Platelet transfusion refractoriness (PTR), in which platelet counts do not increase after transfusion, occurs in many patients receiving platelet transfusions. PTR is a clinical condition that can harm patients. The causes of PTR can be divided into two types: immune and non-immune. Most cases of PTR are non-immune. Among immune causes, the most common is human leukocyte antigen (HLA) class I molecules. PTR caused by anti-HLA antibodies is usually managed by transfusing HLA-matched platelets. Therefore, it is important, especially for hemato-oncologists who frequently perform transfusion, to accurately diagnose whether the cause of platelet transfusion failure is alloimmune or non-immunological when determining the treatment direction for the patient. In this review, we discuss the definitions, causes, countermeasures, and prevention methods of PTR.

The Rh blood group system has C, D, E, c, and e as the main antigens, but ce(f) has been reported as a compound antigen. Anti-f(ce) is an unexpected antibody (Ab) against the ce(f) compound antigen. This paper reports a case with anti-f(ce) and anti-M Abs in a patient with liver cirrhosis. A 47-year-old male patient was repeatedly admitted to hospital due to recurrent hepatic encephalopathy. He showed disorientation and was admitted. A packed red blood cells (pRBCs) transfusion was required, and Ab identification test identified anti-f(ce) and anti-M Abs. Anti-f(ce) Ab can cause fetal neonatal hemolytic disease and a clinically serious hemolytic transfusion reaction (HTR), and anti-M Ab can cause a HTR when it reacts at 37℃. RBCs with Rh haplotype of CDe and negative for M antigen were transfused to the patient. There was no HTR. The possibility of an anti-f(ce) Ab was not considered when an unexpected Ab screening/identification test was performed. It was simply reported as an ‘unknown alloantibody’. Therefore, laboratory physicians should consider Abs to the Rh compound antigen when Abs to Rh antigens are identified, and efforts should be made to identify them to gain basic knowledge about Abs against Rh compound antigens.

Leukoreduction is a process in which the white blood cells (WBCs) in cellular products are intentionally reduced to bring down the risk of adverse transfusion reactions, such as febrile nonhemolytic transfusion reactions or human leukocyte antigen alloimmunization. So far, Korea has not considered leukoreduction of plasma products. However there have been recommendations for leukoreduction to improve patient outcomes. The authors have experience in measuring WBCs and WBC fragment counts in plasma products and have shown that the WBC and their fragments could be efficiently removed using leukoreduction filters. Hence, it may be beneficial to begin discussions on the necessity of using leukoreduction of plasma products.

Background: According to the revision of the Blood Management Act in 2020, medical institutions that meet certain conditions are obliged to install a transfusion management division in Korea. Therefore, this study assessed the management status of the transfusion management division at major medical institutions. Methods: From August 7th to August 18th, 2021, a survey questionnaire was given to laboratory physicians of 10 major medical institutions in Korea, and the installation and operation of the transfusion management division were surveyed. Results: The medical institutions that participated in this survey completed a transfusion management division in the first half of the year. Doctors, nurses, and medical technologists were assigned as medical personnel, and all laboratory physicians were leading the work as the head of the transfusion management division. Regarding the tasks performed at the transfusion management division, all medical institutions conducted a transfusion appropriateness assessment, education related to transfusion, and adverse transfusion reactions. Most medical institutions had difficulties because there was an insufficient basis to calculate the workforce and budget in installing and operating the transfusion management division. Conclusion There are rarely reference materials for the practice and operation of the transfusion management division, which has no precedent in Korea, so it is often difficult for medical institutions to prepare it. This study will be a reference for medical institutions that need to install a transfusion management division in the future.Efforts should be made to legislate transfusion management fees focused on the academic community.

A full term male infant was admitted to the neonatal intensive care unit due to jaundice and mild hemolytic anemia within the first 24 hours of his life. The total serum bilirubin level was 11.2 mg/dL at 24 hours of age. The patient was RhD positive and blood group A, and his mother was RhD positive and blood group B. The direct and indirect antiglobulin tests of the infant were all positive. On antibody screening and identification tests, anti-S antibodies were identified from both the infant and mother. The RBC phenotyping for S antigen revealed positive for infant and negative for mother. This report documents the first case of hemolytic disease of the fetus and newborn due to the anti-S antibody in Korea.
Anemia, Hemolytic ; Antibodies ; Bilirubin ; Coombs Test ; Fetus* ; Humans ; Infant ; Infant, Newborn* ; Intensive Care, Neonatal ; Jaundice ; Korea* ; Male ; Mass Screening ; Mothers

No abstract available.
ABO Blood-Group System/*genetics ; Alleles ; Asian Continental Ancestry Group/*genetics ; Base Sequence ; DNA/chemistry/isolation & purification/metabolism ; Female ; Genotype ; Humans ; Middle Aged ; Pedigree ; Polymerase Chain Reaction ; Polymorphism, Single Nucleotide ; Republic of Korea ; Sequence Analysis, DNA

BACKGROUND: The relationship between the storage age of packed red blood cells (pRBCs) and clinical outcomes is controversial. However, no systematic study regarding how fresh pRBCs were transfused to patients have been available so far. Therefore, we newly defined concepts for supply age (period from blood collection to supply to hospital), storage age (period from supply to transfusion to patient), and transfusion age (supply age plus storage age) and investigated them. The factors affecting each age were also analyzed. METHODS: A retrospective analysis for three ages of pRBCs was performed for patients who were transfused > or =1 pRBCs unit at three university hospitals between January 2009 and December 2013. Inventory age (period from blood collection to inventory check point at each blood bank) was prospectively checked on a daily basis for 30 days. Four blood centers and blood groups of transfused pRBCs were included. RESULTS: The mean supply, storage, and transfusion ages of pRBCs were 6.2, 6.0, and 12.0 days, respectively. 58%, 61%, and 66% of total transfused pRBCs were in a fresh category of supply, storage, and transfusion ages correspondingly. Storage and transfusion ages were affected by ABO blood group, hospitals, and years in listing orders. Inventory age was mainly affected by ABO blood group and hospitals. CONCLUSION: The freshness of transfused pRBCs was affected by hospitals and blood centers. Therefore, using the supply, storage, transfusion, and inventory ages as new norms can be useful to establishment of inventory and supply policies of hospitals and blood centers.
Blood Group Antigens ; Erythrocytes* ; Hospitals, University ; Humans ; Prospective Studies ; Retrospective Studies

No abstract available.
Acute Disease ; Aged ; Bone Marrow/metabolism/pathology ; Female ; Humans ; Janus Kinase 2/genetics ; Leukemia/*complications/therapy ; Mutation, Missense ; Polycythemia Vera/*diagnosis/etiology ; Real-Time Polymerase Chain Reaction ; Remission Induction

PURPOSE: To assess the diagnostic value of Mn-DPDP for the detection of focal hepatic tumors on MR images and to determine the optimal pulse sequence to maximize its effect. MATERIALS AND METHODS: Twenty-three patients with 32 focal hepatic tumors were examined by means of 1.5-T MRI. Before and after the intravenous administration of Mn-DPDP, five pulse sequences were used to obtain T1-weighted images: two-dimensional fast low-angle shot (2D FLASH) with/without fat saturation (FS), spinecho (SE), and three-dimensional fast low angle shot reconstruction (3D FLASH) with/without FS. Quantitative assessment involved determination of the signal-to-noise ratio (SNR) of the liver and the tumor, the percentage signal enhancement ratio (PSER) of the liver, and tumor-to-liver contrast to noise ratio (CNR). Pulse sequences were also evaluated subjectively for tumor conspicuity, delineation, and image artifact. In addition, two experienced radiologists compared tumor detection rates between precontrast and postcontrast images. RESULTS: Mn-DPDP had a marked effect on liver SNR and absolute CNR at all pulse sequences (p<0.05). On postcontrast images, PSER and absolute CNR of the liver were highest at 3D FLASH and 2D FLASH FS, respectively, and significantly higher at GRE than at SE (p<0.05). On postcontrast images, the CNR of focal nodular hyperplasia and hepatocellular carcinoma was positive, while that of hemangioma, metastasis and cholangiocarcinoma was negative. The postcontrast CNR of all tumors except hepatocellular carcinoma increased more than 100%. Qualitative studies showed that tumor conspicuity increased significantly at all sequences except SE, and delineation increased significantly except at SE and postcontrast 2D GRE FS. After Mn-DPDP, GRE more effectively demonstrated tumor conspicuity and image artifact than did SE, and GRE other than 2D FLASH FS was also better than SE for tumor dilineation (p<0.05). The sensitivity of all postcontrast images increased and the tumor detection rate at GRE was significantly higher than at SE. CONCLUSION: Mn-DPDP favorably affects tumor-to-liver contrast, and may be useful in the imaging of focal hepatic tumors, more so with 2D or 3D FLASH pulse sequences than with SE.
Administration, Intravenous ; Artifacts ; Carcinoma, Hepatocellular ; Cholangiocarcinoma ; Dyphylline ; Focal Nodular Hyperplasia ; Hemangioma ; Humans ; Liver ; Magnetic Resonance Imaging* ; Manganese ; Neoplasm Metastasis ; Noise ; Signal-To-Noise Ratio

OBJECTIVE: To determine which preoperative breast magnetic resonance imaging (MRI) findings and clinicopathologic features are associated with positive resection margins at the time of breast-conserving surgery (BCS) in patients with breast cancer. MATERIALS AND METHODS: We reviewed preoperative breast MRI and clinicopathologic features of 120 patients (mean age, 53.3 years; age range, 27–79 years) with breast cancer who had undergone BCS in 2015. Tumor size on MRI, multifocality, patterns of enhancing lesions (mass without non-mass enhancement [NME] vs. NME with or without mass), mass characteristics (shape, margin, internal enhancement characteristics), NME (distribution, internal enhancement patterns), and breast parenchymal enhancement (BPE; weak, strong) were analyzed. We also evaluated age, tumor size, histology, lymphovascular invasion, T stage, N stage, and hormonal receptors. Univariate and multivariate logistic regression analyses were used to determine the correlation between clinicopathological features, MRI findings, and positive resection margins. RESULTS: In univariate analysis, tumor size on MRI, multifocality, NME with or without mass, and segmental distribution of NME were correlated with positive resection margins. Among the clinicopathological factors, tumor size of the invasive breast cancer and in situ components were significantly correlated with a positive resection margin. Multivariate analysis revealed that NME with or without mass was an independent predictor of positive resection margins (odds ratio [OR] = 7.00; p < 0.001). Strong BPE was a weak predictor of positive resection margins (OR = 2.59; p = 0.076). CONCLUSION: Non-mass enhancement with or without mass is significantly associated with a positive resection margin in patients with breast cancer. In patients with NME, segmental distribution was significantly correlated with positive resection margins.
Breast Neoplasms* ; Breast* ; Humans ; Logistic Models ; Magnetic Resonance Imaging* ; Mastectomy, Segmental ; Multivariate Analysis ; Retrospective Studies*