Red cell alloimunization and autoantibodies in transfusion dependent thalassemia patients of Jammu region

Background:Thalassemia is one of the most common genetic disorder of hemoglobin synthesis in Jammu region. Although RBC transfusion is life saving for these patients, it may be associated with some complications like RBC alloimmunization. Thus, alloimmunization against red blood cell antigens increases the need for transfusion and can significantly complicate transfusion therapy. Therefore, screening for unexpected antibodies should be a part of all pretransfusion testing,with antibody identification in the event of a positive result. The aim of the study was to determine the frequency of alloimmunization and autoimmunization and the most common alloantibodies involved.Methods:This was a descriptive study involving a total of 146 thalassemic patients in the age range of 2-32 years receiving regular blood transfusions, registered at SMGS blood bank, Jammu. Antibodies screening, antibody identification, and cross matching was doneon all patient samples included in the study, during the period between November 2014 and October 2015.Results:At the start of the study, 8 patients who tested positive for alloantibodies 3 patients had more than one antibody subtype. Anti-E was the commonest antibody found in 4 (50%) patients. Similarly, at the end of study, antibody screening and then identification revealed presence of antibodies in 10 patients. Only 1 patient had more than one antibody subtype. Anti E was again the commonest antibody found in 5 (50%) patients. Conclusions:The most common alloantibodies identified were anti Rh system antibodies (anti-E and anti-D) followed by Kell antibodies. In order to reduce alloimmunization, a policy for performing extended red cell phenotyping of these patients is essential and at least antigen E and Kell negative blood should be provided for transfusion to these patients.

Seroprevalence of anti SARS-CoV-2 IgG antibodies among adults in Jammu district, India: A community-based study

Background & objectives: Serology testing is essential for immunological surveillance in the population. This serosurvey was conducted to ascertain the cumulative population immunity against SARS-CoV-2 among adults in Jammu district and to understand the association of seropositivity with sociodemographic and clinical correlates. Methods: On September 30 and October 1, 2020, a household survey was done in 20 villages/wards chosen from 10 health blocks in district Jammu, India. Demographic, clinical and exposure information was collected from 2000 adults. Serum samples were screened for IgG antibodies using COVID Kavach MERILISA kit. Tests of association were used to identify risk factors associated with IgG positivity. Crude odds ratio with 95 per cent confidence intervals (CIs) was calculated during univariate analysis followed by logistic regression. Results: Overall adjusted seroprevalence for SARS-CoV-2 was 8.8 per cent (95% CI: 8.78-8.82); it varied from 4.1 per cent in Chauki choura to 16.7 per cent Pallanwalla across 10 blocks in the district. Seropositivity was observed to be comparatively higher in 41-50 and 61-70 yr age groups, among males and in rural areas. Fever, sore throat, cough, dyspnoea, myalgias, anosmia, ageusia, fatigue, seizures, history of exposure, medical consultation, hospitalization and missing work showed significant association with seropositivity on univariate analysis. On logistic regression, only sore throat, myalgia and missing work showed significant adjusted odds of IgG positivity. Extrapolation to adult population suggested that exposure to SARS-CoV-2 was 14.4 times higher than reported cases, translating into Infection fatality rate of 0.08 per cent. Interpretation & conclusions: Since a major part of population was immunologically naive, all efforts to contain COVID-19 need to be vigorously followed while these baseline results provide an important yardstick to monitor the trends of COVID-19 and guide locally appropriate control strategies in the region

Audit of fresh frozen plasma usage, prospective study: a report from department of immunohematology and transfusion medicine, government medical college Jammu, Jammu and Kashmir, India

Background: Fresh frozen plasma is commonly used in tertiary care hospitals. These are used to manage conditions such as coagulation derangements. Unnecessary use of fresh frozen plasma (FFP) is known to increase the risk of side effects in plasma transfusing patients like anaphylaxis, transfusion related acute lung injury (TRALI) and risk of transfusion transmitted infections etc. So judicious use of plasma is extremely important where its benefits outweigh its potential risks.Methods: Prospective observational study conducted over a period of six month. The following data were collected; provisional clinical diagnosis, indication of FFP’S, coagulation profile and gender of the patients. We evaluated all FFP transfusions, classified them as appropriate or inappropriate according to fresh frozen plasma transfusion guidelines of Directorate general of health services (DGHS).Results: A total of 808 FFP units were issued (474 units to males and 334 units to females) over a period of 6 months. Out of these, 15% (122 units) of  FFP’s were issued to intensive care unit (ICU) patients, 12.87% (104 units) to paediatrics ward, 12.25%  (99 units) to emergency ward which include patients with upper GI bleed and lower GI bleed , 6.8% (55 units) to obstetrics patients, 6.18% (50 units) to orthopaedics, 4.45% (36 units)  to road traffic accident patients, 4.20% (34 units) to Hepatic failure patients, 3.09% (25 units) to Cardiothoracic and vascular surgery (CTVS), 2.97% (24 units) to oncology patients, 2.47% (20 units) to snake bite patients, 1.23 % (10 units) to dengue patients, 1.11% (9 units)  to Haemophilia  patients, 27.38% units were issued to the patients were indication for FFP transfusion was not known.Conclusions: study showed that 66.44% were appropriate and 33.56% were inappropriate use of FFP’s in patients. This highlights the pitfalls in use of FFP among clinicians and for that matter there is need of awareness and understanding the transfusion medicine by clinicians.

Distribution of RH and Kell (K) blood group antigens among blood donors in a tertiary care hospital of Jammu region, India

Background: Knowledge about the frequency of red cell antigen phenotype is very important for the creation of donor data bank and to minimize the risk of alloimmunization. This requires the determination of immunological characteristics of blood products and blood recipients by performing phenotyping of clinically significant blood group antigens. The aims and objectives were to study the distribution of Rh and Kell (K) antigen among blood donors of different ethnic groups in a tertiary care hospital.Methods: This was prospective observational cross sectional one-point analysis study which was carried out over a period of one year with effect from November 2015 to October 2016 in the Postgraduate Department of Immunohematology and Blood Transfusion Medicine, Shri Maharaja Gulab Singh (SMGS) Hospital, Government Medical College, Jammu and Kashmir, India. It comprised of voluntary and replacement donors and categorized into different ethnic groups i.e Dogras, Gujjar Muslims, Non-Gujjar Muslims, Kashmiri Pandits, Sikhs and Christian. Donors selection criteria was as per Drug and Cosmetic Act.Results: A total of 500 (Five hundred) blood samples from the donors of all blood groups were typed for the presence of Rh (D, C, E, c, e) and Kell (K) antigens. Out of these 500 samples, 420 were antigen typed by conventional tube technique and 80 samples were typed by column agglutination technique using glass beads. As per ethnicity, maximum donors were Dogras (74%) followed by Non-Gujjar Muslims (9.4%), Gujjar Muslims (9%), Sikhs (5.6%), Kashmiri Pandits (1.4%) and Christians were the least in frequency (0.6%). On phenotyping for Rh and Kell antigens ‘e’ antigen have the ubiquitous distribution and was found to have the highest frequency 486 (97.2%) followed by ‘D’ antigen 472 (94.4%), ‘C’ antigen 426 (85.2%), ‘c’ antigen 320 (64.0%) and ‘E’ antigen 103 (20.6%). Overall frequency of Kell (K) antigen was 2.6%.Conclusions: Knowledge of red cell antigen phenotype frequencies in a population with different ethnic groups can help in creating donor data bank and database for the distribution of blood groups for preparing inhouse cell panels and providing proper antigen compatible blood for patients with multiple alloantibodies and also reduce the risk of RBC antigen alloimmunization along with their complications.

Donor notification in reactive donors and their response to communication

Background: Blood transfusion is associated with the risk of transmitting transfusion transmissible infections (TTI) even after the thorough mandatory TTI screening of blood units. To prevent disease transmission, it is important to inform, notify and counsel the donors about their seroreactive status at the blood centre. The present study determines the response of various TTI reactive donors for post donation counselling after notification and their persistence in society as reactive donors.Methods: It was a retrospective study conducted at tertiary care center from 1May2015 to 30April2017. Re-active donors were called to the blood bank by telephonic call and letters. Reactive donors on complying at center were retested, counselled and referred to appropriate centre for further management.Results: There were 34,204 blood donations over period of two years, out of which 375[1.09%] were reactive donors. Of these HBV reactive comprises of 166/34204(0.48%), HCV were 40/34204(0.11%), HIV reactive donors comprises of 26/34204(0.07%), Syphilis 138/34204[0.40%] and there were five cases of co-infection, two for HIV+ HCV, two cases HIV+HBV and one case of co-infection with HBV+ Syphilis. A total of 375 TTI reactive donors were identified, out of which (227/375) 60.5% contacted by tele-phone calls and letters and remaining (148/375) 39.46% cannot be contacted. Out of 227 contacted donors only 117 donors reported for post donation counselling i.e. response rate of 51.54%.Conclusions: Donor notification is efficient method of curtailing TTI but undermined by communication failure with donors, resulting in persistent load of blood transmissible infectious risk.

Atypical TeratoidJRhabdoid Tumour of Brain

Primitive neuroectodermal tumor (PNET) / medulloblastoma (MB) are the most commonmalignant central nervous tumors of the first decade of life. Atypical teratoid / rhabdoid tumor (ATT / RT) is a tumor of infancy and childhood although occasional cases have also been described in adults. ATT/RT has a characteristic histopathological, immunocytochemical and ultrastructural features. ATT /RT is a rare tumor, incidence of which remains to be defined with only hundred published cases. The present report docurilents the clinical features, histological and immunohistochemical findings of a case of ATT / RT.

Histological analysis of cystic tumour like lesions of central nervous system.

True cysts of the central nervous system (CNS) are rare lesions. A retrospective study of patients with symptomatic non-neoplastic cystic lesions of CNS operated in the Department of Neurosurgery, G.B. Pant Hospital, New Delhi between Jan 1994 and Feb 2001 was conducted. Parasitic cysts, cystic transformation of hemmorhages, vascular malformations and cystic tumours were excluded from the study. A total of 109 cases were reviewed. There were 34, 27, 17, 16, 8, 3 and 2 cases of epidermoid, arachnoid, dermoid, colloid, neurenteric, Rathke's and ependymal cysts and 1 case each of choroid plexus and glial cysts. The clinical presentations, locations, incidence and pathogenesis of these cysts is discussed.

Abdominal Tuberculosis in Surgical Practise.

Thirty patients of abdominal tuberculosis in the age group of 20-40 years weare analyzed. Majority of the cases had abdominal pain as the leading clinical presentation. A significant number of patients also had abdominal lump. Intestinal obstruction / perforation was present in 10 patients requiring surgical intervention. Barium studies (done on 27 occasions) had positive rate of 70%. All patients, where diagnosis of tuberculosis was confirmed, received three-drug anti-tubercular regimen There was no post-operative mortality.