Shamee Shastry

Manipal Academy of Higher Education | MAHE · Department of Immunohematology and Blood Transfusion

Background: Hepatitis E is a fecal orally transmitted disease and an emerging transfusion transmissible infection with potential transfusion safety implications. Hepatitis E Virus screening among blood donors is not routinely done despite the fact that it is endemic in India. As there are very few reports and evidence, the justification for mandati...

Background: Hepatitis E is a fecal orally transmitted disease and an emerging transfusion transmissible infection with potential transfusion safety implications. Hepatitis E Virus screening among blood donors is not routinely done despite the fact that it is endemic in India. As there are very few reports and evidence, the justification for mandati...

Poster Number: P433 ❖ Acute liver failure due to poisoning is an emerging global burden and acetaminophen poisoning is the leading cause in the western world (Bernal et al, NEJM, 2013). ❖ Indian burden of Yellow phosphorous (YP) is 75:1 to acetaminophen poisoning and can be considered equivalent to acetaminophen induced toxic liver necrosis in the...

Background and objectives: The antigen frequencies vary across different regions and ethnic groups. Hence, we aimed to study the prevalence of blood group antigens in our population and to systemize the zone-wise prevalence of the same across India. Materials and methods: Regular voluntary O group blood donors were screened for 21 blood group an...

Introduction and Aim: Platelets are precious blood components with a very short shelf life of only 5 days. Appropriate usage is essential for judicial utilization of these components. Blood utilization metrics help in assessing the demand and understanding the utilization pattern of blood components and in improving transfusion practices. This stud...

Background: Hepatitis E is a fecal orally transmitted disease and an emerging transfusion transmissible infection with potential transfusion safety implications. Hepatitis E Virus screening among blood donors is not routinely done despite the fact that it is endemic in India. As there are very few reports and evidence, the justification for mandati...

Background: The assessment of ADAMTS13 factor activity and inhibitor levels was conducted in severe COVID-19 patients as an observational study. Results: A total of 14 patients were included and the average ADAMTS13 activity level at the time of admission was 28.54±30.74% (range 1.83-86.67%) which was reduced compared to controls (88.09±14.77)....

Background: Autoimmune haemolytic anaemia (AIHA) is a decompensated acquired haemolysis caused by the host's immune system acting against its own red cell antigens.The aim of this national survey is to capture real-world data of clinical practices in AIHA by collecting responses from clinical haematologists across India. Methodology: In this cro...

Background Thromboembolic incidents are a rare but an often-fatal complication that occurs in thalassemia. Assessment of the hypercoagulable state is not done regularly, and we have assessed the utility of Thromboelastography (TEG) in thalassemia. Methodology A prospective single-center cohort study was conducted in a tertiary care set-up. Transfu...

Introduction Knowledge, Attitude and Practices (KAP) surveys prove beneficial to the transfusion services by providing an insight into the donors and, thus, aiding in mobilizing and retaining voluntary blood donors. We aim to study the knowledge, attitude and practices of donors towards blood donation in a pandemic setting. Methods A cross-section...

COVID 19 is caused by Severe Acute Respiratory Syndrome Corona Virus-2 which results in wide range of manifestations. Systemic hypercoagulation is a typical feature of COVID-19. We present a case of COVID-19 in whom TEG was performed on admission and hypercoagulability was diagnosed and hence patient was started on Enoxaparin sodium 6000 IU twice d...

Background: COVID-19 associated coagulopathy (CAC) can either be localized or systemic hypercoagulable state with increased risk of thromboembolism. This study looked into the usefulness of Thromboelastography (TEG) and the velocity curve (V-curve) derivative from TEG in diagnosing and differentiating different stages of CAC. Materials and Methods:...

Introduction: Transfusion transmissible syphilis is caused by Treponema pallidum; blood donors are traditionally screened with non-treponemal antibody tests to ensure transfusion safety. Detection of specific antibodies against T.pallidum is employed in reverse algorithm screening. We aim to analyze the utility of reverse algorithm screening strate...

Unmanageable bleeding is one of the signifcant causes of mortality. Attaining rapid hemostasis ensures subject survivability as a frst aid during combats, road accidents, surgeries that reduce mortality. Nanoporous fbers reinforced composite scafold (NFRCS) developed by a simple hemostatic flm-forming composition (HFFC) (as a continuous phase) can...

Background and objectives: There is a varied prevalence of red cell alloimmunization being reported from different parts of India. This study aimed to estimate the overall prevalence of alloimmunization in India by performing a systematic review of the literature and to establish the most suitable antigen-matching strategy to reduce the red blood...

Background Platelets should be transfused appropriately, based on the cause of thrombocytopenia. The practice and policies of transfusion vary among institutions and even among clinical practitioners, leading to inappropriate use of platelets, which might increase the risk of transfusion-related complications to recipients, and lead to a shortage o...

Objectives: Adverse donor reactions (ADR) may often go unreported due to donor related or blood center related factors. Possible donor related factors are self-ignorance of the adverse reaction, inertia to notify blood centre and non-compliance to follow-up. A better understanding of the self-ignored adverse donor reaction (SIADR) helps in early de...

Optical techniques are becoming increasingly popular for the analysis of body fluids, particularly so after the onset of the COVID-19 pandemic. Raman spectroscopy has found special significance among them due to its ability to perform label-free investigations of biological solutions with high sensitivity and specificity. The integration of Raman s...

Snakebite in India is often attributed to the "big 4," for which polyvalent anti-snake venom is effective. Also significant and less known is the burden of other venomous snakes, one of which is Trimeresurus malabaricus. We report a bite to the face of a tree climber by Trimeresurus malabaricus in the Western Ghats of India, which caused severe loc...

Introduction : With the outbreak of COVID-19 and its containment measures, blood centers faced a huge challenge in balancing blood demand and supply and devising a preparedness plan to withstand the uncertain situation. This study assesses the effect of the COVID-19 pandemic on blood transfusion services and discusses the appropriate mitigation str...

Background - We decided to conduct this study because of the severe infections in 2021 compared to 2020 to understand the Coagulopathy in COVID-19 among our population using Thromboelastography (TEG) and V curve. Materials and methods - All adult patients with a confirmed COVID-19 and TEG report were recruited in the study for one month period. Cit...

Background: Blood donors with high Hb are often deferred for the presumed risk of polycythemia vera (PV). However, adequate data to substantiate or refute this hypothesis is lacking. Methodology: We conducted an observational study on blood donors found to have high hemoglobin (Hb ≥18 g/dl) during the pre-donation screening process using a portable...

Background: According to the American Society for Apheresis (ASFA) guidelines, thrombocytapheresis is a Category II indication in symptomatic patients and is a Category III indication when used as secondary or prophylactic treatment. The role of thrombocytapheresis is to prevent untoward complications that might occur even before the cytoreductive...

Hepatitis E virus (HEV) usually causes self-limiting acute hepatitis, but the disease can become chronic in immunocompromised individuals. HEV infection in pregnant women is reported to cause up to 30% mortality, especially in the third trimester. Additionally, extrahepatic manifestations like neuronal and renal diseases and pancreatitis are also r...

Background In an ethnically diverse country like India, establishing a national rare donor registry is a massive challenge. We aimed to establish a regional rare donor registry at our center by screening the local donor population for rare phenotypes. Methods Serological testing of O blood group donors was done using monoclonal antisera from Bio-R...

A 42-year-old male with aplastic anemia admitted for management of anemia with a recent history of blood transfusion was noted to have a hematocrit of 19.7% which necessitated packed red blood cell (PRBC) transfusion. His pre-transfusion typing demonstrated A1 Rh (D) positive group on forward testing. However, his serum showed varying grades of agg...

Naturally occurring anti‐Kpa antibody is extremely rare and was first reported in 1957, named after the first producer ‘Penney’. However, the subsequent anti‐Kpa reports presented were all anti‐Kpa due to isoimmunization. Individuals with severe bacterial infections particularly Gram‐negative bacteria are known to be capable of producing cross‐reac...

Para-Bombay is a rare phenotype with a homozygous nonfunctional FUT1 gene and a normal FUT2 gene leading to H-deficient red blood cells (RBCs) with or without ABH substances, depending on inheritance of the ABO gene. This case is about a 5-day-old male baby suffering from sepsis who required a 45-mL packed RBC transfusion. The baby’s sample tested...

BACKGROUND: Outcomes in childhood cancer has dramatically improved in the West due to intensification of chemotherapy along with improved supportive care, however in LMIC like ours, deaths in remission secondary to MDR sepsis and viral infections is alarming and has drastically reduced cure rates. Very few IV antibiotics have been FDA approved late...

Background Rh D expression varies with population and ethnicity. Accurate typing of Rh D antigens among blood donors is important to prevent development of anti D among recipients of blood transfusion. We aimed to screen blood donors for variant D phenotypes and accurately characterize them by genotyping. Material and methods We have done prospect...

Background: Prediction of transfusion requirement is part of preoperative management in a surgical case. We aimed to develop one such tool for patients undergoing cardiac surgery. Methods: A retrospective study for a period of 3 years was done to develop the scoring tool, Transfusion Requirement Prediction Score for Cardiac Surgery (TRPS), and i...

Crystalloid fluids, a subset of intravenous (IV) fluid solutions are commonly used in clinical settings. The influence of these fluids on the functions of blood components are least explored. Raman spectroscopy combined with optical trapping has been widely used to evaluate the impact of external stress agents on red blood cells. The present study...

Hyperhemolysis syndrome is one of the life threatening complications of packed red cell transfusion characterized by the destruction of both allogenic transfused cells and autologous red cells. One of the main features of hyperhemolysis syndrome is the drop of hemoglobin level lower than that prior to transfusion(Eberly et al. 2015). The purpose of...

Background: Biomaterials containing platelets have been used to promote healing of ulcers and burns, as well as in implantology and maxillofacial and plastic surgery to achieve wound healing and tissue repair. Commercial devices to prepare autologous biomaterials involve diverse preparation methods that can have high production costs and low yield...

The positive antibody screen during pre-transfusion testing helps in the detection of clinically significant antibodies. However, sometimes clinically insignificant antibodies might perplex the serologic workup and can cause a delay in transfusion. Prompt recognition and timely resolution of these discrepancies in pre-transfusion testing, although...

Background and Aims: Outcomes in childhood cancer has dramatically improved in the west due to intensification of chemotherapy and improved supportive care. In LMIC like India, infections related deaths brings down the overall childhood cancer outcome. Also, there is an alarming rise in MDR infections among pediatric cancer patients in India and th...

Background: Overordering of blood has been a challenge faced by the blood bank staff. The present study addresses the role of maximum surgical blood ordering schedule (MSBOS) in optimizing the blood inventory management. Methods: The blood requests for elective surgical procedures from various surgical departments were reviewed to constitute MSBOS...

Purpose: Donor deferral results in loss of potential, motivated blood donors, and thereby, availability of blood for needy patients. This study analyses the frequency and reasons for donor deferral, including high hemoglobin deferral, which is underreported in India. Methods: Retrospective analysis of the deferral record of whole blood donors from...

Objective: We aimed to assess the frequency distribution of of ABO haemolytic disease of newborn (ABO-HDN) and to know the predictive value of immunohaematological tests in identifying at risk neonates. Background: ABO incompatibility, although a common cause of haemolytic disease of newborn, has several unaddressed issues related to it. Materi...

Hydroxyethyl starch (HES) is a commonly used intravenous fluid in hospital settings. The merits and demerits of its application is still a debatable topic. Investigating the interaction of external agents like intravenous fluids with blood cells is of great significance in clinical environments. Micro-Raman spectroscopy combined with an optical twe...

Fibrinolysis activity in various acquired clinical conditions were diagnosed using thromboelastography (TEG) and Thrombin Gneration Assay (TGA) by TEG.

Hemoglobin (Hb) estimation is a critical investigation in prospective blood donors. There are numerous techniques for Hb estimation, choosing an appropriate method is essential. Point of care devices (POC) have made quantification of Hb possible even in the field or community settings. Validation against a standard measure is necessary before imple...

Background: For appropriate management of hemolytic disease of the fetus and newborn (HDFN), it is important to detect irregular red cell antibody in the antenatal period. Though it is a simple one-step method, it is not part of routine antenatal screening in many developing countries. To reiterate the importance of antenatal antibody screening, w...

Background: Variation in the reactivity on Rh D typing may pose challenges in interpretation and ambiguity in further patient management. Materials and Methods: A prospective study was conducted in the department of transfusion medicine for a period of 18 months. Blood grouping was performed by fully automated equipment employing column agglutinati...

Objective: Refractoriness to platelet transfusion is defined as Corrected Count Increment (CCI) <5000 after two sequential ABO identical transfusions. Immune causes include alloimmunization to HLA and/or platelet-specific antigens. Analysis of various factors leading to platelet refractoriness would help in the management of the patient in a timely...

Extracellular tonicity has a significant influence on human red blood cell deformation capability. Advancements in the area of laser physics and optical trapping have opened up a plethora of applications for understanding cell structure and dynamics. Here, Raman Tweezers technique was employed to investigate the impact of extracellular tonicity by...

Thromboelastography is a viscoelastic test which uses whole blood sample for routine coagulation screening purpose. Even though it is an easy procedure, many critical steps affect the final result of the test and we describe such an incident in this report. The root cause analysis of two aberrant TEG reports on two different occasions was initiated...

A clinical syndrome that is consistent with intravascular hemolysis and that mimics hemolytic transfusion reaction is called pseudo-hemolytic transfusion reaction (PHTR). We present one such clinical scenario with PHTR. A 24-year-old patient was referred to our center with all the signs and symptoms of hemolytic reaction (HTR) on the second postope...

Passenger lymphocyte syndrome (PLS), a subtype of graft-versus-host disease, is due to the production of antibodies by the donor “passenger” B lymphocytes against recipient's red cells. It is a rare disorder encountered mostly in ABO blood group-mismatched solid organ transplantation. The present case report illustrates the clinical presentation an...

Anti-D is still the most common antibody causing severe haemolytic disease of the fetus and newborn (HDFN). In a mother with a very high titer of anti-D, antibodies can coat and block the D antigens on the red blood cells of the newborn. This blocking phenomenon prevents agglutination of the D-positive red cells with the IgM anti-D typing reagent,...

Introduction: Thromboelastography (TEG) is a whole blood clotting assay largely used in major surgeries and trauma to monitor patients' in vivo hemostatic status. Standardization of kaolin-activated citrated whole blood thromboelastography is not done in the Indian population. This study primarily aims to derive reference ranges of kaolin-activate...

: Glanzmann's thrombasthenia is a rare inherited bleeding disorder characterized by the quantitative or qualitative defect of glycoprotein IIb/IIIa receptor on platelets which leads to ineffective aggregation. Light transmittance aggregometry is considered as the gold standard for diagnosis of Glanzmann's thrombasthenia. Thromboelastography (TEG) i...

Snakebite associated thrombotic microangiopathy (TMA) is a spectrum of disorders characterized by microangiopathic hemolytic anemia, thrombocytopenia and acute kidney injury (AKI). We carried out this study to find out the prevalence of TMA in hematotoxic snake envenomation and to analyze its impact on the clinical outcome of patients. Retrospectiv...

Background: The present report illustrates a case with rare "P null" phenotype due to a large deletion in chromosome 22q13.2 and with clinically significant anti-PP1P^k antibody. Patient blood management in such cases is challenging. Case report: The transfusion center supporting the tertiary care referral center in the southern part o...

Alcohol is commonly used as sterilizing agent in hospital settings. Alcohol abuse is also associated with numerous medical complications. It influences the coagulation mechanics and erythropoiesis. Optical tweezers are being extensively used in research labs for the trapping as well as manipulation of biological cells. The biochemical investigation...

The dermal penetration of bisphenol-A (BPA) from thermal papers into the human skin is a matter of major health concern due to its extensive use in developing countries like India, one of its largest users in the world. Bisphenol A is widely used in the manufacture of many consumer goods like polycarbonate water bottles, baby bottles, food containe...

Background and Objectives: Regular and repeat blood donations may cause reduced body iron stores (BIS), which may lead to a shrinking donor pool. Furthermore, hemoglobin (Hb) itself is quite an inadequate measure to detect iron deficiency. Hence, our primary aim was to understand the effect of repeated blood donations on BIS in regular blood donors...

BACKGROUND: Considering the higher use of fresh-frozen plasma (FFP) in our hospital, we desired to determine the pattern, prevalence, and potential complications of its utilization in new-born and children with the primary aim to observe its effect on the conventional coagulation screening (CCS) parameters. SUBJECTS AND METHODS: Patients' demograp...

Background. Sero-reactivity disclosure to blood donors is an important issue of public domain. The sensitivity of situation demands both confidential as well as trust laden atmosphere while notifying them. Our aim was to assess and analyze the response rate of sero-reactive donors towards post-donation notification and counselling. Material and met...

The use of normal saline for washing red blood cells and treating critically ill patients is a regular medical practice in hospital settings. An optical tweezer in combination with Raman spectroscopy is an analytical tool employed for the investigation of single cell dynamics, thus providing molecular fingerprint of the cell by optically trapping t...

A 54-year-old male patient was admitted with low-grade intermittent fever not associated with chills. The cell grouping of the patient sample showed O Rh D positive and serum grouping as B, with a discrepancy to be resolved. Series of immunohematological workup was performed to rule out the discrepancy. Reviewing the past proxy history revealed tha...

Post snake bite renal failure due to thrombotic microangiopathy (TMA) is often overlooked and not considered as a separate entity while managing the patient. This case report highlights the efficacy of Therapeutic Plasma Exchange in managing the post envenomation TMA. Anti‐snake venom was administered following severe hematotoxic envenomation, but...

Background: The use and benefit of fresh blood and leuco-reduced blood for critically ill patients has been inconclusive. In this study we have tried to observe the same, in patients admitted to intensive care unit. Study design and methods: Prospective study was done to observe the effect of transfusion in critically ill patients in a tertiary...

A 54-year-old male patient was admitted with low-grade intermittent fever not associated with chills. The cell grouping of the patient sample showed O Rh D positive and serum grouping as B, with a discrepancy to be resolved. Series of immunohematological workup was performed to rule out the discrepancy. Reviewing the past proxy history revealed tha...

Description: 1. Visible cold agglutinates present in the EDTA sample of patient. 2. These spontaneous agglutinates interfered with patients' blood typing. 3. They were resolved using DTT Reagent

Optimal functioning of blood transfusion service during after hours with limited resources are highly challenging. Best transfusion practice guidelines recommends to avoid non-urgent transfusions during out-of-core hours for the concern of patient’s safety. This study aimed to evaluate the after hour packed red cell transfusion practice and to iden...

Detection of nonspecific antibodies unrelated to blood group antigen that causes nuisance in pretransfusion testing is a rare event. Their interpretation is often made only after the exclusion of all possible clinically significant antibodies and results in the unnecessary expenditure of reagents and human resources. We report one such nuisance ant...