Knowledge, attitudes and practices of resident doctors and interns on safe blood transfusion practices: a survey-based study

ABSTRACT Introduction: The knowledge of clinicians regarding blood transfusion services may impact patient care and transfusion outcome. The wide variation in transfusion practices among clinicians leads to inappropriate blood product usage and jeopardizes patient safety. Hence, this survey study aimed to assess knowledge, attitude and practice among the residents and interns of safe blood transfusion. Methods: The online survey was based on self-administered questionnaires of three sections: 1. Demography; 2. Knowledge, and; 3. Attitude and Practice. One point was assigned for the correct response of each question in every section. The knowledge score was further categorized into three categories, depending on the points obtained. The participants were also divided into four groups, depending on their experience. The Kruskal-Wallis test was applied to determine the difference of knowledge and practice scores in three designated groups of residents and interns. A p-value of less than 0.05 was considered to be significant. Result: A total of 247 residents and interns participated in this study. Thirteen participants had an incomplete response. Out of 234 participants, Senior Residents (SR), Junior Residents (JR), and interns were 70, 96 and 68 participants, respectively. The knowledge scores of interns were significantly low, as compared to SRs and JRs. Practice scores of interns were also significantly low, compared to the JRs. However, most of the residents and interns (85%) were aware of the pre-transfusion testing. Conclusion: Therefore, the mandatory incorporation of the transfusion medicine subject in the undergraduate curriculum can help the young budding doctors to better implement the patient blood management.

Prospective identification of potential factors influencing stem cell mobilization and the necessity for plerixafor use in newly diagnosed multiple myeloma patients undergoing autologous stem cell transplantation

ABSTRACT Introduction: To study the efficacy and safety of single large volume leukapheresis by using generic G-CSF or G-CSF plus Plerixafor in achieving adequate stem cell yield and various factors influencing thereof in newly diagnosed multiple myeloma patients undergoing autologous stem cell transplant . Method: This prospective study was undertaken among 55 newly diagnosed multiple myeloma patients undergoing autologous stem cell transplant and aged between 18 and 75 years. Mobilization and harvesting of stem cells were performed by using GCSF or GCSF plus Plerixafor and large volume leukapheresis, respectively. A stem cell yield of ≥2 × 106 kg-1 and the number of apheresis procedures were primary efficacy endpoints, while the ideal stem cells yield >5 × 106 kg-1, the engraftment day and D100 response/graft sustainability were secondary endpoints. Result: The primary endpoint was achieved in all cases in both the groups by using a single LVL leukapheresis procedure. Fulfillment of all the secondary endpoints was satisfactory and comparable in both the groups. Age, pre-apheresis CD34+ count and number of interruptions during the LVL were significant factors influencing the stem cell yield (p < 0.05). Adverse drug reactions during the apheresis and post-ASCT period were manageable. Conclusion: The LVL is safe and cost-effective in attaining a minimum of CD34+ cells in a single procedure with manageable adverse reactions. Judicious intervention during the procedure may be helpful in ensuring the adequate yield.

Bombay Blood Group– Detection And Study Of Prevalence Of This Rare Phenotype Along With The Transfusion Recommendations

Four main blood types routinely identified are A,B,AB and O. Bombay phenotype individuals are typed as group O on forward ABO typing. Their red cells lack A,B,H antigens and their sera contain anti-A, anti-B and anti-H. It is important to correctly type individuals who are Bombay phenotypes because these individuals require autologous blood donation or blood from another Bombay individual. The present prospective study was conducted over two years to study the prevalence of Bombay phenotype with transfusion recommendations to the blood recipients. All the donor and patient’s blood group were confirmed by tube method. All blood samples showing O blood group on froward grouping and agglutination with O cell in reverse grouping, were tested for Bombay blood group using anti-H.Out of 76,204 cases constituting 49,604 donors and 26,600 patients, Bombay phenotype was detected in 12 cases (0.015%) constituting 4 number of donors and 8 number of patients. All cases were further ruled out to be para Bombay phenotypes and were found to be non secretor by agglutination inhibition test. Four cases out of 12 patients requiring blood transfusion 3 could be issued Bombay blood group and but death occurred in one case due to delay in the surgery for the unavailability of this rare phenotype. Thus, it is recommended that all blood group donors and patients should be routinely screened by both forward and reverse grouping for screening of Bombay phenotype to reduce the risk of hemolytic transfusion reaction resulting from issue of O blood group to Bombay blood group recipients