Platelet transfusion practice during dengue fever epidemic.

Blood components especially platelet concentrates due to their short shelf life are frequently in limited supply. Appropriate use of blood components is required to ensure their availability for needy patients as well as to avoid the unnecessary risk of transfusion-transmitted diseases. Medical audit of blood transfusion practice, which forms an important part of quality assurance programme in a transfusion centre, can provide grounds for improvement in transfusion medicine practice. During the epidemic of dengue fever in Oct., 1996, 1837 patients were admitted as dengue haemorrhagic fever in a teaching hospital in Delhi. Two hundred and eight patients (11.3%) were given platelet transfusions. Retrospective analysis of these platelet transfusions was done. It was observed that in only 52 (25%) out of 208 patients the information on platelet counts was provided. History of active bleeding was obtained only in 65 (31.2%) patients. About 35% patients received unnecessary prophylactic transfusions and during 89% of the transfusion episodes inappropriate dose of platelet concentrate was given. Information regarding post-transfusion recovery could be obtained in only 16.5% of transfusion episodes. The study emphasises the need for development of specific guidelines for transfusion of blood components, constant interaction and co-ordination amongst clinicians and transfusion centre for implementation of these guidelines, and a regular medical audit to review the optimal utilisation of blood components.

Comparison of pleural fluid cytology and pleural biopsy in the evaluation of pleural effusion.

Pleural fluid cytology and pleural biopsy results were studied in 65 cases of pleural effusion. The efficacy of pleural biopsy in diagnosis of neoplastic and non-neoplastic pleural diseases was compared. Of the 24 cases with confirmatory evidence of cancer, 17(70.8%) has positive cytologic findings in pleural fluid, whereas pleural biopsy was diagnostic in only 13 cases (54.1%). For non-malignant pleural effusion in 41 cases 40(97.5%) has a definite diagnosis (tuberculous pleuritis, acute fibrinous pleuritis or hydatid cyst) which could be made by cytology while only 31(75.6%) out of 41 were diagnosed on pleural biopsy. The study indicates that cytologic evaluation of pleural fluid is more efficaceous in the diagnosis of malignant and non-malignant pleural disease than percutaneous pleural biopsy.

Anaphylactoid transfusion reaction with anti-IgA antibodies in an IgA deficient patient: a case report.

A case of anaphylactoid transfusion reaction associated with anti-IgA antibodies is reported. The patient had low levels of serum IgA. She developed serious reaction characterised by erythematous rash, pruritus, cyanosis and dyspnoea after transfusion of otherwise compatible blood. Review of literature reveals that anaphylactoid transfusion reactions are very rare although frequency of anti-IgA in general population is quite high. The IgA deficient donors (aIgA) form a unique resource of blood components for the clinical management of patients with anaphylactoid reactions caused by anti-IgA.

Blood transfusion services in Delhi.

In 1991, approximately 40% of total blood requirement in Delhi was collected from commercial blood donors. The rest was supplied by voluntary and replacement donations in hospital-based blood banks and by voluntary blood recruiting agency (Indian Red Cross Society). This study analyses the standards of working and quality assurance in 26 blood transfusion centers in Delhi. The majority of these centers are ill-equipped and lack trained manpower. Most of these do not have adequate testing facilities and any standardized procedure for blood collection. Quality assurance scheme is not being followed and documentation and record maintenance is grossly inadequate. This reports also gives the recommendations for improvements of blood transfusion services in Delhi.