No abstract available.
Bowen's Disease*

The Dia and Mia antigens have been detected in Koreans with a frequency of 6.4∼14.5% and 0.9%, respectively. This study evaluated the effectiveness of different screening cells using the cells with Diaand Mia antigens for unexpected antibody screening. An unexpected antibody-screening test was performed separately using different screening cells, including the Dia antigen (Panel D) and Mia antigen (Panel M). A total of 2,077 specimens from 1,847 patients were collected, among which 49 (2.32%) and 43 (2.08%) were positive using Panel D and Panel M, respectively. Twenty-seven patients were positive with both panels, 2012 were negative with both panels, and thirty-eight patients showed a discordant result. The suspected anti-Diaand anti-Mia were detected in 4 (0.19%) and 5 (0.24%) patients, respectively. Therefore, the frequency of anti-Dia and anti-Mia antibodies in this study may be helpful for selecting unexpected antibody screening reagents.

BACKGROUND: Management of patients with massive hemorrhage often requires the massive blood transfusions. However, few studies have investigated the effects of massive transfusions on non-traumatic patients. Therefore, this study analyzed mortality and descriptive data for patients receiving massive transfusion, including non-trauma patients and trauma patients. METHODS: We reviewed a retrospective audit of massive transfusions to investigate the major causes, patient characteristics, ratio of the blood components, and the mortality of massively transfused patients. The analysis was performed using electronic medical records collected from January 2010 to December 2013. Patients who had received a massive transfusion (≥10 units of RBCs within 24-hours) were categorized into trauma and non-trauma patients. We calculated the ratio of blood components and investigated the relationship between ratio and mortality. Descriptive statistics were used to characterize the patients and the indications. RESULTS: A total of 532 massive transfusions were performed, including 187 trauma and 345 non-trauma patients. The overall mortality rate was 32.0%, encompassing 36.4% of the trauma patients and 29.6% of the non-trauma patients. The mortality in trauma patients was significantly reduced (P<0.001) within the first 48-hours compared with that in non-trauma patients, which was due to the high FFP: RBC ratio transfusion. The annual FFP: RBC ratio in trauma patients showed an increasing trend. Non-trauma patients showed no relationship between mortality and procedure indication/blood component ratio. CONCLUSION: We report clinical data pertaining to massive transfusions. Annual increasing FFP: RBC ratio in trauma patients was associated with a decreasing mortality. Non-trauma patients showed heterogeneous characteristics and a lower FFP: RBC ratio than trauma patients.
Blood Transfusion ; Electronic Health Records ; Hemorrhage ; Humans ; Mortality ; Retrospective Studies ; Tertiary Care Centers*

BACKGROUND: Massive transfusion is defined as an 8- to 10-unit transfusion of red blood cells (RBC) within 24 hours in an adult or a 4- to 5-unit transfusion of RBC within 1 hour. Massive transfusion plays an important role in saving the lives of trauma patients. We investigated changes in blood volume and blood product ratios used in massive transfusion in trauma patients at emergency room (ER) and traumatic center emergency room (TER) and evaluated prognostic factors of patients based on mortality. METHODS: We compared massive transfusion requirements for trauma patients between the ER and TER such as amount of transfusion, mortality, and ratio of products. The patients selected were over 18 years old. The patients who were transfused with more than 10 units of RBC within 24 hours were defined as massive transfusion patients. RESULTS: There were a total of 189 people who received massive transfusions at the ER over 4 years, and 67 patients were transfused at the TER over 1 year. There was no significant difference in the ratio of blood products between the two groups, but the mortality rate of the ER (63.1%) was significantly higher than the TER (41.8%). CONCLUSION: The ratio of blood products was not related to patient mortality, but the mortality rate of the TER was lower than that of the ER.
Adult ; Blood Volume ; Emergencies* ; Emergency Service, Hospital* ; Erythrocytes ; Humans ; Mortality ; Tertiary Care Centers*

OBJECTIVES: This study aimed to identify problems and issues that arise with the implementation of online health information exchange (HIE) systems in a medical environment and to identify solutions to facilitate the successful operation of future HIE systems in primary care clinics and hospitals. METHODS: In this study, the issues that arose during the establishment and operation of an HIE system in a hospital were identified so that they could be addressed to enable the successful establishment and operation of a standard-based HIE system. After the issues were identified, they were reviewed and categorized by a group of experts that included medical information system experts, doctors, medical information standard experts, and HIE researchers. Then, solutions for the identified problems were derived based on the system development, operation, and improvement carried out during this work. RESULTS: Twenty-one issues were identified during the implementation and operation of an online HIE system. These issues were then divided into four categories: system architecture and standards, documents and data items, consent of HIE, and usability. We offer technical and policy recommendations for various stakeholders based on the experiences of operating and improving the online HIE system in the medical field. CONCLUSIONS: The issues and solutions identified in this study regarding the implementation and operate of an online HIE system can provide valuable insight for planners to enable them to successfully design and operate such systems at a national level in the future. In addition, policy support from governments is needed.
Electronic Health Records ; Health Information Exchange* ; Health Information Management ; Health Level Seven ; Information Systems ; Primary Health Care

Background: The maximum surgical blood order schedule (MSBOS) is a list of surgical procedures with the corresponding recommended number of blood units. Nevertheless, with the advances in surgery and transfusion medicine, a need for updates in the MSBOS has been suggested. This study evaluated the need for regular revision of the MSBOS. Methods: The surgical procedures performed between August 2016 and July 2021 were investigated retrospectively. The transfused blood units for each type of surgery were analyzed in elective, single surgeries performed more than ten times per year. The Transfusion index (TI) and the Transfusion probability (TP) for each type of operation were calculated in five one-year intervals. Furthermore, the surgeries performed more than 10 times in all one-year intervals and presented a TI≥0.5 at least once during the study period were subjected to further analysis. Results: A total of 96,040 elective surgical procedures were performed during the five-year study period, including 77,639 single surgeries performed ≥10 times in one year. The average transfused blood units and the average TP per year decreased over time. In addition, the percentage of the number and type of operations presenting TI≥0.5 changed. Among the 27 surgeries that were further studied, six showed constant TI≥0.5; six changed from TI≥0.5 to ＜0.5, and 15 displayed fluctuations in TI. Conclusion Changes in surgical blood utilization was observed among one-year periods, which implies the need for regular revision of MSBOS.

Background: The currently recommended pre-transfusion testing techniques for patients with autoantibodies are complex, time-consuming, and labor-intensive. Therefore, although the red blood cell (RBC) selection method using crossmatched RBC agglutination reaction grades (i.e., the “least incompatible” transfusion) is discouraged, many institutions still use it. We aimed to evaluate the effectiveness of this method combined with Rh subgroup phenotyping. Methods: We retrospectively investigated RBC transfusions from January 2019 to December 2021 in patients presenting as auto-control-positive via antibody identification (auto-control (+) group), where Rh subgroup phenotype-matched RBCs were selected based on the agglutination reaction grades of crossmatched units. For each study patient, an auto-control-negative patient was matched based on age, sex, department, and pre-transfusion Hb levels (auto-control (−) group). The mean Hb change per unit, transfusion-associated symptom/sign reports, and agglutination reaction grades upon crossmatching were analyzed. Results: In the auto-control (+) group, the Hb change per unit among different agglutination reaction grades of transfused RBCs and among different relative grades of transfused RBCs and crossmatching auto-controls was not significantly different (P=0.392 and P= 0.132, respectively). No significant difference was observed in Hb changes and transfusion-associated symptom/sign occurrence between the auto-control (+) and auto-control (−) groups (P=0.121 and P=0.822, respectively). In addition, no definite evidence of hemolysis in the auto-control (+) group was observed in the medical record review. Conclusions Together with Rh subgroup phenotyping, selecting the RBC unit with the lowest agglutination reaction grade upon crossmatching does not adversely affect transfusion efficiency.

Patients with sickle cell anemia are chronically transfused. Therefore, it is important to prevent the alloimmunization of RBC antigens. The authors identified a high frequency antigen-negative blood group in patients with sickle cell anemia. As the number of foreigners residing in Korea is increasing, it is necessary to know what to consider when transfusing blood to sickle cell anemia patients. Patients with sickle cell anemia should be informed of the exact blood group type using extended RBC typing to confirm the ABO, Rh, Kell, and Duffy blood types at diagnosis or before the first blood transfusion. Extended matched blood transfusion can reduce the risk of alloimmunization of RBC antigens.
Anemia ; Anemia, Sickle Cell* ; Blood Transfusion ; Diagnosis ; Duffy Blood-Group System ; Emigrants and Immigrants ; Erythrocytes* ; Humans ; Korea

OBJECTIVES: The demand for hospice has been increasing among patients with cancer. This study examined the current hospice referral scenario for terminally ill cancer patients and created a data form to collect hospice information and a modified health information exchange (HIE) form for a more efficient referral system for terminally ill cancer patients. METHODS: Surveys were conducted asking detailed information such as medical instruments and patient admission policies of hospices, and interviews were held to examine the current referral flow and any additional requirements. A task force team was organized to analyze the results of the interviews and surveys. RESULTS: Six hospices completed the survey, and 3 physicians, 2 nurses, and 2 hospital staff from a tertiary hospital were interviewed. Seven categories were defined as essential for establishing hospice data. Ten categories and 40 data items were newly suggested for the existing HIE document form. An implementation guide for the Consolidated Clinical Document Architecture developed by Health Level 7 (HL7 CCDA) was also proposed. It is an international standard for interoperability that provides a framework for the exchange, integration, sharing, and retrieval of electronic health information. Based on these changes, a hospice referral scenario for terminally ill cancer patients was designed. CONCLUSIONS: Our findings show potential improvements that can be made to the current hospice referral system for terminally ill cancer patients. To make the referral system useful in practice, governmental efforts and investments are needed.
Advisory Committees ; Cancer Care Facilities ; Health Information Exchange* ; Health Level Seven ; Hospices* ; Humans ; Investments ; Methods ; Patient Admission ; Referral and Consultation* ; Terminally Ill* ; Tertiary Care Centers

No abstract available.
Histiocytosis, Sinus* ; Lymphatic Diseases*