Fahd A. Kuriri

Background: Persistent microcytosis in adults with normal or only mildly reduced haemoglobin usually prompts investigation for iron deficiency or thalassaemia trait. In some patients, however, the cause remains uncertain despite haemoglobin fractionation and targeted molecular testing. Case Presentation: An asymptomatic adult male had longstanding microcytosis, with haemoglobin of 13.6 g/dL, a red blood cell count of 5.67 × 10⁶/μL, and a mean corpuscular volume of 72 fL. Serum iron was low, but ferritin remained within the reference range at 100.5 ng/mL. Haemoglobin fractionation showed HbA₂ of 2.4% and HbF below 1%, without an abnormal fraction. Multiplex PCR, sequencing of HBA2, HBA1, and HBB, and MLPA of the alpha-globin gene cluster identified no causative deletion, sequence variant, or copy-number change within the scope of testing. Rare or untested mechanisms remained possible. Empirical iron treatment was not initiated. Interpretation: The longstanding microcytosis, relatively preserved red blood cell count, normal HbA₂ and HbF, and preserved ferritin were consistent with a thalassaemia-like phenotype. Classical raised-HbA₂ beta-thalassaemia trait was considered less likely. An inherited alpha-globin abnormality or another disorder of haemoglobin synthesis remained possible, although it could not be confirmed. The preserved ferritin made absolute iron deficiency less likely, but iron-restricted erythropoiesis could not be excluded because additional iron studies were unavailable. Conclusion: This case highlights the difficulty of interpreting a stable microcytic phenotype when molecular testing does not establish a causative abnormality. Molecular findings should be considered alongside the longitudinal haematological pattern and interpreted within the analytical scope of the methods used. Iron treatment should be reserved for patients in whom iron deficiency has been demonstrated by appropriate testing.

Transfusion-related acute lung injury (TRALI) remains one of the most serious yet often overlooked complications of blood transfusion, contributing to significant morbidity and mortality worldwide. It manifests as acute respiratory distress and non-cardiogenic pulmonary edema within 6 hours of transfusion, requiring immediate recognition and intervention. However, diagnosing TRALI is complex, as its clinical presentation overlaps with other causes of acute lung injury, and its underlying mechanisms remain incompletely understood. This review examines the global burden of TRALI, shedding light on underreporting issues, particularly in resource-limited settings where surveillance systems are inadequate. It explores both antibody-dependent and antibody-independent pathways, focusing on neutrophil activation, inflammatory mediators, and donor-specific factors that drive TRALI pathogenesis. While leukoreduction and improved donor selection have contributed to risk reduction, challenges persist, including the absence of standardized diagnostic criteria, gaps in data from low-income regions, and a lack of reliable biomarkers for early detection. Despite advances in understanding TRALI, more research is needed to refine diagnostic tools, enhance blood product safety, and develop targeted preventive strategies. By addressing these gaps, we can improve transfusion safety and patient outcomes on a global scale, ensuring that life-saving transfusions do not come with life-threatening risks.

Aim: This study aimed to examine the link between C-reactive protein (CRP), serum iron, and hematological indices in a cohort from a Saudi hospital, with a focus on inflammation-induced hypoferremia. Methods: A retrospective cross sectional study was carried out involving 2478 patients attending a tertiary care hospital in Saudi Arabia during the period January 2023 through December 2024. C-reaction are protein serum, iron and hematological indices were measured by immunoturbidimetric and colorimetric methods. Results: There was a marked negative correlation between CRP and serum iron concentration. As CRP levels increased, serum iron concentration decreased significantly, with a mean serum iron concentration of 14.2 μmol/L in the high CRP group, compared to 21.5 μmol/L in the low CRP group (p < 0.01). Notably, CRP emerged as an independent variable correlated with serum iron levels, emphasizing its role in inflammation-induced changes in iron metabolism. The other correlation with serum ferritin and red cell distribution width is also in accordance to the impact of inflammation on hematological indices. There were differences in serum iron between genders, but the correlation between CRP and serum iron level was consistent in both genders. Conclusion: This research highlights the role of chronic inflammation in hypoferremia and emphasizes the significance of CRP as a key marker of inflammation, which impacts iron metabolism. The findings have implications in explaining the aspects of anemia of chronic disease (ACD) and underline the need for integrating markers of inflammation in the assessment and management of Anemia. Further studies are needed to explore novel therapeutic approaches targeting hepcidin and cytokine pathways.

Blood donation plays a critical role in healthcare systems by supplying blood and blood products for surgeries, emergency care, and chronic disease management. In Saudi Arabia, the prevalence of genetic disorders, like sickle cell disease and thalassemia, further increase the need for a stable blood supply. However, high rates of donor deferrals remain a significant barrier to maintaining a reliable blood supply. This study aims to analyse the main factors contributing to blood donor deferrals at King Fahad Hospital Al Hofuf between January 2023 and August 2024. By identifying and correlating key deferral reasons with donor demographics, the study seeks to provide actionable insights to reduce deferral rates and enhance donor retention. This retrospective observational study analysed blood donation records of 21,149 donors, including both eligible and deferred individuals. Demographic data (age, gender, nationality) and medical assessments (hemoglobin levels, blood pressure) were collected and analysed to identify deferral trends. Descriptive and inferential statistics were applied to assess the relationships between donor characteristics and deferral reasons, with chi-square tests and logistic regression used to identify predictors of deferral. Data analyses showed that 89.5% of deferred donors were male, with the largest group of deferrals aged 21-30 years. Low hemoglobin was the most common deferral reason, affecting 27.5% of all deferred donors, with female donors disproportionately affected by anemia-related deferrals. Male donors were more frequently deferred for aspirin use (13.2%) and blood pressure issues (15.9%). Seasonal trends showed deferral peaks in January and November, while the highest donation rates were recorded in April and October. Addressing the higher rates of deferral due to low hemoglobin and cardiovascular issues through targeted public health interventions could significantly improve donor retention and ensure a more reliable blood supply. Implementing iron supplementation programs for female donors and cardiovascular health screenings for male donors could reduce deferral rates.

Objective. Blood donation is critical in Saudi Arabia due to high rates of sickle cell disease and thalassemia. Recent trends show a decline in the number of blood donors, threatening blood supplies for medical treatments. This study aims to identify factors that influence blood donation decisions and behaviors among young Saudi Arabian adults to develop strategies to enhance donation rates. Methods. A cross-sectional study was conducted with 407 university students in Riyadh Province (Shaqra, Riyadh City, Al-Majmaah and Al-Duwadimi) and occurred from December 2022 to May 2023, using convenience sampling. Data were collected via online questionnaires and analyzed using logistic regression. Results. Findings revealed a significant gender disparity in donation rates with males more likely to donate. Knowledge gaps were prevalent, especially regarding eligibility criteria. Support for organ donation, prior experience of receiving blood, and high levels of self-determined motivation positively associated with donation likelihood. Conversely, amotivation was a strong negative predictor of donation. Conclusion. This study highlights the importance of educational interventions to address misconceptions about blood donation and tailor campaigns to enhance donor motivation. Strategies focusing on these aspects could improve the donor pool and ensure a stable blood supply for patients with blood disorders in Saudi Arabia.

Background: In Al-Ahsa, Saudi Arabia, the high consanguinity rates contribute to the prevalence of inherited hemoglobinopathies such as sickle cell disease and thalassemia, which frequently require blood transfusions. These transfusions carry the risk of alloimmunization, necessitating a precise blood component matching to mitigate health risks. Local antigen frequency data is vital for optimizing transfusion practices and enhancing the safety of these medical procedures for the Al-Ahsa population. Methods: This study investigated the distribution of Duffy, Kidd, Lewis, and Rh blood group antigens in 1,549 individuals from the region; comparing the frequencies with global data. Results: Serological analyses revealed a high prevalence of the Fy(a+b-) and Jk(a+b+) phenotypes in the Duffy and Kidd blood groups, respectively, with Jk(a-b-) being notably scarce. The Lewis blood group exhibited a significant presence of Le(a-b+) and Le(a+b-) phenotypes, whereas Le(a+b+) was less common. In the Rh system, the D antigen was most prevalent, with other antigens following in descending order of frequency. Conclusions: The study underscores the regional variation in antigen frequencies, emphasizing the need for local blood banks to adapt their screening and matching practices to mitigate the risk of alloimmunization and enhance transfusion safety. These findings are pivotal for refining transfusion strategies and understanding the immunohematology landscape in Al-Ahsa.

This article provides an overview of conventional, new, and future treatment options for sickle cell disease (SCD), a genetic disorder affecting the production of hemoglobin. Current treatments include hydroxyurea, a conventional SCD treatment that increases the levels of fetal hemoglobin, and new treatments such as voxelotor, a recently approved SCD treatment that selectively binds hemoglobin, preventing formation of sickled red blood cells. In addition to discussing the mechanisms of action of current SCD treatments, potential side effects are also discussed, highlighting the need for new treatments that can address the limitations of current treatments and improve the quality of life for people with SCD. Future treatments, such as gene therapy, are also explored as promising treatment options for SCD patients.

Achillea fragrantissima, a desert plant commonly known as yarrow, is traditionally used as an antimicrobial agent in folklore medicine in Saudi Arabia. The current study was undertaken to determine its antibiofilm activity against methicillin-resistant Staphylococcus aureus (MRSA) and multi-drug-resistant Pseudomonas aeruginosa (MDR-P. aeruginosa) using in vitro and in vivo studies. A biofilm model induced through an excision wound in diabetic mice was used to evaluate its effect in vivo. The skin irritation and cytotoxic effects of the extract were determined using mice and HaCaT cell lines, respectively. The Achillea fragrantissima methanolic extract was analyzed with LC-MS to detect different phytoconstituents, which revealed the presence of 47 different phytoconstituents. The extract inhibited the growth of both tested pathogens in vitro. It also increased the healing of biofilm-formed excision wounds, demonstrating its antibiofilm, antimicrobial, and wound-healing action in vivo. The effect of the extract was concentration-dependent, and its activity was stronger against MRSA than MDR-P. aeruginosa. The extract formulation was devoid of a skin irritation effect in vivo and cytotoxic effect on HaCaT cell lines in vitro.

Introduction. The risk of developing transfusion-related complications, especially alloimmunization, is an ongoing concern for transfusion-dependent patients. It is important to determine the rate of alloimmunization and autoimmunization in Al-Ahsa Region, Saudi Arabia, where sickle cell disease (SCD) and thalassemia incidence rates are the highest in Saudi Arabia. Methods. A cross-sectional study was conducted to review the transfusion history of patients with SCD and thalassemia at the King Fahad Hospital (KFH) in Al-Ahsa, Saudi Arabia. 364 transfusion-dependent patients were included in this study. Results. Alloimmunization rates in patients with SCD and thalassemia were 16.7 and 11.97, respectively, while autoimmunization rates in patients with SCD and thalassemia were 5.3 and 0.7, respectively. The most frequent alloantibodies among the study participants were against Kell, Rh blood group systems. Conclusion. Blood transfusion-related alloimmunization and autoimmunization compromise the proper management of chronically transfused patients. Ideally, extended matched phenotyping should be implemented to prevent alloimmunization and reduce the risk of developing blood transfusion-related alloantibodies.

The study developed a simple and inexpensive method to induce biofilm formation in-vivo for the evaluation of the antibiofilm activity of pharmacological agents using Swiss albino mice. Animals were made diabetic using streptozocin and nicotinamide. A cover slip containing preformed biofilm along with MRSA culture was introduced into the excision wound in these animals. The method was effective in developing biofilm on the coverslip after 24 h incubation in MRSA broth which was confirmed by microscopic examination and a crystal violet assay. Application of preformed biofilm along with microbial culture induced a profound infection with biofilm formation on excision wounds in 72 h. This was confirmed by macroscopic, histological, and bacterial load determination. Mupirocin, a known antibacterial agent effective against MRSA was used to demonstrate antibiofilm activity. Mupirocin was able to completely heal the excised wounds in 19 to 21 days while in the base-treated group, healing took place between 30 and 35 days. The method described is robust and can be reproduced easily without the use of transgenic animals and sophisticated methods such as confocal microscopy.