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Title :Enhancing Donor Screening for Higher Blood Bank Levels: Investigating G6PD Examination Cancellation. I send all the document that you need to writ this project, the idea and criteria of writing also how the score will be done. in the data analysis I want to compare the G6PD Kit ( saving in reagent kit before and after ) between donors and patent in 2019 – 2020 – 2021 and 2022.also I send one of my friend example project to flow the criteria.
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King Fahad Armed Forces Hospital
ImpACT of ImplemenTAtion of ‘Sickle Cell DiSEASE Acute PAinful Crisis
CliniCAL PAthwAy’ AT KFAFH: On reducing the number of ER visits,
ADMIssion, rEAdmission rATes, opiods, consumption And cost
Dr. Iman Alhazmi
Dr. Ahmad Alhartini, Dr. Aseel Jambi
Contact No.: 0555773685
Email: iahazmi@hotmail.com
ABSTRACT
Sickle cell disease (SCD) is an autosomal recessive disorder of hemoglobin, associated with
consanguineous marriages in Saudi Arabia. The prevalence of SCD in Saudi Arabia varies from 1 % to
17 %. The vaso-occlusive crisis is the most common complication of sickle cell disease in adults, which
is the primary reason why these patients seek medical care in emergency departments. Adequate pain
management will result in fewer episode crisis and reduce readmission rates. The study goal is to ensure
proper pain management to prevent relapses, to a lower rate of admission, ED visits and to control the
consumption of narcotics through the implementation of a clinical pathway.
A total of 374 SCD Patients (12 years and above with isolated painful crisis) was identified by KFAFH
Emergency Department registration data. The diagnosis of SCD was confirmed by Hb electrophoresis.
The primary source of patient information was conducted from the patient file, ED registration, and
chart review for one year before (May 2016- April 2017) implementation of clinical pathway and one
year after (May 2017- April 2018) implementation of the clinical pathway.
Overall, the results showed a drop in ER visits/Patient, rate of admission/ patient, and readmission
rate by> 75.55%, 41.87 %, and 54.51 % respectively.
Decrease in Meperidine and Tramadol consumption by > 33%, and 54 % respectively.
Cost saved after implementation of the pathway is more than 410,709 S.R/year.
Proper pain management after implementation of painful crisis management clinical pathway showed a
lower rate of admission and a significant decrease in a number of ED visits. In addition to costeffectiveness from reducing hospital admission and opioids consumptions.
Keywords: Painful crisis management, Sickle cell anemia, Morphine, Opioid, Oxycodone.
INTRODUCTION
Problem Description
Sickle cell Disease (SCD) is the most common autosomal recessive disorder associated with
consanguineous marriages in Saudi Arabia. Data on SCD prevalence in Saudi Arabia is limited.
However, it considered the highest prevalence among the surrounding countries. According to a study
conducted between 2011 and 2015, the incidence rate was 49.6 (45.8 for carriers and 3.8 for cases) per
1000 persons (Alsaeed et al., 2018).
SCD is a chronic blood disorder that affects almost all organs with variable clinical manifestations. The
acute painful crisis is the hallmark manifestation of the SCD and the leading cause of emergency
department (ED) visits and hospitalization (S. K. Ballas & Lusardi, 2005). Much of the devastation
caused by the disease is due to the recurrent crisis. Vaso-occlusion, inflammation, and nociception are
the main pathophysiological mechanisms contribute to the acute painful crisis which can lead to serious
complications such as acute chest syndrome and multiorgan failure (Samir K Ballas, 2015).
At the present time, about 500 adult patients with SCD are following up at King Fahad Armed Forces
Hospital (KFAFH) in Jeddah. We have noticed an increasing number of ED visits together with an
increase in the consumption of opioids by SCD patients who are presented with a primary complaint of
an acute pain crisis. Opioids were often prescribed in the ED without blood testing or laboratory
monitoring. Moreover, patients who have been prescribed to take controlled-release opioids combined
with short-acting opioids to control the breakthrough pain, might experience frequent attacks of
breakthrough pain and result in the consumption of relatively large amounts of short-acting opioids.
Thus, SCD patients were at high risk of developing prescription opioids addiction, some cases of this
problem have been recorded of patients come to the ED at KFAFH about three times daily to ask for
opioids. Meperidine and Tramadol were the opioids of choice in such cases. The annual consumption
of Meperidine Injection, Tramadol injection, and Tramadol Capsules reached up to ( 22,488 vials /
16,275 vials / and 60,860 Capsules ) respectively. (May 2016-April 2017).
Unmanageable pain is the major cause of hospital readmissions as the pain has not been controlled
appropriately in the ED or with the prescribed pain relief medications at home. Discharging patients
from the hospital does not necessarily indicate the end of the crisis. Nearly 16% of all SCD patients
were readmitted to the ED within one week of discharge (Samir K Ballas, 2015). The average ED visits
by SCD patients reached up to 1600 visits/ month.
Available Knowledge
Different approaches have been implemented in different parts of the world for the management of
painful crisis. (Wright et al, 2004) reported a day case approach in painful crisis. Their Experience
showed positive impact on pain control and admission rates when cases of uncomplicated pain were
managed on outpatient bases.
Most of the guidelines recommend avoiding the use of Meperidine to manage the acute painful crisis
of SCD. The National Institute for Health Clinical Experts (NICE) made a strong recommendation to
ensure that Meperidine is not used to treat the SCD acute crisis. There are at least two reasons why
Meperidine shouldn’t be used; Firsts, Meperidine is associated with a high risk of seizures in SCD
patients. Second, Meperidine has a limited effective dose which may not provide enough analgesic
effects, resulting in pseudo-addiction or pseudo-drug-seeking behavior. Furthermore, according to the
British National Formulary (BNF), Meperidine is not indicated for continuous or ongoing pain such as
the recurrent acute painful crisis of the SCD patients (NICE, 2012).
Tramadol irrelatively considered as a safe analgesic with a low potential for dependence relative to
other opioids. However, tramadol dependence may occur when it used for prolonged periods of time
(more than several weeks to months) and especially when it used at supra-therapeutic doses. The recent
data revealed that the number of tramadol disabuses is growing up, especially among the Middle East
countries. (WHO, 2014)
According to World Health Organization (WHO), the choice of analgesia should be based on the pain
severity, where opioids should be used only for moderate (scale 4-6) to severe (scale 7- 10) pain.
Morphine is the opioid of choice for the SCD painful crisis (Telfer et al , 2014)
It is recommended to discontinue the use of Meperidine and replaced a protocol of intermittent doses
of short-acting opioids with intravenous morphine infusions and oral controlled-release morphine.
Rationale
A clinical pathway for the management of the SCD acute painful crisis has been initiated at KFAFH
in Jeddah. The aims of this clinical pathway management were to unify the practice, standardize the
care and judicious the use of opioids at KFAFH. The main objectives were to decrease the number of
ED visits, the admission rates, and the consumption of opioids.
Adequate pain management will result in fewer episode crisis, reduce the admission rates and ED visits.
Limited data exist about adults’ pain management for sickle cell anemia in Saudi Arabia.
The clinical pathway intends to provide advice on a basic, minimum standard of care for patients with
acute painful crises and SCA and pay particular attention to adequate Opioids consumption and
monitoring for complications.
Specific Aims
▪
▪
▪
To reduce the rate of ER visits/ patient by more than 50 % within one year.
To decrease the rate admission/ patient, and readmission rates by more than 30%, and 40%
respectively within one year.
To reduce the consumption of Meperidine and Tramadol by more than 25%, and 40 %
respectively within one year as secondary outcome.
METHODS
Context
The King Fahd Armed Forces Hospital is situated in the busy seaport of Jeddah on the western seaboard
of the Red Sea. the hospital has five city-wide satellite clinics form part of a KFAFH national network
of healthcare facilities directly managed by the Medical Services Division (MSD) of the Ministry of
Defense and Aviation (MODA). is the tertiary hospital, with more than 500 bed capacity One of the
primary concerns of the Ministry of Defense and Aviation is to provide medical care to all of the Armed
Forces personnel. Therefore, medical services have been established in all military locations. The
hospital provides a wide range of primary, secondary and tertiary medical services to members of the
Saudi Arabian Armed Forces and their dependents.
In-service training and education are actively promoted by the Departments of Medical Education and
Nursing Education and from within the individual departments. The hospital is also a designated
training center for junior medical and nursing staff.
Almost 500 adult patients with SCA are following up. The monthly visits reached up to 1600 visits.
We performed a retrospective review of the medical records of adults with sickle cell disease at KFAFH
through Emergency department registration data and admission records for one year periods before
(May 2016- April 2017) and one year periods (May 2017- April 2018) perspective after the institution
of the clinical pathway.
A total of 374 SCD Patients (12 years and above with painful crisis) was identified by KFAFH
Emergency department registration data. The diagnosis of SCD was confirmed by Hb electrophoresis.
The primary source of patient information was conducted from the patient file, ED registration, and
chart review.
Interventions
After review of the literature, a clinical pathway was drafted for the management of painful crisis
(Appendix 1).
Every patient who presents with acute painful crisis baseline laboratories will be drawn and analgesia
will be given within 30 minutes of arrival. Type of analgesia used is based on pain severity. Mild pain
(1-3) non-opioid like acetaminophen and NSAIDs is used. Morphine will be given for patients with
moderate to severe pain (≥ 4). If the patient is allergic, then hydromorphone is used. If the patient is
allergic to both, oxycodone is the medications of choice.
Initial laboratories include CBC, LFT, Renal profile and crossmatch should be requested for all patients
to evaluate them fully and objectively stratify the severity of the crisis.
Adult Sickle Cell Unit (ASU) was launched as a separate entity from the Emergency Department
concurrently to receive patients with an isolated painful crisis during working days from 8 am to 3 pm.
Patients with SCA who presented to the ED with the isolated painful crisis were referred to the unit for
management if their condition were stable.
The pathway includes two different parts. Initially, the patient will be given the first dose followed by
maximally 2 boluses if pain persists (each is 30 minutes apart). The second part for patients who did
not achieve satisfactory relief in the emergency department was admitted to the medical service. On the
medical ward, vital signs continued to be monitored every hour until the patient reported relief and no
longer required dose escalation.
Educational lectures about Sickle Cell Anemia (SCA), painful crisis and the pathway were given to all
involved physicians in Emergency and Internal Medicine Departments.
Patients with sickle cell disease who had used the new pathway were informed of the change in
treatment.
Staff: Iman Alhazmi, MD, Consultant Adult Hematology. Ahmad Alhartani, BPhm, Msc, Narcotics and
Controlled Manager. Aseel Jambi , Msc, Pharm.D. Patient safety specialist. Abdulaziz Alhadad,
Internal Medicine Resident. Amani Khalifa, Internal Medicine Resident. Sara Albesher, Internal
Medicine Resident.
Division of Hematology / Oncology, Department of Medicine; Department of Pharmacy; and
Department of CQI.
Study of Interventions
The pathway was applicable for patients: Twelve years and older, Transferred for adult hematology
care already, Presented with the isolated painful crisis.
The pathway was not applicable if: 1) Patient is still following up with pediatric hematology (between
12- 16 years old), Pregnant patients, and Other associated manifestations, e.g. fever, hypoxia, or
priapism.
All patients with SCA who presented to ED were registered by time in a specific record and statistics
were reviewed daily. Daily round on admitted cases with SCA was done by the project team.
Over a period of 2 months, we noticed a decrease in a number of the cases presenting during working
hours without changes on the frequency after hours (from 3:30 pm – 7:30 am) ( Figure1&2). Although
no more Tramadol or Meperidine was prescribed, patients were given morphine without laboratories
and regardless of pain severity. Also, we noted that all cases of SCA were admitted as a painful crisis
without consideration of the complexity and variable manifestations of the disease.
Figure 1
Figure 2
Because of the initial findings, the pathway was edited (Appendix 2). The first step aims to segregate
cases of SCA by different complaints. For each complaint, appropriate laboratories will be ordered and
needed specialty will be consulted. If the patient is presenting with the isolated acute painful crisis, nonopioid analgesia will be given initially until the laboratories confirm the severity of the crisis. If
laboratory results did not show changes from baseline, the patient will be given appointment at Sickle
Cell Anemia Clinic to be seen within a week at maximum.
Measures
▪
▪
Once data are collected, analyzed over a period of approximately one year (May 2016- April
2017) before and one year after (May 2017- April 2018) implementation of the clinical pathway.
Sample size: a convenience sample of all SCD Patients over 12 years old and had who had visited
ED at KFAFH will be included in the study. (N= 374)
▪
SPSS version 23 used to perform basic statistical functions such as descriptive statistics to
determine the variance (age, gender, WBCs, Hb, platelet count, LDH, total bi lirubin, conjugated
bilirubin.
▪
▪
▪
▪
Patients demographics data will be summarized by descriptive analysis for continuous variables
(age, gender, WBCs, Hb, Platelet count, LDH, bilirubin,..)
Means, median, SD, and interquartile calculated
For categorical variables, the frequency is listed.
Correlation coefficient used to measure the association between two variables (e.g., number of
admissions and the new pathway, the amount of opioids consumption and proper pain admission).
Table 1: Patients Demographics
Mean
(N=374)
Median
Range
Pain score
4
4
6
Temperature
36
36.7
4.9
O2 Saturation
94
96
14
WBCs
14
14
9
Hb
9.08
8.90
2.90
Ritecolocyte
0.32
0.25
0.77
Platelets
447
451
182
LDH
451
442
286
Bilirubin
47
46.5
27.1
Conjugated Bilirubin
19.5
18.5
22.3
4
8
Admission %
Yes= 10.23%
Length of Stay
4
Analysis
Data were collected from three sources: ED record of SCA patients visits, the Therefore electronic
system (all ED forms are scanned after completion), and Oasis electronic system (main electronic
system of the hospital) where all patients who were registered in ED department with risk factor indicate
“ Sickle cell Anemia” were captured.
A total of 374 ED forms were reviewed. The decision regarding each patient was evaluated. Most of
the cases were discharged with an outpatient appointment as their laboratory were stable.
Data were analyzed both qualitatively and quantitatively concerning differences among a number of
ED visits, the number of admission and readmission while descriptive statistics were used to compare
the differences in the variables in the study. A t-test was used to compare the means of gender, age, and
lab values (e.g. WBCs, Hb, MCV, HBF, Temperature, O2 saturation).
30
Table 2: Comparison of Study Population
Before 2016/2017
(N=316)
After 2017/2018
(N=374)
Male
55%
55%
Female
45%
45%
Age
32 years
33 years
HBs
67.7
85.4
HBF
8.9
9.4
MCV
82.1
81.8
HBA2
9.8
8.3
MCH
29.9
29.6
Hhydroxyurea
16.1%
16 %
Follow-up
26.26%
26.47 %
Ethical Considerations
The authors thank Dr. Reem Alqunfthi & Dr. Survana Raju to initiate the pain management pathway.
Therefore, we would like to extend our sincere gratitude to them.
This study was approved from the research and ethics committee, reference ethical number: (REC
217).
RESULTS
▪
Rate of Emergency Department Visits / Patient
•
During one-year (May 2017 to April 2018) total of 4861 visits for SCA patients compared to
14615 during the previous year (May 2016 to April 2017). After review of ED registration
forms, patients who were still following-up with pediatric or pregnant were excluded. The total
number of visits were 4508 and 14398 during 17/18 and 16/17 respectively. Hemoglobin
electrophoresis for all patients who were registered in ED as SCA was reviewed. Ninety-two
patients were excluded because 62 were sickle cell trait, 27 had normal electrophoresis and 3
no electrophoresis done at our hospital and their laboratories did not support the diagnosis of
SCA.
•
A total of 374 patients in 2017/18 visited ED (4319 visits) compared with 316 patients (14273)
in 2016/17. The eldest patient was 56 years old and the youngest was 13. The majority were
male. Thirty-two of the patients had thalassemia trait based on low MCV and MCH. only 26
% were following up regularly in the clinic and 17% were not a complaint on folic acid.
Patients demographic in details (Table 1).
31
•
The annual rate of ED visits/patient dropped by 75.55% (45 vs. 11.5) (Figure 3). There was a
progressive reduction in the frequency of ED visits over the year (Figure 4). It was more
evident after editing the pathway (third month), where it dropped by 51%. By the end of the
year, the visits dropped by 88.24%.
•
Figure 3&4: The frequency of ED visits by month during the year of implementing the clinical
pathway and the preceding year.
Figure 3
Rate of ED Visits/Patient
45
Before
After
Figure 4
Total ED Visits per Month
After
▪
Rate of Admission / Patient
•
The rate of Admissions/ patient dropped by 41.87% (Figure 5).
▪
Figure 5: Annual admission rate / patient for Sickle Anemia during 2016/2017 and 2017/2018.
Rate of Admission/ Patient
After
32
Not all admissions were isolated painful crisis. Underlying causes like Acute Chest
Syndrome (4%), osteomyelitis (1%), Fever (16%), Priapism (1%), abdominal pain (6%), no
pain (6%), Pregnant (11%) were noticed.
▪
Readmission Rate: Readmission Rate declined from 29.13 % to 13.25% by 54.51%.
Figure 6: Readmission Rate
Readmission rate
35
29.13
30
25
13.25
After
After
▪
Opioids Consumption:
•
Although Tramadol and Meperidine medications were still prescribed by other departments ,
consumption of Tramadol and Meperidine decreased collectively by 54 % and 33%
respectively. (Figure 7 & 8). Morphine had been used by another department also prior to
starting the pathway, but the increase was almost by 29% only. Other medications were not
available in the hospital earlier so the comparison is not feasible.
•
Figure 7&8: Annual Consumption of Tramadol and Meperidine before and after clinical
pathway implementation.
Figure 7
Tramadol Consumption
60860
27930
16275
10821
After
TRAMADOL INJECTION 100mg/2ml
33
TRAMADAOL CAPSULE 50mg
Figure 8
Meperidine Consumption
6094
After
Table 3: Comparison of Annual Opioids Consumption
Name of Medication
Before
After
Meperidine Injection
100mg/2ml
Meperidine Injection 50ml/ml
Tramadol Injection
100mg/2ml
Tramadol Capsule 50mg
12,053
8,032
% Decrease in
consumption
33%
10,435
16,275
6,094
10,821
41.60%
33%
60,860
27,930
54%
Cost of Narcotics:
Total saving = 68,709 SR
Table 4: Comparison of Annual Opioids Cost before and after implementing clinical pathway
for acute painful crisis
Medication
Before
After
Saving
Meperidine 100 mg
27,722 SR
18,474 SR
9,248 SR
Meperidine 50 mg
24,000 SR
14,016 SR
9,984 SR
Tramadol capsule
51,122 SR
23,461 SR
27,661 SR
Tramadol Injection
65,100 SR
43,284 SR
21,816 SR
Cost of Admission:
• Average Cost of ED Bed = 2,000 SR (without considering the overhead cost)
520 Admission (2016/2017) – 349 Admission (2017/2018) = 171×2,000 SR = 342,000 SR
34
DISCUSSION
Summary
Sickle cell Disease (SCD) is the most common autosomal recessive disorder associated with
consanguineous marriages in Saudi Arabia.
At King Fahad, Armed Forces Hospital (KFAFH) in Jeddah almost 500 adult patients with SCA are
following up.
During reviewing annual consumption of opioids from 2014 – 2017, the narcotics pharmacy noticed
the significant increase in consumption of meperidine and tramadol. While investigations most of those
medications were prescribed for SCA patients. subsequently, they evaluate the guidelines with the
hematologist. They found that the meperidine was not the drug of choice for treating painful crisis. In
addition, the monthly visits reached up to 1600 visits. In some cases, a patient would come to the ED
three times daily for opioids.
In the USA a shift in the management of sickle cell pain from meperidine to morphine occurred in the
1990’s. They recommend using morphine, rather than Meperidine, in acute pain management. (Ballas
et al, 2012). Pain in SCA is variable. Other than acute pain secondary to Vaso-occlusive crisis, It could
be neuropathic, chronic, or because of other associated conditions. Proper evaluation of pain types is a
must to initiate the appropriate management. Short-acting opioids are not the treatment of choice in all
of them.
One study found that Patients who received meperidine experienced more withdrawal. Meperidine is
more lipid soluble than morphine and has an elimination half-life of two to four hours and duration of
action of only two to three hours. Its increased lipid solubility means a more rapid onset of central
nervous system effects that increase its abuse potential and makes it more attractive to drug seekers.
With meperidine, the lack of analgesic potency, its short duration of action, abuse potential and adverse
effects with repeated doses, means that there is little to recommend this drug (O’Connor et al, 2000).
Moreover, Meperidine should not be used to treat acute sickle cell pain in patients with impaired renal
function, history of seizure disorder, or those on serotoninergic medications. (Ballas et al , 2007).
The usual opioids side effect profiles of morphine and meperidine are similar, with respiratory
depression, cough suppression, nausea and vomiting, urinary retention and constipation
The advantage of Morphine is being more water and lipid soluble, making it faster acting and easier to
inject in small volumes of water, as well as no central nervous system excitability or seizures in compare
to meperidine.
Previous studies reported that using intravenous and controlled release oral morphine instead of
meperidine reduced the frequency of hospital admissions of patients with painful crises and their length
of stay (Ballas et al , 2012).
Several months after the appliance of Clinical Pathway, some patients refused to take morphine and
they insist to receive intramuscular meperidine. The change in treatment was met with strong resistance
by most of the patient.
This study is the first study in Saudi Arabia that discussed how to manage the pain crisis for SCA
patient. The results can be generalized to all SCA patients.
This study showed that The rate of admissions / patient for sickle cell pain decreased by 41.87%, total
readmission by 54.51 %, and the rate of emergency department visits / patient by 75.55% after initiation
of the clinical pathway.
35
Analysis of the data showed that consumption of opioids was decreased by 33 %, and by 41.6 % for
meperidine 100 mg, and 50 mg respectively. For Tramadol capsule the consumptions were significantly
decreased by 54%, and 33% for Tramadol Injection.
The cost saved for admission after implementation of the clinical pathway is more than 410,709 SR.
These reductions were sustained in the second 6-month period of 2017 /2018.
Sickle cell disease Committee has been formed. Also, multidisciplinary Sickle cell anemia clinic was
created.
Interpretations
We did experience a decrease in emergency department visits once the protocol was established, the
decline in emergency visits is best explained by a decrease in the number of visits per painful crisis.
This was confirmed by reviewing the frequency of emergency visits that occurred before and after the
clinical pathway.
We think that hospital admission of sickle cell disease declined because we were providing effective
pain treatment, but the decrease was certainly not entirely attributable to the change in medications.
We believe that physicians, nurses and patients education sessions played a critical role in the success
of the clinical pathway. These sessions included information about pain control and the benefit of the
clinical pathway.
Limitations
The main limitation we have is that adherence was not 100% by physicians. Some admitted patients
received opioids without evidence of an acute painful crisis. In addition, we failed to measure changes
in pain, satisfaction, or quality of life. Further studies are needed.
Sickle cell patient have earned the label of “Problem Population” by emergency department, for sickle
cell pain often get mistaken for signs of drug addiction. Physicians should differentiate between
tolerance and addiction.
PCA (Patient control Analgesia) was not required in our hospital for SCD.
Conclusions
Proper pain management for sickle cell Anemia patients leads to a decrease in ED visits, reduce hospital
admissions, and readmission rates. Consequently, more than 400,000 SR was saved after the
implementation of the pathway.
Unfortunately, expenditure on researches and the clinical care of SCD patients is negligible.
Therefore, ministries of health, medical institutions, research organizations, and international agencies
should cooperate and work together for improvement.
36
References
1.
Alsaeed, E. S., Farhat, G. N., Assiri, A. M., Memish, Z., Ahmed, E. M.,
Saeedi, M. Y., Bashawri, H. (2018). Distribution of hemoglobinopathy
disorders in Saudi Arabia based on data from the premarital screening and
genetic counseling program, 2011-2015. J Epidemiol Glob Health, 7 Suppl
1, S41-s47. doi:10.1016/j.jegh.2017.12.001
2.
Ballas, S. K. (2015). Sickle cell pain: Lippincott Williams & Wilkins.
3.
Ballas, S. K., & Lusardi, M. (2005). Hospital readmission for adult acute
sickle cell painful episodes: frequency, etiology, and prognostic
significance. Am J Hematol, 79(1), 17-25. doi:10.1002/ajh.20336
4.
NICE, N. I. f. H. a. C. E. (2012). NICE clinical guideline 143 – sickle cell
acute painful episode Management of an acute painful sickle cell episode in
hospital.
Retrieved
from
https://www.nice.org.uk/guidance/cg143/evidence/full-guideline-pdf186634333
5.
WHO. (2014). Tramadol Update Review Report, 36th ECDD (2014)
Agenda item 6.1. Retrieved from
http://www.who.int/medicines/areas/quality_safety/6_1_Update.pdf
37
G6PD COUNT for donors BY MONTHS
MONTHS
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
2019
Count of Sample No
883
984
721
1059
692
948
1186
745
744
861
877
920
MONTHS
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
G6PD COUNT for donors BY RESULT
2019
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
NEGATIVE
838
915
673
1007
657
890
1104
700
711
802
825
853
POSITIVE
45
69
48
52
35
58
82
45
33
59
52
67
TOTAL
883
984
721
1059
692
948
1186
745
744
861
877
920
2020
Count of Sample No
670
956
562
486
400
618
741
780
678
532
726
784
2020
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
MONTHS
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
2021
Count of Sample No
593
609
1015
423
734
766
502
902
33
NEGATIVE
621
895
529
456
372
570
700
726
631
491
681
749
POSITIVE
49
61
33
30
28
48
41
54
47
41
45
35
TOTAL
670
956
562
486
400
618
741
780
678
532
726
784
2021
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
NEGATIVE POSITIVE TOTAL
561
32
593
568
41
609
983
32
1015
417
6
423
694
40
734
727
39
766
486
16
502
866
36
902
32
1
33
COUNT BY MONTHS
MONTHS
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
2019
Count of Sample No
883
984
721
1059
692
948
1186
745
744
861
877
920
TAT
Sample_No
AB-10000
AB-10001
AB-10002
AB-10013
AB-10014
AB-10015
AB-10016
AB-10017
AB-10019
AB-10020
AB-10021
AB-10022
AB-10023
AB-10024
AB-10025
AB-10026
AB-10027
AB-10028
AB-10029
AB-10030
AB-10031
AB-10032
2019-2020-2021
TAT
14
14
16
17
17
17
18
8
8
8
8
9
9
9
9
10
10
10
10
10
10
10
2020
MONTHS Count of Sample No
Jan
670
Feb
956
Mar
562
Apr
486
May
400
Jun
618
Jul
741
Aug
780
Sep
678
Oct
532
Nov
726
Dec
784
AB-10033
AB-10034
AB-10035
AB-10036
AB-10037
AB-10038
AB-10039
AB-10040
AB-10041
AB-10042
AB-10043
AB-10044
AB-10045
AB-10046
AB-10047
AB-10048
AB-10049
AB-10050
AB-10056
AB-10057
AB-10058
AB-10059
AB-10060
AB-10061
AB-10062
AB-10063
AB-10064
AB-10065
AB-10066
AB-10067
AB-10068
AB-10069
AB-10070
AB-10071
AB-10072
AB-10073
AB-10074
AB-10075
AB-10076
AB-10077
AB-10086
AB-10087
AB-10088
AB-10089
AB-10090
AB-10091
AB-10092
10
10
10
11
11
11
11
11
11
11
11
12
12
12
13
14
14
15
8
8
8
9
10
10
11
11
11
11
11
12
12
12
12
12
12
13
14
14
14
15
7
7
9
9
9
10
10
AB-10093
AB-10094
AB-10096
AB-10097
AB-10098
AB-10099
AB-10100
AB-10101
AB-10103
AB-10106T
AB-10106T
AB-10106T
AB-10107
AB-10115
AB-10116
AB-10117
AB-10118
AB-10119
AB-10120
AB-10121
AB-10122
AB-10123
AB-10124
AB-10141
AB-10142
AB-10143
AB-10144
AB-10145
AB-10146
AB-10147
AB-10148
AB-10149
AB-10151
AB-10152
AB-10153
AB-10154
AB-10155
AB-10157
AB-10158
AB-10160
AB-10161
AB-10163
AB-10164
AB-10172
AB-10173
AB-10174
AB-10175
10
10
11
11
11
11
11
11
12
12
12
12
13
13
14
14
14
16
16
16
16
16
16
9
9
9
9
10
10
10
10
10
12
12
12
12
14
16
16
8
9
9
9
10
10
10
10
AB-10176
AB-10177
AB-10178
AB-10179
AB-10180
AB-10182
AB-10183
AB-10184
AB-10185
AB-10186
AB-10187
AB-10188
AB-10189
AB-10190
AB-10191
AB-10192
AB-10193
AB-10194
AB-10195
AB-10196
AB-10197
AB-10198
AB-10199
AB-10200
AB-10201
AB-10202T
AB-10203
AB-10204
AB-10205
AB-10206
AB-10207
AB-10208
AB-10209
AB-10210
AB-10211
AB-10212
AB-10213
AB-10214
AB-10215
AB-10216
AB-10217
AB-10218
AB-10219
AB-10220
AB-10221
AB-10222
AB-10223
10
11
11
11
11
11
11
12
12
12
12
12
12
12
12
12
12
12
12
13
13
14
14
14
14
15
15
16
16
9
9
9
9
9
10
10
10
10
10
11
11
11
11
11
12
12
12
AB-10224
AB-10225
AB-10226
AB-10227
AB-10228
AB-10229
AB-10230
AB-10231
AB-10232
AB-10233
AB-10235
AB-10236
AB-10237
AB-10240T
AB-10241
AB-10242
AB-10244
AB-10245
AB-10246
AB-10249
AB-10250
AB-10251
AB-10252
AB-10253
AB-10254
AB-10255
AB-10256
AB-10257
AB-10258
AB-10259
AB-10260
AB-10261
AB-10262
AB-10263
AB-10264
AB-10265
AB-10266
AB-10267
AB-10268
AB-10269
AB-10270
AB-10271
AB-10272
AB-10273
AB-10274
AB-10275
AB-10276
12
12
13
14
14
14
14
14
14
14
16
16
16
16
17
17
17
17
8
9
9
9
10
10
10
10
10
10
10
10
10
11
11
11
11
12
12
12
12
12
12
13
13
13
13
14
14
AB-10277
AB-10278
AB-10279
AB-10281
AB-10282
AB-10283
AB-10284
AB-10285
AB-10286
AB-10287
AB-10288
AB-10289
AB-10290
AB-10291
AB-10292
AB-10293
AB-10294
AB-10295
AB-10296
AB-10297
AB-10298
AB-10299
AB-10300
AB-10301
AB-10302
AB-10303
AB-10304
AB-10305
AB-10306
AB-10307
AB-10308
AB-10309
AB-10310
AB-10311
AB-10312
AB-10314
AB-10315
AB-10316
AB-10317
AB-10318
AB-10319
AB-10321
AB-10322
AB-10323
AB-10324
AB-10325
AB-10326
14
14
17
8
8
8
8
8
9
9
10
10
11
11
11
11
11
11
12
12
12
12
12
12
12
12
12
12
12
12
12
13
13
14
14
16
16
16
16
17
17
7
8
8
8
9
9
AB-10326
AB-10327
AB-10328
AB-10329
AB-10330
AB-10331
AB-10332
AB-10333
AB-10334
AB-10335
AB-10336
AB-10337
AB-10338
AB-10339
AB-10340
AB-10341
AB-10342
AB-10342
AB-10343
AB-10344
AB-10345
AB-10346
AB-10347
AB-10348
AB-10349
AB-10350
AB-10351T
AB-10352
AB-10353
AB-10354
AB-10355
AB-10356
AB-10357
AB-10358
AB-10359
AB-10361
AB-10362
AB-10363
AB-10364
AB-10365
AB-10366
AB-10367
AB-10368
AB-10369
AB-10370
AB-10371
AB-10372
9
10
10
11
11
11
11
11
11
11
11
12
12
12
12
12
12
12
12
13
13
13
13
13
14
14
14
14
14
14
15
15
15
15
16
10
10
10
11
11
12
14
14
14
14
15
15
AB-10373
AB-10375
AB-10376
AB-10378
AB-10379
AB-10380
AB-10381
AB-10382
AB-10383
AB-10384
AB-10385
AB-10386
AB-10387
AB-10388
AB-10389
AB-10390
AB-10391
AB-10392
AB-10393
AB-10394
AB-10395
AB-10396
AB-10397
AB-10398
AB-10399
AB-10401
AB-10402
AB-10403
AB-10405
AB-10406
AB-10407
AB-10408
AB-10409
AB-10410
AB-10411
AB-10412
AB-10414
AB-10415
AB-10416
AB-10417
AB-10418
AB-10419
AB-10420
AB-10421
AB-10422
AB-10423
AB-10424
16
8
8
9
9
11
11
11
12
13
14
14
14
15
15
15
15
15
15
15
16
16
16
16
9
9
9
9
10
10
10
10
10
10
11
11
13
13
13
13
13
13
13
13
13
13
13
AB-10425
AB-10426
AB-10427
AB-10428
AB-10429
AB-10430
AB-10431
AB-10432
AB-10434
AB-10435
AB-10436
AB-10437
AB-10438
AB-10439
AB-10440T
AB-10441
AB-10442
AB-10443
AB-10444T
AB-10445
AB-10445
AB-10446
AB-10447
AB-10448
