Blood Transfusion Status Based on the Literature of the 1920s in Korea / 대한수혈학회지

The ABO blood type was discovered by Karl Landsteiner in 1901. The frequency of occurrence of the ABO blood type in Korea was reported in the journal of the Joseon Medical Association in 1922. The status of 54 transfusions at one medical clinic in 1924 was reported at a medical congress in 1925. Many direct transfusion cases in Korea were identified by a literature search for articles published during the 1920s.

Effects of the new diagnosis-related group-based payment system and the increased incentive policy rates on the utilization rate of diagnostic laboratory test in Korea

A new diagnosis-related group (DRG) based payment system has been implemented in most public hospitals in Korea. We investigated the effects of the new DRG system and its incentive policy on the utilization rate of diagnostic laboratory tests. Three groups were categorized; 36 hospitals under the new DRG system (participant group), 72 hospitals (control-1) matching with 36 participants according to the number of beds, and 42 tertiary hospitals (control-2). The patients of acute myocardial infarction, cerebral infarction, type 2 diabetes mellitus, and gonarthrosis receiving total arthroplasty were included. We analyzed the mean length of stay and the number of diagnostic laboratory tests conducted during hospitalization of the three groups according to the new DRG system and the incentive policy rates under the new DRG system. Before participating in the new DRG system, the number of diagnostic laboratory tests in the participant group was less than that in the two control groups for all four diseases. However, although the participant group’s length of stay decreased under the new DRG system, the number of diagnostic laboratory tests increased as the maximum incentive policy rate increased. The increment of the number of diagnostic laboratory tests was prominent in the period of a maximum of 35% incentive policy rates. Finally, the number of diagnostic laboratory tests of the participant group was similar to or exceeded that of the control-2 group. The new DRG system’s incentive policy rates played a driving force on the increased utilization rate of the diagnostic laboratory test. For preparing in advance for the change in incentive policy rates, monitoring and guidelines for the utilization of diagnostic laboratory tests are necessary.

Getting patient blood management Pillar 1 right in the Asia-Pacific: a call for action

Preoperative anaemia is common in the Asia-Pacific. Iron deficiency anaemia (IDA) is a risk factor that can be addressed under patient blood management (PBM) Pillar 1, leading to reduced morbidity and mortality. We examined PBM implementation under four different healthcare systems, identified challenges and proposed several measures: (a) Test for anaemia once patients are scheduled for surgery. (b) Inform patients about risks of preoperative anaemia and benefits of treatment. (c) Treat IDA and replenish iron stores before surgery, using intravenous iron when oral treatment is ineffective, not tolerated or when rapid iron replenishment is needed; transfusion should not be the default management. (d) Harness support from multiple medical disciplines and relevant bodies to promote PBM implementation. (e) Demonstrate better outcomes and cost savings from reduced mortality and morbidity. Although PBM implementation may seem complex and daunting, it is feasible to start small. Implementing PBM Pillar 1, particularly in preoperative patients, is a sensible first step regardless of the healthcare setting.

Patient Blood Management: Future Perspective in Korea / 한양의대학술지

Blood transfusion is an essential medical procedure that can save a patient's life. But, in the near future, it is anticipated that blood transfusion products will be lacking in Korea. Patient Blood Management (PBM) is an evidence-based, mult-idisciplinary approach to optimizing the care of patients who might need transfusion. This goal is fulfilled by clinically managing or preserving the patient's own blood instead of imprudently resorting to allogeneic blood. It can be said that Korea just begun the journey toward the PBM implementation. However, strong support from the government and endeavors from professional societies will make rapid and substantial success in implementation of PBM in Korea.

Assessment of the Training Program for Improvement of Blood Management at Hospital Blood Centers by Korea Centers for Disease Control and Prevention : Analysis of Survey Results (2015∼2017) / 대한수혈학회지

BACKGROUND: The Korea Centers for Disease Control and Prevention (KCDC) has been providing a nationwide, one-day training program for workers of hospital blood centers once a year since 2013. We evaluated the achievement levels of the program through surveys. METHODS: The survey was conducted immediately after the program in 2015, 2016, and 2017. Respondents' occupations, institutions, program contents, and operational aspects were asked. RESULTS: The response rate was 56.2%∼73.2%. The occupations of respondents were medical technologists 66.9%∼75.7%, nurses 16.1%∼22.1%, and others (administrators, et al.) 1.5%∼11.3%. About 86.1%∼88.2% of respondents answered that the program as a whole was satisfactory or very satisfactory; 88.9%∼94.7% thought that it is necessary or very necessary; 77.9%∼84.1% answered that the appropriate length of the program was one day; 53.8%∼69.1% answered that the appropriate number of program is once per year; and 23.4%∼53.8% or 40.3%∼61.4% answered that the appropriate season for the program by the KCDC should be the first or the second quarter, respectively. CONCLUSION: This study suggests that the training program plays a useful role in meeting the needs of workers for hospital blood centers.

Renoprotective effects of febuxostat compared with allopurinol in patients with hyperuricemia: A systematic review and meta-analysis

BACKGROUND: Hyperuricemia is reported to be related to rapid progression of renal function in patients with chronic kidney disease (CKD). Allopurinol, a uric acid lowering agent, protects renal progression. However, it is not widely used in patients with CKD because of its serious adverse event. Febuxostat can be alternatively used for patients who are intolerable to allopurinol. We aimed to determine renoprotective effect and urate-lowering effect between the two drugs. METHODS: We performed a systematic review and meta-analysis of randomized controlled trials to assess the effects of febuxostat compared to allopurinol in patients with hyperuricemia. MEDLINE, Embase, and Cochrane Library databases were searched to identify research publications. RESULTS: Four relevant publications were selected from among 3,815 studies. No significant differences were found in the changes in serum creatinine from baseline between the febuxostat and allopurinol groups. Changes in estimated glomerular filtration rate (eGFR) were observed between the two groups at 1 month (mean difference 1.65 mL/min/1.73 m², 95% confidence interval [CI] 0.38, 2.91 mL/min/1.73 m²; heterogeneity χ² = 1.25, I² = 0%, P = 0.01); however, the changes in eGFR were not significantly different at 3 months. A significant difference did exist in the changes in albuminuria levels from baseline between the febuxostat and allopurinol groups (mean difference −80.47 mg/gCr, 95% CI −149.29, −11.64 mg/gCr; heterogeneity χ² = 0.81, I² = 0%, P = 0.02). A significant difference was also observed in the changes in serum uric acid from baseline between the febuxostat and allopurinol groups (mean difference −0.92 mg/dL, 95% CI −1.29, −0.56 mg/dL; heterogeneity χ² = 6.24, I² = 52%, P < 0.001). CONCLUSION: Febuxostat might be more renoprotective than allopurinol.

A Survey of Physicians' Opinion on Informed Consent for Transfusion after the Introduction of the National Blood Transfusion Guideline / 대한수혈학회지

BACKGROUND: The decision on whether or not to transfuse should be based on agreement from the patient's own understanding and free will. In Korea, the transfusion guideline first developed in 2009 specified that informed consent should be obtained before transfusion. The standard consent form has also been distributed since 2010. The purpose of this study was to evaluate the degree of improvement in obtaining informed consent for blood transfusion. METHODS: Prior to the development of the transfusion guideline in 2008, an e-mail survey was conducted on 105 clinicians. In 2015, questionnaires were sent to 1,179 clinicians, 32 academic societies, and 6 institutions. RESULTS: Forty-three and 374 answers were received in 2008 and 2015, respectively (response rate, 41.0% and 30.7%). Compared with 2008, the use of explanatory materials increased from 20.9% to 70.5%, and consent acquisitions using a written form increased from 27.9% to 81.7%. The number of respondents who answered that informed consent for transfusions is absolutely necessary also increased from 51.2% to 71.3%. Among the reasons why obtaining informed consent for transfusion can be difficult, the response that standardized consent form is unavailable decreased from 51.2% to 26.9%. CONCLUSION: The transfusion guideline and the standard consent form have contributed greatly to the improvement of obtaining informed consent before blood transfusion at medical institutions in Korea.

Bacteremia Caused by Eggerthella lenta in an Elderly Patient with an Intra-abdominal Abscess

Eggerthella lenta is an anaerobic, non-spore-forming, non-motile, gram-positive bacillus that can be isolated from human feces and a few other clinical specimens. Bacteremia caused by the organism is rare but, when present, is always of clinical significance. E. lenta is an emerging pathogen that has been under-recognized because of difficulties with its laboratory identification. Few reports on E. lenta infections and the optimal treatment thereof are available. We describe a case of bacteremia caused by E. lenta in an elderly patient with an intra-abdominal abscess. We also review the current literature.

Comparison of the Ability of Multiplex and Singleplex PCR to Detect Human Respiratory Viruses

BACKGROUND: The use of the multiplex polymerase chain reaction (PCR) technique for respiratory viruses has become popular in Korea owing to its convenience and sensitivity. However, concerns remain with regard to possible interference due to multiplexing. METHODS: We compared the analytical sensitivity and virus interference of a commercially available, multiplex PCR kit (AdvanSure Respiratory virus real-time PCR kit, LG Life Sciences, Korea) with that of singleplex PCR to detect 11 viruses including coronavirus 229E and OC43; parainfluenza virus 1 (PIV 1), parainfluenza virus 2 (PIV 2), and parainfluenza virus 3 (PIV 3); influenza virus A (INF A) and influenza virus B (INF B); respiratory syncytial virus A (RSV A) and respiratory syncytial virus B (RSV B); adenovirus; and rhinovirus A, B, and C. RESULTS: The lowest detected viral concentrations of coronavirus 229E and OC43, INF A and B, RSV A and B, adenovirus, and rhinovirus A, B, and C were the same for both, multiplex and singleplex systems. However, the lowest detected viral concentrations of PIV1, 2, and 3 differed by 1 dilution factor between the two systems. Threshold cycle (Ct) values for mixed viruses within the same well were not significantly influenced by each other, where the difference between Ct values ranged from 0.24 to 1.99. CONCLUSIONS: Analytical sensitivity of multiplex PCR was comparable to that of singleplex PCR for respiratory viruses. No significant interference was observed with mixed virus samples using multiplexed PCR.

A Survey on the Awareness and Usage of the National Transfusion Guideline in Korea / 대한수혈학회지

BACKGROUND: Transfusion guidelines play an important role for the appropriate use and quality assurance of blood and transfusion services. The Korean national transfusion guideline was developed in 2009 and went under full amendment in 2016. The purpose of this study was to investigate the awareness and practicality of the transfusion guideline in Korea. METHODS: Questionnaires about the Korean national transfusion guideline were sent by traditional mail or e-mail to a total of 1,179 clinicians, 32 academic societies, and 6 institutions. RESULTS: Three hundred and seventy-four answers were received; a response rate of 30.7%. The proportion of respondents with good awareness of the guideline was 23.3%, which is a significant increase compared with 10.9% in 2008. Respondents with good awareness were more dependent on the transfusion guideline when making transfusion decisions. CONCLUSION: There was a considerable increase in the awareness of the national transfusion guideline in Korea.

Four Cases of Acquired Aplastic Anemia Affecting an Entire Family after Ingesting Ganoderma lucidum / 대한내과학회지

We report four cases of Ganoderma lucidum-induced aplastic anemia involving members of the same family. A 33-year-old man and three family members were admitted to the hospital due to fever and pancytopenia. The illness arose after ingesting herbal wine containing G. lucidum 2 weeks earlier. A bone-marrow biopsy showed hypocellularity in three of the four family members (the exception was the one who died). They were treated with supportive management, including transfusions, granulocyte colony stimulating factor, and empirical antibiotics for neutropenic fever. The pancytopenia improved 4-5 weeks after the symptoms first appeared.

False-Positive Elevation of Creatine Kinase MB Mass Concentrations Caused by Macromolecules in a Patient who Underwent Nephrectomy for Renal Cell Carcinoma

No abstract available.

Establishment and Multicenter Evaluation of a National Reference Panel for Syphilis Antibodies in Korea

BACKGROUND: Establishment of a national reference panel for syphilis antibodies is necessary to evaluate the performance of in-vitro diagnostic tests for syphilis and to verify test quality. This study aimed to establish a national reference panel for syphilis antibodies, to assess the suitability of a panel for non-treponemal and treponemal testing, and to assess the reactivity of the various tests currently in use. METHODS: Treponemal pallidum particle agglutination (TPPA)-positive and -negative fresh frozen plasma samples were obtained. After the fresh frozen plasma was converted to serum by defibrination, the samples were pooled. Two candidate reference standards containing no syphilis antibodies and 10 candidate reference standards containing syphilis antibodies were prepared on the basis of reactivity in the TPPA assay. Candidate reference standards were tested by three laboratories using five non-treponemal tests and four treponemal tests. RESULTS: All three laboratories reported positive non-treponemal test results for the mixed-titer performance panel (MP)/6-MP/12. MP/1, MP/2, and MP/3 were negative for non-treponemal tests. MP/4 and MP/5 were reported either as positive or negative according to the laboratories. All laboratories reported positive TPPA results for MP/3-MP/12 and negative results for MP/1 and MP/2. No significant difference was detected among the treponemal testing results in three laboratories. CONCLUSIONS: We established 12 candidate national reference standards containing various concentrations of syphilis antibodies. A collaborative study using nine tests demonstrated that 12 candidate national reference standards presented consistent results, except a few assays with low sensitivity, and thus could be used as a national reference panel for syphilis antibody testing.

Clinical Characteristics of Vivax Malaria and Analysis of Recurred Patients

BACKGROUND: Plasmodium vivax malaria is an acute debilitating illness characterized by recurrent paroxysmal fever and relapses from hypnozoites in the liver. Although a few studies reported clinical characteristics of vivax malaria in civilians after reemergence in the Republic of Korea, only a small group of patients was analyzed. MATERIALS AND METHODS: We retrospectively reviewed the medical records of patients who had been diagnosed with vivax malaria by peripheral blood smear in a university-affiliated hospital located in a malaria-endemic area between January 2005 and December 2009. RESULTS: During the study period, a total of 352 malarial cases from 341 patients were diagnosed. Vivax malaria was most commonly developed in July and August, 24.7% (87/352), and 21.9% (77/352), respectively. The mean (SD) age was 42.5 (14.7) years and the number of male patients was 243 (71.3%). Six patients had a previous history of vivax malaria from 6 months to 10 years before. A total of 337 patients (98.8%) had fever and the mean (SD) body temperature was 38.3 (1.4)degrees C. Common associated symptoms were chills (213/341, 62.5%), headache (115/341, 33.7%), and myalgia (85/341, 24.9%). Laboratory findings included thrombocytopenia (340/341, 99.7%), anemia (97/341, 28.5%), leukopenia (148/341, 43.4%), increase of aspartate transaminase (177/341, 51.9%), and increase of alanine transaminase (187/341, 54.8%). Hypotension (14/341, 4.1%), altered mentality (3/341, 0.9%), azotemia (3/341, 0.9%), spleen infarction (2/341, 0.6%), and spleen rupture (1/341, 0.3%) developed as complications. Chloroquine was administered to all patients and primaquine was administered with mean (SD) 3.39 (0.82) mg/kg to 320 patients. There were 11 recurrent infections during the study period. The median (range) time to recurrent infection was 100 (32-285) days. Platelet counts were higher (86,550 vs. 56,910/mm3) and time to treatment of malaria was shorter (5 vs. 7 days) in relapsed cases compared with first occurrence cases (P=0.046). CONCLUSIONS: The overall recurrence rate of vivax malaria was 3.2% (11/341) in this study. In recurred cases, malaria was diagnosed earlier and thrombocytopenia was less severe. To evaluate the risk factors associated with recurrence and adequate dose of primaquine in Korean patients, further large-scale prospective studies will be needed.

Comparison of Sputum and Nasopharyngeal Aspirates for Molecular Detection of Community-Acquired Pneumonia Pathogens / 임상검사와정도관리

BACKGROUND: Community-acquired pneumonia (CAP) is a leading cause of infectious diseases and mortality. CAP is primarily treated by administration of adequate antibiotics against the causative pathogens. Because detection of some pathogens by the conventional culture method is difficult, the use of molecular diagnostic methods is increasing. Although an optimal specimen type is very important for proper testing, there is no consensus on the optimal specimen type for detecting CAP pathogens. In this study, we compared sputum specimens and nasopharyngeal aspirates (NPAs) for molecular detection of 4 CAP-causing bacterial species. METHODS: From September 2011 to January 2012, we collected sputum specimens and NPAs from CAP patients on the first or second day of hospitalization. The specimens were tested for Mycoplasma pneumoniae, Streptococcus pneumoniae, Chlamydophila pneumoniae and Legionella pneumophila by using commercial real-time PCR. RESULTS: We collected 63 sputum specimens and 96 NPAs from 109 patients and found positive results for 38.1% (24/63) and 28.1% (27/96), respectively (P = 0.251). There were no significant differences in the positive rates obtained for sputum specimens of different quality. CONCLUSIONS: The results obtained using NPAs and sputum specimens for the molecular detection of CAP pathogens were comparable.

Evaluation of the Chorus Mycoplasma pneumoniae IgM Assay for the Serological Diagnosis of Mycoplasma pneumoniae Infection / 임상검사와정도관리

BACKGROUND: Mycoplasma pneumoniae is the most frequent cause of respiratory tract infections in school-aged children and adolescents. M. pneumoniae infection has variable clinical manifestations and is resistant to beta-lactam antibiotics, making correct diagnosis important. We evaluated the newly introduced Chorus M. pneumoniae IgM (DIESSE Diagnostica, Italy) assay for early diagnosis of M. pneumoniae infection. METHODS: The Chorus M. pneumoniae IgM and particle agglutination (PA) (Fujirebio, Japan) assays were tested on 75 serum specimens from 52 hospitalized children at a tertiary-care hospital between September 2011 and November 2011. A positive PA result was defined as an antibody titer of > or =1:40. The concordance of the Chorus M. pneumoniae IgM and PA results and the correlation of the Chorus M. pneumoniae IgM Index with the PA titer were analyzed. Furthermore, the Chorus M. pneumoniae IgM and PA results (PA-patient positive/negative) based on the clinical cutoff of the PA assay were compared in acute-phase specimens. RESULTS: The concordance rate of the Chorus M. pneumoniae IgM and PA results was 90.7% (kappa value= 0.5), and the Chorus M. pneumoniae IgM Index and PA titer correlated well (Spearman's correlation coefficient, 0.872, P < 0.001). However, 82.6% (19/23) of patients who were negative for M. pneumoniae by PA using the clinical cut-off were Chorus M. pneumoniae IgM-positive. CONCLUSIONS: The Chorus M. pneumoniae IgM assay is convenient and gives objective results. However, to make Chorus suitable for routine laboratory use, additional validation studies are required to determine the criteria for use in convalescent specimens.

A Draft Proposal for Korean Classification and Coding System for In Vitro Diagnostic Medical Devices

BACKGROUND: The Global harmonization task force (GHTF) recommends a separate regulation system for in vitro diagnostic medical devices (IVDD), because false test results can pose a risk to individual and/or public health. However, in Korea, many reagents for IVDD are not monitored, although IVD analyzers and some reagents are monitored under the Medical Device Act and Pharmaceutical Affairs Act, respectively. Our aim was to propose a draft for a Korean coding and classification system for IVDD. METHODS: For preparing the draft, we reviewed the Korean Current Procedural Terminology for Health Insurance and principles of the coding and classification system for IVDD of the GHTF, the USA, Japan, Canada, Australia, and the EU. The draft was reviewed by consultants from relevant societies, such as Korean Medical Association, Korean Society for Laboratory Medicine, The Korea Association of Medical Technologists, and Korea Association for Diagnostic Laboratory Reagents, and was then publicly discussed at a conference. RESULTS: IVDD were classified into 4 classes on the basis of the risks they pose to individual (IR) and public health (PR): class 1 (low IR and low PR), class 2 (moderate IR and low PR), class 3 (high IR and/or moderate PR), and class 4 (high IR and high PR). IVD analyzers, reagents and other general laboratory equipments were categorized and coded using the letter D and 7 (2+3+2) digits. CONCLUSIONS: This draft for the Korean IVDD classification and coding system could be used for effective management and regulation of IVDD in Korea.

A Draft Proposal for Korean Classification and Coding System for In Vitro Diagnostic Medical Devices

BACKGROUND: The Global harmonization task force (GHTF) recommends a separate regulation system for in vitro diagnostic medical devices (IVDD), because false test results can pose a risk to individual and/or public health. However, in Korea, many reagents for IVDD are not monitored, although IVD analyzers and some reagents are monitored under the Medical Device Act and Pharmaceutical Affairs Act, respectively. Our aim was to propose a draft for a Korean coding and classification system for IVDD. METHODS: For preparing the draft, we reviewed the Korean Current Procedural Terminology for Health Insurance and principles of the coding and classification system for IVDD of the GHTF, the USA, Japan, Canada, Australia, and the EU. The draft was reviewed by consultants from relevant societies, such as Korean Medical Association, Korean Society for Laboratory Medicine, The Korea Association of Medical Technologists, and Korea Association for Diagnostic Laboratory Reagents, and was then publicly discussed at a conference. RESULTS: IVDD were classified into 4 classes on the basis of the risks they pose to individual (IR) and public health (PR): class 1 (low IR and low PR), class 2 (moderate IR and low PR), class 3 (high IR and/or moderate PR), and class 4 (high IR and high PR). IVD analyzers, reagents and other general laboratory equipments were categorized and coded using the letter D and 7 (2+3+2) digits. CONCLUSIONS: This draft for the Korean IVDD classification and coding system could be used for effective management and regulation of IVDD in Korea.

Prevalence and Distribution of Human Papillomavirus Infection in Korean Women as Determined by Restriction Fragment Mass Polymorphism Assay

The development of a prophylactic vaccine that targets human papillomaviruses (HPV) 6, 11, 16, and 18 to prevent cervical cancer has increased interest in the ethnic and geographical distributions of HPV genotypes. We investigated HPV prevalence and type distribution by restriction fragment mass polymorphism (RFMP) testing a total of 60,775 specimens (aged 18-79 yr, median 44) taken from liquid-based cytology. Overall HPV positive rate of total patients was 34.2%. Among the positive patients, 87.7% was single type infections, and 12.3% was multiple HPV types. HPV-16 was the most prevalent genotype observed in 2,307 (26.0%), followed by type 52 in 2,269 (25.5%), type 58 in 1,090 (12.3%), type 18 in 633 (7.1%), type 56 in 436 (4.9%). The pattern of high risk-HPV positive rate according to age showed U-shape with a peak in HPV prevalence among women less than 30 yr of age, and a second peak among the older females aged 70 to 79 yr. The leading four high-risk HPV genotypes were HPV-16, HPV-52, HPV-58, and HPV-18 in descending order. In conclusion, this study provides the most representative prevalence and type-specific distribution of HPV among Korean women, and demonstrates that the epidemiology of HPV infection is different from that of other regions of the world.

Splenic infarction in a patient with autoimmune hemolytic anemia and protein C deficiency / 대한혈액학회지

Splenic infarction is most commonly caused by cardiovascular thromboembolism; however, splenic infarction can also occur in hematologic diseases, including sickle cell disease, hereditary spherocytosis, chronic myeloproliferative disease, leukemia, and lymphoma. Although 10% of splenic infarction is caused by hematologic diseases, it seldom accompanies autoimmune hemolytic anemia (AIHA). We report a case of a 47-year-old woman with iron deficiency anemia who presented with pain in the left upper abdominal quadrant, and was diagnosed with AIHA and splenic infarction. Protein C activity and antigen decreased to 44.0% (60-140%) and 42.0% (65-140%), respectively. Laboratory testing confirmed no clinical cause for protein C deficiency, such as disseminated intravascular coagulation, sepsis, hepatic dysfunction, or acute respiratory distress syndrome. Protein C deficiency with splenic infarction has been reported in patients with viral infection, hereditary spherocytosis, and leukemia. This is a rare case of splenic infarction and transient protein C deficiency in a patient with AIHA.