TRANSMEDCON 2021 Posters

. 2022 Apr;16(Suppl 1):S12–S45.

TRANSMEDCON 2021 Posters

PMCID: PMC9490889

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

Blood Components: 39: Blockage of inline leucodepletion filters during component preparation: A case series

Vaishali Zende ¹, Samir Shrivastava ¹, Pradnya Chavan ¹, Rajesh Sawant ¹

Introduction: Universal Leucodepletion was implemented at our hospital to minimize the risk of several transfusion related complications, including febrile non-hemolytic transfusion reactions, cytomegalovirus (CMV) infection and HLA allo-immunization. Failure of leucodepletion has been noted in a small number of blood donations and is characterized by clotting or blockage during filtration and on occasions complete occlusion of the filter of the blood bag with inline filter.

Aim: To investigate reasons for blockage of in-line leucodepletion filters during component preparation.

Materials and Methods: As a part of continuous quality improvement initiative in our department, every case of blocked leucodepletion filter was investigated for sickle cell hemoglobinopathy. The resultant data over a period of 23 months was analysed for donor demographics, complete blood count and results of sickling test.

Results: Blockage of leucodepletion filters was noted in 16(0.11%) units amongst 14384 whole blood units processed for component separation. 14(87.5%) out of 16 were donations obtained were from male donors. Mean Hemoglobin, MCV and Haematocrit values were 17.3g/dl, 85.2fl and 51.6% respectively. 6 (37.5%) out of 16 donors were O Rh(D) positive blood group and all but one donors were less than 40 years of age. sickling test was positive in 10(62.5%) out of 16 donations. 4(25%) donors were traced to sickle cell endemic zones. All red blood cell components were discarded in the above cases. Donor notification was done in all sickling test positive cases.

Conclusion: Occlusion of leucodepletion filters during component preparation was found to occur randomly in a small proportion of donors and has been often correlated with donors having sickle cell trait. Positive sickling test was significantly associated with blocked leucodepletion filters. Currently, there are no national recommendations for routine screening of sickle cell trait nor is there guidance for notification and counseling of such donors.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

46: Quality assessment of platelet concentrates prepared by buffy coat pooling method

Joyisa Deb ¹

Introduction: Platelet transfusion is indicated in a myriad of clinical conditions presenting as thrombocytopenia. Platelet concentrates that have been traditionally licensed in our country are random donor platelet concentrate (RDP-PC) and apheresis platelet concentrate (AP-PC). Buffy coat pooled platelet concentrate (BCP-PC) is a comparatively novel blood component product which has been commonly used in Europe. It has essential features of both RDP-PC and AP-PC in terms of high platelet count, leukoreduction and less turnaround time.

Aims and Objectives: Analyze the quality parameters and biochemical markers of BCP-PCs prepared to establish an in-house preparation protocol.

Methodology: For preparation of a BCP-PC, four quadruple 450 ml top and bottom bags were processed and 100 to 120 ml buffy coat were hanged after the first spin by automated component separator. The four same group buffy coats were pooled together and buffy coat pooled platelet concentrates were prepared after second spin. 10 products were prepared and assessed for different quality and biochemical parameters after 1 hour of preparation.

Results: The mean platelet count was 3.26+/- 0.15 *1011 per unit and mean volume was 293+/- 26 ml per unit. The other biochemical parameters like pH, pCO2, pO2, HCO3 were also within normal reference limits. All the BCP-PCs passed the quality control criteria as per Drugs and Cosmetics (Second Amendment) Rules, 2020.

Discussion: Buffy coat pooled platelet concentrates can be prepared easily especially in resource constraint settings. In our study, pool of 4 buffy coats was prepared which resulted in good yield of the product. Hence, it can be a good alternative for meeting platelet transfusion requirements of critical patients during emergency hours especially after Government of India has green signalled the use of BCP-PC for use in clinical settings in Drugs and Cosmetics (Second Amendment) Rules, 2020.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

47: Analysis of reason for discard of blood and blood components in a tertiary care hospital

S Saravanan ¹

Introduction: Blood is highly precious fluid containing vital nutrients, oxygen, clotting factors in adequate quantity and for which till date no artificial replacement has been discovered. As its availability is limited, indication for transfusion should be clearly defined so that there is no wastage of this valuable resource. BTS can be improved by proper education and training of the staffs so that discard of blood and blood components can be reduced.

Aim: The current study was conducted to determine rate and reasons for wastage of blood and its components.

Materials and Methods: This was a retrospective study of various causes of discard of blood and blood components carried out in blood bank Tirunelveli medical college hospital for the period of 5 years from January 2017 to October 2021. Data was collected from donor register, discard register, transfusion transmitted infection screening register and blood component separation register. Data were entered in the XL sheet.

Results: A total of 42,777 blood units collected and 67,365 blood components were separated during the study period out of which 10,411 (15.5%) platelet were discarded.1135 other components were discarded for various reasons. 188 units (0.43%) were discarded because of transfusion transmitted infections. 414 units (0.96%) were discarded due to expiry with non- utilizations. 292 units (0.67%) were discarded due to Low collection and 9 units(0.02%) were discarded due to leakage in the bag.

Conclusion: Discard rate of red cells was high in 2020 because, elective surgeries were stopped due to covid 19 pandemic. As shortage of blood components is seen during the disaster, components also be discarded due to expiry in untowed pandemic situations.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

67: Utilisation of blood and blood components in a tertiary care hospital

Lincy Thiyagarajan ¹, P Arumugam ¹, Swathandran Hamsavardhini ¹

Introduction: Blood and its components are very significant for human life and therefore blood transfusion is a life saving intervention. WHO data indicated that 87.5% of the developing countries collect less than half of the blood needed to meet the requirements. Studies on developing countries reported that most of the blood supplies are used for complications of pregnancy and childbirth.

Aim: To estimate the utilisation of Blood components in the department of obstetrics and Gynaecology. Comparative blood components utilisation analysis in medical and surgical management of obstetrics and gynaecology cases.

Materials and Methods: This study is a retrospective cross sectional descriptive study. Data collected relating to utilisation of blood components in Obstetrics and gynaecology cases, including therapeutic, emergency, and surgical indications. Data collected for a period of one year from November 2020 to October 2021.

Results: A total of 8091 components like PRBC,FFP,PC,CRYO were transfused of which 6043 (74.6%)in Obstetrics, 2048(25.3%) in Gynaecology. PRBC transfusions were most indicated in Obstetrics 2711(44.8%) more in therapeutic indications 1965(72.4%).FFP transfusions were more in Obstetrics 915(15.1%) more in surgical conditions 639(69.8%).Platelets utilizations was highest in Obstetrics 1661(27.4%),965 (58%) in surgical conditions.Cryoprecipitate transfusions were high in Obstetrics therapeutic conditions 434(60.5%).

Conclusion: Blood component utilisation was high in Obstetrics compared to Gynaecology. PRBCs were the most commonly utilized blood component in both Obstetrics and Gynaecology followed by Platelet concentrates in Obstetrics. Transfusion of blood components were more in therapeutic than surgical indications. Blood inventory management, reducing wastage, establishing and adhering patient blood management programmes and policies will further help in proper utilisation of blood components.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

78: A study on extraction efficiency of platelets by buffy coat method in a tertiary centre

Aswin K Mohan ¹, Ashish Jain ¹, Daljit Kaur ¹, Suhasini Sil ¹, Joyisa Deb ¹, Gita Negi ¹

Aim of the study was to calculate the extraction efficiency of refrigerated centrifuge (Cryofuge 6000i) for extracting platelets from whole blood collected in 450 ml Quadruple bags (Q4) by buffy coat method. The donors were screened with a questionnaire and a brief physical examination was done as per national guidelines. The whole blood from selected blood donors was collected and the volume estimated and platelet count calculated. Platelet concentrate was prepared by initial hard spin at 3500 RPM for 9 minutes followed by second soft spin of 900 RPM for 6 minutes. Once the platelet concentrate was prepared by buffy coat method, the volume and platelet count of the bag was noted and platelet yield was calculated. This was done for 40 Q4 bags. The extraction efficiency of centrifuge was calculated as per the formula: Extraction efficiency of the centrifuge = Platelet yield of the platelet concentrate unit / Total platelet counts in the whole blood bag X 100. In our study, platelet count of the donor ranged from 163 x 10^3/microL to 325 x 10^3/microL. The mean platelet count of the donor was found to be 230.15 x 10^3/microL.

The platelet yield of the RDP units collected ranged from 5.635 x 10^10 to 7.85 x10^10/microL and mean platelet yield of the RDPwas 6.588 x 10^10/microL.
Extraction efficiency of centrifuge while processing 40 units of whole blood ranged from 42.59% to 85.30%. The mean extraction efficiency was found to be 57.45%.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

93: Beyond the horizon: An analysis of the impact of helicopter transport on the quality control of blood components

A Vasanth Asirvatham ¹, V S Srikanth ¹, Rajat Bansal ¹, Pallavi Singh ¹, Siddharth Mittal ¹, Archana Bajpayee ¹

Introduction: The outreach of voluntary blood donation camps is limited by resources, time and distance as they play a role in the quality of blood components (BC). There is limited data on the influence of helicopter flight on the quality of BC.

Aim: To analyze the quality of BC prepared from whole blood (WB) collected at a remote voluntary blood donation camp and transported via helicopter.

Methods: 70 WB units were collected from military personnel at Airforce Hospital Jaisalmer and transported in two ice-lined transport boxes maintained at ambient temperature (20-24C). Military Mi-17 helicopter transported WB units to our hospital from camp site (290kms distance) in 90 minutes at a speed of 200km/hr and at altitude of 7000ft. 70 units of PRBC, FFP each and 10 RDP were prepared. Quality control (QC) was checked on Day 5 from every 5th PRBC prepared and from four randomly selected RDPs prepared from 450ml bags.

Results: All 14 PRBC units (450ml units-seven and 350ml units -seven) tested passed volume and hematocrit QC as per NABH criteria. The mean hematocrit was 58.64% (+/- 2SD). Hemolysis after air transport and 5-day storage was less in all units with a mean of 0.16%. All four RDP units met NABH criteria for QC except one with <6 x 1010platelets/unit. The mean volume, platelet count/unit and pH were 75ml (+/-2SD), 13.63 x1010 (+/-2SD) and 7.3 (+/-2SD) respectively. RBC contamination was <0.5 mL (mean 0.1).

Conclusion: There was no compromise in QC of PRBC and RDP units prepared from WB exposed to barotrauma and mechanical trauma during helicopter transport. Maintenance of cold chain during storage and transport of WB units is vital. With proper planning and resources, conducting voluntary blood donation camps in distant and remote regions in a safe and effective manner is possible.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

116: Blood component utilization and wastage in a tertiary health care system

Gargi Roy Choudhury ¹

Introduction: The whole blood is a mixture of cells, colloids and crystalloids, and can be separated into different blood components. Each component has different use.

Aims: The aims is to find (1) collection and utilization of blood and its components, and (2) the reasons for wastage of blood components and methods for reducing blood component wastage.

Materials and Methods: This is a retrospective study. Data relating to collection and usage of blood and its component from January, 2021 to October, 2021 were collected from the blood bank, Silchar Medical College and Hospital. Data regarding donation, issue and discard of blood and its components were collected month wise for last 10 months and processed and categorized.

Results: The reasons for wastage are sero-reactivity, leakage etc. The most encountered reasons for utilization were anemia and thrombocytopenia.

Conclusion: Blood and its components are very important resources and hence should be used in a justifiable manner.

Reference

1.Basu D, Kulkarni R. Overview of blood components and their preparation. Indian J Anaesth. 2014;58:529–37. doi: 10.4103/0019-5049.144647. [DOI] [PMC free article] [PubMed] [Google Scholar]

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

134: To assess quality of blood components prepared by automated blood component separation system: A pilot study

Ritesh Kumar ¹, Diptiranjan Rout ¹

Introduction: Conventionally, whole blood drawn from donor is separated by 2 methods: Platelet rich plasma (PRP-PC) method and Buffy coat (BC-PC) method.[1] This leads to variation in quality parameters which are dependent on operator expertise and multiple other factors. Induction of automation into the blood component separation technique yields a better blood component quality by removing operator related factors. This implies a much better transfusion outcome.

Aims and Objective: To assess the hematological and volumetric quality parameters of different components viz. Packed RBC, Plasma, Platelets and Buffy coats as per regulatory guidelines.

Materials and Methods: A pilot study was planned with 31 random donors. Whole blood is drawn from donors after screening as per Drugs and Cosmetics Act.^[2] Whole blood units drawn from the donors are separated by Automated blood component separation methods (REVEOS, Terumo BCT, USA) into 4 components.

Results: All the blood units included in the study are collected in 450 mL blood bags. The turnaround time to process 4 blood units into all 4 components was 18-20 mins. Mean hemoglobin content of Packed RBC after leucofiltration was 19.26 gm/ dL. Mean hematocrit of Packed RBC after leucofiltration was 60%. Mean WBC content of the PRBC units < 1000 / mL. The mean volume of different components yielded were i) Packed RBC – ~ 280 ml ii) Plasma – ~ 208 ml iii) Platelet – ~ 66 ml iv) Buffy Coat – 11 ml. Mean Platelet yield index was 76 x 10⁹/unit. Pooling of group specific platelet units resulted in a mean platelet content of 2.3 x 10¹¹/ unit.

Conclusion: Blood components prepared by automated system are confirming to regulatory quality parameters of components. There was an added benefit of reduced turn-around time (TAT) for blood component separation which resulted in saving significant man-hours.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

Blood Donors and Blood Donation: 1: Study of predonation and postdonation haematological and biochemical values in healthy donors undergoing platelet apheresis at Dhiraj blood bank

Ashu Dogra ¹

Background: Platelet transfusions are one of the blood components that are routinely requested by clinicians. Single donor platelets collected through apheresis technique provides adequate dose to patients without risk of alloimmunization. The present study thus aims to compare the pre and post plateletapheresis parameters of complete blood counts and biochemical parameters serum calcium and serum magnesium in healthy voluntary donors.

Materials and Methods: The study was conducted on 60 randomly selected plateletpheresis donors. The details of plateletpheresis were explained to each donor before the procedure. Plateletpheresis was done using Fresenius comtec Automated Cell Separator machine. Hematological parameters such as hemoglobin (Hb), hematocrit (Hct), platelet counts, mean platelet volume (MPV), and white blood cell (WBC) counts were analyzed both before and after plateletpheresis procedure.

Results: A total of 60 donors were subjected for apheresis, all of which were males. The mean age of the plateletpheresis donors was 30 years. The mean BMI of plateletpheresis donors belonged to “Pre-Obese” category (26.73). The mean platelet count before apheresis was 259× 103±31.2 /μl with the range and the mean platelet count after apheresis was 205.2× 103 ±8.0/μl; The mean value of platelet count dropped significantly in postdonation. siimilarly, the mean Hb level before apheresis was 14.2±1.3 g/dl and the mean Hb value after apheresis was 14.0±1.3 g/dl; the mean value of Hb dropped marginally in postdonation. Serum calcium before procedure ws 10.80 ± 1.30 and 30 minute after procedure was 10.20±1 .28. serum magnesium b efore procedure was 2.15± 0.30 and after procedure was 2.10±0.25.

Conclusion: Since Donor safety was ensured throughout the procedures but to prevent any unfavorable events, and for the benefit of donors and patients, its recommended that hematological and biochemical parameters should be tested following the procedure in plateletapheresis donors.

Keywords: Apheresis, blood donors, platelet count

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

4: Postvaccination serological experience of SARS-COV-2 IgG antibodies among blood and convalescent plasma donors

Neha Singh ¹

Background: The world has been introduced by several vaccines e.g. Pfizer, sputnik, covaxine, covishelid, and many more. The vaccine has proven its efficacy and proven to save so many lives which have been threatened by covid -19. In 2019 covid 19 has been bitten this world and declared himself to the pandemic. The above studies have been observed at tertiary care hospitals among blood and convalescent plasma donors.

Aim: To, assess the serological experience of SARS-COV-2-IgG antibodies in convalescent plasma, and blood donors.

Methodology: All recently recovered COVID-19 patients, who were previously infected with SARS-CoV-2, had a history of vaccination for covid 19 recruited as the sample. Results were interpreted in the VITROS chemiluminescence system.

Results: There were 1489 blood donations and 63 convalescent plasma donations have been done during the above period. Among Blood donors (101) have been experienced with post-vaccination donations. {26} convalescent plasma donors had also a history of vaccination. Extracted data from all donors, it was observed that a total of 164 donors had shown reactivity of SARS-COV-2-IgG antibodies and another transfusion-transmitted reaction marker (5%). Total serological reactivity of antibodies in all donors was (10%). Serological presence of antibodies among vaccinated donors was (8.1) % .female had the highest response of antibodies comparison to male donors.

Conclusion: The hyperimmune response among CP donors who went under jabs.60% among post-vaccinated blood donors has seen a seropositive immune response where females had a higher index of antibodies concentration comparison to males. A genetic variation would be the leading cause of antibodies response. Educated people had more aware of vaccine participation.

Keywords: Convalescent plasma, hyper immune response, post vaccination, sera reactivity

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

24: A study on the effect of predonation water ingestion on vasovagal reactions in whole blood donors

Barsha Baisakhi Panda ^1,²

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

28: Evalution of donor deferral pattern in COVID-19 convalescent plasma donor

Krishna Mayani ¹

Introduction: The whole world facing challenging time due to COVID-19 pandemic.Passive immunization using the plasma of recovered COVID-19 donors, which contains specific Ig G and Ig M anti SARS-COV-19 antibodies that neutralize the virus offers a suitable therapeutic strategy in the absence of effective treatment. Convalescent plasma refers to plasma collected from individual, following resolution of infection and development of antibodies. convalescent plasma may offer the only short-term strategy to confer immediate immunity to susceptible individuals. Many donors willing to donate convalescent plasma but deffer due to donation criteria.

Aim: The aim of this study is to evaluate the donor defferral pattern in COVID-19 convalescent plasma donor.

Methods: This was a retro-spective study in COVID-19 convalescent plasma donor over a period of 6 month. For plasma donation, donor selection standard operating procesure was followed and donor subjected to questionnaire.

Results: In recent COVID-19 pandemic , 1st case of COVID-19 was reported at 4th April 2020 in Jamnagar. 1st convalescent plasma donated on 6th July 2020 in Jamnagar. A total of 300 donors counselled for convalescent plasma donation from July 2020 to December 2020. Total 102 (34%) donors were deffered for different reasons includes 76 temporary deferred 74.50%) and 26 permanently deferred (25.49%) as per the guidelines given by ICMR. Out of 277 male registered donors 82 (80.39%) and out of 23 female registered donors 20 (19.60%) donors were deferred respectively.

Conclusion: Most common cause of donor deferral is non development of IgG anti SARS-COV-19 antibodies in male donor and low Hb in female donor.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

30: Adverse donor reaction during and after plateletpheresis in a tertiary health institution

Kaushik Patra ¹

Aim: Plateletpheresis is the process of collecting platelets, a component of blood involved in blood clotting. The term specifically refers to the method of collecting the platelets, which is performed by a device used in blood donation that separate the platelets and return other portion of blood to the donor. Platelet transfusion can be a life-saving procedure in preventing and treating serious complications from bleeding and haemorrhage in patients having disorders manifesting as thrombocytopenia like in dengue patients, ITP, aplastic anemia, and patients undergoing chemotherapy for leukaemia.

Methods: A retrospective analysis of adverse events associated with donor plateletpheresis was conducted in Dept. Of transfusion medicine at SCB Medical College, Cuttack, over the period (of 10 month) from January 1, 2021 through October 31, 2021.

Results: Out of 395 platelet donors, 93 were repeat donors, male:female ratio was 359:36 . About 31 (7.84%) adverse events were identified during platelet donations with occurrence in the first time donors=27 (8.94%) and in repeat donors=4 (4.3%). Incidence of adverse events among males was 7.52% and females was 11.1%. Local reactions related to venous access 17 (54.83%) were the most common adverse events. Generalized donor symptoms 9 (29.04%) of donors, 5 (16.13%) related to apheresis - citrate reactions were observed. During plateletpheresis occurred 28 (90.32%) adverse events and 3 (9.68%) after.

Conclusion: Donor plateletpheresis is a generally safe procedure, well tolerated by donors. Understanding risk factors for possible occurrence of adverse events provide support for adoption of measures to prevent them.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

60: Analysis of whole blood donor deferral during COVID pandemic

Manu Mangat Marandi ¹

Introduction: During this covid pandemic period, Deferrals lead to loss of precious whole blood donors (WBD) in Voluntary blood donation (VBD) camps.Donor deferral results in loss of potential, motivated blood donors, and lose of donor units for need full patients.

Aims and Objectives: This study analyses the frequency and reasons for donor deferral, including covid vaccination, post covid period with other deferral criteria's.

Materials and Methods: Data for blood donation in outdoor camps over five month from June 2021 to October 2021 are analyzed retrospectively. The VBD camp are organised by different organization within Cuttack district with supervion of SCBMCH blood bank. National guidelines and NACO guide line were used for selection and deferral during pandemic for whole blood collection.

Results: 347(18.32%) WBD were deferred out of 1894 presenting for donation during the study period. Most (66.82%) of the donors were deferred on physical examination and hemoglobin (Hb) testing. Most common reasons for deferral were low Hb (55.90%), abnormal blood pressure (8.06%), chronic disease and medication (11.23%), underweight donors (2.30%) and covid vaccination and post covid period deferral (22.47%). Females were found to have higher deferral rate than males (46.66% vs 10.61%) among donors.

Discussion and Conclusion: It is important to determine the rate and causes of WBD deferral to guide the recruitment and retention efforts at local, regional, and national level during this covid pandemic periods.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

61: Analysis of the reasons for deferral of blood donors during COVID-19 pandemic and vaccination

G Saranya ¹, V Shanthini Gilda ¹, A Ruth Jenila ¹, M Sintha ¹

COVID-19 has caused a huge impact on blood donation. Donor selection during COVID-19 pandemic was one of the crucial step, to provide safe blood. I am presenting the abstract of my paper for oral presentation on the Analysis of the reasons for Deferral of Blood Donors during COVID-19 pandemic and Vaccination.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

69: Blood donors' perspectives and expectations on blood donation during the COVID-19 pandemic

Swathandran Hamsavardhini ¹, P Arumugam ¹

Introduction: The novel Coronavirus (2019-nCoV, officially known as SARS-CoV-2 or COVID-19) was first reported in December 2019, as a cluster of acute respiratory illness in Wuhan, China, from where it spread rapidly to over 198 countries. The pandemic threatens the blood supply but we do not know its effect on blood donations or the perceptions and expectations of donors.

Aims and Objectives: To know the impact of the Covid-19 pandemic on blood donation and the expectations of blood donors at the Regional Transfusion Center.

Materials and Methods: We conducted a cross-sectional study among the voluntary blood donors at the Department of Transfusion Medicine, TNMGRMU from March 2020-April 2021. Using a semi-structured questionnaire, collected data on participants' knowledge on COVID-19, current protective measures, and their expectations.

Results: Of 410 donors included, 243 (59.2%) were enrolled from blood collection sites and 167 (40·7%) were contacted by phone. All the participants were males, and the majority were younger than 32 years. A total of 410 (92·9%) participants believed that the COVID-19 is a lung disease, but some declared that it suppresses the immune system (3·7%), it affects the blood clotting Mechanism (2·3%), or a flu-like disease (1·1%). The participants reported that social distancing and hygiene (86·4%) are the most important measures that need to be in place for safe donation. Moreover, 95·4% said they would return to donate blood if there is better transportation, and (94.6 %) would return to donate if the pandemic is controlled.

Conclusion: The altruistic factor was the most common motivation for donating blood during the pandemic period. Most of the donors know COVID-19, its transmission routes, and its manifestations. In the absence of barrier measures, they perceive blood donation as a threat to their health. Offering mobile blood collection sites will reduce the effect of the transportation problems.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

76: To study the distribution of Rh and Kell blood groups in blood donors

Maryada Rooprai ¹

The blood transfusion aims to ensure adequate and safe blood. The Rh and Kell blood groups are highly immunogenic blood group systems. The antibodies against these antigens can result in severe hemolytic reaction. The transfusion of ABO compatibility but phenotype blood may result in alloimmunization especially in patients who require multiple transfusions in hematological disorders and malignancies. The knowledge about the frequency of the red cell alloimunization is important for minimizing the risk of alloimmunization. It will be beneficial for reducing the transfusion reactions and hemolytic disease of fetus and newborn. This study will aim at providing data regarding the frequency of Rh and Kell antigen with their phenotype expression in blood donors.

Aim of Study: The aim is to study the frequency of Rh and Kell blood group antigens and phenotype among blood donors to compare with different ethnic groups.

Materials and Methods: This will be a study of entire one year. It will include voluntary donations and the samples taken will be processed for Rh and Kell antigen typing on Neo iris Immucor automated platform that uses micro-plate haemagglutination technique and commercial antisera for phenotyping.

Clinical Significance: The presence of anti kell and anti Rh antibodies in an indivisual in whom multiple transfusion is done can lead to the extensive transfusion reaction. Such as in Rh negative pregnancies, thalassemia patient where multiple transfusions are required, the knowledge about the phenotyping the donor can prevent the reactions due the alloimmunisation and relatively safe bood can be transfused to the patients.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

77: Hemodynamic changes in healthy blood donors during whole blood donation: A prospective cross-sectional observation study

M Don Davis ¹

Introduction: Safe blood donation is essential to maintain adequate blood supply. Vaso-vagal reactions are the most common acute complication related to blood donation. We studied the hemodynamic changes that occurred during whole blood donation.

Aim: To ascertain the normal hemodynamic changes occurring during the process of blood donation and also to analyze hemodynamics of donors who had adverse donor reactions (ADR).

Materials and Methods: 1000 whole blood donors who fulfilled the donor eligibility criteria were recruited and their Blood Pressure (BP) and pulse rate (PR) were measured at pre-donation, after 50% donation, immediately and ten minutes post-donation and analysed also the vitals in donors with ADR were monitored at the time of reaction and post recovery.

Results: The mean age, weight, BMI, BSA and EBV were 30.94±8.59 yrs, 74.19±35.86 kg, 25.47±4.15 kg/m2, 1.83±0.23 msq and 5409±950.24 ml respectively.

Out of 1000, 30 donors had ADR, among that 3 had ADR before and 27 had ADR after completion. And 20 donors were first time donors who had ADR.

Conclusion: All donors had a gradual drop in blood pressure until the end of the donation, and no further drop was observed 10 minutes after the donation. The ADR group had relatively higher drop in BP at 50% donation than the non-ADR group. Therefore, donors who had a higher drop in BP at 50% donation have a higher risk of ADR. This study also showed first-time donors have a higher rate of adverse reaction.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

87: Predonation deferral of blood donors: A retrospective study in a tertiary care hospital of north east India

Nayana Bora ¹

Blood donation Donor deferral

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

90: Review of donor's prior donation records - lessons learnt

Srivalli Arjunan ¹

Background: The purpose of donor screening and deferral procedures is to minimize the possibility of transmitting an infectious agent from a unit of donated blood to the recipient of that unit, as well as ensuring the welfare of the donor himself. As a part of regular pre donation screening, the review of donor's previous donation records might aid in reducing the residual risk of the donation, ensuring the selection criteria being followed and would help us to determine the efficacy of counselling.

Aim and Objective: To ascertain the utility of reviewing donor's prior donation records.

To review the donor's prior infectious disease screening record and identify discrepancies
Any discrepancy in the blood groups.

Materials and Methods: The donation records were reviewed for any donor who gives history of prior donation in Rotary ttk blood centre. For any sample that is tested reactive, the respective donor's previous records were reviewed. The duration of the study is from March 2021 to October 2021.

Discussion:

Total number of donors who donated between April 2021 to Oct 2021 are 9552, Of which 860 donors were found to be a repeat donor and
171 were found to be reactive. 4 donors were found to donate before completion of 3 months inter donation interval. 3 donors who have been tested reactive earlier were found to have donated again
No discrepancies in Blood groups were identified in any of the repeat donors.

Conclusion: Review of donor's prior donation records is an attempt to minimise residual risk of donated unit and ensuring effective counselling. Eventually, the process will ensure a healthy voluntary donation culture.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

96: Evaluation of different reasons and rate of deferral among whole blood donors attending a tertiary care centre in North-Western India

Girraj Prasad Mathuria ¹

Introduction: For safe blood transfusion blood donor selection is one of the most important measures. A large number of blood donors are not able to donate blood successfully for several reasons either temporarily or permanently. Individuals disqualified from donating blood are known as deferred donors.

Aims and Objectives: To find out rate and reasons of deferral among whole blood donors.

Methods: Data for whole blood donors presenting for donation in a blood center over 6 months from 1st January 2021 to 30 June 2021 were analyzed retrospectively. National guidelines and departmental SOP were used for selection and deferral of Whole blood donors.

Results: 1308 (10.6%) whole blood donors deferred out of 12339 presenting for donation during the study period. Most common reason for deferral were low Hb (54.5%), Under weight (3.5%), medicine (6.5%), High blood pressure (11.9%) Less sleep hours (3.6%), Covid-19 vaccination within 14 days (2%), Previous donation within 3 months (2%), Surgical causes (1.2%) and others (14.8%).

Conclusions: In our study temporary deferrals were more compared to permanent deferrals. Most common cause for deferral is Low Hb level. Increase public awareness, encouragement and by giving clear explanation for deferral reasons, we can overcome the problem of unnecessary deferrals.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

122: Donor notification: Double edged sword: What to do and what not to do

Spruha Dholakia ¹, Bhavnaben Fultariya ¹, Nishit Vachhani ¹, Sanjiv Nandani ¹

Introduction: Donor notification and counselling plays a key role in maintaining the blood safety as well as it leads to comprehensive donor care. However certain scenarios bring uncertainity for the blood centre regarding notifying the donor.

Aims and Objectives: The study aims at highlighting the limitations of blood banks while notifying the sero status of the donor and the repercussions from the donor regarding the same.

Materials and Methods: The study was conducted retrospectively for a period of 34 months from January-2019 to October-2021 at a standalone Life Blood Centre, Rajkot. Total 36318 donations were carried out. Out of them 0.58% (n=212) were tested reactive. All of them were notified. Most of them responded to the calls 99.98% (n=211). Responders were documented and were informed about further followup.

Results: Out of total 212 notified reactive donors, 42.4% (n=90) donors tested reactive when they underwent testing at other laboratories/ICTC for confirmation and further treatment whereas 57.6% (n=122) donors tested non reactive at other labs. This non reactivity was because of the less sensitive methods used to screen and confirm the serostatus of the donor which resulted in increased donor anxiety and anger towards blood centre and its way of testing donated blood.

Conclusion: A blood centre is a screening centre for blood being donated and not a diagnostic laboratory to give out sero reports to the donors. This basic knowledge needs to be imparted to all the donors. Moreover, higher the sensitive method being followed for screening of blood bags, safer is the quality of blood being issued from the blood centre. At the same time higher the reactivity ratio goes, more donor needs to be notified thereby leading to increasing the anxiety and denial. Hence, donor notification for any blood centre is a double edged sword and it needs to be addressed delicately.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

125: Evaluation of hematological and hormonal parameters in plateletpheresis donors

Pradeep Kumar Maurya ¹

Introduction: Single-donor platelets are collected by centrifuging a fixed volume of subject blood. Citrate (ACD) anticoagulants inhibit the calcium-dependent clotting cascade. As ionized calcium levels fall due to chelation by citrate, calcium mobilization secondary to increased PTH secretion during apheresis is seen.[1] TPO is the principal regulatory body of thrombopoiesis and increases output by stimulating thrombocyte synthesis in donors.

Aims and Objectives:

To study the alteration in hematological parameters in plateletpheresis donors
To study the alteration in serum Thrombopoietin (TPO) levels in plateletpheresis donors
To study the alteration in serum Parathormone (PTH) levels in plateletpheresis donors.

Materials and Methods: Donors were selected as per guidelines laid down by the Drugs and Cosmetics Act, 2020.[2] Sampling was done for ABO and Rh grouping and transfusion transmissible infections. Plateletpheresis procedures were performed on COM.TEC, Fresenius Kabi, Germany®. On day 0, a complete hemogram and serum parathormone (PTH) levels were evaluated before and after plateletpheresis. Evaluation of serum TPO levels was done before plateletpheresis on day 0 and after plateletpheresis on day 3.

Results: WBC count, RBC count, Hb, Hct, MCV and platelet count showed statistically significant (p<0.001) fall in values post plateletpheresis. PTH showed statistically significant rise (p<0.001) while TPO showed statistically not significant rise (p>0.05) after plateletpheresis.

Conclusion: In our study, a statistically significant drop in hematological parameters was seen postplateletpheresis. With the continuous infusion of ACD, symptoms of hypocalcemia were observed and postplateletpheresis PTH levels were found to be raised significantly, as well as postplateletpheresis TPO levels were found to be raised to increase the reduced platelet counts.

References

1.Silberstein LE, Naryshkin S, Haddad JJ, Strauss JF., 3rd Calcium homeostasis during therapeutic plasma exchange. Transfusion. 1986;26:151–5. doi: 10.1046/j.1537-2995.1986.26286152904.x. [DOI] [PubMed] [Google Scholar]
2.Drugs and Cosmetics Act, 2020. The Gazette of India: Extraordinary. CG-DL-E-11032020-218602. No. 142; March 11, 2020 [Google Scholar]

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

129: Delayed adverse reactions in blood donors

Sunil Kumar ¹

Blood donor experiences both early and delayed adverse reactions. A higher percentage of delayed adverse reactions were reported1, hence donor follow-up after the donor has left the donation site is important. Many delayed adverse reactions may go unnoticed unless the donor reports back to blood centres. A telephonic interview was used to evaluate the incidence and characteristics of delayed adverse reactions.

To analyze the frequency of early and delayed adverse reactions in blood donors
To correlate the frequency of donor reactions with donor profile in whole blood donors and in plateletpheresis donors.

The study was conducted over one year for blood donations at a tertiary care centre. Donors were selected according to the guidelines laid down by the Drugs and Cosmetics Act 20202. Donors can also experience a delayed adverse reaction to blood donation just after leaving the donation center or maybe much later. Donors were contacted twice, the next day and four weeks after donation, to inquire about their general well-being and particular delayed adverse reactions in compliance with an international standard format (International Society of Blood Transfusion).

Early adverse reactions were found in 2.03% donors, VVR was maximum 1.04% followed by 0.47% hematoma and 0.40% bruise. The incidence of delayed adverse reactions was 8.16%, of 3.32 fatigue followed by 2.21% bruise and 1.60% painful arms. A significant association of frequency of donation was found with delayed adverse reactions such as fatigue (p=0.001) and bruise (p=0.033). More proportion of bruise was observed in first-time donors while fatigue in repeat donors.

Delayed adverse reactions are more common than early. Post donation follow-up has provided a thought into donor experiences and can be used as a valuable tool in donor hemovigilance. This will help to improve donor retention and promote voluntary donation in future.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

131: Frequency of ABO and Rh blood group among blood donors at tertiary care hospital of central India

Amogh Tiwari ¹

Introduction: The ABO and Rh are the major (clinically significant) blood group antigens. The character of the ABO blood groups is exclusively and integrally heritable, genetically determined at conception and remain fixed for life. Hence its frequency distribution follows a known pattern governed by gene transmission from generation to generation and varies with the race and geographical distribution of human being.

Aim: To evaluate frequency of ABO and Rh blood group in central India.

Objectives: 1) To evaluate the frequency of Age distribution in blood donors. 2) To evaluate the frequency of gender distribution in blood donors.

Materials and Methods: A retrospective study carried out at Blood Bank, at the tertiary care hospital of Central India. The data of voluntary blood donors during the year 2018 to 2021 (total 03 year) was obtained from blood bank record and data was analysed according to age, sex and blood groups.

Results: Total 2509 blood donors were assessed. The frequency of ABO blood group was blood group B (37.9%), followed by O (30.9%), A (22.3%). and AB (8.9%). Rh positivity was predominantly seen in 92% of the donors. Frequency of age groups among male and female donors was maximum in age bracket of 21-30 years (55.47%) and (56.29%) respectively.

Conclusion: Present study concludes that; Blood group B was most common followed by O. Rh positivity was seen among the donors. Female contribution was very less.

References

1.Behra R, Joshi YR. Distribution of ABO blood group and RH (D) factor in western Rajasthan. Natl J Med Res. 2013;3:73–5. [Google Scholar]
2.Upadhyay DK, Banskota GN, Das PK, Sohal A. Distribution of ABO and Rh blood groups in Nepalese medical students. JMCJMS. 2013;1:17–20. [Google Scholar]

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

141: Classification of adverse donor reactions according to new severity grading tool and analysis of vasovagal reactions

Shivanand Hemant Kumatagi ¹, R Amita ¹, Rudrappan Raj Bharath ¹, Gupta Debasish ¹

Introduction: Adverse donor events are observed frequently during blood donation. They may be localised or generalised. To assess the severity of these reactions, the Hemovigilance Programme of India has recently introduced new Severity Grading Tool (SGT). Our study focusses on application of this tool to the donor reactions observed in our center.

Aims and Objectives: The aim of this study is to classify donor reactions according to new severity grading tool. The objectives of this study are: Identify incidence of donor reactions in each severity grade and diagnosis. Determine common symptoms associated with vasovagal reaction.

Materials and Methods: It is a retrospective descriptive analysis analysing 5992 blood donations from January 2021 to November 2021. The adverse donor reactions were described according to new severity grading tool and diagnosis. The vasovagal reactions were studied according to the age, gender, weight, symptoms, frequency of donation , change in pulse rate, systolic blood pressure and diastolic blood pressure. The data was analysed in Microsoft excel.

Results: The incidence of adverse donor reactions was 1.8% among whole blood donations. More than 96% reactions accounted were of grade I. Among which 63% were vasovagal reactions, 31% hematoma and 4% were delayed bleeding. There were 6 mixed reactions. Most common symptom experienced during vasovagal reaction was dizziness followed by sweating , loss of consciousness less than 60 seconds.

Conclusion: Adverse donor reactions are more common among first time donors. They should be observed for most common symptoms reported like dizziness, sweating and loss of consciousness.

Donor reactions are hindrance to the donor retention strategy. The practises must be ensured to reduce such events to the minimum.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

Cellular Therapies: 42: Therapeutic leukocytapheresis to relieve priapism due to leukostasis in CML patients: Our experience in a tertiary care centre

Suhasini Sil ¹, Gita Negi ¹, Aswin Mohan ¹, Anju Kurup ¹, Daljit Kaur ¹, Ashish Jain ¹

Introduction: Therapeutic leukocytapheresis is performed in patients with hyperleukocytosis (WBC count >50,000 to 100,000/μl) to prevent/cure symptoms of leukostasis by decreasing leukocyte count. CML patients have circulating immature myeloid cells, causing leukostasis manifesting as respiratory distress or vascular complications like stroke, priapism etc.

Aims and Objectives: The aim of this study is to report two cases of CML with complaints of priapism who were treated by one procedure of therapeutic leukocytapheresis.

Materials and Methods: One of the patients, who was diagnosed with CML 3 years back, was Imatinib defaulter, the other patient was newly diagnosed with CML. Total leukocyte counts were 1.65 lac/μl and 1.79 lac/μl respectively, and both received hydroxyurea on admission. One procedure of therapeutic leukocyte depletion was performed in each patient within 38hrs and 48hrs of development of priapism. Both the procedures were performed in the Spectra Optia continuous flow system accessed through the femoral catheter of the patient. The blood/anticoagulant (ACD-A) ratio was kept 12.0 in both procedures.

Results: In both patients, two total blood volumes were processed with runtime 157 mins and 180 mins and product collected were 796ml and 1016ml in collection bags respectively. After a single procedure of leukocytapheresis, there was significant drop of leukocyte count to 20640/μl and 32200/μl, with leukocyte reduction of 87.4% and 82% respectively. Also, there was a drop in LDH value and improvement of vascular complication (priapism) within 24 hours and 36 hours of procedure. Both the patients were on Imatinib only after completion of the first procedure and did not require any more procedures. The patients were discharged on 6th and 8th day after procedure.

Conclusion: Therapeutic leukocytapheresis is an effective way to alleviate leukostasis in CML. Although ASFA-AABB considers clinical leukostasis to be Category I (grade 1b) indication, its evidence should be studied in large cohort of patients.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

62: Effect of various centrifugation parameters in preparation of autologous platelet rich plasma

Saina Abdul Salam ¹

Introduction: The Platelet Rich Plasma (PRP) is an endogenous therapeutic technology that has immense scope in regenerative medicine due to its potential to stimulate and accelerate tissue healing ,attributable to their hemostatic potential and presence of multiple growth factors and cytokines. Quality of the PRP prepared is one of the important factor affecting the result. Literature is sparse regarding factors affecting quality and Standardization of procedure in refrigerated centrifuge EPPENDORF 5810 R.

Aims and Objectives: To analyse the effect of various parameters (centrifugation time, speed, acceleration, decceleration) during standardization of PRP preparation by double centrifugation technique in swing bucket, which would aid in maximum PRP yield. The final quality control criteria was the platelet count of final concentrate and yield compared to initial count. Variables tested were quantity of whole blood, type of anticoagulant, the speed/duration of centrifugation, platelet agitation favourability and various pellet extraction methods.

Results: Maximum yield (3 times baseline) was obtained with a low spin of 1600 rpm x 15 minutes with acceleration of 9 and deceleration of 4, and a high spin of 3200 rpm x 8 minutes with acceleration of 9 and deceleration of 4. Platelet agitation and incubation of final Platelet concentrate for 1 hour (than 2 hours) yielded much better platelet count than without agitated. 14 ml whole blood in CPD (than ACD) was adequate for a preparation of 2 ml PRP. Homogenising of the platelet pellets in final platelet concentrate yielded low platelet count compared to platelet extraction to concentrate. No red cell contamination associated with these centrifugation parameters.

Conclusions: The optimum platelet yield was obtained with above configurations in EPENDORF 5810 R and the results were reproducible.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

Clinical Transfusion Practice and Patient Safety: 15: Exchange transfusion utilizing reconstituted blood in a preterm twin with hemolytic disease of fetus and newborn: A case report

Dilna Christy Edison ¹, Amit Kumar Biswas ¹, A K Baranwal ¹, A A Pawar ¹, Ujjwal Dimri ¹

Introduction: Hemolytic disease of fetus and newborn (HDFN) is a condition where fetal red cells are coated with maternal IgG alloantibodies that are directed against paternal red cell antigens. These red cells undergo accelerated destruction, causing anemia, and increased erythropoiesis in the liver of the fetus. Our patient was a one day old, Preterm, female, sole live twin of Rh isoimmunized pregnancy for whom a demand for ET was received in view of severe anaemia (Hb 3.2 g/dL) with hyperbilirubinemia (cord blood indirect bilirubin 6.2 mg/dL).

Aims and Objectives:

To remove fetal red cells coated with maternal alloantibodies
To replace sensitized RBC's with antigen negative RBC's that has normal in vivo survival.

Materials and Methods: Around 300 ml of O Rh D negative fresh, leukoreduced, irradiated and washed PRBC unit was crossmatched with both mother and newborn. A reconstituted blood was prepared through addition of AB plasma to attain a final hematocrit of 50.4% and issued immediately. This reconstituted blood was transfused through an umbilical vein catheter, by manual push-pull technique under continuous monitoring of heart rate and SpO2. Two such cycles were done at an interval of three days.

Results: Baby improved significantly with a fall in indirect bilirubin by 50% of initial values and a rise in fetal hemoglobin to 10.2 g/dL after second cycle. The baby was given supportive treatment along with double surface phototherapy and eventually discharged after 2 weeks of hospitalization.

Conclusion: This case highlights the importance of timely intervention in form of ET in a case of HDFN. ET corrects anaemia and decreases serum bilirubin thereby reducing the risk of kernicterus in a newborn.

Reference

1.American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004;114:297–316. doi: 10.1542/peds.114.1.297. [DOI] [PubMed] [Google Scholar]

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

19: Effect of blood donor factors on outcomes in patients received blood transfusion during perioperative period in cardiac surgery

Vidushi Gupta ¹, Gopal Patidar ¹, Radheshyam Meher ¹, Milind Hote ¹, Yashaswi Dhiman ¹, Anjali Hazarika ¹

Introduction: Blood transfusion is lifesaving intervention in various medical and surgical conditions. Blood transfusion can have both positive and negative consequences on recipient. The adverse effects that are direct and immediate can be objectified and managed accordingly. Some donor-specific features that can affect patient outcome are quite difficult to accurately connect.

Aim: To evaluate the effects of blood donor characteristics on outcome of red cell recipients who underwent cardiac surgery.

Methods: A retrospective observational study was conducted in admitted patients who had cardiac surgery between January 2018 to December 2020. Blood donor characteristics such as age, gender and body mass index(BMI) were analysed for association with outcomes (length of hospital stay(LOS), mortality and readmission) of red cell recipients. Donor age and BMI were categorized as ≤30 years, >30 years and ≤25 kg/m2, >25 kg/m2 respectively. Donor and recipient gender matching was done as fully match, fully mismatch, and partial mismatch. Bivariable and multivariable binary logistic regression was used to find out independent risk factors.

Results: During study period, 5788 patients had cardiac surgery; receiving total of 20,348 red cell units. Of which, 522 (9%) died, 531 (9.2%) re-admitted and median LOS was 11 days (IQR 7-18). For LOS, BMI>25 kg/m2 (OR,1.21;p=0.02), female to male transfusion (partial: OR,1.82; p=0.005; fully: OR,3.29; p=0.053) had detrimental while male to female transfusion had beneficial effect (OR, 0.85; p=0.006). BMI>25 kg/m2 (OR, 2.25, p=0.00) and female to male transfusion (partial: OR, 1.98, p=0.005) had deleterious effect on mortality. Male to female transfusion (OR, 1.28; p=0.01) and female to male transfusion (partial: OR, 1.88; p=0.01) both increased the chance of readmission. No effect of donor age on patient outcome was observed.

Conclusion: Blood donor characteristics, particularly gender and BMI, can influence patient outcomes. Association between shorter hospital stays in gender mismatched transfusions from male donors and mortality in male patients due to transfusions from female donor is intriguing but needs to be confirmed.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

20: To study the effect of blood transfusion on serum hepcidin levels in chronically transfused patients of β-thalassemia major

Sujay Bhowmik ¹, Amit Biswas ¹, Ajay Baranwal ¹, Amit Pawar ¹, Ujjwal Dimri ¹

Background: Hepcidin is the key regulator of systemic iron homeostasis. Iron-loading anemias are disorders in which hepcidin is regulated by opposing influences of ineffective erythropoiesis and concomitant iron overload. In β-thalassemia major, transfusions rather than dietary iron absorption are the predominant cause of iron overload. In chronically transfused patients, hepcidin concentrations are significantly higher than non-transfused patients, presumably due to both increased iron load and the alleviation of ineffective erythropoiesis.

Aim: To evaluate the effect of blood transfusion on serum hepcidin levels in chronically transfused patients of β-Thalassemia major and correlate with haemoglobin and serum ferritin levels pre and post-transfusion

Methods: 16 β-Thalassemia major patients requiring monthly transfusions were included in the study. Blood samples were collected pre-transfusion and 7 days post-transfusion, were evaluated for serum hepcidin using enzyme immunoassay and for haemoglobin and serum ferritin. Data was statistically analyzed through SPSS software and p-value < 0.05 considered statically significant.

Results: Post-transfusion levels of haemoglobin, serum ferritin and serum hepcidin increased. Post-transfusion levels of hepcidin are near normal levels. Pre and post-transfusion hepcidin concentrations were both associated positively with hemoglobin and serum ferritin levels. The hepcidin-ferritin ratio indicated hepcidin was relatively suppressed given the degree of iron loading.

Conclusion: Serum hepcidin concentrations reflect competing influences from erythropoiesis, anaemia, and iron overload. Serum hepcidin levels are dynamic over the inter-transfusion interval and reflect suppression of erythropoiesis by transfusion-related increase in haemoglobin. Post-transfusion values of hepcidin in patients are near normal suggesting lower ineffective erythropoiesis. Measurement of serum hepcidin in chronically transfused β-Thalassemia patients can be used as follow up investigation along with iron studies.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

27: Role of TPE in neuromyelitis optica (Devic's disease): A case series in a tertiary care centre from western India

Para Trivedi ¹

Introduction: Neuromyelitis optica (NMO) is an inflammatory demyelinating disease that selectively affects the optic nerves and spinal cord, generally following a relapsing course. As per American Society For Apheresis (ASFA) guidelines, Therapeutic Plasma Exchange (TPE) is considered as a second-line treatment for acute episodes of NMO.

Aims and Objectives: Study aims to understand the clinical status improvement of NMO/ NMOSD patients treated with TPE.

Methodology: The effect of TPE on the degree of recovery from NMO was evaluated by performing a single volume plasma exchange with intermittent and continuous flow cell separator by femoral or central line access and scheduled preferably on alternate day intervals from 8 to 10 days. Clinical outcome in response to TPE with patient characteristics and procedural parameters were noted.

Results: All patients were severely disabled before the initiation of TPE and out of them 3 were female and 3 were male; with the mean age being 41.67 (30-62) years. The median duration of disease was 5-10 days. Out of 6 patients, 4 had a history of bilateral optic neuritis, and all patients were anti-aquaporin 4 antibody positive with MRI showing features of NMO. Total 32 TPE procedures were performed on 6 patients, the mean time of start of TPE in the acute attack was 3.5 days. Clinical improvement was observed early in the course of TPE treatment in most patients. Mean volume processed was 4145.97 ml with mean plasma volume removed was 2239.17 ml and mean ACD used was 232.16 ml. One patient developed relapse after 6 months following discontinuation of treatment

Conclusion: Acute NMO can be safely and effectively treated with TPE with marked improvement in the neurological status. The earlier we start TPE in an acute attack, the better will determine the clinical outcome. TPE was well-tolerated and had a low severe adverse event profile.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

32: Evaluation of effect of early use of cryoprecipitate on mortality in trauma patients with hemorrhagic shock

Arun Bhandari ¹, Rahul Chaurasia ¹, Sushma Sagar ¹, S Arulselvi ¹, Tej Prakash Sinha ¹, Abhinav Kumar ¹, Hem Chandra Pandey ¹, Gopal Kumar Patidar ¹, Dinesh Bagaria ¹, Yudhyavir Singh ¹

Introduction: Coagulopathy is a common accompaniment, present in approximately one third of trauma patients with uncontrolled hemorrhage. Fibrinogen plays an important role in both primary and secondary hemostasis through platelet aggregation and formation of stable clot. Plasma fibrinogen levels are known to deteriorate more frequently and earlier than other routine coagulation factors in severely injured trauma patients. Low fibrinogen levels on arrival in emergency is an important risk factor of poorer outcomes. Early replenishment of fibrinogen using cryoprecipitate is critical in ensuring hemostasis in trauma associated coagulopathy.

Aims and Objectives: Assess role of early cryoprecipitate administration on overall mortality and utilization of blood components in severely injured trauma patients.

Materials and Methods: A prospective interventional study was conducted for 1 year duration. The study was done in two phases (6 month each), phase-I: standard transfusion therapy was used whereas in phase-II: one dose of cryoprecipitate was administered within 90 min in addition to standard transfusion therapy. Clinical details, laboratory investigations, transfusions and outcomes were monitored for enrolled patients.

Results: Total of 109 patients were recruited, which included 56 patients in phase I and 53 patients in phase-II. Patient demographics and injury characteristics were similar in both groups. However, the injury severity was more during phase-I. Baseline fibrinogen values were similar in both phases. Blood utilization in both groups was significantly different, with median number of 6(4-9) RBC, 4(1-7) RDP, 4(2-6) FFP in phase I vs. 3(2-6) RBC, 2(2-3) RDP and 4(2-4) FFP in phase-II. Overall mortality in phase I was significantly higher (30.36%) compared to 13.21% deaths in phase-II.

Conclusion: Early administration of cryoprecipitate led to decrease in the overall blood component utilization. Although mortality was lower in patients receiving early cryoprecipitate, both the groups were not properly balanced, and thus needs to be further investigated using Randomized controlled trials.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

35: Management of Bombay Rh negative with clinically significant anti-S for CABG surgery

S Anuragaa ¹

We are presenting a case report on Bombay Rh negative with anti S for CABG surgery. Patient was reexplored twice which increased the demand for more PRBC. Bombay blood group is rare with Rh negative and anti S made the situation even more challenging to manage. We have successfully managed this case with our strategies like ANH, autologous SDP apheresis, donor mobilisation through rare donor registry. We also received 4 PRBC from Bombay, India. But S antigen status was not known. We only issued S negative units to the patient. A total of 4 PRBC, 1SDP, 12FFP, 2 RDP and 9 cryoprecipitate were transfused throughout the hospital stay. The patient was Bombay Rh negative with anti S with major surgery, which was re-explored twice, the patient was managed successfully in spite of all these difficulties with cooperation from different blood banks from all over India.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

36: Implementation of massive hemorrhage protocol at an urban Level I trauma center: One year experience

Rahul Chaurasia ¹, Sapna Chopra ¹, Abhinav Kumar ¹, Narendra Chaudhary ¹, Arulselvi Subramanian ¹, Kapil Dev Soni ¹, Tej Prakash Sinha ¹, Richa Aggarwal ¹

Introduction: Massive hemorrhage protocol (MHP) is a proactive and multidisciplinary approach aimed to provide blood and blood components in a pre-determined and timely fashioned manner to improve the overall outcome of severely bleeding patients. An indigenous low volume MHP was designed for trauma patients at our institute. The protocol was then implemented after appropriate communication and sensitization.

Aims and Objectives: Compliance to the designed MHP protocol and blood utilization during the initial resuscitation was evaluated one year after its introduction at our institution.

Materials and Methods: Retrospective analysis of the MHP activations for 1-year duration was performed. Patient details including demographics, injury, clinical and transfusion details from the patient records. Compliance to critical steps such as trigger values were assessed including, activation criteria, delivery timings of blood components, adherence to pack size, ratios of blood components and endpoints.

Results: MHP was activated for 58 (1.1%) patients presenting at emergency department. A total of 596 RBC, 504 RDP, 405 FFP and 120 units of cryoprecipitate were transfused. Compliance to trigger criteria was 74.1%. Blood group selection was compliant in 82.8%. Time to issue of 1st pack, 2nd and 3rd pack was achieved in 100%, 48.3% and 22.4% patients. Pack size was maintained in 63.8%, 50% and 3.4 for the 1st , 2nd and 3rd pack respectively. Ratio of RBC:RDP:FFP was met in 12.1%. Endpoints were monitored in 43% patients. Median compliance score was 5 (range 2-8).

Conclusion: Inability to keep-up with pack size of blood components in MHP and ratio of blood components were the commonest cause of non-compliance in our study. Increasing pack-size, along with evidence-based approach for plasma and platelet transfusion is priority modification. Alongside, regular hands-on training, simulation exercises, addition of hemostatic adjuncts, laboratory monitoring, and audit will help in improving the compliance and thence the patient outcome.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

48: An audit on fresh frozen plasma usage in a tertiary care hospital in northeast India

Anbarasan Thavamani ¹, A Barindra Sharma ¹, Pratima Khoyumthem ¹

Introduction: Fresh Frozen Plasma(FFP) contains near normal levels of most plasma proteins, including procoagulant and inhibitory components of the coagulation system FFP is not without risk and indeed may be among the most “high risk” of all blood components. Therefore, careful assessment of all FFP transfusion is essential to promote rational use.

Aims and Objectives:

To analyse the trend of FFP usage in different departments in our institute
To assess the appropriateness of each FFP transfusion
To evaluate the adequacy of monitoring of FFP transfusion.

Materials and Methods: Retrospective analysis of all requisitions of FFP was done from August 2020 to August 2021. The indications, laboratory parameters, dosage transfused were recorded and the appropriateness of each transfusion was assessed. AABB guidelines were followed to assess the appropriateness. The requisitions were then categorized into appropriate, inappropriate and inconclusive.

Results: A total of 1347 units of FFP were issued for 363 requisitions, which included 262 (72.2%) males and 101 (27.8 and) females. Most common clinical condition for which FFP used was 'Chronic Liver Disease'. Department of Medicine has the maximum number of 241 requests. Appropriate transfusions were 193 (53.2%), inappropriate were 164 (45.2%) and 6 (1.7%) inconclusive requests. Increased PT/INR with bleeding (145) and increased PT/INR without bleeding (102) were the most common indication for appropriate and inappropriate transfusions respectively.

Conclusion: Percentage of inappropriate FFP transfusion is still high in our institute (45.2%). Therefore, institutional guidelines on FFP use is urgently needed. Regular training of doctors from clinical subjects would also be helpful. Lastly, regular evaluation of all transfusions should be continued.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

54: Efficacy and safety of buffy coat pooled platelets in comparison to single donor apheresis platelets in hemato-oncological patients: A randomized cross over study

Prateek Srivastava ¹, Hari Krishan Dhawan ¹, Divjot Singh Lamba ¹, Rekha Hans ¹, Shankar Prinja ¹, Pankaj Malhotra ², Ratti Ram Sharma ¹

Introduction: Buffy coat pooled platelets (BCPP) have adult therapeutic dose, are leucoreduced and can be issued immediately on receiving a platelet requisition.

Aims and Objectives: This study was aimed at finding out the efficacy and safety of this new product amongst Hemato-oncological patients, in a randomized cross over study design.

Materials and Methods: BCPP was prepared by pooling five O positive buffy coats extracted from top and bottom quintuple bags using chain method, leucofiltered and suspended in PAS. In a randomized cross over design, 85 hemato-oncological patients fulfilling the inclusion criteria were enrolled and assigned either SDAP or BCPP as the first transfusion product and upon receipt of a subsequent requisition the same patient was transfused with second platelet product. Patients were assessed for Corrected count Increment (CCI) and percentage platelet recovery (PPR) one hour after each transfusion.

Results: BCPP had a mean volume of 240 ml, a mean platelet yield of 3.94 x 1011 per bag and mean post transfusion increment of 38,812 per microliter. In comparison, SDAP had a mean volume of 220 ml, a mean platelet yield of 3.2 x 1011 per bag and mean post transfusion increment of 31,941. Mean CCI seen after transfusing SDAP was 16,064 while that after BCPP was 15,778. Mean PPR after SDAP transfusion was 39.22% whereas after BCPP was 38.22%. No transfusion reactions were reported in any of the patients enrolled. Multivariate analysis yielded that BCPP was non-inferior to SDAP in terms of post transfusion CCI (95% CI: -751 – 190) and PPR (95% CI: -2.14 – 0.14) and superior in terms of post transfusion increment of platelets (95% CI: 5666 – 8086).

Conclusion: This study proves that BCPP is non-inferior to SDAP for non-refractory hemato-oncological patients in terms of CCI, PPR. BCPP is good alternative to SDAP in resource constrained settings.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

55: Trauma associated haemorrhage score in massive transfusion protocol

Gunda Vivek ¹

Trauma associated severe haemorrhage score is used in massive haemorrhage to predict the probability of requiring massive transfusion. In this study, 30 poly trauma patients were included who were admitted in our emergency department. TASH score was applied at the time of presentation and analysed retrospectively. Patients were also divided based on their type of injury to see if there is any correlation to TASH score. TASH of >18 considers to have >50 % probability for massive transfusion. Out of 30 patients, 3 patients showed TASH of >18 of which 2 required massive transfusion. 27 patients showed score of <18 of which 11 patients required massive transfusion. Out of 8 neuro trauma patients with TASH score of <18 , 5 required massive transfusion suggesting negative correlation with neuro trauma patients compared to non neuro trauma patients.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

58: Emergency thrombocytapheresis to treat refractory thrombocytosis

Namrata Datta ¹, Somnath Mukherjee ¹, Satya Prakash ¹, Ansuman Sahu ¹, M Sree Bhagavanthi ¹, Bramhadatta Pattnaik ¹, Prabodha Kumar Das ¹

We present a case of a 40 y/M, admitted with EHPVO with symptomatic gastric and esophageal varices who underwent splenectomy with spleno-renal shunt. This patient had high platelet counts in the postoperative period and was planned for thrombocytapheresis to prevent shunt blockage on POD-20 because of no response to hydroxyurea.

1)
To decrease the platelet count of the patient rapidly to prevent thrombotic blockage of shunt.

Therapeutic procedure was performed with pre-procedural counts of 1862X103 /μL. Rest of the pre-procedure investigations were normal and patient was already on Hydroxyurea 1g TD, LMWH 6000 IU, Aspirin 75 mg and Clopidogrel 75 mg OD along with antibiotic prophylaxis. Plateletpheresis procedure was performed on Cobe Sprectra cell separator with Dual Needle ELP kit with LRS Chamber after getting written request from physician and taking proper consent from patient. 3100 ml of WB was processed over 80 minutes with infusion of 300 ml normal saline over peripheral IV cannula charged with 30 ml Calcium gluconate. Ionised calcium levels were 0.95 mEq pre-procedure.

Post-procedure the patient's platelet count was 856X103 /μL and hemoglobin decreased from 11.7 g/dL to 10.8 g/dL. The platelet count of bag showed an yield of 32.8X1011 (Total 497 ml collection with 6600X103/μL) which was above the predicted yield of 23X1011. The patient had hypotension near the end of the procedure which was treated with head-end lowering and oral fluid. The patient was discharged with a platelet count of 7 lakh/cumm with thrombosis prophylaxis and 6 months follow-up revealed no thrombotic complications with platelet count of 468X103 /μL.

This procedure highlights the role of apheresis to as effective measure to rapidly decrease thrombocytosis which is often employed as a last resort to patients not responding to pharmacological agents. Thrombocytapheresis can be used as an emergency measure to reduce platelet counts to prevent end-organ damage because cytoreductive agents take substantial time for action.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

73: Role of platelet rich plasma in treating non healing diabetic foot ulcers: A case report

Amit Kumar Biswas ¹

Introduction: Diabetic foot ulcers are one of the commonest causes of limb amputations. The use of autologous platelet-rich plasma (PRP) enhances the natural wound healing process. A case of chronic non-healing ulcer that showed significant clinical improvement with PRP is discussed here. A 61-year-old male, k/c/o type 2 Diabetes Mellitus for 20 years on irregular treatment, presented with an ulcer over the left great toe with pus discharge and blackish discoloration for 15 days. Due to extensive necrotic skin, even after IV antibiotic therapy, RAY amputation of the great toe was performed. PRP therapy was advised for which, whole blood was collected in 3.2% sodium citrate vacutainers.

Case Report: Vacutainers were first centrifuged at 2400 rpm for 10 min which allows blood separation into the RBC layer, PRP layer, and acellular plasma layer. Using a sterile syringe the PRP and Plasma layer was transferred into another tube which was centrifuged at 3600 rpm for 15 min. This allows the platelets to settle down at the bottom of the tube with very few RBCs. This PRP was mixed with an equal volume of a sterile saline solution containing 100 U/ml human thrombin and calcium chloride (10%). It was then injected 04mm deep inside and 01 cm around the wound followed by standard dressing. The patient was discharged on the 4th post-procedure day as the wound was clean, without any induration and erythema. The wound showed healthy granulation tissue with no pus discharge. A 07 month follow-up period revealed satisfactory healing throughout.

Conclusion: PRP is a cheap, easy, convenient, and effective modality of treatment that provides numerous growth factors like PDGF, EGF, VEGF, TGF- β, KGF and FGF. These factors help in the chemotaxis of stem cells and promote cell proliferation at the site of injury, thereby enhancing wound healing.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

74: Role of thrombocytapheresis in a case of thrombocytosis

Keerti Angampally ¹

Extreme Thrombocytosis is a precursor for thrombotic-hemorrhagic event , and is a forewarning of potentially fatal vascular complications.^[1] Long-term cytoreduction can be performed with chemotherapy but rapid reduction in platelets cannot be achieved by chemotherapy and it may cause end-organ ischemia or develop to life-threatening hemorrhage.

Aims and Objectives: As Per ASFA category, Thrombocytosis is Category II for Symptomatic Thrombocytosis [Recommendation Grade 2C] and Category III for Prophylactic or Secondary Thrombocytosis [Recommendation Grade 2C]. Despite its limited indication, plateletpheresis continues to offer a valuable temporary measure in platelet count reduction before cytoreductive agents exert their maximal effect.

Materials and Methods: We have performed thrombocytapheresis in a 74 year old female with one episode of subarachnoid haemorrhage having a past history of undergoing CABG (with normal platelet count) now presenting blood picture of mild leucocytosis and severe thrombocytosis with platelet count of seventeen lakh. It comes under Category II Grade 2c for thrombocytapheresis as per ASFA.

Platelet-lowering agent (hydroxyurea) along with aspirin was started simultaneously to prevent rapid re-accumulation of circulating platelets. With two procedures, Platelet count reduced to 3.4 lakh and subsequently maintained at 4.6 lakh with platelet lowering agents.

Results: A 80% global reduction in the platelet count was achieved after two therapeutic plateletpheresis procedures.

Conclusion: Extreme thrombocytosis, although quite rare, can be symptomatic and life-threatening in patients and should be considered as an emergency. It is important for the treating physician to be aware of the symptoms and risks associated with hyperthrombocytosis and to have knowledge of early intervention by mechanical removal of platelets by apheresis as effective therapy.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

75: Neonatal packed red blood cell transfusion practice at our tertiory care center, Gwalior MP

Anita Arya ¹, Prakriti Gupta ¹, Sunita Rai ¹, Sachin Singhal ¹, Dharmesh Chand Sharma ¹, Sudha Iyenger ¹

Background: Protein structures RBC antigens are well developed as early as the 6th gestational week, while others such as A, B, H, Lewis, I, which are determined by immunodominant sugars are not fully expressed at birth . The reverse grouping is not applicable in neonates to lack of ABO group antibodies. So identification of ABO blood group is crucial in neonates and transfusion of identical/compatible PRBCs is critical.

Aims and Objectives: To assess the PRBCs neonate's transfusion strategy at our center.

Materials and Methods: The Study was conducted at Blood bank, Medical College, Gwalior from 1^st January 2019 to 31st December 2020. During this period, 1560 PRBCs was transfused in neonates. ABO and Rh grouping was done by conventional method using commercial antisera and Neonatal Gel Card (Tulip). Cross match was done with tube method and AHG Gel Card (Tulip). Whenever there was a discrepancy in ABO group O Rh saline wash PRBCs were transfused irrespective of the patient's blood group. Units were issued as per slandered protocol. Transfusion of other blood components during the study period was excluded.

Results: A total 1560 units of PRBC were given in 1286 neonates, minimum 1 and maximum 4 units / patients. Average age of the patient was 9.4 SD+/- 8.2 days. ABO group distribution was; A 205 (13.14%), B 640 (41.03%), O 589 (37.8%), AB126 (8.08%). In 1216 (77.9%) cases identical PRBC was given while in 344 (22.1%) cases of A2 group, A2B group and discrepant ABO group, O saline wash PRBCs were given.

Conclusion: “O” saline wash PRBCs is a better choice in neonates irrespective of the ABO group because ABO group antigens are underdeveloped in neonates and reverse grouping is not applicable in neonates.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

88: Effect of prestorage leucoreduction on transfusion associated adverse reactions to red blood cells in tertiary care hospital

Arshpreet Batra ¹

Introduction: Transfusion associated adverse reactions(TAARs), associated with transfusion of blood and blood components can range from minor adverse reaction to life threatening ones. Universal leucoreduction is defined as the application of the reduction of leucocyte content of whole blood, RBCs or platelet units (5x10 6 residual white blood cells per unit) to all the units prior to their storage.A significant reduction is seen in:

Frequency and severity of transfusion reactions
Risk of CMV transmission
Risk of HLA alloimmunization
Likely reduced risk of transfusion transmitted bacteria.

Aims: Retrospective analysis comparing rate of TAARs in prestorage leucoreduced and non leucoreduced red blood cells transfusion

Materials and Methods: A retrospective analysis of TAARs with prestorage leucoreduced and non leucoreduced red blood cells was done over a period of one year (January -December 2020).The TAARs were analysed and stratified according to component transfused and the patients were divided into 2 groups:

Those receiving non leucoreduced RBCs (NLR RBCs)
Those receiving prestorage leucoreduced RBCs (PrSLR RBCs).

Prestorage leucoreduction was done by using buffy coat method of component preparation by inline filter quadruple bags containing Sepacell pure RC filters

Results: In the time period of one year (January- December 2020), a total of 21153 RBCs units were transfused out of which:

Prestorage leucoreduced units- 8884 (42%)

Non leucoreduced units- 12269 (58%)

A total of 60 transfusion reactions were reported out of which 6 (i.e. 0.02%) were found to be associated with leucoreduced RBCs and 54 (i.e. 0.25%) were associated with non leucoreduced group. This represented a significant reduction in rate of transfusion associated adverse events with prestorage leucoreduced RBCs.

Conclusion: Leucocytes have been implicated to be a strong contributor to a number of TAARs. The improvement in technology in the area of leukoreduction has been associated with considerable clinical improvement. Universal Leucoreduction, if applied can result in safety of allogenic blood components for recipients.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

95: Resolution of masked native blood group of thalassemia patient by “5 WHY” analysis

Dhivya Kandasamy ¹, Ashwin Kumar Vaidhya ¹, P A Prethika ¹, Ganesh Mohan ¹, Shamee Shastry ¹

We report an unusual discordant Rh grouping report between present (O Rh D neg) and historical group (O Rh D pos) in a thalassemia patient aged 24yrs visiting our center since 2015. The fresh sample also showed O Rh D neg. Past medical history revealed the patient was diagnosed with thalassemia at 8 months of age, blood group was O Rh D neg then, underwent bone marrow transplant at 5 yrs (O Rh D pos) donor but soon graft rejection occurred. However, on regular transfusion support with O Rh D pos thereafter. Recently started on thalidomide therapy (HbF inducer) in view of increased transfusion need. Following this, prolonged transfusion-free period was observed. We sought to elicit reason for O Rh D neg despite no recent transfusion history of O Rh D neg We adopted the “Funnel-shaped problem-solving approach of 5 why analysis?

Why it is considered a discordant Rh grouping report?
Why previous grouping is Rh D positive?
Why present group is Rh D negative?
Why present group is considered a native blood group?
Why was all the grouping after transplant rejection demonstrated as donor group?

Further, we subjected the anti D cell grouping sample for microscopic examination and reviewed past medical, antibody screen, and transfusion details.

1, Discordant Rh grouping report observed between historical and present group
Historical O Rh D positive grouping is due to frequent multiple O Rh D transfusion accompanied by negative antibody screen
Following thalidomide therapy, the transfusion free period allowed unmasking of a native group
Pre-transplant period blood group is O Rh D negative
Despite graft rejection patient continued to receive O Rh D pos transfusion with no anti D development

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

100: Role of therapeutic plasma exchange in ratol poisoning induced ALF: A case report

Vijayasekaran Kuralarasi Priyadarshini ¹, Deepti Sachan ¹, Deepthi Krishna ¹, Mohamed Rela ¹

Introduction: Ratol paste is a rodenticide containing 2 to 5 % yellow phosphorus which is a non metallic irritant with a fatal dose of 8 mg or 1 mg/kg.

Case Report: A 21 year old male, with alleged history of Ratol consumption presented to our hospital 6 days post consumption with hepatic encephalopathy of grade 3.O/E:wt100 kg. His vitals were -HR: 60/min BP :130/70 mm Hg. Blood tests on admission were Hb: 12.4 g/dl, TLC: 13500 cells/ mm3, platelets 79000/mm3, INR 4.41, Creatinine (Cr) 1.10 mg/dl, Total Billirubin (TB) 17.6, Direct Bilirubin (DB): 6.67 mg/dl, AST :252U/L, ALT:995U/L, albumin 3.3 g/dl He was put on mechanical ventilator support and in view of elevated bilirubin and other LFT a diagnosis of Yellow phosphorus [YP] induced ALF was suspected for which he underwent 3 TPE cycles on 3 consecutive days with High volume(HV) plasma exchange of 1.3 PV with an average of 6702ml of blood vloume processed and 474 ml of ACD being used. The choice of replacement fluids used were 5% Albumin, NS 0.9% and FFP. Due to elevated Ammonia (>900 μmol/L) level CRRT (continuous renal replacement therapy) was also done as a supportive therapy. Though his biochemical parameters showed slight improvement in LFT, patient continued to deteriorate and with risk of acute liver failure, liver transplantation was done for the patient. On POD-1 patient was hemodynamically unstable with elevated Ammonia levels and peak lactate 5.1 mmol/ L. He received the post LDLT TPE as he developed acute kidney injury (AKI) with rise in Cr 1.3 to 1.7. He continued to require intensive care along with serial TPE in view of persistent graft dysfunction and worsening AKI with Cr 3.62. After 14 cycles of TPE his graft dysfunction and AKI gradually improved with Cr 1.15 and TB 10.43 on POD 46. Patient's biochemical parameters and clinical status significantly improved and he got discharged.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

102: A retrospective analysis on neonatal exchange transfusion complications

Bodanapu Vinay ¹, Archana Bajpayee ¹, Anubhav Gupta ¹, Neeraj Gupta ¹

Introduction: Neonatal Exchange Transfusion, a potentially lifesaving procedure usually performed in NICU. In exchange transfusion, neonate blood is exchanged with donor blood or blood products. As the procedure is cumbersome and lack of awareness in junior staff and parents regarding its complications is still persists.

Aim: To analyze the trend, rates, indication and complications and to increase awareness regarding Neonatal Exchange Transfusion

Objectives:

To understand the trend, analyze the rates, indication and associated complications of ETs
To increase awareness regarding the procedure and complications in order to manage clinical risks to the staff and to counsel the parents.

Materials and Methods: Retrospective study of all neonates receiving exchange transfusion from January 2018 to October 2021 in AIIMS Jodhpur. Neonate is followed up to 28 days or mortality whichever is prior. Lab parameters were collected before and after exchange transfusion from department of neonatology. Records from blood center are used. The exchange transfusion threshold is set according to bhutani nomogram.

Results: 25 ETs were performed in 21 neonates in a period of Jan2018-Oct 2021,an average of 6.25 ETs per year.15 neonates (71.4%) for hyperbilirubinemia and 2 for anemia (9.5%) and 4 (19%) were exchanged in neonates with both.12 neonates (57.2%) had Rh incompatibility, 7 (33.3%) had ABO incompatibility and others 2 (9.5%). 9 were DAT positive (47.6%). Five neonates (23.8%) were intubated after ETs who were already on O2 support. Overall mortality was 9.5% (n=2) within 28 days of ETs.

Conclusion: The current ETs rate are in decreasing trend (per year per100) as alternative treatments, care and improvement in testing are improved. Mortality cannot be ascribed to ETs, as it was often performed in smaller, sick or more premature neonates whose risks of mortality and morbidity are high regardless of ETs.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

107: Role of erythrocytapheresis in managing sickle cell crisis: Case report from a tertiary care centre

Ashna George ¹, Bemma Paonam ¹, Ganesh Mohan ¹, Dhivya Kandasamy ¹, Vinu Rajendran ¹, Deepika Chenna ¹, Ashwin Kumar Vaidya ¹, Shamee Shastry ¹

Introduction: Erythrocytapheresis is a procedure which removes either abnormal or increased red cell mass. The primary goal of therapeutic red cell exchange (RCE) in Sickle cell crisis is to remove abnormal red cells and replace them with normal allogeneic red cells.

Aim: We present a case of Sickle cell crisis who underwent apheresis red cell exchange in ICU.

Materials and Methods:

A 19-year-old male, a known case of sickle cell disease, presented with low grade, intermittent fever for 4 days, relieved on medication
He also had complaints of headache in the occipital area and joint pain
He further developed tachypnoea and bilateral infiltrates on Chest X-ray
He was on NIV due to desaturation
RCE was performed suspecting sickle cell crisis
HbS prior to the procedure was not performed, hence assumed it as >75%
The calculated volume to be exchanged was 945mL
The first procedure was done with three units and the second was completed with four units of red cells.

Results:

HbS decreased to 33.8% after the first RCE and to 17% after the second procedure
His clinical condition improved and was off Oxygen support after the two procedures
He was discharged after 17 days in the hospital.

Conclusion: Red cell exchange provides improved oxygen-carrying capacity to the patients and reduces the overall viscosity of the blood, especially in sickle crisis.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

108: Thrombotic thrombocytopenia in a case of disseminated malignancy: Failure to respond to therapeutic plasma exchnage

Vasundhara Singh ¹, Nimisha Sharma ¹, Geetika Sharma ¹, Saroj Rajput ¹, Sonu Choudhary ¹, Tathagata Chaterjee ¹, Praneet Ansal ¹

Introduction: Thrombotic thrombocytopenic purpura (TTP) is a life threatening form of thrombotic microangiopathy, characterized by pentad of Microangiopathic Hemolytic Anemia, thrombocytopenia, and neurological deficits, renal injury, and fever. It is caused by the severe deficiency of plasma ADAMTS13 activity. Patients suffering from disseminated malignancy may sometimes present with TTP like symptoms.

Aims and Objective: To notify a case of disseminated malignancy of aggressive nature presenting as TTP, not adequately managed by multiple transfusion and therapeutic plasma exchange.

Materials and Methods: A 32 year old male patient was admitted to our hospital with fever, thrombocytopenia. Diagnosis of Dengue fever was considered however NS1 came out to be negative. Within a course of 6 days6 unit SDP, and 6 units of PRBC were transfused. However, Platelet count and Hemoglobin levelsdecreased further [Tables 1 and 2]. Peripheral blood smear findingsrevealed 25-30 nucleated RBC/100 WBC, olychromatophilic cells, Spherocytes and micro spherocytes. 3-4 schistiocytes/ hpf were also seen. An impression of AIHA with TTP was made possibly EVANS Syndrome, and Therapeutic Plasma Exchange was planned.

Results: Patient improved clinically followed by worsening of symptoms along with dyspnoea. PET CT revealed multiple lymph nodes , pleural and pericardial effusion, Ascitis, omental thickening. Multiple Hepatic lesions and Extensive bony lesions led clinician to reconsider diagnosis.

Conclusion: This case has been presented to highlight the fact that a search for systemic malignancy including bone marrow biopsy should be done when patients with thrombocytopenia fails to respond to therapeutic plasma exchange.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

112: Role of thromboelastography in diagnosis and management of sepsis induced coagulopathy in critically ill patients

Ashwinkumar Vaidya ¹

Introduction: Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. SIC is a systemic inflammatory response to the infection with various clinical manifestations ranging from thrombosis to bleeding. Thromboelastography is a viscoelastic test that measures clot initiation, propagation and clot resolution which identifies the invivo coagulation status.

Aims: Role of Thromboelastography in interpreting SIC and correlating to the clinical severity in critically ill sepsis patients.

Methodology: This was a case control study over 2 years (2018-2020). Patients above 18 years admitted in ICU diagnosed with sepsis were included. The patients were divided based on whether TEG was performed (group A) or not (group B). Patients were classified based on SOFA score into <9 (<33% probability of mortality), 9-11 (40-50% probability), and >11 (>90% probability of mortality). Haematological parameters, TEG and clinical outcome of the patients were collected. The data was analysed using SPSS 22.0.

Results: Among a total of 209 patients, TEG was done in 125 patients (group A) and 84 patients were managed with conventional coagulation tests (group B). Based on the severity of sepsis using SOFA score the patients were distributed evenly between the groups. In group A based on TEG 26 (20.8%) patients had normal tracing, 66 (52.8%) patients had hypocoagulable and 33 (26.4%) patients had Hypercoagulable pattern. The hypocoagulable tracing was associated with a more severe form of SIC with 51.5% patients compared to 34.6% in normal and 31.9% in hypercoagulable TEG. Mortality was significantly reduced in patients managed with TEG (53.2% reduction). Length of Hospital and ICU stay was longer in group A (10.3 vs 6.12 and 19 vs 8.4 respectively). Other morbidities were comparable between groups. The overall correction of SIC at the end point was better in group A (40.4% vs 84.21%, p<0.05).

Conclusion: A hypocoagulable TEG tracing is associated with severe-sepsis and TEG guided management had a better clinical outcome.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

121: Crossmatch to blood transfusion ratio-to evaluation of efficiency of blood product utilization in tertiary care center

Bhoomika Shingala ¹

Introduction: Blood donation done by voluntary donors at blood bank, which must be effectively managed and stocked. Demand is done by different departments before different procedures like reservation prior to surgical procedure in routine practice. Increase blood request and minimum usage can cause waste of blood, technical time, manpower, reagents and materials.

Aim: To evaluate the blood demand and usage of blood in hospital by cross match transfusion ratio as a indicator.

Methodology: This retrospective study is done for 1 year (August 2020 to August 2021) from blood bank Data system of our set up.

Results: Maximum cross match transfusion ratio is in orthopedic department (1.3) and minimum is in thalassemia department is 1.

Conclusion: we can improve this ratio by better communication between clinician and blood bank center. So, we can save unnecessary use of man power, technical time, material and waste of blood or component and electricity. This can cause better management and improve quality of work.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

124: Indications and complications of exchange transfusion in hospitalized neonates from a tertiary care blood centre

Reshma Nambiyar ¹, Manish Raturi ¹, Anuradha Kusum ¹

Neonatal hyperbilirubinemia is a common cause of neonatal morbidity. Exchange transfusion [ET] with or without phototherapy remains the most sought-after procedure to address the rising NNH and reduce the bilirubin-induced neurologic dysfunction in the new born. In this study we evaluate the percentage-drop in unconjugated bilirubin [UCB] after ET and its complications in neonates. Retrospective data was collected for the study period of one year of all neonates that received cross-matched compatible PRBC reconstituted with AB typed FFP. UCB levels both pre and post transfusion were evaluated along with clinical complications namely, hypoglycaemia [<50 mg/dl], hypocalcaemia [<8 mg/dl], hyperkalaemia [>6 mEq/L], thrombocytopenia [<1 lakh/cu.mm], bradycardia [<80 beats/min], apnoea [>20 sec], hyponatraemia [<135 mEq/L] and seizures. The significance level in the data calculation was kept as p- value < 0.05. Of the total [n=470] neonates admitted in NICU, almost 3% [n=15] underwent ET with PT. The most common indication for ET was rising NNH with sepsis. The overall reduction of UCB was 51%. The average reduction in UCB amongst the non-survivors [33%; n=5/15] was 6.1 ± 1.4 (5.1-7.21) as against 12.4 ± 7.6 (6.96-21.64) in the [67%; n=10/15] survivor cohort [p=0.04]. when comparing the survivor [n=10] versus non- survivor [n=5] cohorts, the post ET complications were found higher in non- survival cohorts [p value= 0.0027].The most common complication was thrombocytopenia seen in 47% neonates .The majority of post-ET complications were seen in the non-survivor cohort [p-value = 0.0027]. Complications were common after ET. We should critically deal with them for better neonatal care.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

130: Prevalence of inhibitors in haemophilia “A” patient: An experience from a tertiary care centre in northern India

Brijesh Kumar Yadav ¹, Anupam Verma ¹, Dheeraj Khetan ¹, Shubha Phadke ¹, Rajendra Chaudhary ¹

Introduction: Factor VIII administration to haemophilia A patient's results are an immune response (formation of an inhibitor, which is an antibody to factor VIII) that can complicate the therapy.

Aims and Objectives: To determine the prevalence, quantification, and duration of inhibitors (transient or persistent).

Materials and Methods: This was a prospective observational study. Inhibitor screening was performed by the mixing studies, using pooled normal plasma and the patient's plasma. Bethesda assay was used to quantify inhibitors in samples that tested positive for screening tests, and these patients were followed for up to six months.

Results: Total 200 patients receiving replacement factor (plasma-derived or recombinant) were enrolled. Out of which 14% (28) patients had inhibitors in which 70.8% were high responders (>5 Bethesda units) with mean±SD (range) [22.4±27.1 BU (6.0-102.4)], while 29.1% were low responders (1) (<5 Bethesda units) with a mean±SD (range) BU [2.51±1.19 (1.37-4.0)]. After six months of follow-up, 40.9% patients were still having inhibitors (persistent type) while 13 (59%) patients were free from inhibitors (transient type). Four patients with inhibitors were positive for intron 22 inversion of FVIII gene. Bleeding episodes, annual visits and annual VIII vial requirements were significantly higher in inhibitor-positive patients as compared to those without inhibitors.

Conclusion: We observed factor VIII inhibitors in 14% of our patients with haemophilia A receiving factor VIII replacement therapy. This high prevalence could be due to the fact that, as our institute is a tertiary care centre, all the severe cases are referred to our centre, or may be due to the use of recombinant factor VIII, or both.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

136: Role of granulocyte concentrate in pre and post neutropenic sepsis patients

Purnima Rao ¹, Smita Joshi ¹

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

139: Clinical determinants and pattern of blood and blood component transfusion in neonates

Kaveri Joshi ¹

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

COVID-19 and Transfusion Medicine: 5: Analysis of convalescent plasma donor deferral in a Teritiary Care Center South India

V K Muhammed Shihab ¹, R Sreelatha ¹, Gayathri Abhilash ¹

Introduction: Coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered SARS-CoV-2. Convalescent plasma therapy was conducted as a PLACID trial by ICMR and our department was part of this trial. Stringent donor selection criteria are necessary for safer transfusion in the recipients.

Objectives: Analysis on donor deferral in convalescent plasma collection over a period of 5 months 13 days, from 29th June 2020 to 11th January 2021, in our Transfusion Medicine Department.

Materials and Methods: A retrospective analysis done on convalescent plasma donors who attended Department of Transfusion Medicine, Victoria Hospital, during a period of 5 months 13 days, from 29th June 2020 to 11th January 2021.

Results: Out of the total 138 registered convalescent plasma donors 128 were males and 10 were females. Among the registered donors 71% were replacement donors and 29% were voluntary donors. Total 40 were deferred out of which 34 were males and 6 were females. Reasons for deferral among males were low hemoglobin (32.35%), upper respiratory tract infection (22.58%), hypertension (11.76%), on other medication (8.82%), history of recent or ongoing infection (8.82%), recent history of surgery (5.8%), active varicose ulcer on leg(5.8%), dental extraction (2.9%)and root canal (2.9%). Reasons for deferral among females were H/o pregnancy (50%), low Hb (33.3%) and history of abortion (16.6%). Among the donors 68% were voluntary donors and 30% were replacement donors.

Conclusion: The major cause of deferral were low hemoglobin followed by upper respiratory tract infection Replacement registrations were higher compared to voluntary registrations and replacement deferrals were more compared to voluntary deferrals.

10

Convalescent plasma treatment for SARS-CoV-2 infection: Analysis of SARS-CoV-2 IgG levels of 103 donors in a tertiary care centre in South India, July 2020 to April 2021

A M Gayathri, R Sreelatha¹

Department of Transfusion Medicine, Kidwai Memorial Institute of Oncology, ¹Department of Transfusion Medicine, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India

Introduction: COVID-19 affected lives of millions of people around the globe and claimed lives of thousands. Currently, there are no approved treatments for COVID-19 and convalescent plasma therapy was also tried as a part of clinical trial. Our Institute was involved in PLACID trial under ICMR and hence recovered COVID-19 patients were recruited with the help of social media, non-governmental organisations (NGO) and incentives announced from government during the lockdown period. The IgG antibodies against SARS-CoV-2 in plasma were estimated and donor were selected for convalescent plasma collection.

Objectives: To analyse the SARS-CoV-2 IgG levels of 103 convalescent plasma donors in a tertiary care centre in South India over a period of July 2020 to April 2021.

Materials and Methods: 103 convalescent plasma donor who attended in-house convalescent apheresis plasma donation over a period between July 2020 to April 2021 were subjected to SARS-CoV-2 IgG antibody estimation by ELISA method.

Results: 42 convalescent plasma donors out of 130 had an IgG antibody titre of 1: 640. The ICMR recommended a minimum anti-SARS-CoV-2 IgG antibody titre of 1:640 for considering a convalescent plasma donor for plasma donation.

Conclusion: 40.77% of total recruited donors had ICMR recommended anti- SARS-CoV-2 IgG antibody levels which indicates reduced humoral immune response to SARS-CoV-2 post 28 days from recovery.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

41: Study of demographic characteristics of deferred donors with respect to COVID-19 in a blood bank of a teaching hospital

Minal Wasnik ¹, Ramesh Chandrakar ¹, Saurabh Lahare ¹

From time to time several advisories and guidelines were released by NBTC regarding deferrals related to COVID-19 infection, contact, travel and vaccination for guidance of transfusion services. These include deferral of 28 days for confirmed cases after discharge from treating facility/end of home isolation, history of contact with confirmed/suspected cases, travel history from countries/areas notified by MoHFW as high COVID-19 transmission. Deferral period of COVID-19 vaccination was reduced from 28 days to 14 days in view of fact that no live vaccine is being administered in India. This study was performed to assess donor deferral and donor characteristics with relation to COVID-19 infection, contact, travel history and vaccination. It would help us in donor motivation, selection and donor retention initiatives. This was a retrospective 6-months study (May-October'21) performed in blood bank of a teaching hospital by analyzing deferral data maintained in Department.

Results: Total registrations during this period were 3854, out of which 2887 (75%) accepted and 987 (25%) deferred. Among deferrals 39 (3.9%) were related to COVID-19; of which 30 were deferred due to recent vaccination, 7 had contact history and 2 had recent infection. All were males mainly in age group of 25-34 years (n=20) followed by 35-44 years (n=12). 27 were first time donors and 12 were repeat donors.

Conclusion: Although pandemic affected transfusion services adversely, yet we received good number of young donors (25-34 years). Initially vaccine drive for elderly was started followed by younger population (<45 years) reflected by deferrals due to recent COVID-19 vaccination. We opted strategies like motivating hostel students, healthy attendants of admitted patients, conduction of small camps (10-15 donors), issuing travel passes during the lockdown and maintaining voluntary donor registry. However, we also need to create awareness regarding different deferral reasons related to COVD-19 especially among the young population including repeat donors as well.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

50: Usage of blood products in COVID-19 patients

Apurva Ramteke ¹, Archana Patil ¹

Introduction: Transfusion medicine faced challenges regarding shortage as well as safety of blood products during COVID-19 pandemic. Less elective surgeries and less non COVID-19 admissions in hospital resulted in decreased blood requirement. Only few critically ill COVID-19 patients required blood.

Aims and Objectives:

To find the usage and proportion of blood products in COVID-19 patients
To find most common blood components used.

Materials and Methods:

Retrospective study - Blood Centre, Department of Pathology, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Adgaon, Nashik
Duration – August 2020 to August 2021
Subjects - COVID-19 confirmed cases hospitalized in our hospital
Patient's details like clinical findings, laboratory investigations were obtained from the patient's records and issued blood products details from blood centre records.

Results:

During the study period, out of 3066 confirmed COVID-19 patients, 83 received blood products. The overall transfusion rate was 2.7%
Total 143 blood products were issued
PRC was the most common component transfused (n=83, 57.35% of all components) followed by FFP (n=33, 23.07%) and RDP (n=28, 19.58%)
PRC was transfused to patients with decreased hemoglobin levels, RDP to patients who had thrombocytopenia and FFP to patients with altered coagulation profile.

Conclusion: Usage of blood products in hospitalized COVID-19 patients was low. Patients with low hemoglobin levels, thrombocytopenia or altered coagulation profile, required blood transfusion. However, blood products inventory must be maintained even in pandemic situation.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

Challenges in blood donation during COVID-19 times

Deepa Bhuyan ¹

Introduction: The global COVID-19 pandemic poses unprecedented challenges to the blood supply. Blood Banks all across India and the World have had to manage inventories amidst critical donor shortages and concerns about spread of infection.

Aims and Objectives: To summarize the unexpected challenges in maintaining blood inventory and clarify ways and means to overcome the crisis.

Materials and Methods:

Conventional Blood Bank Donor selection and screening practices.

Results: Donation numbers were affected during COVID-19 pandemic, compounded by increase in Donor deferrals. However, the challenges can be overcome with effective Donor education, motivation and recruitment. Scientific precautions for Donor attendance in Blood Banks should be put in place.

Conclusion: Considering the critical situation in Blood inventory, restrictive transfusion strategies with proper Patient Blood Management should be put in place. Donor motivation is of paramount importance along with safety of personnel.

Reference

1.NBTC Guidelines Dated 25-06-2020 [Google Scholar]

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

Evaluating COVID-19 associated coagulopathy with thromboelastogram and V-curve

Ganesh Mohan ¹, William Wilson ¹, Bemma Paonam ¹, Ashwinkumar Vaidya ¹, Prithvishree Raveendra ¹, Shamee Shastry ¹, Jayaraj Mymbilly Balakrishnan ¹, Shwethapriya Rao ², Souvik Chaudhuri ²

Introduction: COVID-19 Associated Coagulopathy (CAC) can present as either localized or systemic hypercoagulable stage. Severe COVID-19 patients develop systemic thromboembolisms (TEs) even on therapeutic doses of anticoagulants. We decided to perform this study because of the increased number and severity of COVID-19 cases in early 2021 compared to 2020 in our population.

Aim: The aim of the study was to diagnose and categorize CAC using Thromboelastogram and to correlate to the clinical outcome.

Materials and Methods: All adult patients with a confirmed COVID-19 and TEG report were recruited in the study for one month period. Citrated kaolin TEG was performed on the day of admission. TEG parameters included were R and K time, alpha angle, maximum amplitude, clotting index, lysis at 30 minutes. The first-degree velocity curve of TEG is plotted as V-curve which extrapolates thrombin generation potential. Parameters analysed were maximum rate of thrombin generation and time for it as well as thrombin generated. Comparison between survivors and thromboembolisms were made with TEG parameters.

Results: Study included 43 patients with an Average age was 58.34 (±15.35). TEG as well as V-curve of all the patients were hypercoagulable compared to age matched reference. Mortality rate was 32.56% (14/43). TE rate was 30.23% (13/43) on anticoagulation. Majority (34/43) had a hypercoagulable picture at admission. Repeat TEG was performed in 11 patients (median delay of 5 days) and showed persistent hypercoagulable picture. Hypocoaguable TEG at admission increased the risk of mortality (OR = 7.81). Fibrinolysis activity and thromboembolisms were significantly associated (OR = 15.6, r=0.122, P<0.001). Alpha angle, MA, CI and LY 30 had >0.90 area under the curve in thromboembolic events.

Conclusion: TEG is a useful tool in diagnosing and categorizing Coagulopathy associated with COVID-19.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

Haemovigilance: 38: A review of post donation follow-up of blood and apheresis donors during the COVID-19 pandemic

Sonal Kamath ¹, Pradnya Chavan ¹, Rajesh Sawant ¹, Varsha Vadera ¹

Background: Novel corona virus (SARS CoV 2) is a new strain identified from the family of coronaviridae. Covid-19 was declared pandemic by World Health Organisation on 11th March 2020. Various protocols were set and issued by NBTC, SBTC and MoHFW to carry out blood donations safely.

Aim: To evaluate outcome of the new protocol for conduct of post donation follow-up of blood and apheresis donors during the Covid-19 pandemic.

Materials and Methods: As per the circular dated 25th March 2020, process for obtaining health status update within 14 days post donation was implemented at our blood centre. Donors were sensitized to report back to the blood centre about any Covid-19 related health conditions in self or close contact upto 14 days post donation. Dedicated and trained staff members contacted donors by telephone on Day3 and Day 14 post donation. In case of any suggestive symptoms of Covid-19 or confirmed Covid-19 infections in donor or their close contact, the concerned components were recalled and discarded. Retrospective analysis of above data from 1st April 2020 to 30th September 2021 was done.

Results: During the study period, total donors were 11,389 out of which 11(0.09%) donors reported history of fever or symptoms suggestive of Covid-19. 3/11(27%) donors tested Covid-19 positive, while Covid-19 infection was ruled out in 8/11 donors. Total 27 components were quarantined, of which 13 components were discarded which included 5PRBCs, 6FFPs and 2 RDPs. All 8 components from Covid-19 sero-converted donors were discarded. 5 components were already issued to patients before the post donation information was obtained. Recipients of these components were followed up and no adverse outcomes were noted.

Conclusion: Post Donation follow-up of donors could be successfully implemented and it helped to ensure transfusion as well as blood centre staff safety during the pandemic period.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

43: Incidence and risk factors of acute transfusion reactions in patients admitted in intensive care unit on active surveillance

Disha Sharma ¹, Ravneet Kaur ¹, Tanvi Sood ¹, Sanjeev Palta ¹, Paramjit Kaur ¹, Kshitija Mittal ¹

Introduction: The incidence of acute transfusion reactions in critically ill patients varies anywhere between 0.2-10% of blood transfusions.[1]

Aims and Objectives:

Incidence of acute transfusion reaction in intensive care patients on active surveillance
To determine the risk factors associated with acute transfusion reactions.

Materials and Methods: An observational study was conducted on all critically ill patients admitted to ICUs between January 2020 to April 2021. A total of 430 units of blood and blood components transfused were followed closely at an interval of 15 minutes, 1 hour, 6 hours, and 24 hours after transfusion. Transfusion of blood/blood components separated by an interval of 6 hours to a single patient was considered as a separate transfusion episode.

Results:

Incidence of acute transfusion reactions observed in this study was 7.67%
TACO (n= 06; 18%) and FNHTR (n=06; 18%) were common acute transfusion reactions observed
PRBC (n= 16; 49%) was the most common blood component associated with transfusion reaction
The various risk factors associated with acute transfusion reactions were shock (n=12; 57.14%), sepsis (n=20; 55.56%), HTN/CAD (n=11; 61.11%), DM (n= 10; 58.82%), renal disorder/ AKI (n= 7; 70%), CLD/Deranged coagulogram (n=11; 57.89%); ARDS/COVID-19 (n=9; 50%), and Others (n=12; 75%).

Conclusion: Active surveillance will provide us with a true insight into the actual incidence of various acute transfusion reactions.

Reference

1.Chisakuta A, Lackritz E, Mcclelland B, Page R, Zetterstrom H. Appropriate use of blood and blood products. In: Emmanuel JC, McClelland B, Page R, editors. The Clinical Use of Blood. Geneva: World Health Organization; 2001. pp. 7–19. [Google Scholar]

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

51: Effective implementation of “donor safety culture” strategies to monitor and minimize donor adverse reactions in a tertiary care hospital blood centre

Lincy Jacob ¹, Akshata Parab ¹, Jayashree Nawar ¹, Manish Yadav ¹

Donor vigilance involves identifying, monitoring and preventing donor adverse events during and after the donation process, to improve donor safety, satisfaction and encourage donor retention. To adopt a preventive culture of donor vigilance, by developing strategies that promote donor safety. This approach help determine “at risk” factors with the aim to reduce donor adverse events. Donor Adverse Reactions (DARs) that occurred among whole blood (WB) donors at the Blood Centre, were evaluated from January 2017 to October 2021. At risk factors were identified among WB donors and used as a predictive and preventive tool. DARs reported were categorized as per the Hemovigilance Program of India (HvPI) reference document on type of complications.^[1] During this period, 10,430 WB donors donated at our Blood Centre. Of these, 7198 were camp donations and 3232 indoors. The total adverse events were 43 (0.41%), with more recorded in first two years. A total of 33 DARs between 2017-2018, with incidence of 6.2/1000, of which 57.5% were at risk donors based on age, gender, first time donations, mean arterial pressure. Donor Safety Culture (DSC) strategies were implemented in 2019, which addressed risk factors. A significant reduction to 6 DARs with incidence of 2.4/1000 was observed by 2019 and 4 DARs with incidence of 1.5/1000 by 2021. Prevalence of Type B (vasovagal) DARs was 86% and 14% were Type A (hematoma/pain in arm). Promoting a multidimensional DSC was the key to successfully reduce DARs from 0.61% to 0.15%. DSC involves the implementation of a set of preventive strategies that ensure donor safety during and post donation and include an informed, learning and reporting culture. With adequate planning, training and execution of DSC, Blood Centres can minimize adverse events and ensure a smooth donation process

Reference

1.Adverse Blood Donor Reaction Reporting Form Version-2, Haemovigilance Programme of India [Google Scholar]

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

57: Study of adverse transfusion events in a tertiary care oncology centre: A step towards hemovigilance

Juilee Charmode ¹, Sunil Rajadhyaksha ¹, Priti Desai ¹, Anisha Navkudkar ¹

Introduction: Though blood and blood components provide life-saving therapeutic benefits to patients, they may result in acute or delayed complications. Very few studies have analysed adverse transfusion events (ATRs) in oncology patients. Since our institute is an oncology centre, adverse transfusion events in cancer patients were assessed.

Aims: To analyse the types of adverse transfusion events, study their management and assess imputability in oncology patients.

Methods: This study was retrospective review of adverse transfusion events (ATEs) reported from January 2015 to December 2019.

Results: Incidence of ATEs per blood component was 0.074% and per patient was 0.11%. Maximum cases of adverse transfusion events occurred in Adult Hematology patients 33.3% (59/177). Allergic transfusion reactions were most common 48.6% (86/177), followed by FNHTRs 20.9% (37/177). Other ATEs reported were Transfusion associated dyspnoea (12.4%), TRALI (1.7%), anaphylactoid reactions (1.7%), TACO (0.6%), mixed (7.3%) and not related to transfusion (6.8%). Blood component most commonly associated with ATEs was packed red cells 53.1% (94/177) followed by FFP 19.8% (35/177). Incidence per component was more in FFP (0.14%). Allergic reactions were frequently associated with packed red cells (34.9%) followed by FFP (33.7%). FNHTRs were commonly seen with packed red cells (84.5%). Imputability was assessed for each ATE. Most allergic reactions were definite (95.9%). FNHTRs were assessed as probable (74%) and possible (22%).

Conclusion: Overall, adverse transfusion events were commonest in Adult Hematology patients probably owing to multiple transfusions. Allergic transfusion reactions were the most commonly encountered adverse transfusion events followed by FNHTRs. FNHTRs are the most frequent ATEs in most studies but not in our study, might be underreporting as cancer patients tend to develop neutropenia leading to infection and fever. Active reporting of all transfusion events should be encouraged, so that no transfusion event goes underreported and better management can be provided.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

119: A case study of blood transfusion reaction occurs at tertiary care hospital Jamnagar

Digeet Parshottambhai Davad ¹

Background: Any adverse events associated with the transfusion of blood or blood product called blood transfusion reaction. Transfusion is a multistep, multidisciplinary process in which the human error rate has remained unchanged despite multiple interventions. Errors in the collection and labeling of blood samples for pre-transfusion testing increase the risk of transfusion-associated patient morbidity and mortality. “Wrong blood in tube” errors, where the blood in the tube is not that of the patient identified on the label.

Introduction: A case study of 46 year old gynaec patient admitted at G.G.Hospital, Jamnagar for treatment of uterine fibroid. As per patient need one volume RCC issued. After transfusion of 5min blood transfusion reaction occurred.

Aims and Objective: The purpose of this study was to describe the typical sampelling error done by sample collecting person.

Materials and Methods: This poster presents a case study of a patient admitted with dysfunctional uterine bleeding for correction of anemia getting transfusion of PCV.

Conclusion: Prevention studies for such type of error include continuous monitor the process of sample collection and labeling of sample, reporting of such type of error and improve the standard of pre-transfusion sample collection method.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

Immunohaematology: 7: Study of prevalence of autoimmune hemolytic anemia

Sangeeta Samad ¹

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

8: Red cell alloimmunization among antenatal women attending tertiary care center in Bangalore, Karnataka

V Aishwarya ¹, R Sreelatha ¹

Aim: To study the prevalence of alloantibodies among antenatal women and clinical correlation with Hemolytic disease of Newborn and Fetus.

Methods: Antenatal women from study period March 2021 till date were included, ABO grouping and Rh typing done by tube technique. Antibody screening and identification done by using Bio-rad ID microtyping system. Direct antiglobulin test, autocontrol and titration of alloimmunized sample were done. Followed up for medical, transfusion and obstetric history and fetal outcome.

Results: Out of 1700 antenatal women, 1597 were D positive and 103 were D negative. Total of 23 (1.35%) were found. Out of them, 7 (0.43%) were D antigen positive and 16 (15.5%) were D antigen negative. Anti D (n=12) was the most common antibody identified out of which one neonate required exchange transfusion, followed by Anti- c (n =4) , anti-D+C (n=3) , anti-E (n=2), anti-M and anti Le-a (n=1).

Conclusion: The rate of alloimmunization due to anti -D were found to be most common. Hence strict follow up of immunoprophylaxis of D antigen negative women needs to be taken care.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

12: A case of cold agglutinin mediated autoimmune hemolytic anemia in Waldenstrom's macroglobulinemia: An immunohematological dilemma (A case report)

Deepak Kumar ¹

Introduction: Cold agglutinin disease is a group of disorders caused by anti-erythrocyte autoantibodies that preferentially bind RBCs at cold temperatures (4°C-18°C) and may induce hemolysis. Exposure to cold may augment the binding of cold agglutinins causing a sudden drop in hematocrit value with complement mediated intravascular hemolysis. It should be differentiated from secondary cold agglutinin syndrome which is secondary to another disease. We at our centre came across a case which had cold isoagglutinins due to a secondary cause.

Aim and Objective: To confirm the presence of any autoantibodies in the patient.

Materials and Methods: An 80 years old male diabetic patient with chronic kidney disease admitted for abdominal pain and easy fatigability was found to have pallor, icterus and hepatosplenomegaly on examination. Evaluation revealed Dimorphic anemia (Hb-4.6 g/dl), microspherocytes and RBC clumping on Peripheral blood smear and raised Lactate dehydrogenase (815U/L). Demand for transfusion was placed but multiple bags were found to be incompatible. Blood grouping was done by tube method and column agglutination method using gel card which showed Panagglutination. Immunohematologic workup showed Cold reacting autoantibodies, Direct antiglobulin test was positive with Polyspecific (IgG+C3d) card and negative with Monospecific (IgG) card. Indirect antiglobulin test was negative at 37oC. Cold agglutinin titer was 1024 at 4oC.

Results: Patient was diagnosed to have Cold agglutinin disease having high titer autoantibodies with wide thermal amplitude. He was evaluated further and found to be a case of Waldenström's macroglobulinemia. Patient was transfused with best matched units and after he was started on anti-antibody production therapy, compatibility improved significantly. The patient improved clinically with better lab findings, required no further transfusions and was discharged after one month.

Conclusion: Cold agglutinin syndrome is similar to cold agglutinin disease but is secondary to an infection, autoimmune disorder or malignancy.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

18: Prevalence of weak Rh D antigen expression in healthy voluntary blood donors in a tertiary care hospital in Eastern India: A retrospective study

Aditi Khanna ¹, Bibudhendu Pati ¹, Girija N Kanungo ¹, Milind Agrawal ¹, Aruna Sahu ¹

Introduction: Rh is the second most important blood group system, after ABO system. Major antigens of Rh blood group system are D, C, c, E and e. Among these, D antigen has the highest immunogenicity. RhD antibodies are produced only after exposure to non-self RBC containing RhD antigen. When the quantity or specificity of D antigen epitopes show variations, it results in a weaker reaction with anti-D reagents in serological method and hence results in weak RhD expression. Weak RhD typing is recommended for donors to prevent RhD immunization in recipients.

Objectives: This study aims to estimate the prevalence of weak RhD antigen expression in blood donors.

Methods: This retrospective study was conducted in the blood centre of IMS and SUM Hospital, Bhubaneswar from January 2020 till October 2021. Details were collected from the records in the Transfusion Medicine department. Testing of the ABO grouping and Rh typing were done by microplate method (NEO, Immucor Inc.) while the weak RhD typing was done by Gel card CAT method (Tulip Diagnostics, India).

Results: Out of a total of 18338 donors, 17764 (96.9%) were RhD positive and 574 (3.1%) were RhD negative. Inclusive of the ABO system, A RhD negative were 140 (24.4%), B RhD negative were 163 (28.4%), O RhD negative were 232 (40.4%) and AB RhD negative were 39 (6.8%). Out of the 574 RhD negative donors, 7 (1.2%) donors turned out weak RhD positive.

Conclusion: The serological weak RhD positive blood donors are labelled as RhD positive which are not transfused to RhD negative patients to prevent alloimmunisation for RhD antigen. The respective donors, when in need of transfusion as patient themselves, are advised to receive RhD negative blood in the future. Sensitivity of weak RhD testing can be improved by molecular testing of RhD gene.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

56: Association of ABO blood group in malaria infected patients

Jayashree Das ¹

Introduction: Malaria is endemic in North-Eastern India and P.falciparum is the most predominant species. ABO Blood group consists of A, B and H carbohydrate antigens which can regulate the protein activity during infection and antibodies against these antigens.^[1],[2] Cytoadherence and Rosette formation are important components of several possible pathogenic mechanisms.^[3] In this study we tried to assess the distribution of ABO blood group and its relationship with malaria.

Aim: To study the association of ABO blood group in malaria infected patients.

Objective: To ascertain whether any particular blood group is associated with malaria.

Materials and Methods: 150 Febrile cases were studied in AMCH for a period of 1 year from November 2016 to November 2017 by collecting blood for ABO grouping and serum grouping in EDTA vial and clotted vial respectively and blood film was stained with Giemsa. Malaria positivity was diagnosed by using optiMAL kit test. Blood grouping was determined using tube agglutination method, using agglutinating A, B and AB monoclonal ERYCLONE antisera.

Results: This study showed 39 (26%) febrile patients were infected with Plasmodium parasites, amongst which 61.5% males and 38.4% females. Of these 74.3% and 17.9% were found to be infected with P. falciparum and P. vivax respectively. And study showed that 'B' (38.46%) group is more prone to the infection followed by 'O' (35.90%), 'A' (17.95%) and 'AB' (7.69%) group respectively. The present findings indicate that males are more susceptible to malarial infection than females and P. falciparum is the commonest type of plasmodium infection in this region. The prevalence of malaria was found to be the highest in young adults, compared to children and elderly patients.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

64: Anti K antibody: Case report

Jyotsnaa Grace ¹

This is an interesting case report of Anti K antibody in a patient. Immunohematological workup gave a negative IAT but a positive Antibody screening and identification. Antibody screening showed 2+ in 3rd panel and identification showed 2 + in 2nd and 6th panel. The negative IAT however was due to the low prevalence of K antigen in the pooled O red cells used for IAT.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

71: Study of prevalence of autoimmune hemolytic anemia

K Chandrasekaran ¹

This study aims to find out the prevalence of autoimmune hemolytic anemia in a regional referral centre.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

83: Critical analysis of cases of major crossmatch incompatibility in tertiary care hospital in Haryana

Saroj Rajput ¹, Geetika Sharma ¹, Nimisha Sharma ¹, Tathagata Chatterjee ¹

Introduction: Crossmatch is the final and crucial step of pretransfusion testing ensuring transfusion safety. Analyzing the causes of crossmatch incompatibility helps transfusion medicine specialists and physicians to understand the patient's condition better and can guide proper management. We hereby report critical analysis of 4 cases of major crossmatch incompatibility encountered at our blood center.

Aims and Objectives: To find the root cause of major incompatible crossmatch and ensure safe blood transfusion to the patient.

Materials and Methods: Patient's crossmatch sample were received in the laboratory along with blood requisition form. As routine immunohematological testing ABO/Rh blood grouping was done by gel card method. Major crossmatching was performed by column agglutination technology (CAT) and the results were recorded in crossmatch register. If any incompatibility in crossmatch was encountered, repeat blood grouping and crossmatching were performed with fresh sample. The antibody screening and antibody identification by indirect antiglobulin test(IAT) was performed using commercially available 3-cell and 11-cell panels. Direct antiglobulin test (DAT) using gel card was performed, further in DCT positive cases direct Coombs test (DCT) profile was put up.

Results: Case1 was a 40 y/m patient, indication for transfusion was anemia. On crossmatching incompatibility was found .The reason for incompatibility was blood group discrepancy. Case 2 was a 7 month/m, cause of incompatibility was indirect coombs positivity (anti-D). Case 3 was a 38 y/f, cause of incompatibility was indirect coombs positivity (anti- c). Case 4 was a 48 y/f, cause of incompatibility was direct coombs positive blood donor unit.

Conclusion: Crossmatch incompatibilities is a challenge in the field of transfusion medicine. Root cause analysis should be done to find out the cause, so that corrective action can be taken and stepwise approach will enable the provision of safe transfusion. Based on our experience we recommend group and screen, especially in multitransfused individuals and pregnant females.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

89: A rare cause of ABO discrepancy with auto anti-A antibody

T V Kumar Reddy ¹

A 60 year old Male patient was diagnosed with anemia, AIHA? And the hemoglobin level at the time of admission was 5 gm/dl. Patient had No history of blood transfusion. Sample was received at RTC requesting for resolution of blood group discrepancy as well as antibody identification. On blood grouping, patient's forward grouping was “A” and reverse was “O” as shown in Table 1. Patient's IAT was found to be Negative while DAT and Auto control were Positive. For rould out Anti-A1 antibody performed Anti-A1 Lectin gave positive reaction.

Antisera (Monoclonal), Reagent Cells

Anti-A -4+

Anti-B-0

Anti-D-4+

A1 Cell-4+

B Cell-2+

AB Screening Auto-control- 4+ DAT-4+ Anti-A1 Lectin - 4+

OIOIIOIII

04+ 0

On screening patient's sera with 3 cell panel (Surgiscreen Reagent Cells, Ortho Clinical Diagnostics) by Column Agglutination Technique, Negative reaction. To rould out cold allo antibodies Patient's sera was re-tested with the same Screening panel by tube method at three different phases i.e. room temperature (Immediate Spin/IS), 370C and AHG as shown Negative Reaction. DAT performed with Monspecific by Column Agglutination Technique Anti- IgG and Anti-C3. Negative reaction observed with anti-IgG and positive reaction with anti-C3. Cold adsorption and Heat elution test performed with A Pooled cells to confirm Anti-A antibody in the serum as shown in Table 2.

Table 2.

ADR group	Predonation	At 50% donation	Posthonation	At reaction	At recovery
SBP	135.1±12.25	122.2±13.06	102.0±19.26	90.22±14.74	112.5±12.89
DBP	86.63±8.006	80.85±10.95	65.11±15.64	57.33±12.16	72.22±10.49
MAP	102.8±8.42	94.63±11.01	77.42±16.56	68.30±12.60	85.65±10.57
Pulse	83.52±12.97	82.52±13.37	74.00±16.15	68.81±16.10	75.56±13.59

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SBP=Systolic blood pressure, DBP=Diastolic blood pressure, MAP=Mean arterial pressure

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

94: Anti E – in different clinical spectrum

Debapriya Basu ¹, Suvro Sankha Datta ¹, Sabita Basu ¹, Mahua Redyy ¹

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

101: Severe ABO hemolytic disease of the newborn with high titer anti A

Mahua Reddy ¹, Sabita Basu ¹, Suvrosankha Dutta ¹, Nasir Nabi Naikoo ¹, Debapriya Basu ¹

NA

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

113: Beware of cold antibodies: The winter is coming!

Neema Nehra ¹, Sangeeta Pahuja ¹, Deeksha Singh ¹, Ram Vilash ¹

Introduction: Cold agglutinins are antibodies that bind antigens on red blood cells (RBCs) at temperatures below core body temperature (37°C). Cold autoantibodies are IgM type, lead to complement activation and cause in vitro agglutination.

Aims and Objectives: To study the immunohematological approach to cases with cold autoantibody. To correlate cold antibody titre levels with severity of disease.

Materials and Methods: We hereby present 3 cases of cold autoantibodies presenting to our Blood Centre with blood group discrepancy and /or crossmatch incompatibility. In all cases, fresh EDTA sample was collected under strict warm conditions. Extended forward and reverse blood grouping was done at 4°C, 22°C, and 37°C by tube method. Direct Coombs Test (polyspecific and monospecific) and Indirect Coombs Test at 37°C (in Coomb's phase) and at 4°C (in saline phase) were performed. Titre of cold autoantibody was done at 4°C by tube method.

Results: blood group discrepancy was present at 4°C in case1 which was resolved at 22°C and 37°C. DAT was strong positive with complement C3c and C3d. IAT showed panagglutination with positive autocontrol at 4°C in saline phase suggestive of cold auto antibody. case 2 showed panagglutination at 4°C and 37°C and DAT was positive for both IgM and IgG suggestive of mixed AIHA. Case 3 had acrocyanosis with IAT showed panagglutination with positive autocontrol at 4°C in saline phase suggestive of cold auto antibody. DAT showed complement C3d positivity, titre cold autoantibody at 4°C was markedly raised (1024), suggestive of cold agglutinin disease.

Conclusion: This highlights the role of clinical correlation, mono-specific DAT and IAT at 4°C and 37°C for cold antibodies.Thermal amplitude and titre are important for diagnosis. Majority RBCs express I antigen, compatible blood units are hardly available. Patients must be transfused judiciously with least incompatible, ABO and preferably Rh/Kell matched, pre-warmed PRBCs at very slow rate.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

123: Type I ABO discrepancy due to anti-snake venom in two patients: A rare presentation

Brinda Kakkar ¹, R S Mallhi ¹, Joseph Philip ¹

Introduction: ABO discrepancy is mismatch between forward and reverse typing. Important aspect of pre-transfusion testing is detection, recognition and resolution of the ABO discrepancies. Discrepant results must be identified and underlying causes investigated to ensure safe transfusion practices.

Aims and Objectives: Report type I ABO discrepancy due to missing antibody attributable to administration of anti-snake venom (ASV) for management of snake bite in two patients.

Materials and Methods: Semi-automated IH analyzer, Bio-Rad, Cressier, Switzerland was used to perform ABO typing (Diaclon ABO/D (DVI-, DVI-) + reverse grouping cards), Direct coombs test (DCT; LISS/Coombs gel cards) and Indirect coombs test (ICT; three cell screening panel). Repeat ABO typing was performed using fresh sample (if available) by conventional tube technique. All procedures were performed in accordance to manufacturer's kit insert and laboratory standard operating procedures.

Results: Patient 1: 21 year old male, type 1 ABO discrepancy noted (Forward B; Reverse AB). Reverse grouping (A, B and O cell) performed with auto-control at 4°C for 1 hour showed no agglutination. Patients history revealed admission with right lower leg swelling, snake bite over left toe (? Viper) and treated with 40 vials of ASV. Repeat ABO typing (day 5 admission) showed no discrepancy and group reported as B Rh D positive.

Patient 2: 19 year old male, type 1 ABO discrepancy noted (Forward B; Reverse AB). Repeat sample was not available for ABO typing (admitted in outside hospital). History revealed admission with snake bite and treated with 35 vials of ASV.

Conclusion: ASV contains A like substance which can neutralise the anti-A, thus, resulting in type 1 ABO discrepancy. These cases highlight the two most important aspects of resolving any ABO discrepancy case: Reviewing patient's history and Immunohematological testing. Resolutions helps in preventing ABO mis-match transfusions and ensure safe transfusion practices.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

126: Identification and characterization of weak D

Anurag Singh ^1,²

The Rh locus is composed of two highly homologous genes: the RHD and the RHCE gene. “Weak D” RBCs demonstrate reduced quantities of the D antigen. As a result weak or no agglutination reaction is demonstrated by these RBCs with the anti D reagents at the immediate spin phase. Aim and objective is to study the prevalence of weak D in blood donors and To characterize, identify and differentiate the molecular basis of weak D expression in blood donors. Sample collection post donation is sent for blood grouping. Samples coming Rh D Negative are further studied for WEAK D. Samples positive for Weak D are further studied with 3 antisera. Extended Rh phenotyping is done. Post which samples are sent to NIIH Mumbai. There firstly there is DNA EXTRACTION via Phenol Chloroform Method post which RTPCR is done to find three specific exons. Following this RHCE QMPSF is done to further test in the exons. Mutations on exons are tested by Sanger sequencing. Results showed 0.016% of WEAK D among all the total donors and 0.28% among the Rh D negative donors. 90% (n=18) of donors showing 4+ positivity on WEAK D while only 10% (n=2) showed a positivity of +1 and +2 respectively. The most common phenotype came out to be of D neg C pos c pos E neg e pos K neg. 55% showed positivity with Arkray, 10% with J Mitra and 40% with Tulip. It is being concluded that in our studied population it was found that most common Weak D variant that was found was of WILD Type followed by Weak D Type 150. Conventional Test Tube Method is also a reliable method to find out Weak D variants in population. R1r genotype is most commonly seen in Weak D Type 150.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

133: Analysis of blood group discrepancies in patients at a regional blood center in north India

Pandeep Kaur ¹

Background: Blood group discrepancies occur when reactions in cell grouping are not corroborative to those in serum grouping. Aim of this study was to determine the frequency and causes of blood group discrepancies in our blood center.

Methods: A retrospective study was carried out in Department of Transfusion medicine, Adlakha blood center. Data was collected from available records for a period of two years. For Discrepant samples, the ABO and RhD grouping was performed by conventional tube technique using monoclonal IgM Anti-A, Anti-B, Anti-D, Anti-D blend (IgM+IgG), anti-H and anti-A1 lectins (Tulip diagnostics) and in house prepared pooled A1, B and O cells. Antibody screen and identification was done by Column Agglutination Technique (Bio-Rad, Switzerland).

Results: Out of 31848 blood group samples tested, 91 were found to have blood group discrepancies. Out of these, 85 (93.4%) were ABO discrepancies and 6 (6.5%) were Rh D discrepancies.

Among Group IV, out of 46 samples had allo-antibodies, Alloantibodies in Rh-D positive samples were found to be Anti Lea (24.3 %), Anti-M (18.9%), Anti-N (17.9%), Anti-S (13.5%), Anti-E (10.8%), Anti-c (10.8%) and other alloantibodies such as Anti-Leb, Anti-P, Anti-Jka. Alloantibodies in Rh-D negative samples were found to be anti-D (85.7%) followed by Lea and Leb (14.2%). Frequency of Rh discrepancies in our study was 6.5%.

Conclusion: The frequency of blood group discrepancies in our study population was found to be 0.28%. The identification of blood group discrepancies and its resolution is necessary.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

135: A unique harmless IgG auto anti - E in healthy blood donor

Yesha Shah ¹, Sanmukh Joshi ¹, Vasantben Gondaliya ¹, Manisha Rajapara ¹, Mayuri Vekariya ¹

A healthy blood donor was found incompatible with several patient s serum during X matching by IAT so to find the cause for the anomaly with following objectives:

1)
To elucidate on a positive antiglobulin test is due to Ig G antibody or due to complement fraction present on RBC
2)
Whether antibody molecules be eluted from RbC with the strongly positive DAT
3)
To determine antibody specificity to any of the blood group antigen.

DAT on his RBCs was strong positive and elute from his RBC s showed anti e specificity. A rare case of healthy blood donor with positive DAT by IgG anti e is described, while cases of anti e like autoantibody have been documented , anti e as an autoantibody in healthy individual merits as the first of its kind in available literature.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

137: Detection of rare ABO sub groups in different clinical scenarios with advanced red cell serology

Shanthi Bonagiri ¹

Background and Objectives: Weak subgroups of A /B antigen in A/B or AB blood group can cause ABO blood group discrepancy and delay in the selection of red cell unit in emergencies. These weak phenotypes mainly result from weaker expression of an alternate weak allele present at the ABO loci. In this study, we characterized and differentiated the uncommon weak subgroups of A/B in ABO blood group system through various immunohematological investigations in subjects presented with different clinical scenarios.

Methods: The retrospective analysis of uncommon weak sub groups of ABO system in 12 subjects. Initial blood grouping and antibody screening of all the samples were performed using an gel column agglutination test. Samples showing blood group discrepancy or weaker agglutination were subjected to battery of serological investigation including saliva hemagglutination inhibition test and adsorption-elution procedures.

Results: Among 12 subjects only one blood donor, others 3 patients with coronary arterial disease, 3 patients posted for different surgeries, one had Dengue fever, one patient is a neonate with 23DOL. Among 12 sub groups 6 were B sub groups, A2 confirmed in 2 subjects in 4 patients other A (not A2) sub groups were detected. The unexpected naturally occurring anti-A1 antibodies were tested both at 4°C and 37°C temperature. Red cells' While saliva study revealed specific substances, adsorption elution demonstrated “A/B” antigen specificity in different strengths. One case of Bx showed similar goup with his mother.

Conclusion: The subgroups of A and AB are attributed to a reduced number of A antigen sites on the red cells. We conclude that differentiating weak subgroups of “A/B” by serological assays is mandatory for selection of accurate and safe red cell transfusions. Which is possible to a great extent with advanced red cell serology. However, molecular genotyping is essential because it confirms the result later on.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

138: Frequency of red cell alloimmunization and autoimmunization in thalassemia patients: A report from north India

Faisal Ashraf ¹, Meena Sidhu ¹

Introduction: Red blood cell (RBC) alloimmunization and autoimmunization remains a main problem in transfusion dependent thalassemic patients. In the absence of stem cell transplantation, the disease is treated by life-long red blood cell (RBC) transfusion to keep the hemoglobin (Hb) level between 9 and 11.5 g/dL. Although Blood transfusion is life saving for these patients, it may be associated with complications like Red Blood Cell alloimmunization.

Objectives: The aim of this study was to determine the frequency of alloimmunization and the most common alloantibodies involved.

Methods: The prospective and observational study was carried out in the Department of Immunohematology and Blood Transfusion, Govt Medical College and Associated Hospital Jammu for the year 2021. The study population were all transfusion dependent thalassemic patients. Informed consent was obtained from patients or their parents. Antibodies screening, antibody identification, and cross matching was done on all patient samples included in the study, during the year 2020.

Results: During the study interval a total of 92 thalassemia patients were reviewed. Red cell alloimmunization was found in 8 of 92 patients (8.69%), and only two patients (2.17%) developed Autoantibodies. Male to female ratio in this study was 1.66.The most common alloantibody detected was anti-Rh system antibodies (anti-E seen in four patients (50%) and anti-D seen in two patients.

Conclusions: Although the overall incidence of RBC alloimmunization in this study was 8.69%, almost all of the alloimmunized patients had the antibodies which were clinically significant. Thus, pretransfusion antibody screening on patients' sample prior to crossmatching needs to be initiated in North India to ensure safe transfusion practice.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

0: A high titer auto agglutinin with novel blood group specificity in a patient with lymphoma

Sanmukh R Joshi ¹

Introduction: Sd^a is a high prevalence antigen (HPA) described in 1967^[1],[2] but got its system status (038) in 2003 when the gene B4GALNT2 encoding Sd^a synthase was cloned. Antibody gets remarkably neutralized by guinea pig urine. It shows 'mixed-field' (mf) agglutination under microscope.

Aims and Objectives: A patient with anemia and a high-titre autoantibody to HPA required transfusion, so was imperative to find antibody specificity and the compatible blood.

Materials and Methods: Blood specimens in plain/ EDTA were used. The RBCs from random donors, infants and commercial cell panel were used. Reagents papain and AET were prepared in house. Standard serological tethods were used throughout.

Results: The Case: F/68, with 20 years h/o DM-T2; 4y of NHL was presented with moderate anemia (Hb 7.1 g/dL). Her specimen was sent to blood bank and was grouped A Rh.D − on her RBCs that were extensively washed by warm saline to reduce the auto-agglutination. The DAT and auto-control test remained invalid. RBCs of over 350 adults, 10 infants and the identification cell panel strongly reacted with the antibody indicating its specificity to HPA. High titer antibody (>1:1,31,072 with naked eye and 1: 5,24,288 under microscope) preferentially reacted at 4°C. Her serum formed precipitates at 4°C that got readily dissolved at 37°C indicating its cryoglobulin nature. The cryo-poor component showed weaker reaction as compare to the cryo-rich portion Table 1. Antibody property of showing mf reaction with glowing agglutinates and getting neutralised by urine Figure 1 indicated to specificity to antigen of the SID (ISBT038) system. Unlike anti-Sd^a and anti-Sd^x, present antibody reacted with RBCs of the infants suggesting to its novel specificity so provisionally termed as anti- Sd^y in line of an autoantibody earlier designated as anti-Sd^x.^[3]

Table 1.

Normal group	Predonation	At 50% donation	Posthonation	10 min posthonation
SBP	136.8±11.62	129.0±11.62	123.9±13.02	124.0±11.64
DBP	87.07±9.13	84.64±9.24	81.93±10.0	81.4±9.6
MAP	103.7±9.02	99.4±9.18	95.91±10.1	95.91±10.1
Pulse	83.40±13.66	82.11±12.78	82.87±12.83	80.32±12.61

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SBP=Systolic blood pressure, DBP=Diastolic blood pressure, MAP=Mean arterial pressure

Stages of COVID-19 associated coagulopathy observed in patient population

Hemagglutination inhibition by Guinea pig Urine

Conclusion: Antibody in the present case strongly agglutinated RBCs, and neutralized by urine from guinea pig suggested its specificity within the Sid (038) blood group system. A strong reactivity with RBCs from adult and cord blood samples ruling out its specificity to hitherto known specificity as anti-Sd^a or anti-Sd^x, so was provisionally termed as anti-Sd^y.

References

1.Macvie S, Morton J, Pickles M. The reactions and inheritance of a new blood group antigen, Sda. Vox Sang. 1967;13:485–92. [Google Scholar]
2.Renton P, Howell P, Ikin E, Giles C, Goldsmith K. Anti-Sda, a new blood group antibody. Vox Sang. 1967;13:493–501. [Google Scholar]
3.Marsh WL, Johnson CL, Oyen R, Nichols ME, DiNapoli J, Young H, et al. Anti-Sdx: A “new” auto-agglutinin related to the Sda blood group. Transfusion. 1980;20:1–8. doi: 10.1046/j.1537-2995.1980.20180125021.x. [DOI] [PubMed] [Google Scholar]

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

Innovations in Transfusion Medicine: 16: A case report on use of 3^rd generation platelet rich fibrin in dental apical abscess

I S Chaitanya Kumar ¹, Cheranjeevi Jayam ¹, B S Anila ¹, Anilamani ¹, Anand Bodade ¹

Introduction: Regenerative Medicine is an emerging branch of Science and at its simplest, it involves platelet rich plasma, platelet rich fibrin (PRF) usage and at its depth organ re-creation.

Aim: To prepare 3rd generation PRF and to assess the utility for regenerative purpose in dentistry for periapical abscess based on its ability to form a hermetic seal in endodontic surgery.

Materials and Methods: PRF is a fibrin matrix in which platelet cytokines, growth factors, and cells are trapped and may be released after some time and that can serve as a resorbable membrane for other cellular or acellular elements. The third generation PRF was prepared by centrifuging 5mL of blood sample at 700 rcf for 8 minutes in test tubes without anticoagulant. After clotting, the clot is compressed and used as a scaffold with mineral trioxide aggregate (MTA) apexification. Final goal of endodontic treatment is to achieve a hermetic seal.

Results: After the procedure, the membrane helped in maintaining hermetic seal partially, but didn't have strength to serve as background for good MTA condensation and prevent extrusion, especially in large cystic cavities. More cases are needed to ascertain usage.

Conclusion: PRF may possess good biological properties but handling, manipulation to be done during the procedure is still a problem.

Reference

1.Demiriz L, Hazar Bodrumlu E. Retrospective evaluation of healing of periapical lesions after unintentional extrusion of mineral trioxide aggregate. J Appl Biomater Funct Mater. 2017;15:e382–6. doi: 10.5301/jabfm.5000359. [DOI] [PubMed] [Google Scholar]

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

79: The role of platelet rich fibrin in a COVID swab mishap: A case report

S Sanooja Pinki ¹, Vinod Felix ¹

Introduction: PRF (platelet rich fibrin) is a second-generation platelet derivative, with wide range of clinical applications. It is an autologous biomaterial consisting of growth factors, leukocytes and cytokines entrapped in a fibrin matrix, providing a suitable environment to promote the natural wound healing while preventing the local occurrence of infections. Its role is well established in various domain of clinical medicine.

Case Report: A 62-year-old female presented to ENT outpatient with complaints of unilateral watery nasal discharge which worsened with exertion and leaning forward. Her symptoms started after taking COVID 19 nasopharyngeal swab two months back. Hence, CSF rhinorrhoea was suspected and a diagnostic nasal endoscopy was performed which revealed a hole in hadad flap through which CSF was leaking out. She had past history of transnasal transsphenoidal endoscopic excision of pituitary macroadenoma 2 years back and the dural defect was closed with nasal mucosal flap. Thus, a diagnosis of traumatic CSF rhinorrhoea post naso-pharyngeal COVID swab was made. The defect was planned to close in OP using PRF. Four ml whole blood is collected in a vacutainer tube without anticoagulant under sterile precautions and was immediately centrifuged at 3000 rpm for 10 minutes to yield 1 ml of PRF. The product is then placed in to the defect to form a uniform layer. Under antibiotic cover, patient was advised strict bed rest. Follow up nasal endoscopy after one week and re-evaluation after a month revealed complete closure of the defect.

Conclusion: The use of PRF in traumatic CSF rhinorrhea can be a simple, economical and effective treatment which could present a new possibility in regenerative medicine. Till date, there is no reported case from India utilizing PRF in CSF rhinorrhea. Nasopharyngeal swab should be avoided in individuals with history of sinus or skull-based surgeries.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

Quality Issues in Transfusion Medicine: 21: Retrospective analysis of quality indicators in blood centre in a tertiary care hospital in eastern India

Aruna Sahu ¹, Bibudhendu Pati ¹, Girija N Kanungo ¹, Aditi Khanna ¹

Introduction: Blood Transfusion Services are responsible for ensuring safe and quality blood products to the patients. Therefore, to promote high standards of quality in all aspects of Blood Transfusion Services implementation of performance measures known as Quality Indicators is done. Quality Indicators are defined by National Accreditation Board for Hospitals (NABH) in India. These indicators can be used as a tool for Hemovigilance to provide a better understanding for improvement in the quality of blood and safety of patients. Quality indicators analyzed were: TTI %, Adverse Transfusion Reaction Rate %, Wastage Rate %, TAT of blood issued, Component QC failure, Adverse Donor Reaction Rate %, Donor Deferral and % of component issued.

Aim of the Study: Our study was aimed to evaluate and analyze quality indicators as effective performance tools of our blood center.

Materials and Methods: A retrospective study was conducted from January (2020) to March (2021) in our Department of Transfusion Medicine at IMS and SUM Hospital. Any shifts and trends were identified after analysis and the root cause analysis was done.

Results: After analyzing the Quality Indicators, we found Transfusion Transmitted Infection % to be 1.06%, Adverse Transfusion Reaction Rate was 0.123%, Wastage Rate for whole blood 2.05%, PRBC (packed red blood cells) 3.19%, platelets 16.11%, FFP (fresh frozen plasma) 1.52%, SDP 0%. Turnabout Time for routine cases was 56.45 minutes and for emergency 29.83 minutes. The QC failure for PRBC was 14.514%, platelets 6.257%, FFP 4.44%, SDP 5.4%. Adverse Donor Reaction Rate was found to be 0.534%, Donor Deferral Rate 14.03% and Component Issue 97.844%.

Conclusion: Quality Indicators can help in gathering information to identify risk areas and errors in blood banking processes. This will ensure continuous improvement in quality of blood products and set up practice guidelines for safe transfusion to patient.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

53: Incident report as a part of quality management system at blood center of tertiary care institute

Chanchi Khiamniungan ¹, Gita Negi ¹, Ashish Jain ¹, Daljit Kaur ¹, Vaidehi Prasanth ¹, Zikra Syed ¹, Suhasini Sil ¹

Introduction: Quality management in form of incident reporting is vital to create a safer work environment. Its help professionals pinpoint areas of improvement in patients. This helps professionals in working towards creating a proactive and fact-based safety strategy. Incident reporting (IR) systems when coupled with Root Cause Analysis and Corrective and preventive action have the potential to improve patient safety

Aim: To provide an overview of incident reports in Blood centre.

Materials and Methodology: This retrospective study was conducted in the Department of Transfusion Medicine. Data were retrieved from the Incident reporting file, which included 67 incidents reported from September 2017 to November 2021 and included information on causal factors, corrective and preventive actions undertaken. This information allowed the institution to analyze the root cause of the incidents and formulate preventive measures. Three aspects were analyzed: details of the incident, evaluation of cause, and follow up action of the incident.

Results: Out of the 67 incident reports, 23 (34.32%) occurred in component area, 22 (32.83%) in crossmatch area, 10 (14.92%) in donor area, 4 (5.97%) in QC Area, 3 (4.48%) in apheresis lab, 3 (4.48%) in TTI and NAT lab, and 2 (2.99%) interdepartmental errors. On detailed evaluation of the incident, 29 (43.28%) events occurred as a result of process failure, 27 (34.34%) due to technical/clerical error, 8 (11.94%) due to equipment failure, and 3 (4.48%) due to improper handing over of the task. Corrective and preventive actions were recorded and analyzed.

Conclusion: Analysis of incident reports helps to identify the areas lacking in quality and to take corrective and preventive measures to improve overall patient safety and management.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

84: Analysis of blood bank turnaround time for issuance of packed red cells for planned transfusion in outpatients: A prospective study at a tertiary care oncology centre

Aafreen Kotadiya ¹, Sunil Rajadhyaksha ¹, Priti Desai ¹, Anisha Navkudkar ¹

Introduction: The turnaround time (TAT) for providing blood for transfusions is crucial for health-care institutions. However, there is no established national or international benchmark for this TAT due to the dearth of published literature, especially for outpatients visiting the hospital.

Aims and Objectives: Blood bank (BB) TAT for packed red blood cells (PRBC) issuances for outpatients and the factors affecting it were analysed, to determine factors influencing the workflow and recommend feasible BBTAT optimization strategies

Materials and Methods: TAT was captured from the time of receipt of requisition and samples by the BB, BB processing till the PRBC unit issuance for outpatients and prospectively studied over a period of four months, involving three wards providing PRBC transfusions for outpatients.

Results: 2000 PRBC issuances were analysed during the study period. The median BBTAT from receipt of requisition and samples till issue of the compatible PRBCs was 75 minutes in this study. Median compatibility TAT (CTAT) was 56 minutes, while median issue TAT (ITAT) of the PRBCs was 15 minutes. Higher median BBTAT was observed on Mondays (82 minutes) as compared to Sundays (60 minutes); (p<0.05), and during evening shifts on all days, (78 minutes) as compared to morning and night shifts (71 minutes); (p<0.05). Higher median ITATs were resulted majorly by multiple components' issue calls (20 minutes) and overlapping issue calls from different wards (38 minutes) when contrasted with single unit issue calls, i.e. 14 minutes and 15 minutes, respectively; (p<0.05).

Conclusion: Analysing BBTAT helped to understand the factors affecting the BB timelines, efficiency of the BB personnel to perform the tasks and monitor it on a timely basis. Routine monitoring and improving BBTAT not only serves as a quality indicator in Transfusion Medicine, but also helps plan strategies to reduce patient hospital wait times, improves patient safety and customer satisfaction.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

118: External quality assessment scheme: Three year experience as a participating laboratory in a tertiary care centre, north east India

Prabal Das ¹

Introduction: Quality is the degree to which a product or service meets requirements. Quality control and Quality assurance is an important component of Quality Management System as it helps in carrying out a Quality laboratory program systematically thus offering the participating laboratory in performance evaluation thereby improving the quality of the lab practices and overall patient care. EQAS compares results from different laboratories to verify the accuracy and reliability of laboratory results.

Aim and Objective: To evaluate the performance of different test carried out in Blood Bank, Gauhati Medical College and Hospital by comparing it with the organizing laboratory.

Materials and Methods: In the current study EQAS test results were evaluated for past 3 years from 2018 to 2021. Five blood samples were received every 3 months from CMC, Vellore accounting for a total of 15 samples in one year. Out of the five samples received in our blood bank two samples were from patient and three samples were from donor. The entire patient and donor sample were evaluated for ABO and Rh grouping, TTI testing and qualitative haemoglobin analysis. Cross matching was done between the patient sample and donor blood samples. One of the patient's sample was evaluated for Direct coomb's test and Indirect coomb's test. A total of 35 samples were evaluated over the study period by following the standard operating procedure.

Results: Data obtained from ABO and Rh grouping, Direct coomb's test and Indirect coomb's test was concordant with the intended result. In one instance cross matching was discordant with the intended result. Discordant result in one or more instance was observed with TTI testing.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

132: Improving blood transfusion by curbing “near miss” errors in transfusion chain at a blood storage center of a tertiary care hospital

Anshu Gupta ¹, Tanima Dwivedi ¹

Introduction: Near miss' error is defined as an error that is likely to cause, but does not result in any detriment as these are detected before evolving into an 'actual error'. Therefore, these errors should be reported as these point towards weak critical points in the whole transfusion process and require corrective and preventive actions (CAPA).

Aims and Objectives: Near miss errors in blood transfusion can occur at any step starting from decision to select a suitable blood component, to samples collection, to labeling, handling and transportation of samples, to pre-transfusion testing and lastly, administration of whole blood and components. Aim was to identify nature, frequency and location of near miss errors at blood storage centre (BSC) of a tertiary care hospital. These errors were then evaluated for root causes and lastly CAPAs were taken, so as to prevent these errors from resulting in actual harm to the patients.

Materials and Methods: A three years prospective cross-sectional study was conducted in blood storage centre (BSC) of Institute of Human Behavior and Allied Sciences (IHBAS), Delhi for a period of three years from January 2018 to December 2020. Data was collected from all requisition forms sent for blood grouping and cross matching. This BSC had the facility of blood grouping, cross matching, antibody screening, issuing of blood and transfusion reaction management.

Results: We reported 109, 67 and 80 near miss events with a prevalence of 0.77%, 0.51% and 0.76% in 2018, 2019 and 2020 respectively. Clinical near miss (90.2%) predominates over laboratory near miss (9.8%) from total near miss.

Conclusion: The prevalence of near miss events in our storage centre was low. Our study showed increased near miss errors in pre analytical phase. Interventions such as adequate education and training in clinical and laboratory areas and encouraging compliance to guidelines should be followed.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

140: Let's nip in the bud!!! A critical evaluation of the sources of rejection of blood samples/blood requisition forms on receipt at blood centre

Daljit Kaur ¹, Gita Negi ¹, Ashish Jain ¹, Dixa Yadav ¹, Sarika Agarwal ¹

Introduction:

Transfusion safety entails an entire vein-to-vein chain of events from adequate sample labelling, pretransfusion compatibility testing, suitable component issue to right blood administration to the patient^[1]
Sample collection, handling/transport and completeness of the requisition form constitute important pre-analytical variables for quality assurance in Blood Transfusion Services.^[2]

Aim: To evaluate the causes and sources of rejection of blood samples and blood component requisition forms for intended recipients at the Reception of Department of Transfusion Medicine.

Objectives:

To determine various causes of rejection of blood sample and form received at the Blood Centre reception as a requirement for pre-transfusion compatibility testing
To categorize the different specialties of hospital accounting for the sample/form rejection
To identify the preventable errors for improvement in future pre-transfusion testing activities for intended recipients
To recommend the way-forward for advancement in the preliminary check an limiting the errors.

Methodology: Study Design: Prospective observational. Study Duration: 1 year (May 2019 to April 2020). Setting: Department of Transfusion Medicine at Tertiary Care Teaching Hospital.

Results:

A total of 251 errors were reported for 187 patients from various specialties.
The incidence of Requisition Form rejection accounted for 48.2 % (121/251) while it was 51.8% (130/251) for the blood sample rejection.
Wrong blood in tube (WBIT) constituted 55% of the total inappropriate sample received and rejected (30.7%; 40/130) and 15.9% of the total errors reported.

Conclusion:

Timely detection and feedback to the clinicians about inadequate/inappropriate samples/forms prevented serious transfusion related events.

References

1.Quillen K, Murphy K. Quality improvement to decrease specimen mislabeling in transfusion medicine. Arch Pathol Lab Med. 2006;130:1196–8. doi: 10.5858/2006-130-1196-QITDSM. [DOI] [PubMed] [Google Scholar]
2.Bhat V, Tiwari M, Chavan P, Kelkar R. Analysis of laboratory sample rejections in the pre-analytical stage at an oncology center. Clin Chim Acta. 2012;413:1203–6. doi: 10.1016/j.cca.2012.03.024. [DOI] [PubMed] [Google Scholar]

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

Transfusion and Transplantation: 25: EQAS: Behind the scenes

Anoushka Raina ¹, Nikita Gupta ¹, Vikash C Mishra ¹, Nikki Dey ¹, Vimarsh Raina ¹, Vanshika Jain ¹, Ritu Sharma ¹

Participation in External Quality Assurance Programs (EQAS) is of paramount importance for any diagnostic laboratory and helps in precision alignment. While its relevance is recognized, it is a common notion that the EQAS organizers merely send random samples to participants for evaluation. A successful EQAS program has much more going on behind the scenes than is fully understood or appreciated. 12 laboratories from Germany and India participated in the transplant immunology EQAS program.

The backend services were given the topmost priority, including:

Sample selection: To ensure that the participants were exposed to a rich experience, a rare-case sample library was curated by the EQAS team
Round Details: Once the library was curated, two rounds were conducted and one sample was dispatched in each round.
Sample transportation: IATA guidelines were strictly followed for sample packaging and transport, thereby ensuring inertness to outside perturbations.
Submissions and Analysis: An in-house portal was used for data submissions by participants to ensure anonymity and a secure way to handle data and communication.

Result analysis was done with in-house software following ISO/IEC 13528:2015 guidelines. This approach avoided manual errors, helped maintain confidentiality and enabled faster reporting of results. Additionally, it processed meta-data submitted by participants and gave several insights to help improve each participants performance.

In the first round, a single participant fell out of consensus. Careful analysis showed it was due to using functionally expired controls, leading to false conclusions. This was picked up by the meta-analysis done by the in-house software.

In the second round, participants were exposed to a rare case clinical scenario.

Results of one test could not be extrapolated to other tests, causing many labs to give discordant results. This helped participants realize the importance of performing all supplementary analyses for solving a clinical case.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

106: Prospective study to analyze pretransplant compatibility algorithm for live-related donor kidney transplant in Indian setting – Single center report

Arghyadeep Marik ¹, Aseem Tiwari ¹, Geet Aggarwal ¹, Swati Pabbi ¹

Objectives: HLA compatibility between recipient and donor during pre-transplant work-up is very important. The aim of our work was to establish an appropriate test algorithm that could cater to our settings and preclude universality of Anti-HLA antibody identification (HAI).

Materials and Methods: Prospective recipients (and their potential donors) underwent low-resolution HLA typing as well as complement dependent Cytotoxicity assay (CDCXM), flow cytometry cross match (FCXM) and anti-HLA antibody screen (HAS) assays. Additionally, HAI (Single antigen bead {SAB}) was done for all recipients to identify possible DSA. In VXM, antibody specificity was mapped to donor HLA type to determine DSA. Only patients without DSA were cleared for the transplant. Alternatively, patients with DSA were offered an exchange in the kidney paired donation (KPD) program. The screening results (CDCXM, FCXM, and HAS) were analyzed, individually as well as in combination of screening assays (CDCXM+HAS, CDCXM+FCXM, and FCXM+HAS) and the results were compared with those from the HAI test.

Results: Sensitivity and specificity of cell-based assays, CDCXM and FCXM was found to be 14.3 % and 100% and 78.6% and 90.7% respectively. Sensitivity and specificity of HLA bead-based assays, HAS class I was 75.0% and 93.8%, HAS class II was 58.3% and 84.1% and of HAS class I and II both, put together was 78.6% and 80.2% respectively. In the test combination, sensitivity and specificity profile of CDCXM+FCXM was 78.6% and 90.7%, CDCXM+HAS was 78.6% and 80.2% and FCXM+HAS was 100% and 75.5% respectively. Out of all 100 cases analyzed, 47 (47%) cases were positive for both FCXM and HAS, CDCXM+FCXM was positive in 19% of the cases and CDCXM+HAS was positive in 28% of recipients.

Conclusions: Present study suggests that an algorithm comprising of FCXM and HAS combination could be used, universally, since it is 100% sensitive and inexpensive in identifying DSA.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

128: Emphasizing the role of therapeutic plasma exchange in ABO-incompatible live donor liver transplants: A single centre experience

Deepthi Krishna ¹, Deepti Sachan ¹, Akila Rajkumar ¹, Mohamed Rela ¹

Liver transplant is the treatment of choice for end stage liver disease and Liver cancers. There is always a shortage and restricted availability of ABO compatible donors for the transplants; in order to increase the donor pool, ABO-incompatible liver transplants (ABOiLT) are on the rise. Amongst the different desensitization protocols, Conventional therapeutic plasma exchange (TPE) is the simplest method and most widely used along with immunosuppression for pre-operative reduction of ABO titers, to enhance the graft functioning and survival. This study is to stress the role of TPE in ABOi LT done at our setting.

During the study period, 9 patients underwent ABOiLT, majority were peadiatric cases (n=7) and 2 were adults. Overall TPE was performed in 7 patients with baseline ABO titres ranging from 16 to 256 (only IgG). A total of 10 TPE sessions were performed with an average of 1 session per patient. 3 patients (one peadiatric and 2 adults) required TPE in the post transplant phase also. Volume exchanged per session in peadiatric cases show a mean of 1.3 plasma volumes (pv) (1-1.7) and 1.9 pv (1-4 pv) in adult cases. Pre transplant mean titre was 1:4 (1:2 to 1:16) and post transplant mean titre was 1:1 at the time of discharge. Two adult patients received a total of 7 cycles of immunoadsorption procedures with selective column and the rest (n=8) were conventional procedures. Two patients experienced transfusion reactions while performing TPE (mild itching and shivering) and they recovered. All the patients recovered well and were discharged with normal status.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

Transfusion Transmitted Infectious Diseases: 14: Sero-prevalence of transfusion transmissible infections amongst blood donors attending a tertiary care institution of western Assam: A 5-year retrospective study

Abhigyan Mahanta ¹, Ena Dowerah ¹

Introduction: To minimize the risk of Transfusion Transmissible Infections (TTIs) such as HIV-I&II, Hep-B, Hep-C, Malaria and Syphilis during transfusion of blood and blood components, we should screen every unit of donated blood, before transfusion. This increases blood safety and reduces morbidity and mortality.

Aims and Objectives: (1) To analyze the seroprevalence of transfusion transmissible infections (HIVI&II, Hepatitis-B, Hepatitis-C, Malaria, Syphilis) amongst the blood donors attending our tertiary care institution. (2) To study the trends of these infections over a retrospective period of 5 years.

Materials and Methods: The present study was an analysis of secondary data. Data were procured from the archives of the Blood Bank, FAAMCH. Analysis was done using SPSS ver. 22. Charts and graphs were prepared using Microsoft Excel.

Results: Out of 30282 donors, 5755 (19%) were voluntary donors and 24527 were replacement donors. Majority of the donors were male. The overall prevalence of HIV, HBsAg, HCV, Syphilis and Malaria were 0.07%, 0.19%, 0.11%, 0.01% and 0.006%. p-value was calculated to be 0.0061, which is significant.

Conclusion: A trend of increased seroprevalence of transfusion transmissible infections among the replacement donors is seen in this study. Advanced donor screening, public education and awareness, use of newer techniques for TTI screening and encouragement of voluntary participation in blood donation will go a long way in reducing the burden of transmission of these infections in the society.

References

1.Pallavi P, Ganesh CK, Jayashree K, Manjunath GV. Seroprevalence and trends in transfusion transmitted infections among blood donors in a university hospital blood bank: A 5 year study. Indian J Hematol Blood Transfus. 2011;27:1–6. doi: 10.1007/s12288-010-0047-x. [DOI] [PMC free article] [PubMed] [Google Scholar]
2.Makroo RN, Hegde V, Chowdhry M, Bhatia A, Rosamma NL. Seroprevalence of infectious markers & their trends in blood donors in a hospital based blood bank in north India. Indian J Med Res. 2015;142:317–22. doi: 10.4103/0971-5916.166598. [DOI] [PMC free article] [PubMed] [Google Scholar]

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

34: Seroprevalence of transfusion transmitted infections among healthy voluntary blood donors at tertiary care hospital

K Shunmuga Priya ¹

Introduction: Blood transfusion is an effective treatment for saving millions of lives. But Transfusion Transmitted Infection hampers blood safety and causes a serious public health problem. The aim of this study was to assess the seroprevalence of Transfusion transmitted infections among healthy voluntary blood donors.

Materials and Methods: This was a retrospective cross-sectional study, conducted at Tirunelveli Medical College Hospital, for a period of 5 years from January 2017 to October 2021. Data of the blood donors screened during this period was retrieved and analyzed using Screening register and Seropositive donor register.

Results: Among 41867 donors, 176 were seropositive for TTI (n=176/41867) (0.42%). HBV was the most prevalent TTI (n=118/41867) (0.28%). Incidence of HBV showed decreasing trend, while HCV and syphilis showed upward trend for the last 3 years.

Conclusion: Robust donor screening can defer donors with high risk behaviour. But it will be difficult in crowded camp sites. Education about Confidential unit exclusion and implementation can help to reduce wastage.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

63: Seroprevalence of transfusion transmitted infections among blood donors at a tertiary care blood centre in Chennai

D Deepa ¹, P Arumugam ¹, Swathandran Hamsavardhini ¹

Introduction: Transfusion Transmitted Infections (TTI) are the major problem associated with blood transfusion. In India, it is mandatory to test every unit of blood collected for hepatitis B, Hepatitis C, HIV, syphilis and malaria. If the donor is seropositive to any of the infections, the blood bag is discarded. Seroprevalence of HIV, HCV, HBV, Syphilis and Malaria among voluntary blood donors in India is 0.136%, 0.326%, 0.939%, 0.182% and 0.039% respectively as per NACO guidelines.

Aim: The aim of this study was to determine the Seroprevalence of TTI in voluntary and replacement blood donors.

Materials and Methods: This retrospective study was conducted from 1st Nov 2020 to 31st October 2021 in a tertiary care hospital in Chennai. Screening assay for HIV 1 and 2, HBsAg, Anti HCV were carried out by ELISA technique, VDRL and Rapid immunochromatographic tests were used for screening of syphilis and malaria respectively for all 4339 donor samples.

Results: Among the 4339 donors, 3421 (78.84%) were Replacement donors and 918 (21.15%) were voluntary donors.4295 (98.98%) were male donors, 44 (1.01%) were female donors. The overall prevalence of TTIs among Replacement and voluntary blood donors were 1.72% and 2.06% respectively. The seroprevalence of HBV, HIV, HCV, Syphilis and Malaria among Replacement blood donors was 48 (1.40%), 3 (0.08%), 7 (0.20%), 1 (0.02%), 0 and among voluntary blood donors 15 (1.63%), 2 (0.21%), 2 (0.21), 0, 0 respectively.

Conclusion: Pre donation counselling plays an important role and needs more emphasis. Seropositive Donors to be informed, counselled and referred to relevant treatment centres. Sensitive screening assays, advanced techniques like NAT are effective in detecting the organism in the window period and increases the safety of blood transfusion.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

91: A study of prevalence of hepatitis A and hepatitis B virus among the blood donars in a tertiary care centre in Barak valley

Suchismita Roy ¹

97

Seroprevelance of HIV, HBV, HCV, syphills and malaria in blood donors in DMCH Ludhiana year 2020

Jasmeet Kaur

Department of Immunohematology and Blood Transfusion, DMCH Hospital, Ludhiana, Punjab, India

Introduction: Blood transfusion is important to prevent mortality and morbidity but it has its own risks which consists of transmission of Human immunodeficiency virus, Hepatitis B, Hepatitis C, Treponema pallidum (causing syphilis) and Plasmodium spp. (causing Malaria). The Prevalence of TTI'S in voluntary donors is lower than among replacement^[1],[2] and paid donors, Accurate estimation of risk of transmission of TTI's is essential for monitoring the safety of blood supply. Seroprevalence of different TTI's among blood donors is an indirect measure of these infections in the community. Study was conducted to assess the seroprevalence of different TTI's in blood donors in a tertiary care hospital of north India.

Aim: To study seroprevalence of transfusion-transmitted major infections:- HIV, HBV, HCV, Syphilis and malaria) among blood donors at tertiary care medical college blood bank in North India and compare the prevalence of different TTI's among each other in blood donors.

Materials and Methods: This retrospective study was conducted in DMCH LUDHIANA for the year 2020. 2 ml of blood was collected from donors and serum was separated.

Inclusion Criteria: All the voluntary and replacement blood donors 22134 samples from voluntary and replacement blood donors were processed for HIV, HBsAg, HCV by CLIA method (ortho clinical diagnostics) 22134 samples for syphilis by RPR test by Trustline. 22134 samples processed for malaria by Rapid Card test by Abbott. Negative samples 20540 Samples were confirmed by PCR method for HIV, HBsAg and HCV. All positive samples were discarded and seropositive blood donors were sent to appropriate department for treatment.

Results: 0.15% (33 out of 22134) were positive for HIV 1.76% (390 out of 22134) positive for HBsAg 0.75% (166 put of 22134) were positive for HCV 0.73% (162 out of 22134) were positive for VDRL. 0 out of 22134 were positive for Malarial Antigen.

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

111: Incidence of acute graft versus host disease in matched related and mismatched related bone marrow transplant in thalassemia

Aarushi Mittal ¹

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

115: Impact of notification and counselling of reactive blood donors at a superspeciality hospital

Neha Syal ¹

Background: Donor notification is emphasized as an efficient method of curtailing TTIs recently. But its limitations like low notification rate and lack of follow up of treatment of notified donors are still unaddressed. This study was conducted with the aim to analyze the response rate of notified reactive donors, to elicit hidden risks factors and to see impact of donor notification on reactive donors.

Materials and Methods: This retrospective study was conducted in the blood bank of a 350 bedded multispecialty hospital in north India. Data was collected from reactive blood donor counselling register over a period of one year. After six months a telephonic interview was conducted of all the reactive donors who responded to notification calls and came for counselling to inquire if they went for further testing and treatment after they were notified.

Results: There were 1345 whole blood donations over a period of 14 months of which 29 (2.15%) were reactive donors. Notification rate was 48.27%. During counselling 4 donors revealed high risk history which they had denied during pre donation counselling. After telephonic conversation with these notified donors, we analyzed that 7 (50%) donors were taking treatment while 3 donors informed that they got themselves tested from a private lab and were reported negative. Two donors informed that they had not gone for any testing anywhere while we could not trace 2 donors due to change of contact numbers.

Conclusion: Curtailing TTI's through donor notification by blood banks alone is an unattainable mission. A centralized computer data system connecting all blood banks and interlinking of government agencies and blood banks like the recently started NVHCP is need of the hour.

Keywords: Counselling, donor notification, seropositive

Asian J Transfus Sci. 2022 Apr;16(Suppl 1):S12–S45.

142: To do or not to do- discarding of initial NAT reactive and repeat or discriminatory nonreactive NAT units: A persisting dilemma in the mind of transfusion medicine specialists

Ashish Jain ¹, Gita Negi ¹, Daljit Kaur ¹, Zikra Syed ¹, Dixa Kumari ¹, Akanksha Bisht ¹

Background: Nucleic acid testing (NAT) was introduced to reduce the window period of viral transfusion transmitted infections and increase safety of transfused blood. Seronegative units which turn out NAT reactive are termed as NAT yield and a definite benefit has been observed in reducing transmission of infections of HIV, HBV and HCV to the transfusion recipients. In practice, however, there are some situations where initially NAT reactive units on repeat and/or discriminatory testing are found to be non reactive.

Aim: To analyse NAT reactivity, repeat NAT testing and discriminative NAT testing.

Materials and Methods: This study is a retrospective data collection of seronegative, ID-NAT reactive units along with the results of their further testing.

Results: Over a 3-year period, 83 seronegative NAT yields were identified. These units were discarded as per protocol. Out of these 83 initially NAT reactive units, on repeat testing, 53 (63.8%) were repeat reactive in triplicate, 27 (32.5%) were non-reactive in triplicate while repeat testing could not be performed in 3 (3.6%) due to insufficient sample. Discriminatory results were non-reactive in 12 (29.2%) of the 53 repeat reactive units. In toto, no infection was identified in 39 (46.9%) of all the initial NAT reactive units.

Discussion: NAT testing, especially in terms of NAT yield, was found to be beneficial in the early detection and identification of transfusion transmissible infections. As per the regulation, once a unit is found to be reactive, it must be discarded and the donor must be notified. In serology testing, results are obtained directly for the infections being tested. In NAT, however, discriminatory testing is performed only after initial NAT test is reactive. There is a need for proper guidelines to be laid down regarding discard and notification of initially NAT reactive units.

[ref1] 1.Basu D, Kulkarni R. Overview of blood components and their preparation. Indian J Anaesth. 2014;58:529–37. doi: 10.4103/0019-5049.144647. [DOI] [PMC free article] [PubMed] [Google Scholar]

PERMALINK

TRANSMEDCON 2021 Posters

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46: Quality assessment of platelet concentrates prepared by buffy coat pooling method

Joyisa Deb

47: Analysis of reason for discard of blood and blood components in a tertiary care hospital

S Saravanan

67: Utilisation of blood and blood components in a tertiary care hospital

Lincy Thiyagarajan

P Arumugam

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78: A study on extraction efficiency of platelets by buffy coat method in a tertiary centre

Aswin K Mohan

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Daljit Kaur

Suhasini Sil

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Gita Negi

93: Beyond the horizon: An analysis of the impact of helicopter transport on the quality control of blood components

A Vasanth Asirvatham

V S Srikanth

Rajat Bansal

Pallavi Singh

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Archana Bajpayee

116: Blood component utilization and wastage in a tertiary health care system

Gargi Roy Choudhury

Reference

134: To assess quality of blood components prepared by automated blood component separation system: A pilot study

Ritesh Kumar

Diptiranjan Rout

Blood Donors and Blood Donation: 1: Study of predonation and postdonation haematological and biochemical values in healthy donors undergoing platelet apheresis at Dhiraj blood bank

Ashu Dogra

4: Postvaccination serological experience of SARS-COV-2 IgG antibodies among blood and convalescent plasma donors

Neha Singh

24: A study on the effect of predonation water ingestion on vasovagal reactions in whole blood donors

Barsha Baisakhi Panda

28: Evalution of donor deferral pattern in COVID-19 convalescent plasma donor

Krishna Mayani

30: Adverse donor reaction during and after plateletpheresis in a tertiary health institution

Kaushik Patra

60: Analysis of whole blood donor deferral during COVID pandemic

Manu Mangat Marandi

61: Analysis of the reasons for deferral of blood donors during COVID-19 pandemic and vaccination

G Saranya

V Shanthini Gilda

A Ruth Jenila

M Sintha

69: Blood donors' perspectives and expectations on blood donation during the COVID-19 pandemic

Swathandran Hamsavardhini

P Arumugam

76: To study the distribution of Rh and Kell blood groups in blood donors

Maryada Rooprai

77: Hemodynamic changes in healthy blood donors during whole blood donation: A prospective cross-sectional observation study

M Don Davis

87: Predonation deferral of blood donors: A retrospective study in a tertiary care hospital of north east India

Nayana Bora

90: Review of donor's prior donation records - lessons learnt

Srivalli Arjunan

96: Evaluation of different reasons and rate of deferral among whole blood donors attending a tertiary care centre in North-Western India

Girraj Prasad Mathuria

122: Donor notification: Double edged sword: What to do and what not to do

Spruha Dholakia

Bhavnaben Fultariya

Nishit Vachhani

Sanjiv Nandani

125: Evaluation of hematological and hormonal parameters in plateletpheresis donors

Pradeep Kumar Maurya

References

129: Delayed adverse reactions in blood donors

Sunil Kumar

131: Frequency of ABO and Rh blood group among blood donors at tertiary care hospital of central India

Amogh Tiwari

References

141: Classification of adverse donor reactions according to new severity grading tool and analysis of vasovagal reactions

Shivanand Hemant Kumatagi