Risk of Malaria Transmission by Blood Donation from Army Soldiers in Korea / 감염

BACKGROUND: Screening of donor blood for malaria has not been activated in Korea yet in spite of the recent resurgence of tertian malaria among Korean army soldiers in Delimited Militarized Zone areas. Prospective donors (travelers, immigrants, refugees, citizens or residents) following a visit to or coming from an endemic area who have had malaria or taken antimalarial prophylaxis should be deferred for 3 years after cessation of therapy or after departure from malarial area. We studied the risk of the transmission of malaria, especially through army blood donation which comprised up to 57.8% of whole blood donation in Korea. METHODS: The data were collected by personal interview and review of donation records of Korea Red Cross Center and medical records from 174 army soldiers with malaria who admitted to Army Hospital from May 1995 to October 1996. We analyzed the time interval between onset of illness and blood donation, and geographic distribution of the patients. RESULTS: About 70.7% (123/174) of the patients donated blood before the onset of illness, and the interval between blood donation and onset of illness ranged from 2 days to 2,750 days (mean 377, standard deviation 488). Patients who donated blood within 3 years before onset of illness were 87.8%(n=108) of the total blood donation. All donation (n=18) after treatment were within 3 years from 46 days to 342 days (mean 138, standard deviation 80.7). The frequent of blood donations were from the prevalent areas of malaria such as Pajoo City (40%), Younchon Kun (29%), Cholwon Kun (15.5%) and others(15.5%). CONCLUSION: We showed that donated army blood a risk of malaria transmission. Therefore the blood bank needs to set strict guidelines for blood donation especially from Korean army soldiers to control malaria transmission.

Post-transfusion Survival of SAG-M Additive Solution Preserved Red Blood Cells / 대한수혈학회지

BACKGROUDNS: In Korea, CPDA-1 solution is currently used for blood preservation and by this anticoagulant solution, RBCs can be preserved for up to 35 days at the refrigerate temperature. RBC additive solutions (AS-1, AS-3, AS-5, SAG-M, SAG-PM) are widely used in the other countries for longer preservation of RBCs (42 days). We studied the survival of transfused RBCs preserved in SAG-M additive solution. MATERIALS AND METHODS: 400 mL of whole blood were collected from 8 healthy volunteers, Plasma was removed by centrifugation separation method at 2,960g, 10 minute and replaced by 100 mL of SAG-M additive solution. Autologous transfusions were done in two groups on day 20 and 42 with Na51CrO4 (Dupont, USA) labelled RBCs. After 3, 10, 15, 20, 30 minutes and 1, 2, 24 hours, 20 days, the venous blood samples were collected from the volunteers, and their radioactivities were measured by the Gamma-counter (Cobra II, Germany), and 24 hour survival rate were calculated by Moroff's method. RESULTS: The mean 24 hour survival rate was 89.0% in 20 days preservation group and 71.8% in 42 days preservation group. The mean half life of transfused RBCs were 27.8 days (n=2)and 24.3 days (n=4) in 20 days and 42 days preservation group, respectively. No complications were observed during the study period. CONCLUSIONS: The RBCs preserved in SAG-M additive solution were near within allowable survival rates for transfusion.

Experience of Anti-HCV antibody immunoblot test in Korean Blood Donors / 대한수혈학회지

BACKGROUND: All donated bloods collected by the Korean Red Cross Blood Centers are tested for anti-HCV (Hepatitis C Virus) antibody by enzyme immunoassay (EIA) kits made in Korea. EIA test has sustaining problem of false positivity in spite of great progress in manufacturing kits. So, many healthy donors have been reported as being infected with HCV and excluded from next donation. METHODS: Among blood samples of 2,040,151 donors which were tested by two kinds of EIA kits (DONG-A HCV 3.0 and LG HCD 3.0) from 16 blood centers during 12 months, repeatably reactive samples, total 6,851 samples, were supplementally tested by LG HCD CONFIRM immunoblot test. RESULTS: Positive, indeterminate and negative rate in immunoblot tests were 39%, 9%, and 12% respectively among 6,851 repeatably reactive samples. Estimated true positive rate of anti-HCV antibody in Korean blood donors was 0.13%, showing geographical difference between 0.03% and 0.46%. Of EIA repeatably reactive samples, 28% showed greater than 5 signal to cutoff (S/C) ratio and most of them (94%) was revealed to be positive. CONCLUSION: True positive rate of EIA test results is so low that it would be necessary to increase the confidence of such results by immunoblot tests.

Genotyping of ABO and D Antigens / 대한수혈학회지

BACKGROUND: Genes for ABO and Rh phenotypes were recently identified. Although ABO genotyping don't find wide application in hospital transfusion services, it can play an important role in paternity and forensic investigation. In case of Rh system, however, DNA typing may find several practical applications such as prenatal determination of fetal Rho(D) genotype. METHODS: 64 blood samples for ABO genotyping were collected from blood donors (34 A, 30 B) and 18 samples for D genotyping (10 D+, 8 D-). To distinguish A, B and O alleles, we analyzed nucleotide positions 261 and 803 using polymerase chain reaction (PCR) and Restriction Fragment Length Polymorphism (RFLP). PCR products containing nucleotide position 261 were restricted with KpnI and BstEII. Rh genotyping was done by two sets of primers, one set for both RhD and RhCcEe gene amplification, and the other set for RhD only. RESULTS: The frequencies of ABO genotypes found in Korean blood donors were as follows: in the phenotype A group, AO=79% and AA= 21%; and in the phenotype B group, BO=93% and BB=7%. Of 18 blood samples for D genotytping, 10 were typed as RhD positive and 8 as RhD negative, showing full agreement with serological typing. CONCLUSION: ABO and D genotyping can be used when RBCs suitable for serological phenotyping are not available. Futhermore, these will be useful as a supplemental test to solve the problem of blood group typing caused by weak ABO and Rh phenotype.

Irregular Antibody Positivity in Women Blood Donors with History of Parturition / 대한수혈학회지

BACKGROUND: Antibody screening for donated blood is not yet being performed in Korea. Positive rate of irregular antibodies in Korean patients or blood donors has been thought to be much lower than that of foreign contries. We studied to know the actual frequency of irregular antibodies in blood donors with history of parturition using gel card, which was recently introduced in the field of blood banking and considered to be easy to standardize and sensitive to detect irregular antibodies. METHODS: 706 samples were collected from four blood centers in Seoul for 4 months. Antibody screening and identification were done by two kinds of Gel Card (DiaMed-ID corp, DiaMed, Murten, Switzerland) such as Nacl/Enzyme and LISS/Coombs' card. Adsorption- elution test was done in samples of which we could know the antibody specificity. RESULTS: Irregular antibodies were identified in 24 cases among 706 samples, therefore the overall frequency was 3.4% (95% CI: 3.4% +/- 1.3%). Only 4 cases, however, showed positive reaction in both enzyme and Coombs' phase, therefore frequency of clinically significant antibodies was 0.57% (95% CI: 0.57% +/- 0.55%). The identified irregular antibodies were anti-Lea (8 cases), Anti-Rh (3 cases) and Anti-P1 (1 case). Adsorption-elution test showed positive reaction only in 3 cases with anti-Rh antibodies. CONCLUSION: Considering that blood donors with history of parturition comprize just little proportion of total donors in Korea and frequency of irregular antibody is relatively lower than that of foreign countries in same group (0.57% vs 3.8%), it can be concluded that antibody screening be not urgent problem in Korean blood donation program.

Occupational Distribution of Anti-HCV Immunoblot Positive Donors and Anti-HIV Westernblot Postive Donors in Korea / 대한수혈학회지

BACKGROUND: It is widely known that approximately 99.4% of the safety of the blood supply can be met by the careful history taking of donors. In Korea, however, it is generally accepted that there is difficulty in doing careful history taking because donors are mainly recruited from school or army. This study is focused on analyzing the occupational distribution of anti-HCV or anti-HIV antibody positive donors and re-emphasizing the importance of careful history taking for donors. METHODS: Occupation of antibody positive donors was seaeched out from the computer database of the Korean National Red Cross. For the analysis of anti-HCV immunoblot positive donors, database from Jan. 1996 to Dec. 1996 were used. For the anti-HIV Western blot postive donors, database from 1992 to 1996 were used. RESULTS: 2,761 donors were anti-HCV immunoblot positive and searched out for their occupation. (Additional 80 donors were immunoblot positive, but could not be identified from the computer database.). 82% (2,269 donors) of 2,761 donors was not in the group of Students and Soldiers. Anti-HCV immunoblot positive donors were there in Others (1,015 donors) and in Salariate (820 donors) and in Merchants (313 donors). So, positive rate was the highest in Merchants (0.70%) and the second was others (0.44%). Occupational distribution of anti-HIV westernblot positive donors was nearly the same as that of anti-HCV immunoblot positive donors. CONCLUSION: 82% of anti-HCV immunoblot positive donors was not in the group of students and soldiers. Futhermore, occupational distribution of anti-HIV antibody positive donors was nearly the same as that of anti-HCV antibody positive donors. So, if blood collection staff would try to take a medical histroy carefully for donors, even only for individual donors who visit donation room alone or with a few friends, many risky donors may be excluded from donation, and thereby the safety of blood could be increased by appreciable amount in Korean blood donation program.

Effectiveness of Supplemental Enzyme Immunoassay Using Abbott IMx HCV Kit for the Anti-HCV Positive Donors / 대한수혈학회지

BACKGROUND: Only 39% was the positive predictive value of anti-hepatitis C virus (HCV) antibody test done by Korean Red Cross. Supplemental enzyme immunoassay (EIA) by another EIA kit may be also effective for reporting the more correct result to donors, instead of expensive supplemental immunoblot test. METHODS: All repeatedly reactive blood samples by EIA from 16 regional blood centers were retested for anti-HCV antibody by Abbott IMx HCV kit and LG HCD CONFIRM immunoblot kit. Presence of viral RNA was also confirmed using Amplicor HCV TEST kit from 180 samples, which were proportionately selected according to supplemental EIA and Immunoblot results. RESULTS: Of 2,211 repeatedly reactive samples, 909 samples (41%) were reactive and 1,302 (59%) samples were non-reactive with IMx HCV kit. 81% of reactive samples also showed positive pattern on the LG HCD CONFIRM strips and 79% of 1,302 samples showed negative pattern. RNA positivity was estimated 66% and 17% in Abbott IMx HCV positive and negative samples respectively, and 72%, 6%, 20% in LG HCD CONFIRM positive, indeterminate and negative samples respectively. CONCLUSION: HCV RNA positivity in positive samples by Abbott IMx HCV or LG HCD CONFIRM was not statistically significant (z=0.57 < 1.96, alpha=0.05). RNA detection rate by Abbott IMx HCV or LG HCD CONFIRM among HCV RNA positive samples, which was estimated as 73%, 70% respectively, was also statistically insignificant (z=0.375 < 1.96, alpha=0.05). So, it seems to be a good and economical practice that donors are notified of anti-HCV antibody results after supplemental EIA test using Abbott IMx HCV kit.

Study on the Seroincidence of Hepatitic C Virus Infection among blood donors in Korea / 대한수혈학회지

BACKGROUND: Since the introduction of anti-HCV assay, post-transfusion hepatitis (PTH) by Hepatitis C Virus (HCV) was remakably reduced. Recently, based on the estimation of HCV seroincidence rate in blood donors, an investigator insisted that alanine aminotransferase (ALT) test be discontinued as a surrogate marker. This study was designed to determine the HCV seroincidence in Korean blood donors. METHODS: HCV seroincidence was calculated using repeat donors who had donated repeatedly during the 26 months from Nov. 1994 through Dec. 1996. To calculate the person-years according to ALT value, the computer database of the Korean National Red Cross (KNRC) was used in which results for anti-HCV by enzyme immunoassay (EIA) were filed up. To count the true incidence cases, who were defined as donors showing seroconversion by confirmatory test in two successive donation, seroconverted donors by EIA were individually reconfirmed whether they were true seroconverters. Finally, projected impact on HCV risk of discontining of ALT screening was calculated by using two important value previously known, such as periods of seroconversion window for anti-HCV and ALT preconversion window. RESULTS: HCV seroincidence was estimated to be 13.79/100,000 person-years. Seroincidences according to the ALT groups were as follows; 13.22 in the normal ALT group ( or =131 IU/L). By this study, investigators also could find seroconverted donors, whose result for anti-HCV by immunoblot was positive at the first donation and changed to negative by EIA at the next donation, as many as 100 donors. Among these falsely seroconverted persons, 16% of donors showed elevated ALT value. 8 units per 1 million donations were estimated to be discarded only by abnormal results of ALT testing in Korea. CONCLUSION: HCV seroincidence in Korean donors was 2.8 times as high as in American donors. HCV seroincidence calculated by this study seems to be somewhat lower than true rate because of the problem of summing-up the person-years. Considering that higher seroincidence results in more donors in seroconversion window phase, donor selection by careful history taking should be re-emphasized to reduce the seroincidence rate in Korean blood donation program.

Detection Rate of Hepatitis B Virus DNA among Blood Donors showing HBsAg Positivity or Negativity and relatedness with other hepatitis B viral markers / 대한수혈학회지

BACKGROUND: Serologic assay for the detection of hepatitis B virus (HBV) surface antigen (HBsAg) have been used routinely in the screening of blood donors in Korea since 1973. However some investigators have reported the presence of HBV DNA in HBsAg negative blood. So this study is designed to determine the detection rate of HBV DNA according to various patterns of HBV markers in Korean blood donors. METHODS: The presence of HBV DNA in plasma from 469 donors was determined by polymerase chain reaction using commercial kit (Bioneer HBV Detection Kit, Bioneer Corp., Chungbuk, Korea). 289 donors showing all negative results by donor screening tests and 120 donors showing positive results only in HBsAg test and 60 donors showing abnormal result only in alanine aminotransferase (ALT) test (> or =65 IU/L) were included in this study. Other markers for HBV infection such as anti-HBsAb, anti-HBcAb, HBeAg were also tested. RESULTS: 65 (54%) of 120 donors with positive for HBsAg and 5 (1.7%) of 289 donors without abnormal results in screening tests and 3 (5.0%) of 60 donors with elevated ALT were found to have HBV DNA in their plasma. Among 54 cases showing HBsAg-positive/HBeAg-positive, 52 cases (96%) were found to have HBV DNA. HBV markers in 5 cases showing HBsAg-negative/HBV DNA-positive were as follows: 2 (1.3%) among 159 cases showing anti-HBs-positive/anti-HBc-negative and 1 (20%) among 5 cases showing anti-HBs-negative/anti-HBc-positive and 1 (1.8%) among 55 cases showing anti-HBs-positive/anti-HBc-positive and 1 (1.5%) among 65 cases showing no viral markers. 3 cases with HBV DNA among elevated ALT groups were positive only in anti-HBs test. CONCLUSION: This study indicates that serological markers for HBV infection are insufficient to guarantee the safety of donated blood. To improve the safety, it may be suggested that (1) donors with history of viral hepatitis or with history of HBsAg positivity shoud be indefinitely deferred from donation, (2) blood collected from donors who have showed HBsAg positive result at previous donation shoud be discarded, (3) HBsAg-negative /anti-HBs-negative /anti-HBc-positive blood should be discarded, (4) ALT screening should be continuously done because it could screen out HBsAg-negative /HBV DNA-positive blood irrespective of anti-HBc result, (5) HBV detction kit that can also detect HBV mutant shoud be developed, (6) governmental support for HBV vaccination program shoud be done especially for recruits.

The Rh(D) RBC Antigen Density Measurement by Flowcytometry / 대한수혈학회지

BACKGROUNDS: The Rh antigens are important m clinical practice. The classification of Rh phenotype is usually based on the antigen detection done by conventional serologic method, but it has many limitation such as delicate grading of antigen expression. Recently, Flowcytometry has been introduced in immunohematology to detect and quantitate cell bound immunoglobulins to assess blood cell antigens and related antibodies. So, we tried these method to detect Rh(D) antigen and measure its density and evaluated the possibility of clinical usage. MATERIALS AND METHODS: We performed a flowcytometric analysis for the expression of D antigen in D-positive, negative and weak D group in indirect immune fluorescence assay by using polyclonal antibodies. We measured the intensity of immunofluorescence as a degree of antigen density and analysed the difference of mean channel fluorescence value(MCF) among these groups. RESULTS: Weak D groups had the lower fluorescence than D-positive group, while D-negative sample showed the same fluorecence as negative ntrol. The difference of fluorescence intensity of D antigen between that of C antigen were not observed and were statistically insignificant. CONCLUSION: Flowcytometry appear to be a good tool for antigen density measurement in immunohematologic areas and shows the possibility of application to other aspect.

Evaluation of Diagnostic Kits for Hepatitis B Developed by LG Chemical Ltd / 대한수혈학회지

BACKGROUND: Infection of hepatitis B virus(HBV) is one of the most important cause of the liver diseases in Korea, although HBV infection tends to be decreased. Diagnostic kits more accurately detecting HBV infection have been required'in order to diagnose and prevent the HBV infection. Recently LG Chemical Ltd. developed new diagnostic kits for HBsAg, anti-HBs and anti-HBc, using HBV from Korean patients. We evaluated these new kits by comparing them with microplate enzyme immunoassay (EIA) from BehringTU(Germany) and microparticle EIA (MEIA) from AbbottTM(USA). METHOD: Sera from 1,500 healthy blood donors and 500 patients were obtained to test HBsAg, anti- HBs and anti-HBc using diagnostic kits from AbbottTM, BehringTM and LG Chemical Ltd. We analyzed the results of 3 manufacturers and confirmed the discordant results of HBsAg by Southern hybridization after HBV PCR and those of anti-HBs by neutralization assay with HBsAg from LGTM. We also evaluated the reproducibility and detection limit. RESULTS: Of 1,500 healthy blood donors, HBsAg was positive in 34 (2.3%), representing completely the same results from 3 manufacturers. However, of 500 patients, 7 (1.4%) had discordant results; HBsAg was positive in all 7 sera tested with BehringTM and positive in only one tested with AbbottTM and LGTM, respectively. HBV DNA was not detected in all 7 discordant results of HBsAg, so false positive results totaled 7 (1.4%) with BehringTM and 1 (0.2%) with AbbottTM and LGTM, respectively. Of 2,000 sera, the results of anti-HBs and anti-HBc from 3 manufacturers were same in 1,876 (93.8%) and in 1,949 (97.5%), respectively. Results of HBsAg, anti-HBs and anti-HBc from 3 manufacturers were constant on repeating tests. When testing the detection limit, BehringTM kits for HBsAg and anti-HBs retained significantly higher sensitivity than AbbottTM and LGTM. On the other hand, BehringTM kit for anti-HBc showed significantly lower sensitivity than AbbottTM and LGTM. CONCLUSION: The diagnostic kits for HBV developed by LG Chemical Ltd. showed comparable results with those by AbbottTM or BehringTM and will be useful as screening blood donors or detecting patients with HBV infection.

Detection of Platelet-Specific Antibodies Employing Modified Antigen Capture ELISA(MACE) / 대한수혈학회지

Widely used tests for the detection of platelet antibodies in Korea include platelet suspension immunofluorescence test(PSIFT), enzyme immunoassay and mixed passive hemagglutination(MPHA). In these tests, removal of HLA antigens from platelet are required to detect platelet-specific antibodies. Modified antigen capture ELISA(MACE) is known to be very sensitive for the detection of platelet-specific antibodies, in which specific platelet glycoprotein, captured by the monoclonal antibody is used as a target antigen. MACE is very useful for the detection of platelet-specific alloantibodies in neonatal alloimmune thrombocytopenia(NAIT) and posttransfusion purpura(PTP). We employed MACE in our laboratory, using AP2(anti-GPIIb/IIIa, monoclonal), #30 sera(anti-PlA1), 90-545 sera(anti-HLA-B51+52) and LYS sera(multispecific HLA antibodies). LYS sera had been used as our positive control( 1:120) in MPHA. Platelet from PIA1(+), HLA-B5 I, blood group O healthy male donor, gave positive result with #30 sera(1:40) and negative result with 90-545 sera in MACE. With LYS sera, MACE showed negative in 1:120, but positive in 1:20. So LYS sera was thought to contain strong multispecific HLA antibodies and relatively weak antibody(-ies) reacting with GPllb/Illa. Further studies employing different monoclonal antibodies, such as anti-GPIb/IX, -GPIa/Ila and -GPIV are under way.

Prevalence of HBsAg and anti-HCV Among Korean Blood Donors / 대한수혈학회지

o evaluate the seroprevalence of viral hepatitis marker among Korean healthy voluntary blood donors, the positive rates of both serum HBsAg and anti-HCV were analyzed. HBsAg testing was performed in 9,561,768 donors from January 1986 to June 1994 and anti-HCV testing was performed in 4,407,933 donors from May 1991 to June 1994. Positive rates of HBsAg were 3.76% to 6.87% per year and anti-HCV were 0.37% to 0.58% per year. The sex distribution of positive HBsAg and anti-HCV showed higher in male that in female. The age distribution of positive HBsAg was higher in 3th decade and anti-HCV was in 5th decade. The positive prevalence rate of HBsAg and anti-HCV showed highter above the serum ALT 45 IU. The positive rate of HBsAg was higher in group voluntary donors and anti-HCV in various other type of voluntary blood donors. In generally, the positive prevalence rate of HBsAg and anti-HCV showing however decreasing number in every year.

Prevalence of HIV Infected Blood Donors in Korea / 대한수혈학회지

Screening test of Human Immunodeficiency Virus(HIV) infection was introduced on Korean Blood Donor Test Program in July 1987, and the test results between July 1987 and December 1990 were reported on the Korean Journal of Blood Transfusion on May 1992. Moreover, we assessed anti-HIV ELISA screening test result of 3,905,986 blood donors donated at Korean Red Cross Blood Centers between January 1991 and December 1993. The seropositivity of anti-HIV ELISA screening test was 0.26% in 1991, 0.30% in 1992 and 0.18% in 1993.0.15% of all donors in 1991 was reactive repeatedly, and 0.15% in 1992 and 0.08% in 1993. The prevalence of HIV infected donors confirmed by Western Blot Assay was 0.0003% in 1991, 0.0015% in 1992, and 0.0009% in 1993. The sero-positivities of anti-HIV screening tests with AIDSDIA reagent and HIVIRO reagent were 0.32% and 0.17% and the difference was significantly(p<0.05). The sero-positivities of ELISA screening and Western Blot. Assay detecting anti-HIV were lower in soldier group than in non-soldier donor group (p< 0.05).

Anti-pre-S2 and anti-HBS responses to a heat inactivated hepatitis B vaccine in patients with mental retardation / 대한임상병리학회지

No abstract available.

Anti-pre-S2 and anti-HBS responses to a heat inactivated hepatitis B vaccine in patients with mental retardation / 대한임상병리학회지

No abstract available.