The Indian Immunohematology Initiative (III) aims to improve the safety of transfusion in South Asia by training South Asian blood bankers, both physicians and technical workers, to detect and identify blood group antibodies and to diagnose and treat diseases caused by red blood cell antibodies.
The III is a program under the fiscal sponsorship of the Illinois Association of Blood Banks, a non-profit organization devoted to education in blood banking and transfusion medicine. Our educational programs and other activities are conducted by volunteer faculty (see below). The III is directed by Dr. Jim Perkins; the associate director is Ms. Susan Johnson (see Faculty below). We have a memo of understanding with the Asian Association of Transfusion Medicine to produce “wet workshops” on immunohematology in AATM member countries. We also support AATM and other South Asian transfusion medicine educational organizations by participating in their meetings as our resources allow.
We have identified four ways in which we can promote the understanding and practice of immunohematology in India and other South Asian countries:
The III has provided equipment and materials to create two immunohematology (IH) training facilities with our partners at Lions Blood Bank in New Delhi and Rotary Bangalore-ttk Blood Bank. These facilities each have a capacity for 15 participants at a time. They have been used for multiple workshops conducted by III faculty and by faculty and staff of the two respective blood bank
To date III faculty have conducted 120 wet workshops training over 275 blood bank physicians and technical staff at different events including those listed in the table to the right.
By plan we have been handing the teaching of wet workshops at the Delhi and Bangalore facilities over to our capable local colleagues, enabling the core III faculty to develop wet workshops in other South Asian locations.
|ISBTI meeting, Ahmedabad, IN||Basic IH techniques||11/’16||3||25|
|Jeeven BB, Chennai, IN||Comprehensive IH testing||1/’07||6||12|
|ISBTI meeting, Bhopal, IN||Basic IH techniques||11/’07||2||12|
|ISBTI meeting, Bhopal, IN||Advanced IH techniques||11/’07||2||12|
|Staff training, Prathama BB, Ahmedabad||Basic IH techniques||11/’07||2||12|
|Jeeven BB, Chennai, IN||Comprehensive IH testing||1/’08||6||12|
|Rotary ttk BB, Bangalore, IN||Comprehensive IH testing||1/’08||5||12|
|ISBTI meeting, Hyderabad, IN||Basic IH techniques||11/’10||2||12|
|ISBTI meeting, Hyderabad, IN||IH reagent preparation||11/’10||2||12|
|Mumbai, IN||Comprehensive IH testing||10/’12||6||12|
|Lions BB, Delhi IN||Comprehensive IH testing||4/’13||6||15|
|Rotary ttk BB, Bangalore, IN||Comprehensive IH testing||11/’13||6||15|
|Lions BB, Delhi IN||Comprehensive IH testing||4/’14||6||15|
|Rotary ttk BB, Bangalore, IN||Comprehensive IH testing||9/’14||6||15|
|Lions BB, Delhi IN||Comprehensive IH testing||4/’15||6||15|
|Rotary ttk BB, Bangalore, IN||Comprehensive IH testing||1/’16||6||15|
|Lions BB, Delhi IN||Comprehensive IH testing||3/’16||6||15|
|Rotary ttk BB, Bangalore, IN||Comprehensive IH testing||9/’16||6||15|
|IGMS hospital, Male, Maldives||Comprehensive IH testing||1/’18||6||12|
|Lions BB, Delhi IN (Post AATM meeting)||Eval. of a positive DAT||12/’18||3||15|
Instruction at Meetings
In addition to the lectures given as part of the workshops, III faculty have delivered multiple lectures and organized or participated in preconference immunohematology seminars at meetings organized by local, national, and international organizations including:
|MEETING||Preconf. IH Seminar||LOCATION||DATE||Days|
|“International Symposium in Transfusion Medicine”||Karachi, Pakistan||2/’04||3|
|ISBTI annual meeting||Udaipur, India||11/’05||2|
|SAATM annual meeting||Kathmandu, Nepal||12/’05||2|
|Freestanding IH Conference||Indore, India||12/’05||1|
|ISBTI annual meeting||(WW)*||Amedabad, India||11/’06||3|
|ISBTI annual meeting||(WW)||Bhopal, India||11/’07||2|
|ISBTI annual meeting||Lucknow, India||12/’08||3|
|ISBTI annual meeting||(WW)||Hyderabad, India||11/’10||2|
|SAATM annual meeting||Yes||Dacca, Bangladesh||5/’11||3|
|SAATM annual meeting||Yes||Columbo, Sri Lanka||12/’12||3|
|AATM annual meeting, Kathmandu||Yes||Kathmandu, Nepal||9/’14||3|
|AATM annual meeting||Turkey||4/’16||2|
|AABB/AATM combined meeting||Yes||Bangalore, India||12/’16||3|
|AABB/AATM combined meeting||Yes||Delhi, India||12/’18||3|
* “Wet workshop”, see previous table
The website you are viewing now includes instructional materials focused specifically on immunohematology including slide presentations, videos we have made, and immunohematology procedures. The latter are downloadable in Microsoft WORD so that they can be used to develop the an institution’s own immunohematology procedure manual. Our goal is to continue to develop this website to the point that a motivated individual can teach themselves much of immunohematology independently from this source.
Colleagues and former students consult the III faculty in real time regarding individual immunohematological problems on patients and donors through the “Consult Us” email button on this website, as well as through the AATM IH working group administered by our colleague Dr. Ankit Mathur on WhatsApp.
Although semi-automated and automated immunohematologic testing using gel, solid phase, and other test platforms have become common in well-funded South Asian blood bank laboratories of hospitals and blood centers, manual “tube testing” is probably most common and some laboratories still use slide testing, particularly for initial testing of blood donors. When tube testing is performed laboratories in South Asia often use all-purpose centrifuges which require a 1 minute spin for agglutination testing and a 10 minute spin for cell washing, as opposed to a 10 second and 1 minute spin respectively for a higher rpm centrifuge specifically defined for this purpose. And automated cell washers are rarely available. This makes tube testing slow and cumbersome, and works against its availability for specialized testing in labs using non-tube test methods.
The barrier to acquisition of equipment for efficient tube testing is cost. Serologic centrifuges made in the United States or Germany are expensive for a lab in a resource-limited country, and in that context acquisition of non-tube-test equipment that requires less skill and experience to yield accurate routine results may be more attractive. Nonetheless, in order for a blood bank to have access to a complete range of techniques for dealing with problems such as cold- and warm-reactive antibodies, access to tube-test methods is essential. Therefore III faculty early on identified availability of an inexpensive serologic centrifuge as a priority, and began to look for an Indian manufacturer of blood bank equipment
After discussion with III faculty engineers of the Remi company of Mumbai developed multiple prototypes, one of which III faculty suggested for development. The III sent associate director Sue Johnson to Mumbai in October, 2014 to assist in initial validation of the centrifuge, and it has subsequently been used successfully in multiple III wet workshops. This centrifuge is available at an attractive price as the Remi “Quickfuge”.
Four Indian blood bankers completed fellowships, each consisting of two weeks’ training in the laboratory at Evanston Hospital and two weeks at Blood Center of Wisconsin, and a fifth had an abbreviated and focused visit at the same institutions. Unfortunately, due to limitations in faculty time and increased regulation of observer participation in the US we are no longer only able to provide fellowships.
Jim Perkins, M.D. , III Director
Susan Johnson, MSTM, MT(ASCP)SBB, III Associate Director
Martha Rae Combs, MT(ASCP)SBB
Janis Hamilton, MT(ASCP)SBB, MS
Marilyn Moulds, MT(ASCP)SBB
International Society for Blood Transfusion (ISBT)
NorthShore University HealthSystem Medical Group:
The Rotary Club of the Northshore-Wilmette:
Southern Blood Services:
Duke University School of Medicine
Faculty time has been donated by each individual’s home institution. Host institutions provide space, support staff, materials, faculty housing and board, and logistic support.
Cardinal Health Care:
The ILABB, a non-profit (501(c)3) organization, is the ‘fiscal sponsor’ of the III. The ILABB is dedicated to transfusion medicine education historically limited to education within Illinois and surrounding states. However, but in adopting the III it has become an organization of international scope. Without their help we could not exist.
Previously the Center for International Health of Milwaukee Wisconsin served as our fiscal sponsor, and we are grateful for their stewardship.