فصلنامه خون
سال نهم شماره 2 (پیاپی 35، تابستان 1391)

The quality of platelet concentrates (PCs) is affected by the preparation method and the storage conditions. Removing plasma from the platelet storage medium could be an effective way to increase the safety of this product or increase its viability during storage time. In this study, the two media of composol and plasma were compared during the storage of PCs. In this experimental study, fifty-four units of PCs were prepared from Iranian Blood Transfusion Organization. Each unit of platelet concentrate in plasma was divided into two portions. Then in one of the portions, plasma was replaced with composol using a connecting device instrument. Sampling of the bags was carried out at days 2, 4 and 7 from the preparation time. The platelet activation markers of PF4 and P-selectin were studied on the samples. Finally the data were analyzed using Paired Samples T-Test. The levels of P-selectin increased during storage. It was revealed that the levels of P-selectin were lower in plasma and the differences were significant in the two storage media of plasma and composol (p <0.0001). Besides, the concentration of PF4 increased in the two storage media with time. PF4 levels were higher in plasma than that of composol and the difference was significant at the fourth day of storage (p <0.025). This study could imply the potential capacity of composol as a good candidate for plasma substitution in platelet concentrate. This will need further and more complete studies in vivo.

Von Willebrand Disease (vWD) type 3 is an inherited disease characterized by severe clinical manifestations due to haemostatic abnormalities. Because of the autosomal recessive pattern of its inheritance, the disease is more frequent in regions with the high rate of consanguine marriages. We have previously demonstrated that despite various mutations of the gene, the Q793X mutation in exon 18 is more frequent in Iranian vWD patients. We have developed two assays to further investigate this mutation among Iranian patients. The Q793X mutation status was studied in 15 vWD type 3 patients and 30 normal individuals by ARMS-PCR and real-time PCR assays. Melting curve analysis was performed after each real-time PCR experiment. To confirm the results of assays, all amplified gene fragments were sequenced. Three out of 15 patients were previously diagnosed as having Q793X mutation in homozygote status. This was further confirmed by the ARMS-PCR and real-time PCR assays. Interestingly, the mutation was also found in 2 other unrelated patients with unknown mutations. Heterozygote status for the mutation was not detected in normal controls.Q793X mutation in vWF gene is common in Iranian population. However, a particular demographic distribution of the mutation was not observed in this study. Both assays successfully detected the mutation, although each assay has its own advantages and drawbacks. It is up to each laboratory to choose either assay based on their facilities and expertise.

Bacterial contamination of blood components is the major residual infectious risk in modern blood transfusion medicine. This problem especially concerns platelet concentrates because of their favourable growth conditions. Lipocalin 2 (Lcn2) is an iron-sequestering protein in the antibacterial innate immune response, which binds to the bacterial siderophores and prevents bacterial iron uptake. This study aimed to imply antibacterial property of Lcn2 as a bacteriostatic agent to prevent platelet- bacterial contamination. In this experimental study minimum inhibitory concentration (MIC) of Lcn2 was determined following 24 hour incubation at 20-24°C. Antibacterial effects of Lcn2 was then evaluated in the platelet concentrates medium simultaneously inoculating with variety concentration of the bacteria at 20-24°C. Following cultivating of platelets-derived products containing Lcn2 and variety concentration of the bacteria, the results revealed that Lcn2 at concentration of 40 ng/ml effectively inhibited the growth of 1.5×104 CFU/ml Staphylococcus epidermidis, Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli and Enterococcus faecalis. This concentration of Lcn2 also inhibited the growth of 1.5×103 CFU/ml Staphylococcus aureus and Proteus mirabilis. Recombinant Lcn2 inhibited growth of variety of platelet-contaminating bacteria. By using Lcn2 in platelet concentrate it may reduce bacterial contamination. However, to use it in clinic further and complementary studies are required.

The mutations at nucleotide 1896 (G to A) in the precore region of C gene could affect the HBeAg production. The aim of this study was to determine the prevalence of precore stop codon mutation in HBV infected blood donors.In this cross sectional study, 200 HBsAg-positive blood donor samples were included. HBV serum markers (HBeAg and anti-HBeAb) were determined by ELISA using commercial kits. Serum HBV DNA was extracted from HBV infected blood donors samples and the extracted DNA was amplified by PCR method. Then, the samples which were PCR positive were selected for line probe assay to identify HBV precore mutations. Out of 200 samples, 100 positive for HBsAg, HBeAg and anti-HBc by ELISA method were selected. HBV-DNA was detected in all 100 HBeAg-positive blood donor samples. The prevalence rate of precore mutations among HBeAg-positive blood donors was 17.5%. Also, 42.5% of blood donors had no mutation in the precore region. In Iranian blood donors, there is a spectrum of asymptomatic patients with a mixed population of wild-type virus and precore mutants before HBeAg seroconversion.

Blood transfusion committees supervise the blood quality, preparation process of blood transfusion, blood transfusion indications, appropriate use of blood products, and report on blood transfusion complications. The aim of the present study was to evaluate hospital blood transfusion committees in Tehran (2008-2009). In this retrospective study, 143 hospital blood transfusion committees were reviewed. Received reports from hospital committees were the basic data for evaluation. According to the hospital blood bank regulations, appropriate data were extracted from their reports. Statistical analysis was performed by SPSS 19 software. Out of 143 hospitals, 38(27%) submitted their performance reports of the blood transfusion committees to the Tehran Blood Transfusion Center. Committees’ reports were studied based on six performance indicators. The most frequent reported indicator was about reports of the number of committees formed (76%) and the least frequent reported indicator was about transfusion complications (4%). Other reported indicators in descending order included preparation process of blood transfusion (66%), report statistics for the number of blood transfusions (42%), reports about blood transfusion indications (34%) and reports about training programs (28%). Mean scores of monthly transfusions in public and private hospitals were 5.7(2.5-9) and 7.1(4.3-10), respectively with significant differences (p<0.01). None of military hospitals had submitted their reports of monthly transfusion when we were conducting the present study. Findings show an increase in activities of Tehran hospital blood transfusion committees by 20% compare d with the last study in 2005-2006, but more training programs should run to improve the performance quality of the committees.

Acute Lymphoblastic Leukemia (ALL) is associated with a high rate of mortality in adults and the cure rate of the affected patients is nearly 25-40%. In order to achieve a good treatment, diagnosis of ALL subtypes and their consequent differentiation from other types of leukemia are required. The main aim of this study was to classify ALL subtypes by Flowcytometry. One hundred and thirty four patients with ALL were recruited from Shahid Ghazi Hospital (1998 to 2006). In these studies, 86 out of 134 patients were examined by Flowcytometry. About 15.5% of the patients were considered to have pro B-cell ALL, 52% pre B-cell and mature B-cell ALL, and 32% mature T-cell ALL; 64% of the patients with B-cell subtype achieved complete remission after induction therapy, while this percentage for T-cell ALL was 44%. Based on the examined markers, the differentiation of Pre T-cell ALL from mature T-cell ALL was not possible. The response to therapy was higher in the T-cell ALL group compared to B-cell. In this study, the frequency of T-cell ALL was higher than the reference (32%). However, it must be mentioned that the high grade T-cell Lymphoma was differentiated from ALL. The duration of remission and survival in B-cell ALL was longer than T-cell ALL but this difference was not statistically significant.

Blood transfusion is one of the routes of Human T-Lymphotropic virus (HTLV1/2) transmission. Considering that Mashhad (located in Khorasan province) is one of the areas where the virus is endemic, it seems necessary to investigate its prevalence on Mashhad blood donors. In this descriptive study, all eligible blood donors who were anti-HTLV positive based on Elisa and confirmatory tests were considered as HTLV infected individuals and a group of healthy donors was selected as the control through 2006-2008. Data were analyzed with Chi-square by SPSS17. In this study, 250582 volunteers embarked on blood donation. Among them, 1011 (0.4 %) HTLV+ cases were confirmed. The prevalence rates of the virus were 0.47%, 0.39% and 0.35%, respectively. The results of this study shows a decreasing trend in the prevalence of HTLV among blood donors. In fact blood donors are regarded as people who have less risk behaviors. To further improve blood safety, measures should be taken to identify the prevalence rate in general population and the related risk factors so that high risk donors would be excluded effectively.

Bakground and In heart failure patients health related quality of life is significantly affected. Anemia is the prevalent comorbidity in heart failure patients. The aim of the present study was to determine the correlation between hemoglobin level and quality of life in males with systolic heart failure. This is a descriptive correlational study conducted on 100 males with systolic heart failure through 2010. Sampling method was convenience sampling. Data were collected through interview. The instruments used included demographic data form and MLHFQ (Minnesota Living with Heart Failure Questionnaire). Hemoglobin level and echocardiography data were reviewed from medical records. Data were analyzed by SPSS 18 software and descriptive statistical methods such as T test, ANOVA and Pearson correlation coefficient were used. The findings indicated that the mean of hemoglobin level was 14.32 ± 1.86 and 17% of male heart failure patients had anemia. Mean score of quality of life was 41.61 ± 21.30 and 51% of male heart failure patients had poor quality of life. There was a significant positive correlation between the hemoglobin level and physical (p< 0.001), mental, emotional (p < 0.001), social and economic (p= 0.002) dimensions and the total score of quality of life (p< 0.001). This study indicates that the decrease of hemoglobin level negatively impact on life quality of male systolic heart failure patients. Screening, control and management of anemia in heart failure patients may help improve quality of life.

Establishing an intravenous line, which is one of the most common invasive procedures in children, is a source of physical and mental stress. Since one of the responsibilities of medical staff is to take care of children pain and anxiety, attention to this matter is necessary. The aim of this study was to evaluate the correlation between pain and anxiety in children with thalassemia caused by intravenous catheters. In a descriptive study, one hundred and twenty 6-12 year old children with thalassemia in Kerman attended Thalassemia Center through 2009-2010. Demographic characteristics and numerical rating scale were used for measurement of pain and anxiety. Data were analyzed by using descriptive and analytical testing and Spearman rank correlation coefficient. The results showed that children experienced severe to moderate pain and anxiety during injection and also reports showed a significant positive association between anxiety before the injection and pain after the injection. Since nurses play an important role in controlling pain and anxiety especially in case of children, it would be a better and more effective strategy if they are offered necessary training in this regard.