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.
Antibodies ; Blood Cells ; Coombs Test ; Dithiothreitol ; Follow-Up Studies ; Humans ; Immunoglobulins ; Korea ; Lymphoma, Non-Hodgkin ; Sensitivity and Specificity*

BACKGROUND: Because of a lack of substances for platelet (PLT) metabolism and preservation, normal saline (NS) washed PLTs can only be stored for short lengths of time. However, the use of platelet additive solutions (PAS) could help solve this problem. In this study, the in vitro quality of NS washed platelets (wPLTs) stored in two types of PAS were compared with those of wPLTs stored in NS. METHODS: Five units of NS washed apheresis platelets were pooled aseptically and separated into five aliquots for storage in NS only as well as T-PAS+ (Terumo BCT, Lakewood, CO, USA) and CompoSol PS (Fenwal, Lake Zurich, IL, USA) with or without 15 mM glucose. The parameters of wPLTs quality were assessed up to 48 hrs after washing and the whole experiment was repeated 10 times independently. RESULTS: wPLTs in two kinds of PAS had better quality than wPLTs in NS, and wPLTs in T-PAS+ showed better quality than those in CompoSol PS. PAS-stored wPLTs with added glucose maintained stable CD62P and Annexin V expression during storage, but exhibited increased lactate accumulation. Evaluation of in vitro quality revealed that all wPLTs had a rating of 4 immediately after washing. However, only T-PAS+-stored wPLTs with glucose maintained a rating of 4 up to 48 hrs of post-washing. CONCLUSION: Using PAS storage for wPLTs may be beneficial compared to NS. The results presented herein suggest that T-PAS+ containing glucose has the potential to extend storage time by up to 48-hours.
Annexin A5 ; Blood Component Removal ; Blood Platelets* ; Blood Preservation ; Glucose ; In Vitro Techniques ; Lactic Acid ; Lakes ; Metabolism

BACKGROUND: Because ABO reverse typing reagents approved by the Ministry of Food and Drug Safety (MFDS) for manual typing are rare in Korea, 3% DiaCell ABO A₁ red blood cell (RBC) reagents (DiaCell A₁, BioRad, DiaMed, Cressier, Switzerland) and DiaCell ABO B RBC reagents (DiaCell B) for a manual technique were compared with already approved RBC reagents for the acquisition of an import permit. METHODS: Residual plasmas or sera were collected after routine ABO grouping or other tests. The reverse typing tests were performed by a manual tube technique with DiaCell A₁& B as the test reagents and 0.8% ID-DiaCell ABO A₁& B RBC reagents, ID-Card for NaCl, and an IH-1000 autoanalyzer from the same manufacturer of DiaCell A₁& B as the control reagents. Agreements, clinical sensitivities and clinical specificities between test and control reagents were calculated. RESULTS: Comparison tests were performed in 1000 samples, and agreements were 99.9% for DiaCell A₁ and 100.0% for DiaCell B. Clinical sensitivities and clinical specificities were 99.9% and 100.0% for DiaCell A₁ and all 100.0% for DiaCell B, respectively. CONCLUSION: Because the evaluation results of DiaCell A₁ and B were all satisfied with more than 99% as the evaluation criteria of MFDS, they were concluded to be suitable for use as ABO reverse typing reagents for manual typing. The results of this study are also expected to be useful in the design of clinical trials for approval of future in vitro medical devices.
Erythrocytes* ; In Vitro Techniques ; Indicators and Reagents* ; Korea ; Plasma

BACKGROUND: Red blood cell (RBC) transfusion is one of the major treatments for correcting anemia, but its use should be carefully considered because of adverse transfusion reactions and inappropriate usage. Therefore, individual health care facilities have self evaluated their use of transfusion in an attempt to decrease unnecessary procedures. In this study, we evaluated the differences in the minimum hemoglobin (Hb) trigger for RBC transfusion among clinical departments in Severance Hospital. METHODS: We analyzed the electronic medical records of RBC transfusion episodes that were conducted at a Hb level above 8 g/dL from July 2014 to September 2015. We classified these data by clinical department, and considered the overall medical conditions of the patients. The minimum Hb trigger level in this study was defined as the lowest Hb level within 24 hours prior to RBC transfusion. RESULTS: A total of 4,953 RBC transfusion episodes that were conducted at Hb levels above 8 g/dL were analyzed over that period. In general, the minimum Hb trigger level was higher in the operation group than the hemorrhage group. When compared among clinical departments, the department of orthopedic surgery, neurosurgery, rehabilitation medicine, and anesthesiology showed high levels of minimum Hb trigger equal to or greater than 10 g/dL. CONCLUSION: The minimum Hb trigger level differed among clinical departments, with the operation group showing a much higher level of minimum Hb trigger. We hope that these data will be practically applied to establish plans and strategies for managing the appropriateness of RBC transfusions in Korea. In addition, continuous evaluation and transfusion education for clinical departments should be performed.
Anemia ; Anesthesiology ; Delivery of Health Care ; Education ; Electronic Health Records ; Erythrocyte Transfusion* ; Erythrocytes* ; Hemorrhage ; Hope ; Humans ; Korea ; Neurosurgery ; Orthopedics ; Rehabilitation ; Transfusion Reaction ; Unnecessary Procedures

BACKGROUND: Screening for healthy blood donors through donor interviews is essential to the safety of donors and blood resources. Our goal was to suggest educational material for donor interviewers and donors, as well as supplemental material for interview sites, which will help provide an effective interview process. METHODS: We conducted surveys regarding experiences in donor interviews from donor interviewers and cognitive interviews about difficulties during interview from blood donors between September and October of 2015. We additionally conducted a post-survey about provided educational and supplemental materials between December 2015 and January 2016. RESULTS: The possibility of an incorrect answer in the donor history questionnaire (DHQ) was high for questions about sexual contact, imprisonment, or medication, and the reasons were incorrect memories, ignorance about donor interview, or protection of privacy. Cognitive interviews of donors revealed questions and terminology that are difficult to understand. Donor interviewers could obtain improved understanding of the DHQ through educational materials, which were found to be useful for new interviewers or donors. Use of a supplemental flip book for the interview process was found to be useful, especially for blood centers with small blood donations. CONCLUSION: This study investigated difficulties in the donor interview from the perspective of donor interviewers and donors and suggested educational and supplemental materials to address these difficulties. These materials will induce correct and honest answers from blood donors through education and guidance about the donor interview process and help secure the safety of blood products.
Blood Donors* ; Cognition ; Education ; Humans ; Mass Screening ; Privacy ; Tissue Donors*

BACKGROUND: Blood transfusion is important when treating patients with anemia or bleeding; thus, supply of blood components should be stable prior to transfusion. To recruit donors, blood donation sites should be conveniently located. This study evaluated factors responsible for increased donation rates in hospitals and the characteristics of the donors in hospital blood banks without a fixed blood collection site nearby. METHODS: We retrospectively reviewed 687 blood donations at a blood donation center in Pusan National University Yangsan Hospital (PNUYH) from March 2011 to June 2016. A total of 3,053,695 blood donors listed in the 2014 Korean Red Cross Annual Report were compared to donors in PNUYH. We analyzed the age distribution of donor at blood donation centers from Korean Red Cross according to presence and number of high school and college. RESULTS: Comparison with total blood donors in Korea revealed that there were more blood donors in their thirties, office workers and business owners at PNUYH (P<0.001). The percentage of younger donors in their twenties differed significantly according to the presence of a college within a 4 km radius of the blood donation center (P=0.03). The presence of a high school did not affect the proportion of teenage donors (P=0.833). CONCLUSION: The blood donation rate at our medical institution without fixed blood collection sites nearby increased. A regional hospital may be used as a blood collection site to recruit donors in areas in which there are no fixed blood donation centers.
Age Distribution ; Anemia ; Blood Banks ; Blood Donors* ; Blood Transfusion ; Busan ; Commerce ; Gyeongsangnam-do ; Hemorrhage ; Humans ; Korea ; Radius ; Red Cross ; Retrospective Studies ; Tertiary Healthcare* ; Tissue Donors

The primary goal in transfusion medicine is to promote high standards of quality in all aspects of transfusion, including production, management, and transfusion of blood components. To achieve this goal, a transfusion service quality management system should be established. Such a system should include several organizational structures, responsibilities, policies, processes, procedures, and resources with provided specifications and regulations. In this review, we summarize the current knowledge and practices regarding the quality management of hematology tests applied to the donor selection and production of blood components, including red blood cells, platelets, fresh frozen plasma, and cryoprecipitates in the field at blood centers.
Donor Selection ; Erythrocytes ; Hematology* ; Humans ; Plasma ; Social Control, Formal ; Tissue Donors ; Transfusion Medicine

BACKGROUND: Alloantibodies against human neutrophil alloantigen (HNA)-3a are associated with severe and fatal transfusion related acute lung injury (TRALI). HNA-3 genotyping and HNA-3a antibody (Ab) identification are essential to diagnosis and prevention of TRALI caused by HNA-3a Ab. However there had been no laboratory for HNA-3a Ab identification in Korea. The aims of this study were to establish the HNA-3a Ab test in Korea and to estimate the incidence of HNA-3a alloimmunization among pregnant Korean women. METHODS: HNA-3a homozygotes and HNA-3b homozygotes were identified by HNA-3 genotyping. Three HNA-3a homozygotes and three HNA-3b homozygotes are included in the granulocytes panel, which consisted of 10 donors for granulocytes. Sera from 650 pregnant Korean women were tested for granulocyte Ab using a mixed passive hemagglutination assay (MPHA). When a HNA-3a Ab was detected, the woman's HNA-3 was typed to support her HNA-3a alloimmunization. RESULTS: MPHA showed positive reactions in the sera from 26 women (4.0%, 26/650). HLA Abs were detected in 18 women (2.8%, 18/650), among whom HNA Abs were identified simultaneously in 7 women. Granulocyte Abs were detected in sera from 15 women (2.3%, 15/650). The incidence of HNA-3a, HNA-1b, HNA-1a, HNA-2a, and unidentified HNA Abs among pregnant Korean women was 0.77% (5/650), 0.77% (5/650), 0.62% (4/650), 0.15 (1/650), and 0.31% (2/650), respectively. CONCLUSION: In this study, we established the HNA-3a Ab test using MPHA for diagnosis and prevention of TRALI caused by HNA-3a Ab. The incidence of HNA-3a Ab in pregnant Korean women was 0.77% (5/650).
Acute Lung Injury ; Diagnosis ; Female ; Granulocytes ; Hemagglutination ; Homozygote ; Humans* ; Incidence ; Isoantibodies ; Isoantigens ; Korea ; Neutrophils* ; Tissue Donors

BACKGROUND: Leukocyte reduced (LR) and irradiated (IR) blood components are used to prevent immunological transfusion-related adverse reactions. However, so far, reports on the usage of LR or IR blood components in Korea are scarce. METHODS: Data from January, 2007 to December, 2013 provided by the Health Insurance Review and Assessment Service of Korea were analyzed. Disease categories of the patients were classified according to the Korean Standard Classification of Disease. RESULTS: In 2013, 26.7% of total transfused blood components were leukocyte reduced and an increase of 5.3% compared to 2007. The proportion of IR components increased from 21.4% in 2007 to 27.9% in 2013. The percentage of LR (IR) blood components for RBCs, platelets, and SDPs was 15.4% (14.7%), 35.1% (38.8%), and 75.2% (80.1%), respectively, in 2013. In particular, the percentage of IR FFPs units increased gradually over the years, from 11.2% in 2007 to 22.7% in 2013. LR and IR components were used mainly in hemato-oncology patients but the proportion showed a downward trend. Due to aging of the society, transfusion of LR and IR components has inclined trends in the 70's or more. CONCLUSION: Although the transfusion rate of both LR and IR blood component is increasing, it is still remarkably lower than that in developed countries. Therefore, LR and IR blood components should be used more extensively. For this, reimbursement criteria for National Health Insurance for these blood components should be extended and the fee schedule for LR and IR blood components should be adjusted to reflect clinical practice and patient need.
Aging ; Classification ; Developed Countries ; Fee Schedules ; Humans ; Insurance, Health ; Korea* ; Leukocytes* ; National Health Programs

BACKGROUND: Rapid and sensitive detection of transfusion adverse reaction is fundamental to reducing transfusion-related morbidity and mortality. The aim of this study was to develop an effective system for reporting of transfusion adverse reaction. METHODS: Inpatient lists with transfusion adverse reaction on a nurse electronic medical records (EMR) from December 4th, 2014 to May 21st, 2015 were automatically selected and displayed to the computer screen of the blood bank data management system. After review of clinical and laboratory data of suspected patients with transfusion reaction, frequency of transfusion adverse reaction according to blood components was calculated. RESULTS: The frequency of transfusion adverse reactions according to blood components was, in decreasing order, red blood cells (RBC) 0.91% (58/6,404), frozen fresh plasma (FFP) 0.20% (5/2,549), and platelets 0.10% (6/5,728). Of 47 allergic reactions, the relative ratio by blood components was RBC 76.6%, platelets 12.8%, and FFP 10.6%. All of 22 febrile nonhemolytic transfusion reactions were RBC related reactions. CONCLUSION: The online transfusion adverse reaction reporting system based on a nurse EMR is helpful in easy and accurate estimation of transfusion adverse reaction incidence.
Blood Banks ; Blood Group Incompatibility ; Electronic Health Records* ; Erythrocytes ; Humans ; Hypersensitivity ; Incidence ; Inpatients ; Mortality ; Plasma