ACSLM Transfusion Transplantation Advisory Body Graduate Webinar

Wednesday, 8th November 2023, 1PM Zoom.

Chair: Mr Fabian Mc Grath, Lecturer in Transfusion Science, TU Dublin - City Campus 

''Evaluating the Use of Chloroquine Diphosphate and Polyethylene Glycol in reference serology''        
Sarah Fagan. TUDublin/IBTS

BIO:
Sarah graduated from Technological University Dublin in 2023 with First Class Honours in Medical Science. In final year, Sarah majored in Blood Transfusion and Biochemistry, with a minor in Immunology. She completed her thesis, "Evaluating the Use of Chloroquine Diphosphate & Polyethylene Glycol in Reference Serology", with the Irish Blood Transfusion Service. Sarah is currently working as a Medical Scientist in the Blood Transfusion Laboratory in the National Maternity Hospital.

Abstract: 
Serological testing is a vital part of pre-transfusion investigation to ensure the safe provision of blood to patients. This study focused on the effect of Chloroquine Diphosphate (CDP) on Direct Antiglobulin Test (DAT) positive red blood cells (RBCs). CDP removes IgG antibodies bound to the RBC membrane by breaking the disulphide bond that exists between the antigen and antibody. As a result, phenotyping can be performed. In addition, this study also reviewed Polyethylene Glycol (PEG) and its ability to enhance weak antibody reactions.                                                                                                                                           
Materials & Methods: For CDP testing, 80 known positive DAT samples with IgG antibody were treated with CDP and incubated at 37°C for 10-20 minutes. Furthermore, DAT positive samples were also tested at room temperature for 30 minutes and in an 18°C water bath for 10-30 minutes.  Also, eluate samples were sent for IgG subclass investigation to a reference laboratory. For PEG, a comparative analysis was performed between PEG-Indirect Antiglobulin Test (IAT) and Low Ionic Strength Saline (LISS)-IAT using 80 samples containing clinically significant antibodies.     
Results: After treatment of the RBCs with CDP, 50% of DAT positive samples were negative after incubation at 37°C for 10-20 minutes. CDP-treated RBCs incubated at room temperature achieved similar results at 37°C. DAT results incubated at 18°C showed discrepancy when compared to 37°C DAT results. One sample was classified as IgG4, the remaining samples were unsuccessful. When comparing PEG-IAT to LISS-IAT results, 67.5% of the antibody reactions were found to be weaker in LISS but stronger in PEG. Out of the 80 samples, 28.75% of the samples reacted the same in both PEG and LISS
Conclusion: CDP was successful in achieving negative DATs. PEG was also successful in potentiating weak antibody reactions.

''Haematology Reference Ranges During Pregnancy and an Investigation into the Threshold Haemoglobin for Post-Partum Blood Transfusion in the South of Ireland.'' 
Emma Kelly MTU/UCC

Bio:
Emma graduated from UCC/MTU in 2023 with a BSc in Biomedical Science. Currently, she is a student medical scientist at University Hospital Limerick. Her final year project used data from hospitals in the South of Ireland, including Cork University Hospital (CUH), University Hospital Limerick (UHL), and University Hospital Kerry (UHK).

 Abstract:
This study was a retrospective analysis of indirect data collected via APEX examining haematology parameters for the different trimesters of pregnancy in the South of Ireland. A total of 601 pregnancies from March 2022 to March 2023 were investigated. Of these, 406 were from Cork University Maternity Hospital (CUMH), 94 from University Hospital Kerry (UHK), and 101 from University Hospital Limerick (UHL). A transfusion study consisting of 63 post-partum haemorrhage patients was conducted to determine the threshold haemoglobin for blood transfusion.
Different data collection methods such as APEX, Cognos and Millennium were used, along with several statistical tests for normality and reference range development. Haematology parameters included: haemoglobin, neutrophils, platelets, ferritin and B12.
This study found that the platelet reference ranges for this population in the South of Ireland were lower than those of the currently used reference ranges. The ferritin in this population is significantly low, with 85% of pregnancies being iron deficient in the third trimester. A transfusion rate of 4.6% was developed, higher than quoted rates in similar populations.

''The Challenges Associated with Providing a Haemoglobinopathy Service in a Large Tertiary Hospital''

Kate Murphy TUDublin/St James/ IBTS

Bio:
Kate is a 2023 graduate from the BSc in Medical Science from TU Dublin and is currently working as a Medical Scientist in the Blood Transfusion laboratory in St. James’s Hospital. Kate specialised in Transfusion Science and Medical Microbiology in final year. She was delighted to complete her final year thesis in the Blood Transfusion and Haemovigilance department in St. James’s. My thesis focused on the growth of the National Adult Haemoglobinopathy Service which is housed in St. James’s Hospital.

Abstract:
Sickle Cell Disease (SCD) and Thalassaemia are both genetically inherited haemoglobin disorders commonly referred to as haemoglobinopathies. SCD is one of the most prominent inherited genetic disorders worldwide. Patients with severe manifestations of these disorders may require lifelong red cell transfusions to prevent and treat complications such as stroke, acute chest syndrome and anaemia. The number of patients with a haemoglobinopathy in Ireland has increased rapidly over the last number of years. The National Adult Haemoglobinopathy Service was established in St. James’s Hospital (SJH) in 2016.
This project aimed to determine the impact the introduction of the Haemoglobinopathy Service to SJH has had on levels of red cell usage in the hospital. This was achieved by completing a retrospective audit of red cell usage in SJH over an eight year period (January 2015 – December 2022). To highlight challenges faced by the lab and national blood centre in providing suitable blood for this patient cohort, data on the red cell antigen genotype/phenotype of haemoglobinopathy patients who received ≥1 red cell transfusion during the audit period was also collected using the Laboratory Information System (LIS) and Electronic Patient Record (EPR).
Analysis of the data collected showed that the haemoglobinopathy service’s level of red cell usage increased from 172 units in 2015 to 3608 units in 2022. The number of patients transfused by the haemoglobinopathy service increased five fold over the eight year audit period. Inherent differences were observed in red cell antigen expression between the Irish donor population and the haemoglobinopathy patients.