Search

For identification (ID) of irregular antibodies, a standard antibody identification (AI) panel consisting of 18 mandatory antigens expressed on reagent red blood cells is used. The phenotype for each antigen is listed on a red cell antigram provided with each lot of the ID panel. In addition, special type of low-incidence antigens that are clinically significant are separately mentioned on the left- or right-hand column or on the reverse of the antigram. These cases highlight the importance of diligent AI to ensure safe transfusions and prevent adverse transfusion reactions in patients. The ID of rare and low-incidence red cell alloantibodies is important in ensuring safe transfusions and preventing hemolytic disease of fetus and newborn. In routine practice, these types of antibodies are often categorized as having an undetermined specificity due to their rarity and low prevalence in the population. We describe two cases of successful ID of rare and low-incidence red cell alloantibodies, Anti-Colton-b (Co(b)) and Anti-Kpa. Type and screen and irregular AI were performed on Immucor NEO Iris® (SPRCA), for both the female patients. Autocontrol and direct agglutination test were performed by column agglutination technique method (BIO-RAD, Coombs Anti-Ig G cards) and were negative for both the patients. Analysis of respective antigrams was done to rule out or rule in irregular antibodies. Initially, the reaction pattern indicated the presence of anti-Co(b) and anti-Kpa. However, the reaction only occurred in one cell out of the 14 cells tested for both patients. To ensure accuracy, the samples were rerun using different lots using the SPRCA methodology. To confirm the presence of anti-Co(b) antibodies, a selected panel cell was treated with an enzyme to enhance the expression of the Co(b+) antigen. Anti-Co(b) and anti-Kpa alloantibodies were successfully identified and AHG crossmatched; compatible and phenotype-matched blood units were reserved for the patients. Low prevalence antibodies are often missed during antibody screening due to lack of corresponding antigen-positive cells in cell panels or due to their weak reaction pattern and considering it for nonspecific reaction.

A 68-year-old male known follow-up patient of nonalcoholic steatohepatitis and carcinoma stomach was admitted to hospital for further management. The patient was planned for radical gastrectomy and required two units of packed red blood cell (PRBC), due to low hemoglobin of 6.6 g/dl. The patient blood grouping and antibody screening (ABS) were done. Patient ABS was positive. On antibody identification, using eleven-cell identification panel, resolve Panel A (Ortho Clinical Diagnostics, Johnson and Johnson, USA), “anti-f” alloantibody was identified in the patient sample. Select cells, from another resolve panel were used to rule out remaining antibodies. Anti-f antibody is produced due to the exposure of “f antigen.” Anti-f antibody can cause hemolytic disease of fetus and new-born and possible hemolytic transfusion reactions. At our center, we successfully transfused two units of anti-human globulin compatible and “c-negative” units, to the patient without any adverse reactions. Thus, the patient having anti-f antibody can be managed by transfusing “c-negative” or “e-negative” PRBC units or units lacking both the “c” and “e” antigens.

Background: As a part of continuous quality initiatives, while moving from triple bags to quadruple bags, we undertook a study to compare platelet-rich plasma (PRP) and buffy-coat (BC) methods with respect to all blood components (red blood cells [RBCs], random donor platelet concentrate [RDPC], and fresh frozen plasma [FFP]) prepared by PRP and BC methods. Materials and Methods: It was a prospective analysis of different physical and quality parameters of RDPC, RBC, and FFP prepared out of 100 whole blood (WB) donations. Of these, 50 WB units were processed by PRP method using Triple bags and 50 WB units by BC method, using quadruple (top and bottom) bags, with an attached integral filter. Results: RBC prepared by BC method had higher hematocrit (61.3 ± 1.91% vs. 56.03 ± 3.37%; P < 0.05) and lower white blood cell (WBC) contamination (6.3 × 104 ± 6.1 vs. 5.41 × 105 ± 2.5; P < 0.05) in comparison to prepared by PRP method. Higher PLT yield (7.67 × 1010 ± 1.8 vs. 6.47 × 1010 ± 1.5; P < 0.05) and lower WBC count (8.24 × 103 ± 1.1 vs. 1.5 × 104 ± 2.1; P < 0.05) was observed in RDPC prepared by BC method than PRP derived. CD62P expression was lower in RDPC prepared by BC method (31.46 ± 9.7%; P < 0.05) as compared to PRP method (43.35 ± 12.5%; P < 0.05). The BC method also resulted in increased plasma yield (210.56 ± 18.54 ml vs. 187.92 ± 12.93 ml; P < 0.05) in FFP in comparison to PRP method. Conclusion: The blood components produced from WB by the BC method have laboratory variables suggestive of superior quality than those produced by the PRP method.

Background: There are no published reports on desensitization protocol for ABO-incompatible kidney transplants using Immuno-Adsorption (IA) plasmapheresis from India. IA offers certain advantages including processing of larger plasma volumes, quicker reduction of isoagglutinin titers and no requirement of replacement fluids. Aims and Objectives: Authors' center evaluated success of desensitization protocol, and graft/patient outcomes when IA procedures were performed for desensitization in adult and pediatric ABO-incompatible kidney transplant patients. Methods: Patients undergoing ABO-incompatible kidney transplant with use of IA were evaluated at tertiary care center in north India. Patient records for 2-years were collated from hospital information system (HIS) and procedure forms. Results: Sixteen IA procedures were performed in five patients who underwent successful ABO-incompatible kidney transplant. Initial isoagglutinin IgG titer ranged from 32-512. Mean number of IA procedures performed to achieve the desired pre-transplant IgG titer ≤8 was 3.2. New IA column was used for each patient (and re-used for the same patient, if needed, after sterilization with Low temperature steam of formaldehyde). Mean plasma volume processed during each IA procedure was 4.5 times. No adverse events were observed during any IA procedure. All patients achieved successful desensitization. All patients continue to do well clinically with mean follow-up period of 8.8 months. Although IA was expensive, it offered advantages like specificity, larger plasma volume processing with desired reduction in titer, no 'replacement fluid' requirements and no adverse events in present case series. Conclusion: IA plasmapheresis was universally successful in decreasing the ABO-isoagglutinin titers to desired level in all prospective ABO incompatible kidney transplant patients.

Introduction: Serological tests for syphilis contributed greatly to the detection of Treponema pallidum infection in blood donors and especially in those who were missed during the medical selection. Although several different treponemal assays have been evaluated in India, the debate that which treponemal test-formats would be suitable for a particular blood transfusion service is far from settled. Aims and Objectives: The study was undertaken with an objective of comparing conventional immunochromatographic assay (ICA) with new automated T. pallidum hemagglutination assay (a-TPHA) in over 10,000 consecutive blood donor samples with fluorescent treponemal antibody-absorption assay (FTA-Abs) as the gold standard to resolve the discordant samples. Materials and Methods: The study was conducted in the Department of Transfusion Medicine in a large tertiary care hospital in India. Consecutive blood donors from July 2014 to January 2015 were evaluated simultaneously for antitreponemal antibodies by solid-phase ICA (SD BIOLINE Syphilis 3.0, Alere Medical Pvt. Ltd., USA), a-TPHA (Immucor Diagnostics, USA) and FTA-Abs (Biocientifica SA, FTA-Abs, Argentina). Performances of both the assays were evaluated using statistical tools. Results: A total of 10,129 donor samples were evaluated. A total of 113 (1.1%) donor samples were reactive for syphilis; either on ICA or a-TPHA or both. Ninety-one of these 113 reactive samples were reactive on FTA-Abs, giving seroprevalance of syphilis as 0.9%. a-TPHA was superior to ICA in terms of sensitivity, specificity, positive predictive value, negative predictive value, and Youden's index. Conclusion: The new “a-TPHA” is a superior assay to ICA as the screening assay for syphilis in blood donors.

INTRODUCTION: Semi-automated equipment using Column agglutination technology (CAT) is widely used where centrifugation and incubation are automated but substantial amount of the work is still executed manually. Larger laboratories are moving towards automation to eliminate errors, reducing exposure to bio-hazardous samples, assuring traceability, reliability, turnaround time (TAT) and throughput. Moving towards automation and greater reliability, we therefore, decided to install an automated immunohematological (IH) analyzer “Vision”. In this study we evaluated reliability and performance before clearing “Vision” for routine use. MATERIALS AND METHODS: Study was conducted in the Department of Transfusion-Medicine. The primary objective was to assess the reliability of results and compare with routine use semi-automated BIOVUE system (Reference system). Secondary objective was to evaluate the performance (TAT and throughput) of the Vision to handle routine and emergency workload. RESULTS: Total of 1276 known samples were used to assess 2640 pre-transfusion tests (1229 ABO/Rh D typing; 1229 antibody screening; 54 antibody identification; 86 crossmatch and 42 DAT). All 1229 ABO Rh typing results were concordant between the two systems. Overall agreement between the Vision IH analyzer and reference system for ABO Rh typing was 99.95%. All antibody screening, crossmatch and DAT results were concordant between the two systems. TAT of Vision was substantially shorter than the reference system for all test profiles. CONCLUSION: Based on study results, Vision was approved for routine use in laboratory. It was found to be reliable with considerably shorter TAT and capable of handling high throughput of immunohematological tests.

61-year old male patient was admitted to the hospital with clinical picture of hemolytic anemia with hemoglobinuria. Patient was suspected to have Infectious Mononucleosis (IM) with Auto Immune Hemolytic Anemia (AIHA). DAT was positive with anti-C3d specificity. Donath Landsteiner (DL) test was positive; confirming Paroxysmal Cold Hemoglobinuria (PCH). The final diagnosis was IM with PCH. Patient was managed conservatively and discharged after seven days. DL test specifically detects a biphasic autoantibody (IgG type) that binds to RBCs at cold temperatures, and fixes complement on the RBC membrane. However RBCs are only lysed upon warming to 37C when complement cascade proceeds to completion.

Introduction: Anesthetists procure pre-defined number of blood units in advance for surgical patients for ‘just-in-case’ scenarios. This often results in non-usage and discarding of blood units. Blood bank discards blood units returned from operation theatre due to disruption of cold chain. In an effort to reduce this wastage an intervention from transfusion medicine team was undertaken in collaboration with liver transplant team with help of an electronically controlled remote inventory and bedside transfusion management system called BloodTrack Courier. Effectiveness of BloodTrack® Courier in tracing and reducing red cell unit wastage was studied over a four-month period and compared with four-month historical control. Materials and Method: intervention was limited to red cell units issued in elective live-donor liver transplant cases through BloodTrack (Haemonetics Corporation, USA). Controlled access linked to hospital identity cards was provided to Transfusion Medicine Specialists and Liver Transplant anesthetists with different access levels. Pre-allocated RBC units were kept at OT refrigerator for a period of 24-36 hours after which unused units were retrieved by BTS and re-inventoried. Results: Transfusion of RBC units in 60 liver transplant recipients donor before installation was compared with similar 86 liver transplant recipient-donor after installation of BloodTrack. Mean number of RBC units transfused in recipient-donor decreased from 6.2 and 1.0 unit before installation to 5.9 and 0.76 units after installation, respectively. RBC units discarded due to breakage of cold-chain reduced to zero and RBC units successfully returned to blood bank increased 7.6 times. Conclusion: Blood inventory management and remote issue function of Blood Track was very effective in saving RBC units during four-month study period.

Introduction: The authors' center recently changed their pretransfusion testing protocol from “conventional” type and screen (TS) with anti-human globulin (AHG) crossmatch (Policy A) to TS with immediate-spin (IS) crossmatch (Policy B). Red blood cell (RBC) units were issued after compatible IS crossmatch as and when required instead of AHG crossmatch. This study was conducted to compare the effects of change of policy from A to B over 1-year period on crossmatch-to-transfusion (C/T) ratio, RBC issue turnaround time (TAT), outdating of RBC, man-hours consumption, and monetary savings. Materials And Methods: This was a comparative, prospective study conducted by the Department of Transfusion Medicine of a tertiary hospital-based blood bank in Northern India. The Policy B was implemented in the department from January 2014. Relevant retrospective data for comparison of the previous 1 year, when Policy A was practiced, were derived from hospital information system. Results: 23909 and 24724 RBC units transfused to patients admitted to the hospital during respective 1-year period of practice for Policy A and B. There was significant reduction in C/T ratio (1.94 vs. 1.01) and RBC issue TAT (79 vs. 65 min) with Policy B. Expiry due to outdating reduced (37 vs. zero) along with man-hours (16% reduction) and monetary (33% reduction) savings. Conclusion: Use of 'TS with IS crossmatch' policy provides multiple advantages to all the stakeholders; blood banker, clinician, patient, and the hospital management.

Background: Hematopoietic progenitor cell transplantation is increasingly being used as the curative therapy in India for various clinical conditions. There are three main sources of hematopoietic progenitor cells; hematopoietic progenitor cell-apheresis (HPC-A), hematopoietic progenitor cell-bone marrow (HPC-M) and hematopoietic progenitor cell-Umbilical Cord (HPC-C). The number of CD34+ cells in HPC-C is fixed. In HPC-A, the number of CD34+ cells collected is based on the baseline peripheral blood counts and a second harvest can be easily performed. The trickiest calculation of CD34+ cells adequacy is in case of HPC-M harvest, where the end point of harvest cannot be predetermined. Aim: The aim was to study the accuracy of a total leukocyte count (TLC)-based predictor tool in predicting CD34+ dose in comparison to the actual CD34+ cell counts in the harvest. Materials and Methods: This was a prospective study to validate the tool. The data captured included patient and donor demographic data, disease condition, mobilization regimen of the donor, progenitor cell harvest data, dose collected, cryopreservation if any, progenitor cell infusion data, engraftment, and follow-up of the patient including day thirty and day hundred chimerism in a tertiary care hospital. Results: Five patients were included in the study. For each patient, the target dose and volume were collected in a single HPC-M harvest attempt, and no repeat harvests were required. The average volume of HPC-M harvest collected was 195 ml. The average CD-34+ cell dose in HPC-M harvest achieved was 4.3 × 106/kg (Range = 3.39–6.42). This was 85.7% of the targeted dose calculated on the basis of TLC-based predictor tool. Conclusion: This study reiterates the importance of a simple TLC-based predictor tool (formula) for estimation of HPC-M volume to be harvested.