Open Access Original Research Article

Appropriateness of Use of Blood Products in Tertiary Hospitals

Jerold C. Alcantara, Ann P. Opiña, Rhashani Arjay M. Alcantara

International Blood Research & Reviews, Page 54-65
DOI: 10.9734/IBRR/2015/15852

Aims: This study aimed at evaluating the appropriateness of use of blood products in Northern Philippines and sought to find out if significant differences exist on the appropriateness of use of the blood products among the different departments and the tertiary hospitals.

Methodology: The appropriateness of use was determined by the criteria of the joint initiative of the National Health and Medical Research Council (NHMRC) and the Australasian Society of Blood Transfusion (ASBT). The frequency of utilization and the percentage of appropriateness were determined to compare the use of blood products among the different departments and the tertiary hospitals. Contingence tables were formed to test the associations between the categorical variables. The statistical significance was determined by Chi square test when p value <0.05.

Results: A total of 1,075 transfusion events were evaluated with a mean number of 2.43 transfusions per patient. Forty-one percent (41%) received two transfusions, 22% received one, and 37% received three or more transfusions. Five hundred eighty-three (583) transfusions were in the Medicine, 215 in Surgery, 218 in Obstetrics and 59 in Pediatrics. The overall prevalence of appropriate use among the different departments was 65%, and 59% among the tertiary hospitals. Appropriateness of use was statistically different among departments. A significant association also exist between the percentages of appropriate use of the blood products among the tertiary hospitals.

Conclusion: The study revealed that there was substantial variation in the appropriate transfusion practices across study hospitals and appropriateness of use was influenced by the departments regardless of the blood products.

 

Open Access Original Research Article

Effect of Calpurnia aurea Seed Extract on HAART Induced Haematotoxicity in Albino Wistar Rats

Haile Nega Mulata, Natesan Gnanasekaran, Umeta Melaku, Seifu Daniel

International Blood Research & Reviews, Page 66-75
DOI: 10.9734/IBRR/2015/15888

Aim: To investigate the effect of Calpurnia aurea seeds extract on highly active antiretroviral therapy (HAART), first phase regimens (Lamivudine + Efavirenz + Zidovudine) induced heamtotoxicity in rats.

Study Design: Thirty adult healthy male albino wistar rats of weighing about 140-150 gms were used in the present study. They were divided into five groups six each.  Group- I distilled water only; Group- II HAART drugs only; Group- III HAART drugs + 100 mg/kg of CASE (CASE: Calpurnia aurea Seed Extract); Group- IV HAART drugs + 200 mg/kg of CASE and Group- V HAART drugs + 300 mg/kg of CASE were administered orally for 35 day.

Methodology: Matured dried seeds of Calpurnia aurea were collected, powdered and extracted using 70% ethanol. Preliminary phytochemical screening and in-vitro antioxidant properties of extract were done. The HAART and different doses of the Calpurnia aurea seed extract were administered orally for thirty-five days. On 35th day, the rats were fasted overnight and the blood sample was collected by cardiac puncture after sacrificed the rats by cervical dislocation.

Results: HAART did not alter the total WBC (P=0.56, 7340±500 vs 7080±1381) and platelets count (P=0.76, 751000±56059 vs 742200±11921) but significantly alter the total RBC (P=0.001, 7008000±559521 vs 8832000±142211), HCT (P=0.001, 46.56±3 vs 64.75±1) and haemoglobin (P=0.001 12.90±1.12 vs 15.42±0.49) the affected parameters were restored by CASE in dose dependent meaner. However the CASE significantly reduced the platelets counts in the experimental rats.

Conclusion: This report shows that CASE is an effective counter measure for the toxic haematopoietic effects of HAART. This is may be because of CASE contains phytochemicals  such as tannins, flavonoids, terpenoids etc which attenuate the HAART induced hematopoietic cell death in the periphery and bone marrow or it may be promote hematopoietic functions by regulating erythropoietin. Furthermore CASE oral administration reduces the platelet count not in the dose dependant manner. The molecular mechanism of action of the drug needs further clarification.

 

Open Access Original Research Article

Epidemiological and Biological Parameters of Monoclonal Plasma Cell Dyscrasias in Thirty One Patients Consulting a Moroccan Pasteur Institute

Ilham Zahir, Abderahman Bellik

International Blood Research & Reviews, Page 81-91
DOI: 10.9734/IBRR/2015/15692

Aims: To describe epidemiological and biological features of patients with monoclonal plasma cell dyscrasias. The patients were seen at the Moroccan Pasteur Institute in Casablanca during a period of two years and four months.

Place and Duration of Study: Laboratory of immunochemistry, Pasteur institute, Casablanca, Morocco. From April 2006 to July 2006.

Methodology: Thirty one case notes of patients who had a serum or urine monoclonal gamma or beta globulin spike were assessed.

Results: The mean age of the patients was 54.7±10.7 years (range, 26–72 years) and there were more females with a sex ratio 0.82. 66.7% of the patients had a monoclonal gamma globulin peak revealed by electrophoresis. According the results of performed agar gel immuno-electrophoresis, 48% of them had monoclonal immunoglobulin G (IgG) antibodies, followed by class IgA with 29% of cases. Moreover, 55% of the patients were Kappa-chain positive, while 45% were Lambda-chain positive. Assessment of prognostic factors of some patients demonstrated an increased erythrocyte serum rate (66.7% of cases), anemia (50% of cases), a raised of calcium serum levels (37.5% of cases) and β2-microglobulin serum levels were higher than 3.5 mg/l (33.3% of cases). In addition, the mean concentration of proteins was 91 g/l (58.6% of cases), low levels of albumin below 36 g/l were observed (63% of cases) and the monoclonal component levels were above 30 g/l (55.6% of cases).

Conclusion: Some of our records were different from those of other series: our patients were younger with a slight predominance of female individuals. Others were consistent mainly with the more frequently observed monoclonal gamma-globulin peak, and also with the assessed levels of IgG, which is known as the most common isotype in plasma cell disorders. On the other hand, a rise of prognostic factors levels was also noted except for C-reactive protein. Nevertheless, our study pointed out that the majority of patients didn’t have a rigorous monitoring of their disorders by carrying out hematological and serological examinations.

 

Open Access Original Research Article

Laboratory Accuracy of Some Human Immunodeficiency Virus Screening Methods in a Nigerian Blood Bank: Is it time for Universal Adoption of Enzyme-linked Immuno-Sorbent Assay Methodologies as the Minimum Testing Paradigm?

Orkuma Joseph Aondowase, Gomerep Simji Samuel, Egesie Julie Ochaka, Orkuma Jenifer Hembadoon, Mbaave Tsavyange Peter, Onoja Anthony Michael

International Blood Research & Reviews, Page 92-100
DOI: 10.9734/IBRR/2015/17095

Aim: To compare the prevalence rates, relevant indices of laboratory accuracy and proportion of false negative test results for some WHO recommended methodologies used for HIV screening amongst blood donor sata hospital-based blood bank in Nigeria.

Study Design: A cross-sectional.

Place and Duration: Blood bank unit of Jos University Teaching Hospital (JUTH) and the Nigerian National Blood Transfusion Service (NBTS) North Central Zonal Office, Jos between May and August 2008.

Methodology: Four hundred and forty blood donors (379 males and 61 females; aged 18-55 years) predominantly family replacement blood donors who met the minimum criteria to donate blood in Nigeria were included. Blood collection, serum processing, testing and interpretation of results were carried out using standard methods and manufacturers’ instruction. Serum was tested with a rapid test (Determine™ HIV- 1/2) and an EIA [Dia Pro HIV 1/2/0 ELISA] method. The samples were further tested with a 4th generation ELISA [GENSCREEN®PLUS HIV Ag- Ab ELISA].

Results: The prevalence of HIV in blood donors differed with the test method and assay as follows; Determine TM HIV 1/ 2 (3.6%), Dia Pro HIV 1/2/0 ELISA (5.5%) and GENSCREEN®PLUS HIV Ag-Ab ELISA (9.3) respectively.

Determine TM HIV-1/ 2gave a sensitivity of 0.39 (95% CI 0.24-0.55), specificity 1.00,95% CI 0.99-1.00), false negative [FN] (61%), positive predictive value [PPV] 1.00 95% CI 0.79-1.00), and a negative predictive value [NPV] 0.94, 95% CI 0.91-0.96 when compared with GENSCREEN®PLUS HIV Ag-Ab ELISA method. P<0.001.

Dia Pro HIV 1/2/0 ELISA gave a sensitivity of 0.54, 95% CI.37-0.69, specificity 0.995, 95% CI 0.99-1.00, FN(46.3%), PPV (0.9295% CI 0.73-0.99 and a NPV (0.95, 95% CI0.93-0.97) when compared with GENSCREEN®PLUS HIV Ag-Ab ELISA method. P<0.001.

Determine TM HIV 1/2 had a sensitivity of 0.67 95% CI 0.45-0.84, specificity of 1.00; 95% CI 0.99-1.00, FN (33.3%), PPV (1.00 95% CI 0.79-1.00 and a NPV 0.98, 95% CI 0.96-0.99 when compared with Dia Pro HIV 1/2/0 ELISA method. P<0.001.

Conclusion: The prevalence of HIV in blood donors is method dependent with GENSCREEN®PLUS HIV Ag-Ab ELISA higher than Dia Pro HIV 1/2/0 and Determine TM HIV 1/ 2. Dia Pro HIV 1/2/0 is more accurate and has fewer FN test results than Determine TM HIV 1/ 2. There is a need to discourage rapid testing as a major testing algorithm amongst hospital-based blood banks. Instead, ELISA methods should be adopted as the minimum testing paradigm. However, further testing with Nucleic Acid Amplification Testing (NAT) is recommended to validate reliability of this study.

 

Open Access Case Report

A Case Report of Pregnant Woman with Aplastic Anemia: Diagnosis and Management through Subsequent Pregnancy

Harshini Vana, J. B. Vidyashree, Mangala Gowri, Renuka Ramaiah

International Blood Research & Reviews, Page 76-80
DOI: 10.9734/IBRR/2015/15735

Introduction: Aplastic anemia is characterized by decreased bone marrow function with inadequate production of erythrocytes, granulocytes, and platelets. Marrow failure may be caused by absence of or defects in hematopoietic stem cells, abnormalities of the bone marrow microenvironment, or immune disorders. There are no clear guidelines for the management of aplastic anemia during pregnancy.

We report a case of pregnant woman in whom anemia was evaluated and diagnosed as Aplastic anemia, managed through the pregnancy and followed her up until subsequent pregnancy with good outcome.

Case: A 19 year teenage girl, primigravida at 36 weeks of gestation presented to our hospital complaining with generalized weakness since 1 month during her antenatal check up. She was evaluated wherein Hb-5.8g/dL, platelet count 11,000, peripheral smear – Megalocytic Anemia with Leucopenia and Thrombocytopenia and no other abnormal cells, was managed conservatively. She had underwent Vaccum assisted vaginal delivery and was third stage of labor was uneventful without any post partum hemorrhage or other bleeding manifestations. During post-partum period, she developed severe anemia and thrombocytopenia with HB-5g/dL, platetlet count of 21,000 and so bone marrow aspiration was done, found to have hypocellular marrow with atypical lymphoid cells, bone marrow biopsy showed hypocellular marrow with decrease in all 3 hematopoietic cell lines, few lymphoid cells with hyper chromatic nucleus and scant eosinophilic cytoplasm, few megakaryocytes. CMV IgM, IgG were found to be positive, ANC was 150 cells /ml and the diagnosis of severe aplastic anemia was confirmed. As her sister was HLA identical sibling, donor stem cell transplantation was performed. She conceived spontaneously, in this subsequent pregnancy had uneventful antenatal, intrapartum and post partum period, delivered live term baby.

Conclusion: Women with severe anemia and thrombocytopenia are to be thoroughly evaluated so as to make timely diagnosis of the disease.