Volume 43, Issue 2

Background Thalassemia as a hereditary hemoglobinopathy is the most common monogenic disease worldwide. Patients with thalassemia require regular blood transfusion, which provides the risk for the transmission of hepatitis C virus (HCV) as the most common post-transfusion infection in such patients, and this rate is very diverse in different parts of the world. We aimed to determine the prevalence of HCV among patients with thalassemia in Iran. Methods In this study, we searched for articles on the prevalence of HCV among Iranian thalassemia patients in English and Persian databases up to 2017. Heterogeneities were assessed by using an I -square ( I 2 ) test. Prevalence and 95% confidence interval (CI) were calculated using the random effects model. Results In total, 37 studies with 9185 patients were included in the meta-analysis. The prevalence of HCV among Iranian thalassemia patients was 17.0% (95% CI: 14.5–19.8). The rate of prevalence among male and female subjects was 17.4% (95% CI: 13.8–21.9) and 16.8% (95% CI: 13.2–21.1), respectively. Conclusions We found that the prevalence of HCV among Iranian thalassemia patients declined over time and the Iranian Blood Transfusion Organization has had a reasonable performance in HCV screening.

Background Hematological abnormalities are frequently found in geriatric patients. However, little data is available on reference values for total blood cell counts in older patients. This study is focused on the analysis of reference values for white blood cell counts in aged persons ≥60 years. Methods This was a cross-sectional study of outpatient laboratory data of 2015 from a German countrywide working laboratory company; inclusion criteria: age ≥60 years, parameters evaluated by the laboratory company between 1.1.2015 and 31.12.2015; exclusion criteria: glomerular filtration rate (GFR) <60 mL/min, lack of inclusion criteria; primary objective: mean leukocyte count; secondary objective: mean counts of lymphocytes, eosinophil, neutrophil and basophil leukocytes as well as platelets, C-reactive protein (CRP), γ-glutamyl transferase (GGT) and lactate dehydrogenase (LDH) in hematologically healthy persons aged ≥60 years. Results Data of 30,611 persons aged ≥60 years were evaluated by age groups. Results for leukocytes, basophils, eosinophils, neutrophils and lymphocytes remained within the reference ranges recommended by the German Society of Hematology and Oncology (DGHO) and the German Association of Specialists in Internal Medicine (BDI); the lower reference limit for normal platelet values in males was below the DGHO reference value with 136,000/μL (confidence interval [CI] 129,000;142,000); similarly, our results for normal monocyte values were above the DGHO reference values with 6.0% (5.7;6.2) to 14.3% (13.9;14.8) in males and 5.4% (5.2;5.6) to 12.9% (12.6;13.4) in females; CRP, GGT and LDH values were above the BDI reference values, comparable with the previous data of a senior patient cohort analysis. Conclusions Adaptation of reference values for selected laboratory parameters in older German patients should be well considered.

Background Visual inspection is the most widespread method for evaluating sample hemolysis in hemostasis laboratories. The hemolysis index (HI) was determined visually (visual index, VI) and measured on an ACL TOP 750 (IL Werfen) system with a hemolysis-icterus-lipemia index (HIL) module. These values were compared with those measured on clinical chemistry systems Unicel DXC600 and AU680 and with quantitation of free-hemoglobin (Hb) performed by a spectrophotometric measurement method (SMM). Methods The HI was measured in 356 sodium citrate plasma samples, 306 of which were visibly hemolyzed to varying degrees and 50 were not hemolyzed. The analytical performance of each method was evaluated. Results Linear regression analysis, calculated between SMM and the other systems in the study, returned coefficients of determination r 2  = 0.853 (AU680), r 2  = 0.893 (DXC600) and r 2  = 0.917 (ACL TOP 750). An r 2  = 0.648 was obtained for linear regression analysis between VI and ACL TOP 750. In addition, ACL TOP 750 showed an excellent correlation in multivariate analysis (r 2  = 0.958), showing good sensitivity (0.939) and specificity (0.934) and a diagnostic accuracy of 94%. By comparison, DXC600 and AU680 showed coefficients of determination of 0.945 and 0.923, respectively. A cut-off was set at 0.15 g/L free-Hb, as determined by the automated method, such that any hemostasis samples measuring above this threshold should not be analyzed. Based on this criterion, samples were classified as accepted or rejected, and the number of samples discarded during VI or ACL TOP 750 measurements was compared. Conclusions This study confirmed that hemostasis laboratories should consider introducing an objective, automated and standardized method to check samples for hemolysis. By relying solely on visual inspection, up to 50% of samples could be unnecessarily rejected. The ACL TOP 750 system demonstrated a satisfactory analytical performance, giving results comparable to those of the reference method.

Background Renalase (RNL) is a controversial enzyme as to whether it oxidizes catecholamines (CAs) (as is generally accepted) in the blood or not. CAs (dopamine [DPMN], epinephrine [EPI] and norepinephrine [NEPI]) are associated with hypertension, including pregnancy-induced hypertension, which occurs in 8–10% of all pregnancies. Therefore, the aim of the study was to compare CAs and renalase concentration in (i) normotensive controls (C), (ii) patients with preeclampsia (PE) and (iii) patients with severe preeclampsia (SPE), which is one of the well-known symptoms of hypertension. Methods This case-control study involved 90 women divided into three groups – 30 C, 30 PE and 30 SPE – whose age and body mass indexes (BMIs) were similar. A total of 270 blood samples (90 maternal samples, 90 umbilical cord artery samples and 90 umbilical cord vein samples) were obtained. CAs and RNL concentrations of the biological samples were measured by enzyme-linked immunosorbent assay (ELISA). Results Comparing the amounts of CAs, RNL and systolic blood pressure (SBP)/diastolic blood pressure (DBP) between healthy control pregnant women and pregnant women with PE and SPE (SBP/DBP was 120/80 mm Hg for C, above 140/90 mm Hg for PE and above 160/110 mm Hg for SPE), the levels of CAs were significantly increased whereas RNL was reduced. The correlation between SBP/DBP and the amount of RNL in pregnant women with PE and SPE was negative. Conclusions These novel results are evidence that hypertension seen in PE and SPE is directly related to increased levels of CAs and reduced RNL concentrations. The use of RNL preparations may be preferred in future to prevent maternal and perinatal morbidity and mortality due to pregnancy-induced hypertension.

Background In the present study, the researchers evaluated the presence of human anti-mouse antibodies (HAMA) in a normal population and laboratory animal care providers for the first time in the world. Also, the cause of HAMA incidence in the human body through a close contact with mice was identified. Methods The study population consisted of 40 laboratory animal care providers aged between 24 and 57 years with a close contact with mice (e.g. taking care of mice, feeding mice, etc.) and 40 individuals of the same age as the above group with no contact with mice. HAMA was measured in both the case and control groups using sandwich enzyme-linked immunosorbent assay (ELISA) method. Data were analyzed using SPSS 18. Univariate and multivariate linear regression and independent t-test were used. The significance of results was measured based on p < 0.05. Results The present study revealed that the animal care providers had (p = 000) a higher titer of HAMA (4.95 ng/mL) in their blood than the control group (1.67 ng/mL). Also, the individuals in the case group (exposed to mice) were more allergic (43.6%) than those in the control group (15%) (p = 0.003). Conclusions The results of this study revealed that exposure to mice in laboratory care centers can cause production of HAMA in the human body but its titer is possibly lower in Iranian working staff than those in the other parts of the world.

Background Specific metabolic changes during physiological pregnancy are characterized by hyperlipidemia and increased oxidative stress. However, these specific changes raise the question of their pro-atherogenic potential during pregnancy and their influence on the risk of developing cardiovascular disease (CVD) in women later in life, as well as complications during pregnancy. The aim of this study was to investigate the changes in lipid indexes and parameters of lipid peroxidation in non-complicated pregnancy in order to estimate their course of change and potential relationship during non-complicated pregnancy. Methods The study included 43 healthy pregnant women and 38 non-pregnant healthy women, in appropriate ages, as the control group. Lipid parameters and oxidative stress parameters were monitored in a longitudinal study in the first, second and third trimesters, and before delivery during non-complicated pregnancy. Results Results have shown that lipid indexes rise during pregnancy. The values were significantly increased when compared to the first trimester in all lipid indices and in comparison with the control group. Thyobarbituric acid reactive substances (TBARS) and lipid hydroperoxides (LOOH) were not changed significantly during physiological pregnancy, but LOOH showed a significantly higher value in the first trimester compared with the control group. Prooxidative-antioxidative balance (PAB) significantly increases as pregnancy progresses. Conclusions We observed the changes in lipids, lipid indexes and parameters that indicate oxidative modification of lipids in physiological pregnancy that may lead to an atherogenic, prooxidant state.

Background The aim of this study was to evaluate the markers of oxidative stress (OS), as well as the magnesium (Mg) concentration, pregnancy-associated plasma protein A (PAPP-A) and human chorionic gonadotropin (β-hCG) values in patients with previous recurrent miscarriages, with the purpose of comparing the level of OS with normal pregnancy. Methods The study was conducted as a prospective study, which included a total of 95 pregnant women divided into two groups. In the study group (n = 35), there were women with at least three consecutive previous miscarriages. The control group (n = 60) consisted of healthy pregnant women without previous miscarriages and complications in pregnancy. Blood samples were taken between the 11 th and 14 th weeks of gestation, and the values of superoxide dismutase (SOD-1), glutathione peroxidase (GSH-Px) and total antioxidant status (TAS) in the serum, as well as the Mg concentration, PAPP-A and β-hCG values were determined. Results The values of SOD and GHS-Px were statistically higher in the study group, while the values of TAS were statistically significantly higher in the control group. The values of the Mg concentration were statistically significantly higher in the control group, while the values of β-hCG were statistically significantly higher in the study group. When the study group was divided into subgroups according to the outcome of pregnancy, there were statistical differences in the level of GSH-Px, SOD between miscarriages and the term delivery group, as well as in the Mg concentration between miscarriages and the term delivery group and between the term and preterm delivery groups. Higher values of SOD and GHS-Px, and lower values of TAS and Mg concentration could be used as markers for the prediction of spontaneous miscarriages. Conclusions The results of this research indicated higher OS and exhaustion of antioxidant mechanisms in early pregnancy in a group with recurrent miscarriages. Also, lower values of serum Mg concentration could be one of the markers for the prediction of spontaneous miscarriages.

Background Non-alcoholic fatty liver disease (NAFLD) has a high prevalence among patients undergoing laparoscopic sleeve gastrectomy (LSG). Although liver biopsy is the gold standard for assessing histopathologic changes in the liver, it is an invasive procedure. The objective of this study was to evaluate the effect of sleeve gastrectomy on liver enzymes, fibrosis and steatosis scores; ultrasonographic findings; biochemical parameters; and anthropometric measurements in morbidly obese patients with NAFLD. Methods Ninety-seven obese patients who underwent LSG were included in this study. Sex, age, body mass index (BMI), comorbidities, liver enzymes, ultrasonographic findings and laboratory parameters to calculate fibrosis and steatosis scores were collected before surgery and after 1 year of follow-up. Results A total of 88.7% of patients had liver steatosis at the pre-surgical ultrasonographic evaluation and this ratio decreased to 46.4% 1 year after surgery. Alanine aminotransferase (ALT), homeostatic model assessment of insulin resistance index (HOMA-IR), aspartate aminotransferase-to-platelet ratio index (APRI) and liver fat score (LFS) were significantly higher in patients with steatosis grade III vs. others. There were improvements in high-density lipoprotein (HDL), triglycerides (TG), glycated hemoglobin (HbA 1c ), glucose, insulin, BMI, liver enzymes and all NAFLD-related fibrosis and steatosis scores. Conclusions HOMA-IR, ALT, LFS and APRI scores can be used for follow-up procedures in morbidly obese patients with NAFLD who underwent LSG.

Background Neuroendocrine differentiation of prostatic carcinoma is a rare entity associated with metastatic castration-resistant disease. Among useful biomarkers of neuroendocrine differentiation, chromogranin A, serotonin, synaptophysin and neuron-specific enolase stand out, while total prostate-specific antigen (PSA) levels are often low or undetectable. Case presentation We report a case of prostatic adenocarcinoma recurrence after a 6-year disease-free follow-up, in which increased serum chromogranin A levels and undetectable total PSA provided a prompt indication of neuroendocrine transformation, confirmed through immunohistochemical evaluation. Conclusions Neuroendocrine differentiation is a relevant cause of prostatic adenocarcinoma recurrence, and awareness of this entity is crucial due to its underdiagnosis and adverse prognosis.