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Status of Blood Banking in South Asia

Status of Blood Banking in South Asia. Jim Perkins, M.D. Director, Indian Immunohematology Initiative Blood Bank Director, NorthShore University HealthSystem Assistant Professor, University of Chicago. National Red Cross, Kathmandu, Nepal. Prathama Blood Center, Ahmadabad, india.

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Status of Blood Banking in South Asia

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  1. Status of Blood Banking in South Asia Jim Perkins, M.D. Director, Indian Immunohematology Initiative Blood Bank Director, NorthShore University HealthSystem Assistant Professor, University of Chicago

  2. National Red Cross, Kathmandu, Nepal Prathama Blood Center, Ahmadabad, india

  3. Summary: Donations * Countries with very high rates of thalassemia

  4. W.B. donations per 1000 pop. % vol/non-remunerated donations 2008 WHO data

  5. Summary: Blood Center Organization

  6. Indian blood bank spectrum

  7. TTD Screening Tests • Anti-HIV • HBsAg • Anti-HBC • STS • Malaria, various methods • A few hospitals with medical tourists have implemented NAT methods

  8. Summary: Donor Disease Screening

  9. Donor disease test positive rates: Pakistan, 2007

  10. Non-returnable blood components being issued at a large hospital

  11. Transfusion Service Organization: 2 models Hospital blood banks • Mostly replacement donations • Compatibility testing is performed and blood is issued to the care unit • May not be returnable Blood centers • Patient specimen is brought from the hospital • Compatibility testing is performed at the blood center • Blood is issued to the hospital for an INDIVIDUAL patient, often to a family member Consequence: Hemovigilance is compromised

  12. Kathmandu, 2005

  13. Serologic testing • ABO and Rh typing • Not necessarily including reverse typing • Not necessarily in tubes • Crossmatch • Not necessarily by tube/IAT • Positive crossmatch → continue crossmatching to find compatible units • Few institutions can identify antibodies • Few institutions have access to antigen typed donors • Few institutions can do an autoadsorption

  14. Red Cell Antigen Genotype Analysis for More Than 9000 Asian and Multi-Ethnic American Donors M Delaney, G Teramura, S Harris, LK Gaur Red Cell Genomics Lab, Puget Sound Blood Center, Seattle WA, USA Transfusion, abstr. S30, Vol. 52s, 2012

  15. Recent data from SeattleGenotyping performed on 922 self-identified South Asian donorsNumbers in percent Delaney, Transfusion, 2012

  16. The likelihood of a recipient being exposed to ‘not-self’ antigen of the Kpa/b, Jsa/b, and Dia/b pairs

  17. Anti-Kpa, anti-Jsa, anti-Dia NON-REACTIVE with Eur/US screening or panel cells Anti-Kpb, anti-Jsb, anti-Dib Reactive with ALL Eur/US screening or panel cells What would happen if S. Asian patients were making these 6 antibodies?

  18. Antibodies: Lions BB DelhiJan 2011 to Dec, 2012 • 33894 patient T&S • 393 (1.16%) positive antibody screen • 50 (0.15%) patients had autoantibodies • 338 (1%) patients had alloantibodies • 239 (71% of allo-abs) single specificities • 48 (14%) multiple specificities • 51 (15%) unidentifiable

  19. Conclusions • Need to continue to do AHG crossmatches for now • Need to have ‘South Asian’ screening cells, panel cells, and typing sera

  20. Thank you

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