However, there are no restrictions on smoker donors; the only advice given to this population is to abstain from smoking within 2h of donation, to prevent donor side effects such as dizziness and nausea [ 15 , 16 ].
The prevalence of smokers among blood donors and the effect of cigarette smoke exposure on the quality of donated blood have not been extensively explored [ 17 — 19 ]. For this purpose, a question about smoking habits was included in the health history questionnaire administered to all potential donors. In a convenience sampling strategy, donors of both sexes, aged 18—40 years, who confirmed a smoking habit, were invited to participate.
All were informed about the aims and benefits of this study and signed an informed consent form before enrollment. Subsequently, they answered questions about the brand and number of cigarettes smoked per day, time since the last cigarette smoked before blood donation, lifestyle, and socioeconomic information.
Sex- and age-matched non-smoker donors were invited to compose the control group. The resulting sample size was calculated as 31 RBC packs per group [ 20 ]. All precautions to avoid red cell contamination were taken as per standard protocols. RBC packs did not receive any treatment such as irradiation or leukoreduction. A mL sample was collected from each RBC pack through a sterile connection and transferred to a paediatric transfusion pack with the same characteristics to those of the original pack.
Analyses were carried out at three time points—zero the day of donation and every 15 days thereafter—to monitor changes in COHb levels and blood quality over time. Recommended quality control tests were performed as per Brazilian legislation and relevant guidelines [ 15 , 16 ]. At each time point, mL samples were taken from the pediatric transfusion pack by a single puncture, keeping the system closed.
After each collection until the last time point, the RBC pack was returned to the refrigerator, thus reproducing standard blood storage. RBC quality was assessed according to Brazilian legislation [ 16 ] and the manual for quality control of whole blood and components [ 21 ]. Samples were tested for changes in total hemoglobin, hematocrit, free hemoglobin, and degree of hemolysis.
Results were expressed as percentage of CO-saturated blood. Results were entered into a database and tested for normality of distribution by the Shapiro-Wilk method.
The chi-square test was used to compare categorical variables between groups. Generalized estimating equations GEE were used for between-group comparisons at the different time points of analysis 0, 15, and 30 days [ 23 ].
Spearman correlation coefficients were calculated to determine the associations of abstinence interval and number of cigarettes smoked per day with COHb levels. Overall, donations were provided by smokers, representing 5. General characteristics of this smoking donor population are described in Table 1. Free hemoglobin and systolic and diastolic blood pressures were slightly higher in men than in women, while heart rate was slightly lower in men.
Furthermore, 3. Of 1, smoker blood donors, only four all male reported any discomfort after donation, such as dizziness and tingling. Table 2 shows the demographic characteristics of age- and gender-matched smoker and control non-smoker blood donors.
The mean donor age was A higher level of education was more frequent in non-smokers. In the smoker group, the median tobacco burden in pack-years was History of smoking showed a non-significant difference between women and men, with a median of Three donors two male and one female had a smoking history of more than 37 pack-years.
Concerning blood quality, we found that donor smoking did not affect parameters such as hematocrit, hemoglobin, or hemolysis S1 Table. These blood parameters changed slightly over time with storage, without, however, losing the properties required for appropriate and safe transfusion according to national standards [ 16 ]. The median COHb levels from subjects who smoked fewer than 10 cigarettes per day was 6.
There were no differences in hemolysis between packs from smokers and non-smokers, regardless of number of cigarettes smoked per day or abstinence time since last cigarette S1 Table.
Despite an alarming rise in the prevalence of tobacco use worldwide, smoking habits are not carefully investigated prior to blood donation [ 15 , 16 ]. In this study, we found that 5. We also found that, although smoking habit did not affect the overall quality of RBCs significantly, it did increase average COHb levels in RBC packs by up to four times, in a manner dependent to overall smoking burden and time elapsed since the last cigarette smoked before donation.
The prevalence of smoker donors found in this sample 5. Because smoking predicts comorbidity [ 26 ] and loss of eligibility, we suggest that smokers are less likely to donate, contributing to the lower prevalence of smoking among blood donors.
In this study, replicating prior results from the literature, we showed that smoking was more prevalent in men than in women, and that blood pressure and hemoglobin levels were slightly higher in male than in female smokers [ 9 , 27 , 28 ]. As in previous studies, we did not find changes in parameters commonly used to assess quality of packed RBCs for transfusion [ 16 , 28 — 30 ].
An in vitro study has shown that exposure of isolated erythrocytes to cigarette smoke increases hemolysis and COHb levels, with a correlation to increasing oxidative stress parameters [ 31 ].
Moreover, chronic cigarette smoking alters the rheological behavior of RBCs, decreasing their fluidity and compromising the flow properties of blood [ 32 , 33 ]. Further studies are needed to investigate changes in inflammatory parameters or the presence of heavy metals in RBC packs from smoker donors and their potential implications for the recipient [ 19 ].
One study found that active and passive tobacco smokers show higher blood lead levels than never-smokers [ 34 ]. Blood COHb levels in non-smokers range from 0. As expected, COHb levels were higher in RBC packs from donors who smoked more than 20 cigarettes daily and from those who had been abstinent for shorter than 12h. Thus, according to our results, the daily cigarette habit and the length of abstinence from smoking before donation may improve the quality and safety of donated blood.
Blood transfusion provides great clinical benefit. Thus, RBC packs donated by smokers should not be rejected, but may be subject to additional monitoring to avoid potential hazards to the health of the recipient. Although we cannot draw conclusive evidence from our results, additional studies conducted in vitro or in animal models should help establish safe limits for COHb in RBCs. Until there, we suggest that simple, low-cost approaches be adopted by blood banks to minimize risks, such as including a question about tobacco smoking habits in pre-donation screening questionnaires.
In future, once a safe reference range for COHb levels from donated RBC packs has been established, such levels can be monitored immediately after extraction of blood components, helping prevent transfusion of COHb-rich blood to high-risk patients such as cyanotic neonates or older adults with heart disease [ 36 — 38 ].
However, when larger volumes of blood need to be transfused, such as during major surgery or in newborns which often weigh less than 2. One case study showed that, during congenital heart surgery in a newborn, COHb levels in blood reached 3. These studies indicate the relevance of COHb levels for safe transfusion. Distribution of COHb follows a two-compartment model, with a half-life of 1.
Guidelines for blood transfusion services in Brazil and in other countries do not establish rules for smoker donors, except that they should remain abstinent for 2h before and after donation to avoid discomfort [ 15 , 16 , 41 ]. Some authors have suggested cigarette abstinence for at least 24h before blood donation [ 18 ]. According to the data of the World Health Organization, approximately 5 million people die globally each year from the diseases caused by smoking, and if this trend continues, it is expected that by , that number would be 10 million.
Numerous studies indicated that smoking had adverse effects on human health and represented a predisposing factor for development of various pathological conditions and diseases, such as the chronic obstructive pulmonary disease 1 , cancer 2 , pancreatitis 3 , gastrointestinal disorders 4 , periodontal disease 5 , metabolic syndrome 6 , and some autoimmune diseases 7. Cigarette smoking is associated with an increased risk of cardiovascular diseases, including coronary artery disease, peripheral vascular disease 8 , ischaemic heart disease 9 , atherosclerosis 10 , myocardial infarction 10 and stroke The exact mechanisms of occurrence of these disorders in smokers are not known, but it is presumed that these effects are caused by abnormalities in the blood rheology, infection and inflammation, oxidative stress, and alterations of antithrombotic and fibrinolysis system.
Tobacco smoke contains over compounds that have a more or a less adverse effect on human health, among which free radicals, the nicotine and the carbon monoxide are considered the most responsible for pharmacological effects. The nicotine induces formation of a clot in the coronary arteries, it weakens the vascular activity, and increases endothelium dysfunction.
Increase in the level of carboxy-haemoglobin may cause hypoxia, and it is also responsible for sub-endotheliaoedema considering that it alters the vascular permeability and accumulation of lipids Free radicals and peroxides from the tobacco smoke are clearly linked with physiological phenomenon such as synthesis of prostaglandins and thromboxane, and they are also involved in the pathogenesis of various diseases including atherosclerosis, carcinoma, and inflammatory processes.
Effects of smoking on alterations of hemostatic and fibrinolythic system, antioxidant status and hematology parameters were extensively studied, but the studies presented inconsistent results. The present study was conducted to compare the effect of cigarette smoking on some haematological parameters between smokers and age-matched non-smoker controls. Present study was carried out to investigate the relationship effect of cigarette smoking on haematological parameters in a group of clinically healthy volunteers.
A total of subjects were enrolled in the study, 56 smokers and non-smokers in the age range years. Each subject gave an informed consent and study protocol was approved by the Ethical Review Committee. Data on smoking habits and the amount of tobacco consumed were collected by a self-administered questionnaire to be filled in by the participants. Subjects included in this study were free of evidence of active liver and kidney disease, chronic pancreatitis, gastrointestinal disease, inflammatory bowel, history of ischaemic heart disease or and diastolic blood pressure, endocrine disorders, infection, and hormonal therapy.
In all the subjects arterial blood pressure, blood pressure and anthropometric data height, weight and waist circumference were measured. Waist circumference was measured at the midpoint between the lowest rib and the iliac crest. BMI was calculated as body weight kg divided by body height m squared. Blood pressure of each subject was measured with a mercury Sphygmomanometer and a standard stethoscope.
Blood samples were drawn after an overnight fast. Each test procedure was carried out between a. The subjects underwent the following tests: Blood pressure examination to rule out hypertension, estimation of the serum lipid profile, evaluation of the fasting and post prandial blood glucose levels to rule out diabetes, red blood cell count, total leukocyte count, differential leukocyte count, platelet count, packed cell volume, hemoglobin, serum urea and creatinine levels.
Statistical analysis was performed using SPSS version Before statistical analysis, normal distribution and homogeneity of the variances were tested using Kolmogorov-Smirnov test respectively. Correlations between parameters were analyzed using the Pearson R test for variables with normal distribution and the Spearman test for variables with non-normal distribution.
Table 1 shows baseline characteristics of subjects. Table 2 compares the haematological parameters between smokers and non-smokers which shows a statistically significant increase in total leucocyte count, hematocrit, mean corpuscular hemoglobin and hemoglobin in smokers. The rest of the parameters were not statistically significant.
Comparison of haematological parameters between smokers and non-smokers. The Table 3 shows that there was no statistically significant difference in age, body mass index BMI , waist circumference and blood pressure between the male and female smokers.
Baseline characteristics of the smoker subjects -gender differences. BMI-body mass index. The analysis of gender differences in the group of smokers showed statistically significant difference in the number of leukocytes. The values of leukocytes were statistically higher in male subjects compared to female respondents.
A statistically significant difference between other parameters of white blood cells is not found. Male population of smokers had a statistically higher values for the number of red blood cells and hemoglobin, hematocrit, mean corpuscular volume MCV and mean corpuscular hemoglobin MCH values Table 4. Differences haematological parameters between male and female smokers.
The results of our findings showed that cigarette smoking has severe adverse effects on haematological parameters e. Smokers and non-smokers had almost equal values of the total erythrocyte count. Statistically significant larger values of erythrocytes were noted in male smokers in relation to female smokers. In our study, the values of hemoglobin were significantly larger in smokers than in non-smokers regardless of the sex, while there was no significant difference in values of hematocrit between these two groups of subjects.
However, male smokers had significantly larger values of hematocrit in relation to female smokers. The significant increase in Hb in smoker group is correlated with previous studies 13 - In study made by Lakshmi et al.
White head et al. Increase in hemoglobin concentration is believed to be mediated by exposure of carbon monoxide and some scientists suggested that increase in hemoglobin level in blood of smokers could be a compensatory mechanism. Carbon monoxide binds to Hb to form carboxy hemoglobin, an inactive form of hemoglobin having no oxygen carrying capacity. Carboxyhemoglobin also shifts the Hb dissociation curve in the left side, resulting in a reduction in ability of Hb to deliver oxygen to the tissue.
To compensate the decreased oxygen delivering capacity, smokers maintain a higher hemoglobin level than non-smokers Increased number of erythrocytes and values of hematocrit in male smokers can be explained by the fact that tissue hypoxia caused by increased creation of carboxy hemoglobin leads to an increased secretion of erythropoietin, thus increasing erythropoiesis.
Carbon monoxide from the tobacco smoke also leads to an increase in permeability of the capillaries which decreases the volume of plasma, which finally mimics the condition of polycythemia, characterized by an increased share of the erythrocytes in the blood volume, which is reflected also through increased values of hematocrit 14 , In the study of Kung et al. These results contradict the results of the study Pankaj et al.
No difference was observed between the platelets count and MCV in two groups. Asif et al. MCV indicates the size of a red blood cell and presence of red cells smaller or larger than normal size means the person has anemia, elevated levels of MCV in our study indicates that subjects might suffer from megaloblastic, haemolytic, pernicious or macrocytic anemia usually caused by iron and folic acid deficiencies.
Our study established a significantly larger number of leukocytes in smokers of both sexes, in relation to non-smokers. Also, the values of leukocyte count were statistically significantly larger in male smokers. The increased total leukocyte count observed in smokers is similar to earlier studies 25 , Although the exact mechanism of how smoking increases the number of leukocytes is not fully clarified, the smoking induced leukocytosis has several factors and can be explained in different ways.
Some authors claim that increase in the number of leukocytes can be the consequence of nicotine induced release of catecholamine and steroid hormones from the core of the adrenal gland.
It is known that increase in the level of certain endogenic hormones, such as epinephrine and cortisol, result in increase in the number of leukocytes 27 , In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time.
Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them. It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb This had been made possible due to the efforts and the hard work put in it.
The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal.
I wish for a great success for JCDR. Rajendra Kumar Ghritlaharey, M. Shankar P. Hemant Jain, Editor, in March , which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we I and my colleagues have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1.
The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality.
A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in , before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did! Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process.
JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal.
This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed.
The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. I especially like the new and colorful page format of the journal.
Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors. Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened.
Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts.
I faced occasional problems with the online manuscript submission Pre-publishing system, which have to be addressed. Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work. Box , Kathmandu, Nepal. E-mail: ravi.
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