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Article: Surgical management of endometriosis in a severe Hemophilia A female patient and the role of transfusion medicine specialist: A case report with review of literature.

Pinki, Sanooja / Mohan, Ganesh / Venugopal, Divya / Innah, Susheela J

2021 Volume 15, Issue 2, Page(s) 237–240

Abstract: Hemophilia A is an X-linked recessive bleeding disorder occurs due to deficiency of factor VIII (FVIII). The disease manifests exclusively in males though it rarely occurs in females due to complex pathophysiological mechanisms. We present a rare case of ...

Abstract	Hemophilia A is an X-linked recessive bleeding disorder occurs due to deficiency of factor VIII (FVIII). The disease manifests exclusively in males though it rarely occurs in females due to complex pathophysiological mechanisms. We present a rare case of female hemophilia due to skewed X-inactivation which adversely affected the quality of patient life. She presented with recurrent abdominal pain and was diagnosed with severe endometriosis and underwent total abdominal hysterectomy with left salpingo-oophorectomy and appendicectomy. She was infused recombinant factor VIII both prophylactically and postoperatively as per the World Federation of Hemophilia guidelines. Recombinant Factor VIII was supplemented every 12
Language	English
Publishing date	2021-11-01
Publishing country	India
Document type	Case Reports
ZDB-ID	2267310-6
ISSN	1998-3565 ; 0973-6247
ISSN (online)	1998-3565
ISSN	0973-6247
DOI	10.4103/ajts.ajts_6_21
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Article: Comparison of platelet indices in dengue fever patients based on platelet transfusion: A prospective observational study in a tertiary care center.

Asha, J / Baiju, Nithya M / Innah, Susheela J / Rafi, Aboobacker / John, Bins M

Asian journal of transfusion science

2022 Volume 17, Issue 1, Page(s) 21–27

Abstract: Context: Dengue fever is the most prevalent mosquito-borne viral disease in humans. Platelet indices (PIs) are given by the cell counters but are often not reported which is possibly due to under-recognition of the utility of these parameters.: Aims: ...

Abstract	Context: Dengue fever is the most prevalent mosquito-borne viral disease in humans. Platelet indices (PIs) are given by the cell counters but are often not reported which is possibly due to under-recognition of the utility of these parameters. Aims: This study aimed to compare PIs in patients with dengue fever to assess their role in the outcome such as hospital stay and platelet transfusion requirements. Settings and design: Prospective observational study in a tertiary care center, Thrissur, Kerala. Subjects and methods: A group of 250 dengue patients was studied over a period of 18 months. The platelet parameters (platelet count, mean platelet volume [MPV], platelet distribution width [PDW], platelet large cell ratio [PLCR], plateletcrit [PCT] and immature platelet fraction [IPF]) were measured with Sysmex XN-1000 and followed up every 24 h. The clinical features, duration of hospital stay and platelet transfusion requirements details were collected. Statistical analysis used: Independent Results: A total of sample size was 250. The study showed normal PDW and MPV, low platelet count and PCT, and high PLCR and IPF in dengue patients. There were significant differences in PIs (lower platelet count and PCT, higher MPV, PDW, PLCR, and IPF) in comparison between dengue patients based on platelet transfusion. Conclusions: PIs may act as a predictive tool in the diagnosis and predicting outcomes in dengue fever. Low platelet count and PCT, high PDW, MPV, PLCR, and IPF in transfused dengue patients were found to be statistically significant. Clinicians need to be sensitized about the utility and limitations of these indices and rationalize the need for red cell and platelet transfusions in dengue.
Language	English
Publishing date	2022-12-12
Publishing country	India
Document type	Journal Article
ZDB-ID	2267310-6
ISSN	1998-3565 ; 0973-6247
ISSN (online)	1998-3565
ISSN	0973-6247
DOI	10.4103/ajts.AJTS_24_20
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Article: Successful management of Methemoglobinemia and G6PD deficiency in a patient posted for surgical excision of branchial cyst.

Arun, V J / Deorukhkar, Anuradha / Rafi, Aboobacker Mohamed / Charles, Deepak / Devendra, Rati / Innah, Susheela J / Kedar, Prabhakar

Asian journal of transfusion science

2022 Volume 16, Issue 1, Page(s) 128–131

Abstract: A 27-year-old female patient who came for branchial cyst excision was found to have cyanosis and a saturation gap during preanesthetic check-up and hence she was referred to haematology for further workup. She had a Hb of 9 gm% with all other baseline ... ...

Abstract	A 27-year-old female patient who came for branchial cyst excision was found to have cyanosis and a saturation gap during preanesthetic check-up and hence she was referred to haematology for further workup. She had a Hb of 9 gm% with all other baseline tests as normal. Blood samples were sent for methaemoglobin estimation and related work up to the National Institute of Immunohematology (NIIH) Mumbai. She was diagnosed as a case of Methemoglobinemia with a methaemoglobin level of 68.7% with NADH cytochrome B5 reductase activity of 10.82 IU/g Hb. The drug of choice for treatment is Methylene blue and hence G6PD deficiency had to be ruled out prior to initiating therapy. She was found to have a concurrent existence of G6PD deficiency. The blood sample was further sent to NIIH for genetic confirmation. We avoided methylene blue and other precipitating factors that could trigger a haemolysis. She was further consulted by the Patient blood management team to optimize her erythropoiesis and avoid unnecessary transfusions. Anaesthetic consultation and planning were done to avoid drugs that could induce haemolysis. She was started on Vitamin C, Niacin, hematinic and advised to follow up after a month. She was symptomatically better. Cyanosis had reduced, and Hb improved to 12 gm%. She was taken up for surgery with all precautions. The surgery and the post-operative period were uneventful. She was discharged on postoperative day 4 with an advice to continue Vitamin C & Niacin and to follow-up in Haematology OPD after a month.
Language	English
Publishing date	2022-05-26
Publishing country	India
Document type	Case Reports
ZDB-ID	2267310-6
ISSN	1998-3565 ; 0973-6247
ISSN (online)	1998-3565
ISSN	0973-6247
DOI	10.4103/ajts.ajts_152_20
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Article ; Online: Real-World Effectiveness of COVID-19 Vaccine and Identification of SARS-CoV-2 Variants among People Living with HIV on Highly Active Antiretroviral Therapy in Central Kerala of India-An Ambi-Directional Cohort Study.

Thomas, Joe / Rajmohan, Priyanka / Jose, Ponnu / Kannan, Radhika / Jose, Rosmi / Uttumadathil Gopinathan, Unnikrishnan / Raphael, Lucy / Baiju, Nithya M / Krishna, Swathi / Attokaran, Teny / Bency A T, Jubina / Venugopal, Aiswarya / Sheela, Soorya / Kallempadam, Akhila / Jose, Lee / Innah, Susheela J / Varghese, Pulikkottil Raphael / George, Alex

Viruses

2023 Volume 15, Issue 11

Abstract: Background: Vaccine effectiveness for first-generation coronavirus disease (COVID-19) vaccines among People Living with HIV (PLHIV) in India remains unexplored. This study entails the estimation of the real-world effectiveness of COVID-19 vaccines ( ... ...

Abstract	Background: Vaccine effectiveness for first-generation coronavirus disease (COVID-19) vaccines among People Living with HIV (PLHIV) in India remains unexplored. This study entails the estimation of the real-world effectiveness of COVID-19 vaccines (AZD1222/Covishield, BBV152/Covaxin) among PLHIV and the identification of variants of SARS-CoV-2 among those infected with COVID-19. Methods: An ambi-directional cohort study was conducted among 925 PLHIV above 18 years of age in two districts of central Kerala, India, from February 2022 to March 2023. Selected PLHIV were recruited as Participant Liaison Officers (PLOs) for the follow-up on the study participants. At enrolment, basic details, baseline CD4 count, and a Nasopharyngeal (NP) swab for RT-PCR were collected. In the follow-up phase, NP swabs were collected from subjects with COVID-19 symptoms. Positive subjects had a CD4 count and genomic sequencing performed. Results: The mean age of the participants was 46.93 ± 11.00 years. The majority, 819 (93.6%), of participants had received at least one dose of any vaccine, while 56 (6.4%) were unvaccinated. A total of 649 (79.24%) participants were vaccinated with Covishield and 169 (20.63%) with Covaxin. In the vaccinated group, 158 (19.3%) reported COVID-19 infection. Vaccine Effectiveness (VE) for one dose of any vaccine was 43.2% (95% CI: 11.8-64.5), Conclusions: Full vaccination with Covishield and Covaxin was effective against COVID-19 infection among PLHIV on treatment; albeit, that of Covaxin was higher. A gap of 4 to 6 weeks between the two doses of COVID-19 vaccine was found to have higher VE among PLHIV.
MeSH term(s)	Humans ; Animals ; Adult ; Middle Aged ; SARS-CoV-2/genetics ; COVID-19 Vaccines ; ChAdOx1 nCoV-19 ; Antiretroviral Therapy, Highly Active ; Cohort Studies ; COVID-19/diagnosis ; COVID-19/epidemiology ; COVID-19/prevention & control ; Vaccination ; India/epidemiology ; Lepidoptera ; HIV Infections/complications ; HIV Infections/drug therapy
Chemical Substances	BBV152 COVID-19 vaccine (76JZE5DSN6) ; COVID-19 Vaccines ; ChAdOx1 nCoV-19 (B5S3K2V0G8)
Language	English
Publishing date	2023-10-30
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2516098-9
ISSN	1999-4915 ; 1999-4915
ISSN (online)	1999-4915
ISSN	1999-4915
DOI	10.3390/v15112187
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Article ; Online: Serosurveillance of SARS CoV 2 among the healthcare workers of a tertiary care teaching institution in Central Kerala during the post lockdown phase

Rafi, Aboobacker Mohamed / Joseph Tomy, Maglin Monica Lisa / Thomas, Ronnie / Valsan, Chithra / Unnikrishnan, U G / Innah, Susheela J / Kuttichira, Praveenlal

medRxiv

Abstract: Background. Kerala was the first state to have the confirmed case of COVID 19 in the country and it was first confirmed in Thrissur district on 30 January 2020.Our institute being in the heart of the city had to take adequate measures to mitigate the ... ...

Abstract	Background. Kerala was the first state to have the confirmed case of COVID 19 in the country and it was first confirmed in Thrissur district on 30 January 2020.Our institute being in the heart of the city had to take adequate measures to mitigate the spread and treat the required patients by keeping its staff safe & healthy. The hallmark of COVID 19 infection is high infectivity, pre symptomatic transmission and asymptomatic prevalence which could result in high cumulative numbers of infections, hospitalizations, and deaths. Kerala was the first state to confirm community transmission in July 2020.Health care workers being in the forefront in the war against COVID19 are very prone in acquiring the infection and are possible to be asymptomatic sources for cluster formation. Knowing the development of immunity as shown by the presence of anti COV2 antibodies in the population contributes to the epidemiological understanding of the disease. The intent of the study is to do an antibody testing in our hospital to find the serosurveillance of SARS CoV 2 among the healthcare workers in our hospital. Aim: To estimate the seropositivity of SARS CoV 2 among the healthcare workers at Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, six months after revoking the lockdown Methodology: A cross sectional study among the health care workers of the medical college. Multistage Sampling was done with the hospital block as the first stage and departments as the second stage. In the final stage of sampling the test individuals were selected on a first come first served basis after the antibody test availability was declared open and free for all staff. A consent form and a Google form were given to all staff who volunteered for participating in the study. Each consented participant recruited into the investigation completed a questionnaire which covers details regarding demographics, exposure history, Residence & travel. Blood sample was collected and Anti SARS COV2 IgG antibody testing which targets the Spike Protein 1(SP1) was done using the VITROS chemiluminescence platform (Orthoclinical diagnostics, USA). Sampling & testing ranged over a time frame from September 5th to December 15th, 2020 Results: Jubilee Mission Medical College has 2785 working staff at the time of study. A total of 423 staff consented and their samples were tested. 37 staff members tested positive for COVID 19 antibody, yielding an overall prevalence of 8.75% (95% CI, 6.23 to 11.86). 86.5 % (32/37) of them were having a history of COVID-19 Antigen / RT PCR Positivity. We identified a statistically significant linear trend (p value =0.00001), between seropositivity and the degree of severity of COVID 19. Among the various factors which increase the risk of seroconversion, history of undergoing quarantine (p value < 0.001), contact with a confirmed case (p value = 0.002), contact with a caregiver for COVID 19 (p value =0.001) and history of Upper respiratory symptoms (p value =0.001), were found to be significantly associated with positive serology. Conclusions: The overall seropositivity in the current study was found to be 8.75% which is comparable to seroprevalence studies conducted in the United States and Wuhan in China. The pattern of seropositivity across the different category of health workers observed in the present study showed a higher prevalence among nurses. This result is also in agreement with a recent published report from united states. Various measures advised by the national and state health authorities were adequately adhered to. Keeping track of the pattern of development of immunity in the community is part of understanding the illness and forecasting the spread. For the tested HCW, it will boost up morale by ending uncertainty. For the hospital administration it will help in decision making about relative focusing of interventions on patients in general and HCWs. By knowing the immunity status of HCWs, the Institution will be able to contribute authentically to the development of intervention strategies and guidelines from time to time, besides following the available guidelines. Being an educational institution, it is obligatory to train all the elements of care delivery to the future generation of health care workers. Getting experienced from a small but relevant sample was expected to facilitate larger community study envisaged in peripheral areas Jubilee served
Keywords	covid19
Language	English
Publishing date	2021-01-31
Publisher	Cold Spring Harbor Laboratory Press
Document type	Article ; Online
DOI	10.1101/2021.01.27.21250502
Database	COVID19

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Article: Anti IH: An antibody worth mention.

Mohanan, Nithya / Henry, Nittin / Rafi, Aboobacker Mohamed / Innah, Susheela J

Asian journal of transfusion science

2014 Volume 10, Issue 2, Page(s) 152–154

Abstract: A 72-year-old female with co-morbidities posted for surgical correction of fracture neck of femur without any history of transfusions was noted to have a hemoglobin level of 7 g/dl and packed red blood cells transfusion was ordered. Pretransfusion tests ... ...

Abstract	A 72-year-old female with co-morbidities posted for surgical correction of fracture neck of femur without any history of transfusions was noted to have a hemoglobin level of 7 g/dl and packed red blood cells transfusion was ordered. Pretransfusion tests demonstrated A1B group with D positive on forward grouping. Reverse grouping showed a varying grade of agglutination with A, B, and O cells. Agglutination being stronger at 4°C. Antibody screening showed pan-agglutination, direct Coomb's test and auto control were negative. The serum reacted with adult O cells (OIadult) but not with adult Bombay cells (Oh Iadult) or O cord (Oicord) cells. A possibility of a compound cold antibody anti IH was made and A1B compatible cells were transfused to the patient. This case report illustrates anti-IH cold agglutinin with broad thermal amplitude. Uniqueness of this case report was O group incompatibility with A1B group, which was detected earlier and a catastrophic transfusion reaction being subverted.
Language	English
Publishing date	2014-11-01
Publishing country	India
Document type	Case Reports
ZDB-ID	2267310-6
ISSN	1998-3565 ; 0973-6247
ISSN (online)	1998-3565
ISSN	0973-6247
DOI	10.4103/0973-6247.187941
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Article: Utility of Clot Waveform Analysis in Russell's Viper Bite Victims with Hematotoxicity.

Abraham, Siju V / Rafi, Aboobacker Mohamed / Krishnan, S Vimal / Palatty, Babu Urumese / Innah, Susheela J / Johny, Jerry / Varghese, Salish

Journal of emergencies, trauma, and shock

2018 Volume 11, Issue 3, Page(s) 211–216

Abstract: Introduction: In Russell's viper bites, due to the lack of a better alternative, whole blood clotting test (WBCT) remains the standard test even though its reliability and sensitivity has been shown to be low. Activated partial thromboplastin time (aPTT) ...

Abstract	Introduction: In Russell's viper bites, due to the lack of a better alternative, whole blood clotting test (WBCT) remains the standard test even though its reliability and sensitivity has been shown to be low. Activated partial thromboplastin time (aPTT)-based clot waveform analysis (CWA) is an optic absorbance assay that can be used as a global clotting test. In this study, the objective was to assess the changes in CWA and to compare CWA to WBCT and aPTT in patients with Russell's viper envenomation. Methods: The datum was collected prospectively over 2 months as a pilot observational study in a tertiary care center. All proven cases of Russell's viper-envenomated individuals with preliminary CWA data and WBCT were included in the study. The clot wave (CW) of the five individuals, which met all the stringent inclusion criteria, was analyzed and interpreted. Results: CW absorbance sigmoid waveform was deranged in all 5 cases, of which 4 showed a change in CWA even before an abnormal aPTT. Three of the 5 had a normal WBCT but showed early changes in CWA. Atypical biphasic waveform reported in disseminated intravascular coagulation in other prior studies is seen in venom-induced consumptive coagulopathy also. In all patients where a second derivative was plotted, the second (lower) phase of the second derivative showed a slow rise to baseline. Conclusion: CWA showed changes which provided information earlier than the conventional coagulation studies in the snakebite victims studied. While aPTT or WBCT reflects clotting time, CWA conveys the dynamic process of clot formation and stabilization. CWA may reveal disorders of clotting in snakebite victims before the conventional tests become abnormal. Future research should assess the speed and accuracy of the test in diagnosing hemotoxic envenomation and its potential role in guiding antivenom therapy.
Language	English
Publishing date	2018-11-14
Publishing country	India
Document type	Journal Article
ZDB-ID	2461111-6
ISSN	0974-519X ; 0974-2700
ISSN (online)	0974-519X
ISSN	0974-2700
DOI	10.4103/JETS.JETS_43_17
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Article: A case of refractory immune thrombocytopenia in pregnancy managed with elthrombopag.

Purushothaman, Jyothis / Puthumana, Kochuthresia J / Kumar, Aswath / Innah, Susheela J / Gilvaz, Sareena

Asian journal of transfusion science

2014 Volume 10, Issue 2, Page(s) 155–158

Abstract: Immune thrombocytopenic purpura is a common acquired autoimmune disorder defined by a low platelet count secondary to accelerated platelet destruction or impaired thrombopoesis by anti-platelet antibodies. Thrombopoietin (TPO)-mimetic drugs such as ... ...

Abstract	Immune thrombocytopenic purpura is a common acquired autoimmune disorder defined by a low platelet count secondary to accelerated platelet destruction or impaired thrombopoesis by anti-platelet antibodies. Thrombopoietin (TPO)-mimetic drugs such as eltrombopag and romiplostim have been used successfully in many nonpregnant individuals with immune thrombocytopenia (ITP) but studies based on its effects in pregnancy are limited. A 27-year-old multigravida who is a known case of ITP with bad obstetric history was referred to the Department of Obstetrics and Gynecology at 26 weeks of gestation with complaints of mucosal bleeding and recurrent abortions. After 2 weeks of hospital stay, the patient did not respond to treatment with steroid and immunosuppressant. There was a rapid decline in platelet count with mucosal bleeds for which she required frequent platelet transfusions. Due to high costs, short action periods, and other potential maternal and fetal side effects of intravenous immunoglobulin (IVIgG) and anti-D, it was decided that TPO-mimetic drug eltrombopag would be given. After starting treatment with eltrombopag, the patient's platelet count could be maintained between 30,000/μl and 50,000/μl. At 36 weeks of gestation following preterm-induced vaginal delivery, she delivered a male active baby weighing 1.86 kg with an Apgar score of 8/10. After delivery, her platelet count was 60,000/μl. Eltrombopag is a thrombopoietin receptor agonist. It has been assigned to pregnancy category C by the Food and Drug Administration (FDA). There are no adequate and well-controlled studies of use of eltrombopag in pregnancy. In our case, the drug was given in the last trimester of pregnancy and the mother and baby were in good health at the time of discharge from the hospital and during follow-up.
Language	English
Publishing date	2014-11-01
Publishing country	India
Document type	Case Reports
ZDB-ID	2267310-6
ISSN	1998-3565 ; 0973-6247
ISSN (online)	1998-3565
ISSN	0973-6247
DOI	10.4103/0973-6247.177204
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Surgical management of endometriosis in a severe Hemophilia A female patient and the role of transfusion medicine specialist: A case report with review of literature.

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Article: Comparison of platelet indices in dengue fever patients based on platelet transfusion: A prospective observational study in a tertiary care center.

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Article: Successful management of Methemoglobinemia and G6PD deficiency in a patient posted for surgical excision of branchial cyst.

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Article ; Online: Real-World Effectiveness of COVID-19 Vaccine and Identification of SARS-CoV-2 Variants among People Living with HIV on Highly Active Antiretroviral Therapy in Central Kerala of India-An Ambi-Directional Cohort Study.

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Article ; Online: Serosurveillance of SARS CoV 2 among the healthcare workers of a tertiary care teaching institution in Central Kerala during the post lockdown phase

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Article: Anti IH: An antibody worth mention.

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Article: Utility of Clot Waveform Analysis in Russell's Viper Bite Victims with Hematotoxicity.

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Article: A case of refractory immune thrombocytopenia in pregnancy managed with elthrombopag.

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