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   Table of Contents - Current issue
January-June 2018
Volume 3 | Issue 1
Page Nos. 1-80

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Coping with the burden of thalassemia: Aiming for a thalassemia free world Highly accessed article p. 1
Ambuja Kantharaj, Shivaram Chandrashekar
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Blood donor notification: Boon for the community, bane for blood donors, and blood centers? p. 6
Shivaram Chandrashekar, Ambuja Kantharaj
Altruism, warm glove, kinship and a sense of duty are the primary driving forces behind blood donation. The concept of donor cycle starts with donor recruitment and ends with donor retention and recall or with notification of sero-reactive donors. Donor Selection criteria vary from country to country and from region to region. Blood donor counseling is a confidential dialogue between the donor and a trained counselor aimed at ensuring the safety of donors and health of recipients. Predonation counseling covers modes of transmission of HIV, tests carried out on donated blood, confidentiality of test results, information on alternate testing sites and confidential self exclusion. Counseling during donation helps allay fears and is likely to reduce the incidence of adverse reactions in the donor. Post donation counselling aims at educating the donors on the interval between donations, care of the phlebotomy site, special instructions in case of adverse events and specific instructions depending on their job, besides nutritional /medical advice to deferred donors. Posttest counseling and notification of reactive donors is essential for the health of the donor and his family, prevention of diseases, improving blood bank economy by avoiding wastage of blood, and reducing exposure to healthcare workers. Problems in notification are diverse. It creates donor anxiety and suicidal tendencies in some. The kits used in a blood centre may give false positive results. NAT reactivity, with sero-negativity further compounds the problem. Response rate to notification is often poor. All these have made donor notification a boon for the community, but a bane for blood donors and blood centers. Every country must evolve specific guidelines for donor notification. This paper discusses Indian Guidelines for Blood donor counseling and sero-reactive Donor Notification.
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Response to postdonation counseling is still a challenge in voluntary blood donation: A survey from tertiary care blood center p. 13
Shivani S Thaker, Nisha G Raval, AS Agnihotri
Background: Blood transfusion carries the risk of transmission of several infectious agents. The latest method for blood screening such as nucleic acid testing is not affordable in developing countries. Hence, the importance of pre- and postdonation counseling for transfusion transmission infections is paramount. Aim: The study was aimed to find response to postdonation counseling for reactive markers among the voluntary blood donors donating in blood bank. Materials and Methods: This 2-year study was conducted from May 2015 to June 2017. Transfusion-transmitted infections' testing was performed by routine enzyme-linked immunosorbent assay method. The initial human immunodeficiency virus (HIV) reactive donors who return back to the blood bank were confidentially counseled and referred to the Integrated Counseling Cum Testing Centre. The hepatitis B surface antigen (HBsAg) and hepatitis C virus (HCV) reactive donors were referred to General Medicine Department for confirmation by qualitative polymerase chain reaction and follow-up. Venereal disease research laboratory (VDRL) reactive donors were referred to sexually transmitted infections clinic. Results: During the survey, 17,306 units of blood were collected. Among which 7 were reactive for HIV, 117 were reactive for HBsAg, 10 were reactive for HCV, and 101 were reactive for VDRL. Out of 235 donors who were reactive and called for counseling postdonation, only 28.94% responded.
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Iron deficiency and iron deficiency anemia in blood donors at a tertiary care hospital in Islamabad, Pakistan p. 17
Usman Waheed, Muhammad Arshad, Sadia Sultan, Muhammad Saeed, Abida Arshad, Syed Muhammad Irfan, Hassan Abbas Zaheer
Objective: The aim of this study was to evaluate the frequency of iron deficiency anemia among the blood donors. Methods: A prospective, single center cross-sectional study was conducted in the Department of Blood Transfusion Services, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan, from February 2017 to June 2017. A total of 528 blood donors who donated blood without prior screening for hemoglobin levels were enrolled for this study. Blood samples were tested for six hematological and five biochemical parameters including hemoglobin level, red cell count, packed cell volume, mean cell volume, mean cell hemoglobin, mean cell hemoglobin concentration, serum ferritin, iron, total iron binding capacity, transferrin saturation, and unsaturated iron binding capacity. Results: Of 528 blood donors, 251 (47.53%) were first-time donors, 203 (38.44%) had donated twice previously but not in the past 12 months, and 74 (14.01%) were regular donors with minimum three donations per year. All of the donors were males with a mean age of 29.2 years (range = 18–56 years). Of these, the regular donors showed the reduction in mean values of the parameters studied. Conclusion: The blood bank management needs to review the donor selection criteria for donation. Regular voluntary donors should be given an iron supplement to prevent the depletion of iron stores.
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Paradigm shift of high-risk sexual behavior among indian blood donors: A threat to blood recipients p. 21
Sadhana Mangwana, Gajender Nath Gupta
Background: Despite the advances in screening of blood through nucleic acid testing to improve the blood safety, there are chances that blood will be donated during the “window period.” Careful selection of donors is an important and pragmatic risk management strategy to ensure blood safety. Subjects and Methods: The observational study was undertaken in two parts. In the first part, retrospective data of donors attending blood transfusion services of tertiary care center between 2014 and 2016 were collated and analyzed. In the second part, an online survey was conducted to assess the prevalence and awareness among donors. Results: A total of 32,773 donors reported for blood donation, of which 8974 (27.38%) potential donors were deferred. Deferral incidence due to high-risk behaviors increased in 3 years from 2.84% to 9.85% with majority of donors (99.60%) being males. Fifty-two percent of donors were repeat donors while 48% were first-time donors. In the survey, 90% of centers question donors about high-risk behaviors, 58% of centers specifically question about sex history. Fifty percent of seroreactive donors in the first part of the study and 63% of respondents found that donors give a positive history of high-risk behavior at the time of counseling. Discussion and Conclusion: In view of the need for optimization of cost of health-care services and maintaining highest level of transfusion safety, its time to devise new solutions in dealing with potentially risky sexual behaviors. Efforts are also needed to educate the general population to understand potential risks of high-risk behaviors and to promote the self-deferral or confidential unit exclusion.
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Red blood cell phenotyping of blood donors in Islamabad, Pakistan p. 26
Faiza Jabin, Usman Waheed, Saeed Ahmed, Muhammad Arshad, Abida Arshad, Hasan A Zaheer
Background: There are 33 blood groups identified so far representing more than 300 antigens. The blood transfusion services in resource-limited countries including Pakistan only test for ABO and RhD antigens during cross-matching. However, the transfusion of ABO-RhD compatible but unknown phenotype blood may result in alloimmunization, especially in multi-transfused patients. Aims: The aim of this study is to investigate the prevalence of clinically significant minor blood group antigens in population of Islamabad, Pakistan. Settings and Design: A prospective study was conducted at the Department of Blood Transfusion Services, Islamabad. Subjects and Methods: Blood samples from 625 randomly selected blood donors were collected for extended antigen typing. Blood grouping was performed using commercially available antisera. The statistical analysis was done using SPSS version 20.0. Gene frequencies were calculated using the Hardy–Weinberg equation. Results: Of the 625 blood donors, 575 were RhD positive (92%) and 50 (8%) were RhD negative. The frequencies of A, B, AB, and O antigens were (24.64%), (34.72%), (9.28%), and (31.36%), while antigen frequency of K was 4%, Duffy (Fya) 58.24%, Duffy (Fyb) 39.84%, Kidd (Jka) 65.28%, Kidd (Jkb) 42.24%, M 86.88%, N 46.24%, S s49.44%, and s 30.4%. Calculated gene frequency for Kell K was (0.04), Duffy Fya (0.481), Fyb (0.519), Kidd JKa (0.538), JKb (0.462), M (0.699), N (0.301), S (0.445), and s (0.556). Conclusions: The current study depicts the prevalence of the blood group antigens among Pakistani blood donors to be statistically different from those in Caucasians, Chinese, and African populations.
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Machine and man individualities in apheresis adverse events p. 30
Sudipta Sekhar Das, Subrata Sen, Ritam Chakrabarty
Background: Adverse events due to plateletpheresis are not unheard of, citrate-related reactions being the most common. Most of these events are mild and self-limiting. The current study describes adverse events in plateletpheresis using modern apheresis systems. Materials and Methods: The prospective study included 1455 plateletpheresis procedures from July 2013 to April 2016. Procedures were performed on Amicus, Trima Accel and Cobe spectra cell separators. The endpoint of each procedure was a yield of 3 × 1011 platelets (PLTs) per unit. Donor adverse reaction if any was managed, reported, and documented. Results: The median age of donors was 31 years with male-to-female ratio of 13:1. The median body surface area and body mass index were 1.64 m2 and 22.4 kg/m2, respectively. The mean PLT count of donors was 199.8 × 103/uL with a mean hemoglobin value of 13.6 g/dl. ACD infusion was significantly more in the Cobe (P < 0.01). Donation time was least with the Trima compared to Amicus (P < 0.01) and Cobe (P < 0.001). Total whole blood volume processed was higher in Cobe (P < 0.01). Paresthesia due to citrate toxicity was the most common adverse reaction (65.3%), and vascular injury was observed in only five donors. Adverse reaction was significantly more with the Cobe (P < 0.01). The overall incidence of adverse reaction was 3.4%. Conclusion: Serious adverse events were not observed. The modern-generation apheresis machines are more donor-friendly and cause less adverse reactions compared to the older versions. Good donor screening, optimized donor physiognomic and hematological values, and skilled operator are the key factors to reaction reduction by apheresis.
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Luminex-Based Donor-Specific antibody crossmatching for renal transplant: A 3-Year experience in South India p. 34
Ankit Mathur, Samrat Thapa, Latha Jagannathan
Introduction: Although CDC has been the gold standard for many years, this assay is certainly not perfect and its use is associated with several problems. The Luminex anti-HLA antibody detection assay is reportedly more sensitive and specific. One of the test is Luminex DSA cross match which is more sensitive than CDC cross match. It is also considered cost effective tool to evaluate pre and post renal transplant cases. Material and Methods: We started Luminex based Donor specific antibody Cross Match tests (DSA Xm) with lysate by the end of 2009 along with CDC after standardization. This study is planned to evaluate the results of DSA Xm of last three years & also to observe antibody medicated rejections after renal transplant. Results: Total 3137 Luminex DSA Cross Match tests were done & 515 tests were positive cross match with negative CDC xm result. Out of 515 positive results 164 were positive for class I, 223 were positive for class II and 128 were positive for both class I & II. In the three years total 1129 renal transplants were done at various centers and total 42 cases of Antibody medicated rejections were reported. Out of 42 patients, 36 patients had pre transplant history of CDC negative & Luminex DSA xm positive. Conclusion: We evaluated our three year results of DSA Xm test and found a cost effective, sensitive and useful supplementary test to evaluate pre and post renal transplant cases.
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Pretransplant compatibility testing: Algorithmic approach! p. 39
Aseem K Tiwari, Rajni Chauhan
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A study on transfusion practice in obstetric hemorrhage in a tertiary care centre p. 41
Shiffi Fazal, AP Poornima
Context: Blood Transfusion is identified as one of the essential components of comprehensive emergency obstetric care which has drastically reduced the maternal mortality. Aims: This study retrospectively reviewed blood transfusion pattern in patients with obstetric hemorrhage in our tertiary care center Government Medical College, Trivandrum (Sree Avittam Thirunal is a part of Government Medical College, Trivandrum) and analyzed the obstetric indications and risk factors for transfusion. We also analyzed the ratio of components transfused. Materials and Methods: Transfusion request forms of 310 patients admitted to the Department of Gynaecology and Obstetrics in Sree Avittom Thirunal Hospital from January 2013 to May 2013 were retrospectively reviewed for the types and volume of blood component transfused indication for each blood component transfusion noted. Patients who had massive obstetric hemorrhage (MOH) were further analyzed to estimate the ratio of components transfused. Statistical Analysis: Chi-square test (for categorical variables) was done to assess frequency distribution. Logistic regression analysis was done to identify major risk factors. The analysis was done using SPSS version 16. P < 0.05 was considered to indicate statistically significant. Results: We have experienced 299 obstetric patients who underwent blood component transfusion during the study. 73% (218) and 27% (81) cases needed peripartum and antepartum transfusion, respectively. Anemia correction accounted for the maximum cases in antepartum transfusion. The leading obstetric conditions of intrapartum and postpartum hemorrhage include abruptio placenta (51 cases; 23.4%), atonic postpartum hemorrhage (30 cases; 13.8%), placenta previa (54 cases; 24.8%), and uterine inversion (15 cases; 6.9%). About 87.2% received packed red blood cell transfusion and 43.7% received platelet concentrate transfusion. 48.1% received fresh frozen plasma (FFP) transfusion. Only 14.2% (21) were transfused with cryoprecipitate. Nearly 27.4% (82) of study individuals had MOH. 92.35% of cases with MOH received FFP transfusion. Cryoprecipitate transfusion was given to 5.4% (15) of patients with MOH. Significant risk factors for MOH, identified using a multivariable analysis, were placenta previa (OR 20.7, 95%CI 9.6–44.6); abruptio placenta (odds ratio [OR]: 3.4, 95% confidence interval [CI]: 1.2–3.7); atonic postpartum hemorrhage (OR: 1.4, 95% CI: 1.1–3.4); uterine inversion (OR: 1.2, 95% CI: 1.0–1.8); and rupture uterus (OR: 1.84, 95% CI: 1.1–2.4). A significant positive correlation was observed between the number of units of red cell concentrate (RCC) and that of FPP (P < 0.001). The median of FFP/RCC ratio for each patient was 1.42. Conclusions: A preplanned, multidisciplinary protocol yields the best results in the management of obstetric hemorrhage. In conclusion, for MOH where appropriate supplementation of coagulation factors is essential, the transfusion practice of RCC and FFP in the ratio of 1:1.4–2 observed in our institution is acceptable. However, the utilization of cryoprecipitate needs to be improved.
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A study on knowledge and awareness about blood donation amongst government medical, para-medical and nursing undergraduate students in Jamnagar, Gujarat p. 46
Ashishkumar Nathabhai Kanani, Jitendra H Vachhani, Shweta B Upadhyay, Spruha K Dholakiya
Aim and Objective: The aim of the study was to compare the reasons for blood donation and knowledge about blood donation among medical science undergraduate students. Materials and Methods: A random cross-sectional study was conducted among 500 government medical sciences' undergraduate students in Jamnagar during the period of 3 months (February 2017 to April 2017). It constitutes of MBBS, Dental, Ayurvedic, Physiotherapy, and Nursing College. A predesigned, pretested, self-administered questionnaire was devised to collect data. Data were collected after obtaining informed consent. Ethical clearance from the institute was obtained before the study. The results were analyzed using Microsoft Excel 2007 database sheet, and percentage and Chi-square test were applied to calculate association between different variables with P value set as significant when <0.05. Results: The response was gathered from a total of 500 respondents who voluntarily participated in the study. Out of them, 31.52% (n = 165) males and 14.03% (n = 335) females donated blood in their lifetime. Among MBBS students, 90.19% (n = 1100) had shown a good level of knowledge (given a positive response), whereas dental, ayurvedic, physiotherapy, and nursing student respondents showed the same by 78.27%, 71.64%, 89.55%, and 76.27%, respectively. Among factors that hindered the study cases from donating blood, the most important was that they were never approached by anyone (52.2% - whenever required) for blood donation. Conclusion: The conclusion of the present study indicates a greater awareness among the medical and physiotherapy students in comparison to nursing, dental, and ayurvedic students. Hence, these sectors need more targeted attempts to increase awareness and motivation among these masses, which will eventually enable us to increase the spectrum of motivated donors among the common people population.
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A retrospective analysis of donor deferral characteristics for plateletpheresis in a tertiary care hospital, South India p. 52
Sudhir Kumar Vujhini, Kandukuri Mahesh Kumar, Murali Krishna Bogi, B Shanthi
Background: There is an increasing demand for platelets in the recent years due to increase in cancer cases, dengue fever, and other platelet-related diseases. Blood bank plays a vital role in supplying platelet units which have better yield and fewer complications. Single donor platelet (SDP) unit is a useful platelet product in many diseases for raising the platelet count. For better yield, a healthy and young donor is required which is a great challenge for the blood bank staff. Materials and Methods: This retrospective study was carried out for a period of 4 years from January 2014 to December 2017. Data were collected from the records maintained by the Department of Transfusion Medicine and Immunohematology in a Tertiary Care Hospital, Hyderabad, India. Results: Out of 860, a total of 705 Plateletpheresis donors were selected for SDP donation, and the remaining 155 (18.02%) donors were deferred for various reasons. The predominant age range of the deferred donors was 25–34 years (50.32%). Among the deferred donors, males were 90.32% and females were 9.68%. Temporarily deferred donors account for 98.07% and permanently deferred donors were 1.93%. The most common causes for deferral were low platelet count (31.61%), low hemoglobin (27.09%), and poor venous access (20.64%) and the least common cause was dermatitis at the venipuncture site (1.29%). The most common reason for permanent deferral was seropositivity for HBsAg. Conclusion: Selection of plateletpheresis donor with utmost stringency will give good yield of platelets. Temporary deferred donor should be counseled properly so as to encourage them for the future donations when they become eligible, and this bridges the gap between the demand and supply of apheresis platelets.
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Urgent need for a South Asian hematopoietic stem cell donor registry p. 56
Srinivasan Periathiruvadi
For over four decades, Haematopoietic Stem Cell Transplantation remains the only form of curative treatment of patients with blood cancers, Thalassemia and certain congenital immune deficiencies. Poor representation of Asian population in the global donor database and absence of a regional registry for South Asian population is responsible for loss of lives. Hence there is an urgent need for member countries in the SAARC region to work together to enable quick and affordable access to matching stem cells for patients in this region.
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Anomalous blood grouping showing red cell mosaicism in a patient with acute leukemia p. 59
Sanmukh Ratilal Joshi, Komal Savaliya, Manisha Rajapara, Parul Narang
Background: The ABO blood groups are determined by forward grouping on red cells and are confirmed by reverse grouping on serum, both of which must tally to assign proper blood group to an individual. Any anomaly in blood group must resolve before transfusion. Aim: A patient with anomalous blood grouping required to be investigated as pretransfusion tests. Materials and Methods: ABO blood grouping protocol was followed. The patient's red blood cells (RBCs), showing mixed-field reaction, were separated into those showing agglutination from other remaining nonagglutinated RBCs by selective adsorption using anti-A1 lectin and subsequently disagglutinated by incubating with soluble salivary antigen from Group A secretor individual. Results: Of the two RBCs populations, one that was agglutinated by the lectin showed considerably stronger agglutination with anti-A antibody as compared to those that were not agglutinated. Conclusion: Weakened red cell A antigen was presumed to be due to underlying disease process in acute leukemia.
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Responsibility of blood bank regarding referral of initial seroreactive blood donors to integrated counseling and testing center: Sensationalism by the media may lead to disaster p. 62
Suvro Sankha Datta
A case from a hospital-based private blood bank situated in an urban area of eastern India regarding a horrible media trial after referring a blood donor to integrated counseling and testing center due to seroreactivity as per the National AIDS Control Organization guideline.
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Postoperative atypical hemolytic uremic syndrome in nontransplant setting: A case report with review of literature p. 64
Anil Khetarpal, Vidhi Gupta, Urvershi Kotwal
Atypical hemolytic uremic syndrome (aHUS) is a clinical diagnosis characterized by a triad of microangiopathic hemolytic anemia, thrombocytopenia, and renal dysfunction. Postoperative aHUS in nontransplant patients is a rare entity. The proposed underlying mechanism is complement cascade dysregulation. aHUS has high morbidity and mortality. Prompt intervention with early initiation of therapeutic plasma exchange helps in the hematological remission thus reducing morbidity.
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Massive blood transfusion: A case report of transfusion of 70 units of blood and blood products in 24 hours p. 68
Kompal Jain, Sunoor Jain, Nishant Sood, Arun Puri
The mortality of massive blood transfusion is very high ranging from 34% - 40% . Only 60 % of patients receiving more than ten packed red blood cells units within the first 24 hours have survived. We share our experience with massive blood transfusion in which seventy units of blood and blood products were transfused in 24 hours following massive transfusion protocol. To conclude each institute should have massive transfusion protocol to improve the clinical outcome of the patient. Anaesthetist should be aware about local resources and should ensure early communication with laboratory, haematologist and blood bank. In view of cost, increased demand, urgency, availability and risk of infections, blood substitutes are of great concern specially in developing countries. This case study also emphasizes on future research to make blood substitute with more similarities and minimum complication to replace donated blood.
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One case many learnings: A case of blood group discrepancy along with multiple alloantibodies Highly accessed article p. 72
Samrat Thapa, Latha Jagannathan, Ankit Mathur, TV Kumar Reddy, Santanu Chakraborty
Routinely, Immunohematology Reference Testing Center receives samples with blood group discrepancy, presence of allo/autoantibodies, positive direct antiglobulin test (DAT), etc. We are presenting a case in which we not only resolved blood group discrepancy but also identified multiple alloantibodies reacting at different phases. A tricenarian female patient was diagnosed with chronic anemia with hemoglobin level below 7 g/dl. The patient had a history of blood transfusion and pregnancy as well. On blood grouping, the patient's forward grouping was “AB” and reverse was “O.” Indirect antiglobulin test was found to be positive while DAT and autocontrol were negative. After complete investigation, patient blood group was confirmed to be subgroup of AB along with anti-A1 antibody. Furthermore, a cold-reacting alloantibody with high thermal amplitude was detected along with one warm-reacting alloantibody.
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How many of the rhesus D-Negative cases are actually weak D positive? p. 75
Shivali Sehgal, Priti Chatterjee, Ranjan Kumar, Chintamani Pathak
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A pilot study analysis of transfusion-related adverse events at the tertiary care hospital in Eastern India: Encourages the establishment of institutional hemovigilance program p. 76
Somnath Mukherjee, Dibyajyoti Sahoo, Aishwarya Ramnath, Rituparna Maiti
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Pattern of blood donor deferral in the hilly State of Himachal Pradesh p. 78
Sandeep Malhotra, Masih , ML Kaushal
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Effect of traumatic hemorrhagic shock on the antioxidant enzyme systems of organism: An animal experimental study p. 79
Li Dapeng, Lv Chunlei, Wang Yongqing, Wang Fenjiao, Zheng Wenzhe
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