Meenu Pujani

Adverse reactions in whole blood donors: an Indian scenario

BACKGROUND Whole blood donation is generally considered to be a safe procedure, but occasionally adverse reactions of varying severity may occur during or at the end of the collection. The aim of the study was to estimate the frequency and type of adverse events occurring during blood donation and to assess the practices which would help to minimise them. MATERIALS AND METHODS This retrospective single-centre study was conducted from June 2007 to November 2009 at a regional blood transfusion centre. All whole blood donations made at the centre were analysed. All adverse events occurring during or at the end of donation were noted using a standardised format. RESULTS Overall 113 adverse events were reported in relation to 19,045 donations, resulting in an overall adverse event rate of 0.6%, that is, an incidence of 1 in every 166 donations. Presyncopal symptoms, in other words vasovagal reactions of mild intensity, were the most commonly observed adverse reactions and accounted for approximately 70% of all adverse reactions noted. CONCLUSIONS Only 0.6% of blood donations were complicated by adverse events and most of these events were presyncopal symptoms. Our study reinforces the fact that blood donation is a very safe procedure which could be made even more event-free by following certain friendly, reassuring and tactful practices.

Use of rapid detection tests to prevent transfusion-transmitted malaria in India.

Sir, As we all are aware, transfusion-transmitted malaria is emerging as a major problem especially in developing countries, which fall in the zone of endemicity. Transmission of malaria by blood transfusion was one of the fi rst recorded incidents of transfusion-transmitted infection.[1] The frequency of transfusion-transmitted malaria varies from 0.2 cases per million in nonendemic countries to 50 or more cases per million in endemic areas.[2] Although it was in 1971 that screening of donated blood for viral infections was begun, but there are no defi nite guidelines to the choice of the test. Testing of blood for malarial parasite is mandatory as per the drugs and cosmetic act part X11 B of Schedule F, but there are no clear guidelines to date. Microscopic detection of blood though considered the gold standard for malaria diagnosis for decades is quite labor-intensive and requires adequate technical skill and manpower. This has spurred the development of several nonmicroscopic malaria rapid detection tests (RDT) based on the detection of malaria parasite antigen in whole blood. We at our blood bank, Regional Blood Transfusion Centre, have been routinely screening all donated units of blood for malaria using RDT, based on immunochromatographic methods detecting antigens, histidine-rich protein 2 (HRP2-P. falciparum), and p-lactate dehydrogenase (pLDH-P. vivax) (Paraview, First Sign; Diagnova Pvt. Ltd. New Delhi, India Ltd.) since March 2008. Thick and thin smears were made of all positive cases to corroborate the results of RDT. Total of 11,736 units of donated blood were screened between March 2008 and September, 2009. Three (0.03%) units were found to be positive, 2 for P. vivax, and 1 for P. falciparum. All the three cases were found positive microscopically. None of the donor had given a history of fever/malaria during predonation screening [Table 1]. Table 1 Comparison of rapid detection tests and peripheral smear screening of positive cases The RDT works through lateral flow/immuno chromatographic strip method and signifi es the presence of antigens by a color change on the absorbing nitrocellulose strip. Three main types of antigens are being detected by the commercially available RDTs. Falade et al. in 2009 conducted a study on 391 consecutive potential blood donors in malaria endemic area of South-West Nigeria using 3 methods’ microscopy, OptiMAL RDT (pLDH), and Clinotech Malaria cassette (detects surface protein of merozoites and sporozoites). Microscopy revealed parasitemia in 79 (20.0%) of potential donors, mean level of parasitemia being 445/μl. The corresponding prevalence of malarial parasitemia detected using RDT were 3.8% for OptiMAL and 57.8% for Clinotech, with the results for microscopy being the gold standard.[3] Bharti et al. in 2008 evaluated the usefulness of a new RDT, pLDH/HRP2 malaria card test (First Response Combo Malaria Antigen Test, New Delhi, India) for malaria diagnosis in the forested belt of central India. Analysis revealed that RDT was 93% sensitive, 85% specifi c with a positive predictive value of 79%, and a negative predictive value of 95% (microscopy being used as the gold standard).[4] Kyabayize et al. studied the operational accuracy and persistent antigenicity of HRP2 RDTs for Plasmodium falciparum malaria in a hyperendemic region of Uganda. Using a cross-sectional study design, a total of 357 febrile patients of all ages were tested using RDT out of which 40% (139) had positive blood smears for P. falciparum. RDT had overall sensitivity of 98%, specifi city of 72%, positive predictive value of 69%, and a negative predictive value of 98%. In the children followed-up after successful antimalarial treatment, the mean duration of persistent antigenicity was 32 days, this duration varied signifi cantly depending on pre-treatment parasitemia.[5] Therefore, a donor who is deferred for 12 weeks following completion of treatment will not give a false positive test for malaria by RDT. Importance of recognizing transfusion-transmitted malaria lies in the fact that it can lead to febrile transfusion reaction which can falsely simulate a hemolytic transfusion reaction. It can lead to the widespread dissemination and spread of drug-resistant malarial parasite. The utmost importance is derived from the presumption that the screened blood units are transfused to patients ranging from newborns (requiring exchange transfusions) to the geriatric group. These along with the immune-suppressed (cancer and leukemia therapy) patients are at a higher risk of falling prey to units not effectively screened for malarial parasite. Thus clinicians will waste valuable time manage on lines of hemolytic transfusion reaction. Nonetheless, no matter what strategy is adopted, it is likely that cases of transfusion-transmitted malaria may still occur, so malaria must always be considered in any patient with a febrile illness post-transfusion. Thus we would like to recommend that use of rapid detection devices with peripheral smear screening of positive cases is reasonably reliable method to prevent transfusion-transmitted malaria in India.

Correlation of serology with morphological changes in gastric biopsy in Helicobacter pylori infection and evaluation of immunohistochemistry for H. pylori identification

Background/Aim: Helicobacter pylori is implicated in various gastroduodenal diseases and many tests are available for its detection. The present study attempted to document the morphological changes in the gastric mucosa induced by H. pylori colonization and correlate them with the severity of the infection. The study also compared various diagnostic tests and evaluated the different staining methods used for H. pylori detection, especially immunohistochemical identification. Patients and Methods: One hundred and two patients with dyspepsia were included. Enzyme-linked immunosorbent assay (ELISA) for H. pylori-specific immunoglobulin G (IgG), immunoglobulin A (IgA), and immunoglobulin M (IgM) was used. Rapid urease test was performed on endoscopic biopsy and it was stained with hematoxylin and eosin (H and E), modified Giemsa, and immunohistochemical stains. Results: A significant correlation was found between the density of H. pylori and severity of gastritis. A significant correlation was observed between serology (especially when used in combination, IgG and IgA) and status of H. pylori. Immunohistochemical staining enhanced the diagnostic yield of H. pylori detection. Conclusions: Immunohistochemistry (IHC) should be used judiciously, whereas simple and economical tests like modified Giemsa should be used routinely for the detection of H. pylori. Combined ELISA (IgG and IgA) should be preferred over single ELISA. Simultaneous morphological and serological detection of H. pylori is preferable as H. pylori may not be detected on morphology alone due to its patchy distribution in the stomach.

Donor deferral due to anemia: A tertiary care center-based study

Background: The minimum hemoglobin cutoff for blood donation in India is 12.5 gm% for both male and female donors and the minimum donation interval is 3 months. Donation of one unit of blood results in decrease in hemoglobin by 1 gm% and loss of 200–250 mg of iron. Donor deferral due to anemia is one of the major reasons of temporary rejection of blood donors. In the absence of further workup or advise, it results in loss of valuable donor base. Aim and Objective: To provide baseline information regarding the prevalence and spectrum of anemia in prospective blood donors to help plan a future strategy for donor management. Materials and Methods: Hemoglobin testing of donors was performed using Hemocue and Copper sulfate specific gravity method. Ethylene diamine tetraacetic acid sample of all the donors who failed either or both the screening tests was tested on automated analyzer for evaluation of hemoglobin and red blood cell indices. Results: Of all the donors, 15.5% were deferred due to anemia. Prevalence of anemia in prospective blood donors was 1.8%. It was significantly higher in female donors compared with male donors (34.2% vs 1.2%). The most common type of anemia was normocytic normochromic.

Screening of blood donors for erythrocyte alloantibodies

Abstract Objective To assess the prevalence of the anti-red blood cell antibodies in the donor population of Delhi. Methods This prospective study was conducted in Regional Blood Transfusion Centre (RBTC), Lady Hardinge Medical College (LHMC) and associated hospitals from March 2010 to March 2011. Antibody screening of all donor serum/plasma was performed as routine immunohaematological procedure. Any positive sera were further investigated to identify the specificity of irregular erythrocyte antibody by commercially available red cell panel (ID-Dia Panel, Diamed-ID Microtyping System). The titres and thermal amplitude of the identified antibodies were evaluated. Results A total of 7756 donors were screened, of which 7648 donors were males (98.6%) and 108 were females (1.4%). The maximum number of donors belonged to age group of 26–30 years. A total of four donors showed presence of alloantibodies in their serum (0.05%). On antibody identification, two of them were anti-C, one was anti-Lewisa antibody and one was autoantibody. Discussion This study was conducted to highlight the significance of detecting irregular erythrocyte antibodies in healthy donors.

Congenital ovarian cyst: A report of two cases

Journal of Laboratory Physicians / Jan-Jun 2012 / Vol-4 / Issue-1 63 symptoms are perimenopausal and postmenopausal bleeding per vagina followed by amber-coloured vaginal discharge and abdominal pain. [2] But all these features are present in 6% of cases.[3] Tubal carcinoma usually originates in the ampulla and its pattern of growth can be nodular, papillary, and infiltrative.[1] These tumors are relatively confined to the tube and may not have any alteration in size and shape of the fallopian tube, or it may feature diffuse swelling, a sausage-shape resembling hydro, hemato, and pyosalpinx. Histo-pathological examination reveals a papillary adenocarcinoma extending into submucosa and muscularis layer, as was seen in our case.[2] Preoperative diagnosis of the fallopian tube carcinoma is seldom made prior to surgery. It is suspected in fewer than 5% of cases preoperatively. Primary ovarian neoplasm is the most common preoperative diagnosis made in these patients. Since it is difficult to differentiate the primary fallopian tube carcinoma from epithelial ovarian cancer, Hu et al established diagnostic criteria for their differentiation in 1950, which were modified in 1978. Patients with at least one of the following criteria should have the diagnosis of primary fallopian tube carcinoma.[4-6] • The tumour arises from the endosalpinx. • The histological pattern reproduces the epithelium of tubal mucosa. • Transition from benign to malignant epithelium is found. • The ovaries and endometrium are either normal or contain less tumor than the tube.

Microfilaria in malignant pleural effusion: an unusual association.

Lymphatic filariasis is common in tropical countries and is endemic in India. Filariasis presenting with pleural effusion is an unusual presentation. Malignancy in association of filarial pleural effusion is extremely rare. We report a case of a 60-year-old female who presented with chest pain, loss of weight and breathlessness for a few months. Pleural fluid examination revealed malignant cells, along with microfilaria of Wuchereria bancrofti.

A cytohistological study of p53 overexpression in ovarian neoplasms.

Background: The present study was undertaken to evaluate the diagnostic accuracy of imprint cytology in ovarian neoplasms, investigate the biological significance of p53 expression in malignant ovarian tumors and correlate it with histological type, grade and stage of tumor. Material and Methods: A total of 50 cases including 25 prospective and 25 retrospective cases were studied. Imprint cytology was performed on 25 ovarian tumors and compared with histopathological diagnosis. p53 immunohistochemistry was performed on all 50 cases. Results: On immunohistochemistry, all the benign tumors were negative for p53 while 42% of primary ovarian malignant tumors were positive. p53 expression was found to have a diagnostic value in differentiating benign from malignant tumors. p53 overexpression did not show any significant correlation with prognostic factors as stage of disease, grade of differentiation and type of tumor. Conclusion: The present study confirms the importance of p53 tumor suppressor gene expression as documented by immunohistochemistry in the differentiation of malignant and benign ovarian tumors.

Increased hematogones in an infant with bicytopenia and leucocytosis:a case report.

Hematogones are the normal bone marrow constituents of bone marrow in children and their number decreases with age. As hematogones can resemble malignant lymphoblasts by their morphologic features and by expression of an immature B-cell phenotype, an accurate distinction of hematogone-rich lymphoid regeneration from leukemic lymphoblasts is critical for patient care. The increased number of hematogones had been reported in the bone marrow of children recovering from chemotherapy, aplastic conditions, other forms of bone marrow injury, infections like Cytomegalovirus, HIV and immune thrombocytopenia disorders. We describe here a case of one and half month old male infant with bicytopenia and leucocytosis associated with increased hematogones in the bone marrow due to an unknown probable viral infection.

Correlation of hormone receptor and human epidermal growth factor Receptor-2/neu expression in breast cancer with various clinicopathologic factors

Background: A significant development in the breast carcinoma management is the correlation between the presence of hormone receptors in the tumor and response to hormonal therapy and chemotherapy. Human epidermal growth factor receptor-2/neu (Her-2/neu) overexpression also serves as a very useful parameter to predict response to herceptin. Aim of Study: The study was conducted to correlate immunohistochemical expression of markers such as estrogen receptor (ER), progesterone receptor (PR), and Her-2/neu with various clinicopathologic parameters. Materials and Methods: The study included 509 cases of breast carcinoma over a period of 5 years (from May 2009 to May 2014). Immunohistochemistry (IHC) for ER, PR, and her-2/neu was performed. Results: ER positivity was observed in 42.8% (218/509) cases, PR positivity in 31.8% (194/509) cases whereas her-2 neu positivity was seen in 40.7% (203/509) cases. Triple marker (ER, PR, and Her-2/neu) negative cases were 23.6% (120/509) cases. ER and PR expression was found to have a statistically significant correlation with tumor grade. Statistically significant correlation was observed between tumor size and tumor grade and her-2/neu expression. Her-2/neu expression showed statistically significant association with tumor stage. As the tumor grade increased, the proportion of triple-negative cases went on increasing, which was statistically significant. Conclusion: IHC has an increasingly important prognostic role in determination of factors that affect clinicopathologic features. Nevertheless, the results of this large series showed different patterns of findings with respect to clinicopathologic features.