Von Willebrand factor levels in healthy blood donors and their association with blood group: A tertiary care hospital-based study.

BACKGROUND: von Willebrand disease is a common inherited bleeding disorder caused by the deficiency of von Willebrand factor (vWF).[1] The levels of vWF depend on several factors, including exercise, hormones, and ABO blood type.[2] This study was planned to evaluate plasma vWF levels and factor VIII (fVIII) levels in healthy blood donors and its association with the ABO blood group. AIMS: The aim of this study was to evaluate plasma vWF levels and fVIII levels in healthy donors and its association with the ABO blood group. METHODS: This study was done in 2016 healthy adult blood donors. Complete history and relevant examination were done along with ABO and Rh (D) blood group typing, complete blood count, prothrombin time, activated partial thromboplastin time, vWF antigen (Ag) level, fVIII coagulant assay, and other tests for hemostasis. STATISTICAL ANALYSIS USED: Data were expressed in proportions and mean, median, and standard deviation, respectively. An appropriate test of significance was applied. P < 0.05 was considered statistically significant. RESULTS AND CONCLUSIONS: vWF level of donors ranged from 24 to 186 IU/dL with a mean of 96.31 IU/dL. Low vWF Ag level (below 50 IU/dl) was found in 2.5% of donors while 0.1% (2/2016) had level <30 IU/dL. O Rh (D)-positive blood group donors had the lowest vWF level (87.85 IU/dL), while ARh (D)-negative donors had the highest vWF level (117.27 IU/dL). fVIII level of the donor population ranged from 22% to 174%, with a mean of 98.82%. About 2.48% of donors had fVIII levels below 50%. There was a statistically significant correlation between fVIII level and vWF level (P < 0.001).

Current Challenges and Future Perspectives of Diagnosis of Hepatitis B Virus.

It is estimated that approximately 260 million people worldwide are infected with the hepatitis B virus (HBV), which is one of the leading causes of liver disease and liver cancer throughout the world. Compared with developed countries, low-income and middle-income countries have limited access to resources and advanced technologies that require highly specialized staff for HBV diagnosis. In spite of the heavy burden caused by hepatitis B virus, 90% of people are still undiagnosed. The World Health Organization (WHO) goal of eliminating hepatitis B by 2030 seems very difficult to achieve due to the existing diagnostic infrastructure in low-resource regions. The majority of diagnostic laboratories still use hepatitis B surface antigen (HBsAg)-based tests. WHO's elimination plan is at risk of derailment due to phases like the window period, immune control, and occult HBV infection (OBI) not being detected by standard tests. Here, in this article, we are focusing on various diagnostic platforms for the better diagnosis of HBV. The aim of the elimination of HBV can only be achieved by detecting all phases of HBV infection, which can be executed by a combined approach of using new marker assays along with advanced pretesting and testing methods.

Type and screen method and Coombs crossmatch method for pretransfusion testing: A prospective comparative study in a tertiary care hospital in Delhi.

BACKGROUND: The aim of pretransfusion testing (PTT) is to prevent the immune-mediated hemolytic reaction by the transfusion of incompatible donor red cells. The methods of PTT have evolved over the years and a new method of type and screen (T and S) was introduced, in which only ABO grouping, Rh typing, and antibody screening would be carried out with omission of routine Coombs crossmatch. Although T and S is an accepted method for PTT in developed countries, only a few studies in literature have evaluated its efficacy in India. AIM AND OBJECTIVE: The aim of the study was to compare T and S method with conventional Coombs crossmatch method for PTT. MATERIALS AND METHODS: Two thousand and fifty samples were randomly selected from the samples received in blood bank for requisition of blood transfusion after taking informed consent. ABO blood grouping and Rh typing were performed for each recipient's sample. "T and S" and "Coombs crossmatch" were done simultaneously by two different persons without knowing the result of each test. A commercially available three cell panel was used for antibody screening, in which the recipient's plasma was reacted with red cells in the low ionic strength solution Coombs Gel card at 37°C by column agglutination technology. RESULTS: Antibody screening was positive in 29 (1.41%) patients and negative in 2021 (98.59%) patients. Out of 29 patients, 27 had alloantibodies and 2 had autoantibody. Most common alloantibody found in our study was anti-D. Other antibodies found were anti-K, anti-C + D, anti-E, anti-C, anti-c, anti-Jka, and anti-Mi (a). Crossmatch on first attempt was compatible in 2028 (98.93%) patients and incompatible in 22 (1.07%) patients. Out of 29 patients who were positive for antibody screening, crossmatch was incompatible in nine patients. Crossmatch was compatible in twenty patients, who had positive antibody screen. However, crossmatch compatibility in these patients, reflect either absence of corresponding antigen or antigen present in low dose (heterozygous) in donor blood. On the other hand, out of 22 patients incompatible on first crossmatch, antibody screening was negative in 13 patients and was positive in only nine patients. Hence, 13 patients with antibody would have been missed by antibody screen alone. Kappa statistics was used to compare the efficacy of "type and screening" and "Coombs crossmatch." It showed κ =0.445 (P < 0.001) implying moderate agreement between the two variables of "T and S" and "Coombs crossmatch." CONCLUSION: T and S is a scientifically better method but needs to be implemented with caution. We need to develop our own cell panels having adequate representation of indigenous antigen (including In, Mi (a), etc.,). Large-scale studies need to be done in India with indigenous screening cells to evaluate efficacy and safety of T and S method.

COVID-19 pandemic and care of transfusion-dependent patients of thalassaemia: Experience from a paediatric centre in North India.

AIM: COVID-19 has presented an unprecedented challenge to health services and has significantly affected the management of non-Covid illnesses, like thalassemia. The present study documents the impact of Covid-associated restrictions and disruptions on working of the pediatric thalassemia day care centre (TDCC), and measures taken by TDCC and blood transfusion services to adapt to and mitigate the negative impact of Covid pandemic and associated lockdown on patient care. METHODS: Pre-transfusion haemoglobin and packed cell transfusion requirement were compared across three time periods, namely pre-lockdown, lockdown and post-lockdown in paediatric transfusion-dependent thalassaemia (TDT) patients. Caregivers were interviewed to document any problems faced by them. RESULTS: The study involved 181 TDT patients. There was a significant reduction in mean pre-transfusion haemoglobin and red cells transfused during lockdown phase as compared to pre-lockdown phase. Regular care was interrupted in 45% of patients and 76% of patients getting blood from outside could not get leukoreduced red cells. Investigations, monitoring and continuity of iron chelation were also affected. Blood centre faced 30.5% reduction in blood supply during lockdown. TDCC and blood centre took several steps, including prolongation of service hours and staggering of transfusions to ensure maximum transfusions while ensuring social distancing. CONCLUSION: The COVID-19 pandemic imposed many unprecedented challenges to the routine care of thalassaemic patients; however, some of them could be dealt with by a proactive approach and micro-planning at the institution level. Other similar resource-limited settings could learn from experiences for continued quality care for chronic medical conditions during pandemic like situations.

Assessment of rhesus and kell blood group antigens, phenotypes, and their allelic frequencies in North Indian blood donors.

BACKGROUND: Prevalence of rhesus (Rh) and Kell antigens in a population vary with race, ethnicity, and geographical location. With advances in immunohematology, non-D antigens, and their corresponding antibodies are increasingly being found to be culprits for alloimmunization. MATERIALS AND METHODS: Assessment of the phenotype of Rh and Kell blood group antigen in the healthy donor population from North India was done, and estimation of the frequencies of these alleles in our population was performed. RESULTS: The most common antigen in the North Indian donor population was "e" (95.6%) followed by "C" (89.6%), "c" (57.7%), and "E" (17.29%) in that order. The most prevalent phenotype in the Indian population was found to be "CDe" followed by "CcDe" and "CcDEe." "K" antigen was found to be positive in 1.81% of the population. DISCUSSION: Knowledge of the Rh antigen profiles in a given population can be very helpful in formulating transfusion guidelines specific to a particular population with an aim to minimize the cost and maximize the benefits. With this aim in mind and considering the problems encountered in developing countries like ours, we conducted Rh and Kell antigen profiling of donors. Comparative analysis with other population studies and implications for transfusion protocols is evaluated. CONCLUSION: Assessment of Rhesus antigen profile of a particular population is useful to develop cost effective ways of providing maximum benefits of blood transfusion with least resources.

Autoimmune hemolytic anemia caused by anti "e": A challenge: A case report with review of literature.

Autoimmune hemolytic anemia (AIHA) is featured by short red cell survival due to autoantibodies. AIHA caused by anti 'e' is a tough clinical situation as antigen 'e' is a highly prevalent antigen. The present case highlights the same and different issues related to it.

Reporting adverse transfusion reactions: A retrospective study from tertiary care hospital from New Delhi, India.

CONTEXT: Blood transfusion services have achieved newer heights in the last decade, with developments in cellular techniques, component separation, and integration of molecular methods. However, the system of recording and reporting of the adverse events related to blood transfusion is developing countries like India is grossly inadequate and voluntary in nature. AIMS: This study was undertaken to analyze the retrospective data on adverse events related to blood transfusions in our hospital. SUBJECTS AND METHODS: This retrospective study was done to examine all the transfusion related adverse events reported in a Regional Blood Bank Transfusion Centre of North India over a period of 9 years. Adverse transfusion events related to whole blood, red cell concentrates (RCCs), and all other components were analyzed and classified on the basis of their clinical features and laboratory tests. Average rate of transfusion reactions with the components was also assessed. STATISTICAL ANALYSIS USED: Categorical variables were analyzed using the Chi-square test. P < 0.05 was taken to indicate a significant difference. RESULTS: During this period, a total of 1,60,973 blood/blood component units were issued by our blood bank to various departments of the hospital and 314 immediate transfusion events were reported. The rate of immediate transfusion reactions during the study was 0.19%. Average transfusion reaction rate with RCC was 0.25% with febrile nonhemolytic reactions being the most common type of adverse event (37.2%). CONCLUSIONS: Awareness should be increased among clinicians to correctly prevent, identify, and report transfusion-related adverse events. These measures should be implemented to increase blood transfusion quality and safety.

Audit of pediatric transfusion practices in a tertiary care hospital.

OBJECTIVE: To perform a retrospective audit of transfusion practices, in order to study the appropriate and inappropriate usage of different blood components in pediatric population. METHODS: The present study, conducted over a period of 3 mo analyzed all the episodes of transfusions and divided them into appropriate and inappropriate according to the type of blood components, the requesting departments and the clinical indication of transfusion. Data was reviewed according to the British Committee for Standards in Hematology and American Association of Blood Bank guidelines. RESULTS: A total of 2,145 units of hemocomponents were transfused to children, including 1,181 units of red cell concentrates, 566 units of platelet concentrates/platelet rich plasma, 118 units of whole blood and 280 units of fresh frozen plasma in 1,819 episodes. Appropriate usage of blood components was 59.65%. Whole blood was most appropriately transfused (82.9%). Appropriate indications outnumbered inappropriate requisitions in Department of Pediatric Medicine (70.38 %), Nursery (82.54 %) and Thalassemia day care centre (55.63%). Red cell concentrate was most appropriately indicated in anemias (73.14%) and inappropriately in cases of surgeries (53.6%). Platelets were used more appropriately in all clinical indications. Whole blood was transfused most appropriately (100%) in double venous exchange therapy. Most appropriate indication of fresh frozen plasma usage was coagulopathy (42.57%). CONCLUSIONS: As the appropriate usage (59.65%) of blood components was low in the present study, regular auditing of transfusion practices from time to time is indicated. This not only helps guide their judicious use but also serves to evaluate and decrease their inappropriate usage.

Donor deferral characteristics for plateletpheresis at a tertiary care center in India- a retrospective analysis.

BACKGROUND: The demand for plateletpheresis is increasing day by day due to its many merits over random donor platelets. However, in our country, there is a dearth of apheresis donors due to greater devotion and time required for the procedure and lack of awareness. AIM: The aim of the present study is to analyse the reasons for deferral of apheresis donors at a tertiary care center. MATERIALS AND METHODS: This retrospective analysis was conducted to study the causes, frequency and the type of plateletpheresis donor deferral at regional blood transfusion center, Lady Hardinge Medical College and associated Shrimati Sucheta Kriplani Hospital and Kalawati Saran Childrens' Hospital. The study was undertaken over a period of two years (from January 2010 to December 2011. RESULTS: Out of a total of 343 donors screened, 87 donors were deferred, the overall deferral rate being 25.36%. The most frequent cause of deferral was a low platelet count accounting for 43.5% of all the causes followed by a low hemoglobin level (27.05%). Among the donors deferred for anaemia, 15 out of 23 (65.2%) had hemoglobin in the range of 11.5-12.4gm%, representing 17.2% of all deferrals. CONCLUSION: Based on these findings and the scarcity of apheresis donors in our country, we are of the opinion that the selection criteria for plateletpheresis donors should be revised to accommodate more donors and reduce deferral rate without compromising on the health of the donors.

Treponema pallidum hemagglutination assay seroreactivity among healthy Indian donors and its association with other transfusion transmitted diseases.

BACKGROUND: The aim of the present study was to determine the prevalence of syphilis infection by Treponema pallidum hemagglutination assay (TPHA) among blood donors in Delhi and to study their correlation with other markers of transfusion transmitted infections such as hepatitis C virus (HCV), human immunodeficiency virus (HIV) and hepatitis B surface antigen (HBsAg) so as to establish the utility of TPHA over and above venereal diseases research laboratory test (VDRL), not only as a marker for testing T. pallidum infection, but also as a marker of high risk behavior. MATERIALS AND METHODS: This prospective study was carried out in the Regional Blood Transfusion Centre, Lady Hardinge Medical College and associated Sucheta Kriplani Hospital, New Delhi for a period of 2 years. Donated blood was screened for TPHA seroreactivity along with screening for anti HIV I and II, anti-HCV, HBsAg by third generation enzyme-linked immunosorbent assay test. A total of 8082 serum samples of blood donors were collected from healthy blood donors in our blood bank. They were classified into two groups- test group and control group based on TPHA positivity. The co-occurrence of HBsAg, HIV and HCV infection were determined in TPHA positive blood donors (test group) in comparison with TPHA negative blood donors (control group). RESULTS: We found the TPHA seroreactivity to be 4.4% in Delhi's blood donors. Nearly 8.2% (663/8082) of the donated blood had serological evidence of infection by at least one pathogen (syphilis/HIV/hepatitis B virus/HCV) and 6.63% (44/663) donors with positive serology had multiple infections (two or more). Quadruple infection was seen in one donor, triple infection was seen in three donors and double infection was seen in 40 donors. Prevalence of HIV seroreactivity was found to be statistically significant and HCV seroreactivity statistically insignificant in TPHA positive group in comparison to TPHA negative group. DISCUSSION: In our study, the TPHA seropositivity correlated with higher HIV and HCV seropositivity and the same correlation has been observed by several other studies also. In view of these observations, we propose that testing for syphilis by more sensitive and specific treponemal markers like TPHA rather than VDRL, rapid plasma reagin tests; as TPHA also has the added advantage of picking up all the high risk donors, whereas, VDRL picks up only currently infected donors. Moreover, TPHA should be continued as a marker of high risk behavior especially in high prevalence areas like India where we don't have universal access to markers like nucleic acid amplification technique.

Alloimmunisation in thalassaemics: a comparison between recipients of usual matched and partial better matched blood. An evaluation at a tertiary care centre in India.

BACKGROUND: There is an ongoing controversy regarding provision of usually matched blood (i.e. matched for ABO-D antigens) or phenotypically matched blood (also matched for Rh and Kell antigens) for multiply transfused thalassaemics, especially in developing countries. A pilot study conducted at our centre revealed an alloimmunisation rate of 3.79% with Rh and Kell alloantibodies accounting for 90% of all antibodies. The present cross-sectional study was conducted to assess the impact of a policy of partial better matching (for Rh cDE and Kell antigens) of blood on alloimmunisation in thalassaemics. MATERIAL AND METHODS: In this cross-sectional study three groups of patients were considered. Group 1 comprised 211 thalassaemics who received usually matched (UM) blood until April 2009. Their rates of alloimmunisation have already been published in a prior study. Group 2 consisted of 46 thalassaemics who were enrolled after April 2009 and have received partially better matched (PBM) blood (matched for ABO, Rh cDE and Kell antigens) since the initiation of transfusion therapy. Group 3 (UM→PBM) comprised the patients from group 1 who, from April 2009, were given partial better matched blood. Antibody screening (using a 3-cell panel) and antibody identification (11-cell panel) were carried out to detect the presence of alloantibodies. RESULTS: None of the thalassaemic patients in group 2 (PBM) developed alloantibodies. Eight thalassaemics in group 3 (UM→PBM) developed new alloantibodies (after April 2009). DISCUSSION: According to the results of the present study, providing at least partially better matched blood appears to improve the efficacy of transfusion for chronically transfused thalassaemics. Large-scale, comprehensive, multicentre studies need to be carried out to formulate realistic, evidence-based, economically feasible transfusion policies for thalassaemic children based on the red blood cell antigen profile of the population.

Screening of blood donors for erythrocyte alloantibodies.

OBJECTIVE: To assess the prevalence of the anti-red blood cell antibodies in the donor population of Delhi. METHODS: This prospective study was conducted in Regional Blood Transfusion Centre (RBTC), Lady Hardinge Medical College (LHMC) and associated hospitals from March 2010 to March 2011. Antibody screening of all donor serum/plasma was performed as routine immunohaematological procedure. Any positive sera were further investigated to identify the specificity of irregular erythrocyte antibody by commercially available red cell panel (ID-Dia Panel, Diamed-ID Microtyping System). The titres and thermal amplitude of the identified antibodies were evaluated. RESULTS: A total of 7756 donors were screened, of which 7648 donors were males (98.6%) and 108 were females (1.4%). The maximum number of donors belonged to age group of 26-30 years. A total of four donors showed presence of alloantibodies in their serum (0.05%). On antibody identification, two of them were anti-C, one was anti-Lewis(a) antibody and one was autoantibody. DISCUSSION: This study was conducted to highlight the significance of detecting irregular erythrocyte antibodies in healthy donors.

Concurrent audit of fresh frozen plasma: experience of a tertiary care hospital.

UNLABELLED: Fresh frozen plasma (FFP) transfusion is among the highest risk of all blood component transfusions and also the most inappropriately used blood component. All these factors have impact on safety, economy, and work burden. OBJECTIVE: To assess the utilization of FFP in a tertiary care hospital. METHODS: Concurrent audit was conducted manually over the period of 4 months from April 2010 to July 2010. Patient's age, sex, clinical diagnosis, indication for FFP transfusion, and coagulation profile were noted. Data were analysed and episodes of transfusion were divided into appropriate and inappropriate. Requests were further classified according to the requesting department, clinical diagnosis, and coagulation profile. RESULTS: A total of 1763 units of FFP were transfused to 560 patients in 877 episodes of requisition. Out of 877 episodes, about 686 (78.2%) requests were found to be inappropriate. Highest number of FFP requisitions was received from department of paediatrics and paediatric surgery (580 episodes). Most inappropriate requests were received from the department of orthopaedics (88.9%) and paediatrics (80.17%). The most common indication for FFP transfusion was surgical/traumatic bleeding/massive transfusion (40.9%) in which 68.5% requests were inappropriate. Out of 686 inappropriate episodes, the most common cause was in setting of normal or mildly altered coagulation profile irrespective of bleeding status of patient. DISCUSSION: Inadvertent use of FFP is a major problem and guidelines are not strictly adhered to. Concurrent audit of FFP use needs to be done to make appropriate interventions to prevent misuse of this valuable commodity.

The prevalence of irregular erythrocyte antibodies among antenatal women in Delhi.

BACKGROUND: Universal screening of all antenatal women, including D antigen-positive pregnant ones, is mandatory in most developed countries. However, no guidelines on this issue are available for developing countries such as India. Furthermore, there is limited information on immunisation rates in pregnant women (D antigen-positive and D antigen-negative) from India. We, therefore, studied the prevalence of alloantibodies among multigravida women in India. MATERIALS AND METHODS: In this prospective study, carried out to detect the prevalence of alloantibodies among multigravida women in India, 3,577 multigravida women attending antenatal clinics were typed for ABO and D antigens and screened for alloantibodies by column agglutination technology. The medical history and detailed obstetric history of these women were reviewed and information recorded on any prior haemolytic disease of the foetus and newborn among siblings and/or blood transfusions. RESULTS: The overall prevalence of alloantibodies in this study was 1.25%. There was a statistically significant difference between alloimmunisation rates in the D antigen-negative and D antigen-positive groups (10.7% versus 0.12%, respectively). Anti-D antibody contributed to 78.4% of total alloimmunisations in our study. DISCUSSION: Anti-D was the most common culprit responsible for alloimmunisation. Other alloantibodies found included anti-C, anti-M, anti-S and anti-c. Large-scale population-based studies are required to assess the real magnitude of alloimmunisation in pregnant women in India.

Prevalence, risk factors and virological profile of chronic hepatitis B virus infection in pregnant women in India.

A large program was conducted by the Government of India to study the prevalence and profile of chronic hepatitis B virus (HBV) infection and its risk factors in pregnant women attending a tertiary care hospital in India. From September 2004 to December 2008 consecutive pregnant women attending the antenatal clinic were screened and those found positive for HBsAg were enrolled. Healthy non-pregnant women of child-bearing age, who presented for blood donation during the same period, served as controls. Women with symptoms of liver disease or those aware of their HBsAg status were excluded. Of the 20,104 pregnant women screened, 224 (1.1%) and of the 658 controls, 8 (1.2%) were HBsAg positive (P = ns). Previous blood transfusions and surgery were significant risk factors for infection with HBV. Of the women who were HBsAg positive, the ALT levels were normal in 54% of the women and HBV DNA levels were above 2,000 IU/ml in 71% of women. The median HBV DNA levels were higher in women who were HBeAg positive compared to the HBeAg negative group. The most common HBV genotype was D (84%) followed by A + D and A (8% each). In conclusion, the prevalence of HBsAg positivity among asymptomatic pregnant women in North India is 1.1% with 71% having high HBV DNA levels. These women may have a high risk of transmitting infection to their newborns.

Adverse reactions in whole blood donors: an Indian scenario.

BACKGROUND: Whole blood donation is generally considered to be a safe procedure, but occasionally adverse reactions of varying severity may occur during or at the end of the collection. The aim of the study was to estimate the frequency and type of adverse events occurring during blood donation and to assess the practices which would help to minimise them. MATERIALS AND METHODS: This retrospective single-centre study was conducted from June 2007 to November 2009 at a regional blood transfusion centre. All whole blood donations made at the centre were analysed. All adverse events occurring during or at the end of donation were noted using a standardised format. RESULTS: Overall 113 adverse events were reported in relation to 19,045 donations, resulting in an overall adverse event rate of 0.6%, that is, an incidence of 1 in every 166 donations. Presyncopal symptoms, in other words vasovagal reactions of mild intensity, were the most commonly observed adverse reactions and accounted for approximately 70% of all adverse reactions noted. CONCLUSIONS: Only 0.6% of blood donations were complicated by adverse events and most of these events were presyncopal symptoms. Our study reinforces the fact that blood donation is a very safe procedure which could be made even more event-free by following certain friendly, reassuring and tactful practices.

Critical evaluation of peripheral smear in cases of anemia with high mean corpuscular hemoglobin concentration in children: a series of four cases.

Mean corpuscular hemoglobin concentration (MCHC), a parameter that is reported as a part of a standard complete blood count by automated analyzer, is a measure of the concentration of hemoglobin in a given volume of packed red blood cell. Values of MCHC significantly above reference range are not physiologically possible due to limitations on solubility of hemoglobin. The high MCHC can give us a clue to certain type of hemolytic anemia and necessitate critical evaluation of peripheral smear to reach a definitive diagnosis. Here we are presenting a series of four cases with raised MCHC, emphasizing the importance of systematic and meticulous examination of the peripheral smear to render a definitive diagnosis.