Background: Thrombopoietin (TPO) is regulated by a feedback mechanism between megakaryocytes and ... more Background: Thrombopoietin (TPO) is regulated by a feedback mechanism between megakaryocytes and platelets. This is important in plateletpheresis donors to compensate for donation-associated platelet loss. Aims and Objectives: The aim and objective of this study were to investigate changes in serum TPO levels in healthy plateletpheresis donors and its correlation with platelet recovery pattern. Materials and Methods: Out of 50 plateletpheresis donors recruited in the study over 1 year, only 29 completed follow-up and were further analyzed. Plateletpheresis procedures were performed on two types of cell separators (TRIMA ACCEL®, Terumo BCT Lakewood Colorado and AMICUS®, Fresenius Kabi, Germany). Platelet parameters were estimated pre- and post-platelet donation, at 3rd- and 5th-day postdonation. Serum TPO levels were determined using quantitative sandwich enzyme-linked immunosorbent assay technique (Raybiotech, USA) as per the protocol of the manufacturer. Results: The majority of donors (72%) in our study were first-time donors. The baseline platelet count was 226 ± 44 × 103/μl with a significant decline (30%; P < 0.001) in postdonation phase and remained below baseline on the 3rd and 5th day. The serum TPO levels increased significantly (P < 0.001) from a baseline of 227.81 (interquartile range [IQR]: 176.06) pg/ml to 269.94 (IQR: 110.68) pg/ml postdonation and remained elevated from baseline levels on the 3rd and 5th day. An inverse relation was observed between change in serum TPO levels and platelet count during postdonation phase which was not statistically significant (P > 0.05). Conclusion: Serum TPO levels increase significantly post plateletpheresis donation corresponding to decrease in platelet counts showing that TPO plays a vital role in compensatory mechanism after platelet loss.
Transfusion related acute lung injury (TRALI) is an uncommon but potentially fatal adverse reacti... more Transfusion related acute lung injury (TRALI) is an uncommon but potentially fatal adverse reaction to transfusion of plasma containing blood components. We describe a case of 10-year-old male child with aplastic anemia, platelet count of 7800/l, B positive blood group who developed fever (39.2C), difficulty in breathing and cyanosis within 2 hrs after transfusion of a random platelet concentrate. Despite the best resuscitative efforts, the child died within next 24 hrs. The present case highlights the fact that TRALI should be kept as a differential diagnosis in all patients developing acute respiratory discomfort within 6 hrs of transfusion. Without a &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;gold standard&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; the diagnosis of TRALI relies on a high index of suspicion and on excluding other types of transfusion reactions. Notification to transfusion services is crucial to ensure that a proper investigation is carried out and at-risk donor and recipients can be identified, and risk reduction measures can be adopted.
International Journal of Contemporary Medicine, 2014
Background: Dengue fever (DF) going into dengue shock syndrome (DSS) and dengue hemorrhagic fever... more Background: Dengue fever (DF) going into dengue shock syndrome (DSS) and dengue hemorrhagic fever (DHF) has challenged the blood transfusion services in the form of urgent requirement of platelets. Single donor apheresis platelets technology has helped the transfusion services that would have otherwise to arrange a large inventory of random donor platelets. Aim: To analyze the critical issues in the management of dengue outbreak during the year 2012 at a tertiary care institute. Study Design and Method: This is a retrospective study of records of the 186 serology proven dengue patients' requisitions, who received SDAP transfusion support from our department and analyses of the critical issues faced in managing the dengue patients. Results: A total of 239 single donor apheresis platelets (SDAP) procedures were done for 186 patients with serology proven dengue infection. Total 139(58.15%) SDAP requisitions were received from our own institution while 100(41.84%) requisitions were from other hospitals in the region. We observed that 20.43% SDAP requisitions did not qualify either prophylactic or therapeutic criteria for platelet transfusion according to the current guidelines. A total of 205 voluntary SDAP donors are registered in our emergency donor panel for plateletpheresis, out of this only 29 (14.14%) responded for SDAP donation during the dengue outbreak. Conclusions: Following appropriate guidelines for prophylactic and therapeutic blood and blood components transfusions and a well-planned emergency donor panel registry are essential pre- requisites for successful
World Health Organization (WHO) recommends screening of syphilis in low prevalence populations of... more World Health Organization (WHO) recommends screening of syphilis in low prevalence populations of blood donors by treponemal tests like enzyme-linked immunosorbent assay (ELISA), whereas in India screening is done by rapid plasma reagin (RPR). The present pilot study evaluated the performance of ELISA compared to RPR, keeping Treponema pallidum hemagglutination assay as a reference test. ELISA was equally sensitive (100%), more specific (56.3% vs. 0%), more accurate (83.7% vs. 62.7%), had better positive predictive value (79.4% vs. 62.8%) and negative predictive value (100% vs. 0%), and less biological false positivity (37.2% vs. 20.6%) when compared to RPR. The WHO recommendations of screening for syphilis in low prevalence population of blood donors using ELISA may be adopted for usage in transfusion services that have the facility of ELISA.
Convalescent plasma (CP) therapy is one of the promising therapies being tried for COVID-19 patie... more Convalescent plasma (CP) therapy is one of the promising therapies being tried for COVID-19 patients. This passive immunity mode involves separating preformed antibodies against SARS-CoV-2 from a recently recovered COVID-19 patient and infusing it into a patient with active disease or an exposed individual for prophylaxis. Its advantages include ease of production, rapid deployment, specificity against the target infectious agent, and scalability. In the current pandemic, it has been used on a large scale across the globe and also in India. However, unequivocal proof of efficacy and effectiveness in COVID-19 is still not available. Various CP therapy parameters such as donor selection, antibody quantification, timing of use, and dosing need to be considered before its use. The current review attempts to summarize the available evidence and provide recommendations for setting up CP protocols in clinical and research settings.
BACKGROUND: Postpartum microangiopathies are rare but are associated with high maternal and fetal... more BACKGROUND: Postpartum microangiopathies are rare but are associated with high maternal and fetal mortality requiring early diagnosis and prompt treatment to improve the outcome. AIMS AND OBJECTIVES: This retrospective study aims to assess the efficacy of plasma exchange (PE) therapy in postpartum thrombotic microangiopathies. MATERIALS AND METHODS: We did retrospective analysis of all plasma exchange procedures performed in patients of postpartum thrombotic microangiopathies over a period of 1 year (2015-2016). Patient's pre- and post-plasma exchange hematological and biochemical parameters were recorded and compared for analyzing the response to the therapy. Patients were followed telephonically even after their discharge from the hospital. RESULTS: Hematological and renal profile improved in 8 out of 9 patients after PE therapy. Survival after PE therapy was 40% in post partum atypical HUS and 75% in patients with HELLP syndrome at 4 months of follow up. CONCLUSION: Early initiation of PE therapy in postpartum thrombotic microangiopathies can reduce morbidity and mortality associated with them.
Background: Thrombopoietin (TPO) is regulated by a feedback mechanism between megakaryocytes and ... more Background: Thrombopoietin (TPO) is regulated by a feedback mechanism between megakaryocytes and platelets. This is important in plateletpheresis donors to compensate for donation-associated platelet loss. Aims and Objectives: The aim and objective of this study were to investigate changes in serum TPO levels in healthy plateletpheresis donors and its correlation with platelet recovery pattern. Materials and Methods: Out of 50 plateletpheresis donors recruited in the study over 1 year, only 29 completed follow-up and were further analyzed. Plateletpheresis procedures were performed on two types of cell separators (TRIMA ACCEL®, Terumo BCT Lakewood Colorado and AMICUS®, Fresenius Kabi, Germany). Platelet parameters were estimated pre- and post-platelet donation, at 3rd- and 5th-day postdonation. Serum TPO levels were determined using quantitative sandwich enzyme-linked immunosorbent assay technique (Raybiotech, USA) as per the protocol of the manufacturer. Results: The majority of donors (72%) in our study were first-time donors. The baseline platelet count was 226 ± 44 × 103/μl with a significant decline (30%; P < 0.001) in postdonation phase and remained below baseline on the 3rd and 5th day. The serum TPO levels increased significantly (P < 0.001) from a baseline of 227.81 (interquartile range [IQR]: 176.06) pg/ml to 269.94 (IQR: 110.68) pg/ml postdonation and remained elevated from baseline levels on the 3rd and 5th day. An inverse relation was observed between change in serum TPO levels and platelet count during postdonation phase which was not statistically significant (P > 0.05). Conclusion: Serum TPO levels increase significantly post plateletpheresis donation corresponding to decrease in platelet counts showing that TPO plays a vital role in compensatory mechanism after platelet loss.
Transfusion related acute lung injury (TRALI) is an uncommon but potentially fatal adverse reacti... more Transfusion related acute lung injury (TRALI) is an uncommon but potentially fatal adverse reaction to transfusion of plasma containing blood components. We describe a case of 10-year-old male child with aplastic anemia, platelet count of 7800/l, B positive blood group who developed fever (39.2C), difficulty in breathing and cyanosis within 2 hrs after transfusion of a random platelet concentrate. Despite the best resuscitative efforts, the child died within next 24 hrs. The present case highlights the fact that TRALI should be kept as a differential diagnosis in all patients developing acute respiratory discomfort within 6 hrs of transfusion. Without a &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;gold standard&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; the diagnosis of TRALI relies on a high index of suspicion and on excluding other types of transfusion reactions. Notification to transfusion services is crucial to ensure that a proper investigation is carried out and at-risk donor and recipients can be identified, and risk reduction measures can be adopted.
International Journal of Contemporary Medicine, 2014
Background: Dengue fever (DF) going into dengue shock syndrome (DSS) and dengue hemorrhagic fever... more Background: Dengue fever (DF) going into dengue shock syndrome (DSS) and dengue hemorrhagic fever (DHF) has challenged the blood transfusion services in the form of urgent requirement of platelets. Single donor apheresis platelets technology has helped the transfusion services that would have otherwise to arrange a large inventory of random donor platelets. Aim: To analyze the critical issues in the management of dengue outbreak during the year 2012 at a tertiary care institute. Study Design and Method: This is a retrospective study of records of the 186 serology proven dengue patients' requisitions, who received SDAP transfusion support from our department and analyses of the critical issues faced in managing the dengue patients. Results: A total of 239 single donor apheresis platelets (SDAP) procedures were done for 186 patients with serology proven dengue infection. Total 139(58.15%) SDAP requisitions were received from our own institution while 100(41.84%) requisitions were from other hospitals in the region. We observed that 20.43% SDAP requisitions did not qualify either prophylactic or therapeutic criteria for platelet transfusion according to the current guidelines. A total of 205 voluntary SDAP donors are registered in our emergency donor panel for plateletpheresis, out of this only 29 (14.14%) responded for SDAP donation during the dengue outbreak. Conclusions: Following appropriate guidelines for prophylactic and therapeutic blood and blood components transfusions and a well-planned emergency donor panel registry are essential pre- requisites for successful
World Health Organization (WHO) recommends screening of syphilis in low prevalence populations of... more World Health Organization (WHO) recommends screening of syphilis in low prevalence populations of blood donors by treponemal tests like enzyme-linked immunosorbent assay (ELISA), whereas in India screening is done by rapid plasma reagin (RPR). The present pilot study evaluated the performance of ELISA compared to RPR, keeping Treponema pallidum hemagglutination assay as a reference test. ELISA was equally sensitive (100%), more specific (56.3% vs. 0%), more accurate (83.7% vs. 62.7%), had better positive predictive value (79.4% vs. 62.8%) and negative predictive value (100% vs. 0%), and less biological false positivity (37.2% vs. 20.6%) when compared to RPR. The WHO recommendations of screening for syphilis in low prevalence population of blood donors using ELISA may be adopted for usage in transfusion services that have the facility of ELISA.
Convalescent plasma (CP) therapy is one of the promising therapies being tried for COVID-19 patie... more Convalescent plasma (CP) therapy is one of the promising therapies being tried for COVID-19 patients. This passive immunity mode involves separating preformed antibodies against SARS-CoV-2 from a recently recovered COVID-19 patient and infusing it into a patient with active disease or an exposed individual for prophylaxis. Its advantages include ease of production, rapid deployment, specificity against the target infectious agent, and scalability. In the current pandemic, it has been used on a large scale across the globe and also in India. However, unequivocal proof of efficacy and effectiveness in COVID-19 is still not available. Various CP therapy parameters such as donor selection, antibody quantification, timing of use, and dosing need to be considered before its use. The current review attempts to summarize the available evidence and provide recommendations for setting up CP protocols in clinical and research settings.
BACKGROUND: Postpartum microangiopathies are rare but are associated with high maternal and fetal... more BACKGROUND: Postpartum microangiopathies are rare but are associated with high maternal and fetal mortality requiring early diagnosis and prompt treatment to improve the outcome. AIMS AND OBJECTIVES: This retrospective study aims to assess the efficacy of plasma exchange (PE) therapy in postpartum thrombotic microangiopathies. MATERIALS AND METHODS: We did retrospective analysis of all plasma exchange procedures performed in patients of postpartum thrombotic microangiopathies over a period of 1 year (2015-2016). Patient's pre- and post-plasma exchange hematological and biochemical parameters were recorded and compared for analyzing the response to the therapy. Patients were followed telephonically even after their discharge from the hospital. RESULTS: Hematological and renal profile improved in 8 out of 9 patients after PE therapy. Survival after PE therapy was 40% in post partum atypical HUS and 75% in patients with HELLP syndrome at 4 months of follow up. CONCLUSION: Early initiation of PE therapy in postpartum thrombotic microangiopathies can reduce morbidity and mortality associated with them.
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