History Of Previous Transfusion Research Articles

Major crossmatch compatibility of rabbit blood with rabbit, canine, and feline blood.

To evaluate the major crossmatch compatibility between rabbit recipients, rabbit donors, and the major canine and feline blood types. Prospective in vitro study in December 2021. Academic veterinary teaching hospital. Whole blood samples were collected from 11 healthy New Zealand White rabbits (Oryctolagus cuniculus) with no previous transfusion history. Three pigtail segments were acquired from dog erythrocyte antigen (DEA)-1-positive, DEA-1-negative, and feline type A blood units. Whole blood was collected from a healthy type B blood donor cat. Blood from each rabbit recipient underwent a major crossmatch using standard tube crossmatch methodology with itself and the following donor blood types: rabbit, DEA-1-positive, DEA-1-negative, feline type A, and feline type B. Self-crossmatches and crossmatches between rabbit recipients and conspecific donors were negative for hemolysis and agglutination. Crossmatches between rabbit recipients and canine and feline donors yielded no hemolysis but produced varying degrees of macroscopic and microscopic agglutination. Rabbit recipients had 1.4 (95% confidence interval: 1.1-1.8) times the risk of macroscopic agglutination when major crossmatched with canine blood compared to feline blood. No significant difference in agglutination was found between DEA-1-positive and DEA-1-negative or feline type A and type B donors. These findings support allogeneic blood transfusions between rabbits being highly compatible and suggest rabbits have naturally occurring alloantibodies against both canine and feline red blood cells. However, feline red blood cells had a lower rate of in vitro incompatibility on major crossmatch, suggesting potentially higher in vivo compatibility if an emergency xenotransfusion is needed. Further prospective research is needed to determine if xenotransfusion is associated with a higher incidence of acute and delayed transfusion reactions in rabbits than allogeneic transfusions.

Clinical significances and distribution of unexpected antibodies found in infants

IntroductionThe unexpected antibody test is an essential for ensuring the safety of blood transfusions. In infants, different pre-transfusion tests and transfusion strategies are needed due to their immature antigen/antibody system. This study aims to analyze the pattern of unexpected antibodies and their clinical significance in infants. MethodsA retrospective analysis was conducted on the results of unexpected antibody identification tests performed on infants under one year of age at Asan Medical Center from 1999 to 2022. Patients’ unexpected antibody identification test results and clinical information were investigated. The results of unexpected antibody identification and phenotype of each patient’s mother were collected. Results45 cases of antibody results were studied. 25 cases were found in infants under 4 months of age, and 18 cases (76%) were associated with hemolytic disease of the fetus and newborn (HDFN). The most common unexpected antibody in infants was anti-M (17 cases). There was one case of severe HDFN caused by anti-M. In 10 cases, anti-E and anti-c were found together, and 9 of these cases were associated with HDFN. There were four cases with a history of previous transfusion. ConclusionsNon-ABO antibodies found in infants showed a different pattern compared to adults. Interpreting unexpected antibody tests in infants, it is important to consider the clinical status of the infant and the test results of the mother, due to possibility of HDFN. To our knowledge, this is the first study to reveal the distribution and clinical significances of unexpected antibodies found in infants in Korea.

Blood Transfusion Complications and Associated Factors Among Blood-Transfused Adult Patients at Debre Markos Comprehensive Specialized Hospital, Ethiopia: A Cross Sectional Study.

Blood transfusion is the infusion of whole blood or its components into the veins of the patient to improve tissue oxygenation and maintain hemostasis. Besides its clinical use, it can pose a risk of transfusion complications with different factors. The aim of this study was to assess blood transfusion complications, and associated factors among transfused adult patients at Debre Markos Comprehensive Specialized Hospital, North West Ethiopia, 2022. An institution-based cross-sectional study design was conducted on a total of 182 patients from March 20 to June 15, 2022. Patients were enrolled in the study using consecutive sampling method. The socio-demographic and clinical data were collected using a structured questionnaire and data extraction sheet, respectively. About 3 ml of anti-coagulated blood and 30 ml of urine samples were collected to assess transfusion complications. CBC and Coombs test were performed from blood and urinalysis from urine, respectively. Chi-square, Fisher's exact test, and binary logistic regression were done using SPSS version 25. P-values less than 0.05 are declared as statistically significant. An acute transfusion reaction (ATR) was encountered in 12 (6.6%) patients. It was 4.13, 7.78 and 3.96 times more likely to occur among patients with a previous history of transfusion, abortion, and transfused blood stored for more than 20 days compared to their counterparts, respectively. In addition, the odds of developing ATR increase by 2.07 as the number of transfused blood units increases by 1 unit. The incidence of acute transfusion reactions was high. During transfusion, clinicians should closely monitor patients who had history of transfusion, abortion, transfused old blood and more than 1 unit.

Rhesus (Rh) blood group antigens in multiparous women attending antenatal clinic in tertiary hospital, port harcourt, Nigeria

The routine blood screening test carried out for pregnant women attending antenatal clinic in Tertiary Hospital Port Harcourt, Nigeria especially with regards to blood group system is limited to ABO/Rh D antigen screening. This cross-sectional, hospital-based study was aimed at determining the prevalence of the Rh C, c, E and e blood group antigens in multiparous women attending antenatal clinic in Tertiary Hospital Port Harcourt, Nigeria. A total of one hundred and twenty (120) pregnant females within the age range of 18-40years were recruited randomly into the study between February-June, 2022. Blood samples were aseptically collected by venipuncture into EDTA sample bottle; Rh C, c, E and e blood group antigens were assay for using microwell agglutination technique. Data generated was statistically analyzed by simple percentage calculation and defining the percentage frequency of Rh antigens. Results obtained showed the percentage distribution of 17.5% for Rh C, 89.2% for Rh c, 39.2% for Rh E and 90.8% for Rh-e. Percentage distribution of Rh antigens amongst studied population based on parity showed that G3P2 group had the highest percentage positivity of 8(6.7%) for Rh-C antigen while those carrying their first pregnancy (prime) had the highest percentage positivity of 33(27.5%), 15(12.5%) and 36(30.0%) for Rh-c, Rh-E and Rh-e respectively. Distribution of Rh antigens with respect to previous transfusion history in studied participants showed 6 (5.0%), 15 (12.5%), 6 (5.0%) and 17 (14.2%) percentage positivity for Rh-C, Rh-c, Rh-E and Rh-e respectively. This study revealed a percentage positivity of 17.5%, 89.2%, 39.2 % and 90.8% for Rh-C, Rh-c, Rh-E and Rh-e respectively with high percentage expression for Rh-c, E and e antigens found on the red cells of Antennal Women carrying their first pregnancy. Furthermore, there is a high percentage expression of Rh antigens in previously transfused pregnant women in this study. Although routine phenotyping of these blood group antigens will be a financial burden in a resource limited country like Nigeria. It is expedient and needful to take into cognizance the fact that the presence of Rh C, c, E and e antigens may likely be the cause of some delayed transfusion reactions and haemolytic disease of the foetus and new born. Therefore, there is need for the inclusion of Rh C, c, E and e in routine antigen typing for pregnant women in other to help ameliorate red blood cell alloimmunization and delayed haemolytic transfusion reaction during pregnancy. Furthermore, there is need to promulgate policies that promote the optimum stocking of Rh-e, c antigen negative blood in blood banks in the area for emergency use.

The complexities of transfusion reactions: Coexistence of a delayed haemolytic transfusion reaction and post-transfusion purpura.

Immune-mediated acute or delayed transfusion reactions occur when there is immunological incompatibility between transfused blood products and recipient's antibodies. Acute haemolytic transfusion reactions occur within 24 h and are delayed after 24 h up to 10 days following transfusion, whereas post-transfusion purpura (PTP) typically occurs 7-10 days post-transfusion. We present a case of a previously transfused and recently post-partum female who developed both delayed haemolytic transfusion reaction (DHTR) and PTP. A 42-year-old woman, G2P1, with non-alcoholic liver disease, portal hypertension and previous transfusion history with allogeneic anti-E, developed a severe DHTR and PTP following a complicated post-partum course and multiple transfusions. The antenatal and initial post-partum pre-transfusion antibody screens were negative. Subsequently five red cell antibodies, including anti-c, anti-Fya, anti-Jkb and anti-S and the reappearance of anti-E were, however, identified during follow-up investigations along with the anti-platelet antibody HPA-3a and human leukocyte antigen class I antibodies. Anti-E, anti-Jkb and anti-S were eluted from the circulating red blood cells. To our knowledge, there have been only two other case reports of DHTR and PTP occurring in the same patient.

ABO discrepancy in pediatric lymphomas and solid organ tumors.

Objective: To determine the frequency of ABO discrepancies in pediatric patients of lymphoma and solid organ tumors and to categorize these discrepancies and their resolution. Study Design: Cross-sectional study. Setting: Department of Hematology & Transfusion Medicine, The University of Child Health Sciences & The Children’s Hospital, Lahore. Period: November 2020 to September 2021. Material & Methods: ABO blood group discrepancies were assessed by tube method of blood grouping, using antisera A, B, AB & D for forward grouping and A, B, and O cells for reverse grouping. Auto control was also run. The resolution techniques were used accordingly. The collected data was checked for its completeness, consistency and accuracy before analysis which was done on SPSS version 26. Results: In this study, a total of 105 subjects were included with mean age of 5.64 ±2.1 years. Among them 72(68.6%) were male and 33(31.4%) were female. Out of total samples processed, three (2.9%) discrepancies found, 1 in female and 2 in male patients. There were two cases of Group I ABO discrepancies, one of which was resolved by elution, antibody screening and identification and other by incubation at 37oC and correlation with previous transfusion history. One case of Group II ABO discrepancy which was resolved by incubation at 40C for 30 minutes. Conclusion: This shows that ABO discrepancies occur in pediatric patients of lymphoma and solid organ tumors. So, the interpretation of forward and reverse ABO blood grouping, identification and resolution of ABO discrepancies in these patients should be done very carefully to avoid any transfusion related adverse reactions.

Evaluation of Blood Requisition Forms Submitted to Transfusion Medicine Department of a Tertiary Care Hospital in Dhaka, Bangladesh

Introduction: Blood requisition form (BRF) analysis is one of the most efficient and effective approaches to assess and monitor rational use of blood and its product. BRF is the first line of communication between the clinicians and transfusion medicine specialists which helps to recognize and evaluate inappropriate use of blood. This issue is frequently underrated by the clinicians which results in increased risk of inappropriate transfusion. The current study is aimed to examine the pattern of completion of blood requisition forms and to ensure safe blood transfusion. Materials and methods: This cross sectional prospective study was conducted from January 2020 to December 2021, at the Department of Transfusion Medicine, Sir Salimullah Medical College Mitford Hospital, Dhaka, Bangladesh. A total of 32,133 blood requisition forms that were submitted during the study period were compiled and reviewed anonymously. The data were analyzed using Microsoft Excel. Results: During the study period, a total of 32,133 Blood requisition forms were analyzed. Only 15.2% of these forms were duly completed. Rest of the forms had one or more important parameters left blank. The most common incomplete BRF items were the clinical history or differential diagnosis of the patient (52.66%), presumed date and time of transfusion (95.19%), previous transfusion history (95.9%), and referring doctor’s name and designation (88%). Blood requests were more for females (52.02%) than males (47.98%) during the period. Requisitions were more for adults (90%) than pediatric patients. Conclusion: The current study provides evidence that the rate of completion of BRFs is not satisfactory. The request forms evaluated were not covering acceptable demographic and clinical data of the patients. Both the Hospital Transfusion Committee (HTC) and the Department of Transfusion Medicine can help to improve and standardize transfusion practice by working together. Sir Salimullah Med Coll J 2022; 30: 142-147

A GE:-13 (GECT-) HETEROZIGOUS AND GE:-14 (GEAR) HOMOZIGOUS PHENOTYPE DETECTED BY RANDOM SCREENING FOR GE:-2 BLOOD DONORS IN BRAZIL

We report a rare case of GE:-13 and GE:-14 phenotype blood donor identified by random screening during blood bank routine. This is a descriptive work using immunohematology data from immunohematology reference laboratory (LRI) where samples were tested. A 29 year old blood donor, woman, self-declared as african american from the São Paulo city with no history of previous transfusions or pregnancies. Her blood was typed as O RhD+ (C-E+c+e+) and K- and the antibody screening was negative in gel cards. The phenotypes identified as Ge:-2,3 were confirmed by screening for GE:-2 blood group performed by hemagglutination in DG Gel cards using in house anti-Ge2 and others anti-Ge2 and anti-Ge3 from our inventory. Genomic DNA was isolated from donor whole blood and GE genotyping was performed by PCR-SSP techniques for analysis of exons 2, 3 and exon 4. The genetic variations that influence the expression of high-incidence antigens are deletions that involve exons 2, 3, 4 and the single nucleotide exchange (SNVs) in exons regions of the GYPC gene. These mutations, if not studied by molecular tests, may result in serological interpretation errors. Thus, sequencing by Sanger method of GE gene was performed and revealed a nucleotídeo change 59C>T (Pro20Leu in GPC) in Exon 2 in heterozygous and a nucleotide change 333A>C (non-coding) (Gly19Arg in GPD) in Exon 4 in homozigous state. No other nucleotide changes were identified. One of the criteria for AABB reference laboratory certification in immunohematology is the screening for blood donors with rare phenotypes. For this reason, donors from the Hospital Israelita Albert Einstein are tested with anti-Ge2 antiserum. The aim is detect the rare phenotype Ge:-2, for compatibility tests in patients with anti-Ge2 alloantibody. The antigens of the Gerbich System are located on glycophorins C (GPC), D (GPD) or both. There are eight highly prevalent antigens known as Ge2, Ge3, Ge4, GEPL, GEAT, GETI, GECT, GEAR. Polymorphisms that involve high incidence antigens such as deletions in introns and single nucleotide exchange (SNVs) in exons regions of the GYPC gene, if not studied by molecular tests, may result in serological interpretation errors. The fact of donor has a GECT allele (GE*01.-13) in heterozygosity does not imply the development of antibodies. The homozygous GEAR allele (GE*01-14) could result in the production of a rare anti-GEAR antibody in case of transfusion or pregnancy, however the clinical importance of this antibody is still unknown. Few articles report that these mutations can lead to loss of epitopes and the phenotypes can be interpreted as Ge:-2 or Ge:-3 in serological screening. This case showed that the molecular sequencing was crucial to determine the correct mutations present in the GYPC gene and consequently the correct deduction of the phenotype.

Emergency presentation and immediate outcome of children with autoimmune hemolytic anemia

Aim: This study aims to analyze the clinical spectrum, severity of anemia, challenges in arranging cross matched blood in the emergency department (ED), and treatment outcomes of children with autoimmune hemolytic anemia (AIHA). Methods: Retrospective analysis was conducted in the tertiary care pediatric ED between October 2019 and September 2021. All direct antiglobulin test (DAT)-positive children were included in the study and those DAT negative were excluded from the study. The details regarding clinical condition, laboratory parameters, history of previous transfusion, difficulties related to cross-matching, requirement of steroid, and intensive care management were documented. Results: A total of 29 children were diagnosed to have AIHA. The most common clinical feature at diagnosis was fever (72.4%) followed by pallor (51.7%). Cross-matching was difficult for 9 children (31%) due various incompatibilities. Ten children required intensive care. Secondary causes were identified in 25 cases. Mortality was 10%. Conclusion: Identifying secondary causes of pediatric AIHA are essential and larger data from multiple centers will contribute toward creating the best clinical approach and emergency management of children with AIHA.

Outcome of type and screen versus crossmatch in cardiovascular surgery patients: A comparative study.

BACKGROUND:The need for an anti-human globulin (AHG) cross-match (XM) when the antibody screen (ABS) is negative is debatable and a matter of policy.AIM:(1) To compare the outcomes of type and screen (T and S) method versus the AHG-XM in terms of posttransfusion alloimmunization and hemolytic reactions. (2) Calculation of XM transfusion ratio in both groups.MATERIALS AND METHODS:The study included 200 patients undergoing elective cardiovascular surgery. Group I patients (n = 100) were issued packed red blood cell units after ABO and RhD typing, an ABS followed by an immediate spin XM (T and S protocol), while Group II (n = 100) patients by an AHG-XM. In Group II patients, if incompatibility was found, then an ABS and identification were performed. A posttransfusion ABS and a direct antiglobulin test (DAT) was done on the 4th day. The XM, ABS (3-cell panel) and DAT were done using the gel technique (Bio-Rad, Switzerland). Thus, the outcomes of T and S method versus the AHG-XM in terms of posttransfusion alloimmunization and hemolytic reactions was measured. The XM transfusion ratio was also calculated in both groups.RESULTS:In each of Groups I and II, 99 patients (99%) were transfused. There was no significant difference between the two groups based on previous transfusion (P = 0.621) or combined history of transfusion and pregnancy (P = 1). In Group I, all the patients were negative for ABS. In Group II, an AHG-XM was incompatible for 1 patient (1%) due to anti-c and anti-E alloantibodies and had a history of pregnancy as well as transfusion. In both the groups, none of the patients had any adverse transfusion reaction and the posttransfusion ABS and DAT were negative.CONCLUSION:ABS is a better tool than AHG-XM in detecting alloantibodies in patients having the previous history of transfusion and/or pregnancy.

Accuracy of a point-of-care major crossmatch test and risk factors for major crossmatch incompatibility in cats

Major crossmatch testing can help identify immunologic incompatibilities between blood donors and recipients; however, there are limited studies describing the accuracy of point-of-care crossmatch tests. The first aim of this study was to determine if a gel-based, point-of-care major crossmatch method (GEL-CM), without antiglobulin-enhancement, could accurately detect compatible and incompatible donor–recipient pairings, using an antiglobulin-enhanced laboratory-based major crossmatch method (LAB-CM) as the reference standard. The second aim was to describe the incidence of, and risk factors for, major crossmatch incompatibility in cats. Nineteen previously-transfused cats and 32 transfusion-naïve cats, representing 132 unique donor-recipient pairings, were included in this study. Both LAB-CM and GEL-CM tests were performed for most parings.There was poor agreement between the LAB-CM and GEL-CM results (kappa = 0.111; 95% confidence interval [CI], −0.093 to 0.314). Transfusion-naïve cats had incompatibility rates of 3% and 6% using LAB-CM and GEL-CM, respectively; previously-transfused cats had incompatibility rates of 32% and 26% using LAB-CM and GEL-CM, respectively. History of previous transfusion was the only identified cat risk factor for an incompatible LAB-CM (odds ratio [OR], 31.0; 95% CI, 3.77–254.98; P = 0.0019) and GEL-CM (OR, 5.7; 95% CI, 1.72–19.20; P = 0.0054). Further studies are needed to determine if GEL-CM can detect clinically-relevant immunologic incompatibilities that would result in transfusion reactions. Major crossmatch testing is of greater importance in cats that have previously received a transfusion.

Erythrocyte Autoantibody Positivity in Serological Cross-matching.

To investigate the erythrocyte autoantibody positivity detected in the serological cross-matching (XM), and its possible effects on salient hemogram parameters. A descriptive study. Balıkesir Atatürk City Hospital's Blood Transfusion Centre, Faculty of Medicine, Department of Anesthesiology and Reanimation, Balıkesir University, Turkey, from 2017 to 2018. Erythrocyte autoantibody positivity, which was detected in the traditional serological cross-matching for a pre-transfusion laboratory test were analysed retrospectively. Later, hemogram changes in the previous (no erythrocyte autoantibodies) and following (erythrocyte autoantibodies present) transfusions were investigated using statistical methods. Erythrocyte autoantibody positivity rate was 10.16% (342/3,365). There was no statistically significant difference in the increase of hemoglobin, hematocrit, and red blood cell between the period when erythrocyte autoantibodies were detected or not, (p = 0.27, 0.13, and 0.09, respectively). Erythrocyte autoantibodies positivity found on routine cross-match exmination, which must be considered together with parameters such as previous transfusion history, other pre-transfusion laboratory test results, and clinical presentation and management. Key Words: Transfusion, Erythrocye autoantibody, Alloantibody, Hemogram, Cross-matching.

Exploration of risk factors for non-survival and for transfusion-associated complications in cats receiving red cell transfusions: 450 cases (2009 to 2017).

To describe red blood cell transfusion practices and short-term outcomes in anaemic cats. To determine clinical variables associated with non-survival and transfusion-related complications. In this retrospective study, blood bank records from the Ontario Veterinary College Health Science Centre (OVC-HSC) were reviewed to identify cats that received packed red blood cells or whole blood from 2009 to 2017. We extracted cause of anaemia, history of previous transfusion, pre- and post-transfusion packed cell volume, pre-transfusion compatibility testing, volume and dose of blood product, age of red blood cell unit, transfusion-associated complications and patient survival. A total of 450 transfusion events were recorded in 267 cats. Blood loss was the most common indication for blood transfusion (44.9%), followed by ineffective erythropoiesis (37.5%) and red blood cell destruction (22.5%). Transfusion-associated complications occurred in 10.2% events and there was a 20.2% mortality after transfusion. Mean increase in packed cell volume 24-hours after transfusion was greater in cats undergoing major cross-match testing before transfusion (7.2%) versus those that did not (4.0%). Non-survival was associated with higher packed cell volume before transfusion, low patient body temperature before transfusion, anaemia due to blood loss and number of transfusions administered. Older age of transfused blood units was associated with non-survival and transfusion-related complications. This study was observational and so our analyses were exploratory, but suggest that major cross-match before transfusion tended to have greater transfusion efficacy and transfusion of older blood products might have detrimental effects on survival.

Hepatitis B Surface Antigen (Obsag) in Pregnant Women Attending Antenatal Clinic at The General Hospital, Amaku, Awka, Anambra State, Nigeria

This study was carried out to determine the prevalence of HBsAg among pregnant women attending antenatal clinic at General Hospital in Agba, Ekwulobia, Anambra State. Two hundred pregnant women who consented voluntarily after thorough explanation of the purpose of the study were recruited for this study. The samples were tested for the presence of antibodies using rapid Dia Spot HBsAg rapid test strip developed by Dia Spot Diagnostics, USA and ClinotechHBsAg (Clinotech diagnostics, Richmond, Canada). Analysis of the result showed that 23(11.5%) of the pregnant women had HBsAg. Statistical analysis, however, showed no significant difference between the prevalence and the age of patients, parity, trimester and type of family. The frequency of HBY carriers did not vary significantly with the Use of condoms and contraceptives. However, there was a significant frequency variation in the distribution of HBsAg between those that have previous history of transfusion, operation, circumcision and those who never had history of operation, transfusion or circumcision Therefore, the need to institute public health measures to reduce disease burden and transmission, including routine screening of all pregnant mothers for HBV infection and early passive-active immunization of babies born to HBsAg-positive mothers are advocated.

Audit and education: Role in safe transfusion practice.

BACKGROUND:Auditing and education are the tools for improvement in the transfusion practices. Clinicians are not providing patient's demographic data and medical history to the blood bank that required transfusion. This missing information in blood request forms can lead to transfusion reactions to the patient. So we planned to analyse the blood request forms received at our blood bank and the impact of educational program for the clinicians.METHODS:A total of 6894 blood request forms were received from the month of July 2014 to December 2014 at a blood bank in Amritsar, India. We evaluated for completeness of the blood request form in parameter columns like second identification (CR No. or Father/Husband Name), diagnosis, pre transfusion hematological parameters, quality and quantity of blood component required, history of previous transfusion and adverse transfusion reaction, urgency of transfusion, medical officer name and signature, phlebotomist name and signature etc. A series of CMEs on “Safe Transfusion Practices” were organized for clinicians and hospital staff from 1st August 2014 and improvement in clinicians’ behavior was analysed.RESULTS:A total of 60.83% requests were not filled completely during the study period. Of these 91.42% were in the month of July, which decreased to 48.76% in the month of December 2014 with a total improvement of 42.66%. Incomplete second identification (91.03%) and history of previous transfusion and adverse transfusion reactions (80.21%) were the commonest incomplete fields in the month of July 2014. In the month of December 2014, an improvement in incomplete second identification was observed (12.8%) however phlebotomist signature was still a major incomplete field (45.19%). A statistically significant (p value = 0.004, paired ‘t’ test) improvement in completeness of forms was observed.SUMMARY:Results of medical audit and using those as a basis for developing a highly targeted educational program, can improve the clinicians’ approch towards transfusion practices.

The role of routine screening in blood-borne pathogens in Chinese patients undergoing joint arthroplasty.

ObjectivesSurgeons face a substantial risk of infection because of the occupational exposure to blood-borne pathogens (BBPs) from patients undergoing high-risk orthopaedic procedures. This study aimed to determine the seroprevalence of four BBPs among patients undergoing joint arthroplasty in Shanghai, China. In addition, we evaluated the significance of pre-operative screening by calculating a cost-to-benefit ratio.MethodsA retrospective observational study of pre-operative screening for BBPs, including hepatitis B and C viruses (HBV and HCV), human immunodeficiency virus (HIV) and Treponema pallidum (TP), was conducted for sequential patients in the orthopaedic department of a large urban teaching hospital between 01 January 2009 and 30 May 2016. Medical records were analysed to verify the seroprevalence of these BBPs among the patients stratified by age, gender, local origin, type of surgery, history of previous transfusion and marital status.ResultsOf the subjects who underwent arthroplasty surgery in our institution, pre-operative screening tests were available for 96.1% (11 609 patients). The seroprevalence of HBV, HCV, HIV and TP was 5.47%, 0.45%, 0.08% and 3.6%, respectively. A total of 761 seropositive cases (68.4%) were previously undiagnosed. Pre-operative screening for HIV resulted in a low cost to benefit ratio, followed by HCV and HBV.ConclusionRoutine HCV and HIV screening prior to joint arthroplasty is not a cost-effective strategy. Considering the high rate of undiagnosed patients and the shortage of protective options, targeted pre-operative screening for HBV and syphilis should be considered for the protection of healthcare workers in China who have not been vaccinated.Cite this article: Bone Joint Res 2017;6:566–571.

Transfusion-related adverse reactions in pediatric and surgical patients at a tertiary care teaching hospital in India.

BACKGROUND:Use of blood and its components is lifesaving. However, their use is often associated with adverse events.OBJECTIVE:To analyze the pattern of adverse reactions associated with transfusion of blood and its components in pediatric and surgical patients at a tertiary care teaching hospital.MATERIALS AND METHODS:Patients receiving transfusion of blood or its components in a randomly selected unit each from Departments of Pediatrics, including thalassemia OPD and surgery, were monitored intensively for a period of 6 months. Clinical course, management, outcome, causality, severity, seriousness, and preventability of observed transfusion reactions (TRs) were analyzed.RESULTS:A total of 411 pediatric and 433 surgical patients received 594 and 745 transfusions respectively during the study period. Of these, TRs were observed in 69 (11.6%) children and 63 (8.4%) surgical patients. Majority of reactions in children (48, 69.5%) and surgical patients (51, 80.9%) were acute, developing within 24 h of transfusion. TRs were observed with packed cells (13.2%), cryoprecipitate (10%), platelet concentrate (14.3%) and fresh frozen plasma (1.3%) in pediatric patients and with packed cells (7.2%), whole blood (25%) and platelet concentrate (62.5%) in surgical patients. Most common TRs included febrile nonhemolytic TRs (FNHTRs) and allergic reactions. Reactions were more frequent in patients with a previous history of transfusion or those receiving more than one transfusion and in children, when transfusion was initiated after 30 min of issue of blood component. Majority of reactions were managed with symptomatic treatment, were nonserious, moderately severe, probably preventable and probably associated with the suspect blood component in both populations.CONCLUSION:Transfusion reactions in children and surgical patients are commonly observed with cellular blood components. Majority of reactions are acute and nonserious. FNHTRs and allergic reactions are the most common transfusion reactions. Risk of transfusion reactions is more in patients receiving multiple transfusions.

Prevalence, Specificity and Titration of Red Cell Alloantibodies in Multiparous Antenatal Females at a Tertiary Care Centre from North India.

Screening and detection of clinically significant antibodies among antenatal women plays an important role in transfusion safety and preventing hemolytic disease of fetus and newborn. Routine screening of antenatal women for antibodies is not done in all blood centres of our country and so immunization rates are not known in pregnant women. We studied the prevalence of alloantibodies and titration of Anti D among antenatal multiparous women in Jammu region. In present prospective study, 750 antenatal multiparous women attending antenatal clinics were typed for ABO and D antigens. Alloantibody screening was done, if positive, specificity of alloantibody was ascertained by using commercially available red cell panel by tube method. Rate of alloimmunization was correlated with Rh D status, gravida, previous transfusion history and bad obstetric history. Titration of alloantibody D was done in first and third trimester of pregnancy. In present study most common blood group detected was B positive (38.4%). Rh D negative cases constituted 7.6% of total cases. Rate of alloimmunization was 2%. A significant correlation was seen between Rh D-negative and alloimmunization (21% in D-negative and 0.45% in D-positive). There is significant increasing degree of alloimmunization with increase in Gravida. Alloimmunization in females with bad obstetric history was high (4.41%) as compared to females with no bad obstetric history showing only 1.76%. Alloantibodies detected were Anti-D, Anti-E, Anti-C and Anti-K. Anti-D constituted 80% of all alloantibodies detected. Six women in their third trimester had raised titers of anti-D. Most common alloantibody detected was anti-D (80%). Alloantibodies to other Rh antigens and Kell blood group systems were also identified. To minimize alloimmunization in Rh D negative women, proper Anti D immunoprophylaxis should be implemented.

Red Cell Distribution Width Cannot Predict Acute Mesenteric Ischemia: Reply

To the Editor,We are honored to see that our published article aboutthe relationship between acute mesenteric ischemia (AMI)and red cell distribution width (RDW) took attention [1].Zhang et al. [2] shared their opinions about the topic, andthey deservedly pointed out some blurred details. It is ourmission to clarify these issues:First, RDW is not a specific marker, but a clue thatsomething wrong is going on in the body leading to anincrease in reticulocytes in the blood. There are hundreds ofdifferent physiologic and pathologic conditions that maycauseRDWrise.Inourmethodssection,weclearlyidentifiedthat our exclusion criteria included ‘‘patients with any illnessthat could affect RDW levels, such as thalassemia trait,hereditary elliptocytosis, and hemoglobin C disease’’ [1].Neither the patients with AMI nor control group had renal/hepatic dysfunction, thyroid or bone marrow disease, previ-ous history of transfusion within 3 months, or malnutrition.ThestudygroupsconsistedofTurkishethnicitywithoutusingmedications that may influence RDW. However, we couldnot stabilize some of the comorbidities that were also knownas etiologic factors in AMI such as atrial fibrillation, chronicheartfailure, arterialhypertension, anddiabetesmellitus.Wementioned this point in our limitations section [1].Second, as the study groups were gathered from theemergency department (ED), there were no delay betweenblood sampling and RDW measuring. After the bloodsamples are sent via pneumatic system in our ED, theparameters are measured in a special part of the laboratoryto prevent delays: emergency laboratory part. Thus, wethink that our laboratory procedure has got no influence inRDW measurements.Third, in our first table, there were 13 parameters thatwere significantly different between AMI patients andcontrols. We were analyzing the laboratory parameters ofstudy population, and thus we did not take into accountdemographic features and comorbidities in multivariateanalysis. As some of these laboratory parameters wereassociated with each other, we carefully chosen sevendifferent parameters in the multivariate analysis. Studyingseven parameters as multivariate analysis in a population of159 is very acceptable and enough for the statistical power[1]. In the logistic analysis, we only gave statistically sig-nificant results. The odds ratio of RDW was 1.058 (95 %CI 0.754–1.485; wald: 0.106, p = 0.745).Fourth, Zhang et al. kindly requested the reason ofconflicting results about RDW levels and ischemia/necrosissize and mortality between our study and Bilgic et al.’sstudy [1–3]. Our study has got superiorities discussed to thearticle by Bilgic et al. We measured the size of ischemia/necrosis in centimeters, while they just grouped the patientsaccording to approximate necrosis length without measur-ing the exact size. Moreover, we did not need resectionsurgery in the first look for all the patients with AMIcontrary to their study population. Most important, weexcluded patients with comorbidities that may affect RDW,and for the etiologic factors that may affect this parameter(atrial fibrillation, chronic heart failure, hypertension, anddiabetes mellitus), we discussed them with univariateanalyses between patients with and without mortalities. Wewere unable to see these exclusion criteria and discussionsin the study by Bilgic et al.

Seroprevalence of Cytomegalovirus Infection amongst Pregnant Women in Kaduna State, Nigeria

Cytomegalovirus (CMV) is a major public health problem throughout the world. It is the leading cause of congenital infections leading to neurological disabilities in children that result to severe sequelae such as sensor neural hearing loss, neuro-developmental delay and blindness. This study was conducted to determine the seroprevalence of human cytomegalovirus among pregnant women in Kaduna State, Nigeria. Three hundred and sixty three (363) blood samples were collected from 330 pregnant women attending antenatal clinics and 33 non pregnant women attending the Outpatient Department in three selected General Hospitals in Kaduna State. Serum obtained from the blood samples were examined for the presence of CMV IgG antibodies by IFA method. About 94.8% of pregnant women tested positive to CMV IgG antibodies while all (100%) of the non pregnant women tested positive. There was no statistically significant association between CMV and pregnancy (÷2=1.784, df=2, p=0.182). Infection with CMV was strongly associated with zone location (÷2=15.381, df,=2, p=0.000) and employment status of the women (÷2=5.519, df=1, p=0.018). There was no significant association between CMV infection and age, gravida, gestation age, education, number of marriages and history of previous transfusion. The high prevalence of CMV infection observed in this study indicates that the virus is prevalent in the study area and it is therefore advisable that routine screening of CMV infection be implemented for all antenatal women in the State. Keywords : Seroprevalence, Cytomegalovirus, IgG, Pregnant women, Kaduna, Nigeria