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Introduction: Children are more vulnerable to anaemia due to their rapid growth, which requires an expanding erythroid mass and a high tissue iron demand. Anaemia can negatively impact psychomotor and cognitive development and can lead to a decline in immunity. Reticulocytes are precursors to erythrocytes and make up about 1% (ranging from 0.5% to 2.5%) of circulating erythrocytes. The reticulocyte content serves as a measurement of haemoglobin within the reticulocyte and correlates directly with the functional availability of iron in the bone marrow. Consequently, it is considered one of the strongest predictors of Iron Deficiency (ID). The Reticulocyte Haemoglobin Content (RET-Hb) level is useful for diagnosing anaemia before it clinically manifests in a patient. Aim: To assess the effectiveness of RET-Hb content as a predictor for early response to oral iron therapy in comparison to haemoglobin levels. Materials and Methods: This prospective interventional study was conducted in the Department of Paediatrics at a tertiary care Hospital in Thrissur, Central Kerala, India, over a period of 18 months, from December 2019 to June 2021. A total of 44 samples were included in the study, and socio-demographic details were collected using a semistructured proforma from patients with haemoglobin levels below the mean reference value. Baseline haemogram parameters {Mean Corpuscular Volume (MCV), Mean Corpuscular Haemoglobin (MCH), Mean Corpuscular Haemoglobin Concentration (MCHC), Red Cell Distribution Width (RDW), Haemtocrit (HCT)}, reticulocyte indices, and ferritin levels were measured before administering oral iron therapy (T0). These parameters were reassessed after seven days (T1) and 30 days (T2) following the initiation of therapy. The Chi-square test was used to assess the association between various factors, and Pearson’s correlation coefficient was utilised to find the correlation. Results: The mean age of the participants was 3.46±2.2 years, with 24 males and 20 females included in the study. The mean RET-Hb was 21.15±1.71 pg before the initiation of treatment, which significantly increased to 23.37±1.95 pg and 25.77±1.56 pg at days 7 and 30, respectively. The haemoglobin level increased from 8.37±1.25 g/L to 8.55±1.19 g/L and 9.72±0.98 g/L at T1 and T2, respectively, which was statistically significant. The Absolute Reticulocyte Count (RET#) also showed a significant early increase after initiating treatment. Conclusion: These findings indicate that RET-Hb and RET# are reliable early predictors of response to iron therapy, alongside haemoglobin levels, and can be used as effective alternatives.

INTRODUCTION: Snake bites tend to cause a high mortality in those who develop coagulopathy. However, there is very limited literature on clotting factor assays in these patients, especially in the presence of clinical bleeding. The aim was to assess the coagulation profile and individual coagulation factors in patients with hematotoxic snake bites. MATERIALS AND METHODS: This was a prospective observational study of clotting factor levels in victims of snake bites with hematotoxicity admitted to a single hospital in south India for 12 months. In 43 individuals who fulfilled the criteria, we measured platelet count, prothrombin time (PT), international normalized ratio, activated partial thromboplastin time (aPTT), fibrinogen levels, coagulation factors V, VII, VIII, IX, and X, and the qualitative factor XIII assay. RESULTS: Forty-three patients fulfilled the criteria and their samples were studied. There were 36 Russell's viper (Daboia russelli), 4 Hump-nosed pit viper (Hypnale hypnale), and 3 unknown snake bite victims samples, in which factor assays were done. All the Russell viper bite victims without a recordable clotting screen had deficiency of Factor V (0.5%–49.62%, Mean – 20.27%), Factor X (0.08%–92.3%, Mean – 70.73%), and qualitative factor XIII. Pit viper patients showed normal levels of Factor I, V, VII, VIII, IX, X, and XIII despite prolonged PT and aPTT. CONCLUSIONS: Early detection and treatment of envenomation remains the cornerstone of managing snake venom-induced consumptive coagulopathy. Anti-snake venom plays a major role in the reversal of coagulopathy. Blood and blood products would be useful when coagulopathy does not revert by ASV alone. Evidence-based transfusion can be implemented and cryoprecipitate may be used as many of the patients had factor XIII and fibrinogen deficiency as part of venom-induced coagulopathy. To improve patient management and thereby the outcome of patients CMEs and training programs for the treating physicians also has to be implemented so that guidelines are formulated and followed.

Background and Objectives: Platelet transfusions are widely used to treat thrombocytopenia of various etiology. There are two different methods of preparation of platelet concentrate from whole blood: one is platelet-rich plasma method (PRP) and the buffy coat removed (BCR) method. This study aimed to compare the clinical outcome of patients with dengue fever transfused with platelets prepared by PRP method and BCR method. Methodology: A total of 100 patients with thrombocytopenia due to dengue fever were enrolled in the study, with fifty patients in each group. The outcome of patients transfused with PRP-derived platelets and BCR platelets was compared on the basis of absolute and corrected count increment (CCI), percent platelet recovery, and incidence of posttransfusion reactions. Results: The mean absolute count increment in patients who received BCR-platelet concentrate (BCR-PC) was 23,900/μl ± 7022.56/μl. The mean absolute count increment in patients who received PRP-derived PC was 18,910/μl ± 7482.42/μl. The difference was statistically significant with P = 0.001. The mean CCI of PRP group was 12,847 ± 5146.76 and in the BCR group, it was 12,897 ± 4266.82, and this difference was not statistically significant (P = 0.957). None of the patients transfused with BCR platelets reported a transfusion reaction, whereas one out of fifty (2%) patients transfused with PRP platelets had febrile nonhemolytic transfusion reaction. Conclusion: On the basis of count increment, CCI, percent platelet recovery, and incidence of posttransfusion reactions, BCR platelet transfusions showed a better outcome than PRP platelet transfusions.

Background: Fresh frozen plasma (FFP) should be thawed before transfusing to the patient. Prolonged or uncontrolled thawing can denature plasma proteins. The potential risk of contamination by wet thawing had always been a point of concern. Aims: Here, we compared and evaluated the effect of thawing on clotting factor activities by two different methods (wet and dry) and other factors such as risk of bacterial contamination, throughput, turnaround time, and efficacy of thawing. Subjects and Methods: All FFPs were prepared from Group O donors and stored at −40°C. Twenty-one FFPs were thawed in Plasmatherm II at 45°C for 15 min and another 21 were thawed in thawing bath at 37°C for 20–30 min randomly. Analysis of prothrombin time, activated partial thromboplastin time, fibrinogen, and factor VIII was done in ACL TOP 300 (IL) at the time of preparation and immediately after thawing of FFPs. Volume, duration of thawing, ease of use, accessibility, and equipment maintenance were also compared. Results: There was a statistically significant difference in coagulation parameters after thawing in both methods compared to the time of preparation (P < 0.05), but all values were within normal limits. There was no significant difference in coagulation parameters between the two methods (P > 0.05). Mixed bacterial growth was observed from swabs taken from the water bath. Conclusion: Plasmatherm II can be a good alternative to water bath to rapidly thaw FFPs by preserving coagulation factors and eliminating the risk of bacterial contamination.

Background: Process Excellence is a value based approach and focuses on standardizing work processes by eliminating the non-value added processes, identify process improving methodologies and maximize capacity and expertise of the staff. Aim and Objectives: To Evaluate the utility of Process Excellence Tools in improving Donor Flow Management in a Tertiary care Hospital by studying the current state of donor movement within the blood bank and providing recommendations for eliminating the wait times and to improve the process and workflow. Materials and Methods: The work was done in two phases; The First Phase comprised of on-site observations with the help of an expert trained in Process Excellence Methodology who observed and documented various aspects of donor flow, donor turn around time, total staff details and operator process flow. The Second Phase comprised of constitution of a Team to analyse the data collected. The analyzed data along with the recommendations were presented before an expert hospital committee and the management. Results: Our analysis put forward our strengths and identified potential problems. Donor wait time was reduced by 50% after lean due to better donor management with reorganization of the infrastructure of the donor area. Receptionist tracking showed that 62% of the total time the staff wastes in walking and 22% in other non-value added activities. Defining Duties for each staff reduced the time spent by them in non-value added activities. Implementation of the token system, generation of unique identification code for donors and bar code labeling of the tubes and bags are among the other recommendations. Conclusion: Process Excellence is not a programme; it's a culture that transforms an organization and improves its Quality and Efficiency through new attitudes, elimination of wastes and reduction in costs.

A 66-year-old female patient presented with complaints of abdominal discomfort, pigmentation and numbness of both lower limbs for 3 years duration. On examination, she had erythema of the face and palms. Investigations revealed high hemoglobin (Hb), hematocrit (Hct) and erythropoietin. Ultrasonography abdomen showed large uterine fibroid. As there are increased tendencies of thromboembolic episodes in patients undergoing surgeries with such high Hb and Hct, a target to achieve a Hb of 15g/dl and Hct of 45 was set in the patient. Repeated phlebotomies were done over 10 days with oral hydration only and the Hb was brought down to 18 g/dl on the day prior to surgery. On the day of surgery, pre-operative phlebotomy was done so as to remove 2 units of 350 ml blood and was transfused intraoperatively to combat blood loss. Post-operatively Hb was 12.4 g %. Patient was discharged on the 10 th post-operative day with further follow-up evaluations being uneventful.