Publications by authors named "Sangeeta Pathak"

25 Publications

  • Page 1 of 1

Effectiveness of convalescent plasma in Indian patients with COVID-19.

Blood Cells Mol Dis 2021 Feb 18;88:102548. Epub 2021 Feb 18.

Hematology & Bone Marrow Transplant Division, Max Healthcare, New Delhi, India. Electronic address:

Background: Convalescent plasma (CP) is being used as a treatment option in hospitalized patients with COVID-19. Till date, there is conflicting evidence on efficacy of CP in reducing COVID-19 related mortality.

Objective: To evaluate the effect of CP on 28-day mortality reduction in patients with COVID-19.

Methods: We did a multi-centre, retrospective case control observational study from 1st May 2020 to 31st August 2020. A total of 1079 adult patients with moderate and severe COVID-19 requiring oxygen, were reviewed. Of these, 694 patients were admitted to ICU. Out of these, 333 were given CP along with best supportive care and remaining 361 received best supportive care only.

Results: In the overall group of 1079 patients, mortality in plasma vs no plasma group was statistically not significant (22.4% vs 18.5%; p = 0.125; OR = 1.27, 95% CI: 0.94--1.72). However, in patients with COVID-19 admitted to ICU, mortality was significantly lower in plasma group (25.5% vs 33.2%; p = 0.026; OR = 0.69, 95%CI: 0.50-0.96). This benefit of reduced mortality was most seen in age group 60 to 74 years (26.7% vs 43.0%; p = 0.004; OR = 0.48, 95% CI: 0.29-0.80), driven mostly by females of this age group (23.1% vs 53.5%; p = 0.013; OR = 0.26, 95% CI: 0.09-0.78). Significant difference in mortality was observed in patients with one comorbidity (22.3% vs 36.5%; p = 0.004; OR = 0.50, 95% CI: 0.31-0.80). Moreover, patients on ventilator had significantly lower mortality in the plasma arm (37.2% vs 49.3%; p = 0.009; OR = 0.61, 95% CI: 0.42-0.89); particularly so for patients on invasive mechanical ventilation (63.9% vs 82.9%; p = 0.014; OR = 0.37, 95% CI: 0.16-0.83).

Conclusion: The use of CP was associated with reduced mortality in COVID-19 elderly patients admitted in ICU, above 60 years of age, particularly females, those with comorbidities and especially those who required some form of ventilation.
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http://dx.doi.org/10.1016/j.bcmd.2021.102548DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7891064PMC
February 2021

Convalescent plasma: Would it prove to be magic potion/boon in the current scenario of COVID pandemic?

Authors:
Sangeeta Pathak

Asian J Transfus Sci 2020 Jan-Jun;14(1):1-3. Epub 2020 Jul 24.

Senior Consultant and Head, Blood Bank, Max Super Speciality Hospital, New Delhi, India.

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http://dx.doi.org/10.4103/0973-6247.290652DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7607998PMC
July 2020

Daratumumab for pure red cell aplasia post ABO incompatible allogeneic hematopoietic stem cell transplant for aplastic anemia.

Blood Cells Mol Dis 2020 Jul 2:102464. Epub 2020 Jul 2.

Division of Hematology and Bone Marrow Transplant, Max Super-speciality Hospital, India.

Pure red cell aplasia is a known complication after ABO incompatible stem cell transplant. Due to rarity of disease, no established treatment guidelines are available for PRCA. Daratumumab is a monoclonal antibody against CD38 expressed by plasma cells. In this report we present our experience of successfully managing a patient of post-transplant PRCA with daratumumab. Our patient had failed multiple lines of therapy prior to receiving daratumumab. Response was seen after the 3rd weekly dose of daratumumab.
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http://dx.doi.org/10.1016/j.bcmd.2020.102464DOI Listing
July 2020

Outcome of universal screening of neonates for COVID-19 from asymptomatic mothers.

J Infect 2020 09 19;81(3):452-482. Epub 2020 Jun 19.

Department of Obstetrics and Gynaecology, Hinchingbrooke Hospital, North West Anglia NHS Foundation Trust, Huntingdon, Cambridgeshire, PE29 6NT, United Kingdom.

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http://dx.doi.org/10.1016/j.jinf.2020.06.037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7303651PMC
September 2020

Daratumumab in dialysis-dependent multiple myeloma.

Blood Res 2020 Mar 30;55(1):65-67. Epub 2020 Mar 30.

Division of Hematology and Bone Marrow Transplant, Max Super-Specialty Hospital, New Delhi, India.

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http://dx.doi.org/10.5045/br.2020.55.1.65DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7106121PMC
March 2020

Re: Restrictive versus routine episiotomy among Southeast Asian term pregnancies: a multicentre randomised controlled trial.

BJOG 2020 04 10;127(5):648-649. Epub 2020 Feb 10.

Hinchingbrooke Hospital (North West Anglia NHS Foundation Trust), Huntingdon, Cambridgeshire, UK.

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http://dx.doi.org/10.1111/1471-0528.16098DOI Listing
April 2020

Adequate Engraftment With Lower Hematopoietic Stem Cell Dose.

Clin Lymphoma Myeloma Leuk 2020 04 8;20(4):260-263. Epub 2020 Jan 8.

Division of Hematology and Bone Marrow Transplantation, Max Super-specialty Hospital, Saket, New Delhi, India. Electronic address:

Background: Adequate hematopoietic stem cell dose is required to proceed with autologous stem cell transplantation (ASCT).

Patients And Methods: We conducted a retrospective analysis of 108 patients with multiple myeloma and lymphoma who underwent ASCT with noncryopreserved stem cells at our center. Data were compared for patients who received stem cell dose < 2 × 10/kg with those who received a higher dose.

Results: The median CD34 dose collected in the lesser dose group was 1.76 × 10/kg (1.22 to 1.97 × 10/kg). Mean CD34 dose of the whole group was 4.96 ± 4.2 × 10/kg. Neutrophil engraftment was similar in both groups (12 vs. 11 days) (P = .065). Similarly, platelet engraftment occurred in 12 versus 11 days in both groups (P = .017). Length of hospital stay was similar in both groups. There was no significant difference in the incidence of proven bacterial infections between the 2 groups. There was no transplant-related mortality in lower dose group.

Conclusion: ASCT can be safely performed with lower hematopoietic stem cell dose in noncryopreserved setting.
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http://dx.doi.org/10.1016/j.clml.2019.12.018DOI Listing
April 2020

Impact of the EPISCISSORS-60 mediolateral episiotomy scissors on obstetric anal sphincter injuries: a 2-year data review in the United Kingdom.

Int Urogynecol J 2020 09 31;31(9):1729-1734. Epub 2020 Jan 31.

Department of Obstetrics and Gynaecology, Hinchingbrooke Hospital, North West Anglia Foundation NHS Trust, Huntingdon, UK.

Introduction And Hypothesis: This time-series analysis was carried out to determine if the use of the EPISCISSORS-60®, episiotomy scissors specifically designed to achieve a cutting angle of 60°, would continue to sustain obstetric anal sphincter injuries (OASIS) reductions at our hospital 2 years after its introduction.

Methods: We compared data from 2,342 women delivered in 2014 (prior to the introduction of EPISCISSORS-60®) with that of 4,498 women delivered from 2016 to 2017 (after the introduction of EPISCISSORS-60®).

Results: There was a reduction of OASIS in all nulliparous vaginal deliveries (NVD; 7.2% vs 5.1% p = 0.05), and a 50% reduction of OASIS (7.5% vs 3.7%) in operative vaginal deliveries (OVD) (p = 0.02). There was a statistically significant association between episiotomies performed with EPISCISSORS-60® and a reduction in OASIS (SVD: 6.9% vs 1.5% p = 0.006; OVD:28.6% vs 2.6% p < 0.0001). Additionally, there was an increase in the use of episiotomies in all nulliparous vaginal deliveries (29% vs 33.7%; p = 0.01). We also found a 78% reduction of OASIS with episiotomies compared with no episiotomies in the 2016-2017 group (6.9% vs 1.5% p = 0.006).

Conclusions: Our results suggest that there might have been a sustained reduction in OASIS rates associated with using EPISCISSORS-60®.
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http://dx.doi.org/10.1007/s00192-019-04201-7DOI Listing
September 2020

Quality improvement can revolutionize tuberculosis care in India: A review.

Indian J Tuberc 2019 Oct;66(4):539-548

Rice University, USA.

Background/purpose: Access, cost and quality are limiting parameters of any healthcare delivery system. RNTCP (Revised National Tuberculosis Control Program) has largely addressed the access and cost issues, however the quality of care is a major hurdle in TB care today.

Methods: We propose using an evidence based method of quality improvement principles to address many quality issues ranging from delayed turnaround time in testing, to low patient satisfaction, and slow private sector engagement.

Results: We propose a 5 step approach to learning and conducting quality improvement at the district level. Step 1: Form a team and define the problem Step 2: Develop baseline data Step 3: Create a process map Step 4: Bring a change through a PDSA Plan-Do-Study-Act cycle Step 5: Prepare run charts.

Conclusion: We cannot expect a different result by doing the same thing over and over again. This holds particularly true for the TB program in India. A major paradigm shift is necessary if we wish to achieve TB Free within our lifetimes. A shift from quality assurance to quality improvement offers this hope for change and TB elimination.
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http://dx.doi.org/10.1016/j.ijtb.2019.11.008DOI Listing
October 2019

Building local roadmaps for TB free India.

Indian J Tuberc 2019 10 11;66(4):492-495. Epub 2019 Apr 11.

Program Director of (Collaboration for Elimination of TB Among Indians) CETI, Indore, MP, India.

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http://dx.doi.org/10.1016/j.ijtb.2019.04.004DOI Listing
October 2019

Complementary therapy and alternative medicine: effects on induction of labour and pregnancy outcome in low risk post-dates women.

Heliyon 2019 Nov 22;5(11):e02787. Epub 2019 Nov 22.

North West Anglia NHS Trust, Hinchingbrooke Hospital, Department of Obstetrics and Gynaecology, Huntingdon, UK.

Background: Complementary therapy and Alternative medicine (CAM) is used worldwide for many ailments and is a popular option amongst pregnant women for general wellbeing and managing symptoms. Many studies investigating the use of CAM in the antenatal and intrapartum period have been conducted however there is a lack of evidence regarding its effects on induction of labour and delivery. We established a post-dates clinic comprising of an antenatal check and CAM for low risk pregnant women to determine the impact of CAM on these outcomes.

Methods: This was a cohort study with convenience sampling. A total of 1044 women were included. 397 received a combination of three CAM techniques (acupressure, reflexology and aromatherapy) and 647 women received standard clinical practice. The primary outcome was rate of induction of labour and secondary outcomes such as rates for epidural, length of labour, oxytocin use for induction or augmentation of labour, mode of delivery, blood loss during delivery, postpartum haemorrhage, significant perineal trauma, shoulder dystocia and admission of the baby to a special care unit were analysed.

Findings: CAM did not have an effect on rates of induction of labour in nulliparous or multiparous women attending the post-dates clinic. However, we noted that nulliparous women who received CAM had shorter labours (mean 8.4 vs 10 h, p = 0.0002), less oxytocin augmentation (23% vs 35%, p = 0.0002), lower epidural rates (41% vs 50.5%, p = 0.02) and reduced blood loss regardless of mode of delivery (mean reduction 82ml, p = 0.03; 95%CI = -159 to -5). There were no significant differences in secondary outcomes when CAM was used in multiparous women apart from a 5.3 times increased risk of significant perineal trauma (6% vs 2%, p = 0.004) and those who had their labours induced after CAM had a higher risk of requiring an emergency caesarean section (5% vs 1%, p = 0.012). There was no difference on shoulder dystocia and neonatal admissions rates with CAM.

Conclusion: There is no reduction in induction of labour rates with the use of CAM. The other effects of CAM on labour and delivery outcomes are varied and potentially only beneficial in a selected group of women. Further research must be carried out before making any clear recommendations on its use.
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http://dx.doi.org/10.1016/j.heliyon.2019.e02787DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6881689PMC
November 2019

Paroxysmal Cold Hemoglobinuria in a 4-year-old Child.

Indian Pediatr 2019 10;56(10):879-880

Department of Transfusion Medicine, Max Superspeciality Hospital, Saket, New Delhi, India.

Paroxysmal Cold Hemoglobinuria is a rare cause of intravascular hemolysis presenting in children following an acute viral illness. It is usually self-limiting in nature. We present the details of a 4-year-old boy who presented with rapid onset intravascular hemolysis. Donath Landsteiner antibody test was positive and hemolysis resolved within two weeks of onset.
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October 2019

Case series of prenatal diagnosis of fetal intrahepatic lesions and postnatal outcome.

Ultrasound 2019 May 17;27(2):127-130. Epub 2019 Jan 17.

Department of Obstetrics and Gynaecology, Hinchingbrooke Hospital, North West Anglia NHS Foundation Trust, Cambridgeshire, UK.

With advancing technology, it is becoming common for antenatal ultrasound to detect echogenic lesions in fetal abdomen. Paucity of data in this field, however, makes it difficult to counsel patients. We report four cases of fetal liver echogenic lesions, postnatal outcome (delivered during 2015-2016) and a literature review to increase awareness. Intrahepatic calcification is relatively common with an incidence of approximately 5-10 in 10,000 pregnancies. Prenatal detection of echogenic lesions in fetal abdomen causes huge anxiety and stress to parents; therefore, it is important for the ultrasonographers to be up to date with the evidence-based management of these lesions. Most lesions would carry no or little risk to neonate; however, few cases may require careful planning to optimise the time and place of delivery. We describe four cases between February 2015 and December 2016 using machine Voluson S6 and E8.
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http://dx.doi.org/10.1177/1742271X18821147DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6475977PMC
May 2019

Autologous Hematopoietic Stem Cell Transplantation for Multiple Myeloma in India.

Indian J Hematol Blood Transfus 2018 Jul 22;34(3):564-565. Epub 2018 Mar 22.

1Division of Hematology and Bone Marrow Transplantation, Max Superspeciality Hospital, New Delhi, India.

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http://dx.doi.org/10.1007/s12288-018-0951-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6081323PMC
July 2018

Hematopoietic stem cell transplantation using non-cryopreserved peripheral blood stem cells graft is effective in multiple myeloma and lymphoma.

Bone Marrow Transplant 2018 09 29;53(9):1198-1200. Epub 2018 Mar 29.

Department of Transfusion Medicine, Max Superspeciality Hospital, New Delhi, India.

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http://dx.doi.org/10.1038/s41409-018-0174-9DOI Listing
September 2018

Comparative study of episiotomy angles achieved by cutting with straight Mayo scissors and the EPISCISSORS-60 in a birth simulation model.

Int Urogynecol J 2017 Jul 16;28(7):1063-1066. Epub 2016 Dec 16.

Hinchingbrooke Hospital, Huntingdon, UK.

Introduction And Hypothesis: We compared the clinician's ability to cut episiotomies at the recommended 60° angle with traditional straight Mayo scissors compared with patented fixed-angle episiotomy scissors EPISCISSORS-60® in a simulated setting using mounted incision pads. The hypothesis was that fixed-angle episiotomies would achieve a more accurate cutting angle of 60°.

Methods: Angles were cut on episiotomy incision pads in a mounted birth model simulating crowning: 110 midwives and doctors cut an 60° episiotomy with Mayo scissors and then EPISCISSORS-60. Angles were measured with protractors. Average angles were calculated and the one-tailed paired t test was used to compare groups.

Results: Mean angle was 45° with Mayo scissors [SD = 9, 95% confidence interval (CI) = 43.3-46.7, interquartile range (IQR) 38-50] and 60° with the EPISCISSORS-60 (SD = 3, 95% CI = 59.3-60.7, IQR = 58-60). Two-thirds of cuts with Mayo scissors were below 50°.

Conclusions: In a simulated setting the majority of operators are unable to cut an episiotomy at the recommended 60° angle with Mayo scissors. The EPISCISSORS-60 cut an episiotomy a statistically significant 15° wider than regular Mayo scissors and achieved the recommended 60° in the vast majority of cases. If these findings translate into real life situations, then cutting episiotomies at 60° is expected to make a valuable contribution in reducing third- and fourth-degree tears in both spontaneous and operative vaginal deliveries. Variability in mediolateral episiotomies should be reduced by use of fixed-angle scissors or through validated health professional training programmes to improve visual accuracy.
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http://dx.doi.org/10.1007/s00192-016-3227-xDOI Listing
July 2017

Evaluation of training programme uptake in an attempt to reduce obstetric anal sphincter injuries: the SUPPORT programme.

Int Urogynecol J 2017 Mar 25;28(3):403-407. Epub 2016 Oct 25.

Addenbrooke's Hospital, Cambridge, UK.

Introduction And Hypothesis: The objective was to assess the feedback from a quality improvement training programme to reduce obstetric anal sphincter injuries (OASIS).

Methods: Training sessions were organised that included evidence-based information on OASIS risk factors and training on models to measure perineal body length (PBL), perform episiotomies with standard and 60° fixed angle scissors (EPISCISSORS-60®), and measure post-delivery episiotomy suture angles with protractor transparencies. Feedback forms using a Likert scale (1-4) were completed and analysed. The setting was an evidence-based quality improvement programme (Strategy for Using Practical aids for Prevention of OASIS, Recording episiotomies and clinician Training [SUPPORT]) at two National Health Service (NHS) Hospitals in the UK. The participants were midwives and doctors attending the SUPPORT training programme RESULTS: All of the participants (100 %) would recommend the training programme to a friend or colleague. 92 % felt that the training session improved their knowledge of the impact of PBL and perineal distension and their knowledge of the relationship between episiotomy angle and OASIS "a lot" or "somewhat".

Conclusion: Based on this feedback, we recommend the addition of the knowledge content of the SUPPORT programme to other centres providing perineal assessment and repair courses.
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http://dx.doi.org/10.1007/s00192-016-3158-6DOI Listing
March 2017

Use of complementary therapies for low risk post dates pregnancy: a national survey.

Pract Midwife 2016 Oct;19(9):29-32

Use of complementary and alternative medicines (CAM) is increasing throughout pregnancy, including post-dates women, with the aim of reducing medicalisation; however the clinical effectiveness is not proven. The aim of this study (Pathak and Pauley 2015) was to investigate the use of CAM for low risk post-dates women in the UK. An online questionnaire was sent to health care professionals involved in providing care to pregnant women. Massage, aromatherapy and hypnobirthing were the top three modalities reported. Only 58 per cent of respondents reported formal training. Seventy four per cent of respondents reported not auditing their practice of CAM. To conclude it was found that the clinical effectiveness of CAM is yet to be proven and that more research in this area is required.
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October 2016

Comparison of obstetric anal sphincter injuries in nulliparous women before and after introduction of the EPISCISSORS-60(®) at two hospitals in the United Kingdom.

Int J Womens Health 2015 9;7:949-55. Epub 2015 Dec 9.

Department of Obstetrics and Gynecology, Hinchingbrooke Hospital, Huntingdon, UK.

Aim: To assess whether the introduction of episiotomy scissors specially designed to achieve a cutting angle of 60°, EPISCISSORS-60(®), in two hospitals in the UK would result in a reduction in obstetric anal sphincter injuries (OASIS) in nulliparous women.

Methods: A structured training program for all doctors and midwives provided a theoretical framework around OASIS including risk factors and the role of episiotomies and a practical hands-on training element to use EPISCISSORS-60(®) correctly and to measure perineal body length and post-suturing angles. Data for perineal body length, post-suturing angles, user feedback, episiotomy use, and incidence of OASIS were collected through specifically designed forms and the general hospital data collection system.

Results: Data were available for 838 nulliparous vaginal deliveries. Mean perineal body length was 37 mm in spontaneous vaginal delivery group (standard deviation [SD] =8.3, 95% confidence interval [CI] =34-39) and 38 mm in the operative vaginal delivery group (SD=8, 95% CI=35-40). Post-suturing episiotomy angles were 53° (SD=6.5, 95% CI=50.7-55.8) in spontaneous vaginal deliveries and 52° (SD=9.6, 95% CI=49-54) in operative vaginal deliveries. EPISCISSORS-60(®) were rated as "good" to "very good" by 84% of users. There was a 47% increase in the number of episiotomies in nulliparous spontaneous vaginal deliveries at Poole (P=0.007) and a 16.5% increase in the number of episiotomies in nulliparous operative vaginal deliveries in Hinchingbrooke (P=0.003). There was an overall 11% increase in episiotomy numbers in nulliparous vaginal deliveries (P=0.08). There was a statistically significant OASIS reduction of 84% in nulliparous spontaneous vaginal deliveries in women who received an episiotomy (P=0.003).

Conclusion: Initial results after introduction of EPISCISSORS-60(®) show that the majority of health care professionals achieve post-suturing episiotomy angles between 40° and 60°. The results also show a significant increase in the use of episiotomies in the delivery of nulliparous women. There has been a statistically significant reduction in OASIS in nulliparous spontaneous vaginal deliveries.
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http://dx.doi.org/10.2147/IJWH.S94680DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4677767PMC
December 2015

Transfusion transmittable infections - Seroprevalence among blood donors in a tertiary care hospital of Delhi.

Asian J Transfus Sci 2013 Jul;7(2):116-8

Blood Bank Max Super Speciality Hospital, Saket, New Delhi, India.

Context: Transfusion transmittable infections (TTI) continue to be a major threat to safe transfusion practices. Blood is one of the major sources of transmission of infectious diseases viz. human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), syphilis, malaria, and many other infections in India. Screening assays for the infectious diseases with excellent sensitivity and specificity helps to enhance the safety of the blood transfusions reducing the diagnostic window period as much as possible.

Aims: The present study was designed to determine the seroprevalence of TTIs viz., HIV, HCV, and HBV, among the blood donors in Max Super Specialty Hospital, New Delhi, India based on dual testing strategy using high sensitive screening assays such as enhanced chemiluminescence assay and nucleic acid testing (NAT).

Materials And Methods: A total of 41207 blood units collected from the donors (both voluntary and replacement donors) were screened for the TTI s, viz., anti HIV 1 and 2 antibody, anti HCV antibody, anti HBcore antibody, and HBsAg by enhanced chemiluminescence assay on VITROS(®) ECiQ immunodiagnostics system. NAT was performed using Roche Cobas(®) TaqScreen MPX assay, which can detect simultaneously HIV 1 (groups M and O), HIV-2, HCV, and HBV on Roche Cobas(®) s201 system.

Results: The seroprevalence of HIV, HBsAg, anti HBcore antibody, and HCV based on enhanced chemiluminescence assay was found to be 0.25, 0.2, 7.06, and 0.7%, respectively. A total number of 6587 samples from July 2010 to December 2010 were tested on NAT, of which 3 samples were reactive for HBV in NAT; this was missed by enhanced chemiluminescence assay.

Conclusions: Based on the seroprevalence study of infectious diseases viz., HIV, HBV, and HCV, we conclude that screening of blood and blood components by dual testing strategy using high sensitivity serological assay like enhanced chemiluminescence technology and NAT helps in detecting the potentially infectious blood units in all phases of infection, which aids in enhancing the safety of blood transfusion and reducing the potential risk of post-transfusion infection.
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http://dx.doi.org/10.4103/0973-6247.115566DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3757770PMC
July 2013

Frequency and clinical significance of placental histological lesions in an unselected population at or near term.

Virchows Arch 2011 Dec 27;459(6):565-72. Epub 2011 Oct 27.

Division of Fetal-Maternal Medicine, Rosie Maternity-Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 2QQ, UK.

Associations between specific placental histological abnormalities and obstetric outcomes are reported. However, most data are based either on high-risk cases or relate to case-control studies selected from those with abnormal placental histology findings, with the unavoidable biases that these approaches entail. This study reports the frequency of the several common, objective and predefined histological abnormalities of the placenta as identified by pathologists blinded to all clinical information. A total 1,153 women were recruited from an unselected population delivering at 34-43 weeks. Histological findings in common obstetric outcome groups were compared to those of the unselected population, and odds ratios and predictive values were calculated. Normal histological findings were present in 72.1% of pregnancies with normal outcomes and in 79.1%, 66.6%, 80%, and 74.8% of pregnancies affected by pre-eclampsia (PET), pregnancy-induced hypertension (PIH), gestational diabetes (GDM), and small for gestational age (SGA), respectively. Chronic placental underperfusion was seen more frequently in PIH (odds ratio (OR) 2) and SGA (OR 1.4), while villitis of unknown aetiology was observed more commonly in cases with PIH (OR 3.2). Fetal thrombotic vasculopathy was twice as common in cases with GDM whilst massive perivillous fibrin deposition was much more frequent in those with PET (OR 20.2) and SGA (OR 8.9). Chorangiomata were 13 times more common in pregnancies with PET. However, in all cases, positive predictive values were low, with the majority of cases with histological abnormalities being associated with normal outcome. At term, specific placental histological lesions are significantly more common in complicated pregnancies, but the clinical significance of such lesions in a specific case remains uncertain, since the majority will be identified from clinically uncomplicated normal pregnancies.
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http://dx.doi.org/10.1007/s00428-011-1157-zDOI Listing
December 2011

Type and screen policy in the blood bank: Is AHG cross-match still required? A study at a multispecialty corporate hospital in India.

Asian J Transfus Sci 2011 Jul;5(2):153-6

Blood Bank, Max Super Specialty Hospital, 1-2, Press Enclave Road, Saket, New Delhi, India.

Background: Antibodies against only about 25-28 blood group antigens are known to cause hemolytic reactions (HTRs), and red cell antibody screening should detect such clinically significant antibodies. An extension of the antibody screening test is the 'type and screen' done to detect clinically significant antibodies, omiting the anti-human globulin (AHG) cross-match.

Aim: The aim of this study was to find out if the type and screen procedure is a safe method for pre-transfusion testing when compared to the AHG cross-match currently in use in India.

Materials And Methods: We evaluated data from 45373 patients for whom a total of 61668 units of packed red blood cells (PRBC) were cross-matched in the AHG phase using DiaMed(®) ID cards. An antibody screen was carried out in all the patients using the DiaMed(®) ID-DiaCell I+II+III. The AHG cross-match was also carried out for all recipients, irrespective of the result of the antibody screen. The results were compared to see if there were any cases where the antibody screening was negative but the AHG cross-match showed incompatibility.

Results: Not a single case was found where the antibody screen was negative and AHG cross-match showed incompatibility. In 68 cases the antibody screening was positive. Out of the 68 cases, AHG cross-match was incompatible with at least one unit of PRBC in 41 cases.

Conclusion: The screening cell panel adequately detected the clinically significant antibodies in the Indian population in our study. The type and screen policy can be safe, efficient, cost-effective, and beneficial to the transfusion service in India.
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http://dx.doi.org/10.4103/0973-6247.83242DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3159246PMC
July 2011

Relationship between placental morphology and histological findings in an unselected population near term.

Virchows Arch 2011 Jul 12;459(1):11-20. Epub 2011 Apr 12.

Division of Fetal-Maternal Medicine, Rosie Maternity-Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 2QQ, UK.

Whilst individual histological features are well described, there are no universally agreed criteria as to what constitutes a clinically significant histological lesion of the placenta in an uncomplicated pregnancy, nor has the presence of such histological findings been systematically related to quantitative morphological characteristics of the placenta (such as placental shape, cord insertion and cord coiling). This study aims to explore this relationship and further to describe the incidence of predefined categories of histological lesions of the placenta in an unselected obstetric population recruited prior to delivery. The study is based upon the placental examination of 1,156 women with singleton pregnancies recruited prospectively in a single unit. Placentas were analysed where deliveries occurred between 34-43 weeks. The incidence of normal histological findings and specific histological categories, such as ascending genital tract infection, chronic placental underperfusion, intervillous thrombus and villitis of unknown aetiology, were noted. The relationship between placental morphological indices: coiling index, cord centrality index (distance of cord insertion on the chorionic plate from the centre) and eccentricity (shape of the placenta) and histological lesions was investigated. There were no significant differences between cord centrality and eccentricity between placentas with and without histological lesions except an association between hypercoiling of the umbilical cord and intervillous thrombosis and villitis of unknown aetiology (p = 0.024 and p = 0.009, respectively). The macroscopic morphological features of the placenta cannot predict the presence or absence of the histological placental lesions, nor are these lesions in general associated with differences in cord centrality, placental eccentricity or cord coiling.
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http://dx.doi.org/10.1007/s00428-011-1061-6DOI Listing
July 2011

Placental weight, digitally derived placental dimensions at term and their relationship to birth weight.

J Matern Fetal Neonatal Med 2010 Oct;23(10):1176-82

Division of Fetal Medicine, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 2QQ, UK.

Objective: A few recent studies have investigated the relationship between birth weight and digitally derived placental dimensions, and no standardised methodology has been used. The aims of this study are to compare manually derived placental measurements with those derived digitally and to establish the relationship of birth weight to the placental weight and circumference.

Methods: Three hundred fifty-one consecutive unselected women with singleton pregnancy delivering in a tertiary maternity unit at 37-42 weeks were recruited. Manual and digital placental axis measurements (using calibrated digital imaging and 'Image J' software) were obtained and the circumference derived. The relationship between the two methods was assessed using a Bland-Altman plot analysed. The relationship between z-scores of birth weight, placental weight and placental circumference was investigated.

Results: Manually and digitally obtained placental long axis, short axis and circumference measurements show close correlation (r=0.70, 0.70 and 0.83, respectively). The z score of birth weight is significantly correlated with the z score of placental weight (r=0.59, p<0.001) and z score placental digital circumference (r=0.40, p<0.001). Birth weight:placental weight ratio is 7.20 and birth weight:placental circumference=64.57 g/cm.

Conclusion: There is close though not perfect agreement between the manual and digital placental measurements. Birth weight is strongly correlated with placental weight and circumference at term.
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http://dx.doi.org/10.3109/14767051003615434DOI Listing
October 2010