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Sekhar Das S, Mukherjee S, Chowdhury S. Immunohematological evaluation of red cell alloimmunization and statistical assessment of various adsorption techniques in warm autoimmune hemolytic anemia. Transfus Apher Sci 2023; 62:103769. [PMID: 37507272 DOI: 10.1016/j.transci.2023.103769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/18/2023] [Accepted: 07/24/2023] [Indexed: 07/30/2023]
Abstract
Adsorption techniques are widely applied to detect underlying masked alloantibodies in warm autoimmune hemolytic anemia (WAIHA). We established various adsorption techniques with an aim to detect alloimmunization in WAIHA This study conducted over a period of nine years included 298 patients of WAIHA. Complete immunohematological evaluation was performed on these 298 samples following departmental protocols. Clinical and laboratory details of patients were obtained from patient files. Various adsorption methods were performed and statistically evaluated in the study. Out of 479 cases of autoimmune hemolytic anemia, WAIHA comprised of 62.2 % (N = 298). A total of 139 (46.6 %) serum samples revealed autoantibodies. Adsorption study was performed in 101 (72.7 %) indicated samples and 24 (23.8 %) of these showed 26 alloantibodies. Among the patients subjected to adsorption study hemolytic marker were significantly deranged in the alloimmunization group (p < 0.01). Polyethylene glycol (PEG) adsorption was the quickest (52.2-54.6 min) of all adsorption techniques with minimum (1.3-1.5) numbers of adsorptions needing for complete removal of serum antibodies. The LISS-papain (LP) technique was found to be more sensitive and specific compared to the other two techniques. The agreement between PEG adsorption and LP adsorption was found to be 'perfect' (96.4 %) with a Cohen's kappa (k) value of 0.9. We conclude that identification of alloantibody specificities underlying a warm autoantibody is critical for a safe and effective transfusion. All WAIHA patients with history of blood transfusion, pregnancy or both should be subjected to adsorption study. Selection of a suitable adsorption technique depends on multiple important factors.
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Affiliation(s)
- Sudipta Sekhar Das
- Department of Transfusion Medicine, Apollo Multispeciality Hospitals, Kolkata 700054, India.
| | - Sourav Mukherjee
- Department of Transfusion Medicine, Apollo Multispeciality Hospitals, Kolkata 700054, India
| | - Sourav Chowdhury
- Department of Transfusion Medicine, Apollo Multispeciality Hospitals, Kolkata 700054, India
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Goenka MK, Goenka U, Patil VU, Das SS, Afzalpurkar S, Jajodia S, Mukherjee M, Shah BB, Moitra S. Kinetics of Covid-19 antibodies in terms of titre and duration among healthcare workers: A longitudinal study. Natl Med J India 2023; 35:201-205. [PMID: 36715043 DOI: 10.25259/nmji_109_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background Most individuals with Covid-19 infection develop antibodies specific to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, the dynamics of these antibodies is variable and not well-studied. We aimed to determine the titres of naturally acquired antibodies over a 12-week follow-up. Methods We recruited healthcare workers who had tested positive on a specific quantitative reverse transcription-polymerase chain reaction (qRT-PCR) for SARS-CoV-2, and then tested for the presence of immunoglobulin G (IgG) antibody against the same virus at baseline and again at 6 and 12 weeks. The antibody titre was determined by a semi-quantitative assay based on signal/cut-off ratio. Healthcare workers with antibody positivity were divided into those with high titre (ratio ≥12) and low titre (<12). Their demographic details and risk factors were surveyed through a Google form and analysed in relation to the antibody titres at three time-points. Results Of the 286 healthcare workers, 10.48% had high antibody titres. Healthcare workers who had tested positive by qRT-PCR and those who had received the Bacille Calmette-Guérin (BCG) vaccination or other immune-boosters had a higher frequency of high antibody titres. While there was a significant decline in antibody titres at 6 and 12 weeks, 87.46% of individuals positive for IgG antibody persisted to have the antibody even at 12 weeks. Conclusion Healthcare workers who tested positive for SARS-CoV-2 on qRT-PCR had a high positivity for the specific antibody, which continued to express in them even at 12 weeks. Further follow-up is likely to enhance our understanding of antibody kinetics following SARS-CoV-2 infection.
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Affiliation(s)
- Mahesh Kumar Goenka
- Department of Clinical Imaging and Interventional Radiology, Apollo Multispeciality Hospitals, Institute of Gastrosciences and Liver, Kolkata, West Bengal, India
| | - Usha Goenka
- Department of Clinical Imaging and Interventional Radiology, Apollo Multispeciality Hospitals, Institute of Gastrosciences and Liver, Kolkata, West Bengal, India
| | - Vikram Uttam Patil
- Department of Clinical Imaging and Interventional Radiology, Apollo Multispeciality Hospitals, Institute of Gastrosciences and Liver, Kolkata, West Bengal, India
| | - Sudipta Sekhar Das
- Department of Transfusion Medicine and Blood Bank, Apollo Multispeciality Hospitals, Institute of Gastrosciences and Liver, Kolkata, West Bengal, India
| | - Shivaraj Afzalpurkar
- Department of Clinical Imaging and Interventional Radiology, Apollo Multispeciality Hospitals, Institute of Gastrosciences and Liver, Kolkata, West Bengal, India
| | - Surabhi Jajodia
- Department of Clinical Imaging and Interventional Radiology, Apollo Multispeciality Hospitals, Institute of Gastrosciences and Liver, Kolkata, West Bengal, India
| | - Muhuya Mukherjee
- Department of Biostatistics, Apollo Multispeciality Hospitals, Institute of Gastrosciences and Liver, Kolkata, West Bengal, India
| | - Bhavik Bharat Shah
- Department of Clinical Imaging and Interventional Radiology, Apollo Multispeciality Hospitals, Institute of Gastrosciences and Liver, Kolkata, West Bengal, India
| | - Saibal Moitra
- Department of Allergy and Asthma Research Centre, Apollo Multispeciality Hospitals, Institute of Gastrosciences and Liver, Kolkata, West Bengal, India
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Biswas RN, Das SS, Chakrapani A, Sen S. Induction of thrombotic thrombocytopenic purpura by dengue virus infection in a critical patient: Role of therapeutic plasma exchange. Asian J Transfus Sci 2023; 17:285-287. [PMID: 38274960 PMCID: PMC10807527 DOI: 10.4103/ajts.ajts_56_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 05/22/2022] [Accepted: 05/29/2022] [Indexed: 11/04/2022] Open
Abstract
Thrombotic thrombocytopenic purpura (TTP) secondary to dengue fever is a very unusual occurrence. Both conditions are fatal and can result in significant mortality and morbidity if left untreated. In this case, we present a young lady who suffered dengue fever followed by microangiopathic anemia, thrombocytopenic purpura, and altered sensorium. Investigations revealed microangiopathic hemolysis; there was no evidence of disseminated intravascular coagulation. As soon as, we diagnosed the patient as having TTP, we treated her with serial plasma exchange therapy, steroids, and monoclonal antibodies such as rituximab. The patient responded very well to the treatment and completely recovered from neurological symptoms and laboratory parameters also normalized. Hence, timely diagnosis and starting appropriate treatment immediately are key factors for successful outcomes.
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Affiliation(s)
- Rathindra Nath Biswas
- Department of Transfusion Medicine, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
| | - Sudipta Sekhar Das
- Department of Transfusion Medicine, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
| | - Anupam Chakrapani
- Department of Clinical Hematology, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
| | - Subrata Sen
- Department of Transfusion Medicine, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
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Sekhar Das S, Chaudhuri K, Mukherjee S. Clinical and immunohematological characterization of autoimmune hemolytic anemia in children. Transfus Apher Sci 2023:103703. [PMID: 36934038 DOI: 10.1016/j.transci.2023.103703] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/17/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023]
Abstract
Autoimmune Hemolytic Anemia (AIHA) in childhood is uncommon and estimated to be three per million annually under 18 years of age. Detailed immunohematological and clinical characterizations are essential for correct diagnosis of the disease and its management. In this study we described AIHA in children with regards to patient demography, underlying etiology, disease classification, antibody characterization, clinical features, degree of in vivo hemolysis and transfusion management. The prospective observational study was conducted over a period of 6 years and included 29 children with newly diagnosed AIHA. Patient details were obtained from the hospital information system and patient treatment file. The median age of the children was 12 years with a female preponderance. Secondary AIHA was observed in 62.1% patients. The mean hemoglobin and reticulocyte were 7.1 gm/dL and 8.8 percentages respectively. The median polyspecific direct antiglobulin test (DAT) grading was 3+. Red cell bound multiple autoantibodies were found in 27.6% children. Free serum autoantibodies were present in 62.1% patients. Twenty six of the 42 units transfused were "best match" or "least incompatible". Follow-up of 21 children showed clinical and laboratory improvement with DAT still positive at the end of 9 months. AIHA in childhood requires advanced and efficient clinical, immunohematological and transfusion support. Detailed characterization of AIHA is important, as they determine degree of in vivo hemolysis, disease severity, serological incompatibility and necessity of blood transfusion. Although blood transfusion in AIHA is a challenge but it should not be withheld in critically ill patients.
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Affiliation(s)
- Sudipta Sekhar Das
- Department of Transfusion Medicine, Apollo Multispeciality Hospitals, Kolkata 700054, India.
| | | | - Sourav Mukherjee
- Department of Transfusion Medicine, Apollo Multispeciality Hospitals, Kolkata 700054, India
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Das SS, Das S, Shastry S, Shenoy V, Mandal S, Datta SS. Real-world data from India on clinical practices in the management of autoimmune haemolytic anaemia: A survey-based cross-sectional assessment. Transfus Clin Biol 2023; 30:137-142. [PMID: 36202315 DOI: 10.1016/j.tracli.2022.09.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Autoimmune haemolytic anaemia (AIHA) is a decompensated acquired haemolysis caused by the host's immune system acting against its own red cell antigens. The aim of this national survey is to capture real-world data of clinical practices in AIHA by collecting responses from clinical haematologists across India. METHODOLOGY In this cross-sectional study, a structured, 26-question online survey was conducted in India by few members of the special interest group in immunohaematology between January and March, 2022. The final survey consisted of questions covering place of work, amount of AIHA cases being evaluated by the haematologist over preceding years, basic demographic, clinical and laboratory features of the patients being treated under them etc. Descriptive statistical analysis was performed during the assessment. RESULTS The survey response rate was 48.2% (53/110), 69.8% (37/53) have diagnosed and managed more than 10 AIHA cases in the last 3 years with a female preponderance. There was considerable variability in response. While 56.6% (30/53) of respondents do have the access to the facilities to subtype AIHA cases; 32.1% (17/53) of clinicians would prefer administering high dose steroids for 6 weeks or more in non-responding patients, and only 45.3% (24/53) would assess the risks of thrombosis in AIHA. There is unanimous agreement among the participants that health-related quality of life should be taken into consideration in patients and the need for a national registry of patients with AIHA in India. CONCLUSION The current national survey showed that some aspects of AIHA management were consistent; others were less so, but also significant variations were observed in certain clinical practices, where the evidence base is limited. A joint effort is needed to establish a national patient registry by including both clinical haematologists and transfusion medicine specialists which could potentially standardise AIHA management and future research in India.
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Affiliation(s)
- Sudipta Sekhar Das
- Department of Transfusion Medicine, Apollo Multispeciality Hospitals, Kolkata, India
| | - Soumya Das
- Department of Transfusion Medicine, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Shamee Shastry
- Department of Immunohematology and Blood Transfusion, Kasturba Medical College, Manipal, Karnataka, India
| | - Veena Shenoy
- Department of Transfusion Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Saikat Mandal
- Department of Transfusion Medicine & Blood Centre, Jaypee Hospital, Noida, Delhi NCR, India
| | - Suvro Sankha Datta
- Department of Transfusion Medicine, Tata Medical Center, Newtown, Rajarhat, Kolkata 700160, India.
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Das SS, Mukherjee S, Chakrapani A, Bhattacharyya D. Clinical perspectives, immunohematologic insights, and transfusion management in IgA-associated autoimmune hemolytic anemia. Immunohematology 2022; 38:82-89. [PMID: 36190199 DOI: 10.21307/immunohematology-2022-047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Autoimmune hemolytic anemia (AIHA) due to warm-reacting IgA autoantibodies is rare. Here, we explored the clinical and immunohematologic characteristics of patients suffering from IgA-associated warm AIHA (WAIHA) and their transfusion management. The 9-year study included 214 patients with WAIHA who were further classified into two groups: (1) IgA-associated WAIHA and (2) non-IgA-associated WAIHA. Clinical and laboratory details were obtained from patient files and the Hospital Information System. All immunohematologic investigations were performed following standard operating procedures and established protocols. Among the 214 patients with WAIHA, 17 (7.9%) belonged to the IgA-associated group; of these, two IgA-only WAIHA cases were found. The mean hemoglobin in this group was 5.58 g/dL, and 15 (88.2%) of these patients received a total of 32 units of packed red blood cell (RBC) transfusions. In vivo hemolytic markers were significantly abnormal in the IgA-associated WAIHA group when compared with the non-IgA group. Secondary WAIHA was found in 11 (64.7%) patients with IgA-associated WAIHA. Patients with IgA-associated WAIHA received more blood transfusions than individuals in the non-IgA group (p = 0.0004). A total of 17 (7.9%) patients with WAIHA experienced adverse events to blood transfusion. Detailed characterization of WAIHA with particular emphasis on IgA-associated and non-IgA-associated WAIHA is essential to evaluate the disease characteristics, access the degree of hemolysis, understand the immunohematologic behaviors of the antibodies, and manage blood transfusions.
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Affiliation(s)
- S S Das
- Transfusion Medicine, Apollo Multispeciality Hospitals Ltd., 58 Canal Circular Road, Kadapara, Phool Bagan, Kankurgachi, Kolkata, West Bengal, India, 700054
| | - S Mukherjee
- Transfusion Medicine, Apollo Multispeciality Hospitals Ltd., Kolkata, India
| | - A Chakrapani
- Clinical Hematology, Apollo Multispeciality Hospitals Ltd., Kolkata, India
| | - D Bhattacharyya
- Clinical Hematology, Apollo Multispeciality Hospitals Ltd., Kolkata, India
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Das SS, Biswas RN, Sardar TP, Safi M. An insight to the internal quality control of blood components separated using the latest whole blood collection and processing systems: Experience from a tertiary care hospital blood transfusion service in Eastern India. Asian J Transfus Sci 2022; 16:194-200. [PMID: 36687542 PMCID: PMC9855214 DOI: 10.4103/ajts.ajts_52_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/06/2021] [Accepted: 07/04/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND With blood component therapy becoming the standard of care in transfusion medicine globally, the quality control (QC) of these components has become a routine and mandatory program in all blood centers. Extensive utilization of blood components has been observed in our multidisciplinary tertiary care hospital. We use quadruple bag systems and automated component extraction facilities for collection and processing of whole blood (WB). In this study, we analyzed our data relating to QC of all blood components which we prepare and issue for transfusion. MATERIALS AND METHODS The retrospective 5-year study comprised 47,430 WB collections which were separated into blood components using quadruple bags and automated component extraction machine. A total of 90 units of WB were processed into blood components for the machine calibration and validation. Routine use of the system was started once the calibration and validation results were acceptable. At least 1% of each component prepared was subjected to QC as per departmental standard operating procedures. Statistical analysis was done using the SPSS statistical package. RESULTS The mean volume, hematocrit (Hct), platelet (PLT), and white blood cell (WBC) in 350 and 450 mL WB units were 394.63 mL, 39.43%, 0.93 × 1011, and 3.12 × 109 and 507.75 mL, 40.72%, 1.13 × 1011, and 3.45 × 109, respectively, with mean recovery of PLT and WBC in buffy coat being 95.54% and 68.63% and 97.87% and 74.51%, respectively. As high as 89.91% RBC recovery was noted in the packed red blood cell units which were subjected to QC. QC of random donor platelets was performed in 979 (2.36%) units with acceptable results. The mean fibrinogen and FVIII values were estimated to be 469.17 mg and 217.34 IU (1.07 IU/mL) and 600.21 mg and 273.39 IU (1.11 IU/mL) in fresh frozen plasma units prepared from 350 and 450 mL WB, respectively. A total of 578 (1.62%) units of cryoprecipitate were investigated for QC with favorable results. CONCLUSION We conclude that QC data generated in this study will provide invaluable information about the performance of the latest blood collection systems. QC of all blood components under study complied with both national and international standards. We opine that all blood centers should establish a complete QC program and adhere to departmental protocols and manufacturer's instructions for its execution and effective outcome.
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Affiliation(s)
- Sudipta Sekhar Das
- Department of Transfusion Medicine, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
| | - Rathindra Nath Biswas
- Department of Transfusion Medicine, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
| | - Tirtha Pratim Sardar
- Department of Transfusion Medicine, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
| | - Mahammad Safi
- Department of Transfusion Medicine, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
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Chaudhary R, Das SS. Application of flow cytometry in transfusion medicine: The Sanjay Gandhi Post Graduate Institute of Medical Sciences, India experience. Asian J Transfus Sci 2022; 16:159-166. [PMID: 36687536 PMCID: PMC9855202 DOI: 10.4103/ajts.ajts_61_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 05/30/2022] [Accepted: 06/05/2022] [Indexed: 01/25/2023] Open
Abstract
The application of flow cytometry (FC) is diverse and this powerful tool in used in multiple disciplines such as molecular biology, immunology, cancer biology, virology, and infectious disease screening. FC analyzes a single cell or a particle very rapidly as they flow past single or multiple lasers while suspended in buffered solution. FC has a great impact in the field of transfusion medicine (TM) due to its ability to analyze individual cell population and cell epitopes by sensitive, reproducible, and objective methodologies. The main uses of FC in TM are detection of fetomaternal hemorrhage, diagnosis of paroxysmal nocturnal hemoglobinuria, quantification of D antigen, detection of platelet antibody, quality control of blood components, for example, residual leukocyte counts and evaluation of CD34-positive hematopoietic progenitor cells in stem cell grafts. In recent years, FC has been implemented as an alternative method for the detection and characterization of red cell autoantibodies in autoimmune hemolytic anemia. Many workers considered FC as a very good complement when aberrant expression of various erythrocyte antigens needs to be elucidated. It has been extensively used in the resolution of ABO discrepancies and chimerism study. FC has also been used successfully in various platelet immunological studies. In the recent past, FC has been used in several studies to assess the platelet storage lesions and elucidate granulocyte/monocyte integrity and immunology. FC analysis of CD34+ stem cells is now the method of choice to determine the dosage of the collected progenitor cells. The technique is vastly used to evaluate residual leukocytes in leukodepleted blood components. We conclude that flow cytometers are becoming smaller, cheaper, and more user-friendly and are available in many routine laboratories. FC represents a highly innovative technique for many common diagnostic and scientific fields in TM. Finally, it is the tool of choice to develop and optimize new cellular and immunotherapeutic trials.
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Affiliation(s)
- Rajendra Chaudhary
- Department of Transfusion Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sudipta Sekhar Das
- Department of Transfusion Medicine, Apollo Multispeciality Hospitals, Kolkata, West Bengal, India
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Das SS, Mukherjee S. Influence of immunohematological markers on severity of in vivo hemolysis in human warm autoimmune haemolytic anemia. Transfus Apher Sci 2022; 61:103492. [PMID: 35773127 DOI: 10.1016/j.transci.2022.103492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/13/2022] [Accepted: 06/16/2022] [Indexed: 10/17/2022]
Abstract
Autoantibody production in autoimmune haemolytic anemia (AIHA) is the result of the loss of self-immunological tolerance of the host. Here we investigated the various immunohematological markers that may influence the severity of in vivo hemolysis in warm AIHA (WAIHA). Complete direct antiglobulin test (DAT) evaluation and immunohematological characterization were performed in 247 patients of WAIHA following departmental protocols. Clinical and laboratory details of patients were obtained from patient file. The median age of WAIHA patients was 47 years with a female preponderance. Lymphoproliferative diseases were the major underlying causes of secondary WAIHA. The mean haemoglobin (Hb) and reticulocyte count (Retic) were 6.43 gm/dL and 7.58% respectively. Single autoantibody bound to red cells was investigated in 151 patients. The main IgG subclass was IgG1. Multiple autoantibodies like IgG+ C, IgG+IgA and IgG+IgA+C were found in 87 (35.2%) patients. Free autoantibodies were observed in 112 patients with a median indirect antiglobulin test (IAT) reactivity of 2+. Derangement of haematological and biochemical values was statistically significant with increase in DAT reactivity, presence of multiple autoantibodies on red cells, coating of red cells by IgG3 or multiple IgG subclass, higher DAT dilution and increasing IAT reactivity. We conclude that several important but simple immunohematological parameters may influence the degree of in vivo hemolysis in WAIHA. Since a set of common haematological and biochemical test determines the severity of in vivo hemolysis therefore a comprehensive clinical and immunohematological evaluation is advisable for a correct diagnostic and therapeutic workup of WAIHA.
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Affiliation(s)
- Sudipta Sekhar Das
- Department of Transfusion Medicine, Apollo Multispeciality Hospitals, Kolkata 700054, India.
| | - Sourav Mukherjee
- Department of Transfusion Medicine, Apollo Multispeciality Hospitals, Kolkata 700054, India
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Das SS, Kamilya R, Biswas RN, Ghosh S. An insight into the utilization of allogenic blood transfusion and factors affecting blood transfusion in total knee replacement surgery in a tertiary care hospital in Eastern India. Asian J Transfus Sci 2021; 15:133-139. [PMID: 34908743 PMCID: PMC8628226 DOI: 10.4103/ajts.ajts_186_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 07/04/2021] [Accepted: 07/04/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND: Significant blood loss and requirement of allogenic blood transfusion during or after total knee replacement (TKR) have been reported. Incidence of blood transfusion in TKR is highly variable and depends on several factors. We investigated the blood utilization in patients undergoing TKR in our hospital and depicted the important risk factors that determine the need of allogenic blood transfusion in primary unilateral TKR. MATERIALS AND METHODS: The study included 1241 consecutive patients undergoing primary unilateral total knee arthroplasty. All the surgeries were performed by a single surgical team of orthopedists following standard procedure. Patient and disease details were obtained from patient file and hospital information system. Compatibility test was performed in blood bank before blood reservation following mandatory guidelines. Details of test, blood issue, and blood transfusion were documented in the blood bank. RESULTS: Of 1241 enrolled patients, 1069 (86.2%) were female. The median age of patients was 66 years with mean preoperative hemoglobin of 9.9 g/dL. Allogenic blood transfused was needed in 223 (17.9%) patients. Diabetes mellitus, hypertension, thyroid disorders, and chronic heart diseases were the major comorbid conditions. Risk factors such as gender, American Society of Anesthesiologists score, preoperative hemoglobin, and intraoperative and postoperative blood losses were significantly associated with blood transfusion. CONCLUSION: The risk factors determining blood transfusion in TKR vary between studies, however, all centers should establish standard operating procedures describing the surgical procedure and transfusion support in TKR. In addition, each center may develop specific blood management strategy to rationalize blood transfusion in TKR and overall successful care in TKR.
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Affiliation(s)
- Sudipta Sekhar Das
- Department of Transfusion Medicine, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
| | - Ranjan Kamilya
- Department of Orthopedics, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
| | - Rathindra Nath Biswas
- Department of Transfusion Medicine, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
| | - Susanta Ghosh
- Department of Transfusion Medicine, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
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Das SS, Chakrapani A, Bhattacharya S, Biswas RN, Safi M. Immunohematological and Clinical Characterization of Complement and Non-Complement Associated Warm Autoimmune Haemolytic Anemia and Risk Factors Predicting their Occurrences. Indian J Hematol Blood Transfus 2021; 37:623-631. [PMID: 34744345 DOI: 10.1007/s12288-021-01402-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/10/2021] [Indexed: 12/17/2022] Open
Abstract
Antigen - antibody complexes on heavily coated red cells in Warm autoimmune haemolytic anemia (WAIHA) often activates the complement pathway and red cells bound C3 complement component are encountered in complement associated WAIHA (CWAIHA). Patients belonging to CWAIHA and non-complement associated WAIHA (NCWAIHA) may demographically, clinically and immunohematologically behave differently therefore we planned to study the clinical and immunohematological characteristics of CWAIHA and NCWAIHA with emphasis to various potential factors associated with CWAIHA. The prospective study included 229 patients of WAIHA. Complete DAT evaluation was performed in all these patients. Details of patients and their hematological and biochemical parameters were obtained from patient file and Hospital Information System. In vivo hemolysis was documented as per the criteria established by previous workers. Statistical analysis was done using SPSS statistical package. Of the total 229 patients of WAIHA, 83 (36.2%) belonged to the complement associated WAIHA group. A total of 146 (63.8%) patients were females of which 43 (29.4%) had CWAIHA. The median age of WAIHA patients was 37 years. A total of 46 (56.1%) patients above age 40 years suffered from CWAIHA. Where secondary WAIHA was found in 121 (52.8%) patients; more than half (61.4%) with CWAIHA had underlying aetiology. Over 95% of patients in both categories presented with weakness and pallor. Strong DAT (> 2 +) was observed in 86.7% of CWAIHA patients. Factors like gender, age, aetiology and DAT IgG dilution were independent risk factors for CWAIHA. DAT remained positive even at the end of 10 months of successful treatment. We conclude that detailed characterization of WAIHA with particular emphasis to complement and non-complement associated WAIHA is essential to evaluate the disease characters, immunological behaviours, prognosis and therapeutic management. Moreover an understanding of the risk factors of CWAIHA will help physicians / hematologists and immunohematologists to manage WAIHA more prudently and solicitously.
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Affiliation(s)
- Sudipta Sekhar Das
- Department of Transfusion Medicine, Apollo Gleneagles Hospitals, Kolkata, 700054 India
| | - Anupam Chakrapani
- Department of Transfusion Medicine, Apollo Gleneagles Hospitals, Kolkata, 700054 India
| | - Soumya Bhattacharya
- Department of Transfusion Medicine, Apollo Gleneagles Hospitals, Kolkata, 700054 India
| | - Rathindra Nath Biswas
- Department of Transfusion Medicine, Apollo Gleneagles Hospitals, Kolkata, 700054 India
| | - Mahammad Safi
- Department of Transfusion Medicine, Apollo Gleneagles Hospitals, Kolkata, 700054 India
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Das SS, Biswas RN, Safi M. "Auto-anti-A1" in a healthy young blood donor: A rare cause of ABO discrepancy. Asian J Transfus Sci 2021; 15:87-89. [PMID: 34349463 PMCID: PMC8294444 DOI: 10.4103/ajts.ajts_42_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 08/02/2020] [Accepted: 12/13/2020] [Indexed: 11/23/2022] Open
Abstract
”Auto-anti-A1” has been sparsely discussed in the literature. Only few workers in the past depicted such antibody in transfused and nontransfused patients. The current case is probably the first example of auto-anti-A1 in a healthy young blood donor who was typed as ABO Group “A1B.” The cold reacting autoantibody in the donor was serologically characterized in details and was found to be nonhemolytic. ABO discrepancy was resolved and the donor was finally typed as “A1B Negative.” Therefore, we concluded that auto-anti-A1 may be a rare cause of ABO discrepancy and its resolution is essential to confirm blood group and subsequent blood transfusion management.
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Affiliation(s)
- Sudipta Sekhar Das
- Department of Transfusion Medicine, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
| | - Rathindra Nath Biswas
- Department of Transfusion Medicine, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
| | - Mahammad Safi
- Department of Transfusion Medicine, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
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Das SS, Sen S, Zaman RU, Biswas RN. Plateletpheresis in the Era of Automation: Optimizing Donor Safety and Product Quality Using Modern Apheresis Instruments. Indian J Hematol Blood Transfus 2021; 37:134-139. [PMID: 33707846 PMCID: PMC7900306 DOI: 10.1007/s12288-020-01337-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/11/2020] [Indexed: 11/26/2022] Open
Abstract
The increases in major surgeries, transplantations and speciality clinics have significantly increased the utilization of platelet concentrates including single donor platelets (SDP). The advantages of SDP or apheresis platelet have been discussed elaborately by previous authors as compared to random donor platelets. Here we share our experiences of plateletpheresis procedures using the modern apheresis machines with regards to product quality and donor safety. This study included 3016 procedures of plateletpheresis (1397 on Amicus and 1619 on Trima accel cell separators) on eligible donors using recommended apheresis kits. A target yield of 3 × 1011 was set as the end point of each procedure. Donor details, procedure details and donor adverse reactions if any were documented. Statistical analysis was done using the SPSS statistical package (version 13, USA). Of the total 6276 donors screened 2049 (32.6%) were deferred due to various reasons. Out of remaining 4227 eligible donors; 3016 (71.4%) underwent plateletphereis procedures based on the requirement of SDP by the patients. Mean pre-procedure platelet count and hematocrit in donors were 188.3 × 106/mL and 41.7% respectively. Mean procedure time in Amicus (76.6 min) was significantly more than the Trima accel (64.3 min) (p = 0.02). Platelet yield by Trima accel and Amicus was 2.96 × 1011 and 3.08 × 1011 respectively (p = 0.061). A total of 40 donors (1.33%) suffered adverse effect during or after apheresis procedures. While the modern plateletpheresis devices are both donor and user friendly at the same time they provide quality product consistently in lesser time.
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Affiliation(s)
- Sudipta Sekhar Das
- Department of Transfusion Medicine, Apollo Gleneagles Hospitals, Kolkata, 700054 India
| | - Subrata Sen
- Department of Transfusion Medicine, Apollo Gleneagles Hospitals, Kolkata, 700054 India
| | - R. U. Zaman
- Department of Transfusion Medicine, Apollo Gleneagles Hospitals, Kolkata, 700054 India
| | - Rathindra Nath Biswas
- Department of Transfusion Medicine, Apollo Gleneagles Hospitals, Kolkata, 700054 India
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Affiliation(s)
- Sudipta Sekhar Das
- Department of Transfusion Medicine, Apollo Gleneagles Hospitals, Kolkata 700 054, India.
| | - Kaustabh Chaudhuri
- Department of Transfusion Medicine, Apollo Gleneagles Hospitals, Kolkata 700 054, India
| | - Rathindra Nath Biswas
- Department of Transfusion Medicine, Apollo Gleneagles Hospitals, Kolkata 700 054, India
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Agarwal VK, Das SS. Rationalizing blood transfusion in elective breast cancer surgery: Analyzing justification and economy. Asian J Transfus Sci 2020; 14:39-43. [PMID: 33162704 PMCID: PMC7607976 DOI: 10.4103/ajts.ajts_107_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 02/06/2018] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Transfusion of allogeneic blood in breast cancer surgery is variable, and differences of transfusion incidence have been observed in the literature. Most hospital guidelines including ours dictate group and reserve policy of blood before breast surgery. Here, we aimed to audit the blood utilization in patients undergoing elective breast surgery in our hospital and thereby optimize the blood ordering schedule, economic burden, and loss of clinical resources. MATERIALS AND METHODS The study included 478 breast cancer surgeries over a period of 6 years. Patient and disease details were obtained from patient file and hospital information system. Blood samples sent to blood bank were subjected to compatibility test and reserved. All transfusions were documented, and statistical analysis was done. RESULTS Of the total 478 patients, most underwent wide local excision of the breast and modified radical mastectomy. A total of 16 patients received 71 units of blood and blood components in all categories of surgeries. Only 103 were younger women (≤40 years), with a mean age of 31 years. Nontransfused patients were significantly more than transfused ones (P < 0.05). Frequency of blood transfusion was more in young patients (4.9%). Seven (22.6%) of the total 31 Stage IV patients received blood transfusions. Frequency of blood transfusion was more in patients undergoing surgery after chemotherapy (8.8%). A significant loss of time and loss of revenue was observed. CONCLUSION We conclude that routine compatibility test is not justified for all patients undergoing breast surgery. A more targeted approach is needed to reduce blood demand and associated cost to patient and blood transfusion services.
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Affiliation(s)
- Vikas K Agarwal
- Department of Surgical Oncologym, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
| | - Sudipta Sekhar Das
- Department of Transfusion Medicine, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
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Goenka M, Afzalpurkar S, Goenka U, Das SS, Mukherjee M, Jajodia S, Shah BB, Patil VU, Rodge G, Khan U, Bandyopadhyay S. Seroprevalence of COVID-19 Amongst Health Care Workers in a Tertiary Care Hospital of a Metropolitan City from India. J Assoc Physicians India 2020; 68:14-19. [PMID: 33187030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Seroprevalence studies for COVID-19 evaluate the extent of undetected transmission in a defined community, with special significance among health care workers (HCW) owing to their greater exposure and potential to transmit. METHODS A total of 1122 HCW (approximately 25% of the employees) of a large tertiary care hospital in India were recruited for this cross-sectional study. COVID PCR-positive HCW were excluded. Based on their risk-assessment, participants were grouped into three categories. A questionnaire was administered and they were tested for SARS-CoV-2-IgG antibodies using the chemiluminescence. RESULTS The overall seroprevalence among workers was 11.94%, which included 19.85% in COVID units, 11.09% in non-COVID units, and 8% in administrative workers (p=0.007). Antibody prevalence was highest in the department of gastroenterology (11.94%), followed by oncology (10.53%), pathology (10.26%), emergency medicine (7.84%) and critical care medicine (7%). Housekeeping staff, food and beverage staff, lab assistants and technicians had higher seroprevalence rate than doctors and nurses (p < 0.0001). HCW with a history of BCG vaccination in childhood and those who received an adequate prophylactic dose of hydroxychloroquine (HCQ) had a lower seroprevalence as compared to those who did not (7.31% vs. 16.8% and 1.30% vs. 11.25% respectively). CONCLUSION BCG vaccination, HCQ prophylaxis, and the job profile influence the seroprevalence rate in HCW. Seroprevalence rate and follow-up evaluation of its durability may help hospitals to triage their staff at risk, rationalize their placement, prioritize the use of PPE, thereby potentially reducing the risk.
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Affiliation(s)
- Mahesh Goenka
- Director and Head, Medicine, Apollo Gleneagles Hospitals, Kolkata, West Bengal
| | - Shivaraj Afzalpurkar
- Registrar, Institute of Gastrosciences and Liver, Apollo Gleneagles Hospitals, Kolkata, West Bengal
| | - Usha Goenka
- Director and Head, Department of Clinical Imaging and Interventional Radiology, Apollo Gleneagles Hospitals, Kolkata, West Bengal
| | - Sudipta Sekhar Das
- Senior Consultant and Head, Department of Transfusion Medicine, Apollo Gleneagles Hospitals, Kolkata, West Bengal
| | - Mohuya Mukherjee
- Clinical Data Analyst, Apollo Gleneagles Hospitals, Kolkata, West Bengal
| | - Surabhi Jajodia
- Consultant, Department of Clinical Imaging and Interventional Radiology, Apollo Gleneagles Hospitals, Kolkata, West Bengal
| | - Bhavik Bharat Shah
- Consultant, Institute of Gastrosciences and Liver, Apollo Gleneagles Hospitals, Kolkata, West Bengal
| | - Vikram Uttam Patil
- Registrar, Institute of Gastrosciences and Liver, Apollo Gleneagles Hospitals, Kolkata, West Bengal
| | - Gajanan Rodge
- Registrar, Institute of Gastrosciences and Liver, Apollo Gleneagles Hospitals, Kolkata, West Bengal
| | - Ujjwayini Khan
- Consultant, Department of Microbiology, Apollo Gleneagles Hospitals, Kolkata, West Bengal
| | - Syamasis Bandyopadhyay
- Senior Consultant, Department of Internal Medicine, Apollo Gleneagles Hospitals, Kolkata, West Bengal
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Samal P, Pradhan S, Das SS. Masquerading of mismatched blood transfusion by underlying autoimmune hemolytic anemia. Asian J Transfus Sci 2019; 13:142-144. [PMID: 31896924 PMCID: PMC6910039 DOI: 10.4103/ajts.ajts_154_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 06/08/2018] [Indexed: 11/30/2022] Open
Abstract
Mismatched blood transfusion due to immunohematological discrepancy is relatively uncommon and in most instances occurs due to Type IV blood group discrepancy which is the discrepancies between forward and reverse groupings. Here, we present a case of a 15-year-old girl with preexisting autoimmune hemolytic anemia (AIHA) who inadvertently received 3 units of wrongly matched packed red blood cell (PRBC), followed by severe intravascular hemolysis. On detailed immunohematological investigation, the patient was found to be autoimmunized and diagnosed with “mixed AIHA” and the patient's blood group was confirmed as “A” positive. Three units of group-specific “best match” PRBC was transfused under close observation without any adverse effect. This highlights the importance of carrying out both forward and reverse blood groupings to avoid mismatched blood transfusion.
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Affiliation(s)
- Priyanka Samal
- Department of Clinical Hematology, IMS and SUM Hospital, Bhubaneswar, Odisha, India
| | - Sarita Pradhan
- Department of Pathology, Division of Hematology, IMS and SUM Hospital, Bhubaneswar, Odisha, India
| | - Sudipta Sekhar Das
- Department of Transfusion Medicine, Aapollo Gleneagles Hospital, Kolkata, West Bengal, India
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Abstract
BACKGROUND AND AIM: Patients with warm autoimmune hemolytic anemia (AIHA) may carry immunoglobulin (Ig) M antibodies that react at room temperature and are nonpathological, but few may have cold agglutinins that react at or above 30°C and are referred to as “mixed” AIHA (MAIHA). Here, we present our experience on characterizing MAIHA both clinically and serologically. MATERIALS AND METHODS: Out of 134 AIHA patients, 13 diagnosed as MAIHA were subjected to detailed immunohematological characterization. Most patients were severely anemic and required urgent transfusions. Resolution of blood group discrepancy, elution, Donath-Landsteiner test, and adsorption study were performed following established protocol. “Best match” blood units were selected and transfused to patients. RESULTS: Eight of the 13 patients had severe hemolysis. The median age of patient was 37 years with a female preponderance and secondary MAIHA was observed in 8 (61.5%) patients. Blood group discrepancy was encountered in 4 (30.8%) patients. Multiple red cell bound autoantibodies and high titer serum-free IgM autoantibodies were detected in all samples. Twenty-nine units of “best match” packed red blood cells were transfused to 12 patients without any adverse reaction. Improvement in hematological and biochemical values was observed in all follow-up patients. CONCLUSION: Patients with MAIHA often present with severe hemolysis necessitating blood transfusions. While red cells are coated with multiple autoantibodies, both warm reactive IgG and cold reactive IgM autoantibodies are present in the serum. These serological complexities not only render a crossmatch incompatibility but often lead to blood group discrepancy. “Best match” blood transfusion is always lifesaving.
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Affiliation(s)
- Sudipta Sekhar Das
- Department of Transfusion Medicine, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
| | - Ritam Chakrabarty
- Department of Transfusion Medicine, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
| | - R U Zaman
- Department of Transfusion Medicine, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
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Chakrabarty R, Das SS. Successful surgical procedure in a patient of aplastic anemia with platelet refractoriness, using cross-match compatible platelets. Asian J Transfus Sci 2017; 11:192-194. [PMID: 28970690 PMCID: PMC5613429 DOI: 10.4103/ajts.ajts_115_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This case marks the beginning of issuing cross-matched platelet products in Eastern India. A known case of aplastic anemia, on regular transfusion support, now presented with obstructed ventral periumbilical hernia requiring urgent surgical intervention. Platelet count at presentation was 13,000/μL. Platelet cross-matching was done by solid phase method. Ten units of random donor platelets were crossmatched. Five units were compatible and transfused. Counts rose to 84,000/μL after 1 h. Surgery was completed successfully. Thus, 50% units were compatible. This indicates possible underlying alloimmunization. Rapid count rise enabled completion of this urgent surgery. This rapid rise of platelet count would not have been possible without cross matching. We conclude that platelet cross matching is a powerful tool for alloimmunized patients.
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Affiliation(s)
- Ritam Chakrabarty
- Department of Transfusion Medicine, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
| | - Sudipta Sekhar Das
- Department of Transfusion Medicine, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
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20
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Das SS, Bhattacharya S, Bhartia S. Clinical and serological characterization of cold agglutinin syndrome in a Tertiary Care Hospital in Eastern India. Asian J Transfus Sci 2015; 9:173-6. [PMID: 26420939 PMCID: PMC4562140 DOI: 10.4103/0973-6247.154258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background and Aim: Cold agglutinin syndrome (CAS) primary or secondary represents approximately 16-32% of autoimmune hemolytic anemia cases. Most patients present with mild, chronic hemolytic anemia with exacerbation of the condition in the cold environment. Red cell transfusions are only indicated when there is a life-threatening anemia causing crisis. We studied the clinical and serological characterization of CAS with the aim that the information gained from this study would help in proper diagnosis and management of these patients. Materials and Methods: The prospective study included nine patients who were admitted with severe anemia. Detailed work-up were conducted to establish the diagnosis, severity of in vivo hemolysis and transfusion management. Results: All patients presented with pallor, weakness, fatigue and painful fingers and toes with exacerbation of symptoms in winter months. Secondary CAS was observed in three patients suffering from malignant lymphoma. Red cells of all patients were coated with complements (C3) more specifically C3d. In one patient suffering from malignant lymphoma, the cold autoagglutinin titer was as high as 4096. Autoantibody in seven patients was specific to “I” antigen and one to “i” antigen. Conclusions: We conclude that detailed clinical and serological characterization is needed to diagnose and manage CAS. Whereas avoidance of cold exposure is the primary therapy, but no critical patient should be denied blood transfusion due to serological complications. All transfusion services should follow the correct protocol to maximize blood safety in CAS.
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Affiliation(s)
- Sudipta Sekhar Das
- Department of Transfusion Medicine, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
| | - Soumya Bhattacharya
- Department of Hematology, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
| | - Shilpa Bhartia
- Department of Hematology, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
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Abstract
Polyagglutination is a condition in which red cells are agglutinated by ABO-compatible adult human sera, but not by cord blood sera and may be acquired or inherited. Lectins are invaluable reagents in the investigation of red cells polyagglutination. We prepared in-house lectin panel and confirmed Tn polyagglutination in a pregnant lady. The lady was anemic and refused blood transfusion elsewhere due to serological discrepancy. We found ABO discrepancy and an incompatible minor cross-match in the initial investigation and suspected polyagglutination. Confirmation of polyagglutination was done using adult and cord sera. We then used the in-house lectin panels to detect the type of polyagglutination. The agglutination pattern with the various lectins was suggestive of Tn polyagglutination, which was further supported by the enzyme study. Most blood banks in India lack commercial lectin panels because of cost and procurement difficulty. Lectins play an important role in the diagnosis and differentiation of polyagglutination and immunohematological management of patient. The important and basic lectins can be prepared in-house using specific raw seeds following standardized protocol.
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Affiliation(s)
- Sudipta Sekhar Das
- Department of Transfusion Medicine, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
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Das SS, Zaman RU, Safi M. Incompatible blood transfusion: Challenging yet lifesaving in the management of acute severe autoimmune hemolytic anemia. Asian J Transfus Sci 2014; 8:105-8. [PMID: 25161349 PMCID: PMC4140051 DOI: 10.4103/0973-6247.137445] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background and Aim: Autoimmune hemolytic anemia (AIHA) is characterized by the production of autoantibodies directed against red cell antigens. Most patients of AIHA arrive in the emergency or out-patient department (OPD) with severe anemia requiring urgent blood transfusion. Here we share our experience of managing these patients with incompatible blood transfusions and suggest the minimal test required to assure patient safety. Materials and Methods: A total of 14 patients admitted with severe anemia, diagnosed with AIHA and requiring blood transfusion urgently were included in the study. A series of immunohematological investigations were performed to confirm the diagnosis and issue best match packed red blood cells (PRBC) to these patients. Results: A total of 167 PRBC units were crossmatched for 14 patients of which 46 units (28%) were found to be best match ones and 26 (56.5%) of these units were transfused. A mean turn around time of 222 min was observed in issuing the “best match” blood. Severe hemolysis was observed in all patients with a median hemoglobin increment of 0.88 g/dl after each unit PRBC transfusion. Conclusion: Decision to transfuse in AIHA should be based on the clinical condition of the patient. No critical patient should be denied blood transfusion due to serological incompatibility. Minimum investigations such as direct antiglobulin test (DAT), antibody screening and autocontrol should be performed to ensure transfusion safety in patients. All transfusion services should be capable of issuing “best match” PRBCs in AIHA.
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Affiliation(s)
- Sudipta Sekhar Das
- Department of Transfusion Medicine, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
| | - Rafiq Uz Zaman
- Department of Transfusion Medicine, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
| | - Mohammad Safi
- Department of Transfusion Medicine, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
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Affiliation(s)
- Hemchandra Pandey
- Department of Transfusion Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Sudipta Sekhar Das
- Department of Transfusion Medicine, Apollo Hospitals, Kolkata, West Bengal, India
| | - Rajendra Chaudhary
- Department of Transfusion Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
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Abstract
Autoimmune hemolytic anemia (AIHA) is not an uncommon clinical disorder and requires advanced, efficient immunohematological and transfusion support. Many AIHA patients have underlying disorder and therefore, it is incumbent upon the clinician to investigate these patients in detail, as the underlying condition can be of a serious nature such as lymphoproliferative disorder or connective tissue disorder. Despite advances in transfusion medicine, simple immunohematological test such as direct antiglobulin test (DAT) still remains the diagnostic hallmark of AIHA. The sensitive gel technology has enabled the immunohematologist not only to diagnose serologically such patients, but also to characterize red cell bound autoantibodies with regard to their class, subclass and titer in a rapid and simplified way. Detailed characterization of autoantibodies is important, as there is a relationship between in vivo hemolysis and strength of DAT; red cell bound multiple immunoglobulins, immunoglobulin G subclass and titer. Transfusing AIHA patient is a challenge to the immunohematologist as it is encountered with difficulties in ABO grouping and cross matching requiring specialized serological tests such as alloadsorption or autoadsorption. At times, it may be almost impossible to find a fully matched unit to transfuse these patients. However, transfusion should not be withheld in a critically ill patient even in the absence of compatible blood. The “best match” or “least incompatible units” can be transfused to such patients under close supervision without any serious side-effects. All blood banks should have the facilities to perform the necessary investigations required to issue “best match” packed red blood cells in AIHA. Specialized techniques such as elution and adsorption, which at times are helpful in enhancing blood safety in AIHA should be established in all transfusion services.
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Affiliation(s)
- R K Chaudhary
- Department of Transfusion Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Sudipta Sekhar Das
- Department of Transfusion Medicine, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
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Das SS, Zaman R, Biswas D. Era of blood component therapy: Time for mandatory pre-donation platelet count for maximizing donor safety and optimizing quality of platelets. Transfus Apher Sci 2013; 49:640-3. [DOI: 10.1016/j.transci.2013.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Revised: 07/08/2013] [Accepted: 07/10/2013] [Indexed: 11/29/2022]
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Das SS, Bhattacharya S, Sen S. Managing uncontrolled postsplenectomy reactive thrombocytosis in idiopathic thrombocytopenic purpura: Role of thrombocytapheresis. Transfus Apher Sci 2013; 49:171-3. [DOI: 10.1016/j.transci.2012.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 09/19/2012] [Indexed: 10/26/2022]
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Das SS, Dey M, Ghosh AK. Determination of anthelmintic activity of the leaf and bark extract of tamarindus indica linn. Indian J Pharm Sci 2012; 73:104-7. [PMID: 22131633 PMCID: PMC3224400 DOI: 10.4103/0250-474x.89768] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Revised: 12/01/2010] [Accepted: 01/30/2011] [Indexed: 11/04/2022] Open
Abstract
The aim of the present study was to evaluate the anthelmintic activity of ethanolic and aqueous extract of leaves and bark of Tamarindus indica Linn using Pheretima posthuma and Tubifex tubifex as test worms. The time of paralysis and time of death were studied and the activity was compared with piperazine citrate as reference standard. The alcohol and aqueous extract of bark of Tamarindus indica exhibited significant anthelmintic activity as evidenced by decreased paralyzing time and death time. The results thus support the use of Tamarindus indica as an anthelmintic agent.
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Affiliation(s)
- S S Das
- Laboratory of Pharmacotherapy of Life-Style Related Diseases, Graduate School of Pharmaceutical Sciences, Tohoku University, 6-3 Aoba Aramaki, Aoba-Ku, Sendai, Miyagi 980 - 8578, Japan
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Affiliation(s)
- Ipsita Nag
- Department of Transfusion Medicine, The Mission Hospital, Durgapur, West Bengal, India
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Das SS, Sen M, Dey YN, De S, Ghosh AK. Effects of Petroleum Ether Extract of Amorphophallus paeoniifolius Tuber on Central Nervous System in Mice. Indian J Pharm Sci 2011; 71:651-5. [PMID: 20376218 PMCID: PMC2846470 DOI: 10.4103/0250-474x.59547] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Revised: 09/11/2009] [Accepted: 11/15/2009] [Indexed: 11/24/2022] Open
Abstract
The central nervous system activity of the petroleum ether extract of Amorphophallus paeoniifolius tuber was examined in mice, fed normal as well as healthy conditions. The petroleum ether extract of Amorphophallus paeoniifolius tuber at the doses of 100, 300 and 1000 mg/kg showed significant central nervous system activity in mice.
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Affiliation(s)
- S S Das
- Department of Pharmacology, Gupta College of Technological Sciences, Ashram More, Asansol-713 301, India
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Agarwal P, Sekhar Das S, Gupta R, Khetan D, Chaudhary R. Quantification of feto-maternal hemorrhage: selection of techniques for a resource-poor setting. Gynecol Obstet Invest 2010; 71:47-52. [PMID: 21160194 DOI: 10.1159/000320734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Accepted: 03/28/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND Though RhD sensitization in RhD-negative mothers is now almost eradicated in the developed world, it continues to be a major health problem in developing nations like India. Inadequate immunoprophylaxis is the main reason. Adequate dose calculation of anti-D Ig is possible through estimation of correct feto-maternal hemorrhage (FMH) volume. In this regard, different methods have been used. METHODS We evaluated three quantitative techniques of estimating FMH: the Kleihauer-Betke test (KBT) and two flow cytometry (FC) techniques, i.e., the indirect immunofluorescence technique (IIFT) and direct immunofluorescence technique (DIFT). Stock solutions of both RhD-positive and D-negative cells were made, and 7 serial dilutions of RhD-positive cord cells in D-negative adult cells were prepared. RESULT Both KBT and FC approximated the expected concentration of fetal RhD-positive cells in all mixtures tested. In both methods, an underestimation of fetal RhD-positive cells was observed when their expected concentration was ≥0.75%. CONCLUSION Though FC is the most sensitive of all techniques, very few laboratories in developing nations can afford such a costly device, so it will be prudent for them to use KBT as the gold standard due to its rapidity, simplicity and affordability.
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Affiliation(s)
- Prashant Agarwal
- Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
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Das SS, Agarwal P, Chaudhary R. Gel Technology: An Easy and Useful Method for Estimating Fetomaternal Hemorrhage in the Blood Banks of Developing Nations. Lab Med 2010. [DOI: 10.1309/lmlc053fqeqrpymc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Das SS, Chaudhary R. Utility of adsorption techniques in serological evaluation of warm autoimmune haemolytic anaemia. Blood Transfus 2009; 7:300-4. [PMID: 20011641 PMCID: PMC2782807 DOI: 10.2450/2009.0079-08] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/28/2008] [Accepted: 01/21/2009] [Indexed: 11/21/2022]
Abstract
BACKGROUND Various adsorption techniques are available to remove serum autoantibodies and subsequently detect the underlying alloantibody in previously transfused patients with autoimmune haemolytic anaemia. We planned to establish a suitable adsorption technique in our transfusion service which can remove all autoantibodies and detect underlying alloantibodies rapidly, cheaply and effectively. STUDY DESIGN AND METHODS We evaluated 71 direct antiglobulin test-reactive patients with warm AIHA over a period of 20 months. Twenty-three of these 71 patients who had a previous history of blood transfusion or pregnancy and were confirmed carriers of autoantibodies (indirect antiglobulin test-reactive) were considered for the adsorption study. Depending on the adequacy of samples, history of blood transfusion and severity of anaemia either autoadsorption or alloadsorption or both using polyethylene glycol (PEG) or low ionic strength saline (LISS)-papain were performed. RESULTS Underlying alloantibodies were detected in 7 of the 23 patients (30.4%) and all these were specific to Rhesus antigens. The mean number of alloadsorptions for complete autoantibody removal using PEG was 1.43 which was significantly lower than the 3.9 using the LISS-papain method (p<0.05). The mean time required by PEG alloadsorption and LISS-papain alloadsorption for autoantibody removal was 93.6 minutes and 177.7 minutes, respectively (p<0.05). Discordant results were not observed in any case and identical alloantibodies were detected by both the techniques. CONCLUSION We found that the PEG method is a rapid, cheap and effective way to remove autoantibodies and detect underlying alloantibodies.
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Affiliation(s)
- Sudipta Sekhar Das
- Dept of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Rajendra Chaudhary
- Dept of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Chaudhary R, Das SS. Significance of Quantitation of Autoantibodies in the Eluate of Sensitized Red Cells in Warm Autoimmune Hemolytic Anemia. Lab Med 2009. [DOI: 10.1309/lmtpwb8znjyeg9ar] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Das SS, Nityanand S, Chaudhary R. Clinical and serological characterization of autoimmune hemolytic anemia in a tertiary care hospital in North India. Ann Hematol 2009; 88:727-32. [PMID: 19119475 DOI: 10.1007/s00277-008-0674-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2008] [Accepted: 12/15/2008] [Indexed: 10/21/2022]
Abstract
Clinical and serological characterization of autoimmune hemolytic anemia (AIHA) helps in the diagnosis, management, and monitoring course of disease. In the present study, we serologically characterized the red-cell-bound autoantibodies in diagnosed AIHA patients with regards to antibody class, subclass, direct antiglobulin test (DAT) strength, and their correlation with in vivo hemolysis. A total of 157 samples were evaluated for DAT. Clinically and serologically, 43 of them were diagnosed as AIHA. Detailed serological characterization of autoantibodies was performed in these 43 patients using the gel technology. Hematological and biochemical parameters were obtained from the Hospital Information System. Polyspecific (immunoglobulin G (IgG) + C3) DAT-positive samples were tested for monospecific DAT (IgG, IgM, IgA, C3c, and C3d) and IgG subclass (IgG1 and IgG3). Thermal amplitude of autoantibodies was determined on eluates. Median age of the patients was 31 years (range, 12-70 years) with male to female ratio of 1:3.3. In 55.8% of patients, AIHA was secondary to an underlying disorder. Patients with strong reactive DAT had increased likelihood of hemolysis (p = 0.000). IgG was the solitary autoantibody coating the red cells in 72.1% of patients. Red cells coated with multiple immunoglobulins/complements and IgG subclass IgG1 and/or IgG3 were more susceptible to undergo hemolysis. Gel technology helps the immunohematologist to diagnose and serologically characterize AIHA patient with regard to red-cell-bound autoantibodies' class, subclass, and titer as these correlate with in vivo hemolysis.
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Affiliation(s)
- Sudipta Sekhar Das
- Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Das SS, Shastry S, Chaudhary R, Verma A. Quality analysis of red cell and platelet concentrates obtained by the automated 'Top-and-Top' blood processing system in a developing country. Transfus Apher Sci 2008; 39:9-14. [PMID: 18573693 DOI: 10.1016/j.transci.2008.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The efficacy of the widely practiced 'Top and Bottom' collection system has been established. We studied efficacy of our new 'Top-and-Top' automated blood component separation system with regards to quality analysis of red cell and platelet concentrates. At installation of machine 59 U of whole blood (WB) were used for its calibration and validation program. Optimum volume, leukocyte-platelet recovery and red cells loss in BC were adjusted as per recommended standards. WB showed mean volume of 510 ml and net hemoglobin content of 63 g/bag. BC recovered 91.7% and 62.7% of platelet and leukocytes, respectively, in a mean volume of 96 ml a hematocrit of 54% and mean platelet of 5.47 x 10(10) were observed in red cell and platelet concentrates, respectively. In many aspects quality of our products could not comply with the recommended European and American standards and this requires a close insight into the series of activities associated with WB collection, separation and quality control program.
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Affiliation(s)
- Sudipta Sekhar Das
- Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareily Road, Lucknow, India
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Chaudhary R, Khetan D, Sinha S, Sinha P, Sonker A, Pandey P, Das SS, Agarwal P, Ray V. Transfusion support to Dengue patients in a hospital based blood transfusion service in north India. Transfus Apher Sci 2006; 35:239-44. [PMID: 17097349 DOI: 10.1016/j.transci.2006.08.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2006] [Revised: 08/18/2006] [Accepted: 08/21/2006] [Indexed: 10/23/2022]
Abstract
We evaluated transfusion requirements in a retrospective study of 245 patients with various categories of Dengue infection. The majority (155/245) of our patients were of the Dengue fever (DF) category. There was no correlation between clinical bleed and platelet count as 81 non-bleeding patients were having counts < 20 x 10(3)/microL. Coagulopathy was observed in 37% of the patients with Dengue hemorrhagic fever or Dengue shock syndrome. A rapid response to platelet and fresh frozen plasma (FFP) transfusion was observed in all cases. However, inappropriate transfusion was a major concern as transfusion of 21.5% platelet concentrates was considered inappropriate.
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Affiliation(s)
- Rajendra Chaudhary
- Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India.
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Ghosh A, Saha DR, Hoque KM, Asakuna M, Yamasaki S, Koley H, Das SS, Chakrabarti MK, Pal A. Enterotoxigenicity of mature 45-kilodalton and processed 35-kilodalton forms of hemagglutinin protease purified from a cholera toxin gene-negative Vibrio cholerae non-O1, non-O139 strain. Infect Immun 2006; 74:2937-46. [PMID: 16622232 PMCID: PMC1459690 DOI: 10.1128/iai.74.5.2937-2946.2006] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2005] [Revised: 10/14/2005] [Accepted: 02/14/2006] [Indexed: 11/20/2022] Open
Abstract
Cholera toxin gene-negative Vibrio cholerae non-O1, non-O139 strain PL-21 is the etiologic agent of cholera-like syndrome. Hemagglutinin protease (HAP) is one of the major secretory proteins of PL-21. The mature 45-kDa and processed 35-kDa forms of HAP were purified in the presence and absence of EDTA from culture supernatants of PL-21. Enterotoxigenicities of both forms of HAP were tested in rabbit ileal loop (RIL), Ussing chamber, and tissue culture assays. The 35-kDa HAP showed hemorrhagic fluid response in a dose-dependent manner in the RIL assay. Histopathological examination of 20 microg of purified protease-treated rabbit ileum showed the presence of erythrocytes and neutrophils in the upper part of the villous lamina propria. Treatment with 40 microg of protease resulted in gross damage of the villous epithelium with inflammation, hemorrhage, and necrosis. The 35-kDa form of HAP, when added to the lumenal surface of rat ileum loaded in an Ussing chamber, showed a decrease in the intestinal short-circuit current and a cell rounding effect on HeLa cells. The mature 45-kDa form of HAP showed an increase in intestinal short-circuit current in an Ussing chamber and a cell distending effect on HeLa cells. These results show that HAP may play a role in the pathogenesis of PL-21.
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Affiliation(s)
- A Ghosh
- Division of Pathophysiology, National Institute of Cholera and Enteric Diseases, Calcutta 700010, West Bengal, India
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Wareham DW, Abbas H, Karcher AM, Das SS. Treatment of prosthetic valve infective endocarditis due to multi-resistant Gram-positive bacteria with linezolid. J Infect 2006; 52:300-4. [PMID: 16099052 DOI: 10.1016/j.jinf.2005.05.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2004] [Accepted: 05/25/2005] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Clinical experience with linezolid in the treatment of infective endocarditis either alone or in combination with other agents is limited. We describe our experience in the treatment of two patients with IE due to multi-resistant Gram-positive bacteria. METHODS One patient with MRSE and one with VRE endocarditis were treated with regimens containing linezolid. The killing kinetics of linezolid in combination with gentamicin or vancomycin against isolates of Staphylococcus epidermidis and Enterococcus faecalis were analysed in vitro. RESULTS Clinical response and eradication of bacteraemia was achieved with linezolid therapy in both patients. Time-kill curve studies showed that linezolid was bacteriostatic against the MRSE and VRE isolates used. Combination with gentamicin or vancomycin did not produce synergy or antagonism but at best only marginal additive effect. CONCLUSIONS Although bacteriostatic, linezolid provides an important therapeutic option in IE due to multi-resistant Gram-positive pathogens. It challenges the conventional wisdom that bactericidal synergy is required for the effective treatment of most cases of IE due to Gram-positive organisms.
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Affiliation(s)
- D W Wareham
- Department of Medical Microbiology, Barts and The London NHS Trust, London E1 1BB, UK
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Chaudhary R, Das SS, Khetan D, Sinha P. Effect of donor variables on yield in single donor plateletpheresis by continuous flow cell separator. Transfus Apher Sci 2006; 34:157-61. [PMID: 16510315 DOI: 10.1016/j.transci.2005.09.040] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2005] [Revised: 08/15/2005] [Accepted: 09/30/2005] [Indexed: 11/18/2022]
Abstract
The quality of single donor platelets (SDPs) in terms of yield influences platelet recovery in the recipient. Various donor factors such as pre-donation platelet count and hemoglobin (Hb) concentration affect the platelet yield. We studied the influence of pre-donation donor clinical and laboratory factors such as gender, age, weight of the donor, platelet count and Hb on the platelet yield. A total of 94 plateletpheresis procedures performed on continuous flow cell separator (CS3000, Baxter Healthcare, Round Lake, IL, USA) were evaluated for platelet yield. A relationship between pre-donation donor variables and yield of platelets was studied using the Pearson correlation. The mean platelet yield was 2.8+/-0.73x10(11). While a direct relationship was observed between pre-donation platelet count and yield (r=0.50, p<0.001), no such correlation was noticed with donor Hb concentration (r=-0.10, p>0.005). Similarly, no correlation was observed between gender (r=0.05), age (r=0.11) and weight (r=0.18) of the donor with yield. Optimization of platelet yield, which is influenced by pre-donation platelet count, is an emerging issue in blood transfusion services. Identification of such factors may help in selecting donors to obtain higher platelet yields and consequently better clinical outcome.
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Affiliation(s)
- Rajendra Chaudhary
- Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India.
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Choudhury D, Pal AK, Sahu NP, Kumar S, Das SS, Mukherjee SC. Dietary yeast RNA supplementation reduces mortality by Aeromonas hydrophila in rohu (Labeo rohita L.) juveniles. Fish Shellfish Immunol 2005; 19:281-291. [PMID: 15820128 DOI: 10.1016/j.fsi.2005.01.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2004] [Accepted: 01/10/2005] [Indexed: 05/24/2023]
Abstract
A feeding trial was conducted for 60 days to delineate the effect of dietary ribonucleic acid or chitin on haematological parameters, phagocyte respiratory burst and resistance to Aeromonas hydrophila of Labeo rohita juveniles. One hundred and twenty-six (avg. wt. 13.40 +/- 0.17 g) juveniles were randomly distributed in six treatment groups, each one in three replicates. Six isonitrogenous (crude protein: 34.34-35.37%) and isocaloric (414-425 kcal 100 g(-1)) purified diets were prepared with different concentrations of either ribonucleic acid or chitin except the control group, viz., control, T1 (0.1% ribonucleic acid), T2 (0.2% ribonucleic acid), T3 (0.4% ribonucleic acid), T4 (25 mg chitin kg (-1)) and T5 (50 mg chitin kg (-1)). Weight gain %, specific growth rate, feed efficiency ratio, protein efficiency ratio did not vary significantly (P > 0.05) among the experimental groups. Haemoglobin content and total erythrocyte count were observed within the normal range and were not influenced by the dietary immunostimulants. Highest total leukocyte count was found in the T(3) group. The immunomodulatory effects of dietary immunostimulants were studied by using nitroblue tetrazolium (NBT) assay and serum parameters, namely total protein, albumin, globulin and A/G ratio. The respiratory burst activity (NBT) of blood phagocytes was highest in the T3 group followed by the T2 group, which varied significantly (P < 0.05) from other groups. Significantly (P < 0.05) higher total protein, globulin and lower A/G ratio was observed in the T(3) group. The relative percent survival after challenging with Aeromonas hydrophila was highest in the T3 group, compared to the control group, followed by the T2 group. The results indicate that dietary ribonucleic acid at 0.4% enhances phagocyte respiratory burst and protection of Labeo rohita juveniles to challenge by A. hydrophila.
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Affiliation(s)
- Dharitri Choudhury
- Department of Fish Nutrition and Biochemistry, Central Institute of Fisheries Education, Versova, Mumbai, India
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Abstract
It is well known that citrate induces ionized hypocalcaemia by the chelating effect during plateletpheresis. However, the kinetics of serum magnesium (Mg) ions has not been well documented. We, therefore, evaluated biochemical changes in healthy donors during plateletpheresis procedure. Ten healthy donors underwent plateletpheresis on continuous cell separator (CS3000, Baxter, Round Lake, IL, USA) and 10 on intermittent flow cell separator (MCS 3p, Hemonetics, Braintree, MA, USA). Serum levels of total and ionized calcium (tCa and iCa, respectively) and Mg (tMg and iMg, respectively) were measured before, during and after the procedures. Although, the fall in tCa (from 2.62 +/- 0.12 to 2.36 +/- 0.12 mmol L(-1)) and tMg (from 0.89 +/- 0.01 to 0.79 +/- 0.01 mmol L(-1)) was modest and not significant; drop in iCa (from 1.33 +/- 0.1 to 0.84 +/- 0.1 mmol L(-1)) and iMg (from 0.53 +/- 0.01 to 0.35 +/- 0.1 mmol L(-1)) was statistically significant (P < 0.001). There were no significant differences observed between the CS3000 and MCS 3p cell separators regarding the fall in Ca and Mg. None of the donors experienced any adverse reactions during the procedures. In the study, an acute ionized hypocalcaemia and hypomagnesaemia have been observed after the plateletpheresis; therefore, measurement of both the ions may be monitored. However, there is no justification for prophylactic supplementation of either of these elements.
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Affiliation(s)
- S S Das
- Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Chaudhary R, Sekhar Das S, Agarwal P, Shanker Shukla J. Quality systems in automated plateletpheresis in hospital-based blood transfusion service in north India. J Clin Apher 2005; 20:81-5. [PMID: 15892080 DOI: 10.1002/jca.20056] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The issues of providing quality blood products and maintaining donor safety are primary aims of blood transfusion services. A comprehensive quality system should be in place to fulfill these aims, which can be attained through strict adherence to the established standard operating procedures (SOPs). The Drugs and Cosmetics Act of India, which controls the licensing of blood transfusion services, does not provide clear guidelines regarding plateletpheresis procedure. We, therefore, established our own SOP and operational flow chart for plateletpheresis that can be easily followed by other centers in India. A total of 100 plateletpheresis procedures performed using two cell separators (CS3000 Baxter Healthcare, Round Lake, IL; MCS3p, Haemonetics Corporation, Braintree, MA) were evaluated following our established SOP. The mean platelet yield in CS3000 was 2.9 +/- 0.84 x 10(11) and in MCS3p it was 2.88 +/- 0.75 x 10(11)per unit. However, only 4-7% of SDPs showed WBC levels <5 x 10(6) due to lack of appropriate methods to quantitate residual WBC counts. Six of 100 donors complained of hypocalcemic symptoms. The operational flow chart designed in this study was found to be simple and easy to adapt by blood transfusion services in this country.
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Affiliation(s)
- Rajendra Chaudhary
- Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
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Solanki KK, Das SS, Britton KE. Infection is not specific for bacterial osteo-articular infective pathology. Eur J Nucl Med Mol Imaging 2003; 30:181-2; author reply 183. [PMID: 12583365 DOI: 10.1007/s00259-002-1034-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Britton KE, Wareham DW, Das SS, Solanki KK, Amaral H, Bhatnagar A, Katamihardja AHS, Malamitsi J, Moustafa HM, Soroa VE, Sundram FX, Padhy AK. Imaging bacterial infection with (99m)Tc-ciprofloxacin (Infecton). J Clin Pathol 2002; 55:817-23. [PMID: 12401818 PMCID: PMC1769796 DOI: 10.1136/jcp.55.11.817] [Citation(s) in RCA: 132] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AIMS The diagnosis of deep seated bacterial infections, such as intra-abdominal abscesses, endocarditis, and osteomyelitis, can be difficult and delayed, thereby compromising effective treatment. This study assessed the efficacy of a new radioimaging agent, Tc-99m ciprofloxacin (Infecton), in accurately detecting sites of bacterial infection. METHODS Eight hundred and seventy nine patients with suspected bacterial infection underwent Infecton imaging and microbiological evaluation. The sensitivity and specificity of Infecton in detecting sites of bacterial infection were determined with respect to Centres of Disease Control, World Health Organisation, and Dukes's criteria. RESULTS Five hundred and seventy four positive and 295 negative images were produced. These included 528 true positives, 46 false positives, 205 true negatives and 90 false negatives, giving an overall sensitivity of 85.4% and a specificity of 81.7% for detecting infective foci. Sensitivity was higher (87.6%) in microbiologically confirmed infections. CONCLUSIONS Infecton is a sensitive technique, which aids in the earlier detection and treatment of a wide variety of deep seated bacterial infections. The ability to localise infective foci accurately is also important for surgical intervention, such as drainage of abscesses. In addition, serial imaging with Infecton might be useful in monitoring clinical response and optimising the duration of antimicrobial treatment.
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Affiliation(s)
- K E Britton
- St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
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Britton KE, Wareham D, Solanki KK, Das SS. Imaging of bacterial infections with 99mTc-labeled human neutrophil peptide-1. J Nucl Med 2000; 41:2099-102. [PMID: 11138699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
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Das SS, Britton KE, Solanki KK, Wareham DW. Technetium-99m labelled antimicrobial peptides discriminate between bacterial infections and sterile inflammations. Eur J Nucl Med 2000; 27:1865-8. [PMID: 11189950 DOI: 10.1007/s002590000377] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Das SS, Richards CJ. Pre-operative counselling-the patients' views. J OBSTET GYNAECOL 2000; 20:308-9. [PMID: 15512561 DOI: 10.1080/01443610050009700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- S S Das
- Caerphilly District Miner's Hospital, UK
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Abstract
We evaluated the diagnostic and therapeutic efficacy of large loop excision of the transformation zone (LLETZ) performed in the first visit (see and treat policy) as compared to LLETZ treatment performed as an interval procedure. Data of 248 patients were analyzed of which 206 patients had LLETZ. Two thirds of the procedures were performed at the first visit. Of all the women who had the 'see and treat policy' 94.9% were diagnosed to have cervical intraepithelial neoplasia (CIN) on histology compared to 90.8% in the interval treatment group. A total of 3 (1.4%) patients were detected to have microinvasive carcinoma. There was no difference in the immediate postoperative complication rate, overtreatment rate and need of repeat treatment in both the groups. Single visit colposcopy and loop treatment is a safe and effective option for treatment of cervical epithelial abnormalities. The experience of the colposcopist is very important.
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Affiliation(s)
- S S Das
- St Mary's Hospital, Isle of Wight, United Kingdom
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Abstract
The Ziehl-Neelsen (ZN) stain is important in identifying organisms that are acid fast, principally Mycobacterium tuberculosis. However, decolorisation with a weaker acid concentration (for example 1% hydrochloric acid), often used in ZN staining in histology, can result in a wider variety of organisms appearing acid fast and can be a cause of misidentification. To illustrate this point, a patient is described with pulmonary nocardiosis who was misdiagnosed as having tuberculous empyema on pleural biopsy.
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Affiliation(s)
- E S Olson
- Department of Medical Microbiology, St Bartholomew's Hospital, London, UK
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