[Trace back of thalassemic patients with positive HCV markers to their donors in adult thalassemia center]

Transfusion transmitted infection is one of the most important transfusion reactions. In this study, we tried to find new cases of HCV in thalassemic patients having referred to Adult Thalassemia Clinic after 1996 and to trace them back for sources of infection. This was a descriptive study in which all patients were studied; census method of data collection was used. Those patients with no test record before 1996 that appeared to be positive in their first test attempt were not considered a new HCV positive case. The new cases were just those whose past negative HCV Ab test results changed into positive in new test. For data analysis, SPSS version 14 was used. Out of 395 file records, 274[69.4%] were thalassemia major, and 110 [27.8%] intermediate. We had 109 HCV positive cases [27.5%] out of whom 21 were those infected after 1996. Out of the latter, 5 had complete medical records by which 54 blood donors were identified; however, only 37 [68.5%] were traced and found to be negative for HCV Ab. Noteworthy that 81% of these safe donors were shown to be repeated donors. Since there had been one or more donors whose donations had been administered to each patient with no possibility for them to be traced, we were not able to prove the transmission of HCV from donors to recipients. Other possibilities including hospital transmission, patient to patient transmission, and transmission by nurses involved in blood administration should be taken into account

[Evaluation of elevated FVIII in patients with thrombophilia]

Thrombus formation may form enhanced coagulation or impaired fibrinolysis. An increased tendency for the blood to clot is referred to as the hypercoagulable state or thrombophilia which includes various inherited and acquired clinical disorders or mixed conditions. There are many studies suggesting that elevated factor VIII may be a common and independent risk factor for thrombotic events. We tried to assess the level of factor VIII in patients with idiopathic thrombosis. Our cases were the patients with idiopathic venous thrombosis having referred for hypercoagulable studies to Coagulation Lab in Iranian Blood Transfusion Organization. The inclusion criterion was the occurrence of thrombotic event confirmed by objective diagnostic methods coupled with three months of follow-up without any other disorder. Our controls were from healthy blood donors and matched with the cases on sex, ethnicity, and age. Plasma of a healthy person was used to establish the normal reference range according to which our patients are compared. Factor VIII levels were measured using a one-staged assay, the PTT based Diagonistica Stago on the STA compact automated coagulation factor analyzer. SPSS and Chi-square were finally used for data analysis. One hundred fifty two cases and 130 controls enrolled. The mean factor VIII level for cases was 157.26 IU/dl [SD +/- 53.8] with the minimum level of 66 and maximum of 364 IU/dl. For controls, the mean factor VIII level was 111.78 IU/dl [SD +/- 29.68] with the minimum level of 42 and the maximum of 195 IU/dl. These levels were statistically significant and higher in the case group. The elevated FVIII level was higher in females than males [35.3% vs 23.8%] and increased with age. The normal range in the control group varied within 52-171 IU/dl, which is higher than the normal level of 50-150 IU/dl. There are many studies showing that increased FVIII level may be an independent risk factor for thrombosis. Our results suggested elevated FVIII level in 28.9% of the patients with thrombosis compared to 3.1% in the control group. So, factor VIII measurement is recommended to be practiced in routine thrombophilia screening programs

[Evaluation of the effect of Virkon disinfectant in reducing bacterial contamination of platelet components]

One of the main steps in reducing bacterial contamination of blood and blood components is the correct use of appropriate disinfectants at blood collection sites and blood processing areas.Virkon is one of the most effective disinfectants consisting of a high percentage of surfactant.The purpose of the present study was to test the bactericidal effect of Virkon on native species of bacteria seen in Iran by selecting a suitable concentration of Virkon. This was an interventional study. 169 samples were taken from laboratory benches, instruments and outer surfaces of blood bags. After the growing bacteria were identified, their CFU/ml was also determined. Later, all the laboratory benches and instruments involved in the preparation of platelet components were disinfected using [1%] Virkon solution. 101 samples were taken from disinfected areas and swabs were plated on to standard bacteriological media and plates were read. 1100 segments from platelet bags were also separated and the platelet contents were plated and any bacterial growth were assessed using quality control department guidelines. Finally, all the data were analyzed using SPSS, Chi-square and Fischer exact test. Out of 169 samples which were plated before disinfection by Virkon, 96 were 56.8% gram positive, 101 were 59.8% gram positive cocci, 159 were 94.8% gram negative b., and 139 were 82.2% gram negative cocci. Out of 101 samples post-disinfected by virkon solution, 25 came out to be 24.8% gram positive b., 17 were 16.8% gram positive cocci, and 6 were 5.9% gram negative b. Out of 1100 segments separated from platelet bags, 4 showed bacterial growth [0.0036%], 2 had gram positive b. growth, and 2 had staph. By using correct concentration of Virkon solution and following the exact manufacture's instruction for use, we were able to observe log reduction in bacterial contamination of the areas where blood components were prepared. The reduction of bacterial contamination in platelet components prepared after disinfection of the working areas by Virkon solution should be emphasized

study of effect of short-term, temporary deferral on blood donor return rate

Blood donors are deferred for numerous reasons. Some reasons for permanent deferral are intravenous drug use, male homosexual contact or certain positive test results. However, the majority of donor deferrals are short-term temporary deferrals [STTDs] that are resolved in a matter of days, weeks or months, thereafter donors would be considered again as eligible blood donors. The effect of STTDs on blood donor return rates and subsequent blood donations is studied. The present study was historical cohort. Donors facing STTDs during the 15 Dec 1999 to 15 Mar 2000 were randomly computer-matched with non-deferred donors on the basis of donation date [case group: 804 donors; control group: 295 donors]. Computer records were evaluated during the 3 years that followed [2 1 Mar 2000 to 2 1 Mar 2003] to determine donor return rates. Chi-square analysis was used for comparison. The most common reasons for STTDs were elevated blood pressure, certain medication, bacterial infection, cold, and sore throat. Blood donor return rates were 32.4% [in the case of those deferred for cold /sore throat], 42% [those deferred for medication], 29.3% [those with hypertension], and 37.3% [for bacterial infection] over the 3 years that followed. Non deferred donors were a little more likely than donors with STTDs to return over these 3 years [36.6% vs. 34.8%; p=0.57], and non-deferred donors donated more whole blood units. Donors with STTDs have a negative impact on blood donor return rates. The blood center's goal should be to keep donors in the donor pool. Measures to alleviate negative effects on donors with STTDs should be also taken

[Evaluation of appropriate blood administration in hospitalized patients]

Considering the increasing trend of blood use, one of the main issues in blood safety is appropriate blood administration encompassing the size of needle lumen, use of high- flow sets for transfusion, and blood warming. In this descriptive study, 2713 hospitalized patients from two hospitals receiving blood and blood components were evaluated for blood administration. From 2713 recipients, 2386 [88%] received unwarmed blood, and 230[8.5%] warmed blood. Regarding the rest 97 [3.5%] no data were received. Out of the total number of recipients, 65[2.3%] received blood with high flow rate through needle and 2585 with low rate. Regarding the rest 64 no data were received. 1804 patients [66.9%] were transfused with number 18 needle, 464 [17.1%] with number 20, 119[4.3%] with number 22, 122[4.4%] with number 16, and a few [7.8%] with different needle numbers. The needle sizes used for blood transfusion were appropriate. But high-flow sets for rapid transfusion and blood warming methods were inappropriate

Flowcytometric evaluation of antibodies against histocompatibility antigens and platelet-specific antigens in patients with hematological disorders following the transfusion of platelets concentrates

Blood transfusion may lead to the manifestation of anti-HLA and platelet-specific antibodies that may in turn bring about different problems like platelet refractoriness. It appears that the study of antibodies against HLA-Class I and platelet-specific antigens are useful for the selection and success of the appropriate treatment protocol. The aim of this study was to detect anti-HLA and anti-platelet-specific antibodies by flowcytometry in patients with hematologic disorders [including Acute Leukemia, Aplastic Anemia] and patients with ITP. In this descriptive study, anti-HLA and platelet-specific antibodies were detected by flowcytometric technique, using 62 sera drawn from patients with different hematological disorders who showed a poor response to platelet transfusion and 20 from patients with ITP. The results of anti-HLA antibodies were then compared by Panel Reactive Antibodies [PRA]. Our results showed 44 [53.7%] out of 82 patients had anti-HLA Class-I antibodies in their sera. The frequency of each antibody isotype was found to be as follows: IgM [51.2%], IgG [32.9%] and IgA [1.2%]. 36 [43.9%] out of 82 patients had platelet specific antibodies and the frequency of each antibody isotype was found to be as follows: IgM [40.2%], IgG [30.5%] and IgA [12.2%]. 27 [31.7%] out of 82 patients had both antibodies. No difference was found between the two groups in platelet specific antibodies. Despite significant correlation between flowcytometry and PRA methods, PRA can only detect antibodies which react with complement. With increase in the number of platelet transfusion, immunization to HLA antigens occures; moreover, immunization against platelet specific antigens may also occure during autoimmunity. The presence of these antibodies may be one of the reasons of poor response to platelet transfusion and platelet refractoriness in patients under study. Conducting similar studies with higher number of samples, platelet cross-match, and the use of HLA- matched platelets for these patients are recommended

Relative sensitivity of third generation hepatitis C virus antibody detection assays: evaluation of 20 kits

The most important challenge in selecting suitable assays for the detection for the anti-HCV is sensitivity. In this study, 20 assays [EIA method] were compared with each other and with anti-HCV 3.0 Enhanced SAV [Ortho Company Production] as the reference assay recommended by WHO. 20 kits were compared by 3 to 4 serconversion and 2 to 3 performance panels. The relative sensitivity of kits was calculated based on WHO recommendations. In seroconversion relative sensitivity of 3 assays was the same as the reference assay and 5 assays showed lower relative sensitivity, but the differences between these five kits and the reference assay appeared just in two samples. In performance panels, two assays came out to be the same as the reference assay and the other 5 assays detected just 2 samples to have a level lower than anti-HCV 3. In all seroconversion and performance panels, the best results were obtained by ETI-AB-HCH-K4 [146] [Diasorin], Monalisa Anti-HCV plus Version 2 [BIO-RAD], Hepanostica Anti-HCV ULTRA [BIOMERIEUX], Anti-HCV-EIA 3rd [Avicenna Medial Center], and HCV AB [DIA PRO]. For improvement of blood safety, the assay with high sensitivity is recommended to be used, and the samples with weak positive reactions especially in seroconversion and low titer performance panels should be given more attention

diagnostic value of CD14 and CD64 expression in differential diagnosis of monoid subtype of acute myeloid leukemia

Although the French-American-British [FAB] Classification system is the basis for the diagnosis and treatment of AML, it has its own limitations. During recent years immunophenotyping by flow cytometry is widely used for the identification of AML'S subtypes. Immunophenotyping has been especially helpful in discrimination of AML with monocytic differentiation [M4-M5] from nonmonocytic subtypes [M0- M1- M2- M3- M6- M7]. However several studies have indicated that CD14 mostly is negative when applied to leukemias with monocyte differentiation.Some studies have shown that CD64 [FC RI] is an early and specific myelo-monoid marker. In this study we evaluated CD14 and CD64 antibodies to identify cells of monocytic lineage in 216 cases of AML who were referred to IBTO flow cytometry laboratory. These monoclonal antibodies prepared by DAKO company and were conjugated with Phyco Erythrin. The samples were analysed by Epics-x1 Flow cytometer. The markers were considered positive if 20% or more of the cells expressed it. The Chi-square test was also used in SPSS software.Results revealed that CD64 was highty specific [88%] and sensitive [67%] and CD14 was highty specific [96%] but not sensitive [31%] with >95% confidence rate. These results are compatible with other studies.Finally because of high sensitivity of CD64, it should be considered in all of immunophenotyping protocols as a sensitive and specific marker for monoid cells. Acute leukemia, FAB, Immunophenotyping, Flow cytometry, Acute myeloid leukemia, Acute monocytic leukemia, CD14, CD64

[ Evaluation of the attitude of Iranian women towards blood donation]

The most important goal of IBTO is to prepare safe and sufficient blood and blood components; thus, the appropriate screening of donors out of low-risk population is significant. It is likely that women population compared with men is at lower risk in regard to high-risk behaviors leading to blood-transmitted infections. However, the donation attempts on part of women compared to men are less frequent. A cross-sectional study was conducted on Iranian female population at the age range of 17-65 in eight provinces of Iran. A questionnaire was prepared. The number of samples was calculated as 12000 using statistical formulas. The sampling method was multi-stage cluster. Finally, the data were analyzed using SPSS 11 statistical software. The age average of women under study was 32.6 +/- 12.1. Most of them were married, housekeeper, and had diploma. 24.1% of them had a record of blood donation while 75.4% never enjoyed such an experience. The educational background and employment rate of women with no blood donation precedent were significantly lower than those with previous history of blood donation [P