فصلنامه خون
سال نوزدهم شماره 2 (پیاپی 76، تابستان 1401)

Aortic aneurysm repair surgery (AAAs) is associated with massive bleeding that causes coagulation disorders during and after surgery. Considering that blood consumption in these patients has been studied in a few articles, we decided to investigate more.

In a cross-sectional study, patients with abdominal aortic aneurysms requiring surgical repair from January 2018 to August 2020 were evaluated at Shohada-e-Tajrish Hospital. The blood component utilization was evaluated. Graph Pad prism 9.0.0 (121) software was used for statistical analysis (p < 0.05 was considered significant).

Of 20 patients with aortic aneurysm repair, 16 (80%) were male and 4 (20%) were female. Seven cases (35%) of them received Fresh frozen plasma (FFP) in addition to packed red blood cells (PRBCs). The mean of FFP utilization was 3.7 ± 1.5 units and in 13 patients (65%) only PRBcs were transfused. Platelets was not transfused in any of the patients. The relationship between red blood cells transfusion with the hemoglobin level before surgery and patient age was evaluated. Also, the relationship between INR before surgery and FFP transfusion was assessed, none of which was statistically significant.

Despite extensive aortic artery surgery and massive bleeding, in 65% of patients only packed red blood cells were transfused. In 35% of patients, in addition to PRBC, FFP was transfused, but no platelets was administered.

in-vitro immunization is one of the common methods of immunization as a preliminary step in the production of Monoclonal Antibodies. In this method, peripheral blood mononuclear cells (PBMC) are isolated and incubated in culture medium with necessary factors for immunization. Antigen-specific B lymphocytes proliferate and differentiate into cells that secrete specific antibodies. In the current study, we aimed to identify various factors and contributing elements on B cell In-vitro immunization process for the generation of antibody against Kell blood group antigen.

In this experimental study, Kell antigen was purified from Kell+ whole blood. Peripheral blood mononuclear cells were isolated using a density gradient approach from Kell- whole blood bag. After exposure to L-Leucyl-L-leucine methyl ester (LLME), they were incubated with other required factors for immunization, including antigen (500-1000 ng/ml), adjuvant (5-20 mg/ml), and cytokines (9.5 pg/ml). After 7-11 days, cells supernatant was evaluated using a sensitive method, ELISA, for antibody production.

It was observed that the most desirable culture condition for immunization and further production of specific anti-Kell antibody from mononuclear cells was 0.25 mM concentration of LLME employing 500-1000 ng of Kell antigens and 10 microliter MLC. In the mentioned condition, the optical density was read at 450 nm as 2.052 ± 0.03, which was the representative of production of specific anti-Kell antibody.

  Based on the study, immunization in culture medium against Kell antigen can be done. By employing different factors, the production of anti-Kell producing cells in culture condition can be optimized.

The clinical manifestations of bleeding diseases is very important in terms of proper management and prevention strategies. The aim of this study was to determine the frequency of early clinical manifestations of bleeding diseases in Hamadan.

In this cross-sectional study, 76 patients with hemorrhagic diseases with medical records in Besat Hospital during 2020-2021 in terms of age, sex, type of hemorrhagic disease, the primary clinical manifestations, coagulation factor level, family history of hemophilia, number of blood product injections, receiving way of blood products and illness severity were evaluated. Data were analyzed using chi-square test and SPSS software version 23.

The mean age of patients was 24.60 ± 15.56 years; 82.92% were male and 17.08% were female. Hematoma (18.42%), petechiae and ecchymosis (18.42%), bleeding after circumcision (18.42%), and nosebleeds(10.50%) were the  most  common initial manifestations. Hemophilia type A with 67.1% which was severe (66.77%), moderate (14.4%) and mild (18.83%). No significant difference between the severity of hemophilia with the initial manifestations of the disease and the type of product was observed and neither between girls and boys in terms of initial clinical manifestations.

In this study, the most common BDs in hemophilia occurred within the ages of 1-2 years with Glanzman syndrome the most frequent. Hematoma, petechiae, ecchymosis, and bleeding were the most common occurrences in hemophiliacs. Most of them had a severe form of the disease and in terms of type, severity, and first clinical manifestations of  hemophilia the findings were almost similar to the results of other studies.

Blood consumption is of great importance in the world and Iranian medicine and is effective in saving the lives of many patients. The high cost of preparing blood and blood products indicates the considerable importance of managing the use of blood bags.

This study was descriptive and cross-sectional. The study tool was a researcher-made questionnaire with five options based on the Likert scale; its validity and reliability were confirmed by experts. The sample included 201 anesthesiologists, surgeons, and operating room staff of Nemazee Hospital to complete the questionnaire. Data were analyzed in SPSS 23 software.

In evaluating the current situation of optimal blood consumption management in the operating rooms from the participants' point of view, the most common items included:  "Development of educational programs to manage blood consumption through meetings and lectures, and retraining and training workshops" and "Registration and reporting of reasons for obsolescence of blood products (e.g. poor performance in over-ordering)" (79.1% and 78.1%, respectively). In terms of feasibility, the most common factors improving the current situation consisted of: "Use of safe blood transport equipment in the hospital" and "Prioritize the use of older blood bags instead of newer blood bags (in accordance with FIFO law (First In / First Out) by blood banks)".

This study showed that blood reservation is done too much. In this regard, there is a need for more control in terms of quality and quantity in the operating room of hospitals.

Considering the importance of training of nurses in the field of blood transfusion, we evaluated the level of knowledge of nurses regarding blood transfusion.

This was a descriptive cross-sectional study performed on nurses in Shiraz hospitals in 2019-2020. The level of knowledge was determined using a questionnaire before and after the course by pre-test and post-test. The questionnaire consists of two parts. The first part has a questions regarding demographic characteristics . The second part has 28 four-answer questions about blood and blood components, indication, administration and complications. The data was analyzed using SPSS-23 software by paired t tests, chi-square, McNamara , change score t test, Anova ,and  correlation tests .

The mean score of awareness after class was significantly increased (13.47 ± 3.80 from 28 to 20.21 ± 5.45 out of 28) (p < 0.001). The increase in awareness was significant in all blood transfusion items.

  Due to the lack of sufficient knowledge of nurses in the field of blood transfusion the education of nurses is essential to improve blood safety. Therefore, planning training classes in the field of transfusion medicine on a regular and continuous basis and evaluating the impact of education is recommended.

Acute lymphoblastic leukemia is a malignant hematologic disorder of lymphoid lineage. As a result of chemotherapy side effects, treatment with medicinal plants has recently been considered by researchers. Previous studies on Moringa olifera have shown its anti-cancer properties on some cancer cell lines. The aim of this study was to investigate the cytotoxic effects of Moringa oleifera leaves on Jurket and Raji cell lines of acute lymphoblastic leukemia.

In this experimental study, after preparing aqueous and ethanolic leaf extract of Moringa olifera, Jurket and Raji cells were treated with different concentrations of extracts for 48 hours. Cell groups’viability was assessed by trypan blue staining and MTT assay. Peripheral blood mononuclear cells (PBMC) were used as a control group. Statistical analysis of data was performed using Gragh Pad Prism 6 and one-way ANOVA test.

Treatment of Jurkat and Raji cells with all concentrations of aqueous and ethanolic extracts led to inhibition of cell growth. The highest percentage of growth inhibition was obtained at a concentration of 150 μg/mL of aqueous extract, 48.5% and 47.4% for Jurkat and Raji cell lines, respectively. Also, the highest lethal percentage was obtained at a concentration of 50 μg/mL of ethanolic extract, 73.4% and 78.5% for Jurkat and Raji cell lines, respectively. The IC50 dose was obtained in all study groups at a concentration of 150 μg/mL.

The leaves of Moringa olifera have the capacity to inhibit the growth and viability of Jurkat and Raji cell lines of acute lymphoblastic leukemia.

Blood transfusion in patients with beta-thalassemia major can be considered as one of the major individual and social problems of this disease. This study is aimed to evaluate the effect of an aerobic exercise course on transfusion blood volume of patients with β-thalassemia major.

The present study was a quasi-experimental study with pre-test, post-test design with a control group in 2020-2021 in Zahedan. The subjects of the present study (24 patients with thalassemia major aged 15 to 35 years) were randomized by variable block method and were divided into two groups of exercise (n= 14) and control (n= 10). Participants in exercise group started regular walking for 8 weeks. Paired t- test statistical method was applied to analyse the data within the groups while analyse of covariance (ANCOVA) method was utilized to compare the groups, p< 0.05.

Intra-group comparisons revealed the reduction of transfusion blood volume following 8 weeks of aerobic exercise in both exercise (2421.43 ± 462.73 mL, p = 0.001) and control (2130.0 ± 330.15 mL, p = 0.039) groups, when compared to the pre-study exercise. Results of inter-group comparisons demonstrated no significant difference in two studied groups (p = 0.221), although the reduction of transfusion blood volume in exercise group was more evident than the control group.

According to the results, it is concluded that doing aerobic exercise training accompanied with the treatment methods utilized for thalassemia major patients reduced their need for blood transfusions, when exercise duration is sufficiently long.

Although there have been significant advances in the treatment of cardiovascular patients, but the side effects of treatment are the most critical challenges that cardiologists face today after surgery. Inflammation is one of the complications of using anesthetics and blood transfusions in patients. Therefore, in this study, the factors related to erythrocyte storage lesion and their effect on the molecular aspects of inflammation induced by blood transfusion and the use of anesthetics after heart surgery were investigated to reduce this problem.

Relevant literature was identified by a PubMed search (2001-2021); the search was limited to English-language papers containing the following terms and phrases, “Thoracic surgery”, “Inflammation”, “Anesthesia”, and “Blood Transfusion”.

Factors related to the lysis of RBCs accumulate during the storage of blood products in the bags including Hb, Heme, and ammonia; can cause inflammation through distinct pathways in the post-surgical patients. Using different anesthetics can also trigger inflammatory responses. However, some of these anesthetics act as a double-edged sword and can induce inflammation or prevent it.

Identifying the factors that increase due to immune response stimulation and the pathways preventing inflammation can be an excellent therapeutic strategy to reduce inflammation after cardiac surgery.