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BACKGROUND: Minor ABO-incompatible apheresis platelet transfusion poses a risk of hemolytic transfusion reactions in non-Group O recipients when donor's plasma possesses unusual high titers for anti-A and anti-B. The aim was to determine whether the hemolysin test can be used as a screening tool to predict high-titer Group O platelet apheresis donors. METHODS: A prospective study, with Group O platelet donor's samples, was tested for hemolysin test and antibody titration test in parallel. Antibody titration was also performed on products suspended in platelet additive solution (PAS). Hemolysin test was assessed for diagnostic accuracy against antibody titration. Chi-square test and Mann-Whitney U-test were used to determine the relationship between the hemolysin test and antibody titration. RESULTS: Among 107 Group O platelet donations, median anti-A and anti-B titers in donors were 32 (8-128) and 32 (4-256), respectively. High titer (≥128) for ABO antibodies was seen in 18% of donations, whereas hemolysin test was positive in 69% of donations. Hemolysin test results differ significantly with antibody titration results (P = 0.03). Hemolysin test had higher sensitivity (89%) with a strong negative predictive value (94%). None of the products suspended in PAS had high-titer antibodies. CONCLUSION: Adopting hemolysin test as a screening tool may label a large number of units (69%) unsuitable for ABO-incompatible platelet transfusion. Alternatively identifying donors with high antibody titer or positive hemolysin test and selectively suspending their product in PAS may be a cost-effective approach and certainly prevent high-titer antibodies in the product.
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INTRODUCTION: Age of red blood cell (RBC) units at the time of irradiation is important and prolonged storage of preirradiated units is detrimental. The objectives were to determine RBC age at irradiation, days from expiry (DFE), and percentage of late transfusions of irradiated RBC. To estimate the concordance on expiry of irradiated RBC units with present American Association of Blood Banks (AABB)/Directorate General of Health Services (DGHS), New Delhi over British Committee for Standards in Hematology (BCSH) and Council of Europe (CE) guidelines. METHODS: All the RBC units irradiated for a 1 year period were included. Retrieved data included date of collection, irradiation, revised expiry, and issue of blood. Late transfusions are units transfused in the last 2 week of RBC's shelf-life and wastage due to expiry was determined. Chi-square and Kruskal-Wallis test were used for comparisons between the guidelines. RESULTS: Out of 1303 RBC units irradiated, the median age for irradiation was 2 (0-36) days and 99.3% units irradiated within day +14. Median DFE for these units transfused was 26 (0-28) days. 2.8% units expired as per local standards. Late transfusions happened in 121 (9.3%) units transfused. AABB/DGHS practice was not concordant with CE standards for 86 (6.6%) units and with BCSH 94 (7.2%) units. Overall discordance between the present practices was CE and BCSH was seen in 130 (10%) events. CONCLUSION: Median RBC irradiation age and DFE was two and 26 days respectively at our center. Only 90% concordance was observed between AABB/DGHS and CE/BCSH guidelines with 9.3% units transfused as late transfusions. Restricting late transfusions of irradiated RBC can act as surrogate to improve the quality of units transfused through an inexpensive strategy.
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BACKGROUND: The extent of involvement of cervical lymph nodes is known to be the most important prognosticator in oral squamous cell carcinoma (SCC) that significantly affects the survival rate of patients. The clinical, radiological and pathological factors that can predict cervical lymph node metastasis are yet to be ascertained clearly, which poses a challenge for the surgeon to determine the extent of neck dissection. AIM: This study aims to identify the clinical and histopathologic predictors of lymph node metastasis among patients with oral SCC and to devise a scoring system based on those predictors to aid in better clinical decision-making regarding the extent of neck dissection. SETTING: Malabar Cancer Centre, a specialized tertiary cancer care center in Kerala, India. METHODS: A retrospective review of 160 patient records and biopsy slides collected and preserved between June 2014 and May 2016. CONCLUSION: The clinicopathologic parameters such as site of cancer (P = 0.03), histologic differentiation (P = 0.03), shape of rete pegs (P = 0.002), pattern of invasion (P = 0.0001) and depth of invasion >3 mm (P = 0.016) were significantly associated with the risk of lymph node metastasis. The risk score devised based on these predictors serves as an efficient tool in aiding clinical decision-making regarding the extent of neck dissection.
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BACKGROUND: Fiber-optic bronchoscopic biopsies yield very small bits of tissue, leading to high false negativity in lung cancer diagnosis, after paraffin embedding. AIM: The aim of the present study is to assess the diagnostic efficacy of squash smear cytology of fiber-optic bronchoscopic biopsies and to compare this with standard paraffin embedded sections and sputum cytology. MATERIALS AND METHODS: A total of 100 suspected cases of lung cancer were subjected to fiber-optic bronchoscopic biopsies. Multiple biopsies from each were divided into two portions. One portion was processed routinely and paraffin sections made. Squash smears were made from the other and stained by Papanicolaou method. The diagnostic efficiency of two methods was compared. A positive diagnosis of cancer by any of the diagnostic modalities initially or during 6 months follow-up was taken as the gold standard. RESULTS: Out of 100 cases, 91 cases proved to be cancer. The pick-up rate was 0.77 for squash cytology, 0.55 for tissue sections, and 0.31 for sputum cytology. The pick-up was higher for endo-bronchial tumors by all methods. The agreement between squash cytology and tissue sections was 100% for small cell carcinoma and adenocarcinoma and 88% for squamous cell carcinoma. CONCLUSION: Squash smear cytology has better pick-up rate than paraffin embedding in fiber-optic bronchoscopic biopsies and should be the preferred method when only one or few bits are available.