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REVIEW ARTICLE
Thromboelastography as a novel viscoelastic method for hemostasis monitoring: Its methodology, applications, and constraints
Anupam Verma, Hemlata
January-June 2017, 2(1):8-18
DOI:10.4103/GJTM.GJTM_4_17  
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.
  2,665 273 1
ORIGINAL ARTICLES
Verification of column agglutination technology with conventional tube technology for naturally occurring antibody titration
Nidhi Mehta, Ishita R Chakraborty, Minal Rane, Vijayata Ambre
July-December 2016, 1(2):46-50
DOI:10.4103/2455-8893.189846  
Background: Pre-transfusion compatibility testing is performed in order to prevent transfusion of incompatible donor red cells that might result in an immune mediated hemolytic transfusion reaction, thereby forming a critical element in the process of transfusion to enhance blood safety. Titers are generally determined with a semi-quantitative assay by serial double-fold dilution. Several different techniques have been employed for titration, of which the conventional tube test (CTT) and column gel card test –Column Agglutination Technique (CAT) are the most frequently used. Historically, CTT has been used as the standard technique for immunohaematological studies, such as direct antihuman globulin test for the diagnosis of autoimmune haemolytic anaemia and in screening for specific antibodies in transfusion medicine. Study Design and Methods: For this study, 51 plasma samples from donors were subjected to antibody titration using the two techniques CAT and CTT. For the purpose of standardization and reproducibility of results, all 51 samples were tested by two technicians and the results obtained were a total of 70 antibody titers. Dilutions were continued to a titer of 1:1024 with the aim of allowing for at least two negative tubes beyond the titer end-point. The statistical analysis of the data has been done in MS-Excel. Results: Out of the 70 titer samples, 57 samples showed identical titer values in the methods performed by both the technicians. 8 samples showed titer values higher in Technician 2 by one dilution as compared to Technician 1, whereas 5 samples showed titer values lower in Technician 2 when compared to Technician 1 (one dilution low in 4 samples and two dilutions low in 1 sample). Conlcusion: CAT titers demonstrated up to a twofold difference as compared to CTT titres, as demonstrated in the figures presented. This disparity is not unusual and can be attributed to the lack of standardization which can be reduced by Column Agglutination Technology. CAT uses specific volumes of red blood cells and the reagents are dispensed by pipettes. Also, the procedure is technically simpler due to the elimination of washing steps and results in well-defined end points. Column Agglutination Technique offers not only sensitivity, but also the best titer turnaround time, eliminating almost 45 minutes of incubation period alone. The results of testing by CAT are comparable to CTT but have the advantages of ease of performance, better standardization of cells, most importantly stable results and reproducibility. Implementation of antibody titers by the gel method would clinically benefit the management of ABO incompatible solid-organ transplant patients.
  2,519 178 -
REVIEW ARTICLES
The human leukocyte antigen system … simplified
Anand Deshpande
July-December 2017, 2(2):77-88
DOI:10.4103/GJTM.GJTM_45_17  
Human leukocyte antigen (HLA) and transfusion medicine go hand in hand. Transfusion medicine experts are involved in transplants, particularly hematopoietic stem cell transplant. A lot of clinical challenges such as febrile nonhemolytic transfusion reactions, transfusion-related acute lung injury, and also graft versus host disease are caused by HLA antibodies. It is a unique genetic system located on chromosome 6 and its protein products situated on white cells. Histocompatibility in transplant scenario is not the only function of HLA antigens but the main role is to present peptides to immune system and regulate cellular and humoral immunity. HLA Class I (A, B, and C) and HLA Class II (DR, DQ, and DP) antigens are different in structure and function. Typing methods have progressed from earlier serology-based techniques to sequence-based typing to next-generation sequencing. Cross matching techniques have also changed from complement-dependent cytotoxicity (which is still considered a gold standard) to microbead-based assay to flow cytometry. Finally, HLA and its disease association has long been established, particularly so in cases of ankylosing spondylitis.
  2,436 209 -
ORIGINAL ARTICLES
Red Blood Cell Alloimmunization in Multi - transfused Patients: A Bicentric Study in India
Amit Agrawal, Ankit Mathur, Sanjana Dontula, Latha Jagannathan
January-June 2016, 1(1):12-15
DOI:10.4103/2455-8893.178005  
Background: It is well-known that alloimmunization to red blood cell antigens resulting from the genetic disparities between donor and recipient is one of the risks of blood transfusion. The antibody screening cells are used to detect unexpected antibodies. The risk of alloimmunization is higher in patients who have received multiple blood transfusions such as thalassemia, other hematological disorders, renal failure patients on dialysis who receive blood transfusions, and females with bad obstetric history. Antibody screening test using 2–3 cells panel is not a mandatory pretransfusion testing in India and is performed routinely in limited blood centers. Materials and Methods: This bicentric study has been carried out to look at prevalence of antibodies in multi-transfused patients who have higher risks of alloimmunization such as patients who have received multiple blood transfusions such as thalassemia, other hematological disorders, renal failure patients on dialysis who receive blood transfusions, and females with bad obstetric history in the North as well as South India. The study was conducted at two blood centers, one regional blood transfusion of North India and one at South India. Totally, 4569 cases were analyzed and 258 patients were selected for antibody screening and identification. Results: Of total 4569 patients, 258 multi-transfused patients were studied. Among these, seven patients (2.71%) were found alloimmunized. The risk of alloimmunization was 2.90% in thalassemia, 0% in chronic renal failure patients, 3.77% in pregnant females with bad obstetric history, and 2.78% in other multi-transfused patients like cancer. Discussion: Regular monitoring through antibody screening and transfusion of blood matched for minor erythrocyte antigens are recommended in these patients.
  2,129 178 -
Bank to bedside: A reliable and efficient transportation of blood by pneumatic tube system
Manish Raturi, Shamee Shastry, Aaditya Shivhare
January-June 2016, 1(1):7-11
DOI:10.4103/2455-8893.178001  
Background: Turnaround time (TAT) is an important quality indicator in blood banking. This study evaluated the effectiveness of the pneumatic tube system (PTS) to reduce TAT and its effect on the quality of the blood products. Materials and Methods: The PTS (Swisslog GMBH, Germany) which connects to 29 stations was installed at our 2032-bedded tertiary care referral center. The system transports the carrier at an average speed of 25 feet/s (7.6 m/s). Acknowledgment slips were sent along with the blood components through this carrier system to know the time of receipt. Quality control parameters were checked before and after PTS transport in 10 bags of each of the blood components (packed red blood cells [PRBC], platelet concentrate, and fresh frozen plasma [FFP]). Data were analyzed using IBM SPSS Statistics 20. Results: PTS was used for 220 events to deliver 69% PRBC (n = 152), 15% FFP (n = 34), 14% platelets (n = 30), and 2% cryoprecipitate (n = 4), respectively, to 11 destinations. The average transport time by PTS was 1.36 ± 0.34 min and for human-based transport, it was 7.92 ± 1.40 min and this difference was found to be statistically significant (P < 0.001). The mean latent time was 5.85 ± 4.39 min. Conveyance in the PTS did not reinforce any negative changes on the quality of any blood component. Conclusion: PTS is rapid and reliable for the transport of the blood products to bedside.
  2,017 116 -
Evaluation of two methods for counting residual leukocytes in leuko-reduced platelets: Nageotte's method and flow cytometry
Rizwan Javed, Sabita Basu, Deepak Kumar Mishra
July-December 2016, 1(2):43-45
DOI:10.4103/2455-8893.189854  
Introduction: Leukoreduced (LR) blood components are used for the prevention of several transfusion adverse effects. Advancement in technology has led to newer methods to count residual leukocytes (rWBC) which miss detection on most standard automated hematology analyzers. Materials and Methods: Samples from thirty eight platelet concentrates (prepared by Buffy-coat method) were randomly taken on the day of preparation for rWBC count using Nageotte's chamber and flowcytometer. Results: The rWBC count on Nageotte's ranged from 2.5 WBC/μL to a maximum of 600 WBC/μL where as the flowcytometric count had a lowest of 1.97 WBC/μL to a highest of 740 WBC/μL. We found that the WBC counts using the Nageotte's method and flowcytometeric method are highly correlated. The concordance correlation coefficient or intraclass correlation coefficient which is a measure of reliability was 0.78 Conclusion: In view of the high concordance in correlation coefficient between the two methods, Nageotte's method could be skillfully performed for assessing leukoreduction in LR platelet concentrates of resource constrained blood banks of developing nations.
  1,870 155 -
SHORT COMMUNICATION
Impact of regulation of blood transfusion services in Islamabad, Pakistan
Hasan Abbas Zaheer, Usman Waheed
January-June 2016, 1(1):29-31
DOI:10.4103/2455-8893.178003  
The strengthening of the regulatory authorities is the backbone of the blood safety systems reforms being implemented in Pakistan. One of the key elements of this reform process is the re-activation of blood transfusion authorities (BTAs) to guide and steer the overall development of the blood sector in Pakistan. The success of these efforts will also help fulfill the government's international commitment in achieving the millennium development goals. The revived Islamabad BTA has in a very short time developed a very successful model of regulation based on constructive nonpunitive approach. A database of facilities providing blood services in Islamabad has been created, their registration and licensing completed and a system of regular inspections and re-inspections developed and capacity building of the technical and management staff conducted. In addition, as a result of strict adherence to the minimum licensing criteria, the standard of practices, equipment, manpower, and financial resource allocations of the blood centers in Islamabad have improved significantly in the public as well as the private sector. The successful demonstration of a practical model of regulation best suited to the prevailing scenario in Pakistan has provided a framework which will be followed in all confederating units through the provincial authorities.
  1,817 183 -
REVIEW ARTICLE
Noninvasive fetal RHD genotyping from maternal plasma
Disha S Parchure, Swati S Kulkarni
January-June 2016, 1(1):21-28
DOI:10.4103/2455-8893.178007  
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.
  1,844 140 1
REVIEW ARTICLES
Social marketing of voluntary blood donation/organ donation
Amit Agrawal
July-December 2016, 1(2):69-71
DOI:10.4103/2455-8893.189856  
Social marketing is the use of marketing principles and techniques to influence a target audience to voluntarily accept, reject, modify, or abandon a behaviour for the benefit of individuals, groups, or society as a whole. Voluntary Blood donation/Organ donation is an ongoing movement. World over, it is well recognised that collection of blood only from voluntary, non-remunerated blood donors from low- risk populations is an important measure for ensuring safe blood. There is also the problem in the realm of organ donation – due to the shortage of organs and donors for stem cells many thousands of patients are dying globally.The concept of social marketing will add donors to pool and help in overcoming deficiency over period of time.
  1,815 132 -
CASE REPORTS
A rare combination of autoimmune hemolytic anemia and primary antiphospholipid syndrome evolving into systemic lupus erythematosus
Swarupa Nikhil Bhagwat, Jayashree Harihara Sharma, Dnyaneshwar Shridharrao Patale
July-December 2016, 1(2):88-90
DOI:10.4103/2455-8893.189845  
The association of autoimmune hemolytic anemia (AIHA) with primary antiphospholipid antibody syndrome (primary APS) has not been well established. However, the occurrence of AIHA in primary APS may define a subgroup of patients with a significant risk for subsequent development of SLE. We report a case of 28 year old male who presented with clinical features of cerebral arterial thrombosis and symptomatic anemia. Subsequently the diagnosis of primary APS and warm type AIHA was made. Patient was treated for cerebral thrombosis along with glucocorticoids and least incompatible red cell concentrates. After a regular follow up of 20 months, the patient developed positivity for antinuclear antibody and oral mucosal ulcers confirming the diagnosis of SLE. This case emphasizes that patients with primary APS should always be evaluated for AIHA as this combination is not impossible, though rare. It poses a significant risk of development of SLE. Transfusion medicine specialist has a role to play in the diagnosis and management of AIHA.
  1,691 75 -
ORIGINAL ARTICLES
A study on knowledge and awareness about blood donation amongst government medical, para-medical and nursing undergraduate students in Jamnagar, Gujarat
Ashishkumar Nathabhai Kanani, Jitendra H Vachhani, Shweta B Upadhyay, Spruha K Dholakiya
January-June 2018, 3(1):46-51
DOI:10.4103/GJTM.GJTM_1_18  
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.
  1,668 79 -
REVIEW ARTICLES
Current status of blood banks in India
Vikas Bhatia, Babita Raghuwanshi, Jyotiranjan Sahoo
July-December 2016, 1(2):72-74
DOI:10.4103/2455-8893.189847  
Despite the current advances in technology in health-care delivery, access to safe blood and blood products and their judicious use remains a big challenge. There is a stark difference between developed and developing nations as less than half of hospitals in developing nation provide blood transfusion services. While the health sector in India has made outstanding accomplishments in the past few decades, it has not reciprocated sufficiently to fulfil the country's objective on blood transfusion facilities. Indian blood transfusion network is plagued by inadequacy of blood storage centers, dominance of private sector over public sectors, lack of proper facilities, storage & quality of services etc. Revamping blood transfusion system is the basic necessity to provide basic care. The challenges to overcome such hindrances may be unification of blood transfusion services to maintain the standard or duplication of services, focus on quality of service provided, adoption of newer technologies, strengthening of reporting and information system to maintain the inventory, emphasis on equitable distribution blood and blood products and many more. These changes can be made through framing a strong policy, functional planning and setting standards.
  1,568 161 -
EDITORIAL
Ethics that apply to blood banks, apply to newspapers as well. How about some responsible reporting by the print media?
Shivaram Chandrashekar
July-December 2017, 2(2):73-76
DOI:10.4103/GJTM.GJTM_47_17  
  1,558 100 -
ORIGINAL ARTICLES
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
DOI:10.4103/2455-8893.189844  
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.
  1,486 139 2
Apheresis platelets in additive solution: Is it a good alternative to conventional group-specific apheresis platelets?
Amit Agrawal
January-June 2017, 2(1):19-23
DOI:10.4103/GJTM.GJTM_5_17  
Introduction: India is among the medium developed countries with a population over 1.25 billion with areas of difficult terrains, landslides, and there is requirement of platelets for dengue outbreaks,cancer patients or patients needing intensive care. Use of nongroup-specific platelets is common and the incompatible plasma comes with complications at times. Thus, finding group-specific platelets have always been difficult. Arranging group-specific donor is really a challenge, especially in cases of international patients, outstation patients, and patients that require numerous platelet transfusions, more so in hospital-based blood banks that have limited voluntary apheresis blood donor registry. Materials and Methods: This study was conducted in multispecialty tertiary health-care hospital of Delhi/NCR where the majority of patients are from a different place or different state or a different country. To make do with the available donors who are often replacement donors of a group different from the patient, platelet additive solution (PAS) was used to replace the incompatible plasma. Use of PAS was implemented on all apheresis prepared using storage solution for platelets (SSP+, Macopharma, France) using apheresis platform. PAS was added after collection of hyperconcentrated platelets units. Control group (n = 10) included patients receiving group-specific platelets during the study. Results: A total of 130 apheresis units were prepared on PAS during the study. 126 units were issued to 77 patients. 99.2% of donors under study were male and 47.7% in age group 18–30 years and 31.5% of blood Group O positive. Final platelet volume prepared was 300 ± 20 ml. Mean platelet volume and product pH were within normal range. Conclusion: Use of PAS for apheresis platelets eliminates the need for group-specific platelets converting all single-donor apheresis platelets to universal platelets, thereby helping in better management without compromise in patient safety.
  1,478 133 -
A study of centralized individual donor nucleic acid testing for transfusion transmitted infections to improve blood safety in Karnataka, India
Ankit Mathur, Sanjana Dontula, Latha Jagannathan
January-June 2017, 2(1):24-28
DOI:10.4103/GJTM.GJTM_8_17  
Introduction: Karnataka state has a total of 176 blood banks, with a total collection of around 650,000 units annually. From January 2014, all units under the Department of Health and Family Welfare services are tested at NAT Lab established at the Central facility and from September 2014, standalone Regional Blood Transfusion Centre was included in the State Government project. Aim and Objective: The aim of the study is to analyze the nucleic acid testing (NAT) for our donor population and demonstrate consolidation of blood transfusion service through a centralized testing center for NAT and also to assess safety benefits of implementing individual donor NAT (IDNAT). Materials and Methods: We collect nearly 40,000 units annually from voluntary donors with 30% repeat donations. The donors undergo strict predonation counseling, donor questionnaire, and medical examination. The units collected are tested for human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) by ECI using VItros 3600. All the units are tested by NAT at Central NAT Lab, screened by Procleix® Panther System by Grifols. Results: From September 2014 to March 2016, total 50,903 samples tested for NAT. Of 50,903 samples, 588 samples (1.15%) were reactive by Chemiluminescence including 265 for HBV, 188 for HCV, and 135 for HIV. Total NAT reactive samples were 254, out of this 11 reactive for HIV-1 (0.02%), 2 reactive for HCV (0.003%), 235 (0.46%) reactive for HBV. There was one HIV and 10 HBV infection cases that were not detected by serology but reactive by NAT. The yield detected is 0.021% or one in 5000. Conclusion: The IDNAT project has helped in preventing window period infections thus reducing the treatment cost and burden on healthcare. It has added benefits in blood safety and should be considered along with the basic quality assured blood transfusion system such as volunteer base for blood donation, provision of donor self-deferral, donor notification, and quality assured sensitive serological methods.
  1,449 93 -
Evaluation of the platelet cross-matching in oncology patients
Sadhana Mangwana, Nikhil Simon
January-June 2016, 1(1):16-19
DOI:10.4103/2455-8893.178006  
Context: Platelet transfusion is an essential part of managing cancer. Refractoriness to platelet transfusion poses great challenge in the treatment of thrombocytopenic patients. Aims: The prospective study was undertaken to correlate and evaluate the result of the platelet cross-matching with posttransfusion count increment and to ascertain the effectiveness of routinely performing platelet cross-matching in Indian perspective. Subjects and Methods: ABO compatible, leukoreduced, random-donor platelets were randomly transfused to 30 thrombocytopenic, oncology patients. Platelet cross-match and platelet antibody screen were performed using solid-phase red-cell adherence (SPRCA) techniques and corrected count increment (CCI) was ascertained. Statistical Analysis: Statistical Package for Social Sciences version 16, Chi-square test were used for statistical analysis. Multivariate analysis and step-wise regression procedure were used to choose the set of best predictors. Results: One hundred and twenty-two units (86%) were negative cross-matched while 20 units (14%) were positive platelet cross-matched. Mean CCI was 28,927 ± 23,007 which was more and statistically significant in females than in males. Four cases (13.33%) showed platelet refractoriness with CCI <5000 including three cases of leukemia (25% of hematological malignancies). Patients with low CCI showed positive cross-match and antibodies against platelets. Conclusion: Platelet cross-match using SPRCA is an effective and rapid first-line approach for selecting compatible platelets as compared to human leucocyte antigen-matched platelets in the treatment of thrombocytopenic cancer patients. Platelet cross-match along with testing for anti-platelet antibodies should be an important component in the management of oncology patients which is less time-consuming and cost-effective than the molecular testing.
  1,403 120 -
Monitoring errors in a blood bank immunohematology laboratory: Implementing strategies for safe blood transfusion
Sudipta Sekhar Das, Ritam Chakrabarty, RU Zaman
July-December 2017, 2(2):118-123
DOI:10.4103/GJTM.GJTM_40_17  
Background: Errors occurring at patient bedside during specimen collection are the most common causes of adverse outcomes. We planned this prospective study to estimate the incidence and nature of transfusion errors, identify the source, site of occurrence, and assess the underlying problems in the system with the aim to prevent the potentially fatal human error. Materials and Methods: The study was performed over a period of 5 years at a hospital based blood transfusion service where all errors and discrepancies both in the recipient and donor samples were reported into an 'incident and error reporting register' and then analyzed. Results: While a total of 72,381 patient samples were received for pretransfusion testing, 43,762 samples were from blood donors for ABO and Rh grouping. A total of 79782 blood components were issued to patients during the study. Out of 229 errors in the blood transfusion chain, 164 (0.22% of total requisitions and 0.21% of total component issued) were reported in patient pretransfusion samples, and 65 errors (0.15%) were reported in donor samples. Majority of the errors were clerical in nature and related to human errors. Of the 164 errors in pretransfusion testing samples, 107 (65.2) were observed in night shift. The overall error frequency per 1000 requisitions was 2.26. Conclusion: Near miss event reporting can prevent potential transfusion associated mortality and morbidity caused by simple human ignorance. A good error reporting not only helps in accurate collection and analysis of data but also makes recommendations that improve transfusion safety.
  1,354 144 -
Blood utilization practices in elective surgical patients in a Tertiary Care Hospital of Uttarakhand
Akshat Kuchhal, Gita Negi, Dushyant Singh Gaur, Meena Harsh
July-December 2016, 1(2):51-56
DOI:10.4103/2455-8893.189843  
Background: Ordering of blood is a common practice in elective surgical procedures. Unnecessary blood orders need to be waived to reduce both workload and financial expenditure. We need to optimize the quantity of blood being cross-matched, by assigning each surgical procedure, a tariff of transfusion. To this effect, the maximum surgical blood ordering schedule(MSBOS) is one such approach. The study was performed with the aim of evaluating whether preoperative blood cross-matching in our hospital is well adjusted to the actual intraoperative blood usage. Materials and Methods: A hospital-based retrospective cross-sectional study was conducted in those patients who underwent elective surgeries in Himalayan Institute Hospital Trust hospital over a period of 1year. Blood requisitions and transfusions were compiled and reviewed. The number of units requested, cross-matched and transfused along with number of patients cross-matched and transfused were collected. The blood bank requisition forms, databases, old surgical records, and discharge sheets were reviewed. Following indices were calculated: (i) Cross-match to transfusion ratio(C/T), (ii) Transfusion probability(T%), (iii) Transfusion index(TI), (iv) MSBOS. Results: Atotal of 2370patients underwent 214 different elective procedures are included in this study. Totally, 1184 red blood cells units were cross-matched, and only 625 units(52.7%) were transfused to 331patients. The overall C/T ratio calculated was 1.8, TI was 0.5 and T% was 61.7%. All these figures were found to be within the desirable range. Based on these indices, MSBOS was formulated for each procedure. Conclusion: The study indicated an adequate overall ratio of C/T, T%, and TI except a few surgeries that showed transfusion indices beyond accepted levels. Developing a blood ordering policy(MSBOS), to guide the clinicians regarding blood usage can decrease over ordering of blood thereby reducing unnecessary compatibility testing, returning of unused blood, and wastage due to outdating.
  1,345 129 -
Analysis on discard of blood and its products with suggested possible strategies to reduce its occurrence in a blood bank of tertiary care hospital in Western India
Ashishkumar Nathabhai Kanani, Jitendra H Vachhani, Spruha K Dholakiya, Shweta B Upadhyay
July-December 2017, 2(2):130-136
DOI:10.4103/GJTM.GJTM_34_17  
Background: Blood is precious and should be utilized judiciously with minimal wasting. By analyzing the data and the reasons for discard, the blood transfusion service can develop plans to evaluate causes that lead to discard of blood and its components and interventions that can be used to optimize their use by training and education. Aim: (1) The aim of the study was to evaluate causes that lead to discard of blood and its components and interventions that can be used to optimize their use by training and education, (2) to introduce possible strategies for minimizing blood wastage, and to observe and compare the discard rate after the implementation of strategies. Materials and Methods: The study of analysis on discard of blood and its products was carried out retrospectively from January 2014 to December 2016 (36-month period), and the data were collected from the blood bank database system using Easy Software in the Department of Transfusion Medicine, Shri M P Shah Govt. Medical College, Jamnagar in Western India. The results were analyzed using Microsoft Excel 2007 database sheet, percentage calculated and Chi-square test was applied between different variables with P value set a significant when <0.05. Results: A total of 66,255 blood units were collected during the study period of 36 months. Out of 66,255 blood units collected, 44,617 were whole blood (WB) whereas components were prepared from remaining blood units. A total of 21,638 packed red blood cells (PRBCs), 6840 platelet concentrate (PC), and 14,372 fresh frozen plasma (FFP) were prepared. Average discard rate of the present study was 6.95%. Discard rate for WB, PRBC, PC, FFP was 3.15%, 2.26%, 28.39%, and 5.36%, respectively. Conclusion: To minimize wastage of blood, there should be proper implementation of blood transfusion policies and coordination between hospital and blood bank staff. Strict adherence to donor selection criteria, taking proper predonation history and counseling, software to identify transfusion transmitted infection (TTI) positive donors, and deferring suspected professional donors who have been screened previously may help in reducing discard due to TTI positivity. Process improvements such as technical expertise in phlebotomy, prevent red blood cells (RBC) contamination during platelet and FFP preparation, precaution during thawing of FFP to prevent leakage, and increased use of apheresis technique prevent wastage of blood components. Continued medical education for technical staff to maintain self-audit, tracking quality indicators of processing and preparation of the blood components, rational use of blood and components, and review the blood management system will further help in reducing the discard rate.
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REVIEW ARTICLE
Blood donor notification: Boon for the community, bane for blood donors, and blood centers?
Shivaram Chandrashekar, Ambuja Kantharaj
January-June 2018, 3(1):6-12
DOI:10.4103/GJTM.GJTM_18_18  
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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ORIGINAL ARTICLES
Clinical audit of fresh frozen plasma usage in a Tertiary Care Hospital of Islamabad, Pakistan
Usman Waheed, Muhammad Taimoor, Lubna Naseem, Hasan Abbas Zaheer
July-December 2016, 1(2):61-65
DOI:10.4103/2455-8893.189851  
Introduction: The supply of blood components in Pakistan far outstrips the demand. In addition, appropriate and rationale use of blood components is not widely practiced. To optimally utilize the limited supply of blood products, it is important to identify and define the gaps in practices and system. The specific aim of the study was to document the practices of the use of fresh frozen plasma (FFP) in a premier tertiary care hospital of Islamabad, Pakistan. Materials and Methods: The study was carried out on 107 randomly selected patients who received FFPs in various clinical units of the Shaheed Zulfiqar Ali Bhutto Medical University Hospital from March to October 2014. Information was retrieved from the transfusion request forms and evaluated according to the American College of Pathologist guidelines for the use of FFP. A questionnaire was also developed for interviewing the senior doctors from each specialty to have their feedback about the transfusion services provided. Nineteen clinicians were randomly selected for this purpose. Results: Requests from 107 patients for 460 FFPs were studied (actual number of FFPs issued was 278). Nearly 68.3% (n = 73) of the patients were males and 31.7% (n = 34) were females. Majority of the units were requested from thalassemia and hemophilia center (40.6%). The patients enrolled in the study had multiple disorders, majority being with coagulation disorders at 40.1% (n = 43). Nearly 98.5% (n = 138) of the request forms were brought to blood bank by the patient attendants. Seventy-three (52%) FFP units were appropriately transfused while 67 (48%) were inappropriately transfused. The most inappropriate use of FFP was seen in Mother and Child Health Centre (MCHC), Oncology, Emergency and Casualty, and the most appropriate use was seen in thalassaemia centre, paediatric units, and medical intensive care unit. Clinician interviews indicate poor knowledge base and inappropriate practices. Conclusion: The study highlighted the inappropriate use of FFPs in a tertiary care hospital and threw light on poor transfusion practices and the lack of implementation of the principles of haemovigilance in the utilization of FFPs. Specific recommendations include, administrative intervention with regular screening of requests by blood bank doctors and senior doctors of the departments using FFP and establishment of guidelines in departments regarding the use of blood components including FFP.
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EDITORIAL
Coping with the burden of thalassemia: Aiming for a thalassemia free world
Ambuja Kantharaj, Shivaram Chandrashekar
January-June 2018, 3(1):1-5
DOI:10.4103/GJTM.GJTM_19_18  
  1,151 188 -
EDITORIALS
Blood banker's ethical dilemma: To assure quality or contain costs
Shivaram Chandrashekar
January-June 2017, 2(1):1-4
DOI:10.4103/GJTM.GJTM_13_17  
  1,171 91 -
SHORT COMMUNICATIONS
Safe red cell transfusion, a challenge in auto-immune hemolytic anemic patients
Biplabendu Talukdar, Subrata Das, Sandip Chanda, Rony Roy Chaudhury, Prasun Bhattacharjya
July-December 2016, 1(2):78-80
DOI:10.4103/2455-8893.189848  
The definition of Auto-Immune Hemolytic Anemia (AIHA) is an increment of anti erythrocyte antibodies (AEA) which mediate the destruction of circulating erythrocyte antigens. Antibodies develop against one's own erythrocyte antigens. Diagnosis of AIHA is made on the basis of auto-agglutination and direct anti-globulin test (DAT). The specificity of erythrocyte antibody is often difficult to identify especially in emergency. This study is based on a case of AIHA on a 62 years old female patient. She also had underlying hypothyroidism, diabetes mellitus and Hypertension.
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