Asian Journal of Transfusion Science

Abstract BACKGROUND: Patient blood management (PBM), as a concept, has reached a considerable level of awareness. In the last few years, the number of awareness activities and campaigns have increased multi-fold and an increasing number of healthcare practitioners have realized the vitality and necessity of PBM. With the WHO issuing a policy brief on urgent implementation, there has been an accelerated impetus to implement the practices of patient blood management. In the low-to-middle income countries, having non-uniform healthcare infrastructure, there is a significant difference in the perceptions around patient blood management. MATERIALS AND METHODS: A capacious survey was done to understand and analyze the current level of understanding, impact of the ongoing educational programs and the preparedness towards the implementation of PBM. This article summarizes the findings of this online survey. The survey consisted of an online google form questionnaire and its analyzed responses. RESULTS: The key survey findings were that while there has been a significant advocacy around the concept, most healthcare professionals either do not have an explicit understanding of or the proficiency to utilize the resources much needed for the systematic implementation of patient blood management in their respective healthcare domains. CONCLUSIONS: The comprehension of scientific knowledge on patient blood management does not guarantee either its perception in the true sense or its implementation in the intended, standardized, and universal manner. In this era of evidence-based medicine, it is imperative that PBM is perceived in its true sense before it is attempted to be adopted as the standard of care.

Anurag Kumar Mishra

Atul Kumar Agarwal

Ajay Gandhi

The current state and the impact of awareness and educational campaigns on patient blood management in India

印度患者血液管理的现状及意识和教育活动的影响

Removal of leucocytes from various blood products has been shown to minimize Febrile nonhemolytic transfusion reactions, HLA alloimmunization, platelet refractoriness in multitransfused patients and prevention of transmission of leukotropic viruses such as EBV and CMV. Rapidly growing size of hemato-oncological patients in our country requiring multiple transfusion of blood and components during the course of their management pose a great challenge to transfusion services to provide them red cell and platelet antigen matched products in alloimmunized subjects. Thus removal of leucocytes below a certain threshold, ≤ 5 x 10<sup> 6</sup> in a blood component certainly helps in prevention of alloimmunization and associated risks in these patients. Currently the best Leucoreduction can be achieved with the help of 3rd and 4th generation leukofilters, both in laboratory and patient bed side, and state of the art apheresis devices. The present article briefly reviews the current literature for pros and cons of leucofilteration and its scope of implementation in the cost constrained settings.

RR Sharma

Neelam Marwaha

Leukoreduced blood components: Advantages and strategies for its implementation in developing countries

白细胞减少的血液成分：在发展中国家实施的优势与策略

Abstract: Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, acquired disease caused by clonal expansion of one or more hematopoietic stem cell lines due to a somatic mutation of the phosphatidylinositol glycan anchor gene. Peripheral blood stem cell (PBSC) harvest is a high-risk procedure and the major concern was regarding the development of COVID infection in the recipient. Herein, we describe an inevitable case of PBSC harvest in a PNH patient who was already started on myeloablation and where the donor became positive 1 day before the harvest. Considering the risk–benefit ratio and the need for elaborate arrangements, the initial plan for bone marrow harvesting was changed to PBSC, and hence, the harvest was performed in a COVID-designated unit. No features of graft versus host disease (GVHD) were observed in the patient. The patient was examined for signs and symptoms of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and there was no evidence of any infection after the procedure. The weekly analysis of the same was done for 1 month after PBSC and the SARS-CoV-2 status remained negative. The authors opine that PBSC from SARS-CoV-2 can be performed safely in some unpreventable situations.

Mohit Chowdhry

Prachi Singh

S Minu Lekshmi

Uday Kumar Thakur

Shishir Seth

A case of allogeneic peripheral blood stem cell in a paroxysmal nocturnal hemoglobinuria patient from a COVID-positive donor: Managing the unpreventable

一例来自COVID阳性供体的阵发性夜间血红蛋白尿患者同种异体外周血干细胞移植：应对不可避免的情况

Abstract: AIMS: To determine the utilization of cross-matched packed red blood cell (PRBC) concentrate in children posted for major elective operative procedures. To evaluate the efficacy of a simple preoperative “screening criteria” for ordering preoperative cross-match. MATERIALS AND METHODS: Data were retrieved from online surgery scheduling system prospectively over a 4-month period (January–April 2022). The number of units cross-matched and those utilized were assessed. A screening criterion was devised in consultation with stakeholders for ordering blood. The utilization of PRBCs was reassessed after implementation of these criteria and reaudited (July–October 2022). A subset analysis of A1 (tunneled catheter placements) and A2 (core pediatric surgical procedures) groups was done to analyze blood utilization. RESULTS: Initial audit showed poor PRBC utilization with 46 units unused of the 54 cross-matched units, and most of these were from A1 group (3 of 29 units and 5 out of 25 units utilized in A1 and A2 groups, respectively). Reaudit after introducing cutoff criteria showed sharp decline (79.3%) in the number of cross-matched units and the number of units returned (84.6% decrease) in A1 group and the number of units returned unused dropped by 50% in the A2 group. There was visible reversal of indicators of utilization (cross-match to transfusion ratio dropped from 6.75 to 1.73 and TI increased from 0.163 to 0.613), indicating optimal utilization. CONCLUSION: This pilot audit clearly demonstrates the gap between requisition and utilization of cross-matched PRBCs. Formulating an effective screening criterion avoids unnecessary cross-matching and wastage of resources and maximizes utilization.

Rajkiran Srinivas Raju

Shubha Attibele Mahadevaiah

Shanthala A. M. Devi

Preoperative cross-matching in major elective surgical procedures in children: An audit of department’s transfusion practices

儿童择期大手术术前交叉配血：科室输血实践的审计

Abstract: Guillain–Barre syndrome (GBS) is an acute, usually symmetrical, and typically de myelinating polyneuropathy, characterized by progressive, ascending paralysis and areflexia, with or without abnormal sensory function. Therapeutic plasma exchange(TPE) was the first therapeutic modality to impact the disease favorably, and several major randomized controlled trials (RCTs) have confirmed its efficacy. Our case is unique, as this critically ill patient admitted in the intensive care unit (ICU), developed a rare form of GBS, the PCB variant of the disease, and was successfully treated with TPE. The diagnosis of PCB can be challenging due to atypical clinical features but its unique presentation does provide sufficient clues to narrow the differential diagnosis, which is helpful in starting empirical therapy at the earliest. Immunomodulation with plasma exchange and IVIG have been found to improve treatment outcomes; 70%–80% of patients usually have a complete recovery. Early diagnosis is very important in the case of the PCB variant of GBS to enable timely intervention. Diagnosis can be made on history and neurological findings alone.

Supriya Kumari

Prashant Pandey

Arghyadeep Marik

Saikat Mandal

Manish Gupta

Praveen Kumar

A rare case of a pharyngeal-cervical- brachial variant of Guillain–Barré syndrome

咽颈臂型吉兰-巴雷综合征一例

Abstract: BACKGROUND: The most common observed complication of plateletpheresis procedure is hypocalcemia due to citrate’s chelation of free calcium. Magnesium is also affected by citrate infusion. We have evaluated the impact of plateletpheresis on the total serum calcium (Ca ++ ) and magnesium (Mg ++ ) levels of the donor. MATERIALS AND METHODS: One hundred and thirty-seven healthy plateletpheresis donors were included in the study. Samples were collected from the donor at 0 min (baseline), 30 min, and 60 min, at the end of the procedure and 30 min after completion of the procedure. The pattern of changes in serum Ca ++ and serum Mg ++ levels at different time points for different apheresis machines (Fenwal Amicus, Fresenius COM.TEC, Spectra Optia, and Hemonetics MCS+) was studied. RESULTS: A significant decline in serum Ca ++ and serum Mg ++ levels from baseline to the end of the procedure was observed. This decline was observed maximum for Hemonetics MCS+. The baseline values were regained 30 min after completion of the procedure. Difference from baseline values 30 min after the procedure was lowest in amicus in the case of serum Ca ++ and COM.TEC in case of serum Mg ++ . Twenty donors (14.60%) experienced adverse donor reactions. CONCLUSION: Serum calcium and serum magnesium levels decreased transiently during the procedure and regained normal values after 30 min of the completion of the plateletpheresis procedure on all four apheresis machines (whether based on continuous or intermittent centrifugation). Hence, it is concluded from our study that plateletpheresis is a well-tolerated and safe procedure.

Ankit Gupta

Sunita Bundas

Sarita Sharma

Prem Chand Malakar

Analysis of changes in serum calcium and magnesium levels during plateletpheresis on different apheresis machines in healthy donors: A cross-sectional study

健康供者不同血细胞分离机血小板采集期间血清钙镁水平变化的横断面研究

Abstract: A 55-year-old female, belonging to Jehovah’s Witness community, had to undergo autologous stem transplantation (ASCT), the last ultimate option for her chemoresistant multiple myeloma. Due to her religious faith, she did not consent to transfusing blood components throughout her treatment course, which made the situation medically and ethically challenging. We, as a multidisciplinary team, formulated an individualized treatment algorithm, counseling sessions, and various special documentation to take the treatment plan forward. Risk–benefit analysis and contingency planning were crucial in her case as it was a one-of-a-kind experience. This bloodless ASCT was successful by means of thoughtful waiting, guarded management, and alternatives to blood components.

Jayagowri Karthikeyan

Autologous stem cell transplant in Jehovah’s Witness: The last hope for survival

耶和华见证人自体干细胞移植：生存的最后希望

Abstract: Alloimmunization is a significant complication of blood transfusion, especially in sickle cell patients, and may lead to a delayed hemolytic transfusion reaction (DHTR). DHTR is defined as evident hemolysis and a positive direct antiglobulin test (DAT) 24 h to 28 days posttransfusion with either a positive eluate or a newly identified alloantibody in the plasma. Hyperhemolysis syndrome (HS) is a fatal form of DHTR in which the posttransfusion hemoglobin (Hb) level is less than the pretransfusion Hb level. In this case series, we have reported three cases of alloimmunized sickle cell disease patients with clinically significant DHTR. The second case is typical of HS. All three cases were DAT positive, alloimmunized with multiple alloantibodies, and had substantial hemolysis posttransfusion. In this series, we have provided an algorithmic approach to resolve such complex immunohematological problems and have highlighted some of the limitations of serology methods. High-dose corticosteroid and intravenous immunoglobulin prove to be an effective treatment for DHTR.

Tahsim Anwar

Satya Prakash

Ansuman Sahu

Somnath Mukherjee

Debasish Mishra

Alloimmunization and consequential delayed hemolytic transfusion reactions in sickle cell disease patients: A case series

镰状细胞病患者中的同种免疫及由此导致的迟发性溶血性输血反应：病例系列研究

Mitu Dogra

Rasika Dhawan Setia

Can computer crossmatch really replace antihuman globulin crossmatch? An intriguing case of missing anti-C on routine antibody screen from a multispecialty center in India

计算机交叉配血真的能取代抗人球蛋白交叉配血吗？印度一家多专科中心常规抗体筛查中缺失抗-C的一个引人入胜的案例

Abbreviation	Asian J. Transfus. Sci.
Journal Impact	0.63
Quartiles(Global)	HEMATOLOGY(Q4)

ISSN	0973-6247, 1998-3565
h-index	28

Publication Information	Publisher: Wolters Kluwer Medknow Publications，Publishing cycle: ，Journal Type: journal，Open Access Journals: Yes
Basic data	Year of publication: 2009，Proportion of original research papers: 95.45%，Self Citation Rate:0.00%， Gold OA Rate: 82.18%
Average review cycle	51 weeks

Asian Journal of Transfusion Science

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The current state and the impact of awareness and educational campaigns on patient blood management in India

Leukoreduced blood components: Advantages and strategies for its implementation in developing countries

A case of allogeneic peripheral blood stem cell in a paroxysmal nocturnal hemoglobinuria patient from a COVID-positive donor: Managing the unpreventable

Preoperative cross-matching in major elective surgical procedures in children: An audit of department’s transfusion practices

A rare case of a pharyngeal-cervical- brachial variant of Guillain–Barré syndrome

The current state and the impact of awareness and educational campaigns on patient blood management in India

Analysis of changes in serum calcium and magnesium levels during plateletpheresis on different apheresis machines in healthy donors: A cross-sectional study

Autologous stem cell transplant in Jehovah’s Witness: The last hope for survival

Alloimmunization and consequential delayed hemolytic transfusion reactions in sickle cell disease patients: A case series

Can computer crossmatch really replace antihuman globulin crossmatch? An intriguing case of missing anti-C on routine antibody screen from a multispecialty center in India