Safety of Red Blood Cell Transfusion by the Emergency Blood Transfusion Protocol / 대한수혈학회지

Background@#Pretransfusion testing is vital for safe transfusion. However, in situations without time to perform sufficient testing, all or part of the pretransfusion testing may be skipped to issue blood quickly. This study evaluated the safety of red blood cell (RBC) transfusion released by an emergency blood transfusion protocol through retrospective analysis at a tertiary hospital for eight years. @*Methods@#All RBC transfusions following the emergency blood transfusion protocol from 2011 to 2018 at Seoul National University Hospital were included in the study. Crossmatching and unexpected antibody screening test results conducted after RBC release and the occurrence of hemolytic transfusion reactions were analyzed. @*Results@#A total of 1,541 cases (5,299 RBCs issued) of emergency blood transfusion were identified. RBCs were issued after performing the immediate spin crossmatch without an unexpected antibody screening test in most cases (1,443; 93.64%), while RBCs were issued with no pretransfusion testing in 98 cases (6.36%). Antibody screening tests performed after the issue of RBCs showed that 17 (1.1%) cases were positive. Two units of RBCs from two different cases showed positive antiglobulin crossmatch test results. However, none of them were suspected to be associated with a hemolytic transfusion reaction. @*Conclusion@#The incidence of incompatible RBC release was very low in patients receiving RBC transfusion through the emergency blood transfusion protocol suggesting it can be used safely with minimal risk of hemolytic transfusion reactions caused by incompatible blood transfusions.

Hematopoietic Stem Cell Registry Report: 2018 / 대한수혈학회지

Background@#Hematopoietic stem cell (HSC) transplantation is an important therapeutic option for many malignant and non-malignant diseases. The whole transplant process involves multiple areas and complex steps. The laboratory procedures include the collection, processing, and storage of HSC. The HSC registry aims to identify the current situation and draw improvement points by voluntarily registering the information of an HSC graft collected by each institute sharing the analyzed data. This study analyzed and shared the data for 2018. @*Methods@#Data for 2018 registered at the HSC registry website (www.ksfa-registry.org) was downloaded and analyzed. The data were to enter the information of each collection and include the demography of the donors, transplant type, instrument, vascular access, mobilization modality, and the number of CD34＋ cells. @*Results@#Two thousand eight hundred eighty-eight collection datasets from 1,373 donors were registered from 19 institutes, which was slightly higher than that reported in 2017. The number of collections in one patient was in the range of 1∼17 times, and the average was two times. In allogeneic HSCT, the number of related donors was higher than that of unrelated donors. The frequency of collecting more than four times per donor was 25.2% for autologous donors, compared to 95.4% for allogeneic donors less than twice. @*Conclusion@#The HSC registry is not limited to identifying the current situation and sharing the analyzed data, but is expected to contribute to the development of guidelines, education of human resources, and the standardization of laboratory procedures involved in hematopoietic stem cell transplantation.

Two Cases of Hypersensitivity Reactions Caused by Human Serum Albumin During Therapeutic Plasma Exchange

Iso-oncotic human serum albumin (HSA) is the primary replacement fluid of choice during therapeutic plasma exchange (TPE). Hypersensitivity reactions to HSA are rare, but require proper evaluation and management. In this article, we report two cases of hypersensitivity reactions to 5% HSA during TPE and discuss strategies to address this problem. The first case was a 60-year-old female patient, who was scheduled for TPE for treatment of recurrent focal segmental glomerulosclerosis after ABO-incompatible kidney transplantation. She developed a pruritic rash on her entire body during the first two sessions of TPE using 5% HSA. The third session was conducted using 500 mL normal saline, 1,000 mL 10% pentastarch, and 750 mL 5% HSA, where she eventually developed a pruritic rash when HSA was infused. There were no adverse events during the fourth and fifth session when fresh frozen plasma was used in place of HSA. The second case was a 50-year-old male patient diagnosed with optic neuritis, who was admitted for five sessions of TPE. The patient developed a pruritic rash on his entire body during the first session of TPE using 5% HSA. The patient experienced no adverse events during the following four sessions using fresh frozen plasma. Certain elements contained in HSA, such as albumin aggregates, prekallikrein activator, and caprylate-modified albumin, might be the reason for these hypersensitivity reactions. Careful selection of alternative replacement fluids is important to avoid premature termination of TPE procedures and secure optimal treatment options for patients.

Minimum Specimen Volume Analysis of ABO/RhD Typing and Unexpected Antibody Screening Using an Automated Immunohematology System DAYmate S / 대한수혈학회지

BACKGROUND: Phlebotomy performed for laboratory testing has the potential to cause anemia in newborns and infants. This study investigated the minimum specimen volume required for an automated immunohematology analyzer DAYmate S. METHODS: Three combinations of tubes were evaluated: I. 6 mL EDTA tube, II. 0.5 mL microtainer (on top of 3 mL EDTA tube), and III. 1 mL sample cup (on top of 6 mL EDTA tube). ABO/RhD cell typing was done using centrifuged red cells; unexpected antibody screening was carried out using plasma, and Type & Screening was conducted using whole blood samples. The lowest specimen volume capable of performing 10 repetitive tests without errors was investigated. RESULTS: ABO/RhD cell typing could be performed from I. 30 μL, II. 25 μL, and III. 25 μL. Unexpected antibody screening could be performed from I. 170 μL, II. 150 μL, and III. 140 μL. According to the hematocrit levels, Type & Screening could be performed from 30%, I&III 650 μL, II. 800 μL; 40%, I&III 650 μL, II. 900 μL; and 50%, I&III 1,000 μL, II. Testing using specimen volumes below 1,000 μL was difficult. CONCLUSION: By separating red cells and plasma, pre-transfusion testing of ABO/RhD cell typing and unexpected antibody screening could be conducted with very small specimen volumes using DAYmate S compared to Type & Screening using whole blood. The application of small-sized sample tubes was more competitive and this is expected to be very useful for preventing iatrogenic anemia in neonates and infants less than 4 months old.

Clinical Significance of Anti-G Alloantibody and Serologic Interpretation Strategies for Patients with an Anti-C+D Pattern: First Report of Anti-G Alloantibody Identification in Korea

No abstract available.

A Case of Anti-JMH Antibody with High-Titer, Low-Avidity Characteristics: The First Case in Korea / 대한수혈학회지

Anti-John Milton Hagen (JMH) is a high-titer, low-avidity (HTLA) antibody against the high frequency red blood cell (RBC) antigen JMH. It occurs very rarely and has not yet been reported in Korea. Here, we report a case of anti-JMH antibody identified in a 92-year-old man without previous blood transfusion history, who had been hospitalized with pneumonia. The patient's hemoglobin level was reduced to 7.6 g/dL on the 35th day of hospitalization, requiring RBC transfusion. Antibody identification test revealed antibodies that showed pan-reactivity to all panel cells at the antiglobulin phase. A titration test confirmed that it was a HTLA antibody. He was given one least-incompatible unit of RBC without any adverse events, and his hemoglobin level increased to 9.3 g/dL. The patient's sample was referred to a reference laboratory and the antibody was identified as anti-JMH. He was successfully transfused with 6 additional units of least-incompatible RBCs without complication. HTLA antibodies against high frequency antigens, such as anti-JMH, are less likely to cause significant destruction of transfused antigen positive RBCs. However, identifying the specificity of these antibodies is necessary to appropriately understanding the clinical significance of the antibody, detecting other clinically important alloantibodies that may coexist, and determining the appropriate blood for transfusion.

Strategies to Prevent Transfusion-Transmitted Infection in Blood Centers / 대한수혈학회지

There has been continuous effort to prevent transfusion-transmitted infection (TTI). Strategies to prevent TTI can be divided into two components: first, determining donor eligibility, and second, managing bacterial contamination of blood products. To determine donor eligibility, medical history taking and screening tests for infectious diseases should be performed. To prevent bacterial contamination, blood collection process should be aseptic, tests for bacterial detection should be performed, and an application of pathogen reduction technology should also be considered. In this review, screening test items and methods, including nucleic acid amplification tests for determining donor eligibility, and precautions for blood collection, bacterial detection methods, and pathogen reduction technology for the prevention of bacterial contamination of blood products were discussed in detail.

Utilization Analysis of Neonatal Red Blood Cell Aliquots and Development of Electronic Issuing System / 대한수혈학회지

BACKGROUND: Although transfusion in neonates needs to be strictly regulated due to the vulnerability of neonates, there is lack of systematic studies and the working process is not well-established. This study was aimed to point out the problems of current status and to improve the efficiency of systems used in blood aliquots for neonatal transfusions. METHODS: Total red blood cell (RBC) aliquots were analyzed between May 2009 and January 2016 in the neonate intensive care unit. We investigated the aliquot number, issued day interval from the first issued aliquot among the post-aliquots, patients' blood type, and discarded RBC units among the requested RBC units. RESULTS: Of the 472 RBC aliquots, 95.4% (450/472) were divided into two units. The distribution of patients' blood type was similar to that of the Korean population, in decreasing order: A blood group (34.3%), B group (28.2%), and O group (27.5%). The second, third, and forth units of post-aliquots were taken after an average of 49.9 (0∼617.9) hours. Among the post-aliquots, the number of units discarded without use was 22.5%. CONCLUSION: According to the evaluation of current status for neonatal transfusions, we should use aliquot RBC properly and reduce unnecessary requests for aliquot RBC. In addition, in order to reduce the number of near misses, we propose a new label to be attached on the aliquotted blood bags and suggest a development of electronic blood issuing system.

Gene Frequency of Human Neutrophil Alloantigen-3 in the Korean Population / 대한수혈학회지

BACKGROUND: In the Korean population, gene frequencies of Human Neutrophil Alloantigen-1 (HNA-1), HNA-2, HNA-4, and HNA-5 were determined using serological and genotyping methods. However, no study assessing the gene frequencies of HNA-3 among the Korean population has been conducted. The aims of this study were to report the gene frequencies of HNA-3, to estimate the risk of HNA-3a (or HNA-3b) alloimmunization, and to secure donors of granulocytes for anti-HNA-3 antibodies among the Korean population. METHODS: Genotyping of HNA-3a and HNA-3b genes of 110 healthy and unrelated Korean donors was performed using a polymerase chain reaction with sequence-specific primers. RESULTS: The observed frequencies of HNA-3a and HNA-3b were 0.695 and 0.305, respectively, among the Korean population. The HNA-3a gene frequency of Koreans was significantly lower than those of American Whites and Germans (P<0.05). The risk of HNA-3a and HNA-3b alloimmunization due to pregnancy (transfusion) was 0.065 (0.084) and 0.147 (0.250), respectively, among the Korean population. The risk of HNA-3a alloimmunization was significantly higher in the Korean population than in the German and American White populations (P<0.05). CONCLUSION: The gene frequencies of HNA-3 and the risk of HNA-3a (HNA-3b) alloimmunization due to pregnancy or transfusion among the Korean population were determined. We also identified individuals who were HNA-3a/3a or HNA-3b/3b for the granulocyte panel which could be used for anti-HNA antibody identification.

Correlation between the Severity of Bone Pain and the Amount of CD34+ Cells after Peripheral Blood Stem Cell Mobilization / 대한수혈학회지

BACKGROUND: Peripheral blood stem cells (PBSCs) are mobilized by granulocyte-colony stimulating factor (G-CSF), which causes several side effects in allogeneic donors. We report on side effects of G-CSF administration and determine which side effects could be used in predicting the amount of harvested CD34+ cells. METHODS: Data from the first PBSC collections of 155 healthy donors between 2007 and 2010 were analyzed. Side effects were assessed using adverse event inventory, which was graded from 1 (mild) to 3 (severe) or 4 (disabling). RESULTS: G-CSF administration caused an elevation of WBC counts (mean 44,834/microL) and 86% of them were neutrophils. The mean mononuclear cells in apheresis products was 6.6x10(8)/kg and mean CD34+ cells was 6.0x10(6)/kg. Bone pain was reported by 151 healthy donors (97%) and severe bone pain was related to more CD34+ cells in apheresis products (P=0.041): 39 for grade 1 (5.1x10(6) CD34+cells/kg), 86 for grade 2 (6.0x10(6)), and 26 for grade 3 (7.1x10(6)). In addition, the percentage of collecting more than 5.0x10(6) CD34+cells/kg during the first leukapheresis showed correlation with the severity of bone pain. CONCLUSION: Bone pain was the most common side effect of G-CSF mobilization and more CD34+ cells were harvested in cases of severe bone pain.

Human Neutrophil Alloantigen-3a Alloimmunization among Pregnant Korean Women / 대한수혈학회지

BACKGROUND: Alloantibodies against human neutrophil alloantigen (HNA)-3a are associated with severe and fatal transfusion related acute lung injury (TRALI). HNA-3 genotyping and HNA-3a antibody (Ab) identification are essential to diagnosis and prevention of TRALI caused by HNA-3a Ab. However there had been no laboratory for HNA-3a Ab identification in Korea. The aims of this study were to establish the HNA-3a Ab test in Korea and to estimate the incidence of HNA-3a alloimmunization among pregnant Korean women. METHODS: HNA-3a homozygotes and HNA-3b homozygotes were identified by HNA-3 genotyping. Three HNA-3a homozygotes and three HNA-3b homozygotes are included in the granulocytes panel, which consisted of 10 donors for granulocytes. Sera from 650 pregnant Korean women were tested for granulocyte Ab using a mixed passive hemagglutination assay (MPHA). When a HNA-3a Ab was detected, the woman's HNA-3 was typed to support her HNA-3a alloimmunization. RESULTS: MPHA showed positive reactions in the sera from 26 women (4.0%, 26/650). HLA Abs were detected in 18 women (2.8%, 18/650), among whom HNA Abs were identified simultaneously in 7 women. Granulocyte Abs were detected in sera from 15 women (2.3%, 15/650). The incidence of HNA-3a, HNA-1b, HNA-1a, HNA-2a, and unidentified HNA Abs among pregnant Korean women was 0.77% (5/650), 0.77% (5/650), 0.62% (4/650), 0.15 (1/650), and 0.31% (2/650), respectively. CONCLUSION: In this study, we established the HNA-3a Ab test using MPHA for diagnosis and prevention of TRALI caused by HNA-3a Ab. The incidence of HNA-3a Ab in pregnant Korean women was 0.77% (5/650).

Therapeutic Plasmapheresis Enabling Radioactive Iodine Treatment in a Patient with Thyrotoxicosis

Therapeutic plasma exchange (TPE) is one possible treatment for patients resistant to conventional antithyroid drugs or requiring urgent attention for thyrotoxicosis. We report a 35-yr-old man with thyrotoxicosis, ultimately attributed to Graves' disease in whom antithyroid drug used initially was soon discontinued, due to abnormal liver function, and replaced by Lugol's solution. Three weeks later, an escape phenomenon (to Lugol's solution) was apparent, so we performed TPE to control the thyrotoxicosis. Two courses of TPE by a centrifugal type machine resulted in diminished levels of thyroid hormone levels, which then rebounded after another two courses of membrane filtration type TPE. However, the patient could be treated with radioactive iodine therapy without any complications at present.

Performance of Four Anti-Heparin/Platelet Factor 4 Immunoassays for the Diagnosis of Heparin-Induced Thrombocytopenia

BACKGROUND: Heparin-induced thrombocytopenia (HIT) is a significant complication of heparin therapy induced by antibodies to heparin/platelet factor 4 (PF4) complexes. We investigated the diagnostic performance of four commercial immunoassays that detect the anti-heparin/PF4 antibody. METHODS: Four different anti-heparin/PF4 antibody assays were performed in 39 patients with suspected HIT: HemosIL AcuStar HIT-IgG, HemosIL AcuStar HIT-total antibody (Ab) (Instrumentation Laboratory, USA), STic Expert HIT (Diagnostica Stago, France), and PF4 Enhanced (Immucor GTI Diagnostics, USA). Patients were diagnosed with HIT when the Chong score was > or =5. RESULTS: The estimated sensitivity and specificity for diagnosis of HIT were 33.3% and 80.0% for AcuStar HIT-IgG, 55.6% and 53.3% for AcuStar HIT-total Ab, 100.0% and 37.9% for STic Expert HIT, and 33.3% and 66.7% for PF4 Enhanced. All specificities significantly increased when 4Ts scores were included in the diagnosis. The areas under the curves (AUCs) for predicting thrombosis in the AcuStar HIT-IgG, AcuStar HIT-total Ab, and PF4 Enhanced assays were 0.639, 0.522, and 0.681, respectively. When the results of each assay were analysed along with 4Ts scores, the AUC increased to 0.927 in the AcuStar HIT-IgG assay and 0.944 in the AcuStar HIT-total Ab and PF4 Enhanced assays. CONCLUSIONS: The STic Expert HIT assay had high sensitivity but low specificity for diagnosis of HIT. The performances of the three other immunoassays were comparable to each other. Specificity significantly increased when assay data were combined with 4Ts scores. Differences in the diagnostic performance of the four immunoassays were not evident, and simultaneous consideration of clinical scoring systems improved performance.

In Remembrance of the 33rd International Congress ISBT Seoul 2014 / 대한수혈학회지

The 33rd International Congress of the ISBT was held in conjunction with the 33rd Congress of the Korean Society of Blood Transfusion (KSBT) and the 2014 Congress of the Korean Hematology Societies in Seoul. The idea to host an ISBT congress came to birth among KSBT members whilst attending the 18th Regional ISBT Congress held in Hanoi in 2007. Finally after 4 years, this idea became reality when Seoul was awarded to host the 2014 International Congress. After a short period of excitement, we soon had to realize that organising an international congress is a huge challenge with tremendous work involved! During the 3 years of preparation the ISBT headquarters and the local organising committee had several meetings that were not easy. But at the end, our concentrated and energetic discussions turned out to be most productive and made this congress a huge success. Highest appreciation again for their marvelous support goes to Peter Flanagan, ISBT President, and Judith Chapman, ISBT Executive Director. During the Korean day, three parallel sessions were held, attracting not only participants from the field of transfusion medicine but also many clinicians working in the field of hematology and transplantation. Martin Olsson, ISBT Scientific Secretary, and the local scientific committee did a great job in preparing an excellent scientific program that not only dealt with traditional topics of transfusion medicine but also hot topics like cellular therapy and clinical aspects of transfusion medicine. A total of 55 sessions were run in five tracks dealing with immunobiology of blood cells, blood safety, clinical aspects, donors & donation, and cellular therapies. 758 abstracts from 68 countries were submitted, among which 93 high quality abstracts were chosen for oral presentations and 603 for poster presentations. With 77 esteemed invited speakers presenting their cutting-edge research, all sessions were well attended and followed by lively discussions between speakers and the audience. Industry was also well presented and participants had the opportunity to exchange their experiences and take home information about the latest developments provided by the 74 exhibitors. But a congress isn't only about science! The opening ceremony started with the traditional presentation of the talking stick to the Congress President, Prof. Kyou-Sup Han. Afterwards, participants enjoyed the serenity and the flowing movements of Seoungmu, the Buddhist monk's dance, and Pungmulnori, a Korean folk music and dance tradition. All participants were greeted with a taste of Korean cuisine at the welcome reception. During the Speakers Dinner, guests had the chance to learn about the history of Korea and the Korean alphabet. The congress party, however, was the highlight of the social events. Since the congress took place in the middle of Gangnam, the southern part of Seoul, it was a must for everybody to learn dancing "Gangnam Style". Participants were invited onto stage to compete for the best dancer award and soon the stage was filled with joyously dancing participants and within seconds the party hall turned into a twilight zone. The party is over. It is time now to prepare calmly for the next stage. Hopefully ISBT Seoul 2014 will serve as a starting point to motivate many researchers working in the field of transfusion medicine and blood program to become more engaged at an international level.

Genotyping for RhD and RhCEce Antigens Using Free Circulating Nucleic Acids in Plasma and Serum / 대한수혈학회지

BACKGROUND: The Rh blood group includes several antigens, of which D, C, E, c, and e are clinically important. Although nucleic acids from whole blood can be used for Rh blood group genotyping, it is also possible to genotype free circulating fetal nucleic acids from plasma and serum. We performed Rh blood group phenotyping and genotyping using nucleic acids from whole blood and free circulating nucleic acids from plasma and serum, respectively. The results were compared. METHODS: Forty-four blood samples were phenotyped and genotyped for RhD and RhCE blood groups. Phenotyping was performed by hemagglutination assay. Further tests were performed on RhD-negative samples. Nucleic acids were extracted from whole blood, plasma, and serum. Plasma and serum were prepared after filtration and genotyped by real-time polymerase chain reaction. RESULTS: RhD blood group results showed one (2.3%) discrepant case in which the DEL phenotype appeared wild RHD genotype. Among nucleic acids, there were seven discrepant results: two from plasma and five from serum based on whole blood nucleic acids. RhCE blood group results showed three (6.8%) phenotype-genotype discordances. Among nucleic acids, seven (15.9%mpared to phenotypes. Kappa coefficients of serum were lower than those of plasma. CONCLUSION: RHD and RHCE genotype could be identified by assaying free circulating nucleic acids in plasma or serum. This study suggests that plasma is more reliable than serum as a specimen for RHD and RHCE genotyping of free circulating nucleic acids.

Establishment of Platelet Antigen and Antibody Tests by Mixed Passive Hemagglutination with Frozen-stored Platelets / 대한수혈학회지

BACKGROUND: Platelet antigen and antibody tests have been used in platelet immunological disorders, such as neonatal alloimmune thrombocytopenia (NAIT) and post-transfusion purpura (PTP). Mixed passive hemagglutination (MPHA) method has several advantages, including frozen preservation of platelets, ability to differentiate between anti-HLA and platelet-specific antibodies, and quick and easy interpretation without expensive equipment. In this study, we intended to develop the MPHA method using indicator cells of anti-Rh(D) sensitized group O, Rh+ RBCs. METHODS: We made indicator cells sensitized with anti-Rh(D) with various strengths (1:32 to 1:256) and determined the optimal strength. We determined the sensitivity of the MPHA and compared the results using flow cytometry. We observed the changes of the reaction according to the storage time of indicator cells. RESULTS: The optimal sensitization strengths of the indicator cells were 1:192 and 1:256. MPHA showed strong positive results with 1:8,192 diluted positive control, while the detection limit of flow cytometry was 1:128. Until the second week (mean 16 days), the indicator cells showed good results comparable to those of fresh ones. CONCLUSION: We developed the MPHA method using indicator cells of anti-Rh(D) sensitized group O, Rh+ RBCs. We produced the indicator cells in our own laboratory and obtained platelet panels with rare antigen typing using frozen-stored platelets. This technology will be used effectively for detection of platelet antigens and identification of platelet antibodies and also for platelet crossmatching.

Probability of Obtaining Specific Antigen-Negative Blood Units through Antigen Testing in Korean Medical Institutes / 대한수혈학회지

BACKGROUND: When unexpected antibodies are identified, selection for specific antigen-negative blood units is needed in order to ensure transfusion safety. We estimated the number of blood units required for antigen testing to obtain specific antigen-negative units in Korean medical institutes. METHODS: We analyzed cases of selection for specific antigen-negative units for recipients who had antibodies identified in Seoul National University Bundang hospital from January 2008 to December 2010 and cases entered into the KRBP (Korean Rare Blood Program) online database from July 2013 to February 2014 from eight medical institutes. RESULTS: A total of 559 cases of 266 patients were analyzed. The antigen types requiring two units on average for one specific antigen-negative unit were E, P1, and Lea. Three units on average were required for one Fyb-negative blood unit, four units for one Jka-negative unit, four units for one Jkb-negative unit, 4.5 units for one Leb-negative unit, five units for one C-negative unit, six units for one M-negative unit, and seven units for one S-negative unit. In cases of obtaining specific antigen-negative units for more than one antigen type, three units on average were required for one E, c-negative unit and seven units for one C, e-negative unit. Other multiple antigen-negative units required up to 20 units. CONCLUSION: The accurate antigen-negative frequency in the Korean population should be investigated. Following this effort, the number of blood units required for selection of specific antigen-negative units could be predicted and practical measures for obtaining specific antigen-negative blood units could be suggested for Korean medical institutes.

Checking Perceived Blood Group of the Patient Upon Phlebotomy: Additional Approach for Accurate Patient Identification and ABO Testing / 대한수혈학회지

BACKGROUND: Accurate patient identification is fundamental in transfusion medicine. Our hypothesis is that an open question about patients' ABO blood group would be helpful for accurate identification of the patient and for accurate laboratory testing. METHODS: We added some blanks, including the patient's ABO blood group on the tube label, which should be filled in by the phlebotomist on the spot. From Aug 1, 2012 to May 31, 2013, we analyzed the effect of the additional step for identification of a misidentification 'incident' in 31,454 tests of 14,864 patients. We surveyed on 21 phlebotomists with regard to whether the changed label reinforces patient identification. In addition, the discrepancy rate between the ABO blood group perceived by the patient and the test result was analyzed. RESULTS: Patient-misidentification error rate during this study was 0.022%, and 81.0% of the phlebotomists answered that the changed label reinforces patient identification. The total discrepancy rate was 1.93%. Patients without previous results showed a higher discrepancy rate (3.08%) than patients with previous results (0.35%). Males (2.48%) showed a higher discrepancy rate than females (1.38%). Patients older than 50 years showed a higher discrepancy rate (2.87%) than patients younger than 50 years (0.82%). According to ABO blood group, group O showed the lowest discrepancy rate (0.87%). CONCLUSION: Checking ABO blood group known by the patient helped phlebotomists to correctly identify the intended patient. Active corrective action by the transfusion laboratory when discrepancies exist could increase test reliability and pave the way for safe transfusion, which will ultimately improve the quality of transfusion medicine.

Frequency of CD36 Deficiency on Platelets and Monocytes in Koreans / 대한수혈학회지

BACKGROUND: CD36 deficiency was first identified in a patient who showed refractoriness to HLA-matched platelet transfusion. CD36 deficiency can be divided into two subgroups. The type I phenotype is characterized by platelets and monocytes exhibiting CD36 deficiency. The type II phenotype lacks surface expression of CD36 in platelets only. In this study, the frequency of type I and type II CD36 deficiency in Koreans was evaluated. METHODS: A total of 220 samples were randomly selected from subjects who requested CBC testing from August 2013 to February 2014. The expression levels of CD36 on platelets and monocytes were analyzed by flow cytometry using FITC-conjugated CD36 antibodies. Correlation between the median fluorescence intensity of CD36 and the number of platelets or monocytes was evaluated using Pearson's correlation coefficient. RESULTS: Type I phenotype, lacking CD36 on platelets and monocytes, was present in 0.9% and type II, lacking CD36 on platelets, was present in 3.2%. The median fluorescence intensity of CD36 did not show correlation with the count of platelets or monocytes. CONCLUSION: Type I subjects may produce alloantibodies against CD36 following transfusion or pregnancy, leading to refractoriness to HLA-matched platelet transfusion, post-transfusion purpura, or neonatal immune thrombocytopenia. Studies to determine exact frequency of CD36 deficiency in Koreans, including a larger population, should be conducted, and more case reports on patients immunized against CD36 are also needed in order to elucidate the clinical importance and relevance of CD36 deficiency testing and the transfusion of CD36-deficient platelets.

Reduction of Perioperative Fresh Frozen Plasma Wastage and Transfusion by Quality Improvement Activity / 대한수혈학회지

BACKGROUND: Empirical use of fresh frozen plasma (FFP) in perioperative blood transfusion leads to high wastage of FFP. However, coordination of many related clinical departments is difficult. Therefore, quality improvement (QI) activities for establishment of appropriate use of FFP are needed. METHODS: Departments of surgery (all surgery departments except ophthalmology) and the departments of anesthesiology, clinical pathology, and nurses met each month from March, 2011 to October, 2011. Each department investigated the number of FFP usages, wastage, and coagulation tests. Primary measured variables and objectives were decrease of 50% of FFP wastage rate compared with the previous year and 50% increase of coagulation testing before using FFP. Secondary measured variables were total amount of FFP usage and report time for coagulation tests. RESULTS: After the QI activities (March, 2011~October, 2011), FFP wastage decreased, from 71.5 units during the second half of 2010 to 37.8 units during the second half of 2011 (-47.1%). Rate of coagulation testing before using FFP more than doubled during the second half of 2011 (57%) compared with the second half of 2010 (25%). The rate of less than 30 minutes report time for coagulation testing increased from 60% to 75%. FFP transfusion per 1,000 surgical cases decreased to from 190 units to 118 units. CONCLUSION: Rate of FFP wastage and transfusion decreased and rate of performance of the blood coagulation test was enhanced through education and training on transfusion and QI activities.