A randomized control trial for evaluation of transfusion related immuno-modulation in patients with meningioma.

BACKGROUND: Blood transfusion necessity in neurosurgery varies based on surgical type, blood loss, and patient anemia. Leukocytes in red blood cells (RBCs) component release pro-inflammatory cytokines during storage, contributing to transfusion-related immunomodulation (TRIM). Our aim was to examine the impact of the leukocyte content in transfused PRBCs on patients undergoing neurosurgery for meningioma tumours. STUDY DESIGN AND METHODS: This prospective randomized controlled trial conducted from 2018 to 2020 by dividing patients randomly into non-leukoreduced (NLR) (n = 65) and leuko-reduced (LR) (n = 65) groups based on PRBCs received during surgery and hospital stay. Hospital and ICU stays, mechanical ventilation duration, and postoperative bacterial infections were observed. Hematological parameters and cytokine levels (IL-10, INF-gamma, and FAS-L) were assessed at pre-transfusion, 24 h, and 7 days post-transfusion. Data analysis included Mann-Whitney U test, Friedman test, Fisher's chi-square test, with statistical significance at p < 0.05. RESULTS: In our study, ICU and hospital stay duration showed no significant difference (p = 0.06) between groups. However, NLR group had longer mean mechanical ventilation (18 ± 40.1 h) than the LR group (12.8 ± 8.6 h). Both groups showed statistically significant increase in Fas-L level on days 1 and 7 (p < 0.05). The IL-10 levels rose 43% in the NLR group, while and decreased by 7% the LR group on day 1. On day 7, IL-10 increased by 75% in NLR and decreased by 40% in LR, with no significance (p > 0.05). CONCLUSION: In conclusion, leukoreduction appeared to offer some immune response protection in term of reducing mechanical ventilation timings and cytokine level changes.

A rare report of H-partially deficient, non-secretor phenotype from India. An Ah like the rèunion and unlike a Para Bombay-Clarifying misinterpretations.

BACKGROUND: H-deficient phenotypes are classified as H-deficient non- secretors (Bombay Oh), H-deficient secretors (Para Bombay), and H-partially deficient non-secretors (O h reunion, Ah and Bh, ABh). REPORT: We report the first case of H-partially deficient non-secretor- the Ah phenotype from India. What makes this report interesting is that they do not fit into the Bombay, or the Para Bombay series of H-deficient phenotypes and these partially deficient non-secretors were exclusively found on Réunion Island, off the East Coast of Africa in 1982. These reunion type phenotypes have not been reported since then and may lead to misinterpretations and confusions when encountered in the current existing laboratory settings especially in the low income (LIC's) and low middle income (LMIC's) countries like our own. Moreover, literature from LMIC and LIC incorrectly uses Ah/Bh for parabombay phenotypes. CONCLUSIONS: H-deficient phenotypes are rare, challenging to identify and assign correct notations. Hence, we have highlighted characteristic differences between H-deficient phenotypes and illustrated a diagnostic laboratory approach to correctly identify and assign notations to them especially in the resource constrained settings.

Extended blood group phenotyping of donors from the lower and middle Himalayan region of Uttarakhand India: A pilot study.

BACKGROUND: The state of Uttarakhand, bordering countries such as Tibet and Nepal, is a multi-ethnic region. Further, erythrocyte alloimmunization may arise from the incompatibility of major and/or minor blood groups between ethnically diverse donors and recipients. We aimed to screen Uttarakhand blood donors (UBDs) for extended phenotyping of their erythrocytes serologically. METHODS: This prospective cross-sectional analysis involved all UBD samples collected at the blood centre of our tertiary-care hospital. Samples were obtained over 9 months (Mar'22 to Nov'22). Donors who were O-typed, DAT-negative and non-reactive for TTI markers were processed further for serological testing using the column agglutination technique utilizing 21 different monoclonal antisera (Ortho diagnostics Pvt ltd, Mumbai India). The research was financially aided by UCOST, Uttarakhand, Government of India. RESULTS: Of the 5,407 blood samples collected, the total number of O-typed samples collected was 1622. Of these 1622, 329 (20.2 %) O-typed samples were selected based on our inclusion criteria and hence further phenotyped. Amongst these 329 UBDs, the average age was 32.7 ± 9.32 (18-52) years and the male-to-female ratio was (M: F = 12:1). The prevalence of high- and low-frequency blood antigens in our study was Rh (D 96.6 %, C 84.8 %, c 63.5 %, E 27.9 % and e 92 %), Lewis (Lea 6.3 %, Leb 31.9 %), Kidd (Jka 87.8 %, Jkb 63.2 %), Kell (K 1.8 %, k 96.3 %) and Duffy (Fya 63.5 %, Fyb 10.6 %). And in the MNS system we received 21.2 % as M, 10.9 % N, 37 % S and 51.3 % as s respectively. We also identified some very rare minor antigens such as Dia 1.8 %, Ina 1.8 %, Cw 0.6 % and, 1.2 % Mur positive donors, which are not common in our population, as per the published literature. Moreover, we also identified one Bombay blood phenotype (Oh) in one of our UBD recruits. CONCLUSION: To sum up, practically with the outcome of this research, we were also able to identify rare phenotypes among the local people and a rare blood donor registry was created. This repository shall also come in use for our multi-transfused patients having different oncological and haematological ailments.

Significance of mandating a dedicated hemovigilance nurse and objectification of 'imputability' levels. Experience from a hospital-based blood centre in India.

BACKGROUND: National Hemovigilance Programme aims at improving patient and donor outcomes by monitoring adverse reactions. This requires an additional effort by existing manpower that is already a handful and may offer a leeway if not mandated and designated to a hemovigilance nurse. AIMS AND OBJECTIVES: To analyse the reported adverse transfusion reactions (ATR) and their subsequent uplink/upload into the Hemovigilance program of India (HvPI) and to observe subjective discrepancy in the diagnosis of ATR and their imputability to transfusion. MATERIAL AND METHODS: ATR were analysed from May 2016 to October 2021 in a hospital-based blood centre in India. Two groups were formed, Group I constituted ATR that were reported and uplinked to HvPI, and Group II constituted all reported ATR irrespective of the uplink/upload. All ATR were reanalysed for a subjective discrepancy in diagnosis and imputability levels. Results were analysed online statistical software MedCalc using the "Exact Poissons Method" and the Chi-square test with a significant p-value of <0.05. RESULTS: In total 169 ATR were reported in 166 patients and 89 (52.6%) were uplinked, with an incident rate of 1 in 1412 and 1 in 743 in Group I and Group II respectively. The difference was statistically significant (p < 0.0001). Allergic reactions were the most common type in both groups followed by FNHTR with PRBC as the most implicated blood product. A discrepancy of around 4.3% and 17.9% in diagnosis and imputability level respectively was observed. CONCLUSIONS: The difference in incidence rates in the two groups indicates a mandate for dedicated hemovigilance nurses in every centre to aid in accurate data sharing with the National hemovigilance systems. Discrepancies in diagnosis can be mitigated by identification and understanding of ATR through case-based objective approach. Discrepancy in assigning imputability levels to adverse reactions can be minimised by objectifying the scales followed by spreading awareness though campaigns. These initiatives can effectively be aided by the hemovigilance nurse.

Association of blood donor's biological characteristics on outcomes of cardiac surgery patients receiving red blood cells transfusion.

OBJECTIVES: This study aimed to assess the association of blood donor variables on the outcome of patients undergoing cardiac surgery. STUDY DESIGN AND METHODS: A retrospective observational study was conducted on patients who had cardiac surgery between January 2018 and December 2020. Blood donor characteristics such as age (≤ or >30 years), sex, and body mass index (BMI) (≤ or >25 kg/m2) were analyzed for association with patient outcomes (length of hospital stay (LOS), mortality, and readmission). Sex matching was done as fully match, fully mismatch, and partial mismatch. Cox regression and Linear regression models were used to study the association with mortality and readmission, and LOS. RESULTS: During the study period, 5788 patients had cardiac surgery; receiving a total of 20,348 red cell units. Of which, 522 (9%) died, 531 (9.2%) re-admitted and median LOS was 11 days (IQR 7-18). BMI >25 kg/m2 (ß, 2.96; p = 0.000), female to male transfusion (partial mismatch: ß, 4.42; p = 0.001; fully mismatch: ß, 9.0; p = 0.02) negatively affected LOS. BMI >25 kg/m2 (HR, 2.07; p = 0.00) and partial mismatch transfusion to male patients (HR, 1.60; p = 0.01) increased mortality. Fully mismatch transfusion to female patients (HR, 1.24; p = 0.01) and partial mismatch to male patients (HR, 1.86; p = 0.01) increased readmission. No association of donor age on patient outcome was observed. DISCUSSION: Blood donor sex, and BMI can influence mortality and LOS in cardiac surgery patients. The use of computer tools to match the patient's and donor's characteristics can assist to eliminate these types of adverse consequences.

Management of blood transfusion services in low-resource countries.

BACKGROUND AND OBJECTIVES: Enabling universal access to safe blood components should be a key component of every country's national healthcare strategy. This study aimed to assess the current status of infrastructure and resources of blood transfusion services (BTS) in low- and middle-income countries. MATERIALS AND METHODS: A cross-sectional survey was designed to gather information on blood donations, components, redistribution, testing resources and quality management systems (QMSs). The survey was distributed to the International Society of Blood Transfusion members between October 2021 and November 2021. RESULTS: A total of 54 respondents from 20 countries responded to the survey. This included hospital-based BTS/blood centres (46%), national blood centres (11%)and national and regional blood services (11%). Voluntary non-remunerated, replacement and paid donors accounted for 94.2%, 84.6% and 21.1% of donations, respectively. Apheresis donation was available in 59.6% of institutions. National/regional criteria for redistribution of blood components were reported by 75.9% of respondents. Blood components incurred payment charges in 81.5% of respondents' institutions, and payments were borne by patients in 50% of them. Testing methods, such as manual (83%), semi-automated (68%) or fully automated (36.2%), were used either alone or in combination. QMSs were reported in 17 institutions, while accreditation and haemovigilance were reported in 12 and 8 countries, respectively. CONCLUSION: QMS was implemented in most of the countries despite the common use of paid donations and the lack of advanced testing. Efforts to overcome persistent challenges and wider implementation of patient blood management programmes are required.

Seroprevalence of SARS-Coronavirus 2 among asymptomatic healthy blood donors from healthcare and non-healthcare settings: Implications for safety of blood donors and blood collection staff during blood donation.

INTRODUCTION: SARS-Coronavirus-2 pandemic has adversely affected blood supply as potential blood donors were afraid of acquiring infection in hospital settings. We aimed to compare COVID-19 seroprevalence among asymptomatic blood donors from healthcare and non-healthcare setting to analyse the difference in exposure level of each group as well as the risk of acquiring infection during the process of blood donation. MATERIAL AND METHODS: Analysis of whole blood donors tested for SARS-CoV-2 IgG antibodies was carried out after categorizing them into healthcare workers (HCW) and non-healthcare workers (NHCW). NHCW were further categorized into residents of containment and non-containment zones and seroprevalence analyzed. Seroprevalence among different ABO blood groups was also analyzed. RESULTS: 1191 blood donors were tested for SARS-CoV-2 antibodies with 9.5 % seropositivity. Significantly lower seropositivity of 3.2 % (p < 0.001) was observed among HCW as compared to 10.9 % seropositivity in NHCW. Among NHCW no difference in seropositivity was observed based on residence in containment or non-containment zone. Significantly higher (p = 0.012) seroprevalence was observed among A blood group donors (12.5 %) as compared to O blood group donors (6.8 %). CONCLUSION: Results suggests that a blood donor, in a hospital setting is less likely to be exposed to COVID-19 disease than when participating in activities of daily living. It is postulated that the lower seroprevalence among HCW as compared to NHCW reflects differences in knowledge and practice of preventive measures among these groups. The findings should instil confidence among blood donors and motivate them to donate blood without fear.

Understanding the role of therapeutic plasma exchange in COVID-19: preliminary guidance and practices.

BACKGROUND AND OBJECTIVES: Cytokine release syndrome in COVID-19 is due to a pathological inflammatory response of raised cytokines. Removal of these cytokines by therapeutic plasma exchange (TPE) prior to end-organ damage may improve clinical outcomes. This manuscript is intended to serve as a preliminary guidance document for application of TPE in patients with severe COVID-19. MATERIAL AND METHODS: The available literature pertaining to the role of TPE for treatment of COVID-19 patients was reviewed to guide optimal management. It included indication, contraindication, optimal timing of initiation and termination of TPE, vascular access and anticoagulants, numbers and mode of procedures, outcome measures and adverse events. RESULTS: Out of a total of 78 articles, only 65 were directly related to the topic. From these 65, only 32 were acceptable as primary source, while 33 were used as supporting references. TPE in critically ill COVID-19 patients may be classified under ASFA category III grade 2B. The early initiation of TPE for 1-1·5 patient's plasma volume with fresh frozen plasma, or 4-5% albumin or COVID-19 convalescent plasma as replacement fluids before multiorgan failure, has better chances of recovery. The number of procedures can vary from three to nine depending on patient response. CONCLUSION: TPE in COVID-19 patients may help by removing toxic cytokines, viral particles and/or by correcting coagulopathy or restoring endothelial membrane. Severity score (SOFA & APACHE II) and cytokine levels (IL-6, C-reactive protein) can be used to execute TPE therapy and to monitor response in COVID-19 patients.

Deterrents in recruitment of COVID-19 convalescent plasma donors: Experience from a hospital-based blood centre in India.

INTRODUCTION: Recruitment of Covid-19 convalescent plasma (CCP) donors may present as a challenge due to inexperience and differences in donor profile as compared to whole blood donation. Present study highlights the deterrents to recruiting CCP donors at a hospital based blood centre. MATERIALS AND METHODS: Potential CCP donors were contacted individually by telephone and a group approach through camp organisers from May to July 2020. Recruitment challenges were noted and deferrals of these recruited donors during screening and medical examination was obtained and analysed. RESULTS: Total 1165 potential CCP donors were contacted. Around 47% donors were lost due to challenges related to information storage and retrieval. Fear of health, family pressure, and fear of a new procedure were major reason (27.2%) for unwillingness to donate. The main reasons for deferral among potential donors were multiparity (38%) and being overage/underage (31.6%). Finally, 468 donors were recruited including 408 by individual approach and 60 by a group approach. From these absence of detectable COVID-19 antibodies were found in 15.4%. Few donors (9.0%) were deferred as they had not completed 28 days post recovery. CONCLUSION: The process of CCP donor recruitment differs from that of whole blood donation and requires an individualised approach with involvement of clinicians in the initial phases of the pandemic. A group approach targeting specific organisations could be adopted for a successful CCP collection program. There is a need to relook into some aspects of donor selection such as consideration of multiparous female donors and overage/underage donors after reviewing scientific evidence.

Comparison of efficacy of low and high dose prophylactic platelet transfusion therapy in thrombocytopenic haemato-oncology patients.

INTRODUCTION: To determine an optimal platelet dose in thrombocytopenic patients is important for their judicious use. Transfusing platelets in different doses and comparing their post transfusion response can achieve this. AIM: To compare the efficacy of low and high dose single donor apheresis platelets (SDAP) with standard dose transfusions in terms of Corrected Count Increment (CCI), Percent Platelet Recovery (PPR) and transfusion free interval. METHOD: It was a prospective case control study done from January 2016 to April 2017. Twenty-eight hemato-oncology patients with CCI ≥5000 at 20-24 hours after standard dose (3 × 1011/unit), received low dose (1.5 × 1011 platelets/unit) and high dose (>4 × 1011 platelets/unit) SDAP. CCI and PPR were calculated after 20 to 24 hours of transfusion. Transfusion free interval and bleeding episodes were also noted. Grading was done according to WHO bleeding scale. RESULT: There was no statistical difference in CCI and PPR when standard dose was compared with low dose (CCI: p = 0.92, PPR: p = 0.89). When standard and high dose was compared, standard dose gave better results than the high dose in terms of CCI (p = 0.006) and PPR (p = 0.008) although the post transfusion increments were comparable (p = 0.938). High dose gave better (p = 0.005) platelet count increments than low dose but CCI (p = 0.04) and PPR (p = 0.05) was significantly less than the low dose. The difference in transfusion free intervals after three doses was not significant. Donor exposure to the patients was significantly (p = 0.000) reduced to 17.5%. CONCLUSION: Possibility of low dose as an alternative to standard dose can be considered in view of comparable platelet response indicators and significantly reduced donor exposure.

Consecutive reactive results in screening of transfusion transmitted infections: Family history of blood donors is also important.

BACKGROUND: Enzyme linked immunosorbent assay (ELISA) test is used for screening of transfusion transmitted infections (TTI) in blood donors. Consecutive reactive results in ELISA is due to sample/reagent carryover or donor related. In this study we tried to find out the possibilities of family history/close contacts with patients of hepatitis among these consecutive reactive donors. AIM: To analyze the consecutive reactive results in ELISA tests for TTI testing on samples of healthy blood donors. MATERIAL AND METHODS: A retrospective observational study was conducted from January 2016 to July 2018 in a tertiary care hospital, North India. Consecutive reactive results by fourth generation ELISA for TTIs screening were evaluated for possible reasons. Confirmation tests were not done. Reactive donors were contacted telephonically for relevant history of close contact with infected personnel. RESULTS: Out of 53,740 donations 1,061 were reactive for TTIs during our study period. Prevalence of Hepatitis B (HBV), Human Immunodeficiency (HIV) and Hepatitis C (HCV) virus infection in blood donors were 1.27%, 0.20% and 0.50% respectively. Consecutive reactive results for HBV were 9.20% (63/685), for HCV 6.0% (16/266) and nil for HIV. There was no sample carryover in this. Out of 79 consecutive reactive donors 69 donated for same patients and 32 were related with infected patient which are statistically significant (p < 0.0001). DISCUSSION: This study recommends that in analysis of consecutive positive results in ELISA along with looking for procedure/sample error, there is also a need to take retrospective history of donors for close contact with infected patients.