Unconfirmed reactive screening tests and their impact on donor management

To determine the percentage of false positive testing for transfusion transmitted infections [TTIs] using immunochromatographic test [ICT] as first line of screening tests and its effect on loss of volunteer blood donors. Over a period of three months, samples from blood bags of donors undergoing phlebotomy at teaching hospital blood banks in Lahore were screened for human immunodeficiency virus [HIV], hepatitis B [HBV] and hepatitis C [HCV] by immunochromatographic tests. Those found positive on initial screening were re-tested by ELISA method at the screening laboratory of the Institute of Haematology and Blood Transfusion Service, Punjab. Lahore. Out of a total of 62090 voluntary blood donors, 469 donors were found to be initially reactive for either HIV, HBV or HCV. Amongst these 96 [0.15%] blood donors were found to have tested falsely positive for HIV, HBV or HCV as compared to testing by ELISA. False positive testing rate of 0.15% or 96 out of a total of 62090 donors is rather small in terms of loss of voluntary donors and appropriate utilization of available resources. Although immunochromatographic testing is not the gold standard, however it serves an important purpose of initial donor screening

Neonatal jaundice and glucose-6- phosphate dehydrogenase deficiency

One hundred new born males babies aged 7 days and above were included in this study. These were divided into two groups - Group I included G6PD normal subjects and Group II included G6PD deficient subjects. Total bilirubin and G6PD enzyme levels were done by commercially available kits. Results were analysed by using students t test and level of significance was done. A significant increase in total bilirubin level was observed in infants of G6PD deficiency, Erythrocyte G6PD level is significantly decreased in 06% of infants born with neonatal jaundice

Frequency of abo and rhesus blood groups in blood donors in Punjab

Objective: To document the frequency of ABO and Rhesus blood groups in the blood donors in Punjab

Design: ABO and Rh grouping was done on all prospective voluntary / replacement blood donors donating blood at major teaching hospital blood banks throughout Punjab over a period of four months from June 2003 to September 2003. The frequency of ABO and Rhesus blood groups in both sexes has been analysed

Settings: Data from all teaching hospital blood banks located at Bahawalpur, Multan, Faisalabad, Lahore and Rawalpindi have been analysed

Subjects: All voluntary or replacement first time blood donors aged 18-60 years of both sexes have been included in this study. Main outcome measures: Documentation of frequency of ABO and Rhesus blood groups in blood donors in both sexes in Punjab

Results: Out of a total of 78768 blood donors, 73322[93.1%] were males and 5446 [6.9%] were females. 94.1% amongst males, while 91.9% amongst females were found to be Rhesus positive. The frequency of Rhesus negative groups in males and females is 5.9% and 8.1% respectively. The frequency of A, B, 0 and AB groups in rhesus positive male donors is 22.6%, 32.4%, 30.5% and 8.6%, while amongst female donors it is 21.5%, 31.6%, 31.0% and 7.8% respectively. Amongst rhesus negative male donors the frequency of A, B, O and AB is 1.46%, 1.85%, 2.22% and 0.39%, while amongst female donors it is 1.76%, 2.74%, 3.13%, and 0.51% respectively

Conclusions: The donor population is predominantly rhesus positive. The blood groups in the order of frequency in rhesus positive donors are B, O, A, and AB; while in rhesus negative donors it is O, A, B, and AB respectively

Prospects and future of conservative management of beta thalassemia major in a developing country

To assess the efficacy, prospects and future of conservative management of beta thalassemia major patients in a developing country. Design: Patients registered at IHBTS were studied over a period of three years. They consented to being managed on moderate transfusion regimen, aiming to maintain a pre-transfusion haemoglobin[Hgb] level of 9.0 ' 1.0g per dL. We studied their transfusion requirements, status for transfusion transmitted infections [TTIs], serum ferritin levels and complications developing as a result of iron overload. Setting: All patients were registered and managed at the Thalassemia Centre, The Institute of Haematology and Blood Transfusion Service [IHBTS] Punjab, Lahore. Subjects: Initially all registered patients were included in this study. Sporadic patients as well as dropouts occurring due to any reason, [patients concurrently seeking treatment at other centres as well, or complying poorly to advised chelation therapy] were excluded from the study. The data presented here conforms to a cohort of 60 regular patients who adhered best to our selection criteria. Main Outcome Measures: 1] The study highlights the deficiencies and problems of conservative management for beta thalassemia major. 2] The major impact of our study is the message that conservative management in a poor country, like ours, is a no-win situation. 3] There is an urgent need to immediately start a prevention programme. In the younger patients, blood consumption even on the moderate transfusion regimen is 120ml/kg/year, however with ascending age the consumption increases to 240ml/kg/year. A substantive number of the patients are either Hep C [35%] or Hep B [1.7%] positive. There are no HIV positive patients. Serum ferritin levels vary widely and could not be controlled due to poor compliance to chelation. 50% of the patients developed one or other complications of iron overload. The cost of treatment depending on the quality of care, is tremendous and beyond the reach of the common man. Conclusions: Conservative management may be the best alternative and at times the only hope for patients in our country. However, in order to decrease the disease load, steps need to be taken to introduce preventive measures

Aclinico- haematological study of factor IX deficiency. Haemophilia B

A total of 100 cases of hereditary coagulation disorders were investigated in the city of Lahore - Punjab. Out of them 38 were found to have factor IX deficiency, Haemophilia B. All were males. 25 patients were children below the age of 12 years where as 13 were adults. Common presenting symptoms in these patients were easy bruising, prolonged bleeding from cuts, post circumcision bleeding, haemarthrosis, and haemotoma formation. Clotting time and Activated partial thromboplastin time were prolonged in all the cases. Mixing experiments were performed on 38 cases and all [100%] showed partial or complete correction of APTT with serum. A mild to moderate reduction of factor IX level was found in most of the cases. Only 3 patients had factor IX level of less than 2 U/dl i.e. severe deficiency of factor IX. Message to be conveyed is that, although factor IX deficiency is clinically indistinguishable from Haemophilia A, correct diagnosis of deficient factor is very important as further therapy and management of the patient in factor IX and factor VIII deficiency is different