Challenges of Establishing a National Rare Donor Program in Iran.

Background: Over the past decades, interest in establishing a National Rare Donor Program has increased significantly worldwide. The experience of developing countries, however, is still limited. Rare blood is defined as a blood group found in a 1000- 5000 population and donor has an absence of a high-prevalence antigen, or the absence of multiple common antigens. Iranian national rare donor program was established in 2009. This paper reports the experiences and challenges of establishing a national rare donor program in Iran. Materials and Methods: This program provides services to all medical centers that need rare units. The main role of rare donor program is to maintain information of rare donors that are identified at the immunohematology reference laboratory located in Tehran. Good manufacturing practices and standard operating procedures are utilized to all activity. The IRL secures frozen blood to make them available when rare blood is required. Results: As many as 1000 different types of rare donors have been identified in Iran, including several individuals whose blood group had developed clinically significant allo-antibodies. In addition to routine donors' personally identifiable information such as addresses and telephone numbers, we also access to the contact information of their close relatives or friends for emergency situation. Contact data are kept up to date at least twice annually. IRL staff are ready to provide services to patients with rare blood types, 24 hours per day, 7 days per week. To date, more than 80 donors with very rare blood group are listed on the IRL rare donor database in 31 centers. Current practice at IRL is to screen the first and second-degree relatives of any patient found to have a rare blood type for a matching blood donor. Iranian blood services need to establish special departments to provide rare blood RBCs and technical assistance for a quicker and more efficient responses to patients and request of their medical staff for blood transfusion. To achieve this aim, there were several challenges, including situation analysis and justification of the program, allocation of financial support by top managers, engineering and technical maintenance, facility and environmental services, employee awareness and communication between blood centers, technologist training in advanced immunohematology. Conclusion: The results of this survey are encouraging and indicate that the information and database for rare donors will provide services to patients with very difficult and complex serology test results requiring rare blood transfusion. The experience of IRL may be helpful for other transfusion centers in developing countries.

Shisha Smoking Practices, Use Reasons, Attitudes, Health Effects and Intentions to Quit among Shisha Smokers in Malaysia.

Despite its popularity, shisha smoking practices, reasons for its use, attitudes, detrimental health effects and intention to quit among shisha users in Malaysia have never been investigated. A total of 503 shisha users responded to a cross-sectional study conducted between July 2015 and March 2016. The majority of users were young people aged 21-30; a small minority were underage. The reasons for shisha use were its growing popularity as a favourite pastime activity and the perception of shisha use as cool and trendy. Just over half (57.3%) agree that shisha use exposes the smoker to large amounts of smoke and the majority were unsure about the health risks of shisha smoking compared to tobacco smoking. The three most common detrimental health effects reported by the study respondents were dry throat, headache and nausea. Regular shisha users have significantly higher detrimental health effects compared to no-regular shisha users. Shisha users with a duration of smoking of 6-12 months (odds ratio (OR) 3.212; 95% confidence interval (CI) 1.651-6.248) and 6 months and below (OR 2.601; 95% CI 1.475-4.584) were significantly more likely to have a higher proportion who intend quitting smoking than shisha users of more than 12 months duration.