Scientific Journal of

  Abstract

 Background and Objectives

 Some blood donors may donate blood for being informed of their HIV test results such people are threats to blood and its derivatives.

 Materials and Methods

 This study was a cross-sectional study using four choice questionnaires which were distributed among 20800 blood donors who had referred to Shiraz Blood Transfusion Organization. The sample was selected using systematic random sampling. Questionnaire included three parts: part one contained demographic characteristics of donors, part two reasons motivating them to donate blood, and three risk factor of HIV if donation occures for HIV checkup. Chi square and regression analysis were used to analyze the data.

 Results

 The average age of donors was 34.46 ± 11.3. 87% of donors were male and 12.3% female 51.8% were married and 48.2% single. 36.3% were first time blood donors and 63.7% had more than one time blood donation record the average number of blood donation attempts among these subjects was 6.7 ± 3.2. 61% of them were tested for HIV in routine tests. Totally, 14.8% of these subjects had donated blood for HIV checkup. Blood donation for HIV checkup was more frequent in males, singles and first time donors (P<0.05). There was no correlation between occupation, education status, age and blood donation and HIV checkup (P>0.05). Risk factors of those who had donated blood for HIV tests were identified to be sexual contacts (38.3% of subjects), contacts with HIV suspicious people (18.7%), intravenous drug users (3.7%), and tatooing (2.8%). The rest 36.5 percent had no known risk factors.

 Conclusions

 14.8% donate blood for HIV checkup in this study and could threaten the blood supply. The most common risk factor in those who referred for HIV checkup was sexual contact with
high-risk partners. Blood donors should receive suitable training for providing safe blood. To this end, they must feel accountable for their blood donation.

 Key words:

  Abstract

 Background and Objectives

  To prepare safe and adequate blood supply to meet patients’ needs and ensure a sufficient number of regular blood donors, knowledge about factors encouraging people to donate blood regularly is essential. Considering its importance, we aimed to survey positive and negative motivation for blood donation.

  Materials and Methods

  This survey was a cross-sectional research with a multiple questionnaire to study the positive and negative motivation toward blood donation in the first half of 1382 (according to Iranian calendar) in Shiraz Blood Transfusion Center.

 Results

  This survey was conducted on subjects with positive motivation who referred to blood transfusion center at the mean age of 32.73 ± 9.6. 92.1% of the subjects were male, and 7.9% female, and 74.3% married. Positive motivation for blood donation included altruistic causes (65.3%), check-up purposes (12.9%), income-earning goals (8.9%), the positive impact of donation on health (8.9%), and curiosity about blood donation (4%). The mean age of the subjects with negative motivation was 25.22 ± 7.54. 22.7% were male, 77.3 female, and 67.7% single. The most important negative motivation was dizziness and faint (45.5%), and lack of time (4.5%). Negative motivation in women was statistically more significant than men (p<0.05).

 Conclusions

  In this study, the main positive motivation for blood donation came out of altruistic reasons, which are considered to be very positive. 12.9% of people just donated for check up that can endanger blood safety.The most important negative motivation was fear of dizziness and faint or disease as a result of donation. This can be removed through holding educational programs and providing sufficient care for donors.

 Key words: B lood donors, Blood donation, Attitude

Abstract

Background and Objectives

Evaluation 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 Methods

In 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.

Results

During 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).

Conclusions

If 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.

Key words: Blood donor, HIV, Hepatitis C, Hepatitis B

  Abstract

 Background and Objectives

 Vasovagal reaction occurs in a small but significant number of blood donors. Vasovagal reactions may decrease return donation and disrupt blood collection activities. The purpose of this study was to define the contributing role of sex, age, weight, and blood pressure in vasovagal reactions.

 Materials and Methods

 This case control study was performed on blood donors who referred to Shiraz Blood Transfusion Center in 2005. A questionnaire was filled out both for the blood donors who had developed vasovagal reactions (case group) and those who had not (control group) appearing prior and after the case group donors. Finally 1500 samples were randomly selected (500 cases & 1000 control). The questionnaire consisted of sociodemographic pattern of blood donors, and signs and symptoms of vasovagal reactions. Chi-square was used for data analysis.

 Results

 The mean age and weight of the case group were 30.55 ± 9.33 and 71.23 ± 9.3 respectively. 72.6% of the case group were male and the average rate of blood donation attempts was 3.34 ± 2.19. The mean age and weight of the control group were 35.27 ± 4.72 and 78.61 ± 12.77 respectively. 90.3% of the control group were male and the average rate of blood donation attempts was 6.58 ± 7.08. The vasovagal reaction was higher in young, low weight, first time, female blood donors (p < 0.005). It was also higher in fatigued, hungry and stressful blood donors (p < 0.005) .

 Conclusions

 Vasovagal reaction is a multi-factorial process. These reactions might be prevented in high risk donors. Considering these risk factors, it is possible to increase repeat donation and donor safety.

 Key word: Blood donor, Vasovagal syncope, Hypertension, Iran

  Abstract

 Background and Objectives

 Blood typing by serologic methods after transfusion has limitations due to presence of donor red cells in recipients. Accurate determination of red blood cells (RBCs) antigens is very important in multitransfused patients including beta-thalassemics and sickle cell anemics. So, the aim of this study was to evaluate DNA- based methods as supplement to the hemagglutination technique to determine the red blood cell (RBC) antigen profile of multitransfused patients with beta- thalassemia.

 Materials and Methods

 DNA was extracted from peripheral blood of 20 apparently normal people and 44 patients including 35 with beta- thalassemia (out of whom 19 had clinical evidence of delayed hemolytic transfusion reaction) , 8 with thalassemia intermedia (out of whom 2 had hemolytic reaction), and one with sickle cell thalassemia. RHD/ RHC/ RHc/ RHE/ RHe/ JKA/ JKB/ FYA/ FYB/ KELL1/ KELL2 alleles were determined by PCR and were then compared with the hemagglutination method.

 Results

 Phenotype and genotype results were the same in all controls. The phenotypes and genotypes of 53 blood antigens of 26 patients were incompatible. Most of the discrepancies (19 cases) occurred in the Rh system, and fifteen in the Duffy and Kidd systems.

 Conclusions

 The results show that screening platelet concentrates for bacterial contamination is necessary for blood transfusion centers and hospital blood banks. Blood typing by serologic method was not accurate in this study but genotyping could determine true blood groups in multitransfused patients and help in selection of RBCs without alloimmunized antigens in future transfusion attempts. Specificity, sensitivity, positive and negative predictive values of hemagglutination method for RhD antigen had good values in comparison to the molecular method. This might be due to pre- transfusion determination of RhD for thalassemic patients so as to receive Rh- matched blood units. It seems pre-transfusion blood typing of Rh and Kell antigens, which are the cause of hemolytic reactions, in comparison to the molecular method could be cost effective. In addition, typing of Rh and Kell antigens in some regular blood donors could be helpdul for selecting antigen-negative RBCs for transfusion dependent patients

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 Key words : Thalassemia, Polymerase Chain Reaction, Blood group antigens

  Abstract

 Background and Objectives

 Having a better understanding about blood use in trauma care helps us plan to ensure adequate blood and design new protocols to avoid blood loss.

 Materials and Methods

 In this cross-sectional study, 362 of traumatic patients having received blood transfusion in Rajaie Trauma Center in 2011 were randomly selected. Through a questionnaire eliciting information about demographic characteristics, the amount of administered packed RBCs, platelets, and fresh frozen plasma (FFP), the prognosis in patients who received more than 10 packed RBC units with patients who received less than 10 was compared. We used t-test and Chi-squared test for data analysis.

 Results

 The average units of RBC, platelet and FFP administered per trauma case were 3.31 ± 3.74 (1-25), 0.92 ± 5.15 (0-76), and 2.59 ± 6.6 (0-55), respectively. The mean number of RBC units transfused did not correlate with sex, type of injury, age, and patient transport time (p> 0.05). The mean number of blood units used was higher for patients with lower Glasgow scores and for those who died after their injury (p< 0.05). The mortality rate, the mean number of FFP and platelet units transfused, and the need for surgery were higher in patients with massive transfusion (p< 0.05).

 Conclusions

 Given the positive correlation of morbidity and mortality rates in traumatic patients with the amount of blood transfusion, it seems imperative for blood to be used appropriately and judiciously. Designing massive transfusion protocols can lead to better blood usage, decline complications, and ensure blood adequacy.

  Abstract

 Background and Objectives

 Considering infectious and non-infectious complications of blood transfusion, we decided to survey physicians’ knowledge about and their attitudes toward autologous blood and to see how education can affect them.

 Materials and Methods

 A cross-sectional study was conducted on general physicians and specialists who ordered blood and blood products in Shiraz hospitals. A questionnaire aiming to elicit demographic characteristics, and evaluate the knowledge about collection methods of autologus blood and its benefit was used for data collection. Then, we provided education about autologus blood for participants. The rate of ordered autologus blood was compared before and after the intervention. We used chi-square, fisher and t-test for data analysis.

 Results

 The mean score of physicians’ knowledge about autologus blood was 14.41 ± 3.32 (2.86-20) that was lower than that of specialists with the mean of 15.95 ± 2. The most common reasons for the use and non-use of autologous blood were blood safety for the former and the lack of knowledge about preparation and prescription of autologus blood for the latter. The knowledge level of physicians was higher in pre-operative collection methods than in other fields of autologous blood collection.

 Conclusions

 Physicians’ knowledge about autologus blood was evaluated to be low and despite their desire for its use, the practical rate was still low. The results showed that even education provided to physicians did not increase the ordering rate of autologus blood.

  Abstract

 Background and Objectives

 Alloimmunization with the prevalence rate of 60% is a common problem in chronically transfused patients. This problem has been reported to be less common in transfused hospital-based patients, amounting to 1-2 percent. Alloimmunization can lead to some difficulty varying from delay in the provision of similar blood types to delayed hemolytic transfusion reactions. The aim of this study was to analyze alloimmunization against RBCs among non-chronically transfused patients in Namazi Hospital in Shiraz.

 Materials and Methods

 Retrospective analysis of 3487 non-chronically transfused patients was conducted with antibody screening test and identification of patients' alloantibodies with the panel cell test. For patients with alloantibody, the data for sex, age, and history of transfusion and surgery were collected. Finally, the data were analyzed by SPSS software v. 15 using chi-square (CI= 95%).

 Results

 Twenty-eight out of 3487 patients had alloantibody (prevalence rate of 0.8%). The most common clinically significant alloantibodies found were anti-K (23%), anti- E (15%) and anti-C (11%). The most common clinically significant alloantibodies identified in males and females were anti-K and anti-C, respectively.

 Conclusions

 Alloantibody prevalence rate did not show any correlation with age and sex and was more common in patients with surgery history and transfusion record. Important factors contributing to the higher prevalence of the above alloantibodies are the higher prevalence of the related antigens in the population, higher antigenicity power, and the lack of crossmatch and grouping for the antigens before blood transfusion.

  Abstract

 Background and Objectives

 The knowledge of physicians and nurses concerning blood transfusion has a significant impact on the optimal use of blood and blood products. The aim was to survey their knowledge regarding transfusion medicine and the effect of education thereof.

 Materials and Methods

 An interventional semi-experimental study was conducted on physicians and nurses who worked in Shiraz hospitals. The questionnaire included demographic characteristics, previous education records, and their experience regarding blood transfusion, transfusion indications, blood administration, and adverse reactions. The mean knowledge of the participants before and after education was calculated. T test, Pair T test, and Chi-squared test were used for data analysis with SPSS 18.

 Results

 The mean knowledge scores of physicians and nurses regarding transfusion medicine were 15.3 ± 6.9 and 9.5 ± 5.2 out of 24, respectively. The mean knowledge score of physicians and nurses who received education regarding transfusion medicine during their medical and nursing courses was more than those who did not (p < 0.01) 98.6% of physicians and 97.1% of nurses believed that their education was not adequate. The mean knowledge score after education increased significantly in physicians (20.8 ± 4.3) and nurses (18.2 ± 3) out of 24 (p < 0.001).

 Conclusions

 The knowledge of physicians and nurses regarding blood transfusion was low. The education can improve their knowledge. It seems necessary for educational courses regarding transfusion medicine to be held and for academic transfusion medicine courses to be added to medical and nursing curriculua.

  Abstract

 Background and Objectives

 Confidential self-exclusion (CUE) system has been designed to enhance transfusion safety as an extra screening test to detect donors who donate their blood during window period. This study was designed to survey the efficacy of CUE option in Shiraz Blood Transfusion Center (southern Iran).

 Materials and Methods

 The present retrospective study was conducted in Shiraz Blood Transfusion Center from 2009-2012. CUE is used for all individuals who refer for blood donation and prefer their blood not to be used if they have any doubt about their blood suitability for transfusion. The prevalence rates of HIV, HBV, and HCV were compared among blood donors who opted in and out of CUE . The data were analyzed using t-test and proportion test in Med Calc-8.

 Results

 From all donors, 4551 (1.13%) opted for CUE. Self exclusion was more frequent among male, single, low-grade education donors, and donors with the history of previous donation (p < 0.05). The prevalence rate of HBV and HCV was higher among donors who opted CUE option (p < 0.05). The prevalence rate of HIV was not higher among donors who opted CUE option (p > 0.05). The sensitivity and specificity of CUE were 4.4% and 98.8%, respectively.

 Conclusions

 In our study, the prevalence rate of HBV and HCV was higher among donors who opted CUE option. There is a need to review the process of CUE option and make some changes to prevent unreasonable CUE option.

Abstract

Background and Objectives

Religious beliefs are one of the positive motivations for blood donation. The present study aimed to compare blood donation on religious days and normal days with respect to donor pattern and safety of donors.

Materials and Methods

This retrospective, cross-sectional study was conducted on individuals who referred to the main centres and portable teams of Shiraz Blood Transfusion Centre, Iran for donation on two days Tasua and Ashura days  and three days 19th, 21st, and 23rd of Ramadan (2009-2013) and on similar dates one month before these religious days .Afterwards, the donors’ characteristics (age, sex, marital status, and donation status), donor deferral rate, and the prevalence rates of hepatitis B, Hepatitis C, and HIV in blood donors were compared among them. The comparisons were made through proportion tests using Med Calc software (v. 8.0).

Results

The results revealed significant increase in the number of blood donors on Tasua and Ashra days (1.4fold). Most of the donors who referred on the religious days were male (p < 0.001). No significant difference was observed regarding marital status and donation status. The prevalence  rates of hepatitis B and hepatitis C were  lower in the blood donors who referred on religious days and  compared to those referring on similar dates (p < 0.001).

Conclusions 

Higher numbers of blood donors and lower prevalence rate  of Hepatitis B and hepatitis C  on religious day shows the importance of recruiting blood donors and providing possibilities for blood donation on these days  can improve blood adequacy and blood safety. 

Abstract
Background and Objectives
Estimation of the frequency and causes of immunization to red blood cells in transfusion dependent thalassemia (TDT) patients can help us know the limitations of current practice and plan   specific measures to reduce it. This study aimed to evaluate the frequency and causes of immunization in TDT patients.
 
Materials and Methods
This case control study was conducted on 732 (TDT) patients between 20 November 2015 to November 2016 in  Dastgheib Hospital, Shiraz, Iran. Direct coombs test, antibody screening, and antibody identification were performed for every TDT patient. Then, the  frequency  and type of antibodies were surveyed. Clinical and laboratory data of immunized and non-immunized patients were compared.
 
Results
All of the case group had positive results in direct or indirect coombs tests. Indirect coombs test (ICT) was positive in 59 patients (63.4%) while direct coombs tests (DCT) was positive in 41 (44%) of immunized patients. In addition, 7 patients (7.52%) showed positive results for both DCT and IAT. The most frequent antibodies were against Kell (48.6%), D (22.7%) and E (18.2%). Our results reflected that lower age of starting transfusion and splenectomy had an impact on higher immunization rate.  
 
Conclusions 
Antbodies against Rh and Kell system were the most frequent antibodies. It seems that extended RBC matching at least for ABO/Rh/Kell antigens must be performed for thalassemia patients with its effect on RBC immunization rate to be then surveyed.
 

Abstract
Background and Objectives
One of the dangers of blood transfusions is the mistakes that lead to the wrong blood transfusion to the patient. This study was performed to identify the types of errors that lead to incompatible transfusions to prevent their recurrence and increase recipients health.

Materials and Methods
This cross-sectional study was performed on complications of ABO incompatibility caused by transfusion in 2019 in Shiraz hospitals. Demographic characteristics of blood recipients (age, sex, diagnosis, history of transfusion, blood type), type of product received, blood type of product received, incompatible blood volume injected, symptoms and causes of ABO incompatibility were determined. Chi-square and t-test were used to analyze data.

Results
A total of 9 complications of ABO incompatibility were reported; 7 cases (77.8%) were due to packed red blood cells, one case (11.1%) due to platelet injection and one (11.1%) due to plasma injection. Seven cases occurred in patients undergoing surgery, one case in neonates and one in thalassemia patients. In terms of clinical symptoms, only one patient developed chills. The rest of the patients had no symptoms. The most common error leading to inconsistency was the lack of accurate identification in 6 cases (66.7%) and in 2 cases (22.2%) sampling error and in one (11.1%) incorrect group writing. 

Conclusions  
It seems that in order to promote safe blood transfusion, it is important to investigate the occurrence of ABO incompatibilities in order to identify blood transfusion chain errors in order to identify the causes of errors and prevent the recurrence of these complications.

Abstract
Background and Objectives
Considering the importance of training of nurses in the field of blood transfusion, we evaluated the level of knowledge of nurses regarding blood transfusion.

Materials and Methods
This was a descriptive cross-sectional study performed on nurses in Shiraz hospitals in 2019-2020. The level of knowledge was determined using a questionnaire before and after the course by pre-test and post-test. The questionnaire consists of two parts. The first part has a questions regarding demographic characteristics . The second part has 28 four-answer questions about blood and blood components, indication, administration and complications. The data was analyzed using SPSS-23 software by paired t tests, chi-square, McNamara , change score t test, Anova ,and  correlation tests .

Results
The mean score of awareness after class was significantly increased (13.47 ± 3.80 from 28 to 20.21 ± 5.45 out of 28) (p < 0.001). The increase in awareness was significant in all blood transfusion items .

Conclusions  
Due to the lack of sufficient knowledge of nurses in the field of blood transfusion the education of nurses is essential to improve blood safety. Therefore, planning training classes in the field of transfusion medicine on a regular and continuous basis and evaluating the impact of education is recommended.