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H-deficient phenotypes, commonly known as Bombay blood type, have more inclination to be found in the Indian subcontinent, and conventional gold standard tube techniques are still the recommended method to identify them, provided a strict adherence to testing protocol. There is more to these phenotypes than just the bombay blood type. This brief communication highlights the identification of three H-deficient phenotypes from a single center that adhered to standard operating procedures and basic testing methodologies. It emphasizes the requirement of indirect Coombs test with pooled “O” cells with blood grouping of every sample irrespective of the testing platform and also the H antigen typing on encountering any suspicion. These H-deficient individuals may not be as rare as we assume them to be provided there are reframed testing policies. Although international collaborations and databases like the International Society of Blood Transfusion database have made it easier to record and share knowledge on blood types, a National network and registries of these rare phenotypes are essential to make them available to the general population who actually benefit from them.

Anti-M antibodies are usually of the immunoglobulin (Ig)-M type and have a cold thermal range, which is generally considered clinically insignificant. However, in some cases, there may also be an IgG component present exclusively. In addition to the discrepancy in blood grouping (attributable to the IgM component), the presence of an IgG component reacting at 37°C can interfere with pretransfusion testing, making it difficult to find fully compatible blood within a short time. In this report, we discuss three children: two boys aged five and 1½ years, respectively, and a female toddler aged 1 year who were all successfully treated using M-antigen negative packed red blood cells along with the standard treatment plan of the hospital. This was made possible by an established institutional blood donor registry comprising O-typed blood donors (n = 374), who were phenotyped for 21 erythrocyte antigens using commercially available monoclonal antisera (Ortho Clinical Diagnostics, Pvt Ltd., Mumbai, India).

Background and Objectives: Uttarakhand, a state in northern India, is home to various local communities, including the Garhwali, Kumaoni, and Jaunsari. In addition, individuals from neighboring countries such as Nepal and Tibet reside in Uttarakhand for many years, resulting in a diverse population. However, currently, there is no regional registry for rare blood donors in this state. The aim of this study was to develop a rare donor registry in Uttarakhand which could in future become a part of the national rare blood donor registry. Methods: During the routine donation process, samples were taken from randomly selected O-typed blood donors who are residents of Uttarakhand. Seventeen monoclonal antisera included Rh (anti-D, anti-C, anti-c, anti-E, and anti-e), Duffy (anti-Fya and anti-Fyb), Kell (anti-K and anti-k), Kidd (anti-Jka and anti-Jkb), Lewis (anti-Lea and anti-Leb), M, N, S, and s (Ortho Diagnostics Pvt Ltd, Mumbai, India). Furthermore, four polyclonal antisera from our serum repository, Diego (anti-Dia), Indian (anti-Ina), Rh (anti-Cw), and anti-Gp-Mur were used for phenotyping. The study was financially aided by the Uttarakhand State Council of Science and Technology (UCOST), Dehradun, Uttarakhand, Government of India. Results: Over a period of 16 months (November 2021–February 2023), out of a total of 17,004 blood donations, O blood type donors accounted for 29.9% (5085/17,004) of the donors screened. Among these, 7.3% (374/5085) of the donors were from the interior and plain areas of Uttarakhand. Our study revealed a high prevalence of k and e antigens, with 96.7% and 92.5%, respectively. The least prevalent antigen was Rh (Cw), observed in only 0.5% of cases. We also identified rare blood antigens such as Diego, Indian, and Gp-Mur and compared our findings with other studies. Furthermore, we identified a donor with an H-deficient phenotype, specifically the Bombay blood group (Oho). Conclusion: We have successfully established a regional registry for rare blood donors in Uttarakhand, which will be valuable for managing complex transfusion scenarios in the future. Further, given Uttarakhand's proximity to China and Nepal, the presence of individuals from these countries aptly connects the fields of anthropology and transfusion medicine.

Background and Objectives: There is limited literature available on the alloimmunization rates among pregnant women in India. Our primary aim was to estimate the occurrence of irregular erythrocyte alloantibody (IEA) immunization amongst women attending our antenatal care (ANC) clinic and to guide our obstetricians for improved ANC as well as their fetal outcomes. Methods: A cross-sectional study was performed at the blood center in North India over 12 months. We recruited a total of 212 study participants. Antibody screening and identification were performed by using semi-automated column agglutination technology and commercially available 3-red cell antibody screen panel with reagent cards having anti-human globulin (AHG) (Ortho Clinical Diagnostics Inc., USA) and 11-red cell antibody identification panel with reagent cards having AHG (Resolve Panel A; Ortho Clinical Diagnostics Inc., USA) respectively. Once identified, the semi-quantitative doubling dilutions, i.e., serial titrations of the respective IEA were performed by the conventional tube technique to assess their potency. The association of various antibodies identified was analyzed using the Pearson's Chi-square test. Results: Of the 7248 pregnant women attending our ANC clinics, the antibody screening was requested for 212 cases. Out of these, 10.8% (n = 23/212) of women were positive and were sensitized both by active and passive immunization. Their average age (in years) was 27.6 ± 3.52 (20 to 34). The majority belonged to the Dehradun district of Uttarakhand. ABO system-wise, the most common type amongst the included subjects was A as recorded in 34.4%, followed by B (30.18%), O (24.12%) and AB (11.3%), respectively. Rh system-wise, nearly 47% (n=100/212) of subjects had Rh (D) negative blood group. Interestingly, amongst these 23 ANC cases with positive IAT, nearly 13% had a history of having received a blood transfusion. Conclusion: To sum up, the screening of majority of ANC in our hospital is restricted to Rh (D) negative pregnancies. Perhaps, more awareness among obstetricians regarding the universal screening of all ANC cases irrespective of their Rh (D) status is the need of the hour.

BACKGROUND: Amidst the raging coronavirus disease-2019 (COVID-19 pandemic), COVID-19 convalescent plasma (CCP) therapy emerged as an important experimental therapy. The majority of the research studies have focused on determining the safety and efficacy of CCP in the management of COVID-19 and little attention has been paid to the source of CCP, i.e., the CCP donor recruitment. The main challenge at our blood center was maintaining high spirits and continuous motivation among the volunteers to keep donating CCP. With this background, our primary aim was to observe the impetus and impediments of potential CCP donors among the SARS-CoV-2 recovered individuals. MATERIALS AND METHODS: All the potential CCP donors who met the inclusion criteria were telerecruited, i.e., contacted telephonically by trained personnel of the blood center. Donors were informed about CCP and its harvest procedure. Subsequently, donors were presented with 10 statements to assess the potential impetus (motivators) and impediments (barriers) toward donating CCP. In addition, SARS-CoV-2 IgG antibody titers were performed using chemiluminescence assay in donors who passed the predonation screening. RESULTS: Based on their medical records, a total of 96 potential CCP donors were contacted telephonically for inclusion in the study. Among these 68.75% (n = 66/96) individuals expressed their willingness to donate CCP. “Altruism from adversity” was the most common motivational factor among voluntary donors (47.8%), whereas kinship was the strongest motivational factor among replacement donors (40%). Logistical reasons such as their distance from the blood center (33.3%) were the most common reason for not donating CCP. About 21.2% (n = 18/66) of the donors were deferred due to absent or low levels of anti-SARS-CoV-2 IgG antibodies. CONCLUSIONS: Motivation factors such as “altruism from adversity” are more common in CCP donation. At the same time, most of the impediments to CCP donation were similar to those of the routine apheresis procedure. Knowledge of these motivators and barriers should form the cornerstone of plasma therapy-based donation program in any future pandemic.

School phobias can be challenging for parents to deal with. Further, up to 5% of children experience fears about going to school. Herein, the Indian parents of a 5-year-old girl child get perturbed by her anxiety and persistent refusals about going to the newly joined school. Consequently, the parents have penned down their child’s psychology and varied emotions regarding the unfamiliar environments she faced in the configuration of a poem.

Introduction: Studies have documented the role of the “neutrophil-to-lymphocyte ratio” (NLR) in influenza virus infection. In addition, morphometric parameters derived from automated analyzers on the volume, scatter and conductivity of monocytes, neutrophils and lymphocytes in many viral etiologies have helped with their early differentiation. With this background, we aimed to characterize the hematological changes of coronavirus-positive cases and also compare them with the healthy controls and patients affected by non-COVID Influenza-like illnesses so that early isolation could be considered. Material and Methods: This was a cross-sectional analytical study carried out in the years 2020–2022. All cases with COVID-19 and non-COVID-19 Influenza-like illnesses and healthy controls above 18 years were included. Cases were diagnosed according to the WHO guidelines. All samples were processed on a Unicel DxH 800 (Beckman Coulter, California, USA) automated hematology analyzer. The demographic, clinical and regular hematological parameters along with additional parameters such as volume, conductivity and scatter (VCS) of the three groups were compared. Results: The 169 COVID-19 cases were in the moderate to severe category. Compared with 140 healthy controls, the majority of the routine hematological values including the NLR (neutrophil-to-lymphocyte ratio) and PLR (platelet-to-lymphocyte ratio) showed statistically significant differences. A cutoff of an absolute neutrophil count of 4350 cell/cumm was found to have a sensitivity of 76% and specificity of 70% in differentiating moderate and severe COVID-19 cases from healthy controls. COVID-19 and the non-COVID-19 Influenza-like illnesses were similar statistically in all parameters except the PLR, mean neutrophilic and monocytic volume, scatter parameters in neutrophils, axial light loss in monocytes and NLR. Interestingly, there was a trend of higher mean volumes and scatter in neutrophils and monocytes in COVID-19 cases as compared to non-COVID-19 Influenza-like illnesses. Conclusion: We demonstrated morphological changes in neutrophils, monocytes and lymphocytes in COVID-19 infection and also non-COVID-19 Influenza-like illnesses with the help of VCS parameters. A cutoff for the absolute neutrophils count was able to differentiate COVID-19 infection requiring hospitalization from healthy controls and eosinopenia was a characteristic finding in cases with COVID-19 infection.

It is a known fact that antiretroviral treatment (ART) is highly efficacious in reducing the sexual transmission of human immunodeficiency virus (HIV). In addition, it is clear now that those infected and living with HIV and having an undetectable viral load below 200 copies per mL, measured 4 to 6 monthwise, do not transmit it sexually to their partners. Therefore, U = U (Undetectable = Untransmittable; where symbol = means similar to) campaign is the message of a new UNAIDS explainer. The authors herein report the blood donation made by an HIV-I positive Indian male under the existing policy of confidential unit exclusion at their blood center. It was alarming because he was driven by an incorrect belief that being in a state of sexual nontransmissibility, due to the regular intake of ART, his donated blood was safe and suitable for blood transfusion too. He firmly believed that the ART he was receiving was highly efficacious in reducing the transmission of HIV through sexual intercourse and misconstrued the same for blood transfusion. After a thorough consultation and discussion with the transfusion medicine specialist, the individual could understand that U = U certainly, does not ascribe to the blood transfusion-related transmission due to a bigger inoculum and the intravenous route of administration.

BACKGROUND: Considering the higher use of fresh-frozen plasma (FFP) in our hospital, we desired to determine the pattern, prevalence, and potential complications of its utilization in new-born and children with the primary aim to observe its effect on the conventional coagulation screening (CCS) parameters. SUBJECTS AND METHODS: Patients' demographics, clinical indications, and pre- and posttransfusion CCS parameters such as the prothrombin time, the international normalized ratio (INR), and partial thromboplastin time were observed over a period of 10 months. Any improvement observed in the laboratory parameters after FFP transfusion was noted. RESULTS: We studied 433 episodes, where 499 FFP units were utilized in 184 patients. Mean age in years was 6 ± 0.16 (new-born to 17). Diagnoses-wise majority had diffuse intravascular coagulation with sepsis 25% (46/184) followed by febrile illness 23% (42/184). Around 46% (84/184) patients had bleeding episodes of which four had known family history of bleeding (three factors IX and one factor XI deficiency). Mean doses of FFP utilized (mL/kg) in children and infants were 12.6 ± 6.3 (n = 297 episodes) and 14.4 ± 6.3 (n = 136 episodes), respectively (P = 0.006). Mean change in INR in the cohort with deranged coagulation parameters against the overtly bleeding cohort was 0.85 versus 0.40 (P = 0.006). CONCLUSION: The study elicits minimal evidence in correcting the coagulation parameters, especially in the infants, whenever FFP was transfused prophylactically. Joint-decision making of the pediatricians and transfusion medicine physician would promote judicious use in children.

Background: Conventional coagulation screening tests such as Prothrombin time, International normalized ratio (INR) and activated partial thromboplastin time are often used to predict bleeding in various clinical situations. We aimed to observe the effect of Fresh-frozen plasma (FFP) on these parameters. Methods: Patients' demographics, pre- and post-transfusion coagulation parameters were noted to assess the level of correction. The magnitude of improvement in INR was determined using the formula given by Holland and Brooks. Data was analyzed using IBM SPSS Statistics 20. Results: Among 2082 episodes, 4991 units of FFP were transfused at an average of 5 units per patient. Median dose of FFP administered per episode was 10 mL/kg (5.8–13.4). The mean change in INR following transfusion was 8.9% of the pre-transfusion INR and thus considered to be statistically significant. Conclusion: FFP transfusions as a prophylactic measure especially in patients with mildly deranged conventional coagulation screening tests without any empirical evidence of clinical bleeding needs further scrutiny. Reduction in INR following FFP transfusions was better in cohort having higher pre-transfusion INR value (> 3.0).

Background and Objectives: Quality control (QC) results of platelet-rich plasma and buffy coat-reduced platelet concentrates (PCs) are presented with the goal to assess their compliance with published guidelines and corrective action taken for any process deviation during their manufacture. Subjects and Methods: Retrospective QC of in-house prepared whole blood-derived platelets (2009–2013) was conducted. Their cumulative results were compared to the published quality standards given by the American Association of Blood Banks, Council of Europe, and Indian guidelines. Data was analyzed using SPSS Statistics version 20. Results: A total of 36,053 PCs were prepared during the study period, and 1.43% (n = 516) was subjected to QC. The aggregate five years mean ± standard deviation (range) of product per bag were volume 58.4 ± 9.5 (37–90) mL, platelet yield 5.89 ± 1.28 (3.1–8.7) × 1010, residual leukocyte count 1.5 ± 1.2 (0.02–5.5) × 107, pH 6.67 ± 0.48 (6.0–7.3), and erythrocyte contamination 0.29 ± 0.2 (0.03-2.0) mL. Swirling was present in all the units. None of the bags showed any microbial growth. Against volume, yield, and erythrocyte contamination 90.0%, 94.3%, and 87.0% units showed compliance to the Indian standards, respectively. All the PCs had pH and leukocyte counts well within the recommended norms. Conclusions: Quality of our platelet product although suboptimal to International standards was well within the national requirements.

Background: Turnaround time (TAT) is an important quality indicator in blood banking. This study evaluated the effectiveness of the pneumatic tube system (PTS) to reduce TAT and its effect on the quality of the blood products. Materials and Methods: The PTS (Swisslog GMBH, Germany) which connects to 29 stations was installed at our 2032-bedded tertiary care referral center. The system transports the carrier at an average speed of 25 feet/s (7.6 m/s). Acknowledgment slips were sent along with the blood components through this carrier system to know the time of receipt. Quality control parameters were checked before and after PTS transport in 10 bags of each of the blood components (packed red blood cells [PRBC], platelet concentrate, and fresh frozen plasma [FFP]). Data were analyzed using IBM SPSS Statistics 20. Results: PTS was used for 220 events to deliver 69% PRBC (n = 152), 15% FFP (n = 34), 14% platelets (n = 30), and 2% cryoprecipitate (n = 4), respectively, to 11 destinations. The average transport time by PTS was 1.36 ± 0.34 min and for human-based transport, it was 7.92 ± 1.40 min and this difference was found to be statistically significant (P < 0.001). The mean latent time was 5.85 ± 4.39 min. Conveyance in the PTS did not reinforce any negative changes on the quality of any blood component. Conclusion: PTS is rapid and reliable for the transport of the blood products to bedside.

Reacting to the repeated messages on his phone, the blood donor goes to a blood center and donates his AB Rh D negative blood. There, he sees the blood center technician whose mother requires this rare blood unit as she is undergoing treatment at the hospital. The very act of blood donation is soul-satisfying for him as he pens down his experience in the configuration of a poem.

The Kleihauer–Betke (KB) test is a time-consuming test with a lot of variables which affect the calculation of the extent of fetomaternal hemorrhage (FMH). There have been several formulae proposed by various authors to calculate FMH using KB test. In this article, we propose a simple mathematical alteration to accommodate the correction for some of the factors that lead to falsely high estimation of FMH.