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1.
Article in English | WPRIM | ID: wpr-894081

ABSTRACT

Background@#In ABO-incompatible (ABOi) solid organ transplantation, the minimization and management of isoagglutinin (IA) against donor ABO antigens between before and two weeks after transplantation is important for preventing hyper-acute rejection. Several factors that can affect the IA titer have been reported. This is the first study to evaluate whether there are IA titer differences between kidney transplantation (KT) and liver transplantation (LT) recipients. @*Methods@#Thirty-eight KT and 32 LT type O recipients, who underwent ABOi KT or LT between March 2013 and March 2018, were enrolled consecutively. The IgM IA and IgG IA titers of the LT and KT recipients at different time points (initial, operation day [day-0], postoperative one week, four weeks, and one year) were evaluated. @*Results@#The LT recipients showed higher initial IgG IA titers than the KT recipients (P=0.01). This higher titer in the LT recipients persisted during the critical phase (from before transplantation to postoperative one week). The IgG and IgM IA titers were similar in the KT and LT recipients at postoperative four weeks. @*Conclusion@#The difference in IA titer between the underlying diseases should be considered in the desensitization protocol before ABOi SOT.

2.
Article in English | WPRIM | ID: wpr-901785

ABSTRACT

Background@#In ABO-incompatible (ABOi) solid organ transplantation, the minimization and management of isoagglutinin (IA) against donor ABO antigens between before and two weeks after transplantation is important for preventing hyper-acute rejection. Several factors that can affect the IA titer have been reported. This is the first study to evaluate whether there are IA titer differences between kidney transplantation (KT) and liver transplantation (LT) recipients. @*Methods@#Thirty-eight KT and 32 LT type O recipients, who underwent ABOi KT or LT between March 2013 and March 2018, were enrolled consecutively. The IgM IA and IgG IA titers of the LT and KT recipients at different time points (initial, operation day [day-0], postoperative one week, four weeks, and one year) were evaluated. @*Results@#The LT recipients showed higher initial IgG IA titers than the KT recipients (P=0.01). This higher titer in the LT recipients persisted during the critical phase (from before transplantation to postoperative one week). The IgG and IgM IA titers were similar in the KT and LT recipients at postoperative four weeks. @*Conclusion@#The difference in IA titer between the underlying diseases should be considered in the desensitization protocol before ABOi SOT.

3.
Article in English | WPRIM | ID: wpr-811093

ABSTRACT

No abstract available.

5.
Article in English | WPRIM | ID: wpr-785340

ABSTRACT

PURPOSE: While there is an urgent need for diagnosis and therapeutic intervention in patients with primary immunodeficiency diseases (PIDs), current genetic tests have drawbacks. We retrospectively reviewed the usefulness of flow cytometry (FCM) as a quick tool for immunophenotyping and functional assays in patients suspected to have PIDs at a single tertiary care institute.METHODS: Between January 2001 and June 2018, patients suspected of having PIDs were subjected to FCM tests, including lymphocyte subset analysis, detection of surface- or intracellular-target proteins, and functional analysis of immune cells, at Samsung Medical Center, Seoul, Korea. The genetic diagnosis was performed using Sanger or diagnostic exome sequencing.RESULTS: Of 60 patients diagnosed with definite or probable PID according to the European Society of Immune Deficiencies criteria, 24 patients were provided with useful information about immunological dysfunction after initial FCM testing. In 10 patients, the PID diagnosis was based on abnormal findings in FCM testing without genetic tests. The FCM findings provided strong evidence for the diagnosis of severe combined immunodeficiency (n = 6), X-linked chronic granulomatous diseases (CGD) (n = 6), leukocyte adhesion deficiency type 1 (n = 3), X-linked agammaglobulinemia (n = 11), autoimmune lymphoproliferative syndrome-FASLG (n = 1), and familial hemophagocytic lymphohistiocytosis type 2 (n = 1), and probable evidence for autosomal recessive-CGD (n = 2), autosomal dominant-hyper-immunoglobulin E (IgE)-syndrome (n = 1), and STAT1 gain-of-function mutation (n = 1). In PIDs derived from PIK3CD (n = 2), LRBA (n = 2), and CTLA4 mutations (n = 3), the FCM test provided useful evidence of immune abnormalities and a tool for treatment monitoring.CONCLUSIONS: The initial application of FCM, particularly with known protein targets on immune cells, would facilitate the timely diagnosis of PIDs and thus would support clinical decisions and improve the clinical outcome.


Subject(s)
Agammaglobulinemia , Diagnosis , Exome , Flow Cytometry , Genetic Testing , Granulomatous Disease, Chronic , Humans , Immunophenotyping , Korea , Leukocytes , Lymphocyte Subsets , Lymphohistiocytosis, Hemophagocytic , Phenotype , Retrospective Studies , Seoul , Severe Combined Immunodeficiency , Tertiary Healthcare
9.
Article in English | WPRIM | ID: wpr-718323

ABSTRACT

BACKGROUND: Although testing to detect weak D antigens using the antihuman globulin reagent is not required for D− patients in many countries, it is routinely performed in Korea. However, weak D testing can be omitted in D− patients with a C−E− phenotype as this indicates complete deletion of the RHD gene, except in rare cases. We designed a new algorithm for weak D testing, which consisted of RhCE phenotyping followed by weak D testing in C+ or E+ samples, and compared it with the current algorithm with respect to time and cost-effectiveness. METHODS: In this retrospective study, 74,889 test results from January to July 2017 in a tertiary hospital in Korea were analyzed. Agreement between the current and proposed algorithms was evaluated, and total number of tests, time required for testing, and test costs were compared. With both algorithms, RHD genotyping was conducted for samples that were C+ or E+ and negative for weak D testing. RESULTS: The algorithms showed perfect agreement (agreement=100%; κ=1.00). By applying the proposed algorithm, 29.56% (115/389 tests/yr) of tests could be omitted, time required for testing could be reduced by 36% (8,672/24,084 min/yr), and the test cost could be reduced by 16.53% (536.11/3,241.08 USD/yr). CONCLUSIONS: Our algorithm omitting weak D testing in D− patients with C−E− phenotype may be a cost-effective testing strategy in Korea.


Subject(s)
Cost-Benefit Analysis , Humans , Korea , Phenotype , Retrospective Studies , Tertiary Care Centers
10.
Article in Korean | WPRIM | ID: wpr-716149

ABSTRACT

BACKGROUND: Pretransfusion tests are essential for safe transfusions, but occasionally, part or all can be omitted when a transfusion is needed urgently in an emergency. The purpose of this study was to share the authors' experience of various pretransfusion test protocols in a tertiary referral hospital in Korea. METHODS: From July 2016 to June 2017, all transfusion cases at Samsung Medical Center were analyzed retrospectively. For each pretransfusion test protocol, the parameters regarding issue, return and disposal rate of blood products, occurrence of hemolytic transfusion adverse effect, and prescription frequency of each respective department and ordering site were analyzed. RESULTS: A total of 90,539 units of red blood cells, 24,814 units of fresh frozen plasmas, 24,758 units of single donor platelets, and 23,303 units of platelet concentrates were issued during the study period. Among them, 3.6%, 1.8%, 0.3%, and 0.4% of red blood cells, fresh frozen plasmas, single donor platelets, and platelet concentrates were issued according to the emergency transfusion protocols. When various pretransfusion test protocols were applied to issue blood products, there was no case in which an adverse hemolytic transfusion reaction was suspected. When compared with usual pretransfusion test protocol, all emergency transfusion protocols showed significantly higher return and wastage rates in red blood cells and fresh frozen plasmas. Platelets also had a higher return and wastage rate, but the difference was not significant. CONCLUSION: These results suggests that there is no different risk of adverse hemolytic transfusion reaction regardless the pre-transfusion protocols, but management about of the increased rate of return and wastage of blood products in emergency transfusions should be considered.


Subject(s)
Blood Platelets , Emergencies , Erythrocytes , Humans , Korea , Plasma , Prescriptions , Retrospective Studies , Tertiary Care Centers , Tissue Donors , Transfusion Reaction
12.
Article in Korean | WPRIM | ID: wpr-34205

ABSTRACT

LW antigens are expressed in higher intensities in D-positive blood cells than D-negative cells, which can result in false identification of anti-D in pretransfusion testing. Although several cases of anti-LW have been reported abroad, to the best of our knowledge, none have been reported in Korea. Herein, we report a case of anti-LW in a 58 year-old RhD positive patient with non-Hodgkin's lymphoma with a positive direct Coombs test and a suspicion of the presence of passive anti-D antibodies because of a history of intravenous immunoglobulin administration. However, during a 5-month follow up, the antibody was confirmed as anti-LW on grounds that it showed weakened reaction in dithiothreitol treated cells and enforced reaction in cord O+ cells when compared to the results from antibody identification panel cells.


Subject(s)
Antibodies , Blood Cells , Coombs Test , Dithiothreitol , Follow-Up Studies , Humans , Immunoglobulins , Korea , Lymphoma, Non-Hodgkin , Sensitivity and Specificity
13.
Article in Korean | WPRIM | ID: wpr-158036

ABSTRACT

Anti-G positivity can be misinterpreted as the presence of anti-D or -C antigen in an antibody identification test, as this antibody is known to show agglutination to D or C antigen-positive red cells. Correct identification of anti-G is important in pregnant women, as prenatal care or the need for RhIG administration can vary between anti-D and -C versus anti-G cases. We recently encountered a D-negative case with suspected anti-D and -C, which was ruled out by adsorption and elution tests, and ultimately confirmed the presence of anti-G. The pregnant woman was a 33-year-old patient with cde Rh phenotype with a previous history of spontaneous abortion, followed by administration of RhIG. The spouse's Rh phenotype was CDe. Initial antibody identification test showed 2+ positivity to C (homozygotes and heterozygotes) and trace to 1+ positivity to D. Upon additional adsorption and elution with R0r (cDe/cde) and r'r (Cde/ cde) red cells, we identified the antibody present in the patient's serum as anti-G. The patient is currently under close follow-up monitoring for anti-G titer using antibody titer testing with both CDe and CcDEe red cells. Periodic fetal cerebral Doppler examination is being carried out without evidence of fetal distress.


Subject(s)
Abortion, Spontaneous , Adsorption , Adult , Agglutination , Female , Fetal Distress , Follow-Up Studies , Humans , Korea , Phenotype , Pregnancy , Pregnant Women , Prenatal Care , Rho(D) Immune Globulin
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