (2/148, 1.4%).

Conclusion: Alloimmunization was strongly correlated with both transfusion history and previous pregnancies (p < 0.01). Antibodies from the Rh blood group system, particularly anti-D, were the most frequently identified, followed by antibodies from the MNS blood group system, predominantly anti-M.

eP079: Immunohematology: Unusual presentation of anti-C antibody along with antigen-C

Jhalak Patel, Vishvas Amin, Palak Panchal, Jyoti Shetty, Emmanuel Christian, Bharat Parmar, Akib Mansuri

Background and Objectives: The Rh blood group system is a complex blood group system. Rh antibodies are produced in Rh negative individuals following exposure to foreign RBCs post transfusion or pregnancy. Anti-C is a rare cause of hemolytic disease of fetus and newborn and is very scarcely reported in the literature. The aim of this case report is to present the unusual findings of the “C” variant in Rh blood group system.

Materials and Methods: The blood grouping and antibody screening was performed on fully automatic immunohematology analyser “QWALYS-EVO” by Digast, France. The compatibility testing was done on fully automatic analyser “Automax-80” by Tulip diagnostics.

Results: The patient’s phenotype was O positive and its Rh and Kell phenotype were D+C+c-E-e+K-. When crossmatched with the same phenotype, all the units were incompatible. Further, O negative having phenotype (D+C+c-E-e+K-) and D positive units with antigen C negative were compatible ruling out possibilities of anti-G. It was noted that Anti-C was present along with antigen C. The blood transfusion was avoided and the blood units was only kept for emergency as it would have caused alloimmunization to the patient against antigen-c.

Conclusion: Rh and Kell Phenotyping facility is a boon to blood centres which ensures transfusion safety to patients.

eP080: Immunohematology: Comparative analysis of in-house versus commercial anti-A1 lectin: Insights from a tertiary care blood center in Southern India

Vijit Joon, Hariharan, Sureshkumar, Sriram, Sahayaraj

Introduction: Lectins are carbohydrate-binding proteins which are obtained from seeds of selected species of plants which plays a pivotal role in blood typing, especially in the detection of A sub groups and H antigen. Lectins have a nonimmune origin. Blood banks often rely on commercially available lectins for this purpose. They are used as tools to detect antigens on surface of Red blood cells. In-house preparation of lectins can be considered as an alternative approach to obtain the Anti-A1 lectin. Preparation of Lectin offers advantages like reduced costs and greater flexibility in titration of lectins.

Aims and Objectives: This study was done in order to assess the efficiency between In house Lectin prepared lectin with Commercial available Anti-A1 lectins in terms of cost-effectiveness, reliability, specificity, and ease of implementation and storage.

Materials and Methods: Seeds of Dolichus biflorus was locally obtained . Following which the seeds were soaked overnight in saline. The soaked seed were then crushed and grounded using mortar & pestle till coarse sand like . The grounded seeds were soaked in saline. The soaked seeds were incubated in room temperature for 12 hours. After the incubation the supernatant was centrifuged to get clear supernatant. The supernatant was then filtered and titres were checked. The solutions were stored in aliquots and taken when required.

Results: The in house prepared Lectin showed specificity with 3+ to 4+ agglutination to A1 and A1B cells for which the results were comparable to commercially available lectins. The titres were adjusted to be reactive to A1 cells at titres 32 and A1B cells at 16. This solution was used for the analysis. Cost of In house prepared Anti-A1 lectin was significantly lower than commercial Anti-A1. The inhouse prepared lectin was stored at 4*c upto 7 days of storage.

Conclusion: The In- house prepared Anti-A1 lectin was found to be as effective as commercially available lectin, with substantial lower cost to prepare and store. This can be adopted in resource poor blood centres.

eP081: Immunohematology: Retrospective study of alloimmunization and spectrum of red serological findings in a tertiary care centre excluding non-obstetric and perinatal patients

B. Shanthi, C. H. Vinay Kumar

Background and Objectives: Red cell alloimmunization occurs when a recipient’s immune system forms antibodies against transfused Red blood cell antigens that are not present in the recipient. Challenges in managing alloimmunized patients include identification and provision of compatible RBC units. The alloimmunization process complicate future transfusions, leading to transfusion reactions, difficulties in finding compatible blood, increased transfusion-related morbidity. This study aims to investigate incidence and rates of alloimmunization, identify associated problems, and explore strategies for resolution and management of blood supply issues in such cases.

Methods: It was a retrospective study done in dept of Transfusion medicine, NIMS, Hyderabad from 2017 to August 2024. Data was taken from documented registers, HIS and previous test reports. All parameters of these patients (Age, sex, transfusion history, obstetric history, diagnosis, blood grouping, alloantibody identified and blood issues) were collected and analysed.

Results: In the study period total 1,24,743 samples came for blood grouping, antibody screening or cross matching. Alloimmunization was observed in 205 patients (0.16%). Most common alloantibody identified was anti-M in 48 patients followed by anti-c in 34 patients. Female predominance was seen in this study with male to female ratio of 2:1. Mean age of the patients was 34.7 years. Most of the patients (189) had a previous sensitization event either in the form of transfusion or pregnancy or both. Thalassemia was the most common diagnosis in the alloimmunized patients. Total 568 blood units were issued to 167 patients with alloantibodies. Blood grouping discrepancies were seen in 93 of 205 patients. Autoantibodies were present in 13 patients along with alloantibodies.

Conclusion: Red cell alloimmunization poses significant clinical and logistical challenges in transfusion medicine. Through preventive measures and strategic management of blood supplies, the impact of alloimmunization can be mitigated. Prophylactic antigen matching, particularly for Rh and Kell antigens, is recommended for patients requiring chronic transfusions.

Keywords: Alloimmunization, RH blood group system and antibody identification, thalassemia

eP082: Immunohematology: Estimation of anti-A IgM agglutinin titers in B-blood group individuals: A cross-sectional study

T. Kingston Xavier, J. Ravishankar

Background and Objectives: ABO blood group system has naturally occurring IgM agglutinins. Knowing the titers in general population can help in mitigating acute rejection during ABO incompatible transplantation and in transfusion of ABO incompatible plasma components (Fresh frozen plasma & platelets). The aim of this study was to estimate Anti-A IgM agglutinin titers in B blood group individuals.

Methods: This was a cross-sectional study performed at a tertiary care hospital-based blood centre from July to September 2024. Anti-A IgM titer was performed using hemagglutination principle by conventional test tube technique with in-house prepared pooled A red cells. While blood donor samples were used to assess titer in healthy individuals, samples received for blood transfusion were used to assess titer in patients. A titer > 64 was taken as high titer.

Results: Among 126 blood samples [donors (n=70) and patients (n=56)], Mean age was 35.26 ±15.34 years, 67.46% were males (n=85), Mean titer was 83.19 ±67.03, Mean titer in males was 87.62 ±67.12, Mean titer in females was 74 ±66.72 and 62.70% had low titer values (n=79). The mean IgM titer was higher in age less than 30 years (n=67) and was statistically significant (p<0.05). Among 70 donor samples, Mean age was 28.24 ±7.17 years, 92.85% were males (n=65), Mean titer was 108.22 ± 65.5, Mean titer in males was 103.75 ±62.28, Mean titer in females was 166.4 ±85.86 and 54.28% had high titer values (n=38). Among 56 patient samples, Mean age was 44.03 ±18.16, 64.28% were females (n=36), Mean titer was 51.89 ±55.09, Mean titer in males was 35.2 ±55.38, Mean titer in females was 61.16 ±53.44 and 83.92 % had low titer values (n=47).

Conclusion: Agglutinin titration will be helpful in preventing transfusion reactions with ABO incompatible plasma components and in cases being planned for ABO incompatible transplantation.

eP083: Immunohematology: Rare blood, rarer genes: Mumbai’s first réunion phenotype blood donor with a novel FUT2 mutation

elvis Alex, Lincy Jacob, Swati Kulkarni, D. Rati, M. Harita, L. Monali, S. Sangeeta, I. Amruta

Background and Objectives: This case report details an expression of mutations in the FUT1 and FUT2 genes resulting in manifestation of rare Réunion phenotype in an Indian blood donor. These mutations led to the partial absence of the H antigen on RBCs with a non-secretor status, complicating the serological profile. We report the investigation of a 37-year-old male donor who presented with a blood grouping discrepancy which was ultimately identified as Ah (Réunion Phenotype). The objective of this report is to illuminate the nuances involved in recognizing and differentiating this rare phenotype from the Para-Bombay phenotype.

Methods: Routine blood grouping revealed a discrepancy, prompting further investigation. Advanced serological tests were conducted to assess the expression of the A and H antigens on RBCs and in secretions. Mutations in ABO, FUT1, and FUT2 were analyzed by DNA sequencing.

Results: To resolve the discrepancy, the donor’s sample was tested with anti-H lectin and the Anti-A1 lectin. An atypical manifestation of a 4+ reaction was observed in the Anti-A (commercial) tube (Forward grouping) while the Anti-H lectin test showed a negative result. However, when polyclonal anti-A and anti-AB were used, a +2 reaction was detected, with no reaction to the commercial anti-H lectin. Antibody screening (commercial cells) by CAT was positive and negative with Bombay Phenotype RhD Positive Cells. Saliva testing revealed that the donor was a non-secretor for A, B and H substances, suggesting the possibility of the Réunion phenotype. Molecular analysis showed the genotype as: FUT1 gene: FUT1*01N.09/FUT1*01W.23 (weak H antigen on RBCs), FUT2 gene: se171,216,428/se171,216,428 (non-secretor) and ABO gene: ABO*A1.01/ ABO*A1.01 (A antigen on RBCs).

Conclusion: This case unravels the diagnostic complexity in classifying and differentiating the Réunion phenotype from the Para-Bombay phenotype, and the indispensable role of molecular diagnostics in addressing blood group anomalies and safeguarding transfusion practices.

eP084: Immunohematology: High frequency antigen negative rare in (a+b-) phenotype in Indian patients producing anti-Inb: A case series

Swati Kulkarni, Swati Kulkarni, Pooja Kshirsagar, Sai Lalitha Challapilla, Shanthi Bonagiri, Soumee Banerjee, Ankit Mathur, Prasun Bhattacharya, Disha Parchure, Manisha Madkaikar

Background: Inb is a high frequency antigen (HFA) of Indian blood group system (ISBT 023) present on red blood cells (RBCs), present in >99% of the population. Antibody against this antigen is known to cause hemolytic transfusion reactions. The identification of alloantibodies to HFA and provision of blood in such cases is often challenging. Targeted-Next Generation Sequencing (tNGS) assay helps in predicting the antibody specificity once the full antigen profile of the patient is known. The aim of this study was to investigate the specificity of the antibody to the HFA.

Methods: This study included four complex serological cases (1 thalassaemic patient, 1 antenatal women and 2 patients requiring transfusion for surgery) where the specificity of the antibody could not be identified and were referred to ICMR-NIIH. After extensive immunohaematological workup, an antibody to HFA was suspected. Genomic analysis was carried out using tNGS assay for 51 genes of 41 blood group systems to provide a complete antigen profile. Specificity of antibody was predicted and further confirmed using antigen-positive cells. Family studies were also carried out for identifying more rare individuals.

Results: Blood grouping in all samples showed cell-serum discrepancy due to presence of an alloantibody showing panaggutination reaction at all phases by CTT. The antibody was suspected against a HFA. Genomic analysis revealed a rare HFA negative “In (a+b-)” phenotype due to homozygous mutation c.137G>C in exon 2 of CD44 gene. After knowing the full antigen profile, antibody was predicted as anti-Inb, which was further confirmed by using preserved rare Ina RBCs. All cases were found to be compatible with Inb negative donor. Twenty two family members of one index case were available for further screening, and two more rare blood donors with “In (a+b-)” phenotype were identified.

Conclusions: High-throughput genotyping is an effective tool for resolving transfusion-related serological challenges and identifying rare donors. The rare donors identified in this study will be registered in the Rare Donor Registry of India to facilitate the provision of rare blood units both nationally and internationally.

eP085: Immunohematology: Invisible threats: Analyzing the prevalence of red cell alloimmunization in tertiary care centre

A. Khanitha Nuzhath, B. Latha, G. Kavitha, R. Vasanthraj

Background: Alloimmunization to red blood cell (RBC) antigens is caused by exposure to the red cell antigens either through transfusion or pregnancy. Clinically significant alloantibodies can lead to serious transfusion reactions or haemolytic disease of the newborn. Although Rh and kell blood group system antigens are most immunogenic but other minor blood group system antigens also contribute to alloimmunization. Naturally occurring antibodies are an exception in which the antibodies may be produced in the absence of exposure to the foreign RBCs.

Aims and Objectives:

1) To estimate the prevalence of red cell alloantibodies in various patients.

2) To ensure safe transfusion and to optimize compatibility testing.

Methods: The prospective study conducted in department of Transfusion Medicine over a period of six months (January 2024 to June 2024). Antibody screening was carried out in patients with a commercially available three-cell panel by the column Agglutination technique. Antibody screening-positive samples were further tested for antibody identification.

Results: The overall prevalence of red cell alloimmunization in antenatal and multi transfused patients. Out of 185 samples tested, alloantibodies identified were 17.8% (n=33) with anti-D being the most common (48.4%), followed by anti D+C (15.1%), anti-Lea (9.09%), anti-Leb (9.09%), anti-c (6.06%), anti-E (6.06%), anti-Fya (3.03%), anti-Jkb (3.03%) and anti k+D (3.03%). The clinically insignificant alloantibodies were (15.1%).

Conclusion: Phenotypically matched antigen-negative crossmatch-compatible blood was transfused if the antibody was clinically significant, whereas for clinically insignificant antibodies, crossmatch-compatible blood at anti-human globulin phase was issued for transfusion.

eP086: Immunohematology: Positives!!! Ain’t no good – A quasi-experimental study to determine the efficacy of crossmatch matched platelets in hemato-oncology patients with suspected alloimmune platelet refractoriness

Daljit Kaur, Gita Negi, Vaidehi Prasanth, Ashish Jain, Dixa Kumari, Priyanka Rathod, O. P. S. Negi, Gaurav Dhingra, Uttam Kumar Nath

Background: Platelet transfusion plays a vital role in the management of thrombocytopenic patients in hemato-oncology settings to prevent hemorrhagic complications. Immune causes of refractoriness involve alloimmunization against human leukocyte antigens (HLA) and human platelet antigens (HPA), post exposure through previous transfusions, pregnancy, or organ transplantation. This study aimed to determine the efficacy of crossmatched platelets in the patients suspected to have alloimmune platelet refractoriness.

Study Design/Methods: A prospective, quasi-experimental study was conducted in the Department of Transfusion Medicine over two years as an intramural research project after approval of the institutional research committee. Platelet crossmatching was performed on patients with haemato-oncological disorders, both adults and children, who were on platelet transfusion therapy and found refractory on two consecutive occasions post single donor apheresis platelets (SDP) transfusion, with low corrected count increment (CCI) of < 5000-7000. Solid phase red cell adherence technology through an automated immunohematology analyzer was utilized. The quantitative data was analysed using mean, median, standard deviation t-test and chi-square tests.

Results: The study population consisted of 92 (47 males and 45 females) patients with median age of 32.5 years (range 4-73 years). A total of 149 ABO compatible SDPs were transfused to 92 patients. The mean CCI and mean percentage platelet recovery (PPR) were observed as 13741.88 ±10255.08 and 34.6±26.5 (mean ± SD) respectively. Of them, 94/149 (63.1%) tests resulted positive for 62% (n=57) of patients and 36.9% tests (55/149) were negative for 38% (n=35) of the total patients tested. Crossmatch compatible platelet transfusion events had a higher mean CCI than that of incompatible episodes (t-test; 17516.1 vs 11424.39; difference is statistically significant; p=005). The difference between adequate and inadequate CCI response for crossmatch compatible and incompatible SDP transfusions was observed to be statistically significant [Chi 2; p=0.0007 (p< 0.01)].

Conclusion: The transfusion of crossmatched platelets to refractory patients ensures better post transfusion platelet increment and platelet recovery. This will in turn benefit the patient from getting multiple donor exposures because of repeated transfusions in view of refractoriness.

eP087: Immunohematology: Phenotypic distribution and clinical relevance of Rh and kell antigens in blood donors: A cross-sectional study

Sonal Sonu, Rajesh Kumar, Maryada

Background and Objectives: The Rh and Kell blood group systems are essential in transfusion medicine due to their role in hemolytic transfusion reactions and hemolytic disease of the fetus and newborn. This study aimed to determine the phenotypic distribution of Rh (D, C, c, E, e) and Kell antigens in voluntary blood donors and explore its implications for improving transfusion safety and donor matching.

Methods: A cross-sectional study was conducted on 5,754 voluntary blood donors over one year. Blood samples were phenotyped for Rh (D, C, c, E, e) and Kell antigens using the Neo Iris Immucor platform. Statistical analysis was performed using chi-square tests, and results were compared with global data to assess regional specificity.

Results: Of the donors, 91.9% were RhD-positive and 8.1% RhD-negative. The e antigen was the most prevalent (98.5%), followed by C (83.8%), c (60.7%), and E (19.2%). The Kell antigen was present in 3.5% of donors. Significant correlations were found between RhD-negative status and blood group O (9.6%, p = 0.009) and the E antigen with blood group A (p = 0.004). The most common genotype was R1r (DCe/dce) at 38.8%, with rare genotypes like r’r (dCe/dce) observed in 0.14% of donors.

Conclusion: These findings provide valuable insights into the phenotypic distribution of Rh and Kell antigens, highlighting the need for extended antigen phenotyping and specialized donor registries. Such measures can reduce alloimmunization risks, particularly in multi-transfused patients.

eP088: Immunohematology: Clinical significance of phenotype-matched RBC to patient with thalassemia

Rakhee Shah, Ripal J. Shah, Tejal Chhabria, Harimoorthy

Introduction: Auto-immune Haemolytic Anaemia (AIHA) is a rare red blood cell disorder that occurs when antibodies directed against a person’s red blood cells cause them to rupture, leading to increased hemolysis. Hemoglobinopathies are a group of inherited disorders because of abnormalities in Hb synthesis or Structure.

Case Report: A case of an 8-year-1-month-old male, with a known case of Thalassemia Intermedia was on/off on transfusion. At the age of 07 years patient was admitted with Hyper Hemolysis Syndrome and Hb of 2.4 gm/dl, transfusion on 2 units of PCV; his Hb reached to 6.1 gm/dl. After 1 year the patient presented with anemia (Hb 3.1 gm/dl), and samples were received for cross-match. At this time, his Blood Group showed discrepancy and the Cross-Match showed incompatibility. So we did DAT, IAT, and Auto, which were also positive. His Biochemical parameters showed Increased Bilirubin and LDH levels, Decreased Hb and Haptoglobulin levels, and reticulocytes present in peripheral blood which indicates a hemolysis picture. The patient also showed Hemoglobinuria and hemoglobinaemia. Due to decreasing Hb level and to find a compatible unit, further investigations like antibody screening and antigen phenotype was performed.

Results: On 11 cell panel, suspected antibodies were Anti-E, Anti-Kell, Anti-M & Anti-S. On Phenotyping result M and S antigens were present. Voluntary donors with the same phenotype could not come for donation. To obtain a compatible RBC unit, we asked his parents’ sample for cross-match and the cross-match showed compatibility with his father’s sample. To verify this, we did father phenotyping and it has shown similar findings except for P antigen. His father came for blood donation. After all mandatory procedures, Leuco-reduced Irradiated blood was issued to this patient. After the transfusion, a compatible PRBC unit his Hb reached to 8.7 gm/dl and he was discharged.

Conclusion: Haemoglonipathies and Thalassemia are common disorders in our country. In Thalassemia, due to multiple transfusions, there are high chances of developing allo and autoantibodies. A phenotyped matched Few donors should be kept in reserve for each patient who is transfusion dependent.

Keywords: Antigen phenotype, auto-immune haemolytic anaemia, thalassemia intermedia

eP089: Immunohematology: Approach to identification of antibodies to high frequency antigens (HFA)

Pragya Silwal, Sangeeta Pahuja Sindhwani

Background and Objectives: Patients with antibodies against HFA (prevalence >90%) poses a challenge to the transfusion medicine specialists. Finding a corresponding antigen-negative compatible unit in such scenario becomes very difficult, particularly in emergency and resource-limited settings.

Methods: We conducted a four years retrospective study to look at the cases wherein the plasma of patient showed pan-agglutination reaction with auto-control negativity. Evaluation (adsorption and elution studies, select cells) was done to segregate antibodies to HFA from multiple alloantibodies. Sample was further tested by enzyme and DTT to identify the specificity of HFA.

Results: Anti Yta and anti-c : 29 year/Fe, G3A1P1 at 38 weeks POG was planned for elective CS. IAT showed pan-agglutination (2+ to 3+) and papain treatment showed enhanced reaction in most of the cells (suggestive of anti-c) and diminished in 2 cells (suggestive of additional antibody). DTT treatment of red cells showed no change in reaction strength. Reference lab found patient’s cells to be Yt(a-) and confirmed presence of anti-Yta and anti-c in the patient’s plasma.

D- -: 24 year/Fe,26 weeks POG with bad obstetric history (G6P4L0A1) and severe anemia. Her Rh profile showed presence of D and absence of C,c,E,e antigens. Strength of IAT didn’t reduce with DTT and papain. Molecular study revealed patient to have D- -phenotype and presence of anti-Rh17 antibody.

In(b): An unbooked primigravida showed pan-reactivity in IAT (diminished by DTT and papain). Serology showed negative reaction of red cells with anti In(b) antisera and positive with In(a) antisera. Molecular analysis confirmed absence of In(b) on red cells, thus suggesting presence of anti-Inb in the patient’s sera.

Family studies were done for all cases and help was sought from referral centres and rare donor registry for transfusion management.

Conclusion: This study highlights the stepwise approach to identify antibodies to HFA and underlines the significance of national rare blood donor registry along with frozen red cell inventory.

eP090: Immunohematology: Rh and kell phenotyping – A closer look

Jhalak Patel, Vishvas Amin, Palak Panchal, Jyoti Shetty, Emmanuel Christian, Bharat Parmar, Akib Mansuri

Background and Objectives: There are currently 45 recognized blood group systems containing 362 red cell antigens. The 45 systems are genetically determined by 50 genes but only ABO and RhD blood group status of the recipient and blood donor are considered when red blood cells (RBCs) are transfused. Patients requiring chronic transfusion support are at high risk of alloimmunization because of disparity between donor and recipient antigenic profile. The chances of alloimmunization are higher if the donor and recipient are of different ethnic backgrounds with varied red cell antigenic profile. Immunogenicity of foreign antigens and number and frequency of transfusions also increase the risk of alloimmunization. The presence of RBC alloantibodies creates the potential for serologic incompatibility, makes the selection of appropriate units for future transfusion more difficult, delays blood transfusion, and presents the risk of haemolytic disease of the fetus and the newborn (HDFN). This study tries to highlight the frequency of Rh and Kell antigens among the blood donors and patients from a period of April to June 2024.

Materials and Methods: The antigen typing for Rh antigens (D, C, c, E, and e) and Kell (K) was performed on the collected EDTA samples from 16,922 voluntary donors and 5102 patient samples. The test was performed by Erythrocyte Magnetic Technique using a microplate (DuoLys) in a fully automated immunohematology system - Diagast Qwalys Evo by France.

Results: A total of 22,024 samples were processed of which of the frequency of “D” antigen was 93.07% (n = 20,498), “C” was 87.31% (n = 19,231), “c” was 59.09% (n = 13,013), “E” was 16.94% (n = 3,731), “e” was 98.98% (n = 21,800), and “K” was 1.72% (n = 381).

Conclusion: Since pre-transfusion phenotyping is not routinely practiced, transfusion of at least Rh and Kell phenotyped donor red cells can lead to a great decrease in the risk of alloimmunization and adverse events related to transfusion.

eP091: Immunohematology: Prevalence of rhesus (C, c, E, e) and kell (K) antigens in blood donors: A targeted RBC antigen typing study from a tertiary care centre in Eastern India

Mansi Sharma, Somnath Mukherjee, Satya Prakash, Ansuman Sahu, Debasish Mishra

Background and Objectives: The Rhesus (Rh) and Kell (K) blood group systems are pivotal in transfusion medicine due to their immunological implications and the potential of alloimmunisation due to corresponding antibodies. The primary objective was to assess the frequency of four key Rh antigens (C, c, E, e) and the Kell (K) antigen, as well as to determine the likelihood of obtaining c, E, and K antigen-negative red blood cell (RBC) units to mitigate the risk of alloimmunisation in patients requiring multiple transfusions. Additionally, the study sought to explore any association between ABO blood group and Rh antigen phenotyping.

Materials and Methods: A retrospective analysis was conducted involving 2,799 blood donors recorded in a tertiary care centre’s minor phenotyping donor register, from Jan 2021 to Sept 2024. Antigen typing for Rh (C, c, E, e) and Kell (K) was performed using tulip neutral gel cards and tube techniques with commercially available monoclonal antisera, as per manufacturer’s guidelines, whenever corresponding antibodies were detected in patients (a targeted approach). Data analysis was performed using R software version 3.5.3. Fisher’s exact test and chi-square test were employed to examine associations between individual Rh antigens and c, E, K antigen-negative units with ABO blood groups. Logistic regression modelling was subsequently applied to investigate these associations further.

Results: Among 2,799 donors, 2,733 (97.64%) were D positive and 66 (2.36%) were D negative. Antigen frequencies were: e (98.97%), C (87.60%), c (39.15%), E (16.44%), and Kell (1.87%). Notably, 59.97% of RBC units were c, E, and K antigen-negative among 1,719 donors. The distribution of these antigen-negative units by ABO blood group was: A (61.86%), B (64.45%), O (57.25%), and AB (57.45%). Significant associations were found between c and C typing with ABO blood groups (p = 0.006 and p = 0.048, respectively), while no associations were observed for c, E, and K antigen-negative units. Logistic regression identified A, B, and O blood groups as significant predictors for ‘c’ positivity and A and B blood groups for ‘C’ positivity (p < 0.05).

Conclusion: This study computes the prevalence of Rh and Kell (K) antigens in the local donor population, particularly emphasising the prevalence of c, E, and K antigen-negative RBC units (59.97%). Notably, c and C typing exhibited significant association with particular ABO blood groups. These insights are crucial for ensuring the timely availability of compatible or optimally matched RBC units, particularly in emergency transfusion scenarios.

eP111: Quality Management: Return of unused blood components with its impact on inventory management – A retrospective study

Gaurav Kumar, Prasad P. Kulkarni, Seema Gupta, Melvin Mathew, Mukta Jain, Masum Reza, Vaishali Thakare

One of the quality indicators for blood transfusion services is blood component wastage. Blood bags may get discarded for number of reasons, including after their expiration date, seropositive units, are not within QC limits, leakages, or are returned with unused component units. The easily avoidable amongst these is the return of unused components. This typically occurs when requests for blood products are made without completing a patient investigation and pre transfusion preparedness. Therefore, blood is requested without assessment of its requirement. This causes wastage of blood units, making it difficult to maintain blood inventory. We analysed returned blood components from different clinical departments retrospectively for a period of 18 months i.e. from January 2022 to June 2023. Total of 113 units were returned, out of which 53 (46.9%) were discarded as they didn’t fulfil the criteria for reuse. The most common reason for return was change in plan of transfusion (28 out of 113, 24.77%) followed by fever prior transfusion (22 out of 113, 19.46%). Maximum no. of return blood units were received from surgical wards (38 out of 113, 33.62%) followed by ICU (35 out of 113, 30.97%). Maximum component units discarded from the total returned bags received were from Surgical departments (21 out of 53, 39.6%) followed by ICU (13 out of 53, 24.5%). The total discard rate due to return components were 0.53%.

eP112: Quality Management: Instrumentation: Purchase, installation, calibration, service and maintenance

Yogini Patel

Vedantaa Institute of Medical Sciences, Dahanu, Maharashtra, India

Instrumentation has been elaborately discussed by many stalwarts in transfusion medicine. Protocols have been implemented by MHFW and NABH on criteria for proper equipment selection, Ordering, installation, calibration, validation and maintenance for types of blood centres. Importance of correlating the type of equipment requirement with the scope of the blood centre. This presentation focuses on the intricate, simple work friendly DOs and DONTs on caring for equipment on daily basis. Technical in-house awareness of standard equipment performance, protocols for daily maintenance and monitoring with start-ups and relevant checklists. Responsibilities of every member of the blood centre from Director level to the housekeeping level.

eP113: Quality Management: Comparative study of quality parameters of apheresis platelets stored in platelet additive solution and in plasma

Amanpreet Kaur, Rajesh Kumar, Sonia Gupta, Deepika Aggarwal, Sonal Sonu, Gulinder Singh

Background: Platelet additive solutions (PAS) are crystalloid, isotonic buffered solution nutrient media used in place of plasma for platelet storage. They replace 60%–70% of plasma in platelet components, so the amount of storage plasma can be decreased. It contain substances that might be beneficial for preservation of platelet function during storage and might protect platelets from the storage lesions and can also be used to extend shelf life of platelet concentrates. Single donor apheresis platelets (SDAP) generally prepared and stored with 200-300 ml of donor plasma with shelf life of 5 days.

Objectives: To study and compare in vitro changes in platelet indices – swirling, pH, platelet count, mean platelet volume (MPV) in PAS and plasma stored apheresis platelets on day 1, 5 and 7th day of collection.

Methods: A prospective study was conducted on 50 randomly selected apheresis platelet products, of which 25 were stored in PAS (study group) and 25 in plasma (control group. Eligible donor selection criteria was as per departmental standard operating procedure. Quality Parameters were compared in both groups on days 1, 5 and 7.

Results: PAS stored platelets well maintained platelet counts and pH (>6.9), gradual decrease in bicarbonates from day 1 (16 mmol/L) to day 7 (5 mmol/L). On visual inspection swirling score indicated good viability at day 1 and in some reduced at day 7 indicating gradual fall in both groups. WBC counts in both groups were in normal range. Bacterial culture done on day 7 in both groups showed no growth.

Conclusions: PAS stored platelets maintained more platelet count in comparison with plasma stored platelets from day 1 to day 7. Gradual decrease in bicarbonates in PAS platelets, helped in maintaining pH till day 7. The addition of PAS maintains quality parameter of SDAP within acceptable limits till day 7 of storage. Additional benefit of PAS is to decrease TTI and allergic reactions in patients.

eP114: Quality Management: Study of the process for issue of blood units with a view to reduce turnaround time (TAT)

A. Yashovardhan, Divya Tejaswi

Background: TAT is one of the quality indicator in blood centers and is calculated as the time taken from the time blood request and samples received to till the blood is crossmatched and available for issue. For PRBC crossmatch, blood centers must have appropriate time limits, for both routine and emergency scenarios.

Aims: Study of process for issue of blood units and blood center plan with a view to reduce TAT.

Objectives:

• To determine the contribution of individual processes & plan within the blood center which contribute to TAT for issue of blood units.

• To minimize complaints against the blood center staff in the reception during busy hours and night time.

Methods: TIME MOTION STUDY used to analyze various steps in the process and to know the motion of staff during the process.

Results: The workflow with present plan shows, movement of staff across various sections and it took 40 minutes 30 seconds to complete the crossmatch and issue of single unit. The nursing staff posted in the reception should take care of entire donor section and transfer of request to LAB -1 and issue of blood units. In night shift single staff is posted, if staff working in the LAB – 1 will not aware of staff came for blood units and they move through various sections to find the technical staff. The proposed plan was to merge Lab – I and reception which shows the reduced staff movement by removing 4 steps in the process and it took 36 minutes to complete crossmatch and issue of single unit & continuous availability of staff in reception during day and night.

Conclusion: The plan change by combining Reception and LAB-I, will minimize the cost of hiring new staff and complaints. The same was discussed with the management for further process.

eP115: Quality Management: Turnaround time of the blood donation process in blood centre at a tertiary care hospital – A prospective study

G. Gunasekaran, J. Ravishankar

Background and Objectives: Turnaround time (TAT) is one of the quality indicators of blood centre defined by National Accreditation Board for Hospitals and Healthcare providers (NABH). The workflow can sometimes have gaps or bottlenecks that prolong TAT of the blood donation process. This can result in a bad experience for the donor and may discourage the donor from donating. This study aimed to evaluate the turnaround time of the whole blood donation process.

Materials and Methods: This was a prospective cross-sectional study done at the Department of Immunohematology and Blood Transfusion from May to June 2024. Blood donation process includes registration, hemoglobin estimation, blood grouping & Rh typing, medical examination, blood collection and post-donation care. The time for each phase of the process was observed separately. Donations that completed the entire process were included in the study. Deferred donations were excluded. The data collected was entered in Microsoft Excel and analyzed.

Results: Out of 123 donors observed, mean TAT for donor to complete blood donation was 47.70±12.60 minutes, pre-donation phase was 25.09±11.42 minutes, donation phase was 6.47±1.84 minutes and post-donation phase was 16.13±5.30 minutes. Prolongation of pre-donation TAT was due to the donors’ food intake more than 4 hours, many donors arriving simultaneously, and duty changeover time of phlebotomists at 1 pm. TAT of post-donation phase was prolonged when adverse donor reactions were encountered.

Conclusion: The longest TAT was observed in the pre-donation phase. This can be reduced by assigning staff or residents exclusively to that donation area, and when many donors come for donations. Creating awareness among first-time donors may alleviate the problems with food intake. Donor adverse reactions can be avoided by skilled phlebotomists, communicating with the donors during blood donation, and continuous monitoring.

eP117: Quality Management: ISO 9001:2015: Enhancing quality in blood transfusion services in standalone blood centers of India

Rakesh Kumar Luhar, Ripal J. Shah, V. Harimoorthy

Prathama Blood Center, Ahmedabad, Gujarat, India

Background: The healthcare management system, particularly blood transfusion management, plays a vital role in modern medicine. Regular monitoring of quality objective in both medical and non-medical parameters in a blood center is essential to ensure effective blood transfusion services. Identifying and correcting deficiencies in a timely manner is crucial to maintaining high standards of care and patient and donor safety.

Aim and Objective: Current study was carried out to measure the impact of monitoring of quality objective and how it can be used as a tool for Continuous Quality Improvement (CQI).

Materials and Methods: This retrospective analysis was conducted at one of the largest standalone blood centers in Western India. Blood centre is ISO certified since 2010 and we used to maintain data as per ISO standard since 2010. The data covering the period from April 2010 to March 2024 was analyzed to calculate 14 quality objective and quality objectives as defined by ISO 9001-2015 QMS.

Results: After data evaluation of these 14 years’ data, it was observed that total Blood collection is 476,925 and an average of blood collection in six months is 17033, and the target average in six months of 1975 blood collection per Monthly – blood donation camp (BDC) only with Repeat BDC 68.60%, Number of donor awareness & motivation Programs 100%, Donor adverse reaction 0.6%, Low quantity 1.0%, whole blood damage 0.3%, expired Platelet 7.7%, Post transfusion reaction 0.04%, Donor feedback analysis 97.1%, Patient Feedback analysis 80.7%, NAT Invalid Batch 1 batch, Attrition rate 2.8%, virology batch Fail 1 batch, Material storage Incident 7 nos.

Conclusion: Quality objective are essential tools that stakeholders in Blood Transfusion Services must implement to enhance quality performance. By tracking and analyzing these objective, Blood centers can identify areas for improvement, optimize processes, and ultimately ensure the provision of high-quality blood components and services.

Keywords: Continuous quality improvement (CQI), performance indicator (PI), quality indicators (QI), quality management system (QMS), quality objective (QB)

eP118: Quality Management: Implementation of internal quality control program for monitoring of HBsAg ELISA performance at a tertiary care hospital

Thiruvenkatam, J. Ravishankar

Background and Objectives: Internal quality control samples may be incorporated in ELISA routinely for the detection of errors occurring due to change in environmental conditions, test system or operator performance. Aim of the study was to prepare HBsAg internal quality control samples, monitoring of results using Levey-Jennings (LJ) charts, their interpretation, identification of errors and corrections applied.

Materials and Methods: This was a prospective cross sectional study conducted at Department of Immuno Hematology and Blood Transfusion, Tirunelveli Medical College, Tirunelveli, Tamilnadu, India. Internal quality control samples for HBsAg ELISA were prepared ‘in-house’ by using positive pooled samples after 56ºC incubation for one hour. Sample with 1:256 dilution gave E ratio of 1.9 and was taken as internal quality control. After 20 runs, mean and SD was calculated. Inter aliquot variation was performed using Coefficient of variation and interpreted to detect errors. LJ chart demonstrating the performance of Internal quality control samples on 26 runs [07 July to 23 September] for HBsAg ELISA was drawn and analyzed.

Results: The Mean of first 20 runs was 3.66 ±1.44 (Mean 1) and LJ chart was drawn. The first 7 runs, when plotted were within normal limits. But the next run showed a shift with value outside 3 SD. The next 6 runs were near the new results (Mean 2). This was followed by another 5 runs near Mean 1. The next 7 runs were near Mean 2. When these results were investigated and analysed, it was found that a new ELISA screening kit was supplied where the runs resulted in Mean 2. A new e ratio and thus a new mean need to be calculated for continuous check if quality.

Conclusion: Inclusion of Internal quality control sample in HBsAg ELISA run is valuable to check the assay performance ensuring reliability and reproducibility of test results.

eP126: Therapeutic Apheresis and Cellular Therapies: Study of nine cases of automated red cell exchange in tertiary care hospital

Bhavika Khunt, Farzana Kothari

Introduction: Red cell exchange is very effective procedure but perhaps underutilized therapy for both acute condition and chronic complications of sickle cell disease. Red cell exchange is removal of patient’s red cell, and it replaced by exogenous normal red cells. The exchange prevents the removed sickle cell from participating in new Vaso-occlusive events by decreasing the sickling percentage as high sickling percentage. Therefore, reduces hemolytic complications and provides added oxygen carrying capacity while decreasing the blood viscosity.

Aim: To study the better experience of the patient’s clinical outcome, challenges, effectivity and complication by automated red cell exchange and to understand how thus procedure can be effectively utilized in the management of patients in Indian scenario.

Materials and Methods: This Retrospective study was conducted in tertiary care center in Baroda Medical College, Gujarat, India between 2022 to 2023. Here we shared our experience on analyzed 09 RCE procedure performed on patients of sickle cell disease on F. KABI Machine of apheresis system.

Results and Discussion: Out of 09 patients who underwent the RCE for sickle cell anemia, only one patient was admitted for hip joint replacement due to avascular necrosis of head of femur. The remaining patients were between 75% to 89% & post RCE was brought down to 24 to 35% and was achieved in a single sitting in all the cases. Ultimately the RCE helped to patients a lot by improving oxygen carrying capacity & patient showed significant improvement.

Conclusion: RCE is a very safe & clinically effective therapeutic procedure. RCE is helpful to reduce iron overload due to top up transfusion. This procedure is underutilized due to various reasons like inadequate awareness/technical expertise, lack of equipment’s & facilities to identify the clinical conditions.

Keywords: Abnormal red cell exchange (RCE), acute RCE, apheresis machine, sickle cell disease

References

1. Swerdlow PS. Red cell exchange in sickle cell disease. Hematology Am Soc Hematol Educ Program 2006;48-53.

2. J Clin Red Cell Exch Res 2016;10:EC28-30.

eP127: Therapeutic Apheresis and Cellular Therapies: Therapeutic plasma exchange: Gold standard treatment for atypical hemolytic uremic syndrome in children in India

Sheetal Chandak, Hansa Goswami

Introduction: Atypical HUS (aHUS) is a serious disease caused by disorder of the complement system or due to genetic etiology. Therapeutic Plasma Exchange (TPE) is a preferred treatment for aHUS.

Materials and Methods: This was a retrospective study carried out over pediatric patients with aHUS between 2017 and 2018. One to 1.5 plasma volume was removed during every TPE and replaced with fresh frozen plasma. Clinical parameters were monitored pre and post TPE.

Results: 119 TPE were carried out in 15 patients. Average pre TPE and post TPE platelet count were 96.53 ± 75.33 x 109/L and 116.80 ± 80.30 x 109/L (p=0.34) Average pre TPE and post TPE hemoglobin was 6.76 ± 1.79 gm/dL and 8.13 ± 2.12 gm/dL (p=0.5) and pre TPE and post TPE serum creatinine was 1.43 ± 1.85 and 0.70 ± 0.63 mg/dl (p<0.01).

Conclusion: TPE is a safe procedure in the treatment of aHUS.

eP128: Therapeutic Apheresis and Cellular Therapies: Role of therapeutic plasma exchange in oncology patients with acute liver failure at a tertiary care oncology centre

Abinash Padhy, Priti Desai, Anisha Navkudkar, Abhaykumar Gupta

Backgrounds and Objectives: Acute liver failure (ALF) in oncology patients is rare but a severe condition that poses significant challenge in patient management. Therapeutic plasma exchange (TPE) has emerged as a potential bridging intervention, but its effectiveness in this patient population remains under-explored. This study elucidates the outcomes of oncology patients with ALF, treated with TPE.

Methods: This study is a single centre retrospective observational study, evaluated over 3 years (January 2021-December 2023). Data was collected from institutional Electronic medical and departmental records, that included patient demographics, procedure details, underlying malignancies, pre and post procedure liver function tests (LFT) and coagulation profile. TPE was initiated as per ASFA recommendation category III grade 2B for ALF.

Results: During the study period, 12 TPE procedures performed on 6 oncology patients (3 males and 3 females) of mean age 39 years (9-66 years), with mean of 2 (1-3) sessions each on alternate day basis. High volume plasma exchange couldn’t be done on these patients, as patients were hemodynamically unstable. On an average 1.25 times the total plasma volume was exchanged per session with combination of Fresh Frozen Plasma, Normal Saline, Albumin as per patient’s clinical requirement. Improvements in pre and post procedure values of PT (40 vs 17 Sec, p=0.023), INR (3.4 vs 2.4, p=0.289), aPTT (80 vs 41 Sec, p=0.136), Sr Bilirubin (24 vs 18 mg/dL, p=0.060), ALT (1178 vs 464U/L, p=0.005), AST (2338 vs 1065U/L, p=0.005), and ALP (127 vs 99U/L, p=0.034) were observed. However, minor clinical improvements were noted. Post TPE >30 days survival was observed in 50% of the patients.

Conclusion: TPE was well tolerated and safe and can be considered as a bridging therapy in oncology patients with ALF as this data showed improvement in coagulation profile and LFT. This need to be evaluated with larger sample size to decide the utility of the procedure in oncology patients.

eP129: Therapeutic Apheresis and Cellular Therapies: Therapeutic plasmapheresis – A boon to low income group North Karnataka patients with GBS

Kavitha Yevoor, Purushottam Reddy, Sunita Vernekar

Need for Study: The reported incidence rates for Guillain-Barre Syndrome are 1 to 2 per 100,000 population. The lifetime likelihood of any individual acquiring Guillain-Barre syndrome is 1:1000. Guillain-Barre Syndrome is an acute ascending paralyzing disorder that is caused by the inflammation of the peripheral nerves.4The primary focus of management is supportive care, and immunotherapy- intravenous immunoglobulin or Therapeutic Plasmapheresis. The Cochrane review published in 2017 summarized that the treatment with Therapeutic Plasmapheresis reduced time (a) on the ventilator, (b) to walk without assistance (c) recovery of full muscle strength.5 The present study is done to evaluate the outcome of Therapeutic Plasmapheresis as the first line treatment in Neurological Disorders.

Objectives of the Study:

1. To determine the effectiveness of Therapeutic Plasmapheresis in the management of Neurological Disorders.

2. To determine the incidence of adverse reactions of Therapeutic Plasmapheresis in the treatment of Neurological Disorders.

3. To estimate the outcome of Neurological Disorders based on Medical Research Council Score.

Materials and Methods: Source of data: This study is carried out jointly in Department of Pathology and Neurology, KMCRI, Hubballi. The study will include every case of Neurological Disorders treated with Therapeutic Plasmapheresis at KMCRI, Hubballi. Retrospective review of Therapeutic plasmapheresis procedures done during a period of 36 months, from june 2022 to May 2024 in a tertiary care teaching hospital in South India. Indications, clinical results and technical factors are discussed.

Results: The main indication for PE was GBS ( 50 patients), Age of patients ranged from 24-72 (mean = 48 years). The most common complications were hypotension (52%). There was no mortality.

Conclusion: The analysis of 56 cases done in our department shows that the procedure is safe, with only minimal procedure related complications and no mortality.

Keywords: Guillain-Barré syndrome, therapeutic plasmapheresis

eP130: Therapeutic Apheresis and Cellular Therapies: Revising the role of therapeutic plasma exchange in pregnancy-associated thrombotic microangiopathy: A case series

S. Sathish, Saptarshi Mandal, P. J. Muthukumaravel, Para K. Trivedi, Rahul, Siddharth Mittal, Archana Bajpayee, Rajesh Jhorawat

Introduction: Pregnancy and postpartum periods pose high-risk of developing thrombotic microangiopathies (TMA). However, the management of pregnancy-associated TMA remains ill-defined. We present a post-partum TMA case series of 6 cases that highlights the importance of early recognition and prompt intervention for pregnancy-related TMA. All these cases presented mainly with isolated Acute Kidney Injury AKI, and underwent Therapeutic Plasma Exchange (TPE) which resulted in favourable maternal & fetal outcome in majority. Although therapeutic plasma exchange (TPE) has been successful in patients with TMA in the past, American Society for Apheresis guidelines 2023 lists this indication (TMA, Pregnancy Associated) under category III with grade 2C recommendation, which suggests that either the evidence is soft, i.e. likely to change with time, or an umbrella category likely to split up, as more evidence accrues. Our case series is likely to contribute evidence in favour of doing the procedure for such case/subtypes.

Aim and Objective: To study the effect of TPE among postpartum TMA with Acute Kidney Injury.

Methods: The Patients included in the series are Six patients admitted to our institute from September 2023 to September 2024 presenting with AKI and diagnosed with postpartum TMA, who underwent at least one cycle of therapeutic plasma exchange. These patients were assessed for laboratory parameters and clinical outcome.

Results: Six postpartum patients with AKI are included in this case series. Indication for TPE in all the cases were thrombotic microangiopathy (TMA). All received 2 to 5 sessions of TPE with 1.3-1.5 plasma volume removed on an average per cycle. The endpoint of TPE was a reduction in lactate dehydrogenase and an increase in platelet count. Five patients responded well on follow-up while one had acute cortical necrosis and remained dialysis-dependent. It has been noted in the previous studies too that a pregnancy or postpartum induced TMA cases was getting converted to chronic kidney disease and becoming dialysis dependent in the long run.

Conclusion: These case series highlighted the successful management of pregnancy-related TMA involving acute kidney injury with therapeutic plasma exchange (TPE). TPE may be a valuable adjunctive therapy in severe cases of postpartum AKI, and its utilization should be considered early in a multidisciplinary approach to ensure favourable maternal outcomes. Early recognition of TMA and prompt intervention with TPE in managing postpartum AKI to prevent irreversible renal damage and improve patient outcomes.

eP131: Therapeutic Apheresis and Cellular Therapies: Erythrocytapheresis (RBC Exchange) in a sickle cell disease patient with a thalamic space occupying lesion: A case report

Pinjari Chinigi Sab, Soumya Das, Rounak Dubey, Sucheta Shrikant Meshram, Vishvdeep Khushoo, Varidh Katiyar, Juilee Shalik Charmode, V. Aishwarya

Background: A 52-year-old female was admitted to the neurosurgery ward with intermittent headaches persisting for one and a half years, associated with vomiting, slow responsiveness, and generalized weakness. CT head revealed right thalamic space-occupying lesion (SOL) with significant perilesional edema and mass effect which required urgent surgical intervention. She was also detected to have homozygous Sickle Cell Disease (SCD).

Objectives: The patient was started on intravenous analgesics Due to critical nature of the patient’s condition and the immediate need for surgery, an urgent automated RBC exchange was scheduled to lower the hemoglobin S (HbS) levels to below 30%. During the procedure, the patient was intubated, and subsequently.

Methods: The patient was transferred to surgical intensive care unit (SICU) for initiation of RBC exchange procedure, using Spectra Optia (TERUMO-BCT) cell separator machine through femoral line access. Based on the PRBC hematocrit (65%) and pre procedure HbS (72.6%), FCR concentration and post procedure hematocrit calculated by the system were 38% and 30% respectively. Prophylactic calcium gluconate infusion was given.

eP132: Therapeutic Apheresis and Cellular Therapies: Young onset valvular dysfunction as a presentation of familial hypercholesterolemia due to LDL receptor mutation and transient response to LDL apheresis

Divjot Singh Lamba, Jayaditya Ghosh, Liza Das, Rekha Hans, Ratti Ram Sharma, Sanjay Kumar Bhadada

Background and Objectives: Familial hypercholesterolemia (FH) is an autosomal dominant disorder causing elevated LDL cholesterol, leading to a high risk of premature atherosclerotic cardiovascular disease (ASCVD). It exists in heterozygous (HeFH) and more severe homozygous (HoFH) forms, with HoFH often due to mutations in the LDL receptor gene. HoFH patients have significantly elevated LDL-C levels, resulting in early ASCVD and complications like aortic stenosis. Advances in treatments, such as statins and apheresis, have improved survival rates, extending life expectancy beyond 50 years.

Case Report: This case study presents a rare instance of homozygous familial hypercholesterolemia (HoFH) in a young female, highlighting early-onset severe aortic stenosis and moderate aortic regurgitation. HoFH, a more severe form of familial hypercholesterolemia, is caused by mutations in the LDL receptor (LDLR) gene, leading to extremely elevated low-density lipoprotein cholesterol (LDL-C) levels. The patient was diagnosed at the age of 7, presenting with multiple xanthomas and an LDL-C level of 392 mg/dL. Despite undergoing several lipid-lowering treatments, including statins, ezetimibe, niacin, and PCSK9 inhibitors, the patient’s LDL-C levels remained significantly high. Additionally, she developed myopathy as a side effect of high-dose statin therapy. Genetic testing confirmed the diagnosis of HoFH, with the mutation located in the LDL receptor gene. Due to the failure of conventional therapies, the patient was treated with LDL apheresis, a procedure designed to lower LDL-C levels. While apheresis resulted in a temporary, substantial reduction in LDL levels, the effect was not sustained, necessitating repeated sessions to manage her condition. The challenges of managing HoFH in this patient, particularly in relation to her valvular dysfunction, underline the need for aggressive early intervention and advanced treatment strategies. LDL apheresis, though beneficial, may only provide transient improvements, emphasizing the need for novel therapies.

Conclusions: The case also highlights the importance of multidisciplinary care and regular follow-up to optimize outcomes in patients with HoFH, especially in settings where access to advanced therapies may be limited. It stresses the ongoing need for research into more effective treatment strategies to improve long-term management and quality of life for patients suffering from this severe genetic disorder.

eP133: Therapeutic Apheresis and Cellular Therapies: Clinical efficacy of granulocyte apheresis using hydroxyethyl starch in an aml patient with neutropenia: A case report

Jayrajsinh Ajitsinh Rathod, Krina Mandora, Manthan Patel, Ashu Dogra, Milind Dighe, Suraj Goyanka

Background and Objective: Bacterial and fungal infections are significant causes of mortality and morbidity in neutropenic patients. Unrestricted antimicrobial use has further worsened the situation due to development of drug-resistant pathogens all over India. Granulocyte transfusion therapy has been shown to be beneficial in these patients by restoring neutrophil counts and aiding in the resolution of infections. This study aims to describe the observed clinical efficacy of granulocyte transfusion in a neutropenic sepsis patient.

Methods: A retrospective observational analysis was conducted on patient receiving granulocyte transfusions at our hospital from voluntary blood donors, in accordance with DGHS guidelines. Granulocytes were mobilized using colony-stimulating growth factor (G-CSF) and dexamethasone, and collected using the Terumo BCT Spectra Optia Apheresis System with Medium Molecular Weight Hydroxyethyl Starch (MMW HES) as the red cell aggregating agent.

Results: A high dose of granulocytes (3.1 x 1010 neutrophils/bag) was achieved without any adverse donor reactions. The patient’s neutrophil count increased, and fever subsided after two units of granulocyte concentrate transfusion, with no adverse reactions observed.

Conclusion: Granulocyte transfusion is a valuable adjunct to antimicrobials and growth factors in treating neutropenic sepsis that is refractory to conventional antimicrobial therapy.

eP134: Therapeutic Apheresis and Cellular Therapies: Thrombocytapheresis in patient of essential thrombocytosis with acquired von willebrand syndrome: A case report

Krina Mandora, Jayrajsinh Rathod, Manthan Patel, Ashu Dogra, Milind Dighe, Suraj Goyanka

Background and Objective: Essential Thrombocytosis (ET) is a clonal myeloproliferative neoplasm (MPN) characterized by the autonomous overproduction of platelets (≥450 x 109/L). Thrombocytosis in such cases is associated with thrombohemorrhagic events and bleeding due to acquired von Willebrand syndrome (AVWS) which can occur when platelet counts exceed 1000 x 109/L. Therapeutic apheresis offers rapid cytoreduction, ameliorating prothrombotic factors associated with dysfunctional platelets. The objective of this study is to describe the clinical efficacy of thrombocytapheresis in a patient with Essential Thrombocytosis.

Methods: A retrospective observational analysis was conducted on a patient undergoing thrombocytapheresis using the Terumo BCT Spectra Optia Apheresis System in the Bone Marrow Transplant (BMT) unit. Four units of cryoprecipitate were transfused before the apheresis procedure due to the presence of AVWD. Pre- and post-complete blood count (CBC) values were compared, and changes in clinical symptoms were noted to assess improvement in the patient’s condition.

Results: The thrombocytapheresis procedure was well tolerated by the patient with no adverse reactions. The platelet count decreased from 17.80 lakh/µL to 7 lakh/µL, representing a 58% reduction. Clinically, the patient showed resolution of the hematoma and bleeding episodes. The patient regained mobility, and was discharged four days after the apheresis procedure.

Conclusion: Thrombocytapheresis is an effective treatment for acute uncontrolled thrombocytosis. This case report shows rapid improvement in symptoms and resolution of thrombotic/hemorrhagic complications following apheresis procedure in timely manner.

eP135: Therapeutic Apheresis and Cellular Therapies: Light from the grave: Therapeutic plasma exchange as a life-saving therapy in postpartum multiple organ dysfunction syndrome

Aditi Garud, Lincy Jacob, Prajakta Joshi, Samruddhi Salve

Background: A 32 year old Primigravida was referred post LSCS with Postpartum eclampsia, altered sensorium, severe sepsis and Multiple Organ Dysfunction Syndrome (MODS). She was put on mechanical ventilation, treated with antibiotics, hemodialysis and 5 cycles of Therapeutic Plasma Exchange (TPE).

Objective: Evaluate the effectiveness of TPE as a life-saving measure by reversal of post-partum MODS, altered sensorium and deranged blood parameters.

Methods: TPE was started immediately on the day of admission. And each procedure was performed on alternate days over 10 days. Approximately 4.2 liters were extracted during each procedure and substituted with replacement fluids including Fresh frozen plasma. During this period the patient also received 3 units of PRBC.

Results: Significant improvement was observed following the second procedure with improved sensorium, multi-organ function and blood parameters. By the second TPE she was alert and responsive, her serum Bilirubin decreased by 69% from 8.4 to 2.6 mg/dl and Serum LDH by 66.5% from 2884 to 966. She was weaned off the ventilator and CBC parameters stabilized to normal levels. On 12th day of admission she was shifted to ward, discharged with HD catheter and weaned off dialysis within a month.

Conclusion: TPE procedure is safe and effective as a life-saving therapy for critically ill patients with Multiple Organ Dysfunction Syndrome. Indication for therapeutic apheresis for sepsis with Multi Organ Failure is category III of ASFA guidelines 2023. However TPE used as the first line of treatment for our patient, was well tolerated, and proved to be lifesaving and effective to ensure a complete recovery.

eP136: Therapeutic Apheresis and Cellular Therapies: Outcomes in thrombotic microangiopathies treated with therapeutic plasma exchange: 10 years experience from a southern tertiary care hospital

Shivanand Hemant Kumatagi, Shamee Shastry, Ganesh Mohan, Deepika Chenna, M. Deep

Background and Objectives: In the 100 years since Eli Moschcowitz reported the first case of thrombotic thrombocytopenic purpura (TTP), there has been remarkable awareness and progress in the diagnosis and management of this rare blood disorder as well as other thrombotic microangiopathies (TMA). Currently there is less understanding of the incidence and pathophysiology of the long-term sequelae of TMA.[¹] The aim of this study was to identify the long-term sequelae following discharge of TMAs treated with therapeutic plasma exchange.

Methods: It is a retrospective observation study conducted over a period of 10 years in a tertiary care hospital located in southern India. All patients who underwent therapeutic plasma exchange for TMA were identified from the register. Their discharge summaries and repeat admissions were analysed from HIS. The demographic details and other clinical details were entered in Microsoft Excel and analysed.

Results: A total of 36 patients underwent therapeutic plasma exchange for TMA in last 10 years. Females constituted 64% of them. The age distribution was 19-45 yrs (39%), <18 yrs (33%), 46-60 yrs (20%), >60 yrs (8%). The conditions diagnosed included Thrombotic thrombocytopenic purpura (36%), Hemolytic uremic syndrome (50%), Undetermined (11%), glomerular type TMA (2%). The causes associated were sepsis – 33%, post partum -13%, Infection – 13% (viral, CMV, gastroenteritis, leptospirosis), accelerated HTN - 5%, renal transplantation -5%. The requirement of other treatment options was as follows: steroids (47.2%), hemodialysis (36.1%), rituximab (19.4%), IVIG (13.9%), MMF (5.5%), cyclophosphamide (5.5%). The mean difference days between admission and initiation of PLEX was higher (9.3+/-7.6) in expired group compared to non-expired group (6.2+/- 7.7) and it was statistically significant (p = 0.03). The in-hospital mortality was 27.7%. The mean repeat admissions for remaining 26 patients was 3 (+/-8). The readmission for relapse was 8%. Other common reasons were gastroenteritis (11%) and graft dysfunction (11%). Other reasons were hypertensive emergency, AKI, medical termination of pregnancy, encephalitis, nephrotic syndrome, anxiety, Heavy menstrual bleeding, headache, tinea infection, vocal cord paresis.

Conclusion: In thrombotic microangiopathies, early initiation of plasma exchange reduces mortality. Most common long term complications are relapse, gastroenteritis and renal graft dysfunction. Other complications are varied but less studied.

Reference

1. Cataland SR, Coppo P, Scully M, Lämmle B; on behalf of the International Working Group on Thrombotic Thrombocytopenic Purpura. Thrombotic thrombocytopenic purpura: 100 years of research on Moschcowitz syndrome. Blood 2024;144:1143-52.

eP137: Therapeutic Apheresis and Cellular Therapies: Significance of stem cell harvest in patients of hematological malignancy receiving autologous peripheral stem cell transplant

Jyoti Tiwari, Tulika Chandra, Ashutosh Singh, Archana Solanki, S. P. Verma

Background: Autologous stem cell transplantation (ASCT) is a common treatment modality in which the patient’s own healthy stem cells are used to replace the diseased stem cells in the bone marrow. ASCT following intensive chemotherapy has been used in patients with hematological malignancies, such as multiple myeloma (MM), lymphoma, or solid tumors.

Objectives:

• Evaluation of CD34 counts with stem cell dose and volume.

• Correlation of recovery time of patients with stem cell dosage.

Methodology:

• A Pilot study of ASCT comprising of 16 patients, inclusive of 11 cases of Multiple myeloma (MM) and 5 of Hodgkin Lymphoma.

• Granulocyte colony stimulating factor (G-CSF) 10 mcg/kg daily in two divided doses was given till apheresis.

• Plerixafor 0.24 mg/kg stat dose was given 11 hours prior to transplant.

• This was followed by apheresis by COMTEC (Fresenius Kabi) via central venous access in the internal jugular vein.

• Stem cell dose was calculated using mid cycle CD34+ cells and the total blood volume processed.

Results:

• All 16 participants were transfused with adequate amount of CD34+ cells

• Average time for harvesting procedure was 246 min (220-280 min)

• Death within 1 year occurred in 2 patients, out of which 1 showed relapse and was

subjected to multiple cycles of HSCT.

• Rest of the 14 recipients of HSCT were free of disease and did not show relapse till the time of follow up.

Conclusion:

Mid cycle CD34+ count can be used as a good indicator for the dose of stem cells in the product and the volume of the product can be adjusted accordingly.

eP169: Transplant Immunology: Outcome of haematopoietic stem cell transplantation for primary immune deficiency disorders in a tertiary care hospital

S. Sumathira, B. Latha, Aruna Rajendiran, G. Kavitha

Background and Objectives: Primary immunodeficiency disorders are inherited disorders with impaired and dysregulated immunity characterized by recurrent infections, failure to thrive. Hematopoietic stem cell transplantation (HSCT) is a curative option available for many primary immune deficiency disorders (PID). In the recent years increased awareness, availability of diagnostics based on flow cytometry, genetic testing, improved supportive care, use of reduced toxicity conditioning and alternate donor HSCT have improved access to HSCT for children with PID in India. We present results on children with PID who underwent HSCT in our Hospital and the factors that influenced outcome.

Methods: This prospective observational study was conducted to know the outcome of HSCT for PID in a tertiary care hospital during the period from August 2023 to September 2024. We analyzed the impact of the type of PID, conditioning regimen, Type of HSCT, cause of Mortality and Overall survival.

Results: A total of 5 children (3 female and 2 male) underwent HSCT for PID at a median age of 12 months (range 5 months to 156 months). HSCT was done for SCID, Gricelli syndrome and Chediak-Higashi syndrome. Matched family donor was available for 2 children. 1 child was transplanted with Haplo-identical donor HSCT and 2 children were transplanted with Matched Unrelated donor HSCT. Busulfan based conditioning regimen was used for 3 children and Treosulfan based conditioning regimen was used for 2 children. The graft source used was peripheral blood stem cells. The survival was superior in children receiving HSCT from Matched Unrelated donor (40%, n=2). Infection is the main cause of mortality in 2 children. The 1 year Overall survival rate was 60%.

Conclusion: Matched Unrelated donor HSCT is now feasible and has made a therapeutic option accessible to all children with PID.

eP170: Transplant Immunology: Outcome of haematopoietic stem cell transplantation for primary immune deficiency disorders in a tertiary care hospital

S. Sumathira, B. Latha, Aruna Rajendiran, G. Kavitha

Background and Objectives: Primary immunodeficiency disorders are inherited disorders with impaired and dysregulated immunity characterized by recurrent infections, failure to thrive. Hematopoietic stem cell transplantation (HSCT) is a curative option available for many primary immune deficiency disorders (PID). In the recent years increased awareness, availability of diagnostics based on flow cytometry, genetic testing, improved supportive care, use of reduced toxicity conditioning and alternate donor HSCT have improved access to HSCT for children with PID in India. We present results on children with PID who underwent HSCT in our Hospital and the factors that influenced outcome.

Methods: This prospective observational study was conducted to know the outcome of HSCT for PID in a tertiary care hospital during the period from August 2023 to September 2024. We analyzed the impact of the type of PID, conditioning regimen, Type of HSCT, cause of Mortality and overall survival.

Results: A total of 5 children (3 female and 2 male) underwent HSCT for PID at a median age of 12 months (range 5 months to 156 months). HSCT was done for SCID, Griscelli syndrome and Chediak-Higashi syndrome. Matched family donor was available for 2 children. 1 child was transplanted with Haplo-identical donor HSCT and 2 children were transplanted with Matched Unrelated donor HSCT. Busulfan based conditioning regimen was used for 3 children and Treosulfan based conditioning regimen was used for 2 children. The graft source used was peripheral blood stem cells. The survival was superior in children receiving HSCT from Matched Unrelated donor (40%, n=2). Infection is the main cause of mortality in 2 children. The 1 year overall survival rate was 60%.

Conclusion: Matched Unrelated donor HSCT is now feasible and has made a therapeutic option accessible to all children with PID.

eP171: Transplant Immunology: Bridging the gap: How HLA allele and haplotype frequency analysis can expedite donor matching

M. Divya, Sam Arul Doss, K. C. Gayathri, Dolly Daniel

Background and Objectives: In the era of cellular and targeted therapies, human pluripotent stem cells (hPSCs), CAR T-cells (Chimeric Antigen Receptor T-cells), and VSTs (Virus-Specific T-cells) are crucial in transplantation, particularly in managing post-transplant complications, and enhancing patient outcomes. These cells can be autologous or allogenic, with the latter being donor-derived, manufactured as patient-specific products and banked. The primary challenge of these cells stems from the inevitable mismatches in the highly polymorphic and immunogenic human leukocyte antigens (HLA), necessitating partially HLA-matched products for the recipients. In the light of this, our study aimed to analyse HLA allele and haplotype frequencies in a small population using custom-developed software.

Methods: This retrospective analysis was conducted in the Department of Transfusion Medicine and Immunohematology. A cohort of patient and donor samples requested for High resolution HLA typing over a period of two years (2022-2024) were used. High-resolution HLA typing was done with MIA FORA kits on the Illumina MiniSeq platform. An in-house built software (Database-Driven HLA Matching Algorithm with Transaction-Safe CRUD Operations) designed by institutional IT team was used and the results were collated.

Results: A total of 3050 patient-donor samples were analysed, revealing 61 observed alleles for HLA-A, 97 for HLA-B, 67 for HLA-C, and 67 for HLA-DRB1. Among the HLA class I alleles, the most frequently observed were A*24:02:01 (28%), A*11:01:01 (26%), and A*33:03:01 (25%) for HLA-A; B*40:06:01 (19%), B*52:01:01 (19%), and B*44:03:02 (14%) for HLA-B; and C*07:02:01 (26%), C*04:01:01 (22%), and C*15:02:01 (21%) for HLA-C. For HLA class II, the most frequently observed DRB1 alleles were DRB1*07:01:01 (31%) and DRB1*15:01:01 (28%).

With this high degree of polymorphisms, the study identified a total of 5,762 haplotype combinations, with five haplotypes standing out as the most frequent:

A*33:03:01B*44:03:02C*07:06:01(13%), A*01:01:01B*57:01:01C*06:02:01(10%), A*33:03:01B*58:01:01C*03:02:02(10%), A*02:11:01B*40:06:01C*15:02:01(7%), and A*11:01:01B*52:01:01C*12:02:02 (6%). These five haplotypes likely reflect the most frequent haplotypes in the general population as well and were distributed among 46% of the population studied.

Conclusion: This study provides a comprehensive analysis of HLA allele and haplotype frequencies within a specific population, highlighting the possible haplotypes that should be targeted for engineering cellular therapy products. Notably, the five most frequent haplotypes are present in 46% of the studied population, offering significant opportunities for targeted allogenic interventions. The in-house software demonstrated its effectiveness in managing complex HLA data, facilitating the precise determination of allele and haplotype frequencies.

eP172: Transplant Immunology: A case report of subgroup of A (Ax) in renal transplant recipient and donor – An unusual mother-son pair

Pooja Modi, Amit Prajapati

Background and Objectives: A Case Report of subgroup of A (Ax) in Renal Transplant Recipient and Donor - an unusual Mother-Son pair. ABO subgroups are phenotypes that differ in the amount of A and B antigen carried on red cells, in secretions and in solid organs of the body.

Methods: Two samples of a male and a female patient for Blood grouping were received from the outpatient department. Discrepant result was obtained in blood grouping in both the patients. The mother was impending kidney donor for his son, who was registered for renal transplant at our transplant institute. On serological test using the Test Tube Method and Anti-A1 Lectin, both the recipient and donor were marked as Ax (Subgroup of A), in order to proceed with the pre-transplant evaluation.

Results: In the present case, since the donor and recipient were of the same A Subgroup, transplant could be performed owing to ABO compatibility.

Conclusion: A donor who is group A also has a non-A1 subgroup, then they could donate a solid organ to a recipient who is primary group B (or O) depending on other factors (Low Anti-A titer in the recipient).

• UNOS (United Network for organ sharing) in the United States of America in its new kidney allocation system (KAS) has implemented the allocation of kidneys from A2 and A2B deceased donors into blood group B candidates.

• UNOS showed that the outcomes of B group candidates, who receive A2 or A2B kidneys was not significantly different from the outcome of B group candidates transplanted with B kidneys.

when a subgroup of A is detected in solid organ transplant donors, provisions can be made for allocations to non-A organ recipients; leading to widening of donor pool for such recipients.

eP176: Recent Advances (Including Molecular Tests): Evaluating the efficacy and safety of autologous growth factor concentrate for the treatment of androgenetic alopecia

Rowena D. L. Robins, Hariharan, Suresh Kumar, Sriraman, Sahayaraj

Introduction: Androgenetic alopecia (AGA) is a prevalent form of hair loss affecting both men and women. This pilot study investigates the efficacy and safety of concentrated growth factor (GFC) therapy, a modified Platelet Rich Plasma (PRP) technique, in enhancing hair density and promoting hair growth in patients with AGA.

Methods: A prospective observational study was conducted from January 2024 to August 2024, involving 10 participants aged over 18 years. Patients were assessed using the Hamilton-Norwood classification. Exclusion criteria included uncontrolled diabetes, bleeding disorders, and active skin conditions. Each participant received 6 GFC injections at four-week intervals, with GFC prepared using the BIOPRO GROFACT Kit. Post-treatment, alopecia grades were re-evaluated, and statistical analysis was performed using the SPSS Software Version 21.

Results: Out of the 10 participants, one patient had a decrement of 3 grades, 5 patients had a decrement of 2 grades and 4 patients had decrement of 1 grade following the procedure. Wilcoxon Signed Rank Test was performed. The calculated p value (<0.05) indicated statistically significant improvement. None of the patients experienced any adverse effects.

Conclusion: GFC therapy demonstrates significant potential as a treatment option for AGA, promoting hair regrowth through the precise delivery of autologous growth factors. The findings support the efficacy and safety of GFC, highlighting its role in improving hair density and overall patient outcomes. Further studies with larger sample sizes are warranted to validate these results.

eP006: Blood Components: Influence of ABO blood groups on fibrinogen levels in fresh frozen plasma: A retrospective study

gulinder Singh, Rajesh Kumar, Sonal Sonu

Background: The ABO blood group system significantly affects various hemostatic factors, including fibrinogen, a critical protein in clot formation. Previous studies have indicated that non-O blood groups (A, B, AB) have higher fibrinogen levels compared to group O. This study aimed to assess the influence of ABO blood groups on fibrinogen levels in Fresh Frozen Plasma (FFP) and its potential clinical implications for transfusion practices.

Materials and Methods: A retrospective analysis was conducted at Dayanand Medical College and Hospital between 2021 and 2023. FFP units from healthy donors were categorized based on ABO blood group (A, B, AB, O). Fibrinogen levels were measured using standardized coagulation assays, and data were extracted from transfusion records. Statistical analysis was performed using ANOVA to evaluate the differences in fibrinogen concentrations between ABO groups.

Results: A comprehensive retrospective analysis encompassed 181 Fresh Frozen Plasma (FFP) units across different ABO blood groups. The distribution of mean fibrinogen concentrations for each group was as follows: A at 321.9 mg/dL, B at 324.0 mg/dL, O at 318.0 mg/dL, and AB at 267.2 mg/dL. The highest concentration was observed in the B group. Statistical evaluation using ANOVA revealed an F-statistic of 2.078 and a p-value of 0.058, which, while not reaching traditional levels of statistical significance (p < 0.05), indicates a trend towards elevated fibrinogen levels in non-O blood groups, most pronounced in the B group. This updated analysis underscores a pattern of higher fibrinogen levels in non-O blood groups.

Conclusion: ABO blood groups have a marked influence on fibrinogen levels in FFP, with non-O groups displaying higher concentrations. This finding is clinically relevant, particularly in the selection of FFP for patients requiring optimal coagulation support, such as in massive transfusions or coagulopathy management. Tailoring FFP selection based on ABO blood group and fibrinogen levels may enhance transfusion efficacy.

eP007: Blood Components: Analysis of the unused returned blood components at a tertiary care oncology centre from Western India

Meena Makwana, Sujata More, Priti Desai, Anisha Navkudkar, Abhaykumar Gupta

Background and Objectives: Unused blood components should be returned to the Blood Centre immediately (within 30 minutes of issue), if a transfusion is not performed. Improper handling of returned components can lead to wastage and risk the safety of future recipients. This study aimed to evaluate the return of blood components across various hospital departments, identify reasons for returns, and propose preventive strategies.

Methods: This retrospective observational study was conducted from August to September 2024 at the Department of Transfusion Medicine in a tertiary care oncology centre in Western India. Each returned occasion was analyzed for component type, number of units returned, site of return, duration outside controlled temperature, and reasons for return. Data were collected using departmental records and Blood Centre software.

Results: During the study period, a total of 9989 blood components were issued, of which 121 units (1.2%) returned to the Blood Centre on 81 occasions. Of the 121 returned units, 44.6% (54/121) were packed red cells, 21.5 % (26/121) were random donor platelets, 14.0% (17/121) were fresh frozen plasma, 9.9 % (12/121) single donor platelets and 9.9 % (12/121) were cryoprecipitate. Total 17.4 % (21/121) units were discarded due to being returned after 30 minutes. The most common reason for return was patient related (patient having fever, breathlessness and chest pain), followed by patient not present at transfusion and transfusion not required any more. The primary site for returns was general day care, followed by Intensive Care Unit and pediatric ward.

Conclusion: This study shows effective utilization of issued units (as only 1.2 % were returned) but also revealing areas for improvement. Majority of returned units were due to patient related factors. Implementing preventive strategies like staff education improved coordination can reduce the occurrence of unnecessary returns.

eP008: Blood Components: Analysis of blood ordering practices in elective onco-surgical cases at a tertiary care oncology hospital

Sujata More, Priti Desai, Anisha Navkudkar, Abhaykumar Gupta

Background and Objectives: Blood transfusion services have a crucial role in management of patients undergoing elective surgeries and are an integral part of the healthcare system. Crossmatch to Transfusion (CT) Ratio, Transfusion index (TI), Transfusion probability (TP) are an important quality indicator used to estimate the appropriate use of blood.

Objective: To analyze the CT ratio, TI, TP at a tertiary care oncology hospital and to assess the efficacy of blood ordering practices.

Methods: This was a retrospective study conducted over a span of two months from August to September 2024. Data was retrieved from the hospital information system and departmental records. This data was used to calculate the CT ratio, TI, TP.

Results: A total of 894 patients (477 Males and 372 Females) undergoing elective onco-surgical procedures were included in the study. Out of the 2456 units of packed red blood cells (PRBC) ordered and cross matched, only 11.97% (294/2456) were transfused; the CT ratio was 8.3. Out of 849 patients, only 154 patients required PRBC transfusion giving TP of 18.13% and TI of 0.3. Major departments requesting PRBCs were 25% (616/2456) from Head and Neck, 21% (517/2456) from Gastrointestinal (GI), 19% (461/2456) from Bone and Soft Tissue (BST). The maximum blood utilization was observed as 27.5% (81/294) in BST, 26% (77/294) in GI and 15.6% (46/294) in Head and Neck. The CT ratio ranged from 6-31 with neuro-oncology having the least (6) and Breast oncology having the maximum (31).

eP010: Blood Components: A retrospective case analysis of cryoprecipitate transfusion in a patient of chronic liver disease (CLD) with disseminated intravascular coagulation (DIC)

Bharat Ninggo, Kh Pratima, K. Rachandra Singh

Aim and Objective: To assess the role of cryoprecipitate transfusion in managing DIC and Thromboelastrography (TEG) based monitoring of coagulation function.

Background: Cryoprecipitate is the plasma product which contains a concentrate of fibrinogen and factors viii, vWF, XIII. It is used to treat a bleeding condition associated with low or deficiency of coagulation factors. Patient with CLD have multiple coagulation abnormalities sometimes may presented with DIC. It is characterized by the simultaneous occurrence of widespread vascular clot deposition, compromising an adequate blood supply to various organs and thereby contributing to organ failure. Cornerstone of managing DIC is treating underlying cause. However, initial management includes replacement of factors with pre-available factors and plasma product such as cryoprecipitate. TEG comes as point of care and real-time diagnosis tool for de-arrange coagulation function and tracking of effect or changes from the replacement of factors deficiency

Case Description: Requisition of 10 units of cryoprecipitate was received at blood bank RIMS on 28/6/2023 for 55 yrs male diagnosed with CLD and presented with manifestation of DIC, like bleeding episodes.

Outcome:

- Significant improvements in TEG tracing after cryoprecipitate transfusion are: -

I) K-value from 17.4 min to 4 min

II) Alpha angle from 23.8 degrees to 51.2 degrees

III) MA value from 21.8 mm to 36.4 mm

- Decrease in R value from 7.2 min to 1.6 min

Conclusion:

1. It was noted that significant improvement in coagulation profile or functions after the cryoprecipitate transfusion which was evident from the TEG recording chart

2. TEG rapidly provides a comprehensive assessment of the entire coagulation process and helpful as a guide for correcting coagulopathy

3. It is also helpful for rational use of blood and its components and reduce wastage.

eP027: Blood Donation and Donor Apheresis: Retrospective analysis of patterns of deferral among blood donors in a tertiary blood centre

Kolahalam Venkata Sai Kiran, Nidhi Bhatnagar, Sangita Shah, Mamta Shah

Introduction: Blood transfusion saves millions of lives. Proper donor selection is an important step to ensure safety of both donor and the recipient. Donors undergo strict selection criteria laid down by the Director General of Health Services and Drug Controller of India to ensure safety and quality of blood and blood products derived from their donation. Due to this, it is likely that donors may get deferred either temporarily or permanently. Rates and Reasons for deferral vary from region to region. All donors who are deferred must receive proper counselling and education regarding deferral reasons and adequate advice to rectify it.

Aim: The aim of the study is to analyse the rates and reasons of donor deferral in our blood centre.

Objectives:

• To observe the rates of deferral among different sexes

• To observe the rates of temporary and permanent deferrals.

• To study the various reasons of temporary and permanent deferrals.

Materials and Methods: It is a retrospective observational study done over a period of 2 years from January 2020 to December 2021. Details of the donors who were deferred either temporarily or permanently during the study period was collected from the donor registry in the Blood Bank Data Management System in our Blood centre.

Results: Out of the 73215 donors who registered for blood donation during the study period, 3192 donors were deferred either temporarily or permanently due to various reasons. Total deferral rate was 4.35% in our Blood centre. The major reasons observed were Haemoglobin less than 12.5 g% (30.6%), Hypertension (6.3%), Ongoing Medication (6%), Surgical Procedures (4.3%) and Prior Vaccination (2.7%).

Conclusion: Knowledge about rates and reasons of donor deferral guides the medical personnel to focus on proper screening of donors. Proper follow up measures and donor motivation programmes can be carried out in case of temporarily deferred donors to bring them back to donor pool.

Keywords: Blood donation, donor deferral, donor selection criteria

eP029: Blood Donation and Donor Apheresis: Analysis of blood donor deferral and action taken in last three years

Jignesh J. Desai, Abhay G. Jhaveri, Rinku V. Shukla, Kruti Dumaswala

Background and Objectives: Donor deferral can be categorized into temporary and permanent. Over the last few years, many blood donation organizations faced challenges of declining donor numbers. The aim of the study was to analyze the Temporary reasons of donor deferral due to three main common causes for the last three years (September 2021 to July 2024) and take proper action to reduce it.

Methods: We analysed the Temporary donor deferral data according to gender and reason (Low Hb, Low BP, Medication etc.). We counselled the donors to make lifestyle changes where appropriate like gave dietary advice and hematinics in case of Low Hb. We advised the donors to consult their doctors wherever needed.

Results: Total deferral rate during the study period (September 2021 to July 2024) was 16211 out of 88845 (i.e.18.35%).

In 2021 : 2183 donors (20.04%) from 10892 total donors

In 2022 : 5997 donors (19.32%) from 31069 total donors

In 2023 : 5521 donors (17.31%) from 31901 total donors

In 2024: 2510 donors (16.75%) from 14983 total donors

Overall The deferral rate is reducing every year.

Conclusion: If we analyse and counsel the deferred donors properly, we can reduce the donor deferral and reduce dissatisfaction about deferral. The deferral rate is reducing every year.

eP030: Blood Donation and Donor Apheresis: Blood donor deferral pattern at SMS blood centre

Vinita Kumari Dotania, Parmendra Pachori

SMS Medical College and Attached Hospital, Jaipur, Rajasthan, India

Background and Objective: Donor deferral is a significant challenge as it leads to the loss of motivated blood donors and reduces blood availability for patients in need. This study aims to analyze the frequency and reasons for blood donor deferral, including high hemoglobin deferral, which is often underreported. According to the World Health Organization (WHO), a nation’s blood requirement is approximately 1% of its population. In India, during 2016-17, there was a shortfall of 1.9 million blood units against the target of 13 million units.

Methods: This retrospective study reviewed the deferral records of whole blood donors at a tertiary care hospital from July 2023 to June 2024. The deferral process was categorized into four stages:

1. Stage A: Evaluation through the Donor History Questionnaire (DHQ)

2. Stage B: Medical examination

3. Stage C: Hemoglobin (Hb) check using the Hemocue Hb 301 Analyzer Hemoglobin System

4. Stage D: Pre-phlebotomy examination. The study followed national guidelines for blood donation screening.

Results: Out of 48956 pre-donation screenings, 9.8% of donors were deferred. The highest rate of deferral (56.04%) occurred at Stage C due to hemoglobin levels, with 53.40% attributed to low Hb and 2.64% to high Hb. High hemoglobin deferrals were seen only in male donors. The deferral rates at stages A, B, and D were 28.54%, 14.97%, and 0.45%, respectively. Female donors had a higher overall deferral rate (48.98%), while first-time donors and those aged 18 to 25 years were frequently deferred due to low hemoglobin, underweight status, or recent tattooing/ear piercing.

Conclusion: Understanding the reasons for donor deferral can inform proactive strategies for donor recruitment and retention. Educate potential donors, especially first-time and young donors, about maintaining healthy hemoglobin levels through diet and supplements.

eP031: Blood Donation and Donor Apheresis: Impact on whole blood donor deferral criteria during pre and post covid pandemic: A retrospective analysis

Poonam Saini, Poonam Saini, Saroj Rajput, Tathagata Chatterjee, Sumit Barik, M. S. Bindra

Background and Objective: Healthy blood donors are crucial for maintaining safe and adequate blood transfusion services, which are vital for patients undergoing surgeries, trauma care, or managing chronic conditions like anemia and cancer. Understanding the reasons for donor deferral is essential for improving recruitment, retention, and ensuring blood safety. This study aims to analyze the deferral patterns of whole blood (WB) donors and comparing the periods before and after the COVID-19 pandemic. By identifying the primary causes of deferrals and any significant shifts due to the pandemic, the study seeks to inform future strategies to optimize donor recruitment and ensure a stable and safe blood supply.

Methods: This retrospective comparative study analyzed WB donor deferral patterns at a tertiary care institute in northern India. Data were collected from donors who were deferred from donating blood during both the pre-COVID and post-COVID periods. The variables studied included the sex of the donor, donor type (voluntary or replacement), type of deferral (temporary or permanent), and reasons for deferral. All data were systematically recorded using a standardized proforma.

Results: A total of 13,457 donors donated blood during the study period, which was divided into two phases: pre-COVID and post-COVID. Of these, 2,026 donors were deferred, resulting in an overall deferral rate of 15.05%. Pre-COVID Deferrals Were 640 donor and the majority of deferrals were temporary, with anemia (24.21%) being the most common cause, followed by high haemoglobin. Post-COVID Deferrals Were 1386 donors were deferred after the pandemic. Similar to the pre-COVID period, anemia remained the primary cause of deferral. Across both periods, 87.79% of deferrals were temporary, allowing for the possibility of future donations and 12.21% were permanent deferrals.

Conclusion: COVID-related deferral criteria (recent illness, vaccinations, exposure) temporarily affected eligibility but did not significantly alter overall deferral patterns. Anemia remained the primary cause of deferral before and after the pandemic, highlighting its ongoing impact on donor eligibility. The study concludes that while pandemic-related challenges existed, medical deferral criteria remained stable.

eP032: Blood Donation and Donor Apheresis: Analysis of reasons for non-donation and role of awareness program for donor motivation in young adults

Minal Wasnik

Background and Objectives: Blood transfusion saves millions of lives worldwide. It depends on blood donation by healthy donor population. Young people are healthy and dynamic. They should be encourage and motivated to donate blood voluntarily. We conducted a questionnaire based study to assess the attitude toward blood donation with the following objectives:

1. To assess the reasons of non-donation among non-donors.

2. To assess the reasons of donation among donors.

3. To assess the impact of awareness session on willingness for donation.

Methods: A cross-sectional questionnaire-based study was conducted on young medical students to assess their attitude towards voluntary blood donation, reasons for non-donation & donation as well as role of awareness programs on donor motivation.

Results: Out of 157 participants, 96.2% had favorable attitude & 89.2% considered voluntary blood donation to be the best. 13 (8.3%) donated blood previously & 144 (91.7%) had never donated previously. Major reasons for non-donation included: fear of weakness/ anemia- 35.7%, fear of infection- 25.5%, health problems- 20.4%, fear of needle- 12.7%, and lack of opportunity- 11.5%. Reasons for donation among previously donated included: to be able to help those in need- 100%. Awareness session to address the misconceptions, explaining blood donation process & importance of voluntary blood donation resulted in improved willingness for donation from 83.4% to 93%.

Conclusion: Improved willingness for donation following awareness sessions highlights the importance of conducting regular information, education and communication activities for donor awareness. Collecting data regarding target donor population is an important strategy for planning specific motivation activities. Strategies like involving young medical students in donor motivation activities/ skits/ street plays, in-house blood donation camps, regular health checkups, maintaining registry of students’ blood groups, use of social media, peer motivation, etc. will be beneficial to inculcate and strengthen the positive beliefs regarding blood donation.

eP033: Blood Donation and Donor Apheresis: Trends of voluntary whole blood donation in the young age group in blood donation camps and measures to motivate and retain young donors – A study in North India

Surender Kumar Vats, Amena Ebadur Rehman, Richa Gupta, Saurabh Jain

Background: The youth of the country, especially college students, can serve as a readily available pool of voluntary blood donors and help tide away some of the scarcity of blood and blood products. This study was conducted to determine the Knowledge, Attitude, and Practice (KAP) regarding Voluntary Blood Donation among medical undergraduate students and non-medical students and to assess the factors which can lead to a subsequent increase in the same.

Methods: A survey was conducted amongst 1000 undergraduate medical students studying in various Medical Colleges in NCR in India and non- medical students, using a structured, self-administered questionnaire survey.

Results: The mean age of the participating students was 22.1 years with a standard deviation of 1.2 of which 59% were females. 71.2% and 61.4% students had correct knowledge regarding interval between blood donation for males and females respectively but the knowledge regarding common causes of deferral was less. Posters and pamphlets were the most common sources of information regarding blood donation. 92.6% of students had a good attitude towards blood donation. 127 (25.4%) students had donated blood previously and 17 (3.4%) of them had donated blood more than once in a year.

Conclusion: The students had a fair knowledge of VBD and the majority had a positive attitude towards it. Steps should be taken to increase the awareness regarding VBD since early sensitization can motivate students to become voluntary blood donors, making them major contributors to the blood donor pool throughout their adulthood and help in overcoming blood shortage in the country.

Keywords: Attitude, knowledge, medical and non-medical students, practice (KAP), voluntary blood donation (VBD)

eP034: Blood Donation and Donor Apheresis: Study of donor characteristics on the yield in single donor platelet pheresis

Parimala Puttaiah, Shubham, Latha Fathima, Vanamala, S. Sitalakshmi, Shanthala Devi

Background: Plateletpheresis procedures (single donor platelets, SDP) produce an average of equivalent of 6-10 units (3-5 × 1011 platelets) of random donor platelet concentrates and have now become the main source of platelets. They carry additional benefits of lowered risk of exposure to transfusion transmitted infections. alloimmunization and FNHTR. Platelet recovery in recipient is influenced by the yield of SDP which in turn is determined by various donor variables.

Aims and Objective: To assess the effect of various donor related factors on the yield of single donor platelets.

Methods: A total of 2296 donors underwent platelet aphaeresis during the study period (2015-2023) in the Dept. of TMIH, SJMCH. Relationship between platelet yield and various donor and machine related factors and the strength of relationship was studied using multivariate analysis method and Pearson correlation coefficient. P value <0.05 was significant. Characteristics studied – Demographics, haemoglobin, Pre-donation platelet count, Blood group, Total blood volume processed, processing time and Platelet yield.

Results: Platelet yield showed high statistical significance with pre-donation platelet count (p=0.001). Weight, haemoglobin, blood volume processed of donors, processing time had significant positive correlation with platelet yield. No statistical significance was seen Age of donor (p=0.409) on platelet yield.

Conclusion: A higher donor platelet count, haemoglobin concentration and weight correspond to high platelet yield. Identification of such factors would have a significant beneficiary effect on platelet yields and thereby leading to better platelet recovery in the recipient.

eP035: Blood Donation and Donor Apheresis: Pre donation deferral pattern among blood donors at tertiary care hospital, Mumbai (Maharashtra)

Shashank Joshi, Bharat Ghodke, Sanjay Surase, Sumedha Shinde

Background: Safe and adequate blood transfusion services is need of modern health care system as even a unit of blood and blood product can save a patient in need. Healthy donors are screened and selected according to the standard guidelines. Few are deferred either temporarily or permanently according to rejection criteria.

Objectives: To analyse pattern of blood donor deferral and to understand common causes of deferral and an attempt to reduce unnecessary temporary deferral. To recruit temporary deferred donor for next blood donation.

Methods: Study was cross-sectional and retrospective for the period of 7 months (March 2024– September 2024) total 258 donors were deferred. It was recorded as per a mandatory donor form which has all demographic details, past medical/surgical history, previous transfusion and blood donation related details.

Results: Total 4189 donors were registered during the period out of which 258 donors were deferred;16 were permanently and 242 were temporarily. Low hemoglobin was the most common cause 156, 39 due to high blood pressure, 19 due to history of medication, 06 due to alcohol consumption, 13 had history of dengue/typhoid/chikungunya, 09 due to tattoo/minor procedure.

Conclusion: All deferred donors were advised according to deferred criteria. So that they can be recruited in future after fitness.

eP036: Blood Donation and Donor Apheresis: Prevalence of transfusion transmitted infections among blood donors and their response to notification

Saurabh Jain, Richa Gupta, Manisha

Introduction: Transfusion Transmitted Infections (TTI) pose a significant concern in the context of blood donation. In order to ensure the safety of blood supply, blood donors in India are screened for HIV, Hepatitis B, Hepatitis C, Syphilis, and Malaria. Donors are offered the option of knowing their TTI reactive status at the time of taking consent for blood donation. Reactive donors are requested to visit the blood centre for further counselling and referral.

Aims and Objectives: To study the sero-prevalence of TTI and to evaluate the response rate of reactive donors to notification.

Materials and Methods: This retrospective observational study was conducted in a tertiary care hospital in Delhi. Data on TTI reactive donors from Jan 2021 to Dec 2023 were collected from departmental records and registers. Reactive donors were notified through three telephone calls immediately after test result, after 48 hours, and on day seven as per departmental Standard Operating Procedure. Responses were analysed.

Results: From 71473 donations, 3029 (4.23%) were TTI-reactive. HbsAg had 982 cases (1.60%), Syphilis 838 (1.17%), HIV 450 (0.62%), Hepatitis C 681 (0.95%), and Malaria 0 (0.0%). Out of all the reactive donors contacted over the telephone, only 1675 (55.29%) responded, and only 1280 (76.41%) attended counselling in the blood centre. Reason of not responding is: - wrong contact details/ not responding on call/ phone switch off/not reachable 940 (31.03%), Deny to attend counselling 290 (9.57%), donors from neighbour state 124 (4.09%).

Conclusion: The low response rate of counselling shows poor healthcare awareness and social stigma regarding TTI. Donors unaware of their reactive status results in secondary transmission of infections. Strict pre-donation counselling and proper notification is crucial to improve response rate and ensure blood safety.

eP037: Blood Donation and Donor Apheresis: Exploring the spectrum of adverse reactions in blood donation: A retrospective analysis of donor data on incidence and patterns

Kamal A. Patel, Priti Mistry, Vishal Mehta, Yazdi Italia

Background and Objective: This retrospective analysis aimed to evaluate the incidence and patterns of adverse reactions related to blood donation. The study focused on identifying key determinants of donor complications, quantifying their frequency, and classifying reaction types based on demographics, donation history, and other relevant factors. By examining historical datasets, the analysis systematically characterized trends in mild, moderate, and severe reactions, revealing correlations between specific donor profiles and increased likelihood of adverse events. These findings provide a foundation for optimizing donor screening protocols and enhancing safety measures to improve donor welfare and ensure the sustainability of blood donation programs.

Methods: A retrospective analysis of donor records pertaining to adverse reactions was conducted from January to December 2024 at Valsad Raktdan Kendra, Gujarat, India.

Results: Out of a total of 17,693 blood collections, 136 individuals (0.8%) experienced adverse reactions. Among the 3,563 in-house collections, 25 donors (0.7%) reported adverse reactions, while 111 out of 14,130 camp collections (0.8%) experienced similar issues. Analyzing donor demographics, 117 out of 15,946 male donors (0.7%) and 19 out of 1,165 female donors (1.6%) experienced adverse reactions. Additionally, among the 3,332 first-time donors, 42 individuals (1.3%) reported adverse reactions, compared to 94 out of 14,361 repeat donors (0.7%). Of the 136 reported adverse reactions, 125 (92%) were characterized by dizziness, 10 (7%) by giddiness, and 1 (0.7%) by nausea/vomiting.

Conclusion: The incidence of adverse reactions in blood donation was low at 0.8% across 17,693 collections, with camp and in-house collections showing similar rates. Female donors experienced a higher incidence (1.6%) compared to male donors (0.7%), while first-time donors had a slightly elevated rate (1.3%) compared to repeat donors (0.7%). Dizziness was the most common adverse reaction reported. These findings enhance understanding of donor safety and inform the management of adverse reactions in blood donation programs.

eP038: Blood Donation and Donor Apheresis: Analysis of grade III vasovagal reactions

Thettayil Joseph John, Pratul Sinha, Vilasini Patil, Romesh Jain

Background: Any untoward feeling experienced by the blood donor before, during or after blood donation is called an adverse donor reaction (ADR). The retention of blood donors is important, if not less than the recruitment of new blood donors. Retention of voluntary blood donors and availability of safe blood is affected by ADR. Hence, our study focuses on the trend of grade III vasovagal reactions (VVR).

Objectives:

1. To study the frequency of various grades of VVR occurring among blood donors in a blood center of a tertiary care health center in central India

2. To assess the factors contributing towards grade III VVR.

Methods: A retrospective analysis of ADR in AIIMS Bhopal was carried out. Data was collected from adverse donor reaction registers, haemovigilance forms and donor screening cards from 1st June 2020 to 30th September 2024. The data comprises the frequency of mild, moderate and severe grades of VVR among blood donors. This data was analyzed and correlated to the various factors that could lead to these complications.

Results: Frequency of VVR among blood donors in AIIMS Bhopal varied from 1.16% to 2.71% over a span of five years. Major factors that contributed to grade III VVR included first time donation (60%), inadequate sleep (40%) and empty stomach (30%).

Conclusion: There was a decreasing trend and then a sudden spurt in grade III VVR in 2024. Inadequate sleep, empty stomach, anxiety, first time donation and history of previous ADR are the major contributing factors showing that with adequate care most of the reactions could have been prevented. Situations like increased waiting period, lack of trained personnel, lack of cheerful and lively environment and decreased post donation waiting period can also contribute to a higher incidence of causative factors leading to grade III VVR.

eP039: Blood Donation and Donor Apheresis: A retrospective study of whole blood donor deferral pattern in a tertiary care hospital in Southern Rajasthan

S. Sainu Ummulkhulzum

Background and Objectives: Blood is an inevitable requirement for health care and blood donors play a pivotal role. However before blood donation it is necessary to screen the donors and defer from donating if they have any conditions or diseases that may affect the quality of blood or lead to adverse reactions to patients or donors. This is to ensure the safety and health of the blood donor as well as the recipient. The aim of this study is to analyse the deferral pattern and its causes among whole blood donors at a tertiary care blood centre.

Methods: Retrospective study from January 2024 to September 2024.

Results: Out of 21311 whole blood donors, 542 donors were deferred. Most common cause of deferral was low hemoglobin, low body weight and ongoing medication. Other causes of deferral are tattoo made within 1 year, surgical causes, underage, high blood pressure and menstruation.

Conclusion: In our study, Low hemoglobin levels were found to be one of the major cause of donor deferral. To avoid this reason of deferral, awareness and continuous education of the donors to improve the hemoglobin levels should be done. All the temporary deferred donors should be educated for the reasons they are deferred. This can help to retain the pool of motivated blood donors.

eP040: Blood Donation and Donor Apheresis: Comparison between hemocue and automated haematology analyser for Hb estimation in blood donors

Bhargavi Rathod, Sangita Shah, Nidhi Bhatnagar, Mamta Shah, Rahul Rajvanshi

Background and Objective: Hemoglobin (Hb) estimation in blood donors is an essential part of the donor screening to ensure both donor safety and the quality of donated blood. Adequate Hb level shows that the donor has enough iron reserve to donate without risking anaemia. Hb estimation is a crucial step in blood donor screening. In India accepted donors must have Hb level of 12.5 gm/dl to donate blood, below this level donors are often deferred from donation. Methods of Hb estimation in blood donors are 1) HemoCue device: Hemocue is portable point-of-care device that estimates Hb using modified azidemethemoglobin reaction. 2) Automated Haematology Analyser: These analysers are commonly used in central laboratories for precise Hb measurements and complete blood count. The objective of this study is to evaluate the performance, accuracy and practicality of HemoCue versus Automated Haematology Analyser for Hb estimation.

Materials and Methods: In this descriptive study, total of 95 donors were selected and their capillary and venous blood sample collected. Hb estimation of capillary blood was done by portable HemoCue photometer and Hb estimation of venous blood was done by Automated Heamatology Analyser . Both data were collected, analysed and expressed as 95% confidence interval.

Results: The HemoCue and Automated haematology analyser’s results correlated well. Hb estimated by HemoCue photometer is 13.96 ± 0.03 gm/dl. Hb estimated by Automated haematology analyser is 14.14 ± 0.04 gm/dl. Variation between these two methods in Hb estimation is 0.2 ± 0.03 gm/dl.

Conclusion: Hemoglobin levels were given by HemoCue were within acceptable range of Hb level confirmed by Automated Heamatology Analyser for same donors. Hence, HemoCue’s practicality in onsite screening ensures accuracy, accessibility and rapid assessment, supporting blood donation efforts across diverse settings.

eP041: Blood Donation and Donor Apheresis: Retrospective analysis of reasons of deferral among blood donors in a blood centre attached with tertiary care hospital of Gujarat

C. Elizabeth Udayan, Mamta Shah, Nidhi Bhatnagar, Sangita Shah, Kamini Gupta

Introduction: Blood transfusion saves millions of lives. Proper donor selection is an important step to ensure safety of both donor and the recipient. Donors undergo strict selection criteria laid down by the Director General of Health Services and Drug Controller of India to ensure safety and quality of blood and blood components derived from their donation. Due to this, it is likely that donors may get deferred either temporarily or permanently. Rates and Reasons for deferral vary from region to region. All donors who are deferred must receive proper counselling and education regarding deferral reasons.

Aim: The aim of the study is to analyse the rates and reasons of donor deferral in our blood centre.

Objectives:

• To observe the rates of deferral among blood donors

• To observe the rates of temporary and permanent deferrals.

• To study the deferral rate among different genders

• To study the various reasons of deferrals

Materials and Methods: It is a retrospective observational study done over a period of 1 year from 1st January 2023 to 31st December 2023. Details of the donors who were deferred either temporarily or permanently during the study period was collected from the donor registry stored with in the Blood Bank Data Management System in our Blood centre.

Results: Out of the 40131 donors who registered for blood donation during the study period, 2071 donors were deferred either temporarily or permanently due to various reasons. Total deferral rate was (5.16%) in our Blood centre. The major reasons observed were Haemoglobin less than 12.5 g% (12%), Hypertension (6.9%), Ongoing Medication (5.8%), Surgical Procedures (7%). And among the rejections temporary deferral rate is (65%) and permanent deferral rate is (35%). When considering among different genderfemale deferral rate is (10.7%) and among male is (5.2%).

Conclusion: Analysing donor deferral data guides health education initiative, encouraging healthy habits and reducing health risk among potential donor and general public. Deferred donors should be informed in warm and supportive manner, the reason of deferral and they should be informed of when they will be able to donate blood in future. It is important to give positive healthy messages.

eP054: Clinical Transfusion Therapy and Patient Blood Management: Revolutionizing blood delivery: Pneumatic tube system for blood components transport

Shital A. Soni, Dhara Patel, Brijesh Patel, Nirali Patel, Parul Prajapati, Truptee Thakkar, Ajay Taviyad

Background and Objectives: Pneumatic tube system (PTS) is a widely used method of transporting blood samples in hospitals. Blood product transport from the blood centre to patient care areas of hospitals is a key step in the transfusion chain. Urgent blood component transfusion may be life saving for patients with cardiac disease. Transport time is shorten with the use of PTS system. At our blood center we receive blood request via PTS so we considered using PTS for transporting blood components. There are reports of hemolysis in blood samples through the PTS, we evaluated this system for transporting blood components especially in packed red cells. To find efficient use of PTS for transportation of blood components within the hospital.

Methods: A total of 100 different blood components were subjected for evaluation transported through PTS which connects 46 stations. The systems transports the carrier at average speed of 4-5 m/s. Pre and post transport quality control parameters, visual appearance, transport time and temperature of packed red cells, thawed fresh frozen plasma cryoprecipitate and platelet concentrate (RDP) were evaluated. Parameters were compared between pre and post transport via PTS.

Results: A total 100 different blood components, 50 units PRBCS, 20 units FFP, 25 Platelets, 5 Cryoprecipitates were evaluated. No statistically significant differences were found between pre and post transport results. All blood components transported matched regulatory requirements for quality criteria. The temperature during transport remained stable and the transport time via PTS was shorter.

Conclusion: The PTS was considered a fast, safe and reliable means of transportation for blood components, also securing quality prerequisites.

Keywords: Blood components, pneumatic tube system, quality criteria

eP055: Clinical Transfusion Therapy and Patient Blood Management: A retrospective study to determine efficiency of aliquoting for pediatric patients in preventing blood wastage and multiple donor exposure

Arzoo Singh, Ravi Rani Mishra

Background and Objectives: Aliquoting involves dividing a single donor blood unit according to weight- based requirements typically dosed at 10-15 ml/kg for PRBC into multiple smaller units known as Aliquots. It helps in sequential transfusion of these smaller units from a single donor unit to a particular patient which minimizes exposure to multiple donors. The objective of this study is to evaluate the efficiency of aliquot preparation in preventing blood wastage and minimising the risks associated with exposure to multiple donors.

Methods: This is a retrospective study. The duration of this study is from June 2023 to June 2024. All the aliquots were prepared using transfer bags and sterile connecting device, labelled with donor number, segment number and patient identifying details. The study sample consisted of total 224 patients requisitions sheets with 512 demands.

Results: The findings revealed that among 512 supplied aliquots, 71.10% of the aliquots were used effectively and 9.96% were returned to the blood centre stock and subsequently supplied to other patients. In the context of 224 patients, the total demand of blood units was met with 512 aliquots instead of 512 original donor units. Consequently, we were able to save 336 donor units in a year also 123 patients came with multiple demands of which only 2 were exposed to multiple donor rest 121 were supplied from single donor units. Therefore, aliquoting effectively prevents multiple donor exposure with efficiency of 98.37% and prevents blood wastage with efficiency of 65.63%.

Conclusion: Aliquot preparation should be done at every government as well as private sector blood centres. Prevention of multiple donor exposure favours better patient prognosis and prevention of blood wastage is very crucial in developing countries like ours. Afterall we as a society need to conserve and maximise the use of this scarce resource “BLOOD”.

eP056: Clinical Transfusion Therapy and Patient Blood Management: Analyzing blood transfusion practices for pediatric and neonatal patients: A tertiary center experience from central India

Romesh Jain, Anubhav Gupta, Vilasini Patil, Pratul Sinha, Snehashish Mishra, Satyam Arora, Rut Naik

Background and Objectives: Blood transfusion is essential in managing pediatric patients with various medical and surgical conditions. Despite the high demand for pediatric transfusions, comprehensive national data on transfusion practices in India are lacking. This study aims to identify the proportion of blood utilized for pediatric patients, determine the most common medical and surgical transfusion indications, and evaluate differences in indications based on age groups.

Methods: A retrospective cross-sectional study was conducted over one year and analyzed transfusion requisitions for patients aged ≤18 years. The study included neonatal (≤1 month) and pediatric (> one month to ≤18 years) patients. All blood requisition forms were screened for laboratory parameters and indications and divided into appropriate and inappropriate episodes according to the British Committee for Standard in Hematology (BCSH) guidelines for transfusion in fetuses, neonates, and older children.

Results: Out of 15,949 blood requisitions, 3,207 (20.10%) were for neonatal and pediatric patients. Medical reasons (71.4%) were the primary cause for transfusions, with anemia (43.01%), thrombocytopenia (24.89%), and coagulopathy (19.69%) being the most common. Surgical indications accounted for 27.93% of transfusions, with gastrointestinal surgery (13.5%) and orthopedics (9.26%) being frequent reasons. Packed red blood cells were the most requested component (61.89%), followed by platelets (21.85%) and fresh frozen plasma (11.16%). In total component requisitions (3207), 64.1% were appropriate, and 35.9% requisitions were inappropriate according to BCSH guidelines. Most of the inappropriate requisitions were received for FFP components.

Conclusion: The study highlights the significant demand for pediatric transfusions, predominantly for medical indications. The findings are consistent with global patterns, underscoring the importance of tailored transfusion protocols and comprehensive management strategies for pediatric patients. This study provides crucial insights into pediatric transfusion practices in Central India, emphasizing the need for region-specific guidelines and improved clinical practices to enhance patient outcomes.

eP057: Clinical Transfusion Therapy and Patient Blood Management: Blood utilisation patterns in abnormal uterine bleeding: A retrospective chart review

Shivanand Hemant Kumatagi, R. Arun, Nabnita Patnaik, Chada Tejaswi, Vasanth Asirvatham, Arya V. Nair, Aswin Mohan

Background and Objectives: Abnormal uterine bleeding (AUB) affects 30% of reproductive age women globally.[¹] The diagnostic guideline using structural and functional causes of AUB adopts the PALM-COEIN criteria. The role of blood transfusion in management of women presenting with AUB is unclear and has not been studied before. Hence, our aim was to study the blood utilisation patterns in patients who presented with AUB.

Methods: It is a retrospective chart review conducted for a period of 2 years in a tertiary care hospital in southern India by departments of Transfusion Medicine and Obstetrics and gynecology. The RhD positive patients of all ABO blood groups are supported by the institute blood storage center while others are supported by outside blood centers. The details of all the patients who were transfused with support from the blood storage center were identified from issue register. Only those who had diagnosis of abnormal uterine bleeding were selected. Then the demographic profile and clinical and transfusion details were entered in Microsoft excel. The data was analysed and the standard transfusion indices were calculated.

Results: Total number of patients who presented with AUB and were transfused with packed red cells were 50. The patient’s age group was mostly 30-50 yrs (84%) followed by 18-29 yrs (14%), >51 yrs (2%). The Blood group frequency was: 50% (O pos), 28% (B pos), 20% (A pos), 2% (ABpos). 75% of them had no previous history of transfusion while 25% had such history. 30% patients had previous history of abortion. Indications for transfusion were 90% anemia, 10% bleeding. The hemoglobin level (gm/dl) was: <7 (82%), 7-8 (12%), >8 (6%). Indication type of blood request was 70% elective, 30% urgent. Antibody screening was negative in all patients. The number of transfusion episodes were 84 (1 unit – 70%, 2 units – 20%, 3 units – 10%). Transfusion indices were calculated as follows: CT ratio: 1.1, BU: 91%, TI: 1.5, TP: 100%.

Conclusion: The transfusion was appropriate in most cases. The good transfusion practises were followed for blood utilization in AUB since the transfusion indices were in acceptable limits.

Reference

1. Sangha R, Keerthy M. Blood transfusion trends in women with abnormal uterine bleeding [14D]. Obstet Gynecol 2017;129:45S.

eP058: Clinical Transfusion Therapy and Patient Blood Management: Safety and efficacy of ABO non-identical platelet transfusion at a tertiary care center in Southern India

M. Swetha, B. Shanthi

Department of IHBT

Background and Objective: ABO non-identical (ABOni) platelet transfusions are often used when ABO-matched platelets are unavailable, posing risks such as reduced platelet recovery. This study investigates the safety and efficacy of ABOni platelet transfusions at a tertiary care center in southern India, aiming to enhance clinical outcomes and transfusion practices.

Methods: This retrospective study analyzed data from January to September 2024 at our blood center, focusing on patients receiving ABOni random donor platelet (RDP) transfusions. Patient demographics, body surface area (BSA), and clinical data were collected. Platelet counts before and 24 hours after transfusion were measured to calculate the corrected count increment (CCI) and absolute platelet increment (API), assessing the efficacy of the transfusions.

Results: A total of 393 patients (233 males, 160 females, ages 5–82) received ABOni platelet transfusions. The highest number of transfusions occurred in the medical oncology group (MOG) with 111 patients, followed by hematology and cardiothoracic departments. Incompatibilities were classified as major (146 cases), minor (227), and bidirectional (20). CCI outcomes were: >4500 in 4% of patients (16), <4500 in 47% (184), no increment in 18% (16), and a fall in platelet count in 31% (122). API showed an increment in 51% of patients, no change in 18%, and a decrease in 31%. No adverse reactions were reported.

Conclusion: ABO non-identical platelet transfusions are generally safe, though their efficacy varies due to patient-related factors. Further studies are needed to better understand these variables and optimize transfusion practices.

eP059: Clinical Transfusion Therapy and Patient Blood Management: Post-transfusion crossmatch incompatibility: Diagnostic and transfusion dilemma exploring from a case series

Ashirbad Sharma, Suman S. Routray, Nirupama Sahoo, Gopal K. Ray, Devi P. Acharya, Sukanta Tripathy

Background: In adults, direct antiglobulin test (DAT) positive is caused by AIHA, transfusion reaction, medications, infections, autoimmune illnesses, and certain cancers. AIHA and delayed haemolytic transfusion reaction (DHTR) have similar clinical and laboratory features, but a thorough medical history and immune-haematological (IH) evaluation can identify them. The lack of an integrated electronic medical record system for blood facilities, multi-care sites, and incomplete medical records exacerbate matters.

Objective: To emphasize the necessity of medical review and detailed pre-transfusion testing in differentiating AIHA and DHTR in post transfusion sample.

Methods: Five referred cases of suspected autoimmune hemolytic anemia (AIHA), with transfusion history, had incompatible crossmatch. This necessitated a review of historical records and comprehensive immunohematological work-up like DAT, Monospecific DAT, thermal specificity of the suspected auto-antibody, antibody screening, antibody identification (AI) were done to exclude underlying alloantibodies due to recent transfusions. Elution study of DAT positive cells and AI of the eluate was also done. Extended phenotyping was performed to aid in diagnosis. Cases were reviewed closely for a detail medical history, and it was recommended that haemolytic markers be sent in conjunction with a haematology consultation.

Results: A comprehensive IH workup in 4 cases out of 5 suggested DHTR except for the one case (CASE-1) where it could not be deciphered due to persistence of pan-positive reactions on antibody identification and elution study. But, the patient was found to have kidd null phenotype serologically, indicating presence of an antibody against the high frequency antigen. Two cases were managed with Rituximab while two other cases required steroids, IVIG and antigen negative blood transfusions.

Conclusion: This case series highlights the critical need for careful differentiation between AIHA and DHTR. While a positive DAT is a common finding, it is not definitive for AIHA, and further evaluation specifically antibody screening and eluate analysis is essential to accurately diagnose DHTR.

eP060: Clinical Transfusion Therapy and Patient Blood Management: A clinical audit – Interventions to improve emergency release blood practices in a quaternary care hospital in South India

V. M. Jyotsnaa Grace, Deepti Sachan, Deepthi Krishna

Introduction: Emergency release of blood is often required for trauma or non-trauma cases where un-crossmatched O negative or group compatible red cell units are issued before completion of pre transfusion testing. The efficient utilization of blood components during an emergency is crucial for improved patient outcome. At present, the need for blood transfusion during an emergency is at the discretion of the treating physician/surgeon.

Aim and Objective: To analyze the parameters involved in emergency utilization of blood and to implement interventions to improve the clinical practice. To compare pre and post implementation results to evaluate the performance of our blood centre and inter-departmental co-ordination.

Materials and Methods: This study was conducted by the Department of Transfusion Medicine, Rela Institute and Medical Centre as a two-phase clinical audit after obtaining ethical clearance from the audit committee. Emergency-release forms (ERF) received at our blood centre from 2019-Dec 2023 (Phase I) were retrospectively analyzed for patient demographics, diagnosis, indication, location of the patient. A revised ERF was created with additional parameters including transfusion trigger, total units transfused in 24 hours, pre and post transfusion laboratory values, Turnaround time (TAT) and outcome of the patient and implemented in 2024. Prospective analysis of data (Phase II) was done for a period of 7 months (January to August 2024) after effective training of blood centre staff and clinical end blood users.

Results: A total of 221 (0.45%) emergency blood requests were received during the period of 2019 to Dec 2023. The major indication for emergency release of blood was therapeutic and the most common diagnosis was Upper Gastrointestinal bleed (UGI) followed by Road traffic accident. Details regarding the indication, location, patient outcome and massive transfusion were not completely documented in the phase I period. The post-implementation analysis showed significant improvement in all parameters especially with regard to TAT, transfusion trigger and patient outcome. The average TAT for emergency requests was 3 minutes, with the longest time being 20 minutes. With respect to patient outcome, majority were discharged in stable condition. Bleeding was the most common transfusion trigger predominantly due to UGI bleeds, followed by postpartum hemorrhage (PPH), and polytrauma. Low hemoglobin with tachycardia was the next common trigger followed by breathlessness, often due to anemia or UGI bleeds. A few patients presented with un-recordable blood pressure due to shock from severe anemia.

Conclusion: As there are no standard guidelines directing the use of emergency blood due to varied hospital transfusion practice and availability of lesser data, effective documentation of parameters such as transfusion trigger (e.g., life-threatening bleeding, shock, or severe anemia) ensures that O-negative blood is used when absolutely indicated. Blood grouping and typing should be well-documented for patients with repeated hospitalizations to reduce the overuse of O-negative in situations where group-specific blood units could suffice. Standardizing the use of uncross-matched O-negative blood or group-specific units is critical for preventing the wastage of O-negative blood. Effective communication, co –ordination and monitoring is necessary to ensure safe and effective use of blood.

eP061: Clinical Transfusion Therapy and Patient Blood Management: ABO antibody titres in healthy blood donors from Eastern India: Prevalence and influencing factors

Devi Prasad Acharya, Sumansudha Routray, Sukanta Tripathy, Gopalkrushna Ray, Nirupama Sahoo

Introduction: Intravascular hemolysis from passively transferred antibodies (because to complement activation) in a modest ABO-incompatible RDP transfusion can be fatal. Western countries have a critical titre level for incompatible RDP issues. There is a rising interest in determining safe or critical titer levels for issuing a minor incompatible RDP in our region.

Objectives: This study aimed to assess the levels of IgM and IgG antibodies against A and B antigens in healthy blood donors.

Materials and Methods: This is a six-month crosssectional, multicentric study of healthy volunteer blood donors in two eastern state tertiary care centers. Factors known to influence ABO titres was recorded. Blood grouping of the donors were performed by gel method (Tulip ABO fwd-rvs card). Pooled A and B cells were employed to measure IgM and IgG antibody titres using the conventional tube method (CTT) at room temperature and Dithiothreitol (DTT) treated serum in AHG phase according to AABB guidelines. High titers was defined as 1:64 or higher for IgM and 1:256 or higher for IgG anti-A and anti-B.

Results: The study included 200 donors, with 62.2% being middle-aged adults (26–44 years) and a mean age of 23.7 years. Nearly 56% of donors had titres >64. The median IgM anti-A and anti-B titres in B and A groups were 64. The median IgM anti-A and anti-B titres in O group were 64 and 32. High titres did not correlate with donor age or blood group. Four O blood donors reported high IgG titres, but none in A or B groups. However, high IgM did not correspond with high IgG.

Conclusion: A substantial portion of donors in our region demonstrated critical antibody titres, including an IgG component across all blood groups. Additional research is necessary to clarify the implications of transfusing these blood products.

eP062: Clinical Transfusion Therapy and Patient Blood Management: Effects of autologous blood transfusion in cardiac surgery reduces donor blood requirement – A prospective cohort study

M. Arun, Archana Bajpayee, Alok Kumar Sharma

Introduction: Cardiac surgery is one of the most critical allogenic transfusion-dependent surgical specialities. The blood transfusion rate in cardiac surgery remains high despite using different blood conservation techniques. Recent studies that suggest restrictive transfusion practices show no evidence of increased harm compared to liberal strategies.

Aims and Objective:

1) Effects Of Autologous Blood Transfusion in Cardiac Surgery.

2) Cost-effectiveness of autologous blood transfusion.

Materials and Methods: This Cohort study was conducted in the Department of Transfusion Medicine, AIIMS, Jodhpur, from August 2017 to March 2020. We hypothesized that a strict blood conservation protocol that directs all cardiac surgery patients whose hb more than 10 g/dl are advised to undergo ANH, this procedure will reduce the number of transfusions required. A total of 83 consecutive patients were included in the study. All the patients undergoing cardiothoracic surgery by a single group of surgeons were included. Patients with preoperative hemoglobin of <10 g/dl were excluded.

Results: Group A included 57 (68.67%)) patients in whom one/ two units of autologous blood were withdrawn after induction of general anesthesia. Group B included 26 (31.32%) patients in whom no autologous blood was withdrawn. In group A, 21.27% of patients required intra/postoperative PRBC transfusion, while in group B, 62.5% of patients required intra/postoperative PRBC transfusion (p-value=0.039), showing significantly lower PRBC requirements in group A. In addition, the number of units of PRBC blood transfused in group A was significantly lower than that transfused in group B (0.44±1.1 vs. 0.58±.86 units respectively; p-value:0.048).

Conclusion: Autologous blood transfusion effectively reduces allogenic blood requirements in patients undergoing cardiac surgery, and it reduces the risk of transmission of the TTI infectious. Compared with other blood conservation strategies, autologous blood donation remains a promising and cost-effective alternative to reduce allogenic blood transfusion in elective cardiac surgery.

eP063: Clinical Transfusion Therapy and Patient Blood Management: Transfusion practices and pattern of blood components in liver disease patients at a tertiary centre in North India

Kailash Kumar, Anupam Verma, Pallavi Rani, Priti Elhence

Background and Objectives: The goal of blood transfusion is to provide a safe, sufficient, and timely supply of blood components to the recipients. In liver disease patients, the transfusion is usually prophylactically and is done to improve the coagulation profile. Presently, the transfusion decision is mainly based on the results of Conventional coagulation tests. But with the advent of point of care test of coagulation, which better define the hemostatic profile, there are no guidelines to define the cut-offs for transfusion based on their value. The objective of this study is: 1) to assess the utilization pattern of blood components and 2) to assess the potential of global tests (Thromboelastography (TEG) and Rotational Thromboelastography (ROTEM)) to assist in targeted transfusion therapy in liver disease patients.

Methods: Prospective study, from August 2023 to August 2024. Data was gathered from patient file, Hospital Information System, Records from Emergency Medicine and Transfusion Medicine Departments. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS, USA).

Results: The blood utilization rate in terms of Cross-match to Transfusion ratio, Transfusion probability, and Transfusion index were 1.02, 99.2%, and 0.99 respectively. A total of 534 liver disease patients were admitted to the Emergency department. Out of which 107 patients (20.4%) had highly deranged coagulation profile. Out of 107 patients, 46 patients (42.9%) required at least one blood component transfusion. Out of 46 patients, in 38 (82.6%) patients the transfusion decision was based on the cut-off values of conventional tests of coagulation. Whereas in 8 patients (17.3%) the TEG and ROTEM were additionally able to predict the deranged coagulation, which was not reflected on conventional tests of coagulation.

Conclusion: The current transfusion guidelines in liver disease patients are based on the cut-offs depending on conventional tests of coagulation. This study compares the values of conventional tests of coagulation with point of care/global test of coagulation. This had assisted us in suggesting transfusion in additional 17.3% patients and in preventing bleed in liver disease patients.

eP064: Clinical Transfusion Therapy and Patient Blood Management: Patient blood management for obstetrics and gynaecological

Rohitkumar Panucha, Jitendra Vachhani, Shweta Upadhyay, Digeet Davad

Background: Patient blood management [PBM] is a multimodal, multidisciplinary approach, adopted to hemoglobin concentration, optimize hemostasis and minimize blood loss to imrove patient outcome. It improves the red cell mass, conserving the patients own blood and improving anaemia. It minimize the use of allogenic transfusion in obstetric and gynaecological practice.

Aim: To provide guidelines for transfusion of blood and blood components in obstetrics and gynaecological patients.

Objective:

1. Study the indications of blood transfusion.

2. Analyse the frequency and utilization of blood and blood components.

3. Minimize the requirements of blood transfusions.

Materials and Methods: A retrospective analysis was conducted to determine the frequency and kind of components used in various obstetric and gynecological cases at G.G.G. Hospital, Jamnagar. Study included patient admitted in obstetric and gynecological ward between january 2023 to december 2023.

Results:

Number of blood transfusions in past 1 year- 9783

Patients admitted in obstetrics & gynaecology ward- 10833

Obstetrics cases-10507.

eP065: Clinical Transfusion Therapy and Patient Blood Management: A universal framework addresses blood shortages, focusing on A-positive and rare negative groups, while reviewing adverse transfusion reactions

Kamal Patel, Priti Mistry, Vishal Mehta, Yazdi Italia

Background: A universal blood transfusion framework was implemented to address shortages, focusing on A-positive and rare negative blood groups (especially in RCC). This strategy optimizes donation and transfusion by prioritizing blood type compatibility, mitigating the vulnerability of rare blood types like AB-negative. For example, A-positive recipients can receive blood from A+, A-, O+, and O-, while AB-positive can accept all blood types. In contrast, rare negative types like AB-negative are restricted to AB-, A-, B-, and O-, making them more prone to shortages. Additionally, the framework integrates a review of adverse transfusion reactions to enhance patient safety. By combining compatibility optimization with safety protocols, the approach aims to improve blood supply reliability and reduce transfusion risks, particularly for critical blood groups.

Objective: The objective of this study was to evaluate the implementation of a universal blood transfusion strategy.

Methodology: A retrospective analysis of blood issuance and transfusion reactions records, focusing on Red Cell Concentrates (RCC), was conducted from January to December 2024 at Valsad Raktdan Kendra, Valsad, Gujarat, India.

Results: Among 5115 requested A-positive RCC units, 891 units (17%) were provided from compatible alternative blood groups such as A-, O+, and O-. Similarly, of the 1561 requested AB-positive RCC units, 225 units (14%) were supplied from compatible groups including AB-, B+, B-, A+, A-, O+, and O-. A review of 16 adverse transfusion reactions revealed that only 2 incidents involved transfusions with compatible alternative blood groups. Of these, one reaction was allergic, and the other was febrile non-hemolytic transfusion reaction (FNHTR).

Conclusion: The universal blood transfusion framework effectively mitigates shortages, especially for A-positive and rare negative blood groups, by optimizing blood type compatibility and incorporating safety measures. This approach enhances transfusion efficiency and safety, offering a robust model for improving blood supply reliability and patient outcomes.

eP069: Hemovigilance: A retrospective study on analysis of adverse whole blood donor reactions and severity in tertiary care centre

P. Kaviya, Bharat A. Ghodke, Sanjay G. Surase, Sumedha Shinde

Background: Blood donation has a remarkable safety record. Any untoward event or complication experienced by donor during or after blood donation process is adverse donor reaction (ADR). Blood Centers have dual responsibility of meeting blood supply for the community & to ensure blood donor’s safety.

Objectives: To analyse the prevalence, characteristics, and severity of ADR among whole blood donors, to enhance donor care and safety.

Methods: This study was conducted retrospectively of 5432 whole blood donors from January 2022 to December 2022 at a tertiary care hospital blood centre Mumbai. Among 5432 donors,5122 (94.2%) were male and 310 (5.8%) were female. Donors were continuously monitored for any ADR during and following donation. All ADR related to whole blood donation were recorded and analysed. Characteristics of donor documented were age, Sex , first time/ repeated donor and severity of ADR were assessed.

Results: Out of 5432 whole blood donors, ADR were observed in 120 (2.2 %) blood donors. Among them 67 (56%) were male and 53 (44%) were female donors. Reaction rate in first time blood donors was 89 (74%) and repeated blood donors was 31 (26%). Most of the ADR were vasovagal in nature and categorized according to symptoms severity as mild 75 (62.5%), moderate 15 (12.5%), severe vasovagal reaction like loss of consciousness with myoclonic jerks by 4 (3.3%) donors and 26 donors (21.7%) experienced local reactions.

Conclusion: ADRs have highly significant relationship with respect to first time blood donors and gender is an independent predictor , with females having higher chances of reaction. Donor hemovigilance plays an important role in safety of blood donation and adopting appropriate donor motivational strategies, pre-donation counselling, and care during and after donation.

eP070: Hemovigilance: KAP analysis of heamovigilance programme among doctors in tertiary healthcare settings

Jaya Shekhawat, Sanjay Prakash

Department of Transfusion Medicine, RNT Medical College, Udaipur, Rajasthan, India

Introduction: The Heamovigilance Program of India, launched in December 2012, is a comprehensive and structured initiative aimed at monitoring and mitigating adverse reactions associated with blood transfusion. This program collects, collates, and analyzes data to identify and address transfusion-related risks, enabling corrective and preventive measures to minimize potential harm to patients. Despite the critical importance of Heamovigilance, under-reporting of transfusion reactions remains a concern among medical professionals. To bridge this knowledge gap, this study aimed to assess the Knowledge, Attitude, and Practice (KAP) of Heamovigilance among doctors.

Methods: This was a cross-sectional questionnaire-based study conducted among 51 Doctors of a tertiary care hospital for a period of 1 month.

Results: Result obtained was analyzed, About 86.7% participants knows about the primary objective of HPvI program and 66.0% had knowledge who co-ordinate HPvI . The attitude was satisfactory regarding adverse events and near miss event reporting. Overall 60% had participated in HPvI training program.

Conclusions: Increasing awareness of haemovigilance among doctors and training on reporting of transfusion reactions will improve spontaneous reporting and help to strengthen the blood transfusion system.

Keywords: Adverse transfusion reaction, haemovigilance

eP071: Hemovigilance: Recipient hemovigilance – A RIMS perspective

Nongmaithem Shivarjit Singh, Pratima Khoyumthem, K. Rachandra Singh

Background and Objective: Haemovigilance Programme of India (HvPI) was launched in December, 2012. It is an integral part of Pharmacovigilance Programme of India which scrutinizes, expedite remedial and preventive actions to be taken to improve blood safety. Department of Transfusion Medicine, RIMS also enrolled in ‘HvPI’ in July, 2014 and started reporting adverse transfusion reaction from 15th July, 2014 onwards. This study is aimed to determine the frequency and type of adverse transfusion reactions in blood recipients in RIMS hospital.

Materials and Methods: A retrospective review of all transfusion reactions reported to Department of Transfusion Medicine, RIMS between July 2014 and May 2024 were done. All data were collected from the transfusion reaction register maintained in the department. All the transfusion reactions were evaluated and classified using standard definitions.

Results and Observation: In our study, 168 transfusion reactions were observed in which 50% of the case (84 in number) was an allergic transfusion reaction, which makes it the commonest followed by Febrile Non-Hemolytic Transfusion reaction (FNHTR) with 75 cases. Females were more affected than males; (F=107, M=61). The age group of 31-40 years were the most affected with 45 cases. Packed red blood cells (PRBC) caused maximum transfusion reactions; 157 out of 168 (93.45%).

Conclusion: Documentation of adverse transfusion event will help in improving transfusion safety. This study allowed for a good assessment of transfusion reactions in RIMS hospital. Proper education of health care team and active participation of all in reporting any adverse transfusion reaction will greatly increase safety of patients undergoing blood transfusion.

eP160: Transfusion Transmitted Diseases (Including NAT): A study on response of sero-reactive blood donors to notification and counselling

Anju Dubey, Atul Sonker

Post donation counselling is an ethical duty of blood centre toward the donors. It includes informing the reactive donors about their serological status, the risk of transmission of infection to other people in the family and society, providing emotional support, assistance in planning behaviour and lifestyle modifications, and then referral for health care follow-up. The study was conducted to analyse the response of sero-reactive blood donors towards notification and counselling. Transfusion transmitted infection (TTI) testing was done on 2460 blood donor samples using chemiluminescence assay (Vitros ECiQ, Ortho Clinic Diagnostics) for Anti-HIV 1&2, HBsAg and Anti-HCV. The donors whose samples were repeatedly reactive (n= 61, 2.48%) were notified and called to blood centre for counselling through postal communication. Those who did not respond were called telephonically and their reasons were recorded.

Table 1.

Response of reactive donors

Marker	Number of repeat reactive donors (n=61); voluntary replacement total (%)	Number of donors responded (n=35); voluntary replacement total (%)
Anti-HIV	4+13=17 (27.87)	4+7=11 (31.43)
HBsAg	5+14=19 (31.15)	2+8=10 (28.57)
Anti-HCV	5+20=25 (40.98)	4+10=14 (40)
Total	14+47=61	10+25=35

HIV=Immunodeficiency virus, HCV=Hepatitis C virus, HBsAg=Hepatitis B virus surface antigen

Table 2.

Reasons for nonresponse

	n (%)
Long distance	11 (42.31)
Busy schedule	7 (26.92)
Not willing to visit blood centre again	3 (11.54)
Will get treated by their preferred physician	3 (11.54)
Other personal reasons	2 (7.69)
Total	26

The responsive blood donors were counselled and referred to ICTC in case of anti-HIV sero-reactivity and gastroenterology department in case of HBsAg & anti-HCV reactivity. There were 26 (42.62%) sero-reactive blood donors who did not respond to notification. Voluntary donors showed a better response to notification. Distance of donor’s residence from blood centre was a major cause of non-response. There is a need to create better awareness among blood donors regarding TTI through effective pre-donation counselling.

eP161: Transfusion Transmitted Diseases (Including NAT): Descriptive analysis of HIV infections in blood donations for transfusion in 2022

Hakizimana Theogene, Hinda Ruton

Introduction: Transfusion of infected blood is one of the foremost causes of morbidity and mortality worldwide, particularly in sub-Saharan Africa, where it is responsible for 5–10% of new HIV infections. Today, there is an increased need to ensure the safety of all donor blood before transfusion. However, the magnitude of transfusion-associated HIV transmission in sub-Saharan African countries remains high due to reduced financial resources and poor HIV antibody screening programs. In 2021 the prevalence of HIV infections in blood donations in high-income countries was 0.002%; Upper middle-income countries 0.10%; Lower middle- income countries 0.19% compared to Low-income countries with 0.70%. In Rwanda there is a policy to reduce HIV prevalence in blood donations for transfusion from 0.07% of 2021 to 0.03% in 2022.

Methodology: This is a retrospective cross-sectional study conducted in Rwanda Biomedical Center/Blood Transfusion Division. The secondary data were extracted in Eprogesa (A blood computerized electronic system) dataset and analyzed using Ms Excel. The findings were presented using Frequencies, tables and graphs.

Results: According to data, among 35 HIV positives cases in 78738 blood donations; with the overall prevalence of 0.04%; new blood donors are more affected than regular and irregular blood donors with 20 (57.1%) to 6 (17.1%) and 9 (25.8%) respectively. The region center of Blood transfusion most affected is Butare and Rwamagana with 9 (25.8%) each.

Conclusion: Despite all efforts to reduce HIV prevalence in blood donations; there is still a slightly more number of HIV infections; a challenge of self-exclusion of persons with risk behaviors and ineffective blood donor recruitment and selection processes could be the cause. Providing pre-donation talk to everyone who comes to donate blood and emphasize on eligible criteria to enhance self-exclusion of those with risky behaviors. The further research is needed to find out the cause of this slight high number of HIV infection in blood donations.

eP162: Transfusion Transmitted Diseases (Including NAT)

Palak Panchal, Jhalak Patel, Vishvas Amin

Transfusion-related illnesses (TTDs) may result from the transfer of infectious organisms during blood transfusion, despite the fact that this procedure is an essential life-saving measure. TTDs continue to be a worldwide public health problem even in the face of strict donor screening procedures and sophisticated testing techniques. Blood transfusions and infections including HIV, Hepatitis B, Hepatitis C, syphilis, and malaria have traditionally been connected. Advances in diagnostic technology, such as nucleic acid testing (NAT), have greatly increased the safety of blood transfusions. As standard serological tests may not be able to identify infected donors during the window period, NAT has become an essential tool for identifying viral infections. Through the direct detection of viral RNA or DNA, NAT reduces the risk of transmission by offering improved sensitivity and earlier identification of blood borne infections. This study investigates the frequency and prevalence of TTDs, looks at how NAT affects blood safety, and contrasts NAT’s effectiveness with traditional serological testing. It also draws attention to the obstacles still standing in the way of accomplishing zero-risk blood transfusions, including new infections, implementation costs, and NAT accessibility in low-resource environments. In order to provide the safest transfusion procedures possible, the study highlights the need of ongoing observation, the use of cutting-edge technology, and the strengthening of blood transfusion services worldwide.

Keywords: blood safety, bloodborne pathogens, nucleic acid testing (NAT), transfusion-transmitted diseases (TTDs), viral infections, window period

eP163: Transfusion Transmitted Diseases (Including NAT): Analysis of factors affecting bacterial contamination in apheresis platelet concentrates (APCs) and leucodepleted packed cells (LD-PRBC)

Kalpesh Chawan, Shashank Ojha, Suryatappa Saha, Amol Tirlotkar, Arunkumar, Hemali Kadu

Background and Objectives: Bacterial contamination of platelets has been a greater implication in safe transfusion practices compared to LD-PRBC. The primary source of contamination is skin bacterial microflora. Aim of this study is to analyze factors affecting bacterial contamination in APCs and LD-PRBC.

Methods: Bacterial screening of APCs and LD-PRBC collected from January 2021 to December 2023 were analyzed by BacT/ALERT. 4-5 ml of sample from APCs and LD-PRBC were inoculated in culture bottle. Inoculated AP units were quarantined for 24 hrs and LD-PRBCs for 48 hrs. True positive units were sub-cultured for bacterial identification. Factors like collection method, cell separator, quality parameters (QC) and donor related factors were correlated with the positive sample.

Results: Total 4352 APCs and 3357 LD-PRBC underwent bacterial screening. Among APCs, 48 (1.1%) tested positive, in which 18 (0.41%) were confirmed as true positive. The organisms identified were 7 Coagulase negative staph (CONS), 2 Staphylococcus aureus, 5 gram-positive bacilli (GPB), 4 gram-negative bacilli (1 Acinetobacter, 1 Kleb. Pneumonia, 1 E. coli, 1 Chryseobacterium). Among 3756 single needle procedures, 15 (0.39%) tested positive and out of 596 double needle procedures, 03 (0.50%) tested positive. 3254 procedures were performed on Amicus, in which 14 (0.43%) came positive and 1098 procedures were performed on Comtec, in which 4 (0.36%) came positive. By using Chi- square test, p- value was not statistically significant (>0.05) in both procedures. In positive APCs after day 3, the pH was less than 6 and swirling was absent. Among 3357 LD-PRBC, 22 tested positive, out of which 11 (0.32%) were confirmed as true positive. The organisms identified were 2, Enterobacter 5 CONS and 4GPB. No transfusion reaction were reported due to bacterial contamination.

Conclusion: By adopting prevention and detection strategies, risks of bacterial contamination of platelets and packed cell can be significantly minimized. This in turn will help in reducing transfusion reaction.

eP164: Transfusion Transmitted Diseases (including NAT): Seroprevalence of transfusion transmissible infections among blood donors at Sawai Man Singh Hospital, Jaipur

Abhinav Jangir, Sunita Bundas

Background and Objectives: The transfusion of blood carries a risk of transmission of infections known as Transfusion Transmissible Infections (TTIs), which include Hepatitis B virus (HBV), Hepatitis C virus (HCV), Human Immunodeficiency Virus (HIV), Syphilis and Malaria. The objective of this study was to evaluate the seroprevalence of TTIs among voluntary and replacement blood donors at Sawai Man Singh Hospital, Jaipur, Rajasthan. The study aimed to contribute to the ongoing efforts to prevent TTIs by identifying trends and emphasizing the need for robust donor screening procedures.

Methods: This retrospective, cross-sectional study was conducted over a period of one year, from July 2023 to June 2024, at Sawai Man Singh Hospital, Jaipur, Rajasthan. A total of 39458 blood donors were screened using serological tests, including ELISA for HBV, HCV and HIV, Rapid card test for Malaria, and VDRL test for Syphilis. Voluntary and replacement donors were both included. The aim was to identify the seroprevalence of these infections among donors and to analyze trends over the one year period.

Results: Out of the total blood donors screened, voluntary donors were 72.1% and replacement donors were 27.9%. Males constituted 97.4% of the donors, while females made up only 2.6%. The overall seroprevalence of TTIs was 1.21 %. HBV was the most prevalent infection at 0.72%, followed by Syphilis 0.31%, HIV 0.07%, HCV 0.06%, and Malaria 0.05%.

Conclusion: The study highlighted the continuing risk of TTIs despite the implementation of pre-donation counseling and screening. HBV was identified as the most prevalent TTI among donors, while Malaria had the lowest seroprevalence. Enhancing public awareness and improving donor screening methods, especially among replacement donors, could further reduce the risk of TTIs.

eP165: Transfusion Transmitted Diseases (Including NAT): Seroprevalence of australian antigen (HbsAg) among blood donors in the local population at standalone blood center

Hetal D. Patel, Tejal P. Chhabaria, Ripal J. Shah

Introduction: Hepatitis B virus (HBV) causes a silent killer disease of the liver with many carriers not aware of their clinical status; therefore, they act as a potential source of infection to others. HBV is highly infectious and can be transmitted by both percutaneous routes and by blood transfusion. Laboratory diagnosis of HBV infection is made by detecting Hepatitis B virus surface antigen (HBsAg), the earliest serological marker of active HBV infection (acute and chronic). Hepatitis B virus (HBV) Infection is one of the leading causes of death worldwide. The most important marker for HBV infection is HBsAg. In the case of the diagnosis of an infectious disease, discordant results may have serious consequences for the patients as it causes unnecessary mental stress and tension. For The proper diagnosis of infection, disease management, prevention, and as well as identification of appropriate Test kits, are necessary.

Objectives: To determine the seroprevalence of HBsAg among blood donors in a stand Alone Blood Center in Ahmedabad, Gujarat.

Methods: The study was conducted on apparently healthy blood donors over 3 years from January 2021 to December 2023 at the Blood Centre to assess the prevalence of hepatitis B virus infection. A total of 90,754 blood donors were included In this study. In this study, For HBsAg ELISA test was used. For initial reactive donors, The second time, HBsAg Hepacard, a Rapid kit, was used to confirm true reactivity.

Results: Out of 90,754 donors, 85,959 (94.81%) were males and 4,795 (5.17%) were females. Out of these blood units, 526 (0.57%) were discarded, and among them, 276 (0.30%) were HBsAg reactive. The Seroprevalence of HBsAg was found to be 0.30%.

Conclusion: Blood Donors are often found to be reactive to hepatitis B surface antigen and others. To reduce this Seroprevalence, more sensitive screening assays and appropriate donor selection are must.

Keywords: Blood donors, hepatitis B surface antigen, seroprevalence

eP166: Transfusion Transmitted Diseases (Including NAT): Nucleic acid amplification test: Bridging the gap in blood safety and re-evaluation of blood screening for transfusion-transmitted infection among Indian donors

Disha N. Patel, Ripal J. Shah, V. Harimoorthy

Prathama Blood Centre, Ahmedabad, Gujarat, India

Background: A total of 30 million blood components are transfused each year in India. Blood safety thus becomes a top priority, especially with a population of around 1.23 billion and a high prevalence rate of human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) in general population. Nucleic acid amplification testing (NAT) in blood donor screening has been implemented in many developed countries to reduce the risk of transfusion-transmitted viral infections (TTIs). NAT takes care of the dynamics of window period of viruses and offers the safest blood pack for donation.

Aims: The aim of this study is to show the value of NAT testing for in blood screening.

Materials and Methods: Over a period of 2 year from May 2016 to May 2018, a total number of 63014 blood donor samples were subjected to tests for HIV, HBV, and HCV by enzyme-linked immunosorbent assay (ELISA) method and 60934 ELISA nonreactive samples were subjected for NAT using multiplex polymerase chain reaction technology.

Results: Of the 63,014 donors tested, 295 were seroreactive. In 60,934 ELISA negative blood samples subjected to NAT, 21 donor samples were reactive for HBV. The NAT yield was 1 in 2901.

Conclusions: The cryptic infections found in blood donors increase the risk of TTIs. Blood screening by both serology and NAT can reduce this threat.

Keywords: Hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus, nucleic acid amplification testing (NAAT), transfusion-transmitted infection (TTI)

eP167: Transfusion Transmitted Diseases (Including NAT): Gap analysis of screening for hepatitis risk factors among blood donors

Vilasini Patil, Romesh Jain, Pratul Sinha

Background: Hepatitis remains a leading cause of transfusion-transmitted diseases (TTDs) worldwide. Common risk factors such as high-risk behaviors, family history of hepatitis, and previous history of jaundice, are frequently under reported by blood donors. The study aimed to assess the gaps in pre-donation screening by analyzing why these risk factors are often not disclosed by donors, focusing on post-notification counseling of those who tested reactive for hepatitis.

Methods: A prospective study was conducted on blood donors who tested reactive for hepatitis B or C infection between January and August 2024. Post-notification counseling sessions were held to disclose the reactive results and offer referral services for further management. Donor’s demographic details, educational background and employment status were collected during counselling session. Assessment of the donors’ awareness regarding Hepatitis infections and reasons for nondisclosure of risk factors during pre-donation screening was done after obtaining informed consent from Reactive donors.

Results: A total 197 donors tested reactive during the study period out of which 58.8% were reactive for Hepatitis B and 22.8% were found reactive for Hepatitis C infection. Prevalence was found to be 1.07% and 0.41% for Hepatitis B & C respectively. Among the reactive donors, 33.3% were uneducated and 41.6% had completed only primary schooling education. High-risk behavior, was revealed by 28.3% donors. 53.7% of donors had No awareness of Hepatitis infection & its modes of transmission. The primary reason for nondisclosure was a lack of understanding of the significance of disclosing risk factors found in 73% donors.

Conclusion: The study identified substantial gaps in the pre-donation screening process for Hepatitis infection, driven primarily by donor unawareness. Despite rigorous screening protocols, these risks remain unidentified, largely due to a lack of donor education. To improve risk disclosure and reduce hepatitis transmission, there is an urgent need to enhance donor education programs, particularly for individuals with lower educational levels, and to provide more private and supportive environments for screening.

eP168: Transfusion Transmitted Diseases (Including NAT): Nucleic acid testing: Experience at a standalone South Indian blood centre

R. P. Prashanth, Ankith Mathur

Background: Addition of Nucleic Acid Testing (NAT) to the Transfusion Transmitted Infection (TTI) screening protocol for voluntary blood donors is being explored by various blood centres globally. Detection of TTIs in their window period is the major benefit of NAT. However, its feasibility depends on several factors and should be evaluated by every centre independently. We present our experience of introducing NAT to our standalone blood centre.

Methods: As per institutional protocol, all chemiluminescent (CLIA) negative samples were routinely tested by minipool NAT (Cobas 5800, Roche Diagnostics). Additionally, donors with CLIA S/Co value > institutional cut-off (IC) were also tested by NAT to streamline the counseling process. Samples are tested in pools of 6. If even 1 sample in the pool is reactive for 1 viral marker, the entire pool is designated as reactive. Each individual sample in the pool is then tested individually for the viral markers. The data provided is of 5 months (May-October 2024)

Results: Total donors tested during study period: 12228

CLIA non-reactive for TTIs:12077

NAT testing done for: 12112 (CLIA negative:12077 , S/Co> IC: 151)

Concordant: 12109

NAT yield: 3 (all HBV).

Conclusion: Addition of NAT to routine screening can be a valuable tool in ensuring blood safety and efficient donor counseling.

eP092: Immunohematology: Serological, hematological and clinical insights into autoimmune hemolytic anemia: A retrospective study

P. Mounika, B. Shanthi

Department of IHBT, NIMS, Hyderabad, Telangana, India

Background and Objectives: Autoimmune hemolytic anemias (AIHAs) are rare and heterogeneous disorders characterized by the destruction of red blood cells through autoantibodies leading to anemia that ranges from no symptoms to severe life-threatening hemolysis. AIHA is categorized based on temperature sensitivity into warm, cold, and mixed types. The autoantibodies involved can be immunoglobulin G (IgG), immunoglobulin M (IgM), immunoglobulin A (IgA), or complement proteins, and the hemolysis may occur either intravascularly or extra-vascularly. The present study was done to evaluate the serological characteristics and transfusion management in patients clinically suspected of autoimmune hemolytic anemia (AIHA).

Materials and Methods: This retrospective study involved 154 patients with clinical suspicion of autoimmune hemolytic anemia (AIHA). Blood samples submitted to the blood bank underwent a comprehensive immunohematology evaluation, which included blood typing, direct and indirect Coombs tests (DCT and ICT), monospecific DAT, and alloantibody identification using column agglutination technique (CAT). Additionally, hematological and biochemical data for each patient, as well as the number of blood transfusions administered, were retrieved from the hospital information system for further analysis.

Results: The median age at presentation was 29 years with a female preponderance (73.3%). Majority of the patients belong to mixed AIHA (66%) followed by warm (18%) and cold (15%). Grouping discrepancy was seen in 88 (57%) cases. The mean pretransfusion Hemoglobin, Reticulocyte count, Serum Bilirubin and LDH were found to be 5.8 g/dL, 7.8%, 3.2 mg/dL and 820 IU/ml. A total of 510 Units of PRBCs were transfused to 75.9% of the AIHA patients.

Conclusion: In our study, mixed autoimmune hemolytic anemia (AIHA) is the most prevalent form, followed by warm and cold types. A significant number of AIHA patients experienced blood group discrepancies, highlighting the importance of thorough immuno-hematological evaluations. Approximately one-third of patients endured severe anemia during their hospital stay, and transfusions even with least incompatible red blood cells were found to be both safe and effective.

Keywords: Autoimmune hemolytic anemia, direct antiglobulin test, hemolysis

eP093: Immunohematology: Evaluation of point of care test - “ABD ® PAD” for detection of weak A and weak D groups

Anjali, Richa Gupta

Background: ABO/Rh discrepancy is one of the most important parameters that needs to be addressed while compatibility testing. In such cases, detailed blood grouping is cumbersome, time taking and requires additional reagents and manpower. This may not be possible in small blood centres or in an emergency. The ABD ® PAD cards have already been validated on a large group of donors by a few authors. The aim of the study was to evaluate the accuracy of these cards specifically for individuals with weak antigenic expression on the red cell surface including blood donors and newborns.

Objectives: To compare the results between the ABD ® PAD & gel card technique and look for concordance. To evaluate whether ABD ® PAD was able to detect weak A and weak D groups.

Methods: This study was conducted in UCMS & GTB Hospital Blood Bank in Delhi over a period of 6 months. 14,400 donors and 900 newborns were included. Subjects with antibody screen positive and newborns with history of Rh incompatibility were excluded. Manual whole blood-based ABD ® PADs were used for ABO and D grouping & results were compared with the standard gel card technique. Discrepancies were further resolved by using Anti-A1 lectin and antibody elution in weak A individuals and by indirect agglutination test in weak D individuals.

Results: The new ABD ® PAD technique detected the 18 weak A and 8 Weak D groups tested in 14,400 donors as revealed by faint color produced in the respective wells which were missed by gel-card technique. However, the remaining cases showed 100% concordance.

Conclusion: The new ABD ® PAD enabled the detection of weak A and weak D individuals which were missed by gel card. The study suggests that ABD ® PAD can be used as point of care test in emergencies and resource limited areas.

eP094: Immunohematology: Seroprevalence of transfusion transmitted infections in healthy blood donors attending a tertiary care hospital in Southern Rajasthan

Nikita Sanadhya, Sanjay Prakash

Introduction: “Blood transfusions can transmit serious infections, posing a significant risk to recipient safety. To prevent the spread of these diseases, screening blood donations is a crucial step in ensuring blood safety.”

Aim: This study aimed to investigate the prevalence of Transfusion-Transmitted Infections (TTIs) among healthy blood donors at a tertiary care blood bank.

Materials and Methods: A cross-sectional retrospective study was conducted from January 2022 to December 2022 (1-year period). Serum samples were tested for Hepatitis B surface antigen (HBsAg), HIV antibodies (Type 1 and 2), Hepatitis C virus (HCV) antibodies and Syphilis. Assay Methods include Enzyme-linked immunosorbent assays (ELISA) using third-generation kits for HBsAg, HIV, and HCV & Venereal Disease Research Laboratory (VDRL) test for syphilis.

Results: A total of 25,184 healthy donors were included out of which the majority of donors were male. The overall seroprevalence of HBsAg, HIV, HCV, and syphilis were 0.26%, 0.87%, 0.15%, and 0.07%, respectively.

Conclusion: To guarantee a safe blood supply, rigorous donor selection and advanced screening methods, including Nucleic Acid Testing, are crucial. Implementing these measures will minimize transfusion-related risks and protect public health.

Keywords: HBsAg, HCV, HIV, seroprevalence, syphilis, transfusion transmitted disease

eP095: Immunohematology: Red blood cell allo-immunization among pregnant women in India: A systematic review and meta-analysis

Sunil Golia, Samruddhi Panwar, Aseem Kumar Tiwari

Background and Objectives: Red blood cell (RBC) alloantibodies in pregnancy may develop against the fetal antigens, that are of paternal origin. This phenomenon poses a substantial risk of Hemolytic disease of the fetus and newborn (HDFN) during pregnancy. HDFN, may contribute significantly to perinatal morbidity and mortality. Several studies conducted in India have assessed the alloimmunization to RBC antigens in pregnant women, but a comprehensive systematic review in this context is lacking in the published literature. Therefore, the authors undertook a systematic review and meta-analysis, to evaluate the current evidence on RBC alloantibodies among pregnant women in India, and suggest recommendations, if any.

Methods: Authors searched the MEDLINE, SCOPUS, CINAHL and Google Scholar bibliographic databases with no restriction in search dates to identify relevant studies. PRISMA flow diagram was used to select the relevant studies. Case reports, comments, letters, conference abstracts, editorials and review articles were excluded. The primary data of the relevant studies were extracted as raw numbers. An aggregate effect size, weighted by sample size, was computed to provide an overall effect size across the studies and 95% confidence intervals (CI) were calculated. The relative weighted contribution of each study was also assessed.

Results: Out of 933 potentially relevant articles, 16 studies with cumulative sample size of 36174 pregnant women were selected. A total of 647 alloantibodies were identified in pregnant women. The prevalence of RBC alloimmunization exhibited a wide variation ranging from 1% (95% CI; 0-4%) to 10.84% (95% CI; 7-16%) in different studies. The overall meta-analytical prevalence of alloimmunization was observed to be 1.78 per 100 pregnant women (95% CI; 1.6-1.9%) with zone-wise prevalence of 1.98%, 1.52%, 3.46%, 1.25% and 1.92% in the South, West, North, Central and East zone, respectively. 1.78% still seems to be highly significant, considering that India is the most populous country of the world. More than 85% of alloantibodies identified were associated with the Rh blood group system. Among clinically relevant alloantibodies, anti-D ranked as the most common, followed by anti-E, combination of anti-D+C, anti-c. After Rh alloantibodies, the next most common clinically significant alloantibodies belonged to the Kell blood group system. Asymmetry was noted in the funnel plot drawn to examine the publication bias in the results; observation being significant (p<0.001).

Conclusion: The analysis of existing literature in India represented significant (1.78%) prevalence of RBC alloimmunization in pregnant women in India and highlighted that anti-D is the commonest allo-antibody found. Based on these results authors recommend adoption of RBC alloantibody screening as a standard of ante-natal care for all pregnant women across India, and striving for 100% access of anti-D immunization.

eP096: Immunohematology: Comparison of automated column agglutination technique (auto-CAT) with conventional test tube (CTT) technique for ABO antibody titration: Concept of clinically acceptable concordance rate (CACR)

L. Gowri Suresh, Aseem Kumar Tiwari, Gunjan Bhardwaj, Shubham Gupta

Background and Objectives: High titer of ABO (anti-A/anti-B) antibody can cause antibody- mediated rejection (ABMR) in ABO-incompatible living donor kidney transplantation (ABOi-LDKT). Desensitization therapy to achieve ABOi-LDKT involves repeated measurements of ABO antibody titers. Though the conventional test-tube technique (CTT) is considered gold standard test for ABO antibody titer measurement, it is cumbersome and subjective. This study aimed to evaluate automated column agglutination technique (auto-CAT) as an alternative to CTT for titration of anti-A/anti-B antibodies in ABOi -LDKT.

Methods: This was a prospective study, carried out in a large tertiary healthcare center between April-June 2024. Total (IgG and IgM) anti-A/anti-B antibody titers were performed using auto-CAT and CTT method in ABOi-LDKT recipients and was compared with CTT. Since variation of titer values is usually considered clinically acceptable if the variation is limited to one-tube dilution (higher or lower), we used a new concept; clinically acceptable concordance rate (CACR), a term published earlier in Japan.[¹]

Results: We examined 70 samples from 10 consecutive ABOi-LDKT recipients. As shown in Table 1, the CACR was found to be very good at 84.3%. The correlation coefficient of the two methods was high at >0.9. Perioperative status did not influence the correlation coefficient value.

Table 1.

Comparison of auto- column agglutination technique with the conventional test-tube technique, in context of clinically acceptable concordance rate

Item	Numbers	Subtotal	Percentage	P
Samples with completely concordant titre value	30	59 (CACR)	84.3 (CACR)	<0.0001
Samples with one-tube variation	29	-	-
Samples with two-tube variation	11	11	15.7
Total number of samples	70	70	100

CACR=Clinically acceptable concordance rate

Conclusion: Auto-CAT is comparable with the CTT technique and is feasible for total (IgG and IgM) anti-A/B antibody titration in ABOi-LDKT.

Reference

1. Matsuura H, Sugiura Y, Matsuno T, Tomiya Y, Shiraki M, Kato C, et al. Feasibility of the automated column agglutination technique for titration of anti-A/B antibodies in ABO-incompatible living kidney transplantation. Ther Apher Dial 2022;26:827-35.

eP097: Immunohematology: Identifiction of rare bombay negative phenotype through immunohaematology work up

Niharika Pillai, Farzana Kothari

Introducion: Bombay phenotype is a rare blood group reported first in Bombay, India by Bhende in 1952. This phenotype lacks, H, A and B antigen on RBCs and secretions and has anti-A, anti-B & anti-H in the serum. Genotypically, a person of the Bombay blood group inherits the recessive form of the allele for the H antigen from each parent and carries the homozygous recessive (h/h se/se) gene.

Methodology: Forward and reverseblood grouping was done using semi-automatedCAT and test tube agglutination. This was followed by testing patient’s RBCs with anti H antisera which showed no reaction. Further DAT, titre of anti-H antibody in the patient’s serum , auto control and 3 and 11 cell panel tests were performed.

Results: A 19 yr old G1P0 female was referred to SSGH, Vadodara for routine blood grouping. The ABO grouping (forward and reverse) showed discordant results. On further workup, the reverse grouping showing agglutination with O pooled cells suspension and no reaction with anti H antisera confirming Bombay group of the patient. RH typing wasnegative . This was followed by DAT (negative), auto control (negative), titreand 3 cell and 11 Cell panels (panagglutination;+ 4).

Conclusion: Bombay Blood group can be misinterpreted as O group unless reverse grouping is performed. As they can only receive same blood group transfusion, it is important to ensure proper grouping and crossmatchingto transfuse matched blood units for such cases.

Keywords: Bombay group, reverse grouping, transfusion reaction

References

1. Makroo RN. ABO blood group system. In: Compendium of Transfusion Medicine. 2^nd ed.

2. Das S, Kumar HR. Bombay blood a rarity. J Biomed Sci 2011;1:122-5.

3. Schaberg EA, et al. Molecular genetics of H. Vox Sang 2000;78:105-8.

4. Bhende YM, Deshpande CK, Bhatia HM, Sanger R, Race RR, Morgan WT, et al. A “new” blood group character related to the ABO system. Lancet 1952;1:903-4.

5. Oriol R, Candelier JJ, Mollicone R. Molecular genetics of H. Vox Sang 2000;78 Suppl 2:105-8.

eP098: Immunohematology: Comprehensive analysis of ABO subgroups: Enhancing blood transfusion safety – A retrospective study

Kuruva Raghunath, B. Shanthi

Department of IHBT

Background: The ABO blood group system is vital for safe transfusions and organ transplants, with subgroups like A1, A2, and weaker variants (A3, Ax, Am) influencing transfusion compatibility due to variations in antigen expression. A1 and A2 are distinguished by their reactivity to “Dolichos biflorus” lectin, while weaker subgroups show reduced agglutination with anti-A sera. Though B subgroups lack equivalents like B2, they remain essential for precise typing. Advanced techniques, such as glycosyltransferase studies and PCR, are crucial for identifying these subgroups, ensuring compatibility and preventing transfusion reactions, particularly in the presence of naturally occurring antibodies like anti-A and anti-B.

Materials and Methods: Present study included all the sample sent for routine blood grouping and antibody screening to department of transfusion medicine from October 2020 to September 2024. 3 ml of sample sent in ethylene diamine tetra acetic acid (EDTA) vial is used for forward grouping and reverse grouping.

Results: In our study, a total of 21 cases of blood subgroups were identified. Among these, the distribution was as follows A subgroup: 10 cases (47.6%), B subgroup: 8 cases (38.1%), AB subgroup: 3 cases (14.3%). The age of patients ranged from 5 to 67 years, with a median age of 36 years. The gender distribution showed that 14 patients (66.7%) were male, and 7 patients (33.3%) were female. Notably, there were 3 cases in which anti-A1 antibodies were identified in individuals with the AB subgroup.

Conclusion: The study suggests that, in addition to ABO and Rh blood typing, detailed subgroup analysis should be performed to accurately identify variants like A1, A2, and other weaker subgroups. This study highlights the importance of identifying subgroups to prevent potential transfusion reactions. Expanding research on the distribution of blood groups and subgroups across regions would help blood banks better estimate the demand and supply of specific types, ensuring safer transfusions.

eP099: Immunohematology: ABO blood group discrepancies: A key consideration in inborn error of immunity

Minu Rose George, K. C. Gayathiri, K. Abirami, Dolly Daniel

Background and Objectives: Type I discrepancies in blood grouping can lead to unexpected reactions in reverse grouping due to weak or missing antibodies. One potential cause is Inborn error of immunity, which should be considered when encountering Type I discrepancies in newborns over 4 months and children. With this background, we aimed to determine the number of Type I discrepancies secondary to Inborn errors of immunity.

Methods: A retrospective study was conducted in the Department of Transfusion Medicine and Immunohematology. Samples from newborns more than 4 months and children (<15 years) received from January 2022 to July 2024 that showed type I discrepancy were included in the study. Demographic details and immunohematological workup data were collected. Resolution of Grouping discrepancy was attempted using prolonged incubation, incubation at 4°C and double serum volume.

Results: A total of 3,54,178 samples were tested during the study period, of which 194 (0.05%) showed discrepancies. Of the 194 samples, 52 (26.8%) showed Type I discrepancy. Of the 52 samples, 46 (88%) were from children under 15 years of age. Of the 46 samples, 7 (15%) were confirmed cases of Inborn error of immunity. The Inborn error of immunity states identified were Severe combined immunodeficiency, Chronic Granulomatous Disease, Ataxia Pancytopenia Syndrome, X-linked agammaglobulinemia, Wiskott-Aldrich Syndrome, and BTD gene mutation.

Conclusion: A significant percentage (15%) of samples from children under 15 years of age that tested positive for type I discrepancy were found to be linked to Inborn errors of immunity. This study highlights the criticality of clinically correlating atypical immunohematological results, particularly Type I discrepancy in children. And also considering the Inborn error of immunity if clinical pictures suggest the same.

eP100: Immunohematology: Study of sickle cell cases by high performance liquid chromatography (HPLC) patterns in tertiary care hospital

Devanshi Gosai, Vidhi Jain

Background: Genes for haemoglobin S are found in high frequencies in Gujarat. The clinical presentation of HbS- β thalassemia is enormously variable, ranging from an asymptomatic state to a severe disorder similar to homozygous sickle cell disease.

Materials and Methods: Haemoglobin A2 and HbF were determined in sickle cell anaemia patients attending Dhiraj general hospital, waghodia, Vadodara by high performance liquid chromatography (HPLC). Hematological parameters were estimated using Sysmex KX-21 and peripheral blood smear examination was assessed using Romanosky staining technique.

Results: A total of 596 cases were studied, out of these 380 (63.7%) cases were HbS positive on HPLC. From all 380 cases of HbS positive, 49 (12.9 %) were HbSS , 184 (48.4 %) were Hb AS and 147 (38.7% ) were double heterozygous for HbS-β thalassemia.

Conclusion: These findings confirm that the frequency of beta thalassaemia in sickle cell patients in Gujarat is higher. It is therefore important to consider the possibility of this variant in patients with sickle cell anaemia since their course may differ from that of patients with homozygous sickle cell anaemia.

Keywords: HPLC, sickle cell disease, thalassemia

eP101: Immunohematology: Yet another conservative approach in cross match test when blood sample is in short supply

Manisha Mohanbhai Rajapara, Sanmukh Joshi

• 10 month old male patient with malaria (P. vivex), thrombocytopenia and anemia (Hb 5.0 gm/dl) was admitted to hospital for malaria treatment.

• His blood specimen was referred to our blood center with a request to provide 120 ml RCC for transfusion.

• He was grouped as O, Rh D+; DAT-, auto control test all were was negative. Antibody screen test showed 4+ agglutination at 4°C

• cross-match test with random 12 blood units carried was incompatible (+4)

• As the antibody reacted in the saline phase, it was further tested using enzyme-treated cells and found to be non-reacting.

• We suspected the antibody to be directed to the antigen that was sensitive to an enzyme, e. g. antigen of the MNS, Duffy, Ina, etc. Of which those from the Fy system could be ruled out as antibodies in this system do not give direct agglutination (IAT reacting).

• As the patient was in the pediatric age group, it was not possible to collect a large sampling from him to test with more blood units, though we have tested some 10 units without any success. There was a dilemma in finding a compatible blood unit and we adopted a unique strategic approach as outlined below:

  1. Since the antibody did not react with enzyme-treated RBCs, but reacted with untreated cells, and that too in the saline phase, we suspected its specificity to antibody to MN blood group system.

  2. The patient’s red cells were typed NN homozygote which has the potential to develop anti-M.

  3. 10 random group O RBC units were tested with known anti-M and anti-N reagents from our stock out of which 3 units were found to lack M antigen.

  4. The RBCs of these 3 units were tested with the patient <’s serum and all three units were found compatible.

  5. One of these was issued as per the requirement of transfusion.

  6. The patient did not show any clinical transfusion with the unit transfused.

Comments:

• A patient’s serum in scarce supply needs to use some conservative approach .1. Saving the test supernatant (TS) and judicial use with appropriate positive control helps us in making use of a reasonably large number of blood units to find a compatible unit in the screening program. In the present case, we aspirated the TS from the reaction chamber from the gel card and tested it, which showed strong reactivity. This approach has provided yet another unique approach to conserving the serum with antibodies when is in short supply.

• As the patient was positive for P. vivax parasites and was on an active anti-malarial regimen, we thought of testing the compatible blood units for the G6PD enzyme deficiency, should it coincidentally present and that would yield drug-induce iatrogenic hemolysis. We found the RBC of the unit with normal G6PD enzyme and the the blood was issued for transfusion.

eP102: Immunohematology: ABO blood group discrepancies

Chintan Nitin Champaneriya, Kruti Dumaswala, Rinku Shukla, Keyuri Jariwala

Background and Objectives: ABO discrepancy is any deviation from the expected pattern of red-cell antigen grouping with serum-grouping or when the forward-grouping results do not correlate with reverse-grouping results. This study was done to determine the incidence and causes of ABO-discrepancies and to identify the correct blood group for safe blood transfusions.

Methods: In this study, there were 57950 samples collected between year of January 2020 to December 2023. All ABO typing was completed and records are maintained at the Suart Raktadan Kendra & Research Center. ABO typing was done which included forward cell grouping and reverse serum grouping by 2 methods.

(a) Tube method

• Forward-grouping

• Reverse-grouping

(b) Automation method (QWALYS®-3 in the E.M. Technology)

(c) If discrepancy was observed the tests were repeated with fresh sample to determine whether the discrepancy was in cell grouping or serum grouping. (techniques such as cell washing, using reagent serum, incubation under varying conditions). The discrepancy was then divided into four groups.

Results: During the study period, 57950 blood grouping tests were performed. ABO discrepancies occurred in 68 (0.1%) of them. Majority Discrepancy in the Elder Age Patients (with history of Anemia) was 32 (47%) and in AIHA Patients was 12 ( 18%). The most common blood group involved was B with 23 (34 %) frequency. 65 ( 96% ) Patients were reverse discrepancy type (Group-I, Group-III, Group-IV discrepancies).

Conclusion: This study emphasizes the need of considering ABO discrepancies in blood banks for recipients (patients) for safe blood transfusion to avoid any fatal complications. This discrepancy ratio is 1: 852. Repeat testing and investigating for ABO subgroups and auto/allo antibodies is important.

eP104: Immunohematology: Impact of multiple alloantibodies beyond anti-D in pregnancy: A case report on newborn outcomes

Nishith Nayan, Bankim Das, Rakesh Kumar, Shweta Ranjan, Shanmathi Mani

Background: Alloimmunization to non-ABO red blood cell (RBC) antigens remains one of the most significant challenges faced by blood banking practitioners. In India, antenatal antibody screening primarily focuses on detecting anti-D in RhD-negative pregnancies. However, antibodies other than anti-D can also influence the outcome of hemolytic disease of the fetus and newborn (HDFN).

Aim and objectives: Aim: To determine the significance of red cell alloantibodies other than anti-D during pregnancy and their effect on the newborn. Objectives: 1. To identify the allo-antibodies present in the patient 2. To assess the effect of these maternal alloantibodies on the newborn.

Materials and Methods: We present a case of a one-day old newborn diagnosed with HDFN. His sample was sent to our blood centre for performing Direct Coomb’s Test (DCT) and Indirect Coomb’s Test (ICT). His mother’s sample was requested for further work-up to find out the cause of positive DCT.

Results: Both the baby and mother had the same blood group (B positive). The baby’s DCT was positive, while ICT was negative. The mother’s antibody screen was positive (reactive in one out of three screening cells). Upon antibody identification, anti-E and anti-S alloantibodies were detected, reactive at the antihuman globulin phase. Acid elution of the baby’s red cells was performed, and the eluate was subjected to antibody screening and identification, which revealed the presence of anti-E alloantibody. The mother’s serum had a very low titre of anti S antibody (1+ reaction in homozygous cells and negative in heterozygous cells, possibly due to the dosage phenomenon), so the eluate did not come positive for anti-S.

Conclusion: As per Royal College of Obstetrics and Gynaecologists (RCOG), antibody screen should be mandatorily performed in all pregnant women along with blood grouping in order to prevent HDFN.

eP105: Immunohematology: Evaluation of a point of care system for ABO grouping and Rh(D) typing

Sonal Kamath, Rajesh B. Sawant, Raees Ahmed, Vaishali Zende

Background: Manual blood grouping is performed in our blood centre in various scenario like in blood donation camps, inhouse donors and also in red cell serology lab during final blood group confirmation prior to issue by testing of sample from donor unit segment.

Objective: To evaluate the sensitivity, specificity, precision and accuracy of the ABD PAD system for blood group testing of donors and recipients.

Methods: Immucor Neo results and Ortho Vision results were considered as standard results for donor and recipient blood group testing respectively. Total 396 donor samples and 360 recipient samples were tested. 47 Rh (D) negative, five samples with weaker sub-groups and two with positive DAT were included in the evaluation exercise for donor samples. The recipient samples included 36 Rh (D) negative, two variants of D antigen, two DAT positive samples, two on Daratumumab therapy, 10 samples of ABO non-identical BMT patients, two samples of patients with multiple alloantibodies and two samples of patients with diagnosed AIHA. Five samples each with hemolysis and lipaemic appearance were included for evaluation exercise. All samples were tested within seven days of their collection and were stored at 2-6 degree Celsius.

Results: In the donor testing scenario, all the 396 results were concordant between the ABD PAD and Immucor Neo. In the patient testing scenario, one sample showed an additional reaction in the forward blood group. This was a patient of Multiple Myeloma with hyperproteinemia and visible roleaux formation. Lipaemia and hemolysis did not affect the test performance adversely. Precision of the test and accuracy of the results could be well established.

Conclusion: The ABD PAD point of care blood group testing system is easy, quick and robust system for both donor as well as recipient blood group testing. The results are dependable in even complex immunohematological scenarios.

eP106: Immunohematology: Transfusion therapy for patients with auto immune hemolytic anemia: Efficacy and safety of partial phenotype matched, blood transfusions

Mangesh Devram Pawar, Rajesh B. Sawant, Raees Ahmad, Minal Rane, Ujwala Demello

Background: Transfusion support may be urgently required for patients with auto immune haemolytic anaemia (AIHA) who present with fulminant haemolysis. Provision of clinically safe transfusion support within a short time remains a challenge in these cases.

Objectives: To evaluate the safety and efficacy of Best matched, Partially antigen matched blood transfusion in patient`s with AIHA.

Materials and Methods: Retrospective analysis of data of 2 years and 6 months revealed 46 patients with AIHA. 25 patient’s (54%) were transfused with best matched blood transfusion which was partial phenotype and K antigen matched . All cellular blood components were leukocyte depleted. The transfused and non-transfused patient group was compared for various clinical and laboratory parameters.

Results: 46 patients had established serologic diagnosis of warm AIHA and DAT was found to be positive in all but one case. 42/46 patients had a positive IAT. The autoantibody titre ranged from 128 to 2048. Reticulocyte count was done in 32 /46 patients and the mean reticulocyte count was 8%. Mean LDH level was 507 U/L. 517 units were cross-matched, of which 130 (25%) units were found to be best matched at a titre (2 to 64) below the autoantibody titre in the patient. 130 units were transfused in 25 patients and the mean post transfusion increase in haemoglobin was 1.8 gm/dl Delayed haemolytic transfusion reaction was reported in 1 case, (but the alloantibody specificity could not be identified) 13/46 patients expired, of which 6 were from the non-transfused group. On median follow up of 375 days, all patients in the transfused group maintained Hb > 10 g/dl with transfusion support.

Conclusion: The provision of partial phenotype matched blood for transfusion support in AIHA cases was clinically beneficial as well as safe at titres below 128. This practice has enhanced transfusion safety in urgent situations.

eP107: Immunohematology: Analysis of red cell alloimmunization in sickle cell disease

Prabhat Samadhiya, Vilasini Patil, Pratul Sinha, Romesh Jain

Background: Red blood cell (RBC) transfusion is a vital therapeutic intervention for patients with sickle cell disease (SCD). Alloimmunization from repeated red blood cell transfusions makes it more difficult to find a compatible crossmatch unit and identify appropriate antigenic phenotype negative blood for transfusions. The study aimed to assess the prevalence of alloimmunization in patients with Sickle Cell disease and identify factors associated with it.

Materials and Methods: A retrospective analysis of alloimmunization data from January 2024 to September 2024 was done on patients of Sickle cell disease of AIIMS Bhopal. Blood request forms received for these patients were analyzed for demographic and transfusion details. Immunohematology workup for antibody screening and Identification done on these forms was assessed.

Results: A total 81 request forms of patients with Sickle cell disease were assessed. The mean age was 19.17 years ranging from 1 to 61 years. 60.5% were male patients and 39.5% were female patients. RBC alloimmunization was found in 13 (16.04%) of SCD patients had a history of multiple transfusion. Multiple alloantibodies were identified in 53.8% patients. The most common alloantibodies identified were Anti-c in 53.8%, Anti-E in 30.7% and Anti-jkb in 15.3% patients.

Conclusion: High prevalence of alloimmunization in patients with Sickle cell disease thus emphasizes the need for prophylactic &/or Extended red cell antigen matching for patients with sickle cell disease receiving red cell transfusions.

eP108: Immunohematology: Retrospective analysis of abo blood group discrepancies in a tertiary care centre

Dhara Shah, Mamta Shah, Nidhi Bhatnagar, Sangita Shah, Kamini Gupta

Background: Ensuring the safety of blood transfusion is a fundamental responsibility of blood centres, necessitating the precise identification of ABO blood groups during pre-transfusion testing.

Objective: To analyse the reasons for commonly occurring ABO group discrepancies and their resolution by serological workup.

Methods: A retrospective observational study was done for a period of one year from April 2023 to March 2024. Blood group discrepancies encountered over the period were retrieved from blood grouping discrepancy register and analysed. Blood group was determined by conventional tube technique and further investigated with additional techniques and reagents. The data was compiled and plotted graphically and expressed in tables and charts.

Results: A total of 1,26,839 samples received for blood grouping; discrepancy was encountered in 325 (0.26%) blood samples. Out of which 78 (24%) was group I, 92 (28.3%) was group II,11 (3.38%) was group III and 144 (44.32%) was group IV discrepancy. Group I discrepancy was resolved by enhancing the reaction by prolonged incubation at 4°C or by increasing serum: cell ratio. Group II discrepancy was noted due to subgroups, which was resolved most commonly by Anti-A1 lectin antisera. Group III discrepancy was resolved by washing the cells 3-4 times with normal saline. The causes for group IV discrepancies are unexpected alloantibodies, cold reactive autoantibodies, Bombay phenotype, Circulating RBCs of more than one ABO groups due to RBC transfusion or exchange transfusion. Cold autoantibodies were resolved by pre warming technique, Bombay phenotype was resolved by anti H lectin.

Conclusion: Resolving discrepancies before transfusion is essential. This study highlights the importance of both forward and reverse grouping. It is crucial to meticulously investigate all ABO discrepancies using available resources. Advanced investigative modalities, including molecular techniques, should be employed when serological methods are insufficient.

eP109: Immunohematology: Evalution of incompatible crossmatch at blood center

Riyaan Firoj, Nidhi Bhatnagar, Mamta Shah, Sangeeta Shah, Kamini Gupta

Introduction: Pre transfusion compatibility testing is one of the most important serological testing. Transfusion poses risk of adverse reaction, among one is immune mediated haemolytic transfusion reaction. The most common cause for immune mediated HTR is transfusion of incompatible donor’s RBCs to recipient. Compatibility testing helps us to find best match (compatible units) for recipient and ensure the safety of transfusion. It is therefore important to detect incompatibility between patients plasma and donor cells and crossmatch should be performed following departmental SOP.

Aim and Objectives: To find out prevalence of incompatible crossmatch to formulate root analysis to help ensure safe transfusion. To serologically categorize the auto and allo antibodies with regard to different antibodies.

Materials and Methods: A retrospective study was conducted in which total incompatible cases of 220 were reviewed out of total 174734 cross matches done by CAT (Column agglutination test) in polyspecific (IgG+c3d) gel cards (BIORAD) over a period 22 months i.e (1st January 2023 to 24th September 2024).

Results: Out of 174734 crossmatches reviewed only 220 were found to be incompatible of which 209 were incompatible due to presence of antibodies, 40 have autoantibody, 97 have alloantibody, 72 have both autoantibody with our without alloantibody, out of 40 patients (autoantibody) 22 are more prevalent in AIHA patients followed by 11 in thalassemia & 5 in sickle cell anemia, & 2 in liver parenchymal disease which are associated with Immune haemolytic anemia. Out of 97 patients of alloantibody 15 have multiple and 82 of them have single antibody of them AntiC: 9, Anti-c: 14, Anti-E: 7, Anti-e: 2, Anti-cw: 2, Anti-K: 2, Anti-k: 2, Anti-Fya: 6, Anti-Leb: 2, Anti-M: 22, Anti S: 6, Anti-s: 2, Anti-Jka: 4, Anti-N: 1, Anti-Jkb:1. 11 of them were due to technical/clerical errors.

Conclusion: Presence of Antibody is most prevalent for incompatibility of which alloantibody are more prevalent and most of alloantibody identified have ANTI-M.

eP110: Immunohematology: Red blood cell alloimmunization in multi-transfused patients in a tertiary care hospital

K. Sindhuja, Nidhi Bhatnagar, Mamta Shah, Sangita Shah, Rahul Rajvanshi

Background and Objective: Alloimmunization of red cells is a common and potentially serious consequence of blood transfusion. The risk of alloimmunization is especially high in patients who receive multiple transfusion, such as patients with thalassemia, sickle cell anemia and chronic renal failure. The frequency of alloimmunization is not uniform among all multi transfused patients and it depends on the age, sex, gender, genetic makeup of the patients as well as number and frequency of transfusion. The development of RBC alloantibodies complicates their long-term transfusion therapy. The incidence of ABO and Rh-D alloimmunization is reduced due to weak D testing and transfusing group “O” red blood cell in patients with ABO blood group discrepancy. Apart from these RBC antigens there are many other antigens which pose a risk for alloimmunization. To investigate the seroprevalence and specificity of RBC alloantibodies in multi-transfused patients, in the risk of alloimmunization is especially high.

Methods: A retrospective study was conducted for 6 months from February to July 2024 on blood specimens of 800 multi-transfused patients excluding alloimmunization caused via pregnancy, abortion and autoimmune hemolytic anemia. All specimens were evaluated for antibody screening & identification test via the erythrocyte magnetized technology and 3 and 11 cell panels by column agglutination technique.

Results: The overall prevalence of RBC alloantibodies was 5.4%. 10 specific types of alloantibodies were identified. The most common alloantibody was Rh blood group system (70.3%) especially E and c, followed by MNS (7.4%) and then KELL and Lewis blood group system (3.7% each).

Conclusion: Most alloantibodies were of the Rh blood group specificity. To improve the quality of blood supplied, especially in multi-transfused patients, it is recommended that fresh, phonotype matched, crossmatch compatible and leukocyte reduced red blood cell should be issued to prevent blood transfusion reaction.

eP119: Quality Management: Evaluation of quality indicators at blood centre in a tertiary care centre in Kerala

S. Greeshma, Hadhiya Thahir, A. P. Poornima, V. L. Kala, N. Sasikala

Background and Objectives: The therapeutic outcome in blood transfusion is directly related to the quality of blood transfusion services which can be achieved through the implementation of Quality management system (QMS). QMS can be monitored with the help of performance measures-Quality indicators. NABH has defined 10 quality indicators, of which 5 are mandatory. This study is aimed to assess the 5 mandatory quality indicators at the blood centre in a tertiary care centre in Kerala.

Methods:

Study Design: Prospective Observational Study

Study Setting: Department of Transfusion Medicine at a tertiary care centre in Kerala

Study Period: 1 Year (December 2022-November 2023)

Study Procedure:

The Five mandatory Quality Indicators as proposed by NABH were assessed.

1. PERCENTAGE OF TRANSFUSION TRANSMITTED INFECTION:

   (Combined TTI cases (HIV+HBV+HCV+Syphilis+Malaeia)/Total number of donors)X100

2. ADVERSE TRANSFUSION REACTION RATE:

   (Number of abverse transfusion reaction/Total number of blood components issued)x100

3. WASTAGE RATE (Excluding discards due to TTI reactivity):

   (Number of blood components discards/Total number of blood components)x100

4. TURN AROUND TIME:

   Sum of Time taken for crossmatch/Total number ofcrossmatches

5. COMPONENT Qc FAILURE (For each component):

   (Number of component Qc failures/Total number of components tested)x100

Samples were collected consecutively till the required sample size is met. The data was compiled, plotted graphically; expressed in tables and charts.

Results:

Percentage of TTI reactivity-1.81% (Meets the benchmark)

(HBV-0.52%, Syphilis–0.48%, HCV-0.45%, HIV-0.33%, Malaria-0.03%)

Adverse Transfusion reaction rate-0.45%

(Allergic transfusion reaction-0.20%, FNHTR-0.18% followed by TAD, TRALI, TACO. No case of hemolytic transfusion reaction were reported during the period)

Wastage Rate-6.17% (PRC-2.47%, PC-13.56%, FFP-2.47%)

Turn around time-For elective cases-80 minutes, For emergency cases-35 minutes

Component Qc failures:

PRC-All passed, PC-93.62% passed, FFP-92% passed Cryoprecipitate-60% passed (Does not meet the benchmark)

Conclusion: Quality indicators are important QMS tool for accomplishment of quality goals. This study helped us in assessing the quality and to identify the flaws in our blood centre. By using this data, one can analyze the root cause and can implement CAPA in order to sustain quality.

eP120: Quality Management: Root cause analysis and CAPA for haemolysis during processing/storage of blood bags

P. N. Sindhu, R. Amita, Debasish Gupta

Introduction: Hemolysis of red cells that occurs during component processing and storage of red cell units has serious clinical implications for the transfused patients. Timely detection of haemolysis is important to minimize adverse transfusion events.

Aim: To do a Root cause analysis of red cell hemolysis encountered during processing/storage of blood bags.

Materials and Methods: The reasons for hemolysis were tabulated under 5M’s – Man, Material, Method, Mother Earth and Measurements. An Ishikawa diagram was constructed based on this for each specific case of hemolysis. This retrospective study was conducted in the blood centre as a comprehensive analysis of haemolysis in red cell units over a period of 15 months from July 2023 to September 2024.

Results: We encountered a total 39 hemolysis during this period , 6 during processing and 33 during storage. The frequency of encountering haemolysis in in-house and outdoor camps was almost similar at 0.5%. Duration of collection was less than recommended except for one which exceeded 11 minutes and the prevalence of haemolysis was seen more with 450 ml blood bags ( Quadruple T &B & Triple bag with SAG-M). Maximum time of return of blood unit was 11 hours. Cold chain was not maintained for one unit . Maximum repeated issue of units were 3.

Conclusion: The study highlights the need for proper documentation of each step of donation, from vein to vein and to identify the reasons for hemolysis in blood bags using the Ishikawa diagram. Steps have been taken as corrective measure , such as numbering the BCMs and monitoring their performance, enhanced documentation practices, periodical temperature monitoring of blood collected from camps. And advanced hemolysis estimation methods. This will help in finding the root cause and initiating CAPA to prevent wastage of the precious resource called blood units.

eP121: Quality Management: Optimizing blood component utilization: A study on returned bags

I. Saraswathi, N. Vivekanand, Puneeth Babu Anne, A. Sai Jahnavi, V. Harini

Background and Objective: Return of issued blood component bags to blood centres compromises product integrity, poses logistical challenges, and raises biohazard concerns. The objective of this study is to identify the most common reason for return of the blood component bags and thereby improve the blood supply chain’s efficiency and safety.

Methods: This is a prospective observational study carried out for a period of 6 months on the number of blood components issued and returned to the Blood Centre; examine reasons for return, component types, storage, transportation and handling.

Results: A total of 2022 components were issued of which 1135 were PRBC (56.1%), 307 were FFP (15.1%), 166 SDP (8.2%) and 414 RDP (20.47%). The number of components returned were 22 PRBC (1.93%) and 2 FFP (0.65%) 4 RDP (0.96%), 1 SDP (0.60%). The main reasons for return were over ordering 8 (36.3%), high blood pressure 6 (27.2%), fever 5 (22.7%), cancelled or postponed procedures 2 (9.0%) failure to secure a cannula for transfusion for PRBC 1 (4.5%), clots in the bag when the component issued was FFP 2 (100%), miscommunication in case of RDP 4 (100%) and SDP1 (100%). Return rates varied significantly with PRBC being the most frequently returned component. The temperature of the components returned when checked was maintained in 21 PRBC (95.4%), 4RDP (100%) 1SDP (100%); percentage hemolysis was calculated for returned PRBC which was 0.7% in 21 PRBC (95.45%). In case the component was returned due to high blood pressure or fever we made sure to find out that the vitals were checked before the component was issued from blood centre.

Conclusion: Our study identifies areas for improvement in blood distribution and transfusion, including inventory management, storage, transport protocols and staff training. Addressing these issues can enhance patient safety, reduce waste and optimize the blood supply chain.

eP122: Quality Management: A prospective study of assessing completeness and accuracy of blood request forms

V. Harini, N. Vivekan, Puneeth Babu Anne, A. Sai Jahnavi, I. Saraswathi

Background and Objective: Incomplete forms can lead to delays, errors, and compromised patient care. Therefore, a quality improvement study to ensure completeness and accuracy of blood requests was carried out.

Methods: Blood request form is divided into 4 sections of which Section 1 contains patient demographic details, Section 2 clinical and lab parameters, Section 3 contains component requirements and Section 4 crossmatch and issue details. A prospective observational study was conducted at our blood centre from January to June 2024 during which request forms were evaluated for completeness and accuracy.

Results: Of the 2727 blood request forms assessed, 1934 (70.9%) forms were found incomplete of which 1062 (54.91 %) forms were inadequately filled in Section 1 with date not being filled on 146 (13.7%) forms, gender on 53 (4.9%), patient location on 141 (13.2%), bed number on 436 (41%). Section 2 was incomplete in 812 (41.98 %) forms of which indication for transfusion was not filled on 76 (9.35%) forms, haemoglobin on 27 (3.32%), platelet count on 86 (10.5%), previous transfusion history on 237 (29.1%), transfusion reactions on 219 (26.9%), pregnancy history on 98 (12%) and previous miscarriage history on 120 (14.7%) forms was not mentioned. Section 3 was incomplete in 68 (3.51 %) forms of which type of request was not filled on 9 (13.2%) forms, date and time of requirement on 21 (30.8%), stamp and signature of in-charge on 7 (10.2%) forms was incomplete. A total of 632 (23.1%) forms revealed inaccuracies with 292 (47%) bed numbers, 118 (19%) in patient location, 66 (10.6%) in indication for transfusion, 61 (9.8%) in platelet count, 56 (9%) in dates, 19 (3.05%) in haemoglobin, 9 (1.44%) in gender, wrong blood group in 11 (1.7%).

Conclusion: The results highlight significant gaps in form accuracy and completeness for which corrective action is warranted.

eP123: Quality Management: Quality indicators as performance tools towards improvement of blood safety and transfusion services – Institutional study

Nandini Raval

Background and Objectives: The Blood Transfusion Services is responsible for ensuring sufficiency, quality and safety of the blood and blood components . A well organized and efficient BTS would contribute toward better patient care and also towards the development of healthcare system in the country. The aim of this study is Evaluation of the all quality indicators as per NABH and assessing as a tool towards transfusion services and also check for the preparedness of our blood centre for NABH accreditation.

Methods: A retrospective study has been conducted for one year period from January-2023 to December-2023 in Blood Centre, Shalby Hospitals. Data were collected from software & registers. Detailed analysis was performed and all corrective actions have been taken.

Results: Upon analyzing the quality indicators , out of 1638 donations over a period of one year, mean TTI% was 2.73% , ATTR was 0.001% with overall wastage rate 1.26% with highest wastage rate 2.68% in month of September due to higher no. of expired PRCs for which RCA and CAPA was done . overall TAT for routine issues were 132.43 mins and for emergency issues, it was 29.51 mins. overall QC failure rate was 0.002% with highest and only QC failure was noted in month of Aug-2023. ADDR was found to be 0.0005% & DDR was 5.73% with C:T ratio of 1.20%.

Conclusion: A well-structured blood transfusion service contributes towards better healthcare in a hospital, which is reflected by quality indicators.

eP124: Quality Management: Blood donor turn around time (TAT): Quality parameter for transfusion services

Shaoli Ray, Sanjay Prakash, Suresh Kumar Lakhara

Background: Turn Around Time (TAT) is defined as time taken by blood donors for entire donation process i.e. from time of entry to time of exit. It indicates quality of blood donation complex.

Aims and Objectives:

To calculate total time taken for blood donation by in house donors.

To evaluate reasons for increase in donation time.

To plan improvement strategies for donation process.

Methods: The study was conducted in Dept of Transfusion Medicine, R.N.T. Medical College, Udaipur with 3000 in-house blood donors randomly selected during January 24 to March 24 time period. Time of registration, Hb test, medical history, phlebotomy, donor exit time was recorded on donor card. If there was delay or donor reaction the details were documented which helped to assess the reason for delay.

Results: The TAT for in house donors was approximately 45 minutes. 94.5% donations were as par TAT. The factors causing increase in donation process are – time taken to understand the procedure, excessive rush of donors during peak hours and weekends, unexpected transient donor reactions and manpower shortage. Strategies to improve and prevent delay include appropriate staff presence at appointed counters, pre-donation counselling, prompt attention to donor reactions and effective management, team effort to overcome any challenges during donation process.

Conclusion: TATs helps to evaluate loopholes in chains of events. Once the shortcomings are detected, necessary measures need to be implemented. This is vital to improve all aspects of donor retention.

Keywords: Counselling, donor reactions, turn around time

eP125: Quality Management: Quality assessment of platelet concentrates prepared by platelet rich plasma and buffy coat method

Krupali Rajendrakumar Panchal, Sangita Shah, Nidhi Bhatnagar, Mamta Shah, Rahul Rajvanshi

Background: Role of any transfusion services is to provide blood and blood components which are safe, pure, potent and effective. So quality control is the most important parameter to assess the efficacy of blood and its component. The present study was undertaken to assess the ex-vivo quality of platelet concentrates prepared by two different methods and compare the efficacies of both methods on various parameters.

Aim and Objective: To evaluate quality control of platelets prepared by PRP method and buffy coat method.

Methods: A total of 60 platelet concentrates (30 units of PRP-PC and 30 units of BC-PC) were selected randomly and tested for quality after collection. 2-3 ml of samples were collected from the selected platelet bags in plain test tubes using aseptic precautions and tested for the following parameters: 1. Platelet count per ml. 2. Platelet count per bag. 3. pH changes.

Results: A total of 60 platelet concentrates (30 of PRP-PC, 30 of BC-PC) were enrolled in this study. The 95% of confidence interval (CI) of platelet per ml of PRP-PC and BC-PC was 915±2.87x10 3 and 1060.33±55.62x103 respectively. The 95% of CI of platelet count per bag of PRP-PC and BC-PC was 5.6±0.10x 1010 and 6.74±0.15x 1010 respectively. The 95% of CI of pH of PRP-PC and BC-PC was 6.8± 0.1and 6.5±0.1 respectively.

Conclusion: In our study it was seen that even though PRP-PC and BC-PC fulfilled the desired quality parameters, platelets prepared by buffy coat method were at better yield in terms of platelet count.

eP139: Therapeutic Apheresis and Cellular Therapies: Collection efficiency in peripheral blood stem cell collection using spectra optia – A retrospective study

J. Latha Fathima, A. M. Shanthala Devi

Background and Objectives: Hematopoietic stem cell transplantation is a standard procedure for varied malignancies and for non-malignant diseases. It involves collection of peripheral blood stem cell (PBSC) by apheresis through automated cell separator. The objective of the study is to analyse the performance characteristics of the cell separator- SPECTRA-OPTIA.

Methods: A retrospective study from January 2021 to September 2024 was conducted. Laboratory parameters like Haemoglobin, Total leukocyte count, platelet count, CD 34 count prior to procedure, cell count and CD 34 of the product and procedural parameters like anticoagulant used, total blood volume processed, duration of run, product volume, total blood volume processed (in ratio), etc. were studied.

Results: A total of 95 PBSC procedures were done. Of these, 51.5 % (49/95) were allogenic and 48.5 % (46/95) were autologous PBSC. Performance characteristics like apheresis yield (AY), apheresis yield per kg, collection efficiency (CE2), collection rate, predictive apheresis yield and performance ratio, etc were calculated. The results include Apheresis yield -440*106 cells, AY/kg -13.5 *106 cells /kg, CE2-71%, cell throughput-2 * 106 cells /minute, collection rate- 5* 104 cells/ml, predictive apheresis yield -426.25 *106, and Performance ratio-103%. Pre CD 34+ count is the important factor in predicting the PBSC yield. Mean pre-CD 34 counts was 70 cells/ul and mean CE2 of Spectra Optia was 288.

Conclusion: Collection efficiency assessment helps to understand the apheresis system, and the performance of cell separator. Primarily the collection efficiency depends on the CD 34 counts on the pre-procedure sample & CE 2 of Spectra Optia. CE2 can be prospectively used to predict the yield based on preCD34 counts.

Keywords: Apheresis, CD 34, collection efficiency

eP140: Therapeutic Apheresis and Cellular Therapies: Therapeutic plasma exchange in autoimmune disorders: A case series

K. Ambuja, C. Shivaram, C. Keerthi

Background: Therapeutic Plasma Exchange (TPE or PLEX) is used in the treatment of various autoimmune haematological, renal and neurological diseases. The goal of TPE is to remove the antibodies found in the plasma. We share our experience of TPE with few autoimmune neurological and haematological/ renal disorders

Case Description: Case 1: A 38 Y/F, with fever, severe joint and body pain since 1 month, NCS+EMG done suggestive of myokinetic discharges. Autoimmune encephalitis panel done was positive for antibodies to CASPR AND LGI-1. Diagnosed with ISAAC syndrome, 5 sessions of PLEX was done. On discharge she was symptomatically better, with only mild pain. Case 2: A 29 y/F with generalised myasthenia gravis; ACHR antibody positive with ocular and bulbar involvement in myasthenic crisis. 7 sessions of PLEX done outside and 3 sessions at our centre. At discharge she was independent of her ADL’s with motor power 5/5 in all 4 limbs. Case 3: A 29 y/F with blurring of vision and weakness of right upper and lower limbs. MRI showed Optic Neuritis and Demyelinating lesions in thoracic and Cervical spine, diagnosed with Neuromyelitis optica. Following 5 sessions of PLEX, spasticity of right upper limb and gait improved. Case 4: A 2 y/F child , with fever, cold, cough x7 days, vomiting, dark urine, ecchymatic patch over left lower limb with anemia,thrombocytopenia, renal dysfunction and normal coagulation s/o thrombotic microangiopathy. ADAMTS 13 deficiency noted. Underwent 4 sessions of PLEX. Renal parameters were normal at discharge. Case 5: A 60 year old lady with unexplained renal dysfunction underwent renal biopsy showed anti-GBM disease with anti-GBM titres more than 500, underwent 8 sessions of PLEX, following which Anti-GBM titre was nil.

Conclusion: TPE is found to be an effective treatment modality for autoimmune diseases.

eP141: Therapeutic Apheresis and Cellular Therapies: Single-center experience of therapeutic plasma exchange in neurological diseases: Indications, efficacy, and safety

Prerna Sachdeva, Anil Khetarpal, Divya Setya

Background and Objective: Neurological diseases with autoimmune or inflammatory etiology pose significant challenges in terms of treatment. Therapeutic plasma exchange (TPE) has emerged as an effective and promising treatment modality for managing these conditions by removing pathogenic autoantibodies, immune complexes, toxins and proinflammatory mediators in conjunction with Immunosuppression. Removed plasma with toxins and autoantibodies is replaced by crystalloids, colloids, and/or normal saline. The aim of the study was to describe the clinical profile and the experience with the usage of TPE in various neurological patients with emphasis on safety and efficacy of TPE.

Methods: This retrospective study analyzed medical records of patients who underwent TPE for neurological diseases by centrifugal aphaeresis device between January 2017 and September 2024 at our institute. Patient Demographics, Clinical Diagnoses, Characteristics of TPE, such as number of cycles, type of replacement solution, and adverse events were collected and evaluated. Descriptive statistics were used to summarize the data.

Result: A total of 73 patients underwent 343 TPE procedures during the study period. There was a slight predominance of male patients (54.8%), with an average age of 41.3 years. The most common diagnosis was Optic Neuritis followed by Guillain–Barré syndrome (GBS).

TPE protocols included exchanging 1-1.5 plasma volume every alternate day, with replacement solution being albumin, fresh frozen plasma or combination of both. Majority of patients showed positive clinical improvement indicating the efficacy of TPE in halting the disease progression and ameliorating symptoms. Adverse Events were reported in 20 procedures but were successfully managed.

Conclusion: The study demonstrates the effectiveness and safety of TPE in the management of neurological diseases at our institute. It is a safe and cost effective treatment modality with minimal side effects or complications. These findings contribute to the growing acknowledgement of TPE as an upcoming therapeutic modality in the field of neurology.

eP142: Therapeutic Apheresis and Cellular Therapies: Hump nosed pit viper snake bite induced VICC unresponsive to ASV treated successfully by therapeutic plasma exchange: A case report

Shivanand Hemant Kumatagi, Shamee Shastry, Ganesh Mohan, Deepika Chenna, M. Deep

Introduction: Hump nosed pit viper (HNPV) snakes are common in western ghats region of India and Srilanka.[¹] Their bites commonly cause local envenoming leading to local pain, swelling, and necrosis. Acute kidney injury is the most common systemic manifestation, and some patients may develop venom-induced consumption coagulopathy (VICC) which usually doesn’t respond to ASV. Here we present a case report of a patient who developed VICC unresponsive to anti-snake venom, but was successfully treated with therapeutic plasma exchange (TPE).

Case Summary: 48 year old male patient presented with alleged history of snake bite of hump nosed pit viper over his left ankle. The chief complaints on admission were pain and swelling till mid leg region which was progressive in nature and associated with redness. He received 20 vials of anti-snake venom in an outside hospital and was referred to our hospital. On examination, he was conscious and oriented, his vital signs were stable, peripheral pulses were palpable on his left foot. Localised rise of temperature, tenderness and swelling were noted. Small bite mark was noted near left achelles tendon. Lab reports showed deranged PT (> 120 sec) and APTT (25 sec). Thromboelastography showed flat line and severe hypocoagulable state indicative of VICC unresponsive to ASV. Envenomation is a category III indication for TPE according to ASFA. We initiated TPE. Total plasma volume processed was 2842 ml. A total of 4 normal saline, 2 albumin and 6 fresh frozen plasma units were used during the procedure. VICC improved on day 2 of plasma exchange as PT came down to 18 sec and TEG was normal. Patient tolerated the procedure well. Patient was put on supportive medication and antibiotics. The swelling gradually reduced and patient condition improved considerably. Patient PT INR improved and was discharged on day 4.

Discussion: Since the available ASV are not effective against HNPV, TPE is best option for treatment. It is also advantageous over FFP transfusion, which involves larger volume of blood products and takes many days to show effectiveness.

Conclusion: TPE may be considered in the management of snake bite envenomation unresponsive to ASV.

Reference

1. Namal Rathnayaka RM, Ranathunga PE, Kularatne SA. Venom-induced consumption coagulopathy following hump-nosed pit viper (Genus: Hypnale) envenoming in Sri Lanka: Uncertain efficacy of fresh frozen plasma. Wilderness Environ Med 2020;31:131-43.

eP143: Therapeutic Apheresis and Cellular Therapies: Peripheral blood stem cells harvest from paediatric donors for allogenic transplantation – Our apheresis experience

Soma Agrawal, Rashmi Jain, Ankita Sharma, Uday Thakur, Mohit Chowdhry

Background and Objectives: The aim of this retrospective study is to report our single centre successful experience in harvesting peripheral blood stem cells from paediatric aged group donors for allogenic haematopoietic stem cell transplantations (HSCTs).

Methods: We retrospectively collected data from our blood centre records of paediatric aged group allogenic donors who underwent PBSC harvest from January 2019 to September 2024 at our tertiary care centre. Demographic and clinical details of paediatric recipient and donor and PBSC harvest characteristics were recorded. Data was analysed using descriptive statistical tools and frequencies.

Results: A total of 98 PBSC harvesting procedures were done during January 2019 to September 2024 from 95 mobilized allogenic paediatric aged group donors on day-care basis. The mean age and weight of the donor noted at the time of apheresis were 8.47 years and 36.89 kg respectively. Of this 46% were matched sibling and 54% were haploidentical allogenic paediatric donors. Femoral HD catheter was used as an access in 74% allogenic donors. Calcium gluconate at the dose of 10 mg/kg or as per primary team’s order was administered through out apheresis to counteract hypocalcaemia due to anticoagulant. The mean pre-CD34+ count and product CD34+ count was 240.7 cells/µL and 4349.1 x106 cells/µL. The minimum and maximum yield procured in 98 procedures were 5.2x106 kg/recipient’s body weight and 86.1 x106 kg/recipient’s body weight. All PBSCs procedures were concluded without any systemic adverse event with successful collection of target dose desired at primary physician’s end.

Conclusion: Our single centre institutional experience corroborates for PBSC harvest from children as allogenic donors is a safer and effective apheresis procedure provided being optimised by an active participation of each clinical stakeholder to overcome physiological, anatomical, psychological, technical and ethical challenges.

eP144: Therapeutic Apheresis and Cellular Therapies: A rare case of therapeutic plasma exchange (TPE) in a steroid-refractory paraneoplastic neurological disorder in small cell lung carcinoma patient

T. Sowmiya Banu, Mohit Chowdry

Background: Paraneoplastic neurologic syndromes (PNS) comprise of cancer-associated neurologic conditions triggered by onconeural antibodies against intracellular antigens shared by the tumor and nervous system (e.g., Hu, CV2/CRMP5, Yo, Tr, & amphiphysin). As per ASFA guidelines 2023, PNS gets category III Grade 2C with incidence of 0.1-1% (4-9 per 1,000,000) there are 2 controlled trials, 15 Case series and no Randomized controlled trials, Case report in TPE. We present a Case of PNS in SCLC where the patient had antibody-mediated sensorimotor and cerebellar degeneration which was unresponsive to high-dose corticosteroids. TPE along with Intravenous Immunoglobulins (IVIG) manifested a good recovery and rehabilitation to the patient.

Case Report: A 63-year-old male, chronic smoker and known case of SCLC on chemotherapy, presented with abnormal behavior, sensorimotor neuropathy, and cerebellar signs. As nerve conduction studies suggested brain or spine-related etiology, CSF-autoimmune and serum-paraneoplastic panels were done, which revealed Anti-GABA-B and Anti-Hu, Anti-CV2 antibodies respectively. Patient was started on high-dose corticosteroids, however symptoms exaggerated and got bedridden. Therapeutic Plasma Exchange was considered as the next option to revitalize the patient by removing antibodies and mediators of tumor in the circulation. Patient underwent three uneventful sessions of TPE daily with 1.5 Plasma Volume exchanged with fluid balance of 100% using 4% Albumin and two Fresh frozen plasma at the end as replacement fluid. Calcium gluconate infusions were given throughout the procedure. Followed by IVIG and chemotherapy were given. After 3 sessions, patient showed clinically significant improvement in the sensorimotor and cerebellar functions and was able to walk with support and maintain his muscle power and sensations at 3 months of follow up establishing the role of TPE in a steroid-refractory case of PNS.

Conclusion: Early diagnosis of PNS and prompt initiation of TPE favors rapid resolution of PNS which rejuvenated the patient. Hence upgradation of PNS in ASFA categorization is pivotal.

eP145: Therapeutic Apheresis and Cellular Therapies: An experience of therapeutic phlebotomy procedures as adjunct therapy in patient with their symptom in a tertiary care hospital

Nehasingh, Bankim Das, Rakesh Kumar, Saurabh Lahare, Sweata Ranjan, Nishit Nayan

Background: Therapeutic phlebotomy is a medical procedure that involves removing blood, particularly red blood cells or serum iron, as a treatment for specific blood disorders. Historically known as bloodletting, this ancient practice had two primary methods: generalized techniques, such as venesection (vein cutting) and arteriotomy (artery cutting), and systemic techniques, including cupping and the use of leeches. The procedure was believed to stimulate the bone marrow to produce new red blood cells while simultaneously reducing serum iron levels. In modern medicine, therapeutic phlebotomy is used to manage conditions by decreasing red blood cell mass, lowering hematocrit (the proportion of red blood cells in the blood), reducing blood viscosity, or inducing iron deficiency. This approach helps alleviate symptoms and complications associated with various diseases.

Objectives: Therapeutic phlebotomy allows for a controlled and gradual decrease in red cell mass leading to improved blood flow and symptomatic relief in polycythaemia. The present study was aimed to determine the impact of serial fixed volume therapeutic phlebotomy protocol on the symptoms in patients of polycythemia.

Materials and Methods: This prospective longitudinal study was conducted over 37 months. The desired haematocrit for polycythemia vera and secondary polycythemia was 45% and 52% respectively. A fixed volume of 250 ml phlebotomy was performe. Presenting symptoms was evaluated before and after each procedure quesnarried based assement like mild, moderate severe relif in symptoms.

Volume to reduced= initial Hct-Desired Hct/79 X blood volume/kg X body weight/kg.

Results: From 2019 to 2024, a total of 151 therapeutic phlebotomy (TP) procedures were performed on 44 patients. Since the introduction of TP in 2019, the mean interval between procedures has been approximately 22 days. Polycythemia vera was the predominant indication for TP, followed by congenital heart disease. Platelet counts varied among patients, with some exhibiting levels exceeding 400,000/µL, while the average platelet count was 340,000/µL. Uncommon presentations for TP included polycythemia with optic neuritis, acute appendicitis, obesity with nasal obstruction, chronic obstructive pulmonary disease (COPD), sarcoidosis, and coronary artery disease with hypertension. Pre-procedure and post procedure symptoms of patient compared with paired T test and chi squared test ( The two-tailed P value equals 0.6657) with mild and moderate symptoms group.

Conclusion: Our protocol yielded rapid and marked improvement in patients of primary and secondary polycythemia with minimal adverse events and significant amelioration of clinical parameters.

eP146: Therapeutic Apheresis and Cellular Therapies: Efficacy of dump freezing for cryopreservation of PBSC for autologous stem cell transplant

Jayesh Rohit, Shailesh Lavana, Arpit Patel, Bhawna Chaudhary, Yogesh Mistry, Santhosh Vandanasetti, Sahil Gupta, Ameya Korane, Niraj Bhatt

Background and Objective: This retrospective analysis aims to assess the efficacy and outcomes of dump freezing (uncontrolled rate freezing) at -80°C using a mechanical freezer for the cryopreservation of peripheral blood stem cells (PBSC) intended for autologous stem cell transplant

Methods: The study involved 20 patients with haematological cancers who underwent autologous stem cell transplant between May 2019 - July 2023. Cryopreservation was achieved using a cryoprotectant mixture of 10% DMSO and 5% albumin. PBSCs were subjected to dump freezing and stored at -80°C until infusion. The viability of stem cells was evaluated at 24 hours post-cryopreservation, at the time of stem cell infusion, and during clinical follow-up to monitor engraftment.

Results: The study cohort comprised 15 male and 5 female patients with a median age of 33 years (range:17-60 years). Two patients were co-infected with HIV. The median storage duration of cryopreserved products was 9.5 (6-13) days. The mean viability of stem cells after 24 hours of cryopreservation was 78.5% (range 65-95%), and at the day of stem cell infusion was 75.05% (range: 55-90%). All patients achieved neutrophil engraftment, median time to engraftment of 9.5 (range: 7-14) days. Most patients (except one) achieved platelet engraftment, median time to platelet recovery of 13.5 (range: 9-60) days. The patient who did not achieve platelet engraftment experienced thrombocytopenia, likely due to a sudden surge in HIV and veno-occlusive disease. Out of the 4 deaths, 3 were attributed to relapse, one was related to the transplant. The remaining patients were alive with a median follow-up of 621 (range: 43-1554) days, all maintaining sustained neutrophil and platelet engraftment.

Conclusion: This study demonstrates that dump freezing is an effective and clinically successful cryopreservation method for autologous stem cell transplant, particularly in resource-constrained settings. It provides a straightforward and cost-effective alternative to controlled rate freezing, yielding positive outcomes and ensuring the viability and engraftment potential of cryopreserved stem cells.

eP147: Therapeutic Apheresis and Cellular Therapies: Role of therapeutic plasma exchange in treatment of transplant associated thrombotic microangiopathy following renal transplantation: A case report

Anshu Mahajan, Naveen Akhtar, Meena Sidhu, Abdul Majeed

Thrombotic microangiopathy (TMA) in renal transplant recipients is commonly associated with various causes such as drug – induced TMA mainly due to administration of calcineurin inhibitors (CNIs), TMA due to ischemia reperfusion injury, Antibody-mediated rejection (ABMR) and viral infections. We report a case of transplant associated thrombotic microangiopathy (TA-TMA) diagnosed in the kidney allograft of a 49 -year-old male who was successfully treated with plasma exchange. He was diagnosed with end-stage renal disease of unknown etiology. Patient present with Thrombocytopenia, hemolytic anemia, elevated lactate dehydrogenase and graft dysfunction three days after kidney transplantation. We diagnosed TA-TMA and administered plasma-exchange (Plex) sessions, steroid pulse and intravenous immunoglobulin. The patient’s laboratory test results show increase in hemoglobin, platelet count and decrease in creatinine level and was discharged on day 12. Plasma exchange is indicated as category-III treatment for transplant associated TMA and as category-I in certain drug induced TMA and antibody-mediated rejection. In recent studies, plasma exchange has resulted in allograft salvage rate of 80% in cases with Post-transplant TMA. In the present case study, TPE resulted in allograft salvage in the patient.

eP148: Therapeutic Apheresis and Cellular Therapies: Rare presentation of smooth muscle involvement in a known case of myasthenia gravis

B. K. Madhan Kumar, Pramanya

38 year old presented with obstipation and abdominal pain for 25 to 30 days and was diagnosed as Adult Hirschsprung disease in Delhi. Biopsy done in Apollo, Chennai showed presence of Ganglionic cells in sero-muscular layers of rectum and sigmoid colon. His Anti-Ach R Ab were high (> 8) and was diagnosed with Myasthenia Gravis presenting with rare smooth muscle involovement. He was also diagnosed to have Thymoma operated on 24/9/24. He also underwent 5 to 6 cycles of PLEX which improved his symptoms.

eP149: Therapeutic Apheresis and Cellular Therapies: Role of therapeutic plasma exchange in different clinical condition in tertiary center

Hirenkumar V. Makwana A. K. A. Darji, Mamta Shah, Nidhi Bhatnagar, Sangita Shah, Kamini Gupta

Introduction: Therapeutic plasma exchange (TPE) is a procedure that removes plasma from the blood and replace with a replacement fluid such as a fresh frozen plasma or albumin. It removes auto-antibodies, pathogenic substance, lipoproteins, Cryoglobulins from the plasma and key role in management of various diseases. Early diagnosis of diseases and starting of therapeutic plasma exchange may enhance fast recovery. A typical goal is to exchange 1-1.5 times estimated plasma volume as per ASFA guidelines.

Aim and Objective: The aim of the study is to determine effects of the therapeutic plasma exchange on the patients with the different diagnosis.

Methods: A retrospective observational study was conducted of all the TPE procedures done in a period of 1 year (March 2023 to February 2024) in tertiary care center. Therapeutic plasma exchange procedure were performed using automated Cell Separator like Spectra Optia and COM-TEC, F. kabi and Amicus. The data was analyzed for the various indications in which TPE was advised.

Results: During the study period procedure of TPE performed on 121 patients out of which The most common indication for TPE was Guillan-barre syndrome (41.32%), followed by Acute Transverse myelitis (18.18%), Myasthenia gravis (13.2%), Liver Parenchyma diseases (8.26%), Neuromyelitis optia (5.78%), Auto-immune Encephalitis (4.95%), multiple sclerosis (2.47%), Hemoglobinopathy (1.65%), Organophosphate poisons (1.65%), TTP (1.65%).

Conclusion: Therapeutic plasma exchange is considered as an effective immune-modulatory treatment. TPE hold strong evidence in improvement of neurological disorders, For the better outcome the clinicians should advice plasmapheresis at an earlier stage before irreversible damage of the diseases as per ASFA guidelines.

eP173: Transplant Immunology: Navigating transfusion needs in heart transplantation surgery in tertiary cardiac care hospital

Dhara Darshan Patel, Shital Soni, Brijesh Patel, Nirali Patel, Parul Prajapati, Truptee Thakkar, Ajay Taviyad

Background and Objectives: Since few years, there is an increase in number of heart transplant being performed in India, and for that increase in demands for blood and blood products. Transplantations may require massive transfusion of blood products. Therefore, blood centres need to predict, prepare and supply the required amount of blood products.

Methods: In this retrospective observational study, we analysed the amount of reserved and transfused blood components as Red blood cells, Fresh frozen plasma, Platelets, and Cryoprecipitates in 37 patients who was planned for heart transplantation surgery in our hospital between September 2022 and September 2024. Data was gathered from blood centre records.

Results: Platelets were the most frequently transfused blood component. Transfusion of blood components during and after heart transplantation surgeries are: Red blood cells (Leucodepleted and irradiated) 3.16 units; Fresh frozen plasma 0.56 units; Platelet concentrates (irradiated) 7.05 units; and Cryoprecipitate 0.29 units and Single donor platelet (SDP) 0.10 respectively. The average transfusion volume of transplants would be optimized every year. To control the emergency situations during surgery, our blood centre has made policy to reserve 5 units of each components ready for transfusion. To prevent this reserve and wastage of blood components it is recommended to implement patient blood management for such patients.

Conclusion: Periodic evaluation of transfusion requirements will facilitate the efficient management of blood products at the time of transplantation and help blood centres predict changes in blood requirements.

Keywords: Blood management, blood transfusion, heart transplantation

eP174: Transplant Immunology: The key to immunologic compatibility in the highly sensitized-the combined role of understanding anti HLA antibody and HLA allelic prevalences

R. Sam Arul Doss, M. Divya, K. C. Gayathiri, D. Dolly

Background: Donor availability for the highly sensitized is a challenge despite high quality HLA typing and Anti HLA antibody detection techniques. A deeper understanding of prevalences of these two entities might help to crack the code.

Aim and Objectives: To evaluate the frequency of allele-specific anti-HLA antibodies and the prevalence of the corresponding HLA alleles to assess the clinical probability of finding an antigen negative donor.

Methods: This retrospective study analysed the frequency of antibody specificities present in 15 highly sensitized patients. Antibody testing was performed using the Luminex Single Bead Antigen Assay (SAB), with an MFI (Mean Fluorescence Intensity) > 1500 considered positive. High-resolution HLA typing was done with MIA FORA kits on the Illumina MiniSeq platform. An in-house built software (Database-Driven HLA Matching Algorithm with Transaction-Safe CRUD Operations) designed by institutional IT team was used to determine the HLA allele frequency and the results were collated.

Results: Amongst 15 patients, the most frequent antibodies were listed in decreasing order and corresponding allele frequency of the Antigen in question is collated. In Class I : Anti HLA-B*57:01 (80%) / HLA-B*57:01 (10%), Anti HLA-B*58:01 (73.33%) / HLA-B*58:01 (10%), Anti HLA-B*15:12 (66.67%) / HLA-B*15:12 (0.29%), Anti HLA-A*24:02 (53.33%) / HLA-A*24:02 (29%), Anti HLA-A*02:01 (53.33%) / HLA-A*02:01 (8%), Anti HLA-B*27:05 (46.67%) / HLA-B*27:05 (2.5%), Anti HLA-A*24:03 (40%) / HLA-A*24:03 (0.1%) Anti HLA-A*01:01 (33.33%) / HLA-A*01:01 (23%), Anti HLA-A*11:01 (20%) / HLA-A*11:01 (26%), and Anti HLA-A*33:03 (25%) / HLA-A*33:03 (13.33%).

Whereas in Class II : Anti HLA-DRB1*07:01 (46.67%)/ HLA-DRB1*07:01 (31%); Anti HLA-DRB1*09:01 (46.67%) / HLA-DRB1*09:01 (1%); Anti HLA-DRB1*12:01 (40%) / HLA-DRB1*12:01 (1%); Anti HLA-DRB1*14:04 (33.33%) / HLA-DRB1*14:04 (17%); Anti HLA-DRB1*04:03 (33.33%) / HLA-DRB1*04:03 (12%); Anti HLA-DRB1*08:02 (33.33%)/ HLA-DRB1*08:02 (1%); Anti HLA-DRB1*10:01 (26.67%) / HLA-DRB1*10:01 (13%), Anti HLA-DRB1*15:01 (20%) / HLA-DRB1*15:01 (28%) and finally Anti HLA-DRB1*15:02 (6.67%) / HLA-DRB1*15:02 (24.3%).

Discussion and Conclusion: Our results highlight the various combinations of antibody frequency and allelic prevalence such as HLA-A*24:02 which shows high prevalence (29%) and moderate frequency (53.33%), suggesting strong immune engagement. Conversely, HLA-B*15:12, despite its high frequency (66.67%), has limited clinical relevance due to its very low prevalence (0.29%). In Class II, HLA-DRB1*07:01 plays a significant role in immune recognition with both high frequency (46.67%) and prevalence (31%). On the other hand, HLA-DRB1*09:01 and HLA-DRB1*12:01, despite their high frequencies, have low prevalence (1%), indicating minimal immune significance. Understanding these various combinations in our population is essential for predicting the chances of finding a suitable donor in highly sensitized individuals.

eP175: Transplant Immunology: Non-HLA antibodies and their role in solid organ transplants

S. Nithya, Ankith Mathur

Background: Non-HLA antibodies have recently begun to be suspected of playing a role in antibody-mediated rejection and graft survival. In the absence of any donor specific HLA antibodies (DSA) in the recipient, antibody mediated rejection (ABMR) may be caused by non-HLA antibodies like Angiotensin II Type 1 receptor (AT1R), Endothelial-1 Type A receptors (ETARs) etc. We report 7 such cases where the clinical suspicion was targeted towards non-HLA antibodies and the immunological findings thereof.

Methods: On suspecting ABMR, the physicians requested non-HLA antibody testing. The test was done on the patient’s serum using the luminex bead based assay by Lifecodes for non-HLA antibodies. It covers 60 antigens and detects IgG antibodies against them. Results, expressed as mean fluorescence intensity (MFI) were analysed using the accompanying Match It! Software. The cases were encountered over 2 years (October 2022- September 2024).

Results: Of the 7 cases, M:F ratio was 4:3. The ages ranged between 30 and 48 years. Relationship of Donors with recipient- cadaver:3 , mother:2, husband:1 and father-in- law:1. H/O previous transplant was present in 1 case.

Pre-transplant testing was unremarkable in all cases. However, post- transplant, all cases presented with features S/O graft rejection and in view of absence of donor specific antibodies, non-HLA antibody screening was requested.

It was negative in 2 cases (no H/O transplant, Pre-transplant cross-match[CXM] and single antigen bead [SAB] assay for HLA antibodies- negative in both cases).

Case 3: first transplant, pre-transplant CXM and antibody screening (LMX)- negative. Symptoms started 2 months after transplant and non-HLA antibodies were positive (4 antibodies with MFIs between 3000 and 6000).

Case 4: first transplant, pre-transplant CXM- negative. Symptoms started 1 week after transplant and non-HLA antibodies were positive (1 antibody with MFI of 1005).

Case 5: second transplant, pre-transplant CXM- negative. Despite positive SAB, the antibodies were not donor specific. So the transplant was performed. Symptoms started 2 months after transplant and SAB was positive, non-HLA antibodies were also positive (>20 antibodies with MFIs between 1000 and 13000).

Case 6: first transplant, pre-transplant CXM- negative. Symptoms started 1 week after transplant and SAB and non-HLA antibodies were positive (>15 antibodies with MFIs between 1000 and 3000).

Case 7: first transplant, pre-transplant CXM- negative. Symptoms started 4 months after transplant and non-HLA antibodies were positive (10 antibodies with MFIs between 1000 and 5000).

Conclusion: In the absence of DSA-HLA antibodies, clinical features of graft rejection should raise suspicion of non-HLA antibodies being the possible cause. However their clinical significance needs more evaluation.

eP178: Recent Advances (Including Molecular Tests): Standardization of SSP-PCR protocol for genotyping of HPA 1, 2, 3, 4, 5 and 15 in North Indian blood donor population

Mridula Pathak¹, Dheeraj Khetan¹, Charan Sai Ramireddi², Alok Kumar², Rajendra K Chaudhary¹, Priti Elhence¹

¹Departments of Transfusion Medicine and ²Molecular Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Background and Objective: Human Platelet Antigens (HPAs) are polymorphic antigens, resulting from single base-pair substitutions, and play a key role in immune-mediated platelet disorders like neonatal alloimmune thrombocytopenia, post-transfusion purpura, and platelet refractoriness. There is scarcity of data on the prevalence of HPA alleles in India. The objective of this study was to develop SSP-PCR protocol for genotyping HPA 1, 2, 3, 4, 5, and 15 in our blood donor population.

Methods: Primer designing was done on the basis of published papers and online bio-informatics tools. 25nM desalted primers were synthesized from commercial source. Gradient PCR (Thermal-cycler, Biometra GmbH, Germany) was done to determine annealing temperatures of individual HPA alleles. Protocol provided by NIBSC was used for standardizing PCR-SSP conditions. Genomic DNA extracted from left over buffy coat samples was used for assay standardization. The amplification products were visualized by agarose gel electrophoresis.

Results: A total of 19 oligonucleotides primer sequences were prepared (04 primer sequences for HPA 1 and 03 each for HPA 2-5, 15). Annealing temperatures for different HPA genes were found to range from 57.5 (for HPA-4,5&15) to 62°C (for HPA-1). Final PCR conditions were standardized using DNA (conc 40 ng/µL) to a total of 21 amplification cycles and final 8 extension cycles. PCR cocktail consisted of 0.4 µL of allele-specific HPA1-5 and -15 “a” and “b” primers (in 12 separate tubes) with 0.4 µL of common HPA primer, 0.4 µL of forward and reverse primers for Human Growth Hormone (HGH) as internal control, 2.9 µL of nuclease-free distilled water, 5 µL of Taq DNA-polymerase and 0.5 µL of DNA.

Conclusion: SSP-PCR protocol for HPA 1, 2, 3, 4, 5, and 15 was successfully standardized. This will enable us determine frequency of different HPA alleles in our population and further develop HPA typed panels for development of platelet serology.

eP179: Recent Advances (Including Molecular Tests): HLA-B*57:01: The genetic spoilsport in abacavir therapy

V. Vijay Anand, Dolly Daniel, Gayathri

Background and Objectives: Abacavir (ABC) is an effective treatment for HIV/AIDS, but it carries a risk of mild to severe hypersensitivity reactions, particularly in patients with the HLA-B*57:01 allele. Approximately 3-8% of patients with this allele may experience adverse effects. There are currently no guidelines for screening for HLA-B57:01 in the Indian population prior to start of therapy. With this background, the study aimed to determine the prevalence of HLA-B*57:01 in our population and to assess if the frequency warranted the screening of the patient population in question.

Methods: This retrospective analysis was conducted in the Department of Transfusion Medicine and Immunohematology. We analyzed a cohort of samples requested for high-resolution HLA typing over two years (2022-2024). High-resolution HLA typing was performed using MIA FORA kits on the Illumina MiniSeq platform. An in-house software, designed by the IT team, was used to determine the HLA allele frequency of HLA-B*57:01. In another cohort of People living with AIDS/HIV (PLHA), we also collected data on HLA-B*57:01 testing using the SSO platform.

Results: The study comprised 3050 samples, all of which underwent high-resolution HLA typing. Within this cohort, it was determined that the prevalence of HLA-B*57:01 was approximately 10%. In another cohort of 146 individuals with PLHA who underwent HLA-B*57:01 locus typing using SSO, 24 patients (16%) tested positive for HLA-B*57:01.

Conclusion: With a population prevalence of 10%, HLA-B*57:01 is likely to occur at a high frequency demonstrated by the data derived from individuals with PLHA in our study. Therefore, it is crucial to screen for HLA-B*57:01 prior to starting Abacavir, in view of it being implicated in the development of a severe drug hypersensitivity reaction.