Two Cases of Successful Plasma Exchange with Unfractionated Heparin Anticoagulation in Patients Exhibiting Anaphylaxis to Acid-citrate-dextrose Formula A / 대한수혈학회지

Plasma exchange performed with the aid of acid-citrate-dextrose formula A (ACD-A) is generally regarded as safe. However, unfractionated heparin (UFH) can serve as an anticoagulant for patients experiencing serious side effects such as anaphylaxis. No guidelines have currently been defined for the stand-alone UFH dosing during plasma exchange. We describe here two patients who developed anaphylaxis to ACD-A during plasma exchange, and we successfully used UFH as a standalone anticoagulant. The first patient was a 55-year-old man who required plasma exchange before ABO-incompatible kidney transplantation. During plasma exchange, he developed an allergic reaction. Thereafter, UFH was used as a standalone anticoagulant during four sessions of plasma exchange; the UFH (5,000 units) was added to a 500 mL normal saline bag and the UFH:whole blood ratio was maintained at 1:28. The second patient was an 80-year-old woman with steroid pulse-resistant neuromyelitis optica. She developed an allergic reaction during the first session of plasma exchange. The patient subsequently underwent five successful sessions of plasma exchange using UFH as a standalone anticoagulant. These findings may be useful when establishing a protocol for UFH as a standalone anticoagulant during plasma exchange in patients who develop an allergic reaction to citrate.

Correlation Between C3d Assay and Single Antigen Bead Assay for Detection of Human Leukocyte Antigen Class II Antibodies

Background@#Detection of anti-human leukocyte antigen (HLA) antibodies is important during the selection of an appropriate donor prior to organ transplantation and also for monitoring the patients after transplantation. In this study, we compared antibodies detected via C3d assays, which monitors C3d complement-binding activities of HLA antibodies with those detected via single antigen bead (SAB) assays. @*Methods@#A total of 66 serum samples were tested in parallel by SAB assays (Immucor Transplant Diagnostics, USA) and C3d assays (Immucor) for the detection of HLA class II antibodies. The relationship between these two methods was analyzed based on the types, numbers, median fluorescent intensity (MFI) values, and positivity of the antibodies using MATCH IT! Antibody (Immucor) program. @*Results@#The number of antibodies obtained based on SAB and C3d assays was the highest with 24 samples (36.4%) in the 11–20 range and 23 (34.8%) in the 2–5 range detected via each assay. Among the SAB-positive antibodies, only 28 (6.4%) of the 440 antibodies with MFI ≤3,000 were C3d-positive, and 341 (61.3%) of the 556 antibodies with MFI ≥3,001 were C3d-positive. Whereas, among the 442 C3d-positive antibodies, SAB assays were positive except for 32 (7.2%) and 41 (9.3%) antibodies in the sections of MFI ≤500 and 1,001 ≤MFI ≤10,000, respectively. C3d-positive samples had higher maximum MFI values based on SAB assays, compared with C3d-negative samples. @*Conclusions@#MFI values of HLA class II antibodies detected through SAB assays in C3d-positive samples were higher than those in C3d-negative samples.

Experience at Department of Laboratory Medicine during the COVID-19 Outbreak in Daegu / 대한임상미생물학회지

The first case of coronavirus disease 2019 (COVID-19) in Korea was reported in January 2020.As the secondary transmissions accelerated within the country, the government revised the outbreak alert for COVID-19 from attention to caution. Mid-February, when a massive outbreak was reported from a church in Daegu, our institution initiated testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). More than 300 laboratory tests were performed within the first 2 months, before the number of cases began to decline. Here, we describe our experience of 4 months at the department of Laboratory Medicine, Keimyung University Dongsan Hospital, located in Daegu, where a massive COVID-19 outbreak occurred.

Experience at Department of Laboratory Medicine during the COVID-19 Outbreak in Daegu / 대한임상미생물학회지

The first case of coronavirus disease 2019 (COVID-19) in Korea was reported in January 2020.As the secondary transmissions accelerated within the country, the government revised the outbreak alert for COVID-19 from attention to caution. Mid-February, when a massive outbreak was reported from a church in Daegu, our institution initiated testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). More than 300 laboratory tests were performed within the first 2 months, before the number of cases began to decline. Here, we describe our experience of 4 months at the department of Laboratory Medicine, Keimyung University Dongsan Hospital, located in Daegu, where a massive COVID-19 outbreak occurred.

Correlation Between C3d Assay and Single Antigen Bead Assay for Detection of Human Leukocyte Antigen Class II Antibodies

Background@#Detection of anti-human leukocyte antigen (HLA) antibodies is important during the selection of an appropriate donor prior to organ transplantation and also for monitoring the patients after transplantation. In this study, we compared antibodies detected via C3d assays, which monitors C3d complement-binding activities of HLA antibodies with those detected via single antigen bead (SAB) assays. @*Methods@#A total of 66 serum samples were tested in parallel by SAB assays (Immucor Transplant Diagnostics, USA) and C3d assays (Immucor) for the detection of HLA class II antibodies. The relationship between these two methods was analyzed based on the types, numbers, median fluorescent intensity (MFI) values, and positivity of the antibodies using MATCH IT! Antibody (Immucor) program. @*Results@#The number of antibodies obtained based on SAB and C3d assays was the highest with 24 samples (36.4%) in the 11–20 range and 23 (34.8%) in the 2–5 range detected via each assay. Among the SAB-positive antibodies, only 28 (6.4%) of the 440 antibodies with MFI ≤3,000 were C3d-positive, and 341 (61.3%) of the 556 antibodies with MFI ≥3,001 were C3d-positive. Whereas, among the 442 C3d-positive antibodies, SAB assays were positive except for 32 (7.2%) and 41 (9.3%) antibodies in the sections of MFI ≤500 and 1,001 ≤MFI ≤10,000, respectively. C3d-positive samples had higher maximum MFI values based on SAB assays, compared with C3d-negative samples. @*Conclusions@#MFI values of HLA class II antibodies detected through SAB assays in C3d-positive samples were higher than those in C3d-negative samples.

First Case of Cellular Cannibalism in Small-Cell Carcinoma of the Bladder Detected in Peripheral Blood

No abstract available.

BRCA1/2 mutations, including large genomic rearrangements, among unselected ovarian cancer patients in Korea / 부인종양

OBJECTIVE: We performed small-scale mutation and large genomic rearrangement (LGR) analysis of BRCA1/2 in ovarian cancer patients to determine the prevalence and the characteristics of the mutations. METHODS: All ovarian cancer patients who visited a single institution between September 2015 and April 2017 were included. Sanger sequencing, multiplex ligation-dependent probe amplification (MLPA), and long-range polymerase chain reaction (PCR) were performed to comprehensively study BRCA1/2. The genetic risk models BRCAPRO, Myriad, and BOADICEA were used to evaluate the mutation analysis. RESULTS: In total, 131 patients were enrolled. Of the 131 patients, Sanger sequencing identified 16 different BRCA1/2 small-scale mutations in 20 patients (15.3%). Two novel nonsense mutations were detected in 2 patients with a serous borderline tumor and a large-cell neuroendocrine carcinoma. MLPA analysis of BRCA1/2 in Sanger-negative patients revealed 2 LGRs. The LGRs accounted for 14.3% of all identified BRCA1 mutations, and the prevalence of LGRs identified in this study was 1.8% in 111 Sanger-negative patients. The genetic risk models showed statistically significant differences between mutation carriers and non-carriers. The 2 patients with LGRs had at least one blood relative with breast or ovarian cancer. CONCLUSION: Twenty-two (16.8%) of the unselected ovarian cancer patients had BRCA1/2 mutations that were detected through comprehensive BRCA1/2 genetic testing. Ovarian cancer patients with Sanger-negative results should be considered for LGR detection if they have one blood relative with breast or ovarian cancer. The detection of more BRCA1/2 mutations in patients is important for efforts to provide targeted therapy to ovarian cancer patients.

Comparison and Evaluation of Diagnostic Assays for Clostridium difficile Infection

BACKGROUND: Clostridium difficile is a leading causative microorganism of pseudomembranous colitis (PMC) and antibiotic-associated diarrhea. In patients who have a history of antibiotic use and diarrhea, the presence of the C. difficile toxin should be confirmed to diagnose C. difficile infection (CDI). In this study, the results of three assays for CDI, which were performed on 1,363 clinical stool samples at a tertiary hospital, were analyzed to evaluate the performance and usefulness of these assays for diagnosis of CDI. METHODS: The results of the VIDAS C. difficile Toxin A&B Immunoassay (bioMérieux SA, France), Xpert C. difficile Real-Time PCR Assay (Cepheid, USA), and ChromID C. difficile Agar (bioMérieux SA, France) culture were analyzed retrospectively. Cases were defined as CDI according to the positive Xpert assay or the positive VIDAS assay and/or culture in the presence of PMC findings after radiological imaging or endoscopic procedures. RESULTS: A total of 1,027 samples (75.8%) tested negative in all three assays, 101 samples (7.4%) tested positive in all three assays, and overall agreement among them was 82.7%. In this study, 291 cases (21.3%) were diagnosed as CDI. Sensitivity and specificity of the VIDAS assay were 38.8% and 99.3%, and those of ChromID culture were 71.5% and 96.5%, respectively. The Xpert assay showed good sensitivity (98.6%, 287/291), whereas the VIDAS assay and ChromID culture showed low sensitivities. CONCLUSIONS: These results suggest that rapid molecular diagnostic assays, such as the Xpert assay, are promising candidates for an initial diagnostic test for CDI.

Adenovirus-induced Hemophagocytic Lymphohistiocytosis in a Previously Healthy Boy: A Case Report and Literature Review / 임상소아혈액종양

A 3-year-old previously healthy boy was admitted because of a 1-week history of fever, abdominal pain, vomiting, and diarrhea. The initial laboratory tests showed hepatic dysfunction with disseminated intravascular coagulation. There was a large amount of pleural effusion, periportal edema, minimal ascites, and splenomegaly. He was initially managed with broad spectrum antibiotics with transfusion. Despite 2 days of treatment, the fever persisted and the results of the laboratory tests had worsened. Bacterial cultures from the blood, urine, pleural effusion, and ascites were all negative. He was finally diagnosed with hemophagocytic lymphohistiocytosis (HLH) based on the diagnostic criteria. Adenovirus was detected in the initial diarrhea and nasal swab specimens using polymerase chain reaction-based method. One year after chemotherapy with dexamethasone, cyclosporine, and etoposide, he is now healthy without evidence of disease recurrence. This is the first Korean case report of adenovirus-induced HLH in a previously healthy child.

Adenovirus-induced Hemophagocytic Lymphohistiocytosis in a Previously Healthy Boy: A Case Report and Literature Review / 임상소아혈액종양

A 3-year-old previously healthy boy was admitted because of a 1-week history of fever, abdominal pain, vomiting, and diarrhea. The initial laboratory tests showed hepatic dysfunction with disseminated intravascular coagulation. There was a large amount of pleural effusion, periportal edema, minimal ascites, and splenomegaly. He was initially managed with broad spectrum antibiotics with transfusion. Despite 2 days of treatment, the fever persisted and the results of the laboratory tests had worsened. Bacterial cultures from the blood, urine, pleural effusion, and ascites were all negative. He was finally diagnosed with hemophagocytic lymphohistiocytosis (HLH) based on the diagnostic criteria. Adenovirus was detected in the initial diarrhea and nasal swab specimens using polymerase chain reaction-based method. One year after chemotherapy with dexamethasone, cyclosporine, and etoposide, he is now healthy without evidence of disease recurrence. This is the first Korean case report of adenovirus-induced HLH in a previously healthy child.

Frequency and Clinicohematologic Characteristics of MPL W515 Mutations in Patients with Myeloproliferative Neoplasms

BACKGROUND: Recently, myeloproliferative leukemia (MPL) W515 mutations have been reported to be molecular markers for myeloproliferative neoplasms (MPNs). We studied the association between MPL W515 mutations and the clinico-hematological features of patients with MPNs. METHODS: Our study included 154 consecutive patients diagnosed with MPNs (31 had polycythemia vera [PV]; 106, essential thrombocythemia [ET]; and 17, primary myelofibrosis [PMF]). MPL W515 mutations were detected by real-time PCR and direct sequencing methods. RESULTS: The MPL W515L mutation was found in 4 patients and the MPL W515A mutation was detected in 1 patient. These 5 patients were diagnosed with JAK2 V617F-negative ET, and they accounted for 12.5% of patients with JAK2 V617F-negative ET. The patients with MPL W515-positive ET showed significantly lower hemoglobin levels and WBC counts than did patients with MPL W515-negative ET or JAK2 V617F-positive ET. CONCLUSIONS: MPL W515 mutation is a useful diagnostic marker for JAK2 V617F-negative MPNs and it is associated with specific hematologic characteristics such as lower hemoglobin levels and WBC counts.

First Case of Pulmonary Mycobacterium parascrofulaceum Infection in a Patient With Bronchiectasis in Korea

No abstract available.

Acute Cellulitis Caused by Neisseria skkuensis / 대한임상미생물학회지

A 73-year-old man visited our hospital because of pain with swelling and redness on the right foot dorsum. He was diagnosed with liver cirrhosis and nodular hepatic cellular carcinoma. Lower extremity CT scan and MRI showed abscess formation in the right foot dorsum. Gram-negative cocci were recovered from the culture of drained pus at the site and identified as Neisseria skkuensis by 16S rRNA gene sequencing. Here, we report the first case of cellulitis due to N. skkuensis and provide a literature review.

A Case of Acute Myeloid Leukemia Transformed from JAK2 V617F-Positive Chronic Neutrophilic Leukemia

Chronic neutrophilic leukemia (CNL) is a rare myeloproliferative neoplasm (MPN) characterized by persistent peripheral blood neutorphilia, bone marrow hypercellularity of neutrophilic granulocyte proliferation and hepatosplenomegaly. Acquired somatic mutation, JAK2 V617F, is the only molecular marker known to have association with classic BCR-ABL1 negative MPNs. However, JAK2 V617F has been detected occasionally in other MPNs such as CNL or other disease entities. We experienced a case of CNL with JAK2 V617F mutation. The patient was diagnosed according to the 2008 WHO classification criteria, and developed AML 9 months after the diagnosis of CNL. The JAK2 V617F was detected in the bone marrow throughout the clinical course. More cases are needed to establish the role of JAK2 V617F in the pathogenesis, prognosis and disease course of CNL.

Bone marrow metastasis of small cell carcinoma of the lung mimicking Burkitt lymphoma/leukemias / 대한혈액학회지

No abstract available.

Evaluation of the Usefulness of Selective Chromogenic Agar Medium (ChromID VRE) and Multiplex PCR Method for the Detection of Vancomycin-resistant Enterococci / 대한진단검사의학회지

BACKGROUND: Accurate and early detection of vancomycin-resistant enterococci (VRE) is critical for controlling nosocomial infection. In this study, we evaluated the usefulness of a selective chromogenic agar medium and of multiplex PCR for detection of VRE, and both these techniques were compared with the conventional culture method for VRE detection. METHODS: We performed the following 3 methods for detecting VRE infection in stool specimens: the routine culture method, culturing in selective chromogenic agar medium (chromID VRE, bioMerieux, France), and multiplex PCR using the Seeplex(R) VRE ACE Detection kit (Seegene Inc., Korea) with additional PCR for vanC genes. RESULTS: We isolated 109 VRE strains from 100 stool specimens by the routine culture method. In chromID VRE, all the isolates showed purple colonies, including Enterococcus gallinarum and E. raffinosus, which were later identified using the Vitek card. All VRE isolates were identified by the multiplex PCR method; 100 were vanA-positive E. faecium, 8 were vanA- and vanC-1-positive E. gallinarum, and 1 was vanA-positive E. raffinosus. CONCLUSIONS: For VRE surveillance, culturing the isolates in chromID VRE after broth enrichment appears to be an accurate, rapid, and easy method for routine screening test. Multiplex PCR is relatively expensive and needs skilled techniques for detecting VRE, but it can be an auxiliary tool for rapid detection of genotype during a VRE outbreak.

Annual Report on External Quality Assessment in Blood Bank Tests in Korea (2009) / 임상검사와정도관리

BACKGROUND: We report here the results of surveys for external quality assessment of blood bank tests performed in 2009. METHODS: Survey specimens were sent three times to 488, 491 and 490 participant institutes, and the response rates for the 1st, 2nd and 3rd trial were 97.7%, 98.0%, and 98.0%, respectively. Test items for the surveys were ABO grouping, Rh (D) typing, crossmatching, direct antiglobulin test, antibody screening and antibody identification test. RESULTS: The average accuracy rates of ABO grouping and Rh typing were 99.6-100% and 98.5-100%, respectively. In crossmatching test, the accuracy rates were 99.3-99.8% for the compatible samples, 92.7-100% for the incompatible samples, and 92.6-93.1% for the samples which could be detected as incompatible only by antiglobulin method. The accuracy rates of direct antiglobulin test were 98.5-100% for negative samples and 98.1-98.8% for positive samples. The correctresults were reported by 98.0-100% of the surveyed institutions for antibody screening test and 82.9-100% for antibody identification test. Nineteen institutions gave repeatedly incorrect answers for crossmatching test. Eight institutions out of them gave incorrect answers for all the test specimens sent out 3 times last year. CONCLUSIONS: The overall results of this survey were good, however, it is required that the institutions where the incorrect results were reported should perform corrective actions for quality improvement.

Prevalence of Metallo-beta-lactamases in Imipenem-non-susceptible Pseudomonas aeruginosa and Acinetobacter baumannii / 대한임상미생물학회지

BACKGROUND: Metallo-beta-lactamases (MBLs) have been reported in gram negative bacilli and are becoming increasingly important clinically because the enzymes hydrolyse almost all beta-lactams, including carbapenems. Thus, the present study was conducted to determine the prevalence of MBL types in imipenem-nonsusceptible Pseudomonas aeruginosa and Acinetobacter baumannii isolated from a tertiary teaching hospital. METHODS: Imipenem-nonsusceptible strains, 128 P. aeruginosa and 93 A. baumannii, were collected from clinical specimens. Identification and susceptibility tests were determined by Vitek GNI and GNS cards. MBL production was determined by modified Hodge test and imipenem-EDTA synergy test. Multiplex PCR amplification of MBL genes including blaIMP-1, blaVIM-1 and blaVIM-2 were performed. RESULTS: Thirty-one P. aeruginosa (24.2%) isolates and 3 A. baumannii (3.2%) were found to be MBL producers. In P. aeruginosa, 20 (15.6%) and 11 (8.6%) isolates were positive for blaIMP-1 and blaVIM-2, respectively whereas 1 (1.0%) and 2 (2.2%) isolates in A. baumannii, respectively. CONCLUSION: IMP-1 is more prevalent MBL type than VIM-2 among imipenem-nonsusceptible P. aeruginosa unlike in other studies. Larger numbers of isolates and sequential studies are strongly recommended for the useful evaluation and monitoring of MBL production in the hospital setting to infection-control.

A Case of Partial Trisomy 15q25.3-qter / 대한진단검사의학회지

A 15q25-qter partial trisomy characterized by pre or postnatal overgrowth, tall stature, macrocephaly and craniosynostosis has rarely been reported. The cause of overgrowth has been thought to be the triplication of the insulin-like growth factor 1 receptor (IGF1R) gene located on the 15q26.3. We report a patient with partial trisomy 15q25.3-qter showing mental retardation, developmental delay, macrocephaly, long narrow face, ptosis, high palate arch, scoliosis, clinodactyly and overgrowth. Additional material located on terminal 2q was found in karyotyping analysis. In bacterial artificial chromosome (BAC) clone-based-array comparative genomic hybridization (aCGH) analysis, a gain of 31 clones on 15q25.3-qter and a loss of 2 clones on 2q37.3 were observed. An extra copy of IGF1R gene was observed on derivative chromosome 2 in FISH analysis. In conclusion, the patient was diagnosed to have de novo 46,XX,der(2)t(2;15)(q37.3;q25.3) chromosome complement. Adequate genetic counseling and regular follow-ups would be needed for the patient.

Annual Report on External Quality Assessment in Blood Bank Tests in Korea (2008) / 임상검사와정도관리

We report here the results of surveys for external quality assessment of blood bank tests performed in 2008. Survey specimens were sent three times to 460, 470 and 473 participant institutes, and the response rates for the 1st, 2nd and 3rd trial were 97.6%, 97.7%, and 97.7%, respectively. Test items for the surveys were ABO grouping, Rh (D) typing, crossmatching, direct antiglobulin test, antibody screening and antibody identification test. The average accuracy rates of ABO grouping and Rh typing were 100% and 98.3-100%, respectively. In crossmatching test, the accuracy rates were 97.5-99.7% for the compatible samples, 92.4-99.2% for the incompatible samples, and 88.2-98.9% for the samples which could be detected as incompatible only by antiglobulin method. The accuracy rates of direct antiglobulin test were 98.4-99.7% for negative samples and 93.4-99.7% for positive samples. The correct results were reported by 99.6-100% of the surveyed institutions for antibody screening test and 98.2-100% for antibody identification test. Twenty-three institutions gave repeatedly incorrect answers for crossmatching test. Ten institutions out of them gave incorrect answers for all the test specimens sent out 3 times last year.