Blood Transfusion Department Research Articles

ANALYSIS OF PRE-DONATION DEFERRAL REASONS AMONGST BLOOD DONORS IN VADODARA, GUJARAT.

Background: Blood transfusion saves lives and improves health, but many patients requiring transfusion do not have timely access to safe blood. Providing safe and adequate blood should be an integral part of every country’s national health care policy and infrastructure.
 Aim: The main aim of the study was to analyze the reasons for pre-donation deferral amongst blood donors attending our blood bank and outdoor camp organized by our blood bank and to evaluate and categorize the reasons into temporary and permanent deferral.
 Materials and methods: It is a Record based Retrospective Study conducted in Department of Immunohematology and blood transfusion over a period of two years from July 2015 to July 2017. The reasons of deferral were analyzed after classification into following categories, namely, temporary- permanent deferral, in-house –camp blood donors, gender-based (male -female), and various age group categories.
 Results: A total of 30,022 prospective blood donors registered for blood donation out of which 2241 blood donors were deferred (7.46%) with low hemoglobin level, medication and hypertension as top three causes. The majority of deferral was seen in 18-25 years of age group which mainly comprises the youth population. The female donors were rejected eight times the male donors.
 Conclusion: The knowledge of the deferral incidences and their causes in a particular region helps in deciding the magnitude and the direction of the blood donor recruitment efforts. This knowl­edge also helps in calculating the eligible and the potential blood donor pool.
 Keywords: Blood Donors, Pre-Donation, Deferral, Temporary, Permanent.

Bone marrow aspiration cytology in Abubakar Tafawa Balewa University Teaching Hospital, Bauchi State, Nigeria: Indications and diagnostic utility

Bone Marrow Aspiration (BMA) cytology is an important diagnostic and monitoring tool where cytological details of the marrow elements are examined using light microscopy. Various hematological diseases are diagnosed and monitored by using BMA. This study aimed at reporting a 3-year BMA experience of Department of Hematology and Blood Transfusion of Abubakar Tafawa Balewa University Teaching Hospital (ATBUTH) Bauchi. This was a retrospective study that involved the use of records of the bone marrow aspirates done from January 1st, 2016 to December 31st, 2018. The age, sex, indications for BMA, anatomical site and final bone marrow diagnosis were collated. The data was analyzed using SPSS Version 23.0 software. One hundred and three (103) bone marrow aspirations were performed during the period under review. Two third of the participants were males, with the median age of 40.0 years and a range of 5 months to 92 years. The commonest indication for BMA was recurrent anemia 45.6%, followed by splenomegaly, fever and lymphadenopathy with 11.7% each. While, the commonest diagnosis by BMA was megaloblastic anemia (28.2%). Mixed nutritional deficiency and Bone Marrow (BM) metastasis are the commoner BMA diagnoses with 12.6% each. Recurrent anemia is the commonest indication for BMA and nutritional anemias (megaloblastic and combined nutrients deficiency) are the commonest BMA diagnoses in Bauchi. Proper evaluation of patients by the clinicians before referral is recommended to ensure that only those that really need the procedure are subjected to it.

The analysis of functioning of department of blood transfusion in high-tech medical center of cardio-vascular surgery in 2015

The article presents indices of functioning of department of blood transfusion related to implementation of tasks of clinical transfusiology in 2015. The analysis was applied concerning planning, blood transfusion therapy and implementation of donor blood in high-tech center of cardio-vascular surgery.

Formation of the pediatric hematology- oncology service in the Krasnodar region and its current activities

In the city of Sochi, in 1986, one of the first children’s hematology department in the USSR was opened. The characteristic features of the profile service of the Krasnodar Region are a strong school of professional doctors based on russian and foreign experience, the continuity of generations, close cooperation with leading federal centers and many years of fruitful work.Today, the Department of Oncology and Hematology with chemotherapy for 70 beds in the 24- hour in- patient department and 30 beds in the intensive care ward operates in Krasnodar. In addition, the hospital has a 30- bed oncology department for patients with solid tumors and tumors of the central nervous system. The expansion of the service is planned for 2023: a day hospital for oncohematological patients, a bone marrow transplant unit and a blood transfusion department with a cryopreservation station for hematopoietic stem cells.Krasnodar Region has been keeping a child cancer registry for more than 40 years. The article presents the main stages of the development of hematological and oncological assistance to children of the Krasnodar Region, the activities of the service now and its plans for the future.

Autoimmune Haemolytic Anaemia in Patients with Cancer Diagnoses

Aims: To determine if AIHA plays a role in anaemia associated with malignancies, and ascertain the cancers in which AIHA occurs.
 Study Design: This was a cross-sectional case-control study.
 Place and Duration of Study: Department of Haematology and Blood Transfusion, University of Port Harcourt Teaching Hospital, Rivers, Nigeria.
 Methodology: We conducted the study on patients with malignancies either on admission in the wards or attending follow up clinics. Healthy age/sex-matched subjects were used as controls. Cases with and without chemotherapy were analyzed as subgroups. Three hundred and seventy-six (376) participants (188 cancer patients and 188 controls) were enrolled in the study. Full blood count, reticulocyte count, blood film, direct antiglobulin test (DAT), indirect antiglobulin test (IAT) and bilirubin assays were conducted on anticoagulated blood samples of all the patients and controls. The DAT was performed on a fresh sample not more than 6 hours after collection using polyspecific anti-human globulin.
 Results: Three (1.6%) of the 188 patients with malignancies were found to have a positive DAT of which 2 (1.1%) had strongly positive DAT with features of haemolysis and therefore had AIHA. The two patients with AIHA had chronic lymphocytic leukaemia. The third case was a weak positive DAT with malignant teratoma but did not have features of haemolysis. The cases of both AIHA and DAT were found in the group without chemotherapy. AIHA was the aetiology of anaemia in 2 (2%) of the 98 cases who had anaemia and were chemotherapy naive.
 Conclusion: AIHA plays a minor role in the aetiology of anaemia in cancer and is more common in lymphoid malignancies. A positive DAT may occur without features of haemolysis.

Investigation of clinical blood transfusion in Yantai City

Objective To investigate the current status of clinical blood transfusion in Yantai City from 2015 to 2016, analyze the weak links of clinical blood transfusion, and explore ways to strengthen clinical blood transfusion management. Methods Form 2015 to 2016, a total of 62 hospitals that signed blood supply agreements with the Yantai Central Blood Central Station were selected as research objects. According to the levels and charactoristics of the 62 hospitals, they were divided into tertiary general and public hospital group (n=12), secondary general and public hospital group (n=21), maternal and child health hospital group (n=5), first-class general and public hospital group (n=12), and private hospital group (n=12). In this study, primary hospitals included maternal and child health hospitals, first-class general and public hospitals and private hospitals. According to the Hospital Blood Transfusion Quality Evaluation and Assessment Form in Yantai City, on-site assessment of the infrastructure related to clinical blood transfusion in 62 hospitals was conducted. The questionnaires were used to investigate the implementaton of autologous blood transfusion in the 62 hospitals. A total of 510 clinical blood transfusion application forms and 270 clinical blood transfusion records were sampled randomly from 62 hospitals in January to June 2016, and the qualification rates of clinical blood transfusion application forms and clinical transfusion records were investigated. The chi-square test or the continuous correction chi-square test was used to compare the differences among hospitals of different groups or levels, which included proportions of hospitals evaluated by indicators of infrastructure related to clinical blood transfusion, implementaton rates of autologous blood transfusion, qualification rates of clinical blood transfusion application forms, and the composition ratio of clinical blood transfusion records of different grades. Results ① Among the 62 hospitals of this study, the proportion of hospitals that built clinical blood transfusion-related information management systems was 19.4% (12/62), proportion of hospitals that connected information with blood stations by internet was 8.1% (5/62), proportion of hospitals with separate blood transfusion department was 50.0% (31/62), proportion of hospitals participating in inter-room quality evaluation was 53.2% (33/62), proportion of hospitals that regularly organized clinical blood transfusion-related staffs to train was 77.4% (48/62), proportion of hospitals that took effective measures to evaluate reasonable clinical blood was 40.3% (25/62). The above 6 indicators of the secondary and tertiary general and public hospitals were significantly higher than those of the primary hospitals, and the differences were statistically significant (χ2=8.832, P=0.003; χ2=4.779, P=0.029; χ2=34.802, P<0.001; χ2=34.030, P<0.001; χ2=4.415, P=0.036; χ2=15.936, P<0.001). ② The total implementaton rate of autologous blood transfusion in 33 secondary and tertiary general and public hospitals in Yantai City was 51.5% (17/33). The implementaton rate of autologous blood transfusion in tertiary general and public hospital group was 83.3% (10/12), which was higher than that of 33.3% (7/21) in secondary general and public hospital group, and the difference was statistically significant (χ2=7.643, P=0.006). ③ In this study, the total qualified rate of 510 clinical blood transfusion application forms of the 62 hospitals was 82.7% (422/510). In evaluation of Cosistency of applying for blood use and application of blood component function , the overall difference in the qualified rates among 5 groups was statistically significant (χ2=31.141, P<0.001). ④ In this study, the total qualified rate of 270 clinical transfusion records in the 62 hospitals was 70.0% (189/270). The overall difference in composition ratios of qualified, partially qualified, and unqualified clinical blood transfusion records in 5 groups was statistically significant (χ2=66.221, P<0.001). Conclusions There is insufficient investment in clinical blood transfusion related infrastructure in hospitals at all levels in Yantai City, and the clinical blood transfusion related infrastructure of primary hospitals is relatively lagging behind. The autologous blood transfusion work and clinical blood transfusion management in some hospitals also need to be improved. The clinical blood transfusion management of some primary hospitals needs to be strengthened, and the competent authorities should strengthen the evaluation of the blood transfusion quality of these hospitals. Key words: Blood transfusion; Blood transfusion, autologous; Blood safety; Blood transfusion management; Clinical blood transfusion

Construction of closed loop management system for blood transfusion in mobile nursing information system and analysis of quality index of blood transfusion

Objective To avoid the adverse consequences caused by human intervention in the process of blood transfusion and to promote the improvement of the quality index of blood transfusion specialist by the construction and application of closed loop management system for blood transfusion in mobile nursing information system. Methods In June 2014, the Nursing Department, the Information Department, the Blood Transfusion Department cooperated to analyzed the a variety of existing hidden dangers in blood transfusion process. After reengineering the related process of blood transfusion and setting up a certain of warning reminders, the closed loop management system for blood transfusion was finally constructed with the help of the research and development company using the mobile information system. A total of 2 202 cases from March to May 2014 before the application of the closed loop management system for blood transfusion in mobile nursing information system and 2 916 cases from January to March 2015 after the application of the system were investigated and analyzed, so as to compare the quality index and the incidence of adverse medical events. Results The implementation rate of blood transfusion in 4 hours, the abnormal cases in inspection per hour, the implementation rate of the inspection 15 min before transfusion, the cases of non-replacement of transfusion device in 4 hours all improved after the application of the closed loop management system for blood transfusion in mobile nursing information system, and the differences were statistically significant (P<0.01) . In addition, there was no case of adverse medical event after the application of the closed loop management system for blood transfusion in mobile nursing information system. Conclusions Transforming the blood transfusion nursing process through information technology can realize the real-time monitoring of transfusion quality indicators and reduce the occurrence of adverse medical events, so as to ensure the transfusion safety. Key words: Blood transfusion; Mobile nursing information system; Closed loop management; Quality index

A regional hemovigilance study of transfusion-related adverse events at a tertiary care hospital

Background: Blood transfusion is a routine, life-saving medical intervention which is generally regarded as safe when done appropriately. Hemovigilance is systemic surveillance of adverse transfusion reactions (ATRs). Aims and Objective: The aim of the study was to analyze the ATRs as a part of Haemovigilance Programme of India under the broad ambit of Pharmacovigilance Programme of India (PvPI). Materials and Methods: A retrospective review of all ATRs reported to the department of immuno haematology and blood transfusion, Victoria Hospital attached to Bangalore Medical College and Research Institute (BMC and RI), Bengaluru, between December 2012 and November 2017 was done. All the reactions were reported in a pre-designed transfusion reaction (TR) reporting form for blood and blood products as per the haemovigilance, PvPI. TR workup was done for all TRs. The frequency and distribution of ATRs year wise over a period of 5 years were assessed. ATRs were also analyzed with respect to age, gender, and types of blood products implicated in ATRs. Results: Total blood components issued by our blood bank to various departments and total ATRs during the study period were 48,576 and 89 respectively. ATRs were experienced by all age groups with a male preponderance (56.18%). Majority of the reactions occurred with whole blood (0.46%) followed by packed red cells (0.19%). The most common ATR observed was febrile nonhemolytic TR (88.76%) followed by anaphylaxis (2.25%). Most of the ATRs were acute reactions and transfusion siderosis being the only delayed reaction. Conclusion: The study emphasizes the continuous need to implement hemovigilance to improve the quality and safety of transfusion therapy.

Leukapheresis in 15 patients weighing 20 kg or less: A single centre experience

The application of apheresis equipment to perform leukapheresis (LK) in low weight paediatric patients is logistically complex and lacking of largest clinical performing experiences, meanwhile, the benefit from LK is controversial. In this study, 15 children with acute lymphoblastic leukemia(ALL)and acute myeloid leukemia (AML) and hyperleukocytosis were treated with the COBE Spectra apheresis system in the general paediatric ward by the staff from the department of Blood Transfusion. 26 LK procedures were performed. 12 patients (80%) were performed with peripheral veins, others (20%) with femoral veins. Median age, body weight of the patients was 4 years (range from1year 10 month to 7 years) and 15kg (range from10 to 20kg). The median white blood cell (WBC) count of pre-first-LK was 289×109/L (range from 108×109/L to 579×109/L). The median decrease in WBC count after each LK was 34% (range from 14% to 54%), and overall decrease in WBC after completion of LK procedures was 45% (range from 15% to 70%). All of the patients had no further signs of leukostasis and achieved marked reductions in WBC counts. Only minor clinical adverse events were attributable to LK. With adequate monitoring and experienced team, LK is a safe and may be a beneficial leukoreduction method in small patients weighing 20kg or less with ALL and AML.

HEPATITIS B VACCINATION IN BLOOD BANK WORKERS.

30Apr 2017 HEPATITIS B VACCINATION IN BLOOD BANK WORKERS. Amruta Khade and MahadeoMane. Department of Immunohaematology and Blood Transfusion, D.Y. Patil Medical College, Kolhapur, Maharashtra.

EVALUATION OF QUALITATIVE AND QUANTITATIVE INDICATORS OF SUBSTITUTIONARY TRANSFUSION THERAPY IN DIFFERENT TYPES OF HEMATOPOIETIC STEM CELL TRANSPLANTATION

Relevance. Hematopoietic stem cell transplantation (HSCT) is one of methods to care patients with malignancy, hematologic and hereditary diseases; in most cases, it requires prolonged and massive substitutionary transfusion therapy. Analysis of effectiveness, cost and need for blood components in different types of HSCT would allow blood transfusion department for more accurate planning in blood output. Objective – to determine the need for blood components in different types of HSCT. Material and methods . From December 2000 to December 2015, 851 patients with malignancies, hematologic and hereditary diseases who underwent 915 HSCT (54repeatedly) were included into the study. Results . Substitutionary transfusion therapy was required in 849 HSCT (92.8% of cases Red blood cell-containing blood components were used in 842 HSCT (92%), platelet containing – in 795 HSCT (86.8%), fresh frozen plasma – in 228 HSCT (24.9%). The total number of blood transfusion in 1 case of autologous HSCT was 14.7 doses, in allogeneic HSCT – 18.5 (p=0,01). On average, transfusion therapy for one recipient of autologous HSCT cost – 57 817.4 RUB, for recipient of allogeneic HSCT – 181 710.3 RUB. The need for blood components was increased in the presence of progression/relapse of the underlying disease (p=0.0001), allogeneic HSCT compared to autologous HSCT (p=0.0001), in patients with a long history of transfusion (more than 30 blood transfusions). Conclusion. Substitutionary transfusion therapy is a key factor increasing the effectiveness of treatment with the help of HSCT by prevention and treatment of anemic syndrome and hemorrhagic complications. Allogeneic HSCT compared to autologous HSCT was associated with significantly higher financial expenditure for providing substitutionary transfusion therapy.

The expanding role of the clinical haematologist in the new world of advanced therapy medicinal products.

Advanced therapy medicinal products (ATMPs) represent the current pinnacle of 'patient-specific medicines' and will change the nature of medicine in the near future. They fall into three categories; somatic cell-therapy products, gene therapy products and cells or tissues for regenerative medicine, which are termed 'tissue engineered' products. The term also incorporates 'combination products' where a human cell or tissue is combined with a medical device. Plainly, many of these new medicines share similarities with conventional haematological stem cell transplant products and donor lymphocyte infusions as well as solid organ grafts and yet ATMPs are regulated as medicines and their development has remained predominantly in academic settings and within specialist centres. However, with the advent of commercialisation of dendritic cell vaccines, chimeric antigen receptor (CAR)-T cells and genetically modified autologous haematopoietic stem cells to cure single gene-defects in β-thalassaemia and haemophilia, the widespread availability of these therapies needs to be accommodated. Uniquely to ATMPs, the patient or an allogeneic donor is regularly part of the manufacturing process. All of the examples given above require procurement of blood, bone marrow or an apheresate from a patient as a starting material for manufacture. This can only occur in a clinical facility licensed for the procurement of human cells for therapeutic use and this is likely to fall to haematology departments, either as stem cell transplant programmes or as blood transfusion departments, to provide under a contract with the company that will manufacture and supply the final medicine. The resource implications associated with this can impact on all haematology departments, not just stem cell transplant units, and should not be under-estimated.

Stress hormone- cortisol and testosterone hormone levels and their role in North Indian Men and Women with Diabetes mellitus type 2.

31Jul 2016 Stress hormone- cortisol and testosterone hormone levels and their role in North Indian Men and Women with Diabetes mellitus type 2. Preeti Yadav , Shashi Seth , Kiran Chugh , S.N. Chugh , P.K.Sehgal and Veena Gehlot. MBBS,MD Biochemistry, Post Graduate Institute of Medical Sciences (PGIMS), Rohtak, Haryana. Department of Biochemistry, Post Graduate Institute of Medical Sciences (PGIMS), Rohtak, Haryana. Department of Biochemistry, Post Graduate Institute of Medical Sciences (PGIMS), Rohtak, Haryana Department of Medicine, Post Graduate Institute of Medical Sciences (PGIMS), Rohtak, Haryana. Department of Blood Transfusion, Post Graduate Institute of Medical Sciences (PGIMS), Rohtak, Haryana. Department of Biochemistry, Post Graduate Institute of Medical Sciences (PGIMS), Rohtak, Haryana

Julie Makani: at the cutting edge of sickle-cell disease

A passion for science is not unusual among medical researchers; rather less common is the capacity to step back from the seductive pleasures of discovery and take a more strategic view of what you're about. Julie Makani has spent a decade and half in the Department of Haematology and Blood Transfusion at Tanzania's Muhimbili University of Health and Allied Sciences in Dar es Salaam. During this time she has shown how choosing the right strategy can foster the kind of invigorating purpose that now underpins her department's programme of work on sickle-cell disease.

James Montgomery Dunlop

James Montgomery Dunlop (“Jim”) left school at 17 and volunteered for the Royal Air Force, where he was a nurse. After a varied career with the Department of Agriculture touring...

Preventing of transfusion syphilis

Goal of the study. To study the prevalence of syphilis markers in donors in the Russian Federation, and to evaluate the effectiveness of measures to prevent blood transfusion syphilis and other bloodborne infections in the Blood Service in Russia. Materials and methods. Performance analysis of sectoral statistical surveys Russian Ministry of Health in the form number 39, «Report of the station, department of blood transfusion, hospital blood leading procurement» and the explanatory notes to them for the period from 2009 to 2013. Analysis of the results of screening donated blood for markers of syphilis. Results. It was found that the incidence of syphilis markers in donors in the whole of Russia was significantly (p &lt; 0,05) decreased (from 0.79% in 2009 to 0.49% in 2013). However, there was heterogeneity in the proportion of donors with markers of syphilis in different regions of the Russian Federation. (From 0.68 to 0.35%). In 2013, the causative agent of syphilis markers are more often detected in donors of the North Caucasus and Siberian Federal Districts, seldom in donors in the North-Western and Urals Federal District. Hence, there remains a certain risk of transfusion transmission of syphilis. In recent years, widely implemented method viral inactivation of plasma and platelet concentrate. In 2013, the procedure viral inactivation subjected to 8% of the total issued for transfusion platelet concentrate. Conclusion. There remains a certain risk of transfusion transmission of syphilis. Further implementation of the methods of inactivation of pathogens in Blood Service of Russia will also contribute to reducing the risk of blood-borne transmission of Treponema pallidum.

Evaluating laboratory request forms submitted to haematology and blood transfusion departments at a hospital in Northwest Nigeria.

BackgroundThe laboratory request form (LRF) is a communication link between laboratories, requesting physicians and users of laboratory services. Inadequate information or errors arising from the process of filling out LRFs can significantly impact the quality of laboratory results and, ultimately, patient outcomes.ObjectiveWe assessed routinely-submitted LRFs to determine the degree of correctness, completeness and consistency.MethodsLRFs submitted to the Department of Haematology (DH) and Blood Transfusion Services (BTS) of Aminu Kano Teaching Hospital in Kano, Nigeria, between October 2014 and December 2014, were evaluated for completion of all items on the forms. Performance in four quality indicator domains, including patient identifiers, test request details, laboratory details and physician details, was derived as a composite percentage.ResultsOf the 2084 LRFs evaluated, 999 were from DH and 1085 from BTS. Overall, LRF completeness was 89.5% for DH and 81.2% for BTS. Information on patient name, patient location and laboratory number were 100% complete for DH, whereas only patient name was 100% complete for BTS. Incomplete information was mostly encountered on BTS forms for physician’s signature (60.8%) and signature of laboratory receiver (63.5%). None of the DH and only 9.4% of BTS LRFs met all quality indicator indices.ConclusionThe level of completion of LRFs from these two departments was suboptimal. This underscores the need to review and redesign the LRF, improve on training and communication between laboratory and clinical staff and review specimen rejection practices.

Blood Donor notification and counseling of reactive test result in Blood Bank of South Gujarat: A better approach to prevent reactive donors from donating blood again

Background: Besides all other measures like predonation donor screening and testing for transfusion-transmitted infections (TTIs) on donated blood, another tool for preventing disease transmission by transfusion is to inform and counsel reactive donors about the status of TTIs reactivity and prevent them for donating blood in future. Materials and Methods: The present observational study was carried out in blood bank of Department of Immunohematology and Blood Transfusion at a Tertiary Care Government Hospital in South Gujarat over a period of 3 years involving total 25,020 donors including 353 reactive donors. The reactive donors were informed by the blood bank counselor about an abnormal test result with an advice to report to the blood bank for one-to-one counseling and repeat testing, as well as for referral to the respective department/integrated counseling and testing center/sexually transmitted disease clinics of the hospital for further management. The response rate of TTIs reactive donors after notification of their abnormal test results was evaluated. Results: Of the 353 TTIs marker-reactive donors, 320 (90.65%) reactive donors could be contacted and of which 261 (81.56%) responded positively to the notification calls and attended counseling at the blood bank and 59 (18.44%) informed donors did not respond at all. Conclusions: In the study, due to incorrect or changed contact details, 33 (9.35%) reactive donors could not be contacted and among 59 nonresponded reactive donors, the major reasons were donor's busy schedule, out of city residence, and not willing to visit the blood bank again.

Intravenous pentazocine dependence in a young sickle cell anemia patient: A case report

Introduction: Painful crisis is the most common manifestation of sickle cell anemia (SCA), hence rapid pain control and analgesia should be provided [1][2]. Pentazocine is a narcotic agonist/antagonist analgesic commonly used in Nigeria for pain management in both medical and surgical conditions. Reports on opioid abuse/dependence amongst SCA patients are not commonly published, we report on a young SCA lady with pentazocine dependence seen at a psychiatric clinic. Case Report: We report a case of a 17-year-old known SCA female with a six-month history of excessive use of pentazocine. She started self-injection of pentazocine 18 months ago following a bone pain crisis and is said to have a strong desire to use the drug which she uses on daily basis. Initially, she started with 30 mg daily but currently injects 60 mg bd. She has developed hyperpigmented macules with indurations and scarification marks on both forearms. A diagnosis of pentazocine dependence with mild depression in a sickle cell anemia patient was made. She was admitted at the drug unit and managed accordingly. Conclusion: Health care workers should be sensitized on the dangers of analgesic abuse especially in patients with sickle cell anemia. All patients with chronic pain that require long duration of analgesic drugs should be counseled on the symptoms of dependence and informed to report immediately to their doctors.

Three is a crowd; complication after oocyte donation (II)

L.E.E.L.O. Lashley1,∗, A. Buurma2, G.M.J.S. Swings3, M. Eikmans3, J.D.H. Anholts3, J.A. Bakker4, F.H.J. Claas3 1 Department of Gynecology and Obstetrics, Leiden University Medical Centre, The Netherlands 2 Department of Pathology, Leiden University Medical Centre, The Netherlands 3 Department of Immunohematology and Blood Transfusion, Leiden University Medical Centre, The Netherlands 4 Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Centre, The Netherlands