Usefulness of Preoperative Autologous Blood Donation for Spinal Fusion / 대한수혈학회지

BACKGROUND: Major orthopedic surgical procedures, including spinal fusions, require 2 or 3 units of transfusion. In this study, we evaluated the usefulness of autologous transfusion by comparing the postoperative infections, the pre- and postoperative serological changes, the amount of transfusion during the operation and the segmented estimated blood loss of the patients who received spinal fusion surgery. METHODS: We analyzed 106 patients who were undergoing spinal fusion surgery and among them, 69 patients were operated on with using autologous transfusion, while 37 cases were operated on with using homologous transfusion. RESULTS: The segmental estimated blood loss was approximately 574.4+/-131.8 mL in group 1 and 635.3+/-250.1 mL in group 2. The mean number of transfused units in the autologous transfusion group was 2.1+/-0.3 units and this was 3.5+/-0.6 units in the homologous transfusion group. There was no significant statistical difference in the hemoglobin level or the complications between the two groups, yet the duration of fever in the group with homologous transfusion was 3.0+/-0.4 days, which was increased compared to that of group 1 (1.4+/-1.3 days). CONCLUSION: The total amount of transfusion and blood loss for the patients who were operated on using autologous transfusion were less, as compared to those for the patients who were operated on with homologous transfusion, and the patients with homologous transfusion showed a significantly decreased duration of fever. It seems that autologous transfusion is a way to shorten the duration of fever and increase the satisfaction of the patients.

A Case of Immune Hemolytic Anemia Induced by Ceftizoxime and Cefobactam (Sulbactam/Cefoperazone) / 대한진단검사의학회지

Simultaneous drug-induced immune hemolytic anemia (DIIHA) caused by multiple drugs is rare. We report a case of a patient who developed DIIHA caused by 2 drugs. The patient's serum exhibited agglutination of ceftizoxime- or sulbactam-coated red blood cells (RBCs; via a drug-adsorption mechanism) and of uncoated RBCs in the presence of sulbactam (via an immune-complex mechanism). Although ceftizoxime is known to exhibit a positive reaction by an immune-complex method with or without reactivity with drug-coated RBCs, this patient's antibodies were reactive only against drug-coated RBCs. On the other hand, sulbactam, which is known to cause hemolytic anemia by nonimmunologic protein adsorption, exhibited positive reactions in tests with both drug-coated RBCs and in the presence of sulbactam. This is the first report of DIIHA due to a sulbactam-cefoperazone combination and the fourth report of DIIHA due to ceftizoxime. Owing to the patient's complicated laboratory results, DIIHA was suspected only at a late stage. We propose that for the prompt diagnosis of DIIHA, tests for all possible causative drugs should be conducted by 2 methods.

A Case of Necrotizing Fasciitis Due to Streptococcus agalactiae, Arcanobacterium haemolyticum, and Finegoldia magna in a Dog-bitten Patient with Diabetes / 대한진단검사의학회지

We report a case of necrotizing fasciitis involving Streptococcus agalactiae, Arcanobacterium haemolyticum, and Finegoldia magna in a 36-yr-old female diabetic patient, which started after a minor dog bite to the toe of the patient. This case suggested that a trivial infection after a minor dog bite in an immunocompromised patient such as diabetes patient could result in a significant complication such as necrotizing fasciitis. The life-threatening infection was cured by timely above-the-knee amputation, as well as penicillin G and clindamycin therapy.

A Nationwide Survey Report on the Blood Transfusion Services in Korea / 대한수혈학회지

BACKGROUND: Inspecting thestatus of blood banks has been done for the larger Korean hospitals, but it has never been done for the smaller ones on a nationwide scale in Korea. Here, we analyzed the status of the blood banks for their transfusion services and equipment, and especially for the smaller hospitals. METHODS: The subjects were all the hospitals that were provided more than one unit of blood by the Korea Red Cross (KRC) in 2006. We divided the hospitals to a big-hospital group and a small-hospital group that received over or under 5,000 units of blood, respectively, from the Korea Red Cross in 2006. The questionnaires were delivered by mail. RESULTS: The number of total hospitals was 2,488 and the number of hospitals in the small-hospital group was 2,381, and this accounted for 95.7% of the total hospitals. The response rate was 23.1%. Among the small-hospital group, 35% had no working manual, 61% were not involved in certification programs and 17% had no refrigerators that were exclusively used for blood. Furthermore, 31% performed only cell typing as ABO typing, 69% didn't test for antibody detection, and 7% used a slide method for crossmatching tests. Only 6% used a blood information sharing system and only 28.4% of the hospitals shipped blood by blood transport containers. The mean amount of discarded blood was 16.8 units and the main component was RBC. CONCLUSION: The level of management and services showed a great difference between the two groups of Korean hospitals. The small-hospital group is thought to need more support and attention from the government. This study will supply essential data for understanding the current state of blood transfusion services and establishing government policies for safe transfusion.

The Efficiency of Plasma Exchange for Renal Allograft Recipients with HLA Antibody before Transplantation / 대한수혈학회지

BACKGROUND: Therapeutic plasma exchange (TPE) is used to remove antibodies from the blood stream, thereby preventing them from attacking their targets. We evaluated the strategies to increase the efficiency of TPE for renal allograft recipients with HLA antibody. METHODS: A total of 11 patients were evaluated from January 2002 to April 2004. All the patients had been diagnosed with end stage renal disease (ESRD) and then they were scheduled for renal transplantation from a living unrelated donor or a living related donor. TPE was performed for all lymphocyte cross-matching (LCM) positive recipients before renal transplantation. One to three sessions of TPE were performed in 8 patients and four to seven sessions of TPE were performed in 3 patients (mean: 2.81 times). We used normal saline and 4% albumin as a replacement solution. RESULTS: Eleven patients, after the patients' LCM positive serum converted to negative, received the renal transplantation. Of the 11 recipients, only 1 recipient suffered from chronic rejection. Ten recipients maintained normal renal function. Among the 11 recipients, 4 recipients were diagnosed with posttransplantation diabetes mellitus. 3 recipients had a past history of graft failure via acute or chronic rejection. Even these 3 recipients experienced successful renal allograft through pre-transplantation TPE. Also, all the recipients were followed up until June, 2005. CONCLUSION: For ESRD patients with positive LCM, pre-transplantation TPE dramatically decreases the incidence of acute or chronic rejections by converting positive LCM into negative LCM.