فصلنامه خون
سال چهارم شماره 2 (پیاپی 14، تابستان 1386)

Background and ObjectivesMost of blood donations are uneventful. However, adverse effects occur in a limited number of donors and have a negative impact on blood donor return rate and donor recruitment. The aim of this study was to evaluate the incidence rate of vasovagal reactions and arm injuries during and after blood donation at Yazd Blood Transfusion Centre.Materials and MethodsThis cross sectional study was performed on 1000 randomly selected blood donors from August 2005 to January 2006 at Yazd Blood Transfusion Centre. Blood donors were examined by physicians for vasovagal reactions during and one hour after blood donation. Donors with arm injuries were interviewed in person after 3 weeks. Data were analyzed statistically using Chi-square, ANOVA, Fischer exact test and T-test.ResultsThe rate of vasovagal reactions was 2%. There was no severe reaction such as convulsion. The most common arm findings were pain (8.2%), bruise (7%) and hematoma (1.4%). Sensory changes such as numbness and tingling (0.7 %) had the least frequency. All donors with arm injuries recovered fully within a week. Repeat and regular blood donors had fewer vasovagal reactions than first time donors (p <0.05). There was no significant correlation between arm injury and the frequency of blood donation. ConclusionsThe incidence of vasovagal reactions in our study was lower than others. It might pertain to correct selection of donors by physicians, the presence of trained, expert personnel for blood collection, and care for donors.

Background and ObjectivesIron deficiency anemia (IDA) and ß thalassemia trait (TT) are the most common forms of microcytic anemia. Some discrimination indices calculated from red blood cell count and red blood cell indices are defined and used for rapid discrimination between TT and IDA. Youden's index is the most reliable method to measure the validity of a particular technique, because it takes into account both sensitivity and specificity. Materials and MethodsWe calculated 10 discrimination indices (Mentzer Index, England and Fraser Index, Srivastava Index, Green and King Index, Shine and Lal Index, red blood cell (RBC) count, red blood cell distribution width, red blood cell distribution width index (RDWI), Mean Density of Hemoglobin per Liter of blood (MDHL) and Mean Cell Hemoglobin Density (MCHD)) in 170 patients with IDA and in 153 patients with b TT (βTT). We divided the patients into two different age ranges of 1 to 10 and 10 to 57 years. ResultsWe determined the number of correctly identified patients by using each discrimination index. None of the indices showed sensitivity and specificity of 100% in the latter group; it was just Shine and Lal Index (S and L) that showed a sensitivity close to 90% and specificity of 100% in the former group. The accuracy order of these discrimination indicies from higher to lower for the former was Shine and lal > RBC Count > Srivastava > Mentzer > England and Fraser > Green and King > RDWI > RDW and in the latter RDWI > RBC count > Mentzer > England and Fraser > Srivastava > RDW > Shine and Lal > Green and King. Youden's index for Shine and lal and RBC Count, and for RDWI and RBC Count has the highest diagnostic value in the former and latter groups respectively. Mean Cell Hemoglobin Density (MCHD) and Mean Density of Hemoglobin per Liter (MDHL) did not show any diagnostic value.ConclusionsNone of the indices was completely sensitive and specific in differentiating between b TT and IDA. MCHD mean and median were very close to normal values for both IDA and b TT patients, but in case of MHDL we have found mean and median values being significantly higher than normal values in b TT and lower in IDA patients. In our study, Youden's index of RBC count and RDWI were the highest ones and they were the most reliable discrimination indices in differentiating b TT from IDA in the latter group while for patients in the former RBC and S & L were the most reliable discrimination indices.

Background and ObjectivesMesenchymal stem cells are appropriate candidates to treat diseases including articular cartilage defects. There are plenty of researches being conducted to make the application of these cells possible. The purpose of this study was to cultivate murine mesenchymal stem cells (MSCs) in alginate gel and transplant them subcutaneously to immuno-suppressed rats to examine their chondrogenic potential in vivo.Materials and Methods 4-6 week old NMRI mice were sacrificed and their bone marrow cells were cultivated in 6-cell plates at the density of 500 cell/cm2. The pure fibroblastic cells appeared after two passages. 2×106 fibroblastic cells were mixed with 1 ml of alginate solution and converted into gel by being exposed to calcium chloride solution. MSCs-embedded alginate gel were then transplanted subcutaneously to 6 rats that had received an immunosuppressive drug (cyclosporine) for transplant rejection to be avoided. 5 weeks after transplantation, the alginate gels were removed and evaluated by histochemistry, RT-PCR for certain cartilage markers, and transmission electron microscopy.Results5 weeks after transplantation, the skin was incised and the alginate gel with its surrounding vascular connective tissue were removed. Tuloidine blue staining indicates that the cells within the gel assumed oval morphology and occupied lacuna-like cavities. RT-PCR analysis revealed that in these cells the mRNA of some cartilage markers such as collagen II (the marker of hyaline cartilage), collagen X (hypertrophied chondrocyte marker in osteogenesis), and aggreacan were largely produced. Ultra-thin sections analysis showed that the cells within the lacuna-like cavity of alginate gel contain a large amount of expanded rough endoplasmic reticulum and secret fibrillar extra cellular matrix. ConclusionsTransplanted murine MSCs cultivated in alginate gel can differentiate into hyaline cartilage with the sign of osteogenic initiation.

Background and ObjectivesVasovagal reaction occurs in a small but significant number of blood donors. Vasovagal reactions may decrease return donation and disrupt blood collection activities. The purpose of this study was to define the contributing role of sex, age, weight, and blood pressure in vasovagal reactions.Materials and MethodsThis case control study was performed on blood donors who referred to Shiraz Blood Transfusion Center in 2005. A questionnaire was filled out both for the blood donors who had developed vasovagal reactions (case group) and those who had not (control group) appearing prior and after the case group donors. Finally 1500 samples were randomly selected (500 cases & 1000 control). The questionnaire consisted of sociodemographic pattern of blood donors, and signs and symptoms of vasovagal reactions. Chi-square was used for data analysis.ResultsThe mean age and weight of the case group were 30.55 ± 9.33 and 71.23 ± 9.3 respectively. 72.6% of the case group were male and the average rate of blood donation attempts was 3.34 ± 2.19. The mean age and weight of the control group were 35.27 ± 4.72 and 78.61 ± 12.77 respectively. 90.3% of the control group were male and the average rate of blood donation attempts was 6.58 ± 7.08. The vasovagal reaction was higher in young, low weight, first time, female blood donors (p < 0.005). It was also higher in fatigued, hungry and stressful blood donors (p < 0.005). ConclusionsVasovagal reaction is a multi-factorial process. These reactions might be prevented in high risk donors. Considering these risk factors, it is possible to increase repeat donation and donor safety.

Background and Objectives Diversity of IgH and Ig κ molecules is generated during B and T Lymphocyte differentiation through the rearrangement of variable, diversity, junction and constant gene segments. Additionally, random insertion and deletions of nucleotides between gene segments make unique sequences which are cell or clone specific. Similar IgH and Igκ genes rearranged in normal cells of lymphoid leukemia cases can be used as a marker of clonality and for evaluation of minimal residual disease (MRD). The purpose of this study is to evaluate the pattern of IgH chain and Igκ gene rearrangements using polymerase chain reaction (PCR) in B-precursor acute lymphoblastic leukemias (ALL) to follow the MRD at day 14, day 28 (end of remission induction), week 10, 3-6 months and 6-12 months after the initiation of treatment. Materials and Methods In our prospective study bone marrow aspirates of 183 children at the mean age of 63.6 months with diagnosis of acute leukemia were collected at admission before any chemotherapy. After reviewing cytomorphology and immunophenotyping, only 140 cases with diagnosis of B-precursor ALLs were selected for study. Mononuclear cells including leukemic blasts were isolated by density gradient. After DNA extraction, IgH and Igκ (Vκ I-IV / Kde) were amplified by consensus primers using PCR. PCR products were analyzed after heteroduplex analysis and polyacrylamide gel electrophoresis (silver stain). The DNA sequences were compared and aligned with the sequences homologous for IgH and IgK published by Gene Bank. The follow up specimens were collected at day 14, day 28 (end of remission induction), day 45-month 3, and 3-6 months and 6-12 months after initiation of treatment. After routine cytomorphologic analysis, similar PCR was done on follow up extracted DNAs in parallel with diagnosis DNA. MRD was considered to be approved positive if bands similar to those at the time of diagnosis were present. Statistical analysis using SPSS software (version 11.5) was performed. Results 90.5% of patients had clonal IgH gene rearrangements. Monoclonal, biclonal and oligoclonal patterns were observed in 57.8%, 34.9% and 5.5% of patients with IgH (CDR III) rearrangement, respectively. Clonal patterns of Igκ-Kde were detected in 59 (67%; n: 88) of BP-ALLs. According to cytomorphology about 92% of patients were in complete remission. MRD positivity decreased from more than 90% to 20% using different gene rearrangements in defined time points. Four patients who relapsed during follow up were MRD positive using 1-3 rearrangements and all except one were in clinical remission. Conclusions Clonal rearrangement of IgH had a pattern similar to other populations. IgK was slightly more frequent than previously reported and the VKI (25%) was the most common type. These differences can be explained by different techniques, DNAs and clonality markers. According to the results, these clonal markers can be used in diagnosis and follow up of MRD.

Background and ObjectivesHospital blood transfusion committees supervise blood transfusion in hospitals. These committees could save time and cost by prevention of blood loss. This study was conducted to assess the performance of hospital blood transfusion committees in Tehran in 2005-2006. Materials and Methods In this retrospective study, 46 reports from 13 hospitals (9 community and 4 private) being sent to Tehran Blood Transfusion Center in 2005-2006 were assessed. All reports were assessed from the perspective of duties entrusted by Iranian Ministry of Health. These duties were classified as (1) report of blood transfusion complications, (2) statistical report of blood transfusions, (3) statistical report of blood orders from different wards of hospitals, (4) report of blood transfusion indications, (5) report of educational programs, and (6) assessment of personnel problems and equipment of blood banks. ResultsReport of blood transfusion complications (77%) and report of blood transfusion indications (23%) were the most and the least reported duties, respectively. The most and the least relative frequencies for all hospitals, community, and private hospitals were 23%-77%, 33%-78% and 0%-75%, respectively. Committee reports in community hospitals were better than private ones, though the difference was not statistically significant (p>0.05). Cross match to transfusion ratio was considerable only in one hospital (3.05). ConclusionsThis study showed that reports of hospital blood transfusion committees in Tehran in 2005-2006 are in a relatively poor condition. This condition in private hospitals was worse than community ones. More focus on reports of blood transfusion indications seems to be necessary. Since cross match to transfusion ratio is an important performance indicator for hospitals, it should receive a higher level of attention of hospital committees.

Background and ObjectivesBlood safety is one of the basic goals of blood centers in the world. Additional screening systems such as self-exclusion and failed are used with routine diagnostic tests to detect transfusion transmitted infections. This study aimed to investigate efficacy of these systems on improvement of blood safety in Sari and Behshahr Blood Centers. Materials and MethodsA retrospective cross-sectional study was carried out using serological data and personal information of donors. The information was obtained from data bank of Sari and Behshahr Blood Centers in 1384. Data analysis was performed using Chi-square test. ResultsThe blood donations of 255 (1.5%) and 87 (0.5%) donors out of 17036 were excluded by failed and confidential self-exclusion methods, respectively. HBV, HCV and HIV infection percentages among control group, failed, and self-exclusion were 3.04%, 3.9% and 9.2% respectively. The positive ELISA percentages of HBs-Ag, HCV-Ab and HIV-Ab in control group were 0.74%, 1.9% and 0.29% respectively. HBs-Ag and HCV-Ab in failed group rates were 0.4%, 3.5% respectively while HIV-Ab rate was 0. Both HBs-Ag and HCV-Ab were 4.6% in CSE group while HIV-Ab rate was 0. ConclusionsThe results indicated that the confidential self-exclusion is an appropriate method to improve blood safety. It has also revealed that it could be possible to exclude infected donors during incubation period.

Background and ObjectivesWhile public focus is on the risks of transfusion transmitted infections, transfusion errors contribute significantly to adverse reactions. Case In this study we describe two cases of mistransfusion; two thalassemic siblings were admitted for monthly transfusion: a 19 year old boy and his sister. The donor whose blood donation was cross matched for the sister had a name similar to the brother; so it was wrongly administered to him that led to the hemolytic reaction. Another 2.5 year old boy with O+ blood group received A+ blood because of the staff error in recording the patient blood group and neglecting the crossmatch. Conclusions The most prevalant complications of blood transfusion are due to human error. In order to decrease errors, it is recommended to double check the blood order form and the information on the blood bag.