It is our privilege to inform that Life Blood Centre, Rajkot, Gujarat, India has been awarded by International Society of Blood Transfusion (ISBT), Amsterdam “ISBT Award for Developing Countries 2020” on December 12, 2020.
The ISBT Award for Developing Country was initiated from 2012. The award is presented every two years to only one blood centre across the globe. It is awarded to blood centre from a Developing Country that has made a significant contribution in strengthening Blood Transfusion Practice within the country. This year due to pandemic international congress was organized virtually from December 12-16, 2020 at Amsterdam. Nearly 1700 delegates participated in the congress and professionals from over 100 countries had share their significant contribution.
Life Blood Centre is the only standalone blood bank from India to be honored with this prestigious award. Copy of excellence certificate is attached along with work of Life Blood Centre acknowledged by Professor Erica Wood - President of ISBT, Amsterdam for your kind reference.
Moreover, in year 2010, 2011 and 2019 Life Blood Centre was recognized at International conferences and received Harold Gunson Fellowship Award from ISBT and in 2020 our application on “Threat of dengue to blood safety in dengue-endemic region” was accepted in the innovative initiative of ISBT named “I TRY IT 2020”.
Life Blood Centre (formerly known as Rajkot Voluntary Blood Bank & Research Centre) was established on 06th December 1981. It was the first blood bank in the entire Saurashtra region of Gujarat state. We remain firmly committed to contribute beyond blood banking by the whole process of voluntary blood collection, testing, storage, distribution of scientifically safe blood and provide vital information on blood transfusion at multi-specialty Hospitals, private Doctors, para medical staffs by providing training and by preparing various brochure and leaflets on define topics. Today, Life Blood Centre (LBC) is considered as one of the most reliable blood banks, having touched hundreds of thousands of lives.
IRRADIATED BLOOD PRODUCT....X RAY IRRADIATOR
TA-GvHD (Transfusion Associated Graft versus Host Disease) is a very rare but usually fatal complication following transfusion of lymphocyte-containing blood components. Although the first reports concerned cases where viable allogeneic lymphocytes had been transfused into immunosuppressed recipients, it became apparent that non-immunosuppressed patients could also experience this problem, particularly if the blood components they received came from an HLA haploidentical unrelated donor or family member.
The risk associated with an individual transfusion depends on the number and viability of contaminating lymphocytes, susceptibility of the recipient’s immune system to their engraftment and degree of immunological (HLA) disparity between donor and patient. The minimum number of transfused lymphocytes necessary to provoke a GvHD reaction is unknown and may vary by clinical settings. Until recently, gamma irradiation of cellular blood components has been the mainstay of TA-GvHD prevention but now X-Ray IRRADIATION cellular blood products are getting into practice.
Fortunately, first installation of X-Ray irradiator of South-East Asia is done in Rajkot at Life Blood Centre.
Pathogenesis, clinical features and diagnosis of TA-GvHD
Pathogenesis:
TA-GvHD is a potential complication of transfusion of any blood component containing viable T lymphocytes when there is disparity in the histocompatibility antigens between donor and recipient. As well as the classical skin, gut and liver involvement seen in GvHD occurring after allogeneic stem cell transplantation, TA-GvHD is characterized by profound marrow hypoplasia and mortality in excess of 90%. There is a particular risk of TA-GvHD when the donor and patient share an HLA haplotype, as occurs within families, or in populations with restricted haplotype diversity In the Japanese population, the incidence of TA-GvHD is 10–20 times higher than in the North American Caucasian population.
Clinical features:
The early features are fever, maculopapular skin rash, diarrhoea and hepatitis occurring 1–2 weeks after transfusion. Bone marrow involvement produces severe hypoplasia with profound pancytopenia.
Diagnosis:
Diagnosis is usually made by biopsy of skin, gut or liver supported by evidence of persistence of donor lymphocytes. The presence of cells of donor origin may be demonstrated by polymerase chain reaction in peripheral blood (Utter et. al., 2007) or short tandem repeat analysis using peripheral blood and skin biopsies from affected and non-affected sites in the patient, and peripheral blood samples from the implicated donors.
Prevention of TA-GVHD
Irradiation
The major technology for preventing TA-GvHD is irradiation of blood components to inactivate residual lymphocytes Gamma rays and X-rays are similar in their ability to inactivate T lymphocytes in blood components at a given absorbed dose. Gamma-irradiators are expensive and eventual decommissioning and disposal present significant difficulties These highly radioactive cores may present a security risk in hospital settings. As the source decays, regular recalibration is required and irradiation time progressively increases. Dedicated X-ray blood irradiators are now available, have been widely used in North Americaand are being introduced by the UK Transfusion Services. X-ray irradiation machines are less expensive and the absence of a radioactive source results in fewer regulatory requirements. Published data indicate that the small differences in red cell permeability found between X- and gamma- irradiated components are not clinically significant. Further work, commissioned by the Joint Professional Advisory Committee of the UK Transfusion Services on blood components irradiated using the Raycell X-irradiator, concluded that gamma and X-irradiation can be regarded as equivalent and both are suitable and safe for clinical use.
Effective dose:
Studies using sensitive-limiting dilution assays indicate that a dose of 25 Gy, measured at the mid-plane of a component, completely abolishes mixed lymphocyte response.
The American Association of Blood Banks (AABB) recommends a dose of 25 Gy to the central area of the component with no portion receiving <15 Gy (AABB 2006). The Japanese Society of Blood Transfusion’s Guidelines recommend a similar dose. In the UK, a minimum of 25 Gy is recommended, but with the dose to any bag in the container not exceeding 50 Gy. To ensure this dose distribution is achieved, consultation with supporting physicists is mandatory.
Blood components that should be irradiated
Lymphocyte viability is retained in stored red cells for at least 3 weeks and TA-GvHD has been reported after transfusion of whole blood, red cells, platelets and granulocytes .TA-GvHD has not been described following transfusion of frozen deglycerolized red cells, which are thoroughly washed free of leucocytes after thawing.
TA-GvHD has not been described following transfusion of cryoprecipitate, fresh frozen plasma or fractionated plasma products, such as clotting factor concentrates, albumin and intravenous immunoglobulin
Donations from family members and HLA-selected donors.....
Because of the sharing of HLA haplotypes, donations from
Family members pose a particular risk of TA-GvHD. Red cells, granulocytes, platelets and fresh plasma have all been implicated in TA-GvHD after transfusion from family members (Agbaht et. al.,2007), and there is an increased risk with donations from both first and second-degree relatives.
Several cases of TA-GvHD have been reported from Japan, where limited diversity of HLA haplotypes in the population increases the chance of a transfusion recipient receiving blood from a HLA haploidentical or HLA-identical donor. These observations are of relevance for patients receiving HLA-selected platelet concentrates from non-family members because of alloimmune refractoriness to random donor platelets. This would be expected to increase the risk of TA-GvHD, especially if the platelet donor is homozygous for one of the recipient HLA-haplotypes (analogous to donations within families or within racial groups of limited genetic diversity). A case of TA-GvHD in an immunocompetent recipient following transfusion of blood components from an unrelated HLA homozygous donor was recently reported , and four more cases were reported from Turkey in immunocompetent recipients who had received non-irradiated blood from relatives. The risk from HLA-selected platelets where the donor is not homozygous is uncertain. However, many transfusion centres now specifically maintain panels of homozygous donors for refractory patients, and in practice it is probably more reliable to recommend irradiation of all HLA-selected platelets, rather than risk the misallocation of some donations
Red cells....
Red cells can be irradiated up to 14 days after collection and stored for at least a further 14 days without significant loss of viability. Irradiation may result in reduced post-transfusion red cell recovery after more prolonged storage, although recovery is still above the minimum acceptable 75%. Irradiation of red cells results in accelerated leakage of potassium and an increase in the level of extracellular potassium. 'Top-up’ transfusions given at standard flow rates do not constitute a risk of hyperkaliemia, even when given to premature neonates. Potassium load may be clinically important in rapid large-volume transfusions, such as neonatal exchange transfusion or intrauterine trans- fusion. Routine removal of supernatant plasma and washing of irradiated red cells is not considered necessary but, if this procedure is undertaken, the washed cells should be transfused as soon as possible, ideally within 3 to 4 hours.
Free haemoglobin levels are increased in stored irradiated red cell components,but remain within acceptable limits. Irradiation has no clinically significant effect on red cell pH, glucose consumption, ATP or 2,3 DPG levels.
Platelets
Irradiation below 50 Gy has not been shown to produce significant clinical changes in platelet function.
Granulocytes
The evidence for irradiation damage to granulocyte function is conflicting, but in any case granulocyte products should be transfused as soon as possible after irradiation.
Recommendation.....
Irradiated components not used for the intended recipient can safely be returned to stock to be used for recipients who do not require irradiated components. The reduction in shelf life must be observed.
Clinical indications of irradiated blood components.......
(a) Definite Indications
(b) Possible Indications
(c) No Indications
Nucleic acid Amplification Testing (NAT)
Nucleic acid Amplification Testing (NAT) is a molecular technique for screening blood donations to reduce the risk of transfusion transmitted infections in the recipients, thus providing an additional layer of blood safety. NAT is highly sensitive and specific for viral nucleic acids .It is based on amplification of targeted regions of viral ribonucleic acid (RNA) or deoxyribonucleic acid (DNA) and detects them earlier than the screening methods thus, narrowing the window period of HIV, HBV and HCV infections.
NAT has been in place in developed countries… USA, EUROPE since long, and has reduced the risk of all these infections by 95% to 53% as reported by various studies. NAT screening thus prove to be more beneficial where the seroprevalence of transfusion transmissible infectious agents is high, as is the case in most developing countries.
In India, mandatory blood screening for HBV, HIV and HCV is done by serological tests for HBsAg and antibodies to HIV 1/2 and HCV. The screened sero negative donations are still at risk for TTIs and thus, need for a sensitive screening test arises to decrease this residual risk which has been reduced significantly over the last tow to three decades in western countries where NAT has been implemented. NAT has been started in few centers in India (Life Blood Centre being the only one in Saurashtra), but it is not a mandatory screening test for TTIs as per drug and cosmetics act-1940. Major barriers in implementing routine NAT testing in India is its high cost and lack of technical expertise in most of the blood centers.
In India, various studies have been carried out, and NAT yield has been derived. NAT yield means a sample is nonreactive by regular screening methods (ELISA) but reactive by NAT. It has been shown by different studies, that NAT yield( NAT reactive but ELISA nonreactive) is 1 in 750 to 2972 donors tested.
NAT is a highly sensitive and advanced technique which has reduced period of HIV, HCV and HBV drastically as shown in the table. As basic quality assured blood transfusion system is already in place such as volunteer base for blood donation, provision of donor deferral, donor notification and counseling along with quality assured sensitive serological methods for testing TTIs, and at the same time looking to the high prevalence and incidence rate of infections in our country, time has come to implement NAT to transfuse the safest blood to the needy patients.
Technology focus :
"Continuous up-gradation has been the motto of Life Blood Centre . The latest technology and equipments made it possible for the cetnre to process the blood as per the highest international standards in blood banking.
Life Blood Centre, Rajkot, Gujarat, Western India is the first blood centre to adopt NAT Technology in Gujarat State.
National Accreditation Board for Hospitals & Healthcare Providers (NABH)
Blood Banks Data:
(* Data from www.data.gov.in)
Life Blood Centre (formerly known as Rajkot Voluntary Blood Bank & Research Centre – RVBB & RC)
Benefits of Accreditation
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