ABSTRACT
Autoimmune haemolytic anaemia (AIHA) is an acquired heterogenous clinical entity with variable presentations like acute haemolysis or mild, chronic haemolysis compounded with acute exacerbation in winters or fatal uncompensated haemolysis. A step-wise approach to the diagnosis and characterisation of AIHA should be undertaken, firstly the diagnosis of haemolysis followed by the establishment of immune nature with the aid of direct agglutination tests (DAT). Simultaneously the other causes of immune haemolysis need to be excluded too. In light of advancements in diagnostics, a wide array of investigations can be used like absolute reticulocyte count, bone marrow responsiveness index to establish the evidence of haemolysis, sensitive gel technology, enhanced DAT assays, e.g., modified DAT with low ionic strength saline solution (LISS) at 4°C, DAT assays utilizing reagents such as anti-IgA and anti-IgM and DAT by flowcytometry, to detect RBC bound autoantibodies (Abs) and monospecific DAT to establish immune causes of haemolysis and characterisation of the autoantibodies. The compensatory role of bone marrow and synchronous pathologies like clonal lymphoproliferation, dyserythropoiesis, fibrosis are important factors in the evolution of the disease and aid in the customisation of treatment modalities. The laboratory work up should aim to diagnose underlying diseases like chronic lymphoproliferative disorders, autoimmune disorders and infectious diseases. Also, tests like autoimmune lymphoproliferative syndromes (ALPS) screening panel and Next-generation sequencing (NGS) panel for RBC membrane disorders, RBC enzymopathies, and congenital dyserythropoietic aneamia have found their place. It is incumbent upon the clinicians to use the all-available diagnostic modalities for the accurate diagnosis, prognostication and customisation of the therapy.
ABSTRACT
Background: Single donor platelet products are preferred over random donor platelet products due to several advantages. However, safety issues with regard to post procedure hematological decrements and serum calcium and magnesium levels in donors undergoing plateletpheresis have been explored minimally. Aims: This prospective study was done to analyze the effects of plateletpheresis on donor's hematological parameters and serum calcium and magnesium levels. Settings and Design: It is a prospective, cross-sectional study conducted in the department of immunohematology and blood transfusion. Material and Methods: This study was undertaken on 150 healthy plateletpheresis donors over a period of 1 year. Blood samples were collected from each donor before and after the procedure, one in ethylenediaminetetraacetic acid (EDTA) vial for estimation of hematological parameters and another in plain vial for serum calcium and magnesium levels. Statistical Analysis Used: Paired t-test was used to analyze the data. Results: This study included donors in the age group of 18 to 60 years who underwent plateletpheresis on Haemonetics model of a machine (MCS) + intermittent flow cell separator. A statistically significant increase was observed in mean post procedural Hb (0.95%), Hct (0.7%), and red blood cell (RBC) count (1.3%). There was a decrease in mean post procedural platelet count (27.5%), white blood cell (WBC) count (4.02%), mean serum calcium (1.5%), and serum magnesium (5.1%), which was statistically highly significant (P < 0.001). No significant change was observed in post procedural mean platelet volume (MPV) and platelet distribution width (PDW). Conclusion: Amid the need of increased demand for plateletpheresis, donor safety must be ensured. Failing to do so can be detrimental to blood supply chain, hence stringent programs for post donation screening of plateletpheresis donors need to be established.
ABSTRACT
BACKGROUND: Red blood cell (RBC) alloimmunization is an immune response against foreign RBC antigens; this generally occurs after sensitization due to multiple blood transfusions and pregnancies. Antibody detection plays a critical role in transfusion medicine as it can detect irregular or unexpected antibodies. This study was done to know the frequency and specificity of unexpected red cell antibodies in the multitransfused patients. MATERIALS AND METHODS: This prospective study was done in the Department of Immuno-Haematology and Blood Transfusion. Antibody screening of 100 multitransfused patients with initial negative antibody screen was carried out prior to compatibility testing and followed for a period of 12 months for each transfusion. Depending on the results, patients were given corresponding antigen-negative blood units. RESULTS: In this study, the rate of alloimmunization was 7%. Total number of samples that were positive for irregular alloantibodies were 4 of 54 cases of thalassemia, that is, 7.4%, whereas 3 of 40, that is, 7.5%, cases of solid malignancies developed alloantibodies. None of the patients of chronic kidney disease formed any alloantibody. Anti-K antibody was the most frequent antibody detected in 3 of 7, that is, 42.8% patients. Anti-E was the second most frequent antibody observed in 2 of 7, that is, 28.57%. However, anti-c and anti-M were detected in one each of 7, that is, in 14.28% each. CONCLUSION: It is concluded here that red cell alloimmunization should not be overlooked in multitransfused patients. To avoid the effects of alloimmunization, routine RBC antibody screening at set time intervals after transfusion should be performed.
ABSTRACT
The present study on cost of a unit of blood was conducted in blood bank of a tertiary care public hospital with an annual collection of 20,748. A retrospective chart review was done to calculate the activity wise annual unit cost of blood, based on WHO guidelines (Blood Safety Unit. safe blood and blood products: costing blood transfusion services, World Health Organization, Geneva, 1998). Cost of blood collection, processing and storage were included. Annualized economic cost of equipments, maintenance, personnel salaries, and consumables were enlisted. It was assumed that all component units prepared carried equal cost. The cost of building, maintenance and office stationary were excluded. Data extracted from records was compiled and analysed using MS Excel. The annual unit cost of blood with component preparation and NAT testing was Rs 1829. Unit cost of blood without NAT testing was Rs 1255. Unit cost of blood if total collection was in-house, that is, excluding expenditure on camps was Rs 1738. The cost of whole blood (that is, if no components were prepared) with ELISA testing, done to ascertain cost at basic functioning was Rs 2521. With NAT testing the unit cost increased by Rs 575, the additional expenditure being equally divided among all components. Expenditure on NAT was high which was 1/3rd of the total expenditure on consumables. The additional cost incurred on each unit due to expenditure on camps was small i.e. only Rs 91 with 30% collection from camps. Voluntary camps ensures safe blood at minimal cost increment and component separation reduces cost and permits judicious use. Hence these activities should be promoted.
ABSTRACT
BACKGROUND: "f" antigen is a compound antigen in Rh blood group system. Anti f has haemolytic potential as described in literature. Its occurrence in an infant as autoantibody with another blood group system ie Jka is very rare. Case report We report a case of 10-month-old infant diagnosed with AIHA with autoantibodies directed towards "f" and Jka antigen. Antibody identification was done and antigen negative blood units were crossmatched & transfused with demonstrable haemoglobin rise and subsequent decrease in DAT grading. RESULT: Auto anti f + Jka was identified in a 10 months old infant. Autoantibodies were identified by identification 3 & 11 cell panel and select cell panel. Results were later confirmed by allogenic adsorption & elution. Patient was transfused antigen negative blood unit which lead to haemoglobin rise & gradual decrease in direct coombs test grading CONCLUSION: To our knowledge, this is the first case report of auto anti f + Jka having haemolytic potential in an infant which shows the importance of extensive immmunohaematology workup in providing compatible blood unit in patients with autoantibody.
