The case of FYA & JKA antibodies

A 28 year old pregnant female was admitted for delivery at a maternity hospital with profuse bleeding. The Blood group was B Positive. Several units of blood cross matched were found to be incompatible and the patient’s blood sample was sent to BMST. Antibody screen & identification was done and Fya & Jka antibodies were detected. A suitable blood unit negative for both the antigens was required to prevent hemolytic transfusion reaction in the patients. Nearly 60 units were tested and finally by mid night blood units negative for Fya & Jka Antigens were identified and issued to the patient for transfusion. The bleeding was controlled, blood units transfused and the patient delivered a healthy baby by LSCS

The case of Anti-M Antibody

A male baby around 2 years old, involved in a Road Traffic accident was admitted at a super specialty hospital. No personal or medical history was available. The patient was bleeding & required transfusion urgently The Blood group was A Positive but several units of blood cross matched were found to be incompatible. The blood sample was sent to BMST. The Antibody screen & identification was done & detected anti-M antibody. After testing more than 23 units of blood, suitable M negative units were issued for transfusion.

BLOOD BANKING AND TRANSFUSION

Since its beginning in 1984, Rotary Bangalore-TTK blood bank, BMST, has grown tenfold in size, and has acquired a reputation for high quality and safe blood products and is one of the largest regional blood transfusion centre and blood component facility in Karnataka.
BMST blood bank has prioritized three guiding principles for all its programmes and services. These are quantity, quality, and accessibility

Quantity

BMST blood bank’s blood collection has grown steadily over the years and currently is around 40,000 units of voluntary donor blood p.a. It has a voluntary donor base of over 5 lakh donors and reaches services to more than 90,000 patients every year.
Over 600 IT industries, colleges and other organizations support us with blood donation camps (BDC). We are their preferred partners for BDCs because of our emphasis on quality, professionalism of our blood collection team, support to donor organizations for their blood needs and strict donor confidentiality policy

One unit of blood collected serves several patients

All the blood collected is separated into components to optimize use so that each unit takes care of the blood needs of several patients. The excess plasma is sent for Fractionation to produce Factor VIII, Factor X, Albumen and Immune Globulins. In addition we also collect Single Donor Platelets by Apheresis

Single Donor Apheresis components

The Aphaeresis procedure is used to collect a particular blood component using the specialized Apheresis machine. Blood is circulated in the machine within a disposable tube set, the selected component is collected in a bag and the rest of the blood is returned back to the donor. This procedure usually takes one to two hours. It is a safe procedure, at any point of time, less than 200mL of the donor’s blood circulates outside the body, being processed by the machine.
The acceptance criteria for Apheresis donation is the same as for regular, Whole Blood donation except that the donor has to weigh at least 55Kg. Apheresis donors can donate more frequently since only a portion of their blood is collected. Apheresis (Single Donor) Platelets for instance can be donated twice in one week

Quality

BMST blood bank has instituted a total Quality Management System and is accredited by the National Accreditation Board for Hospitals (NABH).
Some important policies, processes and procedures followed to ensure Quality in the blood bank are:

Quality in Donor Selection

As a key contributor to blood safety, blood is collected from voluntary blood donors only. Donor selection is based on the detailed medical history and risk factor questionnaire, counseling and medical examination. This emphasis on voluntary donation is based on WHO and other blood safety studies that show a higher prevalence of HIV, Hepatitis and so on among replacement donors. This is attributable to the likelihood of replacement donors not admitting to history of risk behavior.
Blood is collected at voluntary Blood Donation Camps organized at industries, colleges and other institutions. We have a voluntary donor base of over 5 Lakhs; with around 40% repeat regular donors More than 90% of our donors are young, between 18 to 35 years of age; from IT industries and therefore well-educated and well-informed.

Quality in Testing for Transfusion Transmissible Infections

As per the Drug Control mandate, every unit of blood is screened for the five five infections – HIV, Hepatitis B, Hepatitis C, Malaria and Syphilis.

Overcoming the problem of “Window Period”

The screening for Viral Infections HIV, Hepatitis B, and Hepatitis C has an inherent problem. The routine tests used by blood banks are based on the detection of the Viral markers, i.e. Antibodies and Antigens of the Virus. These markers may not appear in the initial few weeks to 1-2 months after an infection. This leaves a “window period” (WP) during which the screening test is false negative, while the risk of transfusion-transmissible infection remains. The WP can never be eliminated fully, but it can be reduced considerably.

At BMST, every unit of blood undergoes two tests to reduce the WP to the extent possible using present day technology.

      • The detection of. Antibodies and Antigens of the Virus is done by the highly sensitive, automated, Chemiluminesence technique.
      • The detection of the viral RNA or DNA directly using the Neucleic Acid Amplification Technology (NAT), by the state of the art facility at Bowring & Lady Curzon hospital, Government of Karnataka.


    Confidential counseling and referral is provided to donors reactive for any transfusion transmissible infection.

Quality in blood grouping and compatibility testing

BMST is a recognized Immunohematology Reference Laboratory for South India
Most blood banks only test for the major blood groups- A, B, O and AB and Rh D (positive or negative) routinely. While the Minor Blood groups are not always relevant for routine and one time transfusions, they become important especially in multi transfused patients, pregnant women, newborns; transplant, certain medical and hematological conditions and so on.
At BMST, blood grouping for Major as well as Minor blood group systems such as other Rh groups; Kell, M,N,S and Duffy, antibody screening and other pre transfusion testing is carried out by advanced, automated & very sensitive techniques.
Hospitals refer difficult and problem cases to BMST where the tests for both Major and Minor blood group systems are carried out and the antibodies are identified and compatible blood is identified and issued to the patient / hospital.

Ensuring Traceability and quality “Vein-to Vein”

It is very important for a blood bank to be able to maintain documentation and trace the history of every unit of blood collected including the donor data, tests done, processing, storage, issue to patients and finally post transfusion adverse reactions if any; details of staff involved, quality of consumables used and quality of final products and so on.

At BMST we do it as follows:

Barcode system:

All blood units, blood samples, donor forms & other related documentation are labeled and identified using the ISBT 128 barcode standards

Blood bank software:

“Hemotrace” version-3 a blood bank software program developed by Mr. Pratap & his team from Centaur Information Systems Pvt. Ltd. along with BMST

 

Features of Hemotrace version -3

  • It is interfaced with the automated testing equipment and barcodes and integrates all functions
  • Provides Intelligent Labeling – Quarantine to finished components category (Donor information, grouping and testing results, composite label, issue label, bio-hazardous labeling)
  • Expiry of blood component is automatically computed on basis of shelf-life, so that expired units do not appear in the blood stock list.
  • Units reactive for Transfusion Transmissible Infectious markers do not appear in the blood stock list.

 

Accessibility

The blood bank offers 24/7 services, besides offering doorstep delivery to far off hospitals. Bulk transfer of blood components is also enabled to other blood banks and blood storage centres in 30 hospitals and supports over 500 hospitals that do not have blood storage or blood bank facilities.

Outreach services
In its efforts to ensure accessibility to safe blood to rural population, BMST with NRHM support, initiated the RakthaVahini programme and between 2009 and 2011 delivered blood components to government district hospitals in Bagalkot, Bidar, Bijapur, Gulbarga, Koppal and Raichur. Blood components were transported to these far-off places in refrigerated containers.
To ensure assured availability of rare blood groups, a Special donor club was formed in 2010.
This is essentially a data-base of donors of Rh Negative as well as other minor blood groups. They are contacted to donate blood for patients who have difficulty in finding compatible blood especially those who have had multiple transfusions such as Thalassemia and Cancer.

Blood collection & blood components utilization & issue 2016- 17

1Number of Blood Donation camps held466
2Total Whole Blood Collection 40865
3Total Blood Components issued84371 of which 30% issued to Govt. Hosp)
4Single donor Aphaeresis Platelet collected 2156
5Free Blood Transfusions for Thalassemia & Hemophilia patients 1884
6Blood Issued to Government hospitals 12332 of which 85% were issued free

Recovery of cost for blood

Blood components are issued free but expenses towards the collection, testing, processing and storage are recovered by blood banks as per Government guidelines. Even these are waived for poor patients, Government Hospitals and Thalassemia patients