-D-/-D- Phenotype Frequency among Korean Donors / 대한수혈학회지

BACKGROUND: To improve Rh-related antigen negative blood supply effectively, the Korean Red Cross (KRC) blood centers have performed Rh phenotype screening tests of C, c, E and e antigens for all donors since April, 2013. Especially for rare ‘-D-/-D-’ blood supply and donor recruitment, we have implemented Rh phenotype confirmation test for all C, c, E and e antigen negative donors. In this study, we report the test results of 7 donors with ‘-D-/-D-’ phenotype. METHODS: All three KRC Blood Laboratory Centers performed Rh phenotype screening tests using the automatic machine, PK7300 (Beckman Coulter, Japan), for all 876,920 donors from January 1, 2018 to April 30, 2018. We then performed the Rh phenotype confirmation test using the tube method manually, at room temperature, 37℃ and antihuman globulin phase. RESULTS: Among 876,920 donors, 14 were Rh antigen C, c, E, e negative as results of Rh phenotype screening test. The results of Rh phenotype confirmation test of these 14 donors showed that 7 donors were Rh antigen C, c, E, e negative. The ratio of -D-/-D- phenotype for all donors was 0.000798%. CONCLUSION: Our data suggests that -D-/-D- phenotype is one of the rare blood groups among Koreans. Although ‘-D-/-D-’ phenotype was confirmed by serologic tests, it is necessary to re-confirm it by molecular genetic techniques.

Traumatic Brachial Plexus Injury: Preoperative Evaluation and Treatment Principles

Brachial plexus injury is regarded as one of the most devastating injuries of the upper extremity. Accurate diagnosis is important to obtain the successful results. Basic preoperative evaluation includes simple radiography, cervical myelography. Magnetic resonance imaging, angiography, electrophysiologic studies and intraoperative studies. Furthermore, proper timing of surgery, surgical indication, plan and sufficient understanding of patients about the prognosis are the key for the satisfactory outcomes. This article provides an overview of the evaluation, diagnosis, intraoperative monitoring, and proper surgical planning for the treatment of posttraumatic brachial plexus injuries.

Radiation Dose from Whole-Body F-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography: Nationwide Survey in Korea

The purpose of this study was to estimate average radiation exposure from 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) examinations and to analyze possible factors affecting the radiation dose. A nation-wide questionnaire survey was conducted involving all institutions that operate PET/CT scanners in Korea. From the response, radiation doses from injected FDG and CT examination were calculated. A total of 105 PET/CT scanners in 73 institutions were included in the analysis (response rate of 62.4%). The average FDG injected activity was 310 +/- 77 MBq and 5.11 +/- 1.19 MBq/kg. The average effective dose from FDG was estimated to be 5.89 +/- 1.46 mSv. The average CT dose index and dose-length product were 4.60 +/- 2.47 mGy and 429.2 +/- 227.6 mGycm, which corresponded to 6.26 +/- 3.06 mSv. The radiation doses from FDG and CT were significantly lower in case of newer scanners than older ones (P < 0.001). Advanced PET technologies such as time-of-flight acquisition and point-spread function recovery were also related to low radiation dose (P < 0.001). In conclusion, the average radiation dose from FDG PET/CT is estimated to be 12.2 mSv. The radiation dose from FDG PET/CT is reduced with more recent scanners equipped with image-enhancing algorithms.

Two Cases of Anti-M of Donated Bloods Confirmed at pH 6.5 / 대한수혈학회지

Anti-M is detected at room temperature and is often found in the sera of people who have never been exposed to human red cells. In a few cases, anti-M can be detected at 37 degrees C or at the antiglobulin phase, and these antibodies can cause hemolytic diseases in newborn or hemolytic transfusion reactions. Some examples of anti-M demonstrate stronger agglutination at low pH (pH 6.5), and when they react with the red blood cells of the MM type (dosage effect). An unexpected antibody test was carried out for the routine screening of donated blood and two cases that reacted to all panel cells at 5 degrees C were found, which indicated anti-M. We repeated the unexpected antibody identification test at pH 6.5 and confirmed the presence of anti-M. The reduction of the test system pH is a useful and simple method for detecting some cases of anti-M.

Morphologic, Cytogenetic and Immunophenotypic Characteristics of CD56 expression in Acute Leukemia / 대한진단검사의학회지

BACKGROUND: CD56 is generally considered to be a natural killer (NK) cell marker, but it is also found in various tissues including acute leukemia. Recently, some reports have showed that positive CD56staining by blast cells is associated with an unfavorable outcome in AML with either t(8;21) or t(15;17)and in some ALL. This study investigated the characteristics of morphology, immunophenotype and cytogenetics and correlated the expression of CD56 of blast cells in 262 acute leukemia patients. METHODS: We analyzed 153 AML and 109 ALL, who underwent flow cytometry for CD56 at diagnosis at Chonnam National University Hospital between January 1999 and May 2003, for morphology, immunophenotype, and cytogenetics, retrospectively. RESULTS: The CD56 antigen was positive in 47 out of 163 AML cases (28.8%) and in 4 out of 109 ALL cases (3.7%). There were no statistically significant differences in the hematological parameters between the CD56+ and CD56- groups in ALL. However, the CD56 expression in AML was significantly high (81.8%) in AML-M2 with t(8;21) and low (5%) in AML-M3 with t(15;17) and was associatedwith the frequent expression of CD34 and HLA-DR. CONCLUSIONS: In conclusion, the CD56 expression in AML is associated with specific translocation, FAB subtype, some antigens CD34 and HLA-DR, and is significantly higher than in ALL.

Morphologic, Immunophenotypic, and Cytogenetic Findings in 339 Patients with Acute Leukemia / 대한진단검사의학회지

BACKGROUND: The findings from morphologic, immunologic, and cytogenetic studies have been used for diagnosis of acute leukemia. Although research regarding the relationship between each of these methods has grown significantly, the results of research in this area is still conflicting. Therefore, a comparative analysis of immunophenotyping results with the results of morphologic and cytogenetic analysis of 339 cases of acute leukemia was performed in this study. METHODS: 339 cases were chosen from the pool of patients with acute leukemia admitted to the Chonnam National University Hospital from July 1994 to December 2000 and comparative analysis was performed on the results of immunophenotyping using flow cytometry (Coulter EPICS XL Flow Cytometer) and morphological findings. Further comparative analysis was performed on 185 cases that also had available data from cytogenetic analysis. RESULTS: Based on the FAB classification for the 339 cases with acute leukemia, 63.7% (216/339) was AML, 35.4% (120/339) was acute lymphoid leukemia (ALL), and 0.9% (3/339) was unclassified acute leukemia. In the AML cases, the CD13 and CD33 expression percentages were 90.0% (188/209) and 68.1% (141/207), respectively. HLA-DR expression percentages, with the exception of M3 and M3v, comprised 72.4% (118/163) and HLA-DR was expressed at 5.1% (2/39) in M3 and M3v. 85.6% (77/90) of B lineage ALL were CD10-positive. Ly+ AML were 18.6% (40/215) and My+ ALL were 35.5% (43/121). Among the cases with available cytogenetic analysis results, 56.3% (76/135) AML and 42.9% (18/42) ALL had evidence of chromosomal abnormalities. CONCLUSIONS: Immunophenotyping results are generally consistent with the findings of morphological classifications and are useful in diagnosis of some subtypes of acute leukemia cases. However, many cases showed expression of unusual markers contrary to morphological diagnosis. Specific cytogenetic findings, t(8;21)(q22;q22), were observed, especially in CD19 and CD56 positive AML.

A Case of Mixed Fungemia with Cryptococcus laurentii and Candida zeylanoides / 대한임상병리학회지

Cryptococcus laurentii is one of several non-neoformans cryptococci that have rarely been associated with human infection. Candida zeylanoides, an unusual Candida species, is also infrequently reported as a human pathogen. We report a case of mixed fungemia with C. laurentii and C. zeylanoides in a 12-year-old girl. The patient with acute myelogenous leukemia was receiving intensive remission induction chemotherapy through a central venous catheter (CVC) and was severely neutropenic. She had been treated with oral fluconazole prophylaxis since admission. C. laurentii and C. zeylanoides were simultaneously isolated from the peripheral blood cultures collected on days 29 and 31 of her hospital stay. The culture of the removed catheter tip grew >15 CFU of both C. laurentii and C. zeylanoides. In vitro susceptibility testing of the strains showed that the MIC of fluconazole for C. laurentii and C. zeylanoides were 8 microgram/mL and 4 microgram/mL, respectively. The patient was successfully treated by CVC removal and by treatment with amphotericin B intravenously. To our knowledge, this represents the first report of C. laurentii and C. zeylanoides fungemia in Korea.

A Case of Sporotrichoid Fish Tank Granuloma / 대한피부과학회지

Mycobacterium marinum, group I photochromogen, is an atypical mycobacterium living in an aquatic environment including swimming pools, lagoon, lake, or fish tanks. Infections with M. marinum are not common, so only three cases have been reported in Korea. In general, skin lesions evolve as a solitary nodule or pustule but occasionally sporotrichoid spreading along the course of lymphatic vessels occurs. A 46-year-old woman visited our department with 2X1.5cm sized erythmatous ulcerated nodule on her right hand dorsum and several rice-sized subcutaneous nodules along the ascending course of lymphatic vessels on her right forearm. She had cleaned fish tank two months before the skin lesion developed. A AFB-positive microorganism was isolated by culture of the tissue specimen, which grew slowly at 30degrees C and those colonies showed yellowish color after light exposure on Ogawa medium. This microorganism was confirmed as M. marinum by polymerase chain reaction and restriction enzyme analysis. To the best of our knowledge, this is the first case of sporotrichoid granuloma due to M marinum infection occurred in association with fish tank in Korea.

Detection of Mycobacterium tuberculosis using BACTEC Mycobacteria Growth Indicator Tube(MGIT) 960 system: Comparison with BACTEC 460 TB system and Ogawa Media / 대한임상병리학회지

BACKGROUND: BACTEC MGIT 960 system(Becton Dickinson, USA; MGIT 960) is a fully automated, noninvasive culture system for mycobacteria, which has been regarded as a sensitive and least labor-intensive method. This study was purposed to evaluate the performance of MGIT 960 compared to BACTEC 460 TB radiometric system(Becton Dickinson, USA; BACTEC 460) and Ogawa media. METHODS: A total of 1,067 clinical specimens submitted from April to June in 1999 was cultured for acid fast bacilli(AFB). All specimens were digested, decontaminated by the 6% sodium hydroxide(final concentration of 1.5%) and 0.5% N-acetyl-L-cysteine method. All specimens were inoculated into three kinds of media: a MGIT, a BACTEC 12B, and an Ogawa medium. The AFB recovered from cultures were identified to M. tuberculosis complex and MOTT by NAP test. RESULTS: Of 106 isolates of M. tuberculosis recovered from all culture systems, 101(95.3 %) were detected in the MGIT 960, 95(89.6%) in the BACTEC 460 and 76(71.7%) on Ogawa media. MGIT 960 plus Ogawa media detected 104(98.1%) isolates and BACTEC 460 plus Ogawa media recovered 96(90.6%) isolates. The mean time required for detection of M. tuberculosis was 12.7+/-5.8 days with MGIT 960, 16.2+/-7.7 days with BACTEC 460, and 22.8+/-9.5 days with Ogawa media. The contamination rate were 5.1% for MGIT 960, 2.7% for BACTEC 460, and 6.7% for Ogawa media. CONCLUSIONS: MGIT 960 is a sensitive and rapid method to isolate M. tuberculosis.

Clinical Effect of Granulocyte Transfusion Therapy in Neutropenia-Related Infection / 대한혈액학회지

BACKGROUND: After a zealous advocates of granulocyte transfusion therapy (GTX) in the 1970s and early 1980s, the use of GTX has diminished strikingly because of the several problems of GTX and the introduction of new antimicrobial agents and recombinant hematopoietic growth factors. Recently, GTX offers renewed interest because several investigators reported the transfusion efficacy of granulocytes collected by stimulating normal donors with recombinant human granulocyte-colony stimulating factor (G-CSF). METHODS: To evaluate the safety and efficacy of GTX, thirteen patients with neutropenia- related infections at Chonnam University Hospital from March 1997 to February 1998 were treated with dexamethasone- or G-CSF-stimulated granulocyte transfusions apheresed from normal donor. RESULTS: Patients received a mean number of 2.4 transfusions (range, 1-7) and a mean dose of 5.5x1010 granulocytes (range, 0.2-19.6). Six patients (46.2%) had favorable responses. Favorable responses occurred among patients with more fungal infection than bacterial infection (71.4 vs 28.6%, P<0.05) and more increment of absolute neutrophil count at 1 hour after transfusion (P<0.05). Adverse reactions of GTX were pulmonary edema in 2 patient (15.4%) and transient hypoxia in 1 patient (7.7%). One patient (7.7%) with pulmonary edema died of severe pulmonary reaction. Two of 20 donors received by G-CSF complained of mild myalgia and bone pain. CONCLUSION: G-CSF- or dexamethasone-stimulated GTXs were well tolerated and may be clinically beneficial for neutropenia-related infection, particularly in fungal infection, that is refractory to antimicrobial therapy.

Evaluation of Vitros 950 for Quantitative Analysis of Digoxin and Theophylline / 대한임상병리학회지

BACKGROUND: We evaluated the Vitros 950 (Johnson & Johnson Clinical Diagnostics, Inc., NY, USA) in the measurement of digoxin and theophylline levels and compared its results to those of the TDxFLx II (Abbott Laboratories, IL, USA) used for therapeutic drug monitoring (TDM) world-widely in order to assess the utility of the Vitros 950 as a TDM instrument. METHODS: From June 1997 to August 1997, 125 and 135 candidates for TDM were randomly chosen to measure digoxin and theophylline, respectively, using the Vitros 950 and TDxFLx II. The relationship between its results and those of TDxFLx II were determined. The within-run and between-run precisions of the Vitros 950 were determined using two controls (Vitros Performance Verifier I and II; J & J Clinical Diagnostics, Inc., NY, USA). The high-concentration control (Vitros Performance Verifier II) was diluted in Vitros 7% BSA to 5 dilutions. And linearity for quantitative analysis of digoxin and theophylline were determined. RESULTS: The coefficients of variation (CV) for the within-run of the Vitro 950 were 0.8% - 4.4%. And the CV for between-run precision of the Vitro 950 were 1.7% - 12.3%. The linearity of digoxin and theophylline were relatively good. The correlations (r) of digoxin and theophylline levels with those determined by the Abbott TDxFLx II were 0.95 and 0.93, respectively (P <0.001). CONCLUSIONS: The recently developed dry slide method of the Vitros 950 proves to good precision and linearity for quantitative analysis of digoxin and theophylline. Its results correlate well with those of the TDxFLx II. The Vitros 950 does not require an elaborate preparatory protocol for the sample, and is easy to use and maintain.So it is considered a highly feasible instrument for stat test.