OVERVIEW OF DEPARTMENT OF TRANSFUSION MEDICINE (BLOOD BANK), TRANSPLANT IMMUNOLOGY & MOLECULAR BIOLOGY AT THE INDRAPRASTHA APOLLO HOSPITALS (IAH), NEW DELHI

For any information kindly contact :
Blood Bank: 011-29872011, 011-29872015
Transplant & Molecular Biology: 011-29872022, 011-29872072

DEPARTMENT OF TRANSFUSION MEDICINE

Blood Transfusion Services (BTS) is the vital part of modern health care system without which efficient medical care is impossible. It is a complex organization requiring careful designing and management.

The aim of a Blood Transfusion Service (BTS) is to provide effective blood and blood products, which are as safe as possible, and adequate to meet the patients need.

Salient Features of the Department:

Receives the donors for blood donation with a warm welcome and act as a bridge between the hospital staff and the technical staff of the blood bank. Donor screening is done by well trained staff, while Donor privacy and confidentiality is maintained at all times. Pretest counseling to defer high risk donors is undertaken. Blood bags with pre storage leukoreduction filter are used that provide 3-4 log Leukoreduced blood. The advantages of leucoreduction include: Prevention of Febrile Non Hemolytic Transfusion Reactions (FNHTR) Prevention of HLA allo-immunization Reduction in transmission of lymphotropic viruses such as EBV, CMV and HTLV-I & II. Prevention of immunomodulation The bags also contain a sample pouch which diverts first 15-30 ml of blood that is used for testing. This has significantly reduced bacterial contamination of blood products. The Blood component preparation Laboratory is a state of the art laboratory that is well equipped with latest instruments. The sterile connecting device has made it possible for us to provide blood components in parts for fulfilling pediatric transfusion requirements. The various components prepared in our laboratory include : Leukoreduced Packed Red Cells (3-4 log leukoreduction) Random Donor Platelets and Fresh Frozen Plasma Cryoprecipitate AHG poor plasma Washed RBCs Irradiated RBCs The Immunohaematology laboratory is a reference centre providing advanced Immunohaematology work-ups, not only for in-house patients but also to patients from other hospitals. Our laboratory is equipped with the fully automated platform �Galileo� from Immucor� for Immunohaematology work up of donors & patients. Besides the fully automated system, the laboratory also utilizes the gel technology by DIAMED. Tests performed at our laboratory include: Donor : Blood grouping (ABO & Rh), Rh phenotyping and Immune antibody screening Patients: Grouping, antibody screening, antibody identification and extended antigen typing if required. Cross matching Advanced work up such as auto/alloadsorption & elution for solving of difficult cases. Direct & Indirect Antiglobulin tests Coomb�s titre The Infectious marker laboratory, besides the five mandatory tests also performs testing of hepatitis B core antibody on all the donated blood units and the units that are found positive are discarded. The ELISA based tests are performed on a fully automated walk away system �EVOLIS�. Latest third/fourth generation kits are used for testing. The laboratory also undertakes Western Blot testing for both donors and patients who are found positive for HIV by ELISA.

TRAINING MODULE
The Department has an active training program for the:

DNB- TRANSFUSION MEDICINE

Primary: 3 yrs Secondary candidates: 2 yrs (Post Diploma)

BIOTECHNOLOGY STUDENTS: minimum of 6 months: Basic assessment would be done in the Department and students would be selected on the basis of their performance and merit

CALL FOR PRIMARY AND SECONDARY DNB STUDENTS IN TRANSFUSION MEDICINE: All the interested students should submit their applications at the earliest to Dr Col Sharma: Medical Advisor, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi.

Individual Donor (ID)-NAT testing based on Transcription Mediated Amplification by Procleix Ultrio Assay is done on all the donated blood units. This has reduced the window period of HIV-I, HBV & HCV considerably and is a step forward in our quest for �zero risk� blood.

The Apheresis laboratory is functional 24 hours, all days. It is equipped with fully automated cell separators which are flexible to produce various components. The various procedures undertaken include: Plateletpheresis Plasmapheresis Granulocytapheresis Besides these the department also performs special procedures such as: Therapeutic Plasma Exchange PBSC collection : Autologous and Allogenic Red Cell Exchange

The Department has initiated an in-house voluntary blood donation program wherein a list of hospital employees willing to donate voluntarily is maintained. This also includes donors with rare blood groups who can be called at the Eleventh hour for blood donation. These Voluntary Blood Donors play a pivotal role in maintaining safe and adequate blood supply that forms the backbone of any Blood Transfusion Service.

The Department also maintains the registration of Voluntary Blood Donors who are willing to donate blood at the IAH. These Voluntary Blood Donors are encouraged to become regular repeat remunerated Voluntary blood donors instead of just one time voluntary blood donors.

Voluntary donors at our hospital are also provided with certain special incentives. As per the departmental policy that all donors who have donated 4 times in a year or at least in 2 years are entitled for an Executive Apollo Health Check up. This is to ensure that our voluntary donors remain in good health at all times.

The Department of Transfusion Medicine at Indraprastha Apollo Hospitals, New Delhi is catering to the transfusion needs of approximately 60 Thalassemic patients. We are providing NAT tested, 3 to 4 log leukoreduced blood for these patients.

In addition we perform regular screening for any irregular red cell antibodies and the extended blood group phenotyping of these patients, helping us in providing the safest possible blood for them.

During the past decade the pace of discovery, invention and innovation in Genetics has accelerated dramatically, more so in the Molecular Genetics arena.

The Apollo Group, in line with its commitment of providing �world class services �second to none�, not only has a cutting edge technology in the Genetic services but also has an equally highly committed human resource comprising of skilled doctors and Scientists to man these services.

Molecular Diagnostics has increased our understanding of oncology and we are no longer treating cancer patients empirically but are able to assist the oncologist in prognosis as well as finding �Minimal Residual Disease�.

Today Molecular diagnostics has reached a stage where it also plays a significant role in investigating recurrent abortions, genetic anomalies and HLA tissue typing for Organ transplantation, both solid organ and Bone Marrow transplants.

SERVICES PROVIDED BY IMMUNOLOGY & MOLECULAR BIOLOGY AT INDRPRASTHA APOLLO HOSPITALS, NEW DELHI

Prenatal & Postnatal Diagnosis Chromosomal Analysis (GTG Banding) - Abortus Material (Product of Conception) Amniotic Fluid -FISH Ploidy for Chromosome 21,18,13,X and Y( 5 probes analysis) Amniotic Fluid -Karyotyping-GTG banding CVS cell culture for routine karyotyping CVS-Complete Chromosomal Analysis (Karyotyping GTG Banding+ Ploidy analysis for Chromosome 21,18,13,X and Y by FISH CVS-FISH Ploidy for Chromosome 21,18,13,X and Y( 5 probes analysis) Cytogenetics Stress Cytogenetics for Aplastic Anaemia Chromosomal Analysis (GTG Banding) -Peripheral Blood Chromosomal Analysis (GTG Banding) -Bone Marrow Couple Karyotype from peripheral blood samples Fluorescence in situ Hybridization (FISH) for Hematological malignancies FISH FOR 1q25,LSI19q13/LSI19p13 Her 2 Neu Gene Amplification by FISH with on Paraffin Embedded tissue Sections FISH FOR CEP XY (MRD ASSESSMENT) for Bone marrow transplant assessment AML FISH panel FISH FOR ALL PANEL (ANY 3 FISH PROBES) TEL/AML, MLL, t(9;22), INV 16 FISH for CLL panel FISH for AML panel FISH FOR CEP-12 AML1/ETO t(8;21) translocation (FISH) FISH FOR CML patients LSI BCR/ABL t(9;22) f N-myc FISH for neuroblastoma FISH FOR LSI D7S486(7q31)CEP-7q LSI 1p36/LSI FISH for MDS PANEL del(5q), del (7q) FISH FOR MULTIPLE MYLEMOMA t(11;14), t(14;18), 13q(del), p53(17p13) HLA typing for Kidney, Liver and Bone Marrow Transplant HLA CLASS -I A,B,C / PCR-SSP/SSOP HLA CLASS-II DQ/DR/PCR-SSP/SSOP HLA LYMPHOCYTE CROSSMATCH&HLA TYPING(DONOR&PATIENT) HLA LYMPOCYTE CROSS MATCH NIH METHODS BONE MARROW TRANSPLANT HLA TYPING HLA B-27, HLA B-51, HLA B-17, HLA-B 15 (SSP- PCR) PANEL REACTIVE ANTIBODY TEST DONOR SPECIFIC ANTIBODY TEST Infectious marker Screening HBV- Quantification(PCR) HBV-Qualitative(PCR) HCV-Quantitative(PCR) HCV- Qualitative(PCR) HCV genotype HIV-Viral Load MRD ASSEMENT( Q-RT-PCR FOR BCR-ABL GENE) HIV Proviral DNA HIV Genotypic Drug Resistance Molecular Genetics BETA Thallasemia - 5 COMMON MUTATIONS - CHILD & PARENTS THAL - MUTATIONS + XMN POLYMORPHISM THALASSEMIA - (8) UNCOMMON MUTATIONS THALASSEMIA - 2nd PRENATAL DIAGNOSIS THALASSEMIA - ALPHA - DELETIONS (3.7 & 4.2 KB) THALASSEMIA - ALPHA,BETA & GAMMA GENE ANALYSIS THALASSEMIA - PRENATAL DIAGNOSIS THROMBOPHILIA PROFILE(FAC V+MTHFR+PROTHROMBIM GENE

PREREQUISTES FOR HLA Typing SAMPLE: Prior appointment in advance is required. Recent photograph of the donor and patient affixed on the form should be duly attested by the treating Physician. The form should be filled appropriately and Thumb Impression/Signature of the donor and the patient should be taken. The sample would be collected in the presence of Consultant, Transplant Immunology and Molecular Biology in Apollo Hospital.

SAMPLE: Patient and Donor Blood sample in 2 EDTA vial.

Turn around Time (TAT): 3 day

PREREQUISTES FOR HLA B 27, HLA B5 ,B51, HLA B15 HLA B17 SAMPLE
SAMPLE: Patient Blood sample in 2 EDTA vial.

Turn around Time (TAT): 5 days

PREREQUISTES FOR BLOOD/BONE MARROWSAMPLE for KARYOTYPING
The blood/bone marrow sample needs to be sent in a heparin vial (3-4 ml sample) along with the patients� clinical history and diagnosis

Turn around Time (TAT): 10 days

PREREQUISTES FOR AMNIOTIC FLUID/PLACENTA/POC for KARYOTYPING
AMNIOTIC FLUID: 15 ml in Falcon Tube

PLACENTA/POC: 5 ml in RPMI media in Sterile Container

CVS: 25-50 mg CVS tissue in RPMI media in sterile container

TAT: 3-4 weeks

PREREQUISTES FOR COUPLE KARYOTYPING FOR RECURRENT ABORTIONS
2 heparin vials of the Couple: 4 ml each

Turn around Time (TAT): 10 days

PREREQUISTES FOR CHROMOSOME BREAKAGE STUDIES
2 Heparin Vials: 3-4 ml

Turn around Time (TAT): 2 weeks

PREREQUISTES FOR FISH
Leukemia/Genetic disorder: Blood/ Bone Marrow sample in heparin vial (3-4 ml)

For Prenatal Cases:
Amniotic Fluid approx 10 ml

Chorionic Villous Sample/Products Of Conception/ Placenta sample: 25-50 mg in RPMI

Turn around Time (TAT): 4-5 days

PREREQUISTES FOR FISH-HER2 NEu
Biopsy Paraffin Block / Polylysine coated tissue slides with 1 H& E slide

Turn around Time (TAT): 7 days after receiving the slides

PREREQUISTES FOR INFECTIOUS MARKER TESTING:
For HIV sample consent form duly signed by the primary physician and patient is required

2 EDTA vials

Turn around Time (TAT): 1 week

FACULTY

Dr. RN MAKROO
MBBS, DIBT, MD ( PATHOLOGY )
Director,
Department of Transfusion Medicine, Molecular Biology & Immunology lab
Indraprastha Apollo Hospitals, Sarita Vihar New Delhi
Ph. No.: +91-9810170969
Email:makroo@apollohospitals.com

Dr. MOHIT CHOWDHRY
MBBS, MD (PATHOLOGY)
Associate Consultant
Department of Transfusion Medicine, Molecular biology & Immunology lab
Indraprastha Apollo Hospitals, Sarita Vihar New Delhi
Ph. No.: +91-9650256131
Email: mohit_c@apollohospitals.com

Dr. AAKANKSHA SAINI BHATIA
MBBS, DNB (PATHOLOGY)
Registrar
Department of Transfusion Medicine,
Indraprastha Apollo Hospitals, New Delhi
Ph. No.: +91-9871989807

Dr. ASHISH FAUZDAR
M.Sc (Microbiology), Ph.D. (Reproductive Genetics)
Molecular Biologist
Department of Transfusion Medicine, Molecular biology & Immunology lab
Indraprastha Apollo Hospitals, New Delhi
Ph. No.: +91-99539951623