Assessment of the Key Performance Indicator Proposed by NABH in the Blood Centre of a Tertiary Health Care Hospital in Southern India.

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.

Quality assessment of platelet concentrates prepared by platelet-rich plasma, buffy-coat, and apheresis methods in a tertiary care hospital in South India: A cross-sectional study.

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.

Urine microscopy and neutrophil-lymphocyte ratio are early predictors of acute kidney injury in patients with urinary tract infection.

OBJECTIVE: Urinary tract infection (UTI) is a common cause of morbidity and hospitalisation in the population worldwide. Upper UTI is indolent and causes subclinical acute kidney injury (AKI) resulting in preventable cause of scarring of renal parenchyma. We explored urinary and serum levels of kidney injury molecule-1 (KIM-1), haematological parameters and quantitative urine microscopy parameters to predict kidney injury. METHODS: Neutrophil-lymphocyte ratio (NLR) is obtained by dividing absolute neutrophil count with absolute lymphocyte count. Quantitative urine sediment microscopy was performed and correlated with clinical, biochemical and haematological findings to predict AKI in patients with UTI. Quantitative ELISA was performed for serum and urine levels of KIM-1. Seventy two adult patients with UTI were enrolled, 45 of whom had AKI while 27 were in the non-AKI group. RESULTS: NLR (p=0.005) and renal tubular epithelial cell-granular cast score in quantitative urine microscopy (p=0.008) are strong predictors of AKI in patients with UTI while rest of quantitative urine microscopy parameters and serum and urinary levels of KIM-1 molecule were not found to be useful in prediction of AKI. CONCLUSION: NLR in haemogram is a novel and useful biomarker for predicting AKI in patients with UTI.

Gilbert's syndrome in healthy blood donors what next??

SETTINGS: This study was done in a tertiary care hospital having bed strength of more than 700 beds at SDM Medical College of Medical Sciences and Hospital, Dharwad, located in Northern Karnataka. AIM: The study was done to ascertain prevalence of Gilbert's syndrome in healthy blood donors and review the literature about feasibility of utilizing blood components from Gilbert's syndrome donors. MATERIALS AND METHODS: The study was done for 18 months and 7030 whole blood units were collected and all the units were subjected to mandatory transfusion-transmitted screening and all the plasma bags which were icteric on visual inspection were subjected to hematological and biochemical investigations to rule out other causes of hyperbilirubinemia. RESULTS: Seven thousand and thirty units were collected and 445 (6.3%) were discarded due to various reasons. Of them, 50 units (0.71%) had Gilbert's syndrome. All had unconjugated hyperbilirubinemia and other hematological and liver function tests were within normal range. Statistical analysis was done to find mean, median, and standard deviation from mean and standard error of mean with lower and upper confidence limits. CONCLUSION: Majority of blood donors whose plasma is icteric are suffering from Gilbert's syndrome (GS). This disease does not cause any harm to donor or patient but raises a lot of concern as many severe disorders also manifest in similar way. The available literature shows that all blood components can be used from donors suffering from GS. There should be introspection. Proper guidelines are to be framed about the use and discarding of blood components in donors with GS.