dr. a. chegini

Excessive blood product transfusions increase morbidity, mortality, and healthcare costs. To address this issue, we investigated the cost savings of implementing patient blood management strategies to reduce unnecessary transfusions.

We conducted a cross-sectional study at Shahid Lavasani Hospital from 2016 to 2018, analyzing laboratory service costs in the blood bank before and after adopting patient blood management. Statistical analyses included Friedman repeated measures tests for three-year trends and Wilcoxon signed-rank tests for two-year trends, using SPSS version 21 for comparison.

In 2016, the average cost of red blood cell transfusions was 209336820 rials, which dropped to 185857980 rials in 2017 and 71.2% to 53494250 rials in 2018. The average cost of plasma in 2016, before the establishment of patient blood management, was 95155368 rials. In 2017, this cost decreased by 79.1%, bringing the average down to 19880784 rials. In 2018, it fell further by 57% compared to the previous year, resulting in an average cost of 8537760 rials. Total laboratory service costs decreased by 5.7% from 2015 to 2016 and 53.8% from 2017 to 2018.

Conclusions  :

Patient blood management reduces costs, making it a financially advantageous strategy for hospitals.

Bleeding management during and after surgery, including the use of cell salvage device (CS), is one of the pillars of patient blood management.The purpose of this article is to investigate the coagulation status of heart surgery patients after using the CS device.

This cohort study (three days) was conducted in the third referral hospital in July 2019 after the establishment of patient blood management. The criteria for entering the study were selecting heart surgery patients who had given informed written consent to join the comprehensive program "patient blood management". After surgery and using the CS device, the patient's vital signs, the total bleeding volume in mL from the chest tube, as well as coagulation parameters were considered in the intensive care unit after surgery for three days.

In July 2019, for sixteen heart surgery patients the CS device was used, including 7 women and 9 men, with an average age of 61.36 years. Three days post-surgery, their vital signs stabilized, and no further surgical intervention was necessary. Follow-up tests revealed a significant reduction in bleeding from the first 6 hours through the end of the first day and from the second to the third day (p = 0.027). Platelet levels and PTT showed no significant changes over time (p = 0.009 and p = 0.006).

The patients’ vital signs were stable after using the device in the intensive care unit, and there was no correlation between the amount of bleeding and the laboratory parameters.

Covid-19 was declared a public health emergency by World Health Organization in jan 2020. Public fear, quarantine, and shutdown created an unpredictable situation for healthcare services worldwide, which created a great challenge for blood transfusion services.

In a cross-sectional study, the data about the request, distribution, and waste of blood products were collected and compared in two time periods (March and February 2019 and March and February 2020) before and at the time or Covid-19 pandemic with test of proportion. The poisson regression test was used to compare the amount of waste, request, and distribution of blood products in two consecutive years.

The request for red blood cells before the pandemic was 920,591 units, but it decreased by 18% to 754,052 units, and the distribution of red blood cells decreased by 17.3% at the time of pandemic, because of the cancellation of surgeries and general quarantine. The RBC wastage decreased from 25878 to 12837 units, a reduction of 50.3% (p = 0.03). However, the demand for leukoreduced red blood cells rose by 10.8%, yet wastage also increased by 8.8%. Waste in red blood cell bags for infants quadrupled during the pandemic. Plasma requests decreased by 4.9%, with a 7.2% decline in distribution, yet plasma waste increased by 6.8%. At pandemic time, Platelet requests decreased by 19%, distribution decreased by 15.6%, and waste decreased by 32.3%.

Conclusions  :

During the COVID-19 pandemic, the waste of RBCs and platelets was reduced. The distribution-to-demand ratio remained relatively stable throughout the pandemic time.

Regular blood donors may experience iron deficiency due to repeated blood donation. Genetic differences might have an impact on iron deficiency in regular blood donors. Some of these genes include those involved in activities related to iron absorption and transfer in blood. In this study, the association of the rs855791 single nucleotide polymorphism in TMPRSS6 gene with iron levels in male regular blood donors was investigated.

In this cross-sectional study, 130 male regular blood donors participated. CBC tests, serum iron, ferritin, and Total Iron Binding Capacity (TIBC) were performed on their blood samples. The genotypes of the target polymorphisms were determined using the allele-specific PCR method. All collected data were analyzed using R software for statistical analysis.

The average age of the regular male blood donors was 45 years with a standard deviation of 10.5. Among the 130 regular blood donors, 28 individuals (21.54%) were homozygous for the T/T allele, 29 individuals (22.31%) were homozygous for the C/C allele, and 73 individuals were heterozygous for the C/T allele. No significant association was observed between the rs855791 single nucleotide polymorphism and iron assessment indicators.

Single nucleotide polymorphism of TMPRSS6 gene (rs855791 v736A) was not associated with iron level and related quantities in regular blood donors.

β-thalassemia patients need regular blood. Regular blood transfusion has side effects. The most common of which is FNHTR. One of the causes of FNHTR is the antibody production against HLA-II antigens. HLA polymorphism vary in different communities and may affect the susceptibility or resistance to FNHTR. In this study, the relationship between HLA-DR polymorphisms and development of FNHTR in multi-transfused thalassemia patients in Tehran province was investigated.

In this cross-sectional study, 88 ß-thalassemia major and intermediate patients with average age 38.63 ± 11.28 with 35 being male (39.8%) and 53 female (60.2%) were enrolled and for better results, 70 thalassemia patients with FNHTR were compared with 18 thalassemia patients without FNHTR. HLA-DR genotype was investigated by PCR-SSP method. Data were analyzed by chi-squared and pearson test.

The results of PCR-SSP showed that HLA-DRB1*11 allele had the highest prevalence (26.7%) in the total study population. No statistically significant correlation between HLA-DR alleles and development of FNHTR was observed. Although HLA-DRB1*10 as a possible genetic marker may play a role in protecting against FNHTR (p = 0.049).

Conclusions :

In this study, no significant association between HLA-DR allele frequency and FNHTR was found. Although alleles HLA-DRB1*03, HLA-DRB1*10, HLA-DRB1*13 and HLA-DRB1*16 have higher prevalence in the no FNHTR group, but only in the case of HLA-DRB1*10 this relationship was significant and was considered as possible genetic markers against development of FNHTR. Further studies investigating HLA-II allelic levels in larger populations may provide more deep data on this association.

Numerous workers experience occupational diseases, especially musculoskeletal disorders, due to various physical, psychological, and individual factors. Among known risk factors for musculoskeletal disorders, work-rest patterns, and muscle fatigue are to be named. Assessment of muscle fatigue plays an important role, leading to a proper design for a work-rest program. This study was aimed to investigate isometric muscle strength in Iranian workers during repetitive activities based on gender and rest time. It has been attempted to present a model for isometric muscle strength. In a laboratory experiment, 31 students comprised of 19 males and 12 females participated, and muscle strength was recorded by a dynamometer. Minitab software results analysis proved that females' upper body muscles showed a higher level of resistance to fatigue rather than males. Furthermore, tests' results for each individual were more in line with cubic regression so that four models with a high R-Sq index (at least 94.4%) and high R-Sq (adj) index (at least 77.8%) were presented to predict isometric muscle strength in short-run. Finally, it has been suggested to use male workers for repetitive activities with a high workload and enough rest time and use female workers for repetitive activities with low workload and high frequency.

The mitochondrial DNA in blood products can cause physiological changes in cells and patient complications. This study aims to evaluate the effect of storage time on the copy number of free mitochondrial DNA in products of RBCs and leukoreduced red blood cells.

In a cross-sectional descriptive study, 15 units of RBCs and 15 units of leukoreduced red blood cells were evaluated. After determining the hematological parameters and the average blood cell count in each bag, the free mitochondrial DNA copy number was evaluated using the RT-PCR method. The mitochondrial DNA copy number was measured in blood products on days 0, 5 and 35. After data collection, Shapiro and Mann-Whitney tests were performed and the analysis was done using REST 2009 software.

The average hemoglobin level in the blood bags was 17.6 ± 4.3 gr/dL. The mean platelet count in packed RBC bags was 132.02 ± 50.60´1000/mm3 of blood. The mean number of red blood cells was 6.07 ± 0.14 million per microliter of blood and the mean WBC count in the blood bags was 4.98 ± 2.3 per microliter. The number of free mitochondrial DNA copies in the packed RBC product was higher compared to the leukocyte-less RBC products on days 5 and 35.

Conclusions  :

The free mitochondrial DNA copy number in RBCs bags was higher than leukoreduced RBCs,
and a direct relationship between the amount of WBC and the number of free mtDNA copy number was observed.

Patient blood management is an evidence-based medical and surgical concept in order to achieve a better clinical outcome for patients. The first step in the establishment of patient blood management is its training. The purpose of this research is to investigate face-to-face and virtual educational methods for the establishment of patient blood management.

In 2016, a prospective study was designed to implement "patient blood management" in Shahid Lavasani Hospital. The hospital staff were randomly selected from three groups of doctors, nurses and laboratory staff to enter one of the virtual and face-to-face training groups. The training focused on the principles of "patient blood management", substitutes for blood products and restrictive blood transfusion. After completing the course, both groups participated in a uniform exam. One-way Annova, chi-square, and paired t-test were used for comparison. We used SPSS version 23 software for analysis.

The average score of people in the face-to-face course was 90.7 ± 10.1 (64-100) and in the virtual course 90.8 ± 10.6 (58-100). There was no significant difference in the average scores of participants in the face-to-face and distance training (p = 0.9). Neither was there any relation between work experience (p= 0.9) and years of education (p = 0.1).

The knowledge gained in the participants of this study did not show a significant difference between the two virtual and face-to-face groups. In order to implement "patient blood management" in hospitals across the country, face-to-face and virtual trainings can be used.

Aortic aneurysm repair surgery (AAAs) is associated with massive bleeding that causes coagulation disorders during and after surgery. Considering that blood consumption in these patients has been studied in a few articles, we decided to investigate more.

In a cross-sectional study, patients with abdominal aortic aneurysms requiring surgical repair from January 2018 to August 2020 were evaluated at Shohada-e-Tajrish Hospital. The blood component utilization was evaluated. Graph Pad prism 9.0.0 (121) software was used for statistical analysis (p < 0.05 was considered significant).

Of 20 patients with aortic aneurysm repair, 16 (80%) were male and 4 (20%) were female. Seven cases (35%) of them received Fresh frozen plasma (FFP) in addition to packed red blood cells (PRBCs). The mean of FFP utilization was 3.7 ± 1.5 units and in 13 patients (65%) only PRBcs were transfused. Platelets was not transfused in any of the patients. The relationship between red blood cells transfusion with the hemoglobin level before surgery and patient age was evaluated. Also, the relationship between INR before surgery and FFP transfusion was assessed, none of which was statistically significant.

Despite extensive aortic artery surgery and massive bleeding, in 65% of patients only packed red blood cells were transfused. In 35% of patients, in addition to PRBC, FFP was transfused, but no platelets was administered.

Apheresis is an efficient method for collecting blood products such as plasma, platelets, red and white blood cells. Considering the importance of donor health and due to the limited number of apheresis donorschr('39') health related articles, we decided to investigate the effect of apheresis on platelet count, hemoglobin, hematocrit levels, and total leukocyte counts of donors.

A descriptive cross-sectional study was performed on 25 donors who were eligible for inclusion criteria in the study from May 2016 to January 2017. Samples were taken from donors before and after platelet apheresis and also 7 days after platelet apheresis to be tested on blood cells. CBC samples were analyzed with calibrated Mindray BC 300 cell counter device and then results were recorded in the prepared checklist and analyzed by SPSS 23 software.

Twenty five male donors had a mean age of  32.4 ± 9.97 years, minimum age 19 and maximum 59 and average weight 85.84 ± 17.2  kg, and mean height  178.2 ± 6.69. There was no significant change in WBC, RBC, HCT, and Hb before and after apheresis and 7 days later in Haemonetics MCS+. Platelet counts decreased immediately after donation from 235.720 ± 52.109  to 176.400 ± 44.240  (103/μL) and it reached to the level of before donation after 7 days (243.400 ± 67.399)(103 /μL).

Conclusions :

There was no significant change in WBC, RBC, HCT, and Hb before and 7 days after donation.

Various antibodies such as antibodies against RBC antigens, anti-HLA, and anti-platelet antibodies are developed after repeated blood transfusions and may lead to transfusion reactions such as platelet refractoriness in recipients. In this study, anti-HLA antibodies were evaluated in hemato-oncological patients, with and without simultaneous platelet refractoriness.

In this descriptive study, performed from 2017 to 2019, presence of anti-HLA antibodies in patients with hemato-oncological disorders, referred to the HSCT Research Center, Shariati Hospital, Tehran, was assessed using Panel Reactive Antibody (PRA) test based on complement lymphocytotoxicity. Data analysis was performed by SPSS (version 16) and chi-square tests.

Of 79 studied patients with hemato-oncological disorders including 34 females (43%) and 45 males (57%) with the age range of 2 to 83 years,  49 were platelet refractory and 30 were not. Anti-HLA antibodies were present in 39 (49.4%) patients and  40 (50.6%) were negative for them. The frequency of panel reactive antibody positive cases was significantly different between patients with platelet refractoriness (62.8%) and those without it (30%) (P = 0.007).

Conclusions :

The role of anti-HLA antibodies in platelet refractoriness is well established. Our study also showed a significant difference in this regard among two groups of hemato-oncological patients with and without platelet refractoriness. The presence of these antibodies does not always mean platelet refractoriness, and antibodies without the ability to activate complement can also cause this complication.