Posttransfusion purpura sans purpura: A novel presentation.

Posttransfusion purpura (PTP) is a rare condition that develops 5-10 days after transfusion of platelet containing blood component. Temporal relationship to blood transfusion, thrombocytopenia, and purpuric rashes with or without bleeding manifestation, supported by the serological presence of antiplatelet antibodies, are characteristic of PTP. We, herein, report a case of posttransfusion thrombocytopenia without purpuric rashes or bleeding symptoms, which is a rare presentation. A 44-year-old multiparous female, being treated for menorrhagia, who was transfused with three packed red blood cell units developed significant thrombocytopenia on day 8 after transfusion of the first unit. Her coagulation profile was normal. No purpuric rashes or bleeding manifestation was seen. Serum revealed the presence of antiplatelet antibodies on performing platelet antibody screen. Her platelet count improved from day 9 and reached above 50,000/µ l on day 10. She was managed conservatively with frequent monitoring for bleeding manifestations and blood counts.

Autologous umbilical cord blood for red cell concentrate transfusion in preterm infants in the era of delayed cord clamping: An uncontrolled clinical trial.

OBJECTIVE: To assess the utility of autologous umbilical cord blood (UCB) for red cell concentrate (RCC) transfusion in preterm infants. METHODS: We recruited preterm infants born at ≤30 weeks' gestation or have an estimated fetal weight <1,200 g. We intended to perform delayed cord clamping (DCC) and to collect UCB following DCC. The quality parameters used included blood culture performed once, and biochemical and haematological parameters assessed weekly. RESULTS: Of the 46 recruited neonates, DCC could be performed for 1 minute in 11 (23.9%) and for 30-59 seconds in 10 (21.7%) infants. The success rate of UCB collection was significantly lower in infants who underwent DCC for 1 minute (27%) compared to those who underwent DCC for 30-59 seconds (70%) or immediate cord clamping (72%) (p value 0.031). Twenty-five UCBs were stored after eliminating three that had positive culture. UCB had satisfactory quality for transfusion from day 3 (when blood culture report was available) to 14 (after which pH decreased to <6.5). Thirteen infants required 27 RCC transfusions. Autologous UCB could be used for only five (18.5%) transfusions. CONCLUSION: The success rate of UCB collection after DCC for 1 minute is low. Autologous UCB meets less than one-fifth of transfusion requirements. Hence, autologous UCB transfusion is not a workable option in preterm infants.

Does proliferation capacity of lymphocytes depend on human blood types?

In vitro human lymphocyte culture methodology is well established yet certain confounding factors such as age, medical history as well as individual's blood type may potentially modulate in vitro proliferation response. These factors have to be carefully evaluated to release reliable test report in routine cytogenetic evaluation for various genetic conditions, radiation biodosimetry, etc. With this objective, the current study was focused on analyzing the proliferation response of lymphocytes drawn from 90 individuals (21-29 years) with different blood types. The proliferation response was assessed in the cultured lymphocytes by cell cycle, mitotic index (MI), and nuclear division index (NDI) after stimulation with phytohaemagglutinin (PHA). To investigate the toxic effect on proliferation, MI was calculated in representative samples of each blood type were X-irradiated. The results showed that there was no significant difference among the cell cycle phases of lymphocytes in different blood types (P > 0.05). Similarly, both MI and NDI of lymphocytes derived from different blood types also did not show significant difference ( P > 0.05). The extensive interindividual variation within and among the blood types is likely responsible for the lack of significant difference in lymphocyte proliferation. Although spontaneous proliferation efficiency of lymphocytes of different blood types after PHA stimulation was grossly similar, the MI observed after radiation exposure showed a significant difference ( P < 0.05) indicating a differential proliferation response among the blood types. Our results suggest that the blood types did not have any impact on PHA-induced proliferation; however, a specific differential lymphocyte proliferation observed after radiation exposure needs to be considered.

Transfusion support in preterm neonates <1500 g and/or <32 weeks in a tertiary care center: A descriptive study.

BACKGROUND: Lack of recent studies focusing on indications, pattern, and benefits of transfusions in low birth weight (B.Wt) and low gestational age (GA) preterm neonates prompted us to undertake this study. AIM: To estimate the transfusion requirements and outcomes in preterm neonates <1500 g and/or <32 weeks. SETTINGS AND DESIGN: This is a cross-sectional study conducted over a period of 2 years in a tertiary care center. MATERIALS AND METHODS: This study was conducted with 101 preterm neonates <1500 g and/or <32 weeks who received blood transfusions in the Neonatal Intensive Care Unit. Restrictive pattern of transfusion was followed. Demographic details and antenatal, neonatal, laboratory, and transfusion parameters were collected. STATISTICAL ANALYSIS USED: Statistical analyses were performed using SPSS 16. RESULTS: The study participants received 311 transfusions. Transfusion requirements decreased with increasing GA and B.Wt. Majority of blood transfusions occurred during the first 2 weeks of life. Packed red blood cells (PRBCs) were the most frequent blood components transfused. Ninety-six percent of the study population had an uneventful transfusion. Mean hemoglobin improvement after PRBC transfusions was 2.3 ± 2.1 g/dl. Improvement in apnea occurred in 76% PRBC transfusions. Infants with sepsis, patent ductus arteriosus, bronchopulmonary dysplasia, disseminated intravascular coagulation, and dyselectrolytemia received more number of transfusions. CONCLUSION: This study would serve as an audit for neonatal blood transfusion therapy. Close adherence to neonatal transfusion policy and restrictive transfusion guidelines helps reduce inappropriate use of blood products and adverse transfusion reactions.

Recovery of Platelet Count among Apheresis Platelet Donors.

INTRODUCTION: Increase in awareness regarding use of single donor platelets and the availability of technology has resulted in increased platelet pheresis procedures. The interval between two succesive plateletpheresis donations is much less compared to whole blood donations. Plateletpheresis procedures are associated with short term and long term adverse events. The effect of plateletpheresis on haematopoietic system remains significant. AIM: To study the recovery of platelet count to baseline in plateletpheresis donors. MATERIALS AND METHODS: Fifty, first time apheresis donors were followed for platelet count recovery. Platelet count was measured before donation and at 30 minutes, 48 hours, 7th day and 14th day post-donation. Donor platelet count recovery to baseline was observed during the two week period. Results were analysed statistically, p<0.05 was considered statistically significant. RESULTS: Platelet count recovered to baseline by 7th day post-donation in 50% of donors in groups I (Pre-donation platelet count 1.5 lacs/µl to 2.2 lacs/µl) and II (Donors with platelet count >2.2 lacs/µl to 2.75 lacs/µl), 30% of donors in group III (Donors with platelet count >2.75 lacs/µl to 3.5 lacs/µl) of the donors. Donor's platelet count recovered to baseline in 85% of donors by day 14 in across the three groups. Recruitment of platelets from spleen was observed in donors with pre-donation platelet count on the lower limit of normal. CONCLUSION: By day 7, donor's platelet count recovered to baseline in majority of the donors. Allowing enough recovery periods for donor platelet count, the minimum interval between two apheresis donations can be 7 days till more prospective studies conclude on the frequency and minimum interval between plateletpheresis donations.

Sudden Death Due to Giant Cell Myocarditis: A Case Report.

The definition of sudden death is variable and there has been no single all-purpose definition. Sudden death can be defined as sudden or unexpected death in an otherwise healthy individual who is not known to have been suffering from any dangerous disease, injury or poisoning and is found dead or dies within 24 hours after the onset of terminal illness. Some authorities limit the duration to 1 hour. Because of the sudden and unexpected nature of death, inquest is conducted in such cases to rule out foul play and ascertain the cause of death. A vast majority of cases are due to cardiac origin followed by respiratory, neurological, gastrointestinal and genitourinary causes. The most common cardiac disease to cause sudden death is ischemic heart disease as a result of coronary atherosclerosis. Coronary artery disease, cardiomyopathies and electrophysiologic abnormalities are the common causes of sudden cardiac deaths. We present a rare case of sudden death in a healthy adult male due to giant cell myocarditis.

Study of endometrial pathology in abnormal uterine bleeding.

INTRODUCTION: Abnormal uterine bleeding (AUB) is the commonest presenting symptom in gynaecology out-patient department. Endometrial sampling could be effectively used as the first diagnostic step in AUB, although at times, its interpretation could be quite challenging to the practicing pathologists. This study was done to evaluate histopathology of endometrium for identifying the endometrial causes of AUB. We also tried to observe the incidence of various pathology in different age groups presenting with abnormal uterine bleeding. MATERIAL AND METHODS: This was a study done at Sri Ramachandra Medical College and Research Institute, Chennai, India on 620 patients who presented with AUB from June 2005-June 2006. Out of which 409 cases of isolated endometrial lesions diagnosed on histopathology were selected for the final analyses. A statistical analysis between age of presentation and specific endometrial causes was done using χ(2) test. RESULTS: The most common age group presenting with AUB was 41-50 years (33.5%). The commonest pattern in these patients was normal cycling endometrium (28.4%). The commonest pathology irrespective of the age group was disordered proliferative pattern (20.5%). Other causes identified were complications of pregnancy (22.7%), benign endometrial polyp (11.2%), endometrial hyperplasias (6.1%), carcinomas (4.4%) and chronic endometritis (4.2%). Endometrial causes of AUB and age pattern was statistically significant with P value <0.05. CONCLUSION: There is an age specific association of endometrial lesions. In perimenopausal women AUB is most commonly dysfunctional in origin and in reproductive age group, one should first rule out complications of pregnancy. The incidence of disordered proliferative pattern was significantly high in this study, suggesting an early presentation of these patients.