ABO blood group discrepancies in blood donor and patient samples at a tertiary care oncology centre: analysis and serological resolution.

INTRODUCTION: In serological testing, determination of ABO grouping requires both antigen typing for A and B antigens and screening of serum or plasma for A and B antibodies. Lack of corroboration between the results of the cell and serum groupings identifies a discrepancy. Analysis of ABO blood group discrepancies was performed to determine the incidence of these discrepancies among healthy blood donors and oncology patients. MATERIALS AND METHODS: ABO discrepancies found during testing of blood samples from blood donors and patients in an oncology centre in the period from January 2015 to December 2018 were analysed. ABO blood grouping was performed using the column agglutination test. Detailed serological workups were carried out to resolve discrepancies. RESULTS: During the study period, a comprehensive analysis was conducted on a large dataset comprising 76,604 blood donor samples and 134,964 patient samples. Of these samples, 117 ABO discrepancies were identified with 13 occurring in blood donor samples and 104 in patient samples. The results demonstrated discrepancies caused by weakened/missing antibodies, weakened/missing antigens, panagglutination and miscellaneous factors in the blood donor samples, with percentages of 0%, 38%, 8%, and 31%, respectively. In patient samples, the percentages were 24%, 27%, 26%, and 15%, respectively. CONCLUSION: Weakened/missing antigen discrepancies were the prevalent type in both blood donor and patient samples. For accurate blood group reporting and management of transfusion needs of patients, a complete serological workup is vital to resolve any blood group discrepancies.

Serial monitoring of ionised calcium levels in plateletpheresis donors: A study from tertiary care oncology centre in India.

BACKGROUND: Plateletpheresis is a safe procedure, and the most common reaction is hypocalcemia which is transient and self-limiting, but it can have an impact on donor experience and donor return rate. AIM: To serially monitor the ionized calcium levels of the plateletpheresis donors and to correlate with symptoms of hypocalcemia if any. METHODS: It was a prospective observational study in 126 healthy voluntary donors eligible for plateletpheresis as per the Departmental SOP and after taking written informed consent. Procedures were conducted on continuous flow centrifugation (CFC) and intermittent flow centrifugation (IFC) cell separators. Donor blood samples were collected in pre-heparinized syringes at different intervals to measure ionized calcium levels (iCa++) by venous blood gas analysis (Cobas 221). RESULTS: There was a continuous and gradual decrease in iCa++ from start to 30-45 minutes during the procedure; while the levels showed a gradual increase at end of the procedure and reached near the baseline values after 15-30 min of completion of the procedure. The change in iCa++ was statistically significant at 30 min and 45 min (p < 0.05), which was correlated with symptoms of hypocalcemia observed in 32.5 % (41/126) of the donors. Females experienced more symptoms of hypocalcemia as compared to males (p < 0.01). Donors who underwent plateletpheresis on the IFC machine experienced more symptoms of hypocalcemia as compared to the CFC machine (p < 0.05). CONCLUSION: For donors with persistent symptoms of hypocalcemia which are unrelieved by procedural modifications (reducing blood return rate, citrate infusion rate, etc.) measurement of iCa++ and administration of oral calcium tablets may be considered.

Unexpected high platelet counts in a potential platelet donor: A clue to essential thrombocythemia.

Essential thrombocythemia (ET) (primary thrombocythemia) is a nonreactive, chronic myeloproliferative clonal disorder in which sustained megakaryocyte proliferation leads to an increase in the number of circulating platelets. It is silent disorder and is diagnosed as high platelet counts with or without associated symptoms or as an accidental finding. We, hereby, report a case of ET as an incidental finding during screening of a potential platelet donor. Donors with high platelet count should be investigated properly to rule out ET. The role of transfusion medicine specialist is not only to recruit donors but also to identify such donors during screening and counsel them for detailed investigation and proper management.

Management of transfusion needs in a case of immunizing anti-M antibody in a patient with acute myeloid leukemia.

Anti-M is a relatively common "naturally occurring" antibody. Unexpected alloantibodies in patient's serum other than ABO isoagglutinins (e.g., anti-M) may cause a discrepancy in the reverse grouping. As long as anti-M does not react at 37°C, it is clinically insignificant for transfusion. However, we found this antibody to be of "immunizing" type which was reactive at 37°C and AHG phase and showing problems in blood grouping and crossmatch. This antibody had both IgM and IgG components. When "M" antibodies active at 37°C are encountered, antigen-negative or red cells that are compatible with an indirect antiglobulin test should be provided.

RHD-Positive Alleles among D- C/E+ Individuals from India.

BACKGROUND: Molecular bases of blood group systems, including Rh blood group, have been poorly studied in the Indian population so far, while specificities of Europeans, East Asians and Africans have been well known for years. In order to gain insights into the molecular bases of this population, we sought to characterize the RHD allele in D- Indian donors expressing C and/or E antigen(s). METHODS: RHD gene was analyzed in 171 serologically D-, C/E+ samples by standard molecular methods such as quantitative, multiplex PCR of short fluorescent fragments (QMPSF) and direct sequencing when necessary. RESULTS: RHD whole gene deletion at the homozygous state was found to be the most common genotype associated with D- phenotype (118/171, 69.0%). Nonfunctional, negative hybrid genes with reported molecular backgrounds were observed in approximately one-third of the samples, while only four samples carry single-nucleotide variations, including one novel nonsense (RHD(Y243X)), one novel frameshift (RHD(c.701delG)), and two missense (RHD(T148R) and RHD(T148R, T195M)) alleles. CONCLUSION: Overall we report for the first time the molecular bases of D antigen negativity in the D-, C/E+ Indian population, which appears to be qualitatively similar to other populations, but with a population-specific, quantitative distribution of D-- alleles.

Comparison of plateletpheresis on three continuous flow cell separators.

INTRODUCTION: Platelet concentrate (PC) remains one of the most important support measures in thrombocytopenic patients. An efficient cell separator is a prerequisite for an optimally functioning apheresis setup. Donor blood count may undergo a temporary reduction after the procedure. AIM: The aim was to find the extent of reduction in donor blood count (hemoglobin, hematocrit, white blood cell, and platelet) after plateletpheresis and to evaluate the cell separator for collection efficiency, processing time, and leukoreduction. STUDY DESIGN AND METHODS: Two hundred and thirty seven procedures performed on the Amicus (N = 121), Fenwal CS-3000 Plus (N = 50) and Cobe spectra (N = 66) in a one year period were evaluated. The procedures performed on the continuous flow centrifugation (CFC) cell separators and donor blood counts (pre and post donation) done were included in the study. RESULTS: The percent reduction in hemoglobin (HB), hematocrit (HCT), white blood cell (WBC) and platelet count ((PLT ct) was 2.9, 3.1, 9, 30.7 (Mean, N = 237) respectively after the procedure. The post donation PLT ct reduced to < 100x109/L (range 80-100) in five donors (N = 5/237, Amicus). The pre donation PLT ct in them was 150-200x109/L. Collection efficiency (percent) of Amicus (79.3) was better as compared to the other two machines (CS: 62.5, Cobe: 57.5). PC collected on Cobe spectra had <1x106 WBC. The donor pre donation PLT levels had a positive correlation to the product PLT yield (r = 0.30, P = 0.000). CONCLUSION: Monitoring donor blood counts helps to avoid pheresis induced adverse events. A cautious approach is necessary in donors whose pre donation PLT ct is 150-200x109/L. The main variable in PLT yield is donor PLT ct (pre donation). High collection efficiency is a direct measure of an optimally functioning cell separator.

Spectrum of HIV/AIDS related cancers in India.

OBJECTIVE: To study the cancer pattern among HIV positive cancer cases. METHOD: The study group included patients registered in the HIV Cancer clinic at the Tata Memorial Hospital (TMH), Mumbai, which is the largest tertiary referral cancer center in India. We used the gender and age-specific proportions of each cancer site of the year 2002 that was recorded in the Hospital Cancer Registry to estimate an expected number of various cancer sites among HIV positive cancer patients during the period 2001-2005. The observed number of site-specific cancer cases was divided by the expected number to obtain proportional incidence ratio (PIR). RESULTS: No case of Kaposi's sarcoma was observed. Increased proportion of non-Hodgkin's lymphoma (NHL) was observed (PIR in males = 17.1, 95%CI 13.33-21.84, females = 10.3, 95%CI 6.10-17.41). In males, PIR was increased for anal cancer (PIR = 10.3, 95%CI 4.30-24.83), Hodgkin's disease, testicular cancer, colon cancer, and few head and neck cancer sites. Among females, the PIRs for cervical cancer (PIR = 4.1, 95%CI 2.90-5.75), vaginal cancer (PIR = 7.7, 95%CI 2.48-23.85), and anal cancer (PIR = 6.5, 95%CI 0.91-45.88) were increased. CONCLUSIONS: The absence of Kaposi's sarcoma and increased PIRs for certain non-AIDS defining cancers among HIV infected cancer cases indicates a different spectrum of HIV associated malignancies in this region. The raised PIR for cervical cancer emphasizes the urgent need for screening programs for cervical cancer among HIV infected individuals in India.

HIV infection and invasive cervical cancers, treatment with radiation therapy: toxicity and outcome.

BACKGROUND AND PURPOSE: To determine the effect of radiotherapy in HIV seropositive cervical cancer patients, tumour response and toxicity and compliance of patients to the treatment. PATIENTS AND METHODS: This study is a retrospective review of 42 HIV seropositive patients diagnosed with carcinoma cervix, between 1997 and 2003 at the Tata Memorial Hospital. The age and symptoms of presentation, clinical stage, response, compliance and tolerance to radiotherapy were studied. RESULTS: Mean age at presentation was 41 years. All patients presented with the symptoms of cervical disease. Of these patients 31(74%) patients had 'Karnofsky Performance Scale' (KPS) more than 80%. Twenty-one (50%) of the patients were of Stage IIIb-IVa. Thirty-two (76%) were started on radiotherapy with radical intent. Compliance to radiotherapy was poor with 24% patients discontinuing after few fractions of radiotherapy. Seven (17%) patients were given palliative radiotherapy. Twenty-two patients completed prescribed radical radiotherapy and 50% of these achieved complete response. Grade III-IV acute gastrointestinal toxicity was seen in 14% of the patients, and grade III acute skin toxicity was seen in 27% of patients, leading to treatment delays. There was good relief of symptoms in patients treated with palliative intent. CONCLUSIONS: Radiotherapy is effective in this set of patients. Palliative fractionation schedules are effective for patients with poor performance status and locally advanced cancers in relieving the symptoms related to carcinoma cervix. An emphasis should be given to the increased acute mucosal and skin toxicity and to improving compliance and clinical outcome of these patients.