ADAMTS13 factor deficiency in severe COVID-19 may not be immune mediated - report from a pilot study.

BACKGROUND: The assessment of ADAMTS13 factor activity and inhibitor levels was conducted in severe COVID-19 patients as an observational study. RESULTS: A total of 14 patients were included and the average ADAMTS13 activity level at the time of admission was 28.54±30.74% (range 1.83-86.67%) which was reduced compared to controls (88.09±14.77). Nine patients had reduced ADAMTS13 factor activity (<40%) and 77.7% among them had severe deficiency (<10% activity). ADAMTS13 inhibitor was positive (>15 IU/mL) only in two patients and an overall mean value was 8.15±5.8. Elevated D-Dimer and length of hospital stay had significant correlation with ADAMTS13 activity (-0.247 and 0.306 respectively). No features of thrombotic microangiopathy were observed and hence no plasma exchange was performed. CONCLUSION: Reduced ADAMTS13 factor activity without inhibitor development may give a clue to the disease progress in COVID-19.

Deletion in the A4GALT Gene Associated with Rare "P null" Phenotype: The First Report from India.

BACKGROUND: The present report illustrates a case with rare "P null" phenotype due to a large deletion in chromosome 22q13.2 and with clinically significant anti-PP1Pk antibody. Patient blood management in such cases is challenging. CASE REPORT: The transfusion center supporting the tertiary care referral center in the southern part of India received a blood sample from a trauma case for pre-transfusion testing. An antibody to a high-frequency blood group antigen was initially suspected. Following extensive immune-hematological workup, the patient was diagnosed to have naturally occurring anti-PP1Pk antibody and a rare "P null" phenotype. The genomic DNA of the patient was analyzed by exome sequencing followed by Sanger's sequencing. Molecular diagnostics revealed a large 21-bp deletion in chromosome 22q13.2 which encodes the A4GALT gene, resulting in truncation of seven amino acids I245-251P and resulted in rare "P null" phenotype. Patient blood management strategies were adopted to manage the patient conservatively without blood transfusion. CONCLUSION: A large deletion in chromosome 22q13.2 had resulted in a rare "P null" phenotype in the present case. The patient was a victim of a road traffic accident, required emergency hospitalization, as well as surgical intervention, and his plasma had antibodies to high-frequency antigens. A rare donor registry plays a major role in providing transfusion support to such cases.

Anti-IH: An Innocuous Antibody Complicating Pre-Transfusion Testing

@#The positive antibody screen during pre-transfusion testing helps in the detection of clinically significant antibodies. However, sometimes clinically insignificant antibodies might perplex the serologic workup and can cause a delay in transfusion. Prompt recognition and timely resolution of these discrepancies in pre-transfusion testing, although time-consuming, is essential for the provision of safe blood to recipients. We report a case with an anti-IH antibody complicating the serological workup of pre-transfusion testing and an approach for its resolution and management. The role of transfusion medicine specialists in the characterization of antibodies and the selection of appropriate blood is paramount or warranted to promote safe transfusion practices.

After Hour Blood Transfusions: A Transfusion Service Perspective.

Optimal functioning of blood transfusion service during after hours with limited resources are highly challenging. Best transfusion practice guidelines recommends to avoid non-urgent transfusions during out-of-core hours for the concern of patient's safety. This study aimed to evaluate the after hour packed red cell transfusion practice and to identify the proportion of avoidable transfusions in our center. The transfusion requests received, cross-matched and issued between 8 p.m. and 8 a.m. from September 2015 to August 2016 were analysed and categorized into 3E's based on the clinical need as Group I-evident need, Group 2-empirical need and Group 3-elective need. The proportion of avoidable transfusion in each group was noted based on BCSH guidelines on red cell transfusion including the patient's clinical, laboratory parameters and transfusion details. The proportion of PRBC requests received, crossmatched and issued between 8 p.m. and 8 a.m. were 24.45%, 23.84% and 27.15% respectively. The rationale for PRBC transfusion documented for evident, empirical and elective need were 56.95%, 29.34% and 13.71% respectively. Out of which, 19.21% [876/4559] was identified as avoidable transfusions providing no immediate clinical benefit to patients. This study highlights the proportion of avoidable transfusion during after hours in our center and emphasizes the need for transfusion guidelines that recommends to restrict after hour transfusions to those patients with active bleeding or urgent clinical need in order to prevent transfusion related adverse events and improve patient safety.

Effect of pre-donation fluid intake on fluid shift from interstitial to intravascular compartment in blood donors.

BACKGROUND: Fluid shifts from interstitial to intravascular space during blood donation helps in compensating the lost blood volume. We aimed to determine the volume of fluid shift following donation in donors with and without pre-donation fluid intake. METHODS: We studied the fluid shift in 325 blood donors prospectively. Donors were divided in groups- with no fluid intake (GI) and either water (GII) or oral rehydrating fluids (GIII) before donation. Fluid shift following donation was calculated based on the difference between the pre and post donation blood volume. The influence of oral fluid intake, age, gender and body mass index (BMI) on volume of fluid shift was analyzed. RESULTS: The fluid shift was significant between donors without fluids (GI: 127 ±â€¯81 ml) and donors with fluid intake (GII & III: 96 ±â€¯45 ml) (p < 0.05). The difference was not significant between donors with water intake (GII: 106 ±â€¯52 ml) and oral rehydrating fluid intake (GIII: 87 ±â€¯41 ml). The shifted fluid volume increased with increasing BMI and decreased with increasing age in females. The fluid shift increased in females than in males. CONCLUSION: The age, gender, BMI and VVR did not significantly contribute to the volume of fluid shift following donation. As per our observation, the oral fluids before donation might not contribute to increase in fluid shift in blood donors after donation.

The study of antilingula and its relation to the lingula and mandibular foramen, the presence of mylohyoid bridging in dry mandibles of South Indian population.

BACKGROUND AND OBJECTIVES: The mandibular foramen and the lingula, because of their relation to the inferior alveolar nerve are of clinical significance for the orodental surgeons. Identification of the antilingula is important in mandibular ramus surgery in which the medial surface of the ramus is not visualized. METHODS: The present study includes adult dry 50 mandibles of unknown age and sex. The measurements were taken using vernier calipers. The points taken for measurements were most prominent point on antilingula, tip of lingula, most anterior, posterior and inferior points of mandibular foramen. The measurements were denoted as A, B, C and D which represent the anterior, posterior, superior and inferior distances. RESULTS: Antilingula was present on right side in 25 and on left side in 28 mandibles. There was a significant difference in distances in mean between the antilingula and mandibular foramen of both the sides (p < 0.001). Retromolar foramen was observed in 6 mandibles. Mylohyoid bridging was seen in 3 mandibles. CONCLUSION: The mandibular foramen was located posterosuperior to the antilingula on both the sides. There was no statistical significance in the distances between the lingula and the antilingula. Therefore antilingula can be used as an important surgical landmark for locating the mandibular foramen in mandibular ramus osteotomies.