Demographic features of donors and causes of blood donor deferral at armed forces institute of transfusion, Rawalpindi

Objective: To determine the demographic features and causes of donor deferral in blood donors

Study Design: Descriptive study

Place and Duration of Study: Conducted at the Armed Forces Institute of Transfusion [AFIT] for a period of 1 year from Jun 2012 to May 2013

Material and Methods: Donors with ages ranging from 18-60 years who reported to the blood bank were incorporated in this study. A comprehensive history was taken from all the potential donors through a structured proforma. A detailed general physical examination was done by the appointed doctor at the blood bank. Furthermore, laboratory testing of the blood samples of potential donors was done. On this basis, donors were accepted or deferred

Results: The commonest cause of the donor deferral was hepatitis C [HCV] [28.6%], the second leading cause was anaemia [24%] and the third leading cause was hepatitis B [HBV] [16.8%]. Syphilis was also a major cause of donor deferral causing the rejection of 10.4% donors

Conclusion: The donor deferral rate is 7.3% and the leading course of donor deferral are chronic infections like hepatitis C and B and diseases like anaemia

Seroprevalence of human T-Cell Lymphotropic Virus-1/2 in blood donors in Northern Pakistan: implications for blood donor screening

Objective: To determine the seroprevalence of Human T-cell Lymphotropic Virus-1/2 [HTLV-1/2] in blood donors in Northern Pakistan

Study Design: Descriptive study

Place and Duration of Study: Armed Forces Institute of Transfusion, Rawalpindi, from July to August 2013

Methodology: A total of 2100 blood donors were screened for anti-HTLV-1/2 antibodies during the study period, in a pool of six, on a highly sensitive, Chemiluminiscent Microparticle Immunoassay [CMIA] based system. The screening testreactive donors were recalled, counseled and interviewed, and a fresh sample was obtained for confirmatory testing. Confirmation was performed using additional immunoassays including Line Immunoassay [LIA]; with additional testing for HTLV-1 pvDNA PCR. Frequency and percentages were determined

Results: Four donors [0.19%] were repeatedly screening test-reactive and were subsequently confirmed to be HTLV-1 infected by line immunoassay and HTLV-1 pvDNA PCR. All four donors were male with mean age of 27 +/- 6.27 years. Two [50%] of the positive donors gave history of Multiple Sexual Partners [MSP]

Conclusion: HTLV-1 seroprevalence in Northern Pakistan blood donors was determined to be 0.19%. Large scale studies, including the cost effectiveness of screening blood donations for anti-HTLV-1/2 in Pakistan, are recommended

Fatal hemorrhagic chickenpox in a case of acute promyelocytic leukaemia

Chickenpox is a viral infection caused by varicella-zoster virus. The infection is rather benign in nature, but in patients with impaired immunity it may result in fatal complications like haemorrhagic chickenpox. The case below is an association of the above complication of chickenpox in a patient suffering from acute promyelocytic leukaemia

Blood volumes of Pakistani male donors: implications for blood donation

Safety of blood donors rest on withdrawing only appropriate quantities of blood. Adjusting the volumes drawn according to the average blood volumes of any population can ensure this. This requires knowledge of total blood volume of donors, which should ideally be measured by standard methods or derived by alternate suitable method. This observational, cross sectional study was undertaken to calculate blood volumes of Pakistani male donor using recommended equations and obtain safe donation volume limits for our population. Height and weight of male Pakistani donors reporting to Combined Military Hospital blood bank was recorded by standardized method. Blood volumes were calculated by two different equations using body surface area. The data was entered in SPSS 10.0 version for Windows and statistical analysis done. Mean total blood volumes of 625 ma le donors calculated was 4819.2 ml with first equation and 4566.8 ml with second equation. 95% CI was between 4796.7 and 4841.6 with first equation and 4541.6 and 4591.9 with second equation. The maximum volumes of donation recommended for western population constitutes less than 12% of calculated total blood volume of our population, with either equation. This is with in safe limits by any standard. 450 ml+45 ml including samples in pilot tubes should be the recommended donation volume in Pakistani donors. The maximum volume being collected in other countries constitute safe limits for Pakistani donors as well. Equations showing better correlation with measured volumes should preferably be used to calculate blood volumes. Impact of collecting blood volumes recommended in this study, on blood donors, should be studied

Primary splenic lymphoma

A middle-aged lady presented with fever and splenomegaly and had been provisionally treated for malaria, typhoid and tuberculosis. Diagnostic splenectomy was performed which revealed diffuse large cell lymphoma, B type, localized to spleen. Patient had remission of disease after splenectomy

Indigenous development of antibody screening cell panels at armed forces institute of transfusion [AFIT]

To prepare good quality screening cells reagent according to the standards, at Armed Forces Institute of Transfusion [AFIT]. Random group O donors, seronegative for HBsAg, HCV and HIV were selected if they resided in Rawalpindi or Islamabad and could be contacted. Micro column Gel technique was used to find out R[1]R[1], Ri[w]r, R[2]R[2] and rr phenotypes with or without K antigen. Repeat sample of these donors were phenotyped for minimum antigens required for reagent cells. Teams of three donors each were made on the basis of Rh, K antigens and homozygosity for E, Fy[a],Fy[b], Jk[a], Jk[b], S, and s antigens. The selected cells were added to preservative suspension containing neomycin and chloramphenicol and dispensed as 8% solution and labeled. Cells were submitted to quality control testing for 35 days shelf life and efficacy was compared with commercial cells. The cells of required phenotype were prepared according to UK guidelines and AABB standards with minor exceptions. Reagent cells had excellent quality confirmed by many quality control procedures and were comparable to commercial cells in efficacy. The cost saving was significant. AFTT can introduce type and screen policy and Maximum Surgical Blood Ordering Schedule using indigenously prepared cells, of good quality and at an affordable price. This will enhance serological safety of recipients and brings AHT near to adopting standard practice of pretransfusion testing

Indigenous development of antibody screening cell panels at armed forces institute of transfusion [AFIT]

To prepare good quality screening cells reagent according to the standards, at Armed Forces Institute of Transfusion [AFIT]. Random group O donors, seronegative for HBsAg, HCV and HIV were selected if they resided in Rawalpindi or Islamabad and could be contacted. Micro column Gel technique was used to find out R1R1, R1wr, R2R2 and rr phenotypes with or without K antigen. Repeat sample of these donors were phenotyped for minimum antigens required for reagent cells. Teams of three donors each were made on the basis of Rh, K antigens and homozygosity for E, Fya,Fyb, Jka, Jkb, S, and s antigens. The selected cells were added to preservative suspension containing neomycin and chloramphenicol and dispensed as 8% solution and labeled. Cells were submitted to quality control testing for 35 days shelf life and efficacy was compared with commercial cells. The cells of required phenotype were prepared according to UK guidelines and AABB standards with minor exceptions. Reagent cells had excellent quality confirmed by many quality control procedures and were comparable to commercial cells in efficacy. The cost saving was significant. AFIT can introduce type and screen policy and Maximum Surgical Blood Ordering Schedule using indigenously prepared cells, of good quality and at an affordable price. This will enhance serological safety of recipients and brings AFIT near to adopting standard practice of pretransfusion testing

Red cell immunization in beta thalassaemia major

To find out the frequency, pattern and factors influencing red cell immunization secondary to multiple blood transfusions in patients of beta thalassaemia major. A cross-sectional study. Armed Forces Institute of Transfusion, Rawalpindi, in November 2002. One hundred and sixty-one patients suffering from beta-thalassaemia major and on regular blood transfusions were included in the study. Their blood samples were tested for blood grouping, direct antiglobulin test and antibody screening/identification using reagents of DiaMed-ID Gel microtyping system. The total rate of red cell immunization was found to be 6.84%. Red cell alloantibodies were detected in 4.97% patients, and belonged mainly to Rh system, with one example each of anti-K, anti-Js b and anti-Jk a. Direct antiglobulin test was positive in 3 patients [1.87%] with increased hemolysis. Two had warm panreactive IgG antibodies suggesting red cell autoimmunization. Red cells of the 3 rd patient showed sensitization with c-3d, with presence of an autoreactive cold agglutinin in the serum having a titre of 1:4. The red cell alloantibody formation was not influenced by age at first transfusion, number of blood transfusions and ethnicity. The rate of red cell alloimmunization in beta-thalassaemia major is relatively low in our setup and may be related to red cell homogeneity between the donor and recipient population. Routine pre-transfusion matching of blood, other than ABO and Rh "D" antigens is not recommended because of low rate of red cell alloimmunization, and high costs associated with such testing. Hyperhaemolysis, due to acquired red cell autoantibodies was found to be an important complication. Patients who develop this complication should be tested for presence of underlying alloantibodies and considered for immunosuppressive treatment

susceptibility patterns of methicillin resistant staphylococcus aureus in Quetta, Balochistan

This study was conducted at Pathology Laboratory, Combined Military Hospital, Quetta to evaluate susceptibility patterns of Methicillin Resistant Staphylococcus areus [MRSA] to commonly used anti staphylococcus antimicrobials during the period April 1996 to November 2000. One hundred consecutive, non-duplicate strains of MRSA isolated from different clinical samples were identified by standard microbiological methodology. They were studied for their susceptibility to co-trimoxazole, erythromycin, tetracycline, gentamicin, chloramphenicol, ciprofloxacin, fusidic acid and vancomycin by disc diffusion technique using modified Kirby-Bauer method. All the MRSA were sensitive to vancomycin. Four% strains revealed resistance to fusidic acid, 62% to chloramphenicol, 79% to ciprofloxacin, 80% to gentamicin, 88% to erythromycin 93 to tetracycline and 97% to co-trimoxazole. Most of the MRSA were multidrug resistant. These strains revealed higher degree of resistance [>60%] to routine anti-staphylococcus anti microbials. Vancomycin and fusidic acid could be life saving anti-staphylococcus antimicrobials in MRSA infections in Quettta