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Introduction: Antenatal antibody screening in India is focused on the detection of anti-D in RhD-negative mothers. HDFN outcome can also be affected by the presence of antibodies other than anti-D. We planned this study to find the impact of 'anti-D in combination with additional antibodies' on the development and severity of HDFN compared with 'anti-D alone'., Methods: This is a retrospective study performed at a referral center in northern India from October 2015 to March 2018. Antibody screening was performed on women with complicated obstetric history. Women with anti-D antibody were included in the study and categorized on the basis of presence of additional antibody (anti-D alone or in combination with other antibody). Various clinical, laboratory & interventional parameters were used to define HDFN and severe HDFN. Perinatal outcome was then compared between the two groups., Results: A total of 176 women with anti-D antibody were included in the study. Of these, 136 cases (77.3%) had anti-D alone while at least one additional antibody was present in 40 (22.7 %) cases. Most common additional antibodies were anti-C, anti-E and anti-c. After excluding 46 women for various reasons, 130 women were left for final analysis. Approximately 57% and 78% of cases were affected by severe HDFN amongst women with anti-D alone and in combination, respectively. Relative risk of developing severe HDFN was 1.7 times higher in women with additional antibody., Conclusions: Patients with combination antibodies were found to have more severe HDFN compared to the ones with anti-D alone., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Iron deficiency is associated with neuropsychological changes such as restless leg syndrome (RLS), pica, hair loss, etc. Our objective was to assess usefulness of history of RLS and pica in relation with iron stores in blood donors. During medical examination, apart from routine questionnaires specific history of RLS and pica was elicited. Along with hemoglobin markers of iron deficiency such as s. iron, s. ferritin and mean corpuscular volume were analyzed. Out of 400 blood donors 41 had h/o pica/RLS/pagophagia. Positive and negative predictive value of above history is 73.17% and 80.5% respectively. We recommend the use of a screening question for pica and/or RLS in blood donor questionnaire., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

ABO discrepancy refers to incongruence between the results of red cell and serum groupings. One such case is described here; the discrepant results of whose routine ABO grouping led to the diagnosis of common variable immunodeficiency. There was no reaction in the reverse grouping of a young patient presenting with recurrent bacterial infections, pointing towards an absence of antibodies in the serum. Diagnosis was made on the basis of markedly decreased serum immunoglobulin levels and by serum protein electrophoresis showing scanty gamma regions., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

This case represents the challenging role of automated cell separators in management of acute hemorrhagic crisis in a young female patient of essential thrombocythemia. A 17 year old girl having body weight of 41 kg presented to us with profuse nasal bleed. Complete blood counts revealed extremely high platelet counts of 2987×10(9)/l. Due to no response by oral hydroxyurea for last 2 months, urgent mechanical platelet reduction was planned to prevent further complication. A rebound phenomenon of increase in circulating platelet count was observed after every therapeutic platelet reduction. Seven procedures had to be performed on alternate days to bring down the platelet counts to less than 600×10(9)/l. Patient was maintained on oral anagrelide therapy and discharged in a stable condition after 14 days. Therapeutic platelet reduction causes rapid platelet reduction and helps in managing acute complications., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Background: Gamma irradiation of blood results in the formation free radicals, which interact with lipids and proteins in the membranes of red blood cells. We have investigated oxidative injury to gamma-irradiated red cells by measuring markers of oxidative injury and its correlation with red cell membrane damage., Methods: Thirty red cell blood units were irradiated at 25 Gy using Gamma Irradiator (Nordion, Canada) and stored at 4°C for 28 days. Markers of oxidative injury such as MDA levels, methemoglobin formation and osmotic fragility and markers of membrane damage including supernatant Hb, supernatant K(+), and LDH were studied., Results: There was a progressive and statistically significant increase in markers of oxidative injury such as MDA (3.76 v/s 5.01), and methemoglobin formation (1.87 v/s 3.58) in irradiated red cells compared to control non-irradiated cells. Exposure to gamma irradiation caused significant increase in markers of hemolysis such as supernatant Hb (0.087 v/s 0.363), K(+) (35.1 v/s 51.2) and LDH (366.9 v/s 587.4) over the storage period of 28 days., Conclusion: Gamma irradiation increases lipid peroxidation and oxidative injury to the red cells., (Copyright © 2012. Published by Elsevier Ltd.)

Background: Alloanti-Kp(b) is a rare, clinically significant antibody against high frequency red cell antigen Kp(b) of Kell blood group system. We report here a case of Haemolytic disease of newborn (HDN) due to anti-Kp(b), which manifested as severe anaemia at the age of 1 month., Aim: To diagnose and successfully manage anti-Kp(b) induced HDN., Methodology: Direct antiglobulin test (DAT), antigen typing, irregular antibody screening and identification were done by polyspecific LISS Coombs Gel card and standard methods., Results: At presentation the neonate had severe anemia with reticulocytopenia. Blood group was B, Rh D positive and DAT was 2+. Anti-Kp(b) was detected in mother's serum. Due to unavailability of Kp(b) negative red cells and incompatible blood group of mother (A(1)B Rh D positive) infant was transfused group B Rh D, Kp(b) positive PRBCs under steroid cover. He was symptom free at 4 months of age and DAT became negative at 6 months., Conclusion: Anti-Kp(b) is capable of causing severe late HDN. Infants born to irregular antibody positive mothers should be investigated and closely monitored for several weeks after birth for immune HDN even if asymptomatic at birth., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Refractoriness to platelet transfusions is a common clinical problem. The present study was conducted to look into patient characteristics affecting the corrected count increment in a tertiary care referral hospital. A total of 161 aphaeresis platelet units were transfused to 40 patients with varied clinical diagnoses. The mean platelet increment was 17,789/mm(3). Median corrected count increment was 7344 and percentage platelet recovery was 22.82%. Logistic regression analysis revealed significant influence of splenomegaly and anti-platelet drugs on refractoriness. Fever, bleeding, sepsis, disseminated intravascular coagulation and cyclosporine use, though more common in the patients with refractoriness they were not statistically significant., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Background: Human errors contribute to one half of all ABO-incompatible transfusions and transfusion-associated fatalities., Material and Methods: We report distribution, type and frequency of errors through a prospective study designed specifically to determine errors reported in the cross match lab with their clinical outcome, and to investigate the contributing factors, and underlying system problems., Results: A total of 342 errors (6.2 per 1000 samples) were reported with majority of the errors being clerical (87.1%) and occurred outside the blood bank (86.5%). Labelling errors were the most frequent incidents encountered with bedside being the major site of deviation. The rate of labeling errors was 6.4 errors per 1000 samples (0.64%) in 32,189 samples studied. Among 80,100 components transfused, the frequency of incorrect blood component transfusion (IBCT) was estimated to be 22.5/100,000 blood components transfused. Miscollected samples (WBIT) occurred at a rate of 1 in 1532 samples (0.65 per 1000 samples). More than half of these errors occurred during the day shift (9 errors per 1000 request form) but more with urgent demands (11 errors per 1000 request form)., Conclusion: This study indicates the importance of proper specimen labeling and implemented cost-effective, non-compromising policy of rejecting each mislabelled specimen and realises the importance of ongoing quality monitoring to improve laboratory performance., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Introduction: Transfusion transmitted Toxoplasma gondii (T. gondii) can result in significant clinical consequences in immunocompromised and multiply transfused patients, pregnant women and fetus etc. Anti-T. gondii seroprevalence, specifically IgM antibodies reflect the risk of transfusion transmission., Methods: Four hundred and ninety-three blood donors in a tertiary care hospital in North India were screened for IgG and IgM anti-T. gondii antibodies by enzyme linked immunosorbent assay (ELISA)., Results: The prevalence of IgG and IgM anti-T. gondii antibodies was 51.8% and 5% respectively. The prevalence was higher in females (M=51.6%, F=89.2%) and in replacement donors (replacement donors=63.2%, voluntary donors=33.5%)., Conclusion: The donor population constitutes a significant risk of transfusion transmitted toxoplasmosis. Effective strategies are required to prevent transfusion transmitted toxoplasmosis., ((c) 2010 Elsevier Ltd. All rights reserved.)

Different types of cell separators are available nowadays based on either continuous or intermittent flow technology to meet the growing demands for single donor apheresis platelets. This prospective study compares the five machines used in our center with regard to procedure parameters, product quality and adverse effects on the donor. A total of 477 plateletpheresis on various machines were performed on eligible donors over a period of 28 months after taking informed consent. All procedures were performed following the departmental standard operating procedure (SOP) and manufacturer's instructions. All donor and procedure related details were obtained from the procedure register. Statistical analysis was done using the SPSS statistical package (version 12, USA). The median age, BSA and BMI of our plateletpheresis donors were calculated to be 29 years, 1.69 m(2) and 23.1 kg/m(2), respectively. Analyzing the parameters related to donor comfort such as donation time (DT), needle time (NT) and processing time (PT), the MCS machines were not "donor friendly" compared to Amicus and Fresenius. Platelet yield by Amicus was significantly higher as compared to other cell separators (p < 0.05). Plateletpheresis associated citrate toxicity was higher with the Amicus and MCS 3p and vasovagal side-effects was observed least with the CS 3000 machine. Though, quality of apheresis product in terms of yield is comparable with all the machines, there are differences in the systems with regard to donor safety, procedure time and donor retention.

Introduction: It is well known that young age, low weight, and first time donation status increase the probability of having a reaction but the effect of these 'risk' factors on the grade of reaction has not been well studied., Aim: To evaluate the prevalence of these factors in blood donation setup, to identify 'at risk' donors with age less than 30 years and weight less than 60 kg and to assess whether there is any contributory role of these risk factors in predicting the grade of reaction., Materials and Methods: A retrospective analysis of 30370 donations was done during 15 month study period., Results: Donor reaction rate of 1.6% was observed in this study of which 7% experienced reaction of moderate and severe grade. Reaction rate among male and female donors were 1.5% and 3.7% respectively. Female gender was found to be an independent predictor for donor reaction even after nullifying the effect of the blood volume drawn. Incidence of vasovagal reaction in 'at risk' donors was 2.0% in contrast to 0.96% in 'general' donor population. Age had a significant affect on reaction rate (p = .035) and all grades of reaction decreased with the age of the donor. Age was found to be a significant predictor of the grade of reaction (p = .008). The effect of weight on the reaction rate as well as on the grade was found to be insignificant (1.5% in 'at risk' donors vs. 1.6% in 'general' donors with p > 0.05)., Conclusion: 1. Age is a significant factor that can predict the rate as well as the grade of reaction; 2. Weight does not predict the grade of reaction, 3. Gender is an independent predictor of donor reaction, with females having 2.5 fold higher chances of reaction. These factors are important for blood collection staff to recognize such 'at risk' donors, and to give more attention to them to reduce donor reaction.

Specialty wise utilization pattern of platelet concentrates (PLT) over a period of 2 months was evaluated prospectively for appropriateness. Overall 4.87 random donor platelets (RDP) (total 1672) units were issued per request. A total of 1101 RDP (66%) were transfused prophylactically against 221 requests (64.4%) while, 571 RDP were transfused for therapeutic (requests=122, 35.6%) reasons. Twenty-three percent of prophylactic requests and 15% of the therapeutic requisitions were not justified. Most common reason for unjustified prophylactic transfusion was unavailability of pre-transfusion platelet count. Concurrent screening of request forms to ensure optimized PLT usage may further decrease platelet misuse at our center.

The efficacy of the widely practiced 'Top and Bottom' collection system has been established. We studied efficacy of our new 'Top-and-Top' automated blood component separation system with regards to quality analysis of red cell and platelet concentrates. At installation of machine 59 U of whole blood (WB) were used for its calibration and validation program. Optimum volume, leukocyte-platelet recovery and red cells loss in BC were adjusted as per recommended standards. WB showed mean volume of 510 ml and net hemoglobin content of 63 g/bag. BC recovered 91.7% and 62.7% of platelet and leukocytes, respectively, in a mean volume of 96 ml a hematocrit of 54% and mean platelet of 5.47 x 10(10) were observed in red cell and platelet concentrates, respectively. In many aspects quality of our products could not comply with the recommended European and American standards and this requires a close insight into the series of activities associated with WB collection, separation and quality control program.

We evaluated transfusion requirements in a retrospective study of 245 patients with various categories of Dengue infection. The majority (155/245) of our patients were of the Dengue fever (DF) category. There was no correlation between clinical bleed and platelet count as 81 non-bleeding patients were having counts < 20 x 10(3)/microL. Coagulopathy was observed in 37% of the patients with Dengue hemorrhagic fever or Dengue shock syndrome. A rapid response to platelet and fresh frozen plasma (FFP) transfusion was observed in all cases. However, inappropriate transfusion was a major concern as transfusion of 21.5% platelet concentrates was considered inappropriate.

The quality of single donor platelets (SDPs) in terms of yield influences platelet recovery in the recipient. Various donor factors such as pre-donation platelet count and hemoglobin (Hb) concentration affect the platelet yield. We studied the influence of pre-donation donor clinical and laboratory factors such as gender, age, weight of the donor, platelet count and Hb on the platelet yield. A total of 94 plateletpheresis procedures performed on continuous flow cell separator (CS3000, Baxter Healthcare, Round Lake, IL, USA) were evaluated for platelet yield. A relationship between pre-donation donor variables and yield of platelets was studied using the Pearson correlation. The mean platelet yield was 2.8+/-0.73x10(11). While a direct relationship was observed between pre-donation platelet count and yield (r=0.50, p<0.001), no such correlation was noticed with donor Hb concentration (r=-0.10, p>0.005). Similarly, no correlation was observed between gender (r=0.05), age (r=0.11) and weight (r=0.18) of the donor with yield. Optimization of platelet yield, which is influenced by pre-donation platelet count, is an emerging issue in blood transfusion services. Identification of such factors may help in selecting donors to obtain higher platelet yields and consequently better clinical outcome.

Changes in platelet indices such as platelet count (PLT), mean platelet volume (MPV) and corrected morphological index (CMI) have been correlated with the quality of platelet concentrates during storage but the acceptability criteria for these is not clearly defined. Platelet distribution width (PDW) is a measure of platelet anisocytosis and together with the MPV provides an adjunctive measure of quality. Hence, we investigated the use of the MPV and PDW with and without EDTA in an assessment of the quality of stored platelet concentrates. The differences in platelet count (dPLT), in MPV (dMPV) and in PDW (dPDW) with and without EDTA incubation were calculated. CMI and the modified CMI were further derived using dPLT, dMPV, and dPDW by simple mathematical calculations. We observed a good correlation of the CMI and modified CMI (r=0.966, p<0.01). The dPDWs underwent significant changes during the storage period in addition to changes in dPLT and dMPV. The dPDW provides a test of good power when compared with the dMPV (R(2)=64.1 and 26.1 respectively). We have observed an increment of 92.76% in the dPDW while it was 71% in the dMPV. This clearly shows that the dPDW is a better marker of quality control when compared to the dMPV during processing and storage of platelet concentrates.