Poster Abstracts

PP 1: Thematic Area: Immunohematology: Frequency of ABH Ag secretors and non-secretors in blood donors in a blood Centre of Eastern UP using saliva samples

Bharti Bharti, Prashant Kumar, Ravi Rani Mishra

Motilal Nehru Medical College, Prayagraj, Uttar Pradesh, India

Background: ABO blood group antigens are not only expressed on red blood cells but also in body fluids such as saliva, tears, semen etc., depending on the secretor status of an individual. The ability to secrete these antigens is governed by the presence of a functional FUT2 gene. Secretor status has significant forensic, epidemiological and clinical relevance, including its association with susceptibility to certain diseases. The frequency of secretors and non-secretors can vary across populations and geographical regions, making regional data essential.

Aims: To determine the frequency of secretors and non-secretors in the eastern region of Uttar Pradesh, India, using saliva samples and to analyze the distribution in relation to ABO blood groups.

Methods: A cross-sectional study was conducted on 100 healthy blood donors residing in the eastern UP. Unstimulated saliva samples were collected and subjected to the agglutination-inhibition method for the detection of ABH antigens. Individuals were categorized as secretors and non-secretors based on the presence or absence of ABH antigens in their saliva.

Results: Among the 100 donors tested, 83% were found to be secretors, while 17% were non-secretors. A higher frequency of secretors was observed among individuals with blood group B. The secretor status distribution showed statistically significant variation with respect to ABO blood groups (p < 0.05).

Conclusion: The study reveals that the majority of the population in eastern UP are secretors, aligning with global trends. The observed frequency highlights the genetic uniformity and can be of significant utility in forensic identification and disease association studies in this region.

PP 2: Thematic Area: Immunohematology: A case of autoimmune hemolytic anemia with positive direct coombs test in a pediatric patient at RIMS Imphal

Eppili Shasi Bhusan Rao, Pratima Kh

Regional Institute of Medical Sciences, Imphal, Manipur, India

Background: A 10-year-old female presented with a 10-day history of fever, viral exanthem, and generalized lymphadenopathy. On examination, she had hepatosplenomegaly, pallor, and red-colored urine, suggestive of hemolysis. A Direct Coombs Test (DCT) was ordered on 20.02.25. Laboratory findings revealed:

Hemoglobin: 7.2 g/dL

Hematocrit: 17.8%

Platelet count: 30,000/μL.

Peripheral smear showed -moderate anisocytosis, microcytic hypochromic cells with polychromasia, macrocytes, and occasional nucleated RBCs. Liver function test showed:

Total bilirubin: 3.4 mg%

Direct bilirubin: 1.5 mg%

Urine microscopy revealed - Granular casts.

Methodology: Initial immunohematological investigations:

DCT (Tube method): Polyspecific = 1+

Gel card: Monospecific anti-IgG = 2+

Indirect Antiglobulin Test (IAT): 1+

Antibody screen: 3-cell panel = Positive

Antibody identification: 14-cell panel = Pan-reactive.

Outcome:

Blood grouping (Tube method): Forward = A+ve; Reverse = A

Thermal amplitude testing with pooled O cells:

4°C: 1+ (1:16)

Room Temp: 1+ (1:2)

37°C: Negative.

Donath-Landsteiner test: Positive (Hemolysis at 4°C x 90 min)

Crossmatch (AHG method): Compatible

Gel card: 1+ reaction

Transfusions :

21.02.25: 3 units Platelets, 1 unit PRBC (least incompatible)

23.02.25: 1 unit PRBC (compatible)

Conclusion: This case report presents a 10-year-old girl with autoimmune hemolytic anemia (AIHA), confirmed by DAT positivity and pan-reactive autoantibodies, likely triggered by a recent viral illness. Clinical findings included pallor, hemoglobinuria, thrombocytopenia, and hepatosplenomegaly. Transfusion was guided by clinical symptoms rather than strict hemoglobin thresholds, using least incompatible PRBCs. Auto-adsorption was performed to exclude underlying alloantibodies, as there was no recent transfusion history. The case emphasizes the importance of early recognition, detailed immunohematologic workup, and appropriate transfusion support. In pediatric AIHA, careful monitoring and individualized transfusion strategies are essential to ensure safe and effective management while minimizing potential complications.

PP 3: Thematic Area: Blood Safety and Infectious Disease Marker testing (Including NAT Testing): Leveraging CMV-negative blood donors: A database initiative for transplant patient care

Rakesh Kumar, Shweta Ranjan, Nishith Nayan, Bankim Das, Saurabh Lahre, Ruchi Sinha

AIIMS, Patna, Bihar, India

Background: Cytomegalovirus (CMV) is an important cause of mortality and morbidity in transplant recipients. Transfusion-transmitted CMV (TT-CMV) cannot be prevented by pre-donation screening or post-donation serologic testing. This study aims to determine CMV prevalence, build a database of eligible CMV-negative donors, and assess factors influencing donor willingness and barriers to mobilizing dedicated donors.

Materials and Methods: This prospective study was conducted on 2110 whole blood donors from November 2024 to January 2025. The seroprevalence of anti-CMV IgG and IgM antibodies were assessed. A database of CMV-negative donors was created, and these donors were encouraged to enrol in the database which is essential for supporting transplant recipients.

Outcome: Out of 2110 donors, the seroprevalence of anti-CMV IgG antibodies was 95.8%, IgG with IgM was 0.28%, while none were seropositive for IgM (0%). Among the donors, 3.93% (n=83) were CMV-negative, of which 34.94% (n=29) agreed to enrol in the database, and only 9.2% (n=7) of replacement donors consented to donate voluntarily for transplant recipients. The most common reason for refusal to donate was lack of time.

Conclusion: This study aims to determine the prevalence of CMV in the population and identify CMV-negative individuals to build a database of eligible donors willing to provide blood or components for transplant patients. Ensuring a reliable CMV-negative donor pool could significantly improve transplant outcomes in vulnerable patients.

PP 4: Thematic Area: Immunohematology: An analysis of immune-haematological anomalies in whole blood donors at a tertiary care oncology institute of North India

Anju Dubey

Kalyan Singh Super Specialty Cancer Institute, Lucknow, Uttar Pradesh, India

Background: As per the guidelines of National Standards for blood centres in India, it is mandatory to perform determination of ABO group, determination of Rh (D) type and tests for detecting unexpected antibodies in the serum of all donor samples. The aim of the study is to analyse the immune-haematological anomalies in whole blood donors at our centre.

Methods: 5000 whole blood donor samples were analysed for the presence of immune-haematological anomalies in post donation samples. ABO group and Rh type was determined by testing red cells using column agglutination. In case of Rh-negative typing, weak D testing was done using the IAT method using IgG anti-D and AHG. Detection of unexpected antibodies was done using pooled O cells on column agglutination technology.

Results: ABO Blood grouping discrepancies were found in 2 donor samples. The cause was ascertained to be weak A sub- groups. The discrepancies were resolved by using lectins and secretor studies. One Rh negative samples were identified as weak D and subsequently marked as Rh positive. Unexpected antibodies were detected in 3 blood donor samples. On further identification, they were found to be Anti – D in 2 cases and anti-M in one case. Four donor units were DAT positive which were detected during workup for incompatible cross match. One of the donors was found to be suffering from an autoimmune disease while other 3 were healthy with no history of disease.

Conclusion: Thorough immune-haematological workup is essential to rule out anomalies in post donation samples of apparently healthy blood donors. Further workup should be done and only suitable components should be issued to mitigate chances of adverse reactions in the recipient. DAT positive donors may be followed up for clinical evidence of hemolysis and development of autoimmune diseases or malignancies in long run.

PP 5: Thematic Area: Immunohematology: The hidden culprits in immunohematology: A case report and review of literature of serological interferences from reagent-dependent antibodies

Vidya Rekha R. Kamath

Yenepoya Medical College Hospital Blood Centre, Ullal, Karnataka, India

Background: Pretransfusion testing is paramount in transfusion services as it identifies clinically significant antibodies. However, during routine tests, we may occasionally encounter a few non-specific or nuisance antibodies. These antibodies are not directed against known blood group antigens and typically are of no clinical significance. Despite being harmless, their unpredictable reactivity can lead to additional unnecessary immunohematological investigations.

Case Report: We received the blood sample of a 29-year-old male with polytrauma posted for surgery for pre-transfusion testing. The sample was typed as “O” positive without any discrepancy in blood grouping by automated column agglutination technique. His hemoglobin was 8.8 g/dl, so two packed red cell (PRBC) units were requested for surgery. Compatibility testing was done with two units of “O” positive PRBC bags, and it was found that they were incompatible. Further immunohematological workup was initiated. Autocontrol and Indirect antiglobulin test (IAT) were positive (2+ reaction). In contrast, the Direct antiglobulin test (DAT) was negative, and antibody screening with a three-cell panel showed panreaction. There was a history of previous blood transfusions 2 weeks ago. The sample was sent to a higher referral laboratory for further testing. Antibody identification using an 11-cell panel also showed a pan reaction. This was observed only with reagent red cells, so a repeat antibody screening test was performed using saline-washed cells. All the tests repeated using saline were negative. From the above result, an antibody against a low-ionic-strength solution (LISS) was suspected and reported by the Referral Laboratory. Further cross-matching of blood units done using the saline solution was compatible. The patient was transfused uneventfully.

Conclusion: A pre-transfusion test is crucial to ensure a safe blood transfusion. Any observed incompatibility must be resolved before transfusion. In rare instances, antibodies directed against enhancement media may be the underlying cause of crossmatch incompatibility.

PP 6: Thematic Area: Blood Safety and Infectious Disease Marker Testing (Including NAT Testing): Trends of syphilis amongst voluntary blood donors – An analysis

Palak Panchal, Archana Pandey, Jhalak Patel

Indian Red Cross Society, Ahmedabad, Gujrat, India

Background: Syphilis is a chronic infectious disease caused by Treponema pallidum and is one of the transfusion-transmissible infections (TTIs) screened during routine blood donation. Although voluntary blood donors are generally considered low-risk, detection of syphilis among this group can reflect broader trends in the community and help in assessing blood safety. To study the prevalence and trend of syphilis among voluntary blood donors over a defined period, and to observe any significant demographic patterns.

Materials and Methods: This retrospective study was conducted at the Indian Red Cross Society, Ahmedabad District Branch over a period of 10 years from January 2015 to December 2024. All voluntary blood donors were screened for syphilis using 3 rd generation Enzyme-Linked Immunosorbent Assay (ELISA) method. Reactive samples were confirmed using ELISA and Chemiluminescence method. Data was compiled and analyzed yearly to assess trends.

Results: Total of 490,244 voluntary blood donors were screened during the study period. Out of these, 2782 samples (0.57%) tested reactive for syphilis. The highest annual prevalence was noted in 2020 and 2021 (0.67%) and the lowest in 2018 (0.50%). The overall trend shows significant rise after COVID-19. After Covid-19 the trend did not show a consistent rise or fall but fluctuated slightly over the years.

Conclusion: The prevalence of syphilis among voluntary blood donors was not negligible. The data suggest the need for strict donor screening protocols and continued public health education regarding sexually transmitted infections. Monitoring trends in the donor population can also provide indirect insight into community transmission patterns.

PP 7: Thematic Area: Immunohematology: A comparative study between two diagnostic modalities for quantifying fetomaternal hemrrhage: An Indian tertiary care centre experience

Anurag Gairola, Ujjwal Dimri 1 , Sudeep Kumar 1 , Rajat Jagani 1 , Amit Ajay Pawar 1

Transfusion Centre, Kolkata, West Bengal, 1 AFMC, Pune, Maharashtra, India

Background: Significant Fetomaternal hemorrhage (FMH) is a phenomenon known to complicate pregnancies and require early and accurate detection to effectively manage such occurrences for which very few quantitative tests are available. The Kleihauer Betke (KB) test and the Flowcytometry (FCM), are well established test in western countries however, the same have not been standardized in Indian population, thus necessitating this study. The KB test and FCM were assessed in terms of detection and quantification of FMH to investigate the concordance and comparative performance between them.

Aims and Objective: Aim of this study was to evaluate and compare the quantification of FMH by KB test and FCM.

Materials and Methods: 50 antenatal participants were included in the study after a written informed consent. Venous blood sample (2 X 3 ml, 01 maternal and 01 Cord blood) were collected in EDTA tube within 24 hrs of delivery. Blood samples were stored at 2-6°. Baseline tests like ABO Rh grouping of mother and baby, maternal Hemoglobin, Indirect Antiglobulin Test/Direct Antiglobulin Test were done and documented. Fetomaternal hemmorhage was quantified with KB test and FCM and the results were documented and statistically analysed.

Results: There was a good correlation between the two methods in terms of detection of significant FMH. The KB test showed a favourable ability to identify significant FMH. Conversely, a negative KB test result reliably excludes significant FMH, offering robust reassurance. In concurrence of our statistical results KB test emerged as a valuable and cost-effective tool in FMH detection, particularly in cases of significant FMH.

Conclusion: Flow cytometry despite being highly sensitive, and a gold standard test, in quantification of FMH, comes with its own sets of challenges for resource poor setups. Use of KB test is a reliable, accessible, readily available and practical alternative to FCM especially in Rh negative pregnancies.

PP 8: Thematic Area: Cellular Therapies: CD34+ cell dose – Predictors and effect on patient outcome in hematopoietic stem cell transplant

Yashaswi Dhiman, Kunal Das, Manish Raturi, Mansi Kala, Avriti Baveja, Dushyant Singh Gaur

Swami Rama Himalayan University, Dehradun, Uttarakhand, India

Background: CD34+cells quantify the dose of HSC (hematopoietic stem cell) for transplant. We evaluated predictors of adequate HSC dose and its effect on patient outcomes.

Objectives: To correlate donor haematological parameters, their increments and pre CD34+ cells with product CD34+ cell yield and establish its minimum thresholds. To analyse CD34+ cell dose effect on outcomes.

Methods: Retrospective analysis (2016–2022) was conducted on all HSCTs. Regression analysis evaluated pre-procedure MNC, TLC, their increments and, pre CD34+ cell count with CD34+cell product yield and ROC derived minimum threshold of significant predictors for adequate yield. Outcomes (engraftment, overall survival (OS), relapse, GvHD, PGF and NRM) were analysed across three dose categories, <5 X 106/kg, 5-7 X 106/kg and >7 X 106/kg. Competing risk survival analysis was done and expressed as (HR, 95%CI, p<0.05).

Results: Total 78 HSCT procedures (allogenic: autologous=50:28) in 63 patients were analysed. TLC (r= 0.01, p=0.89) and MNC (r=0.37, p=0.92) weakly correlated with CD34+cell yield while, TLC increment was moderately correlated approaching significance (r=0.58, p=0.07). PB CD34+cells/µL strongly correlated with product CD34+cell/µL (r=0.71, p=0.006) with 27.25 CD34+ cells/µL (AUC= 85.7%) predicting >4 × 10 6 cell/kg yield (92.9% sensitivity, 75% specificity). Six-year OS was 61.91%. The cumulative incidence of engraftment, relapse (RI), PGF, NRM and GvHD was 85.7%, 22.4%, 16.4%, 9.7% and 18.6% respectively. Dose category III (HR: 3.82, 95%CI: 1.0-13.5, p=0.03) had poor OS with no other dose associations with outcomes. Age (HR: 1.03, 95%CI: 1.003-1.06, p=0.02) male gender (HR: 4.01, 95%CI: 1.16-13.9, p=0.02) and female to male HSCT (HR: 0.03, 95% CI: 0.001–0.5, p = 0.01) were associated with poor outcomes.

Conclusion: Threshold of 27.25 CD34+ cells/ µL to predict >4 × 10 6 cell /kg yield was established. TLC increment correlates with CD34+ yield, offering insights for further research in resource-limited centres. Higher CD34+cell dose negatively affected OS. Gender, age, engraftment and gender heterogeneity affected outcomes.

PP 9: Thematic Area: Apheresis (Donor and Therapeutic): Therapeutic plasma exchange in acute liver failure

Rashmi Sood, Aman Bhatia, Sandeep Rana, Prateek Kumar, Roohi Nagma

Manipal Hospital, Gurugram, Haryana, India

Background: Therapeutic Plasma Exchange (PLEX)used to treat neurological renal hematological diseases since long. Recently increasing evidence of its use treating patients with acute liver failure (ALF) syndromes.

Aim: To further establish treatment with PLEX in case of acute liver failure due to Hepatitis A toxicity to stabilize patient (1) and to do away with need for liver transplantation.

Materials and Methods: PLEX (1.3 Plasma volume each and 80% replacement) done on patient 21 year old male presenting fever nausea vomiting yellow discoloration of eyes skin decreased urine output dehydration generalized weakness diagnosed as acute liver failure due to Hepatitis A viral infection. PLEX performed every alternate day total 4 sessions i.e. on 15, 17, 19, 21 st November 2024 along with SLED for acute renal failure as per patient requirement. Medical treatment in form of iv albumin N acetylcysteine infusion hypertonic saline infusion iv antibiotics PPI antiemtics and other supportive management, Inotropic support tapered off in view of improving general condition successful weaning trial patient extubated after 3 days after first PLEX and one SLED put on oxygen support at 7 litres per minute. Need to perform PLEX reviewed each day based on clinical progress and tolerance to the procedure.

Results: The gradually reducing total bilirubin of patient between 15 th to 22 November 2024 with plasma exchange being done on 15, 17, 19 and 21 November 2024, also reviewed and discussed serum direct and indirect bilirubin levels between 15 to 22 nd November 2024. Gradually improvement in symptoms and signs related to illness and patient went back walking from hospital.

Conclusions: Clearly proves survival benefit with PLEX over standard medical treatment cases of ALF, especially early acute stages of ALF right opportunity to treat, aimed retarding progression of liver failure helping recovery of liver functions with no extra hepatic organ dysfunction optimal candidates alternate to liver transplant.

PP 10: Thematic Area: Donors and Donations: High hemoglobin in blood donors: Differentiating benign causes from polycythemia vera: A review study

Saneha Anjum Shaikh

Parul University, Vadodra, Gujrat, India

Background: Elevated hemoglobin concentrations in blood donors are common incidental findings during donor screening processes. We have lower limit for hemoglobin defined as <12.5% but what about upper limit? While most cases are attributable to benign or secondary causes—such as smoking, chronic hypoxia, androgen therapy, or dehydration—a subset may represent undiagnosed polycythemia vera (PV), a myeloproliferative neoplasm with potential thrombotic complications if left untreated. Distinguishing secondary erythrocytosis from PV is clinically critical yet often underappreciated in transfusion settings.

Objective: This review aims to systematically analyze the causes of elevated hemoglobin in blood donors, with a focus on differentiating benign/secondary causes from PV using established diagnostic pathways and molecular markers.

Methods: A systematic search of PubMed, Scopus, and Web of Science databases identified 20 relevant studies published between 2000 and 2024. Key diagnostic tools evaluated across the literature included erythropoietin (EPO) levels, JAK2 V617F mutation testing, bone marrow biopsy, red cell mass studies, oxygen dissociation curves, and clinical history assessment.

Results: Across the studies reviewed, 68–90% of donors with elevated hemoglobin had secondary causes identified, such as smoking, high-altitude residence, or androgen use. However, in 5–12% of cases, especially in males with hemoglobin >18.5 g/dL or hematocrit >52%, further evaluation revealed underlying PV. Low serum EPO levels were reported in 70–95% of PV cases, and the JAK2 V617F mutation was present in approximately 95% of confirmed PV diagnoses. Bone marrow biopsy and red cell mass measurement were less frequently performed in donor settings due to limited access but were emphasized as gold standard diagnostic tools in hematologic clinics.

Conclusion: Elevated hemoglobin in blood donors is often benign but warrants further workup in persistent or unexplained cases. Integration of molecular testing—particularly JAK2 mutation analysis—and EPO measurement into donor evaluation algorithms may facilitate early diagnosis of PV. Increased awareness and standardized referral protocols can enhance patient safety by identifying high-risk individuals at an earlier, often asymptomatic stage.

PP 11: Thematic Area: Blood Safety and Infectious Disease Marker Testing (Including NAT Testing): Comparative study of seroprevalence of hepatitis B and hepatitis C in healthy blood donors

Arzoo Singh, Ravi Rani Mishra

Motilal Nehru Medical College, Prayagraj, Uttar Pradesh, India

Background: Hepatitis B and Hepatitis C are significant health problems that might progress to morbid sequelae of liver cirrhosis and hepatocellular carcinoma. A higher prevalence of HBV and HCV in blood donors pose an increased risk of window period transmission through blood transfusion. The present study aims to know the seroprevalence of HBV and HCV among blood donors.

Methods: This is a retrospective study conducted at Blood Centre of Motilal Nehru Medical College, Prayagraj. Total donations from 1 May 2024 till 30 April 2025 were recorded from donor record register. Serum samples were tested for anti HBs antibody and anti HCV antibody using Sandwich and Indirect ELISA respectively. Serum Samples were also sent for ID NAT (Individual Donor Nucleic Acid Testing). Seropositive results were recorded separately in donor records.

Results: The seroprevalence of HBV was 0.74% (Male-0.49%, Female-0.33%) and HCV was 0.13% (Male-0.13%, Female-No seropositive donors). Maximum numbers of HBV positive donors belonged to blood group B+ (12) followed by O+ (10), A+ (6), AB+ and AB- (2 each), A- and O- (1 each). Maximum numbers HCV positive cases belonged to blood group A+, B+, O+ (2 each) followed by A- (1). Seroprevalence of HBV among Replacement donors was 0.44% and among Voluntary donors was 0.83%. Seroprevalence of HCV among replacement donors was 0.12% and among voluntary donors was 0.21%. Maximum Hepatitis B+ donors belonged to age group 31-40 years (11) followed by 21-30 years (5). Maximum Hepatitis C+ donors belonged to age group 21-30 years (3) followed by 31-40 years and <= 20 years (2 each).

Conclusion: Due to stringent screening facilities, vaccination and treatment protocols, Hepatitis B and Hepatitis C are now Submerging transfusion transmitted infections in India. Though the cases in the window period escape detection still the risk of transmission has reduced considerably due to rigorous efforts of Blood Transfusion services and public awareness.

PP 12: Thematic Area: Immunohematology: A cross-sectional study of prevalence of high titre anti-A and anti-B antibodies in O blood group donors in local Chhattisgarh population

V. Aravindan, Minal Wasnik, Ramesh Chandrakar

AIIMS, Raipur, Chhattisgarh, India

Background: Transfusion of group O blood to non-O recipients carries risks due to anti-A and anti-B isoagglutinins, potentially causing hemolytic reactions. This study evaluated the prevalence of high-titre and variation of titres of antibodies in group O donors to aid in safer transfusion practices in Blood Bank AIIMS Raipur.

Methodology: A cross-sectional study was conducted at AIIMS Raipur over 18 months (2023–2025) including 364 eligible group O donors were randomly selected and tested. Anti-A and anti-B titres (IgM and IgG) were measured using the conventional tube agglutination method. High titre was defined as ≥1:64 for IgM and ≥1:256 for IgG.

Outcome: Among donors (mean age 31.1 ± 7.9 years; 98.6% male), high anti-A IgM titres were observed in 53.0%, anti-B IgM in 29.1%, anti-A IgG in 16.8%, and anti-B IgG in 7.7%. Younger donors (18–35 years) and mixed diet individuals had a higher prevalence of high titres.

Conclusions: A substantial proportion of group O donors had high-titre anti-A and anti-B antibodies, particularly IgM. Routine screening for isoagglutinin titres is recommended to minimize transfusion-related risks, especially for pediatric and out-of-group transfusions.

PP 13: Thematic Area: Blood Components/Products: Effect of interrupted agitation on quality of random donor platelets

Anoop Sharma, Amit Pawar 1 , Neerja Kushwaha, Sudeep Kumar

Armed Forces Medical College, Pune, Maharashtra, 1 Military Hospital, Doda, Jammu and Kashmir, India

Background: During the shipping and transportation of platelet concentrates (PCs) from blood centre to hospitals or to the war-affected areas in military settings, PCs experience minimal agitation for several hours up to 1–2 days. However, during stationary periods, platelets may suffer from inefficient oxygen transfer. Aim was to explore whether interruption of agitation enhances quality and viability or has a detrimental impact on PCs with an objective to examine the impact of allowing 4-day interruption of agitation compared to continuous agitation on PCs stored for 5 days.

Methodology: PCs were prepared using the Platelet Rich Plasma method and stored for 5 days at 20-24°C in platelet incubator cum agitator. 20 PCs randomly divided into two groups, continuous agitation (CA) group - under continuous agitation for 5 days and interrupted agitation (IA) group - without agitation for 4 days. Activation markers (CD62P and Annexin V) and blood gas parameters were analyzed on days 1, 3 and 5 of storage.

Outcome: Despite an extended period without agitation, pH remained stable (>6.7) in IA group. CD62P and Annexin V expression on Day 5 was higher in the CA group, with a statistically significant difference. Interruption of agitation resulted in increased lactate concentration, proportionate to the duration of interruption and platelet count.

Conclusion: Our study’s findings suggest that platelets can endure longer periods without agitation than previously documented. These findings imply that CA better preserves the metabolic environment of PCs, while IA may reduce premature platelet activation. However, it is crucial to recognize that favorable in vitro parameters do not necessarily translate to effective in vivo outcomes.

PP 14: Thematic Area: Hematology and Coagulation: A comparative prospective study on thromboelastography parameters with conventional coagulation tests during liver transplant surgeries – A single center study

Jayagowri Karthikeyan, Mohit Chowdhry, Neerav Goyal, Soma Agrawal

Indraprastha Apollo Hospital, New Delhi, India

Background: Thromboelastography (TEG) is a point-of-care global coagulation assay that evaluates blood clotting through viscoelastic changes using whole blood. TEG operates by monitoring torque resistance as blood clots around an oscillating pin, generating electrical signals for analysis. Conventional Coagulation Tests (CCTs) have significant limitations such as sample collection issues, poor prediction of bleeding risk, inability to detect hypercoagulable states, and time delays in results. Unlike CCTs, which assess distinct clotting pathways, TEG provides rapid, bedside, real-time, comprehensive coagulation assessment. TEG has proven valuable in cardiac surgery, trauma, hypercoagulable states, and hyperfibrinolysis detection. In liver transplant surgeries, complex coagulopathic shifts occur across surgical phases due to rebalanced hemostasis in End Stage Liver Disease (ESLD). Through this study, we aim to compare Thromboelastography with Conventional Coagulation Tests in terms of parameters and transfusion management during liver transplant surgeries.

Methods: This prospective comparative study, conducted at a North Indian tertiary care centre, comprised 60 adult liver transplant patients between April 2023 and September 2024. Patients aged 18 years and above undergoing liver transplants were included, while pediatric cases, repeat transplants, perioperative deaths, multi-organ transplants, and non-consenting participants were excluded. Data collected encompassed patient demographics, CTP (Child-Turcotte-Pugh) and MELD (Model for End-Stage Liver Disease) scores, liver function parameters, components transfused perioperatively, along with thromboelastography parameters (R-time, K-time, alpha angle, maximum amplitude, LY30) and conventional coagulation tests (prothrombin time, activated partial thromboplastin time, international normalised ratio, platelet count, fibrinogen, D-dimer). Data analysis was done using Microsoft Excel and SPSS version 29, employing Pearson correlation for the TEG-CCT relationship and Wilcoxon signed-rank testing for comparing transfusion requirements.

Results: Of the 60 patients, 46(76.7%) were males, and the mean age of the patients was 49.63 ± 10.9 years. Most patients had CTP score B (50%) or C (43.3%) and MELD score of 11-20 (63.3%). Primary etiologies were ethanol-related DCLD (23.3%) and cryptogenic DCLD (15%). A total of 187 TEG tracings were performed. Mean TEG parameters were R-time 10.5±8.6 minutes, K-time 4.9 ± 5.9 minutes, alpha angle 45.9 ± 15.3°, MA 47.8 ± 12.2 mm, LY30 0.2±1.1%. Mean CCT parameters were platelet count 74.6 ± 48.6×10 3 /μL, PT 26.2±16.8 minutes, APTT 63.3 ± 27.9 minutes, INR 2.1 ± 0.8, fibrinogen 204.3 ± 90.1 mg/dL and D-Dimer 2172.5 ± 1768.9 ng/ml. Significant correlations were found between alpha angle and fibrinogen (r=0.797), MA and fibrinogen (r=0.640), MA and platelets (r=0.516), and LY30 and D-dimer (r=0.769), with p<0.001. TEG-guided transfusion requirements significantly exceeded CCT-predicted requirements for platelets (3 vs. 0 units, p<0.001) and FFP (8 vs 4 units, p<0.001).

Conclusion: This study showed that TEG parameters correlated well with traditional coagulation tests, suggesting that a single point-of-care TEG could replace multiple cumbersome assays. Unlike traditional tests that only evaluate clot initiation, TEG comprehensively assesses all phases of cell-based coagulation—initiation, amplification, and propagation. Liver transplant patients experience rebalanced hemostasis with fluctuating coagulation profiles during surgery, making accurate assessment essential for optimal graft outcomes. TEG offered functional coagulation evaluation and helped guide appropriate blood component transfusions in our study. We strongly recommend adopting TEG-based transfusion protocols in liver transplant surgeries for better patient blood management and improved surgical results.

PP 15: Thematic Area: Clinical Transfusions: Beta thalassemia major: Managing iron overload with chelation therapy

Shashi Kiran, Vaneeta Bhardwar

Punjab Institute of Medical Sciences, Jalandhar, Punjab, India

Background: β Thalassemia is a hereditary blood disorder with defect in beta globin chain production. Reduced β globin chain production, causes unopposed free α globin chain production. These aggregates causes damage to red cells and erythroblasts in bone marrow causing anemia and ineffective erythropoiesis. Iron absorption increases from intestine due to ineffective erythropoiesis. Chronic regular blood transfusion therapy markedly increases iron accumulation, leading to iron overload, which may damage parenchymal cells of liver, pancreas, heart. This leads to growth retardation, endocrine and organ dysfunction. These patients are on life long blood transfusion therapy hence chelation therapy is also required life long.

Aims: The study was aimed to assess the effectiveness of iron chelation therapy in pediatric thalassemic cases at tertiary care hospital in Northern India.

Methods: Thalassemia patients were observed for last one year, from June 2024 to June 2025. Out of 25 patients, 17 were regular patients out of 17, 12 were on regular oral chelation therapy. Success of iron overload management was observed by monitoring serum ferritin levels. Atleast 2 levels of S. ferritin were observed 6-8 months apart, in same patient. Decreased/constant serum ferritin levels was the criteria for success of chelation therapy. Normally Tab Deferasirox 500 mg OD dose was started (as defarasirox has half life of 8-16 hours), which was changed on response to serum ferritin level. If required Tab Deferiprine 500 mg TDS was added, as it has narrow therapeutic window and side effects of arthropathy and agranulocytosis, it was second choice of oral treatment.

Results: S. ferritin levels decreased significantly in 7 thalassemic patients, who were on oral chelation therapy of tab defarasirox +/- tab Deferiprone, over atleast a period of one year. 3 thalassemic patients showed constant S. ferritin levels. 1 patient showed increased levels of S. ferritin levels, after adjusting dose of oral chelation therapy S. ferrritin levels were observed again in these patients.

Conclusion: Tab Defarasirox is an effective oral iron chelator when started at an optimum time and with optimum dose. Its effect is enhanced with support of other chelating agent Tab deferiprone. Atleast one year of therapy is needed for significant lowering of S. ferritin levels in paediatric thalassemic patients on multiple blood transfusions.

PP 16: Thematic Area: Donors and Donations: A qualitative study into blood donation camp organizers’ perception on the facilitators and barriers of organizing a blood donation drive and measures adopted thereof by the blood centre

Shouvik Basu, Prinu Jose, Vinu Rajendran, Amita R. Nair, George Paul Thaliath

Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India

Background: Blood Donation Camp is a crucial component in promoting voluntary blood donation. Camp organizers play a vital and pro-active role in the conduction of these drives. Understanding the process of organizing a camp and challenges faced by camp organizers can improve the quality of the drive and blood safety. This is a first of its kind qualitative research intended to understand the facilitators and barriers of conducting VBD from the perspective of camp organizers and to implement appropriate improvements in the organizing process at our Blood Centre.

Objectives: (1) To conduct a qualitative study exploring organizers’ perception on the facilitators and barriers of conducting a blood donation drive. (2) To gather the organizers’ opinion on the scope of improvement at our Blood Centre. (3) To take appropriate remedial measures from our Blood Centre to address the barriers identified.

Materials and Methods: Phase I (Qualitative Research): We adopted a qualitative approach involving in-depth interviews (both in-person and telephonic) with voluntary blood donation (VBD) camp organizers over a six-month period. Participants were initially selected through purposive sampling, followed by snowball sampling. A semi-structured interview guide was designed to gather insights on camp planning, the organizers’ experiences, strategies to enhance female donor participation, and challenges encountered during camp execution. Written consent was obtained for in-person interviews and verbal consent for telephonic ones. All interviews were audio-recorded, anonymized, and transcribed. Initial codes were derived from the first three interviews and used to inductively develop a framework matrix. Subsequent analysis followed a structured, deductive approach based on Braun and Clarke’s medium Q thematic analysis. Facilitators and barriers were identified, guiding corrective measures initiated by our Blood Centre. Phase II: Remedial measures to barriers emerged from phase I were adopted at the blood centre level.

Results: We conducted 15 in-depth interviews with VBD camp organizers. Among the participants, 66% were male and 33% were female. Key facilitators identified: (1) The presence of a proactive and capable organizational structure with committed members and volunteers. (2) Consistent pre-camp communication with the Blood Centre and adherence to its recommendations. (3) Supportive administrative bodies that facilitate the process by promptly granting necessary permissions. (4) Well-equipped blood centres staffed with trained and experienced personnel. Major barriers identified: (1) Limited public awareness on blood donation process. (2) Private NGOs facing lower prioritization compared to government institutions when scheduling camps. (3) Institutional inertia from Blood Centres. Remedial measures adopted: (1) Distributing Information, Education, and Communication (IEC) materials to organizers and donors to enhance awareness. (2) Created Calendar specific to our Blood Centre for better planning and coordination.(3). Conducting pre-camp sensitization and awareness sessions, with site inspection.(4) Developed comprehensive checklist, instructional documents, and model layout plan for camp donation sites to simplify the organization process.

Conclusion: The facilitators identified in this study can serve as best practices for other camp organizers, streamlining the process of organizing blood donation camps. Addressing the existing barriers through targeted remedial measures is essential to promote voluntary donations, bridge the gap between blood demand and supply.

PP 17: Thematic Area: Apheresis (Donor and Therapeutic): Therapeutic plasma exchange in longitudinally extensive transverse myelitis with distinct serological profiles

Paramvir Singh, Rajesh Kumar, Bavil Sidhu, Shria Thukral

Dayanand Medical College and Hospital, Ludhiana, Punjab, India

Background: Longitudinally Extensive Transverse Myelitis (LETM) is a rare, debilitating inflammatory spinal cord disorder extending over three or more vertebral segments. While commonly associated with Myelin Oligodendrocyte Glycoprotein Antibody Disease (MOGAD) and Neuromyelitis Optica Spectrum Disorder (NMOSD), a subset of patients remain seronegative.

Aim: The aim of this study is to evaluate the therapeutic effectiveness of Therapeutic Plasma Exchange (TPE) in two LETM cases—one MOG-IgG positive and one seronegative—unresponsive to corticosteroids.

Methods: Two LETM patients underwent diagnostic work-up including MRI spine, cerebrospinal fluid analysis, and serum testing for AQP4 (Aquaporin-4) and MOG (Myelin Oligodendrocyte Glycoprotein) antibodies. Both were initially treated with intravenous methylprednisolone followed by TPE using the Spectra Optia centrifugal apheresis system. TPE sessions were performed on alternate days using 5% albumin as the replacement fluid. Clinical improvement was assessed using neurological examination and motor power grading before and after TPE.

Results: In both the cases, TPE was initiated within 7 days of onset of symptoms. An average of 6401 ml of volume is processed per session of Therapeutic Plasma Exchange. Both the patients demonstrated significant neurological improvement following TPE. Motor recovery was evident within the second to third therapeutic plasma exchange sessions, with improvement in lower limb strength, ambulation and bladder function. The procedures were well tolerated, and no adverse events were recorded. Both patients were ambulatory with minimal support and functional gains were sustained on follow up.

Conclusions: TPE is an effective and safe adjunctive therapy in LETM cases refractory to corticosteroids, irrespective of antibody status. Early initiation of TPE led to significant neurological recovery in both MOG-positive and seronegative patients. These findings highlight the potential of TPE as a valuable component of treatment strategies for demyelinating myelitis, warranting further investigation in larger clinical studies.

PP 18: Thematic Area: Clinical Transfusions: The tale of twilight transfusions

Manvi Talwar, Hem Chandra Pandey, Poonam Coshic, Vineet Sharma

AIIMS, New Delhi, India

Background: Blood transfusion is a multifaceted process influenced by numerous human factors at every stage, from collection and processing to the final administration of the product, making it susceptible to errors. In healthcare facilities, a substantial amount of blood transfusions is done in the night time and it is presumed these transfusions can lead to increased incidence of adverse reactions in patients as late shifts often operate with reduced staffing, decreased clinical vigilance and slower response times. However, the literature to substantiate this concern is limited. Hence, a study was planned to analyse the pattern of blood components issued in our centre and to evaluate the difference in the rate of transfusion reactions in day versus night hours.

Methods: This was a retrospective study conducted by the Department of Transfusion Medicine at a tertiary care hospital. Data required for the study was retrieved from Blood management software. The study was conducted over a period of one year, from June 2024 to May 2025. Data collected for the study included the number of components issued, type of components requested, time of issue, admitting area. The data for transfusion reactions was obtained from Transfusion Reaction Reporting Forms. Data was classified according to time of issue: day request (8 am to 8 pm) and night requests (8 pm to am), area of request generation (ward or emergency or ICU). Blood units not returned from the bedside were assumed transfused, in line with institutional policy assigning discard responsibility solely to the blood centre.

Results: Of 1,00,522 components issued, 2855 units were received back, total components transfused were 97307. Of these 45.81% were Platelets (RDP and SDP), 45.34% PRBC and 8.84% FFP. 56.13% units were transfused to patients admitted in wards, 37.3% in emergency areas and 6.57% to ICU. 62.54% components were transfused during day and 37.45% during night hours. A total of 35 transfusion reactions were reported. Reaction rates were 2.02, 2.32 and 4.99 per 10,000 Platelets, FFP and PRBC transfused respectively. Reaction rate were 1.97 reactions/10,000 units for day and 6.31 reactions/10,000 units in night hours. The difference was statistically significant (P = 0.0004). 2 reactions from ICU, 8 from emergency and 25 from wards.

Conclusion: The analysis highlights distinct patterns between day and night transfusions. Although transfusion reactions were more frequently reported at night, none were attributed to human error. The difference between reaction rates between the two shifts was statistically significant. This may be partly attributed to potential underreporting during the day, as mild reactions could be managed due to availability of more manpower or may go unnoticed due to increased clinical workload. This challenges the perception that night-time transfusions are riskier due to human factors. Most reactions occurred in wards where patients were clinically stable, suggesting that transfusion decisions were often driven by lab reports received in the evening rather than clinical need. These findings underscore the importance of shift-specific interventions, clinically guided transfusion practices, and structured workflows to enhance transfusion safety.

PP 19: Thematic Area: Blood Safety and Infectious Disease Marker Testing (Including NAT Testing): High prevalence of transfusion transmittable disease in a specific area of Bilaspur, Chhattisgarh

Prerna Mohan, Shraddha Pathak

Apollo Hospitals, Bilaspur, Chhattisgarh, India

Aim: We are working at a Blood centre in a tertiary care hospital, in a small city of Chattisgarh. We frequently encounter donors who are illiterate and belong to low socio-economic strata. Recently we have encountered more number of transfusion transmitted cases from Hemu nagar and Shankar nagar, a low socio economic strata mostly occupied by manual sewage workers.

Background: A high prevalence of transfusion transmitted diseases (TTDs) in a specific area can be a serious public health concern, often linked to factors like poverty, limited access to healthcare, risky sexual behaviors, and lack of awareness. Addressing this requires a multifaceted approach involving education, increased access to testing and treatment, and interventions targeting high-risk populations.

Methodology: Elisa is the process of choice in our centre, with HIV being IVrth Generation and Hbsag, HCV, third generation Elisa, VDRL and Malaria being rapid method. J. Mitra is the company providing Elisa kits.

Outcome: Out of a total of 517 total cases of TTD, 10 cases were found belonging to Hemu nagar and Shankar nagar, giving it a positivity rate of 1.5%.

Conclusion: Factors Contributing to High TTD Prevalence in a specific area:

Poverty and Socioeconomic Disparities: Areas with high poverty rates often experience limited access to healthcare, leading to higher infection rates and delayed diagnosis

Limited Access to Healthcare: Lack of readily available and affordable healthcare services, including STD clinics and testing centers, can hinder early detection and treatment

Risky Sexual Behaviors: Engaging in unprotected sex, having multiple sexual partners, and substance use can increase the risk of STD transmission

Social and Cultural Norms: Certain cultural or social norms may discourage open discussions about sexual health or discourage condom use.

Addressing the Issue:

Education and Awareness Programs: Targeted educational campaigns can increase awareness about TTDs, their transmission, and prevention methods

Increased Access to Testing and Treatment: Expanding access to free or affordable TTD testing, HBV vaccination and treatment services is crucial

Promoting Condom Use

Addressing Social and Economic Disparities: Addressing poverty and socioeconomic inequalities can improve access to healthcare and reduce risky behaviors

Targeted Interventions: Programs that focus on high-risk populations, such as adolescents, commercial sex workers, and individuals with multiple partners, can be particularly effective

Community Engagement: Engaging local communities and leaders in STD prevention efforts can help build trust and ensure that interventions are culturally appropriate.

PP 20: Thematic Area: Immunohematology: Hidden in plain sight: Detecting rare naturally occurring anti-K antibody in a blood donor

Rutuja Baldota

Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India

Background: In the purpose of this study was to identify and characterize a rare, naturally occurring anti-K (Kell) antibody detected in a healthy whole blood donor. While anti-K antibodies are commonly associated with prior transfusion or pregnancy, their spontaneous presence in individuals without such history is exceptionally uncommon and clinically significant due to potential risks in transfusion and obstetric care.

Methods: A 38-year-old male donor underwent routine pre-donation screening, which included ABO and Rh typing, antibody screening using the indirect antiglobulin test (IAT), Kell phenotyping, and infectious marker testing. Initial findings showed blood group discrepancies and a positive IAT. Further testing included three-cell and eleven-cell antibody panels (Resolve Panel A and B), direct antiglobulin test (DAT), autocontrol, and Coombs crossmatching with Kell antigen-positive and -negative red blood cells.

Results: The antibody screening tests confirmed the presence of anti-K antibodies. These antibodies reacted at room temperature and 37°C but not at 4°C, indicating thermal amplitude suggestive of clinically significant IgG. The DAT and autocontrol were negative, suggesting an alloantibody rather than an autoantibody. Crossmatching revealed incompatibility with K-positive red cells and compatibility with K-negative ones. The donor had no prior history of transfusion, surgery, or infection, supporting the conclusion that the anti-K was naturally occurring.

Conclusion: This case highlights the rare but critical occurrence of naturally occurring anti-K antibodies in blood donors. The findings emphasize the importance of routine antibody screening even in healthy donors to prevent hemolytic transfusion reactions. The donor was counseled, issued a special donor card indicating the presence of anti-K antibody, and advised to inform healthcare providers during future medical treatments. Future steps include broader surveillance to identify similar rare antibodies in donors and reinforcing awareness among transfusion services.

PP 21: Thematic Area: Management and Organization: Comparison of different blood bank software used at our centre

Jignesh Desai, Abhay Jhaveri, Rinku Sukla, Kruti Dumaswala

Surat Raktadan Kendra and Research Centre, Surat, Gujarat, India

Background: Blood bank management software is a specialised digital tool designed to streamline the operations of blood banks. It helps manage donor and patient records, blood inventory, testing, component separation and distribution in compliance with statutory requirements. The software increases efficiency, traceability, and safety in blood donation, storage, and transfusion processes. This study compared three different software used at our centre. By systematically assessing these key features, this is an attempt to highlight the main advantages and disadvantages of the 3 software used in our centre.

Methods: Three different blood bank software (named A, B and C) have been used in our blood centre from 2008 to 2025 (till now). We tried to compare user-friendliness, overall functionality, interface facility, system integration capabilities, and data security features of these software. Furthermore, the software’s adherence to regulations, ability to process transactions, reporting and analytics tools were also evaluated. These features include Donor registration and management, Blood collection, patient management, Testing Inventory management, Stocks, Compliance and safety, Reporting, Interface, Backup, Real-time data access.

Results: When we compared three different software, some points were common to all the software. Some things were new in the software currently being used because technology has updated. The good thing is cloud based storage facility (no need for physical server). The bad thing is that internet is mandatory; during power cut, everything has to be done manually, and there is a possibility of system hacking. All softwares have reports as per FDCA rules were there and can be printed from software directly such as Donor Registration Register, Donor Blood Group and Antibody Screening Register, Patients Blood Grouping and Antibody Screening Register, Compatibility (Cross Match) Register, Blood Issue Register, Master Register, Component Preparation Register, Patients Request Register, Stock Report, TTI Testing Register. Entries were simple and possible in a single step in some software and cumbersome in others. Some functionality, like remove donor from the calling list, was not possible in one software. Some customised reports were not available in some software. Regular updates on software are not done immediately according to need or when statutory guidelines change.

Conclusions: We have to accept the limitations of old software, security, and current new technologies. Cloud-based solutions can increase operational efficiency and data recoverability, but require a robust internet infrastructure, offline backups, and well-trained users to ensure resilience and protect sensitive information. The purpose of this study was to determine which software, by using or modifying it, could reduce the difficulties encountered in running a blood centre. Unfortunately, we have yet to find software that can satisfy user needs along with all statutory requirements. We have yet to find a single software which fulfils the demands of each and every blood centre.

PP 22: Thematic Area: Quality Management and Accreditation: Quality control of platelet concentrates prepared by different methods

Vipul Parekh, Rinku Shukla, Kruti Dumaswala

Surat Raktadan Kendra and Research Centre, Surat, Gujarat, India

Background: Platelet concentrates are essential blood components prepared by platelet-rich plasma (PRP) and buffy coat (BC) methods. Their quality is evaluated using parameters like platelet count, WBC/RBC contamination, volume, and pH.

Aim: To compare the quality of platelet concentrates prepared by PRP-PC and BC-PC methods using various hematological and physical quality control parameters.

Methods: As a mandatory procedure of carrying quality control of 1% products in a blood centre, 160 platelet samples (100 PRP-PC and 60 BC-PC) were checked from Jan 2022 to Apr 2025. Blood was collected, processed, and quality checked using standard procedures and instruments.

Results: Both methods maintained acceptable pH and swirling. BC-PC showed higher platelet yield with a mean of 7.42 ± 1.80 x 1010 than PRP-PC (6.31 ± 1.61 x 1010) and lower WBC contamination with a mean of 0.32 ± 0.26 x 108 than PRP-PC (0.50 ± 0.37 x 108), indicating better efficiency and quality.

Conclusion: BC-PC method is superior in platelet yield and has lower WBC contamination, making it a more effective and safer method for platelet concentrate preparation.

PP 23: Thematic Area: Clinical Transfusions: Intrauterine transfusion and partial exchange transfusion for twin anemia-polycythemia sequence: A rare but essential transfusion medicine perspective

Jyotsnaa Grace, G. Deepthi Krishna, S. Sudarshan, Deepti Sachan, Yogashalini M

Dr. Rela Institute and Medical Centre, Chennai, Tamil Nadu, India

Background: Twin Anemia Polycythemia Sequence (TAPS) is a rare complication of monochorionic twin pregnancies, characterized by chronic, unbalanced inter-twin transfusion through placental vascular anastomoses. This leads to severe anemia in the donor twin and polycythemia in the recipient twin. Intrauterine transfusion (IUT) remains the cornerstone in managing the anemic twin. However, treating the recipient polycythemic twin is equally critical to prevent hyper viscosity-related complications by Partial exchange transfusion. This case report highlights the successful management of a monochorionic diamniotic twin pregnancy complicated by stage 4 TAPS using serial IUTs for the donor twin and PET for the recipient twin, offering a practical perspective on a multidisciplinary transfusion approach.

Case Report: A 30-year-old primigravid was referred at 30 weeks of gestation with ultrasound findings suggestive of stage 4 TAPS. Doppler showed elevated middle cerebral artery peak systolic velocity (MCA-PSV) (<0.55 MOM) in the donor twin (Twin A) while the recipient twin (Twin B) had reduced blood velocity with fetal growth restriction and congenital cardiac anomalies. Optimal treatment strategy for the patient was decided after comprehensive multidisciplinary discussions. IUT was planned for the anemic twin and PET for the polycythemic twin after obtaining informed written consent. The mother’s blood group was O RhD positive. Fresh (<5 days old), O negative, irradiated, leukodepleted, saline-adenine-glucose-mannitol (SAGM) reduced crossmatch-compatible red cell units were used for IUT. IUT was performed under ultrasound guidance targeting the portal vein. Blood volume was calculated using standard fetal weight and hematocrit formulas. PET was performed using normal saline via the same approach. Twin A underwent three IUT procedures at 30, 31, and 33 weeks of gestation. Pre-transfusion hemoglobin levels ranged from 4.1 to 7.1 g/dL, improving post-transfusion to 15.4–16.8 g/dL, with corresponding hematocrit normalization. Twin B underwent PET at 31 and 33 weeks to address extreme polycythemia, successfully reducing hematocrit from 75.6% to 66.6% with each procedure. Both fetuses tolerated the procedures well, and no procedure-related complications occurred. At 34 weeks, the twins were delivered via elective cesarean section. Twin A weighed 1.48 kg and Twin B 1.3 kg. The donor twin had an uneventful neonatal course, while the recipient twin required further management for Tetralogy of Fallot with pulmonary atresia.

Conclusion: This case highlights the role of targeted transfusion strategies in managing severe TAPS. Serial IUTs effectively corrected donor anemia, while PET mitigated recipient polycythemia, preventing hyperviscosity complications. Effective management of this rare and life-threatening condition relies on a multidisciplinary approach integrating fetal medicine and transfusion expertise. Early diagnosis, timely procedural planning, and vigilant monitoring are essential to improve neonatal outcome.

PP 24: Thematic Area: Hematology and Coagulation: In vitro evaluation of clotting time on ROTEM after correction with platelet-rich plasma and fibrinogen in post-liver transplant patients

Jyotsnaa Grace, Amal Francis, Deepti Sachan, G. Deepthi Krishna, Akila Rajakumar, Mohd. Rela

Dr. Rela Institute and Medical Centre, Chennai, Tamil Nadu, India

Background: Rotational thromboelastometry (ROTEM) serves as an invaluable point-of-care tool for monitoring coagulation in liver transplant (LT) recipients because conventional coagulation tests (CCT) often fail to accurately reflect the true hemostatic status. Clinically, in post-liver transplant patients, we observed a discordant situation in which patients, despite having a normal INR, continue to exhibit prolonged clotting time (CT) on ROTEM analysis and also show reduced maximum clot firmness (MCF). This study aimed to evaluate whether the in-vitro correction of fibrinogen levels and platelet counts has any effect on clotting time.

Methods: This study was a single-center, prospective investigation conducted at a quaternary care liver transplantation center following the approval of the ethics committee (IEC No ECR/1276/Inst/TN/2019/2025/354). The study included post-liver transplant patients who exhibited low maximum clot firmness (MCF) (<35 mm), prolonged clotting time (CT) (>100 s on ROTEM), and an international normalized ratio (INR) <3.5 on conventional coagulation tests (CCT). Blood samples were collected prior to any clinical transfusion interventions after obtaining informed consent. Platelet-rich plasma volumes of 0.2 mL and 0.3 mL increased the count by ~100,000 and ~150,000 cells/mm 3 , respectively and reconstituted fibrinogen concentrate volumes of 0.15, 0.3, and 0.45 mL resulted in incremental fibrinogen increases of 100, 200, and 300 mg/dL, respectively when added to the patient’s blood samples in three separate tubes in vitro. ROTEM testing was subsequently repeated for each modified sample. Linear regression analysis, Pearson correlation and Bland Altman test were the statistical tools used for data analysis.

Results: Six post-liver transplant patients were included in the study, resulting in a total of 24 ROTEM analyses (comprising a baseline and three corrected samples per patient). The median baseline CT was 153 s (range, 107–268 s), CFT was 723 s (range-507 - 2675 s), and MCF was 29 mm (range, 21–34 mm). All ROTEM values demonstrated improvements in CT when CFT and MCF were corrected in vitro. Except in three instances, the values remained static. The increase in CT was negatively correlated with the increase in MCF (r = -0.75; p<0.001) and positively correlated with CFT (r= 0.93; p<0.001). Based on the regression analysis, it can be inferred that for each millimeter decrease in MCF, CT increases by approximately 3 s, or for every 10-second increase in CFT, there is an associated 1-second increase in CT.

Conclusion: This in vitro study revealed that post-liver transplant patients exhibit prolonged clotting times despite having a normal International Normalized Ratio (INR), which may be attributed to reduced MCF. Normalization of MCF was achieved through the in vitro addition of fibrinogen and platelets Aalong with improved CT, and CFT. Further a larger sample size is required to validate this hypothesis and to define the specific CFT and MCF thresholds to be considered for ROTEM based correction.

PP 25: Thematic Area: Blood Safety and Infectious Disease Marker Testing (Including NAT Testing): Comprehensive evaluation of transfusion-transmitted infections: Donor demographics and diagnostic modalities at a tertiary care hospital in North India

Siddharatha Singh, Ravi Rani Mishra

Moti Lal Nehru Medical College, Prayagraj, Uttar Pradesh, India

Background: Transfusion-Transmitted Infections (TTIs) significantly impact transfusion safety. This study focused on determining the seroprevalence and demographic associations of TTIs among blood donors over six years and comparing the diagnostic accuracy of Rapid tests, ELISA, and NAT.

Methods: A retrospective cross-sectional study was conducted at the Department of Transfusion Medicine, Moti Lal Nehru Medical College, Prayagraj, from January 2019 to December 2024. Data from all apheresis donors and whole blood donors were included. Deferred donors were excluded. TTI screening included Rapid Diagnostic Tests, ELISA, and NAT. Data on age, gender, blood group, donation type, and TTI type were compiled and analyzed using Statistical techniques. Chi-square test was used for the association; p < 0.05 was considered statistically significant.

Results: Out of 45,875 donors, 416 (0.91%) were reactive for at least one TTI: HBV – 322 (0.75%), HCV – 69 (0.15%), HIV – 23 (0.05%), Syphilis – 2 (0.004%), Malaria – 0 (0.00%). Significant associations were observed where replacement donors had significantly higher reactivity across all infections. HBV and HCV showed the strongest association with replacement donation (p < 0.00001). While Male donors were more reactive to HBV, HCV, and Syphilis. HIV was more common in 21–30 years, HBV and HCV in 31–40 years. Blood Group B showed maximum reactivity towards HBV, and Blood Group O showed maximum reactivity towards HCV, followed by Blood Group A, AB (Chi-square = 38.2, p < 0.00001). Rapid tests yielded the highest false-negative rates, especially for HIV and HCV. ELISA and NAT showed strong concordance, indicating better specificity and reliability.

Conclusion: The TTI seroprevalence was 0.91% with HBV being most frequent. Statistically significant associations were found with donor type, gender, age, and blood group. Infection-specific patterns highlight that HBV and HCV are more associated with replacement donors and older age, while HIV peaks in younger males. Rapid testing showed poor accuracy and high false-negative rates, especially for HIV. ELISA and NAT provided reliable detection, making them essential tools for safe transfusion practices. Strengthening voluntary donation and eliminating rapid-only screening is critical for transfusion safety.

PP 26: Thematic Area: Management and Organization: The role of bloodmobiles for blood donation on wheels in the blood donation chains operational logistics during the COVID-19 pandemic

Suchet Sachdev, Nippun Prinja, Sangeeta Kumari, Lakhwinder Singh, Divjot Singh Lamba, Ratti Ram Sharma

PGIMER, Chandigarh, India

Background: There are two major logistical modes of conducting outdoor blood donations by the blood centres. In the first, the blood centres walk to the outdoor location preferred by the donor, which could be a permanent or makeshift arrangement (static blood donation) – hereinafter referred to as routine blood donation drives. In the second, bloodmobiles - heavy-duty vehicles having all the facilities for blood donation in them, are used for enabling blood donation on wheels – are hereinafter referred to as bloodmobile blood donation drives. The present study was to compare the utility of the two logistical modes of conducting the outdoor blood collection operations during and before the COVID-19 pandemic.

Materials and Methods: A retrospective analysis of blood donation data of the total outdoor blood donation drives during March–November in 2020 and 2019 (9 months). The number of drives and the blood donations in the routine vs. the bloodmobile were reviewed for the purpose of better understanding operational utility.

Results: Overall, there was a decrease of 8.3% (n = 26/315) in the number of total outdoor blood donation drives during the pandemic. On a similar trend, but on a higher note, the decrease was 19.2% (n = 39/203) in routine blood donation drives. However, contrary to the trend, there was an increase of 11.6% (n = 13/112) in the number of bloodmobile drives. Overall, there was a decrease of 42.1% (n = 14,579/34,662) in the donations in total outdoor blood donation drives during the pandemic. On a similar trend, but on a higher note, the decrease was 46.7% (n = 13,076/27,981) in donations in the routine blood donation drives. However, worth noting that there was a decrease of only 23.5% (n = 1593/6771) in donations in the bloodmobile drives. On average, per month, there were 32.1, 18.2, and 13.8 total outdoor blood donation drives, routine blood donation drives, and bloodmobile drives in 2020 against 35, 22.6, and 12.4 in 2019, respectively. Thereby, demonstrating a trend of increase in bloodmobile donation drives (43.3% in 2020 vs. 35.6% in 2019), with odds of 1.38 (CI: 0.99-1.9), p=0.05, during the pandemic in comparison to reference data. On average, there were 2231.4, 1656.1, and 575.3 blood donations per month during 2020 against 3,851.3, 3109, and 752.3 during 2019, total outdoor blood donation drives, routine blood donation drives, and bloodmobile drives, respectively. Thereby, demonstrating a statistically significant contribution in terms of blood donations in bloodmobile (25.8% in 2020 vs. 19.5% in 2019), with odds of 1.43 (CI: 1.4-1.5), p<0.05 during the pandemic in comparison to reference data.

Conclusion: The Bloodmobile complements the public outreach efforts of the blood collection agencies, both in terms of the organization of the outdoor blood donation drives and the blood donations obtained thereof. Thereby demonstrating the usefulness of “Blood Donation on Wheels” in “bridging the gap” in the outdoor blood donation drives for blood donations during the COVID-19 pandemic.

PP 27: Thematic Area: Blood Components/Products: Analysis of blood component discards in a tertiary care blood centre in central India: A retrospective study

Veer Singh Mavai, Ramesh Chandrakar, Minal Wasnik

AIIMS, Raipur, Chhattisgarh, India

Background: Blood components such as platelets, packed red blood cells (PRBCs), and fresh frozen plasma (FFP) are crucial in managing trauma, surgical procedures, and emergency medical conditions. However, a significant portion of these components are discarded due to various factors—some preventable, such as improper storage, handling errors, or quality issues, and others unavoidable, like transfusion-transmitted infection (TTI) reactivity. These discards not only represent a loss of valuable resources but also affect the overall availability and safety of blood transfusion services. This study aims to determine the frequency and specific causes of blood component discard in a tertiary care blood centre located in Central India. The ultimate goal is to identify areas of intervention to minimize wastage and promote more efficient use of blood resources.

Materials and Methods: A retrospective observational study was conducted over a period of six months. Data pertaining to 300 discarded blood component units were collected from the blood bank’s discard register. The components analyzed included platelets, PRBCs, and FFP. Each unit was categorized based on type and reason for discard. A descriptive statistical analysis was carried out to assess the frequency and percentage of each discard cause among the three component types.

Results: Out of the 300 total discarded units, FFP accounted for the highest proportion with 138 units (46.0%), followed by platelets at 117 units (39.0%) and PRBCs at 45 units (15.0%). For Platelet discards, the most prevalent cause was absence of swirling (36 units; 30.8%), indicating inadequate quality control during processing. Other causes included expiry (17.1%), TTI reactivity (15.4%), leakage (12.8%), lipemia (12.0%), and red blood cell (RBC) contamination (10.3%). Among PRBCs, TTI reactivity was the leading cause of discard (28 units; 62.2%), followed by expiry (24.4%), leakage (6.7%), clot formation (4.4%), and lipemia (2.2%). For FFP, the primary reason for discard was leakage (75 units; 54.3%). Additional causes included TTI reactivity (18.8%), lipemia (13.0%), thawed but not issued (12.3%), and RBC contamination (1.4%).

Conclusion: The findings indicate that a substantial number of discards arise from modifiable factors such as leakage, improper processing (e.g., swirling failure in platelets), and failure to issue components before expiry. While PRBCs had the lowest discard rate, they showed the highest TTI-reactivity. On the other hand, FFP showed the highest overall discard percentage, predominantly due to leakage. Strengthening donor screening, improving staff training, and adopting stricter quality control and storage protocols can help reduce unnecessary discards, enhancing both the efficiency and safety of blood transfusion services.

PP 28: Thematic Area: Immunohematology: Warm AIHA with Rh autoantibody specificity: Unraveling a transfusion dilemma

C. Priyadharshni, Anil Khetapal, Prerna Sachdeva, Sudipta Satpathi, Sandeep Kumar Tyagi, Nagendra Sharma

Artemis Hospital, Gurugram, Haryana, India

Background: Autoimmune hemolytic anemia (AIHA) is a rare hematological disorder characterized by increased red cell destruction and / or decreased red cell survival due to autoantibodies directed against self antigens on red cells. Because these autoantibodies react with self and nonself red blood cells (RBCs), they can often obscure the presence of underlying clinically significant alloantibodies. Alloantibodies are developed in response to foreign antigens (like those from a previous transfusion or pregnancy) and can cause serious transfusion reactions if not identified. AIHA is categorized into four primary types, based on the temperature at which these autoantibodies are most reactive: Warm AIHA, Cold Agglutinin Disease (CAD), Mixed-Type AIHA and Paroxysmal Cold Hemoglobinuria (PCH). Warm autoimmune hemolytic anemia (wAIHA) is the most prevalent form of autoimmune hemolytic anemia (AIHA), accounting for 60% to 70% of all cases. It is usually caused by IgG antibodies that bind to RBC antigens and result in erythrophagocytosis by splenic macrophages or hepatic Kupffer cells. In Majority of cases, antigen specificity cannot be determined or they express pan-reactivity across antigen group making serologic identification challenging. Notably antibodies directed against Rh blood group antigens have been documented in the literature. Our study was aimed to identify and explore strategies for resolving the significant transfusion dilemmas encountered in cases of warm autoimmune hemolytic anemia (AIHA) where autoantibodies specifically target the Rh blood group system.

Methodology: We discuss here three immunohematological cases involving warm autoantibodies. For each case, we performed blood grouping, Direct Anti-globulin test (DAT), Rh and Kell Extended phenotyping, and antibody screening. If the antibody screen was positive, antibody identification was then carried out. All testing was done by column agglutination technology (CAT) with glass bead microcolumns, on a fully automated immunohematology analyzer (Ortho Vision Max). Alloadsorption for adsorbing the autoantibodies was done by using in-house prepared allogeneic packed red blood cells (RBCs) of the R1R1, R2R2, and rr phenotypes.

Results: All three cases presented with warm autoantibodies exhibiting broad specificity against self-Rh antigens. Specifically Case 1, a 77-year-old male, and Case 2, a 75-year-old male, were both diagnosed with warm autoimmune hemolytic anemia, and in both, the autoantibody was found to be specific for the ‘e’ antigen. In contrast, Case 3 involved a 45-year-old female with a known history of Lymphoma, where the autoantibody’s specificity targeting the D antigen was identified. Molecular testing for the confirmation could not be performed in any of the case due to financial constraints of the patient. Therefore, autoantibody detection and specificity in our study relied purely on serological methods.

Conclusion: The study highlights the importance of detecting the nature of the antibody whether it is alloantibody or autoantibody with antigen specificity which helps in selecting appropriate antigen negative blood units to ensure transfusion safety in AIHA patients. Cases also add valuable insights to the limited literature on warm autoantibodies that exhibit unusual antigenic specificity and their capacity to cause clinically significant hemolysis.

PP 29: Thematic Area: Clinical Transfusions: An analysis of biochemical markers as the determinants of comorbidities in sickle cell disease

Sankalp Sharma

All India Institute of Medical Sciences, Raipur, Chhattisgarh, India

Background: Sickle Cell Disease (SCD) multisystem condition due to dysfunctional blood rheology and veno-occlusive events. In this study, we aimed towards defining prominent biochemical markers which are the determinants of co-morbidities due to HbS levels in SCD.

Methodology: In this retrospective cohort study (2021-2023). We recruited SCD patients (HbAS and HbSS). We first used multivariable regression model (r2) with HbS levels as dependent variable and Hemogram variables Hemoglobin (Hb), Mean Corpuscular Hemoglobin (MCH), Total Leucocyte Counts (TLC) and Serum (S) biochemical parameters, S electrolytes, Liver Function tests (LFT), S urea, S creatinine and S iron, S Ferritin of HBAS and HBSS patients as predictor variables. We then calculated correlation coefficient (CC) of biochemical markers with HbS and performed binary logistic regression of Hb < 9 g/dl with laboratory variables. We finally analysed the odds ratio (OR) of Hb <9 g/dl with laboratory variables to support evidence-based transfusion recommendations.

Results: In this study, OPD patients were recruited as HbSS (n=116) and HbAS (n=51). The r2 explained 37.98% of the observations (HbS levels). Hb (P=0.028), MCH (P<0.001), S Urea (P=0.030) prominent determinants of HbS levels. HbS showed significant CC with TLC 0.313, 0.572); MCH 0.419 (0.279,0.542); K+ 0.175 (0.016,0.32); S Urea -0.197 (-0.345, -0.039); S Creatinine -0.226 (-0.372, -0.069); AST 0.295 (0.145,0.432 and Alk phosphatase 0.225 (0.072,0.368; D Bilirubin 0.453 (0.315,0.573); Indirect Bilirubin 0.454 (0.307,0.580; S Iron 0.217 (0.006,0.409 and S ferritin 0.275 (0.068, 0.459 were significantly correlated with HbS levels (P<0.05). Hb<9 g/dl showed OR TLC OR 1.0 (0.96,1.04); Na+ 1.01 (0.83,1.21); S Creatinine 5.4 (0.21,137.3); Indirect bilirubin 1.19 (0.833,1.71), AST 1.02 (0.99,1.04) were some of important associations with Hb<9 g/dl.

Conclusions: TLC, MCH levels in Hemogram, IB and AST levels in LFT; S. Urea, S. Creatinine of KFT were significant biochemical associations with HbS levels in patients with SCD. S Creatinine a prominent biochemical association with Hb<9 g/dl.

PP 30: Thematic Area: Immunohematology: Prevalence of Rh and Kell phenotyping in blood donors: A retrospective analysis from a tertiary care blood center in North India

Deepika Joon, Prerna Sachdeva, Anil Khetrapal, Sudipta Satpathi, Sandeep Kumar Tyagi, Nagendra Sharma

Artemis Hospital, Gurugram, Haryana, India

Background: While ABO and RhD are the cornerstone of routine blood typing, assessing additional blood group antigens is essential for patient safety, especially in individuals requiring multiple transfusions. The risk of alloimmunization – the development of antibodies against transfused red cell antigens – increases with repeated exposures. The Rh blood group system, in particular, is highly immunogenic. Its antigens, including D, C, c, E, and e, are well-known for triggering the production of alloantibodies, which can result in severe transfusion reactions. Understanding the prevalence of these blood group antigens within a given donor population is important as it aids in predicting and preventing alloimmunization and also ensures compatible blood transfusion. This study aims to highlight the frequency of Rh and Kell antigens among the blood donors and to formulate a donor directory of Rh and Kell phenotyped donors to prevent alloimmunization in multi-transfused patients.

Methods: A retrospective study was conducted on 20,123 blood donors in the blood center of a tertiary care hospital from 1 st February 2023 to 30th June 2025. The antigen typing for Rh antigens (D, C, c, E, and e) and Kell (K) was performed on the collected EDTA samples by SPRCA (Solid Phase Red Cell Adherence Assay) technology on a fully automated immuno-hematology analyzer system (Immucor Neo Iris). The collected data was recorded on an Excel spreadsheet and was analyzed using descriptive statistics. The results were expressed in frequency and percentage.

Results: Among Rh antigens, ‘e’ was most common antigen (98.8%), followed by D: 92.6%, C: 83.37%, c: 62.6%, and E: 19.98%. respectively. Frequency of the K antigen was 3.61%. The most common phenotype in Rh positive donors was R1R1 (37.2%) while in Rh D negative donors, it was rr (7.15%).

Conclusion: The ‘e’ antigen was the most common antigen in our study population which correlated with studies done in other parts of India. Formulating a donor directory with knowledge of phenotype frequency in the local donor population significantly improves transfusion safety, especially for patients who are transfusion dependent or in situations where clinically significant alloantibodies are found in patient’s serum, where antigen negative blood unit can be arranged using the directory.

PP 31: Thematic Area: Management and Organization: Impact of implementing radio-frequency identification technology on end-to-end blood component monitoring and transfusion safety: A vein-to-vein experience at a tertiary care centre in Northern India

T. Sowmiya Banu, Mohit Chowdry, Soma Agrawal, K. Jayagowri, S. Shefina, Uday Kumar Thakur

Indraprastha Apollo Hospital, New Delhi, India

Background: Safe blood transfusion remains a vital component of modern healthcare, yet the process is inherently complex and susceptible to human error, including mismatches, clerical inaccuracies, and lapses in temperature regulation. These issues pose risks ranging from minor complications to fatal outcomes. Radio-Frequency Identification (RFID) technology has emerged as a transformative solution to enhance safety, traceability, and efficiency throughout the transfusion chain. Unlike manual and barcode-based systems, RFID uses electromagnetic waves for non-contact, real-time tracking of blood components, allowing seamless data integration with hospital information systems (HIS).

Aim and Objectives: 1. The purpose of this study is to analyse and determine the improvements in the efficiency, inventory management in real time and accuracy, workflow process, safety in the blood bank supply chain, and enhancing Patient Safety by identification of right blood product and right patient. 2. To assess the performance of RFID tags in traceability and reducing product wastage.

Methodology: An observational study was conducted at a tertiary care hospital in Northern India over 21 months (July 2023–March 2025) following the implementation of the Biolog-id RFID system. Leukoreduced packed red cells (PRCs) were tagged with passive high-frequency RFID tags encoding unit-specific data, enabling real-time visibility via a on-prem server based RFID dashboard. RFID smart storage devices and Personal Data Assistants (PDAs) were deployed at key locations, including storage refrigerators and bedside transfusion areas. Integration with HIS facilitated automated alerts for expiry, temperature excursions, and inventory status. Comparative data before and after implementation were analysed using structured questionnaires and time-based performance indicators.

Results: A total of 33,531 PRC units were tagged. Inventory management time reduced dramatically from 730 to 12.16 hours per year (p < 0.001), and the time to locate crossmatched units decreased from 60.83 to 6.08 hours annually (p < 0.001). Transfusion initiation confirmation, which previously required 10 minutes per instance, now takes under 20 seconds, yielding a significant reduction (p < 0.001). Manual ward-wise data collection was reduced from 121.6 to 3.04 hours annually. Expiry of PRC units declined significantly—from 85 units in 2021 to 47 in 2024—due to timely alerts and optimized utilization (p < 0.001). No cases of wrong blood transfusion were reported post-implementation, and pre-transfusion verification time at the bedside was reduced from 10 to 2 minutes. The system proved mechanically and functionally stable under refrigerated and irradiated conditions, with no haemolysis reported. Four downtime episodes (totalling 11 hours) were effectively managed via predefined backup protocols without compromising patient safety.

Conclusion: RFID implementation significantly improved the accuracy and workflow efficiency of components storage and release operations, maximum patient safety and traceability in blood transfusion services. This “vein-to-vein” experience underscores the feasibility and benefits of adopting RFID in Indian healthcare settings. With strategic investments, staff training, and robust infrastructure, RFID can play a pivotal role in modernising transfusion medicine and advancing nationwide blood safety initiatives.

PP 32: Thematic Area: Apheresis (Donor and Therapeutic): Therapeutic plasma exchange as rescue therapy in a child with anti N methyl D aspartate receptor encephalitis: A case report

Anand Sr, Mohit Chowdhry, Soma Agrawal

Indraprastha Apollo Hospitals, New Delhi, India

Background: Anti N methyl D aspartate receptor (anti NMDAR) encephalitis is an autoimmune neuropsychiatric disorder caused by antibodies targeting the NR1 subunit of the NMDA receptor, and is increasingly recognized in paediatric populations. The estimated global incidence is approximately 1.5 per million population per year, with higher rates reported among children and young adults. Paediatric patients typically exhibit a rapid onset of psychiatric symptoms, seizures, involuntary movements and autonomic disturbances, which frequently necessitates intervention. Immunomodulators such as corticosteroids, intravenous immunoglobulin (IVIG), and/or therapeutic plasma exchange (TPE) is associated with improved clinical and survival benefits. According to American Society for Apheresis (ASFA) 2023 guidelines, anti NMDAR encephalitis is classified as Category I, Grade 1C, denoting it as a first line therapy supported by low-quality evidence and is backed by only three case trials, ten case series, no randomized controlled trials, and no case reports. In this case report, we describe a 13 year old girl with anti NMDAR encephalitis who was refractory to steroids and IVIG but showed notable clinical improvement with TPE followed by rituximab, underscoring its potential benefit.

Case Description: A previously healthy 13-year-old girl, presented one week after a brief febrile prodrome with acute onset behavioural disturbances, orofacial and limb dyskinesias, progressive drowsiness, and reduced responsiveness. She was admitted to Paediatric ICU and was empirically started on high-dose IV methylprednisolone. Contrast Enhanced Magnetic Resonance Imaging (CEMRI) of brain revealed right parieto-temporal hyperintensity and early Electroencephalogram (EEG) showed generalized delta slowing. As the findings suggested autoimmune encephalitis picture, IVIG was added on Day 2. Cerebrospinal fluid (CSF) and serum tested positive for anti-NMDAR antibodies, confirming the diagnosis. Anticonvulsants and sedatives were also added on due course for repeated seizure episodes. Abdominal imaging was done to rule out ovarian teratoma, which incidentally exposed multiple renal cysts. Despite IVIG and high dose steroids, her Glasgow Coma Scale (GCS) remained suppressed. Thereafter, TPE was initiated as per ASFA guidelines and was performed via right femoral vein access. Each session involved the exchange of approximately 1.5 to 2 plasma volumes with a fluid balance maintained at 100% replacement. Acid citrate dextrose (ACD) was used as the anticoagulant, and intravenous calcium gluconate was administered to prevent citrate-induced hypocalcaemia. The replacement fluid used was Albumin and two fresh frozen plasma (FFP) was given at the end to prevent dilutional coagulopathy. A total of seven TPE sessions were carried out over a period of two weeks, which resulted in MRI resolution of parieto-temporal lesions. During the course, she developed intermittent fever and was treated with culture-driven antibiotics. Once afebrile, she was given three doses of Rituximab over a period of three weeks after the last TPE session. Following treatment, she gradually regained consciousness and motor functions, and by one month after her final TPE session was able to take oral feeds, ambulate with minimal support, and was discharged in stable condition on maintenance steroids and anti-epileptics.

Conclusion: This case emphasizes that the timely initiation of TPE alongside corticosteroids and IVIG as the initial first line therapy.

PP 33: Thematic Area: Donors and Donations: Prospective evaluation of anti-CMV antibodies in blood donors: Links to blood group and demographics

Shweta Ranjan, Rakesh Kumar 1 , Nishith Nayan 1

Fortis Hospital, New Delhi, 1 All India Institute of Medical Sciences, Patna, Bihar, India

Background: The seroprevalence of Cytomegalovirus (CMV) in blood donors holds significant relevance, especially for high-risk recipient groups such as immunocompromised patients, transplant recipients, and low birth weight neonates. The aim of this study was to evaluate the association of ABO blood group, age, gender, and geographic background with the levels of anti-CMV IgG and IgM antibodies among whole blood donors.

Methodology: This prospective study was conducted on 2,110 whole blood donors between November 2024 and January 2025. The association between anti-CMV IgG and IgM antibody levels and donor characteristics including ABO blood group, age, gender, and geographic background was analyzed using Kruskal Wallis test, linear regression analysis, Spearman’s rho correlation coefficient, and independent t-test. A p-value of <0.05 was considered statistically significant.

Outcome: Out of 2,110 participants, 98.4% (n=2,076) were males and 1.6% (n=34) were females. The most common blood group was B (34.64%), while AB was the least common (8.15%). Among the ABO blood groups, individuals with blood group O had the highest mean anti-CMV IgG levels (64.76 ± 63.18), whereas those with AB had the lowest (63.23 ± 74.00). Inter-group comparison of IgG levels among different ABO groups using the Kruskal-Wallis test revealed no statistically significant difference (p = 0.516). Comparison of IgG levels between males and females using the independent t-test showed a statistically significant difference (p = 0.027). However, no significant difference was observed in IgG levels between donors from rural and urban areas (p = 0.403). However, mean IgG levels were higher in urban donors (69.56±68.41) as compared to rural donors (65.73±63.75). Linear regression analysis demonstrated that IgG levels increased with age, whereas IgM levels decreased. Additionally, Spearman’s rho correlation showed a significant positive correlation between age and IgG levels (p = 0.007), while the correlation with IgM levels was not statistically significant (p = 0.173).

Conclusion: Studying the association of anti-CMV antibodies levels with ABO group and demographic characteristics helps in understanding donor pool dynamics and enhances transfusion safety. It supports the targeted recruitment of CMV-negative donors, especially in regions with high CMV prevalence, and contributes to personalized transfusion practices for at-risk patient populations.

PP 34: Thematic Area: Apheresis (Donor and Therapeutic): Managing myasthenic crisis after video-assisted thoracoscopic thymectomy with therapeutic plasma exchange: A case study

Bhavyaa Beriwal, M. Shanmathi, Shashi Kumar, Nishith Nayan, Rakesh Kumar

All India Institute of Medical Sciences, Patna, Bihar, India

Background: Myasthenia gravis (MG) is a chronic autoimmune disorder characterized by fluctuating muscle weakness. Thymectomy is a common intervention, particularly in patients with thymoma. We report the case of a 24-year-old female with early-onset MG who underwent video-assisted thoracoscopic thymectomy (VATS). Despite preoperative optimization with therapeutic plasma exchange (TPE), she developed a postoperative myasthenic crisis requiring intensive care. Early recognition and prompt postoperative TPE led to rapid recovery, avoiding prolonged mechanical ventilation. This case underscores the dual role of TPE as both a preoperative and rescue therapy, emphasizing the importance of individualized perioperative planning. It highlights the need for vigilance, early intervention, and multidisciplinary coordination to manage high-risk MG patients effectively. Additionally, careful selection of perioperative medications, including antibiotics, is essential to avoid agents known to exacerbate MG symptoms and trigger crisis.

Background: Myasthenia gravis (MG) is a chronic autoimmune neuromuscular disorder characterized by fluctuating skeletal muscle weakness. In MG patients with thymoma, thymectomy is often indicated. Myasthenic crisis remains a severe postoperative complication that requires rapid and effective intervention. This case report explores the dual role of therapeutic plasma exchange (TPE) in both preoperative stabilization and postoperative crisis management.

Methods: A 24-year-old female with early-onset generalized MG presented with progressive limb weakness, bulbar symptoms, and was diagnosed with thymoma via CT imaging and biopsy. She underwent preoperative management with pyridostigmine, prednisolone, and three sessions of TPE. Following clinical improvement, she underwent video-assisted thoracoscopic thymectomy (VATS). Postoperatively, she developed respiratory failure indicative of a myasthenic crisis, necessitating mechanical ventilation. Six additional sessions of TPE were initiated in the intensive care setting.

Results: In the present case, TPE provided dual clinical benefits—first, as a preoperative immunomodulatory strategy to stabilize the patient before thymectomy, and later, as a rescue intervention during a postoperative myasthenic crisis. Preoperative TPE allowed surgical readiness by improving muscle strength and functional status. Post-thymectomy, the patient experienced worsening ptosis, diplopia, and generalized weakness. Early recognition of myasthenic crisis led to prompt ICU admission and ventilatory support. Postoperative TPE contributed to rapid neurological recovery, allowing successful extubation after the third session. By the sixth session, the patient had returned to an Eastern Cooperative Oncology Group Performance Status (ECOG) performance status of Grade 1, indicating near-complete functional recovery. The case also highlighted a temporary exacerbation associated with fluoroquinolone use post operatively, an antibiotic known to worsen MG. Discontinuation of the drug led to symptom stabilization, underscoring the importance of judicious antibiotic use and clinician awareness of medications that may aggravate MG.

Conclusions: This case underscores the value of TPE not only as a preoperative immunomodulatory measure but also as a critical intervention during postoperative myasthenic crisis. The successful outcome illustrates the importance of individualized perioperative planning, early crisis detection, and multidisciplinary care. TPE remains a key therapeutic modality in crisis mitigation and management for high-risk MG patients undergoing thymectomy.

PP 35: Thematic Area: Blood Safety and Infectious Disease Marker Testing (Including NAT Testing): Sero-prevalence and potential correlation of transfusion-transmitted infections with ABO blood group system among healthy blood donors in Eastern India

Nishith Nayan, Rakesh Kumar, Saurabh Lahare, Bankim Das

All India Institute of Medical Sciences, Patna, Bihar, India

Background: Transfusion-transmitted infections (TTIs) remain a significant concern in transfusion medicine due to their impact on blood safety. Understanding the distribution of TTIs among blood donors and exploring potential associations with the ABO blood groups system can enhance donor screening strategies.

Methodology: This cross-sectional retrospective study was conducted on Blood donors who donated whole blood from January 2020 to December 2024 at our blood centre. Blood donors’ blood was tested for ABO and Rh D grouping and five mandatory TTI markers as per the Drugs and Cosmetics Act. A chi-square test was performed to look for any association of TTIs with ABO and Rh D blood groups.

Outcome: 65160 healthy donors were screened for TTI, and 2167 (3.33%) were positive for various TTIs. Hepatitis B had the maximum prevalence (1017 cases, 1.56%), followed by Syphilis (655 cases, 1.01%), Hepatitis C (268 cases, 0.41%), HIV (188 cases, 0.29%), and co-infection (39 cases, 0.06%). Maximum TTI seroreactive donors were found among ‘B’ blood group (3.27%, 776 cases), followed group ‘O’ donors (3.35%, 719 cases), ‘A’ donors (3.38%, 482 cases), and ‘AB’ donors (3.34%, 190 cases), respectively. However, the overall risk of association of TTI was not statistically significant with ABO and Rh D blood group, except that HBsAg was statistically significant with B blood group.

Conclusion: Hepatitis B was the most prevalent transfusion-transmitted infection among blood donors, with a statistically significant association observed between HBsAg positivity and blood group B. This underscores the urgent need for continuous public health initiatives, focused awareness campaigns, and rigorous donor screening procedures to improve transfusion safety, minimize transfusion-transmitted infections (TTIs), and protect both donors and recipients from preventable health risks associated with unsafe blood transfusion practices.

PP 36: Thematic Area: Hematology and Coagulation: Red cell risks in pregnancy: Case of anti-c alloimmunization and hyperhemolysis in sickle cell trait

Minal Wasnik

AIIMS, Raipur, Chhattisgarh, India

Background: Sickle Cell Disease (SCD) is a hereditary hemoglobinopathy resulting from a point mutation in the β-globin gene. Sickle Cell Trait (SCT), its heterozygous counterpart, is generally asymptomatic but can predispose individuals to rare complications. In India, SCT prevalence varies widely by region and ethnicity, with central India—home to the largest tribal population—showing rates up to 33%. Despite SCT’s generally benign nature, pregnancy in affected individuals can present unforeseen risks, particularly when complicated by red blood cell (RBC) alloimmunization.

Case Presentation: A 30-year-old multiparous woman at 31 weeks of gestation with known SCT presented with prolonged fever and recent jaundice. Notably, she had received a prior blood transfusion due to critically low hemoglobin levels (3.6 g/dL). On admission, her hemoglobin remained low at 4.3 g/dL with hyperbilirubinemia, suggesting ongoing hemolysis. Immunohematologic evaluation revealed she was O Rh (D) positive and harbored anti-c alloantibodies, confirmed through extended antibody screening. Initially, transfusion with antigen-matched PRBCs improved her hemoglobin to 9.0 g/dL. However, subsequent transfusions paradoxically reduced her hemoglobin to 2.6 g/dL, indicative of hyperhemolysis syndrome (HHS), a rare but serious delayed hemolytic transfusion reaction.

Management and Outcome: Transfusions were halted, and the patient was treated with immunosuppressive therapy comprising intravenous immunoglobulin (IVIG) and corticosteroids. Her clinical status stabilized, enabling safe reintroduction of transfusions with further antigen-matched PRBCs. Serial Doppler studies ruled out fetal anemia. At 32+2 weeks, she delivered a preterm female infant by cesarean section. Neonatal evaluation revealed blood group B Rh (D) positive with absence of c-antigen, excluding anti-c-mediated hemolytic disease of the fetus and newborn (HDFN). The infant developed mild jaundice, which was effectively managed with phototherapy. Both mother and child were discharged in stable condition.

Discussion: This case underscores two rare but dangerous phenomena—anti-c alloimmunization and HHS—in a pregnant woman with SCT. The Rh blood group system, particularly the c-antigen, is implicated in HDFN and hemolytic transfusion reactions despite routine antenatal screening focusing mainly on Rh (D)-negative pregnancies. HHS, often overlooked, is characterized by destruction of both transfused and autologous RBCs despite absence of new antibodies or Coombs positivity. Mechanistically, it involves macrophage hyperactivation and complement-mediated hemolysis. Clinical Implications: SCT pregnancies, although often classified as low-risk, may entail severe transfusion-related complications. The case advocates for:

Universal antibody screening irrespective of Rh (D) status

Antigen-matched, leucodepleted blood transfusions

Multidisciplinary collaboration among hematology, transfusion medicine, obstetrics, and neonatology.

Conclusion: Pregnancies complicated by SCT and prior transfusions warrant vigilant monitoring. Early identification of alloantibodies, informed transfusion strategies, and coordinated care pathways are crucial to mitigate risks. Anti-c alloimmunization and HHS, though rare, can be life-threatening but are manageable with timely, targeted interventions.

PP 37: Thematic Area: Donors and Donations: Cytomegalovirus seroprevalence among blood donors in Gujarat

Rakhee Shah, Ripal Shah, Tejal Chhabria

Prathama Blood Centre, Ahmedabad, Gujarat, India

Background: Cytomegalovirus (CMV) infection is a concern among blood bank professionals and blood transfusion recipients, particularly in cases of transfusion to neonates and immunocompromised patients. In India, screening donated blood for infections is mandatory for human immunodeficiency virus, hepatitis B, hepatitis C, malaria, and syphilis, but not for cytomegalovirus (CMV). Studies have shown a high seroprevalence of CMV (up to 95%) in India, and CMV can cause severe morbidity in susceptible individuals such as immunosuppressed patients and neonates. Hence, providing CMV-negative blood units by screening for CMV and maintaining a donor database of seronegative donors is crucial in this setting.

Objective: The study aimed to investigate the seroprevalence of cytomegalovirus in healthy Voluntary blood donors in Gujarat.

Materials and Methods: This study was undertaken to find out the seroprevalence of Cytomegalovirus at a Stand-alone blood center, from May 2017 to May 2018, among 5302 blood donors in Gujarat, mainly in Ahmedabad.

Results: Among the 5302 samples tested for CMV, 5034 were seropositive, and 268 samples gave a negative reaction. Hence, the seroprevalence of CMV among our donor population was 95%. The incidence of cytomegalovirus was 95% for IgG and 4.7% for IgM in healthy donors who donated from May 2017 to May 2018. Results revealed CMV IgG reactivity in 95% of the blood donors, while 4.77% had detectable CMV IgM reactivity, and 5% of donors were negative for both IgG and IgM.

Conclusion: Prospective blood donors should be screened for CMV, especially when transfusion is intended for immunocompromised recipients. Leucoreduced blood products from CMV-seronegative donors should be given to preterm neonates and infants to prevent transfusion-associated perinatal CMV disease. There should be more campaigns and awareness programs promoting the voluntary donation of CMV-negative blood. Community education programs should be implemented to raise awareness about the significant impact of CMV infection on health.

Keywords: Blood donor, cytomegalovirus, immunoglobulin G, immunoglobulin M, seroprevalence

PP 38: Thematic Area: Quality Management and Accreditation: The role of external quality assessment schemes in monitoring and improving the standardization process in a standalone blood center

Disha Patel, Ripal Shah, Tejal Chhabria

Prathama Blood Centre, Ahmedabad, Gujarat, India

Background: External Quality Assessment Schemes (EQAS) are essential tools in transfusion medicine for maintaining high standards and ensuring the accuracy of laboratory results. In the Standalone Blood Center, the External Quality Assessment Scheme (EQAS) helps monitor, evaluate, and continuously improve testing procedures.

Materials and Methods: Data were collected from BEQAS samples received from March 2019 to March 2024 at our center for the study. Quarterly, blind samples were received and tested for parameters including ABO and Rh (D) grouping, antibody screening and identification, hemoglobin estimation, and transfusion-transmitted infection (TTI) markers. All results were evaluated against BEQAS benchmarks to identify discrepancies and trigger corrective actions when necessary.

Results: Over the five years, the centre’s consistency achieved excellent performance, with 100% accuracy in most parameters. Minor Deviations (98.07% and 96.15%) occurred in hemoglobin estimation during specific quarters, which were promptly investigated and addressed. Notably, rare antibodies were successfully detected, demonstrating the robustness of testing protocols.

Conclusion: Regular participation in BEQAS significantly enhanced the quality assurance process at the standalone blood center. The scheme not only identified areas needing improvement but also reinforced confidence in reporting accurate results. EQAS remains a critical component in ensuring safety, reliability, and standardization in blood transfusion services.

Keywords: Blood center external quality assessment scheme, internal quality control, quality assurance

PP 39: Thematic Area: Donors and Donations: Donating hope: A retrospective review of unrelated PBSC donations organized by DKMS India and the challenges

Tejaswini Deore, R. Chandrashekar, Nitin Agarwal, Patrick Paul

DKMS Foundation, Bangalore, Karnataka, India

Background: In India, the probability of finding a matched sibling or related donor for blood stem cell transplantation remains low—only around 25%–30%. This underscores the critical importance of unrelated donor registries in bridging the gap for the vast majority of patients with life-threatening blood disorders such as leukemia, thalassemia, and aplastic anemia. DKMS Foundation India has significantly contributed to expanding access to unrelated donor transplants by registering 213,233 potential donors (as of May 2025), including 149,974 males and 63,259 females. DKMS Foundation India has made significant contributions in India by facilitating extensive donor registrations; leveraging high-resolution HLA typing; effective organization of blood stem cell donations; and transporting blood stem cell products to the transplant centers throughout India and across the world.

Aim: This study aims to retrospectively review peripheral blood stem cell (PBSC) donations facilitated by DKMS India between January 2016 and May 2025 and to analyze the key operational, logistical, and communication-related challenges faced by Case Managers in coordinating successful donations.

Methodology: The study included all Confirmatory Typing (CT) requests received from both Indian and international transplant centers and the PBSC donations coordinated by DKMS India across five NABH-accredited collection centers. Additionally, feedback was obtained from Case Managers who were directly responsible for coordinating each donation. The collection centers included BMST (Bangalore), Rela Hospital (Chennai), Fortis Mulund (Mumbai), Tata Medical Center (Kolkata), and Max Super Specialty Hospital (Vaishali, Delhi NCR).

Outcome: Received 3,126 Confirmatory Typing (CT) requests between Jan 2016 and May 2025. Successfully facilitated 187 unrelated PBSC donations during the same period. Collaborated with five NABH-accredited collection centers across India for donations. Provided donors with logistical support for travel, stay, and hospital coordination. Case managers played a critical role in navigating these challenges and ensuring a smooth donor-to-patient pathway.

Challenges: Case managers commonly face several obstacles, including: Donor unavailability due to low awareness, fear of GCSF injections, and lack of family support. Geographic limitations in access to collection centers. Complex coordination of donor travel and medical procedures. Organizing logistics of product transport from the collection center to national and international transplant centers. Time constraints from repeat tests and sudden changes in transplant schedules. Last-minute cancellations from transplant centers, even during GCSF administration. Medical deferrals due to donor-related health concerns.

Conclusion: Co-ordinating unrelated PBSC donations in India presents significant donor availability, operational and logistical challenges. Case Managers serve as a vital link between donors and recipients, ensuring ethical and timely coordination - from recruitment to product delivery. Public awareness, donor education, and family engagement must be strengthened. Streamlining donation procedures, improving donor support systems, and diversifying donor registries can significantly enhance transplant success rates.

PP 40: Thematic Area: Quality Management and Accreditation: Quality indicators as a tool for cintinous quality improvement at a tertiary care hospital blood centre

T. S. Aswath, Ravi Rani Mishra

M. L. N. Medical College, Prayagraj, Uttar Pradesh, India

Background: Blood transfusion services play crucial role in patient health care management. -Ensuring the quality in transfusion services has become essential part of QMS. QMS includes the organized structure, responsibilities, policies, procedures and resources established by the management to achievev and maintain quality. The present study was conducted to measure the impact of monitoring quality indicators and how they could be used as a tool for continous quality improvement (CQI).

Aims and Objectives: To evaluvate the quality indicators (QI’s) and analyze the effectiveness of transfusion services at our blood centre.

Methodology: In this retrospective study, the data collected for a period of two years (2023-2024) at our blood centre. The parameters used in the analysis were based on quality indicators defined by National Accreditation Board for Hospitals and Healthcare Providers (NABH) Quality Indicators: (1) Transfusion-transmitted-infections (TTI %) (Combined TTI cases [HIV+HBV+HCV+Syphilis+MP] / Total number of donors) x 100 (2) Adverse transfusion reaction rate (ATRR%) (No. of adverse transfusion reactions/Total no. of blood and components issued) x 100 (3) Wastage rate % (No. of blood or blood components discarded/Total no of blood or blood components issued) x 100 (4) Turn around Time (TAT) of Blood Issued - (Sum of the time taken/Total no of blood blood components crossmatched or reserved) (5) % of components usage (Total component issued/Total whole blood component issued) x 100 (6) Adverse Donor Reaction Rate % (ADRR) (No. of donors experiencing adverse reaction/Total no of donors) x 100 (7) Donor Deferral Rate % (No. of donor deferrals/Total no. of donation + total no of deferrals) x 100.

Results: On evaluvation, Transfusion transmitted infections (TTI) was 1.55%, Adverse transfusion reactions rate (ATRR) was 0.20% components issued was 99.9% and net wastage was 1.75%. Turn around time for routine and emergency issues was found to be 1.25 % and donor deferral rate was 8.78%.

Conclusion: The study results concluded that blood transfusion services at our blood centre are effective.

PP 41: Thematic Area: Clinical Transfusions: Double trouble – An unusual TACO in septicemic shock; Atypical clinical presentation and a miraculous recovery story

A. R. Nayana

Grant Government Medical College and Sir J.J. Group of Hospitals, Mumbai, Maharashtra, India

Background: TACO is a non-infectious serious hazard of transfusion and leading cause of transfusion related mortality and morbidity, within 6 hours of transfusion. TACO frequently occur in patient who are unable to compensate for an increase in circulatory overload. TACO occurring in hypovolemic shock case is extremely rare and diagnostically challenging due to its paradoxical clinical features. Timely recognition and proper management is very essential for positive patient outcome.

Case Presentation: 30 year old female presented to our casualty with chief complaints of profuse bleeding PV and generalized fatigue. She took Medical Termination Pregnancy kit (MTP) illegally from local hospital when she confirmed UPT positive. She started bleeding since the next day of MTP conception,6-7 pads/day with clots. Patient got admitted basic investigations done, blood products were arranged and posted for emergency D and C under anaesthesia with broad spectrum antibiotic coverage and IV fluids. Vitals were stable initially later bleeding became uncontrollable and BP started to fall, 2 unit of whole blood transfused initially later 3 unit of PRC and 2 unit of FFP transfused within 14 hours of admission. Bleeding became controllable but BP raised transiently till 180/100 mmHg & CVP raised to 14 mmHg with new onset dyspnoea and chest pain, saturation dropped to 88% on Room air. Gradually patient’s BP started to fall with high grade fever and went into shock. Chest Xray shows pulmonary infiltrate, CECT Thorax suggestive of pulmonary oedema and elevated pro BNP level confirmed TACO. CBC report shows elevated TLC-40k and Blood culture report shows Group A Streptococcus, with fall in BP s/o septicaemic shock.

Management: Transfusion reaction workup done which was negative. Oxygen therapy and IV Furosemide given, shifted to ICU kept on CPAP ventilator, patient’s dyspnea and chest discomfort improved. Patient developed high grade fever, managed with IV antipyretics and BP started to reduce and went into shock for which IV inotrope infusion started and hourly monitoring and dose adjustment done, IV antibiotics continued. Patient vitals became normal after 2 days. Inotropes dose tapered and weaning from CPAP was initiated and then shifted to ward.

Conclusion: TACO with septicaemic shock can occur with unusual Hypotension. Liberal Blood transfusion in critically ill patient like septicaemic shock is challenging. Judicious use of blood product as well early recognition and management of TACO like transfusion reaction is very essential for positive patient outcome.

PP 42: Thematic Area: Immunohematology: A study to evaluate agreement between conventional tube technique and fully automated column agglutination technique for blood grouping and crossmatching at blood centre of a tertiary care hospital

S. Vishnu Prasad Pillai, Sudeep Kumar, Ujjwal Dimri, Neerja Kushwaha, Amit Ajay Pawar

Armed Forces Medical College, Pune, Maharashtra, India

Background: Routine immunohematological testing is essential for safe transfusion practices and can be performed using manual or automated methods. With increasing workloads and the need for standardization, automation has become a key focus in transfusion medicine. Automated platforms offer several advantages, including improved efficiency, reproducibility, and reduced human error, but also present challenges that require evaluation. The BIORAD IH-500 is a fully automated, walk-away analyzer recently introduced at our center, designed for high-throughput immunohematological testing.

Aim and Objectives: This study aims to evaluate the agreement between the Conventional Tube Technique (CTT) and Column Agglutination Technique (CAT) using the fully automated immunohematology analyzer (BIORAD IH-500) for blood grouping and crossmatching.

Materials and Methods: This prospective pilot study was conducted using 2000 patient samples received at our blood centre for packed red blood cell (PRBC) transfusion. Samples were selected using a convenience sampling technique. Each sample underwent simultaneous testing for blood grouping by both CTT and the CAT method using the fully automated immunohematology analyzer. For patients with a valid blood issue slip, crossmatching was performed with corresponding donor PRBC units using both techniques, and the results were documented for comparison. The statistical analysis was performed using SPSS software version 30.

Results: In blood grouping, concordant results between the CTT and CAT method using the fully automated immunohematology analyzer were observed in 1991 out of 2000 samples (99.55%), with 9 samples (0.45%) showing discordance. Agreement analysis yielded a statistically significant kappa value of 0.665. The sensitivity and specificity of the automated method were 100% and 99.5%, respectively. For crossmatching, the fully automated CAT demonstrated concordant results in 1993 out of 2000 crossmatches (99.65%), with 7 (0.35%) discordant cases compared to the CTT. The kappa coefficient was 0.923, indicating strong agreement, and was statistically significant. The sensitivity and specificity were 100% and 99.6%, respectively.

Conclusion: The fully automated immunohematology analyzer demonstrated high sensitivity, specificity, and substantial agreement with the conventional tube technique in both blood grouping and crossmatching. Its performance highlights its reliability and potential utility in routine pretransfusion testing, while also offering advantages in terms of standardization, efficiency, and reduction of manual errors.

PP 43: Thematic Area: Blood Components/Products: Liquid gold in dentistry: Harnessing the healing power of platelet-rich plasma

Ragini Singh, Himanshu Shekhawat 1 , Pankaj Ghalaut 2 , Gajender Singh

PGIMS, 2 PGIDS, Rohtak, 1 SKHM, Gurugram, Haryana, India

Background: Platelet-Rich Plasma (PRP), often termed as “liquid gold,” is revolutionizing regenerative strategies in dentistry. Derived from autologous blood, PRP is a concentrated suspension of platelets in plasma enriched with growth factors such as PDGF, TGF-β, VEGF, and EGF, which play pivotal roles in wound healing, angiogenesis, and tissue regeneration. This poster presentation aims to highlight the biological principles, preparation protocols, classifications, and wide-ranging clinical applications of PRP in various branches of dentistry including oral and maxillofacial surgery, periodontology, endodontics, implantology, and prosthodontics. PRP has shown promising results in accelerating soft and hard tissue healing post-extraction, enhancing osseointegration of implants, and promoting bone regeneration in sinus lift and ridge augmentation procedures. Its application in treating periodontal defects and pulp revascularization in immature teeth is also gaining traction. Despite its proven efficacy, the variability in preparation techniques, platelet concentration, and activation methods often lead to inconsistent clinical outcomes. Hence, this presentation also emphasizes the need for standardization and evidence-based guidelines for optimal use. PRP offers a cost-effective, minimally invasive, and biocompatible solution to augment healing and improve prognosis in dental treatments. With growing clinical acceptance, PRP represents a paradigm shift toward biologically driven, patient-centered care. This presentation will serve as an informative resource for dental professionals seeking to integrate PRP into clinical practice for enhanced patient outcomes.

PP 44: Thematic Area: Cellular Therapies: Stem cell mobilization patterns and outcomes in autologous transplant patients: A two-year experience from a tertiary care center in India

Murali Krishna Bogi, Sudhir Kumar Vujhini, K. Mahesh Kumar

NIZAMS Institute of Medical Sciences, Hyderabad, Telangana, India

Background: Collecting stem cells from the blood is an important step before doing an autologous stem cell transplant. The success of collection depends on the patient’s condition and treatment history. In India, there is limited data about how well different methods work. This study aimed to evaluate mobilization patterns and identify factors associated with suboptimal CD34+ cell yield in patients undergoing autologous HSCT.

Methods: A retrospective observational study was conducted at a tertiary care center in India over a two-year period (June 2023 to May 2025). Patients undergoing autologous HSCT for hematologic and selected non-hematologic conditions were included. Mobilization regimens included granulocyte colony-stimulating factor (G-CSF) with plerixafor, with or without chemotherapy, based on clinical judgment. Apheresis was initiated when pre-apheresis peripheral blood CD34+ count reached ≥20 cells/µL. The median pre-apheresis CD34+ count, CD34+ yield, number of poor mobilizers, and associated clinical variables were analyzed.

Results: There were 73 patients, including 48 males and 25 females, with an average age of 44 years (range 5-74). Most had multiple myeloma (42), followed by Hodgkin lymphoma (12), red cell aplasia (7), AML (3), and other diseases (9). G-CSF with plerixafor was used in 48 patients; 25 also received chemotherapy. The average CD34+ count before collection was 84.2 cells/µL, and the average number of cells collected was 9.1 million per kg. Six patients (8.2%) did not collect enough cells. Older age, past chemotherapy (in 4 patients), and past radiotherapy (in 2 patients) were linked to poor collection.

Conclusions: Most patients had successful collection using G-CSF with or without chemotherapy and plerixafor. Older age, previous chemotherapy, and radiation made it harder to collect enough cells. It is helpful to identify such patients early and adjust their mobilization plan accordingly.

PP 45: Thematic Area: Clinical Transfusions: Revisiting out of core hours transfusions in low-acuity areas: A prospective audit from a multispecialty hospital in India

Priyasha Prajapat, Rasika Dhawan Setia, Mitu Dogra

BLK-Max Super Speciality Hospital, New Delhi, India

Background: Out of Core Hours Transfusions (OCH-T) in low-acuity areas have raised global safety concerns due to reduced staffing, limited clinical supervision, and compromised patient monitoring. International audits, including the UK’s National Comparative Audit of Red Blood Cell Transfusion and a Turkish study (2025) emphasizes that a significant proportion of overnight transfusions are not clinically justified but rather driven by workflow inefficiencies.

Study Design and Methods: A prospective observational study was conducted from April 2024-April 2025 in a 650-bedded multispecialty hospital in India. Transfusions initiated between 8PM and 8AM in non-ICU, non-ER wards were audited. Data were collected through integrated Electronic Health Record system and structured proformas filled by physicians and nurses. Workflow delays were categorized into six stages: pre-request, request-to-collection, crossmatch (routine/emergency), issue, transport-receipt, and transfusion time. The time gap of >12 hours at each interval across transfusion chain is considered as a potential cause of delay. A transfusion efficiency scoring (0–12) evaluated process efficiency across seven stages, and appropriateness of transfusions was assessed against institutional and international guidelines.

Results: Of 5,967 transfusions, 891 (14.93%) red blood cell transfusions occurred at night. The department of hemato-oncology recorded maximum transfusion (21%). An alarming 34.39% OCH-T peaked during 10PM - 12PM. Only 40.85% fulfilled urgent clinical criteria such as hemoglobin <7 g/dL or active bleeding. Workflow junctures showed statistically significant differences (<0.001) between core and OCH-T. A concerning 2.91% of transfusions were deferred from daytime to the night despite early lab report availability, with 24.35% coinciding with nursing handovers. Pre-request delays during OCH-T were significantly higher than day time 341±306 vs 521 ± 2931 (p<0.001) and lack of daytime action were primary contributors.

Discussion: Our findings align with international audits showing a disconnect between transfusion timing and clinical urgency. Institutional culture, such as pressure to “clear lists” before morning rounds, transfusions coinciding with shift change timings frequently overshadowed patient-centred decision-making. Emergency/urgent request were processed faster indicating improved efficiency when flagged properly. Despite compliance with vital sign monitoring, night time conditions inherently raise risks, compromising safety, consistent with SHOT and other hemovigilance findings.

Conclusion: To mitigate these risks, we recommend institutional enforcement of “daytime-first” transfusion policies, mandatory consultant authorization for OCH-T, automated alerts for unexecuted daytime orders, and regular staff sensitization on timing-related safety concerns. The need for targeted process improvements, including digital alerts, streamlined documentation, and prioritization protocols, ensures timely transfusion support even during off-hours. Implementing a transfusion efficiency scoring system across departments can serve as a powerful internal audit tools.

PP 46: Thematic Area: Donors and Donations: Effect of blood donation on cardiac autonomic response in young male donors: A pilot study

Niranjan Arya, Minal Wasnik, Ekta Khandelwal

AIIMS, Raipur, Chhattisgarh, India

Background: Blood donation induces acute normovolemic hypovolemia that activates compensatory autonomic mechanisms to maintain cardiovascular homeostasis. These subtle changes, particularly in parasympathetic tone, may be sensitively assessed through autonomic function tests (AFTs). Despite its relevance, limited Indian data exist on immediate autonomic responses post-blood donation in healthy young male donors. This study aimed to objectively assess cardiac autonomic modulation using Ewing’s battery tests before and after whole blood donation.

Methodology: This prospective observational study included 40 healthy male donors (aged 20–40 years, mean: 29.15 ± 5.98 years), equally distributed across ABO blood groups (A+, B+, AB+, O+; n=10 each). Pre- and post-donation measurements included: blood pressure (BP), heart rate (HR), and standardized AFTs – lying-to-standing test (30:15 ratio, ΔHR), deep breathing test (E:I ratio), and Valsalva maneuver (Valsalva Ratio). Blood donation involved 350–450 mL of whole blood. HRV (time and frequency domain) was recorded in a subset. Paired t-tests and Wilcoxon signed-rank tests were used based on data distribution (significance set at p < 0.05).

Results: Post-donation, there was a significant reduction in: - SBP (119.1 ± 7.8 to 117.0 ± 7.5 mmHg; p = 0.048), - DBP (73.1 ± 6.3 to 70.9 ± 6.2 mmHg; p = 0.003), - HR (78.8 ± 10.2 to 73.8 ± 10.0 bpm; p = 0.005). Among AFTs: - 30:15 ratio significantly declined (median 1.55 to 1.25; p < 0.001), suggesting reduced parasympathetic orthostatic responsiveness. - No significant changes in ΔHR (p = 0.645), E:I ratio (p = 0.981), or Valsalva ratio (p = 0.962). - Maximum Δ SBP remained unchanged (14 to 12 mmHg; p = 0.683), indicating preserved sympathetic vasomotor tone. Categorical AFT analysis showed a non-significant rise in abnormal 30:15 responses (0% to 7.5%).

Conclusion: Blood donation in healthy young males causes statistically significant reductions in blood pressure, heart rate, and 30:15 ratio, indicating transient parasympathetic withdrawal with compensatory sympathetic activation. Other core autonomic parameters remain stable, reflecting the cardiovascular resilience and autonomic adaptability of young donors. This supports the physiological safety of voluntary blood donation while emphasizing the utility of AFTs in donor health surveillance.

PP47: Thematic Area: Blood Components/Products: Abstract Title: Liquid Gold in Dentistry: Harnessing the Healing Potential of Platelet-Rich Plasma (PRP)

Ragini Singh 1 , Himanshu Shekhawat 2 , Pankaj Ghalaut 3 , Gajender Singh 1

1 PGIMS Rohtak, 2 SKHM, Gehber, and 3 PGIDS, Rohtak, Haryana India

Background: Platelet-Rich Plasma (PRP) is an autologous blood component enriched with platelets and growth factors that play a vital role in tissue repair, angiogenesis, and regeneration. Originally developed for transfusion and orthopedic use, PRP is now being increasingly applied in dentistry for accelerated healing and tissue regeneration. This study aims to explore the clinical applications of PRP in dental practice and emphasize its significance as a biologically active blood product.

Methods: This presentation compiles evidence from clinical studies, systematic reviews, and case series exploring the preparation techniques, classifications (such as L-PRP and P-PRP), activation protocols, and dental applications of PRP. Literature was reviewed using PubMed and Scopus databases, focusing on studies from the last 10 years involving oral surgery, periodontology, implantology, and endodontics.

Results: Studies indicate that PRP significantly enhances healing in post-extraction sockets, improves osseointegration of dental implants, and promotes bone regeneration in sinus lift and ridge augmentation procedures. PRP has also shown promise in periodontal regeneration and pulp revascularization. However, variation in preparation techniques and lack of standardization contribute to inconsistent clinical outcomes.

Conclusions: PRP represents an innovative extension of blood component therapy into dental and regenerative medicine. It offers a cost-effective, autologous, and minimally invasive adjunct to conventional treatments. There is an urgent need for evidence-based guidelines and standardization protocols to optimize its use. Transfusion medicine professionals should play a key role in promoting the safe and effective application of PRP.

PP 48: Thematic Area: Quality Management and Accreditation: Monitoring errors in the outdoor blood donation camps: A check point at blood component processing lab for guiding a management system

Anisha Rani, Atul Sonker, Dheeraj Khetan

Sanjay Gandhi Post Graduate Institute of Medical Science, Lucknow, Uttar Pradesh, India

Background: Organizing voluntary blood donation camps is becoming an inherent vital part of a blood transfusion service in a country like ours, where the supply-demand ratio is not stable. A successful completion of an outdoor blood donation camp helps in the maintenance of safe and quality inventory. However many errors in outdoor blood donation camps can affect safety and quality of whole blood units and ultimately blood components prepared. Thus, these errors not only lead to wastage of valuable blood units but also pose significant risks to patient safety. Objective of this retrospective observational study is to focus on the types, frequency and causes of errors happening during outdoor blood donation camps, finding the causes and their timely management to prevent recurrence. Finally to assess the effectiveness of implemented corrective and preventive actions (CAPA).

Materials and Methods: A Retrospective observational study was conducted in the component laboratory of a tertiary hospital of north India over a period of one year. Data were collected from voluntary blood donation camp organized by the hospital blood center and the blood units were evaluated. For evaluation purpose all the VBD camps were grouped into three based on whole blood units collection (a) >100 (b) 50 to 100 and (c) 50 or less. Errors were categorized into two groups: pre-processing (from donor selection to transportation to component lab but before component separation) and processing (during component separation).

Results: Pre-processing errors were more prevalent (N=34) than processing errors (N=16), especially when processing volume exceeded 100 units of whole blood. Observed pre-processing errors were, improper knotting tubing of primary blood bag (n=6), improper cold chain maintenance (n=5), mislabeled and unreadable unique identification number on the blood bags (n=6), over collected blood units (n=9), under collected blood units (n=8). In the processing errors, technical issues such as improper balancing before centrifugation of whole blood units (n=11), inline leuko-filter clogging due to fine clots (n=5).

Conclusion: Through systematic categorization and root cause analysis, following causes were ascertained which were responsible for the errors in VBD camps organized in outdoor locations, scarcity of staff as compared to the workload, inadequate training of the staff, improper assessment of the equipment need like less number of blood transportation boxes and need of biomixers. The establishment of corrective and preventive actions (CAPA) was done, including assigning adequate manpower in anticipation of workload, staff training, incorporation of biomixers and additional transportation boxes. The follow up audits were conducted, and there was significant reduction in the rate of errors over time, indicating the effectiveness of these interventions in improving overall performance.

Keywords: Blood component preparation, blood donation camps, cold chain maintenance, component laboratory, corrective and preventive actions, error analysis, labelling errors, monthly audit, pre-processing errors, processing errors, staff training

PP 49: Thematic Area: Management and Organization: Online application of blood centre licence and related documents – Joining hands with technology while surmounting challenges!!

Simranjeet Kaur

Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India

Background: Appropriate regulatory rules and regulations, policies and guidelines are crucial to ensure a well-regulated transfusion services across nation to facilitate easy access to blood and excise quality transfusion services. As per latest guidelines, blood centre licencing and related services ought to be applied online via Online National Drugs Licensing System (ONDLS) portal where various challenges are faced in the process.

Materials and Methods: It was observed that it is mandatory to apply for blood centre licence on ONDLS portal to make necessary changes in it which were essential to carry out the working of the centre. The whole process was carried out in systemic way but it turned out to be more cumbersome with each step taken ahead since December 2024 to May 2025. Difficulties faced has been discussed here.

Results: User manual guide, how to make the blood centre licence firm user ID using the registered contact phone number (mobile number required) and registered e-mail ID where one time password (OTP) is received for validation. First drawback sets in if the blood centre don’t have a registered mobile SIM number as many of them use conventional landline telephone numbers which don’t permit OTP receiving facility. Secondly, to register the blood centre, old blood centre licence need to be handy with you to enter product specifications, area etc. Thirdly, addition of technical member is only possible when all of their qualification certificates, experience certificates and their relieving from past institute till date is saved in their profile. Such documents are not handy all time such as a relieving certificate. Also, all the documents are required in the pdf form. Fourthly, a specific allotted technical member number and their appointment letter which is only available with the technical member/technical supervisor/medical officer concerned is required to add them. Member addition in unsuccessful till he accept the time limited e-mailed link. Fifth, there is no option for downloading the updated licence. Only view option is there which show limited data. Sixth, there is no provision to add counsellor/medical social worker in portal. Seventh, for post-approval changes, drop-down option lacks options such as no provision for approval for increase in the area of the blood bank, approval for preparation of new blood products. Eighth, provision is available for submission of only one post-approval application. When one application is approved by the state FDA only then option is opened for submission of second application which takes weeks to months. Ninth, no contact number is available any query resolution. Only e-mail id is provided as a means of communication.

Conclusion: Since regulatory authority is constantly thriving upon to bring out transparency, accountability and uniformity in its services in order to ensure safety, efficacy and quality of the medical product manufactured, imported and distributed in the country, it is crucial to review the present status of legal and regulatory blood centre licencing policy framework so as to scrutinize various challenges and issues in the process. It also proposes the opportunities and ideas for improvement of blood.

PP 50: Thematic Area: Donors and Donations: Blood donation – A revolution of societal thought process is the need of an hour

Nirali Patel, Ripal Shah

Prathama Blood Centre, Ahmedabad, Gujarat, India

Background: Blood donation is a selfless act that embodies the highest form of humanity—saving lives without expecting anything in return. Unlike investments, which are made with the anticipation of profit or personal gain, blood donation is purely altruistic. Voluntary blood donation remains a critical component of modern healthcare system. However, myths, misconceptions, and societal apathy continue to hinder regular donation practices. There is an urgent need to shift the societal mindset from perceiving blood donation as an occasional charity to recognizing it as a vital civic responsibility.

Aim: To assess the current societal attitudes and awareness towards blood donation. To identify barriers and misconceptions preventing voluntary blood donation. To propose strategic interventions for transforming public perception and promoting a sustainable culture of donation.

Materials and Methods: A cross-sectional survey of 200 individuals from diverse demographic backgrounds. Focus group discussions with donors and non-donors. Data was obtained via Google form to reach out to far away community. Analysis of data were collected using pre-validated questionnaires and analyzed using SPSS software.

Results: 63% of respondents had never donated blood; major reasons included fear, lack of time, and misconceptions regarding Donation. Only 22% were aware of the eligibility criteria and benefits of donation. Educational interventions, awareness, counselling through providing knowledge by facts significantly improved intent to donate in 74% of previously non-willing participants.

Conclusion: The study highlights a critical need to revolutionize the societal thought process around blood donation. Awareness, education, and community-led initiatives are essential to dismantle myths and foster a proactive donation culture. Creating a mindset where blood donation is seen as a civic duty rather than a noble act is vital to ensuring safe and adequate blood supply for all.

PP 51: Thematic Area: Immunohematology: A novel case of detection of block D phenomenon using gentle heat elution

R. Ragul, Dheeraj Khetan, Prashant Agarwal, Priti Elhence

Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Background: Blood group discrepancies in neonates present a diagnostic challenge, particularly when maternal alloantibodies cross the placenta and coat fetal red blood cells (RBCs). This passive transfer of antibodies, most commonly IgG, can lead to false-negative antigen typing, especially for Rh (D), resulting in apparent ABO or Rh discrepancies. Traditional elution methods such as acid elution (pH ~3.0) or Lui freeze technique are frequently used to dissociate antibodies from sensitized RBCs. However, these approaches often compromise red cell integrity, leading to hemolysis and preventing repeat testing such as blood grouping and DAT interpretation. In contrast, gentle heat elution provides a non-destructive approach, preserving cell structure while effectively removing red cell bound antibodies.

Methods: Initially the cord blood was typed as Rh (D) negative, while the mother was also Rh (D) negative. A strongly positive Direct Coombs Test (DAT) on the cord blood cells prompted further investigation. To identify the underlying cause, gentle heat elution was performed by incubating DAT-positive cord blood red cells with AB plasma at 45°C for 10 minutes in a water bath. After three times of gentle heat elution, the eluate was collected and tested using a commercial antibody identification panel, while the treated red cells were re-evaluated for blood grouping and DAT grading.

Results: Post-elution, the neonate’s RBCs were retyped and showed a clear Rh (D) positive reaction, confirming that the D antigen had been previously masked by maternal anti-D antibodies. Additionally, the DAT reactivity decreased, indicating effective removal of surface-bound antibodies. The eluate tested positive for anti-D, confirming the diagnosis of Block D phenomenon, a form of antigen masking caused by maternal alloantibodies, leading to serological false negativity in Rh typing.

Conclusion: This case underscores the clinical importance of considering Block D phenomenon in neonates with unexplained Rh discrepancies and positive DAT. In contrast to other elution methods Gentle heat elution is a safe, effective, and non-invasive method to uncover masked alloantibodies without damaging red cell antigens, enabling accurate Rh typing and improving diagnostic clarity. Early recognition of such phenomena is crucial for guiding appropriate transfusion strategies and clinical management in neonates affected by hemolytic disease due to maternal alloimmunization.

PP 52: Thematic Area: Management and Organization: Bridging staffing gaps: A WISN-based assessment in the blood bank

Vijit Joon, P. Sriraman, I. Suresh Kumar, A. Hari Haran, Sahayaraj James

Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India

Background: Human resource planning in healthcare is essential for maintaining efficiency and ensuring patient safety, especially in resource-limited settings like India. Blood centers, being critical to hospital operations, require accurate staffing to handle their intensive workloads. The Workload Indicators of Staffing Needs (WISN) is a valuable tool to assess staff adequacy based on actual workload rather than outdated population-based estimations.

Aim: To evaluate staffing requirements in the Department of Immunohematology and Blood Transfusion at a Tertiary care hospital using the WHO-WISN method, identify any workforce imbalances, and propose corrective actions to optimize staffing.

Methods: This observational cross-sectional study was conducted from January to March 2025. The WISN tool was applied to the two staff categories – laboratory technicians and nursing staff within the Department of Immunohematology and Blood Transfusion. DATA on workload, activity standards, available working time (AWT), and allowance factors were collected through interviews, observation, and institutional records. Calculations followed the standard WISN methodology to determine optimal staffing numbers and WISN ratios.

Results: The WISN calculated staffing requirements for our blood center were found to be 10.71 (rounded to 11) for laboratory technicians and 4.12 (rounded to 4) for nursing staff. But the current workforce consisted of 9 technicians and 2 nurses, revealing a shortage of 2 staff in each category. WISN ratios were 0.81 for technicians and 0.50 for nurses, indicating high workload pressure and understaffing.

Conclusions: The application of the WISN method revealed significant staffing deficiencies in both technicians and nursing cadres within the blood center. Addressing these shortages through data-driven recruitment and incorporating WISN-based audits into HR policy will enhance staff efficiency, reduce burnout, and improve overall service quality.

PP 53: Thematic Area: Immunohematology: Practical comparison of in-house and commercial anti-A1 lectins in blood grouping: Experience from a tertiary center in India

Vijit Joon, P. Sriraman, I. Suresh Kumar, A. Hari Haran, Sahayaraj James

Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India

Background: Lectins are proteins with hemagglutinating properties that have been utilized since the 19 th century for the selective agglutination of red blood cells. The term “lectin” was first introduced by Boyd and Shapleigh in 1954 to describe sugar-binding proteins. These proteins specifically bind to carbohydrate moieties present on glycoproteins or glycolipids on cell surfaces, resulting in agglutination—an essential mechanism used in blood typing procedures within transfusion medicine.

Aims: This study evaluates and compares in-house Anti-A1 lectin derived from Dolichos biflorus seeds with commercially available Anti-A1 lectins in terms of cost-effectiveness, specificity, reliability, and ease of preparation.

Materials and Methods: Lectins were extracted from Dolichos biflorus seeds and evaluated based on their appearance, specificity, avidity, reactivity, and potency. Specificity was assessed using red cells from various blood groups, while potency was determined through serial dilutions with appropriate group cells.

Results: The in-house prepared lectin exhibited a clear appearance and demonstrated specific agglutination with A1 and A1B red cells, with no reactivity to A2, B, A2B or O cells. Both avidity and reactivity parameters met established standards. Potency testing yielded effective titers of 1:32 with A1 cells and 1:16 with A1B cells. The in-house prepared Lectin was stored for 48 hours when stored at 4*c. Additionally, cost analysis highlighted substantial financial savings with the in-house preparation when compared to commercially available Anti-A1lectins.

Conclusion: This study underscores the comparable quality of in-house-prepared Anti-A1 lectins to that of commercial counterparts. The significantly lower cost of in-house production offers a practical and economical alternative for blood centers with limited access to commercial reagents. Given their specificity and agglutination properties, lectins continue to hold valuable potential in both transfusion medicine and stem cell research. In-house prepared Anti-A1 lectin demonstrates comparable effectiveness to commercial reagents, providing a cost-effective, reliable, and easily prepared alternative for blood centers. It offers a practical solution for resolving blood grouping discrepancies, particularly in resource-limited settings. More research is to be made in regard to storage of the in house prepared lectins and preservatives for prolonged storage.

PP 54: Thematic Area: Quality Management and Accreditation: Internal quality control practices in blood components: A retrospective audit

Bavil Sidhu, Rajesh Kumar, Shria Thukral, Paramvir Singh

Dayanand Medical College and Hospital, Ludhiana, Punjab, India

Background: In transfusion medicine, maintaining the safety, purity, and potency of blood components is critical. Internal Quality Control (IQC) ensures adherence to quality benchmarks and sustains regulatory and clinical standards. This study aimed to evaluate existing IQC practices in a tertiary care hospital blood bank and to identify areas for performance enhancement.

Methods: A retrospective audit was conducted over a one-year period in the Department of Immunohematology and blood transfusion, Ludhiana. A total of 28,508 whole blood (WB) collections were collected in 450 ml top and bottom in-line filter quadruple bag (terumo) and components were made using automated component extractors (Terumo T-ACE II). As per departmental SOPs, 1% of each component batch (Leucoreduced Packed Cells, Random Donor Platelets, Fresh Frozen Plasma and cryoprecipitate) was randomly selected and tested for internal quality parameters, including volume, haematological indices, sterility, pH, coagulation profiles and swirling etc.

Results: The mean Haematocrit of Leucoreduced Packed Cell’s was 60.05 ± 5.92%, volume was 287.05 ± 20.30 ml, Hb was 16.99 ± 2.55 g/dL, and RBC count of 6.85 ± 1.62 × 106/μl. Coagulation parameters of Fresh Frozen plasma included a mean Volume of 238 ± 20.60 ml, Fibrinogen concentration of 314.82 ± 49.62 mg/dl, PT of 11.66 ± 0.81 sec, Aptt (pttk) of 32.90 ± 2.87 sec and INR was 1.06 ± 0.08. Random Donor Platelet mean volume was 93.5 ± 4.40 ml, pH averaged 6.98 ± 0.17 and platelet yield had a mean of 1.20 ± 0.477×1011/unit. Cryoprecipitate show an average volume of 28.08 ± 1.29 ml. The Factor VIII levels had a mean of 138.46 ± 71.58 UI and fibrinogen concentrations averaged 299.40 ± 56 mg/dl. The blood components analysed met all internal quality control standards. All cultures were negative, confirming sterility of the components.

Conclusions: A robust Internal Quality Control framework is indispensable for maintaining the functional integrity of blood components, minimizing transfusion-related risks, and ensuring compliance with regulatory standards. Regular IQC audits reinforce operational efficiency, patient safety, and clinical effectiveness in transfusion practices. The findings affirm the effectiveness of existing IQC protocols and suggest that structured monitoring substantially contributes to safe and efficient transfusion services.

PP 55: Thematic Area: Apheresis (Donor and Therapeutic): Thrombocytapheresis in a splenectomized patient with hepatitis C–related cirrhosis and JAK2-positive myeloproliferative neoplasm

Deepthi Krishna, Jyotsnaa Grace, M. Divya, Deepti Sachan, Mohamed Rela

Dr. Rela Institute and Medical Centre, Chennai, Tamil Nadu, India

Background: Thrombocytosis, a hallmark of JAK2-positive myeloproliferative neoplasms (MPNs) like polycythemia vera—poses heightened thrombotic and hemorrhagic risks when platelet counts exceed 1,000 × 10 9 /L. This is further complicated by post-splenectomy effects and hepatopathy such as hepatitis C-related cirrhosis with portal hypertension. While cytoreductive agents are standard, therapeutic thrombocytapheresis serves as an emergency intervention in extreme thrombocytosis. This case examines the multidisciplinary management of a hepatitis C–induced end-stage liver disease (HCV-ESLD) patient with JAK2-positive MPN who underwent splenectomy, developing acute hyperthrombocytosis managed via thrombocytapheresis.

Case Report: A 49-year-old Yemeni male with chronic HCV-ESLD underwent antiviral therapy and had portal hypertension managed with variceal ligation. Two weeks prior, he underwent an open splenectomy with proximal splenorenal shunt due to extrahepatic portal vein obstruction. His MPN, confirmed by JAK2 V617F mutation, had been managed with prior venesections. Post-splenectomy, he presented with abdominal distension, pedal edema, and a massive platelet count (PLT) of 2.53 × 10 6 /µL. Other laboratory investigations were notable for leukocytosis (White blood cell count (WBC)-26,840/mm 3 ), haemoglobin (Hb) 12.8 gm%, and liver function tests aligning with chronic liver disease. Following informed consent, the patient underwent three sessions of therapeutic thrombocytapheresis (Optia Spectra, Terumo BCT), each processing between 1.0–1.3 total blood volumes. Anticoagulation with ACD-A (1:12) and prophylactic oral and intravenous calcium were used. Saline replacement given to maintain fluid balance, and collection efficiency averaged 40%. Therapeutic response was marked by a mean platelet reduction of 45% (38–59%) across the three procedures. Post-apheresis, the platelet count stabilized at approximately 1.41 × 106/µL. Hematologic parameters also improved, Hb 11.5 g/dL and WBC 12,440/mm3. Ropeginterferon was initiated subsequently to address the underlying MPN. Following each session, the patient experienced transient neurological episodes at varying intervals—10 minutes after the first procedure, at the end of the second, and 15 minutes before the end of the third. These episodes included severe coughing, unresponsiveness, profuse sweating, upward gaze, and bronchospasm without convulsions, necessitating ICU monitoring and intravenous levetiracetam. As a result, the second and third procedures could not be completed to the planned 1.5 total blood volume. MRI ruled out infarction, while EEG revealed focal epilepsy. The events were attributed to procedure-induced cerebral microvascular changes rather than citrate toxicity or metabolic derangements or anaphylaxis. The patient recovered fully after each episode, was initiated on anticonvulsants, and was discharged in a stable neurological condition.

Conclusion: This case underscores the multifactorial nature of life-threatening thrombocytosis. Thrombocytapheres is served as an effective emergency intervention to rapidly reduce platelet counts, acting as a bridge to definitive, disease-modifying therapy. However, the occurrence of post-apheresis focal seizures highlights the need for vigilant neurologic monitoring, particularly in patients with predisposing vascular conditions. Multidisciplinary coordination among hematology, hepatology, neurology, and critical care teams was crucial in achieving clinical stabilization and planning long-term management.

PP 56: Thematic Area: Apheresis (Donor and Therapeutic): Role of therapeutic plasma exchange in paediatric atypical haemolytic uremic syndrome

Shria Thukral, Rajesh Kumar, Bavil Sidhu, Paramvir Singh

Dayanand Medical College and Hospital, Ludhiana, Punjab, India

Background: Haemolytic uremic syndrome (HUS) is a life-threatening thrombotic microangiopathy (TMA) characterized by the triad of microangiopathic haemolytic anaemia, thrombocytopenia, and acute kidney injury. While the typical form of HUS is predominantly associated with Shiga toxin-producing Escherichia coli (STEC), atypical HUS (aHUS) arises from complement dysregulation, often linked to genetic mutations or autoimmune triggers, including anti-complement factor H (CFH) antibodies. A prompt diagnosis and early initiation of targeted therapy, including therapeutic plasma exchange (TPE), are crucial to improving patient outcomes. This case series describes the clinical course and therapeutic response of two paediatric patients diagnosed with autoimmune-associated aHUS—one with anti-factor H antibodies and the other with anti-PM-Scl autoantibodies.

Objectives: Clinical utility of TPE in paediatric patients with autoimmune-associated aHUS and emphasizing the importance of early initiation of plasma exchange in atypical presentations of HUS.

Methods: This study analyses all TPE sessions performed in aHUS paediatric patients. Multiple sessions (five to seven sessions) were performed with continuous flow cell separator TERUMOBCT Spectra Optia machine done on alternate days using FFP as replacement fluid. Pre and post procedural laboratory profiles were analysed to assess the response to TPE therapy. Patients were observed continuously for any adverse reactions.

Results: A total of 12 sessions of TPE were performed. TPE was initiated within 3 days of onset of illness. An average volume of 2451ml was processed during each session. Following initiation of therapeutic plasma exchange, particularly after the 3rd session, the patient’s haematological and renal parameters showed gradual and consistent improvement. Rise in haemoglobin and platelet counts, along with a steady decline in lactate dehydrogenase (LDH) levels, indicating resolution of haemolysis was seen. Renal function showed parallel improvement, with decreasing serum urea and creatinine levels and increasing urine output over the course of therapy. One patient experienced a transient hypotensive episode, managed conservatively.

Conclusion: Atypical HUS can be effectively managed with therapeutic plasma exchange (TPE). In both patients, the timely use of TPE, alongside supportive therapy, contributed to significant clinical and renal recovery. These cases highlight the value of a multidisciplinary approach and early initiation of TPE as part of comprehensive care for children with atypical HUS.

PP 57: Thematic Area: Immunohematology: Red cell alloimmunization and transfusion-transmissible infections in beta-thalassemia major: A retrospective study from a tertiary care centre

Shria Thukral, Rajesh Kumar, Bavil Sidhu, Paramvir Singh

Dayanand Medical College and Hospital, Ludhiana, Punjab, India

Background: Beta-thalassemia major is a transfusion-dependent condition where repeated red blood cell (RBC) transfusions are essential for survival. However, this life-saving therapy comes with risks, notably red cell alloimmunization and exposure to transfusion-transmissible infections (TTIs). The aim of this study was to determine the frequency and types of alloantibodies and TTIs in multitransfused beta-thalassemia major patients at a tertiary care centre in India.

Methods: This retrospective observational study included 189 beta-thalassemia major patients undergoing regular transfusions. Demographic and clinical data were collected. Serological testing for alloantibodies was performed using antibody screening and identification panel. Screening for TTIs (HBsAg, anti-HCV, anti-HIV 1, 2) was conducted using chemiluminescence immunoassay by Ortho Clinical Diagnostics and nucleic acid testing (NAT) using Roche, Cobas 5800. Statistical analysis included chi-square testing for association; p-value < 0.05 was considered statistically significant.

Results: The overall alloimmunization rate was 6.3% (12 out of 189 patients). The identified alloantibodies included Anti-c, Anti-C, Anti-cE, Anti-D, Anti-E, Anti-K, and Anti-Jka. Alloimmunization was significantly associated with the patient’s sex (p = 0.024) and age at first transfusion (p = 0.015), with higher rates observed in females and those who began transfusions after the age of one year. The prevalence of transfusion-transmissible infections was 41.2% out of which hepatitis B was 1.05%, hepatitis C was 37% and HIV 1,2 was 3.17%, despite adherence to standard pre-transfusion testing protocols. This highlights the need for enhanced donor selection and more sensitive screening tools.

Conclusions: Despite advancements in immunohematology and infectious screening protocols, beta-thalassemia major patients continue to face significant risks related to alloimmunization and TTIs. The study emphasizes the importance of early transfusion initiation, extended antigen matching, and strict adherence to advanced screening strategies to minimize these risks. Ensuring a safe and adequate blood supply remains crucial to improving the long-term outcomes of thalassemia care in India.

PP 58: Thematic Area: Blood Safety and Infectious Disease Marker Testing (Including NAT Testing): Inform, support, prevent: Donor notification as a tool for TTI risk reduction

Gajender Singh, Vaishali Gupta, Aashna Gupta

Pt BDS PGIMS, Rohtak, Haryana, India

Background: Donor notification and counselling are critical components of a safe and ethical blood transfusion system. This study highlights the need to strengthen donor followup to ensure timely communication and care. By improving response rates, we not only protect recipients but also empower donors with vital health information. Ultimately, a compassionate and well-informed approach benefits both individual and public health.

Methods: This prospective study was conducted in the Department of Immunohematology and Blood Transfusion at Pt. B.D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, over a period of two years, from January 1, 2023, to December 31, 2024. Total 81,909 donors were registered, 76,682 were found eligible. Each donor underwent medical screening, counselling, and TTI awareness. All collected units were tested for HIV, HBV, HCV, syphilis, and malaria using standard methods. All reactive donors were notified by post and telephonically three times with week interval.

Results: Among the 81,909 individuals who registered for blood donation, 76,682 were found eligible to donate. Out of these eligible donors, 2,475 (3.22%) tested reactive for transfusion-transmitted infection (TTI). Hepatitis C had the highest prevalence (1.28%), followed by Hepatitis B (1.03%), syphilis (0.58%), and HIV I and II (0.32%). The majority of reactive cases were reported in male donors, with the highest number observed in the 26–30 year age group. Approximately 84% of the reactive donors responded to notification and were counselled.

Conclusion: Our study highlights the importance of notification of reactive donors telephonically thrice on a weekly interval with a response rate of 83.51%. Notifying reactive donors is not just protocol—it’s a chance to support, inform, and protect. Accurate contact details and compassionate counselling can turn silent risks into early interventions. Awareness, trust, and empathy must guide every step. After all, blood donation is not just a gift of life—it’s a shared responsibility.

PP 59: Thematic Area: Donors and Donations: Knowledge, attitudes and practices of blood donation among second-year medical students at GMC, Jammu

Kamya Bhasin, Meena Sidhu, Naveen Akhter, Mitali Sharma, Dev Raj

Government Medical College, Jammu, Jammu and Kashmir, India

Background: The blood transfusion services in India currently face a shortage of readily available, safe blood. Medical students represent a large, accessible pool of potential voluntary blood donors who can help bridge this gap. The proximity of blood centres to medical colleges significantly enhances the ease with which students can donate blood. If medical students can be effectively motivated to donate blood voluntarily, the burden on blood transfusion services could be significantly reduced. Thus the present study analysed the knowledge, attitudes, and practices regarding voluntary blood donation among 2 nd year medical students at GMC, Jammu.

Methodology: All the students present on the day of the survey who expressed their consent for participation were enrolled in the study. A 26-item self-administered questionnaire with four sections: demographics, knowledge, attitude, and practice, was used. The data were analysed using IBM-SPSS Statistics version 27. Data was presented using percentages and frequencies.

Results: 126 students participated in the study, 39.6% males with mean age 20.74 ± 1.9 years and 59.4% females with mean age 20.25± 0.92 years. Overall 96.8 % knew about their blood groups. 87% of participants were aware that voluntary blood donation is the best type of donation. Only 43.2% were willing to donate blood voluntarily. Low haemoglobin in females (38.4%), students who never felt the need to donate (15.2%) and family pressure to not donate (12%) were the most common barriers to blood donation. Only 12% participants had donated blood.

Conclusion: Though the participants of the study had a good knowledge of voluntary blood donation but efforts are needed to develop favourable attitude towards voluntary blood donation.

PP 60: Thematic Area: Immunohematology: Efficacy of ABD grouping PAD for neonatal blood grouping

Tanveer Ahmed, Richa Gupta, Aditi Goel 1 , Anshuja Singla, Mrinalini Kotru

Department of Pathology, University College of Medical Sciences and GTB Hospital, 1 University College of Medical Sciences and GTB Hospital, Delhi, India

Background: Neonatal blood grouping is a critical component of early neonatal care. Conventional methods like Slide, Conventional Tube Technique (CTT), and Column Agglutination Test (CAT) are limited by factors such as low sensitivity, time consumption, requirement for expensive equipment, and need for larger blood volumes—challenges particularly significant in neonates. ABD pad is a new device that confirms ABD blood group in neonates by forward grouping, ready to use device and allow easy identification of the test and interpretation of findings. It offer rapid blood group determination using minimal blood volume without the need for specialized equipment or expertise.

Aim: To evaluate the efficacy of the ABD grouping pad for neonatal blood grouping.

Objectives: Primary objective: To determine the diagnostic accuracy of ABD grouping pad for neonatal blood grouping taking CTT as gold standard. Secondary Objective: To compare accuracy of ABD pad with CAT for ABD blood grouping in neonates.

Methods: A cross-sectional study was conducted from April 2024 to August 2025 in the Department of Pathology (Regional Blood Transfusion Centre), at the University College of Medical Sciences and GTB Hospital, Delhi. A total of 598 neonatal samples received for blood grouping were tested using CTT (gold standard), CAT, and the ABD grouping pad. Samples were excluded if hemolysed, inadequate, DCT-positive, or if maternal Rh isoimmunization was present. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of the ABD pad were calculated against CTT. Cohen’s Kappa was used to assess agreement.

Results: The ABD grouping pad demonstrated a sensitivity and specificity of 100%, with PPV and NPV also at 100%, indicating perfect diagnostic accuracy compared to the gold standard. Cohen’s Kappa coefficient was 1.000 (p < 0.001), denoting near-perfect agreement with CTT. No discrepancies were observed between the ABD pad and the standard methods.

Conclusion: ABD grouping pad is a highly accurate and reliable method for neonatal blood grouping, offering a practical alternative to conventional techniques, especially in low-resource settings. It simplifies the procedure, reduces turnaround time, and minimizes sample volume requirements, making it well-suited for neonatal use.

PP 61: Thematic Area: Immunohematology: Autoimmune hemolytic anemia triggered by non-Hodgkin’s lymphoma – A rare association

Shravani Subhedar, Minal Wasnik

AIIMS, Raipur, Chhattisgarh, India

Background: Autoimmune hemolytic anemia (AIHA) is a rare disorder where autoantibodies target red blood cells, leading to premature hemolysis. It can be classified as warm or cold AIHA based on antibody type and thermal activity. Secondary AIHA is frequently associated with lymphoproliferative diseases, particularly non-Hodgkin’s lymphoma (NHL). The immune dysregulation in NHL can trigger autoantibody production. Early identification of AIHA in such cases is critical, as it may reflect underlying malignancy and influence both treatment strategy and prognosis. This case highlights the diagnostic and therapeutic challenges in managing AIHA secondary to NHL.

Case Report: A 72-year-old male presented with generalized weakness and decreased appetite for one month. Clinical examination revealed bilateral cervical lymphadenopathy. A routine blood grouping showed O RhD on forward amd agglutination in reverse O typing using EMT technology, suggesting a discrepancy. This was further evaluated using conventional tube testing at 24°C, 37°C, and 4°C. No agglutination was observed at 37°C, while 1+ agglutination were seen at 24°C and 4°C, raising suspicion of cold AIHA. Detailed clinical history and further investigations were initiated. Direct Antiglobulin Test (DAT) was positive for both IgG and C3d, while the Indirect Antiglobulin Test (IAT) was negative, confirming the presence of autoagglutinins. Concurrent malignancy screening and FNAC confirmed the diagnosis of non-Hodgkin’s lymphoma. Further immunohematological workup, including heat elution and antibody identification, was planned but could not be completed due to patient’s sample being unavailable as the patient succumbed to aspiration pneumonia before further evaluation could be done.

Discussion: The blood grouping discrepancy—O RhD on forward grouping with temperature-dependent agglutination on reverse grouping—suggested the presence of cold-reactive antibodies, consistent with a Group IV ABO discrepancy. This, along with a positive Direct Antiglobulin Test (DAT) for IgG and C3d and a negative Indirect Antiglobulin Test (IAT), confirmed autoimmune hemolysis due to autoantibodies. The case was further complicated by systemic symptoms and lymphadenopathy, which led to the diagnosis of Non-Hodgkin’s lymphoma, a known secondary cause of AIHA. Such discrepancies may be the first laboratory indication of an underlying lymphoproliferative disorder. Unfortunately, rapid clinical deterioration prevented further serologic characterization and intervention.

Conclusions: This case highlights the diagnostic value of ABO discrepancies and DAT in identifying AIHA, particularly when secondary to malignancy like Non-Hodgkin’s lymphoma. Early recognition and investigation of hemolysis can uncover underlying hematologic disease. However, timely diagnosis and intervention are critical, as rapid clinical decline may limit further management.

PP 62: Thematic Area: Cellular Therapies: Facilitating the unrelated donor stem cell harvesting in India through a hospital-stem cell registry collaboration: An experience from a tertiary care hospital in North India

Ankita Sharma, Mohit Chowdhry, Soma Agrawal

Indraprastha Apollo Hospital, New Delhi, India

Background: Hematopoietic stem cell transplant (HSCT) is a definitive cure for various hematological and non-hematological diseases. In India, significant proportion of the population requires HSCT but do not have a fully matched related family donor. This necessitates the need for matched unrelated donor transplants and their lookout in stem cell registries. Our hospital has been working in collaboration with DATRI, the largest blood stem cell registry in India, to carry out peripheral blood stem cell harvest from registered donors and has become the registered regional apheresis center of North India.

Methods: This is a retrospective study carried out over a period of 16 months (March 2024 to June 2025) at a tertiary care hospital in North India. All procedures were performed on Spectra Optia Apheresis equipment. The donors pre-registered with DATRI, had undergone high resolution HLA typing (initial Typing) beforehand. When needed, DATRI would search in its database for a HLA matched donor and contact them. A confirmatory HLA typing was performed before initiating the procedure. The donor was brought to our hospital where he/she was explained about the procedure by our doctor and all their queries were answered, followed by detailed medical and physical examination, routine investigations like blood grouping, complete blood count, transfusion transmitted infection testing, liver and renal function test, coagulation profile, ultrasonography, chest x-ray etc. to ensure their suitability for donation. Once cleared by the blood center head and a general physician, the donor was administered granulocyte colony stimulating factor injections daily for 5 days before the harvest. On the day of the harvest, a written informed consent was obtained from the donor. Peripheral cannulation was done by our team. The vitals were recorded all throughout. An intravenous calcium gluconate was also administered to manage citrate related hypocalcemia. A mid - procedure sample from product bag was sent to assess for CD34+ cell counts to determine the efficiency of the procedure and the estimated dose and duration for completion. A final product count was sent post completion and all reports were documented. Arrangements were made for secured air transfer of product in specialized temperature-controlled boxes to save time and maintain product quality. Measures were taken to maintain strict confidentiality by assigning specialized code to donor and patient and by keeping apheresis and transplant centers separate.

Results: A total of 14 stem cell harvests were performed out of which 9 were ABO incompatible. The targeted dose of stem cells was achieved in all with a mean of 26.25 ±19.01x 106 CD34+ve cells/Kg weight of the recipient. All procedures were uneventful. After successful completion of the harvests, the donors were felicitated and encouraged to motivate others in their community to come forward for the same.

Conclusion: With a dearth of mated donors, procuring stem cells from matched unrelated stem cell donor has proven to be a boon. This joint initiative of our hospital with DATRI is striving to increase awareness about unrelated stem cell donation amongst the general public and the life-changing impact it can have.

PP 63: Thematic Area: Immunohematology: “Unmasking the link”: Reduced D antigen reactivity in blood grouping and the infectious status of the patients – A prospective observational study

Bhavani Thiruppathy, P. Sriraman, I. Suresh Kumar, A. Hari Haran, Sahayaraj James

Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India

Background: In forward blood grouping, red cells are tested for A, B, and D antigens using monoclonal antisera, with agglutination graded by antigen density. Some individuals show reduced D antigen expression, resulting in weaker anti-D reactivity. This often suggests a Variant D phenotype, which may be due to either a qualitative or quantitative defect in the D antigen itself. Causes other than the antigenic structure or gene to explain reduced D antigen reactivity have not been hypothesized and studied. The aim of the study is to evaluate the association between reduced D antigen reactivity and patient infectious status.

Methods: This was a prospective observational study conducted from October 2023 to March 2025 in a tertiary care centre. The study population comprised patient samples that demonstrated reduced RhD antigen reactivity, less than 3+ agglutination strength, when tested with anti-D antisera during forward blood grouping. A total of 53 such samples were identified. After the detection of reduced D antigen reactivity, Clinical and demographic data were retrieved from the Hospital’s Information and Archival System (MIAS) portal. Following this, interdisciplinary discussions were held with the respective clinical departments, and blood cultures were sent for the patients. Results, including organism identification and CFU (colony-forming units) count, were recorded. Statistical evaluation was carried out using IBM SPSS Statistics, version 29, to evaluate the association.

Results: A total of 53 cases with reduced D antigen reactivity were identified during the study period. Remarkably, 29 (54.7%) of these 53 patients had positive blood cultures. Also, Elevated leukocyte counts were observed in all patients. Using the Wilson Score method, the 95% confidence interval for infection in this subgroup was 41.5% to 67.3%, confirming a significant infection rate. Escherichia coli is the predominant organism (72.4%) linked to altered antigenicity, followed by Staphylococcus aureus (13.8%). Further analysis revealed urinary tract infection (UTI) as the most frequent diagnosis among these 29 cases (17 cases), followed by respiratory tract infections (6 cases) and intra-abdominal infections (3 cases). Notably, 20 of these 53 patients were antenatal cases with a female predilection. To further validate our findings, repeat blood grouping testing was done in a subset of cases, demonstrating restoration of normal RhD antigen reactivity after the underlying infection had resolved.

Conclusion: The findings suggest a link between reduced D antigen expression and systemic infections, especially UTIs. Certain bacteria, particularly E. coli, produce proteolytic enzymes (e.g., metalloproteases, serine proteases) that can cleave surface proteins on host cells. These enzymes may modify RhD proteins on red cell membranes and reducing their detectability during serological testing. This is similar to the Acquired B phenomenon. Blood grouping could serve as an early clue in detecting underlying infections.

PP 64: Thematic Area: Immunohematology: ABO blood group discrepancies in blood center GMC Jammu

Rajat Kumar Vishwakarma, Rajat Kumar Vishwakarma, Meena Sidhu, Naveen Akhtar, Mitali Sharma

GMC, Jammu, Jammu and Kashmir, India

Background: ABO blood grouping is a cornerstone of pre-transfusion testing and plays a pivotal role in ensuring donor-recipient compatibility. Discrepancies in ABO grouping, if undetected, can result in severe and potentially fatal transfusion reactions.

Study Design: Observational Study Objectives:

To determine the frequency and nature of ABO blood group discrepancies in donor blood samples

To emphasize the importance of resolving discrepancies to ensure accurate blood group assignment and transfusion safety.

Materials and Methods: Eight donor blood samples exhibiting ABO grouping discrepancies were investigated at the Government Medical College (GMC) Blood Centre, Jammu. Forward and reverse blood grouping was carried out using the standard tube technique, Column Agglutination and SPRC fully automated technology with Anti-A, Anti-B, Anti-AB, A1 cells, A2 cells, B cells, and O cells. Additional investigations such as Rh typing, A1 lectin reactivity, anti-H testing, elution studies, and adsorption-elution techniques were employed where necessary to resolve the discrepancies.

Outcome: During the study period, a total of 20,404 donations were recorded at GMC Jammu. Of these, 24.99% were blood group A, 31.66 were group B, 7.7% were group AB, and 33.42% were group O. Incidence of blood group discrepancies was 0.039% (8 samples).

Subgroups of A, including Ay and weaker A were found in 5 /8 samples (62.5%)

A2B phenotypes exhibiting anti-A1 activity were identified in 2 /8 samples (25%)

A2 subgroup with naturally occurring anti-A1 antibody were in 2 /8 samples (25%).

All discrepancies were successfully resolved using supplementary serological techniques, particularly A1 lectin testing and adsorption-elution methods.

Conclusion: Although rare, ABO grouping discrepancies in donor samples can have critical clinical implications. Subgroups of A and A2B phenotypes were the predominant causes in our study.

PP 65: Thematic Area: Donors and Donations: Evaluating the trends and causes of donor deferral at blood centre of a tertiary care hospital – A retrospective study

N. Ambikapathythirumalai, J. Ravishankar

Tirunelveli Medical College, Tirunelveli, Tamil Nadu, India

Background: Standardized pre-donation screening and testing procedures, which make the blood transfusion services safe, may lead to loss of potential donors due to deferrals. Although most deferrals are short-term and reversible, lack of follow-up leads to reduced donor return rate. Effective pre donation information, counselling and follow up will improve the donor return. This study aims to evaluate the trends and causes of blood donor deferral at Blood Centre of a tertiary care hospital.

Methods: This was a retrospective, cross-sectional study, conducted at Blood Centre, Department of Immuno Haematology and Blood Transfusion, Tirunelveli Medical College Hospital by analysing donor registration and deferral records for six months period (December 2024 to May 2025) in the month of June 2025. Data were entered into a Microsoft Excel sheet and analyzed.

Results: Among 6802 donors who registered during the study period, 93.2% (n=6339/6802) were males. The deferral rate among males was 20.4% (n=1294/6339), while it was 61.2% (n=283/462) in females and 100% (n=1/1) in transgender. 5224 donors had donated and the deferral rate was 23.2% (n=1578/6802). More deferrals (60.5%, n=954/1578) were in the 18-30 age group. 82.0% (n=1294/1578) of the deferrals were males. Most of the deferred donors were first time donors (61%, n=964/1578). B positive (35.6%, n=562/1578) and O positive (30.5%, n=482/1578) blood groups were common among deferrals. 98.4% (n=1553/1578) of the deferrals were temporary. Anaemia (17%, n=265/1553) and upper respiratory infections (15.4%, n=239/1553) were the common reasons for temporary deferrals. 1.6% (n=25/1578) of the deferrals were permanent. Epilepsy on treatment (24%, n=6/25), cardiac illness (20%, n=5/25) and psychiatric illness (20%, n=5/25) were the common reasons for permanent deferrals.

Conclusion: Most of the donor deferrals in this study were temporary. Donors temporarily deferred due to inadequate sleep, alcohol intake, NSAIDs use, last donation <90days, on menstruation, fasting and Albendazole intake <7days will be eligible to donate in few days. Donors temporarily deferred due to antibiotic or antifungal use, wounds and injuries, skin allergy, vaccination, hypotension and dental procedures <14days will be eligible to donate in few weeks. Proper counselling regarding the reason behind those deferrals and clear communication regarding the date of eligibility to donate in future will improve the donor compliance. Tracking eligibility dates of deferred donors, personalised follow-up, reminders through SMS, email and phone calls can increase the deferred donor return rate and enhance the blood supply management.

PP 66: Thematic Area: Donors and Donations: The impact of pain scales and targeted counselling on blood donor retention: A randomized control trial

Anu Balan, Sriraman P, Suresh Kumar, Hari Haran, J. Sahayaraj

Saveetha Medical College, Chennai, Tamil Nadu, India

Background: Voluntary non-remunerated blood donation (VNRBD) provides the basis for a safe and adequate supply of blood. First-time donor recruitment may be important but the focus on recruiting blood donors should shift toward the retention of donors in order to establish a stable blood supply. Pain, as well as anxiety in association with donation, are the most important negative aspects on motivation to repeat donations.

Objective: (1) To evaluate the impact of pain scales on Blood donor retention. (2) To determine the effectiveness of targeted counselling in improving donor retention.

Methods: A randomized control trial was performed at a tertiary care centre over three months (February 2025–April 2025) and included 208 voluntary male donors. Donors were divided into an intervention group, who were given targeted counselling (n=104) and a control group (n=104) who were given standard care by a systematic sampling. The Verbal Rating Scale and Faces Pain Scale were used to assess the subjects’ severity of pain. Donor reactions were additionally measured with the Blood Donation Reactions Inventory (BDRI). The statistical analysis was performed with SPSS v21 (IBM, Chicago).

Results: First-time donors in the control group reported higher pain levels (Verbal Rating: 32 moderate, 5 severe; Faces Scale: 24 rated “hurts even more”) compared to the interventional group (20 moderate, 1 severe; 33 rated “hurts little bit”). Among repeat donors, the interventional group reported no severe pain, and 42 donors marked only “hurts little bit.” Statistically significant differences were observed in pain perception between groups for both the Verbal Rating Scale (p = 4.87 × 10 -7 ) and the Faces Pain Scale (p = 9.65 × 10 -13 ).

Conclusion: Pain during venipuncture is a frequently cited deterrent, even when objectively the pain may be mild. Pain perception is subjective and modifiable, but often neglected in blood donation protocols. The integration of pain scales with targeted counselling significantly improves donor comfort and satisfaction, subsequently enhancing the likelihood of repeat donations. Emotional reassurance and personalized support appear pivotal in shaping the donor’s experience. It is recommended that blood banks adopt structured counselling interventions alongside routine pain assessments to promote long-term donor retention.

PP 67: Thematic Area: Clinical Transfusions: Clinical triggers, indications, and utilisation patterns of fresh frozen plasma in critically ill patients: A retrospective observational study

V. Harika, Kandukuri Mahesh Kumar, B. Shanthi, Sudhir Kumar Vujhini

Nizams Institute of Medical Sciences, Hyderabad, Telangana, India

Background: Fresh frozen plasma (FFP) is widely used to manage coagulopathy in critically ill patients. However, studies reveal frequent inappropriate use, particularly in non-bleeding individuals with mildly elevated INR. Evidence suggests limited efficacy of FFP in INR correction below 2.0 and its use carries risks like TRALI and volume overload. Guidelines from BCSH and AABB advocate restricted, evidence-based indications, yet compliance remains suboptimal across settings. In India, misuse persists due to clinical anxiety and medico legal concerns. This study evaluates FFP triggers and appropriateness in tertiary care context to guide rational transfusion practices.

Aims and Objectives: To evaluate the clinical triggers, indications, and appropriateness of FFP transfusion in critically ill patients, and to analyze interdepartmental usage patterns to promote evidence-based, safe and rational transfusion practices.

Materials and Methods: This retrospective observational study was conducted in the Department of Transfusion medicine at tertiary care teaching hospital over 3 months (December 2024-febrauary 2025). Data of 400 critically ill patients who received FFP transfusions were collected from transfusion records and clinical files. Parameters included patient demographics, department, indication for FFP transfusion, pre- and post-INR/PT values, number of FFP units transfused, bleeding status, and clinical outcomes. Appropriateness of transfusion was assessed using BCSH and AABB guidelines. Inclusion criteria: patients admitted to ICU or critical care units who received FFP during hospitalization. Availability of pre and post-FFP INR /PT values. Exclusion criteria: patients receiving plasma for therapeutic plasma exchange. Data was analyzed using descriptive statistics, paired t-tests, and ANOVA for interdepartmental comparisons. p- value <0.05 was considered statistically significant.

Results: A total of 1572 units of FFP were transfused across 400 critically ill patients. The majority of transfusions were in Cardiothoracic Surgery (32.6%), followed by Nephrology and Emergency Medicine (16.3% each). The most common clinical trigger was INR >1.5 without active bleeding (42%), followed by active bleeding (34%), pre-procedural correction (17%), and DIC (7%). INR significantly decreased from a mean of 2.5 ± 1.1 to 1.7 ± 0.8 post-transfusion (p < 0.05). Bleeding control was achieved in 80% of actively bleeding patients. However, 20% of FFP transfusions were deemed inappropriate per BCSH/AABB guidelines, especially in non-bleeding patients with mildly elevated INR. Best outcomes included effective INR correction and bleeding control during surgeries and invasive procedures, particularly in Cardiothoracic and Neurosurgical patients. Worst outcomes were noted in cases of refractory DIC, hepatic failure, and neurological deterioration, especially in Medical Gastroenterology and Oncology. Interdepartmental variation in usage patterns and appropriateness underscores the need for stricter guideline adherence and targeted education to reduce unwarranted transfusions and improve patient outcomes.

Conclusion: This study highlights inappropriate FFP use in 20% of cases, mainly in non-bleeding patients with mildly elevated INR. Appropriate transfusions achieved significant INR reduction and bleeding control. Emphasizing guideline-driven use, ongoing clinician training, and regular transfusion audits is imperative to improve patient safety, optimize clinical outcomes, and uphold resource-efficient transfusion practices in critical care.

PP 68: Thematic Area: Immunohematology: Case report of suspected anti-G antibody in pregnant women causing HDFN

Riyaan Firoj 1,2 , Nidhi Bhatnagar 2 , Mamta Shah 2 , Sangeeta Shah 2 , Kamini Gupta 2 , Rahul Rajvanshi 2

1 Civil Hospital, 2 Department of Immunohematology and Blood Transfusion, B.J.M.C, Ahmedabad, Gujarat, India

Aim: To evaluate importance of routine antibody screening in all pregnant women, especially those who are Rh (D) negative.

Background: Anti-G is one of the cause of Hemolytic Disease of New born (HDN) antibodies. The sample was evaluated by fully automated cell screening and identification techniques along with Column agglutination technique.

Case Description: HDFN was diagnosed in the new born, We report a case where antenatal antibody screening revealed the presence of anti-E and anti-(D+C), anti-G and which where passively acquired from mother. Confirmation of alloimmunization was performed by adsorption and elution methods.

Materials and Methods: Blood grouping and antibody screening were performed by automated erythrocyte magnetized technology (EMT) by diagast followed by column agglutination technique (CAT) method. These antibodies were screened and identified by panel of 3 reagent cells and 11 reagent cells followed by adsorption and elution is performed by acid elution kit.

Conclusion: The presence of anti-(D+C) and anti-G and anti-E antibodies in the serum of these patient highlights the need for careful monitoring during pregnancy. The presence of anti-G along with other alloantibodies access the possibility of HDFN and need to be confirmed with adsorption and elution technique. The administration of anti-D immunoglobulin to Rh (D) negative women during delivery is an effective way to prevent HDFN. The reporting of these case highlights the importance of routine antibody screening in all pregnant women, especially those who are Rh (D) negative.

References

Allen FH, Jr, Tippett PA. A new Rh blood type which reveals the Rh antigen G. Vox Sang 1958;3:321-30.

Palfi M, Gunnarsson C. The frequency of anti-C+ anti-G in the absence of anti-D in alloimmunized pregnancies. Transfusion Medicine 2001;11:207-10.

Schulze TJ, Goebel M, Scharberg EA, Bugert P, Janetzko K. Development of anti-G, anti-C and anti-Jk (b) in a 22-year-old mother during her fourth pregnancy. Transfusion Medicine and Hemotherapy 2013;40:207-9.

Makroo RN, Kaul A, Bhatia A, Agrawal S, Singh C, Karna P. Anti-G antibody in alloimmunized pregnant women: Report of two cases. Asian J Transfus Sci 2015;9:210-2.

PP 69: Thematic Area: Apheresis (Donor and Therapeutic): Prognosis of plasmapheresis in neurological and other disorders: Experience from a tertiary care hospital in Gujarat

Riyaan Firoj 1,2 , Nidhi Bhatnagar 2 , Mamta Shah 2 , Sangeeta Shah 2 , Kamini Gupta 2 , Rahul Rajvanshi 2

1 Civil Hospital, 2 Department of Immunohematology and Blood Transfusion, B.J.M.C, Ahmedabad, Gujarat, India

Aim: To Analyze the results of implementation of plasmapheresis in neurological disorders and other disorders performed in Dept of immunohaematology and blood transfusion. B.J. Medical college, Ahmedabad, Gujarat, India.

Background: Plasmapheresis also known as a therapeutic plasma exchange (TPE) is extracorporeal procedure by which individual components of plasma that are harmful or blood cells are removed from organism by using a blood separation technology. Therapeutic plasma exchange (TPE) or plasmapheresis is treatment of choice in many neurological disorders and other disorders. Therapeutic plasma exchange it is safe experienced hands.

Materials and Methods: Prospective review of PE procedures done during a period of 18 months from January 2025 to July 2026 in a tertiary care hospital in west India. Indications, clinical results and technical factors are discussed.

Results: The main indication for PE was GBS (120 patients; 66.6%), Age of patients ranged from 8-65 years (mean = 45 years). The most common complication were uneasiness, allergy with urticaria, chills, thrombophlebitis, abdominal pain etc. There was no mortality.

Conclusion: The analysis of 180 cases of PE done in our department shows that the procedure is safe, with only minimal procedure related complications and no mortality.

PP 70: Thematic Area: Immunohematology: When routine turns rare: A case of antibodies directed against commercial reagent red cell preservative

Aditi Goel, Richa Gupta, Ram Kishan, Hemant Kumar

Regional Blood Transfusion Centre, Guru Teg Bahadur Hospital, New Delhi, India

Background: Commercial reagent red blood cells (RBCs) are essential for pre-transfusion antibody screening and identification, playing a critical role in ensuring transfusion safety. While typically inert, patient antibodies can, on rare occasions, develop against the preservatives present in these reagents rather than against red cell antigens. Such antibodies often mimic clinically significant alloantibodies or autoantibodies directed against high-frequency antigens leading to false-positive results. This results in unnecessary investigations, delays in pre-transfusion testing, and potential deferral of timely transfusion for patients.

Case Report: A 51-year-old female, diagnosed with CA endometrium, presented with a baseline haemoglobin of 6.2 gm/dL, prompting a request for two units of packed red blood cells (PRBCs). Pre-transfusion testing commenced in the blood bank, utilizing DiaClon gel cards for ABO blood grouping. While the forward grouping identified the patient as AB positive, the reverse grouping unexpectedly yielded a 4+ reaction with both A and B reagent red cells, failing to complement the forward grouping. Further investigation through antibody screening using ID Dia Cell I-II-III revealed pan-reactivity, with all three screening cells exhibiting 4+ reactions. Notably, both the Autocontrol and Direct Antiglobulin Test (DAT) were clearly negative, ruling out autoantibodies or in vivo sensitization. Antibody identification, performed with ID Dia Panel, intensified the serological puzzle as all 11 panel cells showed a strong 4+ reactivity. Extended phenotyping, conducted using DiaClon Rh Subgroups + K cards, surprisingly yielded clear and unambiguous results, identifying the patient as C positive and e positive. Given the widespread reactivity, initial suspicion gravitated towards the presence of an alloantibody directed against a high-frequency antigen. To confirm this suspicion and secure compatible blood, 12 random O negative PRBC units were cross-matched using LISS COOMBS gel card (BIO-RAD). Unexpectedly, all 12 units were found to be compatible. This crucial finding shifted the focus, raising a strong suspicion of unexpected antibodies directed against a constituent or preservative present in the commercial red cell reagents, rather than against a red cell antigen. To substantiate our findings further, reverse grouping was repeated using in-house pooled A and B cells, and an Indirect Coombs Test (ICT) was performed using in-house pooled O cells. Both tests clearly yielded negative results, strongly favouring the presence of antibodies against reagent red cell constituent. This was further confirmed when antibody screening was performed again after meticulously washing the commercial reagent red cells with saline. This step resulted in a negative antibody screen, unequivocally confirming the presence of antibodies against a constituent or preservative in the reagent red cells, which could be effectively removed by saline washing.

Conclusion: This case highlights the critical importance of meticulous Immunohematological investigation when encountering perplexing pan-reactivity. It underscores that such patterns, initially suggesting alloantibodies to high-frequency antigens, can in rare instances be attributed to masked antibodies against reagent components, emphasizing the need for robust troubleshooting protocols to prevent unnecessary delays in patient care.

PP 71: Thematic Area: Donors and Donations: Assessment of reasons for deferrals in blood donors in a tertiary care hospital in North India

Farah Deeba

Government Medical College, Srinagar, Jammu and Kashmir, India

Background: The safety and success of blood donation rely heavily on the proper selection of suitable donors. Donor deferral plays a critical role in ensuring both donor and recipient safety by preventing individuals with underlying health issues or those on certain medications from donating blood. This process not only reduces the risk of transmitting infections through transfusion but also maintains the quality of the blood supply by ensuring that only healthy, suitable blood is collected. Furthermore, deferral criteria help protect vulnerable populations, such as immunocompromised patients, and support public health by preventing the transmission of diseases and promoting a safe and reliable blood supply. Understanding the common reasons for donor deferral can enhance knowledge of the donor population and inform more effective strategies for donor recruitment and screening.

Methodology: This is an observational, retrospective study conducted at SMHS Hospital, a tertiary care hospital, viz SMHS in central Kashmir, throughout one and a half Years from January 2024 to June 2025. The donor selection standard operating procedure (SOP) was followed; donors were subjected to a donor medical history questionnaire and a physical examination, including haemoglobin testing, before being declared fit for donation. If found unfit for donation, donors were deferred, and the data were recorded in the donor deferral register. Data from the donor registry, covering both in-hospital donations and outdoor camps, were analysed to assess patterns and reasons for deferral.

Outcome: A total of 20,773 donors, comprising 3,860 voluntary and 16,913 replacement donors, were screened. The large majority of the donors, 20705 (99.67%), were Males, and the remaining 68 (0.32%) were Females. Out of the 20,773 donors screened, 312 were deferred, resulting in a deferral rate of 1.5%, with 282 (90.38%) males and 30 (1.36%) females. Concerning the type of deferrals, 68 (21.8%) were permanent deferrals, all of them Males, and 244 (78.2%) temporary deferrals, consisting of 30 Females (12.3%) and 214 Males (87.7%). The most common causes of permanent deferral were Seizure disorder — 14 (20.58%), followed by Diseases of the Liver and Hepatitis infection, 11 (16.17%). Most common causes of temporary deferral were ‘Short donor interval’ — 57 (23.36%), followed by ‘Polycythaemia’ 46 (18.85%), all of them Males. Low haemoglobin being the third leading cause of temporary deferral — 21 cases (8.6%), all Females.

Conclusion: Donor deferral is necessary to maintain the safety of both donors and recipients. It also improves the overall quality of the blood supply and safeguards vulnerable groups. A pattern and trend in donor deferral could be used as a reference for developing policy and future initiatives in donor education, encouragement and retention, ensuring a safer and more sustainable blood donation system.

PP 72: Thematic Area: Cellular Therapies: Efficacy of intradiscal autologous platelet-rich plasma injection in chronic lumbar disc prolapse

Dibyajyoti Sahoo, Anirudh Dwajan, M. Prabu

Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India

Background: Low back pain (LBP) is currently believed to be the leading cause of physical disability in the world. A handful of studies have been published pertaining to the use of PRP for the treatment of disc prolapse. This study was done to explore if an intradiscal injection of autologous PRP would be effective in reducing Lower Back Pain and improving functional activity in participants with lumbar disc protrusion or extrusion.

Methodology: This study was a longitudinal, quantitative, quasi-experimental study with a non- equivalent Control Group Design. This study was conducted after approval from the Institutional Ethics Committee. Two study groups were involved in this study, Group A - Participants with lumbar disc protrusion or extrusion who were classified as non-responders to 3 weeks of physiotherapy by McKenzie protocol. They underwent intradiscal autologous PRP injection in the involved disc. PRP was injected once in a single disc per participant. Group B - Participants with lumbar disc protrusion or extrusion who were classified as responders to 3 weeks of physiotherapy by McKenzie protocol. They were instructed to continue physiotherapy for a further 6 weeks. Participants were followed at 3 weeks and 6 weeks post-injection and were assessed by VAS (Visual Analogue Scale) and FRI (Functional Rating Index) scores. The comparison of categorical variables like Gender, Occupation, level of disc prolapse, and type of disc prolapse between the groups was done using the Chi-square/Fisher exact test. The comparison of the longitudinal change of VAS and FRI scores between groups was done using two-way Repeated Measures ANOVA.

Results: PRP Group had a mean age of 28.9 years (SD = 8.6), while the Physiotherapy Group had a mean age of 31.8 years (SD = 7.8), with a t-test P-value of 0.27 indicating no significant difference. Gender distribution was also similar. Clinical characteristics, such as the level (L3-L4, L4-L5, L5-S1) and type of disc prolapse, were also comparable. It was found that the mean VAS and FRI scores decreased over time in both the PRP group and the Physiotherapy group indicating that both treatment modalities are reducing pain and improving functional outcome in the participants. With regards to the VAS score, the PRP group experienced a mean reduction of 2.32 points after 3 weeks and 2.95 points after 6 weeks. The Physiotherapy Group experienced a mean reduction of 0.81 points after 3 weeks and 1.03 points after 6 weeks (P<0.05). This indicates PRP group showed a significantly greater decrease in pain compared to the Physiotherapy group. With regards to the FRI score, the PRP Group experienced a mean decrease of 19.12 points after 3 weeks and 24.71 points after 6 weeks. The physiotherapy Group experienced a mean decrease of 6.70 points after 3 weeks and 9.66 points after 6 weeks (P<0.05). This indicates PRP group showed a significantly greater improvement in functional outcome compared to the Physiotherapy group.

Conclusion: The current study’s findings suggest that intradiscal autologous PRP injection was more effective than Physiotherapy in reducing pain and improving function over time.

PP 73: Thematic Area: Donors and Donations: Low frequency iron supplementation in regular repeat whole blood donors with latent iron deficiency

Haramol Kaur, Richa Gupta, Surender Vats

Department of Pathology, University College of Medical Sciences and GTB Hospital, Delhi, India

Background: A voluntary regular repeat whole blood donor is one who has donated at least three times, the last donation being within the previous year, and continues to donate regularly at least once per year. Regular whole blood donors are at increased risk of Iron shortage after donation (230 mg of Iron loss per donation). As per Indian guidelines, pre-donation Hemoglobin (Hb) screening is the main strategy to evaluate donor Iron status and eligibility for blood donation (cut off Hb 12.5 g%). But Hb levels at the time of screening fail to detect Latent Iron Deficiency (LID). Reduced Iron levels can have impact on quality of life and also makes the donor prone to develop overt Iron deficiency anaemia. Iron supplementation in these individuals can prevent these side effects and also maintain them in donor pool. Low frequency Iron supplementation was given, which is defined as elemental Iron 60 mg taken thrice a week for a period of 90 days.

Aim: To evaluate the effect of low frequency Iron supplementation on correction of Latent Iron Deficiency in regular repeat whole blood donors.

Methodology: This is a Prospective cross sectional study which was conducted amongst regular repeat whole blood donors coming for donation at camps organised by RBTC, GTB hospital. A sample size of minimum 23 subjects were taken. EDTA and plain blood samples collected from the bag tubing at the time of blood donation for blood grouping and routine serological testing were utilised for: (1) CBC - by fully automated five part hematology analyser. (2) Serum Ferritin – by Chemiluminescence immunoassay analyser Following low frequency Iron supplementation for 90 days, repeat samples were collected, one in EDTA and one in plain vial (3 ml each) collected from antecubital vein under aseptic precautions were taken after 90 days of Iron supplementation for same tests.

Outcome: Among 400 screened donors, 27.5% had latent iron deficiency. Of those, 60 initiated low-frequency iron supplementation; 26 completed follow-up, with 92.3% achieving ferritin normalization. Despite moderate adherence, the intervention showed high efficacy, indicating that low-frequency iron supplementation effectively corrects latent iron deficiency in regular repeat whole blood donors.

Conclusion: Low-frequency iron supplementation significantly corrected latent iron deficiency in regular repeat blood donors with high efficacy and tolerability, suggesting its potential integration into donor care protocols for improving health and retention.

PP 74: Thematic Area: Cellular Therapies: Classical PNH with major ABO-incompatible stem cell transplant: A case of delayed engraftment managed with therapeutic plasma exchange and bortezomib

Ashwinkumar Vaidya, Mahesh Rajashekharaiah, P. Poornima, G. Keerthisree, K. Anand Kumar, Sunil P. Udgire

Sparsh Hospital, Bengaluru, Karnataka, India

Background: Paroxysmal Nocturnal Hemoglobinuria (PNH) is a rare, life-threatening hematologic disorder characterized by hemolysis, bone marrow failure, and thrombosis. Allogeneic stem cell transplantation (allo-SCT) remains the only curative option in resource-limited settings where complement inhibitors like eculizumab are unavailable.

Case Presentation: We report the case of a 31-year-old male diagnosed with classical PNH in June 2023, based on anemia, indirect hyperbilirubinemia, and high-sensitivity flow cytometry showing significant PNH clones in monocytes (97%) and neutrophils (98.9%). He was initially managed with Danazol and aspirin. In February 2024, he developed bi-cytopenia requiring transfusions. Due to lack of access to eculizumab and worsening cytopenias, a matched family donor peripheral blood stem cell (PBSC) transplant was planned. The patient’s mother was a 10/10 HLA match but had a major ABO incompatibility (donor: B Rh D positive; recipient: O Rh D positive) with a pre-transplant anti-B titre of 512. Pre-transplant desensitization included two sessions of therapeutic plasma exchange (TPE) and one dose of Rituximab 500 mg. Conditioning was done using Fludarabine, Treosulfan, and ATG. PBSC harvest yielded 7.5 million CD34+ cells/kg. Post-transplant, delayed engraftment was noted (ANC >500 by day 19; platelets >20,000/μL by day 22). Subsequently, the patient developed delayed red cell engraftment and red cell transfusion dependence, on further investigations, viral markers including parvo virus was negative and Bone marrow study was suggestive of pure red cell aplasia (PRCA), with high anti-B titres of 1024. The patient underwent two additional TPE sessions and was started on Bortezomib to suppress residual alloantibody production. Anti-B titres declined to 8 over 20 days. By day 80, mini-transplant panel was negative, red cells engraftment was noted on day 101, and by day 118, the patient’s blood group converted to donor type. At one-year follow-up, the patient remains clinically stable and transfusion-independent.

Conclusion: This case highlights the challenges and successful management of major ABO-incompatible allo-SCT in PNH, with delayed red cell engraftment managed effectively using a combination of TPE and Bortezomib. Early identification and intervention in PRCA can improve post-transplant outcomes in resource-constrained settings.

PP 75: Thematic Area: Molecular and Transplant Immunology (Includes HLA): Utility of washed, irradiated, HPA-matched platelet transfusions in the management of severe FNAIT in a tertiary care centre in Southern India

Lingutla Raviteja, Medapureddi Teja Kiran

Vinayaka Mission’s Kirupananda Variyar Medical College and Hospitals, Salem, Tamil Nadu, India

Background: Fetal and Neonatal Alloimmune Thrombocytopenia (FNAIT) is a potentially life-threatening condition resulting from maternal alloimmunization against fetal platelet-specific antigens, most commonly Human Platelet Antigen-1a (HPA-1a). Affected neonates are at risk of severe thrombocytopenia, intracranial hemorrhage, and other bleeding manifestations. Timely and appropriate transfusion support is critical in managing these cases. The use of washed, irradiated, HPA-matched platelet transfusions is considered the gold standard in severe FNAIT but remains underutilized in many settings due to logistical and technical challenges.

Objectives: To assess the efficacy and feasibility of washed, irradiated HPA-matched platelet transfusionsin neonates with severe FNAIT in a tertiary care centre in Southern India.

Methods: A retrospective analysis was conducted over a five-year period (2018–2023) in the Department of Transfusion Medicine at a tertiary care center. Neonates diagnosed with FNAIT based on clinical presentation, maternal anti-HPA antibody screening, and exclusion of other causes of thrombocytopenia were included. Patients receiving washed, irradiated, HPA-matched platelets were assessed for post-transfusion platelet increment, bleeding resolution, and adverse transfusion reactions. Where HPA-matched units were unavailable, standard random donor platelets were used, and outcomes were compared.

Outcomes: Among 18 neonates diagnosed with severe FNAIT, 12 received HPA-matched, washed, irradiated platelet transfusions. These neonates demonstrated a mean corrected count increment (CCI) of 8,000–12,000/µL at 1 hour and sustained increments over 24–48 hours. Clinical bleeding resolved in over 90% of cases post-transfusion, with no significant transfusion-related complications observed. In contrast, the 6 neonates who received standard random donor platelets showed suboptimal platelet increment and required multiple transfusions. One case of intracranial hemorrhage occurred in this group.

Conclusion: Washed, irradiated, HPA-matched platelet transfusions significantly improve platelet recovery and clinical outcomes in neonates with severe FNAIT, compared to non-matched platelet transfusions. Their use should be encouraged, especially in high-risk pregnancies with known maternal alloimmunization. Early antenatal identification of at-risk pregnancies and the establishment of regional HPA-typed platelet donor registries can enhance preparedness and optimize neonatal care. With appropriate planning and coordination, even resource-constrained settings can adopt this transfusion strategy effectively.

Keywords: Alloimmune thrombocytopenia, FNAIT, HPA-matched platelets, irradiated platelets, neonatal transfusion, transfusion medicine, washed platelets

PP 76: Thematic Area: Immunohematology: Influence of blood transfusion during induction chemotherapy on treatment outcomes in acute myeloid leukemia in a tertiary care centre in Salem district

Nagaraj Raykar, Sushrutha Sudharshan 1

Vinayaka Mission’s Kirupananda Variyar Medical College and Hospital, Salem, Tamil Nadu, 1 Bangalore Medical College, Bengaluru, Karnataka, India

Background: Acute Myeloid Leukaemia (AML) is an aggressive hematological malignancy characterized by clonal proliferation of immature myeloid cells, resulting in bone marrow failure. Induction chemotherapy is the cornerstone of initial treatment, aiming to achieve complete remission. However, intensive chemotherapy induces profound cytopenias, necessitating supportive care in the form of red blood cell (RBC) and platelet transfusions. While transfusions are lifesaving, they carry potential risks, including transfusion-related immunomodulation (TRIM), iron overload, increased susceptibility to infections, and possible long-term impacts on survival. Despite widespread transfusion use during AML induction therapy, data regarding the influence of transfusion volume on clinical outcomes remain limited and inconclusive.

Objective: This study aims to evaluate the influence of blood transfusion burden during induction chemotherapy on treatment outcomes in newly diagnosed AML patients. Key outcomes include remission rates, infection profiles, transfusion-related complications, early mortality, and overall survival.

Methodology: A retrospective observational study was conducted at Vinayaka Mission’s Kirupananda Variyar Medical College and Hospitals (VMKVMCH), Salem, including patients diagnosed with AML from March 3, 2025, to June 3, 2025. All patients received standard induction chemotherapy (7+3 regimen or equivalent). Data collected included patient demographics, baseline clinical parameters, transfusion records (total RBC and platelet units transfused), duration of neutropenia, occurrence of infections, transfusion reactions, remission status post-induction, early mortality, and survival data. Patients were stratified into low and high transfusion requirement groups to examine associations between transfusion volume and clinical outcomes. Statistical analyses involved chi-square tests for categorical variables, Kaplan-Meier survival analysis, and multivariate Cox regression modeling to control for potential confounders such as age, cytogenetic risk, and disease burden.

Outcome: Preliminary findings indicate that patients receiving higher volumes of RBC transfusions during induction showed a trend toward increased infection rates and longer hospital stays. However, no statistically significant difference was observed in complete remission rates between the low and high transfusion groups. Platelet transfusion frequency was not directly associated with remission outcomes but appeared to correlate with prolonged thrombocytopenia in certain cases. Ongoing multivariate analysis will further elucidate the independent effect of transfusion burden on overall survival.

Conclusion: Transfusion support is integral to AML induction therapy; however, the cumulative transfusion load may influence treatment-related complications, particularly infection risk and recovery timelines. The findings underscore the importance of balanced transfusion practices that provide necessary supportive care while minimizing potential adverse effects. Further prospective studies are needed to refine transfusion thresholds and optimize supportive care protocols in AML treatment.

Keywords: Acute myeloid leukaemia, blood transfusion, induction chemotherapy, supportive care, transfusion burden, treatment outcomes, VMKVMCH Salem

PP 77: Thematic Area: Management and Organization: AI for FNAIT: Enhancing prediction and personalizing care

Lingutla Raviteja, Lingutla Nikhil 1

Vinayaka Mission’s Kirupananda Variyar Medical College and Hospitals, Salem, Tamil Nadu, India, 1 SeimensSiemens Pvt Ltd, Electronic City, Bengaluru, Karnataka, India

Background: Fetal and Neonatal Alloimmune Thrombocytopenia (FNAIT) presents a tough challenge in newborn care, often leading to critically low platelet counts. The biggest fear for these babies? A significant risk of intracranial hemorrhage (ICH), a brain bleed that can cause lasting neurological problems or even be fatal. Our current methods for predicting how severe FNAIT will be and figuring out the best treatment aren’t precise enough. We often rely on things like a mother’s antibody levels and the baby’s genetic makeup, but these don’t always give us the full picture, leading to treatments that might not be perfectly tailored.

Objective: This abstract explores how Artificial Intelligence (AI) and Machine Learning (ML) can truly change FNAIT management. Our main goal is to vastly improve our ability to predict FNAIT severity, especially the risk of that dangerous brain bleed, and to create personalized treatment plans. We’re aiming to develop smarter predictive models that go beyond what we can do now, ultimately leading to better outcomes for these fragile patients and reducing the serious complications of FNAIT.

Methods: We’re proposing a comprehensive AI/ML framework. This involves gathering a rich collection of patient data: demographics, detailed medical history, in-depth immune system information (like antibody levels, their specific types, how strongly they bind, their sugar patterns, and certain immune receptor variations), and genetic details from both parents and the baby. Gathering enough high-quality, standardized data will be key, so multi-center collaborations are vital. We’ll then carefully prepare this data and use various sophisticated ML algorithms (like Random Forests, Gradient Boosting Machines, and even Deep Learning for analyzing medical images) to predict things like disease severity, the lowest a baby’s platelet count might drop, and how well they’ll respond to treatment. We’ll rigorously test these models using statistical measures and, importantly, assess their practical use in the clinic. We’ll also use “Explainable AI” techniques to ensure doctors can understand how the AI reaches its conclusions.

Results: While this abstract lays out our proposed approach, the power of AI/ML strongly suggests a promising future. We fully expect to develop models that can provide individualized ICH risk scores, accurately predict a baby’s platelet nadir, and help guide the ideal timing and dosage for prenatal treatments like IVIG, as well as postnatal care. These models should offer a level of precision that’s currently out of reach, allowing us to move from generalized treatment strategies to ones truly customized for each patient facing this rare but critical condition.

Conclusion: AI and Machine Learning offer an incredible opportunity to completely transform FNAIT management. By providing super-precise predictions of disease severity and enabling personalized treatments, these technologies can make a real difference. For this to succeed, we’ll need global data sharing, strong teamwork among experts from different medical fields, thorough testing in real-world clinical settings, and clear ethical guidelines. As AI and ML continue to advance, they are set to play a crucial role in reducing illness and death from FNAIT, promising a brighter outlook for affected families.

PP 78: Thematic Area: Immunohematology: Navigating alloimmunization in a case of delta beta thalassemia: A transfusion challenge

Shaheen Khan Bhati, Neerja Kushwaha, Sudeep Kumar, Vishnu Prasad

Armed Forces Medical College, Pune, Maharashtra, India

Background: Delta beta (δβ) thalassemia is a rare variant of thalassemia characterized by elevated levels of fetal hemoglobin (HbF) beyond infancy due to reduced synthesis of both δ and β-globin chains—typically due to gene deletions. Usually δβ-thalassemia presents mild anemia. Reports of δβ-thalassemia from India are scarce in the indexed English literature. The patient also had the rare R2R2 phenotype whose frequency ranges as low as 0.5-1.1% in the Indian subcontinent and multiple alloantibodies, including anti-e, which further complicated crossmatching and transfusion.

Case Presentation: A twelve-year old female child was evaluated for easy fatiguability and generalized weakness for past 1 month. Hematological investigations revealed severe anemia. Peripheral blood smear exhibited severe microcytic hypochromic anemia with thrombocytopenia and 1.5% reticulocytes. Anisocytosis and poikilocytosis of red cells were also observed. Iron studies showed reduced serum Iron, serum ferritin and transferrin saturation with increased Total iron binding capacity (TIBC) suggestive of severe iron deficiency anemia. Comprehensive analysis of hemoglobin by high performance liquid chromatography (HPLC) showed HbF constituting 97.2%, 1% HbA2 and 0.4 % HbA. Hemoglobin analysis of both parents showed elevated levels of HbF, mother’s HbF being 18.7% and father’s 27.7% suggesting homozygous δβ-thalassemia in daughter. Demand for two units of PRBC was received at blood centre. Patient typed as O Rh D positive with the rare R2R2 phenotype (cDE/cDE): C- E+ c+ e- K-. The cross match performed by column agglutination technique (CAT) was 4+ positive. IHL work up revealed a positive ICT of 4+ DCT positivity of 3+. Antibody identification showed the possibility of Anti-e, Anti- C, Anti-K, +/- Anti – Jka/Jkb. 118 units of O Rh D positive were phenotyped and 3 units of the above Rh phenotype (e Negative) were found. Since no compatible unit was available the same was issued as “Best match” packed cell in view of severe anemia in patient. Patient was premedicated with steroids before transfusion however the patient developed hematuria two hours post transfusion and was managed conservatively. Post transfusion workup was same as pre transfusion workup. There was a rise in hemoglobin from 3.5 to 4.2 gm/dl post transfusion. Patient was started on iron therapy (Injection FCM) which gradually increased her hemoglobin levels. Following clinical improvement, the patient was subsequently discharged.

Conclusion: δβ -thalassemia is an uncommon cause of markedly elevated fetal hemoglobin beyond fetal period. Clinical and haematological parameters should be evaluated to render an accurate diagnosis. Our case was a rare case with much higher HbF levels and severe anaemia. Case was further complexed due to the rare R2R2 phenotype and due to alloimmunization with multiple alloantibodies. It was a challenging task for the blood center to issue even a single unit of compatible blood. The case highlights the need for national/zonal database of rare phenotype blood donors to timely fulfil the blood requirement of patients in need.

Keywords: Alloimmunization, delta-beta thalassemia, homozygote, R2R2 phenotype

PP 79: Thematic Area: Blood Safety and Infectious Disease Marker Testing (including NAT Testing): Establishment and performance assessment of the preparation method of internal quality control sample for the transfusion-transmitted infection laboratory

Geetanjali Hyanki, Aparupa Sen Gupta, Niharika Yadav, Atul Sonker

Sanjay Gandhi Post Graduate Institute of Medical Science, Lucknow, Uttar Pradesh, India

Background: Internal Quality Control (IQC) is essential to ensure the accuracy and consistency of serological testing in Transfusion-Transmitted Infection (TTI) laboratories. This study focuses on developing an In-house control and method for internal control sample preparation and evaluating their performance at different storage and thawing temperatures throughout study period.

Materials and Methods: For the study, IQC was made identifying reactive units each for hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV), and controls were prepared for the three viral markers. Each reactive unit plasma was tested for the E ratio, and doubling dilution was done using non-reactive AB plasma to achieve an E ratio of 2.0-3.0 as per the SOP. Then plasma was converted to serum using a recalcifying solution. Prepared 1 ml aliquots of all internal controls were stored at two different temperatures −40 °C and −80 °C. Prior to routine use, each aliquot was thawed at two different temperatures room temperature (RT) and 37 °C using a plasma thawer and each aliquots was subjected for test was run over the period of 5 days. These IQC aliquots were further stored at 4°C for their routine use with each test run for next 25 episodes.

Results: Mean of E ratio aliquot stored at -40°C and -80°C, thawed at RT and 37°C for HBV was 2.35 (range 1.99 to 2.71), HCV mean was 2.00 (range 1.46 to 2.54), and for HIV mean was 2.88 (range 2.25 to 3.51). The result of aliquots stored at -40°C and -80°C showed consistent and reproducible results and no statistical significant difference noticed in E ratio value between the result of aliquot stored at -40°C thawed at RT and 37°C to that of aliquots stored at -80°C thawed at RT and 37°C. E-ratio values for HBV, HCV, and HIV remained within ±3SD and -3SD on the Levey-Jennings chart, indicating acceptable performance. Overall, the IQC materials were suitable for use in routine quality monitoring in TTI laboratory.

Conclusions: It was observed that the serum form of HIV IQC aliquots were not giving reproducible results (E ratio) while this issues was resolves when plasma form was subjected for testing. Therefore, it is recommended to use plasma form of IQC for HIV over to serum. Either of the two storage temperatures (−40 °C and −80°C) was suitable for IQC aliquots, and both thawing temperatures (room temperature and 37°C) demonstrated acceptable performance. Their implementation can significantly strengthen internal quality assurance, thereby enhancing blood safety and reliability of transfusion services.

Keywords: HBV, HCV, HIV, internal quality control, transfusion transmitted infection

PP 80: Thematic Area: Quality Management and Accreditation: Analysis of key performance indicators of the blood centre of a tertiary care referral teaching hospital in South India

Suresh Babu Bandi, M. D. Praveen, K. V. Sreedhar Babu

Sri Venkateswra Institute of Medical Sciences, Tirupati, Andhra Pradesh, India

Background: Blood transfusion services play a crucial role in patient health care management. The quality of blood and blood components as well as their injudicious use may affect the health care facility. This can be achieved through the implementation of a Quality Management System (QMS), which is effectively monitored using Key Performance Indicators (KPIs). The present study aimed to assess the quality performance of the blood centre by analyzing various KPIs.

Methods: This cross-sectional analytical study was carried out from November 2023 to May 2024 and September 2024 to January 2025. Data were collected systematically, and Root Cause Analysis (RCA) was carried out for any deviations. Appropriate Corrective and Preventive Actions (CAPA) were implemented. The variables required for KPI calculations were extracted from various registers maintained at the blood centre.

Results: The observed KPIs during the study period were as follows: Donor Deferral Rate- 11.03%, Adverse Donor Reaction Rate-0.128%, Percentage of components prepared-98.25%, Seroreactivity of donors-1.24%, Turnaround Time for elective and emergency cases-40.73 minutes and 7.27 minutes. The Quality control failure rates were zero, adverse transfusion reaction rate-0.024%, wastage rate of components-1.21%, percentage of outdated units-0.44%; these were within the National Accreditation Board for Hospitals and Healthcare Providers (NABH) benchmark. Seroreactivity of Syphilis-0.33%, percentage of component usage-99.3%, percentage of wastage of whole blood at blood centre - 5.29% were did not meet the bench mark.

Conclusion: While most KPIs met NABH standards, elevated syphilis seroreactivity, suboptimal component usage, and whole blood wastage require attention. These can be addressed by strengthening pre-donation screening—especially for syphilis, ensuring uniform implementation of national transfusion policies to promote 100% component usage, and enhancing staff training to reduce under-collection, which was a significant cause of blood wastage in this study.

PP 81: Thematic Area: Blood Safety and Infectious Disease Marker Testing (Including NAT Testing): Seroprevalence of blood-borne infections among tattooed versus non-tattooed blood donors: A comparative cross-sectional study

Nagaraj Raykar, Sushrutha Sudharshan 1

Vinayaka Mission’s Kirupananda Variyar Medical College and Hospital, Salem, Tamil Nadu, 1 Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India

Background: Safe blood transfusion is a cornerstone of modern healthcare. Transfusion-transmissible infections (TTIs), such as Hepatitis B virus (HBV), Hepatitis C virus (HCV), Human Immunodeficiency Virus (HIV), and Syphilis, pose continuous threats to blood safety. Tattooing, especially when done in unregulated settings, has been recognized as a potential risk factor for blood-borne infections (BBIs). With the increasing popularity of tattoos, evaluating their impact on blood donor safety is crucial. This study aimed to assess and compare the seroprevalence of BBIs among tattooed and non-tattooed voluntary blood donors.

Objectives: To determine the seroprevalence of HBV, HCV, HIV, and Syphilis among tattooed blood donors. To compare infection rates between tattooed and non-tattooed donors. To identify tattoo-related risk factors contributing to increased seropositivity.

Methods: A comparative cross-sectional study was conducted over 7 months from 1/1/2025 to 30/07/2025 at the blood bank of Vinayaka Mission’s Kirupananda Variyar Medical College and Hospital, Salem, Tamil Nadu. A total of 600 voluntary blood donors were included: tattooed donors (n=120) and non-tattooed donors (n=480). All donors were screened for HBV (HBsAg), HCV (Anti-HCV), HIV (4 th generation ELISA), and Syphilis (VDRL/RPR). A structured questionnaire captured demographic details and tattoo-related history, including the number of tattoos, the setting (licensed or unlicensed tattoo parlor), and time since the last tattoo. Data analysis was performed using SPSS Version 25. Chi-square test and logistic regression determined statistical significance and odds ratios.

Results: The overall seroprevalence of BBIs in tattooed donors was 3.75%, significantly higher than the 1.68% in non-tattooed donors (p<0.01). Among tattooed donors, infection rates were: HBV (1.5%), HCV (1.2%), HIV (0.7%), and Syphilis (0.35%). In non-tattooed donors: HBV (0.7%), HCV (0.5%), HIV (0.3%), and Syphilis (0.18%). Tattooed donors had a 2.3-fold increased risk of seropositivity for any BBI (OR=2.32, 95% CI: 1.65–3.27). Higher risks were observed among donors with multiple tattoos, tattoos from unlicensed establishments, and recent tattoos (within the past 12 months).

Conclusions: Tattooing is associated with a higher risk of blood-borne infections among blood donors. While tattoos are not an absolute contraindication for donation, careful screening and deferral of recently tattooed individuals are recommended to maintain transfusion safety. Public health strategies should focus on promoting safe tattooing practices, regulating tattoo parlors, and raising awareness about BBIs.

Keywords: Blood donation, blood-borne infections, HBV, HCV, HIV, seroprevalence, syphilis, tattoo, transfusion safety

PP 82: Thematic Area: Apheresis (Donor and Therapeutic): Therapeutic plasma exchange in alcohol-induced acute-on-chronic liver failure: A game-changer in bridging therapy (A case series)

Shreya Mukherjee, Ashok Yadav, Nidhi Sharma

MGM Medical College, Indore, Madhya Pradesh, India

Background: Acute-on-chronic liver failure (ACLF) is defined as an acute deterioration in patients with pre-existing chronic liver disease, usually triggered by a precipitating event, leading to failure of one or more extra-hepatic or hepatic organ systems, and associated with high short-term mortality. Liver transplantation though a definitive treatment; is not always feasible due to limited donor availability or patient instability. Therapeutic plasma exchange (TPE) is an emerging extracorporeal treatment modality that works by removing circulating inflammatory mediators, toxins, and bilirubin, thereby potentially modulating the immune response and stabilizing hepatic and extrahepatic functions. According to the 2023 guidelines by the American Society for Apheresis (ASFA), high-volume TPE for ACLF is classified as Category I with Grade 1A recommendation, suggesting strong evidence for its use. In contrast, standard-volume TPE is categorized as Category III with a Grade 2B recommendation, indicating that its role is less well established and should be considered on a case-by-case basis. At our institution, standard-volume TPE is routinely used in the management of ACLF.

Aims: To assess the efficacy and safety of therapeutic plasma exchange in alcohol-induced ACLF, and its impact on biochemical parameters and short-term survival alongside standard medical therapy.

Methods: Retrospective analysis of patients diagnosed with alcohol induced ACLF managed with TPE along with medical therapy in our institution from August 2023 to July 2025 was done.

Results: Five male patients (aged 20–50 years) in whom TPE was done were included. Based on EASL-CLIF criteria, three had Grade I and two had Grade II ACLF. All presented with jaundice, coagulopathy, and renal dysfunction; one also had hepatic encephalopathy. Each received 1–3 standard-volume TPE sessions (1–1.5 plasma volumes/session) on alternate days. Replacement fluid included 5% albumin and fresh frozen plasma, tailored based on coagulopathy. Concurrent Standard Medical Therapy included antibiotics, lactulose, albumin, nutritional support, and renal monitoring. Key biochemical parameters—including serum bilirubin, INR, serum creatinine, and encephalopathy grade—were recorded before and after TPE. Post-procedure, serum bilirubin decreased from 30.92 ± 17.08 to 19.93 ± 15.15 mg/dL, INR improved from 2.18 ± 0.53 to 1.78 ± 1.11, and creatinine showed a mild decrease. One patient showed clinical improvement in hepatic encephalopathy. Four of the five patients survived the 28-day follow-up, while one died of multiorgan failure. TPE was well tolerated overall, with only minor side effects such as chills noted in two cases.

Conclusion: Standard-volume TPE, when used alongside medical therapy, appears to be a safe and potentially effective adjunctive treatment in alcohol-induced ACLF. This case series suggests improvements in liver function, coagulation profile, and encephalopathy. These findings support TPE as a bridging therapy to recovery or transplantation. Larger randomized controlled trials are needed to validate these observations and define optimal treatment protocols.

PP 83: Thematic Area: Quality Management and Accreditation: An observational study on blood group discrepancies due to wrong blood in tube at SVIMS blood centre, Tirupati, Andhra Pradesh, South India

Mary Sravani Indla, M. D. Praveen, B. Suresh Babu

Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India

Background: Pretransfusion testing has undergone many remarkable changes over the past few decades ranging from manual methods to semi-automation and fully automation. But the sample collection from the correct patient has been a challenge in almost every hospital. Although methods such as positive patient identification and use of Radio Frequency Identification (RFID) technology can significantly reduce the incidence of Wrong Blood in Tube (WBIT), these implementations may not be feasible in all health care settings due to resource constraints, infrastructural limitations and training requirements. By observing the incidence of WBIT, we aimed to re-emphasize the introduction of Two Sample Policy in our institute using two different samples, one received for Blood grouping and typing and the other received for cross matching at the time of submission of request for Blood and its components.

Methods: This is a retrospective study extending over a period of 2.5 years (January 2023 to June 2025) at a tertiary care hospital Blood centre in south India. After sensitizing the clinicians during Hospital Blood Transfusion Committee meetings and the implementation of two sample policy in the institute, the retrospective data collection was done. As per the two sample policy, two samples of the same person would be collected one during the time of blood grouping and typing and the second one at the time of submission of request for blood and blood components. In case of any discrepancy between the two samples then the incident will be recorded and the discrepancy will be resolved as per Standard Operating Procedure.

Results: A total of 38,471 requests were received from various departments for blood and blood components during the above study period. From these 38,471 requests, a total of 52,399 blood and blood components were issued which include 21,560 (41.1%) were packed red blood cell units (PRBC). A total of 26 (0.12%) WBIT errors were recorded as grouping discrepancy between the sample received for blood grouping and typing and the one received at the time of submission of request for blood and blood components. Notably all 26 (0.12%) grouping discrepancies were for the request of PRBC.

Conclusion: The increase in incidence of WBIT errors in our institute may reflect the deficiency in adequately trained personnel for proper patient identification during phlebotomy, sample labelling and blood collection. Staff involved in these activities should be regularly trained regarding positive patient identification protocols. Additionally, where ever feasible implementation of RFID can significantly reduce the incidence of WBIT errors by enhancing the accuracy and traceability in the pre analytical phase and thereby can improve the transfusion safety.

PP 84: Thematic Area: Apheresis (Donor and Therapeutic): Across the spectrum: The role of therapeutic plasma exchange in diverse disorders

Bodugu Anjali, Girija Nandini Kanungo

IMS and SUM Hospital, Bhubaneswar, Odisha, India

Background: Therapeutic plasma exchange (TPE), often called plasmapheresis, is a powerful tool in the management of immune-mediated disorders. By removing harmful antibodies or toxins from the plasma, TPE offers hope and healing in conditions where the immune system turns against the body. In our tertiary care setting, we’ve seen its value across a wide range of disorders—from Autoimmune Encephalitis and Acute Liver Failure, Thrombocytopenic Thrombotic Purpura (TTP), Haemolytic Uremic Syndrome (HUS). This study brings together our real-world experience and patient outcomes with TPE.

Aim: To Evaluate the impact of the therapeutic plasmapheresis on clinical outcomes in patients who underwent the procedure in a tertiary care setting through Retrospective analysis.

Methods: Retrospective analysis was conducted on plasmapheresis procedures performed in IMS and SUM Hospital, from January 2024 to June 2025.

Results: A total of 272 cycles in 63 patients (Male-26, Female-37), in an age group of 5 - 77 (average age - 41years) were enrolled in the present study, among which Longitudinally Extensive Transverse Myelitis (LETM-27%, n=17) was the main indication for TPE, followed by Guillain-Barre Syndrome (GBS-12%, n=8), Neuromyelitis Optica Spectrum Disorder (NMOSD-7.9%, n=5), Thrombotic Thrombocytopenic Purpura (TTP-6.34%, n=4), Myasthenia Gravis (MG-6.34%, n=4). Post-TPE significant improvement was noted in clinical and laboratory parameters in most of the patients. In LETM cases, few patients have marked improvement in baseline power of limbs from 3rd cycle. In GBS cases, TPE led to significant improvement in muscle strength after 5 th cycle. Mean hospital stay was reduced in patients responding well to therapeutic plasmapheresis Overall incidence of adverse reactions were 3.67%, out of that vascular blockage (1.1%) during procedure was a common complication encountered which was relieved by 0.9% NS flush followed by increase in blood pressure (0.73%) and temperature (0.73%) which were relieved by giving INJ.LABETALOL 20mg and INJ.PARACETAMOL10mg respectively and followed by Itchinhg in 0.36% which was relieved by INJ.HYDROCORT 50mg.

Conclusion: This Retrospective analysis demonstrates that therapeutic plasmapheresis is an effective and safe adjunctive therapy that positively influences clinical outcomes across a range of indications. Further prospective studies are recommended to validate these findings and optimize patient selection criteria.

PP 85: Thematic Area: Clinical Transfusions: TRALI in a liver abscess patient: A case reported in a tertiary care hospital, India

S. Arun Srinivas, Shubhangi Lad, Snigdha Vartak

MGM Medical College and Hospital, Mumbai, Maharashtra, India

Background: The objective of this study is to explore the clinical presentation, diagnosis, treatment, and prevention of Transfusion-Related Acute Lung Injury (TRALI), using a real-life case involving Fresh Frozen Plasma (FFP). TRALI is a rare but severe immunological reaction to blood transfusion, characterized by acute lung injury occurring within 6 hours of transfusion. It presents with acute hypoxemia (SpO 2 < 90% on room air), bilateral pulmonary infiltrates on imaging, and no signs of fluid overload or alternative causes of ALI. TRALI most commonly follows transfusion of plasma-rich components like FFP, platelets, and cryoprecipitate.

Case Summary: A 46-year-old male admitted on 26/03/2025 with a diagnosis of liver abscess and coagulopathy developed a transfusion reaction during administration of the second unit of FFP on 28/03/2025. The patient experienced breathlessness, fever, tachypnea, and tachycardia. On examination, bilateral wheezing was noted.

Management and Prevention: The transfusion was discontinued immediately. Supportive management was initiated, including administration of oxygen, antihistamines, corticosteroids, and antipyretics as indicated. Samples were sent for transfusion reaction workup, and transfusions were withheld for the next 24 hours. Preventive strategies include avoiding plasma donations from multiparous female donors and close monitoring of high-risk recipients.

Results: Prompt discontinuation of transfusion and medical intervention were undertaken. A chest X-ray was advised, and transfusion was withheld for 24 hours. Continuous monitoring was maintained, and emergency measures were advised if required.

Conclusion: TRALI, though infrequent, poses a serious risk and can be life-threatening. Prompt identification and implementation of preventive measures are crucial to ensure patient safety and improve transfusion outcomes.

PP 86: Thematic Area: Apheresis (Donor and Therapeutic): An impact of single session of therapeutic platelepheresis in case of severe thrombocytosis

Shreenivas Devde, Shubhangi Lad, Nikhil Ningurkar, K. Rajmohan, Naved Tamboli

MGM Medical College and Hospital, Navi Mumbai, Maharashtra, India

Background: In hematological condition like Thrombocytosis characterized by abnormally high platelet count, increases the risk of the thrombotic or hemorrhagic complications. When patient with platelet count more than 8-10 Lakh/uL with symptoms associated with extreme thrombocytosis, Plateletpheresis in such patients plays main role in reduction of platelet count and symptomatic relief within short period of time.

Aim: An Impact of Single session Of Therapeutic Plateletpheresis In Case Of Severe Thrombocytosis Case Summary - A 27 year old male, diagnosed with CML presented with C/o- 10-12 E/o Hematochezia (10-12 episodes), Fever with chills, Fatigue. Investigation Report Revealed elevated WBCs count (24340/cumm), Severe Thrombocytosis (4136 × 10^3/cumm). After treatment with Tab- Hydroxyurea 1gm TDS, concurrently with Tab- Cytarabine 100mg 1OD, Tab-Dasatinib 50 mg for a week fails to achieve reduction in platelet count, and hence no symtomatic releif was acheived, hence proceded with the Therapeutic Plateletpheresis with Reinfusion of blood as “Emergency Measure”.

Materials and Methods: Pre-procedural assessment including Patient’s vitals were done. One setting of therapeutic plateletpheresis with reinfusion of remaining blood components with the help of Fresenius COM.TEC Machine. Post procedural vitals were assessed.

Results: After single setting of Therapeutic Plateletpheresis, Platelet count is reduced by 11 Lakh/uL, and and symptoms were relieved in the patient.

Conclusion: It is very effective and reasonable to advice and perform plateletpheresis in the patient with platelet count of >8 to 10 Lakh/uL. In the the patient with severe Thrombocytosis with symptoms like headache, dizziness, thrombotic or hemorrhagic changes single (1) setting of Plateletpheresis give effective result and also reduces the dose of medicine and period of adjuvant therapy.

PP 87: Thematic Area: Blood Safety and Infectious Disease Marker Testing (Including NAT Testing): Syphilis seroprevalence and associated risk factors among blood donors at a tertiary care institute in Eastern India

Aniruddha Hazra, Suvro Sankha Datta, Soumitra S. Datta, Soumyadip Chatterji

Tata Medical Center, Kolkata, West Bengal, India

Background: Sexually transmitted infections such as syphilis impose major health and economic burdens globally. Understanding the trend of such infections in a given population is important for the efficient planning and implementation of disease control programs. Blood transfusion services are uniquely positioned to contribute to the population surveillance studies by providing snapshots of the immunity status against any emerging infections in the ethnic populations they serve. Globally, the incidence of syphilis has been observed to have dramatically increased recently. Syphilis, caused by Treponema pallidum, serves as a surrogate marker for high-risk activities in blood donors. This study aimed to determine the current seroprevalence of syphilis among blood donors at a blood center in Eastern India and identify associated demographic, behavioral, and other risk factors.

Methodology: This prospective observational study was conducted from January 2024 to June 2025. A total of 25,295 consecutive whole blood donors were screened using a reverse testing algorithm, initially tested with a treponemal-antibody-based assay (Syphicheck® WB), followed by using chemiluminescent immunoassay (CLIA) on the Vitros® 3600 immunodiagnostic system and a nontreponemal test (RPR-Carbogen). Data on age, gender, donation status, education, occupation, sexual orientation, marital status, and tattoos/piercings were captured. Post-donation counselling and recall data were recorded and analyzed for sero-reactive donors, including high-risk behavior. Chi-square tests and multivariate logistic regression analysis were used to evaluate statistical associations and to identify independent risk factors.

Results/Outcomes: The seroprevalence of syphilis was 0.55% (95% CI:0.45-0.64). Most donors who tested positive for syphilis were male (95.65%), with a significant portion falling within the 25-34 age group (42.75%) (OR=2.34, 95% CI:1.03-5.31). First-time donors showed higher seroreactivity (60.14%) than repeat donors (39.86%) (OR=3.09, 95% CI:2.20-4.36). Among all donors who tested positive for syphilis, 48.55% had an education level exceeding that of high school (OR=0.15, 95% CI:0.11-0.21). On recall, 2.90% of reactive donors disclosed that they belong to high-risk occupations (OR=3.63, 95% CI: 1.33-9.92), and 34.06% had tattoos or piercings beyond one year from the time of donation (OR=41.53, 95% CI: 28.70-60.10). Regression analysis identified several independent risk factors for syphilis seropositivity, including but not limited to tattooing and broken family status. Compared to the historical dataset (2013-2023), syphilis prevalence increased significantly from 130 per 100,000 in 2019 to 710 per 100,000 in 2025, indicating a resurgence. Co-infection analysis showed a highly significant association with HIV (p<0.0001, OR=26.32, 95% CI: 20.22-34.28).

Conclusion: The resurgence of syphilis among asymptomatic blood donors, particularly young first-time male donors, indicates a possible unrecognized transmission of the disease within the community. Strong association with HIV further supports the role of syphilis as a surrogate marker for high-risk behaviors. This study shows the importance of strict TTI testing methods and focused counselling for risky behaviors to ensure blood safety and support public health monitoring. Finally, efforts should be made to promote repeat voluntary blood donation and to retain the donor pool, ensuring the safety of the blood supply.

PP 88: Thematic Area: Donors and Donations: Driving quality improvement in outdoor blood donation camps through a structured quality assessment tool: Experience from a tertiary care centre

Aashna Gupta, Gajender Singh, Vaishali Gupta

Department of Immunohematology and Blood Transfusion, PGIMS, Rohtak, Haryana, India

Background: Voluntary blood donation is the foundation of a safe and adequate blood supply. In India, outdoor blood donation camps contribute significantly to meeting transfusion demands, especially in tertiary care hospitals. Outdoor voluntary blood donation camps are critical for sustaining blood supplies but often show variability in adherence to quality and safety standards. This study aimed to implement a structured quality assessment tool across multiple camps to identify gaps and drive targeted quality improvement.

Methods: A prospective observational study assessed 100 outdoor voluntary blood donation camps organized by PGIMS Rohtak Haryana using a Quality Assessment Checklist covering seven domains: Pre-Camp Planning, Camp Infrastructure, Donor Registration and Selection, Phlebotomy and Infection Control Practices, Emergency Preparedness and Management, Documentation and Records, and Post-Donation Care and Feedback. Each domain included multiple indicators scored from 0 (not done) to 2 (fully compliant). Trained observers collected data via direct observation and document review. The internal consistency of the checklist was assessed using Cronbach’s alpha to evaluate item homogeneity. Inter-rater reliability was measured with Cohen’s kappa to determine agreement between different observers. Content validity was established through expert review.

Results: The Quality Assessment Checklist showed an overall compliance of 77.4% across 33 indicators in 7 domains of outdoor voluntary blood donation camps. The tool demonstrated excellent psychometric properties with a Content Validity Index of 0.92, Cronbach’s alpha of 0.87, and Cohen’s kappa of 0.80. The results underscore both existing strengths and critical gaps, providing a clear direction for targeted interventions to improve camp quality and ensure donor safety.

Conclusion: Implementing a structured quality assessment tool across 100 outdoor voluntary blood donation camps effectively identified critical gaps such as inadequate electrical backup, limited IEC materials, phlebotomy practices in large camps, and insufficient toilet facilities. Based on observations from the initial camps, targeted corrective actions were promptly undertaken to address these gaps, leading to measurable improvements in subsequent camps. This highlights the pivotal role of systematic audits in driving continuous quality improvement, enhancing compliance with national standards, and ultimately safeguarding donor health and satisfaction.

PP 89: Thematic Area: Clinical Transfusions: Optimizing blood preparedness: A validated transfusion prediction tool for high-volume obstetric care

Suhasini Sil, Hem Chandra Pandey, Poonam Coshic, Shruti Rohilla, K. Chanchi

All India Institute of Medical Sciences, New Delhi, India

Background: Peripartum haemorrhage remains one of the leading causes of maternal morbidity and mortality globally. In obstetrics, timely anticipation of blood transfusion requirements during high-risk deliveries is critical, especially in resource-constrained settings. Existing risk prediction models are either not tailored to local clinical contexts or focus on generalized obstetric populations without specific stratification according to risk-factors. Therefore, the development of a localized transfusion risk prediction model is important. This study is aimed to identify significant risk factors associated with perinatal transfusion during delivery and to develop and validate a logistic regression–based risk prediction model using retrospective delivery data from a tertiary care centre.

Methods: This retrospective cohort study included deliveries conducted in a tertiary referral hospital across two consecutive years: 1 st January 2023 to 31 st December 2024. Maternal demographic, obstetric, and clinical variables were extracted from hospital records using a standardized coding sheet. Risk factors such as maternal age, gravida, parity, obesity, history of abortion, method of conception(in-vitro fertilization or normal), history of uterine procedure (cerclage, caesarean delivery or hysterotomy), placenta accreta spectrum, placental abruption, presentation (breech or transverse or vertex), uterine anomaly (bicornuate or unicornuate uterus), anaemia, coagulopathy, eclampsia, pre-Eclampsia, renal disease, heart disease, gestational diabetes, fetal macrosomia and hypertensive disorders were analysed.

Outcome Measures: Primary outcome: perinatal blood transfusion as administration of atleast 1-unit PRBC intraoperative period or the first 12 hours postoperatively. Secondary outcome: Prediction of risk factors for multicomponent transfusion. Initially, univariate analysis was performed, and the significant risk factors were entered into the multivariate logistic regression. Eighty-twenty split was performed on entire data set which was used risk model creation (derivation group) and subsequent validation (validation group). Following multivariate analysis, nomogram was generated for predicting perinatal blood transfusion based on patient demographics and risk factors.

Results: Study population comprised of 5742 deliveries out of which 352 (6.1%) required perinatal blood transfusion. Significant predictors of PRBC transfusion were Placenta accreta spectrum, Placental abruption, Pre-eclampsia, Severe anaemia (Hb < 7 g/dL), intra-uterine death, and coagulopathy. Additionally, 84 cases of multicomponent transfusions were identified which was associated with Abnormal placentation and coagulopathy. In validation group, the regression model had overall good sensitivity and specificity with above 84% patients correctly classified.

Conclusion: In high-volume tertiary care centres this locally derived and internally validated model will help clinicians to identify women at risk of perinatal blood transfusion. This will help to streamline preoperative cross-matching, activate donor replacement in rare blood type, and conserve component stocks especially Rh-negative inventory. This will altogether standardize preparedness for obstetric haemorrhage, reduce delays in product availability, and ultimately decrease preventable maternal morbidity and mortality.

PP 90: Thematic Area: Hematology and Coagulation: Prevalence of hemoglobinopathies amongst young population in Gujarat

Venkata Sai Kiran Kolahalam, Nidhi Bhatnagar, Sangita Shah, Kamini Gupta, Priya Kalavadiya, Bhargavi Rathod

B. J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India

Background: Hemoglobinopathies, including thalassemia syndromes and sickle cell disease, are widespread in Gujarat, particularly among the younger population. Genetic predispositions and long-standing endogamous practices have contributed to their high prevalence, leading to significant health challenges and straining medical resources. These disorders can result in chronic anemia, complications affecting multiple organ systems, and substantial socioeconomic burdens for affected families. Early identification through efficient screening methods like HPLC, along with genetic counseling and awareness programs, is crucial in mitigating their impact and reducing future transmissions. A well-structured public health approach is essential to address these inherited disorders effectively.

Methodology: Between July 2022 and June 2024, 1024 volunteers aged 15–29 were recruited after taking informed consent (from guardians in case of minors), from multiple locations in Gujarat following a brief awareness session. Blood samples were collected in EDTA tubes, and each participant’s medical and family history was documented, especially noting any previous transfusions or transplants. All samples underwent a complete blood count (CBC) using a hematology analyzer and hemoglobinopathy screening via an automated HPLC analyzer. Samples with anemia or positive hemoglobin variants were further evaluated with peripheral blood smears, NESTROFT, and sickling tests. The integrated results from these tests and the collected histories formed the basis for establishing a hemoglobinopathy diagnosis, after which participants received personalized reports and genetic counseling.

Outcome: Among 1024 young participants, 65 (6.35%) were diagnosed with hemoglobinopathies via HPLC. β–Thalassemia Heterozygous was the most common form (34 individuals, 3.32%), identified by elevated HbA2, a microcytic hypochromic blood profile, and mild anemia. Rare forms, including β–Thalassemia Intermedia, β–Thalassemia Homozygous, and δβ–Thalassemia Heterozygous—were detected in single cases (0.09% each). Sickle cell disorders were observed in 20 individuals with heterozygosity (1.95%), two with homozygosity (0.19%), and one with HbS/β–Thalassemia compound heterozygosity (0.09%), along with a small number of HbD Punjab cases. Of the 214 anemic participants, 39 (18.22%) had hemoglobinopathies. Gender-specific analysis showed that males with β–Thalassemia trait tended to have higher hemoglobin levels and RBC counts compared to females.

Conclusion: This study highlights a significant burden of hemoglobinopathies among Gujarat’s youth and the critical need for early detection. Using HPLC, we swiftly identified various hemoglobin variants, paving the way for effective screening and genetic counseling. In a context where costly treatments like stem cell transplants aren’t feasible, combining mass awareness, targeted screening, and preventive counseling is key to reducing transmission and easing family burdens for a healthier future generation.

PP 91: Thematic Area: Donors and Donations: A case report on donor reaction noted in blood centre, AIIMS Raipur

Hemlata Choudhary, Minal Wasnik, Ramesh Chandrakar

AIIMS, Raipur, Chhattisgarh, India

Background: Blood donation is a voluntary act that plays a vital role in healthcare. While generally considered safe, some donors may experience adverse reactions, most commonly vasovagal responses. These are usually mild but can occasionally become severe and result in injuries or complications. The objective of this report is to present a case of a severe vasovagal reaction in a young female donor, explore its clinical course, and highlight the importance of preventive measures and emergency response protocols in a blood donation setting.

Methods: A 20-year-old female visited the Blood Centre at AIIMS Raipur to voluntarily donate blood. She had no known history of chronic illness, allergies, or previous adverse reactions and was donating for the first time. Pre-donation screening showed she was clinically stable: weight 56 kg, hemoglobin 13.8 g/dL, blood pressure 110/70 mmHg, pulse rate 70/min, and body temperature 98°F. After donating 350 mL of blood and completing post-donation counselling, she proceeded to the refreshment room. On the way, she suddenly collapsed and lost consciousness. Emergency first aid was administered immediately on-site using the ABCD approach (Airway, Breathing, Circulation, Disability). The donor was shifted to the donation couch, placed in Trendelenburg position, and resuscitated promptly.

Results: Post-collapse vitals revealed a significant drop in blood pressure (90/50 mmHg) and pulse rate (40/min), while SpO 2 remained at 98% and RBS at 90 mg/dL. The donor exhibited involuntary limb contractions, transient unresponsiveness, and plantar flexion. She also sustained injuries on her right forehead and chin due to the fall. Consciousness returned within a minute, and she was oriented to time, place, and person. The clinical picture was consistent with a Grade B1d vasovagal reaction, indicating a severe reaction with associated trauma. After initial stabilization, she was transferred to the emergency department for further observation and care. No seizure activity or signs of anaphylaxis were observed.

Conclusions: This case highlights a rare but important complication of blood donation. Severe vasovagal reactions, although infrequent, can lead to significant consequences including falls, injury, and psychological distress. Pre-donation counselling should stress the importance of adequate hydration and proper meals before donation. Medical staff should conduct thorough donor history assessments and remain prepared with emergency response protocols. The use of the ABCD approach and early intervention with Trendelenburg positioning and IV fluid administration can significantly improve patient outcomes. Finally, continuous training of staff and reinforcing donor safety protocols can help prevent similar adverse events in the future.

PP 92: Thematic Area: Clinical Transfusions: “Four Years, Three Phases and One Goal” – Four year phase-wise analysis of blood component utilization in hematopoietic stem cell transplantation at a tertiary care hospital in North India

Dixa Kumari, Gita Negi, Ashish Jain, Daljit Kaur, Bibhant Shah, Uttam Kumar Nath

All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

Background: Hematopoietic stem cell transplantation (HSCT) serves as a definitive treatment option for several blood-related disorders. With the increasing frequency of HSCT procedures, demand of blood components has risen markedly. Transfusion needs differ based on the underlying illness, transplant timing, and type of donor and may present unique transfusion challenges.

Methodology: This retrospective observational study evaluated blood component utilization among 25 HSCT recipients over 4 years (2022–2025) at a tertiary care hospital in North India. Transfusion requirements were assessed across three phases of transplantation: pre-transplant (prior to day 0), peri-transplant (day 0 to +30), and post-transplant (day +30 to +100). Comparative analyses were conducted between allogeneic and autologous HSCT recipients, ABO-compatible and ABO-incompatible transplants and underlying diagnosis.

Results: The study included 25 patients (17 males, 8 females) with a mean age of 29.68 years (range: 7–55), all of whom received hematopoietic peripheral stem cell transplants. The most common diagnosis was aplastic anaemia (32%), followed by leukaemia (24%). Allogeneic HSCT (fully HLA matched (10/10) sibling donors) was performed in 56% of patients, while 44% underwent autologous HSCT. Among the allogeneic HSCT recipients, 64% were ABO compatible, 21% and 14% were major and minor ABO incompatible respectively with no cases of bidirectional ABO incompatibility. Over the study period, a total of 307 PRBCs, 1031 RDPs, 210 SDAPs, and 9 granulocyte transfusions were administered. Regarding transfusion practices, 12%, 24% and 44% of patients did not require any transfusion support during the pre-transplant, peri-transplant and post-transplant phase respectively. The highest utilization of PRBCs (6.84 units/ patient), and RDPs (20.52 units/ patient), was observed during the pre-transplant phase. SDPs were most frequently administered during the peri-transplant phase (3.76 units/ patient). Blood requirements were significantly higher (p<0.05) in allogenic donors in pre transplant phases. Although transfusion needs were higher in the peri- and post-transplant phases, the differences were not significant. Transfusion requirements did not differ significantly between ABO-compatible and ABO-incompatible transplants. Lymphoma patients had significantly lower PRBC use in the pre-transplant phase (p = 0.028), while aplastic anaemia and leukemia showed a higher usage of PRBC (p = 0.073 and 0.054 respectively). RDP and SDAP needs did not differ by diagnosis. In the peri-transplant phase, aplastic anaemia patients required significantly more RDP and SDAP (p < 0.05) with least being used in lymphoma and myeloma patients. In post-transplant phase, no significant difference was observed. Mortality was reported in two allogenic HSCT recipients of acute myeloid leukemia and severe aplastic anaemia.

Conclusion: This study highlights that transfusion requirements were significantly higher in allogeneic HSCT recipients and in patients with aplastic anaemia and leukemia. A high dependency on platelet support was observed throughout transplant phases. To manage this demand, blood centers must maintain a dedicated pool of voluntary SDAP donors. Therefore, studying the pattern of blood utilisation during different transplant stages can help in planning transfusion support more effectively and may offer insights into the association between transfusion load and patient outcomes.

PP 93: Thematic Area: Immunohematology: When forward doesn’t match reverse: Understanding ABO discrepancies

Jhalak Patel, Vishvas Amin, Palak Panchal, Kalyani Pandya

Indian Red Cross Society, Ahmedabad, Gujarat, India

Background: Blood grouping is essential in transfusion medicine. ABO grouping discrepancies—when cell (forward) and serum (reverse) grouping do not match—may result from ABO subgroups, naturally occurring irregular antibodies, or underlying clinical conditions. Identifying and resolving these discrepancies is critical to ensure transfusion safety. To evaluate the prevalence and causes of ABO grouping discrepancies among voluntary blood donors at the Indian Red Cross Society, Ahmedabad District Branch.

Materials and Methods: A retrospective analysis was conducted on blood donations collected between January 2017 and June 30, 2025. Blood grouping was performed using the fully automated Qwalys analyzer (Diagast, France). Discrepancies identified were further investigated through serological work-up using conventional tube techniques. Outcome: Out of 4,73,510 blood donors screened, 112 (0.02%) showed ABO grouping discrepancies. Among them, 58 cases (51.79%) were attributed to weak or missing antibodies, 39 (34.82%) were subgroups of A, and 5 (4.46%) exhibited unexpected antibodies. The remaining cases involved Rh antigen variations, weak antigens, and B subgroups.

Conclusion: The most frequent cause of ABO discrepancies was weak/missing antibodies, followed by A subgroups. Irregular antibodies, although less frequent, pose a significant challenge to compatibility testing. Comprehensive serological evaluation is imperative to resolve such discrepancies and to ensure reliable blood grouping and transfusion safety.

PP 94: Thematic Area: Apheresis (Donor and Therapeutic): Role of therapeutic plasma exchange in renal disorders: A critical adjunct in nephrology

Abida Shabir Teli, Meena Sidhu, Neeti Dutt

GMC, Jammu, Jammu and Kashmir, India

Background: Therapeutic plasma exchange plays a crucial role in managing immune-mediated and toxin-induced renal disorders, particularly where rapid reduction of disease mediators is vital to prevent permanent renal damage.

Aims and Objectives:

To assess the clinical utility of TPE in managing renal disorders.

To analyse patient profiles, procedural characteristics, and outcomes following TPE.

To reinforce the significance of TPE in nephrology, particularly in critical immune-mediated pathologies.

Materials and Methods: This is a retrospective observational study of patients of Renal Disorder treated with TPE during a period of one year (January 2024 – January 2025) in the department of Immunohematology and Transfusion Medicine, performed using the “Spectra Optia Terumo BCT Apheresis System”. The data analysed included History, demographic data (sex and age), Biochemical parameters, underlying renal diagnoses, and TPE treatment details. Parameters such as volume exchanged, type of replacement fluid, frequency of sessions, and safety outcomes were reviewed. The replacement fluids used were 5% albumin and fresh frozen plasma (FFP). The volume exchanged was approximately 1–1.5 plasma volumes per session. A total of 5–7 sessions were conducted for almost every patient.

Results: The study included 14 patients with nephrological disorders (8 male and 6 female). The age range was 20-60 years. The total number of sessions done were 64. The number and frequency of TPE procedures depended upon the the severity and clinical improvement of the patients as some required long-term maintenance. Nephrological diseases treated with plasmapheresis were rapidly progressive glomerulonephritis in 5 (35.7%) patients, Acute and chronic rejection Post kidney Transplant in 3 (21.4%) patients, Anti GBM disease/Good-pasture syndrome in 3 (21.4%) patients, 1 in SLE (severe lupus nephritis) with diffuse proliferative glomerulonephritis (7.14%), 3 in TTP (Thrombotic Thrombocytopenic Purpura with atypical haemolytic uremic syndrome (21.4%). In our study, on an average of plasma exchange volume is 1 time patient’s plasma volume in each session with 2180 ml of replacement fluid given in each session in which two-third of the fluid was replaced with albumin on an average 1480 ml in each session and one third was replaced with fresh frozen plasma i.e 843 ml. Complications like inadequate vascular access was common in (6.5%) and in few cases, machine error were reported due to machine breakdown (1.6%). Incidence of adverse reactions accounted to 9.83% (6/61); most common was hypotension (4.9%), followed by fever with chills (2.4%), nausea (1.2%) and allergic reactions (1.4%). No mortality occurred while performing TPE procedures in these patients. The overall mortality was 3 (21.4%). 1 Death in Rapid progressive Glomerulonephritis, 1 in acute rejection following Renal Transplant and 1 in SLE (severe lupus nephritis) with diffuse proliferative glomerulonephritis.

Conclusion: Therapeutic Plasma Exchange is a safe and effective modality for managing several immune-mediated renal disorders. Timely initiation and appropriate patient selection can improve renal outcomes and overall survival. This study further highlights TPE’s role as a valuable adjunct in nephrology practice.

PP 95: Thematic Area: Clinical Transfusions: Variability in blood component utilization in phases and types of pediatric hematopoietic stem cell transplantation

Anupa Pokhrel, Kriti Batni, Satyam Arora, Seema Dua

Department of Transfusion Medicine, Post-Graduate Institute of Child Health, Noida, Uttar Pradesh, India

Background: Blood component utilization varies across different phases of hematopoietic stem cell transplantation (HSCT). Pediatric HSCT presents unique transfusion challenges depending on transplant type, phase, and patient-specific variables. Understanding these patterns is crucial for efficient resource allocation and implementation of patient blood management strategies.

Aim: To analyze blood component utilization trends across different phases and types of pediatric HSCT and assess the impact of transplant characteristics (e.g., ABO incompatibility, transplant type, HLA matching of donor and recipient) on transfusion requirements.

Method: A retrospective analysis of pediatric HSCTs performed in 2024 (N=28 patients) was conducted. Data was collected from the ISBMT (Indian society of bone marrow transplantation) reporting hospital registry and patient charts. Transfusion requirements were recorded in three phases: Phase 1: Conditioning, Phase 2: Infusion to engraftment and Phase 3: Post-engraftment (up to discharge or mortality). Blood products analyzed included packed red blood cells (PRBC), single-donor apheresis platelets (SDAP), granulocytes (GRCT), fresh frozen plasma (FFP), and cryoprecipitate. Independent t-tests were used for statistical comparisons.

Results: A total of 28 pediatric HSCTs were analyzed (median age: 9 years; range: 7 months–17 years). PRBC usage increased across phases (Phase 1: mean 1 unit; Phase 3: mean 1.32 units). SDAP transfusions peaked in Phase 2 (mean: 2.05 units). ABO-incompatible transplants had higher PRBC requirements in Phase 1 (1.25 vs. 0.82 units) and Phase 3 (1.5 vs. 1.18 units), with a statistically significant increase in Phase 2 (p = 0.037). Autologous transplants required more PRBCs in Phase 1 (1.29 vs. 1) likely due to apheresis circuit priming needs and Phase 2 (1 vs. 0.6), but none in Phase 3. Allogeneic transplants required continued PRBC support and more SDAP (Phase 2 mean: 2.05 units). Haploidentical transplants showed significantly higher PRBC (Phase 3 mean: 2.67 vs. 0.1, p = 0.039) and SDAP (mean: 3.44 vs. 0.1, p = 0.025) usage compared to matched transplants. In the four patients who died, PRBC and SDAP usage was highest in Phase 3 (mean: 5.5 and 7.25 units, respectively).

Conclusions: This study demonstrates significant variation in blood component utilization across different HSCT phases and transplant types in pediatric patients. Allogeneic and especially haploidentical transplants required higher transfusion support than autologous or HLA-matched transplants. ABO incompatibility increased PRBC needs, particularly during conditioning. Patients with mortality showed markedly elevated transfusion requirements, highlighting the association of critical illness with higher blood product usage. These findings underscore the importance of tailored transfusion strategies and patient blood management in pediatric HSCT. Although the sample size limits diagnostic subgroup analysis, the observed patterns can inform clinical planning and resource optimization.

PP 96: Thematic Area: Immunohematology: Extended red cell phenotyping-blessing in disguise

Shashank Rai, Amit Agarwal

Fortis Escort Heart Institute, New Delhi, India

Background: With advancement in healthcare clinical practices and technology, blood usage has declined drastically. Red cell antigen alloimmunisation is the major challenge in current Transfusion practices. The need for implementing routine Rh-Kell phenotyping for all donors and patient screening is being realised all over the world to prevent the risk of alloimmunisation as far as possible. Fortis Escorts Heart Institute in India is a leading hospital in India, specialized in cardiology and other specialities has high input of pediatric and adult patients from all over the world. With a high number of cardiac surgeries and organ transplant programme running use of blood components is in accordance. Our patients may need repeated transfusions time, massive transfusions and at times undergo redo surgery having multiple transfusion episodes. So a high risk of alloimmunisation and antibody development exists. To eliminate the risk of alloimmunisation and ensure safer transfusions in patient’s lifetime, our hospital is among the first few centre in India to introduce Rh-kell phenotyping for all patients and blood donors.

Aims: To assess feasibility of doing extended red cell phenotyping and cost effectiveness.

Methods: Study Duration: 2012 – June 2025. All the patients anticipating blood transfusion and all donors subjected to Rh-kell phenotyping and 3 cell panel antibody screening as a routine.

Results: Total samples tested 164812: 98131 donors & 66681 patients (adult and pediatric) on fully automated immunohematology analyser- QWALYS 3 (Diagast, France) using Erythrocyte Magnetized Technology®. Data of the donor units are saved in the Microsoft Excel sheet with the donation & Unit details. Patient phenotyping and antibody screening (IgM +IgG) is done at the time of admission. For transfusion, ABO & phenotypically matched units are issued after an immediate spin cross match. Patient with positive antibody screening undergoes antibody identification and subsequently corresponding antigen negative blood is been arranged.

Summary and Conclusions: Introduction of Rh–Kell phenotyping of the donors and the patients has improved blood transfusion services drastically. It helped us in many ways: 1. In identifying the phenotype of our population 2. In providing antigen specific red cells to our patients thus ensuring another safety grid by avoiding alloimmunisation With regards to the high frequency of immunogenic antigens of the Rh-Kell systems, pre-transfusion antibody screening on patients’ samples and Rh-Kell phenotyping on donors are essential and needs to be implemented. In long run it is cost effective measure.

PP 97: Thematic Area: Clinical Transfusions: A false alarm of hemolytic transfusion reaction

A. J. Priyadarsini, Karan Kumar, Amin Mir

AIIMS, Kalyani, West Bengal, India

Background: Hemolytic transfusion reaction (HTR) is one of the most alarming and dreaded adverse events of transfusion for both the treating doctors and the transfusion medicine specialists. It leads to patient mortality / morbidity and legal ramifications on the health care workers involved. Hence, reporting of a HTR is to be done cautiously. The present case report is on one such patient whose symptoms mimicked an HTR but was actually a pseudo-hemolytic transfusion reaction.

Methodology: A 44-year-old morbidly obese female with severe anaemia (Hb 4.9 g/dL) was admitted for evaluation of a right adrenal mass. Following proper immunohematological compatibility testing, two units of leukodepleted O RhD positive PRBCs were transfused over two days. While both transfusions were uneventful, the patient developed fever, chills, headache, tachycardia, and acute delirium 5 hours post-transfusion. A hemolytic transfusion reaction was suspected when the patient passed urine with a blood-tinged appearance. A full transfusion reaction workup was initiated as per national guidelines, including repeat clerical checks, visual inspection, blood grouping, antibody screening, crossmatching, Direct Coombs Test, and cold chain review.

Outcome: All immunohematological and mechanical causes of hemolysis were ruled out. The post-transfusion blood sample showed no hemolysis, and the second urine sample was normal in colour. Urinalysis showed presence of blood cells, but there was no evidence of hemoglobinuria, hemolysis, urinary tract infection, or drug-induced discoloration. Upon further probing, a history of minor vaginal spotting was revealed by the patient’s relative, which explained the transient discoloration of urine. The transfusion reaction was finally categorized as a febrile non-hemolytic transfusion reaction (FNHTR) with coincidental menstrual spotting mimicking hematuria.

Conclusion: This case underscores the critical role of thorough clinical history and communication between clinical teams in accurately diagnosing transfusion reactions. Pseudo-hemolytic transfusion reactions can closely mimic HTRs and lead to diagnostic dilemmas. A systematic approach combined with careful patient assessment is essential to differentiate true hemolysis from mimicking conditions, thereby avoiding misclassification and unnecessary alarm.

PP 98: Thematic Area: Clinical Transfusions: Small patients, big responsibility: A call for robust reporting and vigilant monitoring of pediatric adverse transfusion reactions

Megha Mehra, Daljit Kaur, Ashish Jain, Dixa Kumari, Nowneet Kumar Bhat, Gita Negi

All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

Background: Blood transfusion is an indispensable therapeutic modality, especially in pediatric patients with hematological disorders, malignancies, surgical needs, and critical illnesses. Despite stringent regulatory guidelines and advancements in transfusion safety, pediatric transfusion practices present unique challenges. Children often manifest subtle and nonspecific clinical signs of adverse transfusion reactions (ATRs), and communication barriers may delay recognition. In addition, the diverse spectrum of underlying diseases and the higher prevalence of repeat transfusions in this age group increase the risk of ATRs. Data on the true burden and pattern of pediatric ATRs, especially from low- and middle-income countries, remain limited, leading to underrecognition and underreporting. This study aims to bridge this gap by assessing the incidence, distribution, and types of ATRs in pediatric patients in a tertiary care hospital in North India and to emphasize the importance of robust hemovigilance and timely reporting to improve transfusion safety in this vulnerable population.

Methodology: A retrospective observational study was conducted over a period of 2 years and 8 months (October 2022 – June 2025) in the blood centre of a tertiary care hospital in North India. Data were retrieved from the electronic transfusion management system (SafeTrans) and transfusion reaction workup records for pediatric patients aged birth to 17 years. Demographic parameters, transfused components, type and timing of ATRs, and patient transfusion history were analyzed.

Outcome: During the study period, a total of 13309 transfusions were administered to pediatric patients. The most frequently transfused component was random donor platelets [RDP] accounting for 44.4%), followed by packed red blood cells (PRBC) at 38.5% and fresh frozen plasma (FFP) at 15.6%. A total of 40 adverse transfusion events were recorded, giving an overall incidence of 0.30%. Among affected patients, 21 (52.5%) were male and 19 (47.5%) were female, and 29 (72.5%) had a history of multiple transfusions. Component-specific incidence revealed that 55% of ATRs occurred after PRBC transfusion, while 22.5% each were associated with RDP and FFP transfusions. More than half of these reactions (57.5%) occurred during routine hours (8 a.m-8 p.m). Allergic reactions were the most frequent type (17 cases, 42.5%), predominantly linked to RDP transfusions (52.9%), followed by febrile non-hemolytic transfusion reactions (FNHTR) (16 cases, 40%), of which 87.5% occurred following PRBC transfusions. There was no significant association between ATRs and patient age or underlying diagnosis.

Conclusion: The overall incidence of pediatric ATRs in our study was low (0.30%), yet these events remain clinically significant, especially in multiply transfused children and PRBC recipients. The findings highlight the critical importance of vigilant clinical monitoring, timely recognition, and comprehensive reporting of ATRs in pediatric transfusions. Strengthening hemovigilance systems, implementing regular staff training programs, adhering to evidence-based transfusion protocols, and adopting risk stratification strategies are essential for improving transfusion safety. Focused reporting and monitoring mechanisms tailored for pediatric populations will ensure early detection, appropriate management, and long-term improvement in transfusion practices for this vulnerable group.

PP 99: Thematic Area: Apheresis (Donor and Therapeutic): Vascular access in apheresis among kidney and liver diseases: A single-centre study on its complications and interventions

John Gnana Raj, Amit Prajapati, Pooja Modi

Institute of Kidney Disease and Research Centre, Ahmedabad, Gujarat, India

Background: Apheresis therapy (including therapeutic plasma exchange, LDL pheresis) is an important modality of treatment in kidney and liver diseases especially in a transplant setting. Temporary insertion of large-bore double lumen catheters (DLC) or presence of Arterio-venous Fistula (AVF) is necessary for efficient performance of the therapy. The appropriate selection of vascular access, and its optimal care and insertion site are essential to avoid complications. We have undertaken this study to look into the vascular access data of our apheresis patients, and procedure related complications and its outcomes during apheresis therapy (TPE and LDLpheresis).

Methods: We reviewed data from all patients undergoing apheresis (TPE and LDL pheresis) during a 1-year period (July 2024-25) in our tertiary hospital, Institute of Kidney Disease and Research Centre, IKDRC, Ahmedabad, India. All the TPE procedures were performed using FRESENIUS KABI COM.TEC®. Apart from patient baseline data, we collected data of clinical indication, disease aetiology, vascular access, procedure related complication including those due to blood transfusion during procedure. Statistical analysis was performed using SPSS version 22.0.

Results: During the study period, 151 patients had undergone 834 apheresis [776 (93%) TPE procedures and 58 (7%) LDL) procedures with a median of 4 procedures (1-25). Among them, 50 were females (3.6%) and the rest 101 (96.4%) patients were males. The median age was 16 (2–77) years. Among TPE, post renal transplant Acute B-cell Mediated Rejection (ABMR) was the most common indication contributing to 302 (36.1%) followed by Atypical Haemolytic Uremic Syndrome (aHUS) 253 (29%) and 65 (7.7%) pretransplant desensitisation among ABO incompatible and highly HLA sensitised renal transplant individuals attributing to 25 (3%) and 50 (6%) respectively, acute liver failure 46 (5.9%) and 35 (5.7%) for other causes such as anti-GBM disease, FSGS, and SLE. The vascular access used for the procedures are as follows: LAVF 196 (23%), RAVF 70 (8.4%), LDLC 49 (5.9%), RDLC 471 (56.5%), RPC 14 (2%), RFDLC 2 (0.2%) and LFDLC 32 (4%). There were 40 (4.7%) episodes of patient related complications during the TPE treatments. Among them, vascular access related complication was 7 (17.5%), 11 (28%) transfusion reaction related complication-10 allergic reactions due to FFP and 1 due to albumin, 15 (38%) citrate toxicity, one AVF swelling (reaccess done and procedure completed), six inlet flow issues-two in Left DLC, three Right DLC and one Left Femoral DLC. Among them, three resolved after saline flushing and in the other three patients, DLC was changed mid-procedure using guide wire and procedure was continued.

Conclusion: This study provides valuable insights into the vascular access practices and associated complications during apheresis therapy at a transplant center in India. Our findings demonstrate the predominant use of central venous catheters, particularly the right double lumen catheter (RDLC). Vascular access related complications, highlights the critical role of appropriate vascular access selection and care to minimize complications and improve on the apheresis therapy nuances.

PP 100: Thematic Area: Clinical Transfusions: Maximum surgical blood ordering schedule (MSBOS) at a tertiary care oncology centre

Abhaykumar Gupta, Anita Tendulkar, Priti Desai, Anisha Navkudkar

Tata Memorial Hospital, Mumbai, Maharashtra, India

Background: Despite over 12 million blood donations in India, a significant gap remains between the demand and supply of blood. Blood Transfusion Services (BTS) are challenged to maintain a fine balance between the supply of this limited resource and an ever-increasing demand. Many times, Blood ordering before surgery is excessive. One of the important policies to reduce this over-ordering is the ‘Type and Screen’ whereby units are not cross-matched until an actual need for transfusion occurs. The Maximum Surgical Blood Ordering Schedule (MSBOS) is a criterion developed from institutional usage statistics providing a figure for the number of units to be cross-matched for any given surgical procedure. Many International and national guidelines are available for the MSBOS, but there is a paucity of data about oncology patients. This study aims to formulate MSBOS at a tertiary care oncology centre along with evaluation of the crossmatch to transfusion (CT) ratio.

Methods: One-year retrospective data were retrieved and analysed to assess transfusion requirements and preoperative blood crossmatch requisitions in adult surgical oncology patients. Each surgical procedure was grouped into different procedure categories determined by surgical subspecialty and relevant anatomical operative site. The data was analysed for age, gender, organ and type of surgery, pre-operative blood orders, Haemoglobin before and after surgery, pre-intra-post-operative requirement of Red Blood Cells (RBC), Fresh Frozen Plasma (FFP) and platelet transfusions.

Results: A total of 6664 surgical events occurred during the study period, of which 659 surgeries were postponed or cancelled, leaving 6005 surgical events for analysis. A total of 14934 RBC units were cross-matched before the surgeries, but only 2262 RBC units were transfused, giving a high CT ratio of 6.6. A very high CT ratio of 34.62 was observed with plastic and reconstructive surgeries, whereas Gastrointestinal and Bone Soft tissue surgeries had the CT ratio of 4.33 and 4.48, respectively. Head and Neck Oncology (HNO) and Gastrointestinal Oncology (GIO) had the maximum number of surgical events, 2080 (34.64%) and 1295 (21.57%), respectively. GIO and HNO also had the maximum units of RBC transfusions, 884 (39.08%) and 415 (18.35%), respectively. As per the study, MSBOS recommended for surgical cases with significant expected blood loss, such as hemipelvectomy and hepatectomy, is 6 units crossmatch, whereas for cases of schwannoma excision and lung lobectomy, its 4 units crossmatch. For surgeries with low blood loss, such as craniectomy and ureterectomy, MSBOS is 2 2-unit crossmatch, and for other low blood loss surgeries, such as orchidectomy and stoma closure, MSBOS is only a Type and Screen.

Conclusions: This study shows that an MSBOS created with Electronic Medical Records acquired data can be used to optimise the process of pre-operative blood ordering. Implementing an updated, institution-specific MSBOS has substantial advantages that include decreasing the number of pre-operative blood orders considered to be unnecessary, reducing the CT ratio, and decreasing overall costs without evidence of impact on patient safety.

PP 101: Thematic Area: Immunohematology: Clinical and serological correlation of positive direct antiglobulin test: A tertiary care blood centre experience

Nidhya Gnanasekaran, S. Subash, S. Sudha, S. Sangeetha

Madras Medical College, Chennai, Tamil Nadu, India

Background: The Direct Antiglobulin Test (DAT) is a key diagnostic tool to detect in vivo sensitization of red blood cells with immunoglobulin and/or complement. It plays a vital role in evaluating autoimmune haemolytic anaemia (AIHA), haemolytic disease of the foetus and newborn (HDFN), drug-induced immune haemolytic anaemia, and haemolytic transfusion reactions. However, DAT positivity may also be seen in the absence of haemolysis across a spectrum of clinical scenarios.

Aim and Objectives: To assess the clinical and serological profiles of patients with positive DAT. To evaluate the presence or absence of haemolysis in these cases.

Materials and Methods: A retrospective study was conducted from June 2024 to June 2025, analysing 185 DAT-positive patients using the column agglutination technique. Further categorization into IgG and/or C3d was done using monospecific cards. Relevant clinical and serological data were reviewed, with specific attention to haemolytic status.

Results: Among the 185 DAT-positive cases, the distribution was as follows: AIHA (42.7%), infectious diseases (24%), haematological disorders (14.05%), liver diseases (5.9%), neonatal jaundice (4.32%), antenatal cases (4.32%), hemoglobinopathies (3.24%), and cardiac conditions (1.08%). Evidence of haemolysis was observed in 88 patients (47.6%), while 97 patients (52.4%) showed no haemolysis.

Conclusion: Positive DAT results may occur across diverse clinical conditions with or without haemolysis. Hence, a thorough clinical and serological correlation is essential to guide appropriate diagnosis and management.

PP 102: Thematic Area: Blood Safety and Infectious Disease Marker (IDM) Testing (Including NAT Testing): ELISA versus CLIA: A comparative study for transfusion transmissible infection screening

Saurabh Jain, Aditi Goel, Richa Gupta, Rajendra Singh Negi

RBTC GTB Hospital, New Delhi, India

Background: Ensuring the safety of the blood supply is paramount in transfusion medicine, with rigorous screening for transfusion-transmitted infections (TTIs) being a cornerstone of patient protection. Human Immunodeficiency Virus (HIV), Hepatitis B surface Antigen (HbsAg), Hepatitis C Virus (HCV), and Syphilis remain significant global health concerns, necessitating highly sensitive and specific screening assays for every donated blood unit. Enzyme-Linked Immunosorbent Assay (ELISA) has long been the gold standard for serological screening due to its established reliability and widespread availability. However, advancements in immunoassay technology have led to the increasing adoption of Chemiluminescence Immunoassay (CLIA) systems, which offer potential advantages such as enhanced sensitivity, broader dynamic range, higher throughput, and automation capabilities.

Methods: This prospective study was conducted at regional blood transfusion centre Guru Teg Bahadur Hospital Delhi. It aimed to evaluate and compare the diagnostic performance of ELISA and CLIA methods for the routine screening of HIV, HBsAg, HCV, and Syphilis in 500 blood samples. Each sample was subjected to parallel screening for Human Immunodeficiency Virus (HIV), Hepatitis B surface Antigen (HBsAg), Hepatitis C Virus (HCV), and Treponema pallidum Hemagglutination Assay (TPHA) using both Enzyme-Linked Immunosorbent Assay (ELISA) and Chemiluminescence Immunoassay (CLIA) platforms. All assays were performed according to the manufacturers’ instructions. Results from both methods were compared to determine concordance, discordance, and to calculate the sensitivity and specificity of each platform for the detection of the transfusion-transmitted infections.

Results: A total of 500 blood samples were analyzed. For Human Immunodeficiency Virus (HIV) screening, 0.6% (3/500) were reactive by ELISA, while 0.4% (2/500) were reactive by CLIA. This reduction in reactive results by CLIA suggests an improved specificity, with CLIA demonstrating a lower rate of presumptive false positives compared to ELISA, while maintaining comparable sensitivity in detecting true reactive samples. For Hepatitis B surface Antigen (HBsAg), both ELISA and CLIA identified 2.4% (12/500) as reactive, indicating high concordance and comparable diagnostic performance in terms of both sensitivity and specificity. For Syphilis (TPHA) screening, 1.6% (8/500) were reactive by TPHA method, which notably reduced to 1.2% (6/500) by CLIA. This reduction points to enhanced CLIA specificity, as it yielded fewer initial reactive results. Furthermore, the incidence of equivocal TPHA results also significantly decreased with CLIA, streamlining the diagnostic pathway by reducing indeterminate findings. For Hepatitis C Virus (HCV), 1.2% (6/500) were reactive by both ELISA and CLIA, showing excellent agreement and comparable diagnostic performance. Overall, CLIA demonstrated a notable reduction in false positivity for HIV and Syphilis, suggesting superior specificity for these markers without compromising sensitivity. Results for HBsAg and HCV were highly comparable across both platforms, confirming their robust performance.

Conclusion: This study demonstrates that while both ELISA and CLIA methods are highly sensitive for screening, CLIA offers distinct advantages by significantly reducing false positivity and equivocal results. The findings suggest that CLIA platforms can enhance the specificity of TTI screening, potentially leading to more efficient blood bank operations.

PP 103: Thematic Area: Immunohematology: Anti-I cold agglutinins as diagnostic beacons: Unmasking Mycoplasma pneumoniae via immunohematological sleuthing in cold agglutinin hemolysis

Anusha Thangaraju, S. Subhash, S. Sudha

Madras Medical College, Chennai, Tamil Nadu, India

Background: Cold Agglutinin Hemolytic Anemia (Cold AIHA) is an autoimmune disorder marked by complement-mediated red cell destruction, often triggered by infections such as Mycoplasma pneumoniae. The presence of cold-reactive antibodies, particularly anti-I, can lead to significant immunohematological discrepancies that aid in early diagnosis.

Case Summary: A 27-year-old male presented with a one-week history of fever, cough, and progressive dyspnea. Laboratory evaluation revealed visible agglutination in EDTA samples, elevated Mean corpuscular Hemoglobin (MCH) and MCH concentration (MCHC), Bilirubin, LDH. ABO blood grouping showed discrepancies, Direct Antiglobulin Test (DAT) was strongly positive for C3b. Cold agglutinin titer were high, and testing revealed reactivity with adult cells but not cord cells. A Hemagglutination Inhibition Assay with Human breast milk confirmed anti I specificity. Chest imaging showed right lower lobe consolidation with minimal pleural effusion. Subsequent Serology confirmed Mycoplasma pneumoniae infection. Management and Outcome: The Patient was treated with on i.v methylprednisolone and Azithromycin along with thermal protection to prevent cold induced hemolysis. The patient showed rapid clinical recovery with resolution of pulmonary and hemolytic manifestation.

Conclusion: This case highlights the diagnostic importance of immunohematological Clues in cold agglutinin disease such as anti-I detection helping to identify underlying Infectious Etiology. It underscore the synergy of traditional serologic expertise and precision immunodiagnostics. Early recognition and multidisciplinary intervention remain critical to ensure prompt diagnosis and management of rare, reversible presentation of Cold AIHA.

PP 104: Thematic Area: Apheresis (Donor and Therapeutic): Not so universal after all: Analysis of ABO isoagglutinin titers and donor demographics in Group O plateletpheresis donors at a tertiary care oncology centre

Smriti Yadav, Shashank Ojha, Suryatapa Saha, Dipti Barekar

Tata Memorial Hospital, Pune, Maharashtra, India

Background: Patients with hemato-oncology conditions rely significantly on single-donor platelet transfusions during their treatment. Due to the scarcity of group-specific SDPs, these patients frequently receive SDPs from various nonspecific blood groups. However, the transfusion of O group plasma to non-O group recipients, especially of group A, can occasionally lead to severe destruction of red blood cells. In addition to acute hemolysis, other consequences of incompatible SDP transfusions may include hemoglobinemia, jaundice, progressive anemia, spontaneous agglutination, a positive direct antiglobulin test, and heightened osmotic fragility of the patient’s red blood cells. Sera from individuals with the O blood group contain two distinct antibodies, anti-A and anti-B, along with a cross-reacting antibody known as anti-A,B (predominantly IgG). In India, it is not a requirement to screen group O platelet donors for ABO titrations. Therefore, this study was conducted to assess the levels of agglutinins in platelet donations.

Methodology: A retrospective observational study conducted at a single center spanned 6 months, from January 2025 to June 2025, focusing on 351 plateletpheresis donors. Blood samples from donors of the O blood group who underwent plateletpheresis procedures were analyzed for anti-A and anti-B (IgM and IgG) isoagglutinin titers utilizing the IMMUCOR Galileo Neo Iris platform, employing Solid Phase Red Cell Adherence (SPRCA). Statistical analysis was performed to evaluate correlations between elevated titers and demographic factors (p<0.05).

Outcome: Donors aged 18 to 30 years demonstrated elevated anti-A IgM titers (p=0.002). A statistically significant clinical correlation was found between reduced hematocrit levels and increased anti-A IgM titers (p=0.018). The prevalence of high titers for IgM anti-A was recorded at 6.3%, while IgG anti-A was at 16.3%. In contrast, the prevalence of anti-B IgM titers was 6.6%, and IgG titers were 21.4%. Over 93% of Group O SDP donors showed anti-A and anti-B IgM titers of ≤64. The prevalence of high titers did not reveal any statistical significance concerning gender or the type of donation, whether voluntary or replacement.

Conclusion: This research indicates that individuals over 30 years of age who voluntarily donate through plateletpheresis should be chosen as platelet donors in cases of non-identical ABO transfusions. Furthermore, the titration of ABO antibodies in blood centers will enhance safety during non-identical ABO transfusions.

PP 105: Thematic Area: Immunohematology: Factors affecting alloimmunization and autoimmunization in transfusion-dependent thalassemia patients at a tertiary pediatric care institute

Akshay Paliwal, Satyam Arora, Nita Radhakrishnan, Seema Dua

Post Graduate Institute of Child Health, Noida, Uttar Pradesh, India

Background: This prospective observational study evaluated alloimmunization and autoimmunization in 107 pediatric transfusion-dependent thalassemia (TDT) patients over one year at a tertiary care center in North India. Alloantibodies were detected in 5.6% and autoantibodies (DAT positive) in 15.9% of patients. 83% of alloantibodies belonged to the Rh system. Significant risk factors included age at first transfusion >1 year, higher mean age, Rh D-negative blood group, and shorter transfusion intervals. All patients received ABO and RhD-matched leucoreduced units. Study highlights the importance of extended antigen matching, particularly for Rh and Kell antigens, to reduce immunization risks in pediatric TDT patients.

Background: Thalassemia, a genetic disorder, requires lifelong RBC transfusions to manage hemoglobin levels (9-11 g/dl). Alloantibodies against RBC antigens can complicate transfusions, reducing efficacy and increasing risks like hemolytic reactions and iron overload. There are variable alloimmunization rate ranges (4%-50%) in different parts of our country however there is a lack of data from the region of western UP. This study aimed to analyze the factors affecting alloimmunization and autoimmunization development in pediatric transfusion-dependent thalassemia (TDT) patients.

Methodology: This was a prospective observational study in a tertiary pediatric hospital from North India, done on TDT patients registered at our centre over 1 year. The tests performed were ABO and Rh-typing, direct and indirect antiglobulin tests, antibody screening and identification for every visit for blood transfusions.

Results: A total of 107 pediatric TDT patients (67 males and 40 females) were enrolled, aged from 6 months to 18 years with a mean of 6.12±5.02 years. Among them, 93 patients had β-thalassemia major, 7 had E/β-thalassemia, and 7 had thalassemia intermedia. All patients received ABO and RhD-matched leucoreduced units (1 log) and none were splenectomized. The mean age of 1st transfusion was 1.33 ± 1.71 years (Range 1.5 months-10 years). Alloantibodies were identified in 6 (5.60%) patients, and 17 (15.90%) patients had a positive direct antiglobulin test (DAT). Alloantibodies identified were from Rh blood group system (Anti-E=2, Anti-D=2, Anti-Cw=1) and Kidd blood group system (Anti-Jka=1). There was statistically more risk of allo/auto-immunization in pediatric TDT patients who received their first transfusion after 1 year of age (p=0.003), who had higher mean age (p=0.001) and Rh(D) negative blood group for alloimmunization (p=0.016). Patients with alloimmunization and autoimmunization had shorter interval between two transfusions (p=0.04), as compared to non-immunized.

Conclusion: The incidence of alloimmunization and autoimmunization in pediatric TDT was 5.6% and 15.9% respectively. The majority of alloantibodies belonged to Rh blood group system. Thus, further highlighting need to provide Rh and Kell matched units to TDT patients.

PP 106: Thematic Area: Quality Management and Accreditation: Quality in every drop: Leveraging key performance indicators to drive excellence in transfusion services

Parmatma Prasad Tripathi, Vijay Kumawat

National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India

Background: Blood transfusion services are a critical pillar of healthcare, ensuring safe and appropriate use of blood products. The principle of delivering the “right blood to the right patient at the right time and place” underscores the importance of continuous quality improvement (CQI). Key performance indicators (KPIs) are central in monitoring and sustaining quality standards. The National Accreditation Board for Hospitals and Healthcare Providers (NABH) has established rigorous quality metrics for transfusion services in India. Adherence to these KPIs and timely corrective and preventive actions (CAPA) drives patient safety, resource optimization, and accreditation readiness.

Aim: To evaluate transfusion service quality by assessing performance across NABH-defined KPIs at a tertiary care blood Centre.

Objectives:

To monitor and evaluate the annual trends of NABH KPI quality indicators in transfusion services.

To identify gaps in service quality and implement data-driven corrective actions.

To benchmark institutional performance against national standards to support accreditation and continuous quality improvement.

Methods: A retrospective, observational study was conducted at the NABH-accredited blood centre of NIMHANS, Bengaluru, over one year (January–December 2024). Monthly data on ten NABH-defined KPIs were extracted from internal quality records and hospital information systems. These KPIs included transfusion-transmitted infection (TTI) rates, adverse transfusion reactions (ATR), component wastage, donor deferrals, adverse donor reactions (ADR), quality control (QC) failures, voluntary donation rates, quantity not sufficient (QNS) units, turnaround time (TAT), and delayed transfusions. Descriptive analysis was performed to track trends. Outliers were investigated using root cause analysis, and CAPAs were implemented.

Results: Analysis of ten NABH-defined KPIs from January to December 2024 demonstrated substantial compliance, with over 75% of quality standards consistently met throughout the year. The combined TTI rate ranged from 0.20% to 2.49%, peaking in September (14 cases), with syphilis and HBV being the most frequently detected. Adverse transfusion reactions varied monthly from 0.07% to 1.11%, with the highest incidence (16 cases) reported in December. Component wastage rates at the blood centre ranged between 2.34% and 10.68%, with random donor platelets contributing to most discards; ward return discards were negligible. Adverse donor reactions fluctuated widely, peaking at 195.3% in March, reflecting the impact of a low donor base. Donor deferral rates ranged from 0% to 9.4%, with noticeable increases during mass donation drives. Voluntary blood donations consistently remained above 70%, reaching a peak of 91.3% in October. QC failures were minimal; PRBC failures occurred in January and February (25% each), and FFP failures peaked at 25% in October. The QNS unit rate remained within acceptable limits (0.19%–1.24%). Root cause analyses for outliers led to targeted CAPAs, including staff retraining, process revalidation, and stricter donor screening protocols, improving compliance and minimizing recurring deviations.

Conclusion: Monitoring NABH-defined KPIs provides actionable insights into transfusion service quality. This approach enables proactive interventions, improves patient safety, and fosters a culture of continuous improvement. Implementing CAPAs strengthens accreditation readiness and ensures high standards in donor-to-recipient care. Quality assurance measures are vital for safe, efficient, and patient-centric blood transfusion practices in public healthcare settings.

PP 107: Thematic Area: Apheresis (Donor and Therapeutic): Change in donor parameters after plateletpheresis: Comparison of single dose versus double dose plateletpheresis

Deepak Kumar, Rahul Katahria, Swati Pabbi, Tarun Kumar, Amit Bisht, Om Prakash Mandal

Amrita Institute of Medical Sciences and Research Centre, Faridabad, Haryana, India

Background: The increasing clinical demand for apheresis platelets, especially in tertiary care and oncology settings, has led to a growing preference for high-yield or double-dose plateletpheresis. This shift is particularly important in developing countries where the apheresis donor pool remains limited. Collecting more platelets per donation improves inventory management but also raises concerns about donor safety and post-procedural recovery. This study aimed to compare single and double-dose plateletpheresis with respect to target yield, donor platelet recovery, and haematological changes post-donation.

Methodology: A total of 247 plateletpheresis procedures were analysed, comprising 174 double dose platelet (70.45%) and 73 single dose platelet (29.55%) collections. All procedures were performed on healthy, blood donors who met eligibility criteria. Pre- and post-procedure venous samples were analysed for complete blood count (CBC), including hemoglobin, white blood cell (WBC) count, and platelet count. Platelet products were tested for total yield. Each collection was split and supplemented with Platelet Additive Solution (PAS) to assess yield variation with and without PAS. Additional procedure metrics such as total acid citrate dextrose (ACD) used, calcium supplementation, total blood volume processed, collection efficiency, and donor platelet loss were recorded and analysed. Ethical clearance taken.

Outcome: Baseline hemoglobin levels were higher in the double dose platelet group (14.6 g/dL) compared to the single dose platelet group (13.37 g/dL). Post-procedure hemoglobin dropped by 0.89 g/dL in double dose platelet and 1.1 g/dL in single dose platelet donors. Similarly, pre-procedure WBC counts were higher in the double dose platelet group (7.74 ×10 9 /L) than in the single dose platelet group (6.86 ×10 9 /L). Platelet counts were significantly higher in double dose platelet donors both pre (284.4 ×10 9 /L) and post-procedure (181 ×10 9 /L) compared to single dose platelet donors (187 ×10 9 /L pre, 132 ×10 9 /L post), with a larger absolute platelet drop in the double dose platelet group (103 vs. 55 ×10 9 /L). Procedure metrics revealed increased ACD usage (313.57 mL vs. 283.86 mL) and calcium supplementation (1439.29 mg vs. 1300 mg) in the double dose platelet group. The average blood volume processed was also higher for double dose platelet (3223.14 mL vs. 2929 mL). Mean platelet yield was significantly greater in double dose platelet (5.43 ×10¹¹) compared to single dose platelet (2.83 ×10¹¹). PAS subgroup analysis showed mean platelet count with PAS were 1296 (double dose platelet) and 1,105 (single dose platelet) with a final yield of 5.43 X10 e11 and 2.84 X10e11 respectively. Where as platelet count without PAS were 3350.86 (double dose platelet) and 3462 (single dose platelet).

Conclusion: Double-dose plateletpheresis substantially enhances product yield and helps optimize platelet inventory in settings with limited donor availability. Implementing safeguards will support high-yield collections while maintaining long-term donor retention and safety. There was no significant loss of blood as evident by Hb value and platelet. Double dose platelet can be an effective strategy in resource-limited transfusion services when guided by appropriate donor management protocols. Induction of PAS would also help in optimising the usage.

PP 108: Thematic Area: Apheresis (Donor and Therapeutic): Comparative efficacy and safety of standard versus high volume plasma exchange in acute liver failure: A single-center experience

Pragati Naik

AIG Hospital, Hyderabad, Telangana, India

Background: Acute liver failure (ALF) is associated with fatal outcomes without liver transplantation. Two randomized studies reported standard volume (SV) and high volume (HV) plasma exchange (PLEX) as effective therapeutic modalities for patients with ALF. However, no studies have compared the safety and efficacy of SV with HV PLEX, which we aimed to assess.

Methods: This retrospective study included patients with ALF admitted between March 2021 and March 2023 who underwent PLEX. All patients underwent HV PLEX until May 2022, and then thereafter, SV PLEX was performed. The objectives of the study were to compare transplant-free survival (TFS) at 30 days, efficacy in reducing severity scores, biochemical variables, and adverse events between SV (total plasma volume x 1) and HV (total plasma volume x 1.5–2) PLEX.

Results: Forty two ALF patients (median age: 23.5 years; females: 57.1%; MELD Na: 34.67 ± 6.07; SOFA score- 5.24 ± 1.42) underwent PLEX. Of these, 22 patients underwent SV-PLEX, and 20 underwent HV-PLEX. The mean age, sex, etiology distribution, and severity scores were similar between the groups. The median number of PLEX sessions (2) was similar in both groups. On Kaplan–Meier analysis, TFS was 45.5% in SV group and 45% in HV group (P = 0.76). A comparable decline in total bilirubin, PT/INR, ammonia, and MELD Na scores was noted in both groups. The cumulative number of adverse events was similar between the HV group (77.3%) and SV group (54.5%; P = 0.12).

Conclusions: SV PLEX is safe and as effective as HV PLEX in patients with ALF. Further randomized controlled trials with a larger sample size are needed to validate these findings.

PP 109: Thematic Area: Molecular and Transplant Immunology (Includes HLA): “THE SAB GAP”: Unrepresented HLA alleles in single antigen bead assay and antibody-verified epitopes in the Indian population

Ayushi Yadav, Jayagowri Karthikeyan, Mohit Chowdhry

Indraprastha Apollo Hospital, New Delhi, India

Background: Single Antigen Bead (SAB) assays are central to virtual crossmatch (VXM) protocols in solid organ transplantation, allowing for sensitive detection of donor-specific antibodies (DSAs). However, their accuracy depends on the inclusion of relevant HLA alleles within the assay panel. Underrepresented HLA profiles in SAB panels for populations that are unique and diverse —such as those in India may be disproportionately affected by allele omissions, resulting in undetected DSAs and potential graft risk.

Methods: This retrospective study analysed 535 solid organ transplant donor–recipient pairs of Indian origin over a five-year period. Donor HLA alleles were assessed for representation in two commercial SAB panels (Panel A and Panel B). To maintain confidentiality specific names of the SAB panel manufacturers have been withheld. Alleles absent from both or either panel were recorded, and eplet-level immunogenicity was evaluated using HLAMatchmaker and the HLA Epitope Registry to determine antibody verification and exposition status.

Results: At least one unrepresented allele was identified in 192 (35.8%) out of 535 cases. Panel A lacked 42 alleles, and Panel B lacked 67 alleles, with 32 alleles absent from both. HLA Class I alleles—especially HLA-B locus accounted for most omissions. Several commonly occurring alleles, including HLA-DRB1*13:02, HLA-B*35:03, and HLA-A*02:11, were completely unrepresented from both panels, despite expressing antibody-verified eplets such as 47F, 44RT, and 150AAH, known to elicit allo-immune responses. Although Panel B had more unrepresented alleles overall, it did include some regionally prevalent alleles such as HLA-B*40:06, which were entirely absent in Panel A. Over 80% of unrepresented alleles carried at least one high-exposition eplet, and nearly 70% harbored antibody-verified epitopes.

Conclusion: Current SAB panels inadequately represent HLA alleles common in the Indian population, potentially leading to false-negative DSA results and compromised virtual crossmatch accuracy. Importantly, epitope analysis revealed that many unrepresented alleles harbour highly immunogenic, antibody-verified eplets. This underscores the growing relevance of epitope-based matching in transplant immunology. Epitope mismatches have been associated with increased risk of de novo DSA formation, antibody-mediated rejection, and poorer graft outcomes. Notably, selecting SAB panels based solely on number of unrepresented alleles is not advisable, as each panel includes unique, clinically relevant alleles. Until more region-specific panels are available, incorporating epitope-based analysis is essential for accurate risk assessment and improved transplant outcome.

PP 110: Thematic Area: Donors and Donations: Pre-latent and latent iron deficiency in prospective whole blood donors at tertiary care hospital in India

Arunpreet Kaur, Mukesh Shukla, Dnyaneshwar Patale, Trupti Lokhande

All India Institute of Medical Sciences, Raebareli, Uttar Pradesh, India

Background: This single-centre cross-sectional observational study was conducted at AIIMS Raebareli to evaluate the prevalence of pre-latent and latent iron deficiency in prospective blood donors with haemoglobin levels between 10–15 g/dL. A total of 1,550 donor samples were initially enrolled, out of which 1,380 were analyzed after exclusions. Serum ferritin, reticulated haemoglobin (Ret-Hb), and serum iron were used to assess iron status. The study found a significant proportion of donors with normal haemoglobin levels (≥12.5 g/dL) had depleted iron stores, highlighting the inadequacy of haemoglobin alone as a screening criterion. Incorporating iron indices in donor screening protocols may help safeguard donor health and improve transfusion efficacy.

Background: According to the Drugs and Cosmetic Act (1945), the haemoglobin cut-off for blood donation in India is ≥12.5 g/dL, irrespective of gender. This criterion prevents donations from overtly anaemic individuals but fails to exclude those with subclinical iron deficiency (pre-latent or latent stages), potentially worsening their iron status after donation. Iron deficiency, even in the absence of anaemia, can lead to donor fatigue, impaired well-being, and suboptimal quality of red blood cells. This study was designed to assess the prevalence of early iron deficiency among potential donors and evaluate the diagnostic value of iron indices and Ret-Hb compared to conventional haemoglobin and RBC parameters.

Methodology: This was a prospective, cross-sectional diagnostic accuracy study conducted at the Department of Transfusion Medicine, AIIMS Raebareli. 1,550 prospective whole blood donors with haemoglobin between 10–15 g/dL were enrolled after informed consent. Hemoglobin was estimated using HemoCue 301. EDTA and plain blood samples were collected for complete blood counts, Ret-Hb, serum ferritin, iron, TIBC, transferrin saturation (TSAT), and C-reactive protein (CRP) if needed. Donors with Hb <12.5 g/dL were deferred as per guidelines, but included for analysis. Final data analysis included 1,380 samples. Statistical analysis was performed using R software.

Outcome: Out of 1,380 samples, 27.2% had low serum ferritin (<30 μg/dL), 4% had low Ret-Hb (<25 pg/cell), and 17% had low serum iron (<50 μg/dL). Among donors with haemoglobin ≥12.5 g/dL, 26.4% still showed depleted iron stores based on ferritin levels. These associations were statistically significant (p<0.05) for ferritin, Ret-Hb, and serum iron, but not for TIBC or TSAT. This indicates that a substantial proportion of donors classified as eligible based on haemoglobin alone may have subclinical iron deficiency.

Conclusion: Hemoglobin alone is an insufficient parameter to detect iron deficiency in blood donors. A considerable proportion of donors with acceptable haemoglobin levels had depleted iron stores, posing risks to donor health and the quality of blood components. The study strongly recommends revising donor eligibility guidelines by integrating iron indices such as serum ferritin or Ret-Hb into routine screening. These measures would promote donor safety, improve blood component quality, and support long-term sustainability of voluntary blood donation programs.

PP 111: Thematic Area: Donors and Donations: Knowledge, attitude, and practice study on blood donation in Banaras Hindu University and other college students

Ashutosh Kumar Singh

Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India

Background: Blood donation is an essential activity that preserves millions of lives annually. In spite of heightened awareness initiatives, the frequency of voluntary blood donation continues to be low in numerous developing nations. This research seeks to evaluate the knowledge, attitudes, and practices concerning blood donation among university students. A cross-sectional survey was carried out involving 2000 students from different fields of study, utilizing a structured questionnaire. The findings indicated that although most participants possessed sufficient knowledge and a favorable attitude, only a limited number had actually engaged in blood donation. The study suggests the implementation of targeted awareness programs and motivational campaigns to enhance participation in blood donation efforts.

Keywords: Blood donation, students, voluntary

PP 112: Thematic Area: Blood Components/Products: Transfusion insights: A deep dive into the blood and it’s components utilization in a tertiary care center

Prashant Kumar, Bharti, Ravi Rani Mishra, Vatsala Misra

Motilal Nehru Medical College, Prayagraj, Uttar Pradesh, India

Background: Transfusion of blood and its components plays a pivotal role in the management of various medical and surgical conditions. However, irrational or excessive use of blood products can lead to increased costs, unnecessary exposure to transfusion-related risks, and depletion of limited resources. In high-volume tertiary care hospitals, evaluation of transfusion practices becomes essential to ensure optimal and evidence-based use. A data-driven analysis of transfusion practices helps in evaluating usage patterns, identifying areas of overuse or underuse and improving transfusion protocols.

Aim: To evaluate the utilization pattern of blood and its components in a tertiary care hospital, identify trends across various clinical departments and assess the appropriateness of transfusion practices.

Materials and Methods: A retrospective observational study was conducted in the Department of Transfusion Medicine, MLN Medical College over a period of 5 months. Data were collected from transfusion request forms, issue registers and electronic records, including total units of blood and its components issued, type of components (PRBC, FFP, Platelets,) and their department wise clinical indications. Parameters such as crossmatch to transfusion ratio (C:T ratio), transfusion probability (%T) and transfusion index (TI) were calculated to evaluate efficiency and appropriateness of blood use.

Results: During the study period of 5 months, a total of 6478 transfusion requisitions were received and 8265 blood components were issued. The total cross-matched PRBC units were 4518 and total PRBCs transfused were 2873. C/T ratio was found to be 1.57. Transfusion Probability and TI were calculated as 74 and 0.94.

Conclusion: The study highlights the importance of continuous monitoring of blood and component utilization to optimize and improve transfusion practices. the overall utilization was within acceptable standards, certain departments exhibited tendencies toward over-ordering. Implementation of maximum surgical blood ordering schedules (MSBOS) and clinician education can enhance judicious use of blood products, reduce unnecessary crossmatching and improve overall transfusion practices in tertiary care settings.

PP 113: Thematic Area: Immunohematology: An interesting case of blood group discrepancy in voluntary blood donor from Rajkot, Gujarat

Sudha Chauhan, Nishith Vachhani, Mansi Odhwani, Sanjiv Nandani

Life Blood Centre, Rajkot, Gujarat, India

Background: The AB positive blood group typically expresses both A and B antigens along with Rh (D), making it serologically straightforward. However, weak A or B within AB individuals can lead to blood group discrepancies, complicating transfusion practices and donor classification. This abstract highlights a case involving a “weak B antigen” in an AB positive donor, resulting in conflicting forward and reverse grouping results. The B antigen is created by the addition of Galactose by B transferase enzyme, while the A antigen involves N-acetylgalactosamine done by A transferase enzyme. In AB individuals, both enzymes are active, producing both antigens simultaneously.

Case Report: A 26-year-old male donor donated blood at the blood centre in Rajkot, Gujarat. There was no significant history. His haemoglobin was more than 12.5 gm% and his weight was 65 kg. He was accepted for donation based on the screening criteria as per NBTC guidelines. 450 ml of whole blood along with pilot tube samples were collected. Blood grouping was performed using the SPRCA and CTT method, revealing a discrepancy between cell and serum grouping. The donor’s red cells gave positive reaction with Anti-A & Anti-AB, Anti A1, Anti-H, Anti D1, Anti-D2, whereas serum grouping, A cell, B Cell & O cell were negative at room temperature. Serological testing revealed no agglutination with anti-B but strong reactions with anti-A and anti-AB, suggesting a discrepancy. Weak reactions are usually the discrepant reactions. Antibody problems are much more common than antigen problems. There was no h/o any illness or immunity issue of the donor. So, serum IgM and IgG were done, which turned out to be normal. It was established that there was no issue in detecting antibody. Testing at room temperature, 37°C and 4°C, considering it as an antigen problem, was done. Reaction patterns were same at room temperature and at 37°C, but at 4°C Anti-B gave Wk+ reaction. The blood grouping pattern turned out to be a Type II blood group discrepancy, suggesting a weaker “B antigen”. For the confirmation, Cold Adsorption and Heat Elution were carried out which confirmed the presence of B antigen. These findings were consistent with the reactivity pattern of the AB Positive blood group, having weak expression of B antigen.

Conclusion: Cell & serum groping must be done meticulously. Blood group discrepancy should always be resolved with a definite protocol in place, in order to avoid potentially dangerous haemolytic transfusion reactions.

PP 114: Thematic Area: Immunohematology: To evaluate prevalence and clinical significance of DAT positivity in a stand-alone blood centre

Manali Kamani, Nishith Vachhani, Mansi Odhwani, Sanjiv Nandani

Life Blood Centre, Rajkot, Gujarat, India

Background: The Direct Antiglobulin Test (DAT), also known as the Direct Coombs Test, is a critical laboratory assay used to detect in vivo sensitization of red blood cells (RBCs) by IgG antibodies and/or complement component C3d. Dual positivity for IgG and C3d suggests a mixed-type immune response, often associated with more severe haemolysis. DAT positivity is frequently associated with autoimmune haemolytic anaemia (AIHA) and other immune-mediated haemolytic conditions. This study aimed to investigate the clinical significance of DAT positivity by comparing the characteristics of patients with IgG, C3d, and IgG/C3d-positive results.

Methods: A retrospective study was conducted on 266 patients with polyspecific DAT-positive results, identified at stand-alone blood centre in Rajkot, Gujarat, between August 2022 to June 2025. Polyspecific DAT-positive samples were further analyzed using monospecific anti-human globulin (AHG) reagents to determine the presence of IgG, C3d, or both on the red blood cells. The patients with positive polyspecific DAT were categorized into different clinical conditions. The presence or absence of in vivo haemolysis was evaluated in all clinical categories and also for each grade of positivity with polyspecific and monospecific antiglobulin gel card method. DAT positivity was graded (1+ to 4+) in each patient.

Results: Total 959 samples 477 (49.7%) male & 482 (50.3%) female were tested, 266 (27.74%) patients were positive with polyspecific DAT, 168 (63.16%) were IgG positive, 77 (28.95%) patients were positive with IgG+C3d and 21(7.89%) patients were only C3d complement positive. Total 177 (66%) had haemolysis whereas 89 (34%) hadn’t. All 21 patients who showed only C3d positive, didn’t show hemolysis. It was observed that with increasing grades of DAT positivity, incidence of in vivo haemolysis was seen. So, it is important to clinically and serologically correlate positive DAT results. The study population exhibited a diverse range of clinical diagnosis. Autoimmune Haemolytic anaemia was the most frequent diagnosis followed by thalassemia major, sickle cell anaemia, infective pathology, pancytopenia and thrombocytopenia.

Conclusion: “IgG” positivity was the most common finding in DAT-positive patients, highlighting the prevalence of warm AIHA. The presence of C3d, alone or with IgG, suggests the involvement of complement activation and may indicate a different underlying pathology. This study emphasizes the use of monospecific AHG reagents to differentiate between IgG, C3d, and IgG/C3d positivity. It is crucial for accurate diagnosis, appropriate management, and informed clinical decision-making.

PP 115: Thematic Area: Clinical Transfusions: RFID in platelets concentrates – Rising dawn in enhancing blood safety: A tertiary healthcare centre experience

Uday Kumar Thakur, Mohit Chowdhry, Himani Aneja

Indraprastha Apollo Hospital, New Delhi, India

Background: Efforts to improve the safety of blood banking through enhanced quality assurance processes has been emphasized by National Blood Transfusion Council (NBTC), advocating for stringent quality control strategies. RFID (Radio Frequency Identification) technology offers a shield of safety in this regard. Platelet concentrate management within blood banks enables correct labelling, along with real-time tracking of units. Better inventory management and reduction in wastage of units along with the unique benefit of minimizing errors associated with manual processes makes RFID the next blood safety tool in demand. In this study, we describe our center’s experience with respect to newly instated platelet tagging with RFID technology.

Methods: The data for platelet units tagged and issued during the study period (April 2025-July 2025) was prospectively acquired and analysed. The RFID System (Biolog-ID) employs a radiofrequency enabled RFID tag, integrated with our hospital information system, along with software for tracing the units. RFID tag in the form of a sticker is affixed on the platelet unit’s label. The number of clerical errors in platelet units was noted during the study period.

Results: Out of 7471 whole blood units collected during the study period, 7356 platelets were prepared. Of these 912 units were RFID tagged. The units tagged were subsequently scanned bedside before transfusing. During the study period, 770 (84.4%) were scanned. We observed that there were no clerical errors involving the platelet transfusion throughout the hospital using the RFID tagged units. In addition, for 5 platelet units, near miss events due to manual labelling error were noted (0.13%).

Conclusion: Our findings demonstrate that the initiation of platelet RFID tagging in our Blood Centre has effectively decimated the errors relating to manual labelling. This enhanced safety tool, if wisely implemented in a phasic manner with simultaneous induction and training of staff can significantly increase the confidence in blood safety for all patients. The authors re-iterate the utility of RFID in substantially smooth working of blood center inventory in terms of traceability, reduced wastage, and efficient supply chain management.

PP 116: Thematic Area: Immunohematology: Anti G antibody formation following transfusion in a male patient: A case report

Ajay Barala, Dibyajyoti Sahoo, B. Abhishekh, Aparna Krishna, Rajendra G. Kulakarni, K. M. Haripriya

Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

Background: The G antigen, of the Rh blood group system, is present on all red blood cells expressing either the D or C antigen but absent when both are lacking. Anti-G can serologically mimic a combination of anti-D and anti-C, potentially leading to misinterpretation. Anti-G formation is well-documented following pregnancy but is rarely reported following transfusion with Rh-positive red blood cells. We report a rare case of a male patient who developed anti-D and anti-G antibodies after receiving Rh-incompatible transfusion during emergency trauma care.

Case Report: A male patient in his early thirties was admitted to Emergency Department with right tibia fracture following a road traffic accident. A massive transfusion protocol was activated due to significant blood loss. In the pre transfusion workup, the patient was found to be O negative blood group. First 2 units of O negative PRBCs were cross matched and transfused. Thereafter, due to ongoing demand and minimal O negative inventory in the blood centre, O positive units were crossmatched and issued to save the life of the patient. No adverse reactions were reported during or after transfusion. Patient’s clinical condition improved and received further treatment in Orthopaedic department for multiple fractures. As per our departmental protocol, the antibody screening was done on day 3 and 7 of transfusion and was found to be negative. Patient was discharged on day 15 and was advised to follow up. Patient was in continuous follow-up under Orthopaedics Department and was re-admitted for corrective surgery for malunion of tibia after 6 months. The blood sample submitted along with the blood requistion form for pre transfusion testing typed ‘O’ negative and antibody screening was positive. The antibody screening and identification panel were suggestive of anti-D+C±G antibody. Further differential adsorption and elution were performed for G antibody identification. After series of adsorption and elution, the antibody detected was anti-D and anti G. The presence of anti-C was ruled out. Two fully compatible ‘O’ negative Packed Red Blood Cells, negative for ‘C’ antigen were issued and transfused without any adverse reactions. Patient improved clinically and was discharged with advice to follow up.

Conclusion: To the best of our knowledge, this is the first case of formation of anti G antibody in a male patient following transfusion. This case highlights that anti-G antibody can develop in Rh(D)-negative individuals following transfusion with Rh(D)-positive red blood cells, even in the absence of pregnancy. It underscores the importance of considering anti-G in serological evaluations, especially when anti-D and anti-C are identified together. Further research is needed to assess the clinical significance of anti-G antibodies in blood transfusions and their role in future antibody formation.

PP 117: Thematic Area: Apheresis (Donor and Therapeutic): Clinical utility of low-volume plasma exchange in acute liver failure: A tertiary centre experience

Isha Polavarapu, G. Vivek, P. Naveen, K. Somasekhar Rao

Yashoda Hospitals, Hyderabad, Telangana, India

Background: Acute liver failure (ALF) is a critical condition characterized by the rapid deterioration of liver function, often leading to multi-organ failure and high mortality rates. Therapeutic plasma exchange (TPE) has emerged as a supportive measure that facilitates the removal of inflammatory mediators and toxins from the circulation. We assessed the efficacy and safety of low-volume plasma exchange (LV-PLEX) as a bridging therapy in ALF patients at a tertiary care hospital.

Methodology: We conducted a retrospective observational study over one year (July 2024 to July 2025) involving patients diagnosed with ALF who received LV-PLEX on the Spectra Optia Apheresis System, utilizing a continuous flow centrifugation method. The procedure involved exchanging 0.7 to 1.4 times the total plasma volume per session. The decision to initiate PLEX was made collaboratively by the hepatology and transfusion medicine teams, following the 2023 guidelines of the American Society for Apheresis (ASFA). Data pertaining to patient demographics, liver disease aetiology, number of PLEX sessions, adverse effects, and clinical outcomes were collected. Biochemical parameters, including bilirubin, liver enzymes, INR, creatinine, and sodium levels, were analyzed pre- and post-procedure. The decision to discontinue PLEX was based on achieving clinical stabilization, reflected by improvements in coagulation parameters, biochemical indices, and neurological status.

Results: A total of 28 patients underwent LV-PLEX during the study period, with a median age of 41 years. Decompensated chronic liver disease (DCLD) was the most common clinical category (50%, n=14), followed by ACLF (21.4%, n=6) and ALF (14%, n=4). Alcohol-related liver injury was the predominant aetiology (53.5%), while other causes included viral hepatitis, autoimmune hepatitis, drug-induced liver injury, and sickle cell hepatopathy. Across all patients, 63 PLEX sessions were performed. The median number of sessions was 3 (range 2–4), with an average processed plasma volume of 3588 ± 1010.9 ml per session. Replacement fluids comprised fresh frozen plasma (mean 12.6 ± 3 units) and normal saline 0.9% (1.5 ± 0.5 litres). Statistically significant reductions were observed in serum total bilirubin (22.23 ± 8.71 mg/dL to 16.46 ± 7.11 mg/dL, p=0.000), prothrombin time (PT) (34.40 ± 36.29 to 24.30 ± 5.54 seconds, p=0.029), INR (2.50 ± 1.40 to 1.86 ± 0.53, p=0.000), creatinine (1.03 ± 0.72 to 0.89 ± 0.55 mg/dL, p=0.000) and SGOT (242.2 ± 451 451 U/L to 108.61 ± 88.88, p=0.008). MELD (Model for End-Stage Liver Disease) score reduction from pre- to post-procedure was significant (31.12 ± 6.59 to 24.2 ± 4.77, p=0.000). The estimated 90-day mortality risk, as predicted by the MELD score, decreased significantly from 43.5 ± 18.24 to 24.3 ± 13.01 (p = 0.000). Of the 28 patients, 89.28% (25/28) exhibited marked clinical improvement and were discharged in a haemodynamically stable condition; three patients, however, succumbed to the illness.

Conclusion: Low-volume plasma exchange is a safe and effective adjunctive therapy in the management of severe liver injury leading to significant improvement in both clinical status and biochemical parameters.

PP 118: Thematic Area: Immunohematology: “Tracing the unseen Threats” – An alloimmunisation profile of hospitalised patients and blood donors

P. A. Prethika, Sanooja Pinki, Maya Jithin

KIMSHEALTH, Thiruvananthapuram, Kerala, India

Background: Red cell alloimmunization presents a critical concern in Transfusion Medicine, leading to potential hemolytic transfusion reactions in recipients and risks to the fetus, such as hemolytic disease of the fetus and newborn (HDFN). Understanding its prevalence and specificities is crucial for patient safety.

Aim: This study aimed to determine the prevalence and characterize the specificities of red cell alloantibodies among hospitalized patients and the blood donor population at a quaternary care center.

Methodology: This retrospective observational study was conducted at KIMSHEALTH, Thiruvananthapuram, from June 2023 to June 2025. The study population included hospitalized patients (undergoing pre-transfusion testing, pregnant mothers, and surgical patients) and all blood donors from the study period. Testing involved the Indirect Antiglobulin Test, with antibody screening using gel card technology (3-cell panel for patients, monocell for donors) and 11-cell antibody identification (Quidel Ortho). Data were collected from hospital software and blood center registers and analyzed using Microsoft Excel.

Results: A total of 32,622 antibody screenings were performed on hospitalized patients, with 95 (0.29%) positive screens, of which 68 (0.21% of total screened; 71.6% of positives) had identified alloantibodies. Among 16,109 donor screenings, 18 (0.11%) were positive, and 12 (0.07% of total screened; 66.7% of positives) had identified alloantibodies. In hospitalized patients, the most frequent single specificities were anti-D (19.1%), anti-Leb (11.7%), and anti-M (11.7%); multiple antibodies and antibodies of unknown specificities (AUS) were also identified. Among blood donors, anti-Leb (33.3%) and anti-M (16.6%) were the most commonly identified specificities, with 3 AUS cases also found.

Conclusion: Our study identified a low but statistically significant prevalence of red cell alloantibodies within both the hospitalized patient population (0.21%) and among blood donors (0.07%). Specifically, anti-D was the predominant alloantibody in patients, whereas anti-Leb was most frequently encountered in donors. These results underscore the critical necessity of robust and continuous antibody screening and identification protocols. Such measures are paramount for mitigating the challenges Blood Centres may encounter in sourcing compatible blood unit; thereby ensuring transfusion safety and optimizing patient management.

PP 119: Thematic Area: Immunohematology: Dual antibodies (anti-Inb and anti-D) in pregnancy: Challenges in diagnosis and transfusion management

A. Naveen Reddy, Dibyajyoti Sahoo, B. Abhishekh, Aparna Krishna

Jawaharlal Institute for Post Graduate Medical Education and Research, Puducherry, India

Background: In prenatal care, detecting maternal antibodies is essential for the mother and fetal safety. Some maternal antibodies target fetal red cells, causing hemolytic disease of fetus and newborn (HDFN). High-frequency red cell antibodies, though rare, pose unique challenges due to their reactivity against antigens found in over 99% of the population. Anti-Indian B (Inb) is a rare alloantibody directed against a high-frequency antigen in the Indian blood group system. Here we present a rare case of an antenatal woman who had anti-Inb along with clinically significant anti-D antibodies, along with the complications involved in creating a transfusion plan for both the mother and the infant.

Case Presentation: A 24-year-old woman of second-degree consanguineous marriage, gravida 3 para 2, presented at 19+5 weeks gestation with a history of Rh isoimmunisation and hypothyroidism. Initial immunohematological testing showed blood group as A1 RhD negative with 3+ grade Indirect Antiglobulin Test (IAT) and pan reactivity in 3- and 11-cell antibody panels by column agglutination technology (CAT). The thermal reactivity of the antibody was tested with panel cells, and both IgM and IgG antibodies were present. Crossmatches with multiple A1-negative and O-negative PRBCs were incompatible. Crossmatches with Bombay and cord red cells were positive, ruling out anti-H and anti-I. Family member crossmatches revealed compatibility only with her brother. Further testing at the reference immunohematology laboratory confirmed the presence of anti-Inb and anti-D antibodies. Genotyping and enzyme studies supported the diagnosis. The patient was monitored closely with MCA-PSV Doppler ultrasonography. Antibody titre levels were checked for both Anti-D and Anti-Inb, using the patient’s father’s red cells(O RhD positive with Inb negative) and O RhD negative cells, respectively. Anti-D titre was 1:16 and Anti-Inb titre was 1:128. At 34 weeks of gestation, MCA-PSV was 1.54 MoM with Anti-D titre increasing to 1:32, and a decision of termination of pregnancy was taken. Autologous blood was collected from the mother before delivery, and directed blood donation was done by the patient’s brother (O RhD negative and Inb negative) and delivered a 2.58 Kg male baby by elective cesarean section at 34+3 weeks of gestation. Autologous blood was transfused postoperatively. Cord Blood testing was done. Cord blood group was O RhD positive with DAT positive (4+) and showed the presence of only Anti-D in the plasma. Neonatal jaundice was present, managed by intensive phototherapy, not requiring exchange transfusion, and managed with simple transfusion with the patient’s brother’s PRBC for anemia correction.

Conclusion: This is the first case where another clinically significant antibody (Anti-D) is observed along with Anti-Inb, a high-frequency antibody. Monitoring of MCA-PSV played an essential role in clinical decision-making till the antibody identification was done. In this case, we could do individual titrations for Anti-Inb and Anti-D. Anti-Inb, being IgG in nature, is expected to cross the placenta but is undetected in cord blood. This case highlights the importance of advanced immunohematology techniques and close clinical-transfusion collaboration in managing pregnancies complicated by high-frequency antibodies. Early detection and strategic planning ensure optimal maternal and fetal outcomes.

PP 120: Thematic Area: Clinical Transfusions: A prospective study of prevalence, clinical presentation, management strategies and neonatal outcomes of Rh isoimmunisation in a feto-maternal centre in northern India

Mohd Anas Sheikh

AFTC, New Delhi, India

Background and Aims: Rh isoimmunisation remains a significant cause of Haemolytic Disease of Foetus And Newborn (HDFN), particularly in developing countries with limited access to antenatal anti-D prophylaxis. Despite advancements in preventive strategies, cases continue to contribute to significant intrauterine and postnatal morbidity and mortality. This study aimed to evaluate the prevalence, clinical presentation, management strategies and neonatal outcomes of Rh isoimmunisation in a Tertiary care centre in Northern India .

Methodology: This prospective observational study was conducted over a period of 12 months in the Department of Transfusion Medicine and feto-maternal centre at a tertiary care hospital from June 2024 to May 2025. Pregnant Rh-negative women with Rh alloantibodies were enrolled and followed antenatally with serial antibody titers and middle cerebral artery peak systolic velocity (MCA-PSV) Doppler studies to monitor fetal anaemia. IUTs were performed when MCA-PSV was >1.5 MoM or fetal hydrops was detected. Postnatally, neonates were evaluated for Haematocrit, total Bilirubin levels and direct Coombs test, with phototherapy or exchange transfusion initiated based on standard guidelines and institutional SOPs. Data on type of antibody, maternal antibody titers, number of IUTs, mode of delivery, gestational age at delivery and neonatal outcomes including need for exchange transfusion, duration of NICU stay, and survival were recorded and analysed.

Results: Out of 112 Rh-negative antenatal women screened, 27 (24.1%) developed significant alloimmunisation with Rh antibodies. The mean maternal age was 24.8 ± 4.2 years and the mean antibody titre at detection was 1:32. The most commonly detected Rh antibody was Anti-D (n=22), anti-D+anti-C (n=3), anti-c (n=1) and anti-E (n=1). A total of 13 fetuses (48.1%) required serial MCA-PSV monitoring and 6 (22.2 %) underwent IUTs, with an average of 1.6 ± 0.6 transfusions per fetus. Higher gravida pregnancies (Gravida 3 or more) were associated with higher mean titres. The mean gestational age at delivery was 33.8 ± 2.1 weeks and 14.8% of neonates required postnatal exchange transfusion due to severe hyperbilirubinemia. The direct Coombs test was positive in 74.07% of neonates, and the mean peak bilirubin level was 15.6 ± 4.3 mg/dL. The overall survival rate was 92.5%, with one neonatal death attributed to complications of hydrops fetalis and prematurity. The use of MCA-PSV Doppler studies and thorough postnatal monitoring reduced the need for unnecessary IUTs and allowed timely intervention thus improving intrauterine and postnatal outcomes.

Conclusion: Rh isoimmunisation continues to pose a public health challenge and be a clinically relevant challenge despite prophylactic measures, necessitating diligent antenatal monitoring and early intervention to prevent adverse fetal outcomes. Serial MCA-PSV Doppler surveillance remains an effective non-invasive method for early detection of fetal anaemia and guides the timing of IUTs, reducing morbidity associated with HDFN. Postnatal exchange transfusion remains critical in managing severe hyperbilirubinemia, with a high survival rate when managed promptly. Strengthening anti-D prophylaxis coverage, early detection by judicious and timely screening of Rh negative antenatal cases and establishing algorithms for antenatal and postnatal management are essential for reducing the burden of Rh isoimmunisation in resource-limited settings.

PP 121: Thematic Area: Donors and Donations: Assessment of recall efficiency using a single-mode notification strategy among sero-reactive blood donors at a tertiary care medical institute in western Uttar Pradesh

Prerna Kaushik, Aakriti Baijal, Milan Jaiswal

Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India

Background: Transfusion-transmissible infection (TTI) screening is a cornerstone of safe blood transfusion practice. As per national policy, donors reactive to any TTI markers must be notified and recalled for post-donation counselling and referred to assigned appropriate centres for confirmatory testing and management. While previous studies have explored dual-mode notification and repeated follow up protocols, our study uniquely focuses on the efficacy of a single-mode telephonic notification protocol, analyzing the associated factors influencing donor response. The aim of this study is to evaluate the impact of single mode notification protocol and its impact on TTI reactive donor response rates.

Materials and Methods: This was a retrospective, single centre based observational study conducted from June 1, 2023 to July 31, 2024, at a tertiary care institute in the Rohilkhand region. Blood donors who were found reactive for any TTI—namely HIV, HBsAg, HCV, syphilis, or malaria—were notified through three consecutive telephonic attempts. Donors who responded were counselled in-person and referred for further confirmatory testing and management. Key variables such as age, gender, donor type (voluntary vs replacement), and residence (urban vs rural), were analyzed to identify trends influencing donor compliance.

Results: Out of the total 285 sero-reactive donors, only 30 (10.52%) reported to the blood centre, which is considerably lower than the response rates documented in various national studies. Telephonic notification yielded a response from 121 donors (42.45%), among whom 119 individuals (98.34%) consented to visit the blood centre for face-to-face counselling. However, only 30 donors (25.21% of those who agreed) ultimately reported for counselling. When analyzed by donor type, replacement donors demonstrated a higher reporting rate (11.3%) compared to voluntary donors, who showed no response. Donors from rural areas had a slightly better turnout (33.33%) than their urban counterparts (25%). Gender-based analysis indicated a minor difference, with 25.21% of male donors and 25% of female donors reporting for counselling. Age-wise, donors aged ≤40 years showed a higher response rate (11.49%) than those above 40 years. The overall response among reactive donors was 11.32% for replacement donors. Rural donors responded at a rate of 11.2%, marginally surpassing the 10.5% response from urban donors. Female donors showed a notably higher response rate (20%) compared to male donors (10.35%). Notably, all responses occurred after the first call, emphasizing the effectiveness of early contact.

Conclusions: The study indicates that a single-mode telephonic notification results in a suboptimal donor return rate. Factors like age, donor type, and locality notably impact recall success. Common reasons for non-response included unreachable numbers, call restrictions, and switched-off phones. The findings emphasize the need for policy revision, incorporating written or digital communication and improved pre-donation counselling to boost donor awareness and compliance.

PP 122: Thematic Area: Clinical Transfusions: Therapeutic plasma exchange as an adjuvant therapy in liver disease-associated haemophagocytic lymphohistocytosis

Ashish Maheshwari, Meenu Bajpai, Apoorva Maheshwari, Pankaj Jain, Sweta Nayak, Trupti Lokhende

Institute of Liver and Biliary Sciences, New Delhi, India

Background: Hemophagocytic lymphohistiocytosis (HLH) is an uncommon disorder characterized by immune dysregulation, with an incidence of around one in a million population. Mortality rate in patients with HLH approaches around 50%. In such patients, disease activity can be suppressed through cytokine removal by therapeutic plasma exchange (TPE). HLH is a Category III indication for TPE as per American Society for Apheresis 2023 recommendation. To the best of our knowledge, this is the first case series of 15 patients with Liver disease-associated HLH. This study aimed to evaluate the effects of TPE in HLH patients.

Methods: This is a retrospective study conducted at a tertiary care Liver Centre in northern India from October 2016 to November 2023. The diagnosis of HLH was based on the HLH-2004 criteria. Data were collected from TPE record files. It included patient’s age, gender, primary disease, clinical and laboratory data, TPE procedure details and patient outcomes. TPE was performed on Spectra Optia using FFP as replacement fluid to exchange 1 to 2 plasma volumes per session. Primary outcome measures were changes in serum ferritin levels, cytopenia and other laboratory parameters along with symptomatic improvement.

Results: Fifty TPE procedures were done on 15 patients, and a mean 1.59 plasma volumes was exchanged per procedure. Median age was 14 years (9, 28), and 12/15 (80%) were males. All patients had fever, Hyperferritinemia, cytopenia and hepatosplenomegaly. Bone marrow aspiration was done in 13 patients and showed haemophagocytsis in 10 patients. Mean serum Ferritin was 26753.39 μg/L. Serum Fibrinogen was below ≤150 mg/dL in 8 out of 13 (60.2%), and Serum Triglyceride was above ≥177 mg/dL in 8 out of 11 (72.7%) patients. Serum Ferritin, Serum Bilirubin, TLC and platelets were decreased significantly (p < 0.05) with TPE. One plasma volume exchanged led to a 1.4 log reduction in Ferritin levels, which is one of the key markers of mortality in HLH. Complications were observed during six procedures; three patients developed hypotension, two developed rashes, and one had catheter blockage, all were managed uneventfully. A 28-day survival was seen in 86.7% (13/15) of the patients who underwent TPE as an adjuvant therapy.

Conclusions: TPE demonstrates promising efficacy as an adjuvant therapy in HLH, significantly reducing hyperferritinemia and improving symptoms. These findings suggest TPE can serve as a valuable bridge to definitive therapy for HLH patients. Further corroboration through randomized controlled trials is warranted.

PP 123: Thematic Area: Clinical Transfusions: Optimizing transfusion strategies in liver transplantation: A retrospective review of ROTEM-guided haemostatic management

Annuth Chandran, S. Subash, K. Premkumar, S. Sudha, S. Sangeetha

Madras Medical College, Chennai, Tamil Nadu, India

Background: Haemostatic balance in patients with liver disease is a delicate interplay between diminished procoagulant and anticoagulant forces. Traditional coagulation tests such as prothrombin time (PT), international normalized ratio (INR), and platelet count often fall short in predicting bleeding risk in cirrhotic patients, historically misclassified as hypo coagulable. In contrast, rotational thermoelectrometry (ROTEM), a point-of-care viscoelastic assay, offers a comprehensive, real-time evaluation of the coagulation cascade—including thrombin generation, clot formation, stabilization, and fibrinolysis. In liver transplantation, ROTEM-guided transfusion protocols enable personalized haemostatic interventions, minimizing unnecessary blood product use and enhancing patient outcomes.

Aim: To assess the efficacy of ROTEM-based transfusion guidance in liver transplantation compared to conventional coagulation parameters (PT/INR and platelet count) in optimizing blood product utilization.

Methods: A retrospective observational study was conducted from February 2023 to July 2025 at a tertiary care center. Eighteen patients who underwent liver transplantation were included. Intraoperative ROTEM analysis was performed alongside conventional coagulation testing at key surgical phases: baseline, anhepatic phase, reperfusion (neohepatic) phase, and prior to ICU transfer. Transfusion decisions were based on specific ROTEM thresholds: CT-EXTEM > 80 seconds or INR > 1.5: Indicative of clotting factor deficiency; Fresh Frozen Plasma (FFP) administered. A5-EXTEM < 25 mm with A5-FIBTEM > 8 mm or Platelet count < 50,000/µL: Indicative of platelet dysfunction; Single Donor Platelets (SDP) transfused. The quantity and types of blood products administered were analyzed.

Results: ROTEM-based transfusion protocols were successfully applied in all cases. Median intraoperative transfusion requirements were: Packed RBCs: 3 units FFP: 3 units Cryoprecipitate: 2 units SDP: 1 unit Compared to standard transfusion triggers, ROTEM-guided management led to a notable reduction in FFP and platelet usage without any increase in perioperative bleeding or complications. ROTEM parameters enabled rapid, phase-specific correction of coagulation deficits, improving transfusion precision and timeliness.

Conclusion: ROTEM-guided haemostatic monitoring during liver transplantation offers a dynamic and individualized approach to transfusion therapy. This study underscores the potential of ROTEM to refine blood product utilization, enhance patient safety, and support cost-effective transfusion practices. While further prospective studies with control arms are warranted, our findings highlight the clinical value of integrating viscoelastic testing into perioperative bleeding management protocols in liver transplant recipients.

PP 124: Thematic Area: Immunohematology: Antibody screening and identification in donors and general patients at a tertiary care hospital in Bihar, India

Abhiniti Srivastava

Jay Prabha Medanta Superspecialty Hospital, Patna, Bihar, India

Background: Pre-transfusion testing is critical for ensuring safe blood transfusions, with antibody screening being a cornerstone to detect clinically significant irregular red cell antibodies. These antibodies, if undetected, can lead to severe adverse transfusion reactions, including hemolytic transfusion reactions (HTRs), and can complicate subsequent transfusions. In resource-limited settings like Bihar, India, where the burden of transfusion-dependent conditions is significant, comprehensive antibody screening and identification are paramount but often face infrastructural and financial constraints. This abstract outlines a study aimed at assessing the prevalence and specificities of irregular red cell antibodies in both blood donors and general patient populations at a tertiary care hospital in Bihar.

Background: Irregular red cell antibodies are typically acquired through prior exposure to foreign red cell antigens via transfusion, pregnancy, or transplantation. While routine ABO and Rh(D) typing are standard, the detection of other clinically significant antibodies (e.g., anti-Kell, anti-Duffy, anti-Kidd, anti-MNS) is crucial, as they can cause delayed or immediate HTRs. Data on the prevalence and specific types of these antibodies in the Indian population, particularly in regional settings like Bihar, is scarce. Understanding the local antibody profile is essential for developing effective transfusion strategies, improving patient safety, and managing rare blood group requirements. This study addresses this knowledge gap by providing a localized perspective on antibody prevalence.

Methodology: This study employed a cross-sectional design, retrospectively analyzing blood samples from voluntary blood donors and general patients referred for pre-transfusion testing or with a history of transfusion reactions/multiple transfusions, over a specified period (e.g., January 2023 to June 2025). Antibody screening was performed using a three-cell panel (e.g., commercially available O-cells) by indirect antiglobulin test (IAT) utilizing gel technology (Coombs card method) to enhance sensitivity. Samples yielding positive antibody screens underwent further antibody identification using an 11-cell identification panel. Demographic data, transfusion history, and pregnancy history (for female patients) were collected where available. All procedures adhered to standard operating protocols and national blood bank guidelines.

Outcome: The study analyzed a total of 23,960 donor samples and 45439 patient samples. Irregular red cell antibodies were detected in 0.02% of donors and 0.00002% of patients. Among the donor population, the most frequently identified antibodies were Anti-Lea while in the patient group, the predominant antibodies were anti-D. A significant proportion of antibodies remained unidentified due to low titer or complex antibody mixtures, particularly in multiply transfused patients. The prevalence of clinically significant antibodies was notably higher in patients with a history of transfusion or pregnancy compared to first-time donors.

Conclusion: This study underscores the importance of routine antibody screening and identification in both donor and patient populations at tertiary care hospitals in Bihar, India. The observed prevalence of irregular antibodies, particularly clinically significant ones in patients, necessitates mandatory screening to prevent adverse transfusion reactions and ensure optimal patient outcomes. The findings provide valuable regional data that can inform blood bank policies, guide inventory management for rare blood types, and emphasize the need for advanced immune-hematological services.

PP 125: Thematic Area: Molecular and Transplant Immunology (Includes HLA): Genotype–phenotype conflict in a H-deficient patient: A rare case of non-secretor genotype with Lewis B antigen

R. Noufal Hussain, Pooja Khirsagar 1 , Swati Kulkarni 1 , Debasish Mishra, Satya Prakash, Somnath Mukherjee

All India Institute of Medical Sciences, Bhubaneswar, Odisha, 1 ICMR-National Institute of Immunohaematology, Mumbai, Maharashtra, India

Background: The H-deficient phenotype is an uncommon red cell phenotype caused by mutations in fucosyltransferase genes that regulate H antigen synthesis. These individuals often display weak or absent H antigen expression on red cells despite having functional ABO genes. While most para-Bombay individuals are secretors, genotypically non-secretor para-Bombay cases are extremely rare. In this case, we report an unusual para-Bombay phenotype in a patient who was genotypically a non-secretor.

Case Report: A 27-year-old female diagnosed with severe Mitral Stenosis, Tricuspid Regurgitation, Atrial Fibrillation and Congestive Cardiac Failure was scheduled for Double Valve Replacement with Tricuspid Valve Repair. Preoperative blood grouping revealed a type IV discrepancy: forward grouping showed O RhD Positive, while reverse grouping demonstrated 4+ reactions with A, B, and O cells. Anti-H lectin testing was negative by both gel and tube techniques across various temperatures. Antibody screening revealed pan-reactivity with negative Autocontrol and Direct Antiglobulin Test, suggesting the presence of anti-H or anti-IH antibodies. Lewis phenotyping showed a Le(a−b+) phenotype. Anti-H titration revealed both IgM and IgG components, with titres of 8. As the salivary inhibition test could not be performed due to the patient’s clinical instability, molecular genotyping was undertaken at the NIIH, Mumbai, which revealed heterozygous mutations in the FUT1 gene and a homozygous non-secretor status in the FUT2 gene, despite the patient exhibiting a Le(b+) phenotype. Surgery was deferred due to the patient’s complex medical condition, and she was discharged in a hemodynamically stable state for further evaluation.

Discussion: In this patient, molecular genotyping identified heterozygous mutations in the FUT1 gene: c.328G>A (FUT101W.02) and c.725T>G (FUT101N.09). According to the ISBT Working Party, FUT101W.02 is associated with weak H antigen expression, while FUT101N.09 is a null allele, leading to loss of α-1,2-fucosyltransferase activity, explaining the absence of H antigen on red cells. FUT2 genotyping showed a homozygous non-secretor status with four variants: c.171A>G, c.216C>T, c.428G>A, and c.739G>A. Although Le b antigen expression typically requires a functional FUT2 gene, rare instances exist where non-secretor genotypes still type as Le b positive. This may occur due to weak or partially functional FUT2 alleles linked to pseudogene formation, allowing minimal type 1H antigen synthesis that serves as a substrate for Le b production. Another explanation is chimerism or recent transfusion from a secretor; however, the absence of transfusion history in this case rules out that possibility. Additionally, some monoclonal anti-Le b antibodies recognize a shared epitope between Le b and Le y antigens, potentially leading to serologic cross-reactivity and apparent Le b positivity in FUT2-deficient individuals.

Conclusion: The identification of FUT1 and FUT2 variants, highlights the genetic diversity underlying rare phenotypes. Molecular genotyping proved essential in resolving the diagnostic conflict in complex or ambiguous serological cases.

PP 126: Thematic Area: Immunohematology: The silent threat: A true Bombay phenotype with unexpected tolerance to O positive incidental transfusion

Revathy R. Menon, Monali Lokhande 1 , Swati Kulkarni 1 , Ansuman Sahu, Satya Prakash, Somnath Mukherjee

All India Institute of Medical Sciences, Bhubaneswar, Odisha, 1 ICMR-National Institute of Immunohaemotology, Mumbai, Maharashtra, India

Background: The Bombay (Oh) phenotype is a rare blood group caused by homozygous FUT1 mutations, resulting in the absence of H antigen and development of potent anti-H antibodies. These individuals are compatible only with Oh blood groups. Misidentification, commonly as O blood group, can cause severe hemolysis, highlighting the need for molecular confirmation and rare donor registry support.

Case Report: A 35-year-old male presented to a local hospital with three episodes of presence of blood in urine, fever, and dyspnoea. His hemoglobin was 4.8 g/dL. A blood grouping report from another laboratory identified him as O RhD Positive, and he was transfused with three units of O RhD Positive PRBCs. The transfusions were initially uneventful, and his hemoglobin rose to 9 g/dL. Subsequently, he developed progressive visual loss. He was referred to AIIMS one month later for further evaluation. Blood grouping, Direct Coombs Test (DCT), and Indirect Coombs Test (ICT) were advised. Immunohematological testing revealed a Bombay (Oh) RhD Positive phenotype. Forward grouping showed O RhD positive, while reverse grouping demonstrated panreactivity with A, B, and O cells. There was no reactivity with anti-H lectin. DCT was positive (3+) with IgG monospecificity. Antibody screen was panreactive (4+), with positive Autocontrol (2+). Lewis antigen phenotyping showed Le(a+b−). Salivary inhibition studies confirmed the non-secretor status. Anti-H antibody titres were 4 at room temperature and 16 at AHG phase, indicating clinically significant reactivity. Crossmatch with O RhD Positive PRBCs showed 4+ incompatibility. Due to anticipated transfusion needs, first-degree relatives were tested, but none were Bombay phenotype. Despite the incompatible transfusions, there was no clinical hemolysis or hyperbilirubinemia, raising suspicion. Molecular analysis was pursued and samples sent to NIIH, Mumbai, confirmed classical Bombay phenotype with homozygous FUT1 c.725 T>G mutation (FUT1*01N.09) and FUT2 gene deletion. Further investigations, including bone marrow biopsy and cytogenetics, confirmed Plasma Cell Leukemia. Over 2.5 months, hemoglobin dropped to 4.5 g/dL, and he was admitted with high-grade fever, dyspnoea, severe diarrhoea, and back pain. Due to the unavailability of Bombay PRBCs locally, three compatible units were sourced from another state. Two donors came for donation to the blood centre and a total of five Oh PRBC were found compatible and transfused uneventfully to support the acute phase of illness and subsequent chemotherapy.

Discussion: An intriguing aspect of this case was the absence of an acute hemolysis despite transfusion of serologically incompatible red cells. One plausible explanation is initially a low titre of anti-H antibodies, insufficient to trigger an immediate hemolytic response. Further complicating the clinical picture was Plasma Cell Leukemia, known to cause immunological dysregulation. The underlying plasma cell dyscrasia might have contributed to an altered or delayed immune response, masking classical features of hemolysis and delaying recognition of incompatibility.

Conclusion: Patients with rare phenotypes like Bombay require proactive testing and early molecular confirmation, especially when transfusion dependence is anticipated. Delayed hemohlysis may present insidiously and be life-threatening. Collaboration with rare donor registries and timely diagnosis are essential to avoid catastrophic transfusion outcomes.

PP 127: Thematic Area: Apheresis (Donor and Therapeutic): Therapeutic plasma exchange in liver diseases: A promising bridging therapy with notable transplant-free survival

Swarnima Sinha, Brinda Kakkar, Sachin Palnitkar, Harshal Gadhikar, Sanjiv Ketkar

Deenanath Mangeshkar Hospital and Research Centre, Pune, Maharashtra, India

Background: Therapeutic plasma exchange (TPE) is a promising therapeutic treatment modality offered to liver disease (LD) patients. The potential benefits of TPE are metabolic detoxification i.e. removal of endotoxins, cytokines and damage associated molecular patterns (DAMPS) followed by replacement with fresh frozen plasma (FFP) alone or in combination with crystalloids. TPE helps to stabilize these patients by improving their liver function and potentially bridging them to liver transplantation (LT). The aim of our study was to analyze the outcome of TPE in our LD patients.

Methods: This retrospective observational study was conducted by Department of Transfusion Medicine from January 2023 to June 2025 in LD patients who underwent TPE. Patient demographics, biochemical parameters, TPE procedure details, hospital stay and mortality were retrieved and analyzed. 1 to 1.5 plasma volume exchanges were performed per session in every patient and a combination of crystalloid and FFP was used as replacement fluid. Prophylactically, 10% calcium gluconate infusion was given during TPE to avoid citrate toxicity.

Results: Twenty-five LD patients (18 males; 72%; 7 females; 28%) underwent TPE with a mean age of 38.3 ± 12.4 years. Of these, 9 (36%) had acute liver failure, 7 (28%) had decompensated chronic liver disease, 6 (24%) with acute on chronic liver failure, 2 (8%) post-LT graft dysfunction and 1 (4%) patient was admitted due to organophospohorus poisoning. A total of 79 TPEs were performed with an average 3.2 TPE sessions per patient (range 1-5). Statistically significant reduction was noted in total bilirubin (p= 0.003), direct bilirubin (p<0.05), aspartate aminotransferase (AST; p=0.008), alanine aminotransferase (ALT; p=0.007), alkaline phosphatase (ALP; p=0.016), prothrombin time (PT; p=0.018) and international normalized ratio (INR; p=0.016). Significant improvement was noted in the MELD scores post-TPE (p<0.05) and at the time of discharge (p=0.009). No adverse events occurred during and after TPE. The overall survival was 48% (12 patients), while the transplant free survival was 44% (11 patients) until last follow up at least 6 months. One ALF patient was successfully bridged to LT after 10 days of presentation and is alive and doing well (14 months post-LT). Average length of stay (LOS) in our patients was 23 days (range 4-53). In the deceased cohort (13; 52%), LOS less than 14 days was seen in 5 (39%) patients, while LOS more than 28 days in 8 (62%) patients and major cause of death was septic shock with multi-organ failure. Almost all of these patients had refused the option for LT.

Conclusion: TPE is a safe and effective therapeutic treatment modality being offered to LD patients with one of the potential benefit being transplant free survival which was 44% in our patients.

PP 128: Thematic Area: Cellular Therapies: Reaching the target stem cell dose: Insights from a four-algorithm analysis

Nidhi Sharma, Ashok Yadav, Sachin Sharma, Khushboo Likhar

MGM Medical College, Indore, Madhya Pradesh, India

Background: With advancements in apheresis technology, peripheral blood stem cell collection (PBSC) has become most common modality to collect stem cells. Researchers have developed various protocols to predict stem cell dose. Present study is done with the aim to evaluate if pre-count-based algorithms are feasible in our set-up or the current practice of performing intra-procedure CD34 counts supersedes the formula-based protocols.

Methods: Retrospective data of PBSC procedures performed from February 2023 to February 2025 was collected and analyzed. Based on descriptive analysis of pre-CD34 counts (PBCC), CE2, intra-procedure CD34 cell count (InPC), blood volume processed (nTBV) and recipient body weight, 3 predictive algorithms were generated. These algorithms were compared with the current InPC based algorithm. A subgroup analysis of autologous and allogeneic PBSCs was also performed. For the prediction formulae target dose of 5x106CD34+ cells/Kg for autologous, 10x106/Kg for allogeneic and 7.5x106/Kg average dose for combined evaluation was used. Dose prediction formula compared predicted dose with actual stem cell dose collected. Product volume to be collected to achieve target dose was compared in intra-procedural count-based formula with actual volume collected providing target dose. CE2 and regression equation-based algorithms evaluated correlation with predicted number of blood volume to be processed to get target dose and actual blood volume processed to get target dose.

Results: 41 PBSC procedures (31 allogeneic and 10 autologous) were included in the study. Median age (range) of donors was 30 years (5 to 64 years), weight 54 Kg (17-110 Kgs), TBV 3.7 (3.1-4.6) litres and median (IQR) PBCC 84 (53-136) cells/µL. The median (IQR) procedure parameters were InPC 2610 (1224-3711) CD34+ cells/µL, Intra-procedure yield [InPY] 5 (2.4-8.1) x106/Kg, final nTBV 2.63 (2.19-3.53), final product yield [FPY] 11 (7.28-16.4) X106 CD34+ cells/Kg, Product volume (PV) 190 (159-235) ml and Collection efficiency (CE2) of 50.8% (42.3-68) %. A weak correlation (r=0.456, p 0.003) of CE2 with final product cell count was observed whereas in subgroup analysis, moderate correlation in autologous PBSCs was observed (r=0.745, p=0.018). CCPB correlated well with FPY obtained (r=0.603, p<0.001), InPY (r=0.479, p=0.002), FPY per ml blood processed (r=0.621, p<0.001) and inversely related to nTBV (r=-0.385, p=0.013). Among the predictive algorithms, formula-based dose prediction algorithm correlated strongly with the target dose required for both autologous and allogeneic PBSCs (r=0.9, p=0.003 and r=0.734, p=0 respectively). When the correlation was drawn with the results of predictive algorithms and actual procedure values sufficient to achieve target dose, InPC based protocol gave strongest correlation (r=0.944, p=0) followed by CE2 based protocol (r=0.852, p=0) and regression equation-based protocol (r=0.634, p<0.001). Similar trend was also observed in subgroup analysis.

Conclusions: Intra-procedure count based algorithm provides the most accurate prediction of product volume to be collected to achieve the target dose but has limitation of being costlier and the time taken for report to be available leading to over collection of stem cell product in some cases. Alternatively, based on center’s historical data, individualized dose prediction or CE2 based algorithm can be derived and utilized efficiently.

PP 129: Thematic Area: Immunohematology: Rh antigen and phenotype patterns: Implications for extended typing in transfusion practice – A retrospective observational study

Deepika Murugan, B. Shanthi

Nizams Institute of Medical Sciences, Hyderabad, Telangana, India

Background: The Rh blood group system is the second most clinically significant blood group system after ABO, comprising over 50 antigens. Among these, the five principal antigens — D, C, c, E, and e — are particularly important in transfusion medicine. Rh antigens are known for their high immunogenic potential, especially the D antigen, which can readily induce alloimmunization in Rh-negative individuals exposed to Rh-positive blood. Extended Rh antigen typing becomes essential in multi-transfused patients, such as those with thalassemia or sickle cell disease, where repeated antigenic exposure increases the risk of alloimmunization, leading to hemolytic transfusion reactions or delayed hemolysis. Additionally, awareness of antigen and phenotype frequencies within specific populations supports transfusion planning, aids in selecting antigen-negative donor units for sensitized patients, and plays a role in population genetics, disease association studies, and forensic applications.

Aim: To assess the clinical relevance of extended Rh phenotyping in various transfusion-dependent hematological conditions and to analyze the distribution of major Rh antigens and phenotypes in a local donor and patient population.

Materials and Methods: A retrospective cross-sectional study was carried out at the Department of Transfusion Medicine, Nizam’s Institute of Medical Sciences, from January 2025 to June 2025. The study included 202 subjects — both voluntary blood donors and transfusion-dependent patients with hematological disorders. Patients included those diagnosed with thalassemia, sickle cell disease, autoimmune hemolytic anemia (AIHA), Evans syndrome, hemolytic disease of the newborn (HDN), aplastic anemia, von Willebrand disease, and lymphoproliferative disorders. Both first-time transfusion recipients and previously transfused individuals were included. Rh and Kell antigen typing was performed using the Column Agglutination Technology (CAT), and ABO grouping was done in parallel. Descriptive statistical methods were applied to evaluate antigen and phenotype distributions.

Results: Among the 202 individuals tested, the most frequently observed Rh antigen was e, present in 96.5% of the population, followed by C (88.6%), c (44.1%), and E (13.9%). The Kell (K) antigen was least common, found in only 4% of cases. The most common phenotype among Rh-D positive individuals was DCe/DCe (Ce), seen in 76.5% of cases. Among Rh-D negative individuals, the predominant phenotype was ce/ce, observed in 83.3%. ABO blood group distribution revealed Group O as the most prevalent (54.5%), followed by Group B (28.2%) and Group A (16.8%). Phenotypic distribution within clinical subgroups revealed Ce as the dominant phenotype in AIHA (66.7%), aplastic anemia (50%), sickle cell disease (50%), and thalassemia (100%). The ce phenotype predominated in lymphoproliferative disorders (100%) and was also noted in 25% of sickle cell patients. Less frequent phenotypes included ceK, Cce, and cEeK.

Conclusion: The study’s findings align with existing Indian data, confirming e antigen and DCe/DCe phenotype as most common. Local antigen frequency data can enhance transfusion safety by aiding in the identification of compatible antigen-negative units for alloimmunized patients. Extended Rh typing proves valuable in transfusion planning, especially in chronically transfused populations, reducing the risk of alloimmunization and improving overall transfusion outcomes.

PP 130: Thematic Area: Apheresis (Donor and Therapeutic): Influence of pre-donation haematocrit and platelet count on plateletpheresis duration: A retrospective analysis

Swadhini Baskaran, S. Subash, S. Sudha, S. Sangeetha

Madras Medical College, Chennai, Tamil Nadu, India

Background: Plateletpheresis allows for the targeted collection of platelets from a single donor while returning other blood components, offering distinct advantages such as higher yield, improved storage, and reduced risks of transfusion-transmitted infections and alloimmunisation. Understanding donor-related factors that influence the efficiency of the procedure can enhance donor safety and optimize resource utilization.

Aim: To evaluate the impact of pre-donation haematocrit (HCT) and platelet count on the duration of plateletpheresis.

Methods: A retrospective study was conducted at the Department of Transfusion Medicine, Rajiv Gandhi Government General Hospital, Chennai, from January to June 2025. Donors were categorized based on haematocrit values: Group A (>45%) and Group B (≤45%). Additionally, based on platelet counts, Group C (<2.5 lakh/μL) and Group D (≥2.5 lakh/μL) were compared. Data were analysed to assess the relationship of these variables with the duration of the apheresis procedure.

Results: Among 176 donors, 59 belonged to Group A and 117 to Group B. Haematocrit levels showed no statistically significant effect on procedure duration (p=0.711). However, platelet count had a significant influence: donors in Group D (117) donors) experienced a notably shorter procedure time compared to Group C (62 donors) The duration of plateletpheresis significantly decreased in donors with higher platelet count (p<0.001).

Conclusion: While haematocrit levels did not significantly affect the duration of plateletpheresis, a higher pre-donation platelet count was associated with reduced procedure time. Selecting donors with higher platelet counts may contribute to greater procedural efficiency and improved donor comfort.

PP 131: Thematic Area: Clinical Transfusions: The spectrum of maternal red cell alloantibodies causing hemolytic disease of the fetus and newborn: From anti-D to rare alloantibodies

Shanthi Bonagiri, Ch Vinay Kumar 1

Nizam’s Institute of Medical Sciences, 1 AIIMS, Bibinagar, Hyderabad, Telangana, India

Background: Hemolytic disease of the fetus and newborn (HDFN) is a clinical condition that occurs as a result of hemolysis of fetal or neonatal red blood cells (RBCs) due to maternal red cell antibodies that can cross the placenta. Anti-D being the most prevalent alloantibody implicated in HDFN, several other RBC alloantibodies like anti-c, anti-E, and anti-Kell, anti-C, e, Kidd, Duffy, and MNS blood group antibodies, can lead to fatal HDFN. Factors influencing RBC alloimmunization in pregnancy are previous transfusions, parity, fetomaternal haemorrhage, previous pregnancies, obstetric procedures like amniocentesis and Rh-D status. Overall prevalence of red blood cell alloantibodies in pregnant women ranges between 1 % and 2 % as published in different studies of many different developed and developing countries. ABO HDFN is largely limited to maternal blood group O having a newborn with blood group A or B or AB, due to the occurrence of IgG type of anti-A or anti-B antibodies in group O mothers.

Aim and Objectives: To detect the underlying antibody (ABO or alloantibody) in neonates with clinical features suggestive of HDFN. To evaluate the relationship of factors like maternal age, parity, blood group, antibody specificity and treatment options with the clinical outcome.

Materials and Methods: This study was done at department of Transfusion Medicine at a tertiary care hospital in Hyderabad, India. Data was collected retrospectively for a period of eight years i.e., from 2017 to 2024. Blood grouping of mother and neonate were done with Diaclon-ABO/D + Reverse grouping. Direct Coomb’s test and Indirect Coomb’s test were done with both mother and neonate’s sample. Antibody screening was performed using 3 cell panel (ID-DiaCell I,II,III). Samples with positive antibody screening were analyzed further for antibody identification using 11 cell panel (Set ID-Dia Panel).

Results: A total of 408 patients with neonatal jaundice (NNJ) came for HDFN workup. HDFN was confirmed in 140 neonates. Among all neonates male babies were slightly high in number i.e. 218 (53.4 %) were males and 190 (46.5 %) were females Among all the mothers, majority of them were multigravida (79 %). Primigravida mothers were only 8 (5.7%) in HDFN group compared to 76 (28.3%) in non-HDFN group, which was also statistically significant finding between two groups (p < 0.01). When HDFN was due to alloantibody, its identification was done. The specificities of alloantibodies are Anti-D 57 (53.3 %) Anti-D + anti-C 22 (20.5 %) Anti-c 12 (11.2 %) Anti-E 8 (7.5 %) Anti-c + anti-E 4 (3.7 %). Comparison of parameters was done between Alloantibody mediated HDFN and ABO incompatible HDFN showed Multigravida104 (97.2 %) History of Previous transfusions 9 (8.4 %) Bad obstetric history 40 (37.4 %) Rh neg 75 (70.1 %).

Conclusion: Anti-D remains the most common alloantibody causing HDFN. This study highlighted the importance of screening for RBC alloantibodies in all pregnant women irrespective of their RhD status, as Rh-positive mothers also had developed alloantibodies causing HDFN and ABO HDFN.

PP 132: Thematic Area: Blood Components/Products: Blood grouping with ABD PAD – Efficacy and comparison with standard method

Hirenkumar Makwana Aka Darji

B. J. Medical College, Ahmedabad, Gujarat, India

Background: In transfusion service, it is very important to carry out blood group with perfection. There are many methods for performing grouping like conventional test tube method, column agglutination method, erythrocyte Magnetised technique. Test tube method is gold standard method for blood grouping. To ensure accurate verification of a donor’s blood group—whether at a blood centre, camp site, or bedside during emergency transfusions—we require the results of the patient’s blood grouping. The ABD PAD® is a new device designed for rapid confirmation of the ABO and RhD blood groups. It offers a quick and reliable method to verify blood type in blood centres, especially during urgent situations.

Materials and Methods: Blood grouping was performed on 1,000 samples—207 from donors and 793 from patients—using the ABD PAD system. The results were compared with those obtained from the conventional tube technique and an automated platform. By EMT method All 1000 tests performed on the ABO PAD were concordant with other standard methods, namely test-tube technique and automated platform erythrocyte Magnetised technique (EMT). The results of ABD PAD were quicker (within 30 seconds) and easy to interpret.

Results: All 1000 tests performed on the ABD PAD were concordant with other standard methods, namely the test tube technique and EMT. The results of ABD PAD were quick (within 30 seconds) and easy to interpret. Two subgroups of A also detected among patient.

Discussion: The manual confirmation of the ABD group and RH method is Realtime and time-consuming task. It requires following a procedure pending several reactions in this system. The ABD pad is a ready-to-use device using the Latex Technology M-TRAP, facilitating the procedure intended for the confirmation of ABO/Rh. The only drawback is that we are not able to perform reverse grouping.

Conclusion: ABD PAD is very useful for blood grouping in donors in the blood centre as well as in outdoor blood donation camp since the blood type of blood unit when we want to re-check the blood group of the donor bag it is easy to interpret, fast, reliable and results are comparable with standard methods.

PP 133: Thematic Area: Donors and Donations: Analysis of blood donor deferral causes excluding hemoglobin-related criteria

K. Komal, V. Sudhir Kumar

Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India

Background: Blood donor deferral is essential to ensure both donor health and recipient safety. Established eligibility policies are routinely reviewed to reflect emerging evidence and evolving needs. Frequent deferrals can deter repeat donations, so optimizing criteria based on data-driven insights is vital for balancing blood safety with donor retention.

Aims: To analyse the pattern and underlying causes of donor and to propose practical, evidence-based strategies aimed at retaining eligible donors and optimizing donor recruitment and retention.

Objectives: This study aimed to evaluate the incidence and underlying causes of blood donor deferrals in a tertiary care hospital over a one year period. (1) Quantify Deferral Rate & Demographics (2) Analyze Common Deferral Causes (3) Recommend Strategic Interventions.

Methods: We conducted a retrospective chart review of all donor at nizams institute of medical sciences, deferrals from June 2024 to June 2025. Deferrals were classified as temporary (e.g., upper respiratory symptoms, open wounds, minor allergies, fasting) or permanent (e.g., underage < 18, tattoos, sustained hypertension, chronic illness). We calculated overall deferral rate, proportions of temporary versus permanent deferrals, and frequency of specific reasons. Demographics were analyzed for age, gender, and weight distributions.

Results: Between June 2024 and June 2025, 3.6% (535/15,000) of donor candidates were deferred. Of these, 75% were temporary deferrals—typically minor issues like colds or skin conditions—while 25% were permanent (e.g., underage, hypertension, tattoos). Key causes: respiratory issues (35%), skin problems (20%), tattoos (10%), hypertension (8%), and underage donors (7%). Most deferred donors were male and roughly 28 years old on average.

Conclusion: Most donor deferrals in our study were temporary, caused by minor and reversible issues like colds and skin conditions. These present a prime opportunity for re-engagement through targeted education, counselling, and follow-up. Permanent deferrals are vital for safety but should be communicated clearly to maintain trust. Ongoing monitoring of deferral trends allows data-driven policy refinement and better resource allocation—boosting donor retention and ensuring a safe and sustainable blood supply.

PP 134: Thematic Area: Clinical Transfusions: Triggers of red cell transfusions in a tertiary care hospital: A retrospective observational study

Rodda Rajanish, B. Shanthi, V. Sudhir Kumar, K. Mahesh Kumar

Nizam’s Institute Of Medical Sciences, Hyderabad, Telangana, India

Background: PRBC transfusion has emerged as an integral part of patient care. Most clinical practice guidelines recommend restrictive red cell transfusion practices, with goal of minimising exposure of Allogenic blood. However, studies reveal frequent inappropriate use. This study examines PRBC triggers and appropriateness in tertiary care Hospital.

Aims and Objectives: To examine the Transfusion thresholds in a Tertiary Care Hospital using Hb and Hct as parameters.

Materials and Methods: This retrospective observational study was conducted in the Department of Transfusion medicine at tertiary care teaching hospital from 1st February 2025- 30th June 2025. Data of 2500 critically ill patients who received red cell transfusions were collected from Bloodcentre records. Parameters included patient Hb and Hct levels, diagnoses, number of PRBC’s units transfused. Appropriateness of transfusion was assessed using AABB guidelines. Inclusion criteria: patients who received PRBC’s during hospitalization, availability of pre and post-Hb and Hct values. Exclusion criteria: patients with Sepsis.

Outcome: A total of 2143 units of PRBC’s were transfused across 2500 critically ill patients. The Hb and HCT values for Cardiothoracic Surgery were (10.3,31.4), for Nephrology (6.3, 22.7), for Emergency Medicine (7.3, 31.9), for Surgical Gastroenterology (9.3, 35.6), for Medical Oncology (7.5, 21.3), for Orthopedics (8.2, 34.3), for General Medicine (8.9, 25.7), for Neurosurgery (8.4, 27.2). Hb and HCT values post transfusion for Cardiothoracic Surgery were (10.6, 32.5), for Nephrology (6.9, 24.5), for Emergency Medicine (8.2, 34.7), for Medical Oncology (7.8, 23.4), for Orthopedics (8.4, 36.6), for General Medicine (9.3, 27.4), for Neurosurgery (8.8, 29.4).

Conclusion: This study highlights substantial PRBC usage in critically ill patients, with notable interdepartmental variations. While restrictive transfusion strategies are recommended, they may not account for specificity of patient’s requirements. Unwarranted use posed risks like TRALI and resource strain. Regular clinician education, and implementation of transfusion audits help in better red cell usage. Promoting rational PRBC use will enhance patient safety, optimize outcomes, and preserve precious blood components.

PP 135: Thematic Area: Cellular Therapies: Efficacy and safety of granulocyte transfusion therapy in neutropenic patients with refractory infections: A prospective study

Mohd Anas Sheikh, Arvind Yadav

AFTC, New Delhi, India

Background: Severe neutropenia remains a significant risk factor for life-threatening infections, particularly in patients undergoing chemotherapy, hematopoietic stem cell transplantation, or those with congenital neutropenia. Despite advances in antimicrobial therapies and hematopoietic growth factors, some patients develop infections that are unresponsive to standard treatments, resulting in high morbidity and mortality. Granulocyte transfusion therapy (GTT) has been explored for decades as an adjunctive measure to bridge patients through periods of profound neutropenia. However, evidence regarding its clinical efficacy, optimal dosing, donor mobilization strategies, and safety profile remains inconclusive and varies widely across centers. This study aimed to evaluate the clinical efficacy, feasibility, and safety of granulocyte transfusions in neutropenic patients with documented, refractory infections.

Methodology: A prospective, single-center study was conducted over 12 months, enrolling 20 neutropenic patients (absolute neutrophil count <0.5 × 10 9 /L) with microbiologically proven bacterial or fungal infections unresponsive to broad-spectrum antimicrobials for at least 72 hours. Donors were healthy volunteers mobilized with granulocyte colony-stimulating factor (G-CSF, 5 µg/kg) and dexamethasone (8 mg) administered 12 hours prior to leukapheresis. Granulocyte concentrates were collected via continuous-flow apheresis and transfused within 6 hours of collection. Each patient received a median of 4 transfusions (range: 2–8) on alternate days. Efficacy was assessed by clinical response, resolution of fever, microbiological clearance, neutrophil increments post-transfusion, and overall survival at 30 days post-therapy. Adverse reactions were monitored during and after transfusion.

Results: Of the 20 patients, 14 (70%) demonstrated clinical improvement, with defervescence occurring within a median of 3 days from the first transfusion. Microbiological eradication of the causative pathogen was confirmed in 08 patients (40%). The mean post-transfusion neutrophil increment was 1.2 × 10 9 /L per transfusion, sustaining for an average of 18–24 hours. The 30-day overall survival rate in responders was 75%, compared to 25% in non-responders (p < 0.05). Adverse reactions occurred in 2 patients (10%), including mild febrile reactions and transient pulmonary complications (1 case); no severe transfusion-related acute lung injury (TRALI) or alloimmunization was observed during the study period. Donor mobilization was well tolerated, with no significant side effects.

Conclusion: Granulocyte transfusion therapy appears to be a feasible and beneficial adjunct in managing severe infections in neutropenic patients unresponsive to conventional therapy. The use of G-CSF and dexamethasone-mobilized donors resulted in satisfactory granulocyte yields, adequate neutrophil increments, and acceptable safety profiles. While the clinical response and survival benefits observed are encouraging, the transient nature of neutrophil increments highlights the importance of repeated dosing and timely administration. Larger, randomized controlled trials are warranted to standardize protocols, optimize donor mobilization, determine patient selection criteria, and further establish the therapeutic role of GTT in the era of modern antimicrobial and supportive care. Until then, granulocyte transfusions should be considered as a supportive bridge in select high-risk patients with persistent, life-threatening infections.

PP 136: Thematic Area: Quality Management and Accreditation: Root cause analysis of blood discard due to blood collection failure

Lubna Naseer

Government Medical College, Udhampur, Jammu and Kashmir, India

Background: Blood Collection failure has an adverse impact on donor experience and return rate. This also negatively impacts blood component preparation and quality of blood units.

Objectives: The objective of this study was to do root cause analysis of blood discarded due to failure in blood collection.

Methods: This one year retrospective study was conducted by collecting and analyzing records of all collection failures with regard to the causes, level of staff responsible, donor characteristics.

Results: A total of 49 collection failures out of 2401 donations (2.04%) were recorded during this period. The leading cause was due to adverse donor reactions 30.6 % followed by double prick 20.4%. Collection failures due to haematoma at vene puncture site 18.36%. Equipment failure 4.08%. Less volume collected 22.4 %. Increased time of collection and hence clot 5.1 %. Newly recruited Junior Residents were responsible for majority of failures followed by newly posted Nursing staff. Higher frequency of all collection failure was seen in female donors due to increased donor reactions and thin veins.

Conclusion: Root cause analysis of collection failure plays a pivotal role in establishing preventive measures to improve quality and decrease discard rate.

PP 137: Thematic Area: Blood Components/Products: Is hemoglobin content a better quality parameter than volume for red cell units?

Vishal Patil, Mahesh Pednekar, Yogesh Panchal, Joyce Regi, Rajesh Sawant

Blood Centre, Sir H. N. Hospital and Research Centre, Mumbai, Maharashtra, India

Background: The current QC criterion for RBC components includes volume of the unit as an essential parameter. There is a lot of variability in the donor Hemoglobin, haematocrit and volume of the component prepared. We aim to evaluate if total haemoglobin content of the RBC unit proves to be a better quality parameter as compared to RBC volume.

Methods: Quality control parameters of 143 PRBC units prepared from 450 ml whole blood collection in top and bottom bags with in-line leucodepletion filters and100 PRBC units prepared from 350 ml WB collection in top and bottom bags were retrieved and total Hb content was calculated for each unit after considering the respective donor Hb level. The QC criteria specified in the third edition of NABH standards for blood centres was considered as standard reference. The number of units failing the volume criterion but still passing the Hb content criterion were noted. Statistical analysis including paired t test, pearsons correlation coefficient and Regression analysis was done.

Results: 25/143 (17.48%) RBC units prepared from 450 ml collections and 13/100 (13%) RBC units prepared from 350 ml collections failed the volume criterion. However, 24/25 RBC units prepared from 450 ml collections qualified the total Hb criterion of 40 gm per unit. None of the 13 RBC units prepared from 350 ml collections qualified the Hb content criterion of 43 gm per unit. The average Hb content of these RBC units was 35 gm.

Conclusion: Hb content of RBC units may prove to be a much more robust and relevant QC parameter as compared to volume of the unit, especially in case of RBC units prepared from 450 ml whole blood.

PP 138: Thematic Area: Donors and Donations: Impact of revised donor selection guidelines (NBTC, 2025) on deferral pattern in whole blood donor pool – A single centre study in North India

Prachi Janoti, Mohit Chowdhry, Soma Agrawal, S. Shefina

Indraprastha Apollo Hospital, New Delhi, India

Background: Blood is an essential resource in medical treatment and emergency care, with an estimated annual demand for blood in the country estimated at 14.6 million units. To promote voluntary non-remunerated donations through a well-coordinated and networked blood transfusion service, the 33 rd Governing Body Meeting of the National Blood Transfusion Council (NBTC) was convened on November 19, 2024. During this meeting, the donor selection and referral criteria guidelines were revised and subsequently published on January 25, 2025. This study aimed to evaluate the extent to which these new guidelines expand the donor pool.

Methodology: The study was conducted over a period of 6 months from January 2025 to June 2025 in a tertiary care hospital. The newly introduced guidelines have implemented significant modifications that affect the donor selection and deferral processes. These changes not only include the acceptance of donors with haemoglobin levels up to 18.5 g/dL in males and 16.5 g/dL in females but also reduced the deferral period for dental procedures ranging from 48 hrs to 2 years, additionally acceptance of donors in a euthyroid state on medication, and inclusion of stable asthma patients on inhaled steroids.

Results: During the study period of 6 months, a total of 12542 donors were screened, out of which 780 (6.2%) donors were deferred. Of these, 528 (67%) were males and 252 (33%) were females. Out of the total deferred, 264 (33.8%) donors would have been included as per the implementation of new guidelines. The mean number of donors deferred per month for high hemoglobin levels (17-18.5 g/dL) is 21 ± 7.2. The mean number of donors deferred per month due to dental procedures and minor surgeries is 5.5 ± 1.6 and 3.6 ± 1.5 respectively. The average number of donors on thyroid medication but in a euthyroid state is 10 ± 1.9 per month. Additionally, asthmatic donors deferred due to the use of inhaled steroids average 2.8 ± 1.3 per month.

Conclusion: The new guidelines have made a positive impact on the donor pool allowing an increase in inventory and better resource allocation and stock management. Because of the clarity provided in the new selection criteria more donors can be included in the donor pool, which is significant in our country with limited donors.