Manish Raturi

Barcode error leading to sample misidentification during blood grouping

Patient safety associated with the transfusion process is extremely important due to the propensity of errors to cause catastrophic consequences. To aid blood banks in minimizing these errors, advanced computerized information systems and barcode labeling technology have been introduced. The barcode technology comprises machine readable symbols used to encode information to automate it. It simplifies and improves the patient identification system in laboratory and clinical transfusion practice. Currently barcode technology has become an indispensable advancement allowing the technical staff to bypass the tedious manual check of the sample labels. Our center is a 2032-bed tertiary care facility and administers approximately 30,000 blood components annually. We have a state-of-the-art immunohematology laboratory with fully automated grouping system with an annual load of 54,000 patient samples. Samples are barcoded at the site of reception at the blood bank, using a barcode printer of Zebra Technologies Corporation. Subsequently samples are loaded into automated blood grouping equipment, which has a software into which the patient details are fed manually and the labels are scanned by an built-in scanner. Recently we noticed a blood grouping error (O D1 instead of B D1) and on root-cause analysis it was found to be due to barcode printing error. As visualized in Video Clip S1 (available as supporting information in the online version of this paper), the barcode label printed in the above said barcode printer in our blood bank, for a particular hospital number, was read as a different number belonging to another patient, leading to the blood grouping error. While entering the patient’s blood grouping report to the blood bank software, a discrepancy was noted with the previous grouping report. To resolve the Fig. 1. Possible causes for barcode label error. The fishbone diagram indicates four major categories of causes resulting in a barcode label error. Three examples for such causes are listed per category. The root cause for the error shown in Video Clip S1 was a hardware problem with the printer resolution.

Cumulative quality assessment for whole blood‑derived platelets: A compliance review

Background and Objectives: Quality control (QC) results of platelet-rich plasma and buffy coat-reduced platelet concentrates (PCs) are presented with the goal to assess their compliance with published guidelines and corrective action taken for any process deviation during their manufacture. Subjects and Methods: Retrospective QC of in-house prepared whole blood-derived platelets (2009–2013) was conducted. Their cumulative results were compared to the published quality standards given by the American Association of Blood Banks, Council of Europe, and Indian guidelines. Data was analyzed using SPSS Statistics version 20. Results: A total of 36,053 PCs were prepared during the study period, and 1.43% (n = 516) was subjected to QC. The aggregate five years mean ± standard deviation (range) of product per bag were volume 58.4 ± 9.5 (37–90) mL, platelet yield 5.89 ± 1.28 (3.1–8.7) × 1010, residual leukocyte count 1.5 ± 1.2 (0.02–5.5) × 107, pH 6.67 ± 0.48 (6.0–7.3), and erythrocyte contamination 0.29 ± 0.2 (0.03-2.0) mL. Swirling was present in all the units. None of the bags showed any microbial growth. Against volume, yield, and erythrocyte contamination 90.0%, 94.3%, and 87.0% units showed compliance to the Indian standards, respectively. All the PCs had pH and leukocyte counts well within the recommended norms. Conclusions: Quality of our platelet product although suboptimal to International standards was well within the national requirements.

Adding up the evidence: Trigger for prophylactic plasma transfusion

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Cellular Mimicry in Kleihauer–Betke Assay

The Kleihauer–Betke (KB) test is a time-consuming test with a lot of variables which affect the calculation of the extent of fetomaternal hemorrhage (FMH). There have been several formulae proposed by various authors to calculate FMH using KB test. In this article, we propose a simple mathematical alteration to accommodate the correction for some of the factors that lead to falsely high estimation of FMH.

Bank to Bedside: A Reliable and Efficient Transportation of Blood by Pneumatic Tube System

Background: Turnaround time (TAT) is an important quality indicator in blood banking. This study evaluated the effectiveness of the pneumatic tube system (PTS) to reduce TAT and its effect on the quality of the blood products. Materials and Methods: The PTS (Swisslog GMBH, Germany) which connects to 29 stations was installed at our 2032-bedded tertiary care referral center. The system transports the carrier at an average speed of 25 feet/s (7.6 m/s). Acknowledgment slips were sent along with the blood components through this carrier system to know the time of receipt. Quality control parameters were checked before and after PTS transport in 10 bags of each of the blood components (packed red blood cells [PRBC], platelet concentrate, and fresh frozen plasma [FFP]). Data were analyzed using IBM SPSS Statistics 20. Results: PTS was used for 220 events to deliver 69% PRBC (n = 152), 15% FFP (n = 34), 14% platelets (n = 30), and 2% cryoprecipitate (n = 4), respectively, to 11 destinations. The average transport time by PTS was 1.36 ± 0.34 min and for human-based transport, it was 7.92 ± 1.40 min and this difference was found to be statistically significant (P < 0.001). The mean latent time was 5.85 ± 4.39 min. Conveyance in the PTS did not reinforce any negative changes on the quality of any blood component. Conclusion: PTS is rapid and reliable for the transport of the blood products to bedside.

Further evidence for naturally occurring anti Jk(a) antibodies.

Sir, Antibodies to red cell antigens are considered naturally occurring when there is no obvious source stimulus such as blood transfusion, injection or pregnancy. However, these antibodies are produced as an immune response to some unknown environmental antigens such as pollen grains and other parts of bacterial membranes.[1] The commonly mentioned naturally occurring antibodies belong to the ABO, Hh, Ii, Lewis, MN, P blood group systems. Anti-Kidd antibodies are notorious for confounding features and as a causal for delayed hemolytic transfusion reactions. Even strong AntiKidd antibodies may become undetectable after few weeks or months of immune stimulus and are frequently known to show dosage effect. Anti-Kidd antibodies are often diffi cult to detect and usually are commonly found in combination with other antibodies refl ecting the low immunogenicity of the Kidd antigen.[2] There are numerous reports of these antibodies. Anti Jkb is rarer than anti Jka and there are only two reported cases of naturally occurring antiKidd antibodies in the literature.[3,4] The present case confi rms the possibility of naturally occurring anti-Kidd antibodies.