Development of a Secondary Order Program for Pretransfusion Tests to Improve the Work Efficiency of Blood Bank / 대한수혈학회지

Background@#In the author’s blood bank, if the Ab screening test results are positive in the pretransfusion test, an Ab identification test and polyspecific direct antiglobulin test (DAT) are performed. IgG and C3 monospecific DATs are also performed if the polyspecific DAT is positive. To perform additional tests, clinical technologists used to communicate with the clinical department by telephone, and then the clinical doctor issued the orders.There could be problems with this process, such as clerical errors and reduced work efficiency. Therefore, this study developed the secondary order program to improve the work efficiency of the blood bank. @*Methods@#The secondary order program that allows the laboratory medicine doctors to issue additional test orders, print out barcodes in blood bank, and immediately report the results to the EMR (Electronic Medical Record) was developed. Before (Jul 2018∼Jun 2019) and after (Jul 2019∼Jun 2020) applying the program to inpatients, the number of telephone calls, Ab screening tests, Ab identification tests, polyspecific DAT, and monospecific DAT were compared to evaluate the effectiveness of the program. @*Results@#After applying the program, 515 calls per year (average 43 calls per month) were reduced. Before the program, the results of 68 Ab screening tests and 16 polyspecific DATs were not reported on EMR, but no case was missed after the program. @*Conclusion@#Through the secondary order program, the work efficiency of the blood bank was improved. It is expected that expanding this program to other blood bank tests will help implement tests faster and make them more systematic.

Development of a Secondary Order Program for Pretransfusion Tests to Improve the Work Efficiency of Blood Bank / 대한수혈학회지

Background@#In the author’s blood bank, if the Ab screening test results are positive in the pretransfusion test, an Ab identification test and polyspecific direct antiglobulin test (DAT) are performed. IgG and C3 monospecific DATs are also performed if the polyspecific DAT is positive. To perform additional tests, clinical technologists used to communicate with the clinical department by telephone, and then the clinical doctor issued the orders.There could be problems with this process, such as clerical errors and reduced work efficiency. Therefore, this study developed the secondary order program to improve the work efficiency of the blood bank. @*Methods@#The secondary order program that allows the laboratory medicine doctors to issue additional test orders, print out barcodes in blood bank, and immediately report the results to the EMR (Electronic Medical Record) was developed. Before (Jul 2018∼Jun 2019) and after (Jul 2019∼Jun 2020) applying the program to inpatients, the number of telephone calls, Ab screening tests, Ab identification tests, polyspecific DAT, and monospecific DAT were compared to evaluate the effectiveness of the program. @*Results@#After applying the program, 515 calls per year (average 43 calls per month) were reduced. Before the program, the results of 68 Ab screening tests and 16 polyspecific DATs were not reported on EMR, but no case was missed after the program. @*Conclusion@#Through the secondary order program, the work efficiency of the blood bank was improved. It is expected that expanding this program to other blood bank tests will help implement tests faster and make them more systematic.

Changes in Blood Glucose Level After Steroid Injection for Musculoskeletal Pain in Patients With Diabetes

Objective@#To investigate changes in blood glucose level after steroid injection in patients with type 2 diabetes mellitus (DM) and factors affecting those changes. @*Methods@#We retrospectively studied 51 patients with type 2 DM who underwent steroid injection for shoulder and back pain. Mean fasting blood sugar (FBS) levels for 7 days before steroid injection was used as the baseline blood glucose level, which was compared with FBS levels for 14 days after steroid injection. We compared the differences in blood glucose changes between HbA1c >7% and HbA1c ≤7% groups and those between insulin and non-insulin treated groups. Demographic data, injection site, and steroid dose were analyzed. @*Results@#Compared to baseline, blood glucose significantly (p=0.012) elevated 1 day after steroid injection but not 2 days after injection. In the HbA1c >7% and insulin groups, blood glucose was significantly increased 1 day after injection compared to that in the HbA1c ≤7% (p=0.011) and non-insulin (p=0.024) groups, respectively. Higher HbA1c level before injection was significantly (p=0.003) associated with the degree of blood glucose increase 1 day after injection. No significant differences were noted in the degree of blood glucose increase according to injection site or steroid dose. @*Conclusion@#Higher HbA1c level was associated with greater elevation in blood glucose 1 day after steroid injection. Careful monitoring of blood glucose is required on the first day after steroid injection in patients with poorly controlled DM.

A Case of Donor Cell Leukemia after Allogenic Peripheral Blood Stem Cell Transplantation for Acute Promyelocytic Leukemia with PML-RARA

Rifampin-Induced Immune Hemolytic Anemia during Treatment of Pulmonary Tuberculosis in a Patient with Primary Sjogren's Syndrome / 대한수혈학회지

Drug-induced immune hemolytic anemia is a rare disease that occurs in 1 in 1 million individuals of the general population. Rifampin-induced immune hemolytic anemia is caused by drug-dependent antibodies and this can be treated without complication by drug cessation. Herein, we present a case of rifampin-induced immune hemolytic anemia in a patient with primary Sjogren's syndrome (pSS) which occurred during treatment of pulmonary tuberculosis. At admission, the patient's laboratory tests revealed hemolytic anemia and positive direct antiglobulin test result. Since the incidence of autoimmune hemolytic anemia (AIHA) in pSS is reported to be 3 percent, which is higher than that of the general population, differential diagnosis between AIHA and rifampin-induced immune hemolytic anemia was required for planning future anti-tuberculous treatment. We identified rifampin-dependent antibody by drug-induced immune complex test and diagnosed rifampin-induced immune hemolytic anemia. Based on this experience, if rifampin administration is considered in patients with systemic autoimmune disease such as pSS, which has a high incidence of AIHA, we suggest evaluating the presence and the cause of hemolytic anemia at baseline by testing serum lactate dehydrogenase, haptoglobin, and direct and indirect antiglobulin tests before drug administration to promptly identify the cause of hemolysis if hemolytic anemia develops.

A Case of Lymphoplasmacytic Lymphoma/Waldenström's Macroglobulinemia with IgM-κ and IgA-λ Biclonal Gammopathy

Lymphoplasmacytic lymphoma (LPL) is a low-grade B-cell neoplasm, composed of small B lymphocytes, plasmacytoid lymphocytes, and plasma cells, usually involving bone marrow and sometimes lymph nodes or spleen. LPL with bone marrow involvement and an IgM monoclonal gammopathy of any concentration is designated as Waldenström macroglobulinemia (WM). LPL associated with non-IgM monoclonal gammopathy or biclonal gammopathy is rarely observed. LPL diagnosis was based on clinical, morphological, and immunophenotypic findings. Recently, the test for L265P mutation of the myeloid differentiation factor 88 (MYD88) gene has been helpful in the diagnosis of LPL. Here, we reported the first case of LPL/WM with IgM-κ/IgA-λ biclonal gammopathy in Korea.

Evaluation of Time and Temperature Stability of Paroxysmal Nocturnal Hemoglobinuria Cells by Flow Cytometry

BACKGROUND: Flow cytometry analysis of paroxysmal nocturnal hemoglobinuria (PNH) is significantly affected by the methodology used. The lack of data on the effect of age and refrigeration on PNH clone stability motivated us to study these aspects using flow cytometry. METHODS: Peripheral blood was collected from six patients, of which two presented with PNH. All samples were tested immediately and stored at room temperature (RT, 20–25℃) and at 4℃ for re-analysis at 24, 48, 72 hr and 7 days. Anti-CD59-fluorescein isothiocyanate (Beckman Coulter, USA) and anti-CD235a-phycoerythrin (PE; Beckman Coulter) were used to stain red blood cells (RBCs). Fluorescein-labeled proaerolysin (Cedarlane, Canada), anti-CD15-PE (Beckman Coulter), anti-CD24-PE-cyanin 5 (Beckman Coulter), and anti-CD45-PE-cyanin 7 (Beckman Coulter) were used to stain granulocytes. Flow cytometry was performed using a FC500 flow cytometer (Beckman Coulter). The effects of time and temperature were analyzed using generalized estimating equations. RESULTS: No significant differences in the gated percentage of RBCs and PNH clone size of RBCs were observed between the RT and 4℃ groups up to 7 days of testing. The percentage of gated neutrophils decreased with specimen age (P<0.001) and a better correlation with baseline was obtained at 4℃ than at RT (P=0.014). Neutrophil PNH clones were stable until 48 hr and 72 hr at RT and 4℃, respectively, and could not be analyzed at 7 days. CONCLUSIONS: RBC analysis was successfully performed up to 7 days. For neutrophils, testing within 48 hr is recommended, because the number of gated cells decreases significantly with age.

Effect of Dynamic Balance Exercise in Elderly Patients with Unilateral Knee Osteoarthritis

OBJECTIVE: To evaluate the effectiveness of dynamic balance exercise after intra-articular injection of hyaluronic acid (HA) therapy in elderly patients with unilateral knee osteoarthritis.METHOD: 30 patients with unilateral knee osteoarthritis were enrolled in this study. The patients were randomly divided into two groups: dynamic balance exercise after HA injection group (group A) and only HA injection group (group B). Both groups administered intra-articular HA injection and group A patients continued 20-session exercises for 4 weeks. The assessments were measured before injection and 4 weeks after treatment using the visual analog scale (VAS) for pain, the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) for physical function, Berg balance scale (BBS), and computerized dynamic posturography using SMART Balance Master system for balance function.RESULTS: In both groups, significant improvements in VAS, WOMAC and balance function were observed. Compared between groups, group A showed significant improvements compared to group B in WOMAC and balance function.CONCLUSION: It is suggested that dynamic balance exercise may result in improved balance function and physical function in elderly patients with unilateral knee osteoarthritis.

Development of a Transfusion-Indication Data-Entry Program and Analysis of Transfusion Indications at a University Hospital in Korea / 대한수혈학회지

BACKGROUND: Transfusion guidelines are not only essential for the optimal use of blood products, but also help reduce transfusion-related adverse reactions and improve patients' outcomes. In this hospital, a transfusion-indication data-entry program based on the national transfusion guidelines was developed and applied to the electronic medical record system in 2016. All transfusion orders, except for emergencies, have been performed using this program since then. This study analyzed the reasons for the transfusion to monitor the blood product usage and provide feedback to clinicians.

In Reply: Comment on “Effect of Extracorporeal Shockwave Therapy Versus Intra-articular Injections of Hyaluronic Acid for the Treatment of Knee Osteoarthritis”

No abstract available.

Comparison of ABO Blood Group Typing between Automated Blood Bank Analyzer IH-500 and Manual Method / 대한수혈학회지

BACKGROUND: According to increased availability and awareness of automated blood bank analyzer with its speed and efficiency, use of automated analyzer in hospital blood bank has been increasing rapidly. We compared the ABO blood group typing results between automated analyzer IH-500 and manual method in healthy adults and patients with ABO discrepancies to provide useful information on interpretation of blood grouping results by automated analyzer. METHODS: Among healthy adults who underwent medical examinations, 400 samples (each 100 samples of A, B, O and AB type) were selected and evaluated the results and grades of blood grouping by automated and manual methods. Also, 50 samples showing ABO discrepancies among patients requested for pretransfusion test were selected and compared between two methods. As for samples with ABO discrepancies, further tests such as microscopic examination, reactivity with anti-A1 or ABO genotyping along with medical record review were performed. RESULTS: Agglutination results and grades in healthy adults were consistent between two methods. Meanwhile, 30 (60%) of ABO discrepant samples were related to rouleaux formation and their frequencies and agglutination grades were higher in automated method (Wilcoxon signed rank test, P=0.001). Results of discrepant samples caused by unexpected antibody or ABO subgroup showed no differences between two methods. CONCLUSION: IH-500 automated analyzer was considered useful for mass examination of healthy individuals. Meanwhile, considering the fact that ABO discrepancies by rouleaux formation were more frequent and stronger in automated method, it is recommended to retest their results by manual methods along with medical record review.

Effect of Extracorporeal Shockwave Therapy Versus Intra-articular Injections of Hyaluronic Acid for the Treatment of Knee Osteoarthritis

OBJECTIVE: To evaluate and compare the effects and outcomes of extracorporeal shock wave therapy (ESWT) and intra-articular injections of hyaluronic acid (HA) in patients with knee osteoarthritis (OA). METHODS: Of the 78 patients recruited for the study, 61 patients met the inclusion criteria. The enrolled patients were randomly divided into two groups: the ESWT group and the HA group. The ESWT group underwent 3 sessions of 1,000 shockwave pulses performed on the affected knee with the dosage adjusted to 0.05 mJ/mm² energy. The HA group was administered intra-articular HA once a week for 3 weeks with a 1-week interval between each treatment. The results were measured with the visual analogue scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lequesne index, 40-m fast-paced walk test, and stair-climb test (SCT). A baseline for each test was measured before treatment and then the effects of the treatments were measured by each test at 1 and 3 months after treatment. RESULTS: In both groups, the scores of the VAS, WOMAC, Lequesne index, 40-m fast-paced walk test, and SCT were significantly improved in a time-dependent manner (p0.05). CONCLUSION: The ESWT can be an alternative treatment to reduce pain and improve physical functions in patients with knee OA.

Effect of Korean Red Ginseng on Stress Responses and beta-Adrenergic Receptor Function in a Normal Population / 대한정신약물학회지

OBJECTIVE : There have been few studies to examine the effect of Korean red-ginseng on autonomic nervous system. The aim of this study is to examine the effect of Korean red-ginseng on beta-adrenergic receptor function in a normal population. METHODS : Thirty four healthy normal subjects who were 20-40 years old were recruited for the study. They were randomized into the two groups ; red-ginseng group (n=19) and placebo group (n=15). Three gram of red-ginseng or placebo per day was administered to the study subjects for 3 weeks. Before and after the medications, we measured the lymphocyte beta-adrenergic receptor function (Bmax, cAMP, and Kd), and psychological scales such as the Stress Response Inventory (SRI), Beck Depression Inventory (BDI), and Spielberger State and Trait Anxiety Inventory (STAI). This study was a double-blind, placebo-controlled, randomized, comparative study. RESULTS : There were no significant differences in the changes of beta-adrenergic receptor density (Bmax) and sensitivity (cAMP) and psychological assessments between the two groups according to the medications. However, we found significant (group x time) effects for Kd, and beta-adrenergic receptor affinity (1/Kd) was increased significantly in the Korean red-ginseng group. CONCLUSION : In a normal population, Korean red-ginseng showed a potential effects on the beta-adrenergic receptor function, which may play an important role in the regulation of stress responses

Effect of Korean Red Ginseng on Stress Responses and beta-Adrenergic Receptor Function in a Normal Population / 대한정신약물학회지

OBJECTIVE : There have been few studies to examine the effect of Korean red-ginseng on autonomic nervous system. The aim of this study is to examine the effect of Korean red-ginseng on beta-adrenergic receptor function in a normal population. METHODS : Thirty four healthy normal subjects who were 20-40 years old were recruited for the study. They were randomized into the two groups ; red-ginseng group (n=19) and placebo group (n=15). Three gram of red-ginseng or placebo per day was administered to the study subjects for 3 weeks. Before and after the medications, we measured the lymphocyte beta-adrenergic receptor function (Bmax, cAMP, and Kd), and psychological scales such as the Stress Response Inventory (SRI), Beck Depression Inventory (BDI), and Spielberger State and Trait Anxiety Inventory (STAI). This study was a double-blind, placebo-controlled, randomized, comparative study. RESULTS : There were no significant differences in the changes of beta-adrenergic receptor density (Bmax) and sensitivity (cAMP) and psychological assessments between the two groups according to the medications. However, we found significant (group x time) effects for Kd, and beta-adrenergic receptor affinity (1/Kd) was increased significantly in the Korean red-ginseng group. CONCLUSION : In a normal population, Korean red-ginseng showed a potential effects on the beta-adrenergic receptor function, which may play an important role in the regulation of stress responses