فصلنامه خون
سال شانزدهم شماره 4 (پیاپی 66، زمستان 1398)

HBV, a classic viral Transfusion Transmitted Infection(TTI), is considered an important health and blood safety issue in every society. Prevalence of HBsAg positivity is variable among Iranian blood donors nationwide. This study was performed to determine the frequency of HBsAg positive blood donors and the probable associated risk factors in Mazandaran province in 2013.

In this cross sectional descriptive study, demographic and donation data were gathered from IBTO data base (NEGARE). HBsAg positive donors were recalled for post test counseling and assessment of probable risk factors. SPSS 16 Chicago, χ2 and T-test were used as tools for data analysis.

Among 131950 whole blood donors with mean age of  31.1 ± 9.5, 174(0.13%) proved to be HbsAg positive. Deferral rate was 16.6%. The highest and lowest positivity rates were observed at Babol  and Galoogah, respectively. 95% of positive cases were detected among first time and male donors (p = 0.0001). Older age, lower education level, and first time donation were obtained as demographic risk factors primarily. No significant association between gender and marital status was found. However, post test counseling revealed non-immune dental procedures, high risk sexual contacts, cupping, family history of Hepatitis, hospital admission, tattooing, history of surgery, Intravenous Drug Use (IDU), endoscopic procedures, transfusion history and needle stick as risk factors in HBsAg positive donors.

HbsAg positivity rate in Mazandaran province donors is compatible with the country rate (0.13%). Main risk factors except gender and marital status are almost similar to other studies.

Excessive blood request is a common problem in hospitals. For this purpose, there are some programs called the Maximum Surgical Blood Ordering Schedule (MSBOS) for proper management of blood demand. The aim of this study was to evaluate the demand for blood and blood consumption in different parts of the Children's Medical Center, Tehran.

In the retrospective study, from 2006 to 2016, 17,696 blood transfusions from all 19 parts of the hospital were reviewed. The ratio of blood consumption to the antibody screening test was studied. The second study was conducted on cross-match to transfusion (C/T) Ratio on 15,310 cross-matched blood requests that were measured in the hospital in 2017.

The results of the first study showed of 176696 blood transfusion requests, 77% were consumed. The first study showed that the highest demand was for the surgical department and the lowest request was for the NICU department. C/T Ratio was 1.3 in the second study.
 

The first study showed that 23% of the donated blood was unused. This proves that performance of antibody screening test would bring about economic savings and time reduction in blood preparation especially in emergency situations. The results of the second study (C/T ratio mean = 1.3) indicated the correct blood ordering procedures performed by the hospital have led to blood saving.

Alloimmunization is the most serious problem in thalassemia patients and Anti-K is the most prevalent antibody in these patients. So accurate identification of this antigen can significantly decrease the rate of alloimmunization. Serological phenotyping is usually not reliable in multi-transfused patients. Molecular genotyping can overcome limitations of hemagglutination assays, resolve discrepant serologic typing and guide RBC selection for them. In this regard, we intended to determine the K and k among alloimmunized thalassemia patients using molecular methods and compare the results between different methods.

In this descriptive study, a total of 200 blood samples were collected randomly from alloimmunized thalassemia patients of Tehran Adult Thalassemia Clinic. The phenotype of all samples was determined for K and k. PCR-SSP was performed for all samples. The discrepant results between the phenotype and genotype were re-evaluated by PCR-RFLP and were confirmed by DNA sequencing.

Sixty-three (28%) out of 200 patients developed Anti-K. Molecular typing of samples for K and k antigens revealed 96% (192 patients) KEL*02/KEL*02 and 4% (8 patients) KEL*01/KEL*02 among our samples. Discrepancy between the serology and genotyping results were detected in 8 cases that in all cases correction of genotype results was confirmed by DNA sequencing.

This study demonstrates that antibodies against K antigen continue to develop in thalassemia patients at high rate. Our findings suggest that RBC molecular genotyping is superior to serological phenotyping and is a good alternative and more reliable method especially in multi transfusion patients such as thalassemia patients.

Blood transfusion in medical care is one of the main treatments. However, blood transfusion is not without risk. Investigating the patterns of blood products utilization can help improve blood products usage and predict future blood products demand. Therefore, in this study, the pattern of blood product utilization in Arak hospitals has been investigated.

In this descriptive cross-sectional study, four hospitals in Arak were selected and the desired information including type and amount of utilized blood products and thier relationship with patient characteristics such as age, gender, diagnosis of the disease were evaluated during the first 6 months of 1397 (according to Iranian Calendar). Diseases were classified based on the International Classification of Diseases, 10th. Edition (ICD-10).

All 7300 patients, 54.4% of whom male, received 6928 RBC units, 3829 FFP units, 8196 random platelet units and 171 apheresis platelet units in all four hospitals. In all three types of utilized products (RBC, FFP, platelet), the recipient group with the age range of 41-64 years received the highest rate of blood products and the highest utilization of RBC, FFP, platelet  pertained to patients with neoplasm. The average utilization of RBC was 1.9 ± 2.05 units, FFP was 2.7 ± 2.35 units and platelet was 3.7±4.05 units, and the most utilized product in all four hospitals was RBC.

The results of the current study represents the blood components utilization by age, sex and various diseases in Arak with regard to the relationship between the usage of blood components and the demographic pattern of the region. Therefore, the feasibility of using the obtained pattern in order to predict and plan for the blood components needed for this region based on the demographic pattern of Arak city will be possible.

Analyzing the knowledge of health personnel regarding blood transfusion can lead to the identification of shortcomings and defects in knowledge and provide guidance to medical personnel and blood transfusion centers to reform the existing conditions and revise the related educational programs. Therefore, in this study, the knowledge of different medical groups pertaining to haemovigilance was assessed in university (teaching) hospitals of Kerman.

In this cross-sectional study, 135 health personnel of three university hospitals in Kerman were selected using the convenience sampling method and included in this cross-sectional study in 2018. Each person was given a multiple choice questionnaire assessing the minimum knowledge required for transfusion, storage, and understanding possible side effects of blood products, and the level of awareness of each group regarding these issues was evaluated. Chi-square and t-tests were used for data analysis using SPSS21 software.

The mean knowledge score of all participants was 16.30 ± 3.16 (out of 24 score), which showed an average level of knowledge among the participants. The highest level of knowledge was observed among nurses, followed by residents, and the interns’ knowledge was lower than that of the other two groups; these differences were statistically significant (p = 0.001).

Based on the findings, the level of knowledge of medical personnel regarding blood transfusion is suboptimal, and continuous theoretical and practical training courses are recommended for different target groups.

Hemophilia is one of the chronic disorders of blood coagulation which due to the lack of coagulation factors exposes the person to a variety of physical problems which affect patient. The effectiveness of cognitive-behavioral therapy and treatment based on acceptance and commitment in adherence to treatment, illness perception and quality of life in hemophilic patients was studied in Isfahan city in 1396.

This research was semi-experimental with pre-test and post-test design with control group and follow-up periods. To do the research, 60 hemophilic patients were selected based on eligibility criteria in three groups. The research instrument was a questionnaire for Broadbent questionnaire of illness perception, quality of life and Mariski treatment adherence questionnaire. The statistical analysis was done by SPSS 22 and at two descriptive and inferential levels.

The results of repeated analysis of variance showed that the difference between the mean scores of the two groups of cognitive-behavioral therapy and the control group was significant in the three variables of treatment adherence, illness perception and quality of life (p <  0.05) and the difference between the mean scores of the two groups of the treatment based on acceptance and commitment and the control group were similarly significant in the three variables of treatment adherence, illness perception and quality of life (p < 0.05).

  The results showed that the two cognitive-behavioral treatments and acceptance and commitment therapy could be used to increase adherence to treatment, illness perception and quality of life in patients with hemophilia.

Informing and counseling donors with positive Transfusion Transmitted Infection (TTI) is essential for preventing them from donating blood in future, and starting treatment for reducing complications. So, we evaluated the referral of reactive donors.

This cross sectional study was conducted in Shiraz Blood Transfusion Center over a period of 2.5 years involving 214 reactive donors. The reactive donors were informed by three time telephone calls, one letter, and another telephone call in case of non-return. A trained counselor informed donors regarding abnormal tests and advised to refer to the respective disease clinics of the hospital for further management. The response rate of TTIs reactive donors after notification of their abnormal test results was surveyed according to the demographic status.

Of the 214 TTIs marker-reactive donors, we did not access 10 (4.67%) persons. So, we contacted 204 ones (81 positive for hepatitis C, 117 for hepatitis B, and 6 for HIV). Among 204 reactive donors, 137(67.15%) were referred  out of whom 86 ones (42.15%) were referred after the first call. The response rate was more in educated ones. The response rate was not related to age, gender, and type of reactive tests. Among non-responded reactive donors, the major reasons were, not having enough time, travelling, and long distance.

In this study, the response of reactive blood donors were 67.15%. For better response rate, having the  precise  donor  registry and  informing donors regarding the importance of blood safety and TTI are necessary.

Blood transfusion in critical  patients is a lifesaver and at the same time can be fatal due to possible complications. The purpose of this study was to investigate the barriers to reporting the complications of blood transfusion nad the awareness of these complications in nursing staff.

A descriptive cross-sectional study was performed on the Mashhad nursing staff in the selected hospital. A population of 120 nursing staff was included in the study.  Data collection was done by a researcher-made questionnaire including demographic, knowledge and barrier factors after  the confirmation of its validity and reliability. The data were analyzed by SPSS 16.

The mean age was 36 ± 70 years, 56.67% (68) were women, 75.87% (91) had a bachelor's degree and 71.15% (86) were nurses. The legal issues (3.43%), injection of  corticosteroids before blood transfusion (3.36%), high inquiries and time consuming forms (3.34%) were major barriers in reporting adverse reactions. The mean knowledge score regarding the recognition of reactions was 85.04% (good) and regarding the care after reactions was 72.79% (moderate). There was no significant relationship between the barriers of reporting adverse reactions and demographic characteristics.

It is necessary to provide training on the detection of the transfusion reactions and its importance. There is also a need to take steps to encourage staff to report, ensure non-punishment approach to reporting reactions and errors, facilitate reporting, and simplify design of the reporting form to pave the way for reporting reactions of blood transfusions.