Treatment & Services in Transfusion Medicine Department at Indraprastha Apollo Hospitals Delhi, India

·         Receives the donors for blood donation with a warm welcome and act as a bridge between the hospital staff and the technical staff of the blood bank.

·         Well-trained staff does donor screening, while Donor privacy and confidentiality is maintained at all times.

·         Pretest counselling to defer high-risk donors is undertaken.

·         Blood bags with pre storage leukoreduction filter are used that provide 3-4 logLeukoreduced blood. The advantages of leucoreduction include:

1.     Prevention of Febrile Non Hemolytic Transfusion Reactions (FNHTR)

2.     Prevention of HLA allo-immunization

3.     Reduction in transmission of lymphotropic viruses such as EBV, CMV and HTLV-I & II.

4.     Prevention of immunomodulation

·         The bags also contain a sample pouch, which diverts first 15-30 ml of blood that is used for testing. This has significantly reduced bacterial contamination of blood products.

·         The sterile connecting device has made it possible for us to provide blood components in parts for fulfilling pediatric transfusion requirements. The various components prepared in our
BLOOD COMPONENT PREPARATION LABORATORY include:

1.     Leukoreduced Packed Red Cells (3-4 log leukoreduction)

2.     Random Donor Platelets and Fresh Frozen Plasma

3.     Cryoprecipitate

4.     AHG poor plasma

5.     Washed RBCs

6.     Irradiated RBCs

·         The IMMUNOHAEMATOLOGY LABORATORY is a reference centre providing advanced Immunohaematology work-ups, not only for in-house patients but also to patients from other hospitals.

·         Tests performed at our laboratory include:

1.     Donor: Blood grouping (ABO & Rh), Rh phenotyping and Immune antibody screening

2.     Patients: Grouping, antibody screening, antibody identification and extended antigen typing if required.

3.     Cross matching

4.     Advanced work up such as auto/alloadsorption& elution for solving of difficult cases.

5.     Direct & Indirect Antiglobulin tests

6.     Coombs titre

·         The INFECTIOUS MARKER LABORATORY, besides the five mandatory tests also performs testing of hepatitis B core antibody on all the donated blood units and the units that are found positive are discarded.

·         NUCLEIC ACID TESTING (NAT) LABORATORY: Individual Donor (ID)-NAT testing based on Transcription Mediated Amplification by ProcleixUltrio Assay is done on all the donated blood units. This has reduced the window period of HIV-I, HBV & HCV considerably and is a step forward in our quest for zero risk blood.

·         APHERESIS AND OTHER SPECIAL PROCEDURES:

1.     THE APHERESIS LABORATORY is functional 24 hours, all days. It is equipped with fully automated cell separators, which are flexible to produce various components.

2.     The various procedures undertaken include:

3.     Plateletpheresis

4.     Plasmapheresis

5.     Granulocytapheresis

·         Besides these the department also performs special procedures such as:

1.     Therapeutic Plasma Exchange

2.     Peripheral Blood Stem Cell (PBSC) collection: Autologous and Allogenic

3.     Red Cell Exchange

·         Voluntary blood donation program
The Department has initiated an in-house voluntary blood donation program wherein a list of hospital employees willing to donate voluntarily is maintained. This also includes donors with rare blood groups who can be called at the Eleventh hour for blood donation. These Voluntary Blood Donors play a pivotal role in maintaining safe and adequate blood supply that forms the backbone of any Blood Transfusion Service.
The Department also maintains the registration of Voluntary Blood Donors who are willing to donate blood at the IAH. These Voluntary Blood Donors are encouraged to become regular repeat remunerated Voluntary blood donors instead of just one-time voluntary blood donors. Voluntary donors at our hospital are also provided with certain special incentives. As per the departmental policy that all donors who have donated 4 times in a year or at least in 2 years are entitled for an Executive Apollo Health Check-up. This is to ensure that our voluntary donors remain in good health at all times.

·         Thalassemia initiative
The Department of Transfusion Medicine at Indraprastha Apollo Hospitals, New Delhi is catering to the transfusion needs of approximately 75 Thalassemic patients. We are providing NAT tested, 3 to 4 logleukoreduced blood for these patients.
In addition we perform regular screening for any irregular red cell antibodies and the extended blood group phenotyping of these patients, helping us in providing the safest possible blood for them.

·         Molecular biology and transplant immunology
During the past decade the pace of discovery, invention and innovation in Genetics has accelerated dramatically, more so in the Molecular Genetics arena.
The Apollo Group, in line with its commitment of providing world class services second to none, not only has a cutting edge technology in the Genetic services but also has an equally highly committed human resource comprising of skilled doctors and Scientists to man these services.
Molecular Diagnostics has increased our understanding of oncology and we are no longer treating cancer patients empirically but are able to assist the oncologist in prognosis as well as finding Minimal Residual Disease. Today Molecular diagnostics has reached a stage where it also plays a significant role in investigating recurrent abortions, genetic anomalies and HLA tissue typing for Organ transplantation, both solid organ and Bone Marrow transplants.

·         Services provided by immunology & molecular biology

·         Prenatal & Postnatal Diagnosis

·         Chromosomal Analysis (GTG Banding) - Abortus Material (Product of Conception)

·         Amniotic Fluid -FISH Ploidy for Chromosome 21,18,13,X and Y (5 probes analysis)

·         Amniotic Fluid -Karyotyping-GTG banding

·         CVS cell culture for routine karyotyping

·         CVS-Complete Chromosomal Analysis (Karyotyping GTG Banding+ Ploidy analysis for Chromosome 21,18,13,X and Y by FISH

·         CVS-FISH Ploidy for Chromosome 21,18,13,X and Y (5 probes analysis)

·         Cytogenetics

·         Stress Cytogenetics for Aplastic Anaemia

·         Chromosomal Analysis (GTG Banding) -Peripheral Blood

·         Chromosomal Analysis (GTG Banding) -Bone Marrow

·         Couple Karyotype from peripheral blood samples

·         Fluorescence in situ Hybridization (FiSH) for Hematological malignancies

·         FISH FOR 1q25,LSI19q13/LSI19p13

·         Her 2 Neu Gene Amplification by FISH with on Paraffin Embedded tissue Sections

·         FISH FOR CEP XY (MRD ASSESSMENT) for Bone marrow transplant assessment

·         AML FISH panel

·         FISH FOR ALL PANEL (ANY 3 FISH PROBES) TEL/AML, MLL, t(9;22), INV 16

·         FISH for CLL panel

·         FISH for AML panel

·         FISH FOR CEP-12

·         AML1/ETO t(8;21) translocation (FISH)

·         FISH FOR CML patients LSI BCR/ABL t(9;22) f

·         N-myc FISH for neuroblastoma

·         FISH FOR LSI D7S486(7q31)CEP-7q LSI 1p36/LSI

·         FISH for MDS PANEL del(5q), del (7q)

·         FISH FOR MULTIPLE MYLEMOMA t(11;14), t(14;18), 13q(del), p53(17p13)

·         HLA typing for Kidney, Liver and Bone Marrow Transplant

·         HLA CLASS -I A,B,C / PCR-SSP/SSOP

·         HLA CLASS-II DQ/DR/PCR-SSP/SSOP

·         HLA LYMPHOCYTE CROSSMATCH&HLA TYPING(DONOR&PATIENT)

·         HLA LYMPOCYTE CROSS MATCH NIH METHODS

·         BONE MARROW TRANSPLANT HLA TYPING

·         HLA B-27, HLA B-51, HLA B-17, HLA-B 15 (SSP- PCR)

·         PANEL REACTIVE ANTIBODY TEST

·         DONOR SPECIFIC ANTIBODY TEST

·         Infectious Marker Screening

·         HBV- Quantification(PCR)

·         HBV-Qualitative(PCR)

·         HCV-Quantitative(PCR)

·         HCV- Qualitative(PCR)

·         HCV genotype

·         HIV-Viral Load

·         MRD ASSESSMENT (Q-RT-PCR FOR BCR-ABL GENE)

·         HIV Proviral DNA

·         HIV Genotypic Drug Resistance

·         Molecular Genetics

·         BETA Thallasemia - 5 COMMON MUTATIONS - CHILD & PARENTS

·         THAL - MUTATIONS + XMN POLYMORPHISM

·         THALASSEMIA - (8) UNCOMMON MUTATIONS

·         THALASSEMIA - 2nd PRENATAL DIAGNOSIS

·         THALASSEMIA - ALPHA - DELETIONS (3.7 & 4.2 KB)

·         THALASSEMIA - ALPHA,BETA & GAMMA GENE ANALYSIS

·         THALASSEMIA - PRENATAL DIAGNOSIS

·         THROMBOPHILIA PROFILE(FAC V+MTHFR+PROTHROMBIM GENE)

Blood Transfusion Medicine Department at indraprastha Apollo Hospitals Delhi, India

Blood Transfusion Services (BTS) is the vital part of modern health care system without which efficient medical care is impossible. It is a complex organization requiring careful designing and management.

The aim of a Blood Transfusion Service (BTS) is to provide effective blood and blood products, which are as safe as possible, and adequate to meet the patients need.

The department uses state-of-art technology and stringent quality control protocols to ensure timely supply of the safest possible blood and blood components. The department boasts of Nuclear Amplification Technology (NAT) Laboratory which very few centres in the country currently use.

FAQ's on Physiotherapy Department at Indraprastha Apollo Hospitals Delhi, India

Q- Do I need a doctor's referral for physiotherapy treatment?

Ans- No, however we do recommend that you contact your physician/surgeon as you may require a medical referral (referral by a medical practitioner) to authorise re-imbursement of treatment charges.

Q- What is electrotherapy?

Ans- Electrotherapy is the use of electricity in order to produce different types of energy waves. These waves are then used to effect tissues by reducing swelling, pain and muscle spasm and by strengthening muscles. This results in the promotion of healing.

Q- How quickly will I be seen for my first appointment?

Ans- We will always endeavour to offer you an appointment on the same day or within 24 hours.

Q- How long does a treatment session last?

Ans- Each treatment session lasts approximately half an hour.

Q- Should I bring my X-rays with me?

Ans- Yes and any other relevant medical information you may have.

Q- How many treatments will I need?

Ans- There is no pre-determined number of treatments for a specific condition. However following your initial assessment, your physiotherapist will discuss and agree a treatment plan with you. This may include advice regarding the approximate number of treatments you may require. Individual's response to treatment varies.

Facilities of Physiotherapy Department at Indraprastha Apollo Hospitals Delhi, India

·         Cancer Rehabilitation: Lymphedema management, swallowing retraining and functional issues as weakness, soft tissue tightness, fatigue.

·         Ortho –Sports Rehabilitation: Post Joint replacement, arthroscopic repair, Post- surgical Care

·         Neuro Rehabilitation: Stroke rehab, Post traumatic brain injury, spinal cord injury rehab, paediatric neuro rehab, Assessment of ADLs, Prescription of adaptive equipment.

·         Intensive care--Acute cardio –Pulmonary care

·         Care of the Elderly: Fall prevention, balance and stability, bone health

·         Men & Women Health: Incontinence, Ante-post natal care, osteoporosis

·         Workplace Health: Ergonomics, work place advice

Pain Management: Electro physical agents

Treatments & Services in Physiotherapy Department at Indraprastha Apollo Hospitals Delhi, India

The department has pioneered a number of significant rehabilitation services such as
24 hour intensive respiratory care, Lymphedema therapy, Neuro –stroke rehabilitation, Post- transplant rehabilitation.

·         Inpatient Therapy Services

·         Cardiac & Pulmonary Rehabilitation

·         Neurological Rehabilitation Services

·         Parkinson's Disease Rehabilitation

·         Stroke & Traumatic Brain Injury Rehabilitation

·         Paediatric neruro Rehabilitation

·         Oncology Rehabilitation Services

·         Breast Cancer Rehabilitation

·         Lymphedema Rehabilitation

·         Post-surgical Cancer Rehabilitation

·         Speech & Swallowing Rehabilitation

·         Orthopaedic Rehabilitation Services

·         Amputee Rehabilitation

·         Hand, Wrist, Elbow and Shoulder Rehabilitation

·         Spine Injury & Back Pain Rehabilitation

·         Orthopaedic Bone & Joint Rehabilitation

·         Osteoporosis & Bone Health Rehabilitation

·         Men & Women health

·         Pelvic Floor Rehabilitation

·         Ante and Post natal care

·         Return to Work Services

·         Sport Specific Rehabilitation

Vestibular Rehabilitation

Physiotherapy Department at Indraprastha Apollo Hospitals Delhi, India

Physiotherapy and Rehabilitation Department provides services to inpatients and ambulatory care patients at Apollo Hospitals, focusing on restoring the health, functional abilities and quality of life of people of all age groups affected by acute illness, injury or disability such as stroke, cerebral palsy, spinal cord injuries, heart surgery, amputation, joint replacement, sports injuries or spinal disorders, cancer surgery & congenital disorders.

FAQ's on Pain Management Department at Indraprastha Apollo Hospitals Delhi, India

Q- What is pain?

Ans- Pain is a protective/safety system of the body, where the nerves conveying pain signals to the brain, warn of impending or on-going injury/insult to the body and to take appropriate action.

Q- What is Chronic Pain?

Ans- Chronic pain is the pain that lasts more than 3-4 months and is unresponsive to conservative treatment (Medications, physical therapy).

Q- What are the consequences of pain?

Ans- Chronic pain not only causes physical & mental suffering but also adversely affects family, social and professional life.

Q- What happens if pain becomes chronic?

Ans- Treating pain promptly can prevent it from turning into hard-to-treat chronic pain, when the nervous system becomes hypersensitive. Many times pain lasts beyond healing; when errant nerve impulses keep alerting the brain about tissue damage that no longer exists.

Q- Who treats pain?

Ans- Large number of generalized aches and pains responds to simple pain-killers but should be used with caution in patients with kidney/liver diseases/gastritis.

Moreover these conditions, to a large extent, are as a result of misuse or excessive use of pain-killers. Patients with obvious surgical conditions like trauma/ tumour etc. will need surgery. However large number of patients, who were earlier treated with surgery, like sciatica, are now very well treated with minimally invasive procedures, by pain physicians. Most neuralgias and neuropathies {Diabetic neuropathy/Trigeminal/ Occipital neuralgia/ nerve entrapment/ischemic pain (due to poor blood supply)/abnormal behaviour of nerves} will need specialized pain management; when only medications fail or produce unacceptable side-effects.

Q- How pain specialists treat pain?

Ans- Pain specialists are specially trained physicians, who diagnose exact source of pain or pain generators. For example back/leg pain can be due to muscles/ligaments, joints (facet joints/sacroiliac joints), tear in disc (annular tear/fissure), disc prolapse, Pyriformis syndrome etc; each of which require different treatment modality. Pain physicians non-surgically (Called Interventional Pain Management or IPM) deliver healing/numbing medications to the target. These procedures are generally safe in expert hands.

Q- Are any specialized equipment’s or devices used for managing pain?

Ans- Common pain interventions are performed in OT, using special imaging equipment’s / contrast media & vital sign monitoring. However when the numbing medications at the pain source do not produce lasting effect, the offending nerves are destroyed with Radiofrequency generator; after testing and saving useful nerves. In few cases of intractable pain, a pacemaker like device, called Spinal Cord Stimulator with cordless remote control, is implanted inside the body, which converts the pain message to a pleasant feeling (Neuromodulation). In advanced cancer patients and patients with multiple sources of pain, pain medications are delivered directly into the central nervous system in the spinal cord, through an implantable device (Intrathecal Pain Pump with remote control) that needs only 1/300th of oral medications, thereby drastically reducing side-effects and providing excellent pain relief.

Q- Where can I find a pain specialist?

Ans- Pain specialists run pain clinics in majority of large hospitals in western countries but only in a few selected hospitals in India.

Q- What are the side effects & complications of Interventional Pain Management?

Ans- Like any drug or medical therapy, Interventional Pain Management has its share of side-effects. However they are very minimal in expert hands and mostly due to technical reasons. Drug related complications are very few. The amount of drug used is very less, it remains at the target site and does not circulate to other parts of the body.

Q- What next if IPM fails?

Ans- In some situations, like in long standing back pain where the prolapsed disc has hardened, surgery will be required.