Mohamed A. Abdelaal

Epidemiology of hepatitis C virus: a study of male blood donors in Saudi Arabia

Background: Few epidemiologic reports on the prevalence of hepatitis C in Saudi blood donors have been published.

Circadian rhythm of granulocyte-macrophage colony-stimulating factor in normal subjects and neutropenic hospitalised patients

BackgroundGranulocyte-macrophage colony-stimulating factor (GM-CSF), one of the haemopoietic growth factors, has rarely been detected in human serum. It has, therefore, been suggested that a paracrine model can explain its behaviour where the substance is produced and acts locally. An alternative explanation might be due to blood sampling time with GM-CSF concentrations undetectable at the nadir of secretion.HypothesisWe hypothesised that endogenous production of GM-CSF in humans is subject to diurnal rhythm.MethodsBlood samples were obtained from 17 healthy individuals and 17 neutropenic hospitalised patients with haematological malignancies on myelosuppressive therapy at 6, 12, 18 and 24 hours. In the neutropenic patients, samples were collected at the nadir of the neutrophil count (ANC <0.2 × 109/L). Serum was assayed for GM-CSF levels using an enzyme-linked immunosorbent assay method.ResultsThere were significant differences in the mean levels of GM-CSF within the two groups (P<0.001). In normal subjects, peak GM-CSF levels were reached at six hours (mean = 10.1 pg/ml). Peak levels were reached in hospitalised neutropenic patients at 18 hours (mean = 13.7 pg/ml). The difference between the peak GM-CSF levels in the two groups was not significant (P=0.11). On factorial design analysis, there was a significant interaction between the time of blood collection and the subject groups (P<0.001).ConclusionsOur data are consistent with a diurnal secretion pattern for GM-CSF in both normal and neutropenic patients. As this finding might have practical implications, including timing of administration of GM-CSF in neutropenic patients, further studies are suggested.

Assessment of Becton Dickinson Plain and Serum Separator Tubes in Measurement of 25‐Hydroxyvitamin D3 (25OHD3) by HPLC and Immunoassay Methods

The accuracy of 25‐hydroxyvitamin D3 (25OHD3) measurement on specimens collected into serum separator tubes (SSTs) has been questioned because of possible interference by the gel. Possible interference was investigated in SSTs from Becton Dickinson (BD).

The Saudi clinical practice guideline for the prophylaxis of venous thromboembolism in long-distance travelers

Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a preventable disease. Long distant travelers are prone to variable degree to develop VTE. However, the low risk of developing VTE among long-distance travelers and which travelers should receive VTE prophylaxis, and what prophylactic measures should be used led us to develop these guidelines. These clinical practice guidelines are the result of an initiative of the Ministry of Health of the Kingdom of Saudi Arabia involving an expert panel led by the Saudi Association for Venous Thrombo Embolism (a subsidiary of the Saudi Thoracic Society). The McMaster University Guideline working group provided the methodological support. The expert panel identified 5 common questions related to the thromboprophylaxis in long-distance travelers. The corresponding recommendations were made following the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.

Transfusion medicine illustrated. Sickle cell disease: splenectomy and thrombocytosis.

A 12-year-old boy with sickle cell disease (SCD) presented to the emergency department of our hospital with pain in the back and right leg and inability to walk. This visit was his first to our hospital and no previous laboratory results were available. His blood test results were WBC count, 10.8 ¥ 10 per L; Hb level, 9.4 g per dL; Hct level, 30.3 percent; PLT count, 1352 ¥ 10 per L; reticulocyte count, 3.3 percent; and hemoglobin S (HbS) level, 90.7 percent. The patient had splenectomy at the age of 6 years.Considering the HbS level,previous history of stroke,and multiple episodes of vasoocclusive crises, automated erythrocytapheresis was performed with a commercially available leukoreduction system (COBE Spectra LRS system, Gambro BCT, Inc., Lakewood, CO). The procedure was programmed to achieve an end Hct of 28 percent and fraction of RBCs remaining (FCR) of 30 percent. Four leukoreduced RBC units collected in sterile bags (MacoPharma, Mouvaux, France) and stored in SAGM and CPD anticoagulant preservative solution were used as replacement fluid. A total of 1570 mL of replacement was used including 270 mL of ACD. The procedure was carried out according to standard erythrocytapheresis procedures for the COBE Spectra, with no rinseback and no divert waste step. Post-RBC exchange results were WBC count, 13.9 ¥ 10 per L; Hb level, 9.7 g per dL; Hct level, 29.5 percent; and PLT count, 388 ¥ 10 per L. The removal of PLTs associated with RBC or plasma exchange is well established. Patients can lose up to 30 percent of their circulating PLTs at the end of these procedures. In our patient, however, approximately 70 percent of PLTs were removed during the RBC exchange, perhaps due to the exceptionally high initial PLT count (1352 ¥ 10/L). This excessive removal of PLTs is shown in Figs. A and B. Figure A shows a post-RBC exchange container, the plasma is thickly turbid due to the large amount of suspended PLTs. Figure B taken after 36 hours of gravity sedimentation at room temperature of the same bag shows clear plasma on the top, PLT-containing turbid plasma in the middle, and a thick layer of settled PLTs above the RBCs (see arrow).

Changes in hematological indices and lymphocyte subsets in response to whole blood donation in healthy male donors

Abstract Whole blood donation has immunomodulatory effects, and most of these have been observed at short intervals following blood donation. This study aimed to investigate the impact of whole blood donation on lymphocyte subsets over a typical inter-donation interval. Healthy male subjects were recruited to study changes in complete blood count (CBC) (n = 42) and lymphocyte subsets (n = 16) before and at four intervals up to 106 days following blood donation. Repeated measures ANOVA were used to compare quantitative variables between different visits. Following blood donation, changes in CBC and erythropoietin were as expected. The neutrophil count increased by 11.3% at 8 days (p < .001). Novel changes were observed in lymphocyte subsets as the CD4/CD8 ratio increased by 9.2% (p < .05) at 8 days and 13.7% (p < .05) at 22 days. CD16-56 cells decreased by 16.2% (p < .05) at 8 days. All the subsets had returned to baseline by 106 days. Regression analysis showed that the changes in CD16-56 cells and CD4/CD8 ratio were not significant (Wilk’s lambda = 0.15 and 0.94, respectively) when adjusted for BMI. In conclusion, following whole blood donation, there are transient changes in lymphocyte subsets. The effect of BMI on lymphocyte subsets and the effect of this immunomodulation on the immune response merit further investigation.

The Saudi clinical practice guideline for the prophylaxis of venous thromboembolism in medical and critically ill patients

Venous thromboembolism (VTE) acquired during hospitalization is common, yet preventable by the proper implementation of thromboprophylaxis which remains to be underutilized worldwide. As a result of an initiative by the Saudi Ministry of Health to improve medical practices in the country, an expert panel led by the Saudi Association for Venous Thrombo Embolism (SAVTE; a subsidiary of the Saudi Thoracic Society) with the methodological guidance of the McMaster University Guideline working group, produced this clinical practice guideline to assist healthcare providers in VTE prevention. The expert part panel issued ten recommendations addressing 10 prioritized questions in the following areas: thromboprophylaxis in acutely ill medical patients (Recommendations 1-5), thromboprophylaxis in critically ill medical patients (Recommendations 6-9), and thromboprophylaxis in chronically ill patients (Recommendation 10). The corresponding recommendations were generated following the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach.

Sickle cell disease: splenectomy and thrombocytosis: TRANSFUSION MEDICINE ILLUSTRATED

A 12-year-old boy with sickle cell disease (SCD) presented to the emergency department of our hospital with pain in the back and right leg and inability to walk. This visit was his first to our hospital and no previous laboratory results were available. His blood test results were WBC count, 10.8 ¥ 10 per L; Hb level, 9.4 g per dL; Hct level, 30.3 percent; PLT count, 1352 ¥ 10 per L; reticulocyte count, 3.3 percent; and hemoglobin S (HbS) level, 90.7 percent. The patient had splenectomy at the age of 6 years.Considering the HbS level,previous history of stroke,and multiple episodes of vasoocclusive crises, automated erythrocytapheresis was performed with a commercially available leukoreduction system (COBE Spectra LRS system, Gambro BCT, Inc., Lakewood, CO). The procedure was programmed to achieve an end Hct of 28 percent and fraction of RBCs remaining (FCR) of 30 percent. Four leukoreduced RBC units collected in sterile bags (MacoPharma, Mouvaux, France) and stored in SAGM and CPD anticoagulant preservative solution were used as replacement fluid. A total of 1570 mL of replacement was used including 270 mL of ACD. The procedure was carried out according to standard erythrocytapheresis procedures for the COBE Spectra, with no rinseback and no divert waste step. Post-RBC exchange results were WBC count, 13.9 ¥ 10 per L; Hb level, 9.7 g per dL; Hct level, 29.5 percent; and PLT count, 388 ¥ 10 per L. The removal of PLTs associated with RBC or plasma exchange is well established. Patients can lose up to 30 percent of their circulating PLTs at the end of these procedures. In our patient, however, approximately 70 percent of PLTs were removed during the RBC exchange, perhaps due to the exceptionally high initial PLT count (1352 ¥ 10/L). This excessive removal of PLTs is shown in Figs. A and B. Figure A shows a post-RBC exchange container, the plasma is thickly turbid due to the large amount of suspended PLTs. Figure B taken after 36 hours of gravity sedimentation at room temperature of the same bag shows clear plasma on the top, PLT-containing turbid plasma in the middle, and a thick layer of settled PLTs above the RBCs (see arrow).