Nora Yahia Hakami

Background/Objectives: Grey zone serologic results in blood donor screening pose challenges for transfusion safety, donor management, and blood supply sustainability. In Saudi Arabia, standardized national protocols for managing grey zone outcomes remain lacking. This study aimed to evaluate the prevalence and follow-up outcomes of grey zone serologic results among blood donors at a Saudi hospital over a five-year period. Methods: Serological screening results of six transfusion-transmissible infections (TTIs) markers were extracted alongside nucleic acid testing (NAT) results for HBV, HCV, and HIV. The grey zone was defined as a signal-to-cutoff (S/CO) of 0.90–0.99. Repeat and follow-up results, including subsequent donations, were assessed for seroconversion. Results: A total of 48,241 donations from 38,524 donors were analyzed. Anti-HBc showed the highest reactivity (n = 2312; 4.8%), followed by HbsAg (n = 2292; 0.31%) and syphilis (n = 218; 0.5%). Grey zone results were rare, and most frequent in anti-HBc (n = 76; 0.16%), HCV (n = 39; 0.08%), and HBsAg (n = 28; 0.06%). Grey zone-to-reactive conversion upon subsequent donation was rare. Three donors who initially tested in the grey zone for anti-HBc later tested reactive in subsequent donations, but their HBV NAT remained negative. Conclusions: While grey zone outcomes were infrequent, a subset involving HBV markers showed low-level reactivity on repeat testing. For other TTIs markers, grey zone results likely reflected assay variability rather than true infection. We propose a six-month temporary deferral with follow-up serologic and NAT testing, allowing conditional re-entry for donors with consistently non-reactive results, supporting both transfusion safety and a more sustainable donor pool.

Purpose: Classical Hodgkin Lymphoma (CHL) is a highly curable malignant disease of the lymphoid system. However, some patients may experience a clinical relapse. Biological marker expression may help to predict disease outcomes and guide salvage treatment options. CD20 expression occurs in approximately 30% of CHL cases. The clinical outcomes of patients with CHL and CD20 positivity remain controversial. Therefore, this study aimed to determine the prognostic value of CD20 expression in CHL patients. Patients and Methods: This retrospective study included 52 patients with CHL between 2017– 2023 with a median follow-up of 60 months (range: 24– 72 months). Immunohistochemistry was performed on formalin-fixed, paraffin-embedded tissue biopsies to assess CD20 expression. Chi-square and Fisher’s exact tests were used to analyze categorical data and determine significant differences between the CD20 expression status groups. Overall survival (OS) and Progression-Free Survival (PFS) were assessed using Log rank test. Statistical significance was set at p < 0.05. Results: Of 52 CHL patients, 11 (21.2%) showed CD20-positive Hodgkin Reed-Sternberg (HRS) cells. Most parameters showed no significant differences between the CD20-positive and CD20-negative groups, except for serum albumin level (p = 0.042). Log-rank analysis for OS and PFS revealed no significant differences between the groups. Conclusion: CD20 expression in the HRS cells of CHL patients was not significantly associated with clinical outcomes. Further studies with larger patient populations and extended follow-up periods are required to validate these findings.

Purpose: Jazan Province in Saudi Arabia is notable for its high prevalence of inherited hemoglobinopathies, including sickle cell disease and thalassemia, necessitating frequent blood transfusions for affected individuals. To mitigate risks such as RBC alloimmunization and hemolytic transfusion reactions, ensuring blood compatibility is crucial. The Kell (KEL) blood group system, pivotal alongside the ABO and RH systems, encompasses multiple antigens implicated in these complications. This study aimed to investigate the frequencies of KEL blood group antigens (K, k, Kpa, and Kpb) and determine KEL phenotypes (K/k and Kpa/Kpb) among Saudi blood donors living in Jazan Province. Methods: A total of 138 anonymous healthy Saudi blood donors from Prince Mohammed bin Nasser Hospital in Jazan Province, Saudi Arabia, were enrolled in this study. Anticoagulated blood was analyzed using the gel card technique to assess K, k, Kpa, and Kpb antigens. Results: The prevalence of KEL antigens was as follows: K (n = 9, 6.52%), k (n = 137, 99.28%), Kpa (n = 1, 0.72%), and Kpb (n = 138, 100%). KEL phenotypes observed were K+k+ (n = 8, 5.80%), K+k− (n = 1 0.72%), K−k+ (n = 129, 93.48%), Kp(a+b+) (n = 1, 0.72%), and Kp(a−b+) (n = 137, 99.28%). Conclusion: This study provides insights into the prevalence of KEL blood group antigens and phenotypes in Jazan Province, Saudi Arabia. These findings may contribute to the establishment of a national blood group database and guide transfusion practices to ensure compatibility and minimize alloimmunization risks.

Background: Platelets are a commonly used blood component to prevent or treat bleeding in patients with thrombocytopenia or platelet dysfunction. They are stored at room temperature (22– 24°C) for five days unless specific measures are taken to extend the shelf life to seven days or more. After five days, this study evaluated platelet units’ biochemical changes and bacterial growth. Study Design and Methods: Platelet concentrate was collected from 30 random donors: 8 females and 22 males. The collected samples were then placed on an agitator at room temperature and tested for their pH, protein content, and glucose levels using Roche Combur 100 Test^® Strips. The Haemonetics eBDS™ System was used for bacterial detection. The measurements were taken on day five as the control and then repeated on days 7, 9, and 11 to observe any changes. On days 5 and 7, all parameters remained unchanged. However, glucose levels significantly changed (p=< 0.0001) on days 9 and 11. Regarding pH, a significant change was observed on day 9 (p=0.033) and day 11 (p=0.0002). Results: There were no significant changes in all parameters on days 5 and 7. However, glucose was substantially changed (p=< 0.0001) on days 9 and 11. For pH, there was a significant change in pH on day 9 (p=0.033) and day 11 (p=0.0002). Discussions: Our study found that platelet concentrate extension is possible for up to seven days. However, further studies are needed to evaluate platelet function during expiry time and to assess the stability of platelet morphology and function.

Blood is vital fluid where cellular components are suspended within a non-cellular liquid matrix. The dysfunction or deficiency of these cellular components can cause serious morbidity and even mortality. Meanwhile, transfusion of blood components serves as a cornerstone during surgery, myelosuppression, and congenital disorders of the blood. However, donor-derived blood products are hindered by several challenges such as scarcity of supply, the requirement for matching, significant risks of pathogenic contamination, restricted shelf-life, and several other negative consequences. Currently, ongoing research focuses on addressing these issues, clinical interests have emerged in the bioengineering of artificial blood substitutes, aiming to mimic natural blood while avoiding the aforementioned concerns. Nanotechnology has offered innovative methods, including the development of synthetic red blood cells (RBCs) substitutes for oxygen transport, synthetic platelet substitutes for hemostasis, and synthetic white blood cells (WBCs) substitutes for immune responses. The study presents an overview of the role of nanotechnology in the production of synthetic blood substitutes, as well as an evaluation of the achievements and limitations of the existing state-of-the-art in this area. One area of research currently focuses on using cell culture technologies to make blood cells from stem cells, while another is investigating the use of nanotechnology to create blood cell replacements. In the near future, the product of ongoing research as well as comprehensive preclinical and clinical evaluations might lead to fully synthetic blood replacements for transfusion. Nanotechnology has offered a new perspective on the concept of artificial blood substitutes.

Patient blood management (PBM) is a comprehensive approach to optimizing the care of patients who might need a transfusion. It involves the use of evidence-based strategies to reduce or avoid the need for allogeneic blood transfusions while ensuring that patients receive safe and appropriate care. PBM includes strategies such as preoperative autologous donation, intraoperative cell salvage, and minimally invasive techniques to reduce bleeding. The purpose of this study is to assess the medical staff’s awareness of preoperative PBM in Saudi Arabia. Between April 2022 and July 2022, data was collected using a 10-minute online (Google Forms) self-administered, anonymous, researcherstructured questionnaire adapted from previous studies and translated into both English and Arabic. The questionnaire was divided into three sections. The first section contained sociodemographic data, while the second section was used to estimate physicians’ and nurses’ knowledge of preoperative PBM. Two questions in Part 3 of the questionnaire were used to assess doctors’ and nurses’ preoperative PBM attitudes and practices. The average relationship between patients’ blood management attitudes and levels of awareness. It was revealed that there was a positive attitude (P≤0.005) as well as a high level of awareness (P≤0.002). The effect of job, gender, or geographical distribution on PBM awareness, attitude, and practice was not significant. Despite the fact that the majority of participants have a positive attitude and good awareness of PBM, more efforts should be implemented to improve PBM awareness, which was linked to increased transfusion practices and lower product costs.

The genus Aeromonas is widely distributed in aquatic environments and is recognized as a potential human pathogen. Some Aeromonas species are able to cause a wide spectrum of diseases, mainly gastroenteritis, skin and soft-tissue infections, bacteremia, and sepsis. The aim of the current study was to determine the prevalence of Aeromonas spp. in raw fish markets and humans in Zagazig, Egypt; identify the factors that contribute to virulence; determine the isolates’ profile of antibiotic resistance; and to elucidate the ability of Aeromonas spp. to form biofilms. The examined samples included fish tissues and organs from tilapia (Oreochromis niloticus, n = 160) and mugil (Mugil cephalus, n = 105), and human skin swabs (n = 51) and fecal samples (n = 27). Based on biochemical and PCR assays, 11 isolates (3.2%) were confirmed as Aeromonas spp. and four isolates (1.2%) were confirmed as A. hydrophila. The virulence genes including haemolysin (hyl A) and aerolysin (aer) were detected using PCR in A. hydrophila in percentages of 25% and 50%, respectively. The antimicrobial resistance of Aeromonas spp. was assessed against 14 antibiotics comprising six classes. The resistance to cefixime (81.8%) and tobramycin (45.4%) was observed. The multiple antibiotic resistance (MAR) index ranged between 0.142–0.642 with 64.2% of the isolates having MAR values equal to 0.642. Biofilm formation capacity was assessed using a microtiter plate assay, and two isolates (18.1%) were classified as biofilm producers. This study establishes a baseline for monitoring and controlling the multidrug-resistant Aeromonas spp. and especially A. hydrophila in marine foods consumed in our country to protect humans and animals.

Drug-induced liver damage is a life-threatening disorder, and one major form of it is the hepatotoxicity induced by the drug cisplatin. In folk medicine, Licorice (Glycyrrhiza glabra (is used for detoxification and is believed to be a potent antioxidant. Currently, the magically self-renewable potential of bone marrow mesenchymal stem cells (BM-MSCs) has prompted us to explore their hepatoregenerative capability. The impact of G. glabra extract (GGE) and BM-MSCs alone and, in combination, on protecting against hepatotoxicity was tested on cisplatin-induced liver injury in rats. Hepatic damage, as revealed by liver histopathology and increased levels of serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), and malondialdehyde (MDA), was elevated in rats by received 7 mg/kg of cisplatin intraperitoneally. The combination of GGE and BM-MSCs returned the enzyme levels to near the normal range. It also improved levels of liver superoxide dismutase (SOD) and glutathione (GSH) and reduced MDA levels. Additionally, it was found that when GGE and BM-MSCs were used together, they significantly downregulated caspase9 (Casp9), nuclear factor kappa-light-chain-enhancer of activated B cells (NF-kB), and interleukin-1β (IL-1β), which are involved in severe proinflammatory and apoptotic signaling cascades in the liver. Moreover, combining GGE and BM-MSCs led to the normal result of hepatocytes in several examined liver histological sections. Therefore, our findings suggest that GGE may have protective effects against oxidative liver damage and the promising regenerative potential of BM-MSCs.

Recent studies have indicated that microRNA and VEGF are considered to be genetic modifiers and are associated with elevated levels of fetal haemoglobin HbF, and thus they reduce the clinical impact of sickle haemoglobin (HbS) patients. This cross-sectional study was performed on clinical confirmed subjects of SCD cases. miR-423-rs6505162 C>T and VEGF-2578 C>A genotyping was conducted by ARMS-PCR in SCD and healthy controls. A strong clinical significance was reported while comparing the association of miR-423 C>T genotypes between SCD patients and controls (p = 0.031). The microRNA-423 AA genotype was associated with an increased severity of SCD in codominant model with odd ratio (OR = 2.36, 95% CI, (1.15–4.84), p = 0.018) and similarly a significant association was observed in recessive inheritance model for microRNA-423 AA vs (CC+CA) genotypes (OR = 2.19, 95% CI, (1.32–3.62), p < 0.002). The A allele was associated with SCD severity (OR = 1.57, 95% CI, (1.13–2.19), p < 0.007). The distribution of VEGF-2578 C>A genotypes between SCD patients and healthy controls was significant (p < 0.013). Our results indicated that in the codominant model, the VEGF-2578-CA genotype was strongly associated with increased SCD severity with OR = 2.56, 95% CI, (1.36–4.82), p < 0.003. The higher expression of HbA1 (65.9%), HbA2 (4.40%), was reported in SCD patients carrying miR-423-AA genotype than miR-423 CA genotype in SCD patients carrying miR-423 CA genotype HbA1 (59.98%), HbA2 (3.74%) whereas SCD patients carrying miR-423 CA genotype has higher expression of HbF (0.98%) and HbS (38.1%) than in the patients carrying AA genotype HbF (0.60%), HbS (36.1%). ARMS-PCR has been proven to be rapid, inexpensive and is highly applicable to gene mutation screening in laboratories and clinical practices. This research highlights the significance of elucidating genetic determinants that play roles in the amelioration of the HbF levels that is used as an indicator of severity of clinical complications of the monogenic disease. Further well-designed studies with larger sample sizes are necessary to confirm our findings.