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Background@#ABO genotyping is performed when the exact ABO blood type cannot be determined through serological testing. Conventionally, only exons 6 and 7 of the ABO gene have been analyzed, but our laboratory introduced additional analysis of the proximal promoter and intron 1 ＋5.8 kb site. Accordingly, we report the clinical use of ABO genotyping and distribution of the ABO subgroups based on our experience over the past 5 years. @*Methods@#A total of 265 samples tested at the Samsung Medical Center from August 2017 to July 2022 were retrospectively analyzed at their request. Serological ABO blood typing and direct sequencing of exons 6 and 7 were performed on all samples, and additional analysis of the regulatory region of the ABO gene was performed on 17 samples. Since some of the ABO discrepant cases revealed multiple causes, a total of 339 causes among 238 ABO discrepant cases were analyzed. @*Results@#Among the total of 265 samples, 89.8% (238/265) exhibited ABO discrepancies. Weak red cell reactivity (51.6%, 175/339) was the most common cause of ABO discrepancy, followed by extra serum reactivity (35.7%, 121/339). Among the samples, 40.8% (108/265) were identified as ABO subgroups. Among the 108 ABO subgroup alleles, cisAB.01 in exons 6 and 7 accounted for 82 cases (75.9%, 82/108), and two g.10925C＞T mutations in intron 1 ＋5.8 kb were identified. @*Conclusion@#Through our recent experience of the last 5 years of ABO genotyping, we elucidated the cause of ABO discrepancies and ABO subgroup alleles. The extended sequencing of the regulatory region of the ABO gene was helpful for further understanding the ABO discrepancy caused by weak red cell reactivity. (Korean J Blood Transfus 2023;34:12-20)
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Purpose@#Plasma circulating tumor DNA (ctDNA) could reflect the genetic alterations present in tumor tissues. However, there is little information about the clinical relevance of cell-free DNA genotyping in peripheral T-cell lymphoma (PTCL). @*Materials and Methods@#After targeted sequencing plasma cell-free DNA of patients with various subtypes of PTCL (n=94), we analyzed the mutation profiles of plasma ctDNA samples and their predictive value of dynamic ctDNA monitoring for treatment outcomes. @*Results@#Plasma ctDNA mutations were detected in 53 patients (56%, 53/94), and the detection rate of somatic mutations was highest in angioimmunoblastic T-cell lymphoma (24/31, 77%) and PTCL, not otherwise specified (18/29, 62.1%). Somatic mutations were detected in 51 of 66 genes that were sequenced, including the following top 10 ranked genes: RHOA, CREBBP, KMT2D, TP53, IDH2, ALK, MEF2B, SOCS1, CARD11, and KRAS. In the longitudinal assessment of ctDNA mutation, the difference in ctDNA mutation volume after treatment showed a significant correlation with disease relapse or progression. Thus, a ≥ 1.5-log decrease in genome equivalent (GE) between baseline and the end of treatment showed a significant association with better survival outcomes than a < 1.5-log decrease in GE. @*Conclusion@#Our results suggest the clinical relevance of plasma ctDNA analysis in patients with PTCL. However, our findings should be validated by a subsequent study with a larger study population and using a broader gene panel.
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Individuals with Asia type DEL blood group, the RhD-variant that classified as serologically RhD-negative, do not produce anti-D even when exposed to the D-antigen. Therefore, it is considered safe to transfuse RhD-positive blood products to them. However, such transfusions are still rare in medical institutions, with only two cases reported in Korea. Here, we present cases of two additional patients based on our experience. A 60-year-old female patient undergoing extra corporeal membrane oxygenation (ECMO) for myocarditis presented with severe anemia.The patient was serologic RhD-negative. Due to the lack of RhD-negative RBC inventory for emergency transfusion, RhD-positive blood was transfused. After confirming the patient’s RHD genotype as Asia type DEL, the planned RhD-positive blood transfusion was continued. A total of 13 units of RhD-positive RBCs and 26 units of single donor platelets (SDPs) were transfused over 25 days. Throughout this period, all unexpected antibody tests were negative. The second patient, a 50-year-old male diagnosed with myelodysplastic syndrome (MDS), was serologic RhD-negative, and the RHD genotyping confirmed Asia type DEL. During the hospitalization period, a total of 113 units of RhD-positive SDPs and 10 units of fresh frozen plasma (FFP) were transfused over 64 days, and all unexpected antibody tests were negative. These two cases suggest the transfusion of RhD-positive blood products to patients with Asia type DEL is safe.
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Background@#Remote ischemic postconditioning (RIPoC) is induced by several cycles of brief, reversible, mechanical blood flow occlusion, and reperfusion of the distal organs thereby protecting target organs. We investigated if RIPoC ameliorated liver injury in a lipopolysaccharide (LPS)-induced endotoxemic rats. @*Methods@#Protocol 1) Rats were administered LPS and samples collected at 0, 2, 6, 12, and 18 h. 2) After RIPoC at 2, 6, and 12 h (L+2R+18H, L+6R+18H, and L+12R+18H), samples were analyzed at 18 h. 3) RIPoC was performed at 2 h, analysis samples at 6, 12, 18 h (L+2R+6H, L+2R+12H, L+2R+18H), and RIPoC at 6 h, analysis at 12 h (L+6R+12H). 4) Rats were assigned to a control group while in the RIPoC group, RIPoC was performed at 2, 6, 10, and 14 h, with samples analyzed at 18 h. @*Results@#Protocol 1) Liver enzyme, malondialdehyde (MDA), tumor necrosis factor-α (TNF-α), and nuclear factor-κB (NF-κB) levels increased while superoxide dismutase (SOD) levels decreased over time. 2) Liver enzyme and MDA levels were lower while SOD levels were higher in L+12R+18H and L+6R+18H groups when compared with L+2R+18H group. 3) Liver enzyme and MDA levels were lower while SOD levels were higher in L+2R+6H and L+6R+12H groups when compared with L+2R+12H and L+2R+18H groups. 4) Liver enzyme, MDA, TNF-α, and NF-κB levels were lower while SOD levels were higher in RIPoC group when compared with control group. @*Conclusions@#RIPoC attenuated liver injury in the LPS-induced sepsis model by modifying inflammatory and oxidative stress response for a limited period.
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Among RhD variants, it is considered safe to transfuse RhD positive blood to “Asia-type” DEL and weak D type 1, 2, and 3 recipients. However, transfusing RhD-positive blood cells in the “Asia-type” DEL, (serologically typed as RhD-negative), is still a cause for concern among clinicians. Here, the safety of transfusing RhD-positive blood components to “Asia-type” DEL recipients is re-emphasized by reviewing previously published literature.
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Objective@#This study investigated the hospital use patterns of patients with human immunodeficiency virus (HIV) infections in Korea. The prevalence of HIV infections in Korea is very low and there is no data on the type of medical treatment HIV patients receive. We therefore decided to perform a complete enumeration of the utilization of medical facilities by HIV patients using a nationwide claims database. @*Methods@#The nationwide Health Medical Insurance Review and Assessment (HIRA) service claims database was used to identify and include all new patients with HIV infections from 2013 to 2018. The current inpatient, outpatient, and emergency service use of these patients were investigated. The number of invasive procedures, interventions, and operations performed on these patients, and their death rate, was also investigated. @*Results@#The number of patients visiting outpatient departments increased by 44% from 2013 to 2018. The most frequently visited department was internal medicine, followed by emergency medicine. Dental procedures followed intravenous line insertions as the most common procedures undertaken by patients with HIV. @*Conclusion@#The results of this study show the status of hospital visits by patients with HIV infections in Korea and provide the basic data upon which policy decisions can be based.
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Purpose@#Analysis of circulating tumor DNA (ctDNA) in blood could allow noninvasive genetic analysis of primary tumors. Although there have been unmet needs for noninvasive methods in patients with primary central nervous system lymphoma (PCNSL), it is still not determined whether plasma ctDNA analysis could be useful for patients with PCNSL. @*Materials and Methods@#Targeted deep sequencing of 54 genes was performed in cell-free DNA isolated from plasma samples collected pretreatment, during treatment, and at the end of treatment in 42 consecutively diagnosed PCNSL patients between January 2017 and December 2018. @*Results@#Targeted sequencing of plasma cell-free DNA detected somatic mutations representing ctDNA in 11 cases (11/41, 27%). The detection of ctDNA was not related to the concentration of cell-free DNA or tumor volume. The mutation profiles of these 11 cases varied between patients. The most frequently mutated gene was PIM1 (4/11, 36.4%), whereas KMT2D, PIK3CA, and MYD88 were each observed in three patients (3/11, 27%). The mutations of 13 genes were concordantly found in primary tumor tissue and plasma ctDNA, giving a detection sensitivity of 45%. During the serial tracking of seven patients with complete response, the disappearance of ctDNA mutations was found in four patients, whereas three patients had detected ctDNA mutation at the end of treatment. @*Conclusion@#The plasma ctDNA mutation analysis still has limited value for surveillance and predicting treatment outcomes of PCNSL because the detection efficiency was lower than other systemic lymphomas. Thus, analytical platforms should be improved to overcome anatomical hurdles associated with PCNSL.
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Immune-related adverse events, including immune hemolytic anemia, have been reported in patients treated with immune checkpoint inhibitors. In particular, RBC autoantibodies are important because they can cause hemolytic anemia and interfere with pre-transfusion tests. On the other hand, there are few reports on the characteristics of RBC autoantibodies induced by immune checkpoint inhibitors in Korea. The medical history and laboratory results, including pretransfusion tests of ten patients treated with immune checkpoint inhibitors, were reviewed retrospectively. The median interval from the first administration of immune checkpoint inhibitors to the development of autoantibodies was 12 weeks. In eight patients, only cold autoantibodies were developed. Both warm and cold autoantibodies developed in one patient, and warm autoantibodies alone were detected in one patient.Of seven patients tested by a direct antiglobulin test, two were negative, and the remaining five were positive for IgG and negative for C3d. In conclusion, this study presented ten cases of autoantibody developments in patients treated with immune checkpoint inhibitors and the possible relationship between the immune checkpoint inhibitors and RBC autoantibody development. Further comprehensive studies will be needed to elucidate this relationship.
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Background@#In ABO-incompatible (ABOi) solid organ transplantation, the minimization and management of isoagglutinin (IA) against donor ABO antigens between before and two weeks after transplantation is important for preventing hyper-acute rejection. Several factors that can affect the IA titer have been reported. This is the first study to evaluate whether there are IA titer differences between kidney transplantation (KT) and liver transplantation (LT) recipients. @*Methods@#Thirty-eight KT and 32 LT type O recipients, who underwent ABOi KT or LT between March 2013 and March 2018, were enrolled consecutively. The IgM IA and IgG IA titers of the LT and KT recipients at different time points (initial, operation day [day-0], postoperative one week, four weeks, and one year) were evaluated. @*Results@#The LT recipients showed higher initial IgG IA titers than the KT recipients (P=0.01). This higher titer in the LT recipients persisted during the critical phase (from before transplantation to postoperative one week). The IgG and IgM IA titers were similar in the KT and LT recipients at postoperative four weeks. @*Conclusion@#The difference in IA titer between the underlying diseases should be considered in the desensitization protocol before ABOi SOT.
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Background@#In ABO-incompatible (ABOi) solid organ transplantation, the minimization and management of isoagglutinin (IA) against donor ABO antigens between before and two weeks after transplantation is important for preventing hyper-acute rejection. Several factors that can affect the IA titer have been reported. This is the first study to evaluate whether there are IA titer differences between kidney transplantation (KT) and liver transplantation (LT) recipients. @*Methods@#Thirty-eight KT and 32 LT type O recipients, who underwent ABOi KT or LT between March 2013 and March 2018, were enrolled consecutively. The IgM IA and IgG IA titers of the LT and KT recipients at different time points (initial, operation day [day-0], postoperative one week, four weeks, and one year) were evaluated. @*Results@#The LT recipients showed higher initial IgG IA titers than the KT recipients (P=0.01). This higher titer in the LT recipients persisted during the critical phase (from before transplantation to postoperative one week). The IgG and IgM IA titers were similar in the KT and LT recipients at postoperative four weeks. @*Conclusion@#The difference in IA titer between the underlying diseases should be considered in the desensitization protocol before ABOi SOT.
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No abstract available.
Subject(s)
Erythrocytes , Isoantibodies , Phenotype , Sensitivity and SpecificityABSTRACT
Methods for reproducibly isolating and enriching small extracellular vesicles (EVs) from blood are essential for clinical utilization of small EVs in cancer patients. We combined ultracentrifugation (UC) with polymer-based precipitation (ExoQuick [EQ] or Total Exosome Isolation [TEI] kit) to isolate small EVs (diameter, 30–150 nm) from the serum of breast cancer patients. We compared the performance of four cycles of UC (UC4x) with that of two cycles of UC followed by enrichment using the EQ (UC2x→EQ) or TEI (UC2x→TEI) kits. The mean concentration of small EVs isolated from 1 mL of serum using UC2x→EQ (139.0±29.1 µg) and UC2x→TEI (140.4±5.0 µg) did not differ from that obtained using UC4x (141.8±26.9 µg). The mean number of EV particles obtained using UC4x was 29.2±9.9×109 per mL of serum, whereas UC2x→EQ and UC2x→TEI yielded higher numbers of EVs (50.7±17.0×10⁹ and 59.3±20.6×10⁹, respectively). Concentrations of EV microRNAs, including miR-21 and miR-155, did not differ between the three methods. In conclusion, performing UC prior to the use of polymer-based precipitation kits could be feasible for isolating small EVs from human serum in large sample-based translational researches.
Subject(s)
Humans , Breast Neoplasms , Extracellular Vesicles , MicroRNAs , Translational Research, Biomedical , UltracentrifugationABSTRACT
Subject(s)
Female , Humans , Young Adult , Anemia , Antibodies , Blood Transfusion , Erythrocytes , Intellectual Disability , Iron , Isoantibodies , Korea , Mass Screening , P Blood-Group System , Phenotype , Polymerase Chain Reaction , Prevalence , Rehabilitation , Serologic TestsABSTRACT
Weak D type 102 allele (RHD*01W.102) carrying a missense variant (c.73A＞T, p.Ile25Phe) in exon 1 of the RHD has not been reported in Koreans to date. This is the first report of the weak D type 102 allele in the Korean population. The proposita, a 35-year-old woman, showed a serological weak D phenotype in routine RhD typing. Sequencing of all 10 RHD exons and zygosity testing targeting the hybrid Rhesus box revealed this proposita to harbor the weak D type 102 allele, as well as an RHD deletion (RHD*01W.102/RHD*01N.01). Family studies showed that the weak D type 102 allele was also present in her father and older brother (both assumed to be RHD*01W.102/RHD*01) but not in her mother and oldest brother (both assumed to be RHD*01/RHD*01N.01). In silico analysis of the replacement of isoleucine by phenylalanine at position 25 was done with PolyPhen-2, SIFT, and PROVEAN. While PolyPhen-2 predicted the variant as benign, SIFT and PROVEAN predicted it as damaging and deleterious, respectively, suggesting RHD c.73A>T (I25F) as the cause of serologic weak D phenotype. This patient should be treated as D-negative, when transfusion is needed.
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Epidemiological studies of monoclonal B-cell lymphocytosis (MBL) have been conducted in limited geographical regions. Little is known about the prevalence of MBL in Asia. We investigated the prevalence and immunophenotypic characteristics of MBL in Koreans who had idiopathic lymphocytosis (lymphocyte count >4.0×109/L) and were ≥40 years of age. A total of 105 leftover peripheral blood samples met these criteria among those from 73,727 healthy individuals who visited the Health Promotion Center, Samsung Medical Center, Korea, from June 2018 to August 2019. The samples were analyzed using eight-color flow cytometry with the following monoclonal antibodies: CD45, CD5, CD10, CD19, CD20, CD23, and kappa and lambda light chains. The overall prevalence of MBL in the study population was 2.9% (3/105); there was one case of chronic lymphocytic leukemia (CLL)-like MBL (CD5+CD23+), one case of atypical CLL-like MBL (CD5+CD23−), and one case of CD5−MBL with a lambda restriction pattern. This is the first study on the MBL prevalence in an East Asian population, and it reveals a relatively low prevalence of MBL in healthy Korean individuals with lymphocytosis.
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Weak D and partial D result in quantitative and qualitative changes in RhD protein expression respectively. It is difficult to discriminate weak D from partial D by serological tests alone. RHD genotyping is a useful method that complements serological results. A 64-year-old woman visited our hospital for microvascular decompression surgery. Her blood type was O, D negative by manual tube test and as per auto analyzer results (QWALYS-3 system; DIAGAST, France). Weak D and partial D tests were performed by using two different monoclonal anti-D reagents (Bioscot; Merck Millipore, UK; Bioclone; Ortho Clinical Diagnostics, USA) and a panel of nine monoclonal antibodies, including anti-D IgM and IgG (D-Screen; DIAGAST, France). However, these serological tests could not confirm the subtype of partial D. Therefore, sequencing of RHD exon 1 to 10 was additionally performed for the patient and the case was revealed to be partial DVI type 3.
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The Korean Journal of Blood Transfusion (KJBT) is a representative journal in the field of transfusion medicine and has contributed to the development of the national blood business and clinical research. The KJBT was selected as a candidate journal registered in the Korea Citation Index (KCI) in 2009 and was selected as a KCI-registered journal in 2016. The KJBT has published 796 articles, including 601 original articles and 144 case reports from the first issue to volume 31, number 2. The KJBT has continuously introduced new tools for improving journals but was assessed as having a high self-citation rate because of the characteristics of the journal. Nevertheless, it is necessary to increase the number of papers to improve the value of the KJBT. To accomplish this, continuous efforts of the editorial committee will be needed to provide better services to authors and readers and to promote journals.
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Cis-AB and B(A) alleles encode an ABO enzyme with dual A and B glycosyltransferase activity. Although globally rare, the cis-AB phenotype is found relatively often in Korean, Japanese, and Chinese populations. Cases of the B(A) allele have been reported mostly in the Chinese population. Forward typing performed in a Cambodian woman with an ABO discrepancy demonstrated a strong reaction with anti-A and anti-B reagents, while there was no reaction with lectin anti-A 1. The anti-A 1 antibody was detected in reverse typing. Through ABO gene sequence analyses of exons 6 and 7, one of the alleles was identified as ABO*B.01. In contrast, the other allele harboring a c.803G＞C substitution was either ABO*cisAB.05 or ABO*BA.06 allele. The ABO*cisAB.05 and ABO*BA.06 alleles remain indistinguishable despite routine serological testing and ABO genotyping. To the best of the author’s knowledge, this is the first case report of these variants discovered in a Cambodian individual residing in Korea.
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No abstract available.
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Weak D and partial D result in quantitative and qualitative changes in RhD protein expression respectively. It is difficult to discriminate weak D from partial D by serological tests alone. RHD genotyping is a useful method that complements serological results. A 64-year-old woman visited our hospital for microvascular decompression surgery. Her blood type was O, D negative by manual tube test and as per auto analyzer results (QWALYS-3 system; DIAGAST, France). Weak D and partial D tests were performed by using two different monoclonal anti-D reagents (Bioscot; Merck Millipore, UK; Bioclone; Ortho Clinical Diagnostics, USA) and a panel of nine monoclonal antibodies, including anti-D IgM and IgG (D-Screen; DIAGAST, France). However, these serological tests could not confirm the subtype of partial D. Therefore, sequencing of RHD exon 1 to 10 was additionally performed for the patient and the case was revealed to be partial DVI type 3.