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  1. Musa RH, Muhamad NA, Hassan A, Ayob Y, Yusoff NM
    Asian J Transfus Sci, 2015 Jan-Jun;9(1):48-54.
    PMID: 25722573 DOI: 10.4103/0973-6247.150951
    Rh molecular studies have been previously mainly conducted in Caucasians and African population. There is a limited data on the molecular basis for Rh genotypes among Asians.
  2. Hassan MN, Mohd Noor NH, Johan Noor SR, Sukri SA, Mustafa R, Luc Aster HV
    Asian J Transfus Sci, 2014 Jul;8(2):113-7.
    PMID: 25161351 DOI: 10.4103/0973-6247.137449
    Maternal red blood cell (RBC) alloimmunization may lead to production of harmful antibodies that result in hemolytic disease of fetus and newborn (HDFN). There is insufficient data on the prevalence of HDFN due to RBC alloantibodies in the Malay neonatal population.
  3. Usman AS, Mustaffa R, Ramli N, Diggi SA
    Asian J Transfus Sci, 2013 Jan;7(1):84-5.
    PMID: 23559775 DOI: 10.4103/0973-6247.106750
    OBJECTIVE: Maternal allo-antibody production is stimulated when fetal red blood cells are positive for an antigen absent on the mother's red cells. The maternal IgG antibodies produced will pass through the placenta and attack fetal red cells carrying the corresponding antigen. Allo-immune hemolytic disease of the fetus and newborn caused by anti-E rarely occurs.

    CASE SUMMARY: We report two cases of anti-E hemolytic diseases in neonates. One of the neonates had severe hemolysis presenting with severe anemia, thrombocytopenia, and conjugated hyperbilirubinemia, while the other had moderate anemia and unconjugated hyperbilrubinemia. Although both the neonates were treated by phototherapy and intravenous immunoglobulin, one of them received double volume exchange transfusion.

    CONCLUSION: There appeared to be an increase in the occurrence of hemolytic disease of the fetus and newborn caused by Rh antibodies other than anti-D. In this case report, both patients presented with anemia and hyperbilirubinemia but were successfully treated, with a favorable outcome.

  4. Wei CT, Al-Hassan FM, Naim N, Knight A, Joshi SR
    Asian J Transfus Sci, 2013 Jan;7(1):26-8.
    PMID: 23559760 DOI: 10.4103/0973-6247.106725
    Diego blood group antigen, Di(a), is very rare among Caucasians and Blacks, but relatively common among the South American Indians and Asians of Mongolian origin. The antibody to Di(a) is clinically significant to cause hemolytic disease in a new-born or hemolytic transfusion reaction.
  5. Morish M, Ayob Y, Naim N, Salman H, Muhamad NA, Yusoff NM
    Asian J Transfus Sci, 2012 Jan;6(1):19-23.
    PMID: 22623837 DOI: 10.4103/0973-6247.95045
    The implementation of quality system and continuous evaluation of all activities of the Blood Transfusion Services (BTS) can help to achieve the maximum quantity and quality of safe blood. Optimizing blood collection and processing would reduce the rate of discard and improve the efficiency of the BTS. The objective of this study is to determine the rate of discard of blood and blood component and identify its reasons at the National Blood Centre (NBC), Kuala Lumpur, during the year of 2007 in order to introduce appropriate intervention.
  6. Musa RH, Ahmed SA, Hashim H, Ayob Y, Asidin NH, Choo PY, et al.
    Asian J Transfus Sci, 2012 Jan;6(1):3-9.
    PMID: 22623834 DOI: 10.4103/0973-6247.95042
    Human blood groups are polymorphic and inherited integral structures of the red cell membrane. More than 300 red cell antigens have been identified and further categorized into 30 major discrete systems. Their distribution varies in different communities and ethnic groups.
  7. Al-Joudi F, Ali AB, Ramli MB, Ahmed S, Ismail M
    Asian J Transfus Sci, 2011 Jan;5(1):42-5.
    PMID: 21572715 DOI: 10.4103/0973-6247.75997
    Red blood cell (RBC) alloantibodies may be formed following exposure to RBC antigens. In most cases, the alloimmunization develops during pregnancy or from previous blood transfusions. The RBC antigens and their alloantibodies vary among different human populations and ethnic groups, and they do have a clinical significance for their adverse immunological reactions.
  8. Wan Haslindawani WM, Wan Zaidah A
    Asian J Transfus Sci, 2010 Jan;4(1):25-7.
    PMID: 20376262 DOI: 10.4103/0973-6247.59387
    The appropriate use of blood and blood products means the transfusion of safe blood products only to treat a condition leading to significant morbidity or mortality, which cannot be prevented or managed effectively by other means. The safety and effectiveness of transfusion depend on the appropriate clinical use of blood and blood products. This study was conducted to review the practice of fresh frozen plasma usage (FFP) for transfusion, based on the coagulation profile, requested by various departments in the Hospital Universiti Sains Malaysia (HUSM).
  9. Mokhtar MB, Hashim HB, Joshi SR
    Asian J Transfus Sci, 2016 Jan-Jun;10(1):84-7.
    PMID: 27011678 DOI: 10.4103/0973-6247.172177
    A use of platelet additives solution (PAS) improves storage conditions so as to give increased shelf life to platelets and to maintain hemostatic function.
  10. Hasan I, Arshad A, Rahim NA, Soo PY
    Asian J Transfus Sci, 2020 07 24;14(1):28-32.
    PMID: 33162702 DOI: 10.4103/ajts.AJTS_111_17
    CONTEXT: Whole blood donation is generally considered a safe procedure; however, a small percentage of donors could develop vasovagal reactions (VVRs) during or after completion of blood donation.

    AIMS: This study was undertaken to establish the prevalence of VVR among whole blood donors in Hospital Pulau Pinang and to investigate factors that lead to its occurrence.

    SETTINGS AND DESIGN: A cross-sectional study was conducted involving 27,890 whole blood donations in 2016.

    SUBJECTS AND METHODS: For each donation, donor's demographic and blood donation-related information was extracted from the blood bank database.

    STATISTICAL ANALYSIS USED: Qualitative data including age group, sex, race, frequency, and location of donation were analyzed using Chi-square tests, while blood pressure was analyzed using t-test.

    RESULTS: Overall, 425 cases of VVRs were reported, resulting in a VVR rate of 1.5% (one event in every 65 donations). We found a statistically significant association (P < 0.05) between the occurrence of VVRs with the young age group, female gender, Indian race, first-time donor, lower predonation blood pressure, and donation performed in a mobile donation campaign. The most common vasovagal symptoms are lightheadedness (88%), followed by nausea (5.4%), muscle twitching (3.5%), vomiting (1.4%), loss of consciousness <30 s (1.4%), and paresthesia (0.2%).

    CONCLUSIONS: The prevalence of VVRs among whole blood donors in Hospital Pulau Pinang appeared to be low. Our study reaffirms that blood donation is a relatively safe process, and the incidence of VVR can be further reduced by ensuring strict screening procedure before blood donation.

  11. Iliassa II, Mohammad WM, Tan JJ, Ayob Y
    Asian J Transfus Sci, 2016 Jul-Dec;10(2):145-9.
    PMID: 27605853 DOI: 10.4103/0973-6247.187934
    BACKGROUND: Cryoprecipitate is generally used to treat bleeding patients with hypofibrinogenemia, and the transfusion decision is guided based on published guidelines.
    AIM: This study aimed to evaluate the practice appropriateness in accordance to cryoprecipitate transfusion guidelines in Hospital Kuala Lumpur.
    METHODOLOGY: This cross-sectional study of 117 cryoprecipitates transfused adult patients was conducted in Kuala Lumpur Hospital from January to June 2012. The compliance of the indication of cryoprecipitate was considered as appropriate if indicated for patients who have hypofibrinogenemia (<1.0 g/L) with bleeding, or otherwise inappropriate if pretransfusion fibrinogen level was more than 1.0 g/L, pretransfusion fibrinogen level was not examined and posttransfusion fibrinogen level more than 1.5 g/L.
    RESULTS: Most of the cryoprecipitate prescriptions were found to be inappropriate, which read 81.2% (95% confidence interval = 0.740, 0.880). Patients who underwent neurovascular surgery were the major recipient of cryoprecipitate, but majority of the prescription was found not appropriate. The decision to transfuse cryoprecipitate was found mostly appropriate when was guided by fibrinogen (52.2%), but the percentage dropped to 10.6% when pretransfusion fibrinogen test was not performed. Regrettably, only 19.7% of total cryoprecipitate were given based on pretransfusion fibrinogen level.
    KEYWORDS: Appropriateness; bleeding; cryoprecipitate transfusion; guideline
  12. Yousuf R, Mustafa AN, Ho SL, Tang YL, Leong CF
    Asian J Transfus Sci, 2017 3 21;11(1):62-64.
    PMID: 28316444 DOI: 10.4103/0973-6247.200770
    The G antigen of Rh blood group system is present in almost all D-positive or C-positive red cells but absent from red cells lacking D and C antigens. The differentiation of anti-D and anti-C from anti-G is not necessary for routine transfusion; however, during pregnancy, it is important because anti-G can masquerade as anti-D and anti-C with initial antibody testing. The false presence of anti-D will exclude the patient from receiving anti-D immunoglobulin (RhIG) when the patient actually is a candidate for RhIG prophylaxis. Moreover, patients with positive anti-D or anti-G are at risk of developing hemolytic disease of the fetus and newborn and need close monitoring. Thus, proper identification allows the clinicians to manage patients properly. This case report highlights a rare case of anti-G together with anti-D and anti-C in a pregnant woman. This report disseminates knowledge on identification of anti-G and its importance in pregnant women.
  13. Mazlan AM, Ayob Y, Hussein AR, Namasiwayam TK, Wan Mohammad WMZ
    Asian J Transfus Sci, 2017 Jul-Dec;11(2):95-101.
    PMID: 28970674 DOI: 10.4103/ajts.AJTS_51_16
    CONTEXT: Coronary artery bypass graft (CABG) operation is associated with high frequency of allogeneic blood transfusion due to the acquired hemostatic challenges in patients undergoing CABG. However, allogeneic blood transfusion carries risks of infection, adverse reaction, and mortality as well as prolonged hospital stay and increased hospital cost. It is important to identify patients who require blood transfusion to mitigate their risk factors and reduce the chance of exposure to allogeneic blood.

    AIMS: This study was conducted to evaluate factors that influence the decision to transfuse red cell in first-time elective CABG patients.

    SETTINGS AND DESIGN: This was a cross-sectional study based on a retrospective record review. The study was done in the National Heart Institute.

    MATERIALS AND METHODS: All patients who underwent first-time elective CABG were included in this study. Variables analyzed include age, gender, body weight, preoperative hemoglobin (Hb) level, patients' comorbidities, and other clinical parameters.

    STATISTICAL ANALYSIS USED: Data were analyzed using SPSS software version 20.

    RESULTS: A total of 463 patients underwent first-time elective CABG during the period of the study. Three hundred and eighty-six (83.4%) patients received red cell transfusion. From multiple logistic regression analysis, only age (odds ratio [OR] = 1.040, 95% confidence interval [CI]: 1.003, 1.077, P = 0.032), body weight (OR = 0.951, 95% CI: 0.928, 0.974, P < 0.001), Hb level (OR = 0.500, 95% CI: 0.387, 0.644, P < 0.001), and cardiopulmonary bypass time (OR = 1.013, 95% CI: 1.004, 1.023, P < 0.001) were the significant independent predictors of red cell transfusion.

    CONCLUSIONS: By stratifying patients according to their risk factor for red cell transfusion, the high-risk patients could be recognized and should be enrolled into effective patient blood management program to minimize their risk of exposure to allogeneic blood transfusion.
  14. Iberahim S, Noor NHM, Hassan MN, Bahar R, Yusoff SM, Ramli M, et al.
    Asian J Transfus Sci, 2022;16(2):276-279.
    PMID: 36687544 DOI: 10.4103/ajts.ajts_136_21
    The Diego (Di) blood group system comprises 22 antigens located on the band 3 protein, most of which are low-prevalence antigens. The majority of antibodies to Diego system antigens were of clinically insignificant; however anti-Dia, -Dib, -Wra, -ELO and-DISK may cause hemolytic disease of the fetus and newborn (HDFN) and transfusion reaction. We reported a case of naturally occurring of anti-Dia in a young man who presented to our hospital for wound debridement of fingers injury. His serological results were suggestive of anti-Dia antibody, and his molecular blood group showed he has Di (a-b+) antigen. Anti-Dia may be clinically significant. It can cause mild-to-severe HDFN, but there are only infrequent reports of it being clearly implicated in a hemolytic transfusion reaction. We suggest the need for reagent red blood cell panels to include Dia antigen-positive cells in antibody identification tests for our populations.
  15. Yusop MF, Tahir NM, Azim SMSS, Kamaruzaman AA, Hata NRM, Kugaan A, et al.
    Asian J Transfus Sci, 2023;17(2):251-255.
    PMID: 38274975 DOI: 10.4103/ajts.ajts_38_21
    BACKGROUND: Liver transplantation (LT) is a complicated surgical procedure with high risk for massive intraoperative blood loss due to pre-existing coagulopathy, portosystemic shunts with collateral circulations, and splenomegaly. The transfusion service will direct most of their resources toward LT programs with great impact on cost. The purpose of this study was to evaluate single center transfusion strategies and to identify the risk factors associated with the intraoperative blood loss and blood transfusion.

    METHODS: The study includes 18 patients who underwent LT at Hospital Selayang between January 2020 and December 2020. Retrospective analysis of data included preoperative assessment of coagulopathy, intraoperative blood loss, and blood component transfusion.

    RESULTS: The mean age in the study group was 36.4 ± 12.68 years. The mean intraoperative blood loss was 4450 ± 1646 ml requiring 4.17 ± 3.3 packed red blood cell (PRBC) units, 7.56 ± 5.5 platelet units, and 9.50 ± 6.0 fresh-frozen plasma units. The independent risk factor for high blood loss (HBL) group was lower preoperative platelet count and it is statistically significant (P = 0.024). The HBL group is associated with higher usage of PRBC (P = 0.024) and platelet units (P = 0.031) and it is statistically significant. The length of stay (LOS) in intensive care unit (ICU) averaging 8.6 ± 4.95 days, and there is no significant differences comparing the HBL and LBL group (P = 0.552). The mortality <90 days for all recipients was 22.2%.

    CONCLUSION: The preoperative platelet count for is the most important factor associated with HBL in LT procedure. The usage of PRBC and platelet units was statistically higher in the HBL group. Comparing HBL and LBL patients, there is no difference in terms of the LOS in ICU postoperatively. A larger sample size would be needed in view of relatively small sample size.

  16. Hassan SN, Mohamad S, Kannan TP, Hassan R, Wei S, Wan Ab Rahman WS
    Asian J Transfus Sci, 2023;17(2):169-174.
    PMID: 38274953 DOI: 10.4103/ajts.ajts_125_21
    BACKGROUND AND OBJECTIVE: A number of glycophorin variant phenotypes or hybrid glycophorin variants of the MNS blood group system bear multiple immunogenic antigens such as Mia, Mur, and MUT. In the East and Southeast Asian populations, glycoprotein (GP.) Mur is the most common glycophorin variant phenotype expressing those three immunogens. The aim of this study was to detect MNS system glycophorin variant phenotypes (GP. Mur, GP. Hop, GP. Bun, GP. HF, and GP. Hut) among Malaysian blood donors.

    MATERIALS AND METHODS: In this cross-sectional study, 144 blood donors were selected under stratified random sampling. The deoxyribonucleic acid was extracted from whole blood samples, followed by a polymerase chain reaction assay. Sanger sequencing was used to identify the specific MNS variants and then validated by a serological crossmatch with known anti-Mur and anti-MUT.

    RESULTS: GP. Mur was identified among Malaysian blood donors with a prevalence of 6.94%, and no other variants of the MNS system were found.

    CONCLUSION: The present study substantiates that GP. Mur is the main variant of the MNS system glycophorin (B-A-B) hybrid in Malaysian blood donors. GP. Mur-negative red blood cells must therefore be considered in the current transfusion policy in order to prevent alloimmunization and immune-mediated transfusion reactions, particularly in transfusion-dependent patients.

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