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, "Idiopathic TTP in the Middle East: Epidemiology and Clinical Outcomes in Infection Associated Episodes", Journal of Transfusion and Apheresis Science, vol. 59, issue 6, 2020.
Hussein, E., "Non-myeloablative bone marrow transplant and platelet infusion can transiently improve the clinical outcome of mitochondrial neurogastrointestinal encephalopathy: a case report.", Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis, vol. 49, issue 2, pp. 208-11, 2013 Oct. Abstract

Mitochondrial neurogastrointestinal encephalopathy (MNGIE) is caused by deficiency in thymidine phosphorylase (TP), that regulates thymidine (dThd) and deoxyuridine (dUrd). Toxic levels of dThd and dUrd can lead to mitochondrial dysfunction by impairing mitochondrial DNA replication, causing GI and neurologic deterioration. We studied the impact of bone marrow transplant (BMT) and platelets, as a source of TP on the clinical outcome of MNGIE. We report a case of MNGIE, who presented with severe vomiting. Over time, he was non-ambulatory and his GI symptoms got progressively worse with severe dysphagia, abdominal pain episodes, persistent vomiting and diarrhea. Being unfit for intense conditioning regimen, he received a mini BMT, with mild conditioning regimen. Bone marrow was obtained from his HLA fully matched brother. One month after transplantation, donor chimerism in peripheral blood was 33%. Excellent clinical responses were achieved 3 months after transplantation and circulating donor cell chimerism decreased to 24% with a significant increase in platelet TP activity. Ten months post transplant the patient's symptoms recurred and fresh single donor platelets were infused, with a significant increase in platelet TP activity. Mini BMT and platelet transfusion can transiently increase circulating TP activity and might prevent progress of this fatal disease.

Hussein, E., "Blood donor recruitment strategies and their impact on blood safety in Egypt.", Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis, 2013 Nov 19. Abstract

INTRODUCTION: Because of the high incidence of HCV, blood safety presents a serious challenge in Egypt. Given the constrained economy which limits the implementation of nucleic acid amplification technology, proper recruitment of blood donors becomes of paramount importance. To evaluate the effectiveness of blood donor recruitment strategies, the seroprevalence of positive infectious markers among blood donors was studied.

MATERIALS AND METHODS: Donors' records covering the period from 2006-2012 were reviewed. Blood donations were screened for HCV antibodies, HBs antigen (HBsAg), HIV-1 and 2 and syphilis antibodies.

RESULTS: Of 308,762 donors, 63.4% were voluntary donors (VD). VD of 2011-2012 were significantly younger than family replacement donors (RD) .The overall prevalences of HCV antibodies, HBsAg, HIV and syphilis antibodies were 4.3%, 1.22%, 0.07%, and 0.13%, respectively. All tested markers (except HIV) were significantly higher among RD, when compared to VD (P<0.0001). A consistent steady trend for decrease in HCV seropositivity was observed in RD and VD from 8.9% and 4.2% to 3.8% and 1.5%, respectively. A trend for decrease in HBsAg was demonstrated in VD from 1.2% to 0.53%.

CONCLUSION: The decreasing trends in HCV antibody and HBs antigen is promising and may reflect the improved donor selection criteria.

Hussein, E., and J. Teruya, "Weak D types in the Egyptian population.", American journal of clinical pathology, vol. 139, issue 6, pp. 806-11, 2013 Jun. Abstract

Patients with the most common weak D types 1, 2, and 3 can be safely considered D positive. We evaluated 1,113 Rh-negative Egyptian samples for weak D expression to propose a cost-effective strategy related to D variant testing. D variants were tested using polymerase chain reaction with sequence-specific priming. Fifty samples were D variants (4.5%): weak D type 4.2 (32%), weak D type 4.0/4.1 (16%), and weak D type 15 (2%). Fifteen (62.5%) of 24 samples were identified serologically as partial D. We also studied the probability of the development of anti-D in 52 Rh-negative children with thalassemia who were receiving units for which weak D was not tested. Anti-D alloimmunization was observed in 63.5% of patients with thalassemia. It is prudent to implement weak D typing in Egyptian donors. Weak D variants of Egyptians are significantly different compared with Caucasians. Ethnicity must be taken into consideration when developing clinical and prenatal strategies related to D variants.

Enein, A. A. A., N. A. Eldesoukey, E. A. W. Hussein, M. Hamdi, and N. A. Jamjom, "HLA alloimmunization in Egyptian aplastic anemia patients receiving exclusively leukoreduced blood components.", Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis, vol. 48, issue 2, pp. 213-8, 2013 Apr. Abstract

BACKGROUND: The aim of the work was to detect the presence of anti-human leukocyte antigens (anti-HLAs) class I and II antibodies in sera of multitransfused aplastic anemia pediatric patients using two different techniques. The effect of the implemented transfusion practice on the frequency of these antibodies was studied as well as their effect on the patient's clinical condition.

METHODS: Flowcytometry panel reactive antibodies (FlowPRAs) for HLA class I and II were determined and compared to the results obtained by Complement-dependent-cytotoxicity (CDC) assay.

RESULTS: Over the past 3years, 20 aplastic anemia patients received leukoreduced blood components, 5/20 patients received leukoreduced products exclusively throughout their disease (group1), 15/20 patients had received non-leukoreduced components previously (group2). None of the patients in group1 was FlowPRA positive. Six patients from group2 (40%) were FlowPRA positive, only four out of these six patients showed positive CDC test. Positive and negative predictive values of CDC were 44.4 and 81.4% respectively, with 65% accuracy. Platelet refractoriness was encountered in 13/20 patients; only 3 out of these 13 patients (23%) were FlowPRA I positive (38±18%). One refractory patient died from intracranial hemorrhage. His FlowPRA I was 65.7% and CDC assay failed to detect it.

CONCLUSION: Leukoreduction of blood components minimizes the incidence of HLA alloimmunization. Further investigations for other immune causes of platelet refractoriness are recommended. FCM is a simple and reliable technique for detection of anti-HLA antibodies, while CDC assay lacks sensitivity and specificity.

Hussein, E., and J. Teruya, "Evaluation of blood supply operation and infectious disease markers in blood donors during the Egyptian revolution.", Transfusion, vol. 52, issue 11, pp. 2321-8, 2012 Nov. Abstract

BACKGROUND: The Egyptian revolution took place on January 25, 2011. Millions of protesters demanded the overthrow of the Egyptian president's regime. Many people suffered from life-threatening injuries after violent clashes between police and protesters.

STUDY DESIGN AND METHODS: The overall management of the blood bank operation at Cairo University Hospital was described, in an attempt to evaluate blood safety and establish a standard effective plan to manage blood supply during crisis.

RESULTS: Three days after the uprising, thousands of Egyptians rushed to the hospital to alleviate the blood shortage. A total of 3425 units were collected in 3 days and thousands of donors were turned away. An error delayed processing of 1000 units and they were used as stored whole blood. Apheresis platelets were donated by protesters who were particularly motivated to donate for two victims with liver injury. The usual positive rate of hepatitis C virus (HCV) antibody in Egyptian donors is 3.8%. However, the positive rate of HCV markers in the collected units was only 1.6%. The mean age of donors during the revolution was 31.7±10.4 years while the usual mean age of donors is 39.2±8.5 years. Operating theaters were used only for emergencies. A blood surplus developed that met the hospital needs for 1 month.

CONCLUSION: Revolution resulted in an influx of first-time donors with a relatively low positive rate of HCV antibody. To be prepared for disasters, a systematic approach to spread donors evenly on a daily basis is needed.

Enein, A. A., E. A. Hussein, S. El Shafie, and M. Hallouda, "Factors affecting platelet yield and their impact on the platelet increment of patients receiving single donor PLT transfusion.", Journal of clinical apheresis, vol. 22, issue 1, pp. 5-9, 2007 Feb. Abstract

The aim of this study was to analyze the impact of various donor and machine parameters on PLT yield in 127 PLT apheresis procedures, to optimize PLT yield achieving clinical and economic advantages. One hundred and twenty-seven apheresis procedures were analyzed. Age, gender, volume processed, Hb, and PLT precounts were included as donor predicting variables. AC infusion rate, processing time, and plasma volume collected with PLTs were assessed as machine parameters. We evaluated the post-transfusion effectiveness in 23 patients with thrombocytopenia, studying the effect of PLT dose, ABO group, and PLT storage time. Females gave higher yields, compared to males, P<0.01. PLT yield correlated positively with PLT precount (r=0.512), and TBV (r=0.404), and negatively with donor preapheresis Hb (r=-0.306). Processing time and AC infusion rate had a positive impact on PLT yield. Post-apheresis decrease in PLT count was 53.6+/-26.3x10(11). Donors with Hb>or=12 g/dl, donated safely. Most of the complications were citrate related (13.4% of all procedures). PLT increments in transfused patients correlated positively with the number of units transfused (r=0.41), and negatively with PLT storage days (r=-0.342). PLT increments in patients receiving ABO-compatible PLTs were 75% higher, compared to the increments in patients receiving incompatible PLTs. PLT count and volume processed were the main predictors of PLT yield. Increasing the processing time, the AC infusion rate, or the volume of plasma obtained with PLTs can increase PLT yields. High PLT dose, short storage time, as well as ABO compatibility should be considered during PLT transfusion.