Safe Blood Transfusion Practices Research Articles

Trends in immunological markers of transfusion transmissible infections among blood donors in Mamfe District Hospital, Southwest Cameroon

BackgroundBlood transfusion is associated with exposure to blood Transfusion Transmissible Infection (TTIs). The threat posed by the blood-borne pathogens is disproportionately distributed in different healthcare facilities in Cameroon. Thus, there is a need for continuous surveillance of TTIs in the country. This study aimed to assess the screening procedure for blood transfusion and determine the trend in immunological markers of TTIs among blood donors at the Mamfe District Hospital.MethodsA prospective descriptive, cross-sectional and analytical study was conducted at Mamfe District Hospital from March to May 2022. A total of 165 blood donors were recruited by the consecutive sampling method. Donors were screened using both Rapid diagnostic tests,T. pallidum haemagglutination test and indirect enzyme-linked immunosorbent assay (ELISA) for the detection of TTIs. Data generated was entered into an Excel spreadsheet and analysed using the statistical software R, version 4.2.0. Statistical analysis included descriptive statistics of percentages, means ± standard deviation, and student t-test was used to compare both diagnostic techniques, and was considered significant when p < 0.05.ResultsA hundred and sixty-five donors were enrolled in the study with a male preponderance giving a male-female sex ratio of 22.5 and a mean age of 32.23 ± 8.60 years. The majority (75.2%) of the donors were of the O-positive blood type, repeat donors (69.1%) and were mainly family replacement and paid donors as against the voluntary blood donors (39.4% and 37.0% vs. 23.6% respectively). overall TTIs prevalence was 18.78% (31/165) (), with HBsAg being the most predominant marker at 12.12% (20/165) followed by Treponema pallidum, HCV and HIV antibodies at 4.85 (8/165), 1.21%(2/165), 0.60% (1/165) respectively. Except for the HBV, The prevalence of TTIs was higher when using a single RDT than the ELISA test, and the difference was significant (p < 0.05).ConclusionBloodborne pathogens remain a major menace to safe blood transfusion practice in Mamfe district hospital and their detection could be easily missed if the RDT method alone is used for donor screening. Therefore, the donor screening protocol in Mamfe District Hospital should systematically incorporate a confirmation diagnostic test such as ELISA.

BLOOD DONOR DEFERRAL PATTERN AS A KEY TOOL FOR SAFE BLOOD TRANSFUSION PRACTICE: A RETROSPECTIVE STUDY FROM NORTH EAST INDIA.

Background: Safe blood transfusion practice starts with meticulous selection of blood donors. Recruitment and retention of healthy safe donor is crucial to maintain adequate supply of blood units available for transfusion. The present study was undertaken with the aim to analyze the rate as well as the causes of pre-donation deferral and blood units discarded following screening test for Transfusion Transmitted Infection (TTI). Material and methods: This retrospective hospital-based study was conducted in the Blood Centre, Jorhat Medical College and Hospital, Jorhat, Assam over a period of one year i.e., from 1st October, 2021 to 30th September, 2022. All donors who attended the Blood Centre as well as outdoor voluntary blood donation camps were included in the study. Each and every blood donor was screened as per the guidelines of Drugs and Cosmetics (Second Amendment) Rules, 2020. Transfusion Transmitted Infection (TTI) screening tests were done on the collected blood units and those found to be positive were discarded. The donor records were reviewed and analyzed according to sex, donor type (voluntary or replacement) and reason for deferral. Results: Out of 17030 prospective donors, 14372 (84.39%) donors were accepted for blood donation while 2658 (15.61%) donors were deferred. The deferral rate was higher in females i.e., 35.63% (88 out of 247) compared to males i.e., 15.31% (2570 out of 16783). Deferral percentage of voluntary donors was 19% (2563 out of 13485) and that of replacement donor was 2.68% (95 out of 3545). The rate of temporary and permanent deferral was 99.17% (2636 out of 2658) and 0.83% (22 out of 2658) respectively. The most common cause of temporary deferral was found to be low hemoglobin (41.81%) whereas in case of permanent deferral high risk behaviour (50%) was found to be the leading cause. 3.21% (462 out of 14372) blood units were discarded following screening tests for Transfusion Transmitted Infection (TTI). Hepatitis C was the most common cause of blood units discarded. Conclusion:Asystematic and well organised approach to selection of blood donors is the mainstay of safe blood transfusion practice. Analysis of donor deferral pattern guides us to recruit safe healthy donors and to maintain an adequate pool of blood units available for transfusion

KNOWLEDGE, ATTITUDE, AND PRACTICE TOWARDS VOLUNTARY BLOOD DONATION AND ASSOCIATE FACTORS AMONG KHULNA UNIVERSITY STUDENTS

Voluntary blood donation (VBD) is the foundation of blood safety and safe transfusion methods. It is vital to boost volunteer donor recruitment and retention to ensure a long-term safe blood transfusion practice, especially among university students. The goal was to evaluate Khulna University students' blood donation knowledge, attitude, and practice (KAP) as well as associated factors. A cross-sectional study was conducted at Khulna University in April 2022. Using simple random sampling (SRS), 400 face-to-face interviews were taken, of which 394 records were used for further analysis. A Chi-square test was used to check the association between KAP toward VBD, and binary logistic regression was applied to identify the association between explanatory and outcome variables. The logistic regression reveals that students with good knowledge about VBD are associated with permanent residence (OR: 1.651; 95% CI: 1.028, 2.650) and education (OR: 1.746; 95% CI: 1.012, 3.014). Favorable attitude toward VBD is associated with gender (OR: 1.818; 95% CI: 1.073, 3.079), division (OR: 3.058; 95% CI:1.241, 7.535) and social media time (OR: 0.068; 95% CI:0.001, 0.876). The practice of VBD is associated with gender (OR: 5.375; 95% CI:3.115, 9.273) and current residence (OR: 0.0397; 95% CI:0.181, 0.869). Efforts should be undertaken to use knowledge and a favorable attitude toward students at the Khulna university to accomplish the aim of 100% VBD in the future.

Knowledge, attitudes and practices of resident doctors and interns on safe blood transfusion practices: a survey-based study

IntroductionThe knowledge of clinicians regarding blood transfusion services may impact patient care and transfusion outcome. The wide variation in transfusion practices among clinicians leads to inappropriate blood product usage and jeopardizes patient safety. Hence, this survey study aimed to assess knowledge, attitude and practice among the residents and interns of safe blood transfusion. MethodsThe online survey was based on self-administered questionnaires of three sections: 1. Demography; 2. Knowledge, and; 3. Attitude and Practice. One point was assigned for the correct response of each question in every section. The knowledge score was further categorized into three categories, depending on the points obtained. The participants were also divided into four groups, depending on their experience. The Kruskal-Wallis test was applied to determine the difference of knowledge and practice scores in three designated groups of residents and interns. A p-value of less than 0.05 was considered to be significant. ResultA total of 247 residents and interns participated in this study. Thirteen participants had an incomplete response. Out of 234 participants, Senior Residents (SR), Junior Residents (JR), and interns were 70, 96 and 68 participants, respectively. The knowledge scores of interns were significantly low, as compared to SRs and JRs. Practice scores of interns were also significantly low, compared to the JRs. However, most of the residents and interns (85%) were aware of the pre-transfusion testing. ConclusionTherefore, the mandatory incorporation of the transfusion medicine subject in the undergraduate curriculum can help the young budding doctors to better implement the patient blood management.

Reduction in seroprevalence of viral transfusion-transmitted infections in southwest Nigeria in children with sickle cell disease using an enhanced screening strategy.

Blood transfusion is an integral component in the management of children and adults with sickle cell disease (SCD). Concerns about blood safety due to the high risk of bloodborne infections in sub-Saharan Africa limits the application of this cost-effective strategy in the management of individuals with SCD. In a single-centre, retrospective, longitudinal study in southwest Nigeria, we hypothesised that the use of stringent blood donor selection, along with very sensitive enzyme-linked immunosorbent assay (ELISA) screening methods would reduce transfusion-transmitted infections (TTIs). Among 45 002 eligible blood donors at the Lagos University Teaching Hospital in Nigeria, over a 5-year review period (2015-2019), the seroprevalence rate of viral TTIs was 9.83%. The seroprevalence rates for human immunodeficiency, hepatitis B, and hepatitis C viruses were 1.37%, 6.2%, and 2.25% respectively. Among 172 children with SCD, 71% (122/172) on regular blood transfusion and 29% (50/172) who had never been transfused or had less than two transfusions per lifetime, none acquired any TTIs using our enhanced screening approach during the study period. Thus, safe blood transfusion practices can be provided for children with SCD in sub-Saharan Africa with the use of stringent donor selection protocols and fourth-generation ELISA kits for TTI screening.

Seroprevalence of Transfusion Transmitted Infections among Multiple Transfused Patients in Indian Scenario: Step for Safe Transfusion Practices

Introduction: Transfusion Transmitted Infections (TTIs) is a worldwide problem both in past and in the present days. The risk of TTIs is increased due to the constant need to receive blood transfusion in patients requiring multiple transfusions. The problem of TTIs runs parallel to the prevalence of the infections in the blood donor group and to the number of units transfused. Aim: To estimate the current prevalence of blood TTIs in patients requiring multiple units of blood transfusions and to determine their association with age, gender, various disease category and number of units transfused. Materials and Methods: This cross-sectional retrospective study was conducted in the Department of Pathology, RD Gardi Medical College, Ujjain, Madhya Pradesh, India from January 2017 to December 2020. Patients of all the age groups and both gender from Outpatient and Inpatient Department, requiring regular transfusions and having a history of 10 or more units of blood transfusion were enrolled. Serological detection of TTIs was done by Enzyme-Linked Immune Sorbent Assay (ELISA) method. Statistically the results were analysed using Statistical Package for Social Sciences (SPSS) version 19.0. Results: In this study, 480 patients were included of which 293 (61.1%) were males and 187 (38.9%) females. Maximum 195 (40.6%) were children in age group of &lt;1-10 years. A total of 63 (13.12%) patients with Hepatitis C virus, 9 (1.87%) patients with Hepatitis B virus and 2 (0.42%) patients with Human Immunodeficiency Virus (HIV) infection were found at the end of study. Highest seropositivity of TTI was seen in patient who had undergone &gt;400 number of transfusions , thus association was established but no association detected with age and sex of the patients. Majority of TTIs were positive in thalassemia patients 164 (34.17%) followed by patient undergoing haemodialysis 151 (31.45%). Conclusion: The results of this study raise an alarm to the existence of a significant risk of TTIs in our society. There is requirement of advanced and vigilant screening of donors with proper strategies to reduce the breach in safe blood transfusion practices.

A prospective interventional study to assess the impact of a 'structured compact training' on knowledge and skills of safe blood transfusion practices among nurses working in a tertiary care institute.

There is scarce information on the baseline knowledge and practices of nursing officers in relation to administration of blood components. We set out to evaluate the influence of training on their knowledge and skills through Kirkpatrick's levels of Training Evaluation. This interventional cross sectional study of 7months duration conducted in a tertiary care teaching institute involved 200 nursing officers. Hundred were assigned to study/intervention group and 100 were assigned to control/ comparison group by systematic random sampling. Knowledge was tested in different domains-blood components, pre-transfusion checks, transfusion process, post-transfusion process and blood administration practice. The baseline knowledge scores of intervention and control group were similar-15.16 ± 4.11 and 15.02 ± 4.75 (p=0.831). Post-intervention (phase I) after 1 month, the scores improved significantly for domain A, B, C, D and E to 4.3 ± 2.21 (p=0.0001), 3.46 ± 2.15 (p=0.0001), 7.02 ± 3.55 (p=0.0001), 2.51 ± 1.46 (p=0.0012), and 5.86 ± 3.61 (p=0.0018) respectively. In phase II, after 3 months of training, and the scores were significantly better from baseline for all domains except E. For domain A, B, C, D and E, scores were 3.82 ± 2.46 (p=0.0001), 3.53 ± 1.98 (p=0.0001), 7.38 ± 3.87 (p=0.0001), 2.48 ± 1.55 (p=0.0035), and 5.86 ± 3.61 (p=0.95) respectively. Our study showed that baseline scores were low in the nursing officers. No significant difference was found in baseline scores in subject and control population. However, post-intervention, a significant improvement in scores was observed in the study group across all domains.

Safe Blood Transfusion Practices among Nurses in a Major Referral Center in Ghana.

Errors in transfusion of blood and blood products can lead to preventable morbidity and mortality. Nurses constitute a significant aspect of the transfusion process as they are the last in the chain of getting blood directly to the patient. They must, therefore, be conversant with the current standard of national and international guidelines on blood transfusion and appropriate management of adverse transfusion events. This study assesses the knowledge and practices of blood transfusion safety among nurses at Komfo Anokye Teaching Hospital. A descriptive cross-sectional design was employed, and structured questionnaire (Routine Blood Transfusion Knowledge Questionnaire) was used to collect data from 279 nurses from seven clinical directorates of the hospital. The data were processed with Stata version 14.0. Variables were analyzed using descriptive statistics, and relationships were drawn using inferential statistics. Over 90% of the respondents had a minimum of a diploma in nursing or midwifery, 63% had performed blood transfusion at least 5 times, and 46% had never received any training on blood transfusion. The mean score obtained in all four categories of blood transfusion knowledge assessed was 29, with 54% of the respondents scoring below the mean. The highest overall score on knowledge was 53%. This indicates that nurses had poor knowledge regarding safe blood transfusion practices as stipulated in the clinical guidelines for blood transfusion by Ghana's National Blood Service. There was no statistically significant relationship between training/experience and knowledge of safe blood transfusion practices. Regular and continuous update training and audit are needed to safeguard patient safety during blood transfusion.

Transfusion-associated circulatory overload (TACO): Significance of appropriate pre-transfusion risk assessment to prevent fatal health outcomes.

Madam, Transfusion of blood products is a life rescuing medical intermediation; however, associated adverse transfusion reactions are major pitfalls. Transfusion-associated circulatory overload (TACO) is life-threatening pulmonary oedema that develops secondary to volume overload. Underlying precipitating factors include ages &gt;60 years or &lt;3 years, low body mass index (BMI), rapid transfusion rate and pre-existing volume overload conditions such as heart disease, renal failure, lung disease or low albumin levels. Sign and Symptoms include dyspnoea, tachypnoea, tachycardia, hypoxia, raised jugular venous pressure, broad pulse pressure and hypertension, that appears during or either six hours posttransfusion [1]. TACO should be discriminated from transfusion-related acute lung injury (TRALI) by high jugular venous pressure, pulmonary arterial pressure to &gt;18mmHg, hypertension, brain natriuretic peptide levels (&gt;1200pg/ml) and response to diuretics. Management of TACO includes immediate discontinuation of transfusion, diuretics, supplementary oxygen, and assisted ventilation if indicated [2]. Serious Hazards of Transfusion (SHOT) in 2018 reported TACO as the most typical reason for transfusion-related deaths. Over the period of 11 years (2007-2018), overall cases raised from six to one hundred and ten, including the increase in mortality from one to five and one significant morbidity from three to thirty-six cases [3]. Interestingly, timely and appropriate preventive actions can reduce this severe reaction to zero. A precise risk assessment before transfusion is recommended by SHOT for TACO elimination, especially if the patient has underlying risk factors. Preventive strategies in such predisposed patients include reviewing the need for transfusion, deferring the transfusion until issue can be resolved, transfuse according to body weight, measure fluid balance, consider prophylactic diuretic, slow transfusion rate and monitoring vital signs including oxygen saturation. Thus, TACO is a serious but avoidable transfusion reaction. Appropriate assessment prior to transfusion in every patient is important to ensure safe blood transfusion practice. Continuous...

English

The ABO and Rh (D) blood type distributions vary from one ethnic group to another. However, they play an essential part in population genetics studies, blood transfusion practices and certain medico-legal cases. Thus, this study is aimed to assess ABO and Rh (D) blood group distribution patterns among Natural and Computational Science faculty graduating class students in Woldia University and to document a blood group database and creating awareness among blood donors for safe transfusion. To this end, blood samples from 429 (N=560) volunteer students were taken during the period of 1st February 2020 to 28th April 2020 blood donation campaign and observational cross sectional study design was performed. ABO and Rh (D) typing was done by antigen-antibody agglutination test using commercially available and standard anti-sera. Descriptive statistical measures on phenotypic frequency of ABO and Rh (D) blood types were described in simple percentages. The allelic and genotypic frequencies of the ABO and Rh blood groups were estimated using the assumption of Hardy&ndash;Weinberg equilibrium. The ABO and Rh (D) blood phenotypes respectively were found to be A (28.20%) &gt; B (25.40%) &gt; AB (24.70%) &gt; O (21.67%) and Rh+ (60.13%) &gt; Rh- (39.86%) and the combined ABO/Rh(D) blood groups were in the order A+ (16.31%) &gt; B+ (15.85%) &gt; O+ (14.21%) &gt; AB+ (13.75%) and A- (11.88%) &gt;AB- (10.95%) &gt; B- (9.55%) &gt; O- (7.45%). The allelic frequencies of IA (P), IB (q), IO(r) respectively were 0.314, 0.2939 and 0.4655. The allelic frequencies for ID = 0.3687 and for Id = 0.6313 were found. A genotypic frequency of IAIO was the most frequent (0.2923) and IBIB was the least frequent (0.0863). Whereas, IDId was most frequent (0.4655) and IDID was the least frequent (0.1359). The observed and expected frequencies of individuals having ABO blood group showed no significant difference (&chi;2 = 35.4381, df = 3; P &lt; 0.05) and Rh (D) blood phenotypes of individuals were significantly different (&chi;2 = 0.000011, df = 1; P &lt; 0.05), thus, not fitting Hardy-Weinberg assumptions. The data obtained in the present study could be used as important input for blood bank services to have better blood management and safe blood transfusion practices in different regions of Ethiopia and abroad in the future. &nbsp; Key words: ABO, allele, blood donors, blood groups, distribution, genotype, Rh (D), Woldia University.

Blood group systems

Blood group systems

Towards safe blood-transfusion practice for nurses: Effectiveness of comic-based learning tool

Comic has been used to support education for nurses. This learning approach needs to be explored further because it supports nurses to continue learning during their professional phase. The purpose of this study is to examine the effectiveness of comic in supporting the training of safety blood transfusions administration among nurses. The research design is a controlled trial. The respondents are nurses assigned into control and intervention groups. The intervention group received blood transfusion with comic approach and the control group received conventional standard operational procedure. After two weeks, the safety blood transfusion knowledge of the two groups was measured by using a questionnaire. The data was analyzed by using independent t tests. The result shows that there is a significant mean difference in knowledge between the two groups (p value:0.00), thus comic is an effective learning tool to support a safe blood transfusion administration among nurses.

Prevalence of Transfusion Transmissible Infections in Beta-Thalassemia Major Patients of Pakistan: A Systematic Review

Introduction: β-thalassemia major (TM) is one of the most prevalent inherited hemoglobinopathies in Pakistan. It has one of the highest prevalence of transfusion-dependent TM patients globally, with an estimated greater than 100,000 active cases. Each year, an estimated 5000-9000 new cases of TM are being diagnosed in the country. Blood transfusions (BT) are essential in the management of severe TM; it is critical to have a safe BT to reduce the risk of transfusion transmissible infections (TTIs). Frequent blood transfusions in these patients increase their risk of acquiring TTIs compared to the general population. In this systematic review, we aimed to identify the prevalence of TTIs in transfusion-dependent β -thalassemia major patients in Pakistan. Methods &amp; Material: We performed a systematic literature search to identify studies related to the TTIs and transfusion-related infections in Pakistan from January 1, 2010, to January 31, 2020. The search was conducted using PubMed and PakMediNet (Largest medical database of Pakistan), with initial search retrieved 981 studies. Among these, 166 studies met the inclusion criteria. After further screening by reviewing the articles for relevance and availability of full-length articles, only 14 studies met the final criteria for qualitative synthesis. Results Analysis of 14 studies (n=3786) showed that the seroprevalence of Hepatitis B virus (HBV) of 3.13% (0.66 % to 7.4%) and Hepatitis C virus (HCV) of 26 % (5.56% to 68.2%). There were only two studies reported HIV seroprevalence of 0 % &amp; 0.5% (n=6). The rate of seropositivity for HBV and HCV was directly related to the number of transfusions, higher ferritin levels, and older age groups. There was an increase in the HCV rate with the increasing age of patients. Thalassemia patients who were older than ten years of age had a greater HCV compared to those who were less than ten years of age, i.e., 22% vs. 8.4%, p:0.005, respectively. The mean age was higher in HCV reactive children than non-reactive children. A comparison of HCV in healthy donors vs. thalassemia patients showed a rate of 1.9% vs. 13.1% for T.M. patients. There was HCV infection rate of 74% in the group with greater than 100 BTs compared to 33 % in a group with fewer than 35 BTs. The rate of HCV increased to 75% for the patients who had more than 100 BTs. The majority of the patients were males (51% to 88%). The seroprevalence of TTIs was higher in males than in females (73.4% vs. 26.6%). On average, a single TM patient is exposed to at least 17 different donors annually, requiring 1-2 transfusions every month. The free BT is accessible only in 1 out of 4 thalassemia centers. The majority of patients either need to bring their donors or are dependent on an external source of financial aid as they could not afford the cost of BT treatment. More than half of thalassemia patients (57.2%) need to contact multiple BT centers to search for required blood products. About 42.1% of parents of TM patients did not know about TTIs, whereas 31.6% of them did not know about the bloodborne transmission of HBV and HCV. The majority of parents of TM children had a low income, with 75% of them having income less than 10,000 Pakistani rupees (PKR) per month. The prevalence of TTIs in TM patients was significantly higher (96% vs. 4%) compared to the patients requiring multiple transfusions due to other causes such as leukemia, aplastic anemia, and thrombocytopenia. Conclusion: Our data highlights that the prevalence of transfusion-transmitted infections, especially HCV, is alarmingly higher (26%) in the TM population than in the general population. This is because of a lack of resources, inadequate safety measures, and a fragmented blood transfusion system. These findings warrant the urgent need for better public health measures, safe blood transfusion practices, voluntary remunerated blood-based transfusions, and universal quality-assured donor screening. Without these positive interventions, the current transfusion system can lead to a further worsening of the situation. Large prospective multi-centered clinical trials are required to understand better the high prevalence of TTIs in patients with TM. Disclosures Anwer: Incyte, Seattle Genetics, Acetylon Pharmaceuticals, AbbVie Pharma, Astellas Pharma, Celegene, Millennium Pharmaceuticals.:Honoraria, Research Funding, Speakers Bureau.

Snapshot on physicians’ view on safe blood transfusion in multiply transfused patients in Nigeria

Background: Multiply transfused patients (MTPs) are often at risk of alloimmunization and other transfusion-associated complications. These complications could be ameliorated through extended blood typing prior to transfusion of blood and blood products. Objective: The aim of this study was to assess the knowledge and practice of safe blood transfusion in MTPs by physicians. Materials and Methods: This was a cross-sectional questionnaire-based study of physicians who attended a scientific conference of the West Africa College of Physicians in Asaba, Delta State. Result: Most of the respondents (68%) managed patients requiring multiple blood transfusions. Forty-seven respondents (68.1%) had a blood transfusion policy for MTPs in their respective centers, and 43 (68.1%) had no transfusion trigger hemoglobin level in their respective health facilities. Respondents who had a blood transfusion policy in their centers had a better knowledge of safe blood transfusion than those that did not, P = 0.008. None of the respondents reported carrying out antibody screening before and after multiply transfusing the patients. Although 100% performed initial screening for transfusion transmissible infections (TTIs), only 11.6% repeated screening for TTIs annually. Conclusion: Practice of safe blood transfusion in MTPs was found to be poor among physicians in Nigeria. Hospitals and training institutions should design ways to update knowledge of physicians on safe blood transfusion especially in MTPs and by so doing optimize safe blood transfusion practices, so as to improve the quality of life of patients.

Knowledge on safe blood transfusion practice of senior staff nurses working in tertiary hospital

Transfusion of blood saves life. An error in blood transfusion, at the same time, takes life. A cross sectional study was carried out for assessing the knowledge and practice on blood transfusion among the senior staff nurses using a structured questionnaire through face to face interview in Dhaka Medical College Hospital (DMCH). Among the about half of the respondents (54.8%)% were in the age group above 40 consisting 97.6% of female where 98% were married. By professional education 79% had Diploma in nursing and midwifery and 16.9% had graduation in nursing. This study revealed that the respondents could mentioned the name of screening tests as HBsAg (65.3%), HIV (58.1%), VDRL (53.2%), HBV (23.4%) and HBC (7.3%). Things to be checked and things to be considered also evaluated among the respondent and found responsive results. This study revealed that among the respondents 57% had moderate knowledge on blood transfusion, 41% good knowledge and only 2% had poor knowledge. There is an association between knowledge level on blood transfusion and year of service. This association is statistically not significant having p value 0.074. Among the respondents almost 48.4% stated transfuse screened blood as a preventive measure to fix problems regarding blood transfusion. Around 5.6% of the respondents mentioned maintaining proper system of blood transfusion as a measure. A few respondents (4.0%) said that difficulties due to blood transfusion can be prevented by controlling blood transfusion related side effects. The nurses practice self-protection of them and patient's protection during blood transfusion. There is needed of proper training on blood transfusion for prevention of complication in the patient as well as for the nurses themselves.&#x0D; Asian J. Med. Biol. Res. September 2020, 6(3): 587-593

Prevalence of ABO, RhD and other clinically significant Blood Group Antigens among blood donors at tertiary care center, Gwalior

Background: Among all blood group systems and antigens, ABO and D antigens of the Rh blood group system are of primary importance, hence included in routine blood grouping and transfusion. Other blood group systems and antigens that are important in multiparous women, multi-transfused patients and hemolytic disease of newborn are Kell, Rh, Duffy, and Kidd.Aims and Objectives:  To know the pattern of ABO, RhD and other clinically significant major antigens of Rh, Kell, Duffy and Kidd blood group systems as well as evaluation of phenotypes, genotypes and gene frequency of related antigens among blood donors in Gwalior region.Materials and methods: A prospective study was carried out at the Blood Bank from July 2017 to June 2019. During the study period 48500 blood donors were included for ABO and RhD grouping, Out of them 1000 randomly selected donor samples were processed for complete Rh, Kell, Duffy and Kidd blood grouping.Result:  ABO group pattern was; A - 22.56%, B -  36.52%, AB - 9.8% and O -31.12 %, while RhD status was RhD+ 90.99% and RhD- 9.01% . Prevalence of Rh phenotypes was DCCee 43%, DCcee 33%, DCcEe 10%, dccee 6.5%, DccEe 4.5%, Dccee 1%, DCCEe 0.3% and dccEe 0.2%. Kell phenotype was K-k+ 95.5%, K+k+ 4.5%, while K+ k- and K- k- phenotypes were not encountered in this study. Duffy phenotypes were Fya+ Fyb+ 47.5%, Fya+ Fyb- 35%, Fya- Fyb+17% and Fya- Fyb- 0.5%. Kidd phenotype was Jka+ Jkb- 44.5 %, Jka- Jkb- 26.5%, Jka+ Jkb+ 18% and Jka- Jkb+ 11%.Conclusion: Present study is helpful in the transfusion management of multiparous women and multi-transfused patients. Extended blood grouping is the need of future to ensure safe blood transfusion practices.

Analysis of Blood Donor Deferral in a Tertiary Care Hospital

Introduction: Selection of proper donor according to stringent selection criteria is the prerequisite for safe blood transfusion practice. It is widely known that a large number of blood donors are deferred for different reasons.&#x0D; Objective: The aim of present study is to evaluate the incidence and different reasons of blood donor deferral in atertiary care hospital.&#x0D; Methodology: This retrospective cross-sectional study was carried out in Transfusion Medicine and Clinical Haematology Department of BIRDEM General Hospital, Dhaka, during the period from July 2016 to June 2017.The blood donor of either sex attending the mentioned department were selected purposively and categorized into four groups according to their age for this study. Donors were selected and deferred by medical officer according to national guideline. Deferred blood donors were recorded in register book and were analyzed retrospectively.&#x0D; Results: In current study, 1152 blood donor (8.8%) were deferred attending for allogeneic blood donation during the study period. Out of 13082 registered blood donor 11961were male (91.43%) and 1121 were female (8.57%) and deferral rate was 2.37 times more in female. Majority of the deferred donors (55.38%) were under the age of 40 where 26.82% were in between 40-49 years and 17.8% were in the range of 50 years and above. Age range of highest deferred donors (32.20%) was between 30-39 years. The number of temporary and permanent deferral were 836 (72.57 %) and 316 (27.43%) respectively. Anaemia (33.01%), underweight (21.53%) and hypotension (17.34%) were the most common reason of temporary deferral. Chronic uncontrolled hypertension (42.4%), donors with medication (16.77%) and asthma (15.18%) was the most common cause of permanent deferral.&#x0D; Conclusion: The deferral rate was low and most of the deferred donors were young adult. Temporary deferred donors were higher than permanent deferred donors. The most common reasons for temporary deferral were anemia, underweight and hypotension. Permanent deferral causes were chronic uncontrolled hypertension, donors on medication for various reason and asthma. Donors should be informed with a clear message on their deferral status. It is important to determine the rate and causes of donor deferral for the safety of blood transfusion and to guide the recruitment efforts for safe blood transfusion and to avoid the permanent loss of blood donors.&#x0D; Northern International Medical College Journal Vol.10 (2) Jan 2019: 373-376

Routine indirect antiglobulin testing of blood donors—a further step toward blood safety: an experience from a tertiary care center in northern India

This scientific article emphasizes the importance of a policy for antibody screening of all blood donors as a step to further improve blood safety. We also report the incidence of red blood cell (RBC) alloimmunization in healthy blood donors obtained using a cross-sectional prospective study from September 2017 to January 2019 in the Department of Transfusion Medicine of a tertiary care referral and teaching institute in northern India. The indirect antiglobulin test (IAT) for unexpected RBC antibodies was performed by the conventional tube test with pooled group O RBCs on all donor units irrespective of their D status. Samples with positive IATs were sent to the Immune Hematology Reference Laboratory for further immunohematolo-gy workup, maintaining predefined optimal storage and transport conditions. Of the 10,390 donors studied, 9959 were males and 431 were females. The incidence of unexpected antibodies (antibodies other than those of the ABO blood system) among the blood donors was found to be 0.18 percent (19 of 10,390 with 25 alloantibodies). Of the 19 alloimmunized donors, 16 (84.2%) were male (alloimmunization rate 0.16%, 16 of 9959) and 3 (15.8%) were female (alloimmunization rate 0.69%, 3 of 431) (p = 0.01; chi-square test). In our study, the most frequent alloantibodies identified were of the Lewis blood group system (17 of 25 [68%] in 14 of the 19 alloimmunized donors). The second most common allo-antibodies belonged to the Rh blood group system (4 of 25 [16%] in 3 of the 19 alloimmunized donors), followed by those of the MNS blood group system (3 of 25 [12%] in 2 of 19 alloimmunized donors). Anti-K was found in one donor (1 of 25 [4%]). Based on the results of the study, we recommend that a policy of routinely performing IATs on all donor units, irrespective of their D status, be adopted as an essential component of safe blood transfusion practices.

Knowledge of Blood Transfusion Among Nurses.

Health care professionals' knowledge and skills are fundamental to developing and strengthening the quality of blood transfusion procedures. This study evaluated nurses' knowledge about blood transfusion. This descriptive cross-sectional study comprised 171 nurses in medical and surgical units and intensive care units in two hospitals. Data collection was completed in 2 months. Nurses' knowledge of blood transfusion practices was assessed using a questionnaire. Most had obtained a bachelor's degree in nursing, received in-service blood transfusion training, and demonstrated moderate levels of knowledge on the topic. The least known questions related to the changing of blood transfusion sets, the most frequent cause of blood transfusion reactions, and immunological blood transfusion reactions. New graduates or inexperienced nurses, those working in medical units, and those who did not often implement blood transfusions needed more support to improve their knowledge levels (p < .05). Nurses require in-service training to improve their knowledge of safe blood transfusion practices, specifically because blood transfusion sets are the most frequent cause of blood transfusion reactions and adverse reactions associated with blood transfusion. [J Contin Educ Nurs. 2019;50(4):176-182.].

Antibody screening and identification in donors and general patients at a tertiary care teaching hospital in Western India.

BACKGROUND AND OBJECTIVES:The aim of the blood transfusion service should be to provide effective blood and blood components, which are as safe as possible and adequate to meet patient's need. To achieve safe blood transfusion practice, many blood transfusion center in India follow routine type and screen protocol for all patient's and donor's blood samples to detect unexpected alloantibodies. The present study is aimed at assessing the frequency and type of unexpected red cell alloantibodies in general patient population and donors at a tertiary care teaching hospital in western India.MATERIALS AND METHODS:In this prospective study, samples of patients as well as blood donors were processed for ABO and Rh “D” grouping as well as antibody screening with three cell screening panel on fully automated immunohematology analyzer. Positive sample in three cell screening panel was further evaluated for identification of specific alloantibody with eleven cell identification panel by column agglutination technique. Results were recorded, and data were analyzed to calculate the frequency of unexpected alloantibody.RESULTS:A total of 74,214 patient samples and 80,173 donor samples were processed for type and screen. Out of which, 512 patients and 11 donors were identified with alloantibody. Most common alloantibody found in the present study is anti-D (0.075%), followed by anti-E (0.041%), anti-c (0.021%), anti-K (0.0205%) in Rh and Kell blood group system.CONCLUSION:Antibody screening and identification of specific alloantibody help in identifying most appropriate blood unit that lacks the corresponding antigen and prevent alloimmunization.