A Choice and Precautions of Replacement Fluids for Therapeutic Plasma Exchange / 대한수혈학회지

BACKGROUND: Therapeutic plasma exchange (TPE) is an effective and practical treatment for separation and removal of harmful antibodies or pathogenic substances from the blood. The volume of plasma removed must be replaced by a replacement fluid such as 4~5% albumin solution or Fresh frozen plasma (FFP). We conducted a study of coagulopathy using albumin solution and checked the chemical composition of fresh frozen plasma. METHODS: We measured pre- and post-TPE PT/aPTT for evaluation of the effect of albumin replacement on coagulation from 192 TPE sessions of 19 patients. We also investigated routine chemistry test items including glucose and electrolytes from 10 randomly selected FFP. RESULTS: The post PT and aPTT within four hours after TPE were prolonged due to a transient decrease in coagulation factors, but were normalized within 2 days after TPE. All coagulation time was corrected to the level of the pre-TPE status within four hours before the next TPE except the patients who received TPE 6 times or more. FFP showed higher level in glucose, sodium and inorganic phosphate. CONCLUSION: Albumin exchange produces temporary coagulation factor deficiency. However, this transient factor deficiency rarely causes clinical problems and the factors are rapidly corrected by redistribution and resynthesis. We should be careful about hypocalcemia, hyperglycemia, and hypernatremia when using FFP replacement.

ABO*Ael03/O Genotype with ABO Discrepancy: The First Case in Korea

The Ael subgroup expresses the least amount of A antigens and could only be detected by performing the adsorption-elution test. The frequency of the Ael subgroup is about 0.001% in Koreans, and the Ael02 allele, which originates from A102, is the most frequently identified allele in the Korean population. We report a Korean family with the Ael03 allele identified by molecular genetic analysis. To the best of our knowledge, this is the first such report in Korea to date.

Analysis Survey on Changes in Hospital Blood Donation Center and Satisfaction Level with the Korean Red Cross / 대한수혈학회지

BACKGROUND: Blood supply circumstances in Korea have changed in recent decades because of blood supplier diversification and restructuring of hospital blood donation centers. The purpose of this study is to understand the current status of hospital blood donation centers and their satisfaction levels with the Korean Red Cross Blood Center (KRCBC) and compare with the previous results for sustainable development of the blood supply system. METHODS: During one month in November 2014, we conducted a questionnaire survey through e-mail in 64 hospital blood donation centers which are approved by government. The response rate was 97% (62/64 hospitals). Responses from 62 hospitals were analyzed. RESULTS: The number of hospital blood donation centers were reduced by half from 129 in 2004 to 64 in 2014. There was no blood donation center in hospitals less than 400 beds, except 2 hospitals; 23 hospital (37.1%) blood banks collected no blood components. More than 80% of hospitals were satisfied with the KRCBC service such as donor record lookup and nucleic acid amplification Test (NAT) results lookup. Hospitals with more than 1,000 beds replied that they would not take account of transferring the collection services to KRCBC because of the directed and autologous donation and unexpected emergency blood transfusion. CONCLUSION: The government should be the subject of national blood policy and establish a committee or agency for its comprehensive and consistent execution through close cooperation with the KRCBC and hospitals.

An Analytical Study for Cases associated with Massive Blood Transfusion at a Tertiary Referral Hospital / 대한수혈학회지

BACKGROUND: Massive transfusion (MT) is an unusual event and has been defined as replacement of total body fluid volume in less 24 hours or transfusion of 10 or more RBC units in 24 hours. MT is a high priority treatment for major blood loss. METHODS: We gathered 78 patients receiving MT from 2008 to 2013 at Severance hospital using electronic medical records and performed a retrospective review. For each case, we analyzed patients' characteristics, including sex, age, major causes of MT, and clinical outcome. We also calculated the ratio of each blood component transfused. RESULTS: Patient sex ratio of male and female was 1.60 and percentage of patients over age 40 was 58.4%. The individual diagnostic categories were 28.2% of cardiovascular surgery, 26.9% of liver transplantation, 11.5% of upper gastrointestinal bleeding, and 5.2% of trauma. The overall mortality rate was 47.3%. Mortality rate ranged from the lowest (52.3%) for liver transplantation to the highest (77.8%) for upper gastrointestinal tract bleeding. No correlation was observed between causes of MT and mortality rate. The average usage of FFP: RBC and platelet: RBC ratio was 0.83 and 0.68, respectively. However, recently, the ratio of two components transfused is close to 1.0. CONCLUSION: The highest priority in MT was rapidity and propriety for improvement of patient survival. By regularly reviewing MT cases, we could provide an improved massive transfusion service.

Evaluation of ABO Antibody Titration Using Tube and Column Agglutination Techniques

BACKGROUND: ABO antibody titration is useful for the evaluation of ABO-incompatible bone marrow or solid organ transplantations, yet the results quite vary between different test methods used. We compared the results of microcolumn agglutination and tube methods. METHODS: Anti-A and anti-B isoagglutionin titers were determined in 63 healthy individuals (23 O, 20 A, and 20 B blood groups) using 4 different methods: immediate spin tube (tube), microcolumn agglutination without anti-human globulin (AHG) (CAT), tube with AHG (tube-AHG) and microcolumn agglutination with AHG (CAT-AHG). RESULTS: The median (range) titers of anti-A and anti-B in group O individuals by tube, CAT, tube-AHG, and CAT-AHG methods were 64 (8-512), 64 (8-512), 128 (8-2,048), and 128 (16-2,048); 64 (16-128), 128 (16-256), 128 (16-512), and 256 (16-512), respectively. The median (range) titers of anti-A in group B and anti-B in group A individuals by the four methods were 64 (16-128), 128 (8-128), 128 (8-256), and 256 (8-256); 64 (8-128), 64 (8-128), 32 (8-128), and 64 (8-256), respectively. The isoagglutinin titer measured by CAT-AHGmethod was the highest. The titers measured by CAT and CAT-AHG methods were 0-1 titer higher than those by tube and tube-AHG methods, respectively. Whatever method was used, the isoagglutinin titers were higher in women than in men. CONCLUSIONS: CAT-AHG was the most sensitive method among the four methods tested. Since AHG titer values are critical for the clinical management and CAT has less manual procedures than tube method, CAT-AHG method could be used for the standardization of ABO antibody titration in different institutions.

Characteristics of Intron 6 Nucleotide Sequences of cis-AB in Koreans / 대한수혈학회지

BACKGROUND: The cis-AB is a very rare phenotype in the ABO blood group system. It corresponds to a special ABO allele that encodes glycosyltransferase that is capable of synthesizing both A and B antigens. Until now, the exon 6 and 7 gene sequences of cis-AB alleles are well known. In this study, we report on the intron 6 sequence structure of the cis-AB allele. METHODS: Standard serologic tests for the ABO blood group phenotypes were performed in four cis-AB samples. Allele-separation by cloning and subsequent sequencing was carried out. RESULTS: The results showed that intron 6 of cis-AB is almost identical to the A101 allele except for three single nucleotide polymorphisms at nucleotide positions 163, 179 and 662, where the nucleotides of the A101 replace those of B101. CONCLUSION: The intron 6 sequences of cis-AB in Koreans have both A101 and B101 blood group sequences.

Using Genotyping to Identify an A1B(weak) Blood Group / 대한수혈학회지

Since an exact ABO blood type match is essential for transfusion therapy, any ABO discrepancies should be resolved prior to the issuing of blood. The authors confirmed the ABO blood group of a 50-year-old male using genotyping. On a routine blood group test, the cell type was A+; however, anti-B was undetected in his serum. To determine the cause of this ABO discrepancy, an adsorption elution test and saliva test were performed. The presence of a weak B substance was suspected despite no evidence of the B antigen on red blood cells. Polymerase-chain-reaction restriction-fragment-length-polymorphism (PCR-RFLP) and sequencing analysis of exons 6 and 7 demonstrated that his blood type was A1Bweak (the A allele tested as the A105 subtype, while the B allele was most similar to the B302 subtype). Again, using genotyping, we subsequently confirmed the A1Bweak blood type in a leukemic patient who was in complete remission.