leila kasraian

Buerger’s disease, also known as Thromboangiitis Obliterans (TAO), is a progressive, inflammatory vascular disease with unknown etiology. To address the degree of T cell immunosenescence in this inflammatory disease, the frequency of senescent T cells expressing CD57 and/or CD153 (CD30L) in patients with TAO. In this study, nine male cigarette smoker patients with TAO, nine male healthy cigarette smokers, and nine male healthy non-smoker blood donors were enrolled. PBMCs were extracted from the blood of all participants and stored in liquid nitrogen before use. The percentages of senescent T cells were detected by flow cytometry. The results were analyzed using non-parametric statistical tests. The frequencies of senescent CD3+CD4+CD57+CD153+ and CD3+CD4+CD57-CD153+ T cells significantly increased in patients compared with the non-smoker controls (p=0.01 and p=0.04, respectively). The frequency of senescent CD3+CD4-CD57-CD153+ T cells was higher in patients compared with the smoker controls (p=0.02). In patients with TAO, CD57+CD153- cells were more frequent in CD3hiCD4- and CD3hiCD4+ T cells compared with the CD3loCD4- and CD3loCD4+ T cells (p=0.008 and p=0.0002, respectively). Conversely, the frequency of CD57-CD153+ T cells was significantly higher in CD3loCD4- T cells compared with the CD3hiCD4- T cells (p=0.004). The percentage of CD3+CD4+CD57+CD153- T cells correlated negatively with smoking level in smoker controls (p=0.02, Spearman r=-0.80). Elevated frequencies of senescent CD4+CD57+CD153+ and CD4+CD57-CD153+ T cells in patients compared with non-smoker and smoker controls suggest the contribution of immunosenescence in TAO.

Although blood is donated rather than purchased, collecting, storing, and testing it for viral markers is expensive. During the Cost of Blood Consensus Conference (COBCON), activity-based costing (ABC) was proposed as a standard way to figure out the cost of preparing a unit of blood.

The ABC can be used by any organization that pays for blood or blood products. It was used to determine how much each unit of allogeneic blood costs in Iran, considering the limited blood sources and the importance of cost evaluation studies.

This cross-sectional, descriptive-analytical study was conducted at Shiraz Blood Transfusion Organization in 2020-2021 (Shiraz, Iran). We used the ABC method to determine how much each unit of allogeneic blood costs in Iran. In this study, activity centers were divided into high-level, intermediate, and final activity centers. The resources of each activity center were made up of human resources, consumables, buildings, equipment, and energy.

Direct and indirect costs of producing blood were separately investigated in the studied sub-units. The final estimated cost of preparing one blood unit was almost 13 million IRR (≈308 USD). According to our findings, indirect costs comprised a significant portion (86.45%) of the cost of producing a unit of blood, while direct costs accounted for only 13.55%.

As evidenced by the obtained results, the cost of one blood unit was far more than the national average estimated by the Iran Blood Transfusion Organization. There is a need for additional research on the cost of other blood products and indirect cost reduction strategies.

 The leading cause of mutations in the hepatitis B virus (HBV) genome is the high rate of nucleotide misincorporation during reverse transcription. Most mutations were found within the “a” determinant of the S gene’s major hydrophilic region (MHR). They resulted in escape mutants due to amino acid changes in the MHR. However, mutations outside the MHR can also trigger escape mutants.

 This study focused on further molecular studies on the MHR of genotype D of HBV DNA isolated from patients with chronic HBV infection, together with the coexistence of hepatitis B surface antigen (HBsAg) and hepatitis B surface antibodies (anti-HBs) in their serum samples.

 In this study, serum samples from 83 patients with chronic HBV infection were analyzed by serological and immunological tests for the concurrence of HBsAg and anti-HBs. In addition, the mutation in the HBV DNA was assessed by nucleotide sequencing of S genes within, upstream, and downstream of the MHR.

 Among 83 patients with chronic HBV infection, the coexistence of HBsAg and anti-HBs were detected in 11 (13.25%) individuals. Mutations in eight amino acids of seven samples analyzed for nucleotide sequencing were observed at 27 different sites in three locations, namely upstream, within, and downstream of the MHR. The mutations affected the structure of the epitope and the appearance of an escape mutant.

 The results indicated that mutations downstream and upstream of the MHR play a role in the coexistence of HBsAg and anti-HBs in patients with chronic HBV infection.

 Immunoassayis still used to detect hepatitisCvirus (HCV) antibodies in donated blood inmanydeveloping countries. However, an immunoblotting confirmation test is needed to confirm positive results. Objectives: We compared the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of nucleic acid testing and HCV core antigen (HCVcAg) detection in the serum samples of blood donors with HCV antibodies to determine active infection.

Overall, 90serumsamplesfrom blood donors referred to Fars province, Iran, Blood Transfusion Center duringMarch2017- March 2019 and initially tested for HCV antibodies were included in the study. Enzyme immunoassays were used to detect the HCV antigen and anti-HCV antibody. A commercial reverse transcription-polymerase chain reaction (RT-PCR) kit was used to quantify HCV RNA. The HCV genotypes were also determined by DNA sequencing. In order to compare the HCVcAg detection method with the RT-qPCR reference method, sensitivity, specificity, performance, PPV, and NPV were calculated.

Out of 90 serum samples, 73 were positive for anti-HCV antibody, and 17 sera were negative. The HCVRNA was detected in 60 (82%) of anti-HCV antibody-positive samples, whereas the HCVcAg test detected HCV antigen in 54 (74%) of the samples, indicating a significant correlation between the two assays (r = 0.86). The overall sensitivity and specificity for HCVcAg detection method were 93.85% [95% confidence interval (CI): 84.99 - 98.3%] and 100% (95% CI: 94.64 - 100%), respectively. Based on the statistical analysis, the accuracy of the antigen detection test was 94.83% (95% CI: 87.26 - 98.58%). Moreover, the agreement between HCV RNA detection using RT-qPCR and HCVcAg detection was 97.78% (kappa value: 0.94).

The sensitivity and specificity of HCVcAg detection in blood donors were ideal compared to the RT-qPCR reference method. However, the method should be tested on more HCV antibody-positive and -negative samples. Furthermore, our study revealed a significant association between the number of RT-qPCR-positive cases and the cases diagnosed by the HCVcAg detection method for screening and detecting active HCV infection in blood donors.

Awareness of the prevalence of hepatitis B (HBV) and hepatitis C virus (HCV) infections, as blood transmitted infections, among blood donors can help policymakers improve the guidelines, share experiences, and estimate the blood safety over the country and in
the region. We aimed to determine the prevalence of HBV and HCV infection in Iranian blood donors based on the present published literature.

A meta-analysis was carried out based on the results of an electronic literature search in the international and national databases for all articles published until October 2020. We selected studies that had appropriate sampling and valid statistical analysis as well as proper measurement methods. The heterogenic indices of the studies were determined using Cochran’s (Q) and I-square (I2) tests. According to the heterogeneity results, a fixed or random-effects model was implemented to estimate the pooled prevalence of HBV and HCV. Meta-regression was conducted to explore the suspected sources of heterogeneity.

We included 61 and 58 eligible studies related to HBV and HCV, respectively. The pooled prevalence of HBV was 0.57% (95% confidence interval (CI): 0.47 – 0.67, I2:99.9%) among the blood donors. The range of prevalence rates of HBV was between
0.10% and 2.34% in different areas of Iran. The pooled prevalence of HCV was 0.22% (95% CI: 0.20 – 0.24, I2: 98.64%) in blood donors, which varied between 0.02% and 1.09% in separate locations. Subgroup and meta-regression analyses revealed that the
year of publication, geographical location, and quality of the studies probably generated the heterogeneity.

The prevalence of HBV and HCV decreased steadily in Iranian blood donors during the past two decades. It should be asserted that most of the health policies and safety measures taken in recent years in Iran have been effective and promising

Only 40-50% of cross-matched blood bags are used for surgeries, which leads to wastage of blood bags. We investigated the effectiveness of antibody screening in improving blood consumption during surgeries.

This cross-sectional study was conducted in Chamran and Kosar hospitals in1397-1398 in Shiraz. The number of requested, consumed and cross-matched blood bags and the ratio of cross-match to transfusion in two consecutive years (before and after antibody screening) in Chamran and Kowsar hospitals were compared for one month and five months. The comparison of  ratio test with  Medcalc-7 statistical software was used for analysis.

Results

Prior to the antibody screening program, 585 blood bags were requested, 228 crossmatched and only 84 were transfused in Chamran Hospital. After antibody screening 554 requested  blood bags, 98 and 72 bags were crossmatched and transfused, respectively. The cross match -transfusion ratio was decresed  from 2.71 to 1.36 (p< 0.001, 95% CI: 31-25-41 / 98: 95%). Prior to the antibody screening program, out of 3595 requested blood bags, 3377 and 1468 bags were cross-matched and transfused in Kowsar Hospital, respectively. After antibody screening, out of 2183 requested blood bags, 1658 and 1157 bags were crossmatched and transfused, respectively. The cross - match to transfusion ratio was decreased (2.30 to 1.43) (p< 0.001 < 24/28/29/32: 95% CI) after antibody screening.

Conclusions  

Initiating antibody screening rationalized blood consumption. Therefore, it seems that it should be established in all hospitals, and coordination with insurance organizations should be done to allocate the budget and provide the required kits.

The requests for blood products in elective surgeries exceed actual use, leading to financial wastage and loss of shelf-life. In this study, we assessed the blood transfusion indices in elective surgeries performed in the operating rooms.

In this cross-sectional study, from January to June 2017, a total of 970 adult patients who underwent elective surgeries in the operating rooms of Nemazee hospital, a general referral hospital in southern Iran, were investigated. Demographic, clinical, and laboratory data, such as hemoglobin (Hb), hematocrit (Hct), platelets, prothrombin time (PT), and partial thromboplastin time (PTT) were gathered from medical records. Blood utilization was evaluated using the following indices: cross-match to transfusion ratio (C/T ratio), transfusion probability (T%), transfusion index (TI), and Maximum Surgical Blood Order Schedule (MSBOS).

The overall C/T, T%, and TI ratios were 2.49, 46.6%, and 0.83 for all procedures, and the highest and lowest ratios pertained to the thoracic and cardiac surgeries, respectively. The C/T ratio was ≥2.5 for all surgical procedures except for cardiac surgeries. T% was <30 for thoracic and orthopedics surgeries and ≥30 for other surgical procedures. In all surgical procedures, TI was less than 0.5, except for cardiac surgeries. Also, the MSBOS was about 3 units for cardiac surgeries and ranged from 0.5 to 1 units in other surgeries.

The results of this study showed a high quality blood transfusion practice in cardiac surgeries, possibly due to more focus on this critical ward. Assessing difficulties in the process of reservation, utilization, and preparation of standard protocols and policies are required to improve the blood utilization practice in operating rooms.

The outbreak of a novel coronavirus disease 2019 (COVID-19) began in China in December 2019 and spread worldwide. The current review summarized clinical, radiological, and laboratory findings of patients infected with COVID‐19. Based on many studies, the main symptoms of the disease include respiratory symptoms, fever, cough, and dyspnea; there is also a wide range of biochemical, hematological, and radiological changes in the patients. The signs (or symptoms) and other variables in the early stage or the mild stage of the disease appear in a highly heterogeneous and non-specific manner. Identifying the clinical and paraclinical symptoms of COVID-19 can be effective in controlling it.

Hepatitis C virus (HCV) infection is one of the major bloodborne diseases worldwide. Although many screening tests were introduced and utilized for blood donations, as the main source of HCV transmission, it has still remained a global concern.

The prevalence of HCV infection among blood donors in every country and every WHO region was investigated. A Comprehensive electronic systematic search algorithm in the international databases PubMed, ISI, Scopus, and ProQuest were adopted for articles published until October 2016, using the following keywords: ("Blood Donors" OR "blood donation" OR "donor" OR "donation" OR "blood" OR "blood safety" OR "bloodborne" OR "residual risk" OR "transfusion-transmitted infections") AND ("prevalence" OR "epidemiology") in combination with “hepatitis C” OR “HCV” for hepatitis C. Only cross-sectional studies, which had appropriate measurement and sampling methods, were selected.

The review of the literature showed that the global prevalence of HCV was 854.09 in 100,000. The highest and lowest rates of HCV among WHO divisions were seen in the African region by 2503.61 and the European region by 450.21 in 100,000, respectively. The highest and lowest rates among the countries were seen in Cambodia by 14,670 and Netherlands by 25.370 in 100,000.

It seems that strategies for prevention of HCV infection in blood donations should be considered for the policymakers; low prevalence countries are suggested to share their knowledge and countries with lower socioeconomic status should be aided to control the HCV infection among their blood donors.

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.

Over ordering of blood in elective surgical procedures due to fear of bleeding and unavailability of sufficient blood can cause blood wastage and increase blood bank expenses. This study compared blood ordering and utilization after the introduction of maximum surgical blood ordering (MSBOS) in elective surgeries.
 

This cross sectional study was carried out on one third of Shiraz hospitals (23 hospitals) between 2016 and 2017, Shiraz, Iran. The localized MSOBs was sent as a guideline to the hospitals. The mean number of blood requests, blood utilization, cross matches, cross match to transfusion ratio, and cross match expenses before and after implementing of MSBOS were compared with paired t test by SPSS-21 software.
 

The cross match to transfusion ratio was decreased after implementing MSOBS (2.36 to 1.6) (p < 0.001). In addition, the mean numbers of blood usage and cross matches were also decreased after implementing of MSBOS (13.2%, 42.9%). The cost of  preparing blood and cross matches also decreased (7.67%, 43%).
 

Implementation of MSBOS created a significant reduction in transfusion ordering and providing blood in emergencies. Updating of physician’s knowledge, the revision of MSOBS according to blood usage in the hospitals must be performed for optimal blood management.

Depression is the most common psychiatric disorder associated with hepatitis C..
This study aimed to survey the prevalence rate of depression in patients with Hepatitis C Virus (HCV) before they were aware of their HCV test result..
This cross-sectional study was conducted on all blood donors with confirmed positive HCV test results who donated blood between March 21, 2012 to March 21, 2013 at Fars blood transfusion center in Iran as case group and age- and sex-matched blood donors with negative screening test results as control group. A semi-structured interview based on DSM IV-TR depressive disorder criteria and Beck depression inventory (BDI) was conducted. BDI contained 21 items, each scored from 0 to 3 and total score of 0 to 63 for the whole scale computed by summing up all the items. A cut-off score of ≥ 19 indicated clinically significant depressive symptoms. The prevalence rate and risk factors of depression were determined..
The most frequent risk factors for HCV infection were intravenous drug abuse (59.3%), unsafe sexual contact (30.5%), and history of being imprisoned (25.4%). The prevalence rate of depression in the HCV group was 55.9 % (95% CI: 42.99% - 68.87%) that was significantly higher than the corresponding rate of the control group as 17.7 % ( 95% CI: 8.49% - 28.79%) (P Our study underlined the remarkable prevalence of depression among HCV patients. Therefore, designing depression screening tests is suggested to help such patients before starting the treatment..

ackground: Knowing the human platelet antigens (HPA) and genes frequency in different populations is important not only for population studies but also for clinical transfusion practice. HPA genes frequency in Iran is not evaluated, so we investigated the HPA-2, HPA-3, and HPA-5 frequency and their polymorphism. DNA from 120 Iranians (99 Iranian blood donors and 21 patients with platelet refractoriness) was isolated from peripheral blood mononuclear leucocytes and tested by restricted fragment length polymorphism analysis (RFLP). The frequency of HPA phenotypes was determined as follows: (in donors) HPA-2a/2a:75.4%, HPA-2a/2b:24.8%, HPA-3a/3a:8.1%, HPA-3a/3b:70.7%, HPA-3b/3b:21.2%, HPA-5a/5a:99 % and HPA-5a/5b:1%; (in patients) HPA-2a/2a:66.7%, HPA-2a/2b:33.3%, HPA-3a/3a:23.8%, HPA-3a/3b: 47.6%, HPA-3b/3b:28.6%, HPA-5a/5a:90.5%, and HPA-5a/5b: 9.5%. Frequency of genotypes evaluated by RFLP were as below: HPA-2a=0.87, HPA-2b=0.13, HPA-3a =0.28, HPA-3b=0.72, HPA-5a=0.99, and HPA-5b=0.01 in both donors and patients. HPA gene frequencies observed in Iranians were in the range obtained in previous studies but not exactly equal to other populations. It might be due to their relations with other populations. There was not any significant difference between two groups in this study.

Background and ObjectivesEvaluation of the prevalence trend of blood transfusion-transmitted infections is essential in monitoring blood supply safety, determining effectiveness of donor screening, and estimating residual risk of blood transfusion-transmitted infections. Materials and MethodsIn this cross-sectional survey, data from blood donors who referred to Shiraz Blood Transfusion Center from 2000 till the end of 2005 were collected. Then, we reviewed the number of HBs cases detected by ELISA test, HIV by Western Blot test, and HCV by ELISA. Then, the demographic status, the incidence of hepatitis B, hepatitis C, and HIV in the population of blood donors during these years were evaluated.ResultsDuring 2000 to 2005, 507531 donors embarked on blood donation in Fars Blood Transfusion Center. The prevalence rate of HIV between 1381 to 1385 were 0.019%, 0.008%, 0.007%, and 0.009%, the prevalence rate of HBs 0.57%, 0.52%, 0.53%, and 0.53%, and prevalence of HCV 0.19%, 0.13%, 0.09%, and 0.16% respectively. The prevalence rate of HIV grew in 2000 (p<0.05); it then decreased and stayed stable afterwards. The prevalence rate of HCV had no significant change over time. The prevalence rate of HBs was lower in 2005 (p<0.05). The prevalence rates of HBs, HCV, and HIV were higher among first-time, male, and married blood donors (p<0.05). The prevalence rates of HBs, HCV, and HIV infection were not significantly correlated with age of blood donors(p>0.05).ConclusionsIf we notice the prevalence rate of transfusion transmitted viral infections in blood donors, we understand that the incidence rate of this infection in Shiraz blood donors is less than its rate among normal population and does not change over time; it may be attributed to effective donor screening procedures and the low prevalence rate of transfusion transmitted viral infections in donor population. If we compare the prevalence rate of transfusion transmitted viral infections in our blood donors with that of the other countries, we understand that the prevalence rate of transfusion transmitted viral infections in our country is low. It shows the safety of our blood supply.