Authors:Aphisit Thongthaisin, Duangnapa Intharasongkroh, Pokrath Hansasuta, Jettawan Siriaksorn, Pawinee Kupatawintu, Sasitorn Bejrachandra Pages: 99 - 109 Abstract: Abstract: Introduction: National Blood Centre, Thai Red Cross Society screens blood samples from every donor for HIV with both serological test and nucleic acid testing (NAT). Potential elite controllers (EC) are donors who tested repeatedly reactive by serology, but non-reactive by NAT. There is no study in Thailand to date to find the cause of this group’s test results whether they are due to genetics (true EC) or antiretroviral therapy (ART) drugs (false EC). Objective: To assess the prevalence of HIV false EC in Thai blood donors who tested reactive by serology, but non-reactive by NAT. Materials and Methods: Seventy stored frozen plasma samples from potential EC collected during July to December 2021 were tested for nucleoside reverse transcriptase inhibitors (NRTIs). Positive samples were further tested for non-nucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors (PIs). In addition, Geenius HIV-1/2 confirmatory assay was also performed for all samples. Results: Of 70 potential ECs from total of 315,170 donors (0.02%) during that period, there was one sample (1.43%) that tested positive for NRTIs (tenofovir and emtricitabine). Efavirenz was also found on further testing for NNRTIs. Geenius HIV-1/2 confirmatory assay was positive for HIV-1. Of 69 potential ECs negative for NRTIs, there was 1 sample (1.45%) tested positive for HIV-1, 2 samples (2.90%) tested indeterminate for HIV-2 and 1 sample (1.45%) that tested indeterminate for HIV-1 by Geenius HIV-1/2 confirmatory assay. Conclusion: The prevalence of false EC due to NRTIs treatment was only 1.43% in HIV serology reactive Thai blood donors and should be further study for the human genetics that may be involved with this group. บทคัดย่อ บทนำ ศูนย์บริการโลหิตแห่งชาติ สภากาชาดไทย ตรวจคัดกรองตัวอย่างโลหิตจากผู้บริจาคโลหิตทุกคน ด้วยทั้งวิธีน้ำเหลืองวิทยา และการตรวจหาสารพันธุกรรม ผู้บริจาคโลหิตที่อาจเป็นอีลีทคอนโทรลเลอร์ คือผู้บริจาคที่ผลตรวจน้ำเหลืองวิทยาให้ผลบวกซ้ำ แต่การตรวจหาสารพันธุกรรมให้ผลลบ และยังไม่มีการศึกษาในประเทศไทยถึงสาเหตุของกลุ่มนี้ว่ามาจากพันธุกรรม (อีลีทคอนโทรลเลอร์จริง) หรือการใช้ยาต้านไวรัส (อีลีทคอนโทรลเลอร์ปลอม) วัตถุประสงค์ เพื่อหาความชุกของอีลีทคอนโทรลเลอร์ปลอมในผู้บริจาคโลหิตชาวไทยที่ผลการตรวจด้วยวิธีน้ำเหลืองวิทยาให้ผลบวก แต่การตรวจหาสารพันธุกรรมให้ผลลบ วัสดุและวิธีการ ตัวอย่างพลาสมาแช่แข็งจากผู... PubDate: 2022-06-27 Issue No:Vol. 32, No. 2 (2022)
Authors:Supaporn Maneewan, Wilaivan Nachatree, Pimpilalai Choothanorm, Suparat Burananayok, Chaninporn Yodsawad, Praopim Limsakul, Krit Charupanit Pages: 111 - 119 Abstract: Introduction: Blood donation is a common and important practice to provide blood for the saving of lives in medicine. Although several measures have been used to ensure the safety of both blood donors and recipients, there is still a small proportion of blood donors encountering unwanted post-donation complications, including, delayed bleeding, bruising, and hematomas. One of the causes for these unwanted complications is due to an incomplete or incorrect stop bleeding procedure. Objective: To reduce the possibility of complications, we designed equipment that produces an appropriate force to prevent bleeding of the venipuncture at the antecubital fossa from blood donations in the form of an adjustable armband. Materials and Methods: The armband was designed using the actual pressing force for stop bleeding of the venipuncture from a group of 63 experienced donors and evaluated the reliability with 424 practices in real practices. Results: The armband creates 1.6 N/cm2, which was measured from experienced donors. The armband is adjustable for different arm sizes, providing an appropriate generated force. Use of proper force can reduce the chances of adverse complications to 1.2% comparing to the prior study of the conventional stop bleeding method at 3.4%. Surprisingly, the armband can prevent all cases of delayed bleeding (0.8% found in the conventional stop bleeding method). In addition, the average deterioration of the armband was 1.6%, after 250 times of usage in real practice. Conclusion: The stop bleeding armband is effective in preventing bleeding of a venipuncture from the blood donation process, and it can reduce the number of occurred complications by generating an appropriate force. บทคัดย่อ บทนำ แม้ว่าการบริจาคเลือดจะมีหลายกระบวนการที่สำคัญเพื่อความปลอดภัยของผู้บริจาคโลหิตและผู้รับโลหิต แต่ก็ยังมีเหตุการณ์ไม่พึงประสงค์เกิดขึ้นกับผู้บริจาคโลหิต เช่น รอยฟกช้ำ หรือ เลือดไหลหยุดช้า ซึ่งหนึ่งในสาเหตุคือการหยุดเลือดที่ไม่สมบูรณ์ หรือไม่เหมาะสม วัตถุประสงค์ เพื่อลดการเกิดเหตุการณ์เหล่านี้ จึงมีการออกแบบสายรัดห้ามเลือดให้สายรัดสามารถปรับเปลี่ยนความยาวได้และสร้างแรงกดที่เหมาะสมในการกดห้ามเลือดในแผลที่เกิดจากการเจาะเลือด วัสดุและวิธีการ สายรัดถูกออกแบบให้สร้างแรงกดได้ใกล้เคียงกับแรงกดเฉลี่ยที่วัดมาจากผู้บริจาคเลือดจำนวน 63 คน จากนั้นสายรัดได้ทดสอบในการใช้งานจริงจำนวน 424 ครั้ง ผลการศึก... PubDate: 2022-06-27 Issue No:Vol. 32, No. 2 (2022)
Authors:Suwimon Poopean, Parichart Permpikul, Komgrid Changkaew, Nusara Chomanee, Komon Luangtrakool Pages: 121 - 129 Abstract: Abstract: Introduction: Platelet has a discoid shape and changes its shape upon stimulation and activation. In the past, platelet shape can be visualized by the electron microscope or phase-contrast microscope. Currently, the image from a light microscope can be further magnified by a digital camera. We explored the utility of Wright’s stain platelet smear examined under a light microscope to evaluate the extent of shape change and compared it with pH and swirling which are the current platelet product QC tools. Materials and Methods: We evaluated 72 platelet-rich plasma platelet (PRP-PC) products, 72 buffy coat derived platelets (BC-PC) products, and 72 apheresis platelet (AP-PC) products at day 3 of storage. We evaluated the proportion of discoid platelet from the Wright’s stain platelet smear and compared it with pH and swirling score. Results: Wright’s stain platelet smear enables visualization of platelet shape under a light microscope and can discriminate discoid-shaped platelets from other activated shapes. BC-PC had a higher proportion of discoid platelet compared with PRP-PC and AP-PC (p < 0.05). The proportion of discoid platelets and swirling score were significantly different between platelet products of different ranges of pH (p < 0.05). The reliability of the proportion of discoid platelet is good for both intra-observer (r = 0.98) and inter-observer (r = 0.99). Conclusion: Wright’s stain platelet smear visualized under a light microscope is simple, affordable, and requires limited resources to visualize platelet shape change. The proportion of discoid platelets was correlated with the current platelet QC in blood bank. This method is an alternate tool for in-process monitoring, or the development of a better method to produce platelets. บทคัดย่อ บทนำ เกล็ดเลือดซึ่งในภาวะปกติมีรูปร่างเป็น discoid จะมีการเปลี่ยนแปลงรูปร่างเมื่อมีแรงกระแทกหรือมีการกระตุ้นการทำงานของเกล็ดเลือด ในอดีตการสังเกตรูปร่างเกล็ดเลือดต้องใช้กล้องจุลทรรศน์อิเล็กตรอนหรือกล้องจุลทรรศน์เฟสคอนทราสต์ ในปัจจุบันมีการพัฒนาการใช้กล้องจุลทรรศน์แบบใช้แสงที่สามารถขยายวัตถุได้มากขึ้นเพราะมีการใช้กล้องดิจิตอลมาประกอบ การศึกษานี้ได้ทดลองใช้การย้อมสีไรท์และสังเกตรูปร่างเกล็ดเลือดที่เก็บรักษาไว้ในวันที่สามนำมาเปรียบเทียบกับวิธีการตรวจสอบคุณภาพเกล็ดเลือดที่ใช้ในงานบริการ วัสดุและวิธีการ ผู้ทำการศึกษาทำการประเมินคุณภาพเกล็ดเลือดที่ผลิตจากวิธี platelet rich plasma (PRP-PC), buffy coat method (BC-PC) และเกล็$... PubDate: 2022-06-27 Issue No:Vol. 32, No. 2 (2022)
Authors:Nassawee Vathana, Jassada Buaboonnam, Kleebsabai Sanpakit, Nattee Narkbunnam, Kamon Phuakpet, Bunchoo Pongtanakul, Phakatip Sinlapamongkolkul, Chayamon Takpradit Pages: 131 - 138 Abstract: Background: While adult patients with relapse or refractory (R/R) CD30+ lymphoma can be successfully treated with brentuximab vedotin (BV), an anti-CD30 monoclonal antibody, clinical results in pediatric patients are scarce. Here, we report the outcomes of children with R/R CD30+ lymphoma treated with BV. Methods: Patients with R/R treated with a BV-based regimen were retrospectively included. This was a BV intravenous drip for 1 hr on day 1, 1.4 mg/kg at first dose, titrated up to 1.8 mg/kg in subsequent doses every 21 days, combined with chemotherapy. Those with complete response (CR) underwent autologous hematopoietic stem cell (autoHSCT) transplant, followed by 16 courses of BV monotherapy as a maintenance therapy. Results: Of all 6 patients, 4 had Hodgkin lymphoma (HL), and 2 had anaplastic large cell lymphoma (ALCL). Median age at diagnosis was 12.3 (6.6-13.4) years. Four patients (3 HL, 1 ALCL) achieved CR and subsequently underwent autoHSCT with the median dose to CR of 3 (2-4); the other 2 patients attained partial response. All received maintenance monotherapy BV, without evidence of relapse: total median BV doses being 12 (6-16). Pancreatitis grade 3 was observed in 1 patient in the third BV course. Nontuberculous mycobacterial infection was diagnosed in the 1 patient in the fifth BV course. Conclusion: As a salvage treatment for CD30+ lymphoma in children, BV appears to show promise, but a larger cohort is warranted to better elucidate the clinical outcomes. PubDate: 2022-06-27 Issue No:Vol. 32, No. 2 (2022)
Authors:Nisa Makruasi, Tanaya Siripoon, Rutchaporn Taweerutchana, Supap Makruasi Pages: 139 - 148 Abstract: Abstract: Background: Anemia is a common problem in type 2 diabetes mellitus (DM). The prevalence of anemia in moderate renal impairment (glomerular filtration rate; GFR 15-59 mL/min/1.73m2) was found predominantly among patients coexisting with type 2 DM compared with no type 2 DM. Related studies reported several factors such as diabetic retinopathy (DR), diabetic nephropathy (DN), erythropoietin resistance, obesity, metformin use and hyperglycemia associated with anemia. Identifying risk factors related to anemia may improve patient outcomes. Objectives: The study aimed to determine the risk factors associated with anemia in type 2 DM coexisting with moderate renal impairment. Material and Methods: Medical records of diabetic patients visiting the HRH Princess Maha Chakri Sirindhorn Medical Center from 2009-2014 were gathered and reviewed as a retrospective cross-sectional study. Anemia was defined as hemoglobin (Hb) less than 13 g/dL among males and 12 g/dL among females. Results: From 699 medical records, 120 participants (17.7%) with moderate renal impairment were included in the study. Sixty-five (54.2%) of 120 patients had anemia. The median age of patients was 62.3 years (43-86). The complications of type 2 DM included DN 92 (76.7%) and DR 15 (12.5%). Mean Hb was 12.4 g/dL (8.9-17.6) and mean GFR was 48.5 mL/min/1.73m2 (15.6-59.9). Females (p = 0.001), and DR (p= 0.05) were risk factors associated with anemia, after multivariate analysis. Conclusion: Anemia was found in 54.2% of diabetic cases. Females and DR were risk factors associated with anemia in type 2 DM with moderate renal function. PubDate: 2022-06-27 Issue No:Vol. 32, No. 2 (2022)
Authors:Wannaphorn Rotchanapanya, Peter Hokland, Chureerat Chantharat, Natheeporn Kobpungton, Aekkaphod Liwatthanakun, Weerapat Owattanapanich Pages: 157 - 163 Abstract: Background: Primary splenic lymphoma has been reported as a rare subtype of non-Hodgkin lymphoma. The common presentations are splenomegaly and splenic mass and this malignancy is extremely rare to diagnose from splenic infarction. Case presentation: A 47-year-old Thai female presented acute abdominal pain for 1 week and fever with thrombocytopenia for 2 days. Her fever failed to respond to antibiotics, and she continued to experience constant high grade fever with abdominal pain. She was followed up by physical examination, and developed progressive splenomegaly 5 cm below the left costal margin. Her serological workups for endemic tropical infections and microbiological results were all negative. A bone marrow study did not reveal an aggregation of lymphoid cells. A contrast abdominal computed tomography was repeated; although it did not detect any lymphadenopathies or masses; it found progressive hepatosplenomegaly and splenic infarction. To make a differential diagnosis between splenic infarction and splenic collection, an ultrasound guided percutaneous splenic biopsy was performed. Histological analysis of the splenic biopsy revealed few small aggregates and infiltration of large atypical lymphoid cells with mild degree of nuclear pleomorphism. The nuclei are hyperchromatic with scant cytoplasm and an irregular nuclear outline. Mitotic figures are frequently observed. The red pulps are congested with a focal infarct area. The focal aggregates of atypical lymphoid cells-CD20(+), CD3(-), cyclin D1(-), CD10(-), BCL6(-), and MUM1(+)-with Ki-67 show high activity in more than 80% of tumor cells. This finding was consistent with diffuse large B-cell lymphoma, nongerminal center subtype. Conclusion: In patients with progressive splenomegaly and splenic infarction, Carrying out a differential diagnosis of aggressive lymphomas would be important. In addition to splenectomy, a percutaneous fine needle biopsy of the spleen can help make a definite diagnosis of primary splenic lymphoma. PubDate: 2022-06-27 Issue No:Vol. 32, No. 2 (2022)
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