ABSTRACT
Background: SARS-CoV-2 associated COVID-19 was declared as pandemic in March'20.It led to accelerated scientific development leading to production of several vaccines.In India,first vaccine used was ChAdOx1 nCoV-19.Reports of pro-thrombotic and hemorrhagic complications with it are there but isolated immune thrombocytopenia is rare.We are reporting secondary immune thrombocytopenia (ITP) possibly attributed to COVID-19 vaccine. Aims: A 21-years female came to General Medicine with complaints of weakness,rashes all over body,bleeding from gums, menorrhagia and reddish discoloration of urine.She had history of COVID-19 vaccination 2 days back.On examination, she was mildly febrile, showed multiple pin-point petechial haemorrhages over face,abdomen,both limbs and sub-conjunctival haemorrhage with no complaints of headache/visual disturbances/pain abdomen/respiratory distress.Systemic examination showed no significant findings.She had no previous history of bleeding/drug intake/no family history of bleeding or any other significant conditions. Methods: Lab investigations showed Hb:8.6gm%,TLC:14,400/cmm, platelet counts:10,000/cmm.Peripheral blood smear showed normocytic normochromic RBC with leucocytosis and marked thrombocytopenia with absent hemoparasites.Urine examination showed numerous RBCs with no pus cells.S. electrolytes were normal, SGOT/ SGPT were mildly increased, total proteins were normal.S. bilirubin,urea,creatinine were normal.HIV,HCV,HBsAg,CMV IgM were negative.To rule out connective tissue disorders,ANA and dsDNA were performed which came negative.Her USG abdomen and CTchest were normal.COVID-19 RT-PCR was negative.ITP secondary to COVID-19 vaccination was suspected. Results: She was started with i.v. methylprednisolone pulse therapy for 3 days and IVIG for 2 days and also received trenexamic acid for menorrhagia.She received 6 units of random donor platelets which improved platelet count.After haematology consultation,oral prednisolone for 7 days with alternate day platelet count monitoring was started.She improved symptomatically with no new bleeding.She was discharged after 10 days with an advice to follow up. Summary/Conclusions: ITP is autoimmune disorder with autoantibodies against platelets,more common in females.It is usually idiopathic,but occasionally secondary to viral infections/vaccinations. Incidence of vaccine associated ITP is <1%.Previously reported with various vaccines like influenza,measles,mumps,rubella,etc.Vaccine induced thrombotic thrombocytopenia (VITT) with COVID-19 vaccine has been well documented,but ITP is rare.VITT is usually characterized by major thrombotic episodes at unusual locations like sagittal sinus,splanchnic circulation,etc. with visual, neurological and abdominal features.No such findings seen in our case.Although she had low platelet count,yet mild symptoms which improved with conservative management with steroid and IVIG.Although we could not establish a temporal link;yet based on findings,ITP secondary to COVID-19 vaccine could not be ruled out.It is important to be aware of this complication as although rare,it could lead to significant morbidity and fatal bleed if not managed promptly. Steroids and IVIG is highly effective in ITP irrespective of cause.However,more investigations need to be done to establish a temporal relationship with COVID-19 vaccine. Nevertheless,occurrence of ITP should not be a deterrent in vaccination,though caution should be exerted in history of thrombocytopenia.
ABSTRACT
Aims & Objectives: SARS-CoV-2 infection has been rapidly increasing around the world and has already been declared pandemic by the WHO. First case in Chhattisgarh was reported in Mid- March'20. Since then the number is increasing at an alarming rate. Though majority of the cases are mild-moderate who are managed by home isolation and conservative management;patients having severe disease require hospital admission, with several requiring intensive care. Initially, majority admissions were handled by governmenthospitals, but with increasing burden the private-hospitals were also roped in. We studied the demographic and blood grouping profile of hospitalized Covid-19 patients and relation with mortality. Patients/Materials & Methods: We studied 6-months data (April- September'20) of a private-hospital in Chhattisgarh involved in management of Covid-19 patients. Demographic and blood group data maintained in the Laboratory Medicine department of hospital was analyzed. This was correlated with mortality in these patients. Results: Within 6-months, total 403 patients were hospitalized with 72% males and rest females. Most were in age-group of 41-60 years (49%), followed by ≥ 61 years (33%). B + ve (38%) was commonest blood group followed by O + ve, A + ve, AB + ve. Out of 403, 34 patients (8.4%) died, where 70% were males, mostly ≥ 61 years. Blood group of those who died was B + ve (41%), followed by O + ve (29%), A + ve (20%), AB + ve (5%) and 1 death in B-ve. However, the calculated relative risk showed B + ve (RR = 1, 95%CI), O + ve (RR = 0.9, 95%CI), A + ve (RR = 0.9, 95%CI), showing no increased risk of mortality in association with particular blood group. Discussion & Conclusion: Several western studies suggest that Covid-19 infection is commonly associated with blood group A. However, no studies were found in India. Our findings show B + ve to be most common, with no significant risk of increased mortality among particular blood group. This difference can be due to genetic, immunological variations and individual susceptibility for infection from western population. However, as we studied limited data, the generalization of these findings should be avoided. The preventive measures like hand hygiene, face masks, social distancing norms should be followed irrespective of your blood type.
ABSTRACT
Aims & Objectives: In December 2019, pneumonia of unknown origin was detected in Wuhan, China;later named by the International Committee on Taxonomy of Viruses as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and its associated condition named as coronavirus disease-2019 (COVID-19) by WHO. It was declared as a pandemic on 11th March 2020. First confirmed case was detected on 30th January'20 in India, whereas in our state (Chhattisgarh) on 19th March'20. Though there is no evidence of its spread by blood transfusion, yet the pandemic has severely affected blood transfusion services (BTS). This study was done with objective to see the impact of pandemic on blood donation and utilization along with strategies to effectively manage BTS during this pandemic, and other future health emergencies. Patients/Materials & Methods: We performed this study in Blood Bank of a teaching hospital of central India involved in pandemic management in the region. We analyzed retrospective 18-months data of blood donation and utilization before (April-December'19) and during (January-September'20) COVID-19 pandemic. Results: During 9-months before pandemic (April-December'19), total number of donations were 2089 with 460 voluntary donations (in-house & outdoor). To compensate for increased demands, we increased our voluntary donation leading to collection of 1123 units within first 3-months of 2020. With pandemic spread within the country and state, collection in next 6-months was 1183. However, voluntary donation reduced from 291 in first 3-months to 119 in last 6-months with as less as three in September due to lockdown. As we maintain registry of voluntary donors who came and donated for patients, they were considered replacement donations, thus increasing its number. Blood utilization before was 3693, and 3939 during pandemic (p<0.05);showing increased demand. Discussion & Conclusion: Our strategies such as maintaining voluntary donor registry, calling them on-demand, issuing travel passes for donation during lockdown, conduction of small in-house camps (10-12 donors), motivating hospital-staff, hostel students for donation, counseling patient's healthy attendants, strictly monitoring blood demand and utilization, and avoiding wastage helped us to maintain our inventory and overcome sudden burden on BTS during pandemic.
ABSTRACT
Aims & Objectives: COVID-19, the disease caused by SARS-COV2 virus, has led to a global pandemic. Elderly and those with comorbidities have proven to be more vulnerable to severe disease. We performed a study to analyse the blood transfusion requirement in Covid-19 versus Non-Covid patients hospitalised in our institution. Patients/Materials & Methods: A retrospective observational study of blood and blood products utilisation in Covid-19 patients hospitalised at our centre from January-September'20 was done by analysing the monthly transfusion records maintained in the Department of Transfusion Medicine and Blood Bank, AIIMS Raipur. Transfusion of each blood component were compared in Covid- 19 wards versus non-Covid wards during the specified period. Covid patients were segregated according to blood group, age and gender. Results: 3754 Covid patients have been hospitalised in AIIMS Raipur since the first case diagnosed in Chhattisgarh during the mid of March 2020. 36 (0.95%) patients out of 3754 hospitalized COVID-19 patients received transfusions with 0.77% receiving Packed Red Blood Cells (PRBCs), 0.08% platelets (PLTs), 0.23% Fresh Frozen Plasma (FFP). Covid-19 wards had significantly lower transfusion rates compared to non-Covid wards since total PRBC units issued to Covid wards was 44 as compared to 1899 units dispensed to the non- Covid wards. As was FFP, 33 to Covid wards and 1134 to non-Covid wards, same was the case with Platelets, where only 10 units were issued to Covid wards in comparison to 513 units issued to the Non- Covid wards. O +ve patients received the highest number of transfusions amongst the Covid patients, followed by A +ve, B +ve and AB +ve. Patients in the age group of 16-30 yrs and>45 yrs were the ones who showed maximum transfusion requirement. Discussion & Conclusion: Transfusion requirement by Covid-19 inpatients was fewer as compared to the other hospitalized patients. Only the critically ill patients required transfusion, while the ones with mild to moderate disease were cured by conservative management, at our institute. This data will help our department to plan and prepare for blood resource utilisation during the ongoing pandemic.
ABSTRACT
Aims & Objectives: This study was aimed to evaluate various performance indicators and analyze the blood donation section of our department. Patients/Materials & Methods: A retrospective study was conducted for 1 year and 06 months from January 2019 to June 2020 in the Department of Transfusion Medicine and Blood Bank, AIIMS Raipur, C.G. The parameters used were performance indicators defined by NABH and from several other studies. Results: Total registrations for blood donation during the period between January 2019 to June 2020 were 6600 with 4385 blood donors accepted for donation. Total voluntary donations were 1021 (23.3%) & replacement donations were 3364 (76.7%). In 2019 & 2020 voluntary donations were 579 (21.9%) & 442 (25.4%) & replacement donations 2062(78.1%) & 1301(74.6%). Total deferrals were 2202 (33.4%). Total male donors were 4187 (95.5%) & female donors 197 (4.5%). In 2019 & 2020, 2564 (97.04%) & 1623 (93.1%) male donors and 77 (2.91%) & 120 (6.9%) female donors. Total voluntary blood donation camps were 22 with 18 in 2019 & 04 in 2020. Total 1st time donors were 1703 (38.84%) and repeat donors were 2682 (61.2%). In 2019 & 2020 1st time donors were 977 (37.0%) & 726 (41.7%) and repeat donors were 1665 (63.0%) & 1017 (58.3%). Adverse donor reactions (ADR) were recorded only in the month of April in 2019, with total 05 cases (2.4%), (% ADR = Total ADR in a month/Total donations in the month X 100). In 2020, 14 adverse donor reactions were recorded, in January (03 cases, 0.67%), February (04 cases, 0.92%), May (02 cases, 0.90%), June (05 cases, 2.36%). Total Low volume donations were 365 (8.3%) with 225 (8.5%) in 2019 & 140 (8.3%) in 2020. There were no complaints from blood donors and maximum donation time recorded for a donor (from entry to exit) was 60 min. Discussion & Conclusion: Performance indicators should be implemented to improve quality performance. Due to COVID in 2020, blood donation camps were reduced, but female donors raised in 2020 due to strict replacement policy. This study showed effectiveness of blood donation services at our department .
ABSTRACT
Aims & Objectives: (1) To assess the trend of transfusion transmitted infections (TTIs) among blood donors from the records (January 2017-September 2020) at blood bank, AIIMS, Raipur, C.G. (2) To study the sero-prevalence of TTIs among blood donors from the records. (3) To study the prevalence of seroreactivity amongst voluntary and replacement blood donors. Patients/Materials & Methods: In India blood is screened for five diseases which could be transmitted through blood and produce serious illness- HIV, Hepatitis B, Hepatitis C, Syphilis, and Malaria. A record based retrospective study was conducted from January 2017- September 2020. Data were collected from the records of blood bank which also included data of blood donation camps. Data regarding TTIs prevalence in total blood donors and in replacement and voluntary donors was conducted. Results: Out of total 6624 blood donors, voluntary donors were 1351 (20.39%) and replacement donors were 5325(80.38%). Out of all TTIs, prevalence of HBV (38 cases (0.57%)) was highest followed by HCV & Syphilis having 09 cases (0.14%), HIV had 7 cases (0.11%) and no cases of Malaria were reported. Prevalence of TTIs in voluntary donors was 0.59% (08 cases) and in replacement donors was 1.05% (56 cases). Total 06 (0.89%) TTI cases in 2017, 14 cases (1.38%) in 2018, 19 cases (0.71%) in 2019 & 24 cases (1.04%) in 2020. Total voluntary male donors were 1167 and total voluntary female donors were 184. Discussion & Conclusion: From the above conducted retrospective study it was found that TTIs were more prevalent in replacement donors than voluntary donors. There was year wise raise in total TTI cases (blood donation also raised yearly). Prevalence of HBV was highest and no cases of Malaria were detected (Nil malaria cases were probably due to Antigen testing kit for malaria antigens & strict donor counseling). The number of voluntary donors has risen from 2017 - 2020, but there is male preponderance in both voluntary and replacement donors than females. Numbers of blood donations were comparatively reduced in 2020 due to COVID scenario leading to cancellation of most of the outdoor blood donation camps.