Reverse algorithm for screening of syphilis and trends in prevalence among blood donors in Coastal Karnataka.

BACKGROUND: Transfusion transmissible syphilis is caused by Treponema pallidum; blood donors are traditionally screened with non-treponemal antibody tests to ensure transfusion safety. Detection of specific antibodies against T. pallidum is employed in reverse algorithm screening. We aim to analyze the utility of the reverse algorithm screening strategy for T. pallidum and to determine the prevalence trends among blood donors in our centre. MATERIAL AND METHODS: The study was conducted in a Transfusion Centre catering to the 2030 bedded Tertiary Care Centre in coastal Karnataka in two timelines from 2012 to 2014, and 2019 to 2020, respectively. A fully automated Enzyme-Linked Immunosorbent Assay and Enhanced Chemiluminescence Immunoassay, which detect both IgM and IgG antibodies against T.pallidum were used in the study. Blood donor data from 2008 to 2020 were also analyzed to observe the trend in prevalence rate of syphilis among blood donors. RESULTS: Among 26329 and 388 blood donors screened with ELISA and ECI, 134 (0.51%) and 9 (2.3%) were reactive to T. pallidum antibodies respectively. TPHA confirmed that 104 and 9 donors were reactive from each of the ELISA and ECI reactive donor groups. The increase in the prevalence of syphilis was observed with the use of reverse algorithm compared to the traditional strategy. The prevalence of syphilis in the present study ranged from 0.02 to 0.28%. CONCLUSION: The reverse algorithm screening can give a better result with a positive predictive value of 77.61% and 88.9% for ELISA and ECI. respectively Our study found that the use of reverse algorithm might increase the blood discard rate slightly but adds on to safety of blood components.

Reporting an abrupt-onset persistent hypotensive transfusion reaction in an Indian female patient.

Blood transfusion [BT] may sometimes result in a rare type of adverse event causing an isolated fall in blood pressure, commonly referred to as a hypotensive transfusion reaction [HyTR]. It is mediated by the biological response mediators, in particular cytokines such as bradykinin characterized by a sudden and unforeseen onset of hypotension as the predominant clinical manifestation during BT. In this case, the authors wish to highlight two consecutive episodes of abrupt-onset HyTR following blood administration in an Indian female patient, which, however, characteristically subsided on stopping the BT. She received appropriate management for the same. In fact, on discharge, we advised the patient to receive washed blood components, if needed, to prevent the recurrence of HyTR in future.

COVID-19 vaccination: The impact on the selection criteria of the convalescent plasma donors.

Clinical management protocols for COVID-19 are evolving rapidly as more information about the epidemiology and pathophysiological changes in COVID-19 become available. However, no definite treatment of COVID-19 has been found till date. The COVID-19 convalescent plasma (CCP) therapy has emerged as an important investigational therapy in the management of COVID-19 patients. Additionally, the regulatory agencies, in particular, the Indian blood transfusion council must release some interim recommendations for the blood centres on the CCP blood donor eligibility criteria after COVID-19 vaccination. More clinical trials are needed to know the efficacy of the CCP harvested from COVID-19 recovered individuals who have been vaccinated against those COVID-19 recovered individuals who are not vaccinated to understand the vaccine impact on the IgG titres of anti-SARS-CoV-2 antibodies.

COVID-19 vaccination in the Indian blood donors: Adjudging the impact on the deferral period.

The only efficacious way to provide people with herd immunity against the novel corona virus [nCoV] is to administer an appropriate vaccine and help check the current pandemic. With the genetic sequence data of the nCoV already available since January 10, 2020, leading pharmaceutical companies, world over, in turn, have started working on the clinical trials to produce vaccines against this nCoV. In fact, many vaccines under the Phase III trial have claimed to demonstrate their efficacy to be as high as 95% against the nCoV. In January, the central drugs standard control organization, India had granted the emergency-use authorization [EUA] to two vaccines namely, Covishield (live vaccine, Oxford-AstraZeneca, United Kingdom being manufactured by the Serum Institute of India, Pune) and Covaxin (inactivated vaccine, Bharat Biotech, India). Although, most of the countries offer no deferral period for the donors who have been administered an inactivated vaccine against this nCoV. However, the national blood transfusion council of India has recently recommended a donor deferral period of 28 days from the last dose of vaccination. This could essentially lead to a massive loss of eligible blood donors and jeopardize the already disrupted blood supply management due to the COVID-19 outbreak. The authors, herein, propose a thorough redefining of this deferral period post-vaccination amongst the Indian blood donors.

Indian blood donor selection guidelines: Review in the context of the ongoing COVID-19 pandemic.

The National Blood Transfusion Services under the aegis of the ministry of health and family welfare, India has recently issued guidelines regarding the blood donor selection criteria and the processing of blood. Care has been taken to make the blood transfusions safer. However, COVID-19 has disrupted the organization of the voluntary blood donation drives, whole blood donations [WBD] and restricted the donors' movement to the blood transfusion centres all across the world. While sickness and the need for transfusions are very much in place, the gap of demand against blood collection has widened. Additionally, with the monsoon season at hand, and the categorical challenges of a dengue outbreak, the subsequent need for blood components especially the platelet concentrates is going to rise. Some of the criteria laid for deferring a blood donor from his or her WBD need a categorical revision, considering these unprecedented times. We, therefore, critically analyzed the blood donor selection criteria and hereby, suggest an updating regarding the pre-donation haemoglobin, sexually transmitted diseases, lactation, pregnancy and many such subheadings. We also suggest collecting smaller blood volumes in the blood bags for the optimal benefit of the recipients both for now and also as a measure of pandemic preparedness for future use.

Deciphering the reasons for milky-white blood donor plasma.

Donors who eat a fatty meal before donating blood are known to have an increased level of plasma triglyceride concentrations for several hours. This may contribute to "milky-white" appearance of their plasma samples. We herein report the case of a blood donor who gave a history of the intake of a fatty meal, on the night prior to donation. This was affirmed by his serum lipid concentration done on the following day and on repeating the same subsequently after two weeks of donation respectively.

The blood supply management amid the COVID-19 outbreak.

Due to the government's early intervention such as mass lockdown and curtailment strategies towards mass gatherings, amid the COVID-19 outbreak, the organization of the voluntary blood donation camps have been suspended. It's most significant impact on the blood community has been a dramatic decrease in the number of blood donors. Therefore, our blood stock has almost dried up and put our inventory in a state of jeopardy. Additionally, all the elective surgeries and non-urgent clinical interventions have also been deferred during this time. This has led to a drop in the blood collection, demand as well as the issue at our blood center. With this backdrop, we intended to assess the effect of this mass lockdown on our blood supply management, particularly in two phases [phase-I prior to the outbreak] and phase-II [during the outbreak]. Transitioning back to the normal conditions would most likely depend on the extent and the time duration of this pandemic and associated behavioural change, which is foreseen to remain in effect well beyond the original estimates.