A novel scoring system for early prediction of massive transfusion requirement in trauma patients

Early resuscitation using blood products is critical for patients with severe hemorrhagic shock. We aimed to develop and validate a new scoring system, hemorrhagic shock transfusion prediction (HSTP) score, to predict the need for massive transfusion (MT) in these patients, compared to the widely used Assessment of Blood Consumption (ABC) score. Trauma patients admitted to Emtiaz Hospital in Iran from 2017 to 2021 were retrospectively included. Patients assigned a code 1 or 2 according to the Emergency severity index (ESI) triage system have been divided into MT and non-MT groups. MT was defined as receiving ≥ 10 units of packed cells (PCs) in 24 h. Demographic information, admission vital signs, and lab results available within 15 min were compared between the groups. A new predictive score was developed using logistic regression of statistically significant parameters. Out of 1029 patients, 651 (63.3%) required MT. An arrival, diastolic blood pressure < 79.5 mm Hg, absolute lymphocyte count > 1850/μL, base excess < - 4.25, and blood glucose > 156 mg/dL were independent predictors included in the HSTP score. The sensitivity and specificity were 74.36% and 53.87% for the HSTP score, compared to 31.03% and 76.16% for the ABC score. Moreover, the positive and negative predictive values were 77.88% and 49.03% for the HSTP score, versus 74.15% and 33.66% for ABC. The new scoring system demonstrated higher sensitivity and improved positive and negative predictive values compared to the ABC score. This score can assist physicians in making accurate transfusion decisions quickly, but further prospective studies are warranted to validate its clinical utility.

Does red blood cell transfusion affect clinical outcomes in critically ill patients? A report from a large teaching hospital in south Iran

BACKGROUND

Despite the beneficial effects, RBC transfusion can be associated with infectious and non-infectious complications in critically ill patients.

OBJECTIVES

Investigate current RBC transfusion practices and their effect on the clinical outcomes of patients in intensive care units (ICUs).

DESIGN

Retrospective observational study.

SETTING

Three mixed medical-surgical adult ICUs of a large academic tertiary hospital.

PATIENTS AND METHODS

From March 2018 to February 2020, all adult patients admitted to medical or surgical ICU. Patients who received one or more RBC transfusions during the first month of ICU admission were included in the "transfusion" group, while the remaining patients were assigned to the "non-transfusion" group.

MAIN OUTCOME MEASURES

Mortality and length of ICU and hospital stay.

SAMPLE SIZE

2159 patients.

RESULTS

Of 594 patients who recieved transfusions, 27% of patients received red blood cell (RBC) products. The mean pre-transfusion hemoglobin (Hb) level was 8.05 (1.46) g/dL. There was a significant relationship between higher APACHE II scores and ICU mortality in patients with Hb levels of 7-9 g/dL (OR adjusted=1.05). Also, ICU mortality was associated with age (OR adjusted=1.03), APACHE II score (OR adjusted=1.08), and RBC transfusion (OR adjusted=2.01) in those whose Hb levels were >9 (g/dl).

CONCLUSION

RBC transfusion was associated with an approximately doubled risk of ICU mortality in patients with Hb>9 g/dL. High APACHE II score and age increase the chance of death in the ICU by 8% and 3%, respectively. Hence, ICU physicians should consider a lower Hb threshold for RBC transfusion, and efforts must be made to optimize RBC transfusion practices.

LIMITATIONS

Single-center and retrospective study.

Senescent CD153+ T Lymphocytes Increase in the Peripheral Blood of Patients with Thromboangiitis Obliterans

Background

Buerger's disease, also known as Thromboangiitis Obliterans (TAO), is a progressive, inflammatory vascular disease with unknown etiology.

Objective

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.

Methods

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.

Results

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).

Conclusion

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.

Forecasting blood demand for different blood groups in Shiraz using auto regressive integrated moving average (ARIMA) and artificial neural network (ANN) and a hybrid approaches

Providing fresh blood to keep people in need of blood alive, has always been a main issues of health systems. Right policy-making in this area requires accurate forecasting of blood demand. The current study aimed at predicting demand for different blood groups in Shiraz using Auto Regressive Integrated Moving Average (ARIMA), Artificial Neural Network (ANN) and a hybrid approaches. In the current time series analysis, monthly data of the Shiraz hospitals and medical centers demand for 8 blood groups during 2012-2019 were gathered from Shiraz branch of Iranian Blood Transfusion Organization. ARIMA, ANN and a hybrid model of them was used for prediction. To validate and comprise ARIMA and ANN models, Mean Square Error (MSE) and Mean Absolute Error (MAE) criteria were used. Finally, ARIMA, ANN and hybrid model estimates were compared to actual data for the last 12 months. R3.6.3 were used for statistical analysis. Based on the MSE and MAE of models, ARIMA had the best prediction for demand of all blood groups except O+ and O-. Moreover, for most blood groups, ARIMA had closer prediction to actual data. The demand for four blood groups (mostly negative groups) was increasing and the demand for other four blood groups (mostly positive ones) was decreasing. All three approaches including ARIMA, ANN and the hybrid of them predicted an almost downward trend for the total blood demand. Differences in the performance of various models could be due to the reasons such as different forecast horizons, daily/month/annual data, different sample sizes, types of demand variables and the transformation applied on them, and finally different blood demand behaviors in communities. Advances in surgical techniques, fetal screening, reduction of accidents leading to heavy bleeding, and the modified pattern of blood request for surgeries appeared to have been effective in reducing the demand trend in the current study. However, a longer time period would certainly provide more accurate estimates.

Red Blood Cell Alloimmunization Rates and Related Factors of Patients with Thalassemia in Shiraz, Iran

OBJECTIVE

The development of antibodies against red blood cell (RBC) antigens is one of the most significant adverse effects of chronic blood transfusions. This study aimed to estimate the frequency and causes of RBC immunization in patients with major thalassemia.

METHODS

The findings could help determine the limitation of current practices and help future developments in the selection of suitable blood units for the transfusion support of patients with thalassemia.

RESULTS

The alloimmunization rate was detected in 52 of 650 patients with major thalassemia (8%). The most frequent antibodies were against K (50%), D (26%), and E (15.4%). Sex, age, and splenectomy did not have any impact on the immunization rate. Immunization was lower in patients who had received only leuko-reduced blood units.

CONCLUSION

It is recommended that antibody screening before the first transfusion and extended RBC matching particularly for the most frequent antigens (ABO/Rh/Kell) should be performed for patients with thalassemia.

Prevalence of HBV and HCV Infections in Iranian Blood Donors; An Updated Systematic Review and Meta-Analysis

BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSION 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.

Seroprevalence and Trend of HBV, HCV, and HIV Infections among Blood Donors of Fars Province, Iran (2006-2018)

Background

Blood transfusion is a life-saving procedure; millions of lives are saved each year. However, blood transfusions are associated with certain risks that can lead to adverse consequences. This study aimed to survey the prevalence and trend of hepatitis B virus (HBV), hepatitis C virus (HCV), and Human immunodeficiency virus (HIV) among blood donors of Fars province, Iran (2006–2018).

Methods

This retrospective cross-sectional study was conducted by reviewing the records of the blood transfusion organization of Fars province. A total of 1952478 blood units were screened for transfusion-transmitted infections (TTIs). Then, data were entered into SPSS software (Negare. version 25). Chi-square test was used to compare the sof TTIs among blood donors. Chisquare test for trend was used to analyze the variations in trends of TTIs during this period. Finally, p-values less than 0.05 were considered statistically significant. GraphPad Prism software was used for the depiction of the graphs.

Results

Among the 1952478 blood donations within the 13-years, 4479(0.229 %) of donors were HBsAg, HCV Ab, and HIV Ag-Ab positive. The seroprevalence of HBV, HCV, and HIV was 2684(0.137%), 1703(0.087 %), and 92(0.0047%), respectively.

Conclusion

The current study showed that the overall prevalence of TTIs among blood donors was low and had a descending trend over the years of study.

Blood Transfusion Practice in Operating Rooms in Nemazee Hospital in Southern Iran

BACKGROUND

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.

METHODS

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).

RESULTS

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.

CONCLUSION

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.

Reasons of under-representation of Iranian women in blood donation

The under-representation of women in blood donation can lead to blood shortages. We aimed to determine the factors, which encourage or impede blood donations in women. The findings can help us in designing effective recruitment strategies that could encourage women to donate blood to cover the patients’ needs. This cross-sectional study was conducted in Shiraz, Iran, from the 1st of January 2017 to the 1st of August 2017 on women aged 18–60 years old. The demographic characteristics of the participants, the reasons that motivate blood donors and the factors that discourage non-donors were surveyed. Reasons for lapses in donors were also mentioned. The most frequent reasons for blood donation were altruistic causes (94.4%), moral and personal obligations (89.1%), the feeling of responsibility (82.7%), and awareness of the positive effects on their health (77.4%). The most common deterrents in non-donors were fear of developing anemia (68.4%) or weakness and dizziness (66%), unsuitability due to certain medical conditions (62.4%), and lack of a situation in which they were asked to donate blood (61.8%). Although altruistic reasons are the chief motivating factors for women to donate blood, the overall female contribution in blood donation remains low. Therefore, it is necessary to take measures aiming at informing women about the importance of blood donation and to reduce fears based on misinformation. Confidence in the blood donation organization must be a major consideration in future recruitment strategies to reassure women about the safety of blood donation.

Return rate in blood donors: A 7-year follow up

OBJECTIVE

Determining the current return rates of blood donors and their related factors.

BACKGROUND

Understanding the current pattern of blood donors' return rates and also their motivations will be beneficial when there is a need to implement measures to encourage new blood donors and retain existing ones.

METHODS

This cross-sectional study was conducted on 4200 blood donors in Shiraz, Iran, from 26 November 2010 to 26 December 2010. Blood donors' return rate and its related factors were investigated in a 7-year follow up.

RESULTS

The overall return rates of blood donors indicated a significant yearly decline of 51.2%, 45.1%, 37.6%, 38.8%, 28.7%, 22.7% and 22.1% over a 7-year follow up. The return rates for first-time donors declined annually by 30%, 25%, 21%, 18.5%, 15.2%,12.3% and 11.8% (P ≤ .05). Return rates were higher among male, older, low-educated, Rh-negative and regular donors. Blood donations for altruistic reasons and religious reasons were higher in regular and older donors (P < .001); donation for positive effects on their health and free access to screening tests and curiosity was higher in first-time donors and females (P < .001). The most frequent deterrents were lack of time (42.7%), unsuitable condition (37.6%) and difficult access to donation sites (26.2%).

CONCLUSION

Designing new strategies to retain donors, advertisement, appreciation methods and providing convenient conditions for donation are needed to increase the return rates, particularly in young, highly educated, female and first-time donors.

Polyomaviruses BK and JC DNA infection in peripheral blood cells from blood donors

Objectives

To investigate the prevalence of human polyomavirus (BK and JC viruses) infection in peripheral blood mononuclear cells of healthy blood donors.

Methods

The study included 250 healthy blood donors. Five-milliliter blood was drawn into sterile EDTA tubes and PBMCs were isolated from whole blood. The isolated PBMCs were counted and stored at −70 °C for future investigation. DNA was extracted and subjected to simple, sensitive and specific semi-nested PCR as well as QPCR using both general and specific primers for different assays.

Results

Of 250 blood samples, 66 (26.4%) were positive for BKV DNA (146–34,514 copies/10⁶ cells). JC DNA was found in 45 (18%) blood samples (65–21,250 copies/10⁶ cells). Co-infection with these viruses were found in 11 (4.4%) out of 250 blood samples.

Discussion

Our study provides important data on polyomavirus infection in peripheral blood mononuclear leukocytes in immunocompetent individuals. These data indicate significant differences between the prevalence of BKV and JCV infection in healthy blood donors. The prevalence of BK and JC virus infection is higher in the age range 30–39 years compared to other age ranges.

Blood Product Transfusion in Liver Transplantation and its Impact on Short-term Survival

BACKGROUND

Estimation of the amount of blood products required during liver transplantation can help provision of adequate blood supply, minimize transfusion-associated complications, and plan for preventive measures in high risk patients.

OBJECTIVE

To investigate independent predictors of peri-operative blood product transfusion and its impact on short-term survival of liver transplant recipients.

METHODS

In a cross-sectional study, old charts of patients who underwent liver transplantation between March 2003 and March 2013 at Namazi Hospital, Shiraz, Iran, were reviewed. The mean amount of blood product utilized during surgery and hospital stay and the related factors, including demographic characteristics, pre-transplant laboratory data, pre-transplant clinical data, operation data, and post-transplantation data were recorded.

RESULTS

We studied 1198 patients who underwent liver transplantation. The mean±SD amounts of red blood cells, fresh frozen plasma, and platelet transfusion during surgery and hospital stay were 2.67±3.5, 2.06±3.8, and 1.6±3.8 units, respectively. The mortality rate was significantly higher in patients who received high amounts of blood products (p<0.001). The mean amount of blood products' utilized during operation was significantly (p<0.001) decreased from 2003 to 2013.The mean amount of packed cell usage during operation and hospital stay was significantly (p<0.001) correlated with age, technique of surgery, serum albumin level, cirrhosis, blood urea nitrogen, length of operation, and prothrombin time.

CONCLUSION

Pre-operative factors may predict blood transfusion requirements in patients undergoing liver transplantation. Therefore, evaluation of patients before operation should be considered to provide adequate blood supply and minimize transfusion-associated complications. Understanding pre-operative factors associated with rate of transfusion may help us to best utilize the limited available blood resources.

A Survey on the Prevalence of Depression in Blood Donors with Hepatitis C in Shiraz

BACKGROUND

Depression is the most common psychiatric disorder associated with hepatitis C.

OBJECTIVES

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.

METHODS

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.

RESULTS

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 < 0.001). The severity of depression was also more in the HCV group (P < 0.001). Besides, the prevalence rate of depression was higher among HCV patients with lower education level, previous history of drug abuse, unsafe sexual contact, and previous history of psychiatric diseases. The prevalence rate of depression was higher in the case group even after adjusting for other variables.

CONCLUSIONS

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.

A study on confidential unit exclusion at Shiraz Blood Transfusion Center, Iran

Background:

Confidential unit exclusion (CUE) system has been designed to enhance transfusion safety as an extra additive approach.

Aims:

This study was designed to survey demographic characteristics, prevalence of serologic markers, and reasons of opting CUE.

Materials and Methods:

The cross-sectional study was performed at Shiraz Blood Transfusion Center (Southern Iran). CUE is used for all individuals who refer for blood donation, and donors can choose their blood not to be used if they have any doubt about their blood suitability for transfusion. The prevalence rate of HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) was compared between the blood donors who opted into and out of CUE. Then, the donors were contacted to give another blood sample and the reasons of deferral. Researchers also determined whether their reasons were logical or not. Data were analyzed using comparison of proportions in MedCalc software 7.

Results:

Out of all the donors, 2365 ones (2.3%) opted for CUE. CUE was more frequent among men, singles, donors with low education levels, between 18 and 25 years old, and with history of previous donation (P < 0.05). The prevalence rate of HCV was higher among the donors who opted for CUE (P < 0.05), but it was not the case regarding HBV and HIV (P>0.05). Furthermore, 91.5% of the donors had opted for CUE by mistake and only 8% had chosen CUE logically.

Conclusion:

It is necessary to review the process of CUE, make some changes both in procedure and design, and then survey its effectiveness in blood safety.

The Incidence Rate of Acute Transfusion Reactions in Thalassemia Patients Referred to the Shiraz Thalassemia Centre, Shiraz, Iran, Before and After the Establishment of the Hemovigilance System

This study aimed to investigate the incidence rate of acute transfusion reactions in thalassemia patients before and after the establishment of the hemovigilance system. This prospective descriptive study was conducted at the Dastgheyb Hospital, Shiraz, Iran, from 2009 to 2012. The incidence rate, type, imputability and severity of acute transfusion reactions were compared in thalassemia patients before and after the establishment of the hemovigilance system. A total of 741 thalassemia patients were referred to the Dastgheyb Hospital for transfusions during the study period. The incidence rates of acute transfusion reactions were reported as 0.06% (11 out of 16,214), 0.11% (23 out of 19,660), 0.10% (28 out of 26,129) and 0.2% (50 out of 24,121), respectively, from 2009 to 2012. The most frequent were major allergic reactions and febrile non hemolytic transfusion reactions (FNHTR). The transfusion reactions were increasingly reported after the establishment of the hemovigilance system in 2011 (p < 0.05). The establishment of the hemovigilance system can improve reporting of transfusion reactions. Moreover, evaluation of the incidence rate of transfusion reactions is necessary to design preventive measures to reduce transfusion risks.

Rates and reasons for blood donor deferral, Shiraz, Iran. A retrospective study

CONTEXT AND OBJECTIVE

Knowledge of the reasons for donor deferral can help in planning more efficient recruitment strategies and evaluating donor selection criteria. This study aimed to investigate the rates and reasons for donor deferral.

DESIGN AND SETTING

Retrospective study at Shiraz Blood Transfusion Center, Shiraz, Iran.

METHODS

141,820 volunteers were interviewed confidentially by physicians before blood donation. The rate of and reasons for donor deferral were investigated according to demographic characteristics. The data were analyzed using the comparison-of-proportions test of the MedCalc statistical software.

RESULTS

43,839 people (30.9%) who had come for blood donation were deferred, 1,973 (4.5%) of them permanently. The deferral rate was significantly higher among women, single individuals and first-time donors, compared with men, married individuals and those with a history of previous donation (P < 0.0001). The deferral rate was significantly higher in the 17 to 30-year-old group (P < 0.05). The reasons for deferral were divided into five categories: risk factors possibly related to HIV or hepatitis (43.6%), underlying diseases (31.9%), non-eligible conditions (13.5%), medications that interfere with blood donation (7.8%) and risk factors that may relate to bacterial or viral infections except HIV and hepatitis infections (3.2%).

CONCLUSION

Effective measures are required for documenting the impact of deferral on blood availability, monitoring the effectiveness of and need for deferral, and determining the reasons and rates of deferral.

A survey of resident physicians' knowledge concerning transfusion medicine in Shiraz, Iran

OBJECTIVE

The knowledge of physicians concerning blood transfusion has a significant impact on the optimal use of blood and blood products. The aim was to survey their knowledge regarding this area and identify whether additional training is required.

MATERIAL AND METHODS

This cross-sectional study was conducted on all 1(st) year resident physicians at Shiraz University of Medical Sciences, Iran in 2011. The questionnaire solicited information on demographic variables, knowledge regarding transfusion medicine, education and experience regarding blood transfusion.

RESULTS

The mean total knowledge score regarding transfusion medicine was 15.44 ± 3.3 (7-25) out of 29. Only about one-fourth (27.4%) replied correctly to over 60% of questions. The mean score of knowledge was higher among residents who stated that they received special training regarding blood transfusion in their medical courses (P < 0.01). Seventy-five percent of residents believed that they had received insufficient education and 97.8% believed that they need additional training.

CONCLUSION

The results reflect the uncertainties among resident physicians regarding blood transfusion. It has been suggested that a special transfusion medicine educational program should be added to the medical education curriculum.

Seroprevalence and molecular diagnosis of Toxoplasma gondii infection among blood donors in southern Iran

INTRODUCTION

Toxoplasma gondii is a protozoan parasite which can be transmitted to human through a variety of routes including blood transfusion. This cross sectional study aimed to evaluate the seroprevalence of Toxoplasma infection and related epidemiological features among healthy blood donors.

METHODOLOGY

A total of 1,480 healthy blood donors from five blood service centers in Fars province were analyzed for anti-Toxoplasma antibodies. Blood samples were tested for anti-T. gondii IgG and IgM antibodies by enzyme immunoassay. IgM-positive samples were also tested for the presence of Toxoplasma DNA by Polymerase Chain Reaction (PCR). Demographic characteristics of participants were also recorded during samples collection.

RESULTS

Anti T. gondii antibodies were detected in sera of 286 out of 1,480 blood donors corresponding to an overall seroprevalence of 19.3% in this population.  From these, 182 (12.3%) were seropositive only for IgG, 81 (5.47%) were seropositive only for IgM and 23 (1.6%) were positive for both IgG and IgM. PCR detected active parasitemia in two (1.9%) of the IgM-positive subjects. Age, place of residence and level of education were statistically significant (p < 0.05) with seropositivity to Toxoplasma.

CONCLUSIONS

Our results highlighted that asymptomatic blood donors, especially those with active parasitemia, may constitute a significant risk of transmitting toxoplasmosis to susceptible recipients.

Seroprevalence of Leishmania infection among the healthy blood donors in kala-azar endemic areas of Iran

Visceral leishmaniasis (VL) is a serious health problem in Iran. The disease is mainly transmitted by sand fly bites, but its transmission through transfusion in endemic areas may also occur. The current study aimed to determine the prevalence of Leishmania infection among blood donors in VL-endemic areas in south of Iran. A total of 2003 healthy blood donors from blood service centers in five VL-endemic districts in Fars province, southern Iran, were enrolled in the study. The blood samples were assessed for antibodies against Leishmania infantum by direct agglutination test (DAT). Seropositive subjects were tested for the presence of L. infantum DNA in their buffy coat by the molecular method. Socio-demographic features of the subjects were also documented during sample collecting. The mean age of participants was 36.3 (SD = 10.7 years). Male constituted 94.7 % of the subjects while only 5.3 % of donors were female. Twenty-eight blood donors (1.4 %) were positive for Leishmania infection by DAT. Only one of these seropositive donors was positive for Leishmania infection by polymerase chain reaction. A significant correlation was found between age, the place of residence and seropositivity to Leishmania (P < 0.05). Findings of this study revealed that the prevalence of Leishmania infection among blood donors in transfusion centers in the VL-endemic areas in Iran is relatively high. These asymptomatic blood donors may constitute a risk of transmitting of VL to susceptible recipients.

Positivity of HIV, hepatitis B and hepatitis C in patients enrolled in a confidential self-exclusion system of blood donation: a cross-sectional analytical study

CONTEXT AND OBJECTIVE

Selection of healthy blood donors is essential to ensure blood safety. A confidential self-exclusion (CSE) system was designed so that high-risk donors could confidentially exclude their blood from use in transfusions. This study aimed to compare the demographic characteristics and the results from human immunodeficiency virus (HIV), hepatitis B surface (HBS) and hepatitis C virus (HCV) screening tests on donors who opted to get into and out of CSE.

DESIGN AND SETTING

Analytical cross-sectional study on all volunteer donors at Shiraz Blood Transfusion Organization from March 21, 2006, to March 21, 2008.

METHODS

The results from the abovementioned tests were compared between donors who opted into and out of CSE.

RESULTS

100,148 donors in 2006 and 104,271 in 2007 gave blood. Among these donors, respectively, 829 (0.82%) and 592 (0.57%) opted for the CSE. The prevalence of HIV antibodies, HBS antigens and HCV antibodies in CSE donors was significantly higher than in donors who did not choose CSE (p < 0.05). The prevalence of at least one of these three infections among CSE donors was 3.12% in 2006 and 3.04% in 2007, and was significantly higher than the prevalence among non-CSE donors (0.58% and 0.57%, respectively).

CONCLUSION

Because of the higher prevalence of HBS, HCV and HIV positivity in blood donors who chose the CSE option, offering CSE to blood donors could be a potentially useful method for improving blood safety, since it could increase the detection of infected blood during the window period.

Causes of discontinuity of blood donation among donors in Shiraz, Iran: cross-sectional study

CONTEXT AND OBJECTIVE

the adequacy of blood depends on blood donation rates and numbers of blood donors. To prepare adequate blood supplies, it is essential to investigate the barriers and factors that stop individuals from donating. This study aimed to identify the causes of lapsed donation at our center.

DESIGN AND SETTING

cross-sectional study of volunteer blood donors in Shiraz, Iran.

METHODS

we selected 850 donors who had donated between January 1, 2005 and June 1, 2005, but had not donated again by June 2008. The participants were recruited by letter and telephone, and were interviewed using a specially designed questionnaire that contained items on demographic characteristics, donor motivations and reasons for not returning to donate. We used the chi-square test to identify associations between lapsed donor characteristics and reasons for declining to donate.

RESULTS

the greatest motivation for donation was altruism. The most frequent reasons for lapsed donation were lack of time because of work and self-exclusion for medical reasons. Among first-time donors, the most frequent reasons were unsuitability for donation and lack of time.

CONCLUSIONS

the reasons for not returning to donate are varied and may correlate with demographic characteristics. In this study, the main reason for not returning was lack of time. Changing donation hours so that donors can donate after work, providing mobile teams at workplaces, and shortening the duration of the donation process may help increase repeat donation rates.