Origin and survival outcomes of Pseudomyxoma peritonei-A retrospective study.

BACKGROUND: Pseudomyxoma peritonei (PMP) is an unusual clinical condition typically presenting with widespread mucinous neoplastic lesions within the peritoneum resulting in gelatin material-rich ascites. It was first described by Werth in 1884. Ever since, its clinical presentation, definition, site of origin, and prognosis have been a subject of debate. However, many histopathologic, immunohistochemical, and genetic studies have attempted to locate the primary lesion in the appendix in both genders. OBJECTIVES: To analyze the histological origin and survival outcomes of pseudomyxoma peritonei in patients treated at a regional cancer center. MATERIALS AND METHODS: Fifteen cases of PMP were diagnosed during the five-year study period. The demographic and clinicopathological details were retrieved; the slides were reviewed and histological parameters reassessed. Descriptive statistics were used to express proportions. Continuous variables were recorded as mean (SD) or median (IQR). Kaplan-Meier (KM) curve was used to estimate overall survival. RESULTS: Mean age for PMP was found to be 47.5 years for low grade Mucinous Carcinoma Peritonei (MCP), 54.2 years for high grade MCP, and 58 years for high grade MCP with signet ring cells. Most common overall presentation was abdominal distension in 53.3% (8/15) of cases, followed by acute appendicitis in 20% (3/15) cases. PMP was detected synchronous with the primary tumor in 9/15 cases (60%). Primary lesion in the appendix was grossly identified in 7/15 cases, while it was not explored in the remaining eight cases. Yet, by combined clinical, radiological, histopathological, and immunohistochemical analysis, we identified that most of the cases (14/15) had an appendiceal origin (93.3%). The overall survival for 12 months was 50% and for 18 months was 37%. CONCLUSION: The surgeon and radiologist may well bear in mind the most common possibility of an appendiceal origin for PMP and resect the appendix, irrespective of the presence of a grossly or radiologically detectable lesions. We emphasize that immunohistochemistry helped to detect the site of origin even when the primary was occult.

Intracellular Toll-Like Receptors Modulate Adaptive Immune Responses in Head and Neck Cancer.

The percentage of head and neck cancer (HNC) positive for human papillomavirus (HPV) is unknown in most parts of India. How toll-like receptors (TLRs) affect the adaptive immune response in HNC is also mainly unknown. We here assessed the expressions of HPV DNA, p16, inflammation, and TLRs in oral squamous cell carcinoma (OC) and oropharyngeal squamous cell carcinoma (OPC). Patients with OC (n = 31) and OPC (n = 41), diagnosed during 2017-2018 at the Malabar Cancer Centre (tertiary cancer center), Kerala, India, were included in the study. Immunohistochemistry was performed on tumor specimens against p16, TLR3, TLR7, TLR8, TLR9, CD4, and CD8. Quantitate polymerase chain reaction for 14 high-risk HPVs (HPV16/18/31/33/35/39/45/51/52/56/58/59/66/68) was performed. Seven out of 31 OC (22.6%) were p16+ but only 3.2% (1/31) of OC were positive for HPV DNA. While 24.4% (10/41) of OPC were p16+, HPV DNA was found in only one P16+ OPC and in no P16- OPC. TLR3, TLR7, TLR8, and TLR9 were expressed both in OC and in OPC. The expression of TLR7 was significantly higher in OPC compared with OC. TLR8 expression was correlated with and TLR7 tended to be correlated with the inflammatory score in OPC (r = 0.56, p < 0.05 and r = 0.52, p = 0.08, respectively). In conclusion, the role of HPV in OC and OPC is minor, and p16 constitutes a poor biomarker for HPV positivity in Kerala, India. Intracellular TLRs are correlated with the degree of inflammation in OPC but not in OC and may potentially constitute a medical target in the therapy of HNC in the future.

Ghost Cell Odontogenic Carcinoma with Sarcomatous Transformation : Report of a Rare Case with Review of Literature.

Ghost Cell Odontogenic Carcinoma is a rare malignant odontogenic tumor that can appear as "de novo " or arises from malignant transformation of preexisting benign calcifying odontogenic cysts or dentinogenic ghost cell tumors after multiple recurrences. Ghost cell odontogenic carcinoma is histopathologically characterized by ameloblast-like islands of epithelial cells with aberrant keratinization, simulating a ghost cell, with varying amounts of dysplastic dentine. This article reports an extremely rare case of ghost cell odontogenic carcinoma with foci of sarcomatous change, involving maxilla andnasal cavity which arose from a previously existing recurrent calcifying odontogenic cysts in a 54-year-old man and reviews the features of this unusual and rare tumor. To the best of our knowledge, this is the first case of ghost cell odontogenic carcinoma with sarcomatous transformation to be reported till date. Owing to its rarity and unpredictability of clinical course, long -term follow up of patients with ghost cell odontogenic carcinoma, is mandatory for observation of recurrence and distant metastasis. Keywords: Ghost cell odontogenic carcinoma, maxilla, sarcoma, calcifying odontogenic cysts, ghost cells, odontogenic tumour.

Predicting donor-related factors for high platelet yield donations by classification and regression tree analysis.

INTRODUCTION: Collecting high-dose (HD) or double-dose (DD) apheresis platelets units from a single collection offers significant benefit by improving inventory logistics and minimizing the cost per unit produced. Platelet collection yield by apheresis is primarily influenced by donor factors, but the cell separator used also affects the collection yield. OBJECTIVES: To predict the cutoff in donor factors resulting in HD and DD platelet collections between Trima/Spectra Optia and MCS+ apheresis equipment using Classification and Regression Trees (CART) analysis. METHODS: High platelet yield collections (target ≥ 4.5 × 1011 platelets) using MCS+, Trima Accel and Spectra Optia were included. Endpoints were ≥ 6 × 1011 platelets for DD and ≥ 4.5 to < 6 × 1011 for HD collections. The CART, a tree building technique, was used to predict the donor factors resulting in high-yield platelet collections in Trima/Spectra Optia and MCS+ equipment by R programming. RESULTS: Out of 1,102 donations, the DDs represented 60% and the HDs, 31%. The Trima/Spectra Optia predicted higher success rates when the donor platelet count was set at ≥ 205 × 103/µl and ≥ 237 × 103/µl for HD and DD collections. The MCS+ predicted better success when the donor platelet count was ≥ 286 × 103/µl for HD and ≥ 384 × 103/µl for DD collections. Increased donor weight helped counter the effects of lower donor platelet counts only for HD collections in both the equipment. CONCLUSIONS: The donor platelet count and weight formed the strongest criteria for predicting high platelet yield donations. Success rates for collecting DD and HD products were higher in the Trima/Spectra Optia, as they require lower donor platelet count and body weight than the MCS+.

Predicting donor-related factors for high platelet yield donations by classification and regression tree analysis

Introduction Collecting high-dose (HD) or double-dose (DD) apheresis platelets units from a single collection offers significant benefit by improving inventory logistics and minimizing the cost per unit produced. Platelet collection yield by apheresis is primarily influenced by donor factors, but the cell separator used also affects the collection yield. Objectives To predict the cutoff in donor factors resulting in HD and DD platelet collections between Trima/Spectra Optia and MCS+ apheresis equipment using Classification and Regression Trees (CART) analysis. Methods High platelet yield collections (target ≥ 4.5 × 1011 platelets) using MCS+, Trima Accel and Spectra Optia were included. Endpoints were ≥ 6 × 1011 platelets for DD and ≥ 4.5 to < 6 × 1011 for HD collections. The CART, a tree building technique, was used to predict the donor factors resulting in high-yield platelet collections in Trima/Spectra Optia and MCS+ equipment by R programming. Results Out of 1,102 donations, the DDs represented 60% and the HDs, 31%. The Trima/Spectra Optia predicted higher success rates when the donor platelet count was set at ≥ 205 × 103/µl and ≥ 237 × 103/µl for HD and DD collections. The MCS+ predicted better success when the donor platelet count was ≥ 286 × 103/µl for HD and ≥ 384 × 103/µl for DD collections. Increased donor weight helped counter the effects of lower donor platelet counts only for HD collections in both the equipment. Conclusions The donor platelet count and weight formed the strongest criteria for predicting high platelet yield donations. Success rates for collecting DD and HD products were higher in the Trima/Spectra Optia, as they require lower donor platelet count and body weight than the MCS+.

Frequency of EGFR mutations in lung adenocarcinoma patients - A study from tertiary cancer center of South India.

BACKGROUND AND OBJECTIVES: Epidermal growth factor receptor (EGFR) mutation analysis has become an important part of the initial workup of non-squamous non-small cell lung cancer (NS-NSCLC) patients. This study is attempted as South Indians population is comprised of ethnic groups with diverse genetic makeup and only very limited data on EGFR mutation is available from south India. A detailed understanding of EGFR mutation profile will help in better planning of treatment strategies and resource allocation. METHODS: A retrospective analysis of EGFR mutation frequency in 350 patients diagnosed with adenocarcinoma of lung and its association with pathological characteristics was done. RESULTS: Out of 350 cases of pulmonary adenocarcinoma, within an age group ranging from 30 to 86 years. EGFR mutations were identified in 34.8% (n = 122) cases, out of which 35.24% (n = 43) were in non-smoker females (P = 0.001). Of the 14 cases with resistant type of EGFR mutations, nine were in smoker males and the remaining five in non-smoker females. INTERPRETATION AND CONCLUSION: Overall EGFR mutation frequency observed in our study was similar to other Indian studies. However, in our study, we observed that mutation in exon 21 was less frequent compared to other studies. A similar slightly increased frequency of rare mutations and double mutations were observed in our study. A detailed study of the molecular epidemiology of lung cancer and its association with different geographical zones of India is needed. This understanding will help in better planning of treatment strategies and resource allocation.

The Spectrum of Histomorphological Changes and Pathological Tumor Response following Preoperative Oral Metronomic Chemotherapy in Oral Squamous Cell Carcinoma.

Sithara AravindBackground Oral metronomic chemotherapy (OMCT) represents an emerging concept in cancer treatment involving frequent administration of chemotherapeutic drugs at doses below maximum tolerated doses and with no prolonged drug-free break. OMCT is being tried preoperatively in developing nations with constrained resources to prevent disease progression during the waiting period from diagnosis to surgery (bridge OMCT). The aim of the present study was to assess the spectrum of histomorphological changes and pathological tumor response following bridge OMCT in oral squamous cell carcinoma (OSCC) and to propose a new pathological response scoring system. Materials and Methods A retrospective single-center study comprised of tissue sections of tumor proper and metastatic lymph nodes of 50, locally advanced OSCC patients treated with bridge OMCT, and had completed definitive surgery were analyzed. The present study evaluated the histomorphological features and proposed a new scoring system for pathologic tumor response. The pathologic tumor response was categorized as complete response (pCR), no response (pNR), and partial response (pPR). Results Of the total 50 patients, 2 patients had pCR, 3 had pNR, and 45 patients had pPR as per the new proposed scoring system. Note that 96% of the cases showed no disease progression. Conclusion Bridge OMCT is a novel treatment method that can be used to tide over the waiting period between the diagnosis and surgery in resource-constrained institutions with heavy patient load. This mode of treatment in locally advanced OSCC seems to provide promising results in this setting. Large multicentric trials are warranted to confirm these results.

Testing for Microsatellite Instability in Colorectal Cancer - a Comparative Evaluation of Immunohistochemical and Molecular Methods.

BACKGROUND: Introduction: The majority of colorectal cancers (CRC) develop through the chromosomal instability pathway and approximately 15% display microsatellite instability (MSI) as a carcinogenic event. CRCs with microsatellite instability status have a characteristic phenotype. We aimed to assess the clinico-pathological and MSI profiles of sixty-one cases of CRC through immunohistochemical (IHC) staining for the mismatch repair(MMR) proteins and DNA based Polymerase Chain Reaction (PCR) assay for microsatellite markers. PATIENTS & METHODS: Haematoxylin & Eosin stained sections of the tumor were evaluated for various histopathologic features. Immunohistochemistry was performed for the four MMR proteins, MLH1, MSH2, MSH6 and PMS2. NCI recommended panel of five nucleotide repeat markers was amplified from tumor DNA. RESULTS: The majority of the patients were males above fifty years of age. Around 61% of tumors were in the leftsided colon. Adenocarcinoma NOS (55, 90%) was the most common histological type. A total of 18 (29.5 %) cases showed dMMR by immunohistochemistry. Loss of PMS2 protein and combined loss of MSH2 & MSH6 were the most common findings in low and high MSI respectively. Of the 13 cases selected for PCR analysis, nine cases had high MSI (at least two markers unstable) and four cases had low MSI (one marker unstable) Results of PCR based DNA assay showed good concordance with IHC. No significant statistical association could be identified between the status of MSI by either methods and sociodemographic or clinical features. DISCUSSION: MSI constitutes 12%-20% and 6%-13% of CRCs in Western and Eastern countries respectively. In our series IHC staining revealed that 29.5% of cases showed dMMR. This was similar to other Indian studies which reported a prevalence of 22-27%. The combined loss of MSH2 & MSH6 (78%) was the most common type of dMMR. There was good concordance between IHC and PCR results. The issue of heterogenous or weak staining is a limiting factor in IHC interpretation and few cases of dMMR may be missed. CONCLUSION: To conclude, IHC can be a very useful screening tool to detect microsatellite instability and triage cases of dMMR for MSI biomarker testing. The MSI status also serves as a prognostic and predictive tool. KEY WORDS: Colorectal cancer, microsatellite instability, immunohistochemistry, Polymerase chain reaction.

Determination of mononuclear cell count using peripheral smear and flow cytometry in peripheral blood stem cell products: A retrospective study from an Indian cancer center.

BACKGROUND: Mononuclear cells (MNCs) are considered equivalent to hematopoietic stem cells, and differential count using peripheral smear was routinely practiced to enumerate MNC. Flow cytometry plots used for CD34 enumeration assay can also be used in MNC enumeration as it counts more WBC events than manual methods. The aim was to determine the relationship and degree of agreement between peripheral smear and flow cytometry in MNC enumeration of peripheral blood stem cell (PBSC) products. METHODS: In 63 patients, 73 PBSC products were collected between January 2017 and September 2019. The differences in MNC count estimated by peripheral smear method and from flow cytometry plots used for CD34 enumeration were analyzed using Mann-Whitney test. Agreement between the two methods for MNC enumeration was determined by regression analysis. Receiver operating characteristic curve was performed to determine MNC threshold in peripheral blood and PBSC product for adequate mobilization and harvest. RESULTS: There was no difference in enumeration of median MNC count between peripheral smear and flow cytometry (52% vs. 59%, P = 0.185) in PBSC product. However, regression analysis indicated a constant and proportional difference between the methods with r = 0.52. Cumulative sum test for linearity showed deviation from linearity (P = 0.04). MNC counts in peripheral blood failed to achieve discrimination capacity in predicting adequate CD34+ yield/kg body weight in product. CONCLUSION: Peripheral smear estimated lower MNC counts than flow cytometry with weaker agreements between the two methods. Hence, MNC count derived from flow cytometry plot can substitute peripheral smear method for MNC dose calculations. MNC dose at 3.4 × 108/kg consistently predicted >2 × 106/kg CD34+ cells collected.

Adopting a vein assessment tool improves procedural outcomes in double dose platelet collections - A prospective study.

BACKGROUND: This study aims to determine the phlebotomy and procedural outcomes using a vein assessment tool (VAT) in Double Dose Platelet (DDP) collections by apheresis. METHODS: VAT was based on assessing vein visibility, palpation and size with maximum score of 12 and the least being 0 and the scores were graded as adequate and inadequate. A vein-viewer was used for studying cubital vein patterns (type 1-5). Phlebotomy outcome was defined based on need for re-puncture. Procedural outcomes in terms of target yield attained and RBC reinfusion completed. Chi square test and Mann- Whitney U test were used to assess the vein score and pattern against phlebotomy and procedural outcome. RESULTS: Out of 200 DDP collections, the phlebotomy was successful in 88 % with good procedural outcome in 94 % donations. The cut off in VAT scores for successful phlebotomy was ≥8 (AUC: 70 %). Median vein scores of the arm selected for phlebotomy was 9 and graded adequate in 154 (77 %) donations.Odds for successful phlebotomy was 3.7 times higher when donors had an adequate VAT grades(p = 0.003). Procedural outcomes was favourable when at least one arm had adequate VAT grade when compared to both arms being inadequate (98 % vs 82 %; p < 0.001). Phlebotomy failure was more with first time apheresis donors than repeat apheresis donors (p = 0.014). CONCLUSION: This study indicated that a VAT score with a cut off of ≥8 had better phlebotomy and procedural outcomes in DDP collections and that donor with at least one arm having the VAT score of ≥8 are preferred for DDP collections.

Comparison of abo antibody levels in apheresis platelets suspended in platelet additive solution and plasma

ABSTRACT Background Transfusion of platelets (PLTs) with high ABO antibody titres can pose a risk of hemolysis if the unit crosses the ABO type. The PLTs stored in the platelet additive solution (PAS) remove asubstantial fraction of plasma and replace it with an isotonicbuffered solution.We aimed to assess the difference in anti-A/B antibody levels in Groups O, A and B apheresis platelets (APs) suspended in plasma and PAS. Methodology Apheresis donors are categorized into two groups, Plasma (Group I) and PAS (Group II), each blood group (A, B and O) had 20 samples. The anti-A/B(IgM)antibody levels were recorded from the AP donor (Group II) and from the AP units for both groups. The reduction in the anti-A/B(IgM) antibody levels in the APs suspended in the PAS for each blood group was determined. Results The median anti-A titres in blood Groups B (p = 0.009) and O (p = 0.005) was significantly lower in Group II. However, the difference in anti-B levels was not significant in the blood groups A (p = 0.057) and O (p = 0.205). The median level of reduction in IgM antibody titres across donor samples and the PAS-stored platelets was two-fold. The regression showed a level of reduction in antibody titres which can be explained by baseline donor antibody titres in blood groups A and B compared to blood group O. Conclusion The medianABO antibody titres were lower in APs suspended in PAS than in plasma. Addition of the PAS significantly lowered the IgM antibody titres by twofold, compared to plasma.

Recurrent hyperhemolytic transfusion reaction in myelodysplastic syndrome- A case based approach.

We present here a case report of a 27 year old female, with myelodysplatic syndrome suspected to have recurrent hyperhemolytic transfusion reactions (HHTR). Patient was transfusion dependent for ten years and was transfused with leukodepleted and irradiated Packed Red Blood Cells (PRBC). She presented with signs and symptoms of acute intravascular hemolysis, deranged coagulation profile with post transfusion Hb lower than baseline. Post transfusion workup was uneventful. She was managed conservatively with fluid support and methylprednisolone initially. After few uneventful transfusions, patient developed second episode of HHTR with compatible unit.Immunophenotype favored an inflammatory response possibly induced by monocytic lineage. As transfusion dependent, the patient required methylprednisolone as premedication and all subsequent transfusions were uneventful.

Evaluation Of Pathological Response And Its Predictors In Carcinoma Rectum Following Neoadjuvant Chemoradiation.

BACKGROUND: Neoadjuvant chemoradiation followed by surgery is the standard of care in locally advanced rectal tumors. Better pathologic response after chemoradiation is associated with better outcomes. Pathologic response may depend on various, patient and tumor related factors. The aim of our study was to assess the pathological response using a modified Ryan scoring system and to study various factors which influence the response. MATERIALS AND METHODS: This is a retrospective study carried out at a tertiary cancer centre in India. Patient details and histopathology reports of rectal cancer patients who took neoadjuvant chemoradiation from January 2016 to December 2018 were analyzed. Demographic details, pathological response assessed by modified Ryans tumor regression grade (TRG) score and various factors which influence the pathological response were studied. Those with TRG score 0 (complete response) and1(near complete response) were grouped together as good responders and those with score 3 (partial response) and 4 (poor or no response) as poor responders. Univariate and multivariate analyses were performed using logistic regression to determine factors which influence pathologic response. RESULTS: There were a total of 83 patients. Males and females were equally distributed. 43.4%(n=36) of patients had lower rectal tumors,32.5%(n=27) had midrectal tumors and 24.1%(n=20) had upper rectal tumors. 46% of patients were good responders which includes complete responders ,17% (n=14) and those with a near complete response,29% (n=24). 54% of patients were poor responders,which includes those with incomplete response,36% (n=34) and with no or poor response,18% (n=15). Among the upper rectal tumors, only 20% had good response and among the mid and lower rectal tumors 54% had good response.(p value 0.02).63% of males were good responders in comparison to 37% among females (p value 0.05). DISCUSSION: Response to neoadjuvant chemoradiation with capecitabine in locally advanced rectal tumors in our institute is similar to the literature data with a complete response in 16.9%, near complete response in 28.9% partial response in 36.1% and no response in 18.1% of patients, according to modified Ryan score. It was found that upper rectal tumors had a poorer response when compared to mid and lower tumors and females had a poorer response compared to males. CONCLUSION: Even though neoadjuvant chemoradiation remains the standard of care in locally advanced rectal carcinomas, its benefit in upper rectal tumors needs to be validated in larger studies.

Expression of p16INK4a in oropharyngeal squamous cell carcinoma from a tertiary cancer centre of South India: A preliminary study.

Background & objectives: Human papillomavirus (HPV) and oropharyngeal squamous cell carcinoma (OPSCC) are found to be strongly associated with each other with an increase in incidence has been noted globally over the years. A literature search for data depicting the role of HPV in oropharyngeal carcinoma in South India, however, has resulted in little information, thus, the present study was aimed to assess a possible association between the two among OPSCC patients from a tertiary care cancer centre in South India. Methods: One hundred and fourty three OPSCC cases were included in the study and analyzed for age, gender, marital status, habits, clinical TNM staging, site, laterality, symptoms, histological type (keratinizing and non-keratinizing), primary treatment and follow up period. All the cases were subjected to p16INK4a immunostaining. Statistical analysis was done using SPSS software. Results: Of the 143 cases 12 were found to be p16 positive with no significant difference between the study variables among p16 positive and negative cases. Base of the tongue was the most commonly involved site for the p16 positive cases. The p16 positive cases presented at an elderly age, early stage and were mainly the keratinizing type. Interpretation & conclusions: The p16 positive OPSCC cases constituted a small proportion in the present study and behaved similar to p16 negative cases. Usage of tobacco and alcohol appear to be the susceptible factors even in p16 positive cases. More studies from other States would be helpful to determine if HPV-related SCC in the Indian subcontinent behave differently or similarly to cases from Western countries.

Comparison of abo antibody levels in apheresis platelets suspended in platelet additive solution and plasma.

BACKGROUND: Transfusion of platelets (PLTs) with high ABO antibody titres can pose a risk of hemolysis if the unit crosses the ABO type. The PLTs stored in the platelet additive solution (PAS) remove asubstantial fraction of plasma and replace it with an isotonicbuffered solution.We aimed to assess the difference in anti-A/B antibody levels in Groups O, A and B apheresis platelets (APs) suspended in plasma and PAS. METHODOLOGY: Apheresis donors are categorized into two groups, Plasma (Group I) and PAS (Group II), each blood group (A, B and O) had 20 samples. The anti-A/B(IgM)antibody levels were recorded from the AP donor (Group II) and from the AP units for both groups. The reduction in the anti-A/B(IgM) antibody levels in the APs suspended in the PAS for each blood group was determined. RESULTS: The median anti-A titres in blood Groups B (p = 0.009) and O (p = 0.005) was significantly lower in Group II. However, the difference in anti-B levels was not significant in the blood groups A (p = 0.057) and O (p = 0.205). The median level of reduction in IgM antibody titres across donor samples and the PAS-stored platelets was two-fold. The regression showed a level of reduction in antibody titres which can be explained by baseline donor antibody titres in blood groups A and B compared to blood group O. CONCLUSION: The medianABO antibody titres were lower in APs suspended in PAS than in plasma. Addition of the PAS significantly lowered the IgM antibody titres by twofold, compared to plasma.

Incipient Warthin tumor of intraparotid lymph node in a patient with squamous cell carcinoma of the external auditory canal: An incidental finding.

The occurrence of intranodal salivary gland neoplasm is uncommon; squamous cell carcinoma (SCC) of the external auditory canal (EAC) is another rare occurrence. Clinically, SCC of EAC presents with symptoms similar to other benign otologic conditions. A case of Stage I SCC in EAC region is presented here in a 60-year-old male patient with incidental intranodal Warthin tumor along with the histological differential diagnosis. The patient is being followed up. There is no evidence of recurrence 1 year and 11 months after surgery.

A Study on Influence of Donor Hematocrit on the Procedural Parameters of Concentrated Single Donor Platelets Collected by Two Apheresis Devices.

With improvements in apheresis collection, platelet additive solution (PAS) is steadily replacing plasma as the storage medium in single donor platelets (SDP). Concentrating platelets in SDP with one-third of plasma and two-thirds of PAS is referred as Concentrated-SDP (C-SDP). We studied the influence of donor hematocrit (Hct) in C-SDP procedures. A retrospective study, consisting of 124 and 95 plateletpheresis donors in MCS+ and Trima respectively. We compared two apheresis equipments MCS+ and Trima with regard to donor hematocrit on procedural parameters such as collection efficiency (CE), collection rate (CR), yield per hour (Y/H), yield per litre (Y/L) and percentage blood volume processed (%BV) during C-SDP procedures. Donors were categorized into two groups with Group A (Hct ≤ 46%) and Group B (Hct > 46%) based on mean baseline Hct of the study population. Among the 219 procedures, the overall CE was significantly higher for Trima over MCS+ equipment (77 vs 56, P < 0.001). However, there was no difference in procedural outcomes like CE, Y/L, Y/H, CR with MCS+ or Trima equipment between groups. %BV processed had a negative correlation with hematocrit in MCS+ (r = - 0.305, P = 0.001) and no difference was observed with Trima equipment. Donor Hct influences C-SDP collection only in processed blood volume with MCS+ equipment. Trima had statistically better performance over MCS+ equipments in all procedural parameters during C-SDP procedures. The data will guide apheresis centre to choose equipments based on donor characteristics.

Modeling predonation testing strategies in platelet donations - Approach from low throughput apheresis blood center from India.

BACKGROUND: Hospital-based blood centers in India adopt pre-donation testing for transfusion-transmitted infections (TTI) before plateletpheresis donations. However, the WHO emphasizes on TTI tests be performed on samples collected during the donation process. The study objective was to determine whether cost implications by adopting product testing along with predonation testing or only product testing strategy in platelet donation in Indian blood centers. MATERIALS AND METHODS: Cross-sectional study on registered plateletpheresis donors, strategy-1 with predonation testing using rapid tests and product testing using chemiluminescence (CLIA) were compared with alternate models: Strategy-2 (predonation test using CLIA and product testing with rapid test) and strategy-3 (product testing). For strategy-1 and 2, donors wait for predonation test to complete or visit blood center twice, while strategy-3 donors donate plateletpheresis immediately. The cost implications of these strategies were compared among registered plateletpheresis donors. RESULTS: Out of 560 donors registered with strategy-1, three donors were reactive in predonation tests and six platelet units were discarded at product testing. After modeling, for strategy-2, nine donors would be identified as sero-reactive at pre-donation test only, while in strategy-3, nine units would be discarded in product testing. Only 506 donations were completed in strategy 1 after donor attrition. Recoverable costs was greater for strategy-3 (INR 5,146,500) than strategy-2 (INR 5,120,000) and strategy-1 (INR 5,069,000). CONCLUSION: Strategy-3 appears cost-effective but requires regulatory changes in the Indian setting. Testing apheresis procedures using Strategy 2 had greater cost recovery, and also prevents infectious donations and thereby enhances blood safety with the present guidelines.