Tc-99m ciprofloxacin imaging in diagnosis of chronic bacterial prostatitis / 亚洲男科学杂志(英文版)

<p><b>AIM</b>To investigate the value of Tc-99m ciprofloxacin imaging in the differential diagnosis of chronic bacterial prostatitis.</p><p><b>METHODS</b>The study included 4 normal subjects as the negative controls, 2 patients with acute prostatitis or cystourethritis as the positive controls and 59 patients diagnosed as chronic bacterial prostatitis or chronic pelvic pain syndrome by traditional laboratory tests. In every subject, the single photon emission computerized tomography images were obtained 3 h after intravenous injection of Tc-99m Ciprofloxacin. The results of the imaging were compared with those of laboratory tests.</p><p><b>RESULTS</b>On the images, negative uptake was observed in all normal subjects, while strong hot uptake, in the whole prostate of acute prostatitis patients and in the whole urethra of acute cystourethritis patients. In 13 (68%) of 19 patients categorized as chronic bacterial prostatitis by standard laboratory tests, hot uptake with less intensity than that of acute prostatitis was observed in the prostate area around the prostatic urethra. Negative uptake in the prostate was observed in 6 of 19 patients (32%) categorized as chronic bacterial prostatitis. Interestingly, hot uptake in the prostate was exhibited in 28 (70%) of the 40 patients categorized as chronic pelvic pain syndrome.</p><p><b>CONCLUSION</b>Tc-99m ciprofloxacin imaging is helpful in the differential diagnosis of prostatitis syndrome.</p>

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.

The Prevalence of Obesity and Underweight in Adolescents in Incheon Area and the Relationship between Serum Cholesterol Level and Obesity

PURPOSE: The purpose of this study was to investigate the prevalence of obese and underweight adolescents in Incheon area and to examine the relationship between serum cholesterol level and obesity, then to assess the nutritional condition of adolescents. METHODS: With a questionnaire regarding their demographic characteristics, blood samples were obtained from apparently healthy students aged 12 to 24 years by venipuncture at April and May, 2000. We measured the obesity index using standard body weight and the body mass index(BMI) according to the criteria established by the Korean Pediatric Society in 1998. Obesity was defined as BMI more than 95 percentile, and underweight less than 15 percentile by age and sex. RESULTS: A total of 1,456 students(M:F=685:771) aged 12 to 24 years were included in this study. The prevalence of obesity by standard body weight in adolescents in Incheon were 11.7%:mild obesity 6.5%, moderate 4.6%, and severe 0.5%. By BMI, the prevalence of obesity was 6.4% in males and 6.2% in females. In males, the prevalence of obesity in rural areas was 8.5%, lower than in urban areas(14.3%). The prevalence of underweight by obesity index was 34.1% in rural areas and 22.9% in urban areas. In females, the prevalence of obesity was 12.5% in rural areas and 19.6% in urban areas. There were no significant differences between the two regions(P=0.529). The prevalence of obesity increased with age till 16.3% of peak prevalence in 16 years of age, and then decreased. In males, the prevalence of obesity in academic and vocational school were 13.7% and 9.7%, respectively(P=0.116). In females of the academic and vocational school, the prevalence of obesity was 6.8% and 18.0%, respectively(P=0.001). In obese adolescents, serum total cholesterol was over 200 mg/dL in 6.2%. CONCLUSION: This study revealed that the prevalence of obesity in adolescents was about 12% and that the prevalence of underweight adolescents was considerably high. We think nutritional assessment and intervention are warranted for adolescent students.

Detection of Helicobacter pylori Antigen in Stool by Enzyme Immunoassay

Invasive techniques for diagnosis of Helicobacter pylori (H. pylori) infection require an endoscopic examination which is expensive and inconvenient and may cause complications. Stool cultures for H. pylori or a direct detection of H. pylori antigen in stools by PCR are expensive, tedious, and have a low sensitivity. We recently used an enzyme immunoassay (EIA) to detect H. pylori antigen in stool specimens. A total of 41 patients were seen at Inha University Hospital, Inchon, Korea between September and October 1998. There were 26 men and 15 women who had an average age of 37.6 years which ranged from 5 to 71 years in the present study. All of these patients came to the hospital complaining of an upper abdominal discomfort and were subjected to endoscopy and biopsies. Fifteen had a gastric ulcer, 13 had a duodenal ulcer, 1 had an early gastric cancer, and there were 12 chronic gastritis patients as shown by endoscopy. The biopsy specimens were examined by histology, CLOTM test, and cultures and these results were used as gold standards. Stool specimens were tested for the H. pylori antigen by EIA. A dual wavelength cut-off of 0.100 that was recommended by the manufacturer gave a good performance (87.1% sensitivity, 100% specificity, 100% positive predictive value, 71.4% negative predictive value, and a 90.2% efficiency). But the adjusted cut-off value using the receiver operating characteristic curve improved the performance of the test (using the cut-off value of 0.024, the sensitivity, specificity, PPV, NPV, and efficiency were 100%, 90.0%, 96.9%, 100%, and 97.6% respectively). Re-evaluation of the cut-off value may be needed for Korean patients. This technique is non-invasive, rapid, easy-to-use, and shows good performance characteristics for diagnosis of H. pylori infections. Therefore, this technique may be a substitute for gastric endoscopy especially in children and some patients who are unable to tolerate an endoscopic examination and it may be substituted for a serologic test in epidemiological research.

Iron Status in Adolescents and University Students in Incheon / 대한혈액학회지

BACKGROUND: Iron deficiency anemia (IDA) frequently occurs in adolescents because of accelerated physical growth in boys and girls. This was aimed at assessing the prevalence of iron deficiency and IDA in apparently healthy Korean adolescents according to the gender and age. METHODS: Apparently healthy students(M: F=1: 1.2) aged 11 to 24 years were included in this study and blood samples were obtained from April to May, 2000. Hemoglobin, hematocrit, red blood cell indices, serum ferritin, iron and total iron-binding capacity were measured. RESULTS: In males, the prevalence of iron deficiency was 15.7% in the 11~12 years group, 16.1% in the 13~14 years group, 9.9% in the 15~16 years group, and 6.4% in the 17~18 years group. In females, the prevalence of iron deficiency was 26.8% in 11~12 years group, 27.9% in the 13~14 years group, 38.8% in the 15~16 years group, 36.0% in the 17~18 years group, 30.9% in the 19~24 years group. The prevalence of IDA in males was 3.6% in 11~12 years, 2.1% in 13~14 years group, 1.9% in 15~16 years group, and 0.6% in 17~18 years group. The prevalence of IDA in females was 4.2% in 11~12 years, 9.7% 13~14 years, 20.4% in 15~16 years, 16.2% in 17~18 years group, and 12.4% in 19~24 years group. CONCLUSION: As the prevalence of iron deficiency and IDA were substantially greater than expected, studies of iron state in adolescent girls, especially middle to high school age, should be undertaken to assess iron deficiency.

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.

The significance of the TDx-FLM assay in the fetal lung maturity / 대한산부인과학회잡지

OBJECTIVE: The TDX analyzer, an automated fluorescence polarimeter, has been utilized to assess surfactant content in amniotic fluid. Amniostat-FLM is an immunologic semiquantitative agglutination test for determining the presence of phosphatidylglycerol in human amniotic fluid at concentration indicative of fetal lung maturity. We evaluated the usefulness of the recently introduced TDx-FLM assay in determining fetal lung maturity. METHODS: Seventy-three samples of amniotic fluid were analyzed. Among them, 18 samples were compared with Amniostat-FLM assay. RESULTS: Surfactant/albumin ratio using TDx-FLM assay increased with longer gestational age. And the concordance rate between Amniostat-FLM assay and TDx-FLM assay was 66.9%. CONCLUSION: The TDx-FLM assay appears to be a useful test in the field of fetal lung maturity testing.

The significance of the TDx-FLM assay in the fetal lung maturity / 대한산부인과학회잡지

OBJECTIVE: The TDX analyzer, an automated fluorescence polarimeter, has been utilized to assess surfactant content in amniotic fluid. Amniostat-FLM is an immunologic semiquantitative agglutination test for determining the presence of phosphatidylglycerol in human amniotic fluid at concentration indicative of fetal lung maturity. We evaluated the usefulness of the recently introduced TDx-FLM assay in determining fetal lung maturity. METHODS: Seventy-three samples of amniotic fluid were analyzed. Among them, 18 samples were compared with Amniostat-FLM assay. RESULTS: Surfactant/albumin ratio using TDx-FLM assay increased with longer gestational age. And the concordance rate between Amniostat-FLM assay and TDx-FLM assay was 66.9%. CONCLUSION: The TDx-FLM assay appears to be a useful test in the field of fetal lung maturity testing.

A study of microorganisms in oral & maxillofacial infected patients

Change of Erythropoiesis and Serum Transferrin Receptor Levels with Gestational Age in Healthy Pregnant Women / 대한혈액학회지

BACKGROUND: To investigate the change of iron dynamics, erythropoiesis, and serum transferrin receptor (sTfR) concentration during pregnancy, we measured the reticulocyte subpopulations, reticulocyte maturity index (RMI) and sTfR concentration in normal pregnant women. Also we determined which parameter among sTfR, serum iron, or serum ferritin is more representative for clinical features and erythropoiesis in pregnant women. Method: A total of 283 pregnants were examined for reticulocyte subpopulations, sTfR, and a battery of iron parameters. Reticulocytes and their subpopulations were automatically analyzed by flow cytometry (R-3000; Sysmex, Toa, Japan). Serum iron and TIBC were assayed with the automatic chemical analyzer (Hitachi 747; Hitachi, Tokyo, Japan) and serum ferritin was measured by the chemiluminescence method (ACS 180; Chiron, USA). Soluble transferrin receptor was measured by the immunoenzymometric method (ELISA ; Orion Diagnostica, Finland). RESULTS: There was no significant difference in sTfR concentration between pregnant women in the 1st trimester (2.29+/-0.45 mg/L) and non-pregnant women (2.18+/-0.46 mg/L). However, the sTfR concentration gradually increased with gestational age from the 2nd trimester of pregnancy and reached maximal concentration (5.76+/-1.12 mg/L) in the 3rd trimester. The mean sTfR in postpartum 12 weeks was similar to that in the 1st trimester. RMI in the 3rd trimester was three- to four- fold higher than that in the 1st trimester. The sTfR correlated better with RMI (r=0.62, P<0.01), MCH (r=-0.61, P<0.01) and gestational age (r=0.51, P<0.01) than to serum iron and ferritin. CONCLUSIONS: The sTfR concentration increases with gestational age during pregnancy and returns to normal at 12 weeks after delivery. Elevated sTfR concentration during pregnancy seems to be more influenced by erythroid TfR turnover than by iron depletion. The sTfR is a more reliable predictor of erythropoiesis and iron status during pregnancy than serum iron or ferritin.

Evaluation of Urea Breath Test for the Detection of Helicobacter pylori Infection / 대한임상미생물학회지

BACKGROUND: Helicobacter pylori (H. pylori) is closely associated with gastritis, peptic ulcer and gastric carcinoma. We evaluated the reliability and usefulness of 73C-urea breath test (13C-UBT) for the detection of H. pylori infection and searched for the cut-off value of the test. METHOD : We investigated 45 patients, who underwent esophagoduodenoscopy with multiple biopsy specimens taken for culture, histology and rapid urease test, and 13C-UBT. Sensitivity and specificity of UBT were calculated against the combined biopsy-based test results. RESULT: Of 45 patients, 26 were found to be H. pylori-positive according to combined biopsy-based test-results. Sensitivity and specificity of the 13C-UBT were 100.0% and 89.5 %, respectively. CONCLUSION: The urea breath test provides a simple and reliable and noninvasive method of assessing HL pylori infection status.

Evaluation of Urea Breath Test for the Detection of Helicobacter pylori Infection / 대한임상미생물학회지

BACKGROUND: Helicobacter pylori (H. pylori) is closely associated with gastritis, peptic ulcer and gastric carcinoma. We evaluated the reliability and usefulness of 73C-urea breath test (13C-UBT) for the detection of H. pylori infection and searched for the cut-off value of the test. METHOD : We investigated 45 patients, who underwent esophagoduodenoscopy with multiple biopsy specimens taken for culture, histology and rapid urease test, and 13C-UBT. Sensitivity and specificity of UBT were calculated against the combined biopsy-based test results. RESULT: Of 45 patients, 26 were found to be H. pylori-positive according to combined biopsy-based test-results. Sensitivity and specificity of the 13C-UBT were 100.0% and 89.5 %, respectively. CONCLUSION: The urea breath test provides a simple and reliable and noninvasive method of assessing HL pylori infection status.

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.

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.

CD34 Analysis according to ISHAGE Guideline / 대한혈액학회지

BACKGROUND: Flow cytometric analysis for CD34 has been widely used for hematopoietic stem cell enumeration. The procedure is simple and rapid for clinical use but the lack of standardization resulted in great intralaboratory variations. In 1995, a guideline for CD34 analysis was established by International Society of Hematotherapy and Gene Engineering (ISHAGE) for reliable testing. We performed CD34 analysis using the ISHAGE guideline in umbilical cord blood (UCB), mobilized peripheral blood (MPB) and leukapheresis product (LP) and compared the results with those of in-house method. METHODS: CD34 analyses were performed in thirty units each of UCB, MPB and LP according to the ISHAGE guideline and in-house method and the results were analyzed by the t-test. Both methods used CD45FITC/CD34PE and its isotype controls. In ISHAGE guideline, among CD34+/ CD45+ cells, only those with low forward scattering, low to intermediate side scattering and low to intermediate CD45 fluorescent intensity were identified as stem cells, and the percentage of those cells among CD45+ cells was calculated. In in-house method, cells expressing both CD34 and CD45 antigens were selected by isotype control and the percentage of CD34+/CD45+ cells among CD45+ cells were calculated. RESULTS: Significant differences were observed in the percentages of CD34+ cells in UCB, MPB and LP between ISHAGE guideline (0.25%, 0.42%, 0.80%) and in-house method (0.40%, 0.55%, 1.20%) (P<0.001). So were the CD34+ cell counts : mean values of CD34+ cells in microliter of UCB, MPB and LP were 20, 40, 1,392 by ISHAGE guideline, and 35, 62, 2,079 by in-house method (P<0.001). CONCLUSION: ISHAGE guideline for CD34 enumaration was considered as a simple, rapid and reliable method for clinical setting and to have economic benefits because no additionalmonoclonal antibodies were required.

Prevalence of Impaired Platelet Responsiveness to Epinephrine in Healthy Subjects / 대한혈액학회지

BACKGROUND: The purpose of this study is to investigate the prevalence of impaired platelet responsiveness to epinephrine in healthy subjects. Also, we compared the platelet aggregability in response to various agonists in normal population. METHODS: A total of 156 healthy subjects aged 21 to 57 years were investigated for the evidence of impaired responsiveness to epinephrine. Aggregometer PACKS-4 (Platelet Aggregation Chromogenic Kinetic System-4, Helena, Beaumont, USA) was used for platelet function test. Aggregating agonists (Helena Haemostasis Systems, UK) used in the study were consisted of ADP (10 micrometer), collagen (10 microgram/mL), epinephrine (300 micrometer) and ristocetin (1500 microgram/mL). Population showing platelet aggregability with more than 60% activity was classified as normal group, while aggregability with less than 20% as impaired responsiveness. RESULTS: Of 156 healthy subjects, 20.5% (32/156) showed impaired responsiveness, while 33.9% (53/156) revealed decreased aggregability with the activity of less than 60% to epinephrine. The mean of maximal percent aggregating activity for collagen was 90.5+/-11.4% and that of epinephrine was 66.5+/-34.4%. The mean aggregation activity (84.4+/-11.8%) for ADP in subjects showing normal response to epinephrine was significantly higher, compared with that (65.7+/-16.2%) of impaired responsiveness group to epinephrine (P<0.01). CONCLUSION: Impaired responsiveness to epinephrine, which is observed in healthy subjects, appears to be a kind of normal variant reaction. And this abnormality is not considered to be associated with any evident bleeding disorders.

Change of Serum Transferrin Receptor (sTfR) according to the Developmental Age in Healthy Infants and Correlation to Iron Parameters / 대한혈액학회지

BACKGROUND: Serum transferrin receptor (sTfR) level reflects iron status and the rate of erythropoiesis in bone marrow. Iron deficiency still remains one of the most common nutrient deficiency disorders among infants and young children. The purpose of this study is to investigate age-related changes in sTfR level and determine the prevalence of iron deficiency in healthy infant and young children. And we also defined the correlation between iron parameters and sTfR level. METHODS: A total 151 healthy infants and young children aged 4 to 24 months who had been visited Inha University Hospital for vaccination was investigated for the evidence of iron deficiency. The children were divided into 3 groups according to developmental age, i.e., infants aged 4 to 6 months (n=53), infants aged 7 to 12 months (n=37), and children aged 13 to 24 months (n=61). CBC, iron parameters, and sTfR were tested and analyzed. Serum transferrin receptor was assayed by using IDeATMsTfR IEMA (soluble transferrin receptor immunoenzymometic assay, Orion Diagnostica, Orion Co, Finland) test kits. RESULTS: The prevalence of iron deficiency was 26.0% in infants aged 4-6 months, 22.0% in 7-12 months, and 58.3% in 13-24 months. Among 151 subjects, the mean sTfR value in male children was 5.89+/-1.69mg/L and significantly higher than in female children of 5.11+/-1.92mg/L (P=0.019). The level of sTfR in male infants aged 4-6 months was 5.81mg/L and that of female infants with same age was 4.22mg/L (P=0.001). The sTfR level significantly correlated with MCV (r= -0.56, P<0.001), TIBC (r=0.44, P<0.001), and serum iron level (r=-0.42, P<0.001), however correlation between serum iron level and ferritin was poor (r=0.03, P=0.213). CONCLUSION: Iron deficiency still prevail with high incidence in infants and young children especially children aged 13-24 months. The mean value of sTfR is different according to developmental age. Measurement of sTfR appears to be more correlative to iron status than that of ferritin. On the basis of sTfR value, iron need is greater in male infants than in female infants.

A Case of Autoimmune Hemolytic Anemia Induced by Anti-e / 대한수혈학회지

Autoimmune hemolytic anemia (AIHA) is characterized by the production of Coombs' antibodies, which are responsible for the destruction of RBCs. The antibody specificity of warm AIHA (WAIHA) is very complex while all cells tested are usually reactive in routine test. Although some autoantibodies have broad specificity to the Rh system, apparent specificity for simple Rh antigen (D, C, E, c, e) is rare. A 63 year-old farmer was admitted at Inha University Hospital for evaluation of anemia. He had no history of blood transfusion. He presented overt anemia with decreased Hb (6.6g/dL) and increased reticulocyte count (18.5%, corrected reticulocyte count 8.4%). The direct antiglobulin test (DAT) was strongly positive for IgG and negative for C3d while indirect antiglobulin test (IAT) was weakly positive. Both two different antibody identification test kits identified this antibody as anti-e. His Rh phenotype was CDe. Although the eluted antibody from his own RBCs failed to show specificity against e but agglutinated all the reagent RBCs, we diagnosed this case as WAIHA induced by IgG anti-Rh(e) because his serum agglutinated all e-positive RBCs while it was non-reactive with e-negative RBC in the cross-matching test. Drugs (loxoprofen, cimetidine) couldn't be ruled out as causative agent.

A Case of Autoimmune Hemolytic Anemia Induced by Anti-e

Autoimmune hemolytic anemia(AIHA) is characterized by the production of Coombs antibodies, which are responsible for the destruction of RBCs. The antibody specificity of warm A1HA(WAIHA) is very complex while all cells tested are usually reactive in routine test. Although some autoantibodies have broad specificity to the Rh system, apparent specificity for simple Rh antigen(D, C, E, c, e) is rare. A 63 year-old farmer was admitted at Inha University Hospital for evaluation of anemia. He had no history of blood transfusion. He presented overt anemia with decreased Hb (6.6g/dL) and increased reticulocyte count(18.5%, corrected reticulocyte count 8.4%). The direct antiglobulin test(DAT) was strongly positive for IgG and negative for C3d while indirect antiglobulin test(IAT) was weakly positive. Both two different antibody identification test kits identified this antibody as anti-e. His Rh phenotype was CDe. Although the eluted antibody from his own RBCs failed to show specificity against e but agglutinated all the reagent RBCs, we diagnosed this case as WAIHA induced by IgG anti-Rh(e) because his serum agglutinated all e-positive RBCs while it was non-reactive with e-negative RBC in the cross- matching test. Drugs(loxoprofen, cimetidine) couldn' t be ruled out as causative agent. (Korean J Blood Transfusion 10(1): 61-67, 1999)