Convalescent Plasma Therapy in Coronavirus Disease 2019: a Case Report and Suggestions to Overcome Obstacles

Coronavirus disease 2019 (COVID-19) is rapidly spreading around the world, causing much morbidity and mortality everywhere. However, effective treatments or vaccines are still not available. Although convalescent plasma (CP) therapy can be useful in the treatment of COVID-19, it has not been widely used in Korea because of the concerns about adverse effects and the difficulty in matching patients to donors. The use of ABO-incompatible plasma is not contraindicated in treatment, but can be hesitated due to the lack of experience of physicians. Here, we describe a 68-year old man with COVID-19 who was treated ABO-incompatible plasma therapy; additionally, we comment on the acute side effects associated with ABO mismatch transfusion. To overcome the obstacles of donor-recipient connections (schedule and distance), we propose the storage of frozen plasma, modification of the current Blood Management Law, and the establishment of a CP bank. We suggest that experience gained in CP therapy will be useful for not only the treatment of COVID-19, but also for coping with new emerging infectious diseases.

Usefulness of Serum IGF-I and IGFBP-3 Levels in Children with Short Stature / 임상검사와정도관리

BACKGROUND: Serum insulin-like growth factor-I (IGF-I) and insulin-like growth factor binding protein-3 (IGFBP-3) levels are known markers of growth hormone (GH) secretion. The clinical utility of serum IGF-I and IGFBP-3 testing, however, remains controversial. The aims of this study were to evaluate the usefulness of IGF-I and IGFBP-3 as indicators of GH secretion through the GH stimulation test and to investigate whether a decrease in serum IGF-I levels in children with short stature, regardless of the cause, can be used as a screening test for short stature. METHODS: A total of 262 children presented with short stature, precocious puberty, or premature thelarche and were grouped into 7 tiers based on the 2007 growth chart. Serum IGF-I and IGFBP-3 levels and GH stimulation were analyzed using an immunoradiometric assay, and the data from 68 children who were below the 3rd percentile for height were used to evaluate the usefulness of IGF-I and IGFBP-3 as markers of GH status. RESULTS: GH deficiency was confirmed by the GH stimulation test in 25 of the 68 children, and 15 (15/25, 60%) and 4 (4/25, 16%) of them showed a decrease in IGF-I and IGFBP-3 levels, respectively. The sensitivity and specificity for predicting GH secretion were 60% and 16%, respectively, for IGF-1 and 41.9% and 97.7%, respectively, for IGFBP-3. Decreased serum IGF-I levels were more frequently observed in children below the 25th percentile than in those in the 25th to 95th percentiles. CONCLUSIONS: IGF-I and IGFBP-3 levels have been used as a screening tool for GH secretion in children with short stature, but based on the results of the GH stimulation test in the current study, the levels of IGF-I and IGFBP-3 might not be useful as markers of GH secretion. Evaluating serum IGF-I levels alone is not a sufficient screening test for children with a short stature.

Klebsiella Pneumoniae Associated Extreme Plasmacytosis

Infection-associated plasmacytosis is not uncommon; however, marked plasmacytosis in both peripheral blood and bone marrow that mimicks plasma cell leukemia is a very rare condition. We encountered a case of extreme plasmacytosis associated with Klebsiella pneumoniae sepsis in an aplastic anemia patient. A 42-year-old man presented with high fever of 5 days' duration. Hematological analysis revealed severe neutropenia and thrombocytopenia; his white blood cell count was 900/mm3, with 26% of plasma and plasmacytoid cells in peripheral blood. Bone marrow biopsy and aspiration showed 25% cellularity with marked plasmacytosis (80%), highly suggestive of plasma cell leukemia. On the eighth hospital day, K. pneumoniae was identified in blood and sputum cultures. Fever improved after switching antibiotics, although his hematological condition worsened. His bone marrow cellularity (plasma cell proportion) progressively decreased: the values were 25% (80%), 10% (26%), 10% (11%), and < 10% (< 4%) on the 8th, 30th, 60th, and 90th hospital day, respectively. His plasmacytosis was extremely severe but was confirmed to be reactive with polyclonality. The present case represents the first report of strong suspicion of K. pneumoniae sepsis-associated marked plasmacytosis in an aplastic anemia patient.

A Case of Anaerobiospirillum succiniciproducens Isolated from Blood Culture / 대한임상미생물학회지

Anaerobiospirillum succiniciproducens is a spiral-shaped, gram-negative anaerobic bacterium. A. succiniciproducens is a rare cause of bacteremia in human, especially immunocompromised patients. This organism may be mistakenly identified when using an automated bacterial identification system, and may be mistaken for Campylobacter spp. when using Gram staining. We report a case of bacteremia caused by A. succiniciproducens, which was negative for catalase, oxidase, and urease and confirmed by 16S rRNA sequencing (analysis revealed a 99% similarity), in a 69-year-old patient who was undergoing chemotherapy for treatment of a malignancy. To the best of our knowledge, this is the first report of bacteremia caused by A. succiniciproducens in Korea.

Significance of Serum Eosinophil Cationic Protein and High-Sensitivity C-reactive Protein Levels in Patients with Allergic and Non-Allergic Inflammatory Diseases

BACKGROUND: This study was conducted to evaluate the significance of serum eosinophil cationic protein (ECP) and high-sensitivity C-reactive protein (hs-CRP) levels in children with allergic diseases and non-allergic inflammatory diseases, and to assess the relationships between serum ECP levels and inflammatory parameters. METHODS: In this study, we included 146 children with allergic diseases, 76 children with non-allergic inflammatory diseases, and 25 control subjects. Serum concentrations of ECP, hs-CRP, total IgE, and allergen-specific IgE were measured. RESULTS: Serum ECP levels (77.5+/-88.2 microg/L) of patients with allergic diseases were significantly higher than those of the patients with non-allergic inflammatory diseases (42.2+/-58.8 microg/L) and control subjects (12.7+/-4.2 microg/L) (P0.05). CONCLUSIONS: Measurement of serum ECP and hs-CRP concentrations can be helpful in the clinical evaluation and monitoring of patients with allergic diseases. No significant correlation was observed between serum ECP and hs-CRP levels in allergic patients, thereby suggesting that elevated levels of ECP do not necessarily reflect the degree of systemic inflammation in allergic diseases.

A Case of Blastic Plasmacytoid Dendritic Cell Neoplasm Initially Mimicking Cutaneous Lupus Erythematosus / Journal of the Korean Cancer Association, 대한암학회지

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare disease. The prognosis is poor in most cases with rapid progression despite administering chemotherapy. A 67-year-old man complained of skin rashes on his back and this spread to the trunk, face, arms and thighs, and he was initially diagnosed with cutaneous lupus erythematosus according to the skin biopsy. The skin rashes then became aggravated on a trial of low dose methylprednisolone for 3 months. Repeated skin biopsy revealed a diffuse infiltration of lymphoid cells with medium sized nuclei, positive for CD4 and CD56, negative for Epstein-Barr virus (EBV), indicating a diagnosis of BPDCN. Further workups confirmed stage IVA BPDCN involving the skin, multiple lymph nodes, the peripheral blood and the bone marrow. He was treated with six cycles of combination chemotherapy consisting of ifosphamide, methotrexate, etoposide, prednisolone and L-asparaginase, and he achieved a partial response. Herein we report on a rare case of BPDCN that was initially misinterpreted as cutaneous lupus erythematosus.

Allergen Specific IgE Measurement with Polycheck Allergy: Comparison of Three Multiple Allergen Simultaneous Tests / 대한진단검사의학회지

BACKGROUND: The in vivo skin prick test (SPT) or in vitro detection of allergen specific IgE in serum is commonly used for the diagnosis of allergic disease. In this study, we evaluated the usefulness of a new multiple allergen simultaneous test (MAST) immunoblot assay, Polycheck Allergy (Biocheck GmbH, Germany). METHODS: A total of 100 patients with clinical findings of allergic diseases were tested by SPT and three different MAST assays: Polycheck Allergy (Biocheck GmbH, Germany), MAST CLA allergy system (Hitachi Chemical Diagnostics, USA) and Allergy Screen (R-biopharm, Germany). The results of MAST assays were compared with those of SPT. RESULTS: Concordance rates of MAST assays with SPT were 79-100% for Polycheck Allergy, 88.9-100% for MAST CLA and 72.7-98.3% for Allergy Screen. In ROC curve analysis, significant differences were observed in four of 25 allergens analysed: Alternaria, Birch, Hazelnut and D. farinae. For Alternaria and Birch, Polycheck Allergy (P0.05). CONCLUSIONS: Since Polycheck Allergy showed similar or superior result to the others, it can be used for the detection of allergen specific IgE antibodies.

Ten-year Experience on Acute Promyelocytic Leukemia at Inha University Hospital / 대한혈액학회지

BACKGROUND: Acute promyelocytic leukemia (APL) is a distinct subtype of acute myeloid leukemia in its morphology as well as molecular or genetic profiles, conferring a good prognosis owing to the active roles of all-trans-retinoic acid (ATRA) and anthracyclines. METHODS: Patients diagnosed as APL from March 1997 to April 2006 were analyzed on their clinical features, laboratory profiles, methods of treatment including remission induction, consolidation and maintenance, treatment outcomes, and treatment-related morbidity. RESULTS: Chemotherapy naive were all the 12 patients in our study consisting of 3 males and 9 females. All patients showed typical morphologic feature of APL with cytogenetic abnormality, t(15;17), and PML/RAR alpha fusion gene was confirmed in 10 patients by FISH or PCR. The combination of cytarabine with daunorubicin (n=2) or idarubicin (n=9) was used as an induction regimen with concurrent ATRA administration. For consolidation therapy, cytarabine with anthracycline (n=4) or idarubicin monotherapy (n=8) was used with ATRA. Cytogenetic and molecular remissions were documented after induction chemotherapy (n=11) or first consolidation therapy (n=1). Maintenance therapy with ATRA was done in 11 patients. CR was obtained in 12 patients, with median remission duration of 30.5+ months (range 2 to 86+) at a median follow up duration of 33.5+ months (range 4 to 89+). One patient relapsed after completion of maintenance therapy and died of infection during reinduction chemotherapy. CONCLUSION: Herein is the report of ten years' experience of our hospital in the treatment of APL with favorable results as seen by high CR rate and fewer complications.

Chronic Myelogenous Leukemia with a Variant Philadelphia Translocation: t(11;22)(q25;q11.2) / 대한진단검사의학회지

We report a case of chronic myelogenous leukemia displaying a variant Philadelphia translocation t(11;22)(q25;q11.2). Breakpoint 11q25 has not previously been reported. Reverse transcriptase polymerase chain reaction and fluorescence in-situ hybridization demonstrated the BCR/ABL rearrangement.

Double Minutes Containing C-MYC oncogene with a Normal Karyotype in Acute Myelogenous Leukemia: A Case Report / 대한진단검사의학회지

We report a case of a female karyotype that was normal except for double minutes (dmin) in acute myeloid leukemia. Using fluorescence in situ hybridization, the amplification of C-MYC was detected in both interphase and metaphase cells. The patient of the present case had received only limited therapy with cytosine arabinoside, but lived for more than one year. It supports the recent notion that dmin may not necessarily be associated with a poor outcome.

Balantidium coli in an Asymptomatic Patient: A Case Report / 대한진단검사의학회지

Balantidium coli is widely distributed in hogs, particularly in warm and temperate climates, and in monkeys in the tropics. B. coli is the only pathogenic ciliate and is the largest protozoan parasitizing humans. Some individuals with B. coli infections are totally asymptomatic, whereas others have symptoms of severe dysentery similar to those seen in patients with amebiasis. We report a 5-year-old girl with asymptomatic balantidiasis. The patient was suffering from herpes zoster for several days. She did not have symptoms of dysentery or urinary tract infection. Motile trophozoites of B. coli were observed in the urinary sediment. This is the first report of asymptomatic balantidiasis in Korea.

Usefulness of Calcium Injection in Large-volume Leukapheresis / 대한수혈학회지

BACKGROUND: Hypocalcemia is the most common side effect in large-volume leukapheresis (LVL) for collection of peripheral blood stem cells (PBSCs). We evaluated the effect of intravenous calcium infusion on the hypocalcemic symptoms during LVL. METHODS: Seventy-six LVLs with hypocalcemic symptoms were participated in this study. LVLs were performed using Gambro Spectra (blood rate, 80 mL/min; whole blood to ACD-A with heparin, 24:1) until 20 L of blood was processed. Blood flow rate was slowed to 60-70% of initial in 35 LVLs (group A) and 20 mL of 3% CaCl2 was infused intravenously in 41 LVLs (group B). Serum levels of ionized calcium, total magnesium, and electrolytes were determined before and after each LVL and analyzed with students?-test. RESULTS: The observed hypocalcemic symptoms were perioral paresthesias (71%), digital numbness (17%), chest tightness (4%), chills (4%), headache (3%), and vomiting (1%). Serum ionized calcium decreased by 15.9% in group A (P<0.001) and increased by 1.3% in group B. Total magnesium in group A (11.4%, P=0.002) and potassium in both groups (9.5%, P<0.001 and 8.6%, P=0.02, respectively) were significantly reduced. In group A, hypocalcemic symptoms were not completely relieved but weakened in 63%, and blood flow rate had to be kept below 55 mL/min in 37%. In group B, the symptoms were relieved by 20 mL of 3% CaCl2 in 27% and by 40 mL in 73%. CONCLUSION: Reduction of blood flow for relief of hypocalcemia symptoms was only helpful in lightening the symptoms. Intravenous infusion of calcium was more effective and convenient to alleviate hypocalcemic symptoms and did not affect LVL procedures nor serum levels of ionized calcium.

Alternation of Cytokine mRNA Expression in Human Blood Samples before and after Allogeneic Transfusions / 대한진단검사의학회지

BACKGROUND: Despite proposing clonal depletion, anergy, and alternation of cytokines in peripheral tolerance, the precise mechanism for the immunosuppressive effect of blood transfusion remains unknown. Here, we evaluated the effect of transfusion on the immune system indirectly via quantitation of leukocyte cytokine mRNA expression before and after allogeneic transfusion. METHODS: Samples were obtained from eight patients, being ordered one to four units of leukocytefree erythrocytes, before, 1, and 7 days after transfusion, from November to December, 2002 at Inha University Hospital. We explored the changes in mRNA expression of interleukin-2 (IL-2), IL-4, IL-10, tumor necrosis factor alpha (TNF-alpha) and interferon gamma (IFN-gamma). RESULTS: In four patients who received blood transfusions among eight, significant changes were observed in the blood mRNA levels of INF-gamma and IL-10. The amounts of IFN-gamma mRNA were significantly decreased a day after transfusion to 78.5% and then recovered to 110.9% 7 days later (P=0.032), whereas, that of IL-10 was increased to 151.5% a day after and recovered to 119.1% 7 days later (P=0.034). mRNA expressions of IL-2, IL-4, and TNF-alpha were not detected in all patients. CONCLUSIONS: We observed a significant decrease in leukocyte IFN-gamma mRNA expression and an increase in IL-10 mRNA after transfusion. These findings indirectly represent that down-regulation of the Th1 cells and the up-regulation of the Th2 cells could be caused by allogeneic transfusion.

Clinical Significance of Cytoplasmic Staining in Antinuclear Antibody Tests Using HEp-2 Cells / 대한진단검사의학회지

BACKGROUND: Cytoplasmic stainings in antinuclear antibody tests using HEp-2 cells are usually undetermined and the significance has not been fully understood until now. Hence, we evaluated their clinical characteristics and also the coexistence of other autoantibodies in the sera with cytoplasmic stainings in antinuclear antibody tests. METHODS: We reviewed clinical records retrospectively in 53 sera showing cytoplasmic stainings among 3, 610 sera that were tested antinuclear antibodies from January to September, 2002 and performed antimitochondrial antibodies (AMA) tests using indirect immunofluorescence (IIF) and antibodies to antiribosomal P and extractable nuclear antigens (ENA) tests using enzyme immunoassay (EIA). RESULTS: Among 53 sera with cytoplasmic stainings, 31 sera showed an AMA pattern and 15 sera showed an antibody to ribosomal P pattern. Three cytoskeletal and one golgi complex patterns were also observed. The most common diagnosis was autoimmune disorders (32, 60.4%) and hepatic disorders (excluding autoimmune hepatitis) (6, 11.3%). Hepatic disorders including autoimmune, drug-induced, and alcoholic hepatitis were most commonly observed (32.3%) in sera with an AMA pattern. On the other hand, various autoimmune disorders such as SLE, systemic sclerosis, dermatomyositis, and polymyositis were observed (86.7%) in sera with a ribosomal P pattern. Of 31 sera with the AMA pattern, the corresponding antibodies were confirmed in three by IIF and of 15 sera with a ribosomal P pattern, only one was confirmed to have this antibody by EIA. All the confirmed sera showed high titered (>1: 320) cytoplasmic stainings. Antibodies to ENA were positive in sixteen (RnP, 5; Sm, 4; Ro, 5; La, 2) and anti-DNA in three of the sera. CONCLUSIONS: Although cytoplasmic staining patterns are not disease specific, it is suggested that continuous high titer stainings be followed up since they could provide diagnostic help.

Ex Vivo Expansion and Clonality of CD34 Cells from Bone Marrow, Umbilical Cord Blood and Mobilized Peripheral Blood in Serum-free Media / 대한소아혈액종양학회지

PURPOSE: Umbilical cord blood is increasingly being used in the setting of allogeneic marrow transplantation. However, while neutrophil engraftment is comparable to that of marrow transplants, delayed platelet engraftment is often a concern for cord blood transplant recipients. This delay may be due to relative weakness of the megakaryocyte lineage in cord blood. We evaluated the potential of ex vivo expansion and clonality from different stem cell sources. METHODS: The CD34 cells from bone marrow (BM), umbilical cord blood (CB), and mobilized peripheral blood (PB) were cultured for burst-forming unit of erythrocyte (BFU-E), colony-forming unit of granulocyte and monocyte (CFU- GM) and colony-forming unit of megakaryocyte (CFU-MK) at day 0, day 4, day 7, and day 14 under the combination of growth factors, with cell counts. Cytokines included recombinant human megakaryocyte growth and development factors (100 ng/mL), interleukin-3 (10 ng/mL), stem cell factor (100 ng/mL), and flt-3 ligand (50 ng/mL). RESULTS: CB-derived CD34 cells had significantly higher total cell proliferation than either BM or PB at day 7 (1.6 to 18.2 fold) and day 14 (1.2 to 17.2 fold). The colony count of BFU-E was in general more plentiful in CB than in BM and PB at day 4, day 7 and day 14, among which the difference was the most distinct at day 7 culture. Also, CB CD34 cells produced more CFU-Mk colonies than did BM or PB at day 4 and day 7. There were no differences in colonies count of BFU-E and CFU-Mk between BM and PB. CONCLUSION: Ex vivo expansion of CB cells may be most promising in producing total cellular expansion, CFU-Mk and BFU-E compared with BM and PB, especially at day 7, because the former was the most productive hematopoietic source on a per volume basis.

Analysis of Blood Spot 17-Hydroxyprogesterone Concentration According to Gestational Age and Birth Weight / 대한임상병리학회지

BACKGROUND: High levels of 17-hydroxyprogesterone (17-OHP) are frequently observed in premature infants without congenital adrenal hyperplasia. The purpose of this study is to set cut-off limits of 17-OHP on the basis of gestational age at birth and birth weight. METHODS: Blood spot 17-OHP concentrations were measured in 1,000 infants on the 3th day of life at Inha University Hospital. An enzyme-linked immunosorbent assay (ELISA) method (ICN Neoscreen ELISA 17-hydroxyprogesterone kit, ICN Pharmaceuticals. Inc., Japan) was used. The values obtained were analyzed with respect to birth weight and gestational age at birth in order to decide the appropriate cut-off limits in a neonatal mass screening for 21-hydroxylase deficiency. RESULTS: In the neonatal mass screening for CAH, the cut-off limits for determining the 17-OHP for recall, were decided as follows: (1) 57.65, 39.88, 33.52 ng/mL for gestational age at birth of 35 weeks or less, 36-37, and 38 weeks or more, respectively, and (2) 54.88, 43.86, 32.92 ng/mL for birth weight of 2.49 or less, 2.50-2.99, 3.00 kg or more, respectively. CONCLUSIONS: The cut-off limits on the basis of gestational age at birth and birth weight should be used in the screening for congenital adrenal hyperplasia. We believe that the false positive rate in premature infants can be reduced using this method.

A case of i Phenotype Siblings with Congenital Cataract / 대한수혈학회지

We report a two-generation Korean family in which 2 siblings have congenital cataract and phenotype i. This report is a first case in Korean people and shows the evidence suggesting the linkage of Ii blood group with a recessive form of congenital cataracts.

A Case of Adult Neuroblastoma Involving Bone Marrow / 대한임상병리학회지

Neuroblastoma, which originates in the sympathetic division of the autonomic nervous system, is the most common extracranial solid malignancy in childhood but rarely occurs in adulthood. Only one case of neuroblastoma has been reported in Korean adult. Authors recently experienced a case of neuroblastoma originating from the retroperitoneal cavity with metastasis to the bone marrow and neck. A 29-year-old male was admitted at Inha University Hospital because of abdominal pain and back pain. The patient had a past history of chemotherapy for retroperitoneal tumor in a general hospital 4 years ago. In biochemical test, neuron specific enolase(NSE) was above 260 ng/mL and urine vanillylmandelic acid(VMA) was positive. Immunohistochemical stainings of bone marrow sections, showed positive reactions for NSE, chromogranin, and synaptophysin, however, revealed negative reactions for MIC2, vimentin, and mixed keratin. Pathologic examination showed the characteristic findings of neuroblastoma. We report this case with a review of literature.

A Case of Cerebral Malaria Associated with Renal Failure due to Plasmodium falciparum / 대한임상병리학회지

In recent years, the incidence of imported cases infested with Plasmodium falciparum has been increasing in Korea due to marked increase in travel to malarious area without adequate prophylaxis. Cerebral malaria is an encephalopathy, occasionally associated with infestation of P. falciparum, which can complicate some patients infected with Plasmodium falciparum leading to significant mortality. We experienced a case of 45 year-ld male with cerebral malaria, complicated with disseminated intravascular coagulation and acute renal failure. The patient was thought to be infected in travel to Indonesia, Laos, and Bangkok. Blood smear showed typical multiple intra-rythrocytic ring form trophozoites and banana-haped gametocytes of Plasmodium falciparum. The patient died after comatose state with respiration failure for 24 days despite treatment with exchange transfusion, hemodialysis and chemotherapy. We report this case with a review of the literature.

A Case of Cerebral Malaria Associated with Renal Failure due to Plasmodium falciparum / 대한임상병리학회지

In recent years, the incidence of imported cases infested with Plasmodium falciparum has been increasing in Korea due to marked increase in travel to malarious area without adequate prophylaxis. Cerebral malaria is an encephalopathy, occasionally associated with infestation of P. falciparum, which can complicate some patients infected with Plasmodium falciparum leading to significant mortality. We experienced a case of 45 year-ld male with cerebral malaria, complicated with disseminated intravascular coagulation and acute renal failure. The patient was thought to be infected in travel to Indonesia, Laos, and Bangkok. Blood smear showed typical multiple intra-rythrocytic ring form trophozoites and banana-haped gametocytes of Plasmodium falciparum. The patient died after comatose state with respiration failure for 24 days despite treatment with exchange transfusion, hemodialysis and chemotherapy. We report this case with a review of the literature.