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   Table of Contents - Current issue
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January-June 2021
Volume 6 | Issue 1
Page Nos. 1-116

Online since Saturday, May 29, 2021

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EDITORIAL  

Overcoming challenges in clinicians transfusion practices: A prerequisite for safer transfusions Highly accessed article p. 1
Rajesh B Sawant
DOI:10.4103/2468-8398.317182  
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GUEST EDITORIAL Top

Moving to the next level of precision medicine with patient blood management  Highly accessed article p. 3
Shamee Shastry
DOI:10.4103/2468-8398.317183  
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ORIGINAL ARTICLES Top

Assessment of knowledge, attitude, and practice among health professionals in an oncological hospital on voluntary blood donation - Investigating their participation in programs to promote blood donation Highly accessed article p. 6
Eugenia Kouka
DOI:10.4103/GJTM.GJTM_107_20  
Background and Objectives: Greece, despite its relative blood sufficiency and high international ranking in terms of the number of blood donors compared to its population, faces significant challenges due to the low rate of voluntary blood donors, as well as the demographic aging of the population in the medium to longer term. The purpose of the study is to evaluate the knowledge, attitudes, and practices (KAP) of health professionals at the Oncological Hospital “Metaxa” in Greece, regarding voluntary blood donation (VBD). The objective of this research is to investigate the effect of sociodemographic characteristics of health professionals as regards KAP on VBD and to find factors related to their participation in VBD promotion policies. Methods: The study was based on the review of the relevant literature, followed by empirical research employing the KAP model. The study was conducted on 254 health professionals of the Oncological Hospital “Metaxa.” in the period December 20, 2019 to March 3, 2020, using a questionnaire. The data were analyzed using SPSS version 21 with P value set at 0.05 for statistical significance. Results: The research findings indicate a high score in the knowledge and attitudes of health professionals regarding blood donation (BD), but low performance in the practice. BD correlates to knowledge and attitudes as well as gender. The majority of the health professionals responded positively in terms of their participation in BD programs. Gender, age, professional position, and years of service were associated with participation in BD programs. Conclusions: The results of the research justify the possibility of activating health professionals in policies to promote VBD, to the extent that due to their knowledge and positive attitude regarding BD, they can promote VBD in different population groups and ultimately contribute to an increase in the size of blood supply.
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Hemovigilance: An analysis of adverse effects of blood donation among blood donors in a tertiary-care center p. 15
Anila Mani, Debasish Gupta
DOI:10.4103/GJTM.GJTM_104_20  
Background and Objectives: Hemovigilance is defined as a set of surveillance procedures covering the whole transfusion chain that is intended to collect and assess information on unexpected or undesirable effects resulting from the therapeutic use of labile blood products and to prevent future occurrence and recurrence. The primary goal of the study was to reduce the incidence of adverse events among blood donors and to make blood donation a pleasant experience. Prevention of adverse reactions at the time of blood donation is an important aspect of blood donor motivation and blood donor retention for future blood donations. Methods: This is a one and half year's prospective study which was conducted by the department of Transfusion Medicine. The study assessed untoward blood donor reactions, as a measure to further maximize the elimination of untoward reactions encountered during or after blood donation to secure a healthy donation-transfusion chain. We analysed the causative factors that can lead to complications in blood donors at different phases of blood donation like pre-donation, during donation and post donation phases. Results: Out of 8180 whole blood collections, 252 blood donor complications were observed during the study period. Out of this, 8.73% (n=22) adverse reactions were observed during donation at blood centre, while 91.27% (n=230) reactions occurred in blood donation camps. Among the camp donations, 61.30% (n=141) were at outdoor camps and 38.70% (n=89) were inside Blood Mobile. We had 83.23% (n=6808) of male blood donors and 16.77% (n=1372) of female donors. Out of the 66 females who developed complications, majority were belonging to the age group of 18-25 years. We had 37.90% (n=3100) first time donors and 62.10% (n=5080) repeat donors. Among the repeat donors, 34.59% (n=1757) were regular repeat donors and 65.41% (n=3323) were irregular repeat donors. Out of 130 first time donors who developed complications, 91.5% (n=119) were systemic reactions. 57.1% (n=12) of regular repeat donors and 80.2% (n=81) of irregular repeat donors developed systemic complications. Conclusion: Hemovigilance reporting has reinforced our blood donor safety as well as transfusion safety. Regular reporting of the adverse donor complications helped us to improve proper documentation of all aspects of a complete blood donation sequence not only by the medical officers but also by the blood centre staff members.
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Two sample policy: An effective way to counter wrong blood in tube p. 22
Rasika D Setia, Mitu Dogra, Ramesh Yadav
DOI:10.4103/GJTM.GJTM_94_20  
Background and Objectives: Pretransfusion testing has undergone remarkable changes over the past few decades starting from manual methods to semi-automation to full automation, but sample collection from the right person is out of scope of blood center. Through this study, we tried to address this issue by introducing two-sample policy in our institute. The objective of this study is to emphasize the importance of using two different samples for type and screen and crossmatch. Methods: This is a retrospective study extending over a period of 3.5 years (January 2015–June 2018) in a tertiary care health center. Retrospective data collections were done for the period post implementation of two-sample policy in the institute. As per the two-sample policy, two samples of the same patient would be collected, one at the time of type and screen and other at the time of blood component arrangement request. In case of any discordance between the two samples, incident is generated. Results: Of total 110,949 requests, 85,326 blood/blood components were issued, 56879 of which were for packed red blood cells (PRBCs) and a total of 34,922 PRBC units were released in the study duration. A total of 22/(0.06%) errors were recorded as grouping discrepancy between type and screen sample and sample received for blood component arrangement request. Incidentally, all 22 cases were for the arrangement of PRBC. Out of 22 errors, 20 were near misses and were detected in immunohematology laboratory at the time of compatibility testing and 2/22 (9.09%) errors were actual no harm events. Conclusion: The problem of wrong blood in tube (WBIT) is still a challenge faced by many laboratory persons. The issue can be resolved by training dedicated staff for sample collection. Although this policy has many drawbacks, such as added costs of sample collection and double testing, inconvenience to the patient, delay in providing blood, and increased type O blood use, we would like to emphasize that it would be helpful in error reduction.
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Is convalescent plasma therapy effective for COVID-19? Our initial experience at tertiary care center Highly accessed article p. 26
Neha Jayant Hurkat, Venkat Ramulu, Srinivas Gurram
DOI:10.4103/GJTM.GJTM_111_20  
Background and Objectives: Previous studies suggest that convalescent plasma (CP) may be effective in improving survival rates in COVID-19 patients. But still there is uncertainty regarding effectiveness of CP in improving mortality or clinical improvement in COVID-19 patient as randomized studies were short of statistical significance. We aim to report our initial experience with CP transfusions for COVID 19 patients at a tertiary care set up with regard to its efficacy and safety in patients at various stages of disease. Methods: This is an observational study which includes 324 patients who have received convalescent plasma from 1st July to 31st August 2020 in a tertiary care set up. The outcome of the study was measured by recovery of the patient and discharge from hospital in stable condition. Recovery was defined as no fever for 3 consecutive days, respiratory rate and oxygen saturation returning to normal at room air and patient being hemodynamically stable. Results: The overall recovery was attained in 249/324 patients (76.9%) and 75/324 patients (23.1%) died in hospital. In moderate disease patients the recovery rate was found to be 96.1%. In Severe disease patients, 38.8% recovered and in critically ill patients, 23.4% recovered. 80.6% patients recovered who received plasma within 5 days of hospitalization where as only 67.4% patients recovered who received plasma after 5 days of hospitalisation indicating earlier administration of CP in disease course has better outcomes. SARS-CoV 2 IgG ab levels of CP units correlated with outcome. The recovery was significantly higher in patients who received CP with higher IgG values (>12) as compared to patients who received CP with lower IgG values (<12). No adverse effects of CP transfusion were reported. Conclusion: This study showed CP therapy was well tolerated and could potentially improve the clinical outcomes. Thus it is reasonable to consider CP therapy as an effective, safe and feasible therapeutic option for COVID-19 in the early course of disease.
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Maximum surgical blood ordering schedule for cancer surgeries: An institutional study p. 33
Rima Kusumgar
DOI:10.4103/GJTM.GJTM_71_20  
Background and Objectives: Although blood ordering is a common practice in surgical field, the average requirement for a particular procedure is usually based on subjective anticipation of blood loss rather than on evidence-based estimates. In the absence of an explicit maximum blood demand policy, ordering for blood transfusion is frequently based on subjective anticipation of blood loss instead of evidence-based estimates of average requirement in a particular surgery. Maximum surgical blood order schedule (MSBOS) is a criterion developed from institutional usage statistics providing a figure for the number of units to be crossmatched for any given surgical procedure. Aims and objectives of this study were to prepare and implement MSBOS, to increase blood availability to other medical patients and surgical patients. Promote efficient use of blood inventory, workforce, and consumables. This also helps to reduce unnecessary pre transfusion testing and cross match studies. Methodology: A retrospective analysis of various surgeries was done and then, a maximum surgical blood order schedule (MSBOS) was prepared and implemented and various parameters were analyzed in the largest tertiary cancer care hospital of Gujarat over a 2-year period. The goal was to study the blood ordering strategies in the hospital for surgical patients and evolve an MSBOS. The total units demanded and the corresponding units issued were studied for surgical patients. Thereafter, transfusion probability, transfusion index (TI), and ratio of units crossmatched to actual units transfused (C/T ratio) were calculated. Transfusion guidelines for all surgeries requiring transfusions were proposed and implemented. Results: Crossmatch to transfusion ratio improved from 9.54 to 3.68. Transfusion probability was down to 30.04 from 13.24 and TI increased to 0.31 from 0.179. P value by using Z test for all three parameters was <0.05. Conclusions: Z-test calculation showed significant statistical improvement in the above three measures. The study also identified the common cases where “Type and Screen” (T and S) procedure could be introduced in cases where the transfusion probability was low. The implementation of this proposal will avoid over ordering of blood which is beneficial to the institute.
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A retrospective study of single-unit transfusion in a tertiary care center of Southern India p. 38
Soumya Das, Abhishekh Basavarajegowda
DOI:10.4103/GJTM.GJTM_51_20  
Background and Objectives: Single-unit transfusions continue to be a widespread transfusion practice. Single-unit red blood cell (RBC) transfusions were treated with substantial denunciation in the past but recently have been reviewed as to whether it is acceptable or could be acceptable. This study was undertaken to observe the overall profile of the patients receiving the single-unit transfusion and analyze the possible rationale of such transfusion. Methods: This was a retrospective record-based study conducted in multispecialty tertiary level care teaching hospital over a period of 1 year from January to December 2017. Variables included were age, gender, diagnosis, indication for transfusion, pre- and post-hemoglobin, additional modality of treatment received including other blood components and length of hospital stay. Qualitative variables were described as number and percentages, and quantitative variables as number, mean, and standard deviation. Results: During the study, 50,880 blood components were issued out of which, packed RBCs (PRBCs) accounted to 19760. Twenty-four percent (4742 units) of the total blood units were transfused as single unit of PRBC. 52.1% of these single-unit transfusions were carried out by the surgical specialties. Conclusion: Single-unit transfusions are more common in medical specialties probably due to the chronic nature of the diseases. However, even in surgical specialties, especially those striving toward reducing blood usage and the ones operating in more of an elective setting, single-unit transfusions were higher.
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Blood component therapy in coronavirus disease-2019 patients hospitalized in a tertiary care center in eastern India p. 43
Sudipta Sekhar Das, Rathindra Nath Biswas
DOI:10.4103/GJTM.GJTM_95_20  
Background and Objectives: Most patients with coronavirus disease-2019 (COVID-19) do not need blood transfusion, and only a subset of critically ill patients requires transfusion. Here, we describe the pattern of blood usage in COVID-19 patients in our hospital with regard to indications, clinical and laboratory evaluations, and blood and blood component transfusions. Methods: This is a retrospective study that included 34 hospitalized transfused patients admitted with clinical features and diagnosis of COVID-19. Demographic, clinical, laboratory, and blood transfusion details were obtained from patient files and blood bank software. Statistical analysis was done using the IBM SPSS statistical package. Results: Among the 419 hospitalized COVID-19 patients, 34 (8.1%) received blood transfusion. Levels of D-dimer, serum ferritin, and interleukin-6 as high as 8545 ng/mL, 8486 ng/mL, and 256 pg/mL, respectively, were observed in few patients. Comorbidity was demonstrated in 91.2% of transfused patients. A total of 6 (17.6%) patients succumbed to disease. Packed red blood cell was the main blood component transfused to COVID-19 patients followed by platelet (PLT) and plasma products. A rise in trend in blood utilization was demonstrated from March to June 2020 with a dip in July 2020. Compared to other months, more patients required PLT concentrates in June 2020. Conclusion: Blood utilization in COVID-19 patients is usually low and does not affect the blood inventory significantly. Most transfused patients have been critically ill, and the trend in blood utilization in COVID-19 patients may be difficult to ascertain.
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Impact of COVID-19 Pandemic and Subsequent Lockdown on Blood Transfusion Service in a Tertiary Healthcare Institute of South India – A Learning Experience p. 49
Parmatma Prasad Tripathi, Vijay Kumawat, Gopal Kumar Patidar
DOI:10.4103/GJTM.GJTM_106_20  
Background and Objectives: Coronavirus disease-19 (COVID-19) pandemic has affected people all over the world and poses challenges to health-care services. Lockdown was first response strategy implemented by governments including India to prevent spread of coronavirus 2. The lockdown and anxiety among public had severely affected transfusion services. This paper analyses the impact of COVID-19 pandemic and lockdown on blood transfusion services. Methods: A retrospective analysis of the transfusion services for 5 months was carried out. The data regarding blood collections, blood donation camps, blood issued, and therapeutic plasma exchange (TPE) performed were collected and analyzed during 3 phases of the study period, i.e., phase 1 (pre-lockdown, 84 days), phase 2 (complete lockdown, 40 days), and phase 3 (partial lockdown, 28 days), and compared. Results: A significant drop (P = 0.010) was observed in blood donation from phase 1 to phase 2 but slight nonsignificant improvement was found from phase 2 to phase 3. The issue of blood was significantly reduced from phase 1 to phase 2 (P < 0.0001) and improved from phase 2 to phase 3 (P < 0.0049). There was a significant reduction (P < 0.00001 and 0.002) in patients referred for TPE during two phases of LD. Conclusion: There is significant decrease in blood supply and utilization due to pandemic and lockdown. An emergency blood management plan is required which can include donor education focusing to alleviate donor hesitation, relaxation to donor selection criteria, blood drive planning with inventory management and ensuring staff and product safety.
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Harvesting COVID convalescent plasma using latest-generation apheresis systems: Analyzing factors associated with donor, machine, and manufactured product p. 54
Sudipta Sekhar Das, Rathindra Nath Biswas, Subrata Sen
DOI:10.4103/GJTM.GJTM_109_20  
Background and Objectives: Transfusion of COVID convalescent plasma (CCP) has been found to be a useful and logistically feasible therapeutic strategy in COVID-19. Appropriate guidelines describing donor eligibility criteria, CCP collection and storage, and clinical transfusion of CCP have been described. In this study, we discussed the collection of CCP by plasmapheresis, quality of product obtained, and donor adverse reactions associated with CCP collection. Methods: This observational study included 209 screened eligible donors and 186 procedures of plasmapheresis for the collection of CCP. Donor selection and CCP collection were done as per the guidelines described by regulatory bodies. Statistical analysis was done using the SPSS statistical package. Results: The median age of the eligible donors was 42 years, with a male preponderance. The mean anti-severe acute respiratory syndrome coronavirus 2 immunoglobulin G value (S/Co) was 11.8 in eligible donors. The total mean whole blood volume processed to collect the targeted plasma volume, mean utilization of anticoagulant, and mean time needed to complete the procedure were significantly more in the Spectra Optia cell separator (P < 0.05). Quality of the plasma separated by Trima Accel and Spectra Optia was found to be comparable. A total of 9 (5.1%) donors experienced adverse events during or after plasmapheresis. Conclusion: Plasmapheresis using new-generation automated cell separators has the potential to generate CCP of optimized quality and potency. More emphasis is needed on the quality control of CCP with regard to the establishment of defined quality markers and their allowable limits. Appropriate donor vigilance, donor selection, and equipment management during the procedure may significantly prevent adverse events related to plasmapheresis.
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Crossmatch incompatibility, indwelling experience from a single center, Bangladesh p. 61
Sonia Shormin Miah, Mostofa Ahmed Doha, Ashadul Islam, Quader Islam
DOI:10.4103/GJTM.GJTM_110_20  
Background and Objectives: Crossmatch incompatibility among the blood donor and recipient is common. The cause for which may vary in patients despite rational transfusion practices. Provision of appropriate blood components can also be complicated by transfusion, pregnancy, exposure to drug, or various diseases. Therefore, the reasons for assessing the crossmatching incompatibility are important in transfusion safety. The present study was conducted to determine the prevalence of crossmatch incompatibility in this region and the reasons behind it. Methods: In this retrospective observational study, 32,403 crossmatch data were reviewed from crossmatch register between July 2018 and June 2019. Crossmatch was performed with both saline and antihuman globulin method. Incompatible crossmatch was evaluated further. Results: About 0.15% (n = 50) of patients showed crossmatch incompatibility: of this, 66% were female and 34% male. About 80% of crossmatch incompatibility was associated with multiple transfusions; of these, direct antiglobulin test (DAT) was positive in 78% (n = 39) and indirect antiglobulin test (IAT)/antibody screen was positive in 68% (n = 34) of patients. Both DAT and IAT were positive in 46% (n = 23). Further antibody identification was done. Conclusion: This study highlights the need for introducing antibody screening before compatibility testing, especially in multitransfused individuals.
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An analysis of association of human leukocyte antigen and liver disease patients in a tertiary care hospital, India p. 65
Simmi Mehra, Aseem Kumar Tiwari, Chhavi Rajvanshi, Rajni Chauhan, Randhir Sud, Arvinder Singh Soin
DOI:10.4103/GJTM.GJTM_46_20  
Background and Objectives: In addition, the role of human leukocyte antigen (HLA) in transplantation, importance of HLA in disease susceptibility, and protection has been widely studied. The aim of the present study was to find out the HLA allelic frequency (HLA-A,-B,-DRB1) and its association with liver diseases. Methods: The present study was done for the duration of 4 years from 2013 to 2017 in a tertiary care center which primarily caters to north Indian patient population. A total of 429 patients were studied. The HLA genotyping was performed by molecular method using commercial available low resolution ABDR sequence-specific oligonucleotide probe-based method (Luminex platform). Results: There was an increased association of HLA-A*01 (n = 9, 18.6%), HLA-B*15, B*35, B*40, B*44 (n = 5, 11.6%), and HLA-DRB1*15 (n = 9, 20.9%) in 43 patients with hepatitis B virus (HBV)-related disease. There was an increased association of HLA-A*24 (n = 9, 20.7%), HLA-B*35, B*40 (n = 14, 15.2%), and HLA-DRB1*15 (n = 17, 18.5%) in 92 patients with alcohol-related disease. An increased association of HLA-A*11 (n = 30, 19.6%), HLA-B*35 (n = 24, 16.8%) and HLA-DRB1*15 (n = 28, 19.6%) in 143 patients with hepatitis C virus (HCV) related disease. Conclusion: This is possibly the first study in the north Indian patients having liver diseases related to HBV, HCV, and alcohol related with respect to A, B, and DR loci previous studies from India were conducted to see disease association of HLA class I and class II with respect to HCV only.
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Gray zone sample testing in enhancing blood safety p. 72
Maheshkumar Kandukuri, Sudhir Kumar Vujhini, Shanthi Bonagiri, Murali Krishna Bogi
DOI:10.4103/gjtm.gjtm_2_21  
Background: Gray zone samples with optical density (OD) lying between cutoff OD and 10% below the cutoff OD (cutoff OD × 0.9) were identified during routine Transfusion Transmissible Infections (TTI) screening. Enzyme-linked immunosorbent assay (ELISA) used for this purpose can sometimes fail to detect blood donors who are recently infected or possessing the low viremia. Estimation of a gray zone in ELISA testing and repeat testing of gray zone samples can further help in reducing the risks of TTI in countries where nucleic acid amplification testing for TTIs is not feasible. Methods: Repeat ELISA testing was done on gray zone samples in duplicate, the samples showing both OD values below gray zone were marked nonreactive, and samples showing one or both OD values in the gray zone were marked indeterminate. The samples on repeat testing showing one or both OD above cutoff values were labeled reactive. Results: Out of the 196 gray zone samples, 33 samples turned out to be reactive (as shown in the table), 39 samples were nonreactive, and 124 samples were again in the gray zone and were labeled as indeterminate. Conclusion: Estimation of gray zone samples with repeat testing can further enhance the safety of blood transfusion in resource-poor developing nations where more sophisticated and sensitive methods such as nucleic acid amplification test (NAT) is not available in all the blood banks.
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COVID-19 immunoglobulin G antibodies in healthy blood donors paving way to herd immunity p. 76
Rateesh Sareen, GN Gupta, Pankaj Agarwal, Shyan Saini
DOI:10.4103/gjtm.gjtm_9_21  
Background and Objectives: Herd immunity is the immunity or resistance to particular infection that occurs in group of people when a very high percentage of individuals have been vaccinated or previously exposed to infection. The goal of this study was to assess the development of herd immunity to COVID-19 in parts of Western India. Methods: The study was conducted at a tertiary care hospital in India on routine blood donors who were tested for SARS-CoV-2 immunoglobulin G (IgG) antibody. We systematically investigated 808 healthy donors at various points of time in the 3-month period starting from September 2020 to November 2020 for SARS-CoV-2 seroprevalence. Results: The results of November month show a sudden increase (51.96%) in the later half. The seroprevalence in healthy donors in other towns and cities shows an aggregate average of SARS-CoV-2 IgG antibody 13.59% (200/1472) as against Jaipur city with 36.12% (292/808). Deedwana has higher seropositivity in blood donors 31.5% (24/76) whereas Sujangarh and Jhunjhunu did not have any donors with seropositive status. Conclusion: Our findings could be the tip of iceberg of emerging herd immunity to SARS-CoV-2 infection in India. Future research will determine how long these antibodies will last. Will they be protective toward future COVID-19 infection?
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RH phenotype, ABO and kell antigens, alleles and haplotypes frequencies in North Indian blood donor population p. 81
Sadhana Mangwana, Nikhil Simon, Lalitesh Sangwan
DOI:10.4103/gjtm.gjtm_23_21  
Background and Objectives: ABO, RH and Kell blood group systems are clinically significant blood group systems among 36 blood group systems having total of 360 blood group antigens which cause most cases of alloimmunization following blood transfusions or pregnancy. India has regionally and ethnically very diverse population in different demographic areas. Due to different antigenic expression in different population, knowledge of antigen frequencies among their local and regional donor population is important to assess the risk of antibody formation, probability of antigen negative blood for patients having alloantibodies, inventory management and database for rare antigens thus enhancing patient safety. Aim: To know and compare phenotype prevalence, frequency distribution of ABO, RH and Kell antigens and Alleles in blood donors. Methods: A prospective study was conducted in a tertiary care hospital in North India over three years period. ABO, RH D grouping, RH and Kell phenotypes were performed on blood donors. Hardy Weinberg's equations were used to calculate ABO, RH and Kell allele frequencies and were analyzed. Results: During the study period, 24745 healthy individuals donated blood at Tertiary Care hospital; with 97.26% male and 2.74% female population. Prevalence of ABO antigens were B =37.74%, O = 31.38%, A = 21.77% and AB = 9.09% with allele frequency for O = 0.560, B = 0.266, A = 0.169 and AB = 0.091. The commonest RH phenotype observed was DCCee followed by DCcee, DCcEe, DccEe while commonest RH negative phenotype were ccee and Ccee. Homozygous phenotypes were absent in our population. Amongst five RH antigens phenotyped serologically, highest prevalence was of e antigen followed by D, C, c and E being the lowest. Prevalence of Kell phenotype was 2.57% (K) while that of k as 97.43% with allele frequencies of K and k as 0.0252 and 0.986 respectively. Discussion: Genetic variability in different population result in varied expression of red cell antigens in different races. Knowledge of varied frequency and phenotypic expression of major clinically relevant antigens and RH haplotypes in these blood groups systems would help in more rational approach for blood transfusion, decreasing alloimmunization thus enhancing blood safety.
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SHORT ARTICLES Top

Response to convalescent plasma is not influenced by patient blood type p. 86
William R Hartman, Aaron S Hess, Joseph P Connor
DOI:10.4103/gjtm.gjtm_36_21  
Background: SARS-CoV2 virus is associated with 580,000 deaths and 32.5 million cases of COVID-19 infection in the United States. Data exist suggesting a correlation between blood type and disease acquisition and severity. No such data exist between blood type and disease response to convalescent plasma therapy. Methods: Forty-four hospitalized COVID-19 patients who were transfused with type-specific convalescent plasma were followed to determine therapeutic response and disease survivability. Statistical significance was determined as to whether a correlation between blood type and convalescent plasma treatment exists. Results: No statistically significant correlation exists between blood type and hospital length of stay or disease survivability in hospitalized COVID-19 patients who received convalescent plasma. Conclusion: Blood type does not influence outcome response to convalescent plasma in hospitalized COVID-19 patients.
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Justification of blood requisition: A review in a tertiary care trauma center in Eastern India p. 89
Nitika Kesarwani, Shalini Bahadur, Saurabh Mahajan, Anand Kumar
DOI:10.4103/GJTM.GJTM_96_20  
Background: The purpose of this study is to compile and review the blood utilization in various surgical departments in a tertiary care trauma center. To monitor and improve transfusion practices, analysis of effective usage of blood and its components is necessary. Methods: A retrospective cross-sectional study was done in the department of pathology in our center for a period of 6 months. Data from blood requisition forms, transfusion forms, and issue register were compiled and reviewed. The number of units requested cross-matched and transfused for every patient was collected. Statistical Analysis: The data were entered in SPSS version 20 and analyzed through the calculation of blood transfusion parameters: (i) cross-match to transfusion ratio (C/T), (ii) transfusion probability (T%), and (iii) transfusion index (TI). Results: 2724 units of blood was cross-matched and 2108 units of blood was transfused. The overall C/T ratio calculated was 1.29, TI was 0.77, and T% was 88.2%. All these figures are under the desirable range. Conclusion: The study concluded that though the trauma center in our hospital meets the parameters required for blood transfusion, yet the departments requiring blood should critically analyze the blood requisitions to minimize the blood bank load and cost.
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CASE REPORTS Top

Role of lipoprotein apheresis in the management of familial hypercholesterolemia p. 92
Shamanna Seshadri Iyengar, Ambuja Kantharaj, Chandrashekar Shivaram, DS Hemantha Kumara, Roopa Murgod, G Shreedhara
DOI:10.4103/gjtm.gjtm_37_21  
Familial Hypercholesterolemia (FH) is an autosomal dominant disorder due to a congenital absence of low-density lipoprotein receptor (LDL-R) that transports cholesterol-carrying lipoprotein particles into cells. Absence of these receptors results in increased levels Non-HDL lipoproteins (like LDL, VLDL, Triglycerides, Lipoprotein a) which predisposes to premature atherosclerosis and cardiac complications. Treatment modalities for this condition include use of high intensity statins and diet control. However some of these patients with familial hypercholesterolemia do not respond to diet and drug therapy. Here Lipoprotein apheresis is believed to be a feasible and effective option. Lipoprotein apheresis is a relatively new technique in India used to treat familial hypercholesterolemia. Lipoprotein apheresis using cascade filter is effective in reducing non-HDL lipoprotein levels by 60-75% in a single procedure. However, the disadvantage of the procedure it is expensive and needs to be repeated every 2 weeks for lifetime. This case is being reported for rarity of this condition (1 case per million) and more so the rarity of the use of Lipoprotein apheresis procedure in our country.
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Diagnosis and management of hemolytic uremic syndrome in children: A transfusionist's perspective p. 96
Suvro Sankha Datta, Dibyendu De, Archana Naik
DOI:10.4103/gjtm.gjtm_20_21  
Hemolytic uremic syndrome (HUS) is one of the important causes of severe acute kidney injury in children. Among many etiologies which are responsible for this syndrome, herein we are reporting two interesting cases of HUS caused by anticomplement factor H autoantibodies and Streptococcus pneumoniae infection where the transfusion medicine department played a crucial role in early diagnosis and prompt management.
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HLA class II positivity by lysate crossmatch in renal transplant scenario-dangerous if ignored!!! p. 100
Rajesh B Sawant, Pooja Mehta, Deepali Naker
DOI:10.4103/gjtm.gjtm_22_21  
The detection of antibodies before transplantation is an important step in assessment of patient immunological risk and exclusion of incompatible donors. Many centers have now implemented donor-specific antibody (DSA) along with complement-dependent cytotoxicity crossmatch (CDC XM) for renal transplant cases. A 34-year-old male with end-stage kidney disease was referred for an ABO-compatible transplant from his mother. The CDC XM done 30 days before transplant was negative. DSA XM was negative for Class I (median fluorescence intensity [MFI] 189) and positive for Class II (MFI 1671). Since CDC and DSA Class I were negative, the nephrologists went ahead with the transplantation. On day 6 posttransplant, serum creatinine showed a rising trend (up to 2.13 mg/dl), and therefore, renal biopsy was done which showed mild acute tubular necrosis with positive C4d staining. DSA XM performed on day 15 posttransplant showed negative Class I (MFI 148) and positive Class II (MFI 9987) confirming antibody-mediated rejection (AMR). The patient was started on steroids, and intravenous immunoglobulin and serial plasma exchanges were performed. Then, DSA Class II levels came down to 1602. DSA levels have been monitored periodically and Class II MFI values have been ranging from 2000 to 4000. The patient is maintained on routine immunosuppression, and a graft is intact with serum creatinine level between 1.7 and 1.8 mg/dl 8 months posttransplant. DSA-isolated Class II positivity in renal transplant recipients correlates strongly with AMR and should be considered clinically significant.
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Daratumumab interference with immunohematology testing in a nonmultiple myeloma neutropenic patient, in need of granulocyte transfusion p. 103
Abhaykumar Malind Gupta, Shashank Ojha, Amol Tirlotkar, Vimal Sathyan
DOI:10.4103/GJTM.GJTM_50_20  
Daratumumab (DARA) may interfere with immunohematology tests by binding to endogenous CD38 present on the surface of the red blood cells. DARA was Food and Drug Administration approved for refractory multiple myeloma patients, but now its application is being explored in other oncology patients also. The disease condition of the patient does not change the process of resolution of incompatible cross-matches, and blood transfusion services (BTS) must be vigilant about the drug but not the diagnosis. Effective communication between BTS and oncology departments is crucial in the timely resolution of DARA interferences. All BTS must have standard operating procedures in place for such discrepancies.
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A case report of apheresis granulocyte concentrates and the whole blood-derived pooled buffy coat transfusions in a neutropenic hematopoietic stem cell transplant recipient p. 106
Abhaykumar Malind Gupta, Shashank Ojha, SH Sumathi, Minal Poojary
DOI:10.4103/GJTM.GJTM_97_20  
Granulocytes may be procured either as apheresis granulocyte concentrate (AGC) or as a pooled buffy coat granulocytes (PBCG) derived from whole blood donations. The chronic myelomonocytic leukemia patient with active pneumocystis pneumonia infection, received two transfusions of AGC and PBCG each, for prolonged severe neutropenia. AGCs had a higher mean white blood cells count per bag (1.63 × 1010 vs. 1.53 × 1010), neutrophil count per bag (1.05 × 1010 vs. 0.76 × 1010), and mean neutrophils percentage (62.45% vs. 49.25%), whereas PBCGs had a higher mean red blood cells volume per bag (196.1 vs. 62.5 ml) and platelet counts (5.03 × 1011 vs. 3.6 × 1011). The rise in patients' absolute neutrophil count was comparable with both AGC and PBCG transfusions. Granulocyte transfusions helped in the management of an acute neutropenic crisis. Whole blood-derived PBCGs may be a viable alternative in to AGCs. PBCGs have a lot of logistic issues and each blood center should have its standard operating procedure.
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LETTERS TO EDITOR Top

Teaching the Indian medical graduates “Empathetic Communication Skills” toward cancer patients and their family donors p. 110
Manish Raturi, Kunal Das
DOI:10.4103/gjtm.gjtm_117_20  
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Triage of convalescent plasma – A theoretical consideration or a real necessity? p. 111
Tomasz Wasiluk, Barbara Boczkowska-Radziwon, Agnieszka Zebrowska, Piotr Radziwon
DOI:10.4103/gjtm.gjtm_18_21  
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Evidence of naturally occurring anti-Jkb in blood donor: A rare scenario p. 112
Suresh Kumar, Hariharan Annadurai, Hemamalini Nadesan, Vinodkumar Panicker
DOI:10.4103/gjtm.gjtm_24_21  
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Impact of ABO blood groups on severe acute respiratory syndrome coronavirus 2 susceptibility Highly accessed article p. 114
Noore Saba, Usman Waheed, Muhammad Nisar
DOI:10.4103/gjtm.gjtm_26_21  
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Contact urticaria to thrombophob gel p. 115
Abhishekh Basavarajegowda, Deepa Anand, Prathiba Krishnappa
DOI:10.4103/gjtm.gjtm_31_21  
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