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1.  Anti- CW: In a Young Female Patient. A Case Report with Review of Literature and Frequency of Low Incidence CW (Rh8) Antigen in North India 
If the patient has antibody to low incidence antigen providing compatible blood for transfusion is not a problem. It is however necessary to identify such antibodies to assess their potential to cause hemolytic transfusion reaction and hemolytic disease of newborn. We identified anti Cw in patient’s serum while investigating the cause of incompatible cross match in a female thalassemia patient. Anti Cw is an antibody against Cw (Rh8) antigen, which is a low incidence antigen of Rh system. This case also prompted us to study frequency of Cw antigen in our donor population as the frequency of Cw antigens in our population is not reported. Frequency of Cw antigens in north Indian donors was found to be 1.2 %.
PMCID: PMC4192191  PMID: 25332641
Rh–Hr blood group system; Rh immunization; Pregnancy complications
2.  Circulating thrombopoietin levels in normal healthy blood donors and in aplastic anemia patients in relation to disease severity 
Thrombopoietin (TPO) is the key hematopoietic growth factor regulating the production of platelets from bone marrow megakaryocytes and maintaining platelet hemostasis. This study was done to find any relationship between the levels of thrombopoietin and the severity of disease in patients with aplastic anemia.
Materials and Methods:
Serum samples were collected from 52 patients with a confirmed diagnosis of aplastic anemia and 45 normal healthy blood donors of both sexes over a period of 2 years, and TPO was estimated by using commercially available TPO-specific-enzyme-linked immunosorbent assay.
The median TPO level of 1190 pg/ml (range 625-7651 pg/ml) in aplastic anemia patients was significantly higher than the median TPO level of 121.1 pg/ml (81.25-237.7 pg/ml) in normal healthy blood donors (P = 0.000). No significant difference was observed in TPO levels of male and female patients (P = 0.453). The median TPO concentrations observed in very severe aplastic anemia, severe aplastic anemia, and nonsevere aplastic anemia were 2765 pg/ml (range 625-6451 pg/ml), 1190 pg/ml (range 672.1-7651 pg/ml), and 1111.5 pg/ml (range 761.1-2289.2 pg/ml), respectively. TPO in patients of very severe aplastic anemia was significantly higher than patients of nonsevere aplastic anemia (P = 0.043), with no significant relation among rest of the groups.
TPO levels in aplastic anemia patients were significantly higher than in healthy blood donors; however, in aplastic anemia patients TPO levels were significantly higher only in patients with very severe disease.
PMCID: PMC4339937  PMID: 25722577
Aplastic anemia; blood donor; megakaryocytes; thrombopoietin
4.  Cross-match-compatible platelets improve corrected count increments in patients who are refractory to randomly selected platelets 
Blood Transfusion  2014;12(2):180-186.
Cross-match-compatible platelets are used for the management of thrombocytopenic patients who are refractory to transfusions of randomly selected platelets. Data supporting the effectiveness of platelets that are compatible according to cross-matching with a modified antigen capture enzyme-linked immunosorbent assay (MAC-ELISA or MACE) are limited. This study aimed to determine the effectiveness of cross-match-compatible platelets in an unselected group of refractory patients.
Materials and methods
One hundred ABO compatible single donor platelet transfusions given to 31 refractory patients were studied. Patients were defined to be refractory if their 24-hour corrected count increment (CCI) was <5×109/L following two consecutive platelet transfusions. Platelets were cross-matched by MACE and the CCI was determined to monitor the effectiveness of platelet transfusions.
The clinical sensitivity, specificity, positive predictive value and negative predictive value of the MACE-cross-matched platelets for post-transfusion CCI were 88%, 54.6%, 39.3% and 93.2%, respectively. The difference between adequate and inadequate post-transfusion 24-hour CCI for MACE cross-matched-compatible vs incompatible single donor platelet transfusions was statistically significant (p=0.000). The 24-hour CCI (mean±SD) was significantly higher for cross-match-compatible platelets (9,250±026.6) than for incompatible ones (6,757.94±2,656.5) (p<0.0001). Most of the incompatible cross-matches (73.2%) were due to anti-HLA antibodies, alone (55.3% of cases) or together with anti-platelet glycoprotein antibodies (17.9%).
The clinical sensitivity and negative predictive value of platelet cross-matching by MACE were high in this study and such tests may, therefore, be used to select compatible platelets for refractory patients. A high negative predictive value demonstrates the greater chance of an adequate response with cross-matched-compatible platelets.
PMCID: PMC4039699  PMID: 24333069
crossmatching; corrected count increment; human platelet antigens; platelet refractoriness; predictive value of test
6.  RhD blocking phenomenon implicated in an immunohaematological diagnostic dilemma in a case of RhD-haemolytic disease of the foetus 
Blood Transfusion  2013;11(1):140-142.
PMCID: PMC3557484  PMID: 22790265
blocked D phenomenon; Rh-haemolytic disease of foetus; immunoglobulins; RhD typing
7.  Evaluation of transfusion-related complications along with estimation of inhibitors in patients with hemophilia: A pilot study from a single center 
Apart from inhibitor development in patients with hemophilia (PWH) the old problems of blood borne viral infections and red cell alloimmunization still persist in PWH from developing countries. This study was planned to detect the presence of inhibitors in our PWH and to determine the presence of transfusion transmitted infections (TTI) markers and clinically significant red cell alloantibodies in these patients.
Materials and Methods:
One hundred fourteen PWH were screened for various laboratory tests. Screening for inhibitors was done by mixing study. Blood grouping, TTI testing and red cell alloantibody detection were done as per the departmental standard operating procedures.
Out of 114 patients evaluated 98(86%) had hemophilia A and remaining 16(14%) had hemophilia B. Five (5.1%) patients of hemophilia A were positive on inhibitor screening. On Bethesda assay, one patient was high responder (14.4 BU/ml) and rest 4 were low responders (<5 BU/ml). Overall, 19 PWH were positive for TTI markers and two had clinically significant red cell alloantibody (anti-E and anti-Jkb).
This is probably first comprehensive study from our state on laboratory testing in PWH. The specialty of Transfusion Medicine can be a core part of hemophilia care. The overall prevalence of inhibitors in our hemophilia A patients was 5.1%, which is less as compared to majority of published studies.
PMCID: PMC3613672  PMID: 23559756
Hemophilia; inhibitor; transfusion-related complications
8.  Seroprevalence of malaria in blood donors and multi-transfused patients in Northern India: Relevance to prevention of transfusion-transmissible malaria 
Transfusion-transmissible malaria (TTM) is a major concern in malaria endemic countries. A study was therefore conducted to know sero-prevalence of malaria in blood donors and the risk of TTM to multi-transfused patients at our hospital.
Materials and Methods:
Study subjects were: eligible blood donors (n = 1000), donors deferred due to history of fever in the last 3 months (n = 100), and multi-transfused patients (n = 200). Screening for malaria was done by slide microscopy, immunochromatographic rapid diagnostic test (RDT) for malaria antigen, and anti-malaria antibody by enzyme linked immunosorbent assay.
Malaria antibody prevalence in eligible donors and donors with history of fever, thalassemia patients, and in other multi-transfused patients was 16.9%, 22%, 6%, and 15%, respectively. None of the donors were positive for malaria on microscopic examination. None of the blood donors except one donor with history of fever, tested positive with RDT.
Malaria antibody prevalence in blood donors at our center is high. As blood units donated by such donors have high-risk potential, special processing may be undertaken to reduce the risk of TTM.
PMCID: PMC3439759  PMID: 22988385
Anti-malaria antibody; blood donor; multi-transfused patients; serology; transfusion-transmitted malaria

Results 1-9 (9)