Current Status of Clinical Practice Guidelines in Korea

Background@#The development process of clinical practice guidelines (CPGs) must adhere to development standards and must be supported and steered by a representative and consistent governing body. We aimed to investigate the current status of the most recent CPGs published in Korea through surveys of medical professional societies and literature searches. @*Methods@#We collected CPGs developed in Korea in the past 5 years through several electronic database searches (MEDLINE, Embase, and KoreaMed), hand searches, and surveys of medical society memberships from the Korean Academy Medical Societies. Three authors selected Korean CPGs according to our inclusion/exclusion criteria and extracted data from selected CPGs about general characteristics, characteristics of CPGs for setup, evidence evaluation, and the finalization phase. @*Results@#Out of 2,337 articles searched from various sources and 66 documents collected by survey, 129 guidelines (122 by database searching and 7 by survey) were selected. During the recent 5 years, the yearly numbers of CPGs developed were around 25. A single organization was the most frequent CPG development body (42, 32.6%). The most common development methodologies described in the CPGs included were de novo (53, 41.1%) followed by adaptation (48, 37.2%) and hybrid (4, 3.1%). Systematic literature searching was performed in most of the guidelines (79.8%). The evidence level was reported in 104 guidelines (80.6%).There were 77 guidelines (59.7%) that reported an update plan. Fifty guidelines were published in Korean (41.0%), and 46 guidelines were published in English only (37.7%). @*Conclusion@#Among CPGs developed in Korea in the last 5 years, the proportion adhering to CPG development standards has increased, but there is still room for improvement.

Current Status of Clinical Practice Guidelines in Korea

Background@#The development process of clinical practice guidelines (CPGs) must adhere to development standards and must be supported and steered by a representative and consistent governing body. We aimed to investigate the current status of the most recent CPGs published in Korea through surveys of medical professional societies and literature searches. @*Methods@#We collected CPGs developed in Korea in the past 5 years through several electronic database searches (MEDLINE, Embase, and KoreaMed), hand searches, and surveys of medical society memberships from the Korean Academy Medical Societies. Three authors selected Korean CPGs according to our inclusion/exclusion criteria and extracted data from selected CPGs about general characteristics, characteristics of CPGs for setup, evidence evaluation, and the finalization phase. @*Results@#Out of 2,337 articles searched from various sources and 66 documents collected by survey, 129 guidelines (122 by database searching and 7 by survey) were selected. During the recent 5 years, the yearly numbers of CPGs developed were around 25. A single organization was the most frequent CPG development body (42, 32.6%). The most common development methodologies described in the CPGs included were de novo (53, 41.1%) followed by adaptation (48, 37.2%) and hybrid (4, 3.1%). Systematic literature searching was performed in most of the guidelines (79.8%). The evidence level was reported in 104 guidelines (80.6%).There were 77 guidelines (59.7%) that reported an update plan. Fifty guidelines were published in Korean (41.0%), and 46 guidelines were published in English only (37.7%). @*Conclusion@#Among CPGs developed in Korea in the last 5 years, the proportion adhering to CPG development standards has increased, but there is still room for improvement.

A Family with Axenfeld-Rieger Syndrome: Report of the Clinical and Genetic Findings

PURPOSE: To describe clinical findings in a Korean family with Axenfeld-Rieger syndrome. METHODS: A retrospective review of clinical data about patients with diagnosed Axenfeld-Rieger syndrome. Five affected members of the family underwent a complete ophthalmologic examination. We screened the forkhead box C1 gene and the pituitary homeobox 2 gene in patients. Peripheral blood leukocytes and buccal mucosal epithelial cells were obtained from seven members of a family with Axenfeld-Rieger syndrome. DNA was extracted and amplified by polymerase chain reaction, followed by direct sequencing. RESULTS: The affected members showed iris hypoplasia, iridocorneal adhesions, posterior embryotoxon, and advanced glaucoma in three generation. None had systemic anomalies. Two mutations including c.1362_1364insCGG and c.1142_1144insGGC were identified in forkhead box C1 in four affected family members. CONCLUSIONS: This study may help to understand clinical findings and prognosis for patients with Axenfeld-Rieger syndrome.

Long-Term Outcomes and Predictive Factors for Success of Selective Laser Trabeculoplasty

PURPOSE: To investigate long-term outcomes and predictive success factors for selective laser trabeculoplasty (SLT). METHODS: This retrospective chart review included 66 eyes of 66 glaucoma or ocular hypertension patients who underwent SLT between 2004 and 2011. All patients were followed-up for at least 2 years after the procedure. The intraocular pressure (IOP) was measured before the treatment, at postoperative 1 week, 1 month and every 3 months thereafter. Success was defined as an IOP decrease > or = 3 mm Hg or > or = 20% of the pretreatment IOP. The success rate was determined based on the Kaplan-Meier survival analysis. The predictive success factors were analyzed using the Cox proportional hazard model. RESULTS: The mean follow-up period was 4.78 +/- 1.98 (2-8) years. The mean pretreatment IOP was 23.79 +/- 2.83 mm Hg. The mean IOP reduction was 6.64 +/- 3.21 mm Hg. The success rates were 80%, 75%, 69%, 63%, 50%, 45%, and 42% after 1, 2, 3, 4, 5, 6, and 7 years, respectively. Only high pretreatment IOP was significantly correlated with success (p = 0.044). CONCLUSIONS: SLT was an effective tool for lowering IOP in glaucoma patients. Higher pretreatment IOP was a predictive success factor.

Analysis of Peripapillary Atrophy According to the Optic Disc Shape Using Spectral Domain OCT

PURPOSE: To analyze the structural changes in the beta-zone of peripapillary atrophy (PPA-beta) using cross-sectional image of the optic disc head from spectral-domain optical coherence tomography (SD-OCT) according to the optic disc shape. METHODS: One hundred thirty-seven eyes in 137 patients with glaucoma having PPA-beta and 31 normal eyes (control group) were evaluated retrospectively. Cross-sectional images of the optic disc were taken using the Cirrus HD-OCT. We classified optic disc patterns into normal, focal, myopic, generalized enlargement and senile sclerotic appearance types and analyzed the shape of Bruch's membrane (BM), composition of retinal layer and retinal slope according to the optic disc shape. RESULTS: Among the 137 eyes with glaucoma, 54 eyes were focal disc type, 34 eyes were myopic disc type, 28 eyes were generalized enlargement disc type and 21 eyes were senile sclerotic disc type. The myopic disc group showed a noticeable difference compared to the other groups in terms of a higher percentage of BM defect type, the lowest retinal slope (70.6 +/- 12.0degrees) and the earlier termination of retinal layers. The generalized enlargement disc group showed the highest percentage of curved BM type. Retinal slope angle increased with age and decreased with axial length. CONCLUSIONS: In the beta-zone of peripapillary atrophy, there were several differences in the shape of Bruch's membrane, composition of retinal layers and the retinal slope according to the optic disc shape.

A Case of Korean Patient with Macular Corneal Dystrophy Associated with Novel Mutation in the CHST6 Gene

To report a novel mutation within the CHST6 gene, as well as describe light and electron microscopic features of a case of macular corneal dystrophy. A 59-year old woman with macular corneal dystrophy in both eyes who had decreased visual acuity underwent penetrating keratoplasty. Further studies including light and electron microscopy, as well as DNA analysis were performed. Light microscopy of the cornea revealed glycosaminoglycan deposits in the keratocytes and endothelial cells, as well as extracellularly within the stroma. All samples stained positively with alcian blue, colloidal iron, and periodic acid-Schiff. Electron microscopy showed keratocytes distended by membrane-bound intracytoplasmic vacuoles containing electron-dense fibrillogranular material. These vacuoles were present in the endothelial cells and between stromal lamellae. Some of the vacuoles contained dense osmophilic whorls. A novel homozygous mutation (c.613 C>T [p.Arg205Trp]) was identified within the whole coding region of CHST6. A novel CHST6 mutation was detected in a Korean macular corneal dystrophy patient.

Risk Factors of Graft Failure in Post-Keratoplasty Ocular Hypertension

PURPOSE: To assess the risk factors proceeding to graft failure in post-keratoplasty ocular hypertension patients. METHODS: In 35 eyes diagnosed with post-keratoplasty ocular hypertension (graft failure: 13 eyes; graft survival: 22 eyes), relationships between graft status at the observation time and pre-keratoplasty diagnosis, lens status, history of graft failure, donor size, difference between donor and recipient graft size, donor corneal endothelial cell count, post-keratoplasty intraocular pressure (after 1 week and maintenance intraocular pressure after surgery), and number of antiglaucomatic agents were investigated. The relative risks of each factor to induce graft failure were also evaluated. RESULTS: Previous graft failure history, pre-existing pseudophakic bullous keratopathy and aphakia/pseudophakia showed statistically significant high probabilities of proceeding to graft failure (p < 0.05). In particular, the intraocular pressure 1 week after the graft was statistically higher (p < 0.05) in the graft failure group (24.31 +/- 8.82 mm Hg) than in the graft survival group (16.81 +/- 6.69 mm Hg). CONCLUSIONS: Strict management of intraocular pressure in the early phase of penetrating keratoplasty could contribute to reducing graft failure in post-keratoplasty ocular hypertension patients.

Long-Term Outcomes of Penetrating Keratoplasty in Treating Macular Corneal Dystrophy, TGFBI Dystrophy, and Fuchs' Dystrophy

PURPOSE: To compare long-term outcomes of penetrating keratoplasty in treating macular corneal dystrophy, transforming growth factor beta induced (TGFBI) dystrophy, and Fuchs' dystrophy. METHODS: The present retrospective study describes the postoperative results of 123 eyes in 70 patients; 53 eyes with macular corneal dystrophy, 20 eyes with TGFBI dystrophy, and 50 eyes with Fuchs' dystrophy. All patients received penetrating keratoplasty. The outcome measures included recurrence rate, graft rejection, graft survival rate and corneal endothelial density and other complications. RESULTS: As compared with the other groups, TGFBI dystrophy had the highest recurrence rate (p-value < 0.0001). Fuchs' dystrophy had the lowest graft survival rate (p-value = 0.03). Corneal endothelial cell density was lowest in Fuchs' dystrophy 10 years postoperatively (p-value = 0.0006), but there was no significant difference in corneal endothelial cell density between the 3 groups 1 and 5 years postoperatively. There was no significant difference between the 3 groups in other complications such as graft rejection, secondary glaucoma and persistent epithelial defect (p-value = 0.809, p-value = 0.584, p-value = 0.972, respectively). CONCLUSIONS: Penetrating keratoplasty showed different long-term outcomes in treating 3 types of corneal dystrophies. The difficulty may depend on the pathogenesis of corneal dystrophies.

Transscleral Fixation of Intraocular Lens Using the Triple Cow-Hitch Method

PURPOSE: To report the results of scleral suture fixation using a hydrophilic acrylic intraocular lens (IOL) with 3 hollow haptics through a small corneal incision, the Triple Cow-Hitch Method. CASE SUMMARY: Three-point suture fixation of a XL Stabi ZO IOL was performed in 5 eyes of 5 patients with aphakia after penetrating keratoplasty (PKP), vitrectomy and subluxated lens extraction. Postoperatively, the corrected distance visual acuity and spherical equivalent improved in all measured eyes. There were no cases of pigment dispersion or cystoid macular edema (CME). CONCLUSIONS: In this preliminary study, the triple cow-hitch method of suturing a hydrophilic acrylic IOL is an alternative to the conventional 2-point scleral fixation of sutured IOLs.

Effects of Long Distance Transportation of Specimens on Test Results

BACKGROUND: Accuracy of laboratory test results is an important issue. New guidelines for specimen delivery systems are needed for appropriate pretreatment of specimens and accuracy of results. METHODS: We evaluated various laboratory profiles, comparing the effects of specimen rack holders and coolants within transport containers. The hematology profiles (complete blood cell count [CBC], erythrocyte sedimentation rate [ESR]), chemistry profiles (aspartate aminotransaminase [AST], alanine aminotransaminase [ALT], gamma-glutamyl transferase [gamma-GT], electrolytes [Na, K, Cl], glucose, lactate dehydrogenase [LD], creatinine kinase [CK]), and coagulation profiles (prothrombin time [PT], activated partial thromboplastin time [aPTT], fibrinogen level). We also investigated the effects of transportation time including the presence or absence of hemolyzation. We received from 9 different university hospital laboratories using conventional transporation methods. RESULTS: Hemolytic features were seen in short drawn specimens. Fewer result variations were observed in specimens transported with coolants. Average specimen transportation time was 11.3 hours, and average temperatures of container was 10.9degrees C with coolant and 25.0degrees C without coolants. Non-centrifuged specimens transported with coolants showed increased serum K levels than centrifuged specimens. Coagulation tests showed less than a 10% differences. Centrifuged specimen prior to transportation showed no hemolyzation and no differences in results. CONCLUSIONS: Appropriate temperatures for each analyte should be defined to ensure the accuracy of results. To reduce hemolyzation, appropriate temperature and rack holder should be used. Temperature of the transport container should be monitored in objectively. Coagulation tests should be added as referral tests, if appropriate specimen transport monitoring system for time and temperature could be adopted.

Annual Report on External Quality Assessment in Diagnostic Genetics in Korea (2009) / 임상검사와정도관리

BACKGROUND: The quality control for genetic tests would be of great importance as the test volume and clinical demands increase dramatically. Diagnostic genetics subcommittee of KSQACL performed two trials for cytogenetics and molecular genetics surveys in 2009. METHODS: A total of 67 laboratories participated in the cytogenetic surveys, 30 laboratories participated in the FISH surveys, and 94 laboratories participated in the molsecular genetics surveys in 2009. RESULTS: Almost of them showed acceptable results. However, some laboratories showed unacceptable results for the karyotype nomenclature and detection of complex cytogenetic abnormalities in hematologic neoplasms, and most of them except one showed acceptable results in FISH surveys. The molecular genetics surveys included various tests: M. tuberculosis detection, hepatitis B (HBV) and C virus (HCV) detection and quantification, human papilloma virus (HPV) genotyping, Influenza A (H1N1) detection, gene rearrangement tests for leukemias and lymphomas, apolipoprotein E (APOE) genotyping, methylenetetrahydrofolate reductase (MTHFR) genotyping, hereditary breast and ovarian cancer genes (BRCA1 and BRCA2), and genetic tests for achondroplasia (FGFR3), FMS-like tyrosine kinase 3 (FLT3), JAK2, BRAF, hereditary disorders such as spinal muscular atrophy, Huntington disease (HD), spinocerebellar ataxia (SCA), Prader-Willi/Angelman syndrome (PWS/AS), mitochondrial encephalopathy with lactic acidosis and strokelike episodes (MELAS), myoclonic epilepsy ragged red fiber (MERRF), wilson disease (ATP7B) and cancer-associated genes (KRAS). Molecular genetic surveys showed excellent results in most of the participants. CONCLUSIONS: External quality assessment program for genetic analysis in 2009 was proved to be helpful in continuous education and evaluation of quality improvement.

Annual Report on External Quality Assessment in Diagnostic Genetics in Korea (2008) / 임상검사와정도관리

The quality control for genetic tests would be of great importance as the test volume and clinical demands increase dramatically. Diagnostic genetics subcommitee of KSQACP performed two trials for cytogenetic study in 2008. A total of 41 laboratories participated in the cytogenetic surveys, and most of them showed acceptable results. However, some laboratories showed unacceptable results for the karyotype nomenclature and detection of complex cytogenetic abnormalities in hematologic neoplasias. The molecular genetics surveys included various tests: M. tuberculosis detection, hepatitis B (HBV) and C virus (HCV) detection and quantification, human papilloma virus (HPV) genotyping, gene rearrangement tests for leukemias and lymphomas, apolipoprotein E (APOE) genotyping, methylenetetrahydrofolate reductase (MTHFR) genotyping, hereditary breast and ovarian cancer genes (BRCA1 and BRCA2), and genetic tests for hereditary disorders such as spinal muscular atrophy (SMA), Huntington disease (HD), spinocerebellar ataxia (SCA), Prader-Willi/Angelman syndrome (PWS/AS), mitochondrial encephalopathy with lactic acidosis and strokelike episodes (MELAS), myoclonic epilepsy ragged red fiber (MERRF), wilson disease (ATP7B) and cancer-associated genes (KRAS). Molecular genetic surveys showed excellent results in most of the participants. External quality assessment program for genetic analysis in 2008 was proved to be helpful in continuous education and evaluation of quality improvement.

Annual Report on External Quality Assessment in Diagnostic Genetics in Korea (2007) / 임상검사와정도관리

The importance of quality control for dramatically growing genetic tests continues to be emphasized with increasing clinical demands. Diagnostic genetics subcommitee of KSQACP performed two trials for cytogenetic study in 2007. Cytogenetic surveys were performed by 42 laboratories and answered correctly in most laboratories except some problems in karyotype nomenclature and the detection of complex cytogenetic abnormalities in hematologic neoplasias. The molecular genetics surveys included many kinds of tests: M. tuberculosis detection, hepatitis B (HBV) and C virus (HCV) detection and quantification, human papilloma virus (HPV) genotyping, gene rearrangement tests for leukemias and lymphomas, apolipoprotein E (APOE) genotyping, methylenetetrahydrofolate reductase (MTHFR) genotyping, hereditary breast and ovarian cancer genes (BRCA1 and BRCA2), and genetic tests for hereditary conditions such as Duchenne muscular dystrophy (DMD), Huntington disease, spinocerebellar ataxia, spinal muscular atrophy, and Prader-Willi/Angelman syndrome. Molecular genetic surveys showed excellent results in most of participants. External quality assessment program for genetic analysis in 2007 was proved to be helpful in continuous education and evaluation of quality improvement.

Annual Report on External Quality Assessment in Diagnostic Genetics in Korea (2007) / 임상검사와정도관리

The importance of quality control for dramatically growing genetic tests continues to be emphasized with increasing clinical demands. Diagnostic genetics subcommitee of KSQACP performed two trials for cytogenetic study in 2007. Cytogenetic surveys were performed by 42 laboratories and answered correctly in most laboratories except some problems in karyotype nomenclature and the detection of complex cytogenetic abnormalities in hematologic neoplasias. The molecular genetics surveys included many kinds of tests: M. tuberculosis detection, hepatitis B (HBV) and C virus (HCV) detection and quantification, human papilloma virus (HPV) genotyping, gene rearrangement tests for leukemias and lymphomas, apolipoprotein E (APOE) genotyping, methylenetetrahydrofolate reductase (MTHFR) genotyping, hereditary breast and ovarian cancer genes (BRCA1 and BRCA2), and genetic tests for hereditary conditions such as Duchenne muscular dystrophy (DMD), Huntington disease, spinocerebellar ataxia, spinal muscular atrophy, and Prader-Willi/Angelman syndrome. Molecular genetic surveys showed excellent results in most of participants. External quality assessment program for genetic analysis in 2007 was proved to be helpful in continuous education and evaluation of quality improvement.

Annual Report on External Quality Assessment in Diagnostic Genetics in Korea (2005) / 임상검사와정도관리

Diagnostic genetics subcommitee of KSQACP has performed two trials each for cytogenetic studies and molecular genetic studies in 2005. Cytogenetic surveys were performed by 37 laboratories and answered correctly in most laboratories. And the first trial with whole blood specimen from the patient with cytogenetic abnormality (mosaic Turner syndrome) was successfully done, which could evaluate the whole process for cytogenetic studies from cell culture, harvest and karyotyping.. The molecular genetic test surveys included many kinds of tests like M. tuberculosis, HBV, HCV, HPV, leukemias/lymphomas, ApoE genotyping, MTHFR genotyping, BRCA1 & BRCA2, Duchenne muscular dystrophy, and Huntington disease. Molecular genetic surveys showed excellent results in most of participants. External quality assessment program for genetic analysis in 2005 was proved to be helpful in continuous education and evaluation of quality improvement.

Annual Report on External Quality Assessment in Diagnostic Genetics in Korea (2004) / 임상검사와정도관리

The importance of quality control for dramatically growing genetic tests continues to be emphasized with increasing clinical demands. Diagnostic genetics subcommitee of KSQACP performed two trials for cytogenetic study in 2004. Cytogenetic surveys were performed by 36 laboratories and answered correctly in most laboratories except some problems in karyotype nomenclature, interpretation of FISH test results and the detection of complex cytogenetic abnormalities in hematologic neoplasias. The molecular genetic test surveys included may kinds of tests like M. tuberculosis, HBV, HCV, HPV, leukemias/lymphomas, ApoE genotyping, MTHFR genotyping, BRCA1 & BRCA2, Duchenne muscular dystrophy, and Huntington disease. Each molecular test for HCV, MTHFR genotyping, BRCA1 & BRCA2 analysis and Huntington disease was the first challenge in 2004. Molecular genetic surveys showed excellent results in most of participants. External quality assessment program for genetic analysis in 2004 was proved to be helpful in continuous education and evaluation of quality improvement.

Expression of Preadipocyte Factor-1 (Pref-1) and Vitamin D3 Up-regulated Protein 1 (VDUP1) Genes in Rat Adrenal Gland following Chronic Immobilization Stress / 대한해부학회지

Preadipocyte factor-1 (Pref-1) is expressed in the neuroendocrine organs such as the pituitary gland, the adrenal gland, the pancreas, the testis, etc. Vitamin D3 up-regulated protein 1(VDUP1) gene is known to be a novel member of early response genes as an oxidative stress mediator. The aim of the present study was to investigate whether Pref-1 and VDUP1 is involved in stress response in the adrenal gland following chronic immobilization stress. In situ hybridization for Pref-1 and VDUP1 genes (Pref-1 and VDUP1) was performed in the rat adrenal glands following immobilization stress, 2 hr once daily for 7 days. In situ hybridization analysis revealed that Pref-1 expression was up-regulated in rat adrenal medulla following chronic immobilization stress. However, Pref-1 was down-regulated in the zona glomerulosa of the adrenal cortex following chronic immobilization stress. VDUP1 expression was up-regulated in the zona glomerulosa and the adrenal medulla following chronic immobilization stress. These results show that Pref-1 and VDUP1 may be novel genes responding to chronic immobilization stress in adrenal gland.

Experience of Bloodless Medicine and Surgery in Soonchunhyang University / 대한진단검사의학회지

BACKGROUND: We established a bloodless center at Soonchunhyang University Hospital (SCH) in 1996 and have provided medical and surgical care for Jehovah's Witness patients. In this study, we evaluated their outcomes to provide the basis of bloodless medicine and surgery in Korea. METHODS: A retropective review of the medical records of 757 Jehovah's Witness patients admitted in the SCH Bloodless Center from December 1996 to July 2003 was performed. RESULTS: Among 757 patients, 19 (2.5%) expired during treatment and 4 of them died of cardiopul-monary dysfunction secondary to anemia. As alternatives to blood transfusion, 85 (11.2%) patients were treated with iron, 81 (10.7%) with erythropoietin, 49 (6.5%) with aprotinin, 31 (4.1%) with hemodilution and 28 (3.7%) with cell saver. Four hundreds fifteen (54.8%) of 757 patients underwent surgery. The most frequently involved cinical department was Obstetric/Gynecology (23.8%). The ratio of female and the percentage of cases treated with alternatives to blood transfusion were higher in surgery group than non-surgery group patients.(Chi-square test, P<0.01) CONCLUSIONS: Most Jehovah's Witness patients were treated successfully in our bloodless center with various alternatives to blood transfusion, such as erythropoietin, intraoperative autotransfusion, acute normovolemic hemodilution etc. Collaboration and good communication among surgeons, anesthesiologists, hematologists and blood bank physicians are very important to provide qualified medical or surgical treatment to the patients who have a religious objection to receiving blood or blood-related products.

Analysis of Clinical Features and Hepatitis B Virus DNA Level in the Concomitant Cases of Hepatitis B Surface Antigen and Antibody / 대한임상미생물학회지

BACKGROUND: After an infection with HBV, HBsAg is the first virologic marker detectable in the serum. If anti-HBs against 'a'determinant of HBsAg appears, HBsAg will disappear and the patients will recover from the HBV infection in most cases. However, we encounter not infrequently concomitant cases of HBsAg and anti-HBs. In this study we evaluated HBV DNA levels in concomitant cases to aid in the interpretation of these serologic results. METHODS: This study included 36 cases with positivity for both HBsAg and anti-HBs in an electrochemiluminescent immunoassay as well as a radioimmunoassay. They were tested for HBeAg, anti-HBe, and HBV DNA levels. RESULTS: Chronic viral hepatitis was the most frequent diagnosis (15/36 : 41.7%) and AST and ALT levels were normal in 17 (47.2%) and 20 (55.6%) cases, respectively, among total 36 concomitant cases. HBeAg was positive in 24 and anti-HBe in 17 cases. HBV DNA was positive in 33 cases (91.7%). including all 24 HBeAg positive cases and 9 (75%) of 12 HBeAg negative cases; 6 (50%) of 12 HBeAg negative cases had HBV DNA levels higher than 105 copy/mL. CONCLUSIONS: This study showed that viral replication still exists in most cases of concomitant HBsAg and anti-HBs, and even in some HBeAg negative cases. So in the concomitant cases, HBV DNA quantitation may aid in the interpretation of clinical significance of these cases.

Clinical Significance of Immature Reticulocyte Fraction Determined by Automated Blood Cell Analyzer / 대한혈액학회지

BACKGROUND: Compared with traditional manual method, automated counting of reticulocytes offers greater sensitivity, improved accuracy, and less subjectivity. Also, automated blood cell analyzer enabled to measure immature reticulocyte fraction (IRF). In this study, we investigate the clinical significance of IRF in the evaluation of anemia. METHODS: Reticulocyte counts were measured with automated blood cell analyzer, Technicon H*3 (Bayer Diagnostics, USA) and manual method from 100 cases of anemic group and 20 cases of control group. Then, we compared the values of reticulocyte count between manual method and H*3. For investigate clinical significance of IRF in the evaluation of anemia, IRF determined by H*3 was compared with the absolute reticulocyte count (ARC) and with the reticulocyte production index (RPI). In addition, we subclassified anemic group into 5 different subgroups, such as hemolytic anemia or anemia due to hemorrhage, hematologic malignancy, anemia due to chronic renal failure, iron deficiency anemia, and anemia of chronic disorders. The value of ARC and IRF in each group was analysed. RESULTS: 1) The mean reticulocyte count by H*3 was higher than that by the manual method and the result of these two methods was correlated well (r=0.98, P0.05) with RPI. 3) Both ARC and IRF were increased in patients with hemolytic anemia or anemia due to hemorrhage. High mean value of IRF with reduced ARC were shown in hematologic malignancy. IRF were within normal range with reduced ARC in the group of chronic renal failure. Both IRF and ARC were within normal range in the group of iron deficiency anemia. In anemic group due to chronic disorder, ARC were within normal range with increased IRF. CONCLUSION: reticulocyte counting by the automated blood cell analyzer H*3 allows the improvement of accuracy and sensitivity. Immature reticulocyte fraction can be used for differentiation of various anemic disorders together with absolute reticulocyte count.