Transfusion Update Kanchan Bhardwaj, BL Bhardwaj, Kusum K Thakur, Rajni Bassi, Harnoor Singh Bhardwaj
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1Transfusion Update
Indian Society of Blood Transfusion and Immunohaematology (ISBTI)2
3Transfusion Update
Editor-in-Chief Kanchan Bhardwaj MD MAMS FIAC FIMSA Professor and Head Department of Transfusion Medicine Government Medical College, Patiala, Punjab, India Associate Editors BL Bhardwaj MD MAMS FCCP FIMSA FIACP FNCCP FGSI FIACM Professor Department of Medicine Government Medical College Patiala, Punjab, India Kusum K Thakur MD PGDMCH PGDHHM MISBTI MIMA MAATM Lecturer Department of Transfusion Medicine Government Medical College Patiala, Punjab, India Secretary, ISBTI (Punjab Chapter) Rajni Bassi MD MISBTI MIMA Lecturer Department of Transfusion Medicine Government Medical College Patiala, Punjab, India Assistant Editor Harnoor Singh Bhardwaj MBBS Junior Resident Government Medical College Patiala, Punjab, India Forewords KK Talwar TR Raina Neelam Marwaha An ISBTI Publication
4
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Transfusion Update
First Edition: 2015
9789351525981
Printed at
5Dedicated to
My loving parents Mrs Surjit Saini and Er BK Saini and my teachers6
7Contributors
11 Advisor
Government of Punjab
Health and Medical Education
Member, Punjab Governance Reforms Commission
Dr KK Talwar
MD DM FAMS FNA FACC
FlMSA FIACS (Canada) DSc (hc)
Former Chairman, Board of Governors
Medical Council of India
Former President
National Academy of Medical Sciences
Former Director, PGIMER, Chandigarh
Former Professor and Head
Dept. of Cardiology, AIIMS, New Delhi
Foreword
It is a great pleasure to write a foreword for Transfusion Update. This is a result of the concentrated efforts of the authors and the editorial team in bringing out a book containing the latest practices in transfusion medicine. While covering a majority of the important and challenging topics in the field of transfusion, the authors and editors have made sincere efforts to bring forth the practical points concerning patient care from the transfusion medicine. The challenging problems seen in the practice of transfusion medicine are dealt with in a simplified manner.
Transfusion Update is indispensable for transfusion medicine specialists and clinicians. I am sure that postgraduate students will also find this book containing 81 chapters with pearls of immense value. The book is having four sections consisting of clinical hemotherapy, cellular therapies, blood safety with pathogen reduction technology and miscellaneous. To sum-up, the book is a practical and reference manual for clinicians on issues related to transfusion medicine.
As this transfusion medicine update is being released on the occasion of the 39th Annual National Conference of the Indian Society of Blood Transfusion and Immunohaematology (ISBTI) scheduled to be held at Government Medical College, Patiala, Punjab, India, I congratulate Dr Kanchan Bhardwaj, Editor-in-Chief, for taking great pains in bringing out this volume of over 300 pages for the benefit of dedicated and busy clinicians of our country. I hope the TRANSCON 2014 and the book will add to everyone's knowledge and help everyone to face the challenges of transfusion practice in the years ahead. Dr BL Bhardwaj, Dr Kusum K Thakur and Dr Rajni Bassi deserve special congratulations for successfully completing this important project.
(KK Talwar)
Punjab Governance Reforms Commission, Academic Block, Mahatma Gandhi State Institute of Public Administrations, Institutional Area, Sector-26, Chandigarh 160019
Fax: 91-172-279512112
13Foreword
It gives me immense pleasure in writing the foreword for Transfusion Update. At the outset, I congratulate Dr Kanchan Bhardwaj, a simple, dynamic and competent academician who took this tedious challenging job and came out with the book within short period of time which was the need of the hour.
Publication of the book is unique in itself because it is for the first time in the history of ISBTI for more than forty years of its inception that a publication of ISBTI in the form of the book has been launched and the credit for this goes to Dr Kanchan Bhardwaj.
Blood transfusion services play a vital role in the modern health care system of both developed and developing countries. Importance of transfusion medicine as a branch of medical science can never be undermined and is now considered as an applied para-clinical discipline which demands a significant extent of academic knowledge. In a vastly populated developing country like ours, blood transfusion services remain relatively inadequate, both in quantity and quality of service. In this era of technology, although there is a lot of advancement in the medical field; but, unfortunately, the field of blood transfusion has not kept pace with these advancements.
To improve blood transfusion services in our country, there is a genuine need of good textbooks and the endeavor undertaken by Dr Kanchan Bhardwaj is a step towards this side. The book contains all the relevant chapters including more recent topics on Cellular Therapies including Cord Blood Banking and Transplantation which shall be beneficial for all those engaged in the field of transfusion medicine.
TR Raina MD (Path)
Former Professor and Head
Department of Transfusion Medicine
Government Medical College
Jammu, Jammu and Kashmir
Secretary General
Indian Society of Blood Transfusion and Immunohaematology (ISBTI)
Panchkula, Haryana, India14
15Foreword
Transfusion medicine is a continually involving field. It has a wide spectrum of activities involving the community for purposes of donor motivation, recruitment and retention, complex laboratory technologies for blood component preparation and blood testing, regulatory aspects of blood transfusion services and most importantly clinical transfusion practices, monoclonal antibodies for therapeutics and cellular therapies
Transfusion Update being released on the occasion of TRANSCON 2014 has been diligently compiled by the Organizing Committee, under the initiative of Dr Kanchan Bhardwaj, Organizing Secretary of the Conference. The contents fit in well with the theme—Optimizing Transfusion Therapy. Best practices, recent advances and challenges in clinical transfusion in the fields of medicine, surgery, oncology, obstetrics and neonatology have been included in the scientific program. Articles on scope of apheresis technology, special transfusion support in hemoglobin disorders and hemophilia have also been contributed by experts.
A major section has been devoted to cellular therapies—the most challenging and controversial areas in regenerative medicine. The role of platelets as growth and repair promoters, current status of gene therapy, blood grouping and cord blood transplantation have also been included in the contents. The section on blood safety brings into focus the regulatory, ethical and legal issues in transfusion medicine. It also highlights the hazards of blood transfusion–hemovigilance and its reporting mechanism in the country. State-of-the-art technology, platforms for immunohematology, transfusion transmitted viral infections and bacterial contamination of blood components have also been contributed by the experts. The contents also included quality assurance principles and practices in transfusion services.
All the contributors deserve appreciation for the efforts, they have made in preparing manuscripts and I wish to put on record my sincere praise and appreciation for the Organizing Committee for compiling updated scientific knowledge in the field of transfusion medicine. Transfusion Update would definitely benefit all the readers and help in improving transfusion practices.
Neelam Marwaha MD FAMS FISHTM
Head
Department of Transfusion Medicine
Postgraduate Institute of Medical Education and Research (PGIMER)
Chandigarh, India16
17 Preface
The medical science is changing so fast that it becomes essential for transfusion medicine to keep a pace with the changes. The transfusion therapy is the backbone of clinical practice and its outcome is a measure of patient care. The objective of this book is to raise the level of our expertise in transfusion technology to latest international standards of safe blood transfusion and to keep abreast with the latest innovations in the field of blood transfusion.
It is a pleasure to present Tranfusion Update to our worthy fellow transfusion specialists, and clinicians across the country. The challenging problems seen in practice of transfusion medicine are dealt with in a crystal clear manner. The book will be an indispensible tool in the transfusion medicine specialist and clinician's kit. I am sure the postgraduates will also find this book containing 81 chapters with particular focus on transfusion therapy very useful.
The topics covered under Clinical Hemotherapy are Transfusion Practice in Clinical Medicine, Transfusion in Surgical Practice, Maternal, Fetal and Neonatal Transfusion Practice; Massive Transfusion; Platelet Therapy, Transfusion Practice in Chronically Transfused Patients, Apheresis, Intervention in Bleeding Patients and Transfusion Practice in Oncology. The section on Cellular Therapies has Stem Cell Therapy in Cardiovascular Diseases, Peripheral Artery Disease, Diabetes Mellitus, etc. Blood Safety has NAT, Pathogen reduction technology, leucoreduction, etc. and Miscellaneous has Evidence-based Transfusion Medicine, Blood Bank Accreditation, Molecular Genotyping and its Applications in Transfusion Practice, Rare Blood Group Registry, etc. Details of latest topics will stimulate teachers of transfusion medicine and clinical specialists to do more research in these fields.
The book is being released on the occasion of the 39th Annual Conference of Indian Society of Blood Transfusion and Immunohaematology (ISBTI) being held at Government Medical College, Patiala, Punjab, India. I am sure that Transfusion Update will add to everyone's knowledge and armamentarium to face the challenges of transfusion practice in the years ahead.
I hope the readers will find the book useful for updating their knowledge regarding transfusion practice eventually benefitting their patients.
Kanchan Bhardwaj MD MAMS FIAC FIMSA
Professor and Head
Department of Transfusion Medicine
Government Medical College
Patiala, Punjab, India18
19 Acknowledgments
For the first time in history of Indian Society of Blood Transfusion and Immunohaematology (ISBTI) that scientific lectures have been compiled in the form of Transfusion Update which will be very useful for postgraduate students and teachers of transfusion medicine, and all clinical specialties during their day-to-day practice. The idea was proposed in governing body meeting of ISBTI at Patiala, Punjab, India, and was appreciated by all present especially Dr Sangeeta Pathak, Treasurer, Indian Society of Blood Transfusion and Immunohaematology (ISBTI), Dr Ravneet Kaur, Editor, Asian Journal of Transfusion Science (AJTS) and Professor and Head, Department of Transfusion Medicine, Government Medical College and Hospital, Chandigarh, India and Shri M Satish, Vice President-Technical, ISBTI.
The first and the foremost heartfelt thanks to Dr Yudhbir Singh, National President, ISBTI, whose positive attitude has made this venture a reality. I want to sincerely thank Dr KK Talwar, Advisor to Government of Punjab whose encouraging words has gone a long way in pursuing this venture. I convey my special thanks to Dr TR Raina, Secretary General, ISBTI, who has encouraged me to accomplish this task. I should not forget to pay my gratitude to Dr Neelam Marwaha, Professor and Head, Department of Transfusion Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India, for her consistent guidance. Without consistent perseverance of Dr BL Bhardwaj, this uphill task was not possible.
I express my gratitude and thanks to Dr KD Singh, Principal, Government Medical College, Patiala, Punjab, India, for his kind and expert guidance. I am also thankful to all the clinicians of my institute, who have expressed the need for some written guidelines about blood transfusion, which can be helpful in their day-to-day clinical practice and can guide the junior residents about how best to utilize the Blood Transfusion Services (BTS) for safety of patients. I convey my special thanks to Dr HS Sandhu (Medicine); Dr VK Sharda (Surgery); Dr Surinder Singh (Surgery), Former Principal, Government Medical College, Patiala, Punjab, India; Dr HK Rao (Medicine), Former Head (Medicine); Dr Manjit Kaur Mohi; Dr Paramjit Kaur, Dr Khushpreet Kaur and Dr Preet Kamal Sibia (Gynaecology); Dr JS Bhopal (Anesthesia); Dr Manjit Singh and Dr JPS Walia (Orthopedics), Dr Mohinder Singh and Dr DP Singh (Surgery), Dr Ardaman Singh and Dr Naresh Garg (Medicine), Dr Manpreet Kaur and Dr Meena Garg (Gynecology).
I highly appreciate guidance given by my seniors and colleagues from other institutes such as Dr Kulbir Kaur, Principal, Punjab Institute of Medical Sciences, Jalandhar, Punjab; Dr RR Sharma, Additional Professor, Department of Transfusion Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh; Dr RN Maharishi, Professor and Head, Department of Transfusion Medicine, Guru Gobind Singh Medical College, Faridkot, Punjab; Dr Neeraj Sharma, Professor and Head, Department of Transfusion Medicine, Government Medical College, Amritsar, Punjab; Dr Hitish Narang, Consultant, Satguru Pratap Singh (SPS) Apollo Hospitals, Ludhiana, Punjab; Dr PK Sehgal, Head, Department of Transfusion Medicine, Pt BD Sharma University of Health Sciences, Rohtak, Haryana, India; Dr Amarjit Kaur, Professor and Head, Department of Transfusion Medicine, Dayanand Medical College, Ludhiana, Punjab; Dr Anil Vij, Professor and Head, Department of Medicine, Institute of Medical Sciences, Jalandhar, Punjab; Dr Dharam Paul, Civil Surgeon (Retd); Dr ML Bansal, Editor-in-Chief of Current Medical Journal of North Zone; Dr BK Aggrawal, Professor and Head, Department of Medicine, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Haryana; Dr RP Kudiar, Principal, Acharaya Shri Chander College of Medical Sciences (ASCOM), Jammu, Jammu and Kashmir, India; Dr Anil Kumar Gupta, Professor and Head, Department of Medicine, Acharaya Shri Chander College of Medical Sciences (ASCOM), Jammu, Jammu and Kashmir; Dr PS Gehlot, Professor and Head, Department of Medicine, Pt BD Sharma University of Health Sciences, Rohtak, Haryana, India; Dr Lovedeep Saini, Dr Sumeet Pal Saini, Dr Sukhwinder Singh, Joint Director, BS and QA, Punjab State AIDS Control Society, Chandigarh; Dr Sartaj Kaur Dhillon and Dr Satwant Singh Dhillon, Wisconsin, USA; Dr AS Grover, Principal, Gian Sagar Medical College and Hospital, Banur, Punjab, India.
I am thankful to all my friends and colleagues, who have helped me in writing the book in one way or the other. My special thanks to Dr Gurdeep Kaur Bedi, Professor and Head, Biochemistry; Dr Shashi Prabha, Former Head, Department of Transfusion Medicine; Dr MS Bal, Professor and Head, Department of Pathology; Dr Vijay Kumar Bodal, Dr Anil Suri, Dr Mohanveer Kaur, Dr Maninder Kaur, Associate Professor, Biochemistry; Dr Avnish Kumar, Professor Physiology; Dr Usha Chhabra, Professor and Head (Anatomy); Dr Subhash Kaushal, Professor, Department of Anatomy; Dr Anita Gupta, Professor and Head, Pharmacology; Dr KK Aggarwal, Professor, Forensic Medicine; Dr DS Bhullar, Assistant Professor, Department of Forensic Medicine; Dr Aradhana Sharma, Dr Poonam Singhal, Mr Mahesh Kumar, Mr Sukhvinder Singh and Mr Pawan Kumar, Sandeep Kumari who have contributed in one way or the other for this manuscript. I express my special thanks to Dr Manmohan Singh, Former President, Punjab Medical Council and Dr Sudhir Verma for their ever available guidance and help.
20The book has emerged in its present form due to the untiring efforts of my Associate Editors—Dr BL Bhardwaj, Dr Kusum K Thakur and Dr Rajni Bassi, and Assistant Editor—Dr Harnoor Singh Bhardwaj. My sincere thanks to the eminent contributors for writing their chapters despite their own priorities.
I remember Dr Amrendra S Miranpuri, Assistant Professor, Neurosurgery Cerebrovascular, Stroke and Endovascular Surgical, Co-Director, Neuromedicine Critical Care University of Rochester Medical Center, Rochester, New York; Dr Guwatan Singh Miranpuri, Department of Neurosurgery, University of Wisconsin, Madison, USA; Dr Mandeep Batish; Dr Aastha Miranpuri, Dr Ravisha Bhardwaj, Dr Jatinder Kumar, Mrs Ranju Saini, Er Aasheem Saini, Mr Rasheem Saini, Mrs Nisha Bhardwaj, Dr Kavita Bhardwaj, Er Navpreet Singh, Er Shivani Bhardwaj, Er Ankush Bhardwaj, Dr Paritev Singh and Mr Navnik Singh for their unstinting support, constant cooperation and prompt help.
My sincere thanks to Shri Jitendar P Vij (Chairman), Mr Ankit Vij (Managing Director), Mr Tarun Duneja (Director- Publishing) of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, deserve due credit for their personal involvement in the excellent printing and publication of this book in a record time.
Editor-in-Chief