An analysis of the pattern of blood requisition and utilization in a tertiary care center.

Background: Blood utilization audit helps to formulate guidelines for improving transfusion practice in a health care centre. With increasing demand for blood components being unable to meet the supply particularly in developing countries, there is a need to implement strategies for rational use of blood and its components. The present study aims to evaluate the transfusion practices in a hospital based blood centre. Material and Methods: A retrospective audit was conducted on 1000 blood requisitions and 300 requisitions for fresh frozen plasma and platelets. The requisitions were reviewed for pre transfusion hematological values, utilization trends and appropriateness. Results: Out of 1000 requisitions, 67.8% were for packed red cells and 32.2% were for whole blood. Pre transfusion hemoglobin values were available for 11.1%. The urgency for transfusion and indication was mentioned on 18.1% of requisition forms. The maximum cross match to transfusion ratio was for Department of Obstetrics and Gynaecology. The blood utilization was 41.3%. Out of 300 requisitions for fresh frozen plasma/platelets, 67.33% were for fresh frozen plasma and 32.6% were for platelets. Only 25.66% of requisitions had prothrombin index/platelet count mentioned. Over ordering was seen in 37.33% of requisitions. Conclusion: Retrospective audits help to identify key areas that need interventions to change local guidelines for transfusion. There is need for regular audit to improve transfusion practices in a health care set up. A type and screen policy for routine surgeries and obstetric patients should be implemented to save valuable time and resources in developing countries.

Patterns of infections among blood donors in a tertiary care centre: A retrospective study.

Background. Transfusion-transmitted infections continue to be a threat to safe transfusion practices. We analysed the prevalence and patterns of co-infections among voluntary and replacement donors. Methods. Blood donations collected over a 5-year period were studied for the type of donation (voluntary or replacement), number of seroreactive cases and the number, type and distribution of co-infections. Results. Of the 42 439 units of blood collected over a 5- year period, 19 118 (45%) were from voluntary and 23 321 (55%) from replacement donors. There were 1603 seroreactive cases (3.8%). These included 250 with HIV (0.6%), 734 with hepatitis B surface antigen (HBsAg; 1.7%), 337 with hepatitis C virus (HCV; 0.8%) and 282 (0.7%) with VDRL (Venereal Diseases Research Laboratory) reactivity. Twenty-three (0.05%) of these had >2 seroreactive infections; 20 of these were in replacement donors and only 3 in voluntary donors and the difference was statistically significant (p<0.005). Among HIV seropositive donors, there were 4 seroreactive for syphilis and 5 for HBsAg. Among HIV seronegative donors, 5 were seroreactive for HBsAg and VDRL, 4 for HCV and VDRL, and 2 for HBsAg and HCV. One person was seroreactive for HIV, HBsAg and VDRL. The multiple infection rate showed a decreasing trend over the years. Conclusion. Multiple infections pose a small but definite risk to the recipients of blood products. Voluntary donations are safer as compared with replacement ones and need to be encouraged.

Bombay phenotype in two North Indian brothers: a case report.

Bombay phenotype is unique in the aspect that the red cells are not agglutinated by antisera A, B and H. However the serum of such individuals contains anti A, B and strongly reactive anti H which agglutinates red cells of 'O' group individuals through a wide thermal range. The blood specimen of a 35 year old male donor who donated blood for the first time was subjected to detailed cell and serum grouping. There was a discrepancy between the results. The possibility of Bombay phenotype was considered and the sample was tested with anti H lectin. Further confirmation of blood group and secretor status was done from a reference laboratory. Family studies showed the same blood group in the elder sibling of the propositus. The present case highlights the significance of correlating cell and serum grouping results. Moreover, this blood group is very rare in North India. Family studies revealed the propositus to possess the B gene which was suppressed in the donor but expressed in the offsprings. The use of anti H in discrepant blood grouping results is recommended.

Evaluation of iron stores in blood donors by serum ferritin.

BACKGROUND & OBJECTIVES: Regular blood donation can lead to pre-clinical iron deficiency as well as iron deficiency anaemia. There is a need to increase the national voluntary blood donation for safe blood supply. However, there is paucity of data in the country regarding impact of regular voluntary blood donation on iron status of donors. Hence, iron stores were evaluated by serum ferritin estimation in the voluntary blood donors at Chandigarh. METHODS: 400 voluntary blood donors included in the study were divided into four groups depending upon their periodicity of blood donations. Pre-donation haemoglobin assessment was done by copper sulphate method. Serum ferritin was estimated by indirect ELISA. RESULTS: The number of female donors with deficient iron stores was more as compared to male donors. First time donors had higher mean serum ferritin levels than that in repeat donors. The frequency of donations per year was more predictive of decreased iron stores rather than the number of lifetime donations. An increase in donation frequency was accompanied by a significant decrease in serum ferritin; values <15 microg/l were found in 21 and 46 per cent of male and female donors respectively who donated once per year, in 29 and 27 per cent in those who donated twice per year and in 49 and 100 per cent in those who donated thrice per year. INTERPRETATION & CONCLUSION: Haemoglobin estimation alone in regular blood donors may not be adequate; serum ferritin estimations may need to be done to detect pre-clinical iron deficiency states. Also, iron supplementation needs to be considered in regular, repeat voluntary blood donors.

Prevalence of anemia among school going adolescents of Chandigarh.

This study was conducted to assess the prevalence of anemia and determine serum ferritin status among 1120 apparently healthy adolescents (12 to 18 years) sampled from 11 city and 2 rural schools in Chandigarh. All the boys and the girls were subjected to anthropometric examination and hemoglobin estimation. The estimation of hemoglobin was done by cyanmethemoglobin method. Serum ferritin was estimated by ELISA (UB1 Magiwel enzyme immuno assay) method in 183 students. The overall prevalence of anemia calculated as per WHO Guidelines was significantly higher among girls (23.9%) as compared to boys (odds ratio--3.75, 95% CI--2.59 to 5.43, P < 0.01). Anemia was observed more in rural (25.4%) as compared to urban (14.2%) adolescents (OR--0.49, 95% CI--0.34 to 0.70, P < 0.01). Iron stores estimated by serum ferritin in 183 subjects were deficient in 81.7% and 41.6% of the adolescent girls and boys, respectively.

Solitary plasmacytoma of bone: fourteen years disease-free survival.

Solitary plasmacytomas are rare tumors of plasma cell origin categorized as extramedullary plasmacytoma (EP) and solitary plasmacytoma of bone (SPB). We report here a case of SPB who is off treatment for 14 years and is completely disease-free.

Bone marrow trephine biopsy as an adjunct to bone marrow aspiration.

OBJECTIVE: To determine the relative efficacy of bone marrow aspiration as compared to that of trephine biopsy. METHODS: Bone marrow aspiration and bilateral trephine biopsies were performed in 420 consecutive cases. The diagnosis and findings made on bone marrow aspiration were compared with that made on trephine biopsy in each case. RESULTS: Aspiration alone was sufficient in making a diagnosis in 372 (88.6%) cases as it correlated well with the diagnosis made on trephine sections. In the remaining 48 (11.4%) cases trephine biopsy was necessary for making a diagnosis due to incomplete information provided by aspiration or its inability to give a correct diagnosis. These cases were mostly hypoplastic/aplastic marrow, myelofibrosis and marrow involvement by metastatic tumour and lymphomatous infiltration. Often a bilateral marrow biopsy picked up the diagnostic lesion. CONCLUSION: The decision to perform a marrow aspiration alone or in combination with marrow biopsy depends on the diagnosis being considered. In nutritional anaemias, most hematologic malignancies and immune thrombocytopenias, marrow aspiration alone is sufficient, but for detection of disorders with focal marrow involvement bilateral marrow biopsies are a must.