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Shailesh Kumar Mishra,1 Suchet Sachdev,1 Neelam Marwaha,1 Ajit Avasthi21Department of Transfusion Medicine, 2Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaIntroduction: The study was conducted to assess the knowledge and attitude of college-going students toward voluntary blood donation and to bring out and compare the reasons for donating or not donating blood.Materials and methods: This cross-sectional study was conducted on 1,000 college-going students after taking their consent for participation using a prevalidated, self-administered, structured questionnaire after its content and construct validation.Results: The difference in the means of the level of knowledge among the donor (mean: 14.71±2.48) and nondonor students (mean: 11.55±2.82) was statistically significant. There was significant impact of previous blood donation on the level of knowledge in donor students. The attitude toward blood donation was more positive among blood donor as compared to nondonor students, and the difference in their means was statistically significant. About one in two (45.8%) college-going students fear that either they are not fit enough to donate blood (26.8%) or that they will become weak (19%) after blood donation. Almost one in four (27.4%) have fear of needle pain; therefore, they do not come forward for blood donation.Interpretation and conclusion: The most significant reason hindering blood donation comes out to be related to health of the individual donor. The findings of this study conclude that the national targets of voluntary blood donation could be better met with specific blood donor information, education, motivation, and recruitment strategies focusing on the myths and misconceptions prevalent in the donor demographic area of that particular region, specifically targeting high-school children in countries developing a volunteer donor base.Keywords: knowledge, attitude, voluntary blood donation

Background: To assess the appropriate utilization of platelet transfusions [random donor platelets (RDP) and single donor platelets (SDP)]; a six-month retrospective audit was carried out in a tertiary care hospital. Materials and Methods: A six-month retrospective platelet audit was carried out from May to October 2005 to estimate its preparation, appropriate utilization and wastage rate. Patient′s demographics, transfusion triggers and episodes and ABO and Rh (D) group specific or non-group specific transfusions were also assessed. Results: About 5525 units of platelets [PRP-PC, 3,813 (69%); BC-PC, 983 (17.8%); PRP, 648 (11.7%) and SDP 81 (1.5%)] were prepared and transfused to 853 patients (RDP to 814 patients and SDP to 39 patients) in 2,093 transfusion episodes. Adult and pediatric hemato-oncology were the main user specialties utilizing 39.1 and 87.6% of the RDPs and SDPs prepared. Of the patients receiving RDPs, 95% were transfused ABO and Rh (D) group specific platelets whereas 100% SDPs transfusions were of group specific platelets. 88% of prophylactic platelet transfusions were appropriate as per the recommended BCSH guidelines. However, 12% of the prophylactic platelets were transfused inappropriately in cardiopulmonary bypass (CPB) surgeries with normal platelet counts and no evidence of bleeding related to platelets. Out of 5,444 RDPs prepared 1,585 (29.11%) units were not utilized. Conclusions: Regular audit of blood and blood components is a must so that necessary remedial measures can be taken to maximize appropriate and judicious utilization of each component.

The southern Central Valley of California is one of the most productive agricultural regions in the world. Yet, decades of groundwater use beyond sustainable yield have left rural communities highly vulnerable to shortages and contamination of their drinking water supply. As state regulation begins to address these issues, a need exists to design adaptive and appropriate management systems to increase resilience of rural communities. Targeted managed aquifer recharge on agricultural land (Ag-MAR) near rural communities is one such strategy that could potentially stabilize groundwater tables and maintain or improve groundwater quality in domestic supply wells. Here we present a geographic information system-based multicriteria decision analysis that combines biophysical data (soils, land use, and surface water conveyance) with groundwater modeling and particle tracking to identify suitable agricultural land parcels for multibenefit groundwater recharge within well capture zones of 288 rural communities. Parcels are prioritized using a vulnerability index to change in groundwater supply, derived from well reliance and failures, pesticide applications, land subsidence, and socio-economic data. Our analysis identifies 2,998 suitable land parcels for Ag-MAR within the well capture zones of 149 of the 288 communities, of which 144 rely mainly on groundwater for drinking water. The majority of identified Ag-MAR parcels serve communities ranked as having extreme or very high vulnerability to changes in groundwater supply. Our research produces new understanding of factors contributing to community vulnerability and resilience to changes in drinking water supply and can be used to discuss actions to help achieve a stable and high-quality water supply.

Accepted on 06.02.2001. Code Number: ni03045 Sir, Tuberculosis as a cause of aseptic cerebral venous thrombosis, (CVT) has not been reported in literature. We report here two cases of primary [...]

Byline: Ashis. Pathak, S. Dutta, N. Marwaha, D. Singh, N. Varma, S. Mathuriya Background: Tissue thromboplastin (TTP) is an integral membrane protein contributing to coagulopathy after trauma of brain, which [...]

The article discusses the topics discussed at an international forum on red blood cell (RBC) transfusion. Topics discussed include the response of participants to transfusion indications survey, the list of clinical indications to order RBC transfusion, and the information received by physicians and surgeons regarding RBC transfusion indications.

The article discusses an international forum from the journal "Vox Sanguinis" about donor notification and counselling techniques for transfusion-transmissible infections markers. Topics include notifying donors on positive screening test on the blood that has been donated, the role of counselling and donor notification in both blood safety and donor care, and the important elements for a notification message.

Haemovigilance is a surveillance system which aims to detect and analyse adverse events and reactions in the blood transfusion chain to improve blood safety by instituting corrective and preventive actions. Setting up such a system is a complex task, and it involves both organizational and operational aspects, which may vary between countries depending upon the structure and regulation of blood transfusion services. First and foremost, it should be a part of the National Blood Policy. The organizational structure should ideally have governmental oversight to the programme through its Ministry of Health or equivalent authority. Haemovigilance advisory committees are required to give direction to the programme. During the phase of planning, the following issues need to be addressed: i) whether reporting of all adverse events in the transfusion chain is required, ii) whether reporting will be voluntary or mandatory, iii) what would be the flow of information, iv) adoption of definitions of adverse events and reactions as per international consensus, v) uniform reporting formats and vi) requisite resources. At the reporting end, awareness and training of staff who would be involved in haemovigilance activities needs to be conducted. A validated system for collection, collation and analysis of haemovigilance data is required. Mechanisms for regular publications of haemovigilance reports with recommendations for better transfusion practices should be put in place. This would help in directing policy decisions to improve blood safety. It should also be aimed to establish linkage with the international haemovigilance network and database for exchange of information between member countries. [ABSTRACT FROM AUTHOR]

Background: Platelet rich plasma-platelet concentrate (PRP-PC), buffy coat poor-platelet concentrate (BC-PC), and apheresis- PC were prepared and their quality parameters were assessed. Study Design: In this study, the following platelet products were prepared: from random donor platelets (i) platelet rich plasma - platelet concentrate (PRP-PC), and (ii) buffy coat poor- platelet concentrate (BC-PC) and (iii) single donor platelets (apheresis-PC) by different methods. Their quality was assessed using the following parameters: swirling, volume of the platelet concentrate, platelet count, WBC count and pH. Results: A total of 146 platelet concentrates (64 of PRP-PC, 62 of BC-PC and 20 of apheresis-PC) were enrolled in this study. The mean volume of PRP-PC, BC-PC and apheresis-PC was 62.30±22.68 ml, 68.81±22.95 ml and 214.05±9.91 ml and ranged from 22-135 ml, 32-133 ml and 200-251 ml respectively. The mean platelet count of PRP-PC, BC-PC and apheresis-PC was 7.6±2.97 x 1010/unit, 7.3±2.98 x 1010/unit and 4.13±1.32 x 1011/unit and ranged from 3.2-16.2 x 1010/unit, 0.6-16.4 x 1010/unit and 1.22-8.9 x 1011/unit respectively. The mean WBC count in PRP-PC (n = 10), BC-PC (n = 10) and apheresis-PC (n = 6) units was 4.05±0.48 x 107/unit, 2.08±0.39 x 107/unit and 4.8±0.8 x 106/unit and ranged from 3.4 -4.77 x 107/unit, 1.6-2.7 x 107/unit and 3.2 - 5.2 x 106/unit respectively. A total of 26 units were analyzed for pH changes. Out of these units, 10 each were PRP-PC and BC-PC and 6 units were apheresis-PC. Their mean pH was 6.7±0.26 (mean±SD) and ranged from 6.5 - 7.0 and no difference was observed among all three types of platelet concentrate. Conclusion: PRP-PC and BC-PC units were comparable in terms of swirling, platelet count per unit and pH. As expected, we found WBC contamination to be less in BC-PC than PRP-PC units. Variation in volume was more in BC-PC than PRP-PC units and this suggests that further standardization is required for preparation of BC-PC. As compared to the above two platelet concentrates, all the units of apheresis-PC fulfilled the desired quality control criteria of volume. Apheresis-PC units showed better swirling and platelet count than PRP-PCs and BC-PCs. All the platelet concentrates units had pH well above the recommended norm. [ABSTRACT FROM AUTHOR]

BACKGROUND: HIV/AIDS pandemic brought into focus the importance of safe blood donor pool. AIMS: To analyze true seroprevalence of HIV infection in our blood donors and devise an algorithm for donor recall avoiding unnecessary referrals to voluntary counseling and testing centre (VCTC). MATERIALS AND METHODS: 39,784 blood units were screened for anti-HIV 1/2 using ELISA immunoassay (IA-1). Samples which were repeat reactive on IA-1 were further tested using two different immunoassays (IA-2 and IA-3) and Western blot (WB). Based on results of these sequential IAs and WB, an algorithm for recall of true HIV seroreactive blood donors is suggested for countries like India where nucleic acid testing or p24 antigen assays are not mandatory and given the limited resources may not be feasible. RESULTS: The anti-HIV seroreactivity by repeat IA-1, IA-2, IA-3 and WB were 0.16%, 0.11%, 0.098% and 0.07% respectively. Of the 44 IA-1 reactive samples, 95.2% (20/21) of the seroreactive samples by both IA-2 and IA-3 were also WB positive and 100% (6/6) of the non-reactive samples by these IAs were WB negative. IA signal/cutoff ratio was significantly low in biological false reactive donors. WB indeterminate results were largely due to non-specific reactivity to gag protein (p55). CONCLUSIONS: HIV seroreactivity by sequential immunoassays (IA-1, IA-2 and IA-3; comparable to WHO Strategy-III) prior to donor recall results in decreased referral to VCTC as compared to single IA (WHO Strategy-I) being followed currently in India. Moreover, this strategy will repose donor confidence in our blood transfusion services and strengthen voluntary blood donation program. [ABSTRACT FROM AUTHOR]

A 5-month-old infant with hitherto undiagnosed hemophilia A, who developed a unilateral lower motor neurone type of facial palsy, is described. A high-resolution CT scan confirmed the nerve palsy to be a consequence of a hemotympanum. The patient recovered completely in 7-10 days after therapy with factor V III concentrate. [ABSTRACT FROM AUTHOR]

The clinical and hematological characteristics of ten children with myelodysplastic syndromes diagnosed and followed up over a 3 year period are presented. All of them had anemia and a low platelet count whilst the white blood cell count was variable. Presentation with bilateral proptosis and acute febrile neutrophilic dermatosis (Sweet's syndrome) were unique features observed in one case each. None of these cases could afford specific therapy and thus serve to illustrate the natural history of the disease in pediatric practice. [ABSTRACT FROM AUTHOR]

Liver biopsies from 29 siblings of patients with Indian childhood cirrhosis (ICC) and from two age-matched controls were examined by routine light and transmission electron microscopy. Histochemical stainings for copper and copper-binding protein were also carried out. The mild and non-specific structural alterations that were observed did not differ from those seen in control livers, even though a slight to moderate excess of copper and copper-binding protein was demonstrated in the majority. Aggregates of microtubules seen in some siblings, as well as in control livers, may indicate the preconditions for development of Mallory hyaline. It is possible that these features suggest a susceptibility for the development of ICC but not early disease. [ABSTRACT FROM PUBLISHER]

The aim of this study was to define the scope of problem and clinical implications during the weak ABO subgroup typing in blood donors.Group discrepancies were detected serologically, where the forward and reverse ABO blood typing was discordant out of 86,687 units tested. Confirmation of weak subgroups was done by adsorption and elution techniques.Seventeen weak subgroup discrepancies were found in 86,687 donors units tested, making an overall incidence of 1:5,100 donors or 0.02%. Correct blood typing and labeling of an individual as donor and as a recipient is essential to prevent ABO incompatibility in case of weaker subgroups of A and B. [ABSTRACT FROM AUTHOR]

Aim: This study was designed to analyze the incidence and spectrum of adverse effects of blood transfusion so as to initiate measures to minimize risks and improve overall transfusion safety in the institute. Materials and Methods: During the period from July 2002 to July 2003 all the adverse events related to transfusion of blood and blood components in various clinical specialties were recorded. They were analyzed and classified on the basis of their clinical features and laboratory tests. Attempt was also made to study the predisposing risk factors. Results: During the study period 56,503 blood and blood components were issued to 29,720 patients. A total of 105 adverse reactions due to transfusion were observed during the study period. A majority of the adverse reactions was observed in hemato-oncology patients 43% (n = 45) and in presensitized patient groups 63% (n = 66). FNHTR 41% (n = 43) and allergic reactions 34% (n = 36) were the most common of all types of adverse transfusion reactions, followed by AcHTR 8.56% (n = 9). Majority of these AcHTR were due to unmonitored storage of blood in the refrigerator of wards resulting in hemolysis due to thermal injury. Less frequently observed reactions were anaphylactoid reactions (n = 4), bacterial sepsis (n = 4), hypervolemia (n = 2), hypocalcemia (n = 2), TRALI (n = 1), DHTR (n = 1), and TAGvHD (n = 1). Conclusion: Analysis of transfusion-related adverse outcomes is essential for improving safety. Factors such as improvement of blood storage conditions outside the blood bank, improvement in cross-matching techniques, careful donor screening, adherence to good manufacturing practices while component preparation, bedside monitoring of transfusion, and documentation of adverse events will help in reducing transfusion-related morbidity and mortality.

Removal of leucocytes from various blood products has been shown to minimize Febrile nonhemolytic transfusion reactions, HLA alloimmunization, platelet refractoriness in multitransfused patients and prevention of transmission of leukotropic viruses such as EBV and CMV. Rapidly growing size of hemato-oncological patients in our country requiring multiple transfusion of blood and components during the course of their management pose a great challenge to transfusion services to provide them red cell and platelet antigen matched products in alloimmunized subjects. Thus removal of leucocytes below a certain threshold, ≤ 5 x 10 6 in a blood component certainly helps in prevention of alloimmunization and associated risks in these patients. Currently the best Leucoreduction can be achieved with the help of 3rd and 4th generation leukofilters, both in laboratory and patient bed side, and state of the art apheresis devices. The present article briefly reviews the current literature for pros and cons of leucofilteration and its scope of implementation in the cost constrained settings.

An abstract of the study "Comparison of Conventional Tube Technique With Gel Microcolumn Assay for Antibody Screening and Titration in Rh (D) Negative Pregnant Females," by M. K. Thakur, B. Thakral, R. R Sharma and N. Marwaha is presented.

Background: Limited information is available about prevalence of co infection of transfusion transmitted diseases (TTD) in blood donors. The aim of this study was to determine the current seroprevalence of HBV, HCV, HIV and syphilis and their trends over 1999-2004 in voluntary and relative blood donors (VD and RD) and the prevalence of seropositivity of various co-infections. Study Design and Methods: A retrospective study evaluated the trends of serological results of anti HIV, HBsAg and syphilis on 208,519 samples from voluntary and relative donations from January 1999 to December 2004. From June 2001 to December 2004, 124,964 donations were also screened for anti HCV. Screening for anti HIV 1/2, HBsAg and anti HCV was done using third generation ELISA kits whereas VDRL test was done for syphilis. Each seroreactive marker was checked for the presence of coinfection. The demographic data [age, gender, type of donor, donation status] and risk factor information of co-infected donors was obtained from donor records. The Chi-square test was used to determine the difference in seropositivity rates between coinfected and monoinfected blood donors and the difference in TTD markers in voluntary and relative donors. The strength of association among above values was determined using odds ratio (OR). Results: The overall seropositivity of HBsAg, HIV 1/2 and VDRL was 1.04% (n=2,175), 0.21% (n=448) and 0.42% (n=885) respectively out of 208,519 units screened. HCV seropositivity in 124,964 units collected from June 2001 to December 2004 was 0.65% (n=822). Seropositivity of all the above TTD markers was significantly higher in relative donors. About 1% of our donors had coinfection. Majority of them were young, married, first time, male, relative donors and belonged to high occupational category. HIV seroreactive donors showed an increased risk of being coinfected with HCV and syphilis (OR 3.13 and 3.19 respectively) but not HBsAg positivity (OR 1.07). Co-infection with HBV was present in 1.81% of VDRL positive blood donors as compared to 1.04% in VDRL negative blood donors ( P<0.05). Conclusions: Voluntary non-remunerated blood donors have lowest prevalence of seropositivity for infectious disease markers, including co-infections. Deferral on the basis of occupation alone may decrease donor pool, however stringent donor screening and the practice of self deferrals and confidential unit exclusion would further increase blood safety. [ABSTRACT FROM AUTHOR]

Storage of peripheral blood stem cells for 24 hours at 4 degreesC is a well-established procedure; however, there is scarce literature on viability of stem cells if these are liquid preserved beyond 24 hours.We did extended storage of 6 autologous peripheral blood stem cell harvests up to 96 hours at 4 degreesC and found good recovery in terms of mean CD34 positive cells (11.9x 10[6]/kg body weight in first harvest and 5.36x10[6]/kg body weight in second harvest) and viability by 0.4% trypan blue dye exclusion test [>85% viability in first harvest (stored up to 96 hours) and > 90% viability in second harvest (stored up to 48 hours)].Early engraftment of these stem cells [mean leucocyte engraftment (ANC >500/microL) occurred on day +11 and platelet (> 20,000micropL) on day +14] was observed in 3 patients of multiple myeloma undergoing peripheral blood autologous stem cell transplantation. [ABSTRACT FROM AUTHOR]