Transfused Research Articles

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

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

Intravenous Injection of Tranexamic Acid in Patients with Pelvis or Acetabulum Fractures to Reduce Blood Loss: A Double-Blind, Randomized, Controlled Trial

Background: Despite their low incidence, pelvis and acetabular fractures have a high mortality rate due to extensive hemorrhage. Tranexamic acid (TXA) is an antifibrinolytic drug that inhibits the production of plasminogen. The aim of the current study is to evaluate the safety and efficacy of TXA use for blood loss reduction and the need for blood transfusion in patients with fractures of the pelvis or acetabulum.
 Methods: 108 patients were recruited from two tertiary care hospitals and assigned evenly either to the intervention (TXA) or the control group. TXA group received 15 mg/kg TXA 30 minutes before the fracture reduction and fixation surgery. The number of transfused blood units before, during, and after the surgery was recorded. Blood loss was assessed by calculation of estimated blood loss (EBL), collected blood with drain, collected blood with suction, and weight of the used gauzes during the surgery. The time between fracture occurrence and the surgery, the duration of the surgery, and the days of admission were assessed.
 Results: The mean age was 39.49 ± 15.81 years, and 69.4% were women. 6 patients had pelvic, and 102 patients had acetabulum fractures. The duration of the surgery was not significantly different. The time gap between the reconstructive surgery and fracture occurrence was significantly higher in the TXA group (P = 0.032). The mean postoperative hospitalization time was significantly lower among TXA group patients (P = 0.037). The mean hemoglobin (Hb) in the TXA group was significantly higher, postoperatively (P = 0.028). The mean EBL, the blood volume collected by suction or drain, the weight of the consumed gauze during the surgery, and the number oftransfused blood units were significantly lower in the TXA group. The transfusion rate was significantly lower in patients with a shorter time gap between fracture occurrence and reduction surgery (P = 0.021).
 Conclusion: TXA can decrease blood loss, the transfused blood units during and after the operation, and hospital admission days. Moreover, it did not increase the chance of pulmonary thromboembolism (PTE) or deep vein thrombosis (DVT) in the patients receiving TXA; thus, it can be assumed as a safe and efficient drug in patients with acetabulum or pelvis fractures.

Haemolytic transfusion reactions caused by non-ABO red cell antibodies reported to the Norwegian Haemovigilance System 2004-2020.

The aim of this study was to analyse the reports received in the Norwegian Haemovigilance System from 2004 to 2020 on acute and delayed haemolytic transfusion reactions caused by non-ABO red cell antibodies. Antibody specificity, clinical symptoms and outcomes were included when available. After transfusion of 3.7 million red cell concentrates, reports on 78 cases of haemolytic transfusion reactions caused by non-ABO red cell antibodies were received, corresponding to an incidence of 1 in 47,000 transfused red cell concentrates. There were 30 acute and 48 delayed haemolytic transfusion reactions. A total of 113 red cell antibodies were found: 82 alloantibodies, 6 autoantibodies and 25 cases where the antibody specificity could not be determined. Two fatalities occurred: one caused by anti-Wra and one caused by an unidentified red cell antibody. The most frequently reported antibody specificities were those in the Rh and Kidd blood group systems, representing 24% and 14%, respectively, of all the antibodies identified. In six cases, errors occurred, leading to the issuing of blood units without the required phenotype match. Despite the possible underreporting, the low number of serious haemolytic transfusion reactions reflects an adequate pre-transfusion practice by the Norwegian blood banks.

Tacrolimus-Associated Terminal Ileitis After Kidney Transplantation, Mimicking Crohn Disease: A Case Report

The onset of gastroduodenal ulcers is a frequent complication after transplantation, whereas cases of intestinal ulcers are sporadic and poorly described in the literature. A patient on immunosuppressive therapy with tacrolimus and mycophenolate mofetil after kidney transplant for immunoglobulin A-related glomerulonephritis developed symptoms compatible with Crohn disease 7 months after the transplant. The patient was hospitalized for abdominal pain, diarrhea, fever, and weight loss. Imaging and a colonoscopy showed signs of idiopathic inflammatory bowel disease (IBD) affecting the terminal ileum. Behcet's disease, post-transplant lymphoma, cytomegalovirus, Epstein-Barr virus, or mycobacteria infection were excluded. Mycophenolate mofetil was suspended, and steroid therapy was increased without clinical improvement. Eleven units of blood were required for severe anemia. A further colonoscopy revealed ulcerations involving the cecal fundus, ileocecal valve, and distal ileum with bowel stenosis and suspected ischemia. The patient, therefore, underwent an emergency laparoscopic ileocolic resection. The histologic examination did not reveal clear signs of IBD, ischemia, or viral infection of the ileum. The findings seemed indicative of iatrogenic damage from immunosuppressive therapy. The postoperative course was regular, and after 12 months, the patient was asymptomatic, on low-dose tacrolimus and prednisone therapy. During immunosuppressive therapy, the onset of isolated ileal ulcers, which can mimic IBD, may be a sporadic complication.

Blood consumption in the Role 2 setting: A Department of Defense Trauma Registry analysis.

The Role 2 setting represents the most far-forward military treatment facility with limited surgical and holding capabilities. There are limited data to guide recommendations on blood product utilization at the Role 2. We describe the consumption of blood products in this setting. We analyzed data from 2007 to 2023 from the Department of Defense Trauma Registry (DODTR) that received care at a Role 2. We used descriptive and inferential statistics to characterize the volumes of blood products consumed in this setting. We also performed a secondary analysis of US military, Coalition, and US contractor personnel. Within our initial cohort analysis of 15,581 encounters, 17% (2636) received at least one unit of PRBCs or whole blood, of which 11% received a submassive transfusion, 4% received a massive transfusion, and 1% received a supermassive transfusion. There were 6402 encounters that met inclusion for our secondary analysis. With this group, 5% received a submassive transfusion, 2% received a massive transfusion, and 1% received a supermassive transfusion. We described volumes of blood products consumed at the Role 2 during recent conflicts. The maximum number of units consumed among survivors exceeds currently recommended available blood supply. Our findings suggest that rapid resupply and cold-stored chain demands may be higher than anticipated in future conflicts.

Choice of Entry Point Does Not Affect Clinical and Radiological Outcomes in Antegrade Intra-medullary Nailing in Patients with Shaft of Femur Fracture: A Prospective Randomized Controlled Trial.

The choice of entry point, Greater trochanter (GT), or Piriformis entry (PE) for antegrade intramedullary nailing (IMN) of the femur is crucial. This study was performed to compare these two entry points in the patients with shaft of femur fractures regarding intra-operative parameters, radiological and functional outcomes. Twenty-four patients underwent GT entry nailing, while 25 patients underwent PE nailing. Surgical time, Intra-operative blood units transfused, Intra-operative fluoroscopy exposure by number of C-arm shots taken, mean drop in hemoglobin, and incidence of iatrogenic fracture were recorded. Patients were followed up at 4weeks, 6weeks, and 6months to look for radiological healing and improvements in functional outcome using Modified Harris Hip Score (MHHS). MRI of bilateral hips with pelvis was done in 25 patients at 6months of follow-up to detect any preliminary signs of AVN. The mean drop in hemoglobin in the GT group was significantly lesser than the PE group (p = 0.02). Mean MHHS at 4weeks post-op was also significantly higher in the GT group (p = 0.01). There was no significant difference between both the groups regarding surgical duration, fluoroscopy exposure, radiological and functional outcomes in the long term. None of the patients who underwent MRI displayed any preliminary sign of AVN. GT entry nails lead to lesser surgical time, fluoroscopy exposure, and intra-operative blood loss. Both the nailing systems achieve excellent fracture unions and comparable functional outcomes in the long term, and there is a minuscule risk of AVN in adult patients undergoing IMN.

Prevalence and pattern of blood and blood component utilization at the Kenyatta National Hospital maternity unit in 2022-2023: A cross-sectional study

Background: Blood and blood component transfusion plays a pivotal lifesaving role. Adequate amounts significantly reduce maternal morbidity and mortality. This study aimed to assess the prevalence and pattern of blood and blood component utilization among women managed at the Kenyatta National Hospital (KNH) maternity unit in 2022-2023. Methods: This was a cross-sectional study targeting women admitted to the KNH maternity unit. Participants were recruited through consecutive sampling. A data abstraction chart was used for data collection. The study variables included proportions of patients who required blood or blood components, indications for transfusion, number of units availed against those requested, and outcomes of the participants. To determine the prevalence of transfusion, the proportion of participants who received blood or blood components was calculated over the admissions. To determine the percentage per indication for transfusion, a particular indication was calculated over the total number of indications and expressed in percentages, and the need was calculated as the total need per blood request generated. Continuous data were analyzed for mean and standard deviation. Frequencies and percentages were calculated for variables with categorical data. Results: Among 5567 admissions, 344 participants who needed blood and blood components were sampled over 7 months from October 2022. This represented a prevalence of 6.2%. Of this prevalence, cesarean deliveries made up 3%, SVD 1.4%, and miscarriages accounted for 0.5% among others. Postpartum hemorrhage was the most common indication (34.5%), with 65.4% of participants having their need for blood/blood components met. The deficit in blood units ordered was 12.4%. The majority (98%) were discharged home. While mortality was recorded at 2%. Conclusion: The prevalence of blood/blood components transfusion was 6.2%. Postpartum hemorrhage remains the most common indication for blood transfusion. The need for blood and its components remains unmet both for the number of units and the type of component.

Inadvertent prolapse of a huge cervical fibroid mimicking acute uterine inversion: A case report

Prolapse of cervical fibroid is a rare but life threatening occurrence. This complication may occur early in some patients while in others it may follow complications like constipation, difficulty in micturition to mention a few. A 47 +o year old Para o lady presented to the Accident and Emergency Unit of our hospital with a two(2) day history of a huge mass protruding per vagina and a history of significant bleeding per vagina. Packed Cell Volume was 19% on admission and she had Four(4) units of blood transfused. She subsequently had examination under general anaesthesia and cervical myomectomy was done. Her Post Operative clinical state was satisfactory.

Frequency and Risk Factors of Surgical Site Infection among Sudanese Patients with Oral Squamous Cell Carcinoma.

In Sudan, patients with oral squamous cell carcinoma (OSCC) presented lately in advanced stages. Surgical site infection (SSI) is one of the most common complications of surgical treatment of OSCC which significantly affects the clinical outcomes. The present study aimed to assess the frequency and risk factors of postoperative surgical site infection among OSCC patients underwent surgery at Khartoum Teaching Dental Hospital (KTDH). This is a prospective, analytical, hospital-based study conducted at KTDH during the period from 2022 to 2023. Patients with OSCC were surgically treated and assessed carefully for the development of the SSI. Sixty patients were enrolled in the present study. Twenty-nine (48.3%) patients were above 61 years, with the predominance of males with 42 (70%) patients. The most involved site of OSCC was the lower gingivolabial region in 35 (39.3%) patients. Forty-seven (78%) patients were in advanced stages III and IV. Forty-five (80%) patients had modified radical neck dissection. Blood transfusion was administered in 50 (83.3%) patients. Twenty-six (43.4%) patients developed SSI; 15 (57.7%) patients of them were Toombak dippers. Development of SSI was found to be significantly associated with the tumour site (P value 0.9), clinical stage (P value 0.6), the number of transfused blood units (P value 0.04), and the duration of hospital stay (P value 0.04). In contrast, use of sutures for wound closure was associated with a reduced risk of developing SSI (P value 0.005). Surgical site infection was found in 43.4% of the OSCC patients. It was associated with advanced clinical stage and tumour site. Minimizing the number of blood units transfused intraoperatively, we decrease the duration of hospital stay and the use of sutures for wound closure decreases the risk of SSI significantly.

Rare combination of alloantibodies causing hemolytic disease of the newborn – Challenge for identification

Abstract Hemolytic disease of the newborn (HDN) refers to the destruction of the fetal and newborn red cells by maternal red cell antibodies specific for paternally inherited antigens on fetal red cells or erythroid precursors.[1] ABO-incompatibility is the most common cause of HDN. Rh-negative mothers can be alloimmunized with Rh-positive fetus. Prophylactic Rh immunoglobulin use has greatly reduced the HDN due to Rh incompatibility. Alloimmunization can also occur due to other clinically significant minor blood group antigens such as E, c, C, k, KP(a), Js(a), Js(b), Jk(a), Jk(b), Fy(a), Fy(b), S, s, and U. Multiple alloantibodies in mothers’ blood can pose a difficult challenge for identification and finding compatible blood for exchange transfusion. We report a case of HDN due to multiple antibodies and a rare combination of anti-c and anti-Jkb, challenges associated with the identification, confirmation, and finding of compatible blood units.

Suppression of B-Cell Activation by Human Cord Blood-Derived Stem Cells (CB-SCs) through the Galectin-9-Dependent Mechanism.

We developed the Stem Cell Educator therapy among multiple clinical trials based on the immune modulations of multipotent cord blood-derived stem cells (CB-SCs) on different compartments of immune cells, such as T cells and monocytes/macrophages, in type 1 diabetes and other autoimmune diseases. However, the effects of CB-SCs on the B cells remained unclear. To better understand the molecular mechanisms underlying the immune education of CB-SCs, we explored the modulations of CB-SCs on human B cells. CB-SCs were isolated from human cord blood units and confirmed by flow cytometry with different markers for their purity. B cells were purified by using anti-CD19 immunomagnetic beads from human peripheral blood mononuclear cells (PBMCs). Next, the activated B cells were treated in the presence or absence of coculture with CB-SCs for 7 days before undergoing flow cytometry analysis of phenotypic changes with different markers. Reverse transcription-polymerase chain reaction (RT-PCR) was utilized to evaluate the levels of galectin expressions on CB-SCs with or without treatment of activated B cells in order to find the key galectin that was contributing to the B-cell modulation. Flow cytometry demonstrated that the proliferation of activated B cells was markedly suppressed in the presence of CB-SCs, leading to the downregulation of immunoglobulin production from the activated B cells. Phenotypic analysis revealed that treatment with CB-SCs increased the percentage of IgD+CD27- naïve B cells, but decreased the percentage of IgD-CD27+ switched B cells. The transwell assay showed that the immune suppression of CB-SCs on B cells was dependent on the galectin-9 molecule, as confirmed by the blocking experiment with the anti-galectin-9 monoclonal antibody. Mechanistic studies demonstrated that both calcium levels of cytoplasm and mitochondria were downregulated after the treatment with CB-SCs, causing the decline in mitochondrial membrane potential in the activated B cells. Western blot exhibited that the levels of phosphorylated Akt and Erk1/2 signaling proteins in the activated B cells were also markedly reduced in the presence of CB-SCs. CB-SCs displayed multiple immune modulations on B cells through the galectin-9-mediated mechanism and calcium flux/Akt/Erk1/2 signaling pathways. The data advance our current understanding of the molecular mechanisms underlying the Stem Cell Educator therapy to treat autoimmune diseases in clinics.

Code Heat: Integrating a New Rapid Response in a Blood and Marrow Transplant (BMT) Unit for Febrile Neutropenia Patients to Decrease Time to Antibiotic Administration

Code Heat: Integrating a New Rapid Response in a Blood and Marrow Transplant (BMT) Unit for Febrile Neutropenia Patients to Decrease Time to Antibiotic Administration

Evaluating Mortality Outcomes, Transfusion Characteristics, and Risk Factors Associated With Cirrhotic Trauma Patients Undergoing Emergency Laparotomy Versus Non-Operative Management: A National Analysis.

Patients with liver cirrhosis (LC) demonstrate significantly elevated mortality rates following a traumatic event. This study aims to examine and compare the clinical outcomes in adult trauma patients with pre-existing LC undergoing laparotomy or non-operative management (NOM). Additionally, the study aims to investigate various patient outcomes, including mortality rate based on transfusion needs and timing. This retrospective cohort study utilized the American College of Surgeons Trauma Quality Program Participant Use File (ACS-TQIP-PUF) 2017-21 to compare laparotomy vs NOM in adults (≥18years) with pre-existing LC who presented to trauma facilities with isolated blunt solid organ abdominal injuries (Injury Severity Score ≥16, Abbreviated Injury Scale solid organ abdomen ≥3). Among 929 patients, 38.2% underwent laparotomy, while 61.7% received NOM. The in-hospital mortality rate was lower for patients who received NOM (52.3% vs 20.0%, P < .01). The risk of in-hospital mortality was significantly associated with laparotomy (OR 5.22, 95% CI: 2.06-13.18, P < .01) and sepsis (OR 99.50, 95% CI: 6.99-1415.28, P < .01). On average an increase in blood units in 4 hours was observed among those who experienced an in-hospital mortality (OR 5.65, 95% CI: 3.05-8.24, P < .01) and those who underwent laparotomy (OR 3.85, 95% CI: 1.36-6.34, P < .01). Trauma patients with moderate to severe isolated organ injury and Liver cirrhosis had significantly higher mortality rates, acute renal failure, whole blood units received, as well as longer ICU-LOS when undergoing laparotomy compared to non-operative management.

The effect of transfusion on survival in head and neck cancer after free tissue reconstruction.

To examine if perioperative blood transfusion affects overall survival (OS) and recurrence-free survival (RFS) in head and neck cancer patients who undergo free tissue reconstruction. Retrospective cohort study. The medical records of free tissue flaps between 2007 and 2010 were reviewed. Differences in demographics and clinical factors based on the level of transfused packed red blood cells (PRBC) were examined using chi-squared tests, Kruskal-Wallis tests, and/or ANOVA tests. Survival time was compared using a Cox proportional hazard model. Data were available for 183 patients. Patients who had PRBC transfusion significantly differed from the non-transfused group by flap type, flap with bone, Charlson Comorbidity Index (CCI), and hemoglobin and hematocrit. When stratified into three groups based on units of PRBC; flap type, flap with bone, CCI, preoperative hemoglobin, and hematocrit were found to differ significantly. The 2-year Kaplan-Meier plot demonstrated improved OS for those who did not receive any PRBC transfusion. The use of more than 3 units of blood decreased 2-year OS significantly when compared to the non-transfused group. Finally, after adjusting for CCI using a Cox proportional hazard model, survival was significantly affected by CCI. After controlling for patient age, oncologic stage, cancer subsite, histology, type of free flap, vascularized bone-containing flap, recurrence type, CCI, and preoperative hemoglobin and hematocrit, patients who received 3 or more units of PRBC in the perioperative period had significantly decreased OS. RFS did not differ between the transfused versus non-transfused groups. Level 4.

Comportamiento de la urgencia ginecológica durante la pandemia de COVID-19

Introduction: The COVID-19 pandemic has meant a decrease in gynecological visits to the emergency department. Objective: To characterize the attending in the gynecological emergency service, evaluating the amount of admissions, hospitalizations, need for surgical intervention, morbidity factors, among others, compared to the pre-pandemic situation. Method: A non-concurrent cohort study of hospitalized patients was carried out through a spontaneous attending to the gynecological emergency service between weeks 12 and 28 of 2019 and 2020 at the Hospital Clinico of the Pontificia Universidad Catolica, in Santiago (Chile). Different morbidity factors were measured: admission diagnosis, surgical intervention, surgical complication, hospital stay, admission hemoglobin, and need for transfusion of blood units. Results: A total of 511 visitors to the emergency service were registered between weeks 12 and 28 of 2019, compared to 196 in 2020. In 2019 and 2020, 103 and 72 women were hospitalized respectively (odds ratio [OR]: 2.3). Admission for pregnancy loss decreased (24 vs. 12;p = 0.01), while admission for postmenopausal bleeding increased (9 vs. 22;p = 0.01). There was no change in the surgical interventions performed (86.4% vs. 84.7%;p = 0.7). The hospital stays increased (2.3 vs. 3.1;p < 0.0001) and the need for blood transfusion (2 vs. 7;p = 0.02;OR: 5.4;confidence interval: 1.09-26). Conclusions: The COVID-19 pandemic caused a decrease in spontaneous attending for gynecological pathology at the emergency service, causing an increase in the attend/admission ratio and greater morbidity in hospitalized patients characterized by a greater need for blood transfusion and an increase on the hospital stay. © 2021 Sociedad Chilena de Obstetricia y Ginecologia.

Blood Component Usage and Discard in the Blood Centre of a Tertiary Care Hospital in a Remote Part of North-east India: A Cross-sectional Study

Introduction: Blood and its various components are valuable resources for sustaining life. They are routinely used and form an integral part of patient care. The judicious use of blood and its components is necessary in low socio-economic countries. Aim: To estimate the usage of blood and blood components and its discard in a tertiary care hospital. Materials and Methods: A hospital-based retrospective cross- sectional study was conducted in the Blood Centre, Diphu Medical College and Hospital, Karbi Anglong, Assam, India. Data was retrieved from Blood Centre registers over a period of 12 month, from July 2021 to June 2022. Both replacement and voluntary donors were selected based on donor selection criteria. All collected blood units were stored and subsequently subjected to Transfusion Transmitted Infections (TTI) testing. The data was tabulated using Microsoft Excel sheet. Results: During the study period, a total of 4,525 units of whole blood were collected, and 7,539 blood units, including both whole blood and blood components, were prepared. The highest number of issues during the period comprised of whole blood at 2,468 units. Among blood components, 1,854 units of Packed Red Blood Cells (PRBCs) were most commonly utilised, followed by 1,824 units of Fresh Frozen Plasma (FFP). A total of 334 units (4.43%) of blood/ blood components were discarded due to various reasons, with the highest discard rate observed for Platelet Concentrates (PC) at 71 (6.28%) units. The major reason for discard was seropositivity, accounting for 212 (63.5%) units. Conclusion: Adequate blood inventory, along with proper training and sensitisation of hospital staff, should be conducted at timely intervals regarding proper donor selection, collection, and storage of blood/ blood products. Clinicians should also be engaged to optimise the usage of blood/ blood products. These steps can help minimise wastage in resource limited countries.

Unexpected cause of upper gastrointestinal bleeding: beyond the typical complications of gallstone disease.

An 88-year-old man presented with haematemesis with haemodynamic stability requiring transfusion of 5 units of blood. Physical examination was unremarkable. Upper endoscopy identified a fistulous opening in the proximal second part of the duodenum (D2) with an oozing bleed and blood clots. A computed tomography (CT)-angiogram revealed a 18mm cystic artery pseudoaneurysm next to a fistulous communication between the gallbladder and D2, allowing the passage of a large stone (Bouveret syndrome). The patient successfully underwent emergent arterial embolization guided by a clip endoscopically-placed near the duodenal fistulous orifice. There were no intercurrences or bleeding recurrence.

The Prevalence of Transfusion-Transmitted Infections and Nucleic Acid Testing Among Blood Donors in Makkah, Saudi Arabia.

Despite saving a vast number of lives through blood transfusions, transfusion-transmitted infections (TTIs) still threaten the lives of people needing blood transfusion. Hence, screening blood donors and reviewing the prevalence of TTIs amongst blood donors might show the impact of these infections among our people. The aim of this study was to evaluate the prevalence rates of transfusion-transmitted infections among blood donors in Makkah as foundation for providing harmless blood transfusion in Makkah, Saudi Arabia. A retrospective study was carried out at the Central Blood Bank in Makkah city, Saudi Arabia, from January 1, 2023, to December 31, 2023. A total of 13,706 samples were collected and screened for hepatitis B surface antigen (HBsAg), hepatitis B surface antibodies (HBsAbs), hepatitis B core antibodies (HBcAbs), antibodies to hepatitis C virus (anti-HCV), antibodies to HIV 1 and 2 (HIV I/II Ab), antibodies to HTLV 1 and 2 (HTLV I/II Ab), Malarial antibodies, and antibodies to VDRL. A total of 13,706 blood units were received and tested. Out of the total, 52% were non-Saudi donors and 47.9% were Saudi donors; 28.4% were aged 18 - 28 years, 42.8% were aged 29 - 39 years, 24.4% were aged 40 - 50 years, and 4.4% were aged 51 - 60 years. The majority was O+ blood group (42.7%), followed by A+ (26.2%), B+ (18.7%), AB+ (4.6%), O- (3.8%), A- (2.1%), B- (1.5%), and AB- (0.4%). While 42.6% of the blood units donated were from voluntary donors, 57.4% were donated by replacement donors. Sixty-one samples (0.4%) tested positive for HBsAg, 824 samples (6%) for HBcAb, 43 samples (0.3%) for HCV antibodies, 754 samples (5.5%) for HBsAb, and 44 samples (0.3%) for HIV I/II Ag/Ab combinations. Further, 44 samples (0.3%) were positive for HTLV I/II antibodies, 83 samples (0.6%) for VDRL antibodies, and only 3 samples (nearly 0%) for malaria antibodies. Forty-three samples (0.3%) were positive for NAT-HBV, 7 samples (0.1%) were positive for NAT-HCV, and 6 samples (0.1%) were positive for NAT-HIV. The analysis revealed a statistically significant and strong correlation between HBsAgs and NAT-HBV (r = 0.819, p < 0.0001). In contrast, while there was a statistically significant association between HBsAgs and HBcAbs, the correlation was weak (r = 0.191, p < 0.0001). Additionally, there was an association between HBsAbs and HBsAgs, but the Spearman correlation indicated a very weak relationship (r = 0.042, p < 0.0001). Prevalence rates of transfusion-transmitted infections showed a steady decline in 2023, and these rates were much lower in Makkah than in other parts of the country or in neighboring countries. The importance of using NAT in the screening of blood donors was indicated in this study. These findings could contribute to improving the understanding of TTIs epidemiology and supporting health authorities in controlling blood-borne pathologies.

Molecular typing of Kell, Kidd, and Duffy antigens in direct antiglobulin test-positive autoimmune hemolytic anemia patients.

In autoimmune hemolytic anemia (AIHA) patients, conventional pretransfusion testing is difficult to interpret due to the presence of autoantibodies which may show panreactivity. Molecular phenotyping of red cell antigens could potentially be used to precisely match blood units, thereby reducing the need to perform intensive serologic laboratory testing, hence time delay in providing transfusion to such patients. The aim of this study is to perform the molecular typing for Kell, Kidd, and Duffy blood group antigens in direct antiglobulin test (DAT)-positive red blood cells of AIHA patients and provide corresponding antigen-matched blood for transfusion therapy. Blood samples from 50 normal blood donors and 30 DAT-positive AIHA patients were tested using standard serological techniques and polymerase chain reaction-based methods for Kell (K/k), Kidd (Jka/Jkb), and Duffy (Fya/Fyb) blood group systems. Five patients requiring blood transfusion were given donor blood units identical for Kell, Kidd, and Duffy antigens and followed up. Genotyping and phenotyping results were 100% concordant for normal blood donors. Serological phenotyping of minor red cell antigens showed varied degree of agglutination for AIHA patients. The molecular typing was able to detect the antigen frequency accurately in all samples. The results of genotyping were used to provide Kell-, Kidd-, and Duffy-matched blood for transfusion therapy to AIHA patients with no adverse reaction. Molecular blood group typing has proved immensely useful in the determination of actual antigen profile and hence in providing appropriate transfusion support in patients with AIHA reduced risk of transfusion reactions and alloimmunization.

Interesting case of uterine inversion-managed laparoscopically

Abstract 32-year-old unmarried woman presented with complaints of severe abdominal pain for 2 hours. The pain was sudden in origin, continuous in nature associated with giddiness and vomiting. She had got her menses a day prior , bleeding was heavy with passage of clots. She had menorrhagia for 5 months. On examination, pulse was 112 beats per minute, blood pressure was 100/60mmHg, severe pallor was present. On per vagina examination large fleshy mass was seen protruding in the vagina, cervix was not seen. On per vaginal examination, a globular mass was felt, while cervix could not be palpated separately. Uterine fundus was not palpable. A provisional diagnosis of Uterine inversion was made with a probable prolapsed fibroid or polyp. MRI pelvis confirmed the diagnosis. Her haemoglobin was 5 gm%, and coagulation profile was normal. On laparoscopy, uterine fundus was not visible, the fallopian tubes and ovaries seemed to be pulled into the vagina. Vasopressin was injected and incision was taken on posterior uterine wall (Haultain’s method ) to correct inversion. The uterine walls were slowly pulled upwards using tissue grasping forceps. The myoma was seen after incising the uterine walls. Myoma screw was used to completely enucleate the myoma from uterine bed. The bleeders in myoma bed were coagulated. Posterior uterine wall was sutured using barbed sutures. Bilateral round ligaments were plicated to provide additional strength. An adhesion barrier was placed over the sutured uterine wall to prevent adhesions. She received a total of 4 units of whole blood and 4 units of fresh frozen plasma. She was discharged on day 5 post surgery. Her post-operative course was uneventful. We are presenting this case due to its rare presentation in unmarried female and laparoscopic management of this case by Haultain’s method.