Abstract Objective: To monitor the frequencies of different adverse transfusion reactions and to assess the compliance of clinical staff with the process of sending proper transfusion reaction workup within the specified time. Methods: The retrospective audit was conducted at the blood bank of Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised all transfusion reaction forms received from July 1, 2017, to June 30, 2018. The forms were analysed for type of blood component, time in which it was received by thw blood bank, whether or not the form was completely filled, whether or not all required samples were provided, and the type of reaction. Results: Of the 12,787 units dispensed and transfused, 50(0.39%) transfusion reactions were noted. Allergic was the most frequent type 24(48%). Red cells accounted for 38(76%) of the reactions. In 58(95%) cases, reaction forms were completely filled. Blood bags in 36(59%) and post-transfusion ethylenediaminetetraacetic acid samples in 35(57.3%) cases were received at blood bank within 2 hours of reaction. Conclusion: Incidence of transfusion reactions was found to be low as there was good compliance with procedures on the part of the clinical staff. Key Words: Transfusion reactions, Haemo-vigilance, Clinical audit.

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The term Kangaroo mother care (KMC) is derived from the practical similarities to marsupial care giving -mother acts as an incubator as kangaroo and put low birth infant vertically in between the chest. It is an effective way to meet baby's needs for warmth, breastfeeding, protection from infection, stimulation, safety and love. Objective: The general objectives were to see the implementation challenges and outcome of intermittent KMC at a secondary level district hospital. The specific objectives were to observe the nature of family participation, practice pattern of intermittent KMC, length of hospital stay, effect on weight gain, mortality and problem experienced by the newborns and mothers/caregivers during KMC practice. Materials & Methods: This was an observational study for three months at 250 Bedded District Hospital, Moulvibazar, Bangladesh involving 50 preterm (gestational age <37 week) & low birth weight (<2000 g) newborns and their mothers/caregivers. Participants were included and KMC was initiated in stable newborns according to the national KMC guideline. Information related to the study objectives were obtained from examination and interview and the findings were recorded during the hospital stay and follow up visits in a pre-structured data collection sheet. Results: Among the studied newborns male female ratio was 1.5:1 and 32 (64%) were out born (delivered at home or any other hospitals). The mean postnatal age at the time of admission was 57.90 h, at the time of initiation of KMC was 115.38 h and at discharge was 227 h. So, there was mean delay of 66 h from admission to initiation of KMC and in 47(94%) newborns. Mostly, the delay was due to absence of mothers or eligible caregivers and unstable clinical condition of the newborns. The mean weight at admission and discharge was 1625.80 g and 1520.60 g respectively. Among the family members, mother practiced KMC in 45(90%) [n=50] followed by grandmother 28 (56%). KMC was practiced in 44 (88%) newborns in the evening shift followed by 43 (86%) & 27(54%) in the night & morning shifts respectively. The mean duration of KMC was 2.58 h in the night shift followed by 2.46 h & 2.46 h in the evening & morning shifts respectively. The mean hospital stay was 109.95 h. Total 32 studied newborns completed up to 3 rd follow up after discharge among which 5(15.62%) did not gain weight, 6(18.75%) gained weight at 1st follow up (7th day of age), 14(43.75%) at 2nd follow up (15 th day of age) & 7(21.87%) at 3 rd follow up (30th day of age). The total mortality was 6(12%). Most of the newborns and mothers/caregivers experienced no problem during KMC practice. Conclusion & recommendation: Family motivation and participation is a key to standard KMC practice. Constant supervision and follow up home visit involving community health personnel until the neonatal age is completed constitute the most important aspect for implementing KMC effectively and reducing the mortality.