Open Access Review Article

Informed Consent in Transfusion Medicine: An Ethical Obligation Or a Legal Compulsion to Avert Liabilities for Negligence to the Health Care Provider

Orkuma, Joseph Aondowase, Edward E. Ogar, Esq, Ayia, Nyiutsa George, Joseph Ojobi, Gomerep Samuel Simji

International Blood Research & Reviews, Page 40-55
DOI: 10.9734/ibrr/2021/v12i330154

Blood transfusion is oftentimes life-saving but associated with risks which ought to be disclosed by the health care provider as an ethical obligation and legal requirement. The practice of informed consent to transfusion medicine is quite new and few studies have comprehensively x-rayed its historical, ethical and legal implications with an in depth consideration of professional negligence using decided cases by the adversarial and arbitration systems. PubMed, PubMed Central, Google Scholar, African Journal on Line (AJOL) electronic databases were searched using combined keywords like; “Blood transfusion and informed consent” “informed choice to transfusion medicine practice”, “consent in transfusion medicine”, “health care giver and consent to transfusion therapy”, “transfusion consent and the health care seeker”, “liability and informed consent to transfusion” and “contemporary issues in medical negligence”. Relatedly, printed materials were considered. The 91 studies that met the inclusion criteria were considered with highlights showing that, informed consent to medical treatment generally is an age long practice running from roman civilization to the present but its advocated practice in transfusion medicine a recent event. The practice is also generally low in comparison with informed consent taken for other treatments in similar settings. The consequences of dereliction including infamous conduct amongst professionals or negligence with direct and vicarious liabilities in adversary systems has been set in precedent judgments. These in addition to the present day patient-centered care model as global best practice and quality in health care delivery is compelling for health care providers to imbibe the practice not as a form of defensive medicine but a repertoire to quality and responsive Medicare service.

Open Access Original Research Article

Performance Evaluation: Four Chemiluminescent SARS-Cov-2 Immunoassays and Rapid-Card Test in Mild Disease and Seroprevalence of SARS CoV-2 in Frontline Healthcare Workers

Rasika Setia, Mitu Dogra, Anil Handoo, Gokhula Prasath Thangavel, Ramesh Yadav, Purabi Barman, Raj Kumar Kapoor, Amena Ebadur Rahman

International Blood Research & Reviews, Page 9-22
DOI: 10.9734/ibrr/2021/v12i330151

Introduction: The COVID-19 pandemic raised a host of challenges to modern medicine. Key amongst these were in diagnostics, as most SARS-CoV-2 assays had been rapidly developed and released under emergency-use authorization with limited validation on clinical samples and secondly, an increased risk of COVID-19 infection to healthcare workers (HCW). There are limited inter-assay comparisons to detect SARS-CoV-2 antibodies in cases with milder symptoms of COVID-19, necessary to evaluate whether assays can detect SARS-CoV-2 antibodies in patients with mild infection. 

Aim: Therefore this study aimed to evaluate the performance of four chemiluminescence immunoassays and a rapid immunochromatographic assay in 100 rRT-PCR diagnosed-recovered frontline HCW with milder COVID-19 disease and secondly to evaluate the seroprevalence of SARS-CoV-2 infection in the asymptomatic frontline HCW at a multispeciality hospital in Delhi, India.
Study Design: Serum and plasma samples were obtained from 100 rRT-PCR diagnosed-recovered frontline HCWs with mild disease working across the hospital, and performance of four common chemiluminescence immunoassays evaluated. Also samples of 505 asymptomatic, frontline HCWs working in hospital, who had not developed or shown any symptoms of COVID-19 infection to date was collected and the seroprevalence of infection was evaluated.

Place and Duration of the Study: A study was conducted at BLK Superspeciality Hospital, New Delhi from September to October 2020.

Methods: Four chemiluminescence immunoassays [Abbott SARS-CoV-2 IgG (Nucleocapsid), Roche Elecsys® Anti-SARS-CoV-2 Total (Nucleocapsid), Ortho-Clinical Diagnostics: VITROS Anti-SARS-CoV-2 IgG (Spike) and Anti-SARS-CoV-2 Total (Spike)] and a rapid assay [Medsource Ozone Biomedicals] were evaluated in 100 rRT-PCR diagnosed-recovered frontline HCW with mild disease. Also, seroprevalence was studied in 505 asymptomatic, frontline HCW. 

Results: At manufacturers' thresholds, overall sensitivity for Abbott was 71%, Roche 96%, Ortho (both total and IgG(S) 99% and rapid card 56%. Seroprevalence in asymptomatic frontline HCW was found to be 17.6%, with positivity being higher in the HCW group not facing patients directly compared to direct patient caregivers (P = 0.0034).

Conclusion: Assay performance depends on assay design (total IgM & IgG antibodies versus IgG alone), choice of antigen, and time of sample testing from the onset of disease. In our study, Ortho Vitros total-Ab; IgG (Spike), and Roche Elecsys total-Ab (Nucleocapsid) assays were found to have optimal sensitivity. A seroprevalence study in the frontline HCWs at our institute showed that seroprevalence was higher (17.6%) in HCWs in comparison to the community.

Open Access Original Research Article

Assessment of Gene Frequencies of Human Platelet Alloantigens in Rivers-State, Nigeria Based on ABO/Rhesus Blood Groups Distribution

J. E. Wenah-Emmanuel, E. M. Eze, E. O. Nwachuku, E. Wenah, Z. A. Jeremiah

International Blood Research & Reviews, Page 23-31
DOI: 10.9734/ibrr/2021/v12i330152

Aim: The aim of this study was to assess the Gene Frequencies of Human Platelet Alloantigens in Rivers-State, Nigeria based on ABO/Rhesus blood groups distribution

Study Design:   A randomized controlled trial.

Place and Duration of Study: Rivers State University Medical Centre, Port Harcourt, Safety Molecular Pathology Laboratory, Enugu State, Justcare clinical laboratory Port Harcourt Rivers State and University of Port Harcourt Teaching Hospital, between October 2019 and March 2020.

Methodology: The subjects consisted of apparently healthy individuals who were of Rivers State origin totaling 104 persons aged 17 to 42 years. They were under-graduate and post graduate students of Rivers State University of Port Harcourt. Five major ethnic groups were considered which included Ikwerre, Ogoni, Ijaw, Etche and Ogba. Their demographic information was collected using a sample register and a questionnaire. Samples were collected from the antecubital vein. 10ml of blood was collected, 5ml was transferred into EDTA sample bottle (Ethylene diamine tetracetic acid) while 2ml was dispensed into plain bottle and labeled accordingly. Serological testing including HIV (RVS) screening, HBsag, HCV and VDRL were all as part of the inclusion criteria immediately after samples were collected. The remaining sample was analyzed using genotyping of Human Platelet Antigens by High Resolution Melting Curve Analysis Polymerase Chain Reaction (HRM-PCR), while tile method also known as forward/cell grouping method which is based on haem-agglutination reaction was used for ABO/Rh blood grouping. The melt curve analysis was done using the MicPCR software while the frequency analysis was done using Number Cruncher Statistical Software (NCSS) Version 13. GraphPad Prism Version 8.0.2 was used to determine the statistical significance between the various HPA genotypes and the ethnic groups and p-values of < 0.05 were considered to be statistically significant. Results were presented in percentages, mean+/- standard deviation and in tables

Results: The results showed that the A+ blood group had highest frequencies of 19.2% and 17.7% for HPA-5 b/b and HPA-4 a/a, while the least was 0.8% each for HPA-3 a/a, HPA-4 b/b and HPA-5. For blood group B+, the highest were 20.0% (HPA-5 b/b) and 16.7% (HPA-3 b/b), and the least were 5.0% each for HPA-1 b/b and HPA-4 a/b, while blood group B-  had highest frequencies for HPA-1 a/a, HPA-2 b/b, HPA-3 b/b, HPA-4 a/b and HPA-5 b/b (20.0% each). The blood group O+ HPA gene patterns had their highest values at 19.7% (HPA-5 b/b), 16.5% (HPA-4 a/a) and 13.7% (HPA-3 b/b) and the least was 7.9% (HPA-1 a/b), while for the blood group O-, the highest was observed for HPA-3 b/b and HPA-5 b/b (20.0% each) and the least for HPA-1 a/a and a/b, HPA-2 a/b and b/b, and HPA-4 a/b and b/b (10.0% each).

Conclusion: Based on the results, we conclude that A+ blood group had highest HPA frequencies. Whilst, the highest for blood group B+ were (HPA-5 b/b) and (HPA-3 b/b), and blood group B- had highest frequencies for HPA-1 a/a, HPA-2 b/b, HPA-3 b/b, HPA-4 a/b and HPA-5 b/b. The blood group O+ HPA gene patterns had their highest values (HPA-5 b/b), (HPA-4 a/a) and (HPA-3 b/b) and the least was (HPA-1 a/b), while for the blood group O-, the highest was observed for HPA-3 b/b and HPA-5 b/b and the least for HPA-1 a/a and a/b, HPA-2 a/b and b/b, and HPA-4 a/b and b/b.

Open Access Original Research Article

Survival in Patients with Acute Lymphoblastic Leukemia and COVID-19 in Mexico

Patricia Zagoya Martinez, Jose Alejandro Limon Flores, Jose Alfredo Vidal Vidal

International Blood Research & Reviews, Page 32-39
DOI: 10.9734/ibrr/2021/v12i330153

Aims: To determine the survival of patients with acute lymphoblastic leukemia and COVID-19.

Study Design: Prospective, analytical and relational.

Place and Duration of Study: Hematology department, Hospital of Specialties, High Specialty Medical Unit, National Medical Center "Gral. Manuel Avila Camacho", Puebla, Mexico, during the period June 2020-April 2021

Methodology: Patients aged 15 to 64 years, both sexes, with acute lymphoblastic leukemia and a confirmed diagnosis of COVID-19 by PCR. The variables included were; sex, age (groups: 15-20; 21-29; 30-39; 40-49; 50-59; and 60-64), comorbidities, general treatment and hematological treatment response. Survival was determined for the diagnosis of COVID-19 for 11 months, using the Kaplan Meier estimator and the Log-Rak test; Cox regression model (univariate and multivariate); as well as Chi square and V-Cramer with a 95% confidence interval and using the statistical program SPSS Ver. 25.

Results: The study consisted of 20 patients, of which 33.3% were women, with an average age of 37.75 ± 11.63 years; The men registered an age of 28.50 ± 18.05 years. Overall survival was 50%, with a lower limit of 101.3 and an upper limit of 242.5 days, with a mean of 171.9 days; and median at 17 days. No significant differences were found in survival regarding sex, comorbidities, general treatment and hematological response. However, mortality in patients with comorbidities was higher (p = 0.051).

Conclusion: Survival in patients with acute lymphoblastic leukemia and COVID-19 is low, due to complications that increase mortality, mainly owing to hematological suppression, and even more so with the presence of comorbidities.

Open Access Case Study

Chronic Lymphocytic Leukemia in an Adolescent Girl: A Case Report and Clinico-Pathologic Review

Neelum Mansoor, Naeem Jabbar, Hamza Khan, Ameerah Shaikh, Saba Jamal

International Blood Research & Reviews, Page 1-8
DOI: 10.9734/ibrr/2021/v12i330150

Chronic lymphocytic leukemia (CLL) in pediatric age is rare in the literature. It is a common disease of older adults, characterized by clonal proliferation and progressive accumulation of monoclonal B-cell lymphocytes. The diagnosis is established by immunophenotyping and prognosis is defined by staging system (Rai and Binet), as well as by several biological and genetic markers. We report a case of CLL diagnosed in an adolescent girl presented at 16 years of age. The case is being reported to improve awareness regarding this rare entity in children.

Case Presentation: A 16 year old female presented with fever, weight loss and cervical lymphadenopathy. After baseline workup, lymph node biopsy, bone marrow biopsy along with immunohistochemistry and flowcytometry on peripheral blood was performed to establish the diagnosis. The clinico-pathologic features including extensive immunophenotyping were consistent with CLL.

Discussion: Management guidelines for older adults are very well established but no standardized protocol exists for pediatric age group. We offered her Fludarabine and Cyclophosphamide as first line regimen and she responded well and achieved remission after four cycles. Unfortunately disease relapsed within two years. At this time, determination of optimum therapeutic protocol was a unique challenge as hematopoietic stem cell transplant (HSCT) was not available at our institute.

Conclusion: CLL is an extremely rare malignancy in childhood and adolescence. Therefore age specific treatment protocols are not established. Reporting this case will help in eliciting the high index of suspicion among pathologists and oncologists for this exceptionally unusual and life threatening disease so that delays can be avoided.