Delayed adverse reactions in whole blood donors: Importance of active surveillance in identifying the missing gaps in the donor safety

Background & objectives: The information available regarding delayed adverse donor reactions (D-ADRs) is limited. Proactive follow up of donors for delayed reactions is not done routinely. This study was undertaken to analyze frequency and type of D-ADRs in whole blood donors as also the contributory factors. Methods: In this prospective observational study, all eligible whole blood donors were contacted telephonically twice (24 h and 2 wks after donation) and asked about general health and ADR specific questions. The International Society of Blood Transfusion standard guidelines were used to categorize ADRs. Results: The ADR data of 3514 donors were analyzed in the study. D-ADRs were more common as compared to immediate delayed adverse donor reactions (I-ADRs) (13.7 vs. 2.9%, P<0.001). The most common D-ADRs were bruises (4.98%), fatigue or generalized weakness (4.24%) and sore arms (2.25%). D-ADRs were more common in first time donors as compared to the repeat blood donors (16.1 vs. 12.5%, P=0.002). Females were more prone to D-ADRs (17 vs. 13.6%). Localized D-ADRs were more frequent as compared to systemic D-ADRs (P<0.001). Repeat donors had a lower incidence of systemic D-ADRs (4.11% vs. 7.37%, P<0.001). Interpretation & conclusions: D-ADRs were more common than I-ADRs with a different profile. First time, female and young donors were more prone to D-ADRs. These categories need special care at the time of blood donation. Active follow up of blood donors should be done from time to time to strengthen donor safety

Transfusion practices in cirrhotic patients at a tertiary liver care center from Northern India

Abstract Introduction: Transfusion in cirrhotic patients remains a challenge due to the absence of evidence-based guidelines. Our study aimed to determine the indication of transfusion and the associated transfusion thresholds in cirrhotic patients. Methods: This retrospective observational study was conducted in the Department of Transfusion Medicine at a tertiary care liver center from October 2018 to March 2019. The blood bank and patient records of cirrhotic patients admitted during the study period were retrieved and analyzed to determine the current transfusion practice. Results: A total of 992 cirrhotic patients were included in the study. Blood components were transfused to 402 (40.5%) patients. Sixty-nine (17.2%) patients were transfused to control/treat active bleeding, while 333 (82.8%) were transfused prophylactically. Packed red blood cells (65.4%) was the most commonly transfused blood component, followed by fresh frozen plasma (35.6%), among patients receiving transfusions (therapeutic & prophylactic). The mean pre-transfusion thresholds for: (i) packed red blood cell transfusion: hemoglobin less than 7 g/dL; (ii) fresh frozen plasma transfusion: international normalized ratio over 2.6; (iii) platelet concentrate transfusion: platelet count less than 40,700/µL, and; (iv) cryoprecipitate transfusion: fibrinogen less than 110 mg/dL. The average length of stay of the study population was 5 days (3-9. Conclusion: To conclude, 40.5% of our hospitalized cirrhotic patients were transfused, with the majority of the transfusions being prophylactic (82.8%). Separate guidelines are required for this patient population, as these patients have an altered hemostasis which responds differently to the transfusion of blood components.

Determining the true incidence of acute transfusion reactions: Active surveillance at a specialized liver center

ABSTRACT Background: Blood transfusion is a life-saving procedure, but may cause adverse transfusion reactions (TRs). The reporting of TRs is often missed due to various reasons. The aim of this study was to determine the incidence of unreported acute TRs through active surveillance and to compare it with the incidence of passively reported TRs. Methods: This prospective observational study was done over a period of four months at a tertiary care hospital. A total of 500 consecutive transfusion episodes (TEs) in patients who had received blood component transfusions in the intensive care units were included in the study. Comprehensive data were collected from the blood bank records, patient records and through interviews with the attending clinical staff. The TEs were defined as all blood components issued to a single patient in 24 h. Results: The overall incidence of TRs was 1.8 % (9 cases), with 0.4 % (2 cases) being reported passively, while 1.4 % (7 cases) were identified during active surveillance. The transfusion-associated cardiac overload (TACO) had the highest incidence of 1.2 % (6 cases) in active surveillance. A single case of acute hemolytic transfusion reaction was also observed during active surveillance. The passively reported TRs were one allergic reaction and one febrile non-hemolytic transfusion reaction. Conclusion: Active surveillance of TRs provided an insight into the true incidence of TRs, which is higher when compared with the passively reported TRs. The TACO was found to have the highest incidence and not a single case was reported. There is a need to improve awareness regarding TR reporting.

Effects of therapeutic plasma exchange on liver function test and coagulation parameters in acute liver failure patients

ABSTRACT Background: Currently the treatment of choice for critical liver failure is liver transplantation. Liver failure is treated conservatively until a matching liver donor becomes available. The therapeutic plasma exchange (TPE) plays an important role as a bridge to transplantation by removing accumulated toxins from patient plasma, as well as restoring the coagulation profile. Method: This was a retrospective study on critically ill liver disease patients who underwent TPE from January 2012 to September 2015. The data were collected for the analyses of coagulation parameters, liver function tests, renal function tests, model for end-stage liver disease (MELD) scores, mortality, and hospital stay. Results: In the study duration, a total of 45 patients with critical liver disease underwent therapeutic plasma exchange. The TPE resulted in a statistically significant reduction in the bilirubin level, aspartate aminotransferase (AST), alanine aminotransferase (ALT), prothrombin time (PT), international normalized ratio (INR), serum ferritin level and MELD scores. Higher MELD scores in both pre- and post-TPE were associated with higher mortality during the hospital stay. Conclusion: The TPE is safe and well-tolerated, and it improves coagulation profile and liver function tests in critically ill liver disease patients, but the overall survival remains low.

Circulation of Dengue virus-1 (DENV-1) serotype in Delhi, during 2010–11 after Dengue virus-3 (DENV-3) predominance: A single centre hospital-based study.

Background: Delhi, a city in north India, has so far witnessed several reported outbreaks of dengue. Dengue in Delhi from being epidemic is slowly changing towards being endemic and hyper-endemic. Circulating type of the virus is also changing over the years. In the absence of an effective vaccine, dengue prevention to a major extent relies on virological surveillance, and development of effective, locally adapted control programmes. In the present study, we tried to identify the between-year non-epidemic serotype of dengue virus circulating in Delhi, during 2010–11. Methods: Acute-phase samples were collected from the patients attending the Institute of Liver & Biliary Sciences, New Delhi, India. Dengue diagnosis was done using WHO case definitions. All the samples were subjected to Dengue NS1 Ag ELISA and modified nested RT-PCR. Results: A total of 75 acute-phase samples were received, of which 19 (25.3%) were positive for dengue NS1 antigen. Dengue RT-PCR was positive in 14.6% (11/75) samples. All the RT-PCR isolates were of DENV-1 serotype. No case of concomitant infection with more than one serotype was observed. Median age of involvement was 23 yr (range10–86). Maximum number of cases were seen in the age group of 21–30 yr. Male to female ratio was 1.2 : 1. Maximum number of suspected dengue cases (n=79) was seen during September and October. Conclusions: DENV-1 was circulating in Delhi in the year 2010–11 in non-epidemic period following reported predominance of DENV-3 and co-circulation of all dengue serotypes in the epidemic years 2003, 2006 and 2007.

Platelet alloimmunization in multitransfused patients with haemato-oncological disorders.

BACKGROUND: We studied the incidence of platelet alloimmunization in multitransfused patients with haemato-oncological disorders and determined the factors influencing alloimmunization. We also assessed the effect of alloimmunization on response to platelet transfusion. METHODS: Fifty patients with haemato-oncological disorders who received multiple transfusions were included. The patients were tested for antibodies before they received any transfusion and then after 3-4 weeks of transfusion. Lymphocytotoxicity and platelet immunofluorescence suspension tests were used to detect antiplatelet antibodies. Symptomatic improvement was used to assess the response to platelet transfusions. RESULTS: Thirty patients were positive by the lymphocytotoxicity test, giving an incidence of 60% for anti-HLA antibodies. The panel reactivity of the antibodies ranged from 3% to 100%. Nineteen patients were positive by the platelet immunofluorescence suspension test, 16 of whom were also positive by the lymphocytotoxicity test. The overall incidence of antiplatelet antibodies was 66%. The number of transfusions received and the underlying haemato-oncological disorder were not risk factors for the development of antibodies. Patients with a past history of transfusions and those with a positive obstetric history had a significantly higher incidence of antibodies. The response to transfusion therapy was poor in patients with antibodies, as 71.4% of patients with antibodies were nonresponsive compared to only 26.6% of antibody-negative patients. CONCLUSION: A high percentage of multitransfused patients developed antiplatelet antibodies. Previous sensitization was an important risk factor for the development of antibodies. Patients with high panel reactivity (HLA) showed non-responsiveness to platelet transfusions. Testing for the presence of antiplatelet antibodies and provision of compatible platelets should be important components in the management of patients with platelet transfusion refractoriness.