Safe Transfusion Practice Research Articles

Transfusion-Related Acute Lung Injury

Transfusion-Related Acute Lung Injury is one of the most vital forthcoming risks that need to be addressed, assessed, diagnosed and treated. Blood transfusion save lives, but the side effects of transfusion can be really adverse and concerning. Blood transfusion helps the patient recover from severe blood loss that might lead to severe complications like cardiogenic or hypovolemic shock. Over the years, the health care industry is working on reducing the possible risk and complications of blood transfusion. Worldwide trainings are provided on safe blood transfusion practices. Blood banks are verified with legal authority and inspections are done every now and then. Transfusion-Related Acute Lung Injury is the upcoming concerning issue that needs to be familiar with all health care workers especially nurses since they are the one who keep a close monitoring of patient during the blood transfusion process. Furthermore intervention can be planned accordingly to help manage Transfusion-Related Acute Lung Injury better and treat the symptoms as soon as possible.

Evaluation of the analytical performance of four different manufacturer's reagent red blood cells in antibody detection and identification.

The detection/identification of clinically significant antibodies to red cell antigens form the foundation for safe transfusion practices. This study aimed to evaluate the diagnostic performance of commercially available 0.8% reagent red blood cells (RRBCs) in Australia. 166 patient-derived plasma samples with a positive indirect antiglobulin test (IAT) were tested using column agglutination technology (CAT) with Immulab, Bio-Rad, Grifols and QuidelOrtho screening and identification RRBCs with the respective manufacturer's proprietary CAT system. False-negative antibody screening and identification results were obtained with Bio-Rad (3/61), Grifols (14/68) and Quidel-Ortho (3/59) RRBCs when tested with the respective manufacturer's proprietary CAT system. Zero false-negative results were observed with Immulab RRBCs when tested with samples across all platforms. The sensitivity of the RRBCs used in this study were calculated to be 95.83% (95%CI 88.30-99.13%) for Bio-Rad RRBCs, 82.50% (95%CI 72.38-90.09%) for Grifols RRBCs and 95.65% (95%CI 87.82-99.09%) for QuidelOrtho RRBCs. The sensitivity of Immulab RRBCs were stratified based on performance in the 3 CAT platforms: Bio-Rad CAT (100%, 95%CI 95.01-100%), Grifols CAT (100%, 95%CI 95.49-100%) and QuidelOrtho CAT (100%, 95%CI 94.79-100%). RRBCs used in antibody detection and identification vary in diagnostic performance and should therefore be carefully considered before being implemented in routine patient testing.

Challenges in reliable preoperative blood ordering: A qualitative interview study.

Presurgical blood orders are important for patient safety during surgery, but excess orders can be costly to patients and the healthcare system. We aimed to assess clinician perceptions on the presurgical blood ordering process and perceived barriers to reliable decision-making. This descriptive qualitative study was conducted at a single large academic medical center. Semi-structured interviews were conducted with surgeons, anesthesiologists, nurse anesthetists, nurse practitioners working in preoperative assessment clinics, and transfusion medicine physicians to assess perceptions of current blood ordering processes. Interview responses were analyzed using an inductive open coding approach followed by thematic analysis. Twenty-three clinicians were interviewed. Clinicians felt that the current blood ordering process was frequently inconsistent. One contributor was a lack of information on surgical transfusion risk, related to lack of experience in ordering clinicians, insufficient communication between stakeholders, high turnover in academic settings, and lack of awareness of the maximum surgical blood ordering schedule. Other contributors included differing opinions about the benefits and harms of over- and under-preparing blood products, leading to variation in transfusion risk thresholds between clinicians, and disagreement about the safety of emergency-release blood. Several barriers to reliable decision-making for presurgical blood orders exist. Future efforts to improve ordering consistency may benefit from improved information sharing between stakeholders and education on safe transfusion practices.

Prevalence and Factors Associated with transfusion-transmissible infections among blood donors in Arua regional blood bank, Uganda

BackgroundBlood transfusion services play a very key role in modern health care service delivery. About 118.5 million blood donations were collected globally in 2022. However, about 1.6 million units of blood are destroyed annually due to transfusion-transmissible infections (TTIs). There is a very high risk of TTIs through donated blood to recipients if safe transfusion practices are not observed. This study determined the prevalence and factors associated with TTIs among blood donors in Arua regional blood bank, Uganda.MethodsThis study was a retrospective cross-sectional design that involved a review of a random sample of 1370 blood donors registered between January 1st, 2018 and December 31st, 2019 at Arua regional blood bank, Uganda. Descriptive statistics were used to describe the characteristics of the blood donors. The binary logistic regression was used to determine the factors associated with TTIs.ResultsThe majority of the blood donors were male (80.1%), and the median donor age was 23 years (IQR = 8 years). The overall prevalence of TTIs was found to be 13.8% (95%CI: 12.0-15.6%), with specific prevalences of 1.9% for HIV, 4.1% for HBV, 6.6% for HCV and 2.8% for treponema pallidum. Male sex (AOR = 2.10, 95%CI: 1.32–3.36, p-value = 0.002) and lapsed donor type compared to new donor type (AOR = 0.34, 95%CI: 0.13–0.87, p-value = 0.025) were found to be associated with TTIs.ConclusionThe prevalence of TTIs among blood donors of West Nile region, Uganda was found to be significantly high, which implies a high burden of TTIs in the general population. Hence, there is need to implement a more stringent donor screening process to ensure selection of risk-free donors, with extra emphasis on male and new blood donors. Additionally, sensitization of blood donors on risky behaviors and self-deferral will reduce the risk of donating infected blood to the recipients.

Development of Safe Blood Transfusion Self‐Efficacy Scale for nurses: Validity and reliability study

AimThe aim of the study is to develop a scale to measure nurses' self-efficacy levels regarding safe blood transfusion practice. MethodsThis study, applied in methodological design, was conducted in a public university hospital in Istanbul between March-April 2021. The sample included 372 nurses. A draft form consisting of 75 items was prepared. Content validity, construct validity, distinctiveness, internal consistency reliability, two-half test reliability, test-retest, and item analysis methods were used to determine the psychometric properties of the scale. ResultsThe exploratory factor analysis showed that the scale had a four-factor structure that explained 71.36 % of the total variance. The factor loads of 49 items were found to vary between 0.50 and 0.92. The item-total correlations were found to be between 0.55 and 0.92. The Cronbach's alpha value for the whole scale was 0.96. ConclusionThe results of the analysis show the items constituting Safe Blood and Blood Products Transfusion Self-Efficacy Scale have validity and reliability criteria that can measure the nurses' self-efficacy levels regarding safe blood transfusion practice.

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.

The importance of removing interference caused by Darzalex® (daratumumab) in pre-transfusion testing

Introduction: Multiple myeloma (MM) is a hematologic malignacy characterized by the uncontrolled proliferation of abnormal plasma cells in the bone marrow. Darzalex® (daratumumab) has emerged as a highly effective therapeutic agent for MM, offering an additional treatment option for patients who have developed resistance to other therapies. However, the use of Darzalex® poses challenges in pre-transfusion testing due to its strong binding affinity of the monoclonal anti-CD38 antibody to CD38 protein, resulting in panreactivity with test erythrocytes and complicating the detection of erythrocyte alloantibodies. The objective of this case report is to outline the procedures, significance, and methodologies for mitigating this interference using the DaraEx® reagent. Case Report: We present the cases of three patients diagnosed with MM and treated with Darzalex® at our institution in 2023. Following the administration of Darzalex®, all three patients exhibited positive results on indirect antiglobulin tests (IAT). Cross-matching tests conducted with red blood cell concentrates also yielded positive results, with strengths ranging from 2+ to 3+. To eliminate interference, we used a specific DaraEx® reagent that utilizes Fab fragments of anti-CD38 to mitigate interference by masking CD38 on the cell surface. Subsequent application of this reagent resulted in negative IAT results for all three patients. However, one patient still displayed a weakly positive cross-matching test (&lt;1+), suggesting that complete elimination of interference may not always be achievable with the DaraEx® method. Conclusion: Despite the availability of reliable methods such as dithiothreitol and the DaraEx® reagent for mitigating interference, complete success in eliminating interference remains elusive. This underscores the importance of implementing proactive measures to prevent interference. Patients undergoing Darzalex® therapy should undergo comprehensive immunohematological testing before medication administration. Given the increased need for blood transfusions in MM patients, ensuring the compatibility of blood products is essential for safe transfusion practices.

Transfusion of blood components in pediatric age groups: an evidence-based clinical practice guideline adapted for the use in Egypt using ‘Adapted ADAPTE’

Pediatric transfusion is a complex area of medicine covering a wide age range, from neonates to young adults. Compared to adult practice, there is a relative lack of high-quality research to inform evidence-based guidelines. We aimed to adapt the pre-existing high-quality practice guidelines for the transfusion of blood components in different pediatric age groups to be available for national use by general practitioners, pediatricians, and other health care professionals. The guideline panel included 17 key leaders from different Egyptian institutions. The panel used the Adapted ADAPTE methodology. The panel prioritized the health questions and recommendations according to their importance for clinicians and patients. The procedure included searching for existing guidelines, quality appraisal, and adaptation of the recommendations to the target context of use. The guideline covered all important aspects of the indications, dosing, and administration of packed red cells, platelets, and fresh frozen plasma. It also included transfusion in special situations, e.g., chronic hemolytic anemia and aplastic anemia, management of massive blood loss, malignancies, surgery, recommendations for safe transfusion practices, and recommendations for modifications of cellular blood components. The final version of the adapted clinical practice guideline (CPG) has been made after a thorough review by an external review panel and was guided by their official recommendations and modifications. A set of implementation tools included algorithms, tables, and flow charts to aid decision-making in practice. This adapted guideline serves as a tool for safe transfusion practices in different pediatric age groups.

SHOT UK Collaborative Reviewing and Reforming IT Processes in Transfusion (SCRIPT) survey: Laboratory information management systems: Are we ready for digital transformation?

To understand the use, functionality and interoperability of laboratory information management systems (LIMS) in UK transfusion laboratories. LIMS are widely used to support safe transfusion practice. LIMS have the potential to reduce the risk of laboratory error using algorithms, flags and alerts that support compliance with best practice guidelines and regulatory standards. Reporting to Serious Hazards of Transfusion (SHOT), the United Kingdom (UK) haemovigilance scheme, has identified cases where the LIMS could have prevented errors but did not. Shared care of patients across different organisations and the development of pathology networks has raised challenges relating to interoperability of IT systems both within, and between, organisations. A survey was distributed to all SHOT-reporting organisations to understand the current state of LIMS in the UK, prevalence of expertise in transfusion IT, and barriers to progress. Survey questions covered LIMS interoperability with other IT systems used in the healthcare setting. A variety of LIMS and version numbers are in use in transfusion laboratories, LIMS are not always updated due to resource constraints. Respondents identified interoperability and improved functionality as the main requirements for transfusion safety. A nationally agreed set of minimum standards for transfusion LIMS is required for safe practice. Adequate resources, training and expertise should be provided to support the effective use and timely updates of LIMS. A single LIMS solution should be in place for transfusion laboratories working within a network and interoperability with other systems should be explored to further improve practice.

Assessment of awareness about safe blood transfusion practices among nurses in a tertiary care center in North Kerala

Assessment of awareness about safe blood transfusion practices among nurses in a tertiary care center in North Kerala

Is your blood bag safe for transfusion? Bacterial screening of donor blood and its components: An essential infection control tool for safe transfusion practice

Introduction: Transfusion-associated bacterial sepsis is still a major public health concern that has received little attention. Data on bacterial contamination of blood are scarce, despite rising demand for blood transfusions. Blood bags intended for transfusion should be free of microorganisms. Aim: The aim of the study was to assess the prevalence, identify the microorganisms involved in bacterial contamination of donor blood and blood components and determine blood products most likely to be contaminated, received in microbiology laboratory for sterility testing. Settings and Design: The study was carried out in the department of microbiology in association with the transfusion medicine department of tertiary care hospital in Western Uttar Pradesh from January 2023 to June 2023. Methodology: A total of 87 cellular blood components were tested aerobically for bacterial contamination using the BD BACTEC™ FX 40 automated culture system. For incubation, culture vials that showed positive signals were subcultured onto a set of solid media followed by bacterial identification and antimicrobial susceptibility testing. Results: The overall prevalence rate was 14.9% (whole blood 18.75%, platelets 14.2%, packed cells 13.3% and fresh frozen plasma 10.5%). The contaminants were Aeromonas hydrophila, Sphingomonas paucimobilis, Escherichia coli, Coagulase-negative Staphylococcus spp., Pseudomonas aeruginosa, Delftia acidovorans, and Candida albicans. Discussion: The bacterial contamination in blood products suggests the patient who receives blood products is at risk of developing infection. Implementing proper blood transfusion policies, donor screening and technical staff training will all help to reduce the contamination rate of blood and blood components. Conclusion: Bacterial contamination of blood bags indicates a potential risk of healthcare-associated infection. Microbiological Sterility testing for donor blood bags in blood banks should be used as mandatory infection control Tool for Quality assurance.

Immunohematology Red Cell Serology Testing Reference Laboratory

Immunohematology reference laboratory (IRL) is defined as a fully equipped advanced laboratory that receives samples from various parts of the country for workup. This is a specialized center, where other centers experiencing difficulty in resolving immunohematological tests, refer samples for further workup and resolution. To complete the workup process, ABO RhD typing, antibody screening, identification (ID), antigen phenotyping, and direct antiglobulin tests are performed. In our retrospective observational study 528 cases, worked up from October 2019 to March 2022 were included. The prevalence of alloimmunization found in this evaluation was 68.1%. Among the different alloantibodies, anti-D was most common followed by anti-E and anti-M. In our study, most of the autoantibodies were of Immunoglobulin G (IgG) class (79.31%). Out of the 528 samples, ABO discrepancy was found in 48 samples (9%). Of these, none belonged to Group I or Group III discrepancy types. Group II discrepancies were noted in 28 cases (58.3%) and Group IV discrepancies were found in 20 cases (41.6%). Our study clearly indicates that there is an important role of IRL which is not only limited to ID of alloantibodies or resolution of ABO discrepancies but also supports all the hospitals and transfusion centers in the region by providing phenotype-matched or compatible units and advice for safe transfusion practices.

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.

Analysis of discard of blood components and strategies for optimal and safe transfusion practices at a tertiary care hospital blood bank

Blood transfusion service is lifeline of health care system. Blood is a valuable resource so it should be utilized judiciously with minimal wastage. Seropositive donors not only construct some threat of Transfusion-transmissible infections (TTI) such as HIV, HBV and HCV in blood recipient, they also increase the discard in blood bank. This study was conducted to determine discard rate of different blood components, identifying different causes of discarding the blood and its components and to hit upon different approaches to optimize the use of blood. A retrospective cross-sectional study was conducted at the blood bank of tertiary care hospital from September 2015 to October 2021. All collected Blood units were screened for five infections - HIV, HBV, HCV, Syphilis and Malaria and blood units were discarded as per NACO guideline. During study period a total of 8695 donors were donated the blood and screened for TTIs. From all donations, 201(2.31%) were females donors and 8494(97.69%) were males donors. A total 172 seropositive donors were identified among 8695 donors with an overall seroprevalence of 1.98%.

Type I ABO discrepancy due to missing antibody attributable to anti-snake venom in two patients: A rare presentation

ABO discrepancy is encountered when there is a mismatch between the forward (red cell) and reverse (serum) typing. Discrepancies may arise due to various factors such as clerical/technical errors, age, the underlying disease condition and on-going treatment. It is extremely important to resolve the cases of ABO discrepancy to ensure safe transfusion practices [1]. Here we report two cases of missing antibody attributable to administration of anti-snake venom (ASV) for management of snake bite in two patients.

Whole Blood Donor Deferral Causes and Evaluation in Tertiary Care Centre

Introduction: Blood donor deferral means that an individual is not eligible to donate blood or blood components based on the criteria used to protect the health and safety of both donors and transfusion recipient. A prospective donor may be deferred at any point during the collection and testing process. This step is important in ensuring safe transfusion practices to the recipients and the health of the donor, This is a study to categorise the deferrals according to the reasons and to delineate the causes for deferral among the whole blood donors. Methodology: This was a descriptive cross sectional study performed at Department of transfusion medicine at Kamineni academy of medical sciences and research centre at LB nagar, Hyderabad .This study was performed from January 2018 to December 2020. The various reasons for deferral of the whole blood donors from the donations were collected from the donor deferral registry. Results: The donor deferral rates for the years 2018, 2019, 2020 were 8.3%, 7.9% and 4.3% respectively, out of the total donations the highest deferral rate was among the female population the common reason being anemia, the other causes for deferral being alcohol consumption and tattooing and medical causes. Conclusion: We observe from this study that the maximum number of deferrals among the female population were and the cause is preexisting anemia, it is important to advice and counsel the donors before the blood donation to avoid adverse reactions among the donors as well as the recipients, awareness programs and donor motivation programs must be implemented.

Patient blood management and the Covid-19 Pandemic: An institutional study

Introduction: The COVID-19 pandemic in India is part of the worldwide pandemic of coronavirus disease 2019 (COVID-19). Despite no convincing evidence that this virus can be transfusion-transmitted, the absolute disruption we have seen in everyday life has dramatically reduced the amount of blood donations. Applying the Patient Blood Management (PBM) method is very useful. It is the scientific use of safe and effective medical and surgical techniques designed to prevent anemia and decrease bleeding to improve patient outcomes. PBM conserves a precious community resource, reduces unnecessary hospital and patient care costs, improves patient safety by minimizing exposure to blood, can reduce the risk of hospital-acquired complications and infections, and increases the consumer interest in safety. Efforts to correct anemia in the general population, as well as the imple­mentation of safe blood drive protocols, must be in place to mitigate the risk of viral exposure. This study aimed to assess the indications and requirements of blood and blood products in Covid-19 cases and to develop safe transfusion practices concerning PBM during the Covid-19 pandemic. Methods: This observational study was done in the Blood Bank RLJ Hospital Department of Pathology attached to Sri Devaraj Urs Medical College &amp; Hospital. The records of all COVID-19 positive patient's including their history, blood and blood component utilization from the medical record section, as well as the blood bank and requisition forms sent to a laboratory for investigation and collected over a duration of 6 months (March 2020 to August 2020). Results: Out of 200 COVID-19 positive cases analyzed, only 70 (35%) patients received a blood transfusion, in which 64.28 % (45) patients received single unit PRBCs because of severe anemia and pregnancy-related anemia. Additionally, 25.7% (18) patients received a platelet transfusion because of underlying comorbidities, and 10% (7) received FFP. In all COVID-19 positive patients, we observed a raised ESR. A few patients had raised PT and APTT levels. Patients with mild and moderate anemia presented with microcytic hypochromic anemia and normocytic normochromic anemia. We adopted the Cleveland clinic blood management for low hemoglobin to avoid unnecessary blood transfusions. Conclusion: PBM was found to be an important interventional tool to meet the shortage of blood during the COVID-19 pandemic successfully. An evidence-based emergency blood management plan and flexible regulatory policy should be ready to deal with any disaster and to respond quickly in the case of a blood shortage. While pandemics may reduce the blood supply, our study demonstrated that hospitalized COVID-19 patients had a low level of blood usage. Future studies examining the impact of patient factors may help to further elucidate the mechanisms affecting blood utilization in hospitalized COVID-19 populations.