Successful Treatment of Subclavian Artery Thrombosis by Catheter-Based Thrombus Aspiration and Thrombolytic Therapy: A Case Report

Clinical Information Patient Initials or Identifier Number: BP4****/22 Relevant Clinical History and Physical Exam: A 55 Y / Female C/C : Pain, numbness, cold sensation & weakness of left upper limb for 2 hours. Risk Factor : Hypertension, diabetes mellitus O/E : Pale, cold and absent of radial, ulnar, brachial pulse of left upper limb. Muscle power 3/5 left side. So2 86%, BP undetectable. Right upper limb were normal. BP 160/90 mm of hg, pules : 112 b/min, RR : 26/min. Body Temperature 37.5 C [Formula presented] [Formula presented] Relevant Test Results Prior to Catheterization: CBC : WBC 7450, HB % 10.8 g/dl, ESR 20mm in 1st hour, Platelets : 262000, SARS Cov2 Antigen : Negative PT 14.3 sec, INR : 1.07 APTT : 32.4 sec. blood group: O positive Serum Creatinine : 1.1 mg/dl Plasma glucose 9.7 mmmol/l HIV Ab : Negative HBs Ag : Negative Anti-HCV : Negative Urine R/E : Normal lipid profile : Cholesterol 280mg/dl Vascular duplex ultrasound of left upper limb : A dilated echogenic thrombus had blocked the left subclaviav artery lumen. Relevant Catheterization Findings: Conventional angiography with the lowest amount of contrast agent through the right femoral artery, revealed that left subclavian artery thrombosis with total occlusion distal to Left internal mammary artery. [Formula presented] [Formula presented] [Formula presented] Interventional Management Procedural Step: A5Fr MPA catheter with side holes was negotiated through a right femoral sheath and was placed in the left subclavian artery. Initially thrombus aspiration was done with Eliminate aspiration catheter (TERUMO) with no success. Then suction was done with the MPA catheter itself with partial removal of thrombus. Then a 5Fr Pigtail catheter was placed inside the thrombus and kept in situ. For residual thrombus 250,000u of Inj. Streptokinase as a thrombolytic drug was given through the Pigtail catheter as bolus over 30 min. The maintenance dose 100,000 u per hour was given over 24 hours through the Pigtail catheter via infusion pump. After 24 hours of thrombolytic therapy, her pain was reduced, the left hand became slightly warm, and distal pulses were feebly palpable. Moreover, the skin colour returned to near normal with improvement of pallor. Bleeding was well controlled at the catheter site. Doppler sounds revealed partial improvement of arterial flow. After evaluation of partial improvement, a low dose 1000 iu per hour of heparin (UFH)was infused intravenously for 24 hours. After 48 hours, repeat angiography via the inserted catheter at the site did not reveal any atherosclerotic plaque and confirm the thrombosis-dissolution. The latter practice demonstrated a good blood flowto the left upper distal limb leaving a little thrombus in the superficial palmer arch. [Formula presented] [Formula presented] [Formula presented] Conclusion(s): Catheter-based thrombus aspiration and thrombolytic therapy is primarily reserved for patients with acute viable limb ischemia. As observed in the presented case, thrombus aspiration and thrombolytic therapy is recommended to be considered as an alternative therapeutic method for patients with arterial thrombosis due to the rapid response, shorter treatment time and lower cost, compared to common and sometimes unsuccessful therapies.Copyright © 2023

Mucormycosis in COVID-19 patients: A tertiary care experience

Introduction: Zygomycetes consisting of Mucorales order is a group of fungal infections. These species cause life threatening opportunistic fungal infections mucormycosis. This infection is highly prevalent in immunocompromised. During the 2 nd wave of Covid 19 pandemic corticosteroid treatment was used which has been linked to development of Mucormycosis. In our tertiary care teaching hospital we saw that patients suffering from Covid-19 infections developed mucormycosis. We present these cases in our study. To study the clinical, demographical,and Laboratory parameters in Covid-19 patients with Mucormycosis. Material(s) and Method(s): Retrospective Study. All biopsy proven cases of Mucormycosis (which developed after Covid-19 infection) were included. Relevant Clinical Demographics and Laboratory data was retrieved from the available case sheets. The data was tabulated in Excel sheet and further reviewed. Result(s): A total of 22 patients were diagnosed as suffering from mucormycosis majority were unvaccinated. 11 patients out of 22 (50%) started manifesting mucormycosis within one week of COVID infection. All the patients who had only single comorbidity (22.72%) suffered from mild disease and patient who had more than one comorbidity suffered from moderate (27.27%) to severe (50%) COVID infection. Conclusion(s): It is suggested that patients with Covid-19 infection are at risk for development of opportunistic fungal infections like Mucormycosis. Hence the physicians who are involved in treating such patients must be mindful of the fact that mucormycosis can develop in them. Histopathology helps in establishing a concrete diagnosis of Mucormycosis.Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

The Risk of COVID-19 in People Having a Particular Set of Gene

These risk factors of advancing age, male gender and co-existing health conditions like cancer, cardiovascular diseases, diabetes and obesity do not fully explain why some people have no or mild symptoms whereas others have severe symptoms. Genomewide association study (GWAS) identify a 3p21.31 gene cluster as a genetic susceptibility locus in patients with COVID-19 with respiratory failure. They also found a higher risk among persons with blood group A and protective effect for blood group O than among patients with other blood groups. The particular haplotype in a region of chromosome 3 is contributed to modern humans by neandertals. Another Neanderthal haplotype on chromosome 12 is associated with a 22% reduction in relative risk of becoming severely ill with COVID-19. The ApoE e4e4 homozygous genotype was found to increase the risk of severe COVID-19. Change in angiotensin converting enzyme (ACE) 2 gene was also found to be associated with increased risk of COVID-19, cardiovascular and pulmonary conditions. Copyright © 2021, Kathmandu University. All rights reserved.

Waning Immunity of Primary Chadox1 Ncov-19 Vaccination in Adults of Various Age Group

Background & Objective: The Covid-19 vaccines in India were introduced after the phase III trial. Though the vaccines have obtained EUA (Emergency Use Authorization) efficacy data and duration of protection is still unknown. This study helps us to understand the vaccine efficacy, sustainability of immune response. Method(s): Blood samples and detailed history were collected. Serum sample are collected after 3 months and 6 months after Covishield vaccine to analyze the presence of Anti SARS IgG antibody to S spike protein. Results : Out of the 550 study population, 2% and 16 % had waning antibody titres by 3 months and 6 months respectively after 2 doses of vaccination. Majority of which had co-morbid health conditions (p<0.5) and O +ve blood group people had more secondary vaccine failures. Increasing age had significant association with wanning immunity. Prolonged interval between the 2 doses had positive effect on the sustainability of immune response at 6 months after 2 doses of ChAdOx1 n CoV-19 vaccination. Interpretation & Conclusions : Notable population had waning immunity after 6 months of ChAdOx1 nCoV-19 vaccination. The current recommendation has to be redefined with respect to various factors such as comorbidities and advancing age to obtain maximum vaccine efficacy. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

Probability of Covid-19 in Abo Blood Type during Second Wave in Southern Rajasthan, India

Objectives: Along the course human history of scientific research, the severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) is the most concerning global health problem. Second wave of COVID-19 has adversely affected India. However, India embarked on its immunization program on January 16, 2021, operating 3006 vaccination centers onset Covaxin and CoviShield. This study aimed to ascertain if there is an association amidst ABO blood type and probability of COVID-19 infection in wave. Method(s): This is analytical and observational study conducted on 713 SARS-COVID-19-positive patients of a known ABO blood type, who attended outpatient department and inpatient department during March 26-May 20, 2021, in tertiary care hospital Udaipur (Raj.) Serum inflammatory markers were evaluated by Cobas 6000. Result(s): Out of the 713 patients who were tested positive, 15.56% was blood group Type A, 19.91% was blood group Type B, 13.65% was blood group Type AB, and 46.28% was blood group Type O. On statistical analysis, there were positive association between O+ blood type and peak inflammatory marker (interleukin-6 and D-Dimer). Patients with blood Type O who received a test were more likely to test positive and blood Type B+, A+, A+, AB+, O-, A-, B-, and AB- were less likely to test positive. Conclusion(s): The present study shows an evidence for interrelation between ABO blood groups and SARS-COVID-19. Reported infection prevalence is moderately increased among O+ blood type individuals. Determination of level of inflammatory markers might prove to be helpful to clinicians so as to keep track of severity of infection and evaluate the prognosis of SARS-COVID-19 with specific ABO blood groups. Copyright © 2022 The Authors. Published by Innovare Academic Sciences Pvt Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)

Investigation of the clinical course of Covid-19 patients according to blood groups

The aim of this study is to evaluate the effect of blood groups (BGs) on Covid-19 contraction and prognosis and to reveal the coefficients. Patients who referred to Covid-19 outpatient clinics and had an established diagnosis of Covid-19 were included in the study. Their BGs, previous diagnoses and blood examination findings were retrospectively analyzed. Duration of hospitalization, clinical course and survival were recorded. The mean age of 365 subjects, 210 female and 155 male, was 45,5 years. Subjects with BG A developed Covid-19 at significantly higher rates (p = 0.001), while BG O was found associated with lower rates (p = 0.005). Lymphocyte count was found lower (p = 0.035) and rate of lung parenchymal involvement was higher (p = 0.003) in patients with Rh antigen. It was found that a higher percentage of patients with B BG required treatment in the intensive care unit (ICU) compared to other ABO BGs (p = 0.015). These results suggest a higher risk of Covid-19 contraction in the population with BG A and lower risk for BG O population while indicating poorer prognosis for patients with BG B. Copyright © 2022 Ondokuz Mayis Universitesi. All rights reserved.

Antibody Response After COVID-19 Vaccination in CKD and Kidney Transplant Patients

Background: Vaccination of patients with chronic kidney disease (CKD) and kidney transplants (KTs) may achieve a less robust immune response. Understanding such immune responses is crucial for guiding current and future vaccine dosing strategies. Method(s): This prospective, observational study estimated the immunogenicity of humoral and cellular responses of two SARS-CoV-2 vaccines in different patient groups with CKD compared to controls. Secondary outcomes were adverse events after vaccination and the incidence of COVID-19 breakthrough infection, including illness severity. Result(s): In total, 212 patients received ChAdOx1 nCoV-19 (89.62%) or inactivated vaccines (10.38%). The antibody response against the S protein was analyzed at T0 (before the first injection), T1 (before the second injection), and T2 (12 weeks after the second injection). Seroconversion occurred in 92.31% of controls at T2 and in 100% of CKD, 42.86% of KT, 80.18% of hemodialysis (HD), and 0% of continuous ambulatory peritoneal dialysis (CAPD) patients at T2 of ChAdOx1 nCoV-19 vaccine. Neutralizing antibody levels were above the protective level at T2 in each group. The KT group had the lowest neutralizing antibody and IFNgamma. Blood groups O and vaccine type were associated with good immunological responses. After the first dose, 14 individuals(6.6%) out of the total population experienced breakthrough COVID-19 infection. Conclusion(s): Immunity in patients with CKD and HD after vaccination was strong and comparable to that of healthy controls. Our study suggests that a single dose of the vaccine is not efficacious and delays may result in breakthrough infection. Some blood group and type of vaccine can affect the immune response.

Blood group O is associated with post-COVID-19 syndrome in outpatients with a low comorbidity index.

BACKGROUND: ABO blood group system modulates the inflammatory response and has been implicated in COVID-19. Group O protects against SARS-CoV-2 infection, but there are no data regarding post-COVID-19 syndrome (PCS). Our aim was to assess this possible association. METHODS: Case-control study in a community setting, with subjects who had experienced mild COVID-19. Cases were PCS+, controls were PCS-, and the exposure variable, group O. We collected age, sex, BMI, smoking, comorbidities, inflammatory markers, anti-SARS-CoV-2 IgG antibodies, blood type and clinical data. Five composite inflammatory indices were developed. Multivariate analyses were performed. RESULTS: We analysed 121 subjects (56.2% women), mean age 45.7 ± 16 years. Blood group frequencies were 41.5%, 7.9%, 5.9%, and 44.5% for A, B, AB and O, respectively. Thirty-six patients were PCS+, without significant differences between cases and controls. Compared to non-O, a higher prevalence of PCS (p = .036), and number of symptoms of PCS (p = .017) were noted in group O. Concerning biomarkers, PCS + and PCS- showed no differences in A, B, and AB groups. In contrast, group O PCS + patients had significantly lower albumin-to-globulin ratio and higher lymphocyte count, fibrinogen, CRP levels, and higher percentages of 3 composite indices, than PCS- subjects. Group O showed a 6-fold increased risk of PCS, compared to non-O (adjusted OR = 6.25 [95%CI, 1.6-23]; p = .007). CONCLUSIONS: Group O has shown a consistent relationship with PCS, characterised by a more intense inflammatory burden than the other blood groups. Blood group O could be part of the immunological link between acute COVID-19 and PCS.

Seroprevalence of Sars-Cov-2 antibodies among eligible blood donors of Peshawar, Pakistan

Background and objectives: To determine the seroprevalence of SARS-CoV-2 antibodies and the associated risk factors among healthy blood donors from Peshawar Pakistan, during the second and third waves of the CO-VID-19 pandemic. Methods: The study was conducted on 4047 healthy (with no history or symptoms of COVID-19) blood donors attending regional blood center Peshawar between Nov 2020 and June 2021. Demographic data was collected and donors were screened for the presence of anti-SARS-CoV-2 antibodies using electrochemilumines-cence immunoassay (ECLIA). Results: The mean age of the participants was 27.27±7.13 and the majority (99%) were males. Overall, 59% (2391/4047) of the blood donors were reactive for SARS-CoV-2 antibodies. An increasing trend in seropositivity was observed from 45.5% to 64.8% corresponding to the second and third wave of the pandemic in Pakistan. Logistic regression analysis revealed significantly higher odds of seropositivity among male donors compared to females. Similarly, in multivariable analysis, the odds ratio for seropositivity among blood types AB, A, and B were, 1.6, 1.4, and 1.3 (CI 95%) times higher compared to blood group O (P-value ≤0.0001). Conclu-sions: Seropositivity of SARS-CoV-2 antibodies among blood donors gradually increased during the second and third wave of the pandemic in Pakistan indicating a widespread prevalence of Covid-19 in the general population. Susceptibility to SARS-CoV-2 varies with ABO blood types, with blood group O associated with low risk of infection.

Collection of COVID-19 convalescent plasma in institute for transfusion medicine of republic of North Macedonia and evaluation of anti-SARS-CoV-2 antibody concentration in different donors subgroups

Background: Plasma collected from patients that have recovered from an infectious disease has been transfused over many decades for prophylaxis and treatment of various infectious diseases. Taking into consideration the expansion of COVID-19 pandemics, we started the COVID-19 convalescent plasma (CCP) programme. Aims: The aim of our study is to show our experience with collecting the CCP and to evaluate the SARS-CoV-2 antibody concentration in different convalescent plasma donors' subgroups. Methods: This is a prospective study performed in the Institute for Transfusion Medicine of Republic of North Macedonia since 30 April 2020 till July 2021. Antibody testing was performed at the Institute for Immunobiology and Human Genetics in Skopje using CLIA method with Snibe Maglumi SARS-CoV-2 S-RBD IgG (quantitative) with IgG cut-off larger than 5 AU/ml. All potential donor were tested for: negative RTPCR for SARSCoV-2 before donation, anti-SARS-CoV-2 antibodies, anti- HLA antibodies (where applicable), blood count, blood group, TTI and biochemistry. Preferred method for plasma collection was plasmapheresis which was performed with Terumo BCT Trima Accel and donation of whole blood, depending on the donor preference and venous access. All donors signed inform consent for donation and inclusion in the study. Results: There were 1476 potential CCP donors, but only 700(47.9%) donors fulfilled all the criteria and we obtained 793 units of CCP;639 (80.6%) units from whole blood donors and 154 (19.4%) CCP units from 61 plasmapheresis donors, 485 (69.3%) males and 215 (30.7%) females. Mean age of the donors was 40 years (range 18-63). Mean value of SARS-CoV-2 S-RBD IgG concentration was 31.05 AU/ml, (range from 5.1 AU/ml to >100 AU/ml), mean value of SARS-CoV-2 S-RBD IgG in men was 37.6 AU/ml and 28.9 AU/ml in women (p < 0.05). Distribution of CCP donors according to the ABO blood group was: 301 blood group A (43%) with median value of SARS-CoV-2 S-RBD IgG = 27.15 AU/ml, 220 blood group O (31.4%) median value of SARS-CoV-2 S-RBD IgG = 32.1 AU/ml, 116 blood group B (16.6%) median value of SARS-CoV-2 S-RBD IgG = 35.9 AU/ml and 63 donors had blood group AB (9%) median value of SARS-CoV-2 S-RBD IgG = 26.45 AU/ml. There were 69 donors that were previously hospitalized with mean value of SARS-CoV-2 S-RBD IgG = 48.6 AU/ml, and 629 that were treated at home with mean value of SARS-CoV-2 SRBD IgG = 29.1 AU/ml (p < 0.05), of which 578 had symptoms with mean value of SARSCoV- 2 S-RBD IgG = 29.1 AU/ml and 51 were asymptomatic with mean value of SARS-CoV-2 S-RBD IgG = 29.3 AU/ml. The CCP donors had the following distribution according to the age: 125 donors in the 18-29 age group with median value of SARS-CoV-2 S-RBD IgG = 23.0 AU/ml, 200 donors in the 30-39 age group with mean value of SARSCoV-2 S-RBD IgG = 28.2 AU/ml, 217 donors in the 40-49 age group with mean value of SARS-CoV-2 SRBD IgG = 32.9 AU/ml and 156 donors in the 50-63 age group mean value of SARS-CoV-2 S-RBD IgG = 38.3 AU/ml (p < 0.05). Summary/Conclusions: The collection procedures are safe and effective and collected CCP units were with high concentration and quality. The concentration of SARS-CoV-2 S-RBD IgG in CCP obtained from previously hospitalized patients was significantly larger than in ones that were treated at home. The concentration of SARS-CoV-2 S-RBD IgG was higher in men, in advanced age group and in donors with blood group B. The further studies are needed to clarify the impact of different variables on antibodies concentration/ titre in donors.

The spectrum of ABO hemolytic disease of the fetus and newborn in neonates born to Group O mothers

Background: ABO hemolytic disease of the fetus and newborn (ABOHFDN) is a frequent event, and usually a problem of the neonate rather than the fetus, however, it is difficult to predict the disease severity. Thus, there is a need to increase awareness towards ABOHFDN for optimizing care in terms of early diagnosis and adequate monitoring. Aims: To determine the frequency of ABO-incompatibility in neonates born to group O mothers and to assess the severity of ABO-HDFN in neonates and determine the neonatal outcomes. Methods: This prospective observational study was carried out from February 2020 to May 2021 after obtaining a written informed consent from the mothers. A total of 260 neonates born to blood group O mothers were recruited. The maternal red cell antibody screen (ABS) using a 3-cell panel (Diacell, Bio-Rad, Switzerland) and the neonatal direct antiglobulin test (DAT) were done by column agglutination technique (CAT). For DAT positive samples, the IgG subclass of anti-A/anti-B was determined using DAT IgG1/IgG3 screening cards (Bio-Rad, Switzerland) and a heat elution at 56°C was also performed. The maternal anti-A/anti-B IgG titers was determined by tube technique after treating the serum sample with 0.01 M di-thiothreitol (DTT). The neonatal total serum bilirubin (TSB) and other relevant parameters were also recorded. The requirement for treatment in terms of phototherapy and/or exchange transfusion (ET) and the neonatal outcome were also recorded. Due to travel restrictions during the ongoing COVID-19 pandemic, the follow-up was performed telephonically with parents 6-8 weeks after discharge. Results: Of the 260 group O mothers, none had positive ABS. Of the 260 neonates born to them as an outcome of singleton pregnancies, 84 with blood group O were excluded from the study. The overall frequency of ABO-incompatibility between mother and neonates was 67.69% (176/260). Out of 176 neonates, 77 (43.8%) were group A and 99 (56.2%) were group B, and 15 (8.5%) of them had a positive DAT. Overall, 26.7% (47/176) neonates received phototherapy and 172 (97.7%) neonates survived. The mean (±SD) duration of phototherapy (hours) was 34.17 (±25.67) hours and it ranged from 12- 120 h. Only 1 neonate required ET. None of the neonates required readmission. The median maternal IgG anti-A titre was 16 (8-64) (range: 2-512), while the IgG anti-B titre was 32 (32-64) (range: 4- 512) (p = <0.001). The maximal TSB in neonates had a significant positive association with neonatal birth weight (p = 0.045), maturity at birth (p = 0.037), positive DAT (p = 0.006) and requirement of phototherapy (p = <0.001). Neonatal DAT positivity was significantly associated with maternal IgG titers (p = <0.001), neonatal PCV (p = 0.017), maximal TSB (p = 0.006), requirement (p = <0.001) and duration of phototherapy (p = 0.024). At a cut-off of maternal IgG titre ≥64, it predicted the requirement of phototherapy with a sensitivity of 72.3% and a specificity of 72%. The relative risk (95% CI) of a DAT positive neonate requiring phototherapy was calculated to be 4.55 (3.12-6.33). Summary/Conclusions: The frequency of ABO-incompatibility in neonates born to group O mothers was 67.69% (176/260). The maternal IgG titre of anti-A/anti-B of 64 or more could be a good predictor for identifying the neonates at-risk for developing hyperbilirubinemia requiring further management and combining it with neonatal DAT further enhances the sensitivity to identify such at-risk neonates.

Relationship between the abo blood group and the coronavirus disease 2019 (COVID-19) severity: a population-based cohort study in the Valencian community (Spain)

Background: It has already been published the existence of an association between ABO blood groups and COVID-19 severity. These studies have reported that the ABO blood group is statistically associated with the acquisition of SARS-CoV-2 and survival after the virus infection. Researchers have found that blood group A was associated with a higher risk for COVID-19 infection and severity compared with others blood groups, whereas blood group O was associated with a significantly lower risk compared with non-O blood groups. Aims: This study aimed to demonstrate, in a population-based cohort study in the Valencian Community (Spain), the relationship between the ABO blood group and COVID-19 severity. Methods: A total of 567 regular blood donors from the Valencian Community (Spain) who had been infected by SARS-CoV-2 were recruited. They were divided into three different cohorts based on their symptoms and their requirements during the infection: asymptomatic donors, mild donors, and severe donors. Demographic data were also included. Asymptomatic donors did not have any symptoms;mild donors had the most common symptoms associated with COVID-19 without the need for hospitalization and severe donors needed hospitalization due to severity. For the statistical analysis, we compared the three cohorts with regular blood donors who donated blood in the last 3 years (256,203 donors) in the Valencian Community. Data were analysed using Chi-Square tests. p-values <0.05 were considered significant, standardized residuals were calculated to assess the contribution of each cell to the significance of the test. GraphPad Prism v.7.0 software was used. Results: Our results show that 63.33% of blood donors who had passed COVID-19 disease and required hospitalization (severe donors) were from blood group A while only 26.67% were from blood group O (p-value = 0.0002). The same results were observed in the established cohort for mild donors, with 47.01% and 39.08% from blood groups A and O (p-value<0.0001), respectively (Table 1). These data suggest that blood group A could be a risk factor for COVID-19 infection and group. Regarding asymptomatic donors, only 38.52% were donors from blood group A while 13.12% were donors from blood group B (Table 1). This data indicate that blood group B could be protective against COVID-19 severity (pvalue< 0.0001). Summary/Conclusions: Blood group A and blood group O donors showed a significantly higher and lower risk (p-value = 0.0002), respectively, to require hospitalization after the infection of COVID- 19. However, belonging to blood group B seemed to be associated with low-risk SARS-CoV-2 infection (p-value<0.0001).

Social media approach for sustainable blood collection during pandemic COVID-19: Experience from Sarawak general hospital

Background: The first wave of COVID-19 in Malaysia started on 24 January 2020. Overall blood collection in Malaysia has shown reducing in trend following first wave of COVID-19 infection due to various factors such as Movement Control Order (MCO), blood mobile cancellation by organizers, and overall public stigmatization of contracting COVID-19 infection upon donating blood at the hospital. Aims: Implementing multiple strategies such as establishment of static mobile outside hospital, promotion in social media platform, and donor tele-recruitment to maintain sustainable blood collection during pandemic COVID-19. Methods: Retrospective analysis of blood collection data from January 2020 until December 2021 via Blood Bank Information System Version 2. Results: Our data showed that blood donors prefer to donate at static mobile in which the place is far away from patients, have large space for physical distance and able to comply to Standard Operating Procedure. During period of Movement ControlOrder(MCO) Phase 1, Phase 2, Phase 3, Phase 4 and Phase 5, our blood collection was 462,248,285,408 and 681 respectively which in total was 2084 blood bags. In comparison, blood collection at our blood donation centre was significantly less during MCO Phase 1, Phase 2, Phase 3, Phase 4 and Phase 5 which are 86,4,83,327 and 61 respectively which in total was 557 blood bags. Utilizing social media to promote blood donation is very important. On 3rd August 2020, our blood stock for Group O is reducing in trend and donor turn up at our centre was only 21 and only 8(38%) is blood group O. Hence, we created a post in our facebook platform to invite all our group O to come forward and donate urgently. The post went viral with 638,061 Reach and 10,878 Engagement, resulting significant increase of donor turn up to our blood centre for the subsequent 4 days. On 4, 5, 6 and 7 August 2020, total donor turn up was 73 with 48(66%) group O, 45 with 32(71%) group O, 41 with 26(63%) group O and 62 with 37(60%) group O respectively. Tele-recruitment is essential in the strategy to maintain blood collection. On 17 December 2021, our blood group O has reduced to 132 bags with safe level for group O is 215. There were 29 donors turn up with only 10 donors group O (34%). Hence, we initiated tele-recruitment by personal calling to all 150 blood group O donors to come donate. Subsequently, on 18th and 19th December 2021, we have 177 donors turn up with 86(48%) group O and 178 donors turn up with 88(49%) group O respectively. On 20 December 2020, our stock level for group O has increased above safe level which is 219 bags. Summary/Conclusions: Implementing multiples strategies is essential to maintain sustainable blood collection in order to meet the blood supply demand during pandemic COVID-19.

Reasons for deferral of COVID-19 convalescent plasma donors

Background: Taking into consideration historic success of convalescent plasma in prophylaxis and treatment of various infectious diseases over the century and expansion of COVID-19 pandemics, we started the COVID-19 convalescent plasma program in our country. Aims: The aim of our study was to show the reasons for deferral of the COVID-19 convalescent plasma (CCP) donors. Methods: This is a prospective study organized in the Institute for Transfusion Medicine of Republic of North Macedonia since 30 April 2020 till July 2021. CCP donors eligible for donation were donors without a history of blood transfusion, female donors who have never been pregnant, or who have been tested and found negative for anti- HLA antibodies, age 18-65, in good health that fulfil all other criteria for regular blood donors. All potential donor were tested for: negative RT-PCR for SARSCoV-2 before donation, anti-SARS-CoV-2 antibodies, anti-HLA antibodies (where applicable), blood count, blood group, TTI and biochemistry. Antibody testing was performed at the Institute for Immunobiology and Human Genetics in Skopje using CLIA method with Snibe Maglumi SARS-CoV-2 S-RBD IgG with IgG cut-off for CCP donation larger than 5 AU/ml (cut-off for regular positive result was larger than 1 AU/ml). All donors signed inform consent for donation and inclusion in the study. Results: There were 1462 potential CCP donors, of which 762(52.1%) did not fulfil criteria for CCP donation, 424(55.6%) women and 338 (44.4%) men. There were 454(59.6%) potential CCP donors that did not have enough anti-SARS-CoV-2 S-RBD IgG antibodies (Ab), of which 223(49.1%) had Ab concentration less than 1 AU/ml (29.3% of all deferred donors) and 231(50.9%) had Ab concentration between 1 and 5 AU/ml (30.3% of all deferred donors). In this subgroup of deferred donors, there were 227 women (50%) and 227 men (50%), with mean age 37.2 ± 10.1 (range 18-63). There were statistical significant correlation between the gender and the Ab concentration less than 1 AU/ml and from 1 to 5 AU/ml (Pearson Chi-square: 3.88667, df = 1, p = 0.048671). Multiple regression analysis showed that gender is independently connected with the Ab concentration, OR = 1.4495 (95%CI 1.0016-2.0976), i.e. male gender increases the chance for increased Ab concentration for one and a half times. According to the age group, the majority of deferred CCP donors, because of low Ab concentration, are in the age group from 30 till 39(39.6%), followed by age group from 40 till 49(23.8%), and least deferred donors were in 50 and above age group (13.2%). The most of these deferred donors were treated at home, 451(99.3%) and had symptoms 240(52.9%). Distribution according to blood group in CCP donors deferred due to low Ab concentration was: blood group A- 182(40.1%), blood group O-153(33.7%), blood group B-69(15.1%) and blood group AB-42(9.3%). In the whole investigated group, 65 (8.5%) potential donors were deferred because of low haemoglobin level (less than 12.5 g/dl for women and less than 13.5 g/dl for men), 26 (3.4%) were deferred because of positive TTI markers and 102 (13.4%) women of the total number of deferred donors were deferred because of presence of HLA antibodies (i.e. 24% of investigated women). Summary/Conclusions: There is large percentage of deferred CCP donors mostly because of low Ab concentration, presence of HLA antibodies and low haemoglobin level, but starting of COVID-19 convalescent plasma program was a big success for our institution and our country and helped a lot of patients.

Characterization of SARS-CoV-2 infection in older adults in Cuba, March-June 2020

Introduction: COVID-19 has the potential to impact any population group, however, older adults have a worse prognosis and a higher mortality rate. Objective: Characterize the clinical-epidemiological variables of older adults with SARS-CoV-2 in the first three months of the epidemic in Cuba. Methods: An observational cross-sectional study was conducted in Cuban patients aged 60 years and older, with epidemiological discharge of SARS-CoV-2 infection, between March 11 and June 11, 2020. A questionnaire with clinical and sociodemographic variables was applied. Statistical analyses were performed using the SPSS 22.0 statistical package. Results: 241 patients were studied, 52.3 % presented mild or moderate symptoms. There was an increase in average age from asymptomatic to severe. Blood group O (46.1%) was the most frequent;however, those in group A showed an increased risk of developing symptoms. The most common associated diseases were high blood pressure, cardiovascular disease and diabetes mellitus. Fever, dry cough and shortness of breath were the most frequent symptoms. Conclusions: Patients with blood group A, hypertensive patients and associated cardiovascular diseases presented an increased risk of suffering from symptomatic forms. The vulnerability of older adults comes not only from their age, but also from associated chronic diseases, which is why the protection of this population group is essential.

Correlation between CT chest severity score (CT-SS) and ABO blood group system in Egyptian patients with COVID-19

Background: The 2019 coronavirus disease (COVID-19) has become a global health crisis. CT chest is considered as an important investigation for early diagnosis as well as assessment of severity of COVID-19 pneumonia. Several articles reported that there is a correlation between ABO blood group system and susceptibility as well as prognosis of the disease. In our study we correlated the CT severity score (CT-SS) and the ABO blood group in patients with COVID-19 infection. This study involved 547 symptomatic patients with pathologically proven COVID-19 infection (positive PCR);non contrast CT chest was done for all cases and CT severity score (CT-SS) was calculated followed by its correlation with the patients’ ABO blood group. Aim of the work was to evaluate the relation between CT-SS and the ABO blood groups in Egyptian patients with COVID-19 infection. Results: The mean CT-SS in patients with blood group A patients (n = 153;28%) was 13.7 (moderate severity), while in patients with blood group O (n = 227;41.5%) the mean CT-SS was 6.7 (mild severity). In blood group B patients (n = 139;25.4%) the mean CT-SS was 9.1 (mild to moderate severity) and in blood group AB patients (n = 28;5.1%) the mean CT-SS was 9.7 (mild to moderate severity). Conclusion: COVID-19 patients with blood group A are more prone to aggressive CT findings (higher CT-SS) and consequently may be susceptible to increased risk of mortality compared to the patients with other blood groups;however, patients with blood group O are suggested to have the least CT-SS and appear to be relatively protected.

Characteristics of US Blood Donors Testing Reactive for Antibodies to SARS-CoV-2 Prior to the Availability of Authorized Vaccines.

In the United States, many blood collection organizations initiated programs to test all blood donors for antibodies to SARS-CoV-2, as a measure to increase donations and to assist in the identification of potential donors of COVID-19 convalescent plasma (CCP). As a result, it was possible to investigate the characteristics of healthy blood donors who had previously been infected with SARS-CoV-2. We report the findings from all blood donations collected by the American Red Cross, representing 40% of the national blood supply covering 44 States, in order to characterize the seroepidemiology of SARS-CoV-2 infection among blood donors in the United States, prior to authorized vaccine availability. We performed an observational cohort study from June 15th to November 30th, 2020 on a population of 1.531 million blood donors tested for antibodies to the S1 spike antigen of SARS-CoV-2 by person, place, time, ABO group and dynamics of test reactivity, with additional information from a survey of a subset of those with reactive test results. The overall seroreactivity was 4.22% increasing from 1.18 to 9.67% (June 2020 - November 2020); estimated incidence was 11.6 per hundred person-years, 1.86-times higher than that based upon reported cases in the general population over the same period. In multivariable analyses, seroreactivity was highest in the Midwest (5.21%), followed by the South (4.43%), West (3.43%) and Northeast (2.90%). Seroreactivity was highest among donors aged 18-24 (Odds Ratio 3.02 [95% Confidence Interval 2.80-3.26] vs age >55), African-Americans and Hispanics (1.50 [1.24-1.80] and 2.12 [1.89-2.36], respectively, vs Caucasian). Group O frequency was 51.5% among nonreactive, but 46.1% among seroreactive donors (P< .0001). Of surveyed donors, 45% reported no COVID-19-related symptoms, but 73% among those unaware of testing. Signal levels of antibody tests were stable over 120 days or more and there was little evidence of reinfection. Evaluation of a large population of healthy, voluntary blood donors provided evidence of widespread and increasing SARS-CoV-2 seroprevalence and demonstrated that at least 45% of those previously infected were asymptomatic. Epidemiologic findings were similar to those among clinically reported cases.

Relationship of SARS-CoV-2 Pandemic with Blood Groups.

INTRODUCTION: SARS-CoV attaches to human angiotensin-converting enzyme 2 receptor with the spike protein and infects cells. It can play a direct role in infection by acting as a receptor and/or co-receptor for blood group antigens, microorganisms, parasites, and viruses. OBJECTIVES: We aimed to compare the blood group distribution of patients with SARS-CoV-2 infection admitted to hospital and that of healthy donors. METHODS: A total of 823 patients with a positive SARS-CoV-2 test and clinical symptoms were included in the study. The results were compared with the normal blood group distribution in the region. RESULTS: While the prevalence of COVID-19 in the A, B, and AB blood groups was higher than that in the healthy blood donors, it was lower in the O blood group (p = 0.009). The distribution of demographic and clinical characteristics based on blood groups did not differ significantly. CONCLUSION: Our results are in agreement with other studies suggesting that blood group O individuals are somewhat more resistant to clinically overt infection with SARS-CoV-2 than other blood groups. However, this tendency is not sufficiently established to allow special prophylaxis recommendations for non-O individuals.

Individuals with a Rh-positive but not Rh-negative blood group are more vulnerable to SARS-CoV-2 infection: demographics and trend study on COVID-19 cases in Sudan.

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In Sudan, several haematological studies were conducted to study the ABO blood group distribution among the population, in which the O blood group was dominant followed by the A blood group. However, there is no systematic study into any correlation between COVID-19 and the population's blood group types, therefore we have intended to study the possible effect of blood group on the acquisition of SARS-CoV-2 infection. A questionnaire-based case-control study was carried out on 557 individuals with COVID-19 in Sudan; factors such as age, blood group, previous malaria infection, history of ailments such as diabetes, hypertension and symptoms suffered were also considered and analysed. More women were infected than men, and individuals between 25 and 35 years were the most affected age group. O Rhesus-positive (O+) blood group was the least affected by the disease while A Rhesus-positive (A+) individuals were the most vulnerable. Fatigue, fever and loss of smell were the major symptoms among the patients, but 13% of SARS-COV-2-positive individuals remained asymptomatic. As the Sudan population is largely constituted of O Rhesus-positive inhabitants (approximately 50%) these results might explain the relatively lower COVID-19 incidence in the country.