فصلنامه خون
سال پنجم شماره 1 (پیاپی 18، بهار 1387)

Background and objectivesThe rate of blood use in coronary artery bypass graft (CABG) surgery is high, though having decreased remarkably in recent years. The aim of this study was to determine this rate as well as demographic and clinical factors affecting blood transfusion during CABG. Factors associated with increased risk of transfusion can help us decrease the rate of blood use. Materials and MethodsIn a prospective manner, data were collected from patients having undergone CABG surgery in Emam Reza teaching hospital of Mashhad for about 14 months. The correlation of variables including age, sex, height, weight, body mass index, body surface, estimated blood volume, preoperative hemoglobin concentration, and surgeon with the independent variable of "need for blood transfusion" was evaluated. Finally, predicting variables were determined by the use of logistic regression methods. ResultsThe rate of blood use was 77.6%. The use of whole blood was more frequent than packed red blood cells. In almost 70% of patients, the number of blood units administered ranged from 1 to 2. The predicting variables were determined to be surgeon and height of patients. ConclusionsThis study and other credible transfusion guidelines help us change individual physician practice and restrict indications such as hemoglobine level for blood transfusion in CABG. These changes might result in major rate reduction in blood use.

Background and objectivesIn the mammalian cells, there is a relationship between telomere length and both cancer and senescence. Progressive telomere shortening has a role in genomic instability and has been reported in a wide range of human cancers as well as in transformation and progression to hematologic malignancies. Chronic myelogenous leukemia (CML) has different stages in the process of its progression. In this study, we examined the telomere length changes in peripheral blood leukocytes of CML patients in chronic (CP) and blastic phases (BP). Materials and MethodsIn this descriptive study, we examined the telomere length in 21 CML patients (14 in chronic and 7 in blastic phases) having reffered to Hematology–Oncology and BMT Research Center of Shariati Hospital since March 2004 using Southern blot analysis; the results were then compared with age-adjusted normal controls. Data were analyzed through logestic regression and Anova. ResultsAt the time of diagnosis, 71.43% of chronic phase patients had a shortened TRF compared to normal age-adjusted individuals. The mean telomere length values in chronic and blastic phases were 6.98±1.26 kb and 4.81±1.06 kb, respectively; it showed significant telomere length reduction in age-adjusted normal controls. Moreover, the mean telomere length values in BP-CML showed significant statistical differences as compared to CP-CML. Mean values of telomere length reduction in CP-CML and BP-CML as compared with normal age-adjusted control group were 3.31±1.38 kb and 5.27±0.9 kb, respectively. ConclusionsThe significant statistical differences in mean telomere length of CP-CML and BP-CML as compared with age-adjusted normal controls and the apparent differences of TRF in chronic and blastic phases can be useful in prediction of phase of disease progression.

Background and objectivesKnowing about the effects of blood donation on blood donors plays an important role in donor recruitment as these effects determine the decision of donors on whether to donate again or not. The aim of the present study was to determine the psycho-social and physical effects of blood donation on donors. Materials and MethodsIn this cross sectional study conducted at Yazd Blood Transfusion Center, between September 2005 and January 2007, 1000 randomly selected blood donors participated in the study and were asked to fill the especially formatted questionnaire. Data were analyzed through chi-square, ANOVA test, and logestic regression. Results955 (95.5%) subjects were male and 45 (4.5%) female. Two thirds of donors reported one or more positive effects. 2.9% of donors reflected only negative effects. Positive effects included the sense of satisfaction, sense of happiness and relaxation, and positive post donation feeling. Negative effects in females were more frequent than in males. The mean duration of positive effects was 15.1±6.9 days, while that of negative effects was 3.1± 1.1 days. There was no correlation between the number of donations or age and occurrence of effects (P= 0.109). ConclusionsMost of the effects reported by the blood donors were positive and lasted for a much longer duration than the negative effects. 80% of donors experienced more than one positive effect. Even though few of the donors most of whom with a single status reported negative effects. It is advisable for further studies to be conducted for these effects to be reduced particularly in women. A clear illustration of donor experiences as part of recruitment programs can reduce undue fear in unaware prospective donors leading into increased donor recruitment.

Background and objectivesIn current protocol for isolation and expansion of mesenchymal stem cells (MSCs), the use of fetal calf serum (FCS) as a medium supplement is inevitable. FCS is immunogenic for human subjects and may transfer infection in the case of transplantation. In the search for an appropriate substitute for FCS, in the present study the effect of plasma prepared from peripheral blood on the growth of MSCs has been examined. Materials and MethodsMarrow cells obtained from rat long bones were cultivated both in the mediums containing FCS and in those with plasma prepared from rat peripheral blood for the primary culture and the three consequent passages. The cells present in all four passages were evaluated at each culture stage for population doubling number, viability, and the rate of proliferation by cell count, MTT assay, and plotting growth curve, respectively. The cells from primary culture were also examined with respect to their clonogenic activity. All experiments were replicated 10 times and the average values for each group were statistically compared. Furthermore, passage 3 cells from each group were examined in terms of bone and adipogenic differentiation by specific staining as well as RT-PCR. ResultsThe cultures from plasma group appeared morphologically more homogenous than those from FCS group. In general, the cells from FCS groups had a better status in terms of total population doubling number and MTT test but these differences were not significant in passage 3. Moreover, growth curve plotted for each group indicated that the proliferation of cells in the plasma group is somewhat slower than those in FCS groups. The culture of plasma groups showed more colon cells compared to FCS groups but the colons in the latter appeared larger than the former. The cells from both groups were readily differentiated into osteoblastic and adipogenic cells lineages; this was confirmed by alizarin red and oil red staining, the bone expression of osteopontin and osteocalcin, and the expression of PPAR-alfa, PPAR-gamma, and C/EBP-alpha for adipose cells. ConclusionsTaken together, plasma as a substitute for FCS can support proliferation of MSCs and maintains their viability in vitro. Although this support was somehow less strong than FCS, plasma could still be considered a safe substitute for FCS.

Background and objectivesDrug resistance is a common cause of treatment failure in malignant disorders especially hematological malignancies. Overexpression of P-glycoprotein (pgp) is the most common cause of drug resistance. Studies on the importance of pgp are controversial that is attributed to the lack of a standard method for pgp assay and the lack of consistency with clinical data. The aim of this study is Multiple drug resistance (MDR) evaluation according to pgp expression in leukemic cells at the beginning of treatment, and prediction of responses to treatment, relapse or death. Materials and MethodsBetween June 2001 and May 2006, we studied 185 leukemic patients. Diagnosis was performed on each case via morphology, based on immunotypes, and by cytogenetic method; pgp expression was also evaluated by flowcytometry. For pgp evaluation, we collected peripheral blood or bone marrow samples in EDTA. Then, patients went under treatment by standard protocols and their responses to treatment were observed. Patient follow ups for response to treatment, complete remission, resistance to induction, relapse or death were conducted. Finally, clinical data were compared with laboratory results. Mann-Whitney, kruscal-valis, kaplan-meier, and chi-square tests were used for data analysis. ResultsFrom 185 patients with the median age of 28.5 years (within the age range of 11-76), 128 patients showed AML and 57 ALL. 62% were male and 38% female. Pgp expression showed no significant correlation with age, sex, type of leukemia, and white blood cells count. There was no significant association between pgp expression and AML subtype. Two-year Overall Survival (OS) and Disease Free Survival (DFS) were 63% and 42% respectively. DFS showed significant correlation with pgp in ALL and non-M3 subtype of AML (P=0.024). Conclusionsexpression of pgp would be a prognostic factor for relapse prediction and might be important in treatment planning.

Background and objectivesHuman parvovirus B19, a member of the parvoviridae family, with single-stranded DNA is a very minute and non-enveloped virus. Human parvovirus B19 causes a number of clinical illnesses including infectious erythema (fifth disease), hydropes fetalis, transient aplastic crises, arthropathy and congenital aplasia. B19 virus is transmitted via respiratory tract, blood products, and blood transfusion. Parvovirus B19 DNA is detectable through molecular techniques such as PCR. Previous studies indicate that individuals who have anti B19 IgG are negative. IgM antibody against B19 lasts for a few months and IgG antibody persists for many years or lifelong. The aim of this study was to evaluate the prevalence of B19 among blood donors in Tehran. Materials and MethodsIn this cross-sectional study, sera of 730 blood donors who were negative for HIV, HBsAg and HCV were tested for IgG and IgM anti-B19V using ELISA. Then, all of the sera were tested for presence of B19 DNA through semi-nested PCR. ResultsOut of 730 blood donors, 4 (0.5%) had IgM antibody thereby being reported positive; 338 subjects (46.3%) were positive for anti-B19 IgG. DNA B19 was not found in any of the subjects (0%). ConclusionsAlthough B19 may cause adverse reactions in some blood recipients, screening blood donors for B19 is not essential. In this study, the high prevalence of IgG on one hand and the lack of any positive cases of B19 DNA on the other indicate of the low risk of the latter to be transfusion transmittable. Further studies on blood donors particularly high risk groups are recommended.

Background and objectivesThalassemia is the most common hereditary anemia in our region. Due to thalassemia-driven abnormality in synthesis of globin chains in red blood cells, these globules do not lead a natural life and will die immediately. Appropriate therapy of thalassemia includes a regular monthly blood transfusion. However, patients will inevitably confront with several side effects particularly iron overload and iron sedimentation in body critical organs and tissues including heart, ductless glands and liver. The aim of the present study is to determine more precisely the frequency of adenoidal abnormality in Iranian thalassemia patients by examining a higher number of samples. So that early diagnosis and necessary treatment measures would be more likely. Materials and MethodsThis descriptive research included all thalassemia major patients having referred to medical centers affliated to Iranian Blood Transfusion Organization. The sampling was census-based. First of all, reports of adenoidal tests as well as other associated parameters were achieved from medical folders. ResultsOut of 437 thalassemic patients, 10 (1%) suffered from hypothyroidism and one from hypoparathyroidism. 80% of hypothyroid and 100% of hypoparathyroid patients were affected by thalassemia major. Ferritin average in hypothyroid and non- hypothyroid groups had no significant difference. ConclusionsThe results showed that screening platelet concentrates for bacterial contamination is necessary for blood transfusion centers and hospital blood banks. The comparison of the results of this sudy compared with others showed that a lower number of thalassemic patients live in Iran compared with other countries.