Open Access Original Research Article

The Evaluation of Blood Requests for Transfusion and It’s Utilization in Four Iranian Hospitals

Azita Chegini, Alireza Ebrahimi, Amirhossein Maghari

International Blood Research & Reviews, Page 1-6
DOI: 10.9734/IBRR/2015/17177

Background: Transfusion is one of the most important elements of healthcare. In order to save human lives, 85 million blood units are used in the world annually. Access to blood products is a common problem throughout the world. Presently, demand is increasing significantly for blood usage. The main goal is to evaluate blood usage in four hospitals by comparing them with international standards and utilization of efficient methods to prevent unnecessary transfusions.

Materials and Methods: This is a retrospective hospital based survey carried out at Tehran Blood Transfusion Centre. Data regarding blood transfusion requests, units requested, units cross matched, unused units returned and other details were collected from the blood bank laboratory records in four Iranian hospitals. The crossmatched to transfusion ratio was evaluated.

Results: There were a total of 548,568 requests for units of blood in total. 196,059  units were  crossmatched  and 82,320 units  were transfused. The proportion of C/T (total) was 2.38 and the proportion of transfusions to the number of beds was 16. The C/T ratios for all hospitals were 2.38. Only 42% of blood cross matched units was utilized.  One of four hospitals in our survey which specializes in cardiac the C/T ratio is 1.86 and the ratio of blood infusion to hospital bed is 19.7.  Another hospital specializes in pediatric hematology oncology and C/T ratio is 1.04 (the ratio of blood infusion to hospital bed=19.6). A 1,000 bed general hospital with cardiac and oncology departments in which C/T ratio is 2.94.

Conclusion: We saw over ordering requests of blood units which is different in 4 hospitals. The number of beds and departments can have a direct effect on the C/T ratio. The quantity of blood used depends on the number of beds and fields of specialization present at the hospital.  

Suitable usage of blood depends on great hospital and number of expertise. There is a need to expand our hemovigilance teaching program. Use of abscreening helps to achieve a more efficient blood utilization and should be engaged in our locality to prevent unnecessary demands.

 

Open Access Original Research Article

Anti-retroviral Treatment Related Haematological Disorders among HIV- Infected Children Attending HIV Clinic at Yekatit 12 Hospital, Addis Ababa, Ethiopia

Mestewat Debasu, M. K. C. Menon, Yididya Belayneh, Workeabeba Abebe, Degu Jerene, Daniel Seifu

International Blood Research & Reviews, Page 1-18
DOI: 10.9734/IBRR/2015/20197

Background: The Management of drug toxicities is increasingly becoming a crucial component of human immunodeficiency virus infection and improvement of antiretroviral therapy in developing countries like Ethiopia. The severity of hematological abnormalities in children who are taking ART is not known well in Ethiopian Hospitals.

Objective: The study was undertaken to determine the severity of HAART related hematological disorders in HIV positive children who were on HAART at Yekatit 12 Hospital, Addis Ababa, Ethiopia.

Methods: A cross sectional study was conducted from May 2012 to February 2013 among children who had been on HAART for maximum of twelve months. Data collection using questionnaires and measurement of complete blood count and CD4 + T cell counts were made by using standard methodology. The results were tested using appropriate statistical methods (mean, Standard Deviation, Odd Ratio, p-value and F test value).

Results: A total of 106 patients (<18 years) were enrolled  in the study and had a mean age of 6.5±3.4 years, a median age of 7 years and female to male ratio of 1.04:1. The prevalence of anemia was 18.9%, 12.3% and 10.4% at baseline, at six months, and at twelve months post-treatment, respectively. Their mean hemoglobin level increased by 1.0 gm/dl at six months and by 1.7 gm/dl at twelve months of follow up with statistically significant values (p <0.001), and F test value presented 15.87. Patients who were put on AZT based regimen were more likely to develop anemia than those on D4T-based regimen, (OR=4.5, p-value <0.05). The prevalence of thrombocytopenia at baseline was 8.5%, but it was lowered for both at six and twelve months by 5.7%. The thrombocyte count of AZT based regimen showed statistically significant association (p- <0.05) and F test value as 2.98. The prevalence of neutropenia at baseline and at six months was similar with the value of 2.8% while at twelve months it was higher at 5.7%.

Conclusion: Anemia, neutropenia and thrombocytopenia were the hematological abnormalities among HIV infected Ethiopian children taking HAART. Anemia was the most common abnormality, but significantly lesser than in many other hospitals in Ethiopia and among those who were on AZT based regimen. It is recommended that even in limited laboratory monitoring, HAART can be safely used and health professionals may consider other risk factors associated with the development of cytopenia before selection of second line of HAART drug regimen.

 

Open Access Short Research Article

Relationship between Glucose Level, Lipid Profiles, and Waist to Height Ratio (WHtR)

Hazizi Abu Saad, Aina Mardiah Basri, Zahratul Nur Kalmi

International Blood Research & Reviews, Page 1-9
DOI: 10.9734/IBRR/2015/19616

A cross sectional study was carried out to determine the relationship between glucose level, lipid profiles, and waist to height ratio (WHtR) among adults in a workplace setting. Respondents were recruited from government staff in two ministries, each from the federal territories of Kuala Lumpur and Putrajaya, Malaysia. Socio-demographic information was collected using a set of questionnaire and anthropometric measurement including weight, height, percent body fat, and waist and hip circumference were measured. Antropometric assessments were measured and blood sample was collected in the morning before 10 AM, after the respondents undergone 12 hours of overnight fasting. A fingerpick blood sample was collected to measure blood glucose and lipid profiles. A total of 210 respondents were recruited for this study. The majority of the respondents (81.9%) were aged 34 years and younger. Approximately 16.8% were obese and 25.1% overweight. Based on WHtR, 47.1% of the respondents were classified as having WHtR≥0.5. Based on odds ratio, having a high WHtR (≥0.5) was found to be related to increased risk of having high BMI (OR=18.125; 95% CI 8.583-38.276), high triglyceride (OR=6.202; 95% CI 2.517-15.281), elevated blood pressure (systolic OR=4.351; 95% CI 2.026-9.344, diastolic OR=4.932; 95% CI 1.571-15.484), high blood glucose (OR=3.084; 95% CI 1.186-7.831) and low HDLC (OR=3.506; 95% CI 1.862-6.600). For the subjects of this study, WHtR was found to be significantly related to lipid profile and blood glucose level.

 

Open Access Case Report

Combined Closed-circuit Acute Normovolemic Hemodilution and Deliberate Hypotension in a Jehovah’s Witness: A Case Report

Otu E. Etta, Emma Etuknwa

International Blood Research & Reviews, Page 1-4
DOI: 10.9734/IBRR/2015/20054

Aims: To enlighten both clinicians and Jehovah’s Witness patients on closed-circuit acute normovolemic hemodilution (ANH) and deliberate hypotension (DH) as safe and acceptable blood conservation strategies.

Case Presentation: A 32 yr old male Jehovah’s Witness patient was scheduled for nephro-lithotomy on account a right nephrolithiasis (Staghorn calculus). He was fit and young weighing 76 kg with packed cell volume of 34%. The anticipated blood loss during the surgery was 1500 ml or more, hence we decided to use combined closed-circuit ANH and DH. These combined strategies were accepted by the patient; they minimized blood loss to only 400 mls and provided a good operating field visibility.

Discussion: Several blood conservation strategies have been developed and accepted by Jehovah’s Witness patients provided the blood circulation circuit is not broken. Our resident doctor and patient were not initially aware of the acceptability of ANH by the Jehovah’s witness. Blood conservation strategies could be used either singly or in combination, our patient was suitable for both.

Conclusion: Combined closed-circuit ANH and DH are safe and acceptable to Jehovah’s witness patients.

 

Open Access Case Study

A Case of Isolated CNS Relapse in a CML Patient on Chronic Phase

Laurence Adlai B. Morillo, Flordeluna Zapata-Mesina, Ma Rosario Irene D. Castillo

International Blood Research & Reviews, Page 1-8
DOI: 10.9734/IBRR/2015/17731

We report a patient who achieved hematologic response with Imatinib mesylate and is in chronic phase, but after several years developed neurologic symptoms and was eventually documented to have an isolated CNS relapse. The patient was treated with intrathecal chemotherapy to clear the spinal fluid of the leukemia cells. Imatinib mesylate (STI-571) is a potent and selective inhibitor of BCR-ABL tyrosine kinase and has emerged as a treatment of choice in chronic myeloid leukaemia. However because of poor penetration of the drug to the blood-brain barrier of the central nervous system (CNS), then the CNS acts as a sanctuary site for malignant cells.