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This study aims at examining the clinical impact, of antibodies detected on an ELISA mixed antigen tray format (LATM, One Lambda) in the absence of complement dependent cytotoxicity (CDC) positivity. All patients who underwent renal transplantation in 2007 and 2008 had their final pre-transplant sera retrospectively analyzed by the LATM assay. These patients were then followed-up with clinical, biochemical, and histopathological end points defined by elevation of serum creatinine and/or histopathological criteria. Among 164 patients who were studied, 149 received grafts from live related donors and 15, from deceased donors. 31 (19%) of the transplanted patients demonstrated pre-transplant anti-HLA IgG antibodies on the assay. Totally, 15 were positive for class I antibodies, 4 for class II antibodies, and 12 for both class I and class II antibodies. 44 patients (36%) experienced rejection. 8 out of 31 (26%) ELISA positive patients and 36 out of 133 (27%) ELISA negative patients experienced rejection. Among 15 patients who received deceased donor transplants, 4 were positive for ELISA, and 11 were negative. All 4 (100%) of the ELISA positive patients experienced rejection as compared to 3 out of 11 (27%) ELISA negative patients (P = 0.01). The ELISA LATM assay did not show any predictive value for rejection in our overall patient population; however, results in the specific setting of deceased donor transplants merit further exploration.

Transfusion services all over the world are constantly trying to improve blood safety and to reduce the residual risk of transfusion-transmissible infections (TTI). Current mandatory tests to detect TTI in India include testing for human immunodeficiency virus 1 and 2 antibodies, hepatitis B surface antigen (HBsAg), hepatitis C virus antibodies, syphilis, and malaria. Studies from Europe and America suggest that the addition of nucleic acid testing (NAT) will increase the detection rate of the transmissible viral infections, thereby increasing safety of blood transfusion [1][2][3][4][5][6]. In India, NAT is not mandatory although several major blood banks have already included this in their screening profile.The article by Sodhi et al. [7] in this issue of the Journal highlights this question. Six percent of their 150 patients who had multiple transfusions developed evidence of hepatitis B virus infection, with seven of the nine patients developing clinical viral hepatitis. The authors showed that testing stored serum samples from the blood donor for antihepatitis B core (HBc) antibody and HBV DNA quantitation by realtime polymerase chain reaction (PCR) detected HBV infection in six of the nine donors. HBV DNA was detected in four of them; the two others having only IgG anti-HBc. In the other three patients, they concluded that the source of hepatitis B infection was other than the transfusion. The prevalence of HBsAg in healthy blood donors, as reported in their paper was 0.56 %.Sensitivity and specificity of the currently used fourthgeneration enzyme-linked immunosorbent assays are much better than the earlier versions but it is clear that they fail to detect donors in the window period and with occult infections without detectable levels of circulating HBsAg. It has been suggested that the addition of anti-HBc testing may be a costeffective strategy, though there have been reports of occult infection in anti-HBc-negative individuals. Therefore, without NAT testing, the addition of anti-HBc as a routine practice would only lead to a higher rate of discard of blood units as the rate of anti-HBc positivity in blood donors is 10 %-20 % [8].There are excellent research studies and detailed reviews [1-6] from Europe and America which clearly showed that the addition of NAT increased the rate of detection of viral infections in potential donors. NAT is now mandatory in screening potential donors in many of these countries. From India, a detailed multicentre evaluation of NAT was published in 2008 involving eight large blood banks from metropolitan centers [9]. It was reported that eight additional infected donors were detected out of a total 12,224 samples. The highest yield was for HBV infection (6/8) [9]. There are a few other reports from India [10][11][12][13][14][15] which also show that the addition of tests to detect nucleic acids (NAT or PCR) increased the yield of donors who are hepatitis B positive. In China and Taiwan, with a high endemicity of hepatitis B, the addition of NAT increased the detection of o...

Background: Corona Virus Disease 2019 (COVID19) is a global pandemic, the outbreak of which started in China in December 2019. Apart from the clinical symptoms and pulmonary computed tomography (CT) findings, several laboratory biomarkers also play an important role in management of these patients so that immediate attention can be given to those with severe disease and critical illness. In this study we tried to find the association of various laboratory biomarkers in COVID-19 patients, analyzed around the time of admission, with the severity of the disease and outcome. Methods: In this study 1048 COVID19 positive cases admitted in our hospital during the study period from April 2020 to October 2020 were included. The cases were clinically assessed based on the severity of the disease at the time of presentation and during the course in hospital and categorized into 3 categories as Mild, Moderate and Severe according to our hospital protocol for management of COVID 19 patients. The clinical and laboratory data were retrieved from electronic medical records. The levels of various laboratory parameters at/around the time of admission were compared with clinical categories, severity and outcome of the disease. Result: We found a statistically significant association of severity and outcome of COVID-19 with various laboratory parameters. There were significantly higher levels of D-dimer, LDH, CK, CRP, Sr Ferritin, cTnI, NT pro BNP, PCT, IL-6 and lower ALC in non survivors compared to survivors and in severe disease compared to mild disease with a p value of <0.05. Conclusion: In this study we propose that along with the initial clinical assessment, age and concurrent co-morbidities of COVID-19 patients which determine the need for their admission to ICUs, the initial assessment of several laboratory parameters is helpful in triaging the patients who need intensive care so that proper allocation of resources can be done.

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