Sir Ganga Ram Hospital, New Delhi, India

Blood Transfusion Medicine

The hospital being a premier tertiary care hospital, patients come from all over the country and neighbouring countries. A licensed blood bank exists in the hospital since 1974 and has the stat-of-art equipment and technology. Good Manufacturing practices (GMP) are followed at all phases of donors selection & screening, phlebotomy, serological blood processing and preparation of blood components. Standards in the techniques and quality control are meticulously maintained as laid down in the Drugs and Cosmetic Act, of the Regulatory Authority, Director Drugs Controller (india), Ministry of Health & Family Welfare, Government of India, National Accreditation Board for hospital and health Care Providers and WHO.

Objectives & Aims:

Ensure easily accessible and adequate supply of safe and good quality Blood and its components in time.Supply blood and its components tested for the transfusion transmitted infections by Elisa & NAT. Assures the supply of blood and its components safe as much as possible and of good quality to the patients. Provide high quality services. Services are managed by highly qualified and trained personnels.Department runs round the clock and blood and its components are supplied as and when requested

The annual requirement of blood in Delhi and from neighboring areas is about 5,00,000 units of blood, and all blood centers collect about 3,50,000 units of blood. That means there is shortage of blood about 1,50,000 units of blood every year. The blood center of this hospital needs about 100 blood donors every day to meet the transfusion need of patients of this hospital. With increase in population and development of more advanced medical and surgical procedures, the need of blood is ever increasing. There is no substitute for blood. Only blood donors can help to maintain adequate supply of blood to save the lives of those who need it.You can help the blood center to meet the need of blood by donating blood yourself and motivating your friends / colleagues to donate blood and by becoming regular voluntary blood donor.Source of Blood Blood is accepted from voluntary, non-remunerated healthy donors and relatives and friends of the patients who are healthy with no history of any infection after proper counseling. Donors with history of transfusion transmitted infection or have risk behaviors for acquiring them are advised to exclude themselves from donating blood.

  • A blood donor must be in good health§  Age between 18 to 65 years§  Weight about 50 kg or more.
  • Hemoglobin level at least 12.5 g/dl.
  • It is safe to donate blood every three months
  • Persons with high risk behavior for having AIDS and who had jaundice (Hepatitis B or C) should exclude themselves from blood donation Blood donation procedure

Blood donation is simple harmless and painless procedure and consists of:

  • Registration – Blood donation form is filled
  • Donor Counseling
  • Medical examination; blood is taken if the person is medically fit
  • Simple laboratory tests- Hemoglobin estimation, ABO & Rh(D) grouping is done before donation Blood is withdrawn with sterile and disposable needle in bags.
  • There is no chance of getting any infection by donating blood.
  • Actual blood donation takes 8-9 minutes

Some drink / refreshment is given after donation and donor is advised to rest for 8-10 minutes.

Services Provided:

  • Screening of blood for transfusion-transmitted diseases
  • Anti-HIV 1 & 2 by ELISA by fourth generation test and HIV-1 by NAT
  • HBV (HBsAg) by ELISA and NAT
  • HCV (anti-HCV) by ELISA and NAT-Syphilis-Malaria
  • Red Cells serology - tests for ABO & Rh(D) group
  • Antibody screening for complete and incomplete antibodies
  • Antihuman globulin test - manual and I.D. Gel column  technology
  • Titer of complete antibodies in saline
  • Titer of incomplete antibodies by antihuman globulin test (I.D. Gel technique)
  • Compatibility test is done both for complete & incomplete antibodies
  • Compatibility test for incomplete antibodies is done by Coombs' test (I.D.Gel Technology)
  • Adverse reactions of blood transfusion are investigated.

Blood Components Available

  • Leukocytes-reduced & depleted Red cells
  • Leukocytes reduced Platelet concentrate Leukocytes reduced Fresh Frozen Plasma Leukocytes reduced Cryoprecipitate

Leukocytes-Reduced Blood Components

Donor leukocytes present in cellular blood components are linked to wide range of transfusion adverse reactions mainly non-hemolytic reactions (FNHTR), HLA alloimmunization, platelet refractoriness, transfusion related acute lung injury (TRIAL)

Techniques for preparing leukocytes reduced components are:

  • Semi-automated method (using Top and Bottom quadruple bags and Automatic Electronic Component Extractor (OPTI II / T- ACE II)
  • Pre-storage leukocytes-depleted blood component are prepared in blood bags with inline integral leukocytes-depletion filter Apheresis

Leukocytes-Reduced/Depleted Red Blood Cells

1. Red blood cells leukocytes reduced to log 1 (80-85%) in 1 unit of red blood cells  prepared by removing buffy coat and stored in additive solution Adsol for 42 days2.    Pre-storage red blood cells leukocytes-depleted to log 3 (99 –99.9%) in 1 unit of red blood cells prepared by removing buffy coat and filtering red blood cells through inline leukocytes depletion filter and stored in SAG-M additive solution for 42 days.

Platelet Concentrates:

  • Preparation of random donor platelets from buffy coat - platelet yield is ≥ 5-6X 1010.
  • Platelet Apheresis – Platelet yield is 3.5-5 X 1011, leukocytes reduced to log 3 (99.9%) in 200 ml plasma

Plasma

  • 180 –200 ml in one unit, leukocytes-reduced
  • Can be kept in frozen state (FFP) at – 300 to - 400C for 1 year

APHERESIS

What is Apheresis?

Apheresis is special type of donation in which a specific component, viz. platelets, gametocytes (white cells) plasma or stem cells are withdrawn from a donor using special equipment called Cell Separator: the remaining components are returned into donor’s blood circulation. It is very safeWhat is the advantage of Apheresis.

Random Donor Platelet concentrate prepared from one unit of whole blood contains less number of platelets. For therapeutic dose of platelets for an adult patient 6-8 units of random donors platelets are required, while one unit of platelets prepared by apheresis is sufficient. Besides platelets prepared by apheresis are leukocytes reduced. Thus there are less chances of transfusion transmitted-infections and platelet refractoriness with the use of platelet apheresis.

The following procedures of Apheresis are done:

  • Platelet Apheresis
  • Granulocytes  Apheresis
  • Plasma apheresis
  • Therapeutic plasma exchange
  • Peripheral blood stem cells collection, and can be preserved in DMSO solution at --800 C for 1year if required for autologous and allogenic transplantation

Cryoprecipitate (Factor V111)

Prepared on the specific demand from fresh frozen plasma.

Merits of Platelet-Apheresis

  • Average yield of platelets is 3.5 - 5x1011 in one unit
  • Plasma volume 200 ml
  • Leukocytes are < 5.5x106 in one units
  • Low risk of alloimmunization & platelet refractoriness

Common conditions for therapeutic plasma exchange are:

  • Myaesthenia Graviso Goodpastures syndrome Acute Gullian-Barre syndrome Waldenstorm's macroglobinaemiao Inflammatory / Idiopathic Neuropathy.
  • Plasma Exchange have been done in cases of Myaesthenia Gravis and Inflammatory & Idiopathic neuropathies.

Common conditions for peripheral stem harvesting:

  • Multiple Myelomao Leukemia in remissiono Lymphomaso Cancers Peripheral Stem Cells harvesting for autologous transplantation have been done in cases of multiple myeloma.

Recent addition:

Fully Automated Immuno-Hematological Analyzer IH-1000 for doing ABO cell and serum & Rh(D) grouping, antibodies screening and identification, cross-matching and other blood serology tests. It can processes 160 samples at a time and can randomly access fresh blood samples for processing in between. 100% of blood collected is processed into leukocytes reduced/ depleted blood components since last 2 years. It eliminates allergic and febrile non hemolytic transfusion reaction.