Transfusion Requirement in Anemia observed in Patients with Carcinoma Breast undergoing Chemotherapy

Introduction: Carcinoma Breast is the second most commonmalignancyaffecting women. Adjuvant chemotherapy is themainstay treatment modality along with surgery. Anemiaand thrombocytopenia are the hematological complicationsin patients with breast cancer who undergo chemotherapy.This study was carried out with an objective to identify theproportion of anemia and the requirement of Packed Red Cellstransfusions in these patients.Material and methods: This is ahospital based prospectivestudy, done for a period of one and a half years from January2016 to June 2017.As per the inclusion criteria125 consecutivecases who underwent chemotherapy for Carcinoma Breastat Department of Radiotherapy, Govt. Medical College,Thiruvananthapuram were included for the study. Therequirement of Packed Red Cell (PRC) was assessed in thesepatients. Data was analysed with SPSS software (version 21).Results: Among the 125 patients, 60% of patients wereanemic in prechemotherapyphase with a preponderance ofmild anemia,haemoglobin (Hb) 11-11.9gm/dl (as per theWHO classification of anemia in non pregnant females).Inpost chemotherapy phase the prevalence of anemia was94.4% withincreasing severity; majority (56%) of patients hadmoderate anemia (Hb 8-10.9gm/dl). During chemotherapy,22.4% of the study population required PRC transfusion.Conclusion: Due to the high prevalence of chemotherapyinduced anemia and itseffects on quality of life (QOL), evenmild degrees of anemia should be detected and evaluatedbefore commencing chemotherapy. PRC transfusion shouldbe reserved for patients with severe anemia

Transfusion Requirement in Thrombocytopenia Observed in Patients with Carcinoma Breast Undergoing Chemotherapy

Introduction: Breast cancer is the commonest cancer inurban Indian females, and the second commonest in the ruralIndian women. The estimated number of breast cancer casesin India during 2012 was 145,000 cases with an incidencerate of 25.8 per 100,000 women. In Kerala, Breast cancer hasan annual incidence of 14.9/100,000 population. This studywas carried out with an objective to identify the proportion ofthrombocytopenia and the requirement of platelet transfusionsin these patients.Material and methods: This was a hospital based prospectivestudy, done in the Department of Transfusion medicine fora period of one and a half years from January 2016 to June2017. As per the inclusion criteria 125 consecutive cases whounderwent chemotherapy for Carcinoma Breast at Departmentof Radiotherapy, Govt. Medical College, Thiruvananthapuramwere included for the study. The requirement of platelettransfusions were assessed in these patients. Data wasanalysed with SPSS software (version 21).Results: Among the 125 patients, thrombocytopenia wasnoticed in 5.4% study population in prechemotherapy phase,majority having only grade I thrombocytopenia. In Postchemo phase thrombocytopenia was observed in 11.2% of thestudy group, grade I thrombocytopenia in 8.8% and grade IIthrombocytopenia 2.4% of patients. Platelet transfusion wasrequired in 5.4% of the patients during chemotherapy.Conclusion: Due to the high prevalence of chemotherapyinduced hematological complications, even mild degrees ofthrombocytopenia should be detected and evaluated beforecommencing chemotherapy. Platelet transfusion should bereserved for patients who were really required. This studygives an insight regarding the proportion of thrombocytopeniain patients with carcinoma breast undergoing chemotherapyand their platelet transfusion requirements, which will help intaking care of these patients and inventory management of theblood banks.

The Effect of Storage on Platelets in Platelet Rich Plasma and Platelet Concentrate

Introduction: Platelets are routinely isolated from wholeblood and stored in plasma for 5 days. The platelets undergovarious storage changes starting from collection, processingto storage and the underlying conditions within the patientswhich may affect the therapeutic benefit to the recipient. Studyaimed to assess the quality of platelets in platelet rich plasmaand platelet concentrate and to evaluate the effects of storageon platelets in platelet rich plasma and platelet concentrate.Material and methods: The study was carried out in theDepartment of Transfusion Medicine and Department ofMedical Laboratory Technology in Government MedicalCollege, Thiruvananthapuram after obtaining approval fromthe Institutional Ethical Committee. The study period was sixmonths. The samples were collected from platelet rich plasmaand platelet concentrate bags under sterile conditions. Theirquality was assessed using the parameters such as swirling,volume of the platelet concentrate, platelet count, WBC countand pH on day 0, day 3 and day 5 of storage.Results: A total of 64 samples were evaluated and of these95% have fullfilled all 5 parameters of quality control with ascore 5 and 5% had score 4. Thus in our study majority of theprepared units were of the desired quality. All the parameterswere assessed and the results obtained on both the units werewell above the values of recommended norms.Conclusion: The quality of platelet concentrates weremaintained well within the usual 5 days thus an extension ofplatelet storage time is recommended.

Early Prediction of Coagulopathy in Acquired Bleeding Disorders - Revisited Using Rotational Thromboelastometry

Introduction: Acquired bleeding disorders are a major causeof mortality, both in the developed and developing countries.An acute haemorrhage should be managed immediately withblood products, factor concentrates or anti-fibrinolytics.Investigations to detect coagulopathies typically includebaseline screening tests like prothrombin time, activatedpartial thromboplastin time, platelet count and fibrinogenlevel. These tests have a long turn around time whichfrequently lead to a blinded approach towards blood productsupport leading to under or over transfusion. In contrast,rotational thromboelastometry (ROTEM) which assesseshaemostasis from the start of clot formation to fibrinolysisgives earliest results within ten minutes. This study wasdone to establish a correlation between ROTEM parametersand standard coagulation profile in the context of acquiredbleeding disorders.Material and Methods: A total of 138 subjects - 70 patientswho presented with acquired bleeding disorders and 68 subjectsdiagnosed to be normal on the basis of a complete coagulationwork up were included as the cases and controls respectively.All samples were subjected to standard coagulation profileand ROTEM analysis which included Clotting Time, ClotFormation Time, Alpha Angle, Maximum Clot Firmness andMaximum Lysis.Results: The Maximum Clot Firmness had a very goodco relation with serum fibrinogen levels (k value - 0.807;p<0.000; Sensitivity - 88%; Specificity - 92%), and goodcorrelation with platelet count (k value - 0.793; p< 0.000;Sensitivity - 86%, Specificity-92%), whereas Clot FormationTime showed moderate correlation with aPTT. Clotting timehad a poor correlation with prothrombin time and activatedpartial thromboplastin time.Conclusion: The achievement of haemostasis is a crucialfactor for determining patient outcomes in acquired bleedingdisorders. The gold standard test to diagnose coagulopathy is thestandard coagulation profile. Rotational thromboelastometrycorrelates well with standard coagulation parameters. Thistest which is performed on whole blood showed interpretableresults within 10 minutes, whereas standard coagulationprofile required an average of 45 – 75 minutes. In view of thegood correlation to the standard coagulation profile, it appearsthat Rotational Thromboelastometry results can be safely usedto implement early transfusion therapy for haemorrhage.