فصلنامه خون
سال ششم شماره 4 (پیاپی 25، زمستان 1388)

Background and ObjectivesThe prevention and control program of major beta-thalassemia disease is one of the most important preventive programs in the Iranian health system which has been implemented for more than one decade. This study aimed to assess the outcomes of this program in districts of Isfahan province and discuss new disease cases (1997-2007). Materials and MethodsThe method of this study is descriptive and cross-sectional. Patients born after the onset of the screening program (Mar-1997) in 20 districts of Isfahan province were included in data collection. Provincial reference clinic for thalassemia was responsible for data collection conducted through completion of questionnaires. The data were analyzed by SPSS 11. ResultsIt was revealed that 47 cases (49%) out of 96 were born to the unscreened couples who were unaware of their carrier state. Out of the former, 43 couples had been married before the onset of screening program. The parents of 34 cases (35.4%) had been screened in the program and 15 cases (15.6%) were born to the unscreened couples with the previous experience of delivery of thalassemia-affected infants. ConclusionsSupport and revival of genetic counseling teams that regularly receive training, follow up of suspicious thalassemia cases or carrier couples, information dissemination about prevention program of thalassemia in the community, establishment of valid registry systems for present patients and continuous referral of their parents to health centers for surveillance and service delivery to foreign refugees are the most important points that the findings of this study consider significant.

Background and ObjectivesHepatitis B is one of the major diseases that has the potential to be transmitted by blood transfusion. Specific genotypes of hepatitis B virus are increasingly recognized for their clinical significance and association with particular viral mutations. The aim of this study was to investigate the prevalence of hepatitis B virus genotypes in blood donors of Kerman, Yazd and Isfehan Blood Centers. Materials and MethodsSera of 120 blood donors, who were positive for hepatitis B surface antigen (HBsAg) using ELISA method, were selected. HBV DNA was extracted from sera using commercial kits and the p gene sequences were amplified by nested-PCR. HBV genotypes were determined by direct sequencing of the polymerase gene of HBV. The obtained sequences were aligned with Clustal W programme. Phylogenetic trees were constructed by the Neighbor-joining (NJ) method. The data were analyzed with Fisher test by SPSS 11.5 ResultsOut of 120 HBsAg positive volunteer blood donors, 69 (57.5%, CI 95% = 48.65-66.34)) were positive for HBV DNA sequence. Sequence analysis was done on the positive samples. Genotype D was detected among 100% of HBV infected volunteer blood donors. ConclusionsThe prevalence rate of genotype D was found to be 100%. These findings may have an impact on the immunological and genetic diagnosis of HBV as well as on the selection of diagnostic kits and viral quality control panels.

Background and ObjectivesUmbilical cord blood has been used successfully as a source of hematopoietic stem cells for transplantation. Knowing that cord blood could be bacterially contaminated at the time it is being obtained and afterwards during the time it is being processed, we decided to perform the present study to determine any possible bacterial contamination and find out the root causes in Royan Cord Blood Bank (RCBB). Materials and MethodsRCBB during 3 years received 3074 cord blood units (CBUs) upon which relevant investigation was made. In order to determine the root cause of the bacterial contamination, 800 CBUs were tested out of each of which two samples were taken. The data were analyzed with Chi-square by SPSS 16. ResultsOut of 3074 CBUs, 93 units (3.02%, CI 95%=2.3-3.6) were shown to have bacterial contamination. Out of the 800 units tested to detect the root cause, 26 samples (3.3%) were proved to be bacterial culture positive out of which 25 (96.2%) were shown to be contaminated at the time they were obtained and 1 (3.8%) during processing. The isolated bacteria were aerobic in 19 cases (73.1%) and anaerobic in 7 (26.9%). ConclusionsThe results show that bacterial contamination mostly is caused at the time blood is obtained from the cord in hospital obstetrics wards and most of the isolated bacteria were shown to be skin flora. Given the high value of cord blood stem cells and the risk of septic transplantation, it is necessary to prepare training programs for midwives and phlebotomists.

Background and ObjectivesGenetic variations and mutations are of the etiological factors leading to leukemia. Among these genetic alterations, polymorphisms are present on gene surfaces of some critical molecules. The aim of this study was to assess individual and/or combined role of these two polymorphisms (C677T and A1298C) in resistance against pediatric acute lymphoblastic leukemia. Moreover, the frequency rate of these important polymorphisms has not been reported in Iran so far and the present study is the first attempt to this end. Materials and MethodsUsing PCR and RFLP analyses, we studied the prevalence rate of the C677T and A1298C Methylenetetrahydrofolate (MTHFR) genotypes in 103 pediatric ALL patients and 160 age-sex matched control patients. The data were analyzed with Hardy-weinberg and Chi-square by SPSS 16. ResultsNo significant association between two common polymorphisms of MTHFR or combination of polymorphisms with the risk of ALL was observed. The study also showed the high prevalence of A1298C which was significantly higher than that reported for most Asian population (40.67% in our study versus 17-19% in Asian). It is proved that C677T prevalence pattern is similar with those in most Asian populations. ConclusionOur findings suggest that the MTHFR C677T and A1298C gene variants do not have a major influence on the susceptibility to pediatric ALL. But despite the absence of any significant association, the frequency of MTHFR 677TT was lower among patients than general population which may support previous evidence about its protective effect against ALL.

Background and ObjectivesPNH is a chronic hemolytic disease. Due to rarity and absence of any clear statistical and epidemiologic information about this disease, the aim of this study was to evaluate the prevalence, and clinical or laboratory signs about PNH in patients that referred to Shiraz University of Medical Sciences. Materials and MethodsWe reviewed 18 PNH-affected cases admitted in Namazee and Shahid Faghihi hospitals during 1 977 -2008. To evaluate patient's data, we designed a questionnaire that addressed demographic, clinical, and laboratory features, together with diagnosis and relevant treatment procedures. ResultsOut of the patients, there were 11 male and 7 female all within the age range of 14-57 years. The most common clinical features were anemia and pallor in 17 patients (94.4%), jaundice in 10 (55.5%), aplastic anemia in 6 (33.3%), and vein thrombosis in 5 (27.7%). Pancytopenia was reported in 50% of patients. As far as the treatment procedures are concerned, the patients were shown to be treated with prednisolon, folic acid, danazol, iron and antiplatelet drugs. There were also 10 patients who recieved blood transfusion because of low Hb levels. ConclusionsPNH is a rare and chronic disease that should be considered in all patients with hemolytic anemia where other possiblities causes have been eliminated.

Background and ObjectivesDiabetic foot ulceration represents a major problem in the health care of diabetic patients. The response to standard treatment is often poor and acts as a common cause of amputation. The diabetic foot imposes on patients and the healthcare system excessive expenses. The aim of this study was to assess the therapeutic effect of platelet gel on diabetic foot ulcer. Materials and MethodsThis randomized clinical trial study was done on 70 hospitalized diabetic patients; they were divided into two equal groups and followed for three weeks. Both groups received intravenous antibiotics (metronidazole + ceftriaxone) during hospitalization. Granulation tissue formation ready for grafting or epithelialization were tokens of ulcer recovery and positive response to treatment. The data were analyzed with Fisher and T-test. ResultsHospitalization period was shorter in case group (5 ± 1.6 vs. 11 ± 3.6 days in control) (p< 0.001). All ulcer cases in the former group healed completely. Amputation was necessary for six patients in the control group. ConclusionsThe results showed the effectiveness of platelet gel in treatment of chronic diabetic ulcers. So we recommend it as a suitable cellular therapy to accelerate the healing process and prevent amputation.

Background and ObjectivesAcquired Immune Deficiency Syndrome (AIDS) has social, psychological, and biological consequences thereby changing it into a phenomenon that could threaten mental health of society and even those affected. Thus, in the present research we have aimed to study the two-way impacts of personality disorders and AIDS in patients exposed to high-risk behaviors. Materials and MethodsThe main purpose of this research is to perform a comparative study of personality and psychological disorders among HIV positive and negative individuals. Consequently, 60 people were selected as the sample group from whom 30 were the ones under treatment in Mashad Consultation Center for Infectious Diseases and Behavioral Disorders; the others were 30 non-infected people who were selected randomly. They all were assessed by means of the Millon Clinical Multiaxial Inventory–II. The obtained data were finally analyzed by the use of T-test and Man-withney test. ResultsThe results displayed the fact that HIV positive individuals compared with HIV negative ones suffered a higher level of emotional and behavioral disorders in their lifetime. Schizotypal personality, borderline disorder, paranoid, anxiety, dysthymia, alcohol and drug dependence, thought disorder, major depression and delusional disorder were the problems investigated. ConclusionsUnfavorable procedures of psychological growth can impair the personality development thereby making people susceptible to being infected with disease provoking factors including AIDS being affected with AIDS in turn can act as an effective variable in emergence of emotional and psychological impairments.

Background and ObjectivesReports concerning serious illnesses caused by transfusion transmitted infections (TTI) in 1980s have caused numerous legal, social and economic consequences both for the patients and the societies. As a result, several lawsuits against authorities in the government and industry have been filled by the patients or advocacy groups. In Iran in 1990s such lawsuit was started against authorities of national blood transfusion organization. In this paper, comparative consequences of theses lawsuits have been evaluated. Materials and MethodsMain databases such as Pubmed and ISI Web of Science have been searched for any such reports in both developing and developed countries in the past three decades. ResultsAlthough prevalence of TTI (e.g. AIDS and hepatitis C) in Iranian patients was substantially lower compared to the data reported in developed countries, compensation paid to the patients, as percent of GDP per capita, was significantly higher. Similar discrepancy was also observed in extension of the compensation and verdicts against national authorities that was much severer. Iran was the only country which had to provide in addition to substantial compensation free comprehensive treatment for the patients in extra to the existing national insurance system. As a result of such lawsuits, Iran has closed its only national plasma fractionation plant and after that it had to rely only on imported plasma products to meet the patients’ need. ConclusionsComparison of consequences of TTI in Iran with those of developed countries indicates a clear imbalance between the event and its consequences. This obviously has caused a clear unfair shift of the country’s health system privileges toward TTI contracted patients. On the other hand this unfair verdict against national authorities has ignored concepts of failure and fault in medical interventions.