Publications by authors named "Satyam Arora"

26 Publications

  • Page 1 of 1

Survey based cross-sectional study to analyse the variation of practices at blood centres during COVID-19 pandemic in India.

Transfus Apher Sci 2021 Apr 14:103131. Epub 2021 Apr 14.

Department of Transfusion Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.

India has almost 3,000 blood centres collecting more than 11 million units annually. Maintaining blood supply during the COVID-19 pandemic is a huge challenge. We conducted a cross-sectional study by an online survey to analyse the variation of practices across blood centers of India during this pandemic. A total of 196 blood centers completely responded to the online survey. Most of the blood centres who responded were part of Government hospitals (60 %), part of an academic institutes (55.6 %) and were directly supporting a COVID hospital (67.5 %). Almost 95.4 % blood centers reported reduction of blood donation mainly due to lockdown (50 %) and inability to conduct camps (17.3 %). Scheduling blood donations was one of the most difficult to implement strategy for maintaining adequate blood donation (40.2 %). Blood center manpower management was also a challenge and upto 48 % blood centers operated in two batches to ensure social distancing in blood banks and reduce the risk of exposure. Hemato-oncology (36.8 %) and obstetrics (33.7 %) were major utilizer of blood during the pandemic. There were marked variations in use of PPE by blood banks staff as well as strategies adopted while conducting immunohematology tests on COVID-19 positive patients samples. This pandemic has highlighted some of the major limitations of the health services but blood services have risen to the challenge and strived to maintain the blood supply chain while ensuring blood donor and staff safety. The wide variations in the practices adopted highlights the need for uniform guidelines for blood services in future pandemics.
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http://dx.doi.org/10.1016/j.transci.2021.103131DOI Listing
April 2021

Lessons learned in the collection of convalescent plasma during the COVID-19 pandemic.

Vox Sang 2021 Mar 27. Epub 2021 Mar 27.

Unit Transfusion Medicine, Sanquin Blood Supply Foundation, Amsterdam, Netherlands.

Background: The lack of definitive treatment or preventative options for COVID-19 led many clinicians early on to consider convalescent plasma (CCP) as potentially therapeutic. Regulators, blood centres and hospitals worldwide worked quickly to get CCP to the bedside. Although response was admirable, several areas have been identified to help improve future pandemic management.

Materials And Methods: A multidisciplinary, multinational subgroup from the ISBT Working Group on COVID-19 was tasked with drafting a manuscript that describes the lessons learned pertaining to procurement and administration of CCP, derived from a comprehensive questionnaire within the subgroup.

Results: While each country's responses and preparedness for the pandemic varied, there were shared challenges, spanning supply chain disruptions, staffing, impact of social distancing on the collection of regular blood and CCP products, and the availability of screening and confirmatory SARS-CoV-2 testing for donors and patients. The lack of a general framework to organize data gathering across clinical trials and the desire to provide a potentially life-saving therapeutic through compassionate use hampered the collection of much-needed safety and outcome data worldwide. Communication across all stakeholders was identified as being central to reducing confusion.

Conclusion: The need for flexibility and adaptability remains paramount when dealing with a pandemic. As the world approaches the first anniversary of the COVID-19 pandemic with rising rates worldwide and over 115 million cases and 2·55 million deaths, respectively, it is important to reflect on how to better prepare for future pandemics as we continue to combat the current one.
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http://dx.doi.org/10.1111/vox.13096DOI Listing
March 2021

Characterization of neutralizing versus binding antibodies and memory B cells in COVID-19 recovered individuals from India.

Virology 2021 06 5;558:13-21. Epub 2021 Mar 5.

ICGEB-Emory Vaccine Center, International Center for Genetic Engineering and Biotechnology, Aruna Asaf Ali Marg, New Delhi, India. Electronic address:

India is one of the most affected countries by COVID-19 pandemic; but little is understood regarding immune responses to SARS-CoV-2 in this region. Herein we examined SARS-CoV-2 neutralizing antibodies, IgG, IgM, IgA and memory B cells in COVID-19 recovered individual from India. While a vast majority of COVID-19 recovered individuals showed SARS-CoV-2 RBD-specific IgG, IgA and IgM antibodies (38/42, 90.47%; 21/42, 50%; 33/42, 78.57% respectively), only half of them had appreciable neutralizing antibody titers. RBD-specific IgG, but not IgA or IgM titers, correlated with neutralizing antibody titers and RBD-specific memory B cell frequencies. These findings have timely significance for identifying potential donors for plasma therapy using RBD-specific IgG assays as surrogate measurement for neutralizing antibodies in India. Further, this study provides useful information needed for designing large-scale studies towards understanding of inter-individual variation in immune memory to SARS CoV-2 natural infection for future vaccine evaluation and implementation efforts.
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http://dx.doi.org/10.1016/j.virol.2021.02.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7934698PMC
June 2021

ABO blood group and COVID-19: a review on behalf of the ISBT COVID-19 working group.

Vox Sang 2021 Feb 12. Epub 2021 Feb 12.

Department of Pathology & Cell Biology, Columbia University, New York, NY, USA.

Growing evidence suggests that ABO blood group may play a role in the immunopathogenesis of SARS-CoV-2 infection, with group O individuals less likely to test positive and group A conferring a higher susceptibility to infection and propensity to severe disease. The level of evidence supporting an association between ABO type and SARS-CoV-2/COVID-19 ranges from small observational studies, to genome-wide-association-analyses and country-level meta-regression analyses. ABO blood group antigens are oligosaccharides expressed on red cells and other tissues (notably endothelium). There are several hypotheses to explain the differences in SARS-CoV-2 infection by ABO type. For example, anti-A and/or anti-B antibodies (e.g. present in group O individuals) could bind to corresponding antigens on the viral envelope and contribute to viral neutralization, thereby preventing target cell infection. The SARS-CoV-2 virus and SARS-CoV spike (S) proteins may be bound by anti-A isoagglutinins (e.g. present in group O and group B individuals), which may block interactions between virus and angiotensin-converting-enzyme-2-receptor, thereby preventing entry into lung epithelial cells. ABO type-associated variations in angiotensin-converting enzyme-1 activity and levels of von Willebrand factor (VWF) and factor VIII could also influence adverse outcomes, notably in group A individuals who express high VWF levels. In conclusion, group O may be associated with a lower risk of SARS-CoV-2 infection and group A may be associated with a higher risk of SARS-CoV-2 infection along with severe disease. However, prospective and mechanistic studies are needed to verify several of the proposed associations. Based on the strength of available studies, there are insufficient data for guiding policy in this regard.
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http://dx.doi.org/10.1111/vox.13076DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8014128PMC
February 2021

Convalescent plasma to aid in recovery of COVID-19 pneumonia in a child with acute lymphoblastic leukemia.

Transfus Apher Sci 2021 Feb 24;60(1):102956. Epub 2020 Sep 24.

Department of Paediatric Surgery, Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida, Delhi NCR, India.

The natural history of COVID-19 infection in children is still evolving as the pandemic unfolds. Few cases of severe and often fatal COVID-19 have been reported although the infection is mild in the large majority. Children with cancers are recognised as a high risk group for all infections. Since there aren't any definite treatment guidelines established in children with severe COVID, treatment is guided by adult recommendations which too are often not evidence based. We report the case of a 4-year-old girl with severe COVID-19 associated pneumonia who presented to us as febrile neutropenia. The use of convalescent plasma along with steroids and IVIG showed dramatic results in this child and she recovered without the need for any specific treatment. This is highlighted as one of the earliest cases that is reporting the use of convalescent plasma in a child; the first ever in a child with underlying malignancy.
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http://dx.doi.org/10.1016/j.transci.2020.102956DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7836621PMC
February 2021

IgA-mediated autoimmune hemolytic anemia in an infant.

Transfus Apher Sci 2020 Apr 13;59(2):102695. Epub 2019 Dec 13.

Department of Transfusion Medicine, Super Speciality Paediatric Hospital and Post Graduate Teaching Institute (SSPH & PGTI), Noida, UP, India. Electronic address:

Autoimmune Hemolytic anemia (AIHA) a relatively uncommon form of hemolytic anemia in children, occurs due to the premature destruction of red blood cells caused by presence of autoantibodies directed against antigens on RBCs. Warm reactive AIHA is the most common form due to IgG isotype of immunoglobulin class binding to autologous RBCs at 37C and confirmed with a positive DAT screening. We present a case of DAT-negative primary warm AIHA in an infant due to IgA antibody. A 10 month old male infant presented with dark colored urine and irritability for past two months, with associated history of fever, diarrhea and vomiting. He had received one red cell transfusion 10 days prior. On physical examination he had pallor with tachycardia without splenomegaly. On investigation his hemoglobin was 5.8 g/dl, WBC 25.9 × 10/mm and normal platelets counts. Peripheral blood smear had spherocytes and biochemical values showed high bilirubin and LDH. Immunohematological work up revelaed polyspecific DAT was negative but monospecific DAT screening showed strong (4+) positivity for IgA and a weak IgG positivity. The patient was diagnosed as IgA-mediated Warm AIHA and was started on prednisolone at 2 mg/kg/day following which hemoglobin improved over the next 2 months. After 2 weeks, prednisolone was tapered and stopped by the end of 3 months. Patients with clinical and laboratory evidence of acute hemolysis, an additional screening for IgA antibody may be done even in cases where poly-specific DAT is negative. Early detection helps in avoiding further investigations and provide efficient management.
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http://dx.doi.org/10.1016/j.transci.2019.102695DOI Listing
April 2020

Outcome of 51 autologous peripheral blood stem cell transplants after uncontrolled-rate freezing ("dump freezing") using -80°C mechanical freezer.

Asian J Transfus Sci 2018 Jul-Dec;12(2):117-122

Department of Hematology, BLK Super Speciality Hospital, New Delhi, India.

Background And Objective: Controlled-rate freezing is a complicated, expensive, and time-consuming procedure. Therefore, there is a growing interest in uncontrolled-rate freezing (UCF) with -80°C mechanical freezers for cryopreservation of hematopoietic stem cells. This is a retrospective analysis of efficiency of UCF and outcome of autologous peripheral hematopoietic stem cell (PBSC) transplants at our center from December 2011 to June 2016.

Materials And Methods: Cryoprotectant solutions used included 5% dimethyl sulfoxide and 5% albumin with 2% hydroxyethyl starch and stored at -80°C mechanical freezer till transplant. Evaluation of cryopreservation was studied by analyzing the variation in cellularity, viability, and CD34+ stem cell dose recovery as well as clinical follow-up with engraftment.

Results: A total of 51 patients (23 females and 28 males) underwent autologous PBSC transplantations with a median age of 31 years (range: 3-60 years) for both hematological and nonhematological indications. Mean recovery post by UCF at -80°C mechanical was 92.9% ± 15.5% for nucleated cells, 86.6% ± 15.5% for viability, and 80% ± 21.5% in CD34+ dose. The median day to neutrophil engraftment was 10 (range 5-14 days) and platelets engraftment was 15 (range 8-45 days). The cryopreserved products were stored at -80°C for median 7 days (range 2-41 day) before transplant.

Discussion/conclusion: Our analysis shows that PBSC can be successfully cryopreserved with mechanical uncontrolled rate freezing. This is a cheap and simple method to freeze the stem cells for a short period in resource-constrained setting.
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http://dx.doi.org/10.4103/ajts.AJTS_42_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6327762PMC
January 2019

Hematopoietic Progenitor Cell Mobilization for Autologous Stem Cell Transplantation in Multiple Myeloma in Contemporary Era.

Clin Lymphoma Myeloma Leuk 2019 04 20;19(4):200-205. Epub 2018 Dec 20.

Blood and Marrow Transplant and Cellular Therapy, Moffitt Cancer Center, Tampa, FL.

Successful stem cell mobilization and adequate harvesting of hematopoietic progenitor cells (HPCs) is necessary for patients with multiple myeloma (MM) undergoing high-dose chemotherapy and autologous stem cell transplantation (ASCT). Several advances have increased the efficiency and yield of HPC collection methods, and sufficient CD34 cell collection can be expected for most patients with MM considered to be ASCT candidates. However, in some patients, HPCs will fail to mobilize and an adequate number of CD34 cells will not be collected. In our review, we have discussed the various strategies available for mobilizing HPCs in patients with MM and the evolution of these strategies over time. We have also discussed the concept of mobilization failure, the factors predictive of poor mobilization, and the potential mobilization regimens for such patients.
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http://dx.doi.org/10.1016/j.clml.2018.12.010DOI Listing
April 2019

Dedicated donor unit transfusions reduces donor exposure in pediatric surgery patients.

Asian J Transfus Sci 2017 Jul-Dec;11(2):124-130

Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Background: Many strategies have been explored to reduce multiple donor exposures in neonates such as use of restrictive transfusion protocols, limiting iatrogenic blood loss, use of recombinant erythropoietin and single donor programs.

Method: In our study we assessed the feasibility of dedicating single donor units with reserving all the components from the same donor for the specified neonates/infants undergoing surgery and estimating reduction of donor exposure. Fifty neonates undergoing surgery were included in the prospective study group and the transfusion details were compared with 50 retrospective cases with same inclusion criteria.

Results: An intra-operative blood loss of >13 ml/Kg was significantly associated with transfusion ( <0.05) which was most frequently administered in the intra-operative period. Donor exposure rate of overall transfusion was 1.15 in the study group as compared to 4.03 in the retrospective control group. In study group Donor Exposure Rate (DER): Transfusion Rate (TR) ratio was 1:1.5 and Transfusion per Donor Unit (TPDU) of 1.5, means that one donor unit contributed to 1.5 transfusions in each patient and contributed to 50% reduction in donor exposure in each patient as compared to retrospective control group.

Conclusion: Our study showed that by practicing dedicated donor unit transfusion policy, for neonates undergoing surgery we could significantly reduce the donor exposure.
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http://dx.doi.org/10.4103/ajts.AJTS_57_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5613418PMC
October 2017

Extracorporeal photopheresis: Review of technical aspects.

Asian J Transfus Sci 2017 Jul-Dec;11(2):81-86

Department of Transfusion Medicine and Hematology, BLK Super Speciality Hospital, New Delhi, India.

Extracorporeal photochemotherapy (ECP) is considered as an immune modulating therapy majorly targeting the T cells of the Immune system. ECP induces an anti-inflammatory condition with tolerogenic responses without inducing a global immunosuppression state which is a typical feature of other therapeutic options such as steroids. Clinical indication of ECP has grown over time since its initial applications. Our review discusses the technical aspects of the concept of photopheresis with the available methods for its clinical applications.
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http://dx.doi.org/10.4103/ajts.AJTS_87_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5613442PMC
October 2017

Erratum to: Platelet Derived Biomaterials for Therapeutic Use: Review of Technical Aspects.

Indian J Hematol Blood Transfus 2017 Jun 24;33(2):168. Epub 2017 Mar 24.

Department of Transfusion Medicine, Fortis Hospital, New Delhi, India.

[This corrects the article DOI: 10.1007/s12288-016-0669-8.].
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http://dx.doi.org/10.1007/s12288-017-0800-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5442070PMC
June 2017

Growth Factor Variation in Two Types of Autologous Platelet Biomaterials: PRP Versus PRF.

Indian J Hematol Blood Transfus 2017 Jun 6;33(2):288-292. Epub 2016 Sep 6.

Department of Transfusion Medicine, Dr Ram Manohar Lohia Hospital, New Delhi, India.

Autologous platelet biomaterials represent a key source of cytokines and growth factors extensively used for clinical and surgical applications involving tissue regeneration; wound healing and tissue repair. In this communication we discuss the growth factors released by activated platelet rich plasma (PRP) and platelet rich fibrin (PRF) releasate. Our study highlights that significantly higher growth factors (TGF-ß1) are released by activated PRP as compared to releasate of PRF. The various growth factors released by both platelet products are significantly higher than the baseline concentration in the whole blood and have different bio-mechanism hence should be individualized as per the clinical indication.
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http://dx.doi.org/10.1007/s12288-016-0721-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5442062PMC
June 2017

Platelet Derived Biomaterials for Therapeutic Use: Review of Technical Aspects.

Indian J Hematol Blood Transfus 2017 Jun 29;33(2):159-167. Epub 2016 Mar 29.

Department of Transfusion Medicine, Fortis Hospital, New Delhi, India.

Whole blood is composed of both cellular and plasma components, providing a rich source of therapeutic products. Of late, platelet derived biomaterial (platelet rich plasma) consisting of plasma proteins and platelets are increasingly being used for various indications. Protocols for preparation and nomenclature of this biomaterial vary widely amongst authors and are often not well defined. Additionally, they are not uniformly documented in the literature, making results difficult to compare or replicate. In this paper we review the evolution and type of these products available for clinical use. Further we will discuss the scientific rational and technical aspects in preparation of these platelet biomaterials in order to administer them in various fields of medicine.
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http://dx.doi.org/10.1007/s12288-016-0669-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5442043PMC
June 2017

Comparison of Amicus and COBE Spectra for allogenic peripheral blood stem cell harvest: Study from tertiary care centre in India.

Transfus Apher Sci 2017 Jun 24;56(3):439-444. Epub 2017 Apr 24.

Departments of Hematolgy, BLK Super Speciality Hospital, Delhi, India.

Introduction: Most common source of stem cell graft for both autologous and allogenic haematopoietic transplants are peripheral blood haematopoietic progenitor stem cells. Adequate collection of the CD34+ cells and safety of the allogenic donor during the leukapheresis are of prime importance to an apheresis physician. Our retrospective analysis is a comparison between of two platforms namely, COBE Spectra and Amicus, for CD34+ mononuclear cell collection.

Material And Method: The study included the data of GSCF (Granulocyte-Colony-Stimulating Factor) mobilized allogenic PBSC collections at our centre from January 2015 to June 2016. The apheresis platforms used were COBE Spectra and Amicus. Blood cell counts were done using LH750 Beckman Coulter (Florida, Miami, USA). CD45+ & CD34+ cell counts were done using BD FACS Canto-II Flow-Cytometer by ISHAGE guidelines.

Results: A total of 170 PBSC (100 COBE Spectra & 70 Amicus) harvests were done on 143 donors, of which 116 completed the collection in a single session and 27 required a second session. Demographic details and pre harvest peripheral blood counts for both the groups did not show any statistical differences. Amicus processed higher blood volume with higher ACD exposure and procedure time compared to COBE Spectra. Higher platelets loss was with COBE Spectra harvests with higher product volumes collection. Collection efficiency (CE2), collection ratio, CD34+ cells dose was similar on both the platforms. RBC contamination, absolute lymphocyte and monocytes counts were significantly higher with Amicus harvest product compared with COBE Spectra. A total of 14 (8.2%; citrate toxicity) adverse reactions were reported out of 170 allogenic PBSC collections.

Discussion/conclusion: Our study suggests that both Amicus and COBE Spectra platforms offer comparable results for allogenic PBSC collections. Amicus offers a concentrated PBSC product with lesser volume and platelets loss but higher RBC contamination.
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http://dx.doi.org/10.1016/j.transci.2017.04.002DOI Listing
June 2017

Role of signal-to-cut-off ratios of anti-hepatitis C virus antibody by enzyme immunoassays along with ID-NAT for screening of whole blood donors in India.

Asian J Transfus Sci 2016 Jan-Jun;10(1):75-8

Department of Transfusion Medicine, Dr. Ram Manohar Lohia Hospital, New Delhi, India.

Background: The use of elevated signal-to-cut off ratios (S/CO) as an alternate to further supplemental testing (i.e., RIBA) has been included in the guidelines provided by the Centres for Disease Control and Prevention for HCV diagnostic purposes since 2003. With availability of screening by NAT and non availability of RIBA, further confirmation of HCV infection has been possible at the molecular level (RNA).

Aims: To study the role of S/CO ratios of anti hepatitis C virus antibody detection by enzyme immunoassays (EIA) along with ID-NAT for screening of whole blood donors.

Methods: In this study we reviewed the donor screening status for anti HCV from January 2013 to May 2014. All the donations were screened for anti HCV with fourth generation ELISA (BioRad Monolisa Ag-Ab Ultra) as well as with ID NAT (Procleix Ultrio). The S/CO ratio of all the anti-HCV reactive samples were analysed for their presence of HCV RNA.

Results: On screening 21,115 donors for HCV, 83 donors (0.39%) were found reactive on pilot tube and repeat plasma bag testing (S/Co ratio ≥1) by ELISA. 41 donors were HCV RNA reactive with ID-NAT. 4 samples out of 41 were NAT yields and 37 were concordant reactive with ELISA. The S/Co ratio of anti-HCV reactive samples ranged from 0.9-11.1 [mean = 5.1; SD ± 2.9] whereas S/Co ratio of anti HCV and NAT reactive samples (concordant positives) ranged from 4.1-11.1 [mean 7.3]. In our analysis we found that S/CO ratio of 4 showed positive predictive value (PPV) and sensitivity of 100%.

Summary/conclusions: Our study showed that S/CO of 4 for anti HCV on ELISA would have maximum positive predictive value of having donor with HCV RNA. S/CO ratio of 4 is very close to 3.8 which was the CDC guideline. The presence of anti-HCV does not distinguish between current or past infections but a confirmed anti-HCV-positive result indicates the need for counseling and medical evaluation for HCV infection.
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http://dx.doi.org/10.4103/0973-6247.165838DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4782500PMC
March 2016

Quantification of platelets and platelet derived growth factors from platelet-rich-plasma (PRP) prepared at different centrifugal force (g) and time.

Transfus Apher Sci 2016 Feb 3;54(1):103-10. Epub 2016 Feb 3.

Department of Transfusion Medicine, Dr Ram Manohar Lohia Hospital, New Delhi, India.

Introduction: Platelet derived biomaterials represent a key source of cytokines and growth factors extensively used for tissue regeneration; wound healing and tissue repair. Our study was to quantify platelets and growth factors released by PRP when prepared at different centrifugal force (g) and time.

Material And Methods: Our study was approved by the institutional ethical committee. One hundred millilitres of whole blood (WB) was collected in bag with CPDA as the anticoagulant(AC); (14 mL for 100 mL WB ratio). Nine aliquots of 10 mL each were made from the bag and set of three aliquots were made a group. PRP was prepared at varying centrifugal force (group A: -110 g, group B: -208 g & group C: -440 g) & time (1: -5 min, 2: -10 min & 3: -20 min). Contents of each PRP prepared were analysed. Commercial sandwich ELISA kits were used to quantify the concentrations of CD62P (Diaclone SAS; France), Platelet derived growth factors-AB (Qayee-Bio; China), transforming growth factor-β1 (DRG; Germany) and vascular endothelial growth factor (Boster Immuno Leader; USA) released in each PRP prepared.

Results: Eight volunteers were enrolled in the study (24-30 years). The baseline blood counts of all the volunteers were comparable (p ≥ 0.05). Mean ± SD of platelet yield of all nine groups ranged from 17.2 ± 4.2% to 78.7 ± 5.7%. Each PRP was activated with calcified thromboplastin to quantify the growth factors released by them. Significantly higher (p < 0.05) transforming growth factor-β1 and vascular endothelial growth factor were released compared to the baseline.

Conclusion: Our study highlights the variation in both force (g) and time results in changes at cellular level and growth factor concentrations.
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http://dx.doi.org/10.1016/j.transci.2016.01.028DOI Listing
February 2016

Hemolysis: A positive agglutination reaction while studying titration of anti A/B antibody for ABO-incompatible solid organ transplants.

Asian J Transfus Sci 2015 Jul-Dec;9(2):115-6

Department of Transfusion Medicine, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India.

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http://dx.doi.org/10.4103/0973-6247.162682DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4562127PMC
September 2015

Rapid plasma reagin test: High false positivity or important marker of high risk behavior.

Asian J Transfus Sci 2015 Jan-Jun;9(1):109

Department of Blood Bank, Dr. Ram Manohar Lohia Hospital, New Delhi, India.

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http://dx.doi.org/10.4103/0973-6247.150979DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4339923PMC
February 2015

Maternal anti-M induced hemolytic disease of newborn followed by prolonged anemia in newborn twins.

Asian J Transfus Sci 2015 Jan-Jun;9(1):98-101

Department of Paediatrics, Dr. Ram Manohar Lohia Hospital, New Delhi, India.

Allo-anti-M often has an immunoglobulin G (IgG) component but is rarely clinically significant. We report a case of hemolytic disease of the fetus and newborn along with prolonged anemia in newborn twins that persisted for up to 70 days postbirth. The aim was to diagnose and successfully manage hemolytic disease of newborn (HDN) due to maternal alloimmunization. Direct antiglobulin test (DAT), antigen typing, irregular antibody screening and identification were done by polyspecific antihuman globulin cards and standard tube method. At presentation, the newborn twins (T1, T2) had HDN with resultant low reticulocyte count and prolonged anemia, which continued for up to 70 days of life. Blood group of the twins and the mother was O RhD positive. DAT of the both newborns at birth was negative. Anti-M was detected in mothers as well as newborns. Type of antibody in mother was IgG and IgM type whereas in twins it was IgG type only. M antigen negative blood was transfused thrice to twin-1 and twice to twin-2. Recurring reduction of the hematocrit along with low reticulocyte count and normal other cell line indicated a pure red cell aplastic state. Anti-M is capable of causing HDN as well as prolonged anemia (red cell aplasia) due to its ability to destroy the erythroid precursor cells. Newborns with anemia should be evaluated for all the possible causes to establish a diagnosis and its efficient management. Mother should be closely monitored for future pregnancies as well.
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http://dx.doi.org/10.4103/0973-6247.150968DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4339947PMC
February 2015

Blood donor notification and counseling: Our experience from a tertiary care hospital in India.

Asian J Transfus Sci 2015 Jan-Jun;9(1):18-22

Department of Transfusion Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Dr. Ram Manohar Lohia Hospital, New Delhi, India.

Aims: To evaluate the response rate of transfusion-transmissible infection (TTI)-reactive donors after notification of their abnormal test results for the year 2012.

Materials And Methods: This study is an observational descriptive study performed in our department over a period of 1 year. We evaluated the response rate of TTI-reactive donors after notification of their abnormal test results over 1 year as per the existing strategy (three telephonic and two postal communications).

Results: During the study period, among the annual donation of 15,322 units, 464 blood donors were found to be seroreactive. Of these 464 seroreactive cases, 47 were HIV positive, 284 were reactive for Hepatitis B surface antigen (HBsAg), 49 were Hepatitis C (HCV) positive and 84 were VDRL reactive. The TTI-reactive donors (464) for various markers were contacted: 229 (49.4%) telephonically and the remaining 235 (50.6%) not contacted on phone were informed by post. Of the 229 contacted donors, the response rate was 98.2% as only 225 donors reported (221 on the first, three on second and one on the third call) for one to one counseling. The remaining four non-responders were - one HIV and three HBsAg reactive. The remaining 235 (50.6%) reactive donors did not respond to any communication.

Conclusion: Donor notification and post-donation counseling are an essential aspect of the blood bank that entails provision of information on serological status, assess the impact of test results on the donor and finally referral for medical care. As in our data only 49.4% of the blood donors could be contacted successfully, incomplete demographic details was the major limiting factor in communicating with rest. Of the 229 contacted donors, the response rate was 98.2%. A large majority (94.75%) of the notified donors in our study contacted their health care provider when given clear instructions to do so. These results are encouraging because they indicate that a major element of the notification message is acted upon when it is worded clearly. The very high response rate of the contacted donors ensured their concern for knowing their test result status.
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http://dx.doi.org/10.4103/0973-6247.150941DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4339925PMC
February 2015

Sensitivity of individual donor nucleic acid testing (NAT) for the detection of hepatitis B infection by studying diluted NAT yield samples.

Blood Transfus 2015 Apr 23;13(2):227-32. Epub 2014 Oct 23.

Blood Bank, Dr Ram Manohar Lohia Hospital, New Delhi, India.

Background: Screening blood donors for the presence of hepatitis B virus surface antigen (HBsAg) has been the backbone of blood safety. However, occult hepatitis B infection (OBI) in donors can be missed when only HBsAg screening is used. Nucleic acid testing (NAT) is capable of detecting OBI among donors. The aim of our study was to analyse the sensitivity of NAT for detecting OBI.

Material And Methods: The kits used during the study for serology testing were BioRad Monolisa™ HBsAg Ultra (HBsAg screening), Abbott Architect for anti-HBcAg (total) and anti-HBsAg testing, and Vitros® by Ortho Clinical Diagnostics for anti-HBcAg (IgM). Procleix Ultrio was used for individual donor-NAT (ID-NAT) and Abbott m2000 for estimation of HBV DNA. Out of 28,134 HBsAg non-reactive donors, 25 were ID-NAT-reactive. Of these 25 NAT yield samples, 18 were studied further at different dilutions from 1:2 to 1:16. The doubling dilutions were made with HBV non-reactive AB plasma. Undiluted samples were used for all serological tests and for HBV DNA estimation.

Results: Of the 18 samples studied, nine were NAT-reactive at a dilution of <1:4 and five out of these showed presence of antibody to core antigen (IgG+IgM). Antibody to surface antigen was present in only two of the nine NAT-reactive samples, one with antibody to core antigen and the other without. Six had a viral load in the range from <10 to 38 IU/mL whereas the viral load in the remaining three samples was not determined. Among the other nine samples which were NAT-reactive at dilutions≥1:4, antibody to core antigen (IgG+IgM) was present in seven.

Discussion: Our study showed that ID-NAT testing along with HBsAg screening could detect most potentially HBV infectious donors (including those with OBI). NAT screening for HBV on diluted samples could compromise blood safety because samples with a low viral load will escape detection.
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http://dx.doi.org/10.2450/2014.0048-14DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4385070PMC
April 2015

Reactive donor notification: First error reported.

Asian J Transfus Sci 2014 Jul;8(2):135-6

Blood Bank, Dr. Ram Manohar Lohia Hospital, New Delhi, India.

Donor notification and post-donation counseling is an essential role of blood bank. If a donor is reactive for any marker, the blood bank counselor, informs the donor and advices him/her to report to the blood bank for further counseling and management. The counselor at our blood bank informed a young female voluntary donor to be reactive for HIV both with ELISA as well as NAT. When the donor reported to blood bank, the repeat testing was negative and no history of high risk behavior could be elicited. The hospital information system (HIS) records were checked again immediately for clarification and showed consistency with her demographic profile. But when her manual records and donor questionnaire were retrieved, showed information displayed in the HIS system was wrongly interpreted by the counselor. In this era of information technology being highly advanced, the role of manual record keeping is still the gold standard.
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http://dx.doi.org/10.4103/0973-6247.137456DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4140059PMC
July 2014

Alloimmunization and autoimmunization in transfusion dependent thalassemia major patients: Study on 319 patients.

Asian J Transfus Sci 2014 Jul;8(2):84-8

Department of Transfusion Medicine, RML Hospital, New Delhi, India.

Background: The development of anti-red blood cell antibodies (both allo-and autoantibodies) remains a major problem in thalassemia major patients. We studied the frequency of red blood cell (RBC) alloimmunization and autoimmunization among thalassemia patients who received regular transfusions at our center and analyzed the factors, which may be responsible for development of these antibodies.

Materials And Methods: The study was carried out on 319 multiply transfused patients with β-thalassemia major registered with thalassemia clinic at our institute. Clinical and transfusion records of all the patients were examined for age of patients, age at initiation of transfusion therapy, total number of blood units transfused, transfusion interval, status of splenectomy or other interventions. Alloantibody screening and identification was done using three cell and 11 cell panel (Diapanel, Bio-rad, Switzerland) respectively. To detect autoantibodies, autocontrol was carried out using polyspecific coombs (IgG + C3d) gel cards.

Results: Eighteen patients out of total 319 patients (5.64%) developed alloantibodies and 90 (28.2%) developed autoantibodies. Nine out of 18 patients with alloantibodies also had autoantibodies. Age at first transfusion was significantly higher in alloimmunized than non-immunized patients (P = 0.042). Out of 23 alloantibodies, 52.17% belonged to Rh blood group system (Anti-E = 17%, Anti D = 13%, Anti-C = 13%, Anti-C(w) = 9%), 35% belonged to Kell blood group system, 9% of Kidd and 4% of Xg blood group system.

Conclusion: Alloimmunization was detected in 5.64% of multitransfused thalassemia patients. Rh and Kell blood group system antibodies accounted for more than 80% of alloantibodies. This study re-emphasizes the need for RBC antigen typing before first transfusion and issue of antigen matched blood (at least for Rh and Kell antigen). Early institution of transfusion therapy after diagnosis is another means of decreasing alloimmunization.
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http://dx.doi.org/10.4103/0973-6247.137438DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4140069PMC
July 2014

Serological characterization of occult hepatitis B virus infection among blood donors in India.

Transfus Apher Sci 2014 Oct 30;51(2):162-7. Epub 2014 Jul 30.

Blood Bank, Post Graduate Institute of Medical Education and Research (PGIMER), Dr Ram Manohar Lohia Hospital, New Delhi, India.

Introduction: Discovery of hepatitis B infections characterized by the presence of viral genome without detectable HBsAg (Occult Hepatitis; OBI) has initiated a considerable amount of research in this regard. Our study is a serological and molecular characterization of OBI among the donors who donated at our blood bank during the study period.

Material And Method: During the study period HBsAg ELISA non reactive ID-NAT reactive donors samples were screened for presence of antibody against HBc, HBs and HBe. Molecular analysis of these NAT yield samples was undertaken for detection of the viral load and genotyping.

Result: We studied 28,134 HBsAg ELISA non reactive donor samples. On testing them with ID-NAT, HBV DNA was detected in 25 samples. Eighteen samples out of these 25 NAT yield were further worked up. The 66.6% of the NAT yield samples (12 out of 18) were reactive for antibody against HBc. The 25% (3 out of 12) of these NAT yield samples having antibody against core antigen also had antibody against HBs. The 27.7% (5 out of 18) of NAT yield detected by ID-NAT did not have any detectable serological marker in blood. Four out of 12 core antibody positive NAT yield samples had genotype A HBV infection.

Conclusion: As per our study molecular detection of HBV DNA by ID-NAT, we were able to analyze 18 HBV NAT yield cases among 28,134 HBsAg ELISA non reactive donors. Out of 18, 12 donors were OBI whereas the rest (6) were in window period (WP yield) of HBV infection. One out of every 3.6 NAT yield detected by ID-NAT was non reactive for all serological markers.
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http://dx.doi.org/10.1016/j.transci.2014.07.008DOI Listing
October 2014