Abstract: AIM: The aim of the study was to demonstrate that ID-NAT is more sensitive and specific in HCV detection in dialysis patients than serological tests such as chemiluminescence. Second, to establish that ID-NAT results are more in concordance to gold standard RT-PCR compared to chemiluminescence. MATERIALS AND METHOD: A prospective observational single center study conducted in the Department of Transfusion Medicine and Immunohematology and Department of Nephrology, Indraprastha Apollo Hospital, New Delhi from September 2020 to December 2022. The blood samples from patients within inclusion criteria were run with chemiluminescence, ID-NAT and RT-PCR. Results were analyzed to determine the association between categorical variables and Cohen kappa values, to show the concordance between the gold standard and the ID-NAT and RT-PCR. RESULTS: The total number of subjects who participated in the study was n = 145 and were all Indians from neighboring states near to the institution. As reflected in the study results, among the 130 non-reactive results in CMIA, PCR showed 127 negative and 3 positive results. In similar manner, among 15 reactive results in CMIA, 13 were positive and 2 were negative in PCR (p value 0.001). In the present study, it was revealed that among the 129 non-reactive results in ID-NAT, 129 were negative in PCR ( P value <0.001). Prevalence of HCV among patients with ID-NAT was 11.03% (CI = 6.44% to 17.30%). Similarly, the agreement of chemiluminescence with RT-PCR revealed kappa value = 0.819, whereas ID-NAT showed kappa value = 1, thus showing superior concordance to said gold standard. CONCLUSION: The study results confirm that ID-NAT is a more efficient and reliable test method compared to serological tests such as chemiluminescence in detecting HCV cases in immunosilent cases or cases in the immune period.

Abstract: BACKGROUND: Total hip replacement (THR) is frequently associated with significant blood loss, often necessitating transfusions. Judicious transfusion practices are essential, especially in resource-limited settings. This study aimed to evaluate transfusion requirements and identify the perioperative predictors of transfusion in patients undergoing THR. MATERIALS AND METHODS: A retrospective observational study was conducted at a tertiary care center in Eastern India from January 2022 to December 2024. Data from 102 adult patients undergoing elective primary or revision THR were analyzed. Demographic, clinical, surgical, and transfusion-related parameters were compared between transfused and nontransfused groups. Statistical significance was set at P < 0.05. RESULTS: Of the 102 patients, 70.6% required red blood cell (RBC) transfusion. Transfused patients had significantly lower baseline hemoglobin (Hb; 9.13 ± 1.51 vs. 10.47 ± 1.59 g/dL, P < 0.001), greater intraoperative and postoperative blood loss, longer hospital stays, and higher American Society of Anesthesiologists physical status classification scores. General anesthesia use and presence of comorbidities were significantly associated with transfusion need, whereas spinal anesthesia and tranexamic acid (TXA) use were protective factors. A total of 225 blood components were used, primarily RBCs. CONCLUSION: A high transfusion rate was observed in THR patients, predominantly influenced by preoperative anemia, blood loss, comorbidities, and anesthesia type. TXA use and spinal anesthesia significantly reduced transfusion need. Optimizing Hb levels preoperatively, standardizing TXA use, and preferring spinal anesthesia could enhance blood conservation. These findings support the need for targeted blood management protocols in orthopedic surgeries in resource-limited settings.

Abstract BACKGROUND: Neutropenia, defined by a decreased neutrophil count, compromises the body’s ability to combat infections. Patients undergoing cytotoxic therapies or suffering from hematological malignancies often experience profound neutropenia. Although advancements in chemomobilization therapy and antimicrobial agents have lessened the reliance on granulocyte transfusions (GTXs), these transfusions remain a valuable therapeutic option for managing severe neutropenia, particularly in cases where other treatments fail to produce a sufficient response. MATERIALS AND METHODS: A retrospective and observational study was carried out at a tertiary care center to analyze the data from granulocyte harvests and transfusions performed between January 2022 and June 2024. Information was gathered on both the donors and the patients who received GTXs. RESULTS: A total of eight patients with febrile neutropenia received 23 GTXs, resulting in clinical improvement in five cases. The primary pathogens identified included Klebsiella pneumoniae, Escherichia coli, and Pseudomonas aeruginosa. GTXs led to a significant increase in total leukocyte count (TLC) and absolute neutrophil count, with a P < 0.05. Donor mobilization using steroids and granulocyte-colony stimulating factor effectively elevated donor TLC levels. However, the granulocyte harvest procedures were associated with a significant decrease in donor TLC, platelet count, hemoglobin, and hematocrit (P < 0.05). The apheresis process was generally well-tolerated, with minor donor adverse events. CONCLUSION: GTXs have the potential to improve neutrophil counts in patients with febrile neutropenia. However, their clinical effectiveness depends on multiple factors. Additional research is needed to explore the determinants of treatment response and to devise more effective approaches for managing this condition.

Abstract The anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a systemic disorder characterised by necrotising pauci-immune inflammation of small and medium blood vessels due to antibodies directed against leukocyte proteinase 3 (PR3-ANCA) and myeloperoxidase (MPO-ANCA). Diffuse Alveolar Haemorrhage (DAH) is a fatal complication of AAV. We report two cases of Granulomatosis with Polyangiitis (GPA) associated with DAH, which were managed with plasmapheresis. A 56-year-old rheumatoid arthritis female was referred with azotaemia, vomiting, abdominal discomfort, joint pains, dizziness, and hematemesis. Initial workup revealed azotaemia, microscopic haematuria, absolute neutrophilia, positive acute phase reactants, crescentic glomerulonephritis, DAH and PR3-ANCA positivity suggesting GPA. A 47-year-old diabetic male presented with chest pain, fever, joint pain, haemoptysis and shortness of breath. Initial examination revealed drowsy, difficult mobilisation, conjunctival haemorrhage, oral ulcers, reduced air entry, palpable purpura, pedal oedema and hypotension. Investigations revealed microcytic hypochromic anaemia, abnormal coagulation profile, azotaemia, and positive acute phase reactants. Bilateral lung infiltrates, DAH and PR3-ANCA positivity inferred GPA. Both patients were managed with antibiotics, pulse steroids, cyclophosphamide and plasmapheresis, conferring clinical and laboratorial improvement. This case report depicts the usefulness of plasmapheresis alongside immunosuppressants to manage patients of DAH associated with GPA.

Abstract INTRODUCTION: Although the soluble ABO substances (SAS) are present in various secretions, saliva is the richest and most available source. Not much literature exists or has been studied to see whether or how much conformance exists in individuals with regard to these secretions. Hence, in this study, we aimed to look for the conformance/agreement for the presence of these substances in plasma and saliva. MATERIALS AND METHODS: This was a cross-sectional study performed on 46 ABO donors in a tertiary care teaching hospital blood center in Southeastern India. The presence of SAS in plasma and saliva was ascertained using the standard hemagglutination inhibition tests. The presence of these substances was analyzed for agreement between them (plasma and saliva) and was ascertained by Kappa statistics. RESULTS: About 77% of the tested population in the study were secretors, as determined by the salivary secretor status. Only 45.7% (16/35) of those who had SAS in saliva also had them in plasma. There was fair agreement (κ = 0.3, P = 0.005) between the secretor status and the tests for secretor testing between the plasma and salivary secretion of SAS. CONCLUSION: Only about one-third of people who secrete soluble ABO substances in the saliva also secrete them in the plasma, as tested by hemagglutination inhibition test.

Abstract Identification of rare blood group phenotype is important as the incidence being very low and it is important to detect them in routine blood banking so that we can ensure safe and appropriate transfusion. A 48-year-old male blood donor, who has donated more than 10 times, donated whole blood at a blood donation camp conducted by a peripheral government hospital. His historic blood group was O Rh D Positive. The blood unit was transferred to our blood center. On performing routine ABO grouping and Rh typing, forward grouping showed the group as “Bombay O” Rh D positive, and reverse grouping was not found complimentary. Further testing confirmed that the donor’s blood group was Para-Bombay A (Ah) Rh D positive. The para-Bombay phenotype is very rare, and only a few cases have been reported in India. This blood group is characterized by the absence of A, B, and H antigens on red blood cells (RBCs) with the presence of ABH substances in secretions or by the weak expression of A, B, and H antigens on RBCs with the absence or presence of ABH substances in body secretions. This rare phenotype can be mislabeled as the “O” group if all detailed investigations are not performed.

Abstract Delayed hemolytic transfusion reaction (DHTR) represents a significant yet often underrecognized complication associated with blood transfusion. DHTR is characterized by the gradual destruction of transfused red blood cells, typically occurring days to weeks posttransfusion. As the demand for blood transfusions continues to rise, understanding the clinical implications of DHTR becomes increasingly crucial for healthcare providers. DHTR can lead to severe morbidity, affecting patient outcomes and prolonging hospital stays, thereby imposing additional burdens on healthcare systems. This case study presents a 52-year-old male who developed acute renal failure due to DHTR post-packed RBC (PRBC) transfusion, and a subsequent immunohematological workup revealed the presence of anti-Kidd (Jkb) antibodies. Laboratory tests showed a significant drop in hemoglobin levels, increased total bilirubin, elevated lactate dehydrogenase (LDH) levels, and an increased reticulocyte count. The patient’s post-transfusion Direct Antiglobulin Test (DAT) was positive, and further testing suspected the presence of anti-E, Lea, and anti-Jkb antibodies. Anti-Jkb antibodies were confirmed through an acid elution of DAT-positive cells. Further transfusion support for the patient was provided with Rh and Kidd “b” phenotype-matched B-positive PRBC, and no transfusion reactions were noted. He was discharged after improvement in his clinical condition and laboratory parameters. This case study shows that it is essential to identify and manage alloantibodies, especially in patients receiving multiple transfusions, to prevent severe hemolytic reactions and ensure patient safety.

Abstract BACKGROUND: Limiting the use of blood components to occasions when they are strictly required can minimize risks to patients due to transfusion, thereby conserving a limited resource and also contain cost. AIMS AND OBJECTIVES: In this study we aim to determine the effect of prospective monitoring of transfusion requests on the appropriate use of blood components. MATERIAL AND METHODS: This is a prospective interventional study performed at a tertiary care hospital based blood centre. Blood request forms were audited with respect to indications for transfusion and the clinical and laboratory parameters of the patient. Requisitions (N = 6000) were monitored by trained medical officer for compliance with institutional guidelines. The treating clinician was contacted for relevant discussion prior to processing the request. In case of disagreement, the original request was always honoured. Rate of inappropriate transfusion episodes after intervention were compared with those prior to the intervention. RESULTS: Requests for wrong dose/indication for FFP and platelets were the most common inappropriate practices noted. There was a significant reduction in the rates of inappropriate transfusion episodes (red cells 59% to 20% (P=0.002), platelets 40% to 15%(P=0.001), FFP 70% to 38%(P=0.002) and cryoprecipitate 30% to 18%(P=0.031). Acceptance of red cell units up to 7-10 days old increased by 48%. Acceptance of out-of-group platelet transfusions increased from nil to 31% (P=0.001). CONCLUSION: The retrospective audit was useful to identify the current patterns of blood usage and areas of improvement. Prospective monitoring of blood requisition forms was useful in reducing the rate of inappropriate transfusions.

Abstract Acute chest syndrome (ACS) is a severe complication of sickle cell disease (SCD) that demands prompt medical attention. Approximately one-fifth of patients with a history of ACS progress rapidly to respiratory failure within 24 h, often leading to multiorgan failure. A 23-year-old male with a history of SCD and multiple vaso-occlusive crises presented to the emergency department with fever, chest pain, and breathlessness. Diagnosed with SCD 8 years prior, he had been on hydroxyurea 500 mg daily but had discontinued the medication 3 months back. He was admitted to the intensive care unit for urgent management and placed on noninvasive ventilation. The chest X-ray revealed new right lung consolidation. As the clinical condition deteriorated, he was intubated and placed on mechanical ventilation in the prone position. Routine management included intravenous (IV) morphine, antibiotics, and IV fluids. The patient urgently required a transfusion of two packed red blood cell units due to a critically low hemoglobin level of 4.1 g/dl, followed by automated red cell exchange (RCE). Automated RCE improved the PaO2/FiO2 ratio, and prone ventilation was no longer necessitated. He was suspected of hemophagocytic lymphohistiocytosis due to fever, splenomegaly, hypertriglyceridemia, and hyperferritinemia. He was treated with therapeutic plasma exchange of 1.2 plasma volumes, followed by IV immunoglobulin. Hemodialysis was performed to treat acute kidney injury. His condition gradually improved, and he was extubated.

Abstract INTRODUCTION: The knowledge and attitude level of medical professionals is different at different phases of their careers. Since one size does not fit all and there were no questionnaires available specifically designed for the medical interns, we undertook this exercise to design one for them duly considering their curriculum, exposure, and the nature of work they are expected to do with regard to blood transfusion. METHODOLOGY: The questionnaire was designed, and the questions were framed considering the type of information that was required, themes and items for inclusion, appropriate wording for comprehension, layout, and presentation of questions by the nominal group technique of subject experts. Piloting of the questionnaire was done to check for feasibility, validation, and reliability. RESULTS: The questionnaire on pilot testing displayed acceptable feasibility with a difficulty rating of 63%. The precision of the questionnaire was indicated by reliability, with test–retest responses showing near-perfect agreement for all the questions with a kappa value between 0.8 and 0.99 (P = 0.008). The value of Cronbach’s alpha for the cumulative score of the test–retest of the pilot population (n = 11) was also good (α = 0.806). CONCLUSION: The questionnaire prepared for assessing the knowledge and attitudes of the interns was reliable and was validated with acceptable contents and repeatability. The procedure may be adopted easily by others who intend to prepare their questionnaire.