SUMMARY . Transfusion-transmitted infections (TTI)continue tobe a major challenge for Blood transfusionorganizations across the world. The problem is moreseriousinthedevelopingcountrieswithlowereconomicmeans. Multitransfused patients (MTPs) in thesecountries are at higher risk of infection, and studies ofinfection in these patients can be a useful index forexamining the blood safety filters in place. The presentarticlereviewsthesituationinIran,whereprevalenceofthe major viruses of concern, namely,hepatitisB virus,hepatitisC virus(HCV)andhuman immunodeficiencyvirus,studiedinthesepatientsisreportedovera9-yearperiod. It is demonstrated that HCV is the mostprevalent TTI and remains a major health problemfor these patients.Key words: Iran Blood Transfusion Organization,Iranian multitransfused patients, transfusion-trans-mitted viruses.The blood supply in the developed world has neverbeen as safe as it is now. During the past two decades,initiatedlargelybytheAIDSepidemic,therehavebeendramatic progressive reductions in the risk of trans-fusion-transmitted clinically significant blood-borneinfections. This level of safety has been accomplishedas a result of extensive research to characterizetransfusion-transmitted pathogens, development ofstrategies to measure infection rates in blood donor aswellasinrecipientpopulations,characterizationoftheearlyviraemia,andimplementationofmorerestrictivedonor eligibility criteria and increasingly sensitivelaboratory techniques for donor screening.Blood is now so safe in the developed countries thatclassic approaches, such as prospective follow-up andretrospectivelook-backstudiesofrecipients orstudiesthat determine the frequency of missed infections inscreened donors, to measure transfusion risk arevirtually unable to document transfusion events. Riskestimates for the major viruses of concern, namely,human immunodeficiency virus (HIV), hepatitis Cvirus (HCV) and hepatitis B virus (HBV), are nowbased on mathematical models that integrate datafromfourpotentialsourcesofrisk:(i)markernegativewindow-phase donations, (ii) immune variant viralstrains, (iii) persistent antibody-negative (immunosi-lent)carriersand(iv)proceduraltestingerrors(Kleinman& Busch, 2000; Busch, 2001). These model-basedestimates indicate current residual risk for HCV, HIVand HBV as being 1:30 million, 1:8 million and 1:260000, respectively, in England (Soldan et al., 2003). InCanada,the residualriskfor HIV isestimatedas1/7 8million; for HBV, it is reported as 1/153 000 and forHCV, it is 1/2 3 million, which is lowered to 1/13million using nucleic acid techniques (NAT) (OBrienet al., 2007). In the United States, the recent reports men-tion 1:1 9 million for the HIV andHCVand1:205 000for HBV (Busch et al., 2005; Davenport & Mintz,2007).The exciting developments in transfusion medicinethathaveoccurredinthepastyearsrepresentprogressin transfusion practice only where it has beenimplemented and accessible. However, implementa-tion of these methods has brought limited safetyagainst significant expense. There is a growing dis-crepancyintheimplementationofthesedevelopmentsbetween the industrialized and the developing world.The underlying mechanisms are complex and dependon many factors such as infrastructure, cultural andbehaviouralcircumstances,humanresources,politicalstructure and economy.Transfusion-transmitted infections (TTI) thereforecontinue to be a serious problem in underdeveloped

Transfusion-transmitted infections among multitransfused patients in Iran: a review.

Introduction: This study was conducted to determine the current molecular prevalence of human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV), and human T lymphotropic virus-1/2 (HTLV-1/2) circulating among drug abuser inmates incarcerated in prisons located in Central Java, Indonesia. Methodology: Socio-epidemiological data and blood specimens were collected from 375 drug abuser inmates in four prisons. The blood samples were analyzed with serological and molecular testing for HIV, HBV, HCV, HDV, and HTLV-1/2. Results: The seroprevalence of HIV, HBsAg, HCV, HDV, and HTLV-1/2 in drug abuser inmates was 4.8% (18/375), 3.2% (12/375), 34.1% (128/375), 0% (0/375), and 3.7% (14/375), respectively. No co-infections of HIV and HBV were found. Co-infections of HIV/HCV, HIV/HTLV-1/2, HBV/HCV, HBV/HTLV-1/2, and HCV/HTLV-1/2 were prevalent at rates of 4% (15/375), 1.3% (5/375), 1.1% (4/375), 0.3% (1/375), and 2.1% (8/375), respectively. The HIV/HCV co-infection rate was significantly higher in injection drug users (IDUs) compared to non-IDUs. Triple co-infection of HIV/HCV/HTLV-1/2 was found only in three IDUs (0.8%). HIV CRF01_AE was found to be circulating in the inmates. HBV genotype B3 predominated, followed by C1. Subtypes adw and adr were found. HCV genotype 1a predominated among HCV-infected inmates, followed by 1c, 3k, 3a, 4a, and 1b. All HTLV-1 isolates shared 100% homology with HTLV-1 isolated in Japan, while all of the HTLV-2 isolates were subtype 2a. Conclusion: Drug abuser inmates in prisons may offer a unique community to bridge prevention and control of human blood-borne virus infection to the general community.

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Molecular epidemiology of HIV, HBV, HCV, and HTLV-1/2 in drug abuser inmates in central Javan prisons, Indonesia

The aim of the study was to assess the prevalence of HCV, HBV, and HIV infections among the patients with hemophilia Patients with Hemophilia A and B were evaluated who visited hospital for factor replacement therapy The viral markers tested in these patients included anti-HCV-Ab, HBsAg, and anti-HIV-Ab Seroprevalence was compared from 5717 exchange healthy blood donors for same markers A total of 173 multitransfused male hemophiliacs showed prevalence of 514% for HCV, 173% for HBV, and nil for HIV In blood donors seroprevalence was 19% for HCV, 181% for HBV, while no HIV-positive case was detected Prevalence of anti-HCV-Ab was significantly high in patients with hemophilia than normal donors (P = 0005) This study showed that HCV infection was more frequently identified than HBV and HIV infections in multitransfused hemophiliacs The frequency of hepatitis C among blood donors is also higher than that of hepatitis B which is showing downward trend

https://journals.sagepub.com/doi/pdf/10.1177/1076029611398122

Transfusion transmitted infections in patients with hemophilia of Karachi, Pakistan.

Prevalence of anemia and iron profile among children and adolescent with low socio-economic status.

Bilirubin encephalopathy/kernicterus is relatively rare, but continues to occur despite universal newborn screening. What is more interesting is the spectrum of clinical and even neuropathological findings that have been reported in the literature to be associated with bilirubin encephalopathy and kernicterus. In this review, the authors discuss the array of clinicopathological findings reported in the context of bilirubin encephalopathy and kernicterus, as well as the types of diagnostic testing used in patients suspected of having bilirubin encephalopathy or kernicterus. The authors aim to raise the awareness of these features among both pediatric neurologists and neuropathologists.

Clinicopathological Spectrum of Bilirubin Encephalopathy/Kernicterus.

Background: The aim of this study was to determine the iron status and the prevalence and risk factors of iron deficiency anemia (IDA) among adolescent girls in Central Jakarta, Indonesia. Methods: A cross-sectional study was conducted among 12- to 15-year-old girls studying in junior high schools that were categorized into high and low socioeconomic status (SES). Their menstrual and nutritional status, parents’ education level and income, and iron intake were assessed. Tuberculin test and assessments for C-reactive protein levels and hematologic and iron parameters were also conducted. Results: Iron status was normal in 69.3% of 163 subjects. The prevalence of non-anemic iron deficiency was higher (17.2%; 3.1% iron depletion and 14.1% iron deficiency) than that of IDA (13.5%). The prevalence of IDA was lower among girls from the high SES than that among girls from the low SES (11.5% and 15.8%, respectively). There was no significant relationship among IDA and nutritional status, menstrual status and characteristics, SES, iron intake, and parents’ education level and income; however, bioavailable iron intake in all subjects was found to be less compared to the recommended daily allowance (RDA). Conclusions: The higher prevalence of non-anemic iron deficiency than IDA is a potential risk factor for increasing the prevalence of IDA in the future. No significant relationship was found between IDA and its risk factors; however, iron intake was less compared to the RDA in all subjects, which requires further attention.

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Iron Status, Prevalence and Risk Factors of Iron Deficiency Anemia Among 12- to 15-Year-Old Adolescent Girls from Different Socioeconomic Status in Indonesia

This study compares the minimally invasive Bilistick and a noninvasive method with standard Total Serum Bilirubin (TSB) measurement in preterm newborns receiving phototherapy. We assess the agreement of Transcutaneous Bilirubinometer (TcB) and Bilistick bilirubin measurements with standard TSB measurement in preterm infants receiving phototherapy. Bilirubin was measured by using TcB and Bilistick in 94 preterm infants in RSCM Jakarta Neonatal Ward from October 2016 to March 2017, with gestational ages of < 35 weeks, before phototherapy and after 24 and 48 h of phototherapy. There was significant correlation before, at 24 and 48 h of phototherapy between TSB and either TcB (r = 0.874; r = 0.889; r = 0.878 respectively; p < 0.0001), or Bilistick (r = 0.868; r = 0.877; r = 0.918 respectively; p < 0.0001). The mean difference and limits of agreement before, at 24 and 48 h of phototherapy between TcB and TSB were 0.81 ± 1.51 mg/dL (− 2.14 to 3.77 mg/dL); 0.43 ± 1.57 mg/dL (− 2.66 to 3.51 mg/dL); 0.41 ± 1.58 mg/dL (− 2.69 to 3.50 mg/dL), respectively. For Bilistick they were − 1.50 ± 1.47 mg/dL (− 4.38 to 1.38 mg/dL); − 1.43 ± 1.47 mg/dL (− 4.32 to 1.46 mg/dL); − 1,15 ± 1.31 mg/dL (− 3,72 to 1,42 mg/dL), respectively. Both methods are reliable for measuring TSB before, during, and after phototherapy in preterm infants. TcB tends to overestimate while Bilistick underestimates TSB.

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Agreement test of transcutaneous bilirubin and bilistick with serum bilirubin in preterm infants receiving phototherapy

Indonesia consist of many island inhabited by many ethnic groups with different social economic condition. As in other parts of the world, anemia is still one of the major health problem in Indonesia. The reported anemia prevalence differs in each area and age groups, ranging from 5.4% in well nourished preschool children to 56.3% in primary school children; and 19% to 62.5% in pregnant women. The causes of anemia mostly reported were nutritional like iron deficiency, abnormal hemoglobin besides other conditions. In Cipto Mangunkusumo Hospital as the national referral hospital in Indonesia, in the adults groups, the cause of anemia reported were 14% with iron deficiency, 54% aplastic, 16% hemolytic and 16% other causes. Whereas in the child health department the cause were 29% nutritional deficiency, 31% thalassemia, 10% aplastic, 4% hemolytic and 26% other causes. Thalassemia is quite often reported in Indonesia. In 1955 Lie-Injo first reported the HbE as the most frequently found abnormality among many ethnic groups in Indonesia, ranging from 2.5% to 13.2%. In later studies the prevalence reported varies very much. It was reported as 9.5% in newborns, 22% in pregnant women, and 15.95% to 60% in athletes. The carrier frequency in some areas was between 6-10%, while the pattern of mutation varied widely within each region. Hemophilia cases in Indonesia is still not diagnosed adequately, only 530 cases were reported. The problems were lack of diagnostic laboratories and awareness. As many as 56.9% of the hemophilia patients who received cryoprecipitate were reported positive with HCV antibody. Hematological malignancy is now also became an increasing problem in Indonesia, in child health department the prevalence of leukemia was 57%, and lymphoma 13% among other malignancies. In National Cancer hospital, the prevalence leukemia as diagnosed using morphology and flowcytometry, were 51.4% AML, 19.7% B-ALL, 14.6% T-ALL, 4.5% preB-ALL, with 9.8% cases with co expression, and 30% other malignancies. Due to geographical situation, economic condition and lack of diagnostic laboratory facility many abnormalities were unable to be diagnosed properly.

Some hematological problems in Indonesia.

Background The treatment protocols of childhood acute lymphoblastic leukemia (ALL) have been improved. Some factors such as age, sex, and nutritional status could influence therapy outcome. Objective To study the survival differences among age, sex, and nutritional status groups in childhood ALL. Methods A retrospective Kaplan-Meier survival analysis of childhood ALL was performed in Cipto Mangunkusumo Hospital since January 1st 1998 until December 31st 2003. We excluded patients aged 2- 2- 0.05). Five-year-EFS of male and female subjects were 29% and 45% (P >0.05). Overall survival of well-nourished, undernourished, and malnourished patients were 42%50% and 57% respectively (P >0.05). The five-year-EFS of wellnourished, undernourished, and malnourished subjects were 33%,38%, and 51%, respectively (P >0.05). Conclusion Childhood ALL aged 1-2 years had the highest survival rate while those of 10-18 year old had the lowest. There were no survival rate differences between sex and nutritional status groups.

Survival and prognostic factors of childhood acute lymphoblastic leukemia

Latar belakang. Obesitas merupakan salah satu masalah gizi yang banyak ditemukan pada anak. Beberapa penelitian menunjukkan hubungan obesitas pada peningkatan risiko relatif beberapa keganasan. Keganasan yang paling sering ditemukan pada anak adalah leukemia limfoblastik akut. Bagaimana prognosis leukemia limfoblastik akut pada anak obes? Tujuan. Mengetahui prognosis pasien leukemia limfoblastik akut anak dengan obesitas. Metode . Studi deskriptif menggunakan data registrasi semua pasien baru leukemia limfoblastik akut pada 1 Januari 2007 – 31 Desember 2009 di Departemen Ilmu Kesehatan Anak FKUI/RSCM. Hasil. Selama penelitian tiga tahun didapatkan 12 pasien leukemia limfoblastik akut dan obesitas dengan prevalens 6,1%. Usia berkisar 2-14 tahun dengan rerata 6,4 tahun. Sembilan dari 12 pasien merupakan kelompok risiko tinggi dan sebagian besar (6 dari 9 pasien) datang dengan jumlah rerata leukosit adalah 101.650/mm3 (66.700-159.000/mm3). Remisi pada fase induksi didapatkan pada 10 dari 12 pasien. Relaps terjadi pada tiga pasien, semuanya terjadi pada fase pemeliharaan dengan tempat relaps adalah sumsum tulang (dua pasien) dan intrakranial (satu pasien). Dua dari tiga subjek penelitian yang relaps, meninggal dunia dengan penyebab kematian perdarahan intrakranial. Kesimpulan. Obesitas mempengaruhi prognosis pada pasien leukemia limfoblastik akut anak.

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Endang Windiastuti

Papers

Iron Status, Prevalence and Risk Factors of Iron Deficiency Anemia Among 12- to 15-Year-Old Adolescent Girls from Different Socioeconomic Status in Indonesia

Agreement test of transcutaneous bilirubin and bilistick with serum bilirubin in preterm infants receiving phototherapy

Some hematological problems in Indonesia.

Survival and prognostic factors of childhood acute lymphoblastic leukemia

Prognosis Leukemia Limfoblastik Akut pada Anak Obes