The impact of COVID-19 pandemic on blood supplies and transfusion services in Eastern Mediterranean Region.

BACKGROUND: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has spurred a global health crisis. The safety and supply of blood during this pandemic has been a concern of blood banks and transfusion services as it is expected to adversely affect blood system activities. We aim to assess the situation in the Eastern Mediterranean Region (EMR) during the first months of the pandemic. MATERIALS AND METHODS: A survey was designed to address blood supply, transfusion demand, and donor management during the coronavirus disease-19 (COVID-19) pandemic. Medical directors of different blood banks were invited to participate. RESULTS: A total of 16 centers participated with representation from 15/19 countries in the region. In total, 75% were from national blood banks. Most centres had a decrease in the blood supply, ranging from 26-50%. Representatives from 14 countries (93.3%) believed that public fear has contributed to a decrease in donations. Most centres (n=12, 75%) had a reduction in transfusion demand, while those who did not, reported heavy involvement in treating patients with underlying haemoglobinopathies and haematological malignancies. Half of the centres activated their contingency plans. Four centres had to alter the blood donor eligibility criteria to meet demands. All centres implemented donor deferral criteria in relation to SARS-CoV-2, but were variable in measures to mitigate the risk of donor and staff exposure. CONCLUSION: Blood services in the region faced variable degrees of blood shortages. We summarize lessons learnt during this pandemic for the blood banks to consider to plan, assess, and respond proportionately to future similar pandemics.

Transfusion knowledge of medical and surgical specialty board residents: a cohort study.

OBJECTIVES: This study was conducted to assess transfusion knowledge between different specialty board residents and to identify areas of need for further education. BACKGROUND: Physicians' knowledge of transfusion medicine (TM) is critical for patients' safety. Many clinicians who are involved in day-to-day transfusion practice have little or no formal training in TM. There are no studies to assess physician's TM knowledge locally. METHODS: A comprehensive anonymous survey was developed to assess baseline TM knowledge of all the residents. The survey is composed of different sections, including a questionnaire on resident's demographics, resident's self-reflection on their TM knowledge and 30 multiple choice questions addressing basic and clinical TM knowledge in two major domains: component selection and transfusion practice and transfusion safety and transfusion reactions. Finally, the residents' opinion on educational needs was assessed. RESULTS: A total of 130 residents were surveyed. The lowest score obtained among the two major domains assessed was in the transfusion safety and transfusion reaction domain, with a mean score of 4·34 of 15 (SD ± 3·27). The mean score obtained on component selection and transfusion practice was 7·1 of 15 (SD ± 3·74). A substantial proportion of the residents (74·7%) admitted minimal baseline knowledge in the field of TM. Finally, 94·5% of the residents admitted the need for more education during residency, whereas 49·5% thought additional education is required during the first year of practice. CONCLUSION: This survey shows serious TM knowledge deficiency and indicates the need for additional education among all physicians during training.

Correlation between flow cytometry and molecular findings in autosomal recessive chronic granulomatous disease: A cohort study from Oman.

BACKGROUND: Chronic granulomatous disease (CGD) is an X-linked (XL) or autosomal recessive (AR) primary immunodeficiency disease. Respiratory burst assessment by flow cytometry is a rapid test of granulocyte stimulation, and results predict the underlying genotype. This study aims to describe the immune-phenotypic profile of patients with CGD diagnosed in our center and correlate that with underlying genetic mutations. METHODS: Immuno-phenotypic and genetic data on all patients with CGD diagnosed at Sultan Qaboos University Hospital (SQUH) were reviewed. RESULTS: A total of 32 patients were diagnosed with CGD using molecular studies. Genetically confirmed individuals included 1 patient with XL-CGD (a large deletion involving the CYBB and XK genes resulting in a McLeod phenotype), 27 patients with AR-CGD with a c.579G>A (p.Trp193X) mutation at the NCF1 gene, and 4 patients with AR-CGD with a c.784G>A (p.Gly262Ser) mutation at the NCF1 gene. Flow cytometry and molecular results were available for comparison in 26 patients with AR-CGD. The patients with AR-CGD had a range of flow cytometry-generated fluorescent patterns as follows: reduced neutrophil stimulation with a sharp peak (12/26), reduced neutrophil stimulation with a broad peak (11/26), and a complete lack of neutrophil stimulation (3/26). No consistent flow cytometry-generated fluorescent pattern was observed in either of the 2 AR mutations identified in our patients. CONCLUSION: Flow cytometry is a robust test of CGD diagnosis. However, results should be interpreted with caution when predicting the underlying probable genotype, and results need to be complemented with definitive molecular studies.

Intra-operative cell salvage in cardiac surgery may increase platelet transfusion requirements: a cohort study.

BACKGROUND AND OBJECTIVES: The cell saver (CS) has been widely utilized in cardiac surgery to reduce red blood cell (RBC) transfusion. We aim at examining its effect on the rate of allogeneic transfusion, morbidity and mortality in our population. MATERIALS AND METHODS: Retrospective review of all patients operated at the Sultan Qaboos University Hospital between 2008 and 2013 was performed. Patients' demographics, comorbidities and surgical details were retrieved. Study end-points included blood transfusion, infection, renal failure and mortality. Baseline characteristics of both groups were compared and differences were adjusted for in the multivariable logistic regression. RESULTS: A total of 673 patients were included (CS = 395, non-CS = 278). Baseline characteristics were similar except for systemic hypertension, congestive heart failure and use of cardiopulmonary bypass. The CS group had higher transfusion rates of platelets (CS 36% vs. non-CS 18%; P < 0·001) and plasma (CS 31% vs. non-CS 19%; P < 0·001). After adjusting for baseline differences, CS use increased the odds of receiving platelet transfusion (odds ratio (OR) 3·2; P < 0·001) but not of plasma transfusion (OR 1·6; P = 0·087). There was no difference in the rate of RBC transfusion (CS 45% vs. non-CS 40%; P = 0·212), renal failure (CS 11% vs. non-CS 6%; P = 0·139), infection (CS 16% vs. non-CS 13%; P = 0·434) and mortality (CS 5% vs. non-CS 2%; P = 0·146). CONCLUSION: The CS use increases platelet requirements and has no impact on the rate of RBC transfusion in our population. These findings warrant caution with generalized use and require larger studies to confirm its results.

Transfusion indication predictive score: a proposed risk stratification score for perioperative red blood cell transfusion in cardiac surgery.

BACKGROUND AND OBJECTIVES: Red blood cell transfusion is known to be associated with increased morbidity and mortality in cardiac surgery. This study was performed to derive a score to predict that risk in our patients. MATERIALS AND METHODS: Clinical details of patients who underwent cardiac surgery at the Sultan Qaboos University Hospital over 5 years were reviewed. We used univariable and multivariable logistic regression to develop the score, the Hosmer-Lemeshow test for calibration, the receiver operator curve for discrimination and the bootstrap procedure for internal validation. RESULTS: The sample included 413 patients. The following were found to be statistically significant transfusion predictors (score given): cerebrovascular disease (4), use of aspirin or clopidogril within 7 days of surgery (3), non-elective surgery (2), haematocrit <35% (2), glucose-6-phosphate dehydrogenase (G6PD) deficiency (2), use of cardiopulmonary bypass (2), age > 60 years (1), diabetes mellitus (1) and male gender (-2). We classified the observations into three groups: group 1 with total score of <2, group 2 with total score of 2-5 and group 3 with total score of >5. The calculated probabilities of receiving transfusion were 42%, 63% and 91% for groups 1, 2 and 3 respectively. CONCLUSION: We derived a simple score that can be utilized to assess the need of blood transfusion in patients undergoing cardiac surgery. We are the first to report G6PD deficiency and history of cerebrovascular disease as predictors. We recommend prospective external validation of the proposed score on a larger cohort of patients.

The pneumatic tube system does not affect complete blood count results; a validation study at a tertiary care hospital.

INTRODUCTION: Effect of the pneumatic tube system (PTS) on sample quality is controversial. Herein we aim at evaluating the impact of sample transportation via the PTS on complete blood count (CBC) results. METHODS: Duplicate CBC samples from normal donors and anemic patients were sent in parallel to the laboratory for testing through the PTS and the courier (CO). We used scatter plots, Bland-Altman plots, correlation coefficient (r), and coefficient of determination for the validation. RESULTS: A total of 115 samples (donors: 59, patients: 56) were tested. There was excellent correlation between both methods for red blood cell parameters (r range = 0.9213-0.9958) and platelet count. White blood cell (WBC) count and differential count showed similar results (r range = 0.8605-0.9821) for all, with exception of basophils which showed modest correlation (r = 0.4827 for patients and 0.5758 for normal donors). Most of the differences in measurement of all CBC parameters were within the 95% confidence interval of the mean difference on Bland-Altman plots. CONCLUSION: Modern PTS can be safely used for transporting CBC samples.

Potential pitfalls in the diagnosis of Hb Handsworth in areas with high prevalence of HbS.

Hb Handsworth is a rare α-globin structural variant caused by a missense mutation either on the α2 or α1-globin gene (HBA2 or HBA1: c.55G>C, p.Gly18Arg). This variant might be erroneously diagnosed as HbS unless secondary confirmative tests are carried out. We encountered a child with a prominent peak eluting in the 'S' window on high-performance liquid chromatography (HPLC). Sickle solubility test, gel electrophoresis, and selective direct nucleotide sequencing of α1, α2, and ß globin genes were performed on the patient's sample. In addition, previous HPLC results on a cord blood sample were retrieved. Sickle solubility test was negative. Gel electrophoresis revealed a band migrating at the S region with an extra faint band seen on acid gel electrophoresis. Molecular analysis of α2 globin gene revealed heterozygous state of Hb Handsworth. Hb Handsworth is a rare variant that can mimic HbS on HPLC. Failure to recognize this rare variant in regions where HbS is highly prevalent may result in serious misdiagnosis and subsequent incorrect genetic counseling.