BackgroundABO-incompatible live donor liver transplant (ABOi-LDLT) is being widely done to bridge the gap of demand and supply of organs. Different desensitization regimes are being used to reduce titer of blood group antibodies for successful transplant and accommodation of graft. The authors used cascade plasmapheresis (CP) to bring down titer of naturally occurring blood group antibody to 16 or lower.Material and methodsFour recipients of ABOi-LDLT were of blood groups O, O, B, and B while donors were of blood groups B, A, AB, and AB, respectively. Desensitization protocol included immunosuppressive drugs and plasmapheresis. CP consisted of separating patient’s plasma as the first step and passing it through pore size based filter column as the second step. The first step was performed using disposable kit (PL1, Fresenius Kabi, Germany) with minor modification on apheresis equipment COM.TEC (Fresenius Kabi, Germany). Pore size based filter column used was 2A column (Evaflux, Kawasumi Laboratories, Japan). Blood group antibody titer (immunoglobulin G (IgG)) was done by column agglutination technology (Ortho-Clinical Diagnostics).ResultsCases 1, 2, 3, and 4 with pre-CP titer of 1,024, 512, 32, and 64 required four, three, one, and one CP procedures, respectively. No signs of antibody-mediated rejection were exhibited on histopathological evaluation by any of the patients. Successful organ engraftment occurred as documented by post-operative liver function tests and liver biopsy.ConclusionCascade plasmapheresis offers a cost-effective and efficient way to decrease blood group antibody titer and helps in successful transplant.

Ret-He can be used as a routine screening test to detect LID in blood donors. This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation.

Indications for therapeutic apheresis (TA) are dynamic; they keep changing and expanding because of introduction of newer treatment modalities and accumulating evidence in the form of case-reports, case-series and original articles. We evaluated our therapeutic plasmapheresis (TP) data and compared this data with an earlier published Indian report for indications, frequency, response rate and adverse reactions. We conducted a retrospective analysis of all TP procedures performed from January 2014 to June 2016 in department of Transfusion Medicine at a tertiary care hospital. All TP procedures performed for various clinical disorders including neurological, hematological, renal, hepatic and rheumatologic indications were included in the study. Analysis was performed with respect to demography, procedure details and response. 187 patients (118 Males and 69 females) underwent 683 TP procedures during study period. According to 2013 ASFA guidelines, 99, 59 and 29 patients belonged to category I, II and III respectively. In comparison with the earlier report, the number of patients and procedures have increased, indications have changed, response rate is comparable, and the frequency of adverse reactions have decreased. In the last decade there has been increase in number and spectrum of indications for therapeutic apheresis and frequency of procedures. The response rate and safety of these procedures have also improved.

CME intervention, based on the 2010 edition of ASFA guidelines for therapeutic apheresis appears to have had a positive impact on physicians TA practices.

Background Many centres provide D-mismatched platelet transfusions. Platelet concentrates may contain enough red cells leading to the formation of anti-D antibody in D-negative recipient. In resource-poor settings, random donor platelet concentrate (RDPC) is used often and carries higher risk of alloimmunization. At our institution, platelets are transfused across the ABO and Rh blood group barrier without any RhIG immunoprophylaxis. In this study, we retrospectively appraised alloimmunization after D-positive platelet transfusion in D-negative patients. Materials and MethodsSingle-centre 5-year data were collected from Hospital Information System (HIS) for D-negative patients who received D-positive platelet transfusions. Naive patients who had neither pre-existing antibody nor received D-positive platelet transfusion before admission were included. Those who had repeat antibody screening at least 28 days after D-positive platelet transfusion were considered.Results A total of 332 D-negative patients who received 1996 D-positive platelet transfusions were analysed. Median follow-up was 7 weeks (range = 4-90). Anti-D was detected in three (0Á9%) D-negative patients at 5, 8 and 24 weeks after receiving D-positive platelet transfusions. Two of these patients received RDPCs and one received both RDPCs and single donor platelet concentrates.Conclusion D-positive platelet transfusion to D-negative patients seems an acceptable practice as only 0Á9% patients developed anti-D antibody.