The Effect of Pre-Storage Irradiation Blood on Quality of Red Blood Cells.

Background: Irradiation leads to increased storage lesions that may have harmful effects if transfused. Various storage lesions research has been carried out, and only very few articles are available on the impact of gamma irradiation on RBC storage lesions. Since there has been no study about finding the best time for irradiation, we decided to investigate the effect of irradiation on Red blood cells at different storage times after blood collection Materials and Methods: A total of 40 units of red blood cells divided into two groups, irradiated and non-irradiated. Irradiated RBCs were divided into three groups and each group containing ten units. The remaining ten units were considered as non-irradiated controls. Sampling from these irradiated and non-irradiated blood units was performed weekly to evaluate biochemical parameters and free plasma hemoglobin/Hemolysis index levels. Results: A significant increase in the mean values of plasma potassium, plasma Hb/Hemolysis index, and LDH, as well as a significant reduction in the mean value of 2,3 DPG and plasma sodium, were observed in both groups. Although the reduction of 2,3 DPG is extremely remarkable, it is compensated 24-48 hours after transfusion. Hence, the clinical result of 2,3-DPG-depleted RBC transfusion is known to be negligible. The irradiation group alteration was more notable than the non-irradiated one and the changes in the parameters were most significant in the group having been stored for a longer period after irradiation. Conclusion: Our investigation on the impact of gamma irradiation on RBCs makes it possible to suggest a storage time up to 28 days after irradiation is permissible and the best time for irradiation after blood collection is up to 14 days. It is pointed out that the blood unit should be transfused as soon as possible after the irradiation.

Blood supply sufficiency and safety management in Iran during the COVID-19 outbreak.

BACKGROUND: COVID-19 first appeared in Iran on 19 February 2020, and then spread rapidly over the country. In this article, we review the action plan of the Iranian Blood Transfusion Organization with respect to this disease. METHOD AND MATERIALS: We collected data on blood donations and RBC inventory for the first 8 weeks of the outbreak. We also evaluated the trend of blood donations and RBC inventory and compared them with the data of the past year. We include a summary of actions taken by the National Committee on Management of COVID-19 outbreak. RESULTS: Blood donations decreased from 33 275 to 23 465 units during the first 2 weeks of the outbreak with a corresponding decrease in the RBC inventory. But after that, donations gradually increased from 23 465 to 29 665 units. RBC inventory levels improved at the same time. Then, the Iranian New Year's holiday resulted in another downward trend. After the holiday, blood donations revived, along with the RBC inventory. DISCUSSION: Although it appears that this virus cannot be transmitted through transfusion, changes in lifestyle had a significant impact on reducing blood supply. Following implemented measures, we saw an upward trend in blood donations and an adequate supply of RBC units in blood centres, helped by a reduction in demand by hospitals. Blood centres need to be more prepared to manage future viral disasters, especially in case of transfusion-transmissible infections.

Trends and epidemiological analysis of hepatitis B virus, hepatitis C virus, human immunodeficiency virus, and human T-cell lymphotropic virus among Iranian blood donors: strategies for improving blood safety.

BACKGROUND: Blood transfusion is associated with potential risks of transfusion-transmitted infections (TTIs). Different strategies are needed to monitor blood safety and screen the donors' efficacy, such as evaluation of the prevalence and trends of TTIs. This study was conducted to evaluate the prevalence and trends of TTIs, including hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), and human T-cell lymphotropic virus (HTLV 1/2), and the impact of the donors' characteristics such as age, sex, and donor status on the prevalence of TTIs in blood donors in seven large provinces of Iran from 2010 to 2018. METHODS: This study was conducted on the data collected from all blood donations in seven Iranian Blood Transfusion Centers including Ardabil, Alborz, Guilan, West Azarbaijan, North, Razavi, and South Khorasan from April 2010 to March 2018. Demographic characteristics, number of donations, donor status, and screening and confirmatory serological results of all blood donations were collected from Iranian Blood Transfusion Organizations (IBTO) national database. The prevalence and trend of HBV, HCV, HIV, and HTLV 1/2 infections were reported according to the donation year and donor's characteristics. RESULTS: The analysis of the prevalence and trend of TTIs in 3,622,860 blood donors showed a significant decreasing trend in first-time and regular donors. Additionally, compared to first- time donors, regular donors made safer blood donations with lower risks of HBV, HIV, HCV and HTLV 1/2 (P < 0.0001). Although the prevalence of HTLV 1/2 and HBV was higher in females, TTIs had a significant decreasing trend in males and females. Finally, it was found that the prevalence of HBV and HTLV 1/2 increased with age up to 40-49 years and then decreased thereafter. CONCLUSIONS: The decreasing trends of TTIs in Iranian donors during 9 years may indicate that the various strategies implemented by IBTO have been effective in recent years. Other factors such as a decrease in the prevalence of specific TTIs in the general population might have also contributed to these declines.

LY86, LRG1 and PDE9A genes overexpression in umbilical cord blood hematopoietic stem progenitor cells by acute myeloid leukemia (M3) microvesicles.

BACKGROUND: Microvesicles as a new device of cell-cell communication are potentially able to induce some phenotypes and genotypes of an origin cell in a target cell. We evaluate the role of leukemia microvesicles on the leukemia stem cells (LSCs)-specific genes expression in healthy hematopoietic stem progenitor cells (HSPCs). METHODS: HL-60 and NB-4 cell lines were selected for microvesicles isolation by ultracentrifugation. Healthy HSPCs were obtained by magnetic association cell sorting (MACS) and CD-34 micro-beads from umbilical cord blood samples and then, were treated with 20 and 40 µg/ml leukemia microvesicles for 10 days, respectively. LY86, LRG1 and PDE9A genes expression as LSC specific genes were analyzed by QRT-PCR. Surface CD-34 antigen as stemness marker was measured by flow cytometry technique. RESULTS: Healthy HSPCs showed a significant increase in LSC specific genes expression after treatment with both 20 and 40 µg/ml leukemia microvesicles at day 10. All studied groups showed more than 70% surface CD-34 antigen at the last day of experiment which proved HSPCs stemness. CONCLUSION: Our results suggest that healthy HSPCs can be transformed genetically by leukemia microvesicles to over express LSC specific genes. This may be further evidence of leukemia-like transformation by leukemia microvesicles.

Hepatitis C (HCV) Viremic Rate and its Correlation to Demographic Factors among HCV Confirmed Iranian Blood Donors.

BACKGROUND: Hepatitis C virus (HCV) viremia is described as persistent HCV RNA among HCV exposed individuals. HCV viremic rate is defined as the proportion of anti-HCV positive and HCV RNA positive individuals to total anti-HCV positive individuals. Knowledge about HCV viremic rate increases understanding HCV epidemiology and provides the likelihood of HCV viremia infection in a given population. The aim of this study was to evaluate HCV viremic rate and demographic parameter correlations among HCV confirmed Iranian blood donors. METHODS: In this analytical, cross-sectional study, serologically confirmed HCV positive blood donors, who were referred to the Iranian blood transfusion centers around the country from November 2015 to September 2017, were included. HCV RNA RT-PCR was carried out by an in-house qualitative assay. Penalized logistic regression was performed for data analysis. STATA software version 13 was used for statistical analysis. RESULTS: Out of 239 subjects, HCV RNA was amplified in 161 (67.36%, 95% CI 61.21% -73.51%). No statistical associations were found between age, gender, education and marriage status with HCV viremic rate. First time donation was found to be associated with HCV viremia status (adjusted odds ratio [AOR]: 3.26; 95% CI 1.07-9.87). CONCLUSION: The results of this study show the likelihood of active HCV infection occurrence among HCV confirmed Iranian blood donors, as the majority are in the active phase of HCV infection. The viremic rate was associated with first time donation. More effective donor selection process and paying special attention to maintenance of non-infected first time donors as a resource of regular donations are needed to improve blood safety. Follow-up studies on viremic first time blood donors are recommended to clarify impact of factors on the occurrence of HCV viremia.

Analysis of hospital blood components wastage in Iran (2005-2015).

BACK GROUND: Although blood components are precious resources, their wastage is still a problem in hospitals all over the world. As no comprehensive study has evaluated hospital wastage in Iran, the main aim of the study was to identify the wastage as a percentage of issue during 2005-2015 and the secondary objective was to focus on the reasons of the blood components wastage. STUDY DESIGNS AND METHODS: Wastage as a percentage of issues was calculated for red blood cells, plasma and platelet concentrate separately. Also, for each product, the percentage of wastage was calculated as the number of units wasted for each reason divided by the total number of units wasted. RESULTS: The wastage rate of red blood cells, plasma and platelet concentrate was 5.7 ± 0.7, 1.4 ± 0.4, and 3.2 ± 0.5, respectively. The main cause of red blood cells, plasma, and platelet concentrate wastage was date expiry and reserved/returned units of operating room and or ward. In 2015 compared to 2005, despite a significant decrease (p value<0.0001) in red blood cells and plasma expired units, there was a remarkable increase in expired PC units (p value<0.0001). In contrast to expired units, there was a significant increase (p value<0.0001) in reserved/returned units of operating room and or ward for red blood cells and plasma. CONCLUSION: Time expiry and reserved/returned from operating room were the most important reasons of blood component wastage. The percentage of wastage could be decreased by implementing MSBOS program and designing a software application for efficient management of reserved hospital inventories.

Association of HCV genotype with viral load among Iranian blood donors: a penalized logistic regression.

Background: Hepatitis C virus (HCV) is a blood born virus and the leading cause of advanced hepatitis disease. HCV genotype 3a is predominant among Iranian blood donors. The aim of this study was to evaluate the relationship between HCV genotype and HCV viral load. Methods: In this analytical cross-sectional study 106 anti-HCV positive and HCV RNA positive blood donors referred to Iranian blood centers across the county were entered. HCV viral loads were determined by an in-house one step Taq Man Real-Time RT-PCR assay. Penalized logistic regression was performed for data analysis. STATA software version 13 was used for statistical analysis. Results: The mean age was 37.94 ± 9.04 years ranged from 19 to 58 years. Male gender included 104 (98.1%) of subjects. 31, 10 and 65 subjects were infected with genotypes1a, 1b, and 3a, respectively. The mean viral load was 1.44 × 106 ± 4.5× 105 IU/ml. HCV viral load was not significantly different among subjects infected with HCV genotypes 1, 1.49 × 10 6 ± 4.57 × 10 6 IU/ml compare to genotype 3, 1.40 × 10 6 ± 5.58 4.58 × 106 IU/ml (p=0.93). Conclusion: Although not significant, the frequency of subjects with high viral load (> 800,000 IU/ml) was higher in subjects infected with genotype 3 than those of genotype 1. No associations were found between demographic characteristics and HCV genotype. Although the study was unable to find any association between HCV genotype and HCV viral load/ HCV viral load group, it highlighted the role of high viral load in the high circulation of HCV genotype 3a among Iranian blood donors.

Intra-familial Transmission of Chronic Hepatitis B Infection: A Large Population-Based Cohort Study in Northern Iran.

AIM: The aim of this study was to investigate the intra-familial transmission of chronic hepatitis B (CHB) in Golestan province, that has the highest prevalence of CHB in Iran. METHODS: The Golestan Cohort Study (GCS) is a population-based prospective study of 50045 individuals, 40 years or older, initially set-up to study upper GI cancers in Northern Iran. In 2008, a baseline measurement of hepatitis B surface antigen (HBsAg) on the stored serum of all GCS participants identified 3505 HBsAg+ individuals. In 2011, we assessed HBV serological markers in 2590 initially HBsAg+ individuals and their first-degree relatives including spouses (1454) and children (3934). RESULTS: The median (IQR) age of spouses and children were 52 (12) and 25 (12) years respectively. Out of 5388 family members, 2393 (44.5%) had no HBV markers, indicating susceptibility to infection. Of these, 378 (15.8%) were fully-vaccinated children with no apparent response to primary immunization. HBsAg was positive in 2.2% (n = 33) of spouses and 8.2% (n = 325) of children (overall rate of 6.6%). HBcAb was positive in 761 (52.3%) and 914 (23%) spouses and children, respectively. The rate of spontaneous loss of HBsAg (HBsAg-, HBsAb+ and HbcAb+) was 41.3% and 13.9% in spouses and children, respectively. A higher rate of HBsAg+ children (10.2%) was found in families in which the mother was positive for HBsAg compared with families where the father was positive for HBsAg (6.3%) (P < 0.001). When both parents were positive for HBsAg, the rate of HBsAg positivity was high (23.5%, P < 0.001). Despite high virus exposure rates between spouses (52.6 %), the prevalence of HBsAg positivity among them was very low (2.3 %). CONCLUSION: Sexual and parent-to-child transmission are important routes of CHB spread in this population from northern Iran despite the fact that 24 years have passed since the beginning of hepatitis B vaccination in infants. Low percentage of HBsAg positivity in spouses is related to high HBsAg clearance rate among them.

Leukemia microvesicles affect healthy hematopoietic stem cells.

Microvesicles are released by different cell types and shuttle mRNAs and microRNAs which have the possibility to transfer genetic information to a target cell and alter its function. Acute myeloid leukemia is a malignant disorder, and leukemic cells occupy all the bone marrow microenvironment. In this study, we investigate the effect of leukemia microvesicles on healthy umbilical cord blood hematopoietic stem cells to find evidence of cell information transferring. Leukemia microvesicles were isolated from acute myeloid leukemia patients and were co-incubated with healthy hematopoietic stem cells. After 7 days, cell count, hematopoietic stem cell-specific cluster of differentiation (CD) markers, colony-forming unit assay, and some microRNA gene expressions were assessed. Data showed a higher number of hematopoietic stem cells after being treated with leukemia microvesicles compared with control (treated with no microvesicles) and normal (treated with normal microvesicles) groups. Also, increased levels of microRNA-21 and microRNA-29a genes were observed in this group, while colony-forming ability was still maintained and high ranges of CD34+, CD34+CD38-, CD90+, and CD117+ phenotypes were observed as stemness signs. Our results suggest that leukemia microvesicles are able to induce some effects on healthy hematopoietic stem cells such as promoting cell survival and some microRNAs deregulation, while stemness is maintained.

Blood collection, components preparation and distribution in Iran, 2008-2012.

BACKGROUND: The information about the dynamics of blood collection, components preparation and distribution in Iran was measured and compared during 2008-2012. STUDY DESIGNS AND METHODS: The survey instruments were based on collecting data from all 220 blood collections and blood processing centers over the country, registering them in the validated data base and reporting them to headquarter of Iranian Blood Transfusion Organization. RESULTS: Total blood collection increased during this period, and in 2012 represented a 12.6 percent increase compared to that in 2008. On average, red blood cells, fresh frozen plasma and platelet concentrate were prepared from 95.5 ± 2.4, 81 ± 3.8 and 47 ± 8.8 percent of all whole blood collection. From 2008 to 2011, the distribution of whole blood and fresh frozen plasma revealed different patterns. For whole blood, declines were noted, while for fresh frozen plasma increases were reported. In addition the distribution of red blood cells and platelet concentrate did not change considerably. Also between 2008 and 2012, the mean percentage of outdated and discarded units was 3.6 ± 1 and 5.2 ± 4.6. CONCLUSION: This study as a first national survey provides comprehensive information about the blood supply, components preparation and distribution, and helps to define strategy for the future.