Aims & Objectives : 1) To evaluate the usage of plasma in a tertiary care hospital. 2) To evaluate reasons for inappropriate transfusion of plasma. Introduction: FFP contains plasma proteins and all the coagulation factors, including the labile factors V and VIII. There exist only a few firm indications for fresh frozen plasma transfusions and there is a growing consensus that most of the time this blood product is used inappropriately and without any scientific rationale.FFP transfusion is always associated with risks like TRALI,HLA alloimmunisation, Allergic reaction, anaphylactic shock, TTI etc, so FFP should only be transfused when indicated and in adequate volume to achieve haemostasis so that its benefits of transfusion overweighs the hazards of transfusion. Materials & Method : The present study was a prospective study done between Jan 2014 to July 2014 in patients having requested for Fresh Frozen Plasma with or without other components in terms of appropriateness & inappropriateness. The guidelines for plasma transfusion were benchmarked on the basis of American Association of Blood Bank in terms of indication and adequate volumes for transfusion. Result: In this study 1594 units of FFP were used during study in 420 patients in 478 episodes in which in 185 episodes transfusion was appropriate and in 293 episodes transfusion was inappropriate. So appropriate requests were 38% while inappropriate requests were 62%, department of general Surgery and obstetric& gynaecology were the departments with maximum number of inappropriate requests. Conclusion: A continual system of staff education and administrative intervention by conducting regular departmental CME’s will be helpful to reduce inappropriate use in future by making other departments aware of appropriate usage of plasma so that unnecessary transfusion’s & hazards of plasma transfusions could be minimised & plasma usage would really benefit the patient.
Background & Objective: The high prevalence of HIV, HBV, HCV and syphilis has heightened the problems of blood safety in India. TTIs cause fatal, chronic and life-threatening disorders because of their prolonged viraemia and carrier or latent state. Serologic tests utilized routinely in the screening of blood donors, totally not guarantee the absence of these infections among blood donors. Methodology: Samples of HIV, HBsAg, HCV were tested by ELISA and samples of syphilis were tested by RPR method following manufacturer’s instructions. Results: Prevalence of HBV was highest within at the age groups 26-35 years, HCV within the age group between 36-45years, syphilis within the age group between 46-55 years and HIV between 26-35 years. The prevalence of hepatitis B and syphilis was higher among males as compared to females, while for hepatitis C and HIV, it was higher among females as compared to males. Conclusion: Availability of safe blood for transfusion can be achieved by vigorous screening of donors and donated blood. Screening of blood is now mandatory for many diseases and is undertaken routinely in blood banks. The prevalence of TTIs among the Indian blood donors is reported to be ranging as follows; HBV – 0.66% to 12%, HCV – 0.5% to 1.5%, HIV– 0.084% to 3.87%, and syphilis – 0.85% to 3% respectively. Hence strict selection of blood donors with stringent screening and safe methods of detection can minimise risk if TTI. [Shah M NJIRM 2016; 7(1):12-15]
Therapeutic Plasma Exchange (TPE) is performed effectively and safely in adult patients, but the use of TPE is limited in paediatric patients due to lack of universally accepted indications and technical challenges like establishment of adequate vascular access, low blood volume, increased incidence of adverse events during procedure and poor co-operation of patients during procedure. We present our experience of TPE in paediatric patients to assess the effectiveness and safety of TPE in paediatric patients.A total 122 TPE procedures were performed in 40 paediatric patients between 3 to 15 years of age group with Guillain Barre Syndrome (GBS). TPE procedures were performed on alternate days depending on the clinical condition of the patient. Patient's total blood volume was calculated as per Nadler's formula and processed through central double lumen catheter. 1-1.5 plasma volume was exchanged with normal saline and fresh frozen plasma.A total of 122 TPE procedures (with an average of three procedures per patient) were performed on 40 paediatric patients. More than three TPE procedures were performed in 29 patients, of which 27 patients showed improvement from grade-0 and grade-I to grade-III. One did not show any response and succumbed to the disease. Complications were observed in 14 patients which were well managed. Inadequate vascular access was most common complication observed in 11 patients.TPE in paediatric patients has been increasing and has been shown to be effective as first line or adjunctive therapy in selected diseases. It is safe procedure when volume shifts, calcium supplementation and venous access are taken care.
Partial phenotyping of voluntary blood donors has vital role in transfusion practice, population genetic study and in resolving legal issues. The Rh blood group is one of the most complex and highly immunogenic blood group known in humans. The Kell system, discovered in 1946, is the third most potent system at triggering hemolytic transfusion reactions and consists of 25 highly immunogenic antigens. Knowledge of Rh & Kell phenotypes in given population is relevant for better planning and management of blood bank; the main goal is to find compatible blood for patients needing multiple blood transfusions. The aim of this study was to evaluate the frequency of Rh & Kell phenotype of voluntary donors in Gujarat state.The present study was conducted by taking 5670 samples from random voluntary blood donors coming in blood donation camp. Written consent was taken for donor phenotyping. The antigen typing of donors was performed by Qwalys-3(manufacturer: Diagast) by using electromagnetic technology on Duolys plates.Out of 5670 donors, the most common Rh antigen observed in the study population was e (99.07%) followed by D (95.40%), C (88.77%), c (55.89%) and E (17.88%). The frequency of the Kell antigen (K) was 1.78 %.The antigen frequencies among blood donors from Gujarat were compared with those published for other Indian populations. The frequency of D antigen in our study (95.4%) and north Indian donors (93.6) was significantly higher than in the Caucasians (85%) and lower than in the Chinese (99%). The frequencies of C, c and E antigens were dissimilar to other ethnic groups while the 'e' antigen was present in high frequency in our study as also in the other ethnic groups. Kell antigen (K) was found in only 101 (1.78 %) donors out of 5670. Frequency of Kell antigen in Caucasian and Black populations is 9% & 2% respectively. The most common Kell phenotype was K-k+, not just in Indians (96.5%) but also in Caucasians (91%), Blacks (98%) and Chinese (100%).Phenotype and probable genotype showed wide range of variations in different races and religion. Reliable population based frequency data of Rh & Kell antigens has vital role in population genetic study, in resolving medico legal issues and in transfusion practice.
The aim of the blood transfusion service should be to provide effective blood and blood components, which are as safe as possible and adequate to meet patient's need. To achieve safe blood transfusion practice, many blood transfusion center in India follow routine type and screen protocol for all patient's and donor's blood samples to detect unexpected alloantibodies. The present study is aimed at assessing the frequency and type of unexpected red cell alloantibodies in general patient population and donors at a tertiary care teaching hospital in western India.In this prospective study, samples of patients as well as blood donors were processed for ABO and Rh "D" grouping as well as antibody screening with three cell screening panel on fully automated immunohematology analyzer. Positive sample in three cell screening panel was further evaluated for identification of specific alloantibody with eleven cell identification panel by column agglutination technique. Results were recorded, and data were analyzed to calculate the frequency of unexpected alloantibody.A total of 74,214 patient samples and 80,173 donor samples were processed for type and screen. Out of which, 512 patients and 11 donors were identified with alloantibody. Most common alloantibody found in the present study is anti-D (0.075%), followed by anti-E (0.041%), anti-c (0.021%), anti-K (0.0205%) in Rh and Kell blood group system.Antibody screening and identification of specific alloantibody help in identifying most appropriate blood unit that lacks the corresponding antigen and prevent alloimmunization.
Introduction and Aim-Objective: Regulatory authority and voluntary accreditation organization require particular records and documents to be maintained for the operation of the blood bank. It can be accomplished using blood bank data management (BDMS) software in a less labor-intensive manner as compared to manual methods provided that the technical staff is properly trained. Many of the near miss events could be prevented with the use of blood bank software ensuring better patient safety. Hemovigilance scheme though not yet well established in our country which requires robust data management and compilation can be easily retrieved from the software. We present below reports on the effectiveness of Blood Bank Data Management System in strengthening of Blood Transfusion Services. The main aim of the study was to compare computer software with traditional hand-written documents for record management and evaluate BDMS in prevention of near-miss events. Materials and Methods: A comparative study between record keeping by conventional registers and Blood bank Data Management System (BDMS) software was done for period of six months from September 2011 to February 2012. Each of the entry was duplicated in both during this study period. Each of the technicians using the software was asked to rate the user friendliness of the system using an objective method of scoring to prevent any bias. The time taken to enter each donor/patient data manually and on software was also compared. Results: All mandatory registers were electronically maintained. The time taken for the each register was significantly less by the software. The inventory of consumables was excellently managed. Also, the equipment records required to be maintained were available at the click of a mouse. 6 out of 15,220 samples were found to contain Wrong Blood In Tube (WBIT) based on traceability system of prior sample received of the same patient which could have been undetected with manual methods and 4 out of these 6 would have resulted in fatal Hemolytic Transfusion Reaction. Apart from this, two-way traceability of blood products was maintained. 30 out of 35 technicians rated the software as “Excellent” with respect to user friendliness. Conclusion: BDMS is a reinforcing tool in the data management and prevention of near miss events leading to improved safety in Blood transfusion Services.[Gajjar M et al NJIRM 2013; 4(3) : 66-69]
Guillain-Barré syndrome (GBS) is an autoimmune polyneuropathy causing acute flaccid paralysis and it is known to improve with plasmapheresis.To study effects of electrophysiological type of GBS, clinical variant of GBS and time taken for initiation of plasmapheresis on outcome of disease.50 consecutive patients of GBS attending tertiary care hospital underwent clinical examination and electrophysiological studies. Disability grade was calculated and patients were observed for full functional recovery for 6 months.In this study, patients in whom plasmapheresis was started within 7 days (n=39) were observed to have significantly better improvement in terms of smaller peak disability and rapid functional recovery compared to those in whom plasmapheresis was started after 7 days (n=11). (p<0.002). Demyelinating pattern on electrophysiology was observed to have better outcome in terms of all parameters compared to axonal. AIDP variant was observed to have best outcome and AMSAN variant was associated with worst outcome.Rapid institution of plasmapheresis is the most important outcome determining factor. Irrespective of the variant specific comorbidity, early plasmapheresis improves outcome in all parameters.
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