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  Citation statistics : Table of Contents
   2020| January-June  | Volume 5 | Issue 1  
    Online since April 17, 2020

 
 
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REVIEW ARTICLES
A review of novel coronavirus infection (Coronavirus Disease-19)
Neelesh Jain, Animesh Choudhury, Jayesh Sharma, Venkata Kumar, Divyendu De, Richa Tiwari
January-June 2020, 5(1):22-26
DOI:10.4103/GJTM.GJTM_24_20  
Coronavirus (CoV) disease-2019 (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome-CoV-2. The disease started in 2019 in Wuhan, China, and has spread globally, resulting in a pandemic. Common symptoms include fever, cough, and shortness of breath. Muscle pain, sputum production, and sore throat are less common symptoms. While the majority of cases result in mild symptoms, some progress to pneumonia and multiorgan failure. The deaths per number of diagnosed cases is estimated at between 1% and 5%, but varies by age and other health conditions. The infection is spread from one person to others via respiratory droplets, often produced during coughing and sneezing. It takes 2–14 days to develop symptoms from the day of exposure. Reverse transcription-polymerase chain reaction from a nasopharyngeal swab or oropharyngeal swab is the standard method of diagnosis. The infection can also be diagnosed from a combination of symptoms, risk factors, and a chest computed tomography scan showing features of pneumonia. Measures recommended to prevent the disease include frequent hand washing, maintaining distance from other people, and not touching one's face. The use of masks is recommended for those who are suspected to have the virus and to their caregivers, but not the general public. As of now, there is no vaccine or specific antiviral treatment for COVID-19; management involves treatment of symptoms, supportive care, and experimental measures. The World Health Organization declared the 2019–2020 CoV outbreak a pandemic and a Public Health Emergency of International Concern.
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Quality management or the need for a quality culture in transfusion medicine
Cees Th Smit Sibinga, Farrukh Hasan
January-June 2020, 5(1):9-16
DOI:10.4103/GJTM.GJTM_74_19  
With the development of safe blood supply and transfusion comes the introduction of managing quality as a culture. This is implemented through the introduction of a quality system (QS) and a related quality management system (QMS). In many situations in the world the idea is that when instructions are written (SOPs) a QS is in place; one just has to follow the instructions and “that is it, we're done”! However, quality does only partly depend on following instructions at the operational level. What is generally not understood is the importance of designing and implementing QS management as an institutional culture, based on the five key elements (1) organization and (infra) structure; (2) standards (technical and quality); (3) documentation to allow traceability and evidence; (4) education through continued teaching and training; (5) assessment through continued monitoring and evaluation. There are a number of QMSs available which can be applied to procurement and clinical use of blood. Some are “process”- and “operations-oriented” while others deal more with the management aspects, securing a quality environment and culture, necessary for consistency and reliability of the operational processes. The EU European Foundation for Quality Management and Canadian ISQua system are based on fundamental concepts of excellence. To achieve an optimal understanding of the values of quality in transfusion medicine, vein-to-vein, a culture has to be created through ownership development, and commitment to and implementation of the principles of fitness for purpose, the supplier-producer-customer continuum, and customer-orientation and satisfaction.
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AIDE-MEMOIRE COVID-19
AIDE-MEMOIRE COVID-19

January-June 2020, 5(1):7-8
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CASE REPORTS
Case series of severe fetal hemolysis in Rh-C-negative mother
Toshniwal Pramod, Nishanth Rajan, Simon Kingsley, Lalitha Krishnan
January-June 2020, 5(1):90-92
DOI:10.4103/GJTM.GJTM_66_19  
Anti-Rh(c) antibody is the third most common cause of severe hemolytic disease of the fetus and newborn (HDFN). The widespread use of anti-D immunoglobulin has led to arelative increase in the importance of non-RhD isoimmunization as a cause of HDFN. The Rhc is a part of the Rh blood group system and its prevalence in India is 52%–62%. Here, we report two cases with anti-c antibody with severe hyperbilirubinemia who required intravenous immunoglobulin, red blood cells transfusion, and phototherapy.
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Green colored plasma discovered in a male blood donor: A cause for concern?
Shweta Pai, Zubair Hasan, Madhusmita Jena
January-June 2020, 5(1):93-95
DOI:10.4103/GJTM.GJTM_63_19  
The normal color of plasma is yellow, which is owing to the presence of factors such as bilirubin, hemoglobin, carotenoids, and iron transferrin. We recently came across an interesting case of greenish colored plasma in our blood bank. An extensive literature survey revealed that our conspicuous finding was not an isolated one and that similar such rare incidents have been reported in the past, on a sporadic basis. Several diverse reasons have been attributed to the peculiar greenish color like the presence of high ceruloplasmin levels, Pseudomonas aeruginosa infection and so on, but they were ruled out in our case. We thus, report our finding of greenish colored plasma in an otherwise healthy donor because of the rarity of its occurrence and also, to allay any sense of fear or alarm that an encounter may raise in the blood bank staff.
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Importance of red cell serology in optimizing transfusion strategy for patients undergoing allogeneic hematopoietic stem cell transplant
Parmatma Prasad Tripathi, Ashish Jain, Ratti Ram Sharma, Alka Khadwal
January-June 2020, 5(1):84-86
DOI:10.4103/GJTM.GJTM_2_20  
In ABO-incompatible allogeneic hematopoietic stem cell transplant (HSCT) monitoring for the appearance of donor-derived ABO antigens on red blood cells (RBCs) is a valuable tool for deciding the transfusion strategy. It was a retrospective study (6 months) where the patients undergoing ABO-incompatible (major/minor/bidirectional) allogenic HSCT were followed up for blood grouping, direct antiglobulin test (DAT), and antibody screen (ABS). Blood grouping (ABO and RhD) and ABO antibody titers were done by tube technique; DAT and ABS were done using gel technique (Bio-Rad, Switzerland). A total of six patients underwent ABO-incompatible transplant including three major (1 case AB→B; 2 cases B→O), two minor (A→AB; O→B), and one bidirectional (A→B) transplants. ABS and DAT were negative. In major ABO-incompatible transplants, the recipient anti-A/anti-B titers varied from 2 to 16 (immunoglobulin M [IgM]: 2–8; immunoglobulin G [IgG]: 2–16), and in minor ABO-incompatible transplants, the donor anti-B titer ranged from 8 to 32 (IgM: 8–16; IgG: 8–32). In the bidirectional case, the recipient anti-A titer was 32 (IgM = IgG). No plasma/red cell reduction was done in the product before the transplant. A mixed-field agglutination (MFA) was observed with anti-B on posttransplant day 44 in one major ABO-incompatible transplant, with anti-B on posttransplant day 31 in one minor ABO-incompatible transplant, and with anti-A as well as anti-B on posttransplant day 36 in the bidirectional ABO-incompatible transplant, which indicated RBC engraftment. A total of 30 (median: 4.5) packed RBC units were transfused in the posttransplant phase. In conclusion, pretransplant immunohematology work-up and the monitoring of blood group for MFA are important tools for optimizing the transfusion strategy of patients undergoing ABO-incompatible allogeneic HSCT.
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Pseudo-hemolytic transfusion reaction: A case report and review of literature
Shamee Shastry, Muralidhar V Pai
January-June 2020, 5(1):87-89
DOI:10.4103/GJTM.GJTM_68_19  
A clinical syndrome that is consistent with intravascular hemolysis and that mimics hemolytic transfusion reaction is called pseudo-hemolytic transfusion reaction (PHTR). We present one such clinical scenario with PHTR. A 24-year-old patient was referred to our center with all the signs and symptoms of hemolytic reaction (HTR) on the second postoperative day following cesarean section. HTR was ruled out following a detailed transfusion reaction workup. Ultrasound abdomen was suggestive of gross ascites. Exploratory laparotomy showed large rectus sheet hematoma and hemoperitoneum. Internal bleeding and resolution of hematoma caused the signs and symptoms mimicking HTR in the present case. The literature review revealed the other causes of PHTR. Any adverse event occurring in temporal association with transfusion is a trigger for detailed reaction workup. In a case with PHTR, laboratory workup to rule out HTR is one of the important steps in patient management.
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COMMENTARY
Fresh frozen plasma: A new perspective
Subhashish Das
January-June 2020, 5(1):115-116
DOI:10.4103/GJTM.GJTM_60_19  
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EDITORIAL
The story of the emerging coronavirus: SARS-CoV-2/COVID19: Challenges posed and lessons Learnt
Shivaram Chandrashekar
January-June 2020, 5(1):1-6
DOI:10.4103/GJTM.GJTM_28_20  
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LETTERS TO EDITOR
Epidemiology of syphilis in blood donors in Pakistan
Usman Waheed, Noor e Saba, Akhlaaq Wazeer, Muhammad Arshad, Hasan Abbas Zaheer
January-June 2020, 5(1):100-101
DOI:10.4103/GJTM.GJTM_69_19  
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Naturally occurring anti-S antibody in a blood donor: Screening using panel cells
Ankur Goyal, Seema Dua, Satyam Arora
January-June 2020, 5(1):101-103
DOI:10.4103/GJTM.GJTM_5_20  
  - 476 30
Molecular epidemiology of hepatitis delta virus among blood donors in Islamabad, Pakistan
Usman Waheed, Noor e Saba, Akhlaaq Wazeer, Ahmad Farooq, Muhammad Arshad, Hasan Abbas Zaheer
January-June 2020, 5(1):96-97
DOI:10.4103/GJTM.GJTM_4_20  
  - 430 16
Identity card for blood donor – Should it be an option or mandatory for donation?
R Amita, Debasish Gupta
January-June 2020, 5(1):97-98
DOI:10.4103/GJTM.GJTM_12_20  
  - 367 24
Predonation deferral pattern: A single-center experience from Pakistan
Muhammad Saeed, Abdul Waheed, Farhan Rasheed, Usman Waheed
January-June 2020, 5(1):98-100
DOI:10.4103/GJTM.GJTM_13_20  
  - 491 23
ORIGINAL ARTICLES
Analysis of changes in pre- and post-donation hematological parameters among plateletpheresis donors at SKIMS blood bank: A hospital-based study
Imran Khurshid, Irm Yasmeen, Aleem Jan
January-June 2020, 5(1):73-77
DOI:10.4103/GJTM.GJTM_3_20  
Background: Platelet transfusions are routinely needed as an essential part of treatment for patients undergoing cancer therapy, as well as for those with bleeding disorders, and for patients undergoing open heart surgeries or organ transplantation. Our aim was to compare the pre- and post-plateletpheresis parameters of complete blood counts in healthy voluntary donors and to determine the consequences of plateletpheresis on donor's health. Materials and Methods: This study was conducted in the Department of Blood Transfusion and Immunohaematology, SKIMS, over 1 year with effect from June 2018 to June 2019 after getting clearance from the institutional ethical committee. The study was conducted on 100 randomly selected plateletpheresis donors. After donor has been considered eligible for the procedure as per the national guidelines and departmental standard operating procedure, the details of plateletpheresis were explained to each donor before the procedure, and after filling the donor questionnaire form, informed consent was taken from donor for the procedure. Plateletpheresis was done using Trima Accel Automated Cell Separator. Hematological parameters such as hemoglobin (Hb), hematocrit (Hct), platelet counts, mean platelet volume (MPV), and white blood cell (WBC) counts were analyzed both before and after plateletpheresis procedure. Results: A total of 100 donors were subjected for apheresis, all of which were males. 83% of the donors were between the age group of 18 and 40 years while 17% were between the age group of 41 and 58 years. Majority (66%) had a body mass index (BMI) in the range of 18.5–24.9 kg/m2, 32% had 25–29.9, and 2% had 30 or higher, with an overall mean BMI of 23.95 kg/m2. The mean platelet count before apheresis was 227 × 103/μl with the range of 161–330 × 103/μl and the mean platelet count after apheresis was 169 × 103/μl with a range of 113–278 × 103/μl; the mean value of platelet count dropped significantly in postdonation. Similarly, the mean Hb level before apheresis was 15.3 g/dl with the range of 12.3–18.2 g/dl and the mean Hb value after apheresis was 14.7 g/dl with the range of 11.2–16.7 g/dl; the mean value of Hb dropped marginally in postdonation. The mean value of Hct concentration before apheresis was 45% with the range of 36.1%–55.1% and the mean value of Hct concentration after apheresis was 42.3% with the range of 37.3%–52.4%; the mean value of Hct dropped slightly in postdonation. There were also slight changes in the WBC counts and MPV value which were not so significant. Conclusion: A donor with significant decrements should be reviewed and screened for future donations to avoid iatrogenic anemia and thrombocytopenia. Donor safety must be ensured throughout the procedures to prevent any unfavorable events, and for the benefit of donors and patients, training modules for the technical personnel, supervision of transfusion specialists, close monitoring, and follow-up of these donors are required.
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Self-admitted motivating factors and barriers to blood donation in a single center from Southern India
Abhishekh Basavarajegowda, KC Usha, S Mayadevi
January-June 2020, 5(1):34-37
DOI:10.4103/GJTM.GJTM_67_19  
Background and Objectives: Delineating the motivating factors and hindrances for the donation is of utmost importance in planning recruitment strategies for blood donors in the success of blood transfusion services. This study attempts to evaluate the various reasons as to why or why not people donate blood. Methodology: This was an interview-based study. One hundred and fifty donors in each group, regular repeat donors and non-donors who were willing to be a part of the study and were capable of understanding the questionnaire were included in the study. Questionnaire enquired as to what motivated them to donate in case of regular repeat donors and as to why they never donated from non-donors. The responses were recorded and analyzed. Results: Forty-six percent of the respondents admitted that the friends who were already donors were the ones who influenced them to donate. People who never donated blood most commonly (47%) reported that they never donated because they were never asked to. The second-most common cause (32%) was that they perceived themselves to be not healthy enough to donate. Conclusion: This study suggests that individuals who have never donated might be influenced to donate if asked by coworkers, friends, or family while the blood center plays an important role in reminding or encouraging donors to return.
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Clinical outcome of platelet transfusion using platelet-rich plasma-derived platelets and buffy coat-removed platelets in patients with dengue fever – A comparison
Jyothis Purushothaman, Susheela Jacob Innah
January-June 2020, 5(1):38-43
DOI:10.4103/GJTM.GJTM_9_20  
Background and Objectives: Platelet transfusions are widely used to treat thrombocytopenia of various etiology. There are two different methods of preparation of platelet concentrate from whole blood: one is platelet-rich plasma method (PRP) and the buffy coat removed (BCR) method. This study aimed to compare the clinical outcome of patients with dengue fever transfused with platelets prepared by PRP method and BCR method. Methodology: A total of 100 patients with thrombocytopenia due to dengue fever were enrolled in the study, with fifty patients in each group. The outcome of patients transfused with PRP-derived platelets and BCR platelets was compared on the basis of absolute and corrected count increment (CCI), percent platelet recovery, and incidence of posttransfusion reactions. Results: The mean absolute count increment in patients who received BCR-platelet concentrate (BCR-PC) was 23,900/μl ± 7022.56/μl. The mean absolute count increment in patients who received PRP-derived PC was 18,910/μl ± 7482.42/μl. The difference was statistically significant with P = 0.001. The mean CCI of PRP group was 12,847 ± 5146.76 and in the BCR group, it was 12,897 ± 4266.82, and this difference was not statistically significant (P = 0.957). None of the patients transfused with BCR platelets reported a transfusion reaction, whereas one out of fifty (2%) patients transfused with PRP platelets had febrile nonhemolytic transfusion reaction. Conclusion: On the basis of count increment, CCI, percent platelet recovery, and incidence of posttransfusion reactions, BCR platelet transfusions showed a better outcome than PRP platelet transfusions.
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Assessment of a continuing medical education intervention designed to change physician practice regarding blood transfusion
Evangeline K Arulraja, Shari A Whicker, Katherine H Shaver, Linda M Wells, A Paul Dallas, David W Musick
January-June 2020, 5(1):44-50
DOI:10.4103/GJTM.GJTM_6_20  
Background and Objectives: Excessive packed red blood cell (pRBC) transfusions are associated with worse clinical outcomes and unnecessary costs. While multi-faceted continuing medical education (CME) approaches have been shown to be effective methods for changing physician practice, few studies have evaluated this approach as a method for changing blood transfusion practices. Methods: In this prospective cohort study sought to use a multi-faceted CME platform to modify physician transfusion practices. In this prospective cohort study, the authors implemented a multi-faceted CME intervention including didactic presentations, distribution of educational materials, educational posters, and electronic medical record clinical decision support. Primary outcomes were number of pRBC transfusions prior to and after intervention and associated costs. Secondary outcomes included knowledge acquisition, satisfaction, self-reported improvement in knowledge, and intent to change behavior. The intervention targeted physicians from four departments: Surgery, Internal Medicine, Obstetrics and Gynecology, and Emergency Medicine. Results: Fifty-eight physicians participated in the experimental group and seventy-three physicians in the control group. There was a 26% decrease (P <.0001) in pRBC transfusions monthly when comparing the year prior to intervention to post-intervention year. Clinicians reported improved knowledge acquisition regarding transfusion risks and indications (P <.001). Adjusted transfusion practices saved the primary teaching hospital $722,950 following the intervention. Conclusion: This study supports the use of a multi-faceted CME intervention to align clinical practice with evidence-based transfusion guidelines. Future studies should investigate the effectiveness of individual components of multi-faceted CME interventions regarding improved physician knowledge and clinical practice, patient outcomes, and cost-benefit.
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Bulk transfer of blood and its component: A single-center experience after 2 years of its implementation
Rima Kusumgar
January-June 2020, 5(1):51-53
DOI:10.4103/GJTM.GJTM_7_20  
Background and Objectives: BTS in India is highly decentralized and lack many vital resources. National blood policy also depicted safe and adequate blood supply. An Important initiative that can lead to increased efficiency of blood transfusion services (BTS) in our country namely bulk transfer of blood permitting the exchange of blood among licensed blood bank was taken by NACO in the year 2015. In this study we tried to understand the impact of bulk transfer policy in bridging the gap between demand and supply and also prevent the wastages of precious blood resources. Material and Methods: Retrospective analysis of demand-supply of PCV and PC was done for the year 2016-2017. The same done again after implementation of bulk transfer policy for the year 2017-2018 just starting phase (few blood banks adopted) and for the year 2018-2019 after many blood banks taken up bulk transfer. Results: Before implementation of bulk transfer policy only 54.63% patients got red cell concentrate for transfusion and 38.35% patients got platelet concentrate. Supply increases to 68.31% and 69.41% respectively and hence reduces the wastage. Conclusion: Bulk transfer amendment is of great help to prevent wastages of precious blood resources, and hence can win the trust of society and increase voluntary blood donation.
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A retrospective analysis of blood requisition versus utilization practices at national blood bank, jigme dorji wangchuck national referral hospital, Thimphu, Bhutan
Tshering Yangdon, Mahrukh Getshen, Lobzang Tashi
January-June 2020, 5(1):54-57
DOI:10.4103/GJTM.GJTM_70_19  
Background and Objectives: Although National Guidelines on Clinical Use of Blood has been developed, it is a common practice to order blood based on the subjective anticipation of blood loss, instead of evidence-based requirement at National Referral Hospital, Thimphu. However, National Blood Bank follows the maximum surgical blood ordering schedule, thereby saving the resources and making blood available for emergency patients. Nonetheless, the need-based assessment is not conducted to determine the efficacy of the practice. This study aimed to assess the effectiveness of the current practice of following the national guidelines on maximum surgical ordering of blood by evaluating the blood requisition versus utilization practice. Materials and Methods: A hospital-based retrospective study was conducted at national blood bank over a 1-year period (January–December 2018). Demographic data, such as age and sex, and clinical wards with maximum transfusion done were recorded. Blood utilization indices were computed for cross-match-to-transfusion ratio (C:T, <2.5), transfusion index (TI, >0.5) and transfusion probability (%T, >30) to indicate significant blood usage. All data were processed and analyzed with software programs Microsoft Excel 2013 and GraphPad Prism (v 7.04). Results: Of 4012 blood units cross-matched, 3205 blood units were transfused to patients (C:T ratio 1). Majority (65.33%) of the patients were females and 34.66% were males. The overall TI was 1.49 and %T was 73.07%, implying significant blood usage. The maximum request for blood was made from gynecological and obstetrics ward, emergency, and daycare blood transfusion unit. Similarly, the patients transfused with the cross-matched units were also found to be highest for these wards. Conclusion: The study demonstrates that the current practice of maximum blood ordering schedule is effective in saving valuable time and resources. However, there is a need to sensitize the requesting physician on rational order for effective management of the blood inventory.
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Role of extended red cell phenotyping in management of patient with multiple antibodies and their utility in development of indigenous cell panels for antibody screening
Ripal J Shah, V Harimoorthy, Rakhee B Shah, Trupti K Barot, Kishore Maheshwari Kumar
January-June 2020, 5(1):58-62
DOI:10.4103/GJTM.GJTM_8_20  
Background and Objectives: The frequencies of clinically significant blood groups antigens (Rh, Duffy, Kell, Kidd, MNS, P and Lewis) should be known to BTS to manage patients with clinically significant antibodies. This study was conducted to help develop in-house cell panels to manage such patients. Methods and Materials: A total of 331 donors with O blood group with age group of 18 to 45 years, repeatedly donating blood were included in the study. They were screened for antigens of Rh, Kell, Kidd, Duffy, MNS, P and Lewis blood group system. Results: Among 331 donors, 299 (90.3%) donors were RhD Positive. e antigen was prevalent in 328 (99.1%) donors. Only 2 (3.5%) donors with E antigen were lacking D antigen also. All D negative donors (9.7% of total donors) were having strong expression of c and e antigen on their red cells. In Kell system, 100% donors were k antigen positive. All K positive donors are also positive for D antigen. In Kidd and Duffy system, Jka and Fya are more prevalent. In Lewis system, Lea-Leb+ (66.5%) is the commonest phenotype. In MNS system, M antigen was present in 87.61% of donors and s antigen in 83.38% of donors. Conclusions: Knowledge of red cell antigen phenotype frequencies in a population is helpful in terms of their ethnic distribution, in creating a donor data bank for preparation of indigenous cell panels, and providing antigen negative compatible blood to patients with multiple alloantibodies.
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The inconspicuous health benefit of blood donation
Alhaji Bukar, Erhabor Amos Tosan, Osita Simon Obi, Ajibola Sikiru Akinola, Gimba Waziri, Medugu Jessy Thomas, Aghatise Kevin, Christy Chinyere Fredrick, Osareniro Eguagie Osakue, Geogina Erifeta, Humphrey B Osadolor, Mathew Folaranmi Olaniyan
January-June 2020, 5(1):63-67
DOI:10.4103/GJTM.GJTM_14_20  
Background and Objectives: Regular blood donations seem to be beneficial to the health of donors in many ways. There is evidence to suggest that blood donation lowers blood viscosity and alters lipid profile, which is an acceptable parameter for assessing the risk of coronary heart disease. The objective of this study was to assess the pattern in changes of lipid profiles and hematocrit due to blood donation. Methods: This was a cross-sectional study, which comprises 289 apparently healthy male blood donors who were recruited as family replacement and nonvoluntary donors. Those who were ineligible for donation were excluded. Fasting venous blood samples were collected serially before phlebotomy, 1 h, 3 days, 6 days, 9 days, and 12 days after phlebotomy. Lipid profile and hematocrit were estimated appropriately. Results: The mean hematocrit, total cholesterol (T-Chol), low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-Chol (HDL-C), very low-density lipoprotein-cholesterol (VLDL-C), and triglycerides before donations were 32 ± 8 years, 0.46 ± 0.05, 5.04 ± 0.81 mmol/l 2.93 ± 0.56 mmol/l 1.35 ± 0.24 mmol/l, 0.76 ± 0.14 mmol/l, and 1.65 ± 0.29 mmol/l, respectively. Postdonation results indicated an increased in HDL-C and decreased in all the remaining parameters with time. There are statistically significant differences between the levels of the HDL-C (P < 0.001), T-Chol: HDL ratio (P < 0.001), LDL-C (P < 0.001), and T-Chol (P < 0.001) before and at 12 days after blood donations. There was also a decrease in VLDL-C (P = 0.061), triglyceride (P = 0.092), and hematocrit values (P = 0.056), which was not statistically significant. Conclusion: These findings indicated that blood donation may be beneficial to donors, on the short term, since there is decreasing serum T-Chol, LDL-C, VLDL-C, and triglycerides and increasing serum HDL-C concentration. Long-term effects need to be determined in this cohort of donors.
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Evaluation of incompatible crossmatch
Vidushi , Meena Sidhu, Saadat Nazir Shah
January-June 2020, 5(1):68-72
DOI:10.4103/GJTM.GJTM_11_20  
Background and Objectives: Crossmatching is one of the bases of pretransfusion testing. Resolving problems in crossmatching should be carried out after proper planning and following departmental guidelines, and hence that time is not wasted, or blood withheld from patient unnecessarily. The aim of this study was to find the prevalence and cause of incompatible crossmatch and to formulate root cause analysis to help ensure safe transfusion. Materials and Methods: This was a prospective study conducted at a tertiary care hospital in North India, from December 2018 to November 2019. Request for blood components was received along with 2 ml labeled sample in ethylenediaminetetraacetic acid and plain tube. Crossmatching was done by column agglutination method in polyspecific (IgG + C3d) bead cards by ortho clinical diagnostic using semi-automated biovue. In case of any incompatible result, it was resolved using appropriate steps. Results: During the study period from December 2018 to November 2019, only 67 (0.65%) of the 10,320 samples received were found to be crossmatch incompatible and evaluated and appropriate donor units issued. The crossmatch incompatibility was much higher in the females (46, 68.7%) than the males (21, 31.3%). The direct antiglobulin test (DAT) was positive in nine patient samples, and the indirect antiglobulin test was found positive in 37 incompatible crossmatch units. Eleven cases of incompatible crossmatch were due to wrong blood in tube, seven due to contamination of reagents, and three due to DAT-positive donor units. Conclusion: In this study, alloimmunization (55.2%) was the most prevalent cause of incompatible crossmatch, and the most common alloantibody identified was anti-E. Incompatible crossmatch poses a challenge in the field of transfusion medicine. Root cause analysis is a systemic method for identifying all the contributing factors to a problem, so that the corrective action can be taken. A logical stepwise approach will enable the provision of safe transfusion.
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REVIEW ARTICLES
Precious platelets: The utility of cold-stored and cryopreserved platelets
Rizwan Javed, Frozan Ahmadi, Asheer Jawed
January-June 2020, 5(1):17-21
DOI:10.4103/GJTM.GJTM_19_20  
The current storage temperature of platelets prepared by both pooled buffy coats and by apheresis is 22°C + 2°C (room temperature [RT]). The adverse microbiological and metabolic implications associated with RT storage have restricted the shelf life of platelets from 5 to 7 days. The proposed alternative is cold-stored (4°C) platelets that could be stored for 21 days and cryopreserved platelets with dimethyl sulfoxide for up to 2 years at −80°C. An increase in shelf life could be of great utility in rural and military settings. Based on the proven quality and properties of cold-stored platelets, the US Food and Drug Authority has approved its use for up to 3 days in patients having active bleeding.
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The utility of blood components in the care of sick neonates: An evidence-based review
Arohi Gupta, HA Venkatesh
January-June 2020, 5(1):27-33
DOI:10.4103/GJTM.GJTM_21_20  
This article aims to summarize the most current evidence-based practices regarding blood component utility in the care of sick neonates. The indications for transfusion, the transfusion thresholds, and the adverse effects are dealt with in detail. The judicial utilization of blood components is the need of the hour. The right component, right dose, right recipient, right aseptic precautions and constant monitoring of transfusion is very important. Consent for transfuson is another essential step before transfusion.
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SHORT ARTICLES
Nirantara: A conservative approach to economical use of antisera in short-supply
Sanmukh R Joshi, Snehal B Senjaliya
January-June 2020, 5(1):78-79
DOI:10.4103/GJTM.GJTM_18_20  
Background and Objectives: Serological screening for rare antigens may hamper due to scarcity of the reagent antisera. The study aims to develop a conservative approach for scarcely available antisera to maximize outcome from minimum resource. Method: In the LISS tube test for screening the antigen using antiserum, the test supernatant (TS) was harvested after reading the results. The TS was reused in subsequent screening till it showed visible reactivity. The stage at which it ceases to react, the TS was concentrated by carbo-wax (polyethylene glycol) and reused for further screening. Results: Using 8-10 ml of antiserum to rare antigen In(a), we could screen as many as 6868 donors and found 200 donors with In(a+); with 5 ml of anti-Di(a), we could screen 2567 local donors from the Western India; none of them was Di(a+), but four of the 87 Tibetan migrants were positive for the antigen. We could use this approach even on antibody to high-frequency antigen with a slight modification, by adding to the TS the antibody eluted from the sensitized test cell for using in subsequent screening. Conclusion: The recycling of antibody can fruitfully be used several times to conserve the antiserum in short-supply.
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Root cause analysis of an aberrant thromboelastogram tracing – Lessons learnt
Ganesh Mohan, Shamee Shastry, Dhivya Kandasamy, PA Prethika, Chenna Deepika
January-June 2020, 5(1):80-83
DOI:10.4103/GJTM.GJTM_73_19  
Thromboelastography is a viscoelastic test which uses whole blood sample for routine coagulation screening purpose. Even though it is an easy procedure, many critical steps affect the final result of the test and we describe such an incident in this report. The root cause analysis of two aberrant TEG reports on two different occasions was initiated; the tracing initially was normal but developed an abnormal pattern toward the middle portion. The graph suddenly dropped to the baseline and from there, it was demonstrating an abnormal pattern. This can be due to power failure, vibrations during the test, cup dislodging from the pins during run, no validation prior to each test, and out of calibration. The root cause was identified as improper fixing of cups and pins leading to dislodging from the pins during the run and prevention of such incidents can be achieved by individual training of the staffs and periodical evaluation of their competency.
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SPECIAL COMMUNICATIONS
Young professional council with the international society of blood transfusion
Satyam Arora, Arwa Z Al-Riyami, Tyler Hutchinson, Cecile Toly-Ndour, John-Paul Tung, Yanli Ji, Sophie Uyoga
January-June 2020, 5(1):104-107
DOI:10.4103/GJTM.GJTM_15_20  
  - 379 15
SPECIAL COMMUNICATIONS
Thalassemia in Pakistan: A forward-looking solution to a serious health issue
Hasan Abbas Zaheer, Usman Waheed, Yetmgeta Eyayou Abdella, Frank Konings
January-June 2020, 5(1):108-110
DOI:10.4103/GJTM.GJTM_72_19  
  - 817 47
The role of serum kerbs von lungren 6 antigen in transfusion-related acute lung injury
Wang Gui-Qiang, Lin Xin-Mei, Feng Jun-Jian, Zhang Li, Wei Mao-Hua
January-June 2020, 5(1):111-112
DOI:10.4103/GJTM.GJTM_26_20  
  - 263 12
Expression of CD200/CD200R1 from peripheral blood mononuclear cells of primary immune thrombocytopenia and its clinical significance
Zang Yan, Ye Xin, Qian Bao-Hua
January-June 2020, 5(1):113-114
DOI:10.4103/GJTM.GJTM_27_20  
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