The Scientific Journal of Iranian Blood Transfusion
Year:2013 | Volume:10 | Issue:3 (41)|Papers Count:16

Background and Objectives: Every single donated blood unit is a valuable capital. The aim of this study is to evaluate the rate of blood consumption in Kerman hospitals and suggest solutions to reduce the blood wastage.Materials and Methods: This 4-year study evaluates the blood usage and wastage in three selected Kerman hospitals one affiliated to a university hospital, the other to the Social Security Organization, and the last to the private sector.Results: The average usage of pack RBCs is higher than other products in the three hospitals: the university hospital 4190.25±765.66 units per year, the Social Security Organization affiliated hospital 1660.75±162.31 units per year, and the private hospital 231.8±62.9 units per year. Annually, in the university hospital the average request of blood per active bed is 15.09 units/bed and the average usage is 14.8 units/bed; cross matched to transfused blood (C/T) rate is not detectable due to inappropriate cross match registry in the university hospital. In the Social Security Organization affiliated hospital, the average blood request is 6.1 units/bed and the average blood usage is 4.9 units/bed; the C/T ratio is 1.6. In the private hospital, the average blood request is 5.2 units/bed and the average blood usage is 4.4 units/bed; the C/T ratio is 2.9.Conclusions: The evidence shows that the blood usage in Kerman hospitals is approximately similar to the global standards. Since the preparation of a blood unit costs a lot of financial and intellectual charges, improving blood usage based on international standards is necessary.

Background and Objectives: Mesenchymal stem cells are fibroblasts with the capacity of proliferation, colonogenesis, and differentiation to the mesodermal cells that are known as the source for cell therapy purposes. These cells are present in some adult and embryonic tissues in which the bone marrow serves as the main source of human mesenchymal stem cells. Because of some limitations in using the bone marrow, in this study we established a method for isolation of mesenchymal stem cells from placenta and characterized their properties.Materials and Methods: In this experimental study, we obtained 3 placenta tissues from informed consent mothers after normal vaginal delivery. Mesenchymal stem cells were isolated from the placenta, cultured, and were then examined for their proliferation, colonogenesis, immunophenotyping and differentiation capacities from passages 3 and 7.Results: Our results showed the high capacity of proliferation and colonogenesis of placental derived mesenchymal stem cells. Immunophenotyping confirmed more than 95% purity of isolated cells; their surface antigen expression showed the phenotypical properties like those of bone marrow derived mesenchymal stem cells. The cells had the osteocytic and adipocytic differentiation capacity.Conclusions: In this study we successfully isolated mesenchymal stem cells from placenta and cultured them without any alteration in their capacities; consequently, we found out that we can isolate and expand these cells as an alternative source for cell therapies.

Background and Objectives: The most common marker used for HBV infection diagnosis in blood donors is screening for HBsAg. The failure of HBsAg detection in blood donors cause of either the window period, or the mutation in S gene, or the reduction in the antigen synthesis can lead to transfusion-transmitted HBV in blood recipients. There have been reported hepatitis cases following the transfusion of anti-HBc positive blood and blood components. The prevalence of anti-HBc in populations is proportional to the prevalence of HBsAg. It is better then for studies about the prevalence of anti-HBc to be conducted in HBV highly prevalent regions. Thus, the aim of this study was to survey anti-HBc and anti-HBs prevalence rates in blood donors in Sistan-o-Baluchestan.Materials and Methods: In this cross-sectional study, 1500 HBsAg negative samples were collected from Sistan-o-Baluchestan and tested for anti-HBc. All anti-HBc positive samples were tested for anti-HBs. All data were analyzed statistically using Chi-square test.Results: Out of 1500 blood donors who were negative for HBsAg, 144 (9.6%) were positive for anti-HBc with 74.3% having the immunity titer of anti-HBs.Conclusions: In this study, the prevalence rate of anti-HBc was very high. Most of anti-HBc positive blood donors were positive for anti-HBs. Therefore, screening of blood donors for anti-HBc can limit the storage of blood.

Background and Objectives: Alloimmunization with the prevalence rate of 60% is a common problem in chronically transfused patients. This problem has been reported to be less common in transfused hospital-based patients, amounting to 1-2 percent. Alloimmunization can lead to some difficulty varying from delay in the provision of similar blood types to delayed hemolytic transfusion reactions. The aim of this study was to analyze alloimmunization against RBCs among non-chronically transfused patients in Namazi Hospital in Shiraz.Materials and Methods: Retrospective analysis of 3487 non-chronically transfused patients was conducted with antibody screening test and identification of patients' alloantibodies with the panel cell test. For patients with alloantibody, the data for sex, age, and history of transfusion and surgery were collected. Finally, the data were analyzed by SPSS software v. 15 using chi-square (CI=95%).Results: Twenty-eight out of 3487 patients had alloantibody (prevalence rate of 0.8%). The most common clinically significant alloantibodies found were anti-K (23%), anti- E (15%) and anti-C (11%). The most common clinically significant alloantibodies identified in males and females were anti-K and anti-C, respectively.Conclusions: Alloantibody prevalence rate did not show any correlation with age and sex and was more common in patients with surgery history and transfusion record. Important factors contributing to the higher prevalence of the above alloantibodies are the higher prevalence of the related antigens in the population, higher antigenicity power, and the lack of crossmatch and grouping for the antigens before blood transfusion.

Background and Objectives: Chronic lateral elbow epicondylitis known as tennis elbow is an angiofibrolastic tendinosis of the wrist extensors' origin. Healing of this lesion is reported with the use of autologous blood and PRP. The aim of this study was to compare the short term effects of PRP versus autologous whole blood local injection in patients with chronic tennis elbow.Materials and Methods: Forty-five patients with chronic lateral epicondylitis were randomly divided into two groups. Group one was treated with a single 2 mL injection of autologous PRP and group two with 2 mL of autologous blood. Tennis elbow strap, stretching and strengthening exercises were administered for both groups during the 2 month follow up. Pain and functional improvements were assessed using visual analog scale (VAS), Mayo score (Modified Mayo clinic performance index for the elbow), and Pressure Pain Threshold (PPT) at the 0, 4th, and 8th weeks.Results: All pain variables including VAS, PPT, and Mayo scores were improved significantly in both groups 4 weeks after injection. No statistically significant difference was noted between the groups regarding pain scores in the 4 week follow up examination. At the 8th week reevaluations, VAS and Mayo scores improved significantly only in the PRP group. The whole blood group showed clinical improvement.Conclusions: PRP and autologous whole blood injections are both effective methods to treat chronic lateral epicondylitis. Regarding the pain reduction and functional improvement, the PRP treatment seems to be more effective and superior to autologous blood in the short term.

Background and Objectives: About 70% of MSCs die in the early stages of transplantation into the infarcted myocardium. Several solutions have been made to address this problem. In the last decade, preconditioning of MSCs with oxidative stresses has gained a lot of attention. In this study, we have investigated the effects of preconditioning with hydrogen peroxide (H2O2) on the survival of MSCs and their resistance against oxidative stresses.Materials and Methods: Mesenchymal stem cells from bone marrow have been cultured. Cells from the passage four were treated with 5, 10, 15, 20, 30, 40, 50, 60, 80, and 100µm concentrations of H2O2, and were then recovered with the fresh medium. Finally, the treated cells were exposed to 500 mM H2O2 as the killing condition. The percentage of survived cells was analyzed by the MTT assay kit.Results: Preconditioning with 5 and 10 mM H2O2 significantly increased the resistance of MSCs against the apoptosis induced by 500 mM H2O2.Conclusions: Preconditioning of MSCs with oxidative stresses enhances their survival; therefore, it can increase the efficacy of transplantation.

Background and Objectives: The distribution of HLA alleles varies among different ethnic populations. Obtaining HLA data for different ethnic groups will be helpful to determine donor recruitment goals and strategies in unrelated stem cell registries.Materials and Methods: Based on the data available from the Iranian Stem Cell Donor Registry, the frequency rates of HLA-A, B, DRB1 alleles evaluated by PCR-SSP method were reported; 1513 individuals living in Tehran city with six different ethnicities (Fars, Azeri, Kurd, Lur, Gilak, and Mazani) were the participants.Results: Out of 1513 participants, Fars and Azeri ethnic groups had the highest number with 63.12% and 20.02%, respectively. Twenty one HLA-A, thirty-one HLA-B, and thirteen HLA-DRB1 alleles were observed. Data analysis among different ethnicities showed no significant differences between Fars and Azeries except for HLA-DRB1*33 frequency (p<0.005). Significant differences between Fars and Kurds were seen in HLA-A*03/11 and HLA-B*08/51 frequencies. There were significant differences between Fars and Gilaks in HLA-A*03/26, HLA-B*38/52 frequencies (p<0.05).Conclusions: The number of reported alleles in this study was similar to previous ones. There is not much alleles diversity, despite a few differences, across the different ethnic groups.

Background and Objectives: Factor XIII deficiency is one of the rarest bleeding disorders with an estimated prevalence of 1 in 1-3 million in the general population. The main clinical manifestations of the disease are delayed wound bleeding, recurrent miscarriage, intracranial bleeding, and umbilical cord bleeding. The prevalence of the disease in the regions such as Sistan and Baluchistan with consanguinity marriages is higher. The aim of this study was to assess the diagnosis and treatment of factor XIII deficiency in Sistan and Baluchistan province.Materials and Methods: This descriptive study was performed on 205 patients with the severe factor XIII deficiency. The diagnosis of the disease was done by a wide spectrum of characteristics including family history, clinical manifestations, laboratory tests, clot solubility in 5 M urea or monochloroacetic acid 1% environments.Results: It seems that Khash city has the highest prevalence of the disease worldwide. The molecular analysis of the patients showed that an identical homozygote mutation TGG®CGG at codon 187 in exon 4 of catalytic A subunit is responsible of this deficiency. The common manifestations of the disease at time of diagnosis were umbilical bleeding (84.4%), deep soft tissue haematoma (54.4%), and less frequently gum bleeding and finally ecchymosis.Conclusions: It seems that Sistan and Baluchistan province has the highest prevalence of factor XIII deficiency worldwide with a dramatic increase of 46 cases in 2008 to 205 patients in 2012 that alarmed the absence of a screening test in this region.

Background and Objectives: Fibrin based sealants are frequently used to arrest blood loss in surgery. The aim of this study was to prepare fibrin-based sealants from thrombin and fibrinogen and evaluate the hemostatic efficacy of the fibrin sealant in a rabbit animal model.Materials and Methods: In this experimental study, plasma was prepared with the apheresis method. Fibrinogen was prepared by mixing the cryoprecipitate with protamine sulfate and its concentration was assayed with an ELISA method. The fibrin sealant was applied to the controlled animal liver incisions; then, the time of bleeding and the volume of blood loss were measured. Blood loss and time of bleeding were also evaluated in heparinized rabbits.Results: The fibrinogen concentration precipitated with protamine sulfate was measured as being 71±6 mg/ml. The thrombin mixed with fibrinogen had clot time of 5±0.6 seconds. The application of the fibrin sealant significantly reduced the time of bleeding (8.8±2 sec) and blood loss (1.05±0.4 gr) of the rabbit liver incisions compared with the control (643±96 sec, 6.9±1.2 gr) (p<0.001). Despite the use of the fibrin sealant, the blood loss and the time of bleeding were greater, though not statistically significant, in the heparinized rabbits than in the nonheparinized rabbits (p=0.2).Conclusions: The fibrin sealant prepared by the precipitation of fibrinogen and thrombin offers a novel therapeutic approach to obtain autologus sealants for clinical use.

Background and Objectives: Major b-thalassemia is one of the most problematic diseases both for patients and their families as well as for health services. The number of major thalassemia cases born in 1988 was reported to be 1200 which reduced to 250 in 2007. In spite of the success of the screening program, we still experience some new cases of b -thalassemia. This study aimed to investigate the causes of occurrence of new affected infants to help the prevention program.Materials and Methods: In this descriptive analytic study, the parents of b-thalassemia patients having referred were investigated. EDTA blood samples were used for CBC, electrophoresis, and Hb A2 measurment. Simultaneously, the participants were asked to fill out the prepared questionnaire for the causes of occurrence to be evaluated. CBC was performed by sysmex XS800i, electrophoresis by cellulose acetate, and Hb A2 by column chromatography.Results: Sixty eight couples, as the parents of 78 patients with major thalassemia, participated in the project. Out of the total number of patients, 20 (25.6%) were under 13 years of age out of whom 7, 2 and 11 were addressed by the first, second, and third strategies, respectively. Four patients were born due to being left undiagnosed or misdiagnosed due to error in screening and pre-natal tests.Conclusions: In order to minimize the occurrence of new cases, we should promote the education and awareness in underdeveloped and non-urban communities. The couples should be identified and directed. The financial support and the possibility of on time testing could be helpful.

Background and Objectives: Post exposure prophylaxis (PEP) for HIV infection has been shown to significantly reduce the transmission of HIV in occupational exposures. Medical students are one of the high risk groups for exposure to patients’ discharge. The objective of the study was to assess the level of knowledge, attitudes, and practices of nursing and midwifery students.Materials and Methods: In this cross-sectional study, 129 last year nursing and midwifery students consented to participate entered the study by the census sampling method. The questionnaire-collected data were analyzed with SPSS 16.Results: The results showed 45.7% of students having a good level of awareness, 82.2% a positive attitude, and 73.6% the negative practice on PEP.Conclusions: This study showed students’ awareness about and practices on PEP were low and negative. Their positive attitude about PEP would not change their practice and they are still exposed to high risk discharge; therefore, a certain policy should be formulated to improve students’ practices on PEP. Moreover, the authorities should consider some strategies to improve skills, allocate adequate resourses, and exert supervision on student practices.

Background and Objectives: Pre-transfusion inactivation of donor T-cells by irradiation is the method of choice for prevention of TA-GVHD. This study reviewed the usage of irradiated products in one year period in Tehran Blood Transfusion Center.Materials and Methods: There were 1333 requests for irradiated blood products to be evaluated. The data including the quantity and type of irradiated products, patients’ age and indications were gathered. Descriptive statistical analysis was performed by SPSS 18 software.Results: The requested irradiated products in the one-year period of time include platelets (71.3%), packed RBCs (28.1%), FFP (0.4%), paediatric bags (0.2%), and whole blood (0.1%). The age groups of patients having received irradiated products were adults (59.6%), children (25.9%), infants (6.5%), and neonates (3.3%). Indications of prescription consist of leukaemia/lymphoma and Hodgkin (49.6%), allogeneic and autologous bone marrow transplantation (17.7%), immunosuppressive therapy (9.6%), congenital immunodeficiency (8.6%), premature birth (7.6%), aplastic anaemia (6.5%), relatives designated donation (0.3%), and HLA matched plateletphaeresis (0.1%). The increasing trend in the quantity of requests of irradiated products and requesting hospitals was observed.Conclusions: It is recommended that a higher number of hospitals and their staff be informed about irradiated products and their indications and the roles they have on the prevention of TA-GVHD.