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In the third week of November 2024, a critical incident involving the refusal of a blood transfusion was reported at our hospital. The case involved a 65-year-old Indian patient who had been admitted for a proposed stoma closure surgery. Although the healthcare team deemed an urgent blood transfusion necessary as part of the patient's treatment plan, the transfusion was refused due to misinformation from the patient's attendants regarding the patient's original blood type. Their refusal was also driven by a fear of the potential consequences of an erroneous mismatched blood transfusion. The blood transfusion centre (BTC) laboratory confirmed the patient's blood type as B Rh (D) positive. However, the attendants raised concerns about the accuracy of this blood grouping, citing previous misunderstandings and misinformation that led them to believe the patient was AB Rh (D) positive until that point. Despite receiving multiple assurances and thorough explanations from the attending physician and nursing staff, the attendants remained distrustful of the BTC laboratory results and requested a re-evaluation of the patient's blood type. As a result, a fresh blood sample was collected for repeat typing. After a one-on-one discussion with our transfusion medicine specialist, the attendants were ultimately convinced of the confirmed blood type. Subsequently, three compatible packs of packed red blood cells (PRBC) of B Rh (D) positive were issued to the patient over the next three consecutive days from our blood centre. This situation underscores the importance of effective communication and education regarding the patient's actual blood type. Our report further details the incident, its consequences, the associated ethical dilemmas, and recommendations to prevent similar occurrences in future., (Copyright © 2024 Society francophone de transfusion sanguine (SFTS). Published by Elsevier Masson SAS. All rights reserved.)

Background: Blood transfusion necessity in neurosurgery varies based on surgical type, blood loss, and patient anemia. Leukocytes in red blood cells (RBCs) component release pro-inflammatory cytokines during storage, contributing to transfusion-related immunomodulation (TRIM). Our aim was to examine the impact of the leukocyte content in transfused PRBCs on patients undergoing neurosurgery for meningioma tumours., Study Design and Methods: This prospective randomized controlled trial conducted from 2018 to 2020 by dividing patients randomly into non-leukoreduced (NLR) (n = 65) and leuko-reduced (LR) (n = 65) groups based on PRBCs received during surgery and hospital stay. Hospital and ICU stays, mechanical ventilation duration, and postoperative bacterial infections were observed. Hematological parameters and cytokine levels (IL-10, INF-gamma, and FAS-L) were assessed at pre-transfusion, 24 h, and 7 days post-transfusion. Data analysis included Mann-Whitney U test, Friedman test, Fisher's chi-square test, with statistical significance at p < 0.05., Results: In our study, ICU and hospital stay duration showed no significant difference (p = 0.06) between groups. However, NLR group had longer mean mechanical ventilation (18 ± 40.1 h) than the LR group (12.8 ± 8.6 h). Both groups showed statistically significant increase in Fas-L level on days 1 and 7 (p < 0.05). The IL-10 levels rose 43% in the NLR group, while and decreased by 7% the LR group on day 1. On day 7, IL-10 increased by 75% in NLR and decreased by 40% in LR, with no significance (p > 0.05)., Conclusion: In conclusion, leukoreduction appeared to offer some immune response protection in term of reducing mechanical ventilation timings and cytokine level changes., Competing Interests: Declaration of Competing Interest Authors have no conflict of Interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: H-deficient phenotypes are classified as H-deficient non- secretors (Bombay Oh), H-deficient secretors (Para Bombay), and H-partially deficient non-secretors (O h reunion, A h and B h , AB h )., Report: We report the first case of H-partially deficient non-secretor- the A h phenotype from India. What makes this report interesting is that they do not fit into the Bombay, or the Para Bombay series of H-deficient phenotypes and these partially deficient non-secretors were exclusively found on Réunion Island, off the East Coast of Africa in 1982. These reunion type phenotypes have not been reported since then and may lead to misinterpretations and confusions when encountered in the current existing laboratory settings especially in the low income (LIC's) and low middle income (LMIC's) countries like our own. Moreover, literature from LMIC and LIC incorrectly uses A h /B h for parabombay phenotypes., Conclusions: H-deficient phenotypes are rare, challenging to identify and assign correct notations. Hence, we have highlighted characteristic differences between H-deficient phenotypes and illustrated a diagnostic laboratory approach to correctly identify and assign notations to them especially in the resource constrained settings., Competing Interests: Conflict of interest Authors declare no conflict of interest., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Competing Interests: Conflict of InterestAuthors declare no conflict of interest.

Background: The state of Uttarakhand, bordering countries such as Tibet and Nepal, is a multi-ethnic region. Further, erythrocyte alloimmunization may arise from the incompatibility of major and/or minor blood groups between ethnically diverse donors and recipients. We aimed to screen Uttarakhand blood donors (UBDs) for extended phenotyping of their erythrocytes serologically., Methods: This prospective cross-sectional analysis involved all UBD samples collected at the blood centre of our tertiary-care hospital. Samples were obtained over 9 months (Mar'22 to Nov'22). Donors who were O-typed, DAT-negative and non-reactive for TTI markers were processed further for serological testing using the column agglutination technique utilizing 21 different monoclonal antisera (Ortho diagnostics Pvt ltd, Mumbai India). The research was financially aided by UCOST, Uttarakhand, Government of India., Results: Of the 5,407 blood samples collected, the total number of O-typed samples collected was 1622. Of these 1622, 329 (20.2 %) O-typed samples were selected based on our inclusion criteria and hence further phenotyped. Amongst these 329 UBDs, the average age was 32.7 ± 9.32 (18-52) years and the male-to-female ratio was (M: F = 12:1). The prevalence of high- and low-frequency blood antigens in our study was Rh (D 96.6 %, C 84.8 %, c 63.5 %, E 27.9 % and e 92 %), Lewis (Le a 6.3 %, Le b 31.9 %), Kidd (Jk a 87.8 %, Jk b 63.2 %), Kell (K 1.8 %, k 96.3 %) and Duffy (Fy a 63.5 %, Fy b 10.6 %). And in the MNS system we received 21.2 % as M, 10.9 % N, 37 % S and 51.3 % as s respectively. We also identified some very rare minor antigens such as Di a 1.8 %, In a 1.8 %, C w 0.6 % and, 1.2 % Mur positive donors, which are not common in our population, as per the published literature. Moreover, we also identified one Bombay blood phenotype (O h ) in one of our UBD recruits., Conclusion: To sum up, practically with the outcome of this research, we were also able to identify rare phenotypes among the local people and a rare blood donor registry was created. This repository shall also come in use for our multi-transfused patients having different oncological and haematological ailments., (Copyright © 2023 Société française de transfusion sanguine (SFTS). Published by Elsevier Masson SAS. All rights reserved.)

Background: National Hemovigilance Programme aims at improving patient and donor outcomes by monitoring adverse reactions. This requires an additional effort by existing manpower that is already a handful and may offer a leeway if not mandated and designated to a hemovigilance nurse., Aims and Objectives: To analyse the reported adverse transfusion reactions (ATR) and their subsequent uplink/upload into the Hemovigilance program of India (HvPI) and to observe subjective discrepancy in the diagnosis of ATR and their imputability to transfusion., Material and Methods: ATR were analysed from May 2016 to October 2021 in a hospital-based blood centre in India. Two groups were formed, Group I constituted ATR that were reported and uplinked to HvPI, and Group II constituted all reported ATR irrespective of the uplink/upload. All ATR were reanalysed for a subjective discrepancy in diagnosis and imputability levels. Results were analysed online statistical software MedCalc using the "Exact Poissons Method" and the Chi-square test with a significant p-value of <0.05., Results: In total 169 ATR were reported in 166 patients and 89 (52.6%) were uplinked, with an incident rate of 1 in 1412 and 1 in 743 in Group I and Group II respectively. The difference was statistically significant (p < 0.0001). Allergic reactions were the most common type in both groups followed by FNHTR with PRBC as the most implicated blood product. A discrepancy of around 4.3% and 17.9% in diagnosis and imputability level respectively was observed., Conclusions: The difference in incidence rates in the two groups indicates a mandate for dedicated hemovigilance nurses in every centre to aid in accurate data sharing with the National hemovigilance systems. Discrepancies in diagnosis can be mitigated by identification and understanding of ATR through case-based objective approach. Discrepancy in assigning imputability levels to adverse reactions can be minimised by objectifying the scales followed by spreading awareness though campaigns. These initiatives can effectively be aided by the hemovigilance nurse., (Copyright © 2022 Société française de transfusion sanguine (SFTS). Published by Elsevier Masson SAS. All rights reserved.)

Objectives: This study aimed to assess the association of blood donor variables on the outcome of patients undergoing cardiac surgery., Study Design and Methods: A retrospective observational study was conducted on patients who had cardiac surgery between January 2018 and December 2020. Blood donor characteristics such as age (≤ or >30 years), sex, and body mass index (BMI) (≤ or >25 kg/m 2 ) were analyzed for association with patient outcomes (length of hospital stay (LOS), mortality, and readmission). Sex matching was done as fully match, fully mismatch, and partial mismatch. Cox regression and Linear regression models were used to study the association with mortality and readmission, and LOS., Results: During the study period, 5788 patients had cardiac surgery; receiving a total of 20,348 red cell units. Of which, 522 (9%) died, 531 (9.2%) re-admitted and median LOS was 11 days (IQR 7-18). BMI >25 kg/m 2 (β, 2.96; p = 0.000), female to male transfusion (partial mismatch: β, 4.42; p = 0.001; fully mismatch: β, 9.0; p = 0.02) negatively affected LOS. BMI >25 kg/m 2 (HR, 2.07; p = 0.00) and partial mismatch transfusion to male patients (HR, 1.60; p = 0.01) increased mortality. Fully mismatch transfusion to female patients (HR, 1.24; p = 0.01) and partial mismatch to male patients (HR, 1.86; p = 0.01) increased readmission. No association of donor age on patient outcome was observed., Discussion: Blood donor sex, and BMI can influence mortality and LOS in cardiac surgery patients. The use of computer tools to match the patient's and donor's characteristics can assist to eliminate these types of adverse consequences., (Copyright © 2022 Société française de transfusion sanguine (SFTS). Published by Elsevier Masson SAS. All rights reserved.)

Background and Objectives: Enabling universal access to safe blood components should be a key component of every country's national healthcare strategy. This study aimed to assess the current status of infrastructure and resources of blood transfusion services (BTS) in low- and middle-income countries., Materials and Methods: A cross-sectional survey was designed to gather information on blood donations, components, redistribution, testing resources and quality management systems (QMSs). The survey was distributed to the International Society of Blood Transfusion members between October 2021 and November 2021., Results: A total of 54 respondents from 20 countries responded to the survey. This included hospital-based BTS/blood centres (46%), national blood centres (11%)and national and regional blood services (11%). Voluntary non-remunerated, replacement and paid donors accounted for 94.2%, 84.6% and 21.1% of donations, respectively. Apheresis donation was available in 59.6% of institutions. National/regional criteria for redistribution of blood components were reported by 75.9% of respondents. Blood components incurred payment charges in 81.5% of respondents' institutions, and payments were borne by patients in 50% of them. Testing methods, such as manual (83%), semi-automated (68%) or fully automated (36.2%), were used either alone or in combination. QMSs were reported in 17 institutions, while accreditation and haemovigilance were reported in 12 and 8 countries, respectively., Conclusion: QMS was implemented in most of the countries despite the common use of paid donations and the lack of advanced testing. Efforts to overcome persistent challenges and wider implementation of patient blood management programmes are required., (© 2022 International Society of Blood Transfusion.)