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. 2019 May;13(Suppl 1):S9–S17.

PP Transcon 2018 Compilation

PMCID: PMC6573578
Asian J Transfus Sci. 2019 May;13(Suppl 1):S9–S17.

PP 1: Prevalence of bacterial contamination in blood and its components in a tertiary care referral research institute in South India

TVN Sriranjitha 1, IS Chaitanya Kumar 1, KY Sreedhar Babu 1

Background: Allogeneic blood for transfusion is a potential source of infection by a variety of known and unknown transmissible agents. Considerable efforts (National policies, improved donor selection and newer screening techniques) directed towards reducing transmissible pathogens have yielded a major reduction of viral agents especially in developed countries. But transfusion transmitted bacterial infection was identified as the commonest cause of complications associated with transfusion.

Aims: This study aims to determine the spectrum of microorganisms recovered from blood and blood components.

Methods: This study aims to determine the spectrum of microorganisms recovered from blood and blood components retrospectively over a 3½ year study period in our tertiary care teaching hospital from January 2015 to July 2018. Blood and blood components were sent to Microbiology laboratory for culture at three different temperatures (4°C, 22°C, 37°C) as per standard microbiological procedures. Random donor platelets (RDPs), fresh frozen plasma (FFPs), packed red blood cells (PRBCs), whole blood were included in the study.

Results: A Total of 652 blood and blood component samples were sent for culture. Out of which 20 (3.0%) samples were found to be positive. Descending order of frequency of culture positive blood and blood components- PRBC 7 (3.8%), RDP 5 (2.7%), whole blood 5 (2.7%), FFP 3 (1.6%) in corresponding components. Pseudomonas was found to be the commonest organism cultured.

Conclusion: Bacterial contamination remains a common occurrence even with usage of a diversion pouch during phlebotomy and probable cause for contamination may be asymptomatic donor bacteremia. Quality Starts with us, and quality in donor screening and component preparation can lower the risk of bacterial contamination of blood.

Asian J Transfus Sci. 2019 May;13(Suppl 1):S9–S17.

PP 2: Peripheral stem cell collection –A case report

Aparna Kulkarni 1, Joyce Regi 1

Background: Peripheral stem cell collection is done from his 16 yr old, An elder sister of patient. 11 year boy having Acute T Lymphoblastic Leukemia (relapsed) is transplanted with Allogenic bone marrow collected in-house from his elder sister.

Methods: Peripheral stem cell collection is performed on Apheresis instrument of Fresenius Kabi –COMTECH in our hospital. Inj Neukine 300 ug was given to a donor S/C for 5 days, it is a colony stimulating factor with a generic name- Filgrastim. Donor's infective parameters were done as HIV, HBV, HCV, CMV, Additional tests done were Chest Xray, PT, APTT, Urine pregnancy test, Sr.Creatinine. Precount of Donor: TLC- 42.17x10^9/L.

Results: In PBSCC product: (1) Absolute CD 34+ stem cells 1870 (cells/ul). (2) Product Volume: 163. (3) Stem Cell dose: 8.7. (4) PBSCC transplanted to patient on same day. (5) Patient is discharged safely after 34 days.

Conclusion: This will prove to be the best guide to perform peripheral stem cells collection effectively.

Asian J Transfus Sci. 2019 May;13(Suppl 1):S9–S17.

PP 3: Donor deferral pattern at a tertiary care teaching research institute in South India

TVN Sriranjitha 1, IS Chaitanya Kumar 1, KV Sreedhar Babu 1

Background: Blood is a life saving Drug and Altruistic Blood donors are the saviors saving countless lives with their noble act of kindness i.e.,- “Blood Donation”. In order to donate blood a donor has to undergo strict donor screening. In this process, a large number of unfit donors from the donation pool are deferred following stringent criteria based on guidelines from time to time released by the Government.

Aims: To know the various reasons by which donors are deferred at a tertiary care teaching research Institute.

Methods: An attempt was made to know the various reasons by which donors are deferred at a tertiary care teaching research Institute in South India over a period of one year from 1st Jan 2017 to 31st Dec 2017. Descriptive statistics were made using Microsoft Excel.

Results: A total of 2,340 (16.21%) donors were deferred out of 14,433 donors who came for donation, during the study period and the most common causes for donor deferral are Medical and Surgical conditions followed by anemia in males while in females anemia is the leading cause of deferral.

Conclusion: The donor deferral may be reduced by ensuring prevention of anemia among the adult population with a comprehensive anemia eradication programme funded by any Government agency or by lowering the Hemoglobin limit set for blood donation. The medical and surgical conditions resulting in donor deferrals among males cannot be prevented. Safe blood starts with safe donor which starts with meticulous donor screening.

Asian J Transfus Sci. 2019 May;13(Suppl 1):S9–S17.

PP 4: A regional study of qualitative analysis of blood donation protocols among medical officers

Sankalp Sharma 1, Kanwarjeet Singh 1, Saurabh Lehre 1, Ramesh Chandrakar 1, Minal Wasnik 1, Anil Verma 1, Ajay Yadav 1, Kamlesh Sahu 1, Akash Tiwari 1

Background: A qualitative analysis (QA) of Medical Officers (MO) was intended for an overview of deficiencies of Blood donor recruitment protocols and practices.

Aims: To have an overview of deficiencies in Blood donor recruitment protocols and practices.

Methods: A questionnaire {25 questions (18 closed end and 7 open ended Likert scale)} attempted one-time by 60 MO and Post-graduate students from Blood Banks of Chhattisgarh. The QA (Hancock et al. was conducted on principle of phenomenology and triangulation of MO knowledge, preferences and researcher's intuition.

Results: Pre-donation pamphlets are considered sufficient tool of self-deferral by 22 (45%); useful tool 27 (55%); insufficient by 6 (12%) of respondents. Majority of MOs (70%) prefer local language for administering, Donor Health questionnaire with <5% preferring standard language. Transfusion Transmitted Infections reflect General Population Prevalence response was interpreted as donations to be first time donations (FTD) ‘voluntary or replacement at Blood Banks. 19 (42%) of respondents indicated mostly FTD with 13 (29%) indicating an inadequate pre-donation counselling. 42 (93%) indicated replacement donation (RD) with 29 (64%) having inadequate pre-donation counselling. Respondents not aware of protocols including donor Hemoglobin threshold 23 (38%); Syphilis deferral protocol 43 (72%); consent of donor in deferred donation 21 (36%). An incorrect response to recent recommendations ‘NACO 2017 document’ included donation interval of females 17 (29%); upper age limit FTD 55 (92%); Gonorrhoea, Syphilis as permanent deferrals 23 (38%) indicating diverse donor recruitment practices. 28 (63%) associated Hemovigilance reporting to punitive action.

Conclusions: Local language easy to understand questionnaire is preferred by MO. Most donations are replacement FTD. Hemovigilance is under-reported due to ignorance of protocol. A need for sensitising MOs regarding donor recruitment protocols and recent updates by CME and work-shops.

Asian J Transfus Sci. 2019 May;13(Suppl 1):S9–S17.

PP 5: Biomedical waste management and hand hygiene practices in blood bank in a tertiary care setting in north India

Sarika Agarwal 1, Gita Negi 1, Puneet Gupta 1, Sheetal Malhotra 1, Sushant Kumar Meinia 1, Mohan Lal Bhatt 1

Background: Biomedical waste management and hand hygiene practices are important in health care settings including blood banks. Waste generated in blood bank if not handled, treated and disposed properly by health care workers; poses serious health hazards. Monitoring of these practices is essential and should be implemented routinely.

Aims: To evaluate knowledge, attitude and practices regarding biomedical waste management and hand hygiene practices among blood bank staff based on a predefined and validated questionaire.

Methods: This study was conducted in the department of Transfusion Medicine and Blood Bank in a recently established tertiary care hospital in Uttarakhand. A predefined validated questionnaire was used to assess the knowledge, attitude and practices among blood bank staff including residents, nursing officers, technical officers, laboratory attendants and housekeeping staff; and lacunae were identified. Then, serial learning sessions were conducted every month followed by assessment. Assessment was done using multiple choice questions (MCQ) for knowledge and attitude; and objectively structured practical examination (OSPE) for skills.

Results: There was lack of knowledge, attitude and practices among blood bank staff regarding waste management and hand hygiene. They were not well versed with the latest guidelines of waste management and hand hygiene practices. Evaluation of blood bank staff after training sessions improved significantly. There was significant improvement in knowledge, attitude and practices of blood bank staff.

Conclusion: Regular training sessions are essential for continuous improvement and implementation of biomedical waste management and hand hygiene practices.

Asian J Transfus Sci. 2019 May;13(Suppl 1):S9–S17.

PP 6: A survey to assess the patient blood management practices amongst the nurses in a tertiary care hospital

Smita Chouhan 1, Meenu Bajpai 1

Background: Patient blood management (PBM) is a multidisciplinary, patient-centred concept that encompasses clinical management of patient surrounding the transfusion decision-making processes as well as reducing the need for allogenic blood transfusions and ensuring that blood components are available for the patients who need them. But due to lack of knowledge as well as of resources, there is limited translation of PBM guidelines into clinical practice.

Aims: To assess knowledge of health care workers on Patient Blood Management practices.

Methods: A cross-sectional study involving distribution of questionnaire to doctors and nurses. The responses analysed and scores were evaluated for correct and incorrect responses.

Results: The response rate of doctors (69%) and nurses (68.55%). Mean percentage score of practice and knowledge related questionnaire among doctors were 53.6 & 57.4% respectively and that among nurses were 71.78% and 78.35% respectively.

Conclusion: We concluded that training and education sessions focused toward patient blood management may improve the Patient Blood Management practices.

Asian J Transfus Sci. 2019 May;13(Suppl 1):S9–S17.

PP 7: Analysis of deferred donors at a tertiary care hospital

S Kamath 1, R Mehra 1, R Sawant 1, V Vadera 1

Background: Onsite donor deferrals require preservation of a delicate balance from the donor's perspective, deferral leads to disappointment, reluctance to donate again and overall negative image of the blood donation activity for the blood center, it leads to a negative impact on donor retention and increases recruitment costs.

Aims: To analyze deferral incidence, deferral pattern and common causes for temporary and permanent deferrals from among the whole blood donors.

Methods: A retrospective study of 19 months (January 2017 – July 2018) was conducted. 2243 deferred donor records of indoor as well as voluntary blood donation camp donors were analyzed. The reason for deferral was categorized into temporary & permanent. Data was analyzed with respect to age and sex of donors.

Results: Overall deferral rate was found to be 17%, majority of them were voluntary donors 98.16% while related donors were 1.84%. Deferral rate among females was 35.7% while among male donors 5.03%. The commonest reason for deferral was low hemoglobin (39%), abnormal blood pressure (including both high and low, 17%), donors deferred due to ongoing or past history of medications (12%), high hemoglobin (2%) and history of tattoo in the last 3 months (2%).

Conclusion: The present study concludes that many potential blood donations are lost due to temporary deferrals. It is necessary to educate, motivate and treat temporarily deferred donors so that they move out from the category of Non-donors to Permanent Donors. There is also a need to rationalize and revalidate deferral criteria based on studies done in Indian population; for example criteria for Hemoglobin cut-off and criteria for acceptable B.P. so as not to lead to a diminished supply of future donors.

Asian J Transfus Sci. 2019 May;13(Suppl 1):S9–S17.

PP 8: Managing tranfusion in a patient of auto immune hemolytic anemia having auto and alloantibodies

Sudha Chauhan 1, Jyoti P Bhatt 1, Nishith A Vachhani 1, Sanjeev Nandani 1

Background: Auto Immune Hemolytic Anemia (AIHA) is the pathological destruction of red blood cells (RBCs) by antibodies produced against self erythrocyte surface antigens. The red cell auto antibodies appearing as pan agglutinins in the serum make it difficult for transfusion medicine personnel to provide transfusion support for the patient with AIHA. The patient with presence of the underlying alloantibody which can cause hemolytic transfusion reaction, releasing the phenotype matched incompatible units and convincing the physician to accept such units is challenging. We reviewed that profile and outcome of patient with AIHA.

Methods: The patient, M/58 yr having AIHA & JAUNDICE. His blood group was AB POSITIVE. Request of 2 units of RCC received. Due to presence of Autoantibodies & underlying Alloantibodies, matching of blood units was not feasible. Within a week, his Hb fell from 10.0 to 4.5 gm%, IAT was positive, Auto control and DAT also positive (4+) by CAT. The antigen phenotying was carried out by SPRCA.

Results: The patient had high titers of Auto-and underlying Allo antibodies. Initially, two units of “O negative” RCC were transfused along with steroid medication to overcome the antibodies. After two days of treatment, his antibody titers decreased and were able to perform antigen phenotyping. Then phenotype matched 5 units of RCC were transfused. His Hb increased to 10.0gm% with no evidence of BTR.

Conclusion: A rare case of Auto and Alloantibodies, where Antigen Phenotype did the trick to save the patient life.

Asian J Transfus Sci. 2019 May;13(Suppl 1):S9–S17.

PP 9: A case report of rare Bombay blood group and its identification

E Prem Kumar 1, P Nanda Kishore 1

Background: Bombay Blood group was discovered by Bhende and Bhatia in 1952 in Bombay, India. An individual who lacked Antigens of both ABO and Hh System on the surface of RBC while serum contains anti A, anti B and anti H is called as Bombay blood group. The genotype found in Bombay Oh is homozygous hh/sese.

Methods: ABO and RhD blood group were carried in our blood bank by the Column Agglutination Technology (CAT) and Tube agglutination method and further secretor status is confirmed by performing Adsorption Inhibition Test using saliva (tube method).

Results: A 21/M donor has donated blood at our blood bank. The ABO and RhD typing with reverse grouping has the typical pattern of Bombay Oh RhD Positive group as described in the literature. Further tests done were: DCT/ICT by 3 cell panel and Adsorption Inhibition Test (Saliva test) has confirmed the group.

Conclusion: Hence we recommend complete Immunohematology workup using standardised agglutination technologies combined with saliva testing for secretary status (with controls) to identifying Bombay Oh blood group.

Asian J Transfus Sci. 2019 May;13(Suppl 1):S9–S17.

PP 10: Apheresis platelets versus random donor platelets: story from Surat

Jignesh Desai 1, K Ghosh 1, Abhay Jhaveri 1, Rinku Shukla 1

Background: Platelet concentrates are used to treat bleeding disorders due to quantitative or qualitative deficiency of platelets. Some of these disorders are heritable but in majority of cases platelets are used for acquired thrombocytopenia or thrombocytopathy with bleeding or prophylactic when the risk of bleeding is very high. Platelets in blood banks can be produced from random donor collection or from selected individual by apheresis technique.

Aims: To review the use of RDP's versus SDP's.

Methods: This a retrospective study from data of use RDP and SDP at various hospitals of Surat.

Results: There is increased tendency to use more often apheresis platelets (single donor platelet) compared to random donor platelets. In our transfusion center between 2002 to 2015 RDP usage have gone down by 50% from 3735 units/year to 1705 units/year. While apheresis platelet utilization was erratic i.e. 155 units in some year and 539 units in some years. There was no consistent pattern of SDP/RDP use by practicing doctors when compared in different disease conditions.

Conclusion: There is a need to revisit the use of random donor platelets (RDP) as this scarce resource is otherwise wasted and contributes to quite a few transfusion reactions. There is a need to develop clear guidelines for use of SDP versus RDP in Indian patients.

Asian J Transfus Sci. 2019 May;13(Suppl 1):S9–S17.

PP 11: Retrospective analysis fresh frozen plasma component separation and its impact on inventory after implementation at our blood center

Rodda Suresh Babu 1, P Rajasekhar Reddy 1, M Janaki 1

Background: Fresh Frozen Plasma (FFP) is a byproduct of component separation and has shelf life one year. Some blood centres have not been separated due to non-utilization at their setup. This leads to negative perception amongst blood donors regarding proper utilization. NACO has already been issued guidelines to supply surplus plasma to fractionation centres.

Aims: To study the impact of FFP component separation in our setup.

Methods: All blood components collected between January 2015 to August 2018 were retrospectively evaluated i.e., before and after implementation of intervention (by increasing FFP separation). FFP produced in litres (L) was estimated and analysed financial benefit ratio.

Results: Before implementation period of 2015-2016 years 3238 were collected, out of which 269 (8.5%) were separated into components. Among these FFP 0.46% (n=15) were transfused to 11 needy patients. Where as 40.4% (n=1308) were collected as whole blood but issued as Packed RBCS, FFP could have been harvested 190L considering each unit as an average volume 150ml. After implementation period from 2017 to till August 2018 there were 38.88% (n=983) were separated into components. Among these FFP 1.42% (n=36) were transfused to 28 needy patients. Hence we are saving 146L of FFP. The loss incurred before implementation was approximately 2.7 lakh cost.

Conclusion: In the era of component transfusion therapy it is essential for component separation. Separation of FFP prevents wastage of human derived product which is unethical. In blood centres FFP where nonutilised can be supplied to fractionation centres and get economic benefit.

Asian J Transfus Sci. 2019 May;13(Suppl 1):S9–S17.

PP 12: Prevalence of blood groups among donors at a tertiary care teaching research institute in South India

Reddy Kumari 1, D Nagalakshmi Prasanna 1, TVN Sriranjitha 1, IS Chaitanya Kumar 1, KV Sreedhar Babu 1

Background: There are a number of blood groups discovered hitherto, however ABO blood group antigens and RhD remain the most commonly checked significant blood group antigens routinely checked in day to day practise in blood banks and laboratories across India. The Prevalence of these antigens among the general population predicts the availability with which a group donor can be identified and hence is important. A blood donor based prevalence study may correlate well with the population based prevalence and hence the present study was undertaken.

Methods: A retrospective study has been performed to assess the prevalence of blood groups among blood donors donating at a tertiary care teaching research institute in South India over a period of two years from 1st Jan 2016 to 31st Dec 2017. Descriptive statistics were made using Microsoft Excel.

Results: A total of 21,657 donors have donated blood during the study period and Negative groups donors comprised of only 7 percent of total donors. O Pos, A Pos, B Pos and AB Pos group donors were 39, 19, 29, 6 percent respectively.

Conclusion: The most common blood groups in geographical distribution of the present study remain O Pos followed by B Pos as may be seen in other parts of South India.

Asian J Transfus Sci. 2019 May;13(Suppl 1):S9–S17.

PP 13: Blood donor adverse reactions in tertiary care hospital

B Om Prakash 1, R Krishnamoorthy 1, VK Panicker 1, T Ravindra Prasad 1, A Ashwin 1

Background: Blood Transfusion Services have the responsibility to provide safe & adequate blood to the recipients and to ensure donor safe. Blood donation is safer in tertiary care centers where staffs are trained, skilled and well equipped. Occasionally, some donors experience adverse reactions during or after donation.

Aims: To analyse various adverse reaction during & immediately after phlebotomy and the frequency of adverse reaction in whole blood donation.

Methods: A retrospective study was carried out. The data has been collected for the period July 2017 to June 2018 and analyzed. Donors were accepted for blood donation after screening & medical examination by medical officer. Hemoglobin estimation was done by Hemocue method with cut off value 12.5 gm/dl. Donors were observed during and for 30 min after blood donation for any reactions.

Results: Total number of blood donations in the study period were 12269, 77 donors developed adverse reaction, Adverse reaction rates are as follows: Vasovagal reactions – 70 (0.570%), Vomiting – 6 (0.040%), accidental fall- 1 (0.081%). The total percentage of adverse effect was categorized into Mild (0.570%), Moderate (0.040%), Severe (0.008%). Most of the donors had mild type of reactions.

Conclusion: Although the rate of adverse reactions of whole blood donation was very low i.e., (0.627%) and most of the reaction were mild and resolves rapidly, there is need for providing pre donation counseling to educate the donors to further reduce the rate of donor adverse reactions.

Asian J Transfus Sci. 2019 May;13(Suppl 1):S9–S17.

PP 14: Utility of donor feedback analysis as a quality indicator: A pilot study

R Patil 1, R Sawant 1, V Vadera 1

Background: The level of satisfaction of donors with the blood donation system is an important factor which influences their repeat donation. Questionnaire based studies are available in abundance in published literature. We have looked at the utility of voluntary feedback obtained from donors, as a quality indicator denoting donor satisfaction levels.

Aims: Systemic analysis of donor feedback and their categorization for further understanding the perception of blood donors about the donation environment and process.

Methods: The donor feedback records of over a 14 months period were analysed and the various attributes related to staff, environment, blood donation process etc., mentioned therein were noted systematically. Any suggestions/complains were noted separately. The data was analysed for their frequency and the most prominent attributes highlighted in the donor feedback were noted and considered for strategic improvement planning.

Results: The following were the top five attributes donor's appreciated the most:

  1. Staff co-operation (20.84%)

  2. Service offered at the donation area (17.37%)

  3. Donation experience (11.3%)

  4. Hygiene of environment and personnel (10.6%)

  5. Politeness of attending staff (8.68%).

Professional attitude towards donors (7.7%), and smooth process at donation area were also largely appreciated by blood donors. Almost equal proportion (5%) of first time and repeat blood donors had offered their feedback. 12.7% feedbacks featured specific mention of certain team members for the perfect job done. 0.03% of feedbacks were complaints and were predominantly related to waiting period for blood donation, incomplete/inadequate information provided and about the refreshments and memento given to blood donors.

Conclusion: This analysis has given us a good insight into the various staff and donation environment related attributes that contribute significantly towards donor satisfaction. This baseline performance can now be periodically benchmarked for quality improvement and better donor recruitment and retention at our centre. This feedback mechanism proved to be an effective medium for communication of problems faced by blood donors.

Asian J Transfus Sci. 2019 May;13(Suppl 1):S9–S17.

PP 15: Saline washed red cell concentrate: boon or bane

Hetal Randeri 1, Rinku Shukla 1, Dharmistha Patil 1, K Ghosh 1

Background: Washed red cell concentrate (RCC) may be beneficial for multi transfused patients who develop non-hemolytic transfusion reactions NHTR due to plasma proteins or contaminating white blood cells. Washing of red cells with sterile normal saline reduces plasma and leucocytes significantly but have shelf life of 24 hours.

Aims: To justify the use of saline washed red cell concentrate for multi- transfused patients.

Methods: We analyzed six months data of blood components during the period Jan-June 2018.During this 13478 blood was collected and RCC were prepared using semi automated plasma extractor (Hi-care).RCC were washed twice with sterile normal saline in validated laminar air flow without the use of sterile connecting device (SCD).1% of components were subjected to Quality control and parameters like RBC loss, Leukocyte count, Plasma removal and sterility were assessed.

Results: During this period 12940 (96%) buffy coat (BC) RCC and 3773 (29.8%) saline washed RCC were prepared and 27 (1%) were tested for QC. Mean RBC loss was 13.1%, leucoreduction by saline wash method 96.3% and Buffy coat method 92%, Plasma removed 93.2%.Sterility test was negative for all. On comparing both it was observed that saline washed RCC gave 4.3 % more leucoreduction than non saline washed.

Conclusion: Leucoreduction in saline washed RCC is better than BC. This proves to be boon for multi transfused patients rather than giving them non saline washed RCC if sterility is maintained in open system. Moreover this method is cost effective compared to filtrationor SCD which we do not have at our centre.

Asian J Transfus Sci. 2019 May;13(Suppl 1):S9–S17.

PP 16: A case of delayed transfusion reaction in a patient presenting with purpura

Eswar Prasad

Background: Delayed Transfusion Reactions are often under reported but can lead to adverse outcomes. Timely recognition and reporting is important for initiation of appropriate management.

Case Report: A 35-year-old female with history of low hemoglobin (5.2 g/dl) and platelet count (40000/mm3) presented with pain abdomen and menorrhagia at our hospital. She was transfused with four units of random donor platelets (RDPs), but her platelet count didn’t improve. Earlier at an outside facility she was transfused with two units of whole blood in view of low hemoglobin (3.2 g/dl) and platelet count (3000/mm3). A day later one unit of PRBC followed by two units of RDPs were transfused as well. Laboratory investigations for HIV, HBV, HCV and Dengue NS1 were negative. Her coagulation profile was well within normal limits. Incidentally on day three post admission at our centre (day six post transfusion with whole blood), she developed purpura over upper limbs, abdomen and lower limbs associated with mucosal bleeding. This coincided with rapid fall in platelet count (42000/mm3 to 9000/mm3). Suspecting auto immune etiology (ITP) she was treated for low platelet count, with pulse therapy of methyl prednisone (1 g/day) along with transfusion of 6 RDPs/day for consecutive three days. A temporal association with transfusion of whole blood, RDPs and multiparity to a delayed transfusion reaction (Post Transfusion Purpura) was suspected. Additionally, she was investigated for anti-platelet antibodies on SPRCA. Platelet antigen profile of the patient as well as the donor unit could not be assessed as the patient was lost to followup.

Conclusion: The case emphasizes the importance of including Delayed Transfusion Reaction as a differential diagnosis in a patient with acute onset of thrombocytopenia following transfusion of blood components. Timely diagnosis and management are important to prevent further morbidity.

Asian J Transfus Sci. 2019 May;13(Suppl 1):S9–S17.

PP 17: Biomedical waste management and hand hygiene practices in blood bank in a tertiary care setting in north India

Sarika Agarwal 1, Gita Negi 1, Puneet Gupta 1, Sheetal Malhotra 1, Sushant Kumar Meinia 1, Mohan Lal Bhatt 1

Background: Biomedical waste management and hand hygiene practices are important in health care settings including blood banks. Waste generated in blood bank if not handled, treated and disposed properly by health care workers; poses serious health hazards. Monitoring of these practices is essential and should be implemented routinely.

Aims: To evaluate knowledge, attitude and practices regarding biomedical waste management and hand hygiene practices among blood bank staff based on a predefined and validated questionaire.

Methods: This study was conducted in the department of Transfusion Medicine and Blood Bank in a recently established tertiary care hospital in Uttarakhand. A predefined validated questionnaire was used to assess the knowledge, attitude and practices among blood bank staff including residents, nursing officers, technical officers, laboratory attendants and housekeeping staff; and lacunae were identified. Then, serial learning sessions were conducted every month followed by assessment. Assessment was done using multiple choice questions (MCQ) for knowledge and attitude; and objectively structured practical examination (OSPE) for skills.

Results: There was lack of knowledge, attitude and practices among blood bank staff regarding waste management and hand hygiene. They were not well versed with the latest guidelines of waste management and hand hygiene practices. Evaluation of blood bank staff after training sessions improved significantly. There was significant improvement in knowledge, attitude and practices of blood bank staff.

Conclusion: Regular training sessions are essential for continuous improvement and implementation of biomedical waste management and hand hygiene practices.

Asian J Transfus Sci. 2019 May;13(Suppl 1):S9–S17.

PP 18: Hernia formation in blood bags: Are we ready?

Abhinav Verma 1, Pradeep Negi 1, Jitendra Kumar 1, Mohsin Khan 1, Swaroop Singh 1

Background: All the current methods of separation and preparation of three major blood components –RBCs, platelets and plasma rely on one or more centrifugation steps. Following separation by centrifugation, components must be carefully divided into separate containers for further processing. The bulging of sheet or hernia formation is a rare event that occurs during centrifugation.

Aims: The main aim of this case study is to highlight the importance of hernia formation of blood bags and review the component preparation process to ensure good quality.

Methods (Case Study): In January 2018, 429 units of whole blood were collected and centrifugation was done for separation and preparation of blood components. During centrifugation 2 blood bags got ruptured.

Results: The quality records, the manufacturing records and process were reviewed and no particular abnormality was noted with this batch. The thickness, resistance to distortion test and embossing value of sheet extruded for manufacturing of this batch was found to be uniform and within limits. The bag sealing parameters were cross checked and found ok.

Conclusion: The hernia formation has happened due to the placement of bags inside the centrifuge cup. The base of primary bags has 2 tube connectors and this should not be kept upright during packing of bags inside the cup as more stress will act upon this area during centrifugation. Moreover, no hard components like Y-connections or clamps should be placed in between the blood bags and one should avoid free space between bag and the centrifuge cup by adequate packing.

Asian J Transfus Sci. 2019 May;13(Suppl 1):S9–S17.

PP 19: Role of a multidisciplinary team and massive transfusion protocol in improving patient outcome – A case study

Abhinav Verma 1, Pradeep Negi 1, Jitendra Kumar 1, Mohsin Khan 1, Swaroop Singh 1

Background: Management of a massive, life-threatening primary postpartum haemorrhage with DIC is a challenge for the clinical teams and hospital transfusion service. The implementation of a standardized massive transfusion protocol with a multidisciplinary approach is necessary to prevent lethal triad of hypothermia acidosis, and coagulopathy.

Aims: The main aim of this case study is to highlight the importance of a multidisciplinary team approach and MTP protocol in improving patient outcome.

Case Study: The patient was brought to the emergency department of our hospital on 28th June in a very critical condition as a referred patient from another hospital. She had undergone a caesarean section for pregnancy with abruptio placentae with excessive bleeding on 27th June. Investigations showed her haemoglobin as 4.5 and a diagnosis of DIC was made. CT scan detected a massive haematoma inside her abdominal wall and a decision for surgery was taken. MTP was activated and 36 units of blood components (12 units PRBCs (packed red blood cells), 12 units of FFPs (fresh frozen plasmas) and 12 units of PCs (platelet concentrate) were transfused.

Results: The patient recovered fully with 63 units of blood components transfusions and was discharged later. We followed standard blood transfusion protocol of our hospital with a ratio of 1:1:1 for PRBC, FFP and PC respectively. Each MTP pack included 4units of PRBCs, 4 units of FFPs and 4units of platelets.

Conclusion: The rapid infusion of the correct ratio of blood products as per MTP along with multidisciplinary team approach improves patient survival and decrease overall usage of blood.

Asian J Transfus Sci. 2019 May;13(Suppl 1):S9–S17.

PP 20: A pilot study for comparison of new confirmation assay - Geenius HIV 1/2 with conventional western blot assay

Anand 1, Aseem K Tiwari 1, Dinesh 1, Geet 1, Sunder 1

Background: Western Blot (WB) has been the conventional gold standard assay for confirmation of HIV 1/2 since several decades. We compared a relatively newer confirmation assay; Geenius™ HIV 1/2 (BioRad, France) with Western Blot (J. Mitra & Co. Pvt. Ltd. India).

Methods: We conducted a pilot study employing 20 known samples. Fifteen known positive and five known negative samples were simultaneously tested with Geenius HIV 1/2 and WB. Manufacturer instructions were followed for assay run and result interpretation. Nucleic acid Amplification Test (NAT) (Procleix Panther System) was available for resolution of any possible discordant result.

Results: Out of the 20 samples, 15 known positive samples were reactive for anti-HIV by Geenius HIV 1/2, WB and NAT. Five known negative samples were non-reactive by Geenius, WB and NAT. There was complete concordance in results between Geenius and WB. However, while WB is cumbersome (multi-step) and time consuming (6 hrs) and has potential for subjective error in result interpretation due to manual reading of bands, Geenius HIV1/2 is simple, easy and rapid (30 min) chromatographic assay. Availability of electronic reading device reduces potential of any error in result interpretation.

Conclusion: Newer Geenius HIV 1/2 confirmation assay is simple and quick assay which can be reliably used as an alternative to WB.

Asian J Transfus Sci. 2019 May;13(Suppl 1):S9–S17.

PP 21: Prevalence of transfusion transmitted infections in sum hospital blood bank, Odisha - 6 year retrospective study

Jasmine Sultana 1

Aims: To determine the prevalence of TTI in voluntary and replacement donations.

Methods: This retrospective study was conducted in SUM Hospital blood bank Bhubaneswar, Odisha from Jan 2013 to June 2018. A total of 46,125blood units from blood donors were tested for TTI by ELISA (Qualisa-Qualpro Diagnostics- TULIP).Test were performed according to manufacturer's instructions. All the reactive samples were tested induplicate before labeling them seropositive. The donated unit was discarded when found positive for any TTI.

Results: A total of 46,125 donors were included in the study. Of these 38,264 (82.9%) were voluntary and 7,852 (17.10%) were replacement. Male donors 45,074 (97.7%) outnumbered females 1051 (2.3%). A total 686 (1.4%) of the 46,125 donors tested reactive for TTI out of which replacement donors were 558 (1.2%) and voluntary 128 (0.2%). The overall seropositivity for HBV was 434 (0.9%) out of which replacement were 308 (0.66%) and voluntary 126 (0.34%). HIV had seropositivity of 207 (0.4%) with replacement 142 (0.3%) and voluntary 65 (0.1%). HCV constituted 41 (0.08%) of which replacement donors were 34 (0.07%) and voluntary 7 (0.01%). Seropositivity of syphilis was 4 (0.08%) with equal positivity in both group of donors and none tested reactive for malaria.

Conclusion: Study shows that prevalence of TTI was high in male replacement donors. Seroreactivity was higher for HBV followed by HIV, HCV, syphilis and malaria. Stringent donor screening, encouragement for voluntary donation and retention of voluntary donors should therefore be prioritized.

Asian J Transfus Sci. 2019 May;13(Suppl 1):S9–S17.

PP 22: Prevalence of blood donor reactions at a tertiary care teaching institute in South India

C Keerthi 1, MD Praveen 1, IS Chaitanya Kumar 1, R Arun 1, B Suresh 1, KV Sreedhar Babu 1

Background: Blood is a lifesaving Drug and Altruistic Blood donors are the saviours saving countless lives with their noble act of kindness i.e.,- “Blood Donation”. Though blood donation is a safe process, some unwanted events do occur that cause fear and apprehension in donors.

Methods: This is a retrospective study where data was retrieved from the records to know the various blood donor reactions that occurred during and after donation of blood at a tertiary care teaching Institute in South India over a period of one and a half year from 1st January 2017 to 30th June 2018. Descriptive statistics were prepared using Microsoft Excel and analysed using SPSS software.

Results: A total of 17,865 donors have donated blood during the study period and a total of 67 (0.37%) donor reactions occured, out of which 31 (0.17%) were mild, 18 (0.10%) were moderate and 18 (0.10%) were severe. All the donors recovered uneventfully.

Conclusion: Proper donor screening, counselling and effective post donation management can prevent most donor reactions and thus improve donor satisfaction regarding blood donation.

Asian J Transfus Sci. 2019 May;13(Suppl 1):S9–S17.

PP 23: Assessment of abo blood grouping and secretor status in the saliva among healthy voluntary blood donors using absorption inhibition method at a teritiary care centre

A Keerti 1, DSNM Akshitha 1, C Tejaswi 1, Pandu Ranga Rao 1

Background: ABH antigens are integral parts of membranes of RBCs, platelets, lymphocytes, and endothelial cells. ABH soluble substances are also found in body secretions. This can be studied using absorption inhibition method.

Aim: To determine the prevalence of secretor status in saliva of voluntary blood donors using absorption Inhibition method at teritiary care centre.

Materials and Methods: The present study was conducted at kamineni institute of medical sciences, Narketpally on voluntary blood donors. Blood samples and Saliva of 50 voluntary blood donors (age range: 20 – 30 years, Female: 28, Male: 22) was collected. Blood grouping was done by conventional tube method, whereas saliva secretor studies was done by absorption inhibition method. Results of both blood and saliva were correlated.

Results: Among 50 blood donors, 49 were found to be secretors and 1 as non secretors. Among 50 donors, 20 were O blood group, 17 were B blood group, 10 were A blood group and 3 were AB. In secretor studies 0, B, A showed 100% secretor status. 1 out of 3 (33.3%) AB blood group was non secretors and remaining were secretors.

Conclusion: Majority of blood donors showed secretor status which in turn correlated with ABO blood typing. Henceforth this study can be used as a tool for any blood group discrepancies and holds medicolegal importance in field of forensic medicine.

Asian J Transfus Sci. 2019 May;13(Suppl 1):S9–S17.

PP 24: Bombay blood group hurdle to get

M Janaki 1, P Rajasekhar Reddy 1, P Sivakumar 1, Harish 1, R Suresh Babu 1

Background: The ABO system is the most important of all blood groups in transfusion practice. In general population, prevalence of Bombay blood group is about 1:10,000 in India. It is very difficult to supplying emergency situation. The feasibility and economics still doubtful in a diverse population, also donors may have to travel long distances.

Aim: To create an awareness of the rare blood groups. To approach and dealing towards a Bombay phenotype blood units.

Methods: A 48 years illiterate male donated in our blood centre and it was his first time donation and unaware his Bombay (Oh)Rh(D)+ve group. To confirm it, anti-H lectin included in cell grouping and inhibition test performed for determination of secretor status. Regarding availability Bombay (Oh)Rh(D)+ve unit, details was communicated through online sites and others (Red People society persons and Needy society) and also nearby blood centres were informed. On 12thday we had received a telephonic call from a relative whose patient (35 years female) admitted for operative procedures. The unit was issued as per our institutional SOP.

Results: Delay of 12 days after notifying this group(constant follow-up).

Conclusion: Creating an awareness about the rare groups to the public through the various media and social networks is important. To create awareness among the various government and private hospitals is mandatory. Therefore maintaining a Bombay phenotype donor registry is of paramount importance in order to save these patients. Options like cryopreservation or calling donors should also be considered. Government should take step to include the blood group in Aadhar cards.

Asian J Transfus Sci. 2019 May;13(Suppl 1):S9–S17.

PP 25: Awarness of voluntary blood donation among medical students

M Janaki 1, P Rajasekhar Reddy 1, P Sivakumar 1, Jagadeesh 1, R Suresh Babu 1

Background: Blood is an essential component for the life. Blood donation save the life as there is no substitutes to blood. In recent years Blood Transfusion services in India have gained significance and vital part of National Health care system. The voluntary blood donation isthe safest of all types of blood donation. The common potential sources for blood donationare the young and physically fit students from the Education institutions.

Objectives: To asses the knowledge and attitude about Voluntary Blood Donation.

Materials and Methods: A cross sectional study was conducted among the 2nd Year medical students of Santhiram medical college during June 2018. Hundred and eleven (111) students were participated in the study (M=58 F=53). Questionnaire was distributed and data was analysed.

Results: High number of participants agreed the encouraging public about Voluntary Blood Donation (98%) lack of awareness in students (15%) the participants are not having the knowledgeabout the blood groups (28%) cross matching (32%).

Conclusion: Participants had good attitude and poor knowledge about Voluntary Blood Donation. Details of Voluntary Blood Donation should be incorporated in the curriculum. Organizations of awareness programs are essential for medical students and public.

Asian J Transfus Sci. 2019 May;13(Suppl 1):S9–S17.

PP 26: A case of Jehovah's Witness discovered during the immediate postpartum period - An obstetrician's nightmare

M Sridevi 1, Prema 1, Sugandhi 1

Aim: To report a Jehovah's Witness with Obstetric Hemorrhage.

Case Report: 23 years old G2P1L1/previous LSCS underwent Elective Repeat ‘C’ Section had Postpartum hemorrhage (PPH- Class II Hemorrhagic Shock) managed by Active Third Stage Labor Management protocols. Considering her blood loss >1000 ml and further anticipated blood loss, decision to reserve blood, if needed to transfuse was planned, same explained, and to my shock I discovered that she was a JW. Possibility of her life threat with the blood decline explained. Fortunately, she remained stable in the ensuing period.

Discussion: Managing OH in JW is a nightmare. India has JW ratio of 1 to 28692, has 100 times mortality risks. Autonomy and providing health care at my best in this odd situation was a great ordeal for me.

Conclusion: Conflicts exist between beneficence and Autonomy in JW. It is traumatizing to witness demise in JW. It is high time to set a Regional Centre with the necessary Bloodless Management Techniques for the best possible maternal outcome. It is imperative to frame our guidelines for the legal/ethical/medical challenges in the JW. Asking the pregnant women during the first Antenatal visit about the acceptance/rejection of Blood Transfusion, would allay the apprehensions of the Obstetricians when they face JW with OH.

Asian J Transfus Sci. 2019 May;13(Suppl 1):S9–S17.

PP 27: Clinically significant red cell alloantibody titration by gel column assay and its correlation with conventional tube testing in antenatal cases

Nandini Trivedi 1, Milind Dighe 1, Farazana Kothari 1

Aims: The aim of the study was to correlate Gel Microcolumn Assay (GMA) with the conventional Tube test (CTT) technique in performance of alloantibody titration in antenatal cases.

Methods: After taking informed consent, a total of 3500 samples, reffered to dept of IH and BT, AFMC for antenatal immunohematological workup were subjected to ICT by Conventional Test Tube well as Gel Microcolumn Assay over a period of 2 years.

Results: Out of the 3500 antenatal cases tested, 56 were positive in total. out of these, only 20 tested positive by tube method as well as gel method.36 tested positive only by gel method. 36 tested positive only by gel method. the antibody identified was Anti-D in all 56 cases and anti(C+D)in 2 cases.

Conclusion: Gel Microcolumn Assay is a highly sensitive and advanced technology capable of detecting minute levels of antibodies.higher values by Gel Microcolumn Assay should be discussed with treating physician/gynaecologist and critical titres should be established for Gel Microcolumn Assay.

Asian J Transfus Sci. 2019 May;13(Suppl 1):S9–S17.

PP 28: Analysis of transfusion transmitted infections in tattooed versus non-tattooed donors in a tertiary care centre from western India

Para Trivedi 1, Milind Dighe 1, Farzana Kothari 1

Background: Transfusion Transmitted Infections (TTI) is an important problem in voluntary blood donors. Certain studies suggest specific association of some of the TTI with the practice of tattooing which is also prevalent in Indian subcontinent. Hence we tried to assess the difference in prevalence of TTI amongst tattooed and non-tattooed voluntary blood donors at our centre.

Methods: 50 tattooed blood donors presenting in our blood bank were compared with 50 non-tattooed donors matched for age and gender. Tattooed donors were assessed for the site and size of tattoo and whether it was done by a professional tattoo artist. As per the institutional policy the deferral period after getting a tattoo was 1 year. The donated blood is tested for TTIs like Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), Syphilis and Malaria.

Results: 16% of tattooed individuals were positive for TTI as compared to 4% of non-tattooed individuals, the difference being statistically significant. Most common TTIs in tattooed group were HCV (50%) followed by HBV (14%), both HCV and HBV (10%) and HIV (6%). Most common TTI in non-tattooed group was HBV (6%). Size and site of tattoo were not associated with increased risk of TTI; however, getting tattoo from a non-professional artist showed increased risk of TTI as compared to a professional one (23.3% versus 5%).

Conclusion: Tattooed donors had a significantly increased risk for TTI, HCV being most common. Spreading awareness about association of tattooing with the risk of TTI in general populations cannot be overemphasized.

Articles from Asian Journal of Transfusion Science are provided here courtesy of Wolters Kluwer -- Medknow Publications

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