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1.  Antibody screening & identification in the general patient population at a tertiary care hospital in New Delhi, India 
Background & objectives:
The development of alloantibodies can significantly complicate transfusion therapy and results in difficulties in cross-matching of blood. Most literature on alloimmunization is limited to multitransfused individuals, with very few studies on the general hospital patients. This study was aimed at assessing the frequency and type of unexpected red cell antibodies in the general patient population at a multispecialty tertiary care centre in New Delhi, India.
The results of 49,077 antibody screening tests carried out on patients, from January 2009 to December 2012 were analyzed. The clinical and transfusion records were reviewed. The data were compiled and statistically analysed.
A total of 49,077 (29,917; 60.96% males and 19,160; 39.04% females) patient samples were screened for the presence of unexpected antibodies. Antibody screening was positive in 403 patients (0.82%). In the serum samples of 164 patients only autoantibodies were identified, 27 revealed autoantibodies with one or more underlying alloantibodies, while 212 patients had only alloantibody/ies in their serum. The overall alloimmunization rate was 0.49 per cent. Antibodies against the Rh system were the most frequent (64.1%), the most common alloantibody identified being anti E (37.2%), followed by anti D (19.2%).
Interpretation & conclusions:
Since clinically significant antibodies are frequently detected in our patient population, antibody screening and if required, identification is the need of the hour. Since antibodies against the common Rh and Kell blood group antigens are the most frequent, provision of Rh and Kell matched red cells may be of protective value.
PMCID: PMC4248387  PMID: 25366208
Alloimmunization; autoantibodies; general patient population; multitransfused; unexpected red cell antibodies
2.  Detection of alloimmunization to ensure safer transfusion practice 
Serological safety is an integral part of overall safety for blood banks. Emphasis is on the use of routinue Red Blood Cell (RBC) antibody screen test, at set time intervals, to reduce risks related to alloantibodies. Also emphasis is on importance of issuing antigen negative blood to alloantibody positive patients. Effect of using leucodepleted blood on the rate of alloimmunization is highlighted. The concept of provision of phenotypically matched blood is suggested.
Materials and Methods:
Antibody screen test is important to select appropriate blood for transfusion. Repeat antibody screen testing, except if time interval between the earlier and subsequent transfusion was less than 72 hours, followed by antibody identification, if required, was performed in patients being treated with repeat multiple blood transfusions. Between February 2008 and June 2009, repeat samples of 306 multi-transfused patients were analyzed. Search for irregular antibodies and reading of results was conducted using RBC panels (three-cell panel of Column Agglutination Technology (CAT) and two cell panel of the Solid Phase Red Cell Adherence Technology (SPRCAT). Specificities of antibodies were investigated using appropriate panels, 11 cell panel of CAT and 16 cell panel of SPRCA. These technologies, detecting agglutination in columns and reactions in solid phase, evaluate the attachment of irregular incomplete antibody to antigen in the first phase of immunological reaction more directly and hence improve the reading of agglutination. Three to four log leuco reduced red blood cells were transfused to patients in the study using blood collection bags with integral filters.
Alloimmunization rate of 4.24% was detected from 306 multiply transfused patients tested and followed up. The Transfusion therapy may become significantly complicated.
Red cell antibody screening and identification and subsequent issue of antigen negative blood have a significant role in improving blood safety. Centers that have incorporated antibody screen test and identification have ensured safe transfusion. Identified patients should be flagged in a database and information shared. Such patients can be given carry-on cards and educated about the names of the identified antibodies. Full red cell phenotyping of individuals, patients and donors, can be feasibility.
PMCID: PMC3757774  PMID: 24014944
Antibody screen Test; antibody identification; cell panel
3.  Seroprevalence of anti-HCV antibodies among blood donors of north India 
Background & objectives:
Transfusion of blood and blood products although considered as a life saving treatment modality, but may lead to certain infectious and non-infectious complications in the recipients. The purpose of this analysis was to monitor the seroprevalence of anti-HCV antibody in the blood donor population in a hospital based blood bank in north India, to evaluate the trends over the years (2001-2011).
Relevant information of all the blood donors who donated whole blood at the department of Transfusion Medicine, Indraprastha Apollo Hospitals, New Delhi from the January 1, 2001 to December 31, 2011 was retrieved from the departmental records. The number of donors who were found reactive for anti-HCV anatibodies was calculated.
Of the 2,06,022 blood donors, 1,93,661 were males and 12,361 were females. The percentage of whole blood donors found seroreactive for anti-HCV antibodies was 0.39 per cent (n=795). The seroprevalence of anti-HCV in male blood donors was 0.38 per cent (n=750) and the respective seroprevalence in female blood donors was 0.36 per cent (n=45). No significant change in the trend of HCV seroprevalence was observed over the period under consideration. Maximum seroprevalence of anti-HCV was observed in the age group of 18 to 30 yr (0.41%) and the minimum in the age group of 51 to 60 yr (0.26%).
Interpretation & conclusion:
HCV seroprevalence in our study was 0.39 per cent and a decreasing trend with age was observed. No significant change in the trend of anti-HCV seroprevalence was seen over a decade. Since, no vaccine is presently available for immunization against HCV infection, transfusion transmitted HCV infection remains a potential threat to the safety of the blood supply.
PMCID: PMC3767252  PMID: 24056566
Anti-HCV; blood donors; north India; seroprevalence
4.  Hepatitis B core antibody testing in Indian blood donors: A double-edged sword! 
Until lately, anti-HBc antibodies were considered an effective marker for occult Hepatitis B virus (HBV) infection and have served their role in improving blood safety. But, with the development of advanced tests for HBV DNA detection, the role of anti-HBc in this regard stands uncertain.
Materials and Methods:
Anti-HBc and HBsAg ELISA and ID-NAT tests were run in parallel on donor blood samples between April 1, 2006 and December 31, 2010 at the Department of Transfusion Medicine, Indraprastha Apollo Hospitals, New Delhi. A positive ID-NAT was followed by Discriminatory NAT assay.
A total of 94 247 samples were tested with a total core positivity rate of 10.22%. We identified nearly 9.17% of donors who were reactive for anti-HBc and negative for HBsAg and HBV DNA. These are the donors who are potentially non-infectious and may be returned to the donor pool.
Although anti HBc testing has a definite role in improving blood safety, centers that have incorporated NAT testing may not derive any additional benefit by performing anti-HBc testing, especially in resource-limited countries like ours.
PMCID: PMC3353621  PMID: 22623835
Anti-HBc; HBsAg; ID-NAT
5.  Prevalence of HIV among blood donors in a tertiary care centre of north India 
Background & objectives:
India has the second highest HIV population in the world with about 2.5-3.0 million cases. HIV-2 cases among general and blood donor population have also been reported mostly from west and south India. This single centre study was carried out to observe the HIV-1 and HIV-2 prevalence among blood donors from north India.
A total of 2,04,677 people were screened for the presence of HIV infection over the 11 year period (1999 to 2009). Till 2004, a third generation ELISA kit was used. From 2005 till January 2009 all tests were done using the fourth generation ELISA kit which detected the presence of HIV-1 P24 antigen and anti-HIV antibodies. From February 2009 onwards, the kits used were Genscreen ULTRA HIV Ag-Ab Assay.
A total of 506 (0.247%) donors were found to be repeat reactive for HIV. Of these, 486 (96%) donors tested using the Western blot were found positive for HIV-1 infection. Twenty (4%) donors showed a negative Western blot result, none of the donors were found reactive for HIV-2 infection.
Interpretation & conclusions:
The prevalence of HIV was 0.249 per cent among blood donors of north India. No HIV-2 case was found among the studied blood donor population indicating that it is not a threat currently.
PMCID: PMC3284103  PMID: 22310827
Donor screening; HIV-1; HIV-2; north India; prevalence
6.  Evaluation of the red cell hemolysis in packed red cells during processing and storage 
Storage of red cells causes a progressive increase in hemolysis. In spite of the use of additive solutions for storage and filters for leucoreduction, some amount of hemolysis is still inevitable. The extent of hemolysis, however, should not exceed the permissible threshold for hemolysis even on the 42nd day of storage.
Study Design and Methods:
Eighty units of packed red cells, 40 stored in SAGM post leucoreduction and 40 in ADSOL without leucoreduction filters, were evaluated for plasma hemoglobin by HemoCue Plasma Hemoglobin analyzer on the day of collection and on the 7th, 14th, 21st, 28th, 35th and 42nd days thereafter. The hemoglobin and hematocrit were also noted for all these units by the Beckman and Coulter analyzer. Percentage hemolysis was then calculated.
Hemolysis progressively increased with the storage period in all the stored red cell units (SAGM as well ADSOL). However, on day 42nd of storage, free hemoglobin in all the red cell units was within the permissible level (which is 0.8% according to the Council of Europe guidelines and 1% as per the US FDA guidelines). The mean percentage hemolysis was slightly higher in the SAGM-containing bags with an integral leucoreduction filter as compared to the bags containing ADSOL. However this difference was marginal and not statistically significant.
Hemolysis of the red cells increases with storage. However, maximum hemolysis does not exceed the permissible limits at any time thereby indicating the effect of optimum processing and storage conditions on red cell hemolysis.
PMCID: PMC3082708  PMID: 21572708
Additive solutions; hematocrit; hemolysis; leucoreduction
7.  Weak D prevalence among Indian blood donors 
PMCID: PMC2937297  PMID: 20859520

Results 1-7 (7)