Rameez Makhdoomi

Rape victims, pellet victims, unmarked graves, fake encounters, tortures, killed protesters, gagging internet, snapping communication, peace of graveyards ,useless inquiries have defined handling of Kashmir conflict .As Kashmir is witnessing another round of unprecedented unrest and suppression in wake of scores of deaths and blinding of protesters post the killing of Burhan Wani, militant commander I as a student of history and humanity would like to state some facts and appeal to all humans of India . It has become a habit of so called mainstream media and their anchors in cozy studios with illiterate panelists to resort to hurling abuses on Kashmir. But we are also aware that pain, torment of Kashmir has given rise to conscience class in India who not only emphasize with Kashmir but also speak vocally against these atrocities. Here is what first Prime Minister of India stated on the issue . “It [Kashmir] belongs to the Kashmiri people. When Kashmir acceded to India, we made it clear to the leaders of the Kashmiri people that we would ultimately abide by the verdict of their Plebiscite. If they tell us to walk out, I would have no hesitation in quitting. We have taken the issue to United Nations and given our word of honour for a peaceful solution. As a great nation we cannot go back on it. We have left the question for final solution to the people of Kashmir and we are determined to abide by their decision.” (2nd January 1952, Pandit Jawaharlal Nehru, Prime Minister of India). Spreading hate and venom is no answer to political issue of Kashmir.A question to these media channels: Have they ever run their shows on this pragmatic point? Gandhiji has also felt sorry for those nations which treat their news outlets as Bible and then generate dishonest opinion based on that content. This, too, is pertinent for supposed experts who opine on the basis of such fascist content. Debate on pellet gun which is wreacking havoc on eyes of Kashmiris and turning the Kashmir valley into valley of blinds. You have a political dispute at hand admit and crushing people making them blind is no answer. Confusing Kashmir with illogical and unrelated voter turnouts which even by stand of pro-Indian parties are just for governance, high tourist arrivals are no paradigms to settle Kashmir issue.  Pertinently, you tried to confuse Kashmir issue with youth here getting selected in competitive exams like IAS, IPS look what the Kashmir’s First IAS topper and BDirector Education, Shah Faesal has written via a facebook post. He writes – “By juxtaposing my photos with the images of a slain militant commander, a section of national media has once again fallen back upon its conventional savagery that cashes on falsehoods, divides people and creates more hatred,” reads Faesal’s Facebook post. “At a moment when Kashmir is mourning its dead, the propaganda and provocation being dished out from red and blue newsrooms is breeding more alienation and anger in Kashmir than what Indian state can manage.” As a matter of fact hailing from a remote village in Kupwara district, Faesal became the first Kashmiri ever to top the coveted IAS exam He adds -“Personal vulnerability apart, the very fact of becoming a part of a ridiculous debate is something which has disturbed me very much. Have I joined IAS to do a job or to become a part of your sadistic propaganda machine? In fact when I qualified this exam I never thought of spending my whole life scratching the desk and if this nonsense around me continues, I might prefer to resign sooner than later,” he added.  All these realities  suggests the State and government doesn’t want to learn from its past mistakes that beastly use of force and impunity to the alleged perpetrators of human rights violations that include the men in uniform doesn’t help in making Kashmiris obedient by assassinating their genuine political aspirations but is followed by unrest and more unrest. It is high time all in India rise above jingoistic nationalism and for the sake of blinded, annihilated, tormented, shattered Kashmir impresses upon its media to act sanely and also on for government to intimate civilized means to settle the Kashmir issue.

The writer is freelance journalist and can be reached at rameezh3@gmail.com

By Farzana Mumtaz

I was recently in Pakistan invited for a conference on Kashmir and peace in region. The conference was held in capital city Islamabad. The visit to that part of the world gave me a feeling how things are much different  in a place when watched from own perspective rather than from secondary sources . As soon as I entered Lahore the city presented its glittering and historic looks. The people were also nice with culture not much different from the Indian side of Punjab. Lahore as a historic city is home to many attractions. Pertinently,  Lahore has successfully maintained its historical touch. Prominent attraction of Lahore city  is the historical Minar-e-Pakistan (literally “Tower of Pakistan”) a public monument located in Iqbal Park which is one of the largest urban parks in Lahore, Punjab, Pakistan. The tower was constructed during the 1960s on the site where, on 23 March 1940, the All-India Muslim League passed the Lahore Resolution, the first official call for a separate homeland for the Muslims living in South Asia, in accordance with the two-nation theory.

Another must see location is the  Badshahi Mosque  or “Emperor’s Mosque” . This historical mosque was built in 1673 by the Mughal Emperor Aurangzeb in Lahore, Pakistan. It is one of the city’s best known landmarks and a major tourist attraction representing  the beauty and grandeur of the Mughal era

Pertinently, the construction going on metro train suggests that Lahore is trying to make a perfect match of history with modernity. Many beautiful gardens and canals add to charm of Lahore combined with the beautiful markets.

The lush green city of Islamabad is treat to watch in terms of cleanness and attractive forest cover which proves why it is among the best capital cities of the world. Daman-e-Koh, at an altitude of 3000 ft, is a viewing point and hill top modern garden in Islamabad and a very picturesque spot. The entire area provides panoramic view of Islamabad.

Another major attraction is the Faisal Mosque (also known as Shah Faisal Masjid) which  is an exceptionally large and unique mosque in Islamabad. Centaurus Mall is one of Islamabad’s hottest attractions. The Centaurus is a mixed use real-estate development in Islamabad, Pakistan. The project includes a mammoth mall, 36-floor hotel, three 23-floor residential and office towers

People by and large are friendly. The average and literate Pakistanis want freedom from extremism and do not buy much into extremism as they feel it has hurt their country a lot. Shia and  Sunni divide is not to be seen as  many families  consist  of shia , sunni members  without any animosity and living in harmonious relationship.

The constituency of peace is also quite handsome in Pakistan and  wants peaceful resolution of issues. One meets many youth who want to carve a positive image of Pakistan .The pulse on ground is that coming years are going to be crucial for Pakistan as it tries to secure a victory in battle against terrorism.

Overall, the journey to Pakistan was an enthralling experience.

Faizaan Bhat
bhatfaizan10@gmail.com

It is the ninth month of Islamic calendar month of Ramadan the month in which the book of guidance, the book which leads humankind to success, the book which distinguishes right from wrong was revealed. In the words of Allah
“In the month of Ramadhan the Qur’an was revealed, a book of guidance with proofs of guidance which distinguishes right from wrong. Therefore whoever of you is present in that month let him fast But he who is I’ll or on a journey shall fast a similar number of days later. (2:185)
In the month of Ramadan, Muslims fast, don’t eat ,drink from dawn to dusk. Fasting in the holy month of Ramadan is one of the fifth pillar of Islam.  Food, drink are the man’s most basic necessities. When he/she is consumed by hunger and thirst he/she understands pain of hunger, thirst, weak ,ill people. It also gives symbolism of an inner, spiritual eagerness to make all kinds of sacrifices and build a person self control which enables a person to lead successful life.
The month is the annual reminder of the blessings of Quran. The path that mankind must follow, the path that leads to success, the path that was followed by best creation of world Prophet (SAW),the path of obedience.
Ramadan purifies soul, in the words of Prophet(SAW) ” There is a zakat for all things and the zakat of the body is fasting (mishkat 1/639) here zakat means purification of soul which fasting purifies .
The prophet (SAW) also said
“The month of fasting is the month of compassion” (Mishkat al Masibah 1!613).in Ramadan people are compassion, generous which is human aspect of fasting.
Ramadan awakens a sense of humility in all human beings. It produces an atmosphere of compassion. Ramadan teaches us how a society can be turned into truly human brotherhood.

 

Nazima Parray

White color among all the colors has always been a favorite of ‘Saba’. To her this color was a symbol of pure and serene love. This summer mornings were not the usual mornings. These morning breezes were filled with strange smell of death that had just visited her neighborhood. Death is an unwanted guest for everyone but unwillingly one has to welcome it, but death in this form is barbaric and heart wrenching. This time a mother has lost her only hope by the hands of unwanted visitors to Saba’s motherland who claim their ownership on this land. These visitors have changed the identity of her son and have given him the name of a ‘stone-pelter’ and killed with this name.  To her mother his name was ‘suhail’ and the essence of his innocent blood is still afresh on her perforated soul. Little did Saba know that these visitors were destined to change her world too? With suhail’s death, tagged with the new name of ‘Stone pelter’, the killers did get the impunity under law while his family sank into the everlasting and unending pain. He was not alone and his mother was not the only sobbing character under the shade of the gun yielding new members of her neighborhood. There were other sisters, brothers, fathers and spouses crying and wailing for the ones they lost to the trigger happy lot. The gloom in the air and the frown on everybody’s face was not just an outcome of deaths taking place day in and day out but the fear of death and destruction, fear of desecration of honor of mothers, sisters and daughters and the fear of losing the identity.

Saba, dressed in her white school uniform reluctantly left for the school. She left the home saying goodbye to her mother with a promise to return early since Saba had to accompany her mother to buy new white dress which she was going to wear at her uncle’s wedding. She was excited to visit the market with her mother in the evening and enjoyed the discussion about cloths and new fashion trends in the market with her friends. The dabbed giggles of the girls in the school were the only remnant of old pristine glory of the place they lived in. The precincts of the school were, believingly, the only safe domains for these innocent girls where they could be just themselves. Saba discussed the new style of hair tail her mother had taught her to bind, the color of her new nail paint she wanted to wear on the upcoming marriage party and all the mundane matters that matter most amongst the little innocent girls. The closing bells rang and all the girls jumped off the desks and rushed through the doors. Saba, excited with the prospects of visiting the market with her mother too closed her school bag, hung it on the shoulder and hurried herself to the deserted road leading to her house.

Walking along the road, preoccupied with her thoughts weaving hundreds of dreams for her future in her eyes with  the promise to reunite with her family on the back of her mind, Saba, would have never thought her promise of reaching home early would remain unfulfilled. This time there was no stone pelting, no protest, nothing that would engage the uniformed men standing across the streets. The idle uniformed unknown visitors, this time over caught Saba who was lost in her thoughts. A sudden jerk from behind swept her off her feet and eventually off her innocence. These men, with horrifying instincts, took her to some unknown place. They blindfolded her, snatched her bag, threw it off and brutally tore her white uniform into shreds. Horrified Saba was unable to understand what was happening, she was not able to retaliate, she was too meek to resist but her soul was too strong to surrender. She struggled with vain punches and kicks but she was too fragile to give in. These unknown visitors, while talking to each other and deciding who was going to be the first to get the privilege of tearing her chastity, were calling each other with the words like, ‘come visit the heaven’. ‘Heaven’, what heaven are they talking about. ‘Ma’, always used to say only good people goes to heaven but these people don’t seem good at all. They have almost killed me with the weight of their bodies. They are giving me unending pain how come they will visit heaven. Why are they laughing at me? Can’t they see my agony’? Are they not listening to my cries? Please give me my white uniform back, she cried. I have never been nude, not even in front of my mother who gave me birth was what revolved her thoughts that occupied her pleasant dreams some time back. My ribs are broken now so is my soul, she rued while she breathed with difficulty. Please don’t click my pictures, how they are going to entertain you during nights, she would wordlessly convey with her eyes. One after other repeating the same process, process of pain and agony, process of torture and misery. Saba was dying, didn’t need anything just a cup of water. But the water that slipped from her eyes reached her lips was not the water her mother would give her. The taste of this water was salty and warm, this water was the water that oozed out with the grind of her soul, this exuded from her red eyes that watched her body being torn apart, being battered, thrashed with sickening throbs and the soul drenched with the dirty fluid. You have killed me now please let me go I want to see my mother one last time, she pleaded.

Under the open sky and at some distant dark place they left her all alone, alone in the darkness of her dreams, darkness of her future, darkness of her lifeless drained out white flesh, darkness of her sunken eyes and darkness of her parents esteem. Saba, unable to get up and half dead, lying unconscious on the ground, woke up by the first rain drop that touched her nude body. Her white uniform stained with blood and all torn up. Blood of her innocence, blood of her mother’s dreams, blood of her father’s dignity and above all the blood of her virgin body. The stain of this blood on the same white cloth could have given her a new identity of being a good wife had it been out of her nuptial tie. The same white colored dress would have made her the most beautiful bride on earth. These unknown and unwanted brutes snatched everything from her and from her family. These unknown visitors gave her a new life with unending pain and the all new identity of being called RAPE VICTIM.

Saba was an ordinary rape victim, she was the victim of collateral damage, she was the victim where the perpetrators enjoy impunity, she was the victim where her destroyers would be awarded and honored with medals. Saba was just one amongst the thousands whose muzzled voice would not pass beyond the ears of her family, neighbors and the society she would live in. She was no ‘Nirbaya’ for whom thousands of candles would be lit on the streets and for whom the country would mourn. She was an ordinary girl who was destined to be the matter of consumption for the lewd fantasies of her so called protectors of motherland.

When Saba was carried to her home by some passersby who spotted her lying semiconscious on the edge of the road, she did not cry. Her haggard hair, her bruised body and her arms wound up hiding her chest was enough to convey her plight to her mother who ran down the front stairs of her house on seeing her daughter limping inside the compound. Her mother wrapped her body with the dupatta, the dupatta that had never slipped her hair all through the life. No one had ever seen a streak of her hair till this date except for her husband. But today she could feel the nakedness of her body in her child who had been devastated and there was no importance of covering her hair when her honor was splattered into the murky drain. She embraced Saba and frantically shook her, pleading to narrate the happenings to her. But Saba had turned into the stone, she had matured, as if, with the flip of a page. In just few hours the cruel events had transformed her into a silent matured lady from an innocent school girl. Saba, in few moments had become a rape victim, a girl who was not worth attending the marriage party, the girl who cannot go to the market with her mother to buy the latest fashion clothes, the girl who cannot apply her favorite nail paint, the girl who would not get a life partner, the girl who would not go to attend the regular school and would not be sitting and giggling with her friends in the school. The smile, the essence of life, the fragrance of youth, the dreams of lovely future, the dreams of having a loving husband and children vanished in the thin air. Saba lost her life like her neighbour Wamiq did. Wamiq though got the sympathies of the people living around him, Saba was not even lucky to get that. Wamiq would be remembered at least as a ‘stone pelter’, Saba would be cursed as a ‘rape victim’. Wamiq was laid to rest with thousands carrying his body to grave; Saba has not even the grave to carry her.

NOTE-The writeup is a piece of fiction.

Writer Syed Zumair Bukhari

 

 

Isolated every now & then, up the creep,

Life goes on with musings of heap;

Hollowness tempts me deepen deep,

Blissful often unhollows me, i cry ,i weep;

Why couldnt uh hear me? Am i that nigh?

I’ve veiled your reminiscence with every sigh;

On the wedge of hills,i scream your name,

My soul stretches tight across the skies,

The rainbow furnishes shade to reach you,

The time resumes to feel you, to feel us,

I’m burnt-out in my covetousness, blazing high,

Your shadow furnishes breeze to my lingering soul,

I espy uh in the burnt-out ends of smoky day,

Though you’ve a great vision of boulewards,

Your glimpse fades to astonish me,

And slowly I live I die, though it hardly understands,

I being a hypocrite keep things go on,

Uh exist no more in my nest, so doesnt i,

Somewhere far away, I yet feel us,

Abhorrence jammed ecstasy, life walked out,

Time passed by degrees, detached us,

Nothing much to carve up,

We departed long turns back,

Distant us,

Strangers Us . . .

 

Nazima Parray

The education sector in Kashmir has seen a drastic change over the past years. Despite the fact that government of India has introduced number of literacy programme and many other literacy campaigns one third of state’s population is illiterate. Every year huge investment is made by the government so as to improve infrastructure in schools. But this is very disappointing to see number of government schools and colleges without facilities that are required to push the education sector from the old rugged system to the ever growing state of the art pattern. The ratio of school going girls has declined only due to lack of basic health facilities in the government schools and colleges. The irony is that no one is ready to admit their children in government schools. The teachers and the other staff are highly qualified and are drawing a healthy amount of salaries from the government but quality education has become a distant dream. The government schools follow the same out dated curriculum and teaching methodology which is of no use in present innovative world.  Fear of severe punishments from the teachers has become another nightmare for the students with the result illiteracy rate have increased. Sense of morality is sacrosanct for the teachers as well as for the students. It is a sense of morality that will awaken the sense of humanity in an individual. Students should learn these things from their teachers which are their role model .But these things seems less important to the teachers. Tolerance level and intellect bend of mind is seen lacking in them. Habit of listening is a considered healing for the one who is speaking. Our teachers have become a very bad listener and our students have turned dumb. Nobody is ready to give them a patient hearing. With the result they have become distracted and disinterested. Majority of teachers are seen disinterested in teaching. They are teaching either for the monetary purpose or are there by default. Passion dedication is totally absent among many teachers with the result every year our schools drop out ratio is alarmingly increasing. Our youth needs vision and credible guidance from the teachers. Above all they need an example which in our education system is none.

Not only has this but the present political situation and turmoil across the valley become an apparent cause of illiteracy in Kashmir.  Corruption and favoritism in the government sector is on the other hand very discouraging for these poor people. Society at large is also playing its part towards illiteracy. Number of young boys has to quit school only to support their families. On the other hand many parents want to marry their daughters early so as to ease their burden. Discrimination among upper class and lower class has created a barrier for poor students to get stress free education.  It is not that teaching fraternity in the education sector especially in the government is completely responsible for the mess this sector is in, the other factors especially the apathy on the part of government and the bureaucratic setup have a nasty hand which cannot be ruled out. To bring this sector back on rails we need some tough decision making at the top level and some brushing and combing at each level so that the education in real sense is imparted to the children in the most relevant manner. This sprucing at each level should not include the government, bureaucrat   and teachers alone but also the parents, civil society, intellectuals, media and the students themselves. In addition to the changes and improvements that need to be taken care of in the system on the fronts involving teachers, government, students etc, we need thorough revamp in the infrastructure also. The modern techniques with modern equipments and gadgetry need to be employed for adopting unconventional teaching practices. The airy and spacious classrooms with sufficient lighting and comfortable heating arrangements will have to be put in place to give a sense of comfort to the students and to make their learning more attractive. Proper curriculum with the latest teaching methods and the facilities of modern libraries, laborites and computer labs are imperative in the contemporary educational setup. The ease of access to the internet and a contact through interschool competition, symposia are some add-ons that would keep the students glued and enhance the interest of the students and teachers in the process. The need of the hour is not only to focus on books and blackboard but to imbibe the new technology in to the system that along with the general line studies would expand the imagination and intellect of the students

(The writer is a research scholar)

By Raashid Ahsaan

A number of infectious diseases (such as HIV, syphilis, hepatitis B and hepatitis C, among others) can be passed from the donor to recipient.

Among the diseases than can be transmitted via transfusion are:

• HIV-1 and HIV-2
• Human T-lymphotropic virus (HTLV-1 and HTLV-2)
• Hepatitis C virus
• Hepatitis B
• Treponema pallidum
• Malaria
• Chagas Disease
• variant Creutzfeldt-Jakob Disease or “Mad Cow Disease” has been shown to be transmissible in blood products. No test exists for this, but various measures have been taken to reduce risks.

When a person’s need for a transfusion can be anticipated, as in the case of scheduled surgery, autologous donation can be used to protect against disease transmission and eliminate the problem of blood type compatibility. “Directed” donations from donors known to the recipient were a common practice during the initial years of HIV. These kinds of donations are still common in developing countries.

Processing of blood prior to transfusion

Donated blood is usually subjected to processing after it is collected, to make it suitable for use in specific patient populations. Examples include:

• Component separation: red cells, plasma and platelets are separated into different containers and stored in appropriate conditions so that their use can be adapted to the patient’s specific needs. Red cells work as oxygen transporters, plasma is used as a supplement of coagulation factors, and platelets are transfused when their number is very scarce or their function severely impaired. Blood components are usually prepared by centrifugation.
• Leukoreduction, also known as Leukodepletion is the removal of white blood cells from the blood product by filtration. Leukoreduced blood is less likely to cause alloimmunization (development of antibodies against specific blood types), and less likely to cause febrile transfusion reactions.
  • Chronically transfused patients
  • Potential transplant recipients
  • Patients with previous febrile nonhemolytic transfusion reaction
  • Patients with hereditary immune deficiencies
  • Patients receiving blood transfusions from relatives in directed-donation programs
  • Patients receiving large doses of chemotherapy, undergoing stem cell transplantation, or with AIDS (controversial).
  • Neonatal transfusionTo ensure the safety of blood transfusion to pediatric patients, hospitals are taking additional precaution to avoid infection and prefer to use specially tested pediatric blood units that are guaranteed negative for Cytomegalovirus. Most guidelines recommend the provision of CMV-negative blood components and not simply leukoreduced components for newborns or low birthweight infants in whom the immune system is not fully developed. These specific requirements place additional restrictions on blood donors who can donate for neonatal use. Neonatal transfusions are usually top-up transfusions, exchange transfusions, partial exchange transfusions. Top-up transfusions are for investigational losses and correction of mild degrees of anemias, up to 5-15 ml/kg. Exchange transfusions are done for correction of anemia, removal of bilirubin, removal of antibodies and replacement of red cells. Ideally plasma-reduced red cells that are not older than 5 days are used.

1. If an exchange transfusion is necessary, compatible blood must be ordered. If a severely affected ( i.e. hydropic) infant with Rh hemolytic disease is anticipated at birth, it may be necessary to have blood available in the nursery prior to the delivery. The request should be for O negative packed red blood cells of the specific volume needed and of the appropriate CMV status. This blood may be utilized in any one of the following ways:
2. The RBC’s may be given as a simple transfusion (with or without additional Plasmanate) while stabilization of the infant is accomplished.
3. The RBC’s may be used for a partial exchange transfusion to acutely elevate the hematocrit without changing the blood volume in a severely anemic baby.
4. When the need for an emergency, complete exchange transfusion is virtually certain, arrangements can be made in advance for O negative whole blood or O negative PRBC’s resuspended in fresh frozen plasma.
5. For double-volume exchange transfusions for hemolytic disease of the newborn or for hyperbilirubinemia without hemolysis, the blood used will be packed cells (type O, Rh specific for the infant) resuspended to the esired hematocrit in compatible fresh frozen plasma.
6. A partial exchange transfusion is often done for polycythemia (see section on polycythemia). II. Although the standard anticoagulant (CPD) is acidic, the blood need not be buffered. If the infant is severely acidemic, consult the staff neonatologist. III. If possible, the infant should be NPO and the stomach contents aspirated prior to the procedure. IV. The exchange transfusion should be done under a radiant warmer using sterile technique.V. The donor blood should be warmed using the blood warmer to a temperature not exceeding 37oC. VI. The infants blood pressure, respiratory rate, heart rate and general condition should be monitored during the exchange transfusion according to standard nursing protocol.

VII. If the serum bilirubin concentration is at a dangerous level and the blood for exchange transfusion is not yet ready, consider priming the infant with 1 gram/kg (4 ml/kg) of a 25% solution of salt-poor albumin to bind additional bilirubin and keep it in the circulation until the exchange can be accomplished..

VIII. The umbilical vein catheter should be inserted until there is free flow of blood immediately prior to starting the exchange transfusion. See section on placement of umbilical catheters for technique. The exchange transfusion should not be done through an umbilical artery line unless the UAC is used only for blood withdrawal with simultaneous replacement through the umbilical vein or peripheral IV. At the beginning of the exchange transfusion, the first blood sample withdrawn should be sent for 1)total and direct bilirubin; 2) hemoglobin and hematocrit; 3) glucose; and 4) calcium.

1. Use the “exchange transfusion kit”, which contains catheters, stopcocks, waste bag, and calcium gluconate.
2. Ideally, blood (or colloid in the event of a partial volume exchange) should be infused through a peripheral vein at a rate equal to blood withdrawal from the UVC. If the “push-pull” (single catheter) technique is utilized, no more than 5 ml/kg body weight should be withdrawn at any one time.
3. The exchange volume is generally twice the infant’s blood volume, (generally estimated to be 80 ml/kg). The total volume exchange should not exceed one adult unit of blood (450-500 ml). A standard two-volume exchange will remove approximately 85% of the red cells in circulation before the exchange and reduce the serum indirect bilirubin level by one-half. The exchange of blood should require a minimum of 45 minutes.

XII. The need for giving supplemental calcium is controversial. If used give 0.5 to 1.0 ml of 10% calcium gluconate IV, after each 100 ml of exchange blood. Monitor heart rate for bradycardia.

XIII. At the end of an exchange transfusion blood should be sent for sodium, glucose, calcium, total and direct bilirubin, and hemoglobin and hematocrit.

XIV. At the end of an exchange transfusion, the umbilical vein catheter is usually removed. In the event of a subsequent exchange, a new catheter can be inserted.

1. Hypoglycemia often occurs in the first or second hour following an exchange transfusion. It is therefore necessary to monitor blood glucose levels for the first several hours after exchange.

XVI. The serum bilirubin concentration rebounds to a value approximately halfway between the pre- and post- exchange levels by two hours after completing the exchange transfusion. Therefore, the serum bilirubin concentration should be monitored at two to four hours after exchange and subsequently every three to four hours.

XVII. Feedings may be attempted two to four hours after the exchange transfusion.

Terminology

The terms type and screen are used for the testing that (1) determines the blood group (ABO compatibility) and (2) screens for alloantibodies. It takes about 45 minutes to complete (depending on the method used). The blood bank technologist also checks for special requirements of the patient (eg. need for washed, irradiated or CMV negative blood) and the history of the patient to see if they have a previously identified antibody.

A positive screen warrants an antibody panel/investigation. An antibody panel consists of commercially prepared group O red cell suspensions from donors that have been phenotyped for commonly encountered and clinically significant alloantibodies. Donor cells may have homozygous (e.g. K+k-), heterozygous (K+k+) expression or no expression of various antigens (K-k+). The phenotypes of all the donor cells being tested are shown in a chart. The patient’s serum is tested against the various donor cells using an enhancement method, eg Gel or LISS. Based on the reactions of the patient’s serum against the donor cells, a pattern will emerge to confirm the presence of one or more antibodies. Not all antibodies are clinically significant (i.e. cause transfusion reactions, HDN, etc). Once the patient has developed a clinically significant antibody it is vital that the patient receive antigen negative phenotyped red blood cells to prevent future transfusion reactions. A direct antiglobulin test (DAT) is also performed as part of the antibody investigation.

Once the type and screen has been completed, potential donor units will be selected based on compatibility with the patient’s blood group, special requirements (eg CMV negative, irradiated or washed) and antigen negative (in the case of an antibody). If there is no antibody present or suspected, the immediate spin or CAC (computer assisted crossmatch) method may be used.

In the immediate spin method, two drops of patient serum are tested against a drop of 3-5% suspension of donor cells in a test tube and spun in a serofuge. Agglutination or hemolysis in the test tube is a positive reaction and the unit should not be transfused.

If an antibody is suspected, potential donor units must first be screened for the corresponding antigen by phenotyping them. Antigen negative units are then tested against the patient plasma using an antiglobulin/indirect crossmatch technique at 37 degrees Celsius to enhance reactivity and make the test easier to read.

If there is no time the blood is called “uncross-matched blood”. Uncross-matched blood is O-positive or O-negative. O-negative is usually used for children and women of childbearing age. It is preferable for the laboratory to obtain a pre-transfusion sample in these cases so a type and screen can be performed to determine the actual blood group of the patient and to check for alloantibodies.