Transfusion Medicine Research Articles

Frequency of Rh and Kell antigens among blood donors: A retrospective analysis from a tertiary care center in Eastern India

Objectives: The phenotyping of Rh and Kell antigens plays a major role in preventing alloimmunization and adverse events in multi-transfused patients. This study tries to highlight the frequency of Rh and Kell antigens among the blood donors who donated blood at a tertiary care center located in Eastern India. Material and Methods: The study was conducted in the Department of Transfusion Medicine and Blood Bank of All India Institute of Medical Sciences, Patna, from January 2021 to March 2023 on 10,032 whole blood donors of blood groups A, B, O, and AB by column agglutination technique using gel cards for blood grouping and phenotyping. Results: A total of 10,032 whole blood donors of groups A, B, O, and AB were included in the study. The frequency of “D” antigen was 95.77% (n = 9,608), “C” was 90.47% (n = 9,076), “c” was 50.47% (n = 5,063), “E” was 15.9% (n = 1,595), “e” was 99% (n = 9,932), and “K” was 2.67% (n = 268). “c” antigen frequency was 45.81–49.48% in RhD positive blood groups and 100% in all the RhD negative blood groups while “C” antigen frequency was 92.04–94.68% in RhD positive blood groups, and 4–24.13% in RhD negative blood groups. Conclusion: Since pre-transfusion phenotyping in multi-transfusion patients is not routinely practiced, transfusion of at least Rh and Kell phenotyped donor red cells can lead to a great decrease in the risk of alloimmunization and adverse events related to transfusion.

Role of Transfusion Medicine Specialist in Stem Cell Transplant: Experience in Bangladesh

Over the years, the field that was once known as blood banking has evolved into the discipline of Transfusion Medicine. Transfusion Medicine has become a broad, multidisciplinary field which include various facets of clinical medicine. Transfusion medicine specialist plays a vital role in the supportive care of patients undergoing stem cell transplantation, with a spectrum of applications including peripheral blood stem cell collection, graft manipulation, cryopreservation, donor lymphocyte infusions and evaluation of immunohematological issues in ABO and RhD mismatched and other transplant situations.
 Pulse Vol.15, 2023 P: 34-37

Researchers’ views on and practices of knowledge translation: an international survey of transfusion medicine researchers

BackgroundHealth research is often driven by the desire to improve the care and health of the community; however, the translation of research evidence into policy and practice is not guaranteed. Knowledge translation (KT) activities, such as dissemination and end-user engagement by researchers, are important to achieving this goal. This study examined researchers’ views on and practices of KT in the field of transfusion medicine.MethodsAn anonymous, cross-sectional survey was distributed to transfusion medicine researchers in May 2022 by emailing corresponding authors of papers in four major blood journals, emailing grant recipients, posting on social media, and through international blood operator networks. Comparative analyses were conducted for career stage, work setting, research type, and KT training.ResultsThe final sample included 117 researchers from 33 countries. Most participants reported that research translation was important (86%) and felt it was their responsibility (69%). Fewer than half felt they had the skills to translate their research (45%) or knew which strategies to employ (45%). When examining how research findings are shared, most reported using diffusion activities (86%), including publishing in peer-reviewed journals (74%), or presenting at academic conferences (72%). Fewer used dissemination methods (60%), such as developing educational materials (29%) or writing plain language summaries (30%). Greater use of tailored dissemination strategies was seen among researchers with KT training, whilst traditional diffusion strategies were used more by those working in an academic setting. Most participants had engaged end-users in their research (72%), primarily to consult on a research component (47%) or to involve them in the research process (45%). End-user engagement was greater among researchers with established careers, working in both academic and applied settings, and with KT training.ConclusionsWhilst participating researchers acknowledged the importance of KT, they typically focused on traditional diffusion strategies. This is despite well-established knowledge of the limited impact of these strategies in achieving KT. Those with KT training were more likely to use tailored dissemination strategies and engage end-users in their research. This demonstrates the value of sharing knowledge from the KT field with health researchers to facilitate KT.

Inulin Can Improve Red Blood Cell Cryopreservation by Promoting Vitrification, Stabilizing Cell Membranes, and Inhibiting Ice Recrystallization.

In transfusion medicine, the cryopreservation of red blood cells (RBCs) is of major importance. The organic solvent glycerol (Gly) is considered the current gold-standard cryoprotectant (CPA) for RBC cryopreservation, but the deglycerolization procedure is complex and time-consuming, resulting in severe hemolysis. Therefore, it remains a research hotspot to find biocompatible and effective novel CPAs. Herein, the natural and biocompatible inulin, a polysaccharide, was first employed as a CPA for RBC cryopreservation. The presence of inulin could improve the thawed RBC recovery from 11.83 ± 1.40 to 81.86 ± 0.37%. It was found that inulin could promote vitrification because of its relatively high viscosity and glass transition temperature (Tg'), thus reducing the damage during cryopreservation. Inulin possessed membrane stability, which also had beneficial effects on RBC recovery. Moreover, inulin could inhibit the mechanical damage induced by ice recrystallization during thawing. After cryopreservation, the RBC properties were maintained normally. Mathematical modeling analysis was adopted to compare the performance of inulin, Gly, and hydroxyethyl starch (HES) in cryopreservation, and inulin presented the best efficiency. This work provides a promising CPA for RBC cryopreservation and may be beneficial for transfusion therapy in the clinic.

An Assessment of the Viability of Haematological and Haemostatic Parameters of Blood under certain Storage Conditions at the Rivers State University Teaching Hospital Blood Bank in Port Harcourt, Nigeria

Introduction: Despite significant advances in transfusion medicine, concerns about the inherent risks of blood transfusion persist, even under optimal temperature and duration of storage. This makes the evaluation of blood viability a global task (1). Maintenance of adequate temperature is considered a key factor in the viability and quality of stored blood in healthcare institutions. Evaluating the haematological and haemostatic functionality of blood elements at different storage temperature and duration is therefore imperative for improving patient care and resource utilization in Rivers State University Teaching Hospital (RSUTH) blood bank in Port Harcourt.
 Methods: In this cohort study design, a total of sixteen (16) male and female blood donors in equal proportion of sex and ABO blood groups were randomly selected from the Port Harcourt blood donors' population and recruited as study subjects for this research. A well-structured questionnaire and the immunoassays were used to assess the donors' health and serological status respectively. Also the sample obtained were analayzed by automation and data statistically analyzed using ANOVA.
 Results: The results of this study shows a statistically significant decrease in white blood cell count from 4.93×109/L ± 0.33 to 2.79×109/L ± 1.68 (p=0.00) and platelet count from 227.38×109/L ± 32.17 to 153.75×109/L ± 58.39 (p=0.00) at day 7. Also, a significant decrease in platelet count from 227.38×109/L ± 32.17 to 141.50±60.92 at day 14. A significant decrease in Fibrinogen from 340.75mg/L±18.69 to 281.2575 mg/L ±46.41 at day 1 and day 14 respectively, and rise in PT and aPTT from 17.02s ±1.28 to 24.31s ±6.67 and 41.25s±3.23 to 46.63s±6.28 at day 14th to day 21 respectively (p=0.00).
 Conclusion and Implications for Translation: Pooled plasma at 4-60C contain clinically significant amount of coagulation factors up to day 21 in storage. The WBC and platelet is lost within seven day of storage at 4-60C. Lower temperatures, especially freezing at -60°C accelerate the loss of haematological viability of blood especially the depletion of white blood cells and platelets (p=0.00). Antihaemophilic factor and fibrinogen is maintained in FFP at 180 day in storage at -600C.

Managing sickle cell disease and related complications in pregnancy: results of an international Delphi panel

AbstractData to guide evidence-based management of pregnant people with sickle cell disease (SCD) are limited. This international Delphi panel aimed to identify consensus among multidisciplinary experts for SCD management during pregnancy. The 2-round Delphi process used questionnaires exploring 7 topics (antenatal care, hydroxyurea use, transfusion, prevention of complications, treatment of complications, delivery and follow-up, and bottlenecks and knowledge gaps) developed by a steering committee. Thirteen panelists (hematologists, physiologists, obstetricians, maternal fetal medicine, and transfusion medicine physicians) from the United States, the United Kingdom, Turkey, and France completed the first survey; 12 panelists completed the second round. Anonymized responses were collected and summarized by a contract research organization (Akkodis Belgium). Consensus and strong consensus were predefined as 75% to 90% (9-10 of 12) and >90% (≥11 of 12) of panelists, respectively, agreeing or disagreeing on a response to a predefined clinical scenario or statement. In several areas of SCD management, consensus was achieved: experts recommended performing at least monthly multidisciplinary antenatal follow-up, administering prophylactic aspirin for preeclampsia prevention between gestational weeks 12 and 36, initiating prophylactic transfusion therapy in certain cases, or choosing automated red blood cell exchange over other transfusion methods for patients with iron overload or severe acute chest syndrome. No consensus was reached on several topics including the prophylactic aspirin dose, indications for starting infection prophylaxis, routine use of prophylactic transfusions, or use of prophylactic transfusions for preventing fetal complications. These recommendations could inform clinical care for patients with SCD who are pregnant in the absence of large clinical trials involving this population; the identified knowledge gaps can orient future research.

Impact of Anti-M on Grouping and Cross Matching: The Challenges Faced in Three Cases

Anti-M, a frequently encountered antibody of the MNS blood group system, is commonly regarded as a naturally occurring saline agglutinin that can occasionally exhibit clinically significant behaviour. Particularly when reactive at 37°C or during the antiglobulin phase, it can complicate pretransfusion testing and patient management in the blood bank. Three distinct cases (2 males. 1 female) in varying clinical scenarios, ranging from surgery to acute coronary syndrome, are described. The present cases presented discrepancies in blood grouping and compatibility testing, highlighting the challenges posed by the presence of Anti-M antibodies that react at or above room temperature and during the antiglobulin phase, thus defying the usual expectations. It is imperative to provide antigen-negative red cells and those that are compatible by an Indirect Antiglobulin Test (IAT) when Anti-M is reactive at 37°C to ensure safe transfusion. Hence, there is a need to underscore the potential clinical implications in transfusion medicine, as well as the nuances of detecting, identifying, and managing the presence of Anti-M antibodies in patients requiring transfusion.

Blood Banking Capacity in Low-and Middle-Income Countries: Covid-19 Convalescent Plasma in Context.

Blood transfusion capacity in low- and middle-income countries (LMICs), encompassing both the safety and adequacy of the blood supply, is limited. The challenges facing blood banks in LMICs include regulatory oversight, blood donor selection, collection procedures, laboratory testing, and post-transfusion surveillance. A high proportion of LMICs are unable to fully meet clinical demands for blood products, and many do not meet even the minimum threshold of collection (10 units per 1000 population). Suboptimal clinical transfusion practices, in large part due to a lack of training in transfusion medicine, contribute to blood wastage. During the COVID-19 pandemic, high- and LMICs alike experienced blood shortages, in large part due to quarantine and containment measures that impeded donor mobility. COVID-19 convalescent plasma (CCP) was particularly appealing for the treatment of patients with COVID-19 in LMICs, as it is a relatively inexpensive intervention and makes use of the existing blood collection infrastructure. Nonetheless, the challenges of using CCP in LMICs need to be contextualized among broad concerns surrounding blood safety and availability. Specifically, reliance on first time, family replacement and paid donors, coupled with deficient infectious disease testing and quality oversight, increase the risk of transfusion transmitted infections from CCP in LMICs. Furthermore, many LMICs are unable to meet general transfusion needs; therefore, CCP collection also risked exacerbation of pervasive blood shortages.

A comparative study to assess diagnostic efficacy of micro typing gel technique versus conventional tube technique in blood cross-match in blood bank at a tertiary care hospital

Abstract: BACKGROUND: In transfusion medicine, cross-matching and compatibility are determined using the conventional tube approach. The goal of the current study is to compare the microtyping gel approach to the conventional tube method for studying blood cross-match. OBJECTIVES: The objective of the study was to assess the compatibility of donor’s blood with recipient blood by microtyping gel technique and conventional tube technique and comparison of advantages and disadvantages of the two techniques. MATERIALS AND METHODS: This observational, cross-sectional study investigation was carried out in a tertiary care facility’s blood bank for 1½ years. It was decided to compare the effectiveness of the traditional tube and gel techniques. RESULTS: In the current investigation, we evaluated the age of the study participants and found that the majority of the study participants were male (63.17%) and most of them were between the ages of 21 and 40 years. The men-to-women ratio in this study was 1.71:1. About 2300 blood samples were subjected to compatibility testing using both the traditional test tube technology and the microtyping gel technology. The conventional method and the gel card approach are equivalent in terms of sensitivity and specificity. However, the gel card approach is simple to use, quick, reliable, and allows for the recording of data. The spin saline tube approach, in comparison, takes longer and produces unreliable results. This makes the gel card approach preferable to the conventional method. The findings were examined. CONCLUSIONS: Although the conventional tube technology is still regarded as the gold standard for pretransfusion analysis, it nevertheless has several drawbacks and relies on the precise hand–eye coordination of the laboratory staff. We advise using the microtyping gel approach due to its ease of use, stability of outcomes, dispensing of controls and absence of washing process, and equivalent specificity and sensitivity.

Clinical Utilisation of Cryoprecipitate at a Tertiary Care Centre in Telangana, India: A Quasi-experimental Study

Introduction: Cryoprecipitate is a slushy product derived from Fresh Frozen Plasma (FFP) through centrifugation at specific temperatures and speeds. It is rich in factor VIII or antihaemorrhagic factor, fibrinogen, and minor amounts of other clotting factors. Cryoprecipitate is primarily used to correct hypofibrinogenaemia or replenish depleted fibrinogen levels. Aim: To examine the appropriate clinical utilisation of cryoprecipitate (cryo) by various departments in the Institute and evaluate the improvement in patients through laboratory tests. Materials and Methods: A single group quasi-experimental study was conducted in the Department of Immunohaematology and Transfusion Medicine (IHBT) at Nizam’s Institute of Medical Sciences (NIMS), Hyderabad, Telangana, India. The duration of the study was over a period of six years, from May 2016 to April 2022.. A total of 486 cases where cryoprecipitate was requested were included in the present study. The results were analysed using Prothrombin Time (PT) and International Normalised Ratio (INR). Percentages and means were used to assess various parameters in this study. All statistical analyses were performed using Statistical Package for Social Sciences (SPSS) version 25.0. Results: The mean age of the study participants was 52.7 years. A total of 486 cases were included over a period of six years, with 3375 cryoprecipitate transfusions performed. The youngest patient was a 9-year-old male, the oldest patient was an 83-year-old male. Most of the cryoprecipitate was appropriately utilised by the Medical Oncology Department (995 cases, 995 units, 20-25 mL per unit-29.48%), while the Cardiology Department had the lowest utilisation (12 cases, 12 units-0.35%). Utilisation by other departments ranged between 45 and 564 cases or units (1.33% to 16.71% per department). The majority of cryoprecipitate units were issued for multiple myeloma and acute leukaemias (new cases and relapse)-28.38% (958 units), while the least were issued for minor surgery and medical cases (29 cases or 29 units- 0.85%). Conclusion: Cryoprecipitate should be used appropriately to achieve desired results and avoid unnecessary transmission. Clinicians, residents, and surgeons should adhere to comprehensive regulatory guidelines for the appropriate usage of cryoprecipitate or any other blood products, as outlined by their hospital transfusion committee.

Blood Group Discrepancy in a Donor Due to a Rare Ax/Aweak Subgroup Phenotype with ABO*AW.31.01/*O.01.75 Genotype

ABSTRACT The most crucial blood group system in transfusion medicine is still the ABO system. Any unresolved discrepancy could result in the patient receiving blood that is incompatible and could trigger acute intravascular hemolysis. ABO subgroups are one of the astounding differences in blood grouping. The amount of A and B antigens carried by red blood cells and present in secretion varies depending on the ABO subgroup phenotype. Clinically, A1 and A2 are the two most frequently observed subtypes. Many weaker A subgroups have been described, including A3, Axe, am, and el. This example involves an Indian male donor who was initially misclassified as a Group O individual before being identified as an Ax/Aweak subgroup phenotypically. The next-generation sequencing defined the genotype of this case as ABO*AW.31.01/*O.01.75.

Seropositivity and Trends of Transfusion Section Transmitted Infections among Blood Donors: Five Years Cross-sectional Study on 20,392 Blood Donors in a Tertiary Care Hospital of Ahmedabad, Gujarat, India

Introduction: Blood transfusion is a lifesaving intervention. However, it can also be a source of Transfusion-transmissible Infections (TTIs), posing a potential threat to the recipient. Testing for TTIs before blood transfusion is crucial for the safety of recipients. However, donations occurring during the window period, the prevalence of asymptomatic carriers, viral strains with high genetic variability, and technical errors are responsible for TTIs and remain one of the greatest obstacles in transfusion medicine to deal with. All blood donors are to be screened against five major infections-Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), Syphilis, and Malaria. Aim: To study the seroprevalence and trends of TTI among healthy blood donors at the Blood Centre of Ahmedabad, Gujarat, India. Materials and Methods: A cross-sectional study was carried out by reviewing blood donors’ records over a period of five years from January 1, 2018, to December 31, 2022, at the Blood Centre, Department of Pathology, of Sheth L.G. General Hospital, Maninagar, Ahmedabad, Gujarat, India. The data collected for each seropositive donor included the results of TTI testing, the age group of donors, the type of donation, the frequency of donation, and co-infection. The results were expressed in numbers and percentages. Results: Among a total of 20,392 healthy blood donors during the five-year period, the total number of seropositive cases (n) was 243 (1.19%). TTI seropositive donors in years 2018, 2019, 2020, 2021, and 2022 were 60 (1.29%), 50 (1.16%), 39 (1.22%), 45 (1.14%), and 49 (1.16%), respectively. A maximum of 118 (48.56%) seropositive donors were recorded in age group of 18-29 years. Individual seropositive donors during the fiveyear period for HIV, HBV, HCV, syphilis, and malaria were 19 (0.09%), 155 (0.76%), 28 (0.14%), 41 (0.20%), and 00 (0.00%), respectively. Voluntary Blood Donors (VBD) 10,933 (53.61%) exceeded Replacement Donors (RD) 9,459 (46.39%), and repeat blood donors 14,462 (70.92%) surpassed first-time donors 5,930 (29.08%). The seroprevalence of TTI among replacement, voluntary, first-time, and repeat blood donors was 2.41%, 0.14%, 2.06% and 0.84% respectively. Out of 243 seroreactive donors, two donors (0.82%) showed dual reactivity for TTI during the five-year period. Conclusion: Implementation of strict donor selection criteria, utilisation of sensitive screening modalities, promoting public awareness, and dispelling myths regarding the merits of voluntary blood donation, judicious use of blood products, and mass immunisation for Hepatitis B infection are essential interventions needed to curb TTI to a significant extent.

Integrating Artificial Intelligence into the Practice of Transfusion Medicine

Integrating Artificial Intelligence into the Practice of Transfusion Medicine

Blood Donor Counselling, Notification, and Referral: Experience from a Tertiary Care Hospital of North India

ABSTRACT Background and Objectives: The concept of blood donor notification and counseling has gained recognition as an essential component of blood safety and donor care. By examining the effectiveness, feasibility, and acceptability of this intervention, valuable insights can be gained to inform future improvements in practices in the region and around the globe. Methods: This retrospective study was conducted at department of transfusion medicine on 18197 consecutive whole blood & component donors who visited the blood Centre between April 2018 and January 2023. The intervention involved the implementation of a blood donor notification and counseling system. Result: 178 donors were reactive in the study period with prevalence rate of (0.9%).112 (62.9%) donors out of 178 seroreactive donors could be contacted telephonically from the blood Centre. These are called as notified donors. Remaining 66 seroreactive donors could not be contacted. 39 donors out of 178 seroreactive donors were responders and remaining 139 donors were non-responders. Conclusion: This study highlights the significance of an efficient and comprehensive donor referral and notification system in ensuring the safety of blood transfusions but still lot of ground work needs to be done. Effective communication, personalized counseling, and continuous education form pillars of this process. The prevalence of transfusion-transmissible infections among blood donors further emphasizes the need for prompt action and appropriate referral for further evaluation and care.

Seroprevalence of Transmisive Diseases in Healthy Blood Donors: a Five-year Experience in University Clinical Center Tuzla.

The safety of blood products is the most important task of transfusion medicine. Transfusion-transmitted diseases represent a serious public health problem throughout the world, although their percentage of transmission is minimal. Each blood donation is individually tested with serological and molecular tests for the presence of hepatitis B and C viruses, human immunodeficiency virus (HIV), and Treponema Pallidum, regardless of the number of blood donations. To determine the seroprevalence of blood-borne diseases in healthy blood donors at the University Clinical Center Tuzla, to analyze the possible causes of transmission of these diseases, and to compare with the results of research in countries in the region and beyond. The research was conducted retrospectively in the period January 1, 2018. until 31.12.2022. years. Samples of blood donors were tested for hepatitis B surface antigen (HBsAg), antibodies to human immunodeficiency virus (HIV1/2), antibodies to hepatitis C and syphilis, using the fourth generation ELISA method. The highest frequency of transmisive disease markers was reactivity to HBsAg with a total of 63.7% of cases and a prevalence of 0.13%, and the lowest for HIV with a total of 1.4% and a prevalence of 0.003%. Bosnia and Herzegovina has a very low seroprevalence but there is still a risk of disease transmission in the population.

Новые нормативно-правовые аспекты медицинского применения крови и (или) ее компонентов в организациях здравоохранения

This article analyzes the instructions approved by the Resolution of the Ministry of Health of the Republic of Belarus on May 19, 2023 No. 92 “On approval of the Instructions on the procedure for the medical use of blood and (or) its components in healthcare organizations”, in comparison with the Instructions for use approved by the Ministry of Health of the Republic of Belarus from December 1, 2003 No. 118–1103 “Transfusion of donor blood and its components.” New aspects of the rationale for transfusion therapy, additions to the indications and contraindications for blood transfusion, its components, changes in laboratory diagnostics and transfusion techniques, based on the achievements and capabilities of modern transfusion medicine, are reflected.

Estimation of ABO Anti-A and Anti-B Agglutinin Titers among Blood Donors at a Tertiary Care Referral Teaching Hospital Blood Centre in Southern India: A Cross-sectional Study

Introduction: Transfusion of blood Group O and its components with high ABO antibody titers to non O recipients has been shown to cause acute transfusion reactions, especially in platelet transfusions, as platelets contain significant amounts of ABO antigen on their surface as well as Anti-ABO alloisogglutinins in plasma. Aim: To estimate the ABO Anti-A and Anti-B agglutinin titers among blood donors at a tertiary care referral teaching hospital blood centre. Materials and Methods: This cross-sectional observational study was conducted at the Immunohaematology laboratory of the Department of Transfusion Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India, from March 2021 to June 2022. All blood donors presenting to the blood centre were screened for eligibility for blood donation. Donors who fulfilled the eligibility criteria as per the Drugs and Cosmetics Act, 1940, and Rules, 1945 were included. Anti-A and Anti-B titers were determined by the conventional tube method with dilutions of 1 in 2, 1 in 4, 1 in 8, 1 in 16, 1 in 32, 1 in 64, 1 in 128, 1 in 256, 1 in 512, and 1 in 1024. A titer of <64 was considered as a low titer, while a titer of >64 was considered as a high titer. Results: A total of 399 donors were included in the study, with 393 (98.5%) being males and 6 (1.5%) being females. The mean age of the study population was 28.49 years. Among blood group A, the percentage of individuals with an IgM anti-B titer of <64 was 85.44% (88) and >64 was 14.56% (15), whereas in blood group B, IgM anti-A titers of <64 were 65.5% (93) and >64 were 34.5% (49). In blood group O, the percentage of individuals with <64 and >64 titers of IgM anti-A were 52.60% (81) and 47.40% (73), respectively, whereas for anti-B, <64 and >64 titers were 77.92% (120) and 22.08% (34), respectively. Conclusion: It is recommended that a database be maintained in all institutes by estimating antibody titers for every A, B, O blood group donors. Whole blood or platelets from group O donors with IgM Anti-A and Anti-B antibody titers <64 can only be transfused across the ABO barrier. As the majority of group A donors had titers <64, group A platelets may be transfused across the ABO barrier in emergency situations.

Separation of platelets by size in a microfluidic device based on controlled incremental filtration.

The significant biological and functional differences between small and large platelets suggested by recent studies could have profound implications for transfusion medicine. However, investigating the relationship between platelet size and function is challenging because separating platelets by size without affecting their properties is difficult. A standard approach is centrifugation, but it inevitably leads to premature activation and aggregation of separated platelets. This paper describes the development and validation of a microfluidic device based on controlled incremental filtration (CIF) for separating platelets by size without the cell damage and usability limitations associated with centrifugation. Platelet samples derived from whole blood were used to evaluate the dependence of the CIF device separation performance on design parameters and flow rate, and to compare the properties of PLT fractions generated by the CIF device with those produced using a centrifugation protocol in a split-sample study. This was accomplished by quantifying the platelet size distribution, mean platelet volume (MPV), platelet-large cell ratio (P-LCR) and platelet activation before and after processing for all input and output samples. The 'large platelet' fractions produced by the CIF device and the centrifugation protocol were essentially equivalent (no significant difference in MPV and P-LCR). Platelets in the 'small platelet' fraction produced by the CIF device were significantly smaller than those produced by centrifugation (lower MPV and P-LCR). This was because the CIF 'small platelet' fraction was contaminated by much fewer large platelets (∼2-times lower recovery of >12 fL platelets) and retained the smallest platelets that were discarded by the centrifugation protocol. There was no significant difference in platelet activation between the two methods. However, centrifugation required a substantial amount of additional anticoagulant to prevent platelet aggregation during pelleting. Unlike centrifugation, the CIF device offered continuous, flow-through, single-step processing that did not cause platelet aggregation. Such a capability has the potential to accelerate the basic studies of the relationship between platelet size and function, and ultimately improve transfusion practice, particularly in the pediatric setting, where the need for low-volume, high-quality platelet transfusions is most urgent.

S.O.S. – Save our supplies: Understanding reasons to tackle the challenge of wasted returned blood products

ObjectivesTo evaluate the return of blood components across different hospital areas, reasons for the same and suggest preventive strategies which might reduce out of controlled temperature storage (CTS) blood logistics and wastage. Material and methodsA retrospective audit was carried out in the department of Transfusion Medicine from January 2019 to December 2022. Data related to returned blood components was compiled using departmental records and blood centre software entries. ResultsA total of 218 instances of returned components were noted and the total number of components returned were 442 (0.4% of all issued components) (38.4% (170) packed red blood cells, 16.2% (72) single donor cryoprecipitate concentrate, 19.6% (87) platelet concentrate and 25.5% (113) fresh frozen plasma). Components were returned back within 30 mins in only 27% (59/218) of all instances . Wards followed by high dependency units/intensive care units were noted to have the highest number of instances (86 (39.4%) and 69 (31.6%) respectively) with emergency department having the least,comprising 19 instances (8.7%). 77.9% (170/218) instances were observed for routine transfusion requests and 44.5% (97/218) of all instances could have been prevented by an appropriate clinical status assessment of the patient. ConclusionStakeholders such as clinicians, transfusion laboratory professional and nursing staff must take consolidated efforts to eliminate wastage of blood components. Instances of returned blood components can be targeted by the hospital quality team as a quality improvement project.

Prevalence and Characterisation of Irregular RBC Antibodies in Antenatal Females from a Tertiary Care Center in Northern India: A Cross-sectional Study

Introduction: Haemolytic Disease of the Foetus and Newborn (HDFN) is widely known to be caused by the presence of irregular Red Blood Cell (RBC) antibodies in pregnant females. To prevent HDFN, it is crucial to identify these antibodies in pregnant women. Aim: To evaluate the prevalence of irregular red cell antibodies in pregnant women in a tertiary care hospital. Materials and Methods: A cross-sectional retrospective study was conducted in the Department of Transfusion Medicine at Indraprastha Apollo New Delhi, from November 2009 to December 2017. A total of 8,217 prenatal females were examined for irregular red cell antibodies. Antibody screening and blood grouping were performed. The Capture-R ready screen was used to confirm screen-positive tests. Adsorption, elution, and other advanced techniques were utilised as needed. Data was collected from patient records and entered into a Microsoft excel spreadsheet. The statistical analysis was conducted using Statistical Package for Social Sciences (SPSS) software version 14.0 (USA). Statistical tests, including the Chi-squared and Fisher’s exact test, were performed, with a p-value less than 0.05 considered statistically significant. Results: Out of the 8,217 prenatal females examined, 105 (1.27%) had positive screening results with the four cell panel. Red cell alloimmunisation was observed in groups that were RhD negative (n=93/105; 88.57%) and positive (n=12/105; 11.42%). The most prevalent alloantibody among RhD negative individuals was alloantibody anti-D (n= 83/93; 89.24%), followed by alloantibody anti C+ anti D (n=13/93; 13.97%). Anti-D was the most prevalent alloantibody overall (n=83/105; 79.04%). Conclusion: Alloimmunisation rates were notably high among women lacking the Rh D antigen. Individuals with a history of adverse obstetric outcomes showed a statistically significant association with alloimmunisation. Therefore, it is recommended to screen such individuals for alloantibodies to enable early detection and improve the management of HDFN.