Report on the Project for Establishment of the Standardized Korean Laboratory Terminology Database, 2015

The National Health Information Standards Committee was established in 2004 in Korea. The practical subcommittee for laboratory test terminology was placed in charge of standardizing laboratory medicine terminology in Korean. We aimed to establish a standardized Korean laboratory terminology database, Korea-Logical Observation Identifier Names and Codes (K-LOINC) based on former products sponsored by this committee. The primary product was revised based on the opinions of specialists. Next, we mapped the electronic data interchange (EDI) codes that were revised in 2014, to the corresponding K-LOINC. We established a database of synonyms, including the laboratory codes of three reference laboratories and four tertiary hospitals in Korea. Furthermore, we supplemented the clinical microbiology section of K-LOINC using an alternative mapping strategy. We investigated other systems that utilize laboratory codes in order to investigate the compatibility of K-LOINC with statistical standards for a number of tests. A total of 48,990 laboratory codes were adopted (21,539 new and 16,330 revised). All of the LOINC synonyms were translated into Korean, and 39,347 Korean synonyms were added. Moreover, 21,773 synonyms were added from reference laboratories and tertiary hospitals. Alternative strategies were established for mapping within the microbiology domain. When we applied these to a smaller hospital, the mapping rate was successfully increased. Finally, we confirmed K-LOINC compatibility with other statistical standards, including a newly proposed EDI code system. This project successfully established an up-to-date standardized Korean laboratory terminology database, as well as an updated EDI mapping to facilitate the introduction of standard terminology into institutions.

Fatal Hemophagocytic Lymphohistiocytosis associated with Influenza B / 대한내과학회지

Influenza infection may be complicated by various infectious or non-infectious diseases. Among them, hemophagocytic lympho-histiocytosis (HLH) is an uncommon hyperinflammatory syndrome caused by uncontrolled proliferation and activation of macrophages and lymphocytes, and it is often life threatening. A previously healthy male patient was suspected to have HLH after influenza B infection. The diagnosis was established based on clinical diagnostic criteria suggested in the HLH-2004 trial. Despite prompt antiviral therapy, the patient expired on day 19 of hospitalization. Influenza can thus be complicated by HLH. Due to the non-specific manifestations of HLH, clinical suspicion and early diagnosis are important.

Effect of Irradiation on Microparticles in Red Blood Cell Concentrates

Changes in microparticles (MP) from red blood cell (RBC) concentrates in the context of irradiation have not been investigated. The aim of this study was to evaluate how irradiation affects the number of MPs within transfusion components. Twenty RBC concentrates, within 14 days after donation, were exposed to gamma rays (dose rate: 25 cGy) from a cesium-137 irradiator. Flow cytometry was used to determine the numbers of MPs derived from RBC concentrates before and 24 hr after irradiation. The mean number of MPs (±standard deviation) in RBC concentrates was 21.9×10(9)/L (±22.7×10(9)/L), and the total number of MPs ranged from 2.6×10(9)/L to 96.9×10(9)/L. The mean number of MPs increased to 22.6×10(9)/L (±31.6×10(9)/L) after irradiation. Before irradiation, the CD41-positive and CD235a-positive MPs constituted 9.5% (1.0×10(9)/L) and 2.2% (263×10(6)/L) of total MPs, respectively. After irradiation, CD41-positive MPs increased to 12.1% (1.5×10(9)/L) (P=0.014), but the CD235a-positive MPs decreased to 2.0% (214×10(6)/L) of the total MPs (P=0.369). Irradiation increases the number of CD41-positive MPs within RBC concentrates, suggesting the irradiation of RBC concentrates could be associated with thrombotic risk of circulating blood through the numerical change.

Effect of interleukin-29 on interferon- alpha secretion by peripheral blood mononuclear cells

The effect of interleukin [IL]-29, a new therapeutic agent similar to type I interferons [IFNs], on IFN- alpha secretion of human plasmacytoid dendritic cells [pDCs] has not been studied. Therefore, in this study, we aimed to clarify the effect of IL-29 on IFN- alpha secretion of pDCs using human peripheral blood mononuclear cells [PBMCs] in the presence of cytosine-phosphate-guanosinemotif-containing oligodeoxy nucleotides [CpG]. In this experimental and prospective study, PBMCs were obtained from 11 healthy volunteers and divided into four culture conditions: I. control, II. CpG treatment, III. IL-29 treatment and IV. CpG plus IL-29 treatment. The amount of IFN- alpha secretion was measured from each culture supernatant by flow cytometry using the flowcytomix apparatus [eBioscience, Vienna, Austria]. Fractional IFN- alpha production of the cultured PBMCs was measured by intracellular staining using the cytomics FC 500 system [Beckman Coulter, Brea, CA, USA] with CXP Software. The mean +/- standard deviation [SD] of supernatant IFN- alpha secretion per pDC/ micro L was 5.7 +/- 9.3 pg/mL/count/ micro L for condition I, 1071.5 +/- 1026.6 pg/mL/count/ micro L for condition II, 14.1 +/- 21.1 pg/mL/count/ micro L for condition III, and 1913.9 +/- 1525.9 pg/mL/count/ micro L for condition IV. There were statistically significant differences between conditions I and II as well as betweenconditions II and IV. Intracellular IFN- alpha production was only detectable in the pDC fraction from one culture; the production amount was similar between the cells treated with CpG and those treated with CpG plus IL-29. Natural killer [NK] cell production of IFN- alpha was observed in two out of three cultures and one culture showed IFN- alpha production in the monocyte fraction. IL-29 alone did not show any effect on IFN- alpha secretion of PBMCs. However, the addition of CpG along with IL-29 enhanced IFN- alpha secretion of PBMCs. Given that pDCs are the major secretors of IFN- alpha in peripheral blood, this result has suggested the possibility that IL-29 has an enhancing effect in human pDC IFN- alpha secretion. Although the supernatant IFN- alpha secretion was not directly correlated with pDCs's intracellular IFN- alpha production in this study, prolonged incubation of pDC and other PB subsets with CpG or IL-29 for over 4 hours could be applied in future studies. These studies would help to elucidate the mechanism of action of IL-29 in human pDCs associated with viral infections

Evaluation of the Automated Blood Bank Instrument QWALYS-3 for Cross-Matching Tests / 대한수혈학회지

BACKGROUND: The cross-matching test is regarded as an essential pre-transfusion test. It serves an important role in confirming the ABO/Rh compatibility of transfusion and screening for possible unexpected antibodies. We evaluated cross-matching tests in QWALYS-3 (DIAGAST, Loos Cedex, France), comparing the automated process to manual tube methods. METHODS: A total of 545 crossmatching tests from 169 patients, collected from RBC concentrate transfusion orders, were performed using both QWALYS-3 and manual tube methods. All patients were follow-up tested later on with antibody identification tests to confirm the presence of unexpected antibodies in plasma. RESULTS: None of the samples were ABO/Rh incompatible. The presence of unexpected antibodies was later confirmed in 277 tests in 56 patients. Out of those 277 tests, the concordance rate between two methods was 83.8% (232/277). In 268 tests which were later confirmed with no unexpected antibodies, manual tube methods did not show any positive results while five tests were false-positive (5/268, 1.9%) only in QWALYS-3. The overall concordance rate between two methods was 90.82%, and the kappa coefficient was 0.696 (P<0.05) (n=545). CONCLUSION: The QWALYS-3 system has its merits in accuracy, precision, and lack of possible human errors, however, the automated procedure showed some disadvantages, including relatively low cost-and-time-effectiveness, less effective cold antibody detection, and difficulties in handling small quantity samples. Thus, the QWALYS-3 system has meaningful, but only a limited value in the automation of routine cross-matching tests.

A Rare Case of Polycythemia Vera Following Acute Undifferentiated Leukemia Remission

No abstract available.

Evaluation of the Wisecheck Glucose Monitoring System

BACKGROUND: Glucometers are widely used for self-monitoring and point-of-care testing in diabetes management. We evaluated the performance of the recently developed Wisecheck Glucose Monitoring System (Wisemeditech, Korea) compared to that of 2 other well-known glucometer systems. METHODS: The Wisecheck glucometer was evaluated for precision, linearity, and carryover rate. One-hundred fifty samples samples were tested, and the results obtained from the Wisecheck glucometer, ACCU-CHEK Performa (Roche Diagnostics, Germany) and SD GlucoLink (SD Diagnostics, Korea) were compared to those obtained using the laboratory reference method from the Toshiba 200FR (Toshiba, Japan), according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. RESULTS: The coefficient of variation (CV) values for within-run imprecision at low, middle, and high levels were 2.06%, 1.02%, and 2.02%, respectively, and the CV values for total-run imprecision at low, middle, and high levels were 2.98%, 2.41%, and 1.88%, respectively. In the linearity test, the coefficient of determination (R2) was 0.9985 in glucose concentration ranging from 48.6 mg/dL to 428 mg/dL (P<0.0001). The results obtained using the Wisecheck glucometer were well correlated with those obtained using the Toshiba 200FR (R2=0.980, P<0.0001). The carryover rate was 0.12%. CONCLUSIONS: The Wisecheck glucometer showed good precision, linearity, and correlation with the reference method. It provided rapid and reliable measurements of blood glucose levels and seemed appropriate for use in diabetes management.

Factors Affecting the Freshness of Transfused Packed Red Blood Cells / 대한수혈학회지

BACKGROUND: The relationship between the storage age of packed red blood cells (pRBCs) and clinical outcomes is controversial. However, no systematic study regarding how fresh pRBCs were transfused to patients have been available so far. Therefore, we newly defined concepts for supply age (period from blood collection to supply to hospital), storage age (period from supply to transfusion to patient), and transfusion age (supply age plus storage age) and investigated them. The factors affecting each age were also analyzed. METHODS: A retrospective analysis for three ages of pRBCs was performed for patients who were transfused > or =1 pRBCs unit at three university hospitals between January 2009 and December 2013. Inventory age (period from blood collection to inventory check point at each blood bank) was prospectively checked on a daily basis for 30 days. Four blood centers and blood groups of transfused pRBCs were included. RESULTS: The mean supply, storage, and transfusion ages of pRBCs were 6.2, 6.0, and 12.0 days, respectively. 58%, 61%, and 66% of total transfused pRBCs were in a fresh category of supply, storage, and transfusion ages correspondingly. Storage and transfusion ages were affected by ABO blood group, hospitals, and years in listing orders. Inventory age was mainly affected by ABO blood group and hospitals. CONCLUSION: The freshness of transfused pRBCs was affected by hospitals and blood centers. Therefore, using the supply, storage, transfusion, and inventory ages as new norms can be useful to establishment of inventory and supply policies of hospitals and blood centers.

Development of Severe Hemolytic Anemia after Treatment with Anti-D Immunoglobulin in a Patient with Immune Thrombocytopenic Purpura / 대한수혈학회지

A 78-year-old female was admitted due to nasal bleeding and purpuric macules on both legs. The patient underwent renal biopsy, and a diagnosis of Henoch-Schonlein purpura nephritis was made. The patient's platelet count was 1.6x10(10)/L, and, based on results from bone marrow biopsy, the patient was diagnosed with immune thrombocytopenic purpura. Despite treatment with glucocorticoid and IV immunoglobulin, thrombocytopenia continued. The patient's blood group was Rhesus D positive and treatment with IV anti-D immunoglobulin followed. Thereafter, platelet count showed a rapid increase; however, occurrence of hemolytic anemia, hyperbilirubinemia, and hemoglobinuria consistent with intravascular hemolysis was observed.

A Case of Hemophagocytic Lymphohistiocytosis with Clonal Karyotype Abnormalities

There have been a few reports of hemophagocytic lymphohistiocytosis (HLH) with chromosomal abnormalities. Clonal chromosomal abnormalities in HLH patients are usually found in association with hematologic malignancies and rarely with epstein-barr virus (EBV) infection. Here, we report a fatal case of HLH with clonal karyotype abnormalities. A 75-yr-old man was admitted with persistent anorexia and high fever. Laboratory data revealed pancytopenia, hypofibrinogenemia, hyperferritinemia, prolonged prothrombin time and activated partial thromboplastin time, and marked elevated level of serum transaminases. In real time-PCR using whole blood, EBV DNA was not detected but cytomegalovirus (CMV) DNA was detected. The bone marrow aspiration smear showed hyperplasia of mature histiocytes with prominent hemophagocytosis. In chromosomal analysis of bone marrow aspirates, complex chromosomal abnormalities were found. In spite of steroid pulse therapy and antibiotic treatment, he died of disseminated intravascular coagulopathy.

Evaluation of ABO Antibody Titration Using Tube and Column Agglutination Techniques

BACKGROUND: ABO antibody titration is useful for the evaluation of ABO-incompatible bone marrow or solid organ transplantations, yet the results quite vary between different test methods used. We compared the results of microcolumn agglutination and tube methods. METHODS: Anti-A and anti-B isoagglutionin titers were determined in 63 healthy individuals (23 O, 20 A, and 20 B blood groups) using 4 different methods: immediate spin tube (tube), microcolumn agglutination without anti-human globulin (AHG) (CAT), tube with AHG (tube-AHG) and microcolumn agglutination with AHG (CAT-AHG). RESULTS: The median (range) titers of anti-A and anti-B in group O individuals by tube, CAT, tube-AHG, and CAT-AHG methods were 64 (8-512), 64 (8-512), 128 (8-2,048), and 128 (16-2,048); 64 (16-128), 128 (16-256), 128 (16-512), and 256 (16-512), respectively. The median (range) titers of anti-A in group B and anti-B in group A individuals by the four methods were 64 (16-128), 128 (8-128), 128 (8-256), and 256 (8-256); 64 (8-128), 64 (8-128), 32 (8-128), and 64 (8-256), respectively. The isoagglutinin titer measured by CAT-AHGmethod was the highest. The titers measured by CAT and CAT-AHG methods were 0-1 titer higher than those by tube and tube-AHG methods, respectively. Whatever method was used, the isoagglutinin titers were higher in women than in men. CONCLUSIONS: CAT-AHG was the most sensitive method among the four methods tested. Since AHG titer values are critical for the clinical management and CAT has less manual procedures than tube method, CAT-AHG method could be used for the standardization of ABO antibody titration in different institutions.

Evaluation of the Automated Instrument QWALYS-3 for Unexpected Antibody Screening / 대한수혈학회지

BACKGROUND: The use of automated techniques reduces the impact of human errors in blood banking and it improves the standardization and the quality of the achieved results. Erythrocyte Magnetized Technology (EMT) is now being widely used due to its simplicity and efficiency for detecting alloantibody. We evaluated the antibody screening test of the QWALYS-3 (DIAGAST, Loos Cedex, France). METHODS: The evaluation focused on antibody screening using the QWALYS-3 as compared to the standard manual tube method and the Ortho BioVue system in clinical samples (n=100) and frozen stored samples (n=64), which had RBC alloantibody. RESULTS: Using the manual tube method, the sensitivity of antibody screening was 100% by the QWALYS-3 and 42.8% by the Ortho BioVue in the clinical samples (n=7) and 2 results were discrepant by the QWALYS-3 for negative samples. For the known antibodies from the frozen stored samples (n=64) this correspondence rate amounted to 93.7% (n=60). CONCLUSION: The QWALYS-3 system displayed a good match rate with the Ortho BioVue system (92%). It also showed reliable results for the general accuracy when compared to the manual method (concordance rate: 98%). The QWALYS-3 system will facilitate the automation of routine antibody screening with high reliability, sensitivity and specificity compared to the standard manual methods.

A Patient with Fatal Septicemia Caused by a Rare Pathogen Dermabacter Hominis

Dermabacter hominis (D. hominis) is a recently discovered gram-positive bacterial species, and it is usually recognized as an opportunistic human pathogen. Very few documented cases of severe infections caused by Dermabacter hominis have been published. In this report, we describe a case of fatal septicemia caused by Dermabacter hominis.

The Frequency of Unexpected Antibodies by Using Two Micro-column Agglutination Systems: DiaMed-ID and Ortho BioVue Systems / 대한수혈학회지

BACKGROUND: Unexpected antibody screening and identification tests are very important for safe blood transfusion. The micro-column agglutination test (MCAT) is widely used due to its simplicity and efficiency for detecting alloantibodies. We analyzed the frequency of unexpected antibodies at three university hospital blood banks, which use two different MCAT systems. METHODS: From February 2002 to December 2009, a total of 295,876 unexpected antibody screening tests were performed at three university hospital blood banks. Two hospital blood banks (Anam and Ansan Hospitals) used the DiaMed-ID system (DiaMed Ag, Switzerland) and the other (Guro Hospital) used the Ortho BioVue system (Ortho-Clinical Diagnostics, USA) for antibody screening and identification tests. RESULTS: The rates of detecting unexpected antibodies on screening test based on the 'tests performed' and the 'persons tested' were 1.16% per test and 0.96% per person in Korea University Guro Hospital, 0.65% and 0.41% in Korea University Anam Hospital and 0.76% and 0.57% in Korea University Ansan hospital, respectively. There were significant differences in the frequencies based on the two different systems (P<0.001). Among the warm antibodies, Rh antibodies were more frequently detected by the DiaMed-ID system, and Lewis antibodies were most frequently detected by the Ortho BioVue System. CONCLUSION: We should carefully interpretate the frequency of unexpected antibodies in the Korean population because the frequencies of unexpected antibodies are different according to different employed micro-column agglutination systems.

Evaluation of Various Formulae for Glomerular Filtration Rate Estimation and Proposal of New Formulae for the Korean Population / 대한진단검사의학회지

BACKGROUND: Some researchers have questioned the necessity of adjusting glomerular filtration rate (GFR) by body surface area (BSA). We compared the relationship between estimated GFR (eGFR) and radionuclide GFR (rGFR) with or without BSA adjustment by comparing the results obtained using various formulae with those obtained using 2 new proposed formulae. METHODS: A retrospective study was performed using 204 Korean individuals whose GFR had been estimated by the (99m)Tc-diethylenetriaminepentaacetic acid method between March 2004 and July 2008. We used the modification of diet in renal disease (MDRD) II formula, Mayo clinic quadratic (MCQ) formula, Cockcroft-Gault (CG) formula, and lean body mass-adjusted CG formula. Two new formulae, skeletal muscle mass index (SMI)-adjusted CG formula and SMIx3.4/SCr, were proposed by us. We analyzed each parameter with Pearson's correlation coefficient and also obtained the bias values. RESULTS: BSA did not satisfy the fundamental prerequisites of an adjustment factor for rGFR. MDRD II and MCQ GFR estimates demonstrated higher Pearson's correlation coefficient with BSA-unadjusted rGFR than they did with BSA-adjusted rGFR. The other GFR formulae estimates showed better correlation with rGFR and more favorable bias (P<0.001) when both GFR estimates and rGFR values were BSA-unadjusted. SMI-adjusted CG and SMIx3.4/SCr GFR estimates demonstrated correlation with rGFR and bias values similar to those of the MDRD II and CG GFR estimates. CONCLUSIONS: We suggest that absolute, non-corrected GFR and GFR estimate be preferred in daily practice. The absolute, non-corrected GFR and GFR estimate are considered helpful for patients with eGFR< or =60 mL/min/1.73 m2. We also recommend the clinical use of the new formulae, SMI-adjusted CG and SMIx3.4/SCr (BSA-unadjusted).

Using Genotyping to Identify an A1B(weak) Blood Group / 대한수혈학회지

Since an exact ABO blood type match is essential for transfusion therapy, any ABO discrepancies should be resolved prior to the issuing of blood. The authors confirmed the ABO blood group of a 50-year-old male using genotyping. On a routine blood group test, the cell type was A+; however, anti-B was undetected in his serum. To determine the cause of this ABO discrepancy, an adsorption elution test and saliva test were performed. The presence of a weak B substance was suspected despite no evidence of the B antigen on red blood cells. Polymerase-chain-reaction restriction-fragment-length-polymorphism (PCR-RFLP) and sequencing analysis of exons 6 and 7 demonstrated that his blood type was A1Bweak (the A allele tested as the A105 subtype, while the B allele was most similar to the B302 subtype). Again, using genotyping, we subsequently confirmed the A1Bweak blood type in a leukemic patient who was in complete remission.

Clinical Evaluation of SD CHECK GOLD as Point-of-care Glucose Meter / 임상검사와정도관리

BACKGROUND: Self-monitoring devices for blood glucose are widely used as a point-of-care testing (POCT) in the management of diabetic patients. In the present study, we evaluated the performance of SD CHECK GOLD Blood Glucose Testing System (SD diagnostic, Korea) using electrochemical detection technique. METHODS: SD CHECK GOLD was tested for linearity, precision and comparison of method. Other glucometers including ACCU CHEK ACTIVE (Roche Diagnostics Ltd., Germany) and ONE TOUCH ULTRA (Lifescan Inc., USA) were compared for the same categories according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. RESULTS: SD CHECK GOLD revealed good linearity in glucose concentration ranging from 50 mg/dL to 550 mg/dL (r(2)=0.9931). In the precision study, within-run precision and total-run precision (CV)s were within 10%. Excellent correlation was found between SD CHECK GOLD and Toshiba 200FR (Toshiba, Japan) (y=0.9212x, r=0.9756). CONCLUSIONS: SD CHECK GOLD showed good linearity, precision, and correlation with the reference method. No significant effect of testing procedure or operator was found. SD CHECK GOLD provided rapid and reliable results for blood glucose and seemed to be appropriate for the clinical useful in the management of diabetic patients.