فصلنامه خون
سال چهارم شماره 1 (پیاپی 13، بهار 1386)

Background and ObjectivesCytomegalovirus (CMV) is an important pathogen in patients undergoing bone marrow transplantation. The prevalence of CMV varies from 30-100% in different countries as shown by seroepidemiological studies. Only 20-25% of patients develop CMV disease. Because of the similarity between CMV and GVHD and the different therapies required, detection of viral load will be effective in patient's survival. Materials and Methods51 recipients of BMT were monitored for 100 days post-BMT during which the samples were collected weekly. The Real-Time PCR was developed for quantitation of CMV viral DNA, using TaqMan tecnnology. For generation of standard curve, UL83 gene from CMV was cloned into a plasmid using a T/A cloning procedure. RQ-PCR assay was preformed in parallel with pp65 antigenemia assay on 415 samples. ResultsThe results obtained by both techniques were significantly correlated (p<0.01). We could detect 13×101 -15×107 (CMV DNA copies/2×105 cells) by RQ-PCR method. About 76% of patients developed at least one episode of CMV reactivation. First positive result of RQ-PCR appeared 13 days earlier than of pp65 antigenemia. After preemptive therapy, 16 days were required to achieve negative result by RQ-PCR. ConclusionsBoth assays were highly correlated; however, RQ-PCR was more sensitive than the antigenemia assay. After preemptive therapy, negative results of RQ-PCR were the best indicator to determine the endpoint of treatment and its success.

Background and ObjectivesAcute myeloid leukemia (AML) comprises a heterogenic group of malignant disorders involving cell maturation arrest at an undifferentiated stage in bone marrow. Activation of N-RAS proto-oncogene due to point mutations plays a major role in AML malignancy. Since there was no report on the frequency of N-RAS gene mutations in Iranian AML patients, therefore, we decided to determine its frequency and compare the results with age, sex and FAB subtypes. Materials and MethodsIn this descriptive study, 60 de novo AML patients from Tehran Shariati hospital, hematology-oncology and bone marrow transplantation center were screened for the mutations of N-RAS gene at codons 12, 13 and 61. DNA was extracted from peripheral blood samples before the start of chemotherapy. The above mentioned codons were amplified by PCR and analyzed by restriction endnuclease enzymes. ResultsWe were able to detect mutations in 12 out of 60 (20%) patients. Most of the mutations were detected in men with an age over 40 years old. The frequency of mutations for codons 12, 13 and 61 were 15%, 11.6% and 5% respectively. Most of the mutations (33.3%) were found to happen in AML-M4 FAB subtype. We could not detect any mutation in AML-MO, M6 and M7.ConclusionsWe detected mutations in 20% of our AML patients. In general, the frequency of the mutations we found was in agreement with the results of other studies. However, a study with more patients and a wider range of age using a combination of PCR-RFLP and direct gene sequencing is highly recommended

Background and ObjectivesAcute blood complications form the most frequent and important reactions among the blood transfusion adverse effects; acute hemolytic reaction, bacterial contamination, and transfusion related acute lung injury (TRALI) are the most frequent causes of death following blood transfusion. Materials and MethodsIn this descriptive prospective study, 2633 patients hospitalized in surgical and non-surgical departments of 11 hospitals having received blood transfusion were evaluated for acute blood transfusion reactions. ResultsAmong these patients, 20 (0.8%) encountered acute blood transfusion reactions. Out of this group of patients, eight experienced febrile non-hemolytic transfusion reactions, nine had allergic reactions, one developed blood group incompatibility, and two disseminated intravascular coagulation (DIC).ConclusionsThis study indicates that the most prevalent blood transfusion reactions were fever and allergy (0.3%). This reported rate (0.5-6%) is lower than the global rate. The rate of blood group incompatibility in this study was 0.03%, showing a higher prevalence than the global rate (0.004%).

Background and ObjectivesPerfluorocarbons (artificial blood) are keen to bond with oxygen. Therefore, in tissues with blood flow decrease, they would be appropriate candidates to improve oxygen delivery to the ischemic tissues. Moreover, nitric oxide as an active vasodilator increases blood flow. Materials and MethodsTransient common carotid artery ligation was performed on 15 male white anaesthetized rabbits that were randomized into 3 groups. The groups 1 and 2 received FC-43 and mannitol (12ml/Kg) respectively. The group 3 was considered as control without receiving injection. All animals were monitored for 5 hours. Systolic, diastolic, mean arterial blood pressure, heart rate, hematocrite, plasma level of nitrite and electrolytes (Na+, K+, Ca++) were measured before and after carotid artery ligation at 10 min, 30 min, 1 hour, 3hours and 5hours after injection. The animals were kept in isolated cages, and the survival of animals was monitored for one week. Finally all animals were sacrificed and brain water content was measured to compare the intensity of ischemic edema. ResultsA significant increase in nitrite level was observed in the first group at 10 min, 30 min and 1 hour after infusion as compared with the second and control groups (p<0.05). No significant difference was seen in other parameters between the groups between the groups.ConclusionsNitric oxide elevation showed improved blood circulation and oxygen delivery to ischemic tissues. It seems that FC-43 as a soluble oxygen delivery system can improve oxygen delivery to ischemic tissues and help their recovery.

Background and ObjectivesThalassemia is one of the important chronic hereditary diseases. There are nearly 20000 thalassemia major patients in Iran. Multiple blood transfusion and aggregation of iron load cause numerous complications which can be reduced by regular treatments. This study was conducted to determine and compare the problems of thalassemia major clients in regular and irregular follow ups of therapeutic principles.Materials and MethodsThis study was performed as a cross-sectional study. The sample consisted of all thalassemia major clients over 40 years of age having referred to the center of adult thalassemia in Tehran. 224 clients were divided into regular and irregular groups. A questionnaire was used for data collection. ResultsBased on difference between the averages of regular and irregular groups the average rate of psychological problems was 22.7%, sociological problems 18.7%, and economic problems 17.6%. Based on average differences between the two groups, important psychological problems include fatigue due to long periods of treatment (1.5), future hopelessness (1.4), and lack of self confidence (1.2); sociological problems include community unawareness of the disease (1.3), difficult access to various specialists (1.1), and lack of ongoing training classes (1.0); finally economic difficulties include access to necessary drugs and equipment (0.93), quality of free equipment (0.92), and family support (0.8). These are the prominent problems addressed in irregular treatment follow ups. ConclusionsResults have revealed that psychological problems had a more distinct effect relative to social and economic problems on the therapeutic irregular follow ups.

Background and ObjectivesThe process of platelet concentrate production by plasma rich (PRP) method could activate the platelet and granules secretion of beta thromboglobulin, LDH and CD62P. Platelets activated during the preparation process do not have sufficient efficiency for hemostasis in vivo. It seems that platelet preparation by buffy coat method has an ability less than PRP to activate the platelet. Measuring platelet activation indices, such as CD62P expression and beta thromboglobulin, is a useful means to evaluate the percentage of activated platelet concentrates and compare the two methods of buffy coat and PRP. Materials and MethodsIn this experimental study, 15 concentrates were prepared via PRP method and 15 via BC method; 15 intact blood units were also considered as control group. The percentages of CD62P expression, soluble CD62P concentrates, IL-8 level, and CD14 positive cells were evaluated. Special monocolonal antibodies that conjugated with flourecence dye in flocytometric method were used for CD62P and CD14. ELISA method was used for evaluation of soluble CD62P and IL-8. ResultsThe average platelet count in both methods showed no significant difference, but WBC contamination rate in PRP-PCs was more than BC-PCs. In PRP-PCs, we found a little decrease in CD62P expression and increase in soluble form and IL-8 level during reservation time. The level of CD14 showed no significant difference in these components. In BC method during the three day reservation, expression of CD62P, its soluble form, and IL-8 concentrates increased and the level of monocyte surface CD14 showed slight decrease ranging from 0.4 to 0.1. ConclusionsIt is concluded that there is a close relationship between IL-8 and WBC count in platelet concentrates. In PRP method in contrary to BC method, high speed centrifuge causes adhesion, aggregation and platelet activation.

Background and ObjectivesScreening for hepatitis C antibodies using enzyme immunoassay kits is performed routinely in all blood donors. These kits are very sensitive but have different positive predicative values. The aim of this study was to compare the positive predicative value of two enzyme immunoassay screening kits for hepatitis C in blood donors. Materials and MethodsThis cross sectional study was done at Yazd Blood Transfusion Center. Screening tests for 14132 blood donors using anti-HCV- EIA Avicenna and ORTHO HCV-3 ELISA kits were performed in 6 months and the results were compared. Repeatedly reactive results were confirmed by HCV BLOT3.0 (RIBA). Negative results of RIBA were considered false positive. ResultsThe frequency of false positive results of ORTHO kit was less than Avicenna (0.3% compared to 1.6%). Repeatedly reactive results were confirmed by RIBA. Positive predicative value of ORTHO was higher than Avicenna (P<0.001). ConclusionsAlthough both kits were highly sensitive, Avicenna kit showed more false positive results than ORTHO. The results suggest that kits with higher positive predicative value be used to decrease confirmation test costs and deferral rate of blood donors.