فصلنامه خون
سال دهم شماره 1 (پیاپی 39، بهار 1392)

The most important factor for blood donor loyalty is the staff attitude and blood center approach. Blood donor return rate is associated with donor satisfaction and complaint follow up rates. In a retrospective study from 2005 to 2010, we evaluated all complaints in Tehran Blood Transfusion Center. SPSS version 19.5 was applied for statistical analysis. A total number of 468 complaints were evaluated; 43(9%) and 425 (91%) cases pertained to female and male blood donors, respectively. The most frequent complaint was about blood donor rejection. Blood donation department was the target of the highest percentage of complaints. In 91.5% of cases, complaints were followed. The highest level of follow up was seen for blood donation complications (98%). Since the highest percentage of complaints was addressed to blood donation department and pertained to the donor rejection, awareness raising attempts about eligibility criteria would remove most complaints.

Blood transfusion plays a critical role in health system. However, one of the main problems is the excessive order of blood in teaching hospitals. The aim of the study was to investigate the current pattern of blood order and consumption at three teaching hospitals in Kerman city. In a cross-analytical study, blood order forms for 3182 patients were collected from three hospitals from May to July 2010. C/T ratio and TI were analyzed with descriptive statistics and frequency table tests. The overall ratios of C/T (Crossmatch/Transfusion) and TI (Transfusion Index) were 1.33 and 1.81, respectively. The results are considered to be desirable as compared with the standard figures of C/T≤ 2.5 and TI ≥ 0.5. Out of 7731 blood orders, the highest number pertained to heart surgery wards with 1704 (22%), and the least to ophthamology ward with 7 (0.09%). r results show that blood order and consumption in three teaching hospitals in Kerman city during 3 months were desirable. Although in comparison with other studies in Iran inconsistencies in blood order and consumption were seen. In conclusion, it is essential to prepare blood order and consumption protocols according to our regional conditions to improve the blood transfusion status.

Pre-marital screening program for beta-thalassemia is one of the most important preventive programs in Iranian health system. The results of this program in Isfahan province have been evaluated within 1376-89 (1997-2010) in the present article. The method of this study is descriptive and cross-sectional using the current data, received from districts health centers of Isfahan province within 1376-89 (1997-2010). Then we analyzed the data by using SPSS-19 and Excel softwares. Out of 616,457 potential couples screened in pre-marital screening centers, 1194 (0.19%) were considered to be definite carriers of beta-thalassemia (HbA2>3.5 in both partners), and 3314 couples (0.63%) suspicious for. The incidence rate of the disease decreased from 43.7 cases/100,000 live births in 1376 to 1.5 cases/100,000 live births in 1389. The most prevalent causes of new cases were estimated to be marriage of parents before commencement of the program (51%), family values and cultural backgrounds (15%), genetic counseling defects (9%), health care defects (6%), and screening test errors (5%). We conclude that some health-related interventions are required to be made. Promoting genetic counseling, following up suspicious or carrier couples with no screening record, community awareness raising about prevention program of thalassemia especially among students and marriage officers.

Cell signaling elements such as P15 and P16 play an important role in differentiation of primitive cells into various cell types. These factors are involved in controlling gene expression by different mechanisms, of which epigenetics especially methylation is noteworthy. The main objectives of this study were discovering the expression status of target genes in CD34+ cord blood stem cells and determining the methylation changes in the respective genes is this same stage. After collection of cord blood bags and purification and proliferation of stem cells, cellular DNA was isolated. In later stages, cDNA and Bisulfite treated DNAs were synthesized from RNA and DNA of primary cells, respectively. Polymerase Chain Reaction and Methylation Specific PCR were later performed for both genes. After MSP, it was found that the P15 has partial methylation and expression in CD34+ stem cells, and P16 lacks methylation in this stage and is completely expressed. The results of PCR indicated expression of both genes in CD34+ stem cells. Gene expression profile of each tissue or cell is in accordance with its functions; the specific expression of P15 and P16 can indicate a possible role of these genes in biology of CD34+ stem cells in umbilical cord blood. There is always substantial agreement between expression of a gene and its epigenetic changes.

Previous studies have showed that a large percentage of Mesenchymal Stem Cells (MSCs) die in the early stages of transplantation due to oxidative streeses, hypoxia, and serum deprivation. Hence, this study was aimed to address whether induction or inhibition of autophagy would affect the viability of MSCs after exposure to oxidative stress. In this descriptive study, MSCs were isolated from bone marrow with ficol and density gradient method; the fourth passage MSCs were selected in the study. Autophagy was detected by using transfection of GFP-LC3 to MSCs. Induction and inhibition of autophagy were performed by using rapamycin and 3MA, respectively. MSCs were exposed to lethal doses of H2O2 followed by cells viability evaluated with MTT assay. Our results revealed that the enhancement of autophagy in MSCs sensitized them against oxidative stress and inhibition of autophagy led to resistance against oxidative stress in comparison with the control cells. Inhibition of autophagy using non genetic engineering method in MSCs enhances cell viability following exposure to the oxidative stress. This may provide a novel strategy to promote the efficiency of cell therapies following transplantation in the future.

The production of a sufficient number of pancreatic endocrine cells that function similarly to primary islets is one of the methods in treatment of diabetes. The CD133+ cells derived from cord blood (UCB-CD133) express some embryo specific markers such as SSEA-4 and OCT4 and so it can be a candidate for differentiation into insulin secreting cells. Therefore, here we attempt to determine the differentiation potential of UCB-CD133+ cells into insulin secreting cells in vitro. UCB-CD133+ cells were isolated by MACS and differentiated into insulin secreting cells using the medium containing DMEM/F12, bFGF, Nicotinamid, and supplement B27 N2 for 9 days. The expression of insulin and c-peptide protein was detected by immonocytochemistry. The expression of insulin, Nkx6.1, Pdx1, and Glocagon genes was analyzed by RT-PCR; ELISA was performed to analysis the function of differentiated cells in different glucose concentrations (5 and 27 mM). Our results determined that UCB-CD133+ cells expressed insulin and c-peptide at protein level after 9 days of culture. However, the insulin, Nkx6.1, Pdx1, and Glocagon genes were not detected in differentiated cells and they could not respond to different concentrations of glucose. We suggested that UCB-CD133+ cells can differentiate into insulin secreting cells in vitro; however, they are not functional and need to receive more signals in vivo.

Background and Objectives Considering the Wolf law, one of the ways treating osteoporosis is to apply physical loads. In this study, we compared the effect of progressive resistive exercise versus combined resistance training with pulsed electromagnetic fields on total ALP, calcium, phosphorus, and cortisol in severe Haemophilia A with osteoporosis. Materials and Methods Thirty two severe haemophilia A patients with osteoporosis (18-35 years) were assigned randomly to a resistance training (RT), resistance training with pulsed electromagnetic field (RTPEMF), and control groups. RT group performed trunk, upper and lower limb resistance exercises (progressively, as 50-60% 1RM) for approximately 30-40 min, and RTPEMF group was exposed to 30-minute PEMF with frequency of 30 Hz, and 40 Gauss as well as 30-minute resistance training with less repetitions 3 times a week for 6 weeks. Blood total ALP, Ca, P, and cortisol was measured before and after 6 weeks. Results Cortisol level decreased significantly in Rt and RTPEMF groups (12.21 ± 6.2 and 11.65 ± 4.71, respectively) compared to the control and baseline values (20.18 ± 5.81). Total ALP also increased significantly in RT and RTPEMF groups compared to baseline values; and compared to the control group (240 ± 45) it was only RT (242 ± 43) which showed significant ALP increase. Conclusions RT is effective to improve the bone metabolism in severe haemophilia A patients with osteoporosis. Less repetition of resistive exercises to decrease the risk of hemorrhage in hemophilic patients may be compensated for by using PEMF.

Physiological parameters at birth are the main factors for somatic and mental growth in infants. The aim of the study was to investigate the impact of maternal hematologic concentration and BMI measures in primiparous women on some neonate physiological parameters. In the present study, 126 pregnant women having referred to the two hospitals of Hafez and Shushtary were selected to be included. After obtaining the informed consent, hematocrit, hemoglobin, platelet, and GCT values of participants were recorded at the 36 week prenatal visit. The main outcome measures included birth weight and length, head circumference, apgar score, and reflex score at delivery. The data were analyzed by pearson and linear regression analysis. Mother age, height, education, occupation, and sex of infants did not correlate significantly with neonate birth weight, legnth, head circumference, apgar score, and reflex score. However, there was found to be a significant correlation between the intervening factors of BMI, weight, pregnancy weight gain, hematocrit, hemoglobin, and GCT values and the neonate birth weight. The findings of this study showed the importance of mother weight at the beginning and during pregnancy. Pregnant mother nutrition status, weight control, and hematologic indices are the important factors to take care of for the health of neonates to be ensured.

The most common leading causes of death in patients with major beta thalassemia are cardiac complications.The purpose of this study is to determine cardiac function in patients with major thalassemia in Birjand. This descriptive-analytical study was conducted on all patients with major beta thalassemia having referred to special clinics of Valiasr Hospital in Birjand. Variables such as age, sex, frequency of transfusions, serum ferritin, and hemoglobin were studied. For all patients after a thorough examination of heart, ECG, chest X-ray, and echocardiography were performed. All data were collected and analyzed with SPSS software 15.5 by t-test at α ≤ 0.05. We studied 35 patients with major beta thalassemia. The mean age was 9.06 ± 4.33 years. The mean hemoglobin was 9.2 gr/dl and the mean ferritin 2121.6 ng/ml, respectively. Cardiac examinations showed 62.9% of patients to be normal. ECG and chest X-ray in 71.6% and 57.1% of patients were normal, respectively. Out of the total number of patients, 77.8% had abnormal echocardiography. The most common abnormal findings in echocardiography were restrictive diastolic dysfunction. No significant correlation was found between abnormal findings on echocardiography with both ferritin and the number of blood transfusions. However, left ventricular diastolic dysfunction and hemoglobin were not significantly associated (8.5 ± 0.69 gr/dL in normal diastolic function, 9.6 ± 0.99 gr/dL in diastolic dysfunction p= 0.007). The most common finding in our study was left ventricular diastolic dysfunction. Therefore, periodic echocardiography to determine the risk of heart involvement is very valuable.

Transfusion medicine plays an important role in saving human life and it is essential for care workers involved have competent in the field. The present study aimed to assess the knowledge status of clinical care workers about safe transfusion. In this cross-sectional study, 100 nursing and midwifery staff working in 15 Khordad and 22 Bahman hospitals in Gonabad were selected by using the census method sampling. Data collection was done by using two questionnaires: one eliciting individual characteristics and the other measuring the knowledge level about blood transfusion. Data were analyzed by SPSS11.5 software. p< 0.05 was considered as the statistical significant level. The mean (SD) age of the subjects was 31.42 ± 7.05 years, the elapsed time after the final workshop 7.93 ± 8.93 months, and the used common product was whole blood. The knowledge level of 73 percent of the subjects was evaluated as average. No statistically significant relationship between age, sex, education, work experience, the place of work, participation in the transfusion or transfusion-related workshops, the time elapsed from the last workshop, and count in transfusion rate with knowledge level about transfusion was observed. The knowledge level in the morning shift was significantly higher than other shifts. Results showed that the clinical care staffs have the average knowledge level about transfusion. In the morning shift there was the highest knowledge level about transfusion that confirms the positive impact of transfusion practice and experience on the knowledge level.

Wrong blood transfusion brings about adverse complications. Case: we present a 62 year old male with history of chemotherapy for his leukemia. 400mL of blood had been administered before we became aware that it was mismatched. Transfusion was immediately terminated and the supportive therapy began. He was transferred to the intensive care unit. After three days when the liver enzymes were normal, he was discharged.

In this patient, despite mismatched blood transfusion, surprisingly no adverse events happened; the probable explanation is that immunosuppresion due to chemotherapy helped prevent serious complications. However, measures should be taken in the first place to prevent blood transfusion errors and to this end multiple preadministration checking is strongly advised.