Aim: To determine frequency of alloimmunization and autoimmunization among the patient of thalassemia with history of multiple blood transfusions. Methods: This study was conducted by consecutive sampling in six months duration from September 2020 to August 2021 at the department of Hematology and blood Transfusion Medicine, of University of Child Health Sciences, The Children's Hospital Lahore. Any patient with a positive Direct antiglobulin test (DAT) was labeled as auto-immunized and a positive indirect antiglobulin test (IAT) was labeled as alloimmunized. Results: Total 90 cases were enrolled with 62% male and 38% females with a mean age 6.04 + 3.3 years (range of age: 7 months to 14 years). Antibody screening and auto-antibodies were positive in 4.4% (n= 4) cases each, and allo-antibodies in 6.7% (n=6) cases (anti-E in 2, anti-C in 2, anti-K and anti-e in 1 each). Among all these patients of beta thalassemia, spleen was enlarged in 71% cases; around half of these were <5 years old. Around 96% had first transfusion <2 years. The frequency of patients positive on DAT, IAT and on anti-body screening was significantly related to the frequency of blood transfusion Practical Implications: Autoantibodies produce a positive direct antiglobulin test (DAT), resulting in hyperhemolysis of red cells in thalassemic patients, which exacerbates the existing alloantibodies factor in children who have received several blood transfusions. The gap between transfusions will be shortened. Routinely, greater emphasis is placed on the identification of allo-antibodies, but auto-antibodies should also be evaluated so that this phenomena may be better understood and handled. This study was conducted to examine the link between a greater transfusion demand and the existence of auto or allo antibodies in Thalassemia patients. I Conclusion: We found Alloimmunization and autoimmunization together not very uncommon in transfusion dependent patients of Thalassemia. The frequency of transfusions is affected in co-existing states. Extended matching, as well as early diagnosis and control of Auto and allo-antibodies both can improve the efficacy of blood transfusion. Keywords: Autoantibodies, IAT, DAT, Coomb’s test, Thalassemia, Allo-immunization

Objective: To find diagnostic accuracy of increased total leucocyte count (TLC) and decreased absolute neutrophil count (ANC) for diagnosis of neonatal sepsis taking culture and sensitivity as gold standard.Methodology: Samples was collected from all the neonates with suspicion of sepsis admitted to neonatal due to severe bad health condition in the Children Hospital, Lahore. Parents were informed for consent. Total 3.5 cc sample was drawn by venipuncture.2.0 cc in CBC voil containing trisodium citrate, this sample was sent to CBC lab for automated CBC on sysmex KX-21 analyzer and peripheral smear. 1.5 cc was taken in specialized containers for blood culture and was sent to microbiology lab. Neonatal sepsis on TLC, ANC and blood count were be recorded. Patients of sepsis was managed as per hospital protocol. Data was analyzed using SPSS.Results: Neonates in this study was at mean age of 3.86±1.81 days. There was almost equal number of males and females neonates. Male were 155(51.7%) and female babies 145(48.3%). It was noted that 182(60.7%) babies were on term while 118(39.3%) were preterm neonates in this study. Neonatal sepsis was positive on TLC in 101(33.7%) cases. in 115(38.3%) on ANC.It was noted that sensitivity of the TLC was 71% while specificity was 66% with a diagnostic accuracy of 68%. On the other and, ANC sowed a sensitivity as 65%, specificity as 56% and diagnostic accuracy of 65%.Conclusion: Conclusively, TLC and ANC is not a good marker for the taking a neonate for the consideration of neonatal sepsis.

Objective: To Estimate the frequency of blood group discrepancies among Leukemia Children. Study Design: Cross Sectional study. Setting: University of Child Health Sciences, The Children Hospital Lahore. Period: October to January 2020. Material & Methods: This study was conducted among patients in CH and ICH Lahore, regarding ABO blood group discrepancies in leukemic patients, in the year 2019. A total of 200 samples were processed in order to detect ABO blood group discrepancies by tube method of blood grouping, using antisera-A, antisera-B, antisera-D for forward grouping and A-cells, B-cells and O-cells for reverse grouping. Auto-control was also run by reacting patient’s cell suspension with the patient’s own serum. The collected data were checked for its completeness, consistency and accuracy before analysis. Results: In this study, a total of 200 subjects were included out of which 122 (61%) were male patients and 78 (39 %) were female. Most common age group was 6-10 years. ALL 157(78.5%) and AML 43(21.5%). Blood group discrepancy was found in 5 (2.5%) and all were of Group I. Conclusion: The study found that leukemia (ALL, AML) results in ABO discrepancies that must be resolved by proper serological workup. Both forward and reverse grouping should be performed to investigate the correct ABO blood group in leukemic patients and accurately matched blood must be transfused to these patients.