فصلنامه خون
سال بیستم شماره 2 (پیاپی 80، تابستان 1402)

Intravenous immunoglobulin (IVIG) is a biological product containing a mixture of IgGs which is needed to protect special patients against various microbial pathogens. Due to worldwide decrease in the prevalence of viral hepatitis, the protective effect of immunoglobulins in treatment needs to be re-examined. For this reason the presence of, anti-HAV, anti-HBs, Anti HBc, anti-HGV, anti-HDV and anti-HEV antibodies in the IVIG products of Iranian plasma have been investigated.

In this randomized descriptive cross-sectional study, the presence or absence of antibodies against hepatitis A, hepatitis E, hepatitis D, hepatitis G, antibodies against hepatitis B surface antigen and hepatitis B core antigen in 38 different lots of IVIG products from the Iranian recovered and source plasma was determined by ELISA method and anti-HAV and anti-HBs antibodies were titrated.

Total anti-HAV in IVIGs was 38304 ± 17735 mIU/mL and this titer was significantly higher in IVIGs from recovered plasma compared with source plasma. Total anti-HBs titer in IVIGs was equal to 2487 ± 965 mIU/mL, and no significant difference was observed between the two types of recovered and source plasma. Anti-HBc, Anti-HEV and Anti-HGV were detected in all products, while no anti-HDV was found.

Conclusions  :

Despite the worldwide decrease in the prevalence of viral hepatitis and reports of a decrease in anti-HAV and anti-HBs titers in IVIG products, IVIG products prepared from Iranian plasma have acceptable anti-HAV and anti-HBs titers according to the European Pharmacopeia and are suitable for replacement therapy.

Gamma irradiation (GI) of platelet concentrates (PCs) is done to prevent the risk of Transfusion associated graft versus host disease (TA-GVHD). However, some of studies indicate a lower post-transfusion responses and aggravation of platelet storage lesion (PSL) after GI. In this study, the effect of GI on the platelet metabolic status in stored PRP-PCs was investigated.

in our experimental study, 10 PRP-PC were randomly obtained from Iranian Blood Transfusion Organization (IBTO). Then, two ABO- and D matched PRP-PC units were pooled and splited into two bags, one kept as control while other was gamma-irradiated with 30 Gray. Within 7-day storage, glucose concentration and LDH activity were measured by enzymo-colorimetric method. PLT count and pH were measured using a hematology whole blood analyzer and the pH meter, respectively. Swirling was evaluated by visual assessment. Statistical data were analyzed by Kruskal-Wallis test with Dunn’s multiple comparison test and Wilcoxon Mached-Pair test. P values of less than 0.05 were considered to be significant.

Swirling was maintained in both groups throughout the storage period. Platelet count significantly decreased on Days 5 and 7 of storage but there was no significant difference between irradiated and non-irradiated PCs. Glucose decreased whilst LDH activity increased during storage period. The increments of LDH activities were significant on Days 5 (P<.05) and 7 of storage (P<.01) in non-irradiated groups.

Conclusions  :

The quality of irradiated PCs is well maintained throughout the storage period, with minimal difference in metabolic parameters compared to non-irradiated PLTs.

Pancytopenia is one of the main characteristics of serious diseases among children. Therefore, identifying the initial signs of pancytopenia and finding the main cause of its occurrence is important for selection of the appropriate treatment strategy. This study was designed to investigate the clinicopathological and survival characteristics of children with pancytopenia referred to Shahid Sadoughi Hospital between 2010 and 2015.

In this retrospective study, 88 children aged 2 months to 16 years with pancytopenia symptoms were identified. The clinical, pathological, etiology, and survival characteristics of these children were examined and evaluated with the help of SPSS 25 software and log rank test were analyzed.

The ratio of boys to girls was 1.1, which had no significant difference from each other. The frequency of pancytopenia among children one to six years old was equal to 48.87% (43 children) and more than other groups. Fever, bone pain, and general weakness were observed in 32 (36.36%), 17 (19.32%), and 16 (18.18%) children. Also, acute lymphoblastic leukemia and aplastic anemia were reported as the main causes of pancytopenia in 57 (59.1%) and 31 (31.8%) children. The results showed that 9 children had severe pancytopenia, and the survival rate in this group was lower than other children (p value <0.001).

Conclusions  :

Based on the results of this study, the possibility of pancytopenia in children aged 1-6 years with symptoms such as fever, bone pain, and general weakness should be considered to adopt the appropriate treatment and improve the survival rate.

Identifying blood supply chain risks can be effective to avoid failures that may affect the entire supply chain. The purpose of this research is to identify and rank the risks affecting the blood supply chain in the Corona virus pandemic.

In this study, 37 risks were identified based on the background of the research and interviews with 7 experts who had management positions in blood centers. Then, by distributing a researcher-made questionnaire among 113 employees of blood centers, the probability of occurrence and the severity of the impact of risks on the variables and value of each risk were calculated, and 21 critical risks were selected by using the risk matrix. Finally, the risks were weighted and ranked by pairwise comparison method using Expert Choice 11 software.

The results showed that the level of blood collection with a weight of 0.417 bears the highest risk in the blood supply chain. Risks of blood collection planning error (weight = 0.192), failure to comply with safety during blood donation (weight = 0.124), inaccurate information and creating false excitement (weight = 0.09), planning error demand (weight = 0.072) and blood shortage (weight = 0.072) ranked first to fifth.

Conclusions  :

The level of blood collection and as a result the amount of bloodstock bears the greatest risk in the corona pandemic, which can be largely avoided by planning for appropriate information sharing and preventing the creation of false emotions. This can greatly reduce negative effects on the blood supply chain.

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.

Corona is caused by a viral infection called acute respiratory syndrome corona virus 2 which spreads rapidly, causing irreparable damage and death. In order to predict and develop treatment algorithms, the study of biomarkers is important in determining the severity of the disease. Therefore, we investigated the correlation of Interleukin 6 IL-6, Lactate dehydrogenase LDH, C reactive protein CRP and disease severity in COVID-19 patients.

In this descriptive and analytical cross-sectional study, the information of 365 coronavirus hospitalized patients randomly selected in Sina Hamadan hospital during 2019 was entered into SPSS 26. The severity of the disease was also measured according to the defined reference and clinical symptoms and classified into two levels. The data were analyzed with  gamma correlation instability test, Somers' D at significance level of p value <0.05.

It was found that IL-6 with a correlation coefficient of 0.506, LDH with a correlation coefficient of 0.291 and CRP with a correlation coefficient of 0.23, all at the level of 0.01 (p value = 0.01), have a positive effect on the severity of Corona disease and the amount of this positive effect is based on Somers' effect coefficient d 0.839, 0.458 and 0.358, respectively.

Conclusions  :

Patients with severe COVID-19 have significantly higher serum levels of CRP, LDH and IL-6. Baseline levels of IL-6, CRP, and LDH were closely related to the severity of COVID-19 disease. These laboratory markers can be used as clinical indicators of disease exacerbation and prognosis of COVID-19.

Hematopoietic stem cell transplantation (HSCT) is a promising treatment for the hematological disease. Although bone marrow is the major source of hematopoietic stem cells (HSCs), there is a small compartment of these cells in peripheral blood. Mobilization is the process of HSCs release into the peripheral blood, induced by several physiological and pharmaceutical factors. Granulocytecolony-stimulating factor (G-CSF) is the main exogenous drug for mobilization induction. The exercise is a non-invasive approach for mobilization stimulation. 

In this review, we searched the keywords of hematopoietic stem cell transplantation, mobilization, and exercise in reliable databases, including Google Scholar, PubMed, Scopus, and Elsevier. We selected the most relevant ones among potential candidates. Among the 98 selected articles, 63 articles met the necessary criteria and were evaluated.

Exercise is safe and feasible in patients undergoing HSCT and can induce a 2-4 fold increase in peripheral blood HSC quantity. However, the influence is transient and drops back to baseline shortly after the exercise. Studies suggested that exercise-induced mobilization is intensity-dependent, and higher-intensity exercise induces mobilization more effectively than lower intensity.

As the exercise’s effect is transient and insufficient compared to G-CSF, it cannot fully replace the exogenous G-CSF therapy in the clinic. However, it can be applied along with G-CSF as an adjuvant therapy to help with reducing apheresis time and duration, decreasing G-CSF dose and its related side effects, and preventing extra pharmaceutical interventions.

Although von Willebrand's disease (vWD) is the most common hereditary bleeding disorder in the world, the acquired type of the disease (acquired von Willebrand’s syndrome, AvWs) which is seen in some conditions, is less common. Cardiovascular diseases, use of cardiac assistive devices, lymphoproliferative and myeloproliferative disorders are among the most common disorders associated with AvWs. Despite its low prevalence, AvWS is known as a clinically important bleeding disorder.

Considering the importance of the disease, we aimed to investigate and review the disease condition, diagnostic pattern and its clinical and laboratory findings from the disease discovery to the present time by referring to 110 related articles in PubMed, Medline, Scopus and Google Scholar databases.

Clinical and laboratory findings in AvWS and vWD are often similar. So, it can be difficult to distinguish between the two conditions. However, performing screening tests prior to any clinical interventions with a high risk of bleeding, such as surgery, in any individual with an AvWs-associated disorder can greatly facilitate the diagnosis of the disease. Furthermore, a distinction clue between AvWS and vWD is the late onset of AvWS without any previous family and personal history of bleeding.

Conclusions  :

According to published reports, AvWS has been considered as an uncommon disorder. But it seems that its actual prevalence is not rare and compared to what was previously thought, its prevalence is increasing at least in certain groups of patients, due to awareness of specialists especially hemaologists and cardiologists.