Suchet Sachdev

Prevalence of coeliac disease in healthy blood donors: A study from north India

BACKGROUND Blood donor screening can help predict prevalence of coeliac disease in population. METHODS Between December 2010 and June 2011, healthy blood donors were screened using anti-tissue glutaminase antibodies. Those positive underwent duodenoscopy. Their age, gender, body mass index and haemoglobin and histological changes were recorded. RESULTS Of the 1610 blood donors screened, 1581 (98.2%) were males. The mean age of donors was 31.51 ± 9.66 years and the mean body mass index was 22.12 ± 4.24 kg/m(2). Nine (0.56%) men were seropositive. Endoscopic features included reduced fold height (9), scalloping (8), grooving (7) and mosaic mucosal pattern (3). Eight had Marsh IIIa changes whilst one had IIIb change. The prevalence of coeliac disease was 1:179 (0.56%, 95% confidence interval 1/366-1/91, 0.27-1.1%). None of the 9 patients had any symptoms. Their mean haemoglobin and body-mass index was similar to rest of the cohort. CONCLUSION The prevalence of coeliac disease amongst apparently healthy blood donors was 1:179 (0.56%).

Alloimmunization and autoimmunization in transfusion dependent thalassemia major patients: Study on 319 patients

Background: The development of anti-red blood cell antibodies (both allo-and autoantibodies) remains a major problem in thalassemia major patients. We studied the frequency of red blood cell (RBC) alloimmunization and autoimmunization among thalassemia patients who received regular transfusions at our center and analyzed the factors, which may be responsible for development of these antibodies. Materials and Methods: The study was carried out on 319 multiply transfused patients with β-thalassemia major registered with thalassemia clinic at our institute. Clinical and transfusion records of all the patients were examined for age of patients, age at initiation of transfusion therapy, total number of blood units transfused, transfusion interval, status of splenectomy or other interventions. Alloantibody screening and identification was done using three cell and 11 cell panel (Diapanel, Bio-rad, Switzerland) respectively. To detect autoantibodies, autocontrol was carried out using polyspecific coombs (IgG + C3d) gel cards. Results: Eighteen patients out of total 319 patients (5.64%) developed alloantibodies and 90 (28.2%) developed autoantibodies. Nine out of 18 patients with alloantibodies also had autoantibodies. Age at first transfusion was significantly higher in alloimmunized than non-immunized patients (P = 0.042). Out of 23 alloantibodies, 52.17% belonged to Rh blood group system (Anti-E = 17%, Anti D = 13%, Anti-C = 13%, Anti-C w = 9%), 35% belonged to Kell blood group system, 9% of Kidd and 4% of Xg blood group system. Conclusion: Alloimmunization was detected in 5.64% of multitransfused thalassemia patients. Rh and Kell blood group system antibodies accounted for more than 80% of alloantibodies. This study re-emphasizes the need for RBC antigen typing before first transfusion and issue of antigen matched blood (at least for Rh and Kell antigen). Early institution of transfusion therapy after diagnosis is another means of decreasing alloimmunization.

Acute Hemolytic Transfusion Reaction in a Patient with Bombay Phenotype: Implications for ABO Grouping

Bombay blood group is a rare phenotype that is characterized serologically by absence of H, A and B antigens on red cell surface and presence of corresponding antibodies in the serum. We report a case of 45-year old patient having Bombay blood group phenotype who experienced an acute reaction due to transfusion of mismatched blood unit.

Changing epidemiology of coagulase-negative staphylococci in normal flora of skin

Coagulase negative staphylococci (CoNS) have recently emerged as important pathogens causing nosocomial blood stream infections. To evaluate the prevalence of CoNS in cutaneous normal flora, skin swabs were collected from voluntary blood donors and processed for culture and identification using matrix assisted laser desorption ionisation-time of flight (MALDI-TOF). CoNS were isolated from 96% of blood donors, most commonly Staphylococcus hominis (86%), followed by Staphylococcus epidermidis (22%) and Staphylococcus haemolyticus (9%). There has been a shift in the prevalent species of CoNS in the community in India, from the earlier known S. epidermidis towards resistant species such as S. hominis and S. haemolyticus. Routine and rapid speciation of CoNS in clinical isolates with MALDI-TOF should be used effectively to manage these resistant species.

Study of knowledge and attitude among college-going students toward voluntary blood donation from north India

Introduction The study was conducted to assess the knowledge and attitude of college-going students toward voluntary blood donation and to bring out and compare the reasons for donating or not donating blood. Materials and methods This cross-sectional study was conducted on 1,000 college-going students after taking their consent for participation using a prevalidated, self-administered, structured questionnaire after its content and construct validation. Results The difference in the means of the level of knowledge among the donor (mean: 14.71±2.48) and nondonor students (mean: 11.55±2.82) was statistically significant. There was significant impact of previous blood donation on the level of knowledge in donor students. The attitude toward blood donation was more positive among blood donor as compared to nondonor students, and the difference in their means was statistically significant. About one in two (45.8%) college-going students fear that either they are not fit enough to donate blood (26.8%) or that they will become weak (19%) after blood donation. Almost one in four (27.4%) have fear of needle pain; therefore, they do not come forward for blood donation. Interpretation and conclusion The most significant reason hindering blood donation comes out to be related to health of the individual donor. The findings of this study conclude that the national targets of voluntary blood donation could be better met with specific blood donor information, education, motivation, and recruitment strategies focusing on the myths and misconceptions prevalent in the donor demographic area of that particular region, specifically targeting high-school children in countries developing a volunteer donor base.

First report of the impact on voluntary blood donation by the blood mobile from India.

Introduction: The blood mobile is one of the modern methods of mobile blood collection facility funded through the third phase of National AIDS Control Programme by the National Blood Transfusion Council of India. Material and Methods: A retrospective analysis of data in relation to the blood mobile was carried out with respect to the number of blood donation camps, number of blood units collected, adverse donor reactions, and the expenditure that occurred during the blood collection in the blood mobile from 1 st January 2012 to 30 th June 2014. Results: There were 64, 84 and 62 blood donation camps conducted in the blood mobile with collection of 3301, 5166 and 2842 blood units during 2012, 2013 and the first half of 2014. The percentage of voluntary blood collection in blood mobile was 8.5% in 2012, increased to 12.4% in 2013 and stands at 14.39% in the first half of 2014. The difference in the means of the adverse donor reactions in the blood mobile and the outdoor camps was not statistically significant. Discussion and Conclusion: The blood mobile is definitely an asset as far as augmentation of voluntary blood donation is concerned, ensures stable collection of blood for better provision of blood and blood components. However the facility requires a comprehensive annual maintenance with incorporation of onsite quick response team both from the manufacturer of the vehicle, and the blood collection equipments. Adequate provision of funding for operational expenditure would in turn facilitate optimum utilization of this facility.

Donor hemovigilance: Delayed vasovagal reaction with injury in a blood donor

Sir, We report a case of delayed vasovagal reaction in a 19-year-old male blood donor of severe grade and defi nite imputability as per the classifi cation of working group on complications related to blood donation (International Society of Blood Transfusion working party on Hemovigilance and European Hemovigilance Network, 2008) in a blood donor qualifying the blood donor selection criteria as per the standard operating procedure of our department based on the Drugs and Cosmetics Act of India. The blood donor was brought back to the donation venue 11⁄2 h post blood donation by his colleagues. The donor was found to be responsive and reported that he was sitting in the garden adjoining hostel and consequent upon standing in order to walk to his room, experienced light headedness, profuse sweating and then fainted. On examination, the pulse rate was 62/min, regular and blood pressure of 110/68 mm of Hg. There was no h/o of projectile vomiting, no nystagmus. The left thumb was swollen and painful, which is consistent with a post blood donation delayed vasovagal loss of consciousness, followed by fall. Closed reduction with k-wire fi xation of base of distal phalanx was done after X-ray [Figure 1]. Donor was asymptomatic; the nail bed showed early new nail recovery on follow-up. The donor hemovigilance arm of a national hemovigilance system should be based on standardized reporting formats and review initiatives being implemented to reduce adverse reactions. Reporting, monitoring and evaluation of blood donor reactions and the outcome of interventions could help generate evidence for formulating strategies that could have an impact to decrease adverse donor reactions in order to retain willingness to donate blood. [1]

White particulate matter in a packed red blood cells unit.

Aggregate formation in blood units has been known since long. Particulate matter visible to naked eye, white in color, has been described in detail by Rentas et al.[1] White particulate matter (WPM) in blood bags is reported to be composed of normal blood elements, namely aggregates of platelets, with variable amounts of fi brin and trapped red and white cells and not of extraneous material or organisms.[2]

Use of “smartphone” technology for managing workload in transfusion-transmissible infection (nucleic acid testing) laboratory for platelet concentrate inventory management resulting in timely issue of platelets: Experience from a tertiary care center

Sir, Our institute is a large tertiary care center in N o r t h I n d i a w i t h m u l t i s p e c i a l t i e s s u c h a s hemato‐oncology (pediatric and adult), bone marrow transplant, advanced trauma care, cardiothoracic vascular surgery, obstetrics and gynecology, and solid organ transplant units which require platelet concentrates (PCs) for their patients. Our department collects 60,000 whole blood units annually and prepares about 32,000 random donor platelets (RDPs) in addition to 2000 single donor apheresis platelets (SDAPs) to cater demand of large number of patients admitted in different specialties. All the collected whole blood units are subjected to transfusion‐transmissible infection screening using semiautomated individual donation (ID) nucleic acid testing (NAT) in addition to the third‐generation ELISA. However, the SDAPs are prepared as and when required for the patients and respective donors are screened accordingly by performing rapid tests in duplicate using kits from two different lots.

Allergic contact dermatitis to antiseptic medicated dressing applied on phlebotomy site

Adhesive dressing application to the phlebotomy site is a norm that is usually followed by all blood banks as postdonation care. The purpose is to provide an environment conducive for healing i.e. prevent infection. However whether we need a medicated antiseptic dressing is of doubtful value. The risk of infection at phlebotomy site is estimated to be 1 in 200,000,[1] whereas the reported allergy to medicated antiseptics could reach upto 15%.[2]