The Scientific Journal of Iranian Blood Transfusion
Year:2005 | Volume:1 | Issue:2|Papers Count:12

Background and Objectives Mismatched red blood cell phenotypes between donors and recipients in multiple blood transfusions can result in the development of alloimmunization in recipients. We studied in this research the effect of alloantibodies on the increase of need of blood transfusion in major thalassemiacs. Materials and Methods This is a descriptive study in which 2 groups of major thalassemiacs with more and less than 20 days of blood transfusion intervals (27 patients vs. 25) were evaluated for the presence and frequency of alloantibodies and related factors. We used t-test and t-student tables for evaluating the results. Results 55% of patients in the first group had developed alloantibodies and their annual transfused blood volume was more than those who were not immunized (p<0.005). Male gender and initial blood transfusion in children under 3 years old were related to the absence of alloantibodies. 100% of patients in the second group were immunized, and those who received higher amounts of blood units annually (493 ml/kg and 508 ml/kg) were patients with more than two types of alloantibodies. Alloimmunization involved K (27.5%), N (12.5%), CW, s, Fyb (5%), C, S, E, e and M (2.5%) antigens. 100% of antibodies were of warm immunoglobulin type, and 16% both warm and cold. 17.3% of thalassemiacs were splenectomized and their need for transfused blood was less than unsplenectomized patients (p<0.005). In most cases, annual blood transfusion in both groups was estimated to be much more than what was expected. Conclusions We conclude that red blood cell matching, at least for Kell and Rh systems, is necessary to prevent alloimmunization in thalassemiacs. Hypersplenism and low quality of blood, that can increase the need for transfused blood, should be taken into consideration.

Background and Objectives Human serum albumin (HSA) is the major protein component of human plasma. It plays a very important role in transporting of macro molecules and maintaining the normal osmolarity. It is used as a therapeutical protein in patients with hypoalbuminemia and acute bleeding and burning. Albumin consumption in the world is about 500 ton/year. The aim of this research is to study the production of rHSA in shake flask culture by Hansenula polymorpha. Materials and Methods H. polymorpha was used for the production of recombinant human serum albumin (rHSA) in several of shake flask culturing; expression of rHSA was investigated relating several parameters affecting the expression of HSA. To optimize the secretory expression of rHSA under the control of FMD promoter in H. polymorpha RB-11 incubation time, culture media temperature and protease inhibitors were analyzed. Results This study not only established production of rHSA in yeast but also analyzed the correlation between affecting parameters and the level of HSA expression. Comparison of the HSA levels in the culture supernatants showed that the highest HSA yield was 17.6mg/l. The research shows that among three different temperatures (25oC,30oC and 37oC) 37oC was the best temperature and amongst three different incubation times (24h,48h and 72h) 48h was the optimum time and YNB 1% glycerol with buffer was the best derepression medium in comparison with others. Conclusions Using these optimized conditions, stable production of rHSA of around 17.6mg/l was achieved. Our results suggest that affecting experssion factors improved in this study are suitable for production of recombinant albumin.

Background and Objectives Donors embarking on direct blood donation and first-time blood donors contribute to a significant proportion of the blood units collected in our center. However, there are some concerns on the safety of this kind of donation because of the possible existence of incentives for the donor to conceal deferrable risk factors, thus increasing the risk of donation within the window period of transfusion-transmitted infections. We tested the hypothesis that if donors for direct blood donation are less safe than other blood donors, the former would display a higher prevalence of viral markers. Materials and Methods This descriptive analytic study was conducted on 7192 donor forms; this number of donors referred to Zahedan Blood Transfusion Service during 2002 (21 Nov)-2003 (19 Feb). Then, the comparison was made among donors for direct blood donation, volunteer, first time, and regular blood donors. Statistical analyses were performed with the SPSS (version 10.5) and Chi-square test. Results Our study was conducted on 7192 donor forms. 6345 (88.2%) of the subjects were male, 3264 (45.4%) married, and 1511 (21%) above 30 years of age. Prevalence of HBsAg positivity was 2.3 times higher among first-time donors than repeat donors (p<0.0001). Prevalence of Anti- HCV reactivity was 1.5 times higher among first-time donors than repeat donors (p<0.0001). The rate of HBsAg positivity among donors embarking on direct blood donation was 2.4 times higher than volunteer blood donors (p<0.0001), and the rate of Anti-HCV reactivity in the former was 2.4 times higher than in volunteer blood donors (p<0.0001). The age range higher than 30 was significant in the case of HBsAg positive and Anti-HCV reactive blood donors. Conclusions Basesd on the above results, the contamination rate among donors for direct blood donation and first time donors was more than repeat and volunteer blood donors. This calls for an organized program and a better technique and strategy.

Background and Objectives Blood transfusion may lead to the manifestation of anti-HLA and platelet-specific antibodies that may in turn bring about different problems like platelet refractoriness. It appears that the study of antibodies against HLA-Class I and platelet-specific antigens are useful for the selection and success of the appropriate treatment protocol. The aim of this study was to detect anti-HLA and anti-platelet-specific antibodies by flowcytometry in patients with hematologic disorders (including Acute Leukemia, Aplastic Anemia) and patients with ITP.Materials and MethodsIn this descriptive study, anti-HLA and platelet-specific antibodies were detected by flowcytometric technique, using 62 sera drawn from patients with different hematological disorders who showed a poor response to platelet transfusion and 20 from patients with ITP. The results of anti-HLA antibodies were then compared by Panel Reactive Antibodies ( PRA ).ResultsOur results showed 44 (53.7%) out of 82 patients had anti-HLA Class-I antibodies in their sera. The frequency of each antibody isotype was found to be as follows: IgM (51.2%), IgG (32.9%) and IgA (1.2%). 36 (43.9%) out of 82 patients had platelet specific antibodies and the frequency of each antibody isotype was found to be as follows: IgM (40.2%), IgG (30.5%) and IgA (12.2%). 27 (31.7%) out of 82 patients had both antibodies. No difference was found between the two groups in platelet specific antibodies. Despite significant correlation between flowcytometry and PRA methods, PRA can only detect antibodies which react with complement.ConclusionsWith increase in the number of platelet transfusion, immunization to HLA antigens occures; moreover, immunization against platelet specific antigens may also occure during autoimmunity. The presence of these antibodies may be one of the reasons of poor response to platelet transfusion and platelet refractoriness in patients under study. Conducting similar studies with higher number of samples, platelet cross-match, and the use of HLA- matched platelets for these patients are recommended.

Background and Objectives Cytomegalovirus (CMV)infection has been recognized as a complication of blood transfusion. Transfusion-related CMV infection produces dramatic problems in immunocompromised patients including organ transplantation recipients, AIDS patients under immunosuppressive therapy, thalassemia major patients, and premature neonates. Regarding the importance of this infection in multitransfused patients and differences in prevalence of transfusion – related CMV infection in various reports, especially in thalassemia major patients, we decided to detect and compare the prevalence of CMV antibodies in thalassemia patients and blood donors. Materials and Methods In this study we detected anti-CMV antibodies (IgG,IgM) by Elisa technique. We tested these antibodies in 55 thalassemia major patients (45 non-splenectomized and 10 splenectomized) and 1040 healthy donors. Results Our results showed that anti-CMV IgG antibody was positive in 89.6% of control group and 100% of thalassamic group, thus indicating of no significant difference in these two groups. Anti-CMV IgM antibody was positive in 0.04% of control group and in 9.1% of thalassemic group showing a significant difference. The prevalence of this antibody was respectively 30% and 4.5% in splenectomized and non-splenectomized groups of patients. Conclusions Absence of significant difference of anti-CMV IgM antibody in patient and control group reflected high frequency of this infection in our population and also the importance of the use of leukocyte free products for high risk blood recipients. Moreover, the significant difference in anti-CMV IgM antibody in splenectomized and non-splenectomized patient groups is related to the role of spleen in clearance of infectious agents and production of IgM antibody in this organ

Background and Objectives Iron deficiency is a common problem in blood donors and iron deficiency anemia is an important factor limiting the number of donation attempts in regular donors. Limited data is available on the iron status of Iranian donors. Therefore, this study was conducted to evaluate the frequency of iron deficiency and the relevant factors in donors at Yazd Blood Transfusion Center. Materials and Methods 337 persons accepted for blood donation in 2003 were selected randomly. Hemoglobin, serum iron, transferrin saturation and ferritin levels were measured. Then, Chi-square, ANOVA, and Fisher exact test were used for data analysis. Results Results showed that the frequency of reduction in iron stores increased as the number of donations raised (p=0.0001). Reduction in iron stores happened among all regular female donors (100%) and 48% of regular male blood donors. The frequency of iron deficiency in these two groups was 78% in the former and 28% in the latter , while the frequency of iron deficiency anemia was 55.6% and 16% respectively. The frequency of iron deficiency raised in women who had donated only once (p<0.05), while it raised significantly only in male regular blood donors (p<0.05). Conclusions Increase in the number of donations in the absence of iron supplementation leads to iron deficiency anemia, thus resulting in loss of regular donors because of increased deferral rate. It is therefore recommended that blood donors be informed about iron deficiency and the use of iron supplementation for regular blood donors and women of childbearing age who donate a unit of blood.

Background and Objectives Transfusion transmitted diseases (TTD) are of great concern because of their high mortality and morbidity rate among blood recipients; HBV, HCV and HIV are of the infectious agents playing an important role in this regard. Materials and Methods A cross-sectional study was conducted for estimation of TTD among blood donors in Tasoua and Ashoura (2003) in Moharram month, that is a religious month for Muslims, especially Shiites, and for evaluation of the motivation of 441 donors for blood donation. To this end, a questionnaire including 51 questions were prepared to be filled out by donors. Results HBsAg positive and HCV Ab positive prevalence rates were respectively 1.4 and 0.2%. Majority of donors have religious motivation (92%) but a minority cut their heads with dagger as a religious practice. 83% of HBsAg positive donors had a history of blood donation in the past. Conclusions Because common daggers may be used among religious people, probability of TTD can be high in these groups. Majority of HBsAg positive donors had a history of blood donation in the past and for an unknown reason probability of TTD in repeat donors was higher than first time donors. The prevalence of HBsAg positive and HCVAb positive in ordinary blood donors in Ardabil Blood Transfusion Center is lower than their prevalence rate in Tasoua and Ashoura donors.

Background and Objectives Estimation of the production cost of blood and blood products is essential to make more appropriate use of resources and to reduce costs. Materials and Methods The production cost of each blood or blood product unit was estimated in 28 IBTO centers by taking into account provincial credits, and officially communicated and provincial credits (with or without including credits of the first chapter). The production cost of each product was multiplied in its own special index, depending on the complexity of production procedure. We did not use the industrial accounting method to estimate costs. The data obtained were analyzed by SPSS and Excel softwares. Results The production cost of one unit of blood/blood product in 71% of blood centers was estimated to be higher than the average country-wide cost provided from the provincial credits (with or without chapter 1 budget), and officially communicated and provincial credits. The same is true in 75% of blood centers whoes cost was provided from officially communicated and provincial credits without the first chapter being added. Conclusions Most of IBTO centers spend more than the average country-wide cost to produce blood and blood products. It is recommended to revise resource management policies in blood transfusion centers.

Background and Objectives G20210A prothrombin mutation is one of the most prevalent mutations in the western countreis. In most diagnostic algorithms, G20210A prothrombin mutation’s identification is the major tool in determining the cause of thrombosis. However, there is little evidence about the prevalence of this mutation in thrombophilia and its role among Asian and especially Iranian people. According to sporadic investigations there exist some evidence of the low prevalence rate of the mutation in Iranian patients. Case The case at issue has been negative in regard to other inherited and acquired causes; thus, the researchers intended to study the mutation rate in this case. The patient under study had the past record of recurrent miscarriage and CVA. Conclusions Considering the limited number of studies conducted on thrombosis genetic prevalence and their impact on recurrent abortions and thrombophilia in Iran, this study is considered to be the first report on the screening of G20210A mutation. In this regard, the role of this mutation in unexplained miscarriage and exacerebation of underlying disorders could be investigated.