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Blood Donor notification and counseling of reactive test result in Blood Bank of South Gujarat: A better approach to prevent reactive donors from donating blood again
Snehal G Patel, Jitendra N Patel, Arpit C Patel, Kruti A Raja, Gopi H Dobariya, Amrish N Pandya
July-December 2016, 1(2):57-60
Background: Besides all other measures like predonation donor screening and testing for transfusion-transmitted infections (TTIs) on donated blood, another tool for preventing disease transmission by transfusion is to inform and counsel reactive donors about the status of TTIs reactivity and prevent them for donating blood in future. Materials and Methods: The present observational study was carried out in blood bank of Department of Immunohematology and Blood Transfusion at a Tertiary Care Government Hospital in South Gujarat over a period of 3 years involving total 25,020 donors including 353 reactive donors. The reactive donors were informed by the blood bank counselor about an abnormal test result with an advice to report to the blood bank for one-to-one counseling and repeat testing, as well as for referral to the respective department/integrated counseling and testing center/sexually transmitted disease clinics of the hospital for further management. The response rate of TTIs reactive donors after notification of their abnormal test results was evaluated. Results: Of the 353 TTIs marker-reactive donors, 320 (90.65%) reactive donors could be contacted and of which 261 (81.56%) responded positively to the notification calls and attended counseling at the blood bank and 59 (18.44%) informed donors did not respond at all. Conclusions: In the study, due to incorrect or changed contact details, 33 (9.35%) reactive donors could not be contacted and among 59 nonresponded reactive donors, the major reasons were donor's busy schedule, out of city residence, and not willing to visit the blood bank again.
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Noninvasive fetal RHD genotyping from maternal plasma
Disha S Parchure, Swati S Kulkarni
January-June 2016, 1(1):21-28
Alloimmunization to antigens of Rh blood group system is of clinical relevance during pregnancy. Despite the use of antenatal anti-D immunoglobulin prophylaxis, some proportion of RhD-negative pregnant women still become immunized. RhD-negative pregnant women with a heterozygous partner can be reassured and managed less intensively if RhD-negative status of the fetus was confirmed. The conventional techniques used for prenatal testing of fetal RhD status are mainly invasive such as chorionic villus sampling, amniocentesis and cordocentesis, and carry risk of transplacental hemorrhage and pregnancy loss. The discovery of cell-free fetal DNA (cffDNA) in maternal plasma in 1997 has opened up new possibilities for noninvasive prenatal diagnosis. With the use of real time polymerase chain reaction technology, circulating fetal DNA has been detected robustly in the plasma of pregnant women, even in the first trimester of pregnancy. Various assays have been developed to confirm the fetal RHD status by targeting the cffDNA using a combination of multiple RHD exons. The commonly used exons are 4, 5, 7, and 10. Common causes leading to discordant results in fetal RHD typing are low fetal DNA concentration due to extraction inefficiency, lack of fetal DNA control, silent maternal RHD alleles, and manual error. False negative results can prove critical in case of alloimmunized pregnancies and hence use of appropriate controls and strict reporting criteria is important to increase the sensitivity of the assay. Owing to the wide genetic variation of the Rh blood group system, the development of fetal genotyping strategies according to ethnic origin of the patients would further increase the sensitivity. Fetal blood group genotyping by noninvasive method is safe, and numerous groups have reported fetal RHD genotyping in D-negative mothers with close to 100% accuracy. Noninvasive fetal RHD typing can be performed in RhD-negative alloimmunized and nonimmunized pregnancies to decide on clinical management and to restrict the anti-D immunoglobulin prophylaxis, respectively. Thus, the introduction of this test for screening all RHD-negative pregnant women is highly desirable.
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Thromboelastography as a novel viscoelastic method for hemostasis monitoring: Its methodology, applications, and constraints
Anupam Verma, Hemlata
January-June 2017, 2(1):8-18
Thromboelastography (TEG) is a novel viscoelastic method which provides a comprehensive assessment of hemostasis from clot initiation and development to fibrinolysis involving both cellular and plasmatic components of hemostatic system. Apart from surgery its role is expanding into medical specialties with increasing integration into laboratory settings. TEG complements the conventional coagulation tests in assessment of bleeding disorders. Further hemotherapy based on TEG results has been shown to reduce transfusion requirements in varied clinical settings besides helping in identifying coagulopathies in patients with major bleedings. This review article addresses briefly the methodology, clinical applications, interpretation of TEG results including authors' own experience of TEG in different clinical scenarios and limitations of TEG. Overall, this technique seems to be helpful for evaluation of hypercoagulable state and in detecting fibrinolysis which are difficult to be detected with conventional coagulation tests. Kaolin activated citrated blood samples analyzed within 30-60 min of sampling can provide reliable results in a laboratory setting. However, multiple assays using different activators or modifiers may be required for accurate results in selected cases. The operator should be aware about the various preanalytical and analytical variables which can affect the results including limitations of this technique. The tracing of the thromboelastography should be interpreted cautiously taking into consideration the clinical picture of the patient and results of other laboratory tests. With improved model and availability of more assays it is hoped that TEG and other such hemostasis analyzers would bring in the paradigm shift in the hemostasis monitoring and treatment of patients in future.
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Evaluation of deferral pattern among the blood donors in Islamabad, Pakistan
Usman Waheed, Hasan Abbas Zaheer
July-December 2016, 1(2):81-84
Introduction: Temporary or permanent deferrals lead to loss of valuable blood donors and blood units accessible for transfusion purposes. Understanding the rate and reasons of donor deferral provides direction for recruitment and retention strategies of blood donation. The current study was conducted to investigate the prevalence and causes of deferral in blood donors in Islamabad, the federal capital of Pakistan. Materials and Methods: A structured pilot-tested questionnaire was sent to all 19 licensed blood banks of Islamabad through the Islamabad Blood Transfusion Authority. Data submission is a prerequisite for licensing with the authority. The study was conducted between January and December 2015. Results: Most of the deferrals were because of anemia (41%), which was more prevalent in females. Other common causes for deferral in our study were underweight, low blood pressure, and under/overage. Less common causes were the use of certain medications, recent blood donation, history of fainting, and fear of needle. Conclusion: It is imperative to investigate the rate and reasons of donor deferral to guide the recruitment and retention efforts. Donor sensitization on the criteria of recruitment needs to be addressed on priority basis through the public/donor awareness campaigns.
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Optimization of blood transfusion services: Analysis of blood requisition and utilization practices in cardiac surgical patients in a tertiary care hospital, India
Sadhana Mangwana, Neha Bedi, Pinky Yadav, Rakesh Chugh
January-June 2017, 2(1):47-51
Objective: Blood products are vital resources to health-care institutions with constantly growing demands. Gross over-ordering of blood causes exhaustion of valuable supplies and resources and add financial burden to patients undergoing surgical procedure. Aims: Study was undertaken to evaluate blood requisition, utilization, and management in cardiac surgery patients in a tertiary care hospital. Materials and Methods: Prospective study was conducted in cardiac surgery patients over 3 years from 2013 to 2015. Blood utilization indices were computed. Cross match to transfusion ratio (C:T) ratio of 2.0 and below, transfusion index (TI) value of 0.5 or more, and transfusion probability (%T) value of 30% and above were considered indicative of significant blood usage. Statistical analysis was done using Student's t-test. Results: During the study, a total of 15,392 patients' requisitions were received. Out of 25,190 units of blood cross-matched, 18,741 units were issued (C:T ratio 1.34) implying that overall 25.60% of blood was unutilized. From a total of 2752 units cross-matched for cardiac surgery cases, only 1296 units were transfused with C:T Ratio 2.12 implying that 52.91% of blood was unutilized which was much higher and statistically highly significant than in total patients. Overall TI was 1.22 and %T as 83.07% while for cardiac patients, TI was 2.32 with %T as 85.84%. Conclusions: Blood transfusion plays a major role in resuscitation and management of cardiac surgery patients. Blood transfusion services need to adopt blood conserving policies. Efforts should be made to adopt more conservative transfusion thresholds, conduct regular auditing, and periodic feedback to improve blood ordering, handling, distribution, and utilization practices of this scarce resource.
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