Search

Peripheral blood hematopoietic progenitor cell harvest by apheresis in pediatric patients, a double-edged sword, has advantages and disadvantages over conventional bone marrow transplantation. The effect of granulocyte colony-stimulating factor (G-CSF) mobilization on hemostasis in literature is very scarce. A 3-year-old female child with metastatic neuroblastoma planned for autologous transplant. Following G-CSF mobilization (75 mg; 4 days), the procedure was performed with all default parameters in Spectra Optia with an acid citrate dextrose (ACD) flow rate 1:12, assuming 3-total blood volume (TBV) to be processed with 150 ml of expected collection with target yield of 6 × 106 CD34 cells/kg. Despite normal coagulation laboratory parameters, it was abandoned for reasons such as low-flow alarms and thrombi in the kit tubings. In the subsequent procedures, the ACD to whole blood ratio was decreased to 1:16, and used bolus of heparin was followed by continuous heparin infusion throughout the procedure. Despite using heparin anticoagulation, a long thrombus was aspirated at needleless port. The procedure was completed with continuous low-flow alarms. A cumulative dose of 5.67 × 106 CD34 cells/kg was achieved over four procedures, but the cause of hypercoagulability was unknown. All the coagulation parameters were within normal limits before and after the procedure. The exact cause for hypercoagulability remains elusive. There are no studies or case reports in the pediatric population on hypercoagulability following apheresis procedure after G-CSF mobilization, but evidence is available for adults, with lack of explanation. It can also be due to low draw flow from the patient side or embolization of thrombi developed in the anticoagulant unprimed site in the kit tubings. More extensive studies are required to explain the mechanism of hypercoagulability during apheresis procedures in the pediatric population.

The ideal way to screen for the presence of alloantibodies is by antibody screening panels which represent all clinically significant antigens in appropriate dosage. Most centers use pooled O-cells for antibody screening as it has antigens of non-ABO blood group systems that are prevalent in a representative population. Pooled O-cells sometimes fail to detect antibodies to less prevalent red blood cell antigens with reduced expression or show a dosage phenomenon. Despite pooling 4 to 5, O-donor segments, sometimes, it is difficult to detect clinically significant antibodies. False-negative indirect Coombs test by pooled O-cells may delay getting a compatible unit for elective cases where type and screen policy is used. Donor units with weak antigenic expression or units showing dosage can come compatible despite being antigen positive and lead to a hemolytic reaction. We report two cases where antibody screening by pooled O-cells was negative; still, cross-match was incompatible. Antibody screening with a three-cell panel was positive. Antibody identification with 11-cell panels confirmed the alloantibody to be anti-E. The present cases emphasize the importance of three-cell panels over pooled O-cells.

Background and Objectives: In autoimmune hemolytic anemia (AIHA) patients, there is decreased survival of red blood cells (RBCs) because of increased destruction by patients' autoantibodies. Due to decreased survival of RBCs, there is an increase in erythropoiesis and other biochemical parameters of hemolysis. One of the vital tests in AIHA is direct Coombs test (DCT). In this study, we share our experience on the difficulties faced by us during the compatibility testing and providing transfusion support to these patients. Methods: This is a retrospective study done in the department of transfusion medicine in a tertiary care hospital of South India. Patients from January 2020 to March 2021 with the diagnosis of AIHA requiring transfusion were included in this study. A total of 136 patients with positive DCT with AIHA diagnosis requiring transfusion support were included in our study. Results: Out of 136 cases, 58% (n=79) of patients had incompatibility during cross matching while in 42% (n=57) had cross matched compatible unit. In all incompatible cases best match blood was transfused. Most transfusions were done for patients with DCT Grade 4+. Out of 45 patients with mixed AIHA, 40 (88.8%) patients required a transfusion (P < 0.05). Of that 104 patients with transfusion support, 66 (63%) were with primary AIHA and 38 (36.04%) with secondary AIHA. Conclusion: It is tough and challenging to get compatible units in AIHA patients. Best-matched blood is useful when transfusion becomes essential during life-threatening anemia.

Background: Indian Drugs and Cosmetics Act and Rules 1945 states that 1% or 4 units/month of any components prepared and stored should meet specific quality control parameter. Currently, our blood center relies on nonancillary tests such as prothrombin time (PT)/activated PT test for quality check of fresh frozen plasma (FFP). However, the guidelines advice to check the levels of labile coagulation factors, routinely. Aim: This study was conducted to establish coagulation factor assay and assess conditions such as collection, transportation, time of preparation, and storage conditions to assess the level of clotting factors FVIII and fibrinogen in FFP and to identify the association of the levels of clotting factors FVIII and fibrinogen in FFP with its mode of collection and storage. Materials and Methods: A cross-sectional study was carried out delimiting inclusion criteria as the FFP to be prepared from whole blood collected in-house or at outdoor blood collection drives blood with varying duration of storage within 12 months; the exclusion criteria on units that were discarded reasons due to leaking in bags found positive for transfusion transmitted infections. The sample size was calculated based on logistics, budget, and convenient sampling technique. Statistical analysis was carried out using software IBM PASW statistics (SPSS) version 19.0, and independent Student's one-way analysis of variance for levels of statistical significance was considered at P < 0.05 among the parameters such as clotting factors among the different blood groups. Results: There was no significant difference observed on different modes of collection between the levels of FVIII and fibrinogen. However, the difference between FVIII levels with different time-lapse of component processing was statistically significant (P = 0.002). However, regarding fibrinogen such a difference was not a significant difference. Conclusion: Heat-labile factors were maintained as per the DGHS criteria when FFP was prepared within 4 h and stored for 6 months.

Settings: This study was done in a tertiary care hospital having bed strength of more than 700 beds at SDM Medical College of Medical Sciences and Hospital, Dharwad, located in Northern Karnataka. Aim: The study was done to ascertain prevalence of Gilbert′s syndrome in healthy blood donors and review the literature about feasibility of utilizing blood components from Gilbert′s syndrome donors. Materials and Methods: The study was done for 18 months and 7030 whole blood units were collected and all the units were subjected to mandatory transfusion-transmitted screening and all the plasma bags which were icteric on visual inspection were subjected to hematological and biochemical investigations to rule out other causes of hyperbilirubinemia. Results: Seven thousand and thirty units were collected and 445 (6.3%) were discarded due to various reasons. Of them, 50 units (0.71%) had Gilbert′s syndrome. All had unconjugated hyperbilirubinemia and other hematological and liver function tests were within normal range. Statistical analysis was done to find mean, median, and standard deviation from mean and standard error of mean with lower and upper confidence limits. Conclusion: Majority of blood donors whose plasma is icteric are suffering from Gilbert′s syndrome (GS). This disease does not cause any harm to donor or patient but raises a lot of concern as many severe disorders also manifest in similar way. The available literature shows that all blood components can be used from donors suffering from GS. There should be introspection. Proper guidelines are to be framed about the use and discarding of blood components in donors with GS.

Objective: Urinary tract infection (UTI) is a common cause of morbidity and hospitalisation in the population worldwide. Upper UTI is indolent and causes subclinical acute kidney injury (AKI) resulting in preventable cause of scarring of renal parenchyma. We explored urinary and serum levels of kidney injury molecule-1 (KIM-1), haematological parameters and quantitative urine microscopy parameters to predict kidney injury. Methods: Neutrophil–lymphocyte ratio (NLR) is obtained by dividing absolute neutrophil count with absolute lymphocyte count. Quantitative urine sediment microscopy was performed and correlated with clinical, biochemical and haematological findings to predict AKI in patients with UTI. Quantitative ELISA was performed for serum and urine levels of KIM-1. Seventy two adult patients with UTI were enrolled, 45 of whom had AKI while 27 were in the non-AKI group. Results: NLR (p=0.005) and renal tubular epithelial cell-granular cast score in quantitative urine microscopy (p=0.008) are strong predictors of AKI in patients with UTI while rest of quantitative urine microscopy parameters and serum and urinary levels of KIM-1 molecule were not found to be useful in prediction of AKI. Conclusion: NLR in haemogram is a novel and useful biomarker for predicting AKI in patients with UTI.

Abstract: This paper discusses an analytical approach to explaining a nearly constant high job approval rating of president Clinton between January, 1998 and February, 1999. Despite all the controversy and massive information exposure to mostly unflattering news about Mr. Clinton; the public, in nearly all major opinion polls expressed their wish that Mr. Clinton be allowed to complete his second term in the office. The analytical approach is based on the information entropy theory of Shannon. The model is tested using the data from the polling archives of ABC/Washington Post. The results are confirmed by the Kendall's Ä statistics.