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INTRODUCTION: The rate of discarded blood components or "wastage rate" reflects on the whole process, preparation, and production of blood and its quality control. It is the ratio of blood and blood components discarded to the total number of collections. The discard or unusability of blood products are many, and the ones that can be monitored and regarded as indicators to be improvised on are QC failure rate, transfusion-transmitted infection (TTI) positivity, and component discards (other than TTI), including those that caused transfusion reactions. These were studied over four intervention cycles to see if they could be improved. MATERIALS AND METHODS: This was a clinical audit and quality improvement study. The clinical audit was conducted over four cycles over 16 months. Each cycle included three stages wherein the data required for calculating those key performance indicators (KPIs) of the blood center were studied and analyzed, and causes for the poorly performing ones were identified; a corrective plan was drawn and implemented, followed by data collection and interpretation of the same in the next cycle for improvement. The data were compiled using a Microsoft Excel spreadsheet and analyzed using SPSS version 19 (IBM Corporation, New York, USA). RESULTS: The overall discard rates due to all cumulative causes mentioned were at about 5% at the start of the first cycle. The various factors comprising preparatory, preparation, and the management of inventory and issue were analyzed, and corrective interventions were performed in every cycle. The discard rates were reduced to about 3% by the end of the four cycles. The difference was statistically significant, with a P < 0.05. CONCLUSION: The implementation of Corrective and preventive action measures can rectify the deviations in KPIs. The blood center director, staff, and doctors should be responsible for maintaining and continuously improving the quality indicators.
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India achieved impressive strides by providing 1.7 billion doses of the COVID-19 vaccine to more than 940 million people, attaining 100% first dose coverage and 80% overall immunization coverage as of February 9, 2022. Compared to unvaccinated individuals, vaccinated people have considerably decreased risks of infection, serious illness, hospitalization, and death. With the help of this study, we determined the prevalence of COVID-19 IgG antibodies with respect to vaccination. The cross-sectional analytical study was conducted from July 2021 to April 2022 on 809 healthy donors. All donor samples were screened for COVID-19 IgG antibodies against S1 protein using IgG ELISA kits (Qualisa COVID-19 IgG kits, Tulip, Goa, India). Data regarding COVID-19 infection history, vaccination status, type of vaccine, and the number of doses were obtained. All data were entered in Microsoft Excel and analyzed using SPSS version 21. Out of 809 blood donors, a total of 650 participants were vaccinated, among which 89.5% had COVID-19 IgG antibodies and 10.5% had no antibodies. Out of the 159 who had not taken vaccination, 52.8% of the participants had COVID-19 IgG antibodies, and 47.2% of the donors had no COVID-19 IgG antibodies. A total of 617 participants have taken the Covishield vaccine, of which 90.2% had COVID-19 IgG antibodies. A total of 32 donors have taken Covaxin, of which 78.1% had COVID-19 IgG antibodies. The above study has shown that COVID-19 vaccination enhances covid antibody formation, and multiple doses of vaccine ensure longevity of these antibodies.
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INTRODUCTION: Donor vein assessment for the selection of good quality veins is crucial for a successful apheresis procedure. This study intends to find out the effectiveness of a vein assessment scoring tool (VST) used and found to be effective in selecting whole blood donors to reduce the difficulty in identifying good quality veins for the plateletpheresis procedure. MATERIALS AND METHODS: This was a prospective observational study on platelet apheresis donors with the application of a VST consisting of three vein descriptor parameters (vein visibility, vein palpability, and vein size) with 5 Likert-type responses constituting a score of 0-12 for each arm. Two vein assessors independently evaluated the vein in both arms and marked their responses blinded from each other as well from the principal investigator. The scores were then calculated and analyzed at the end of the study for their association with phlebotomy and procedural outcomes. RESULTS: A total of 190 donors were recruited. The mean scores for the arms with successful and failed phlebotomy were 9.1 and 9.4 (SD 2.3), respectively. The intra-class correlation Alpha Cronbach value was 0.834 and 0.837 for total scoring in the left arm and right arm, respectively, between the two assessors. Scores neither showed a correlation with other outcomes like low flow alarms, hematoma formation, number of phlebotomy attempts, and procedure completion. CONCLUSION: The study showed that the vein score tool did not truly predict the phlebotomy outcome in apheresis donors, though there was a good degree of inter-assessor reliability.
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Plaquetoferese , Veias , Humanos , Plaquetoferese/métodos , Reprodutibilidade dos Testes , Doadores de Sangue , Flebotomia/métodosRESUMO
The P blood group system was introduced in 1927 by Landsteiner and Levine. About 75% of the population possesses P1 phenotype. P2 simply implies P1 negative and there is no P2 antigen. Individuals with P2 may have anti-P1 antibodies in there serum are cold-reacting antibodies which are clinically insignificant and occasionally active at 20°C or higher temperatures. However, in certain cases, anti-P1 is clinically significant and may cause acute intravascular hemolytic transfusion reactions. Our case report confirms the complexity and difficulty in the diagnosis of anti-P1. In India, very few cases are reported regarding clinical significant anti-P1. Here, we report a case of IgM type of antibody anti-P1 which was reactive at 37°C and AHG phase in a 66-year-old female planned for Whipple's surgery, who had grouping discrepancies in reverse typing and incompatibility during routine crossmatch.
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BACKGROUND AND OBJECTIVES: High-yield plateletpheresis donations can reduce donor exposure and be economically beneficial as well. However, obtaining a high-yield plateletpheresis from a maximum number of donors with low basal platelet count and its effect on postdonation platelet count of donors undergoing high-yield plateletpheresis has been a matter of concern. This study aimed to assess the feasibility of making high-yield platelet donation as a routine practice. METHODS: It was a retrospective observational study to determine the effect of high-yield plateletpheresis on donor reactions, efficacy, and quality parameters. It was conducted from January 1, 2019 to June 30, 2021, at the Department of Transfusion Medicine in a tertiary care hospital of South India. RESULTS: Out of the 669 procedures, 564 (84.3%) of the collection had a platelet yield of ≥5 × 1011, 468 (70%) of the collection had a platelet yield of 5.5 × 1011, whereas 284 (42.5%) met the target of 6 × 1011 by coulter. The mean drops in platelet count were 95 ± 16 × 103/µl (77,600-113,000/µl), mean platelet recruitment was 1.31 ± 0.51. The mean collection efficiency of the procedure for the 669 cases was shown to be 80.21 ± 15.34, and the mean collection rate was 0.07 × 1011 ± 0.02 per minute. Only forty donors (5.5%) experienced adverse donor reactions. CONCLUSIONS: High-yield plateletpheresis can be done in routine practice with no added adverse donor reaction with effective quality products.
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Quality indicators are tools for continuous improvement to enable the blood center to achieve its standards of the highest quality. Hence, they have to be established and monitored regularly for which NABH (National Accreditation Board for Hospitals) accreditation should be sought for. This study was undertaken to assess the Key Performance Indicators (KPI) through clinical audit quality control study of ten parameters, with a goal to improve and meet the benchmark as defined by NABH. All 10 Key Performance Indicators defined by NABH were analysed prospectively in a tertiary care blood centre of southern India. Parameters were compared to that of bench mark standards. Root cause analysis of all non-conformance parameters were done. Problem were identified and action taken to achieve KPI benchmarks in all deviations. Out of the ten KPI's which were studied, more than 50% meet the quality standards. The ones that did not meet the bench mark were TTI-HIV% which was 0.44%, TTI-Syphilis (RPR)% 0.26%, Number of units received back for discarding 5.96%, PRBC wastage% (on-shelf) was 2.11%, FFP, Cryoprecipitate wastage % (on-shelf) was 2.71%, the mean TAT for crossmatch of emergency PRBC blood was 18.3 min, 41.11% of FFP QC failure failed, Delay in transfusion time beyond 30 min after issue was 19.14%, Donor Deferral rate was 16.36% and TTI Outliers% No. of deviations beyond ± 2SD for HBsAg, HCV, HIV were 14.43%, 12.59% and17.73% respectively. Present study has helped to understand the flaws and problems faced by a tertiary care blood center in sustaining quality. It also actively captured and analysed multiple cross sections of non-conformances.
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INTRODUCTION: In blood banking and transfusion medicine, it is of paramount importance to improve transfusion safety and provide a higher quality of product to maximize the therapeutic outcomes and minimize the risk of developing transfusion-associated complications for patients receiving a blood transfusion. MATERIALS AND METHODS: This was a cross-sectional study conducted at the department of transfusion medicine in a tertiary care hospital of South India from February 2019 to December 2020. The primary objective of the study was to assess the quality of platelet concentrates (PC) prepared by platelet-rich plasma (PRP), buffy-coat (BC), and apheresis method. A total of 760 PCs were subjected to quality assessment, among which 124 were PRP-PC, 176 were BC-PC, and 460 were single donor platelet (SDP). RESULTS: The total percentage of platelets meeting all the six quality control parameters in PRP, BC and SDP was 78.23%, 81.81%, and 89.96%, respectively. Apheresis PCs showed a significantly higher platelet concentration per µL on comparison with whole-blood-derived platelets. BC-PCs were found to be better than PRP-PC with regard to lower white blood cell (WBC) contamination (P < 0.05) and red blood cell (RBC) contamination (P < 0.01). No statistically significant difference was found with regard to platelet yield, volume, swirling, and pH. CONCLUSION: Ex vivo quality of PCs prepared by BC-PC, PRP-PC, and apheresis-PC fulfilled the desired quality control parameters. BC-PC was better than PRP-PC in terms of lesser WBC and RBC contamination and comparable in terms of volume, platelet yield, swirling, and pH. Apheresis PCs showed a higher platelet concentration per microliter on comparison with whole-blood-derived platelets; hence in a blood center where facilities for collection of apheresis product are available, SDPs should be the choice of platelet transfusion.
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Priapism is a rare presentation of Chronic Myeloid Leukaemia (CML). It is also considered a medical emergency as delay in treatment may lead to impotence. Prompt medical and surgical interventions such as hydroxyurea, analgesia, phenylephrine injection and aspiration, open surgical shunting, and local radiation therapy are essential. Leukapheresis effectively reduces leukocyte count rapidly and effectively, thereby an important therapy along with other standard of care in CML-induced priapism. In the present case, priapism was the presenting symptom of CML. The same was managed with various modalities such as hydroxyurea, allopurinol, antibiotics, analgesics, sedatives, phenylephrine injection, and aspiration but failed to reduce priapism pain. With a single cycle of leukapheresis, priapism pain could be reduced significantly.
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The cryoprecipitate is an essential blood product as they are rich in factor VIII, fibrinogen, von Willebrand factor, factor XIII, and fibronectin, and their volume is too small. They play a significant role in the management of massive transfusion nowadays. Usually, they are used without ABO group consideration. We here report a case in which immunohematological problems arose due to out-of-group transfusion of cryoprecipitate. We suggest that the possibility of incompatibility subsequently is to be kept in mind during transfusion of large quantity cryoprecipitate, and ABO group compatible may be preferred.
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The Bombay Rh D negative is the rarest of the rare in blood groups. A 65-year-old male patient with coronary artery disease was admitted for CABG. During grouping, forward showed no agglutination in A, B, D, and H, and reverse showed agglutination in A, B, and O cell. The blood group was confirmed as Bombay Rh D negative. Four units of PRBC was requested for the surgery as it was cardiothoracic surgery. We checked our inventory and rare donor list for Bombay-negative blood. Acute normovolemic hemodilution was done for 2 units preoperatively with saline replacement. Autologous platelet apheresis was done for this patient. During routine cross-match, one unit was incompatible. The patient had naturally occurring anti-S, which was reactive at 37°C and clinically significant. A total of 4 PRBC (Packed Red Blood Cell), 1 Single Donor Platelet (SDP), 12 Fresh Frozen Plasma (FFP), and 9 cryoprecipitate were transfused throughout the hospital stay. The patient was Bombay Rh negative with anti-S with major surgery, which was re-explored twice; the patient was managed successfully in spite of all these difficulties with cooperation from different blood banks from all over India.
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Detection of clinically significant alloantibodies during pretransfusion testing is essential before any blood transfusion. Sometimes, clinically insignificant antibodies unrelated to blood group antigen may interfere with routine testing. Their interpretation is often made only after tedious immunohematology workup resulting in the exclusion of all possible clinically significant antibodies. We encountered such incidence which interfered with crossmatching. In our case, direct antiglobulin test was negative, indirect antiglobulin test and autocontrol were positive with pan-reactive antibody screening test, and group-specific units were incompatible. After meticulous workup, we could find that these antibodies were directed against the enhancement media, low-ionic strength solution in this case.
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India has almost 3,000 blood centres collecting more than 11 million units annually. Maintaining blood supply during the COVID-19 pandemic is a huge challenge. We conducted a cross-sectional study by an online survey to analyse the variation of practices across blood centers of India during this pandemic. A total of 196 blood centers completely responded to the online survey. Most of the blood centres who responded were part of Government hospitals (60 %), part of an academic institutes (55.6 %) and were directly supporting a COVID hospital (67.5 %). Almost 95.4 % blood centers reported reduction of blood donation mainly due to lockdown (50 %) and inability to conduct camps (17.3 %). Scheduling blood donations was one of the most difficult to implement strategy for maintaining adequate blood donation (40.2 %). Blood center manpower management was also a challenge and upto 48 % blood centers operated in two batches to ensure social distancing in blood banks and reduce the risk of exposure. Hemato-oncology (36.8 %) and obstetrics (33.7 %) were major utilizer of blood during the pandemic. There were marked variations in use of PPE by blood banks staff as well as strategies adopted while conducting immunohematology tests on COVID-19 positive patients samples. This pandemic has highlighted some of the major limitations of the health services but blood services have risen to the challenge and strived to maintain the blood supply chain while ensuring blood donor and staff safety. The wide variations in the practices adopted highlights the need for uniform guidelines for blood services in future pandemics.
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Armazenamento de Sangue/métodos , COVID-19/epidemiologia , Bancos de Sangue/organização & administração , Estudos Transversais , Humanos , Índia/epidemiologia , Pandemias , SARS-CoV-2/isolamento & purificação , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: The aim of the study was to compare the effects of single intra-articular platelet-rich plasma (PRP) and corticosteroid (CS) injections in patients with adhesive capsulitis of the shoulder. DESIGN: Patients aged 18-70 yrs of either sex, diagnosed with adhesive capsulitis of shoulder, with less than 6-mo duration, were included. In intra-articular corticosteroid (IA-CS, control) group, 30 patients received a single injection (4 ml) of IA-CS and in IA-PRP (test) group, 30 patients received single IA-PRP injection (4 ml) into the glenohumeral joint under ultrasound guidance. All patients were prospectively followed for 12 wks. RESULTS: Twenty-eight patients in IA-PRP group and 27 in IA-CS group finished the entire 12-wk study period. At 12 wks, decrements in visual analog scale and total shoulder pain and disability index scores, in IA-PRP group, were 58.4 and 55.1, compared with 48.7 and 45.8 in IA-CS group. In range of movement, IA-PRP group showed significant improvement in passive abduction (-50.4 vs. -39.4), internal (-36.8 vs. -25.8), and external rotations (-35.4 vs. -25.9) compared with IA-CS group, respectively. No major complications were observed in any patients. CONCLUSIONS: At 12-wk follow-up, a single dose of IA-PRP injection was found to be more effective than an IA-CS injection, in terms of improving pain, disability, and shoulder range of movement in patients with adhesive capsulitis of the shoulder.