Analysis of RBC Antibody Screening in a Hospital Population Over a Two Years Period

Table of contents

1. I. Material & Methods

total of 378 patients and 2050 donors were included in this study period of two years (July 2016 to June 2018) in the Department of Pathology, St. Stephens Hospital, New Delhi, India. All the hospital population (patients as well as donors) blood samples were included in the study. The antibody screening tests performed were Indirect Coomb's tests, Direct Coomb's tests and Auto control. The method of screening used was gel card technology.

2. II. Statistical Analysis

Qualitative variables are expressed as frequencies / percentages and compared between groups using Chi-square / Fisher's Exact Test. Quantitative variables are written regarding mean ± sd and compared using Unpaired t-test / Mann-Whitney Test. A p-value < 0.05 is considered statistically significant. The data is tabulated in MS Excel and analysis performed using Statistical Package for Social Sciences (SPSS) version 16.0 software.

3. a) Study Design

4. Cross-sectional study b) Sample Size Determination

The formula used for sample size estimation was d 2 n=Z? 2 P(1-P)

5. III. Result and Discussion

Our study included 378 patients and 2050 donors. The age of patients ranged from new born to 80 years with a mean age of 28.64 years. The maximum Author ? ? ? ? ¥: DNB, Junior Resident and Department of Pathology, St. Stephen's Hospital, Delhi. e-mails: [email protected], [email protected], [email protected], [email protected], [email protected] number of cases were in the age group of 21-30 years (58.20 %), followed by 31-40 years (19.84 %) and two cases were in the age group of 71-80 years (0.53 %). Female predominance was seen with a male to female ratio of 1:5.6. The most common causative factors in our study were the previous history of transfusion, females presented with pregnancy either primigravida or multigravida and Rh-negative blood group. Blood group B was the most frequent blood group followed by blood group O. The present study has an alloimmunization rate of 3.44% which is comparable to all the other studies mentioned above. A study by Nikam et al. 7 had least alloimmunization rate of 0.74 %. Choudhary et al. had the highest alloimmunization rate of 9.8%. 3 The percentage of alloimmunization in all the abovementioned studies fall somewhere between <1% to 10%. According to published data rates of alloimmunization in random patients vary from 0 to 3 observational studies in random patients, who most often receive an incidental transfusion, and pregnant women estimated the prevalence between <1-3%. 12 This incidence increases in multi-transfused patients and transfusion-dependent patients. The reported prevalence of alloimmunization in multi-transfused patients in India is comparatively low varying from approximately 3% to 10%. 3,9,13

6. a) Analysis of Autocontrol in Patients

Out of 378 cases, two patients showed auto control positivity.

Out of 378 patients, AC was positive only in two patients, and those were females (0.53%). Among those two patients, one was Rh-positive and the another one was Rh-negative. History of previous transfusion (1.7%) is the most common cause of auto antibodies followed by pregnancy (0.43%). Similarly, in our study, one patient had history of transfusion and other was a pregnant female had auto control positive rate. It was observed in our study that antibodies are more commonly found in the age group between 20-40 years.

There is a paucity of literature on the detection of antibodies by auto control. In our study, only ten donors had antibodies in their blood (0.49%). Makroo RN et al. drawn similar results in his study in which out of 82153 donors 227(0.27%) had antibodies in their blood. 17 The study by Pahuja S et al. had a total of 7756 donors out of which 4(0.05%) donors had antibodies in their blood. 16 Garg N et al. had a similar result of 0.09% antibodies in 47450 donors. 18 The blood with antibodies were discarded and not transfused to patients.

7. IV. Conclusion

Clinically significant antibodies were frequently detected in our patients and donors population. Alloimmunization in Rh D positive women was low as compared to Rh D negative women. The previous history of transfusion was an important cause for the development of antibodies. Males were more than females in donor population showed that males are more active in donating the blood.

We recommended that ? Antibody screening must be done both in patients and donors to find the irregular antibodies. ? Antibody screening should be done in pregnant females to prevent Rh incompatibility or HDFN. ? Antibody screening should be done in donors to detect the presence of alloantibodies and is an important to provide compatible blood products and to avoid transfusion reactions. ? Multi-transfused patients have a high probability of developing alloantibodies, so extended screening is recommended in the patients to prevent hemolytic transfusion reactions.

Figure 1. Table 1 :
1
Year 2018
3
Total Patients n = 378 Gender Distribution Gender n Male 57 Female 321 Total 378 Age Group (Years) Age (Years) n % 15.08% 84.92% 100% % Volume XVIII Issue II Version I
? 10 11 -20 29 16 7.67% 4.23% ( D D D D )
21 -30 31 -40 41 -50 51 -60 61 -70 71 -80 Total 220 75 14 13 9 2 378 58.20% 19.84% 3.70% 3.44% 2.38% 0.53% 100% Medical Research
Mean ± sd ABO Blood Group 28.64 Blood Group n A 88 B 138 AB 42 ±12.13 % 23.28% 36.51% 11.11% Global Journal of
O 110 29.10%
Total 378 100%
Rh D Distribution
Rh D Positive 352 93.12%
Rh D Negative 26 6.88%
Note: In our study ICT was positive in patients with mean age of 30.24 years, whereas DCT was positive in patients with mean age of 37.04 years and AC was positive with a mean age of 30.59 years.A
Figure 2. Table 2 :
2
Author Year Total Patients All Immunised Patients (ICT Positive Cases) The Rate of Alloimmunization (%)
Sirchia et al. 1 1985 1432 74 5.2
Chow et al. 2 1994 436 26 6
Choudhary et al. 3 1999 81 8 9.8
Ansari et al. 4 2007 80 3 3.75
Roopam et al. 5 2009 96 5 5.21
Pahuja et al. 6 2010 211 8 3.79
Nikam et al. 7 2011 74 1 0.74
Usman et al. 8 2011 800 30 3.75
Sood et al. 9 2013 306 13 4.24
Makroo RN et al. 10 2014 49,077 403 0.82
Present study 2018 378 13 3.44
Figure 3. Table 3 :
3
Author Year Total Patients All Immunised Patients (DCT Positive Cases) The Rate of Alloimmunization (%)
Nakamura Y et al. 14 1984 421 14 3.3
Pahuja S et al. 6 2010 211 - 0.47
Valsami S et al. 15 2015 2695 70 2.59
Present study 2018 378 15 4.23
DCT is the cornerstone of the diagnosis of
hemolytic disease of the newborn (HDN). In our study,
out of 378 patients, DCT was positive in 16 patients. The
positivity rate of DCT in our study was 4.23%. Pahuja S
et al. drawn similar results by DCT and had a 0.47% rate
of immunization. 6
Figure 4. Table 4 :
4
Study Year Total Doners All Immunised Doners (ICT Positive) The Rate of Alloimmunization (%)
Pahuja S et al. 16 2013 7756 4 0.05
Garg N et al. 18 2014 47450 46 0.09
Makroo RN et al. 17 2018 82153 227 0.27
Present study 2018 2050 10 0.49
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Appendix A

  1. Clinically Significant Minor Blood Group Antigens amongst North Indian Donor Population. D S Lamba , R Kaur , S Basu . Adv Hematol 2013. 2013. p. 215454.
  2. Red cell alloantibodies in thalassemia major. G Sirchia , A Zanella , A Parravicini , P Rebulla , F Morelati , G Masera . Transfusion 1985 Mar 4. 25 (2) p. .
  3. Red cell alloimmunization in transfused patients: A silent epidemic revisited. H Pandey , S S Das , R Chaudhary . Asian J. Transfus Sci 2014 Jul. 8 (2) p. .
  4. Red blood cell alloantibodies after transfusion, H Schonewill , Leiden . 2008. University Press.
  5. A prospective study for detection and identification of red cell alloantibodies in multiply transfused thalassemia major patients: 34 th National Congress of Indian Society of Blood Transfusion and Immune Haematol, J Roopam , J Perkins , J T Susan , N A Choudhury . 2009. p. .
  6. Red cell alloimmunization in multi-transfused chronic renal failure patients undergoing hemodialysis. J S Shukla , R K Chaudhary . Indian J Pathol Microbiol 1999. 42 p. .
  7. Red cells, HLA and platelet antibody formation in patients with multiple transfusions. M P Chow , H Y Hu , J Y Lyou , J S Lin , C H Yung , A Lee , T D Lee . Actahaematologica 1994. 92 (2) p. .
  8. Frequency of red cell alloimmunization among patients with transfusion dependent beta thalassemia in Pakistan. M Usman , M O Saira , M Moinuddun , S Ahmad , R Perveen , S Usman . Int. J. Hematol Oncol 2011 Jan: 1: 27. (4) p. .
  9. Prevalence of irregular red blood cell antibodies among healthy blood donors in Delhi population. N Garg , T Sharma , B Singh . Transfus Apher Sci 2014 Jun 1. 50 (3) p. .
  10. Antibody screening and identification in the general patient population at a tertiary care hospital in New Delhi. R N Makroo , A Bhatia , N L Rosamma . India. Indian J. Med Res 2014 Sep: 140. (3) p. .
  11. Prevalence of irregular red cell antibody in healthy blood donors attending a tertiary care hospital in North India. R N Makroo , S Rajput , S Agarwal , M Chowdhry , B Prakash , P Karna . Asian J Transfus Sci 2018 Jan: 12. (1) p. .
  12. Detection of alloimmunization to ensure safer transfusion practice. R Sood , R N Makroo , V Riana , N L Rosamma . Asian J. Transfu Sci 2013 Jul: 7. (2) p. 135.
  13. Prevalence of red cell allo-immunization in repeatedly transfused patients with B-thalassemia in. S A Nikam , S B Dama , S A Saraf , C J Jawale , R V Kirdak , R P Chondekar . Organized by Department of Zoology, D.B.F. Dayanand College of Arts and Science 2011. p. . (Bio-Resources for Bio-Industries and Economic Zoology)
  14. Assessment of frequency of alloimmunization and erythrocyte autoimmunization in transfusion dependent thalassemia patients. S Ansari , P V Moshtaghian . Acta MedicaIranica 2008. 46 (2) p. .
  15. Alloimmunization and red cell autoimmunization in multi-transfused thalassemics of Indian origin. S Pahuja , M Pujani , S K Gupta , J Chandra , M Jain . Hematology 2010 Jun 1. (3) p. .
  16. Screening of blood donors for erythrocyte alloantibodies. S Pahuja , S Kushwaha , N Sethi , M Pujani , M Jain . Hematology 2012 Sep 1. (5) p. .
  17. Importance of direct antiglobulin test (DAT) in cord blood: causes of DAT (+) in a cohort study. S Valsami , M Politou , T Boutsikou , D Briana , M Papatesta , A Malamitsi -Puchner . Pediatr Neonatol 2015 Aug 1. 56 (4) p. .
  18. Significance of positive direct antiglobulin test for cord blood -in administration of anti-d-immunoglobulin for postpartum immuneprophylaxis. Nihon Sanka Fujinka Gakkaizasshi, Y Nakamura , I Sada , S Tanaka , Y Nomura , S Shinagawa . 1984 Apr: 36. p. .
Notes
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Analysis of RBC Antibody Screening in a Hospital Population Over a Two Years Period
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Date: 2018-01-15