ABO-incompatible solid organ transplantation (ABOi TPL) is a widely accepted treatment option for treating end-stage renal or liver diseases. Although the appropriate selection of the ABO blood group for transfusion is a key step for successful ABOi TPL, there are no evidence-based guidelines to cope with this issue. In this letter, we suggest appropriate blood selection criteria for ABOi TPL based on the basic principles of ABO incompatibility. For major mismatched ABOi TPL, red blood cells (RBCs) should be of the organ recipient’s ABO group, while platelets (PLTs) and plasma products should be of the donor’s ABO group. For the bidirectional mismatched cases, it is desirable to select recipient type RBCs and group AB PLTs and plasma products.

The unexpected antibody screening test is one of the most important pretransfusion tests. The tests are usually performed using commercial cells, which in Asia may not include clinically important antigens. To overcome this limitation, some laboratories use additional screening cells, including Di a or Mi a . However, these efforts are not supported by the Korean National Health Insurance system. The estimated total medical costs for using additional screening cells are less than the estimated total medical costs for the management of potential hemolytic transfusion reactions caused by missing clinically important antibodies. Hence, it is recommended that the Health Insurance system should be modified to take this into account and address the issue.

BACKGROUND: The presence of pain during interventional pain management such as prolotherapy and intramuscular stimulation is stressful to patients and can affect the treatment outcome. We studied the safety and efficacy of two drug regimens: midazolam alone and midazolam/alfentanil for sedation anesthesia during prolotherapy and intramuscular stimulation. METHODS: Fifty three patients received either midazolam 0.04-0.08 mg/kg (Group M) or midazolam 0.01-0.02 mg/kg with alfentanil 4-8microgram/kg (Group A) for prolotherapy or intramuscular stimulation. We recorded the pain response, sedation score and side effects during the procedure, as well as amnesia, satisfaction and time to discharge after the procedure. RESULTS: Both drug regimens had significant sedation scores, amnesia and overall provided patient satisfaction. The treatment of pain was superior in Group A. Respiratory depression of three patients occurred in Group A. The time to discharge was longer in Group M. CONCLUSIONS: Midazolam and midazolam/alfentanil used for sedation anesthesia during prolotherapy and intramuscular stimulation were both effective; however, midazolam alone was the safer approach.
Alfentanil ; Amnesia ; Anesthesia* ; Humans ; Midazolam* ; Pain Management ; Patient Satisfaction ; Respiratory Insufficiency ; Treatment Outcome

Familial pseudohyperkalemia (FP) is a dominantly inherited condition caused by variants in the gene ABCB6 resulting in red blood cell (RBC) membrane protein defects. FP is generally asymptomatic. However, FP RBCs have an increased permeability to monovalent cations when stored below 37°C. Transfusion of RBC components donated by FP individuals can induce hyperkalemia and may be causally related to transfusion-associated hyperkalemic cardiac arrest, particularly in neonates and infants. Therefore it is necessary to accurately evaluate the frequency of FP occurrence in the Korean population and assess whether FP RBCs have significantly higher supernatant potassium levels. Efforts should be made to recognize the effects of blood products collected from FP donors on blood transfusion recipients to reduce the risk of hyperkalemia, especially in fetuses, infants, and patients at risk of this condition.

BACKGROUND: Despite the increasing demand for transfusions, the availability of blood is hampered by low birth rate and stringent donor qualifications. Therefore, it is important to appropriately utilize blood products and take measures to minimize their wastage. We established an electronic review system for assessing transfusion practice and evaluated the appropriateness of blood transfusion. METHODS: Utilization of red blood cells (RBC), platelet concentrates (PC), single donor platelets (SDP), fresh-frozen plasma (FFP), and cryoprecipitates issued to 3 major blood using departments (Internal Medicine Divisions of Gastroenterology and Hematology/Medical Oncology, General Surgery) at the Seoul National University Hospital was reviewed over a one-month period. A new program was developed to review laboratory test results and blood product information. Criteria for appropriate transfusion were based on the guidelines proposed in 2009 by the Korean Ministry of Health and Welfare and the Korean Society of Blood Transfusion. A comparative audit was also conducted according to the guidelines proposed in 2002. RESULTS: There were 3,705 units of blood components issued to 325 patients during 1,542 transfusion episodes. The number of inappropriately transfused units were 402 (10.9%) at 144 (9.3%) episodes. The rates of inappropriate transfusion episodes (as per the 2002 guidelines) per blood components were as follows: RBC, 0.4%; PC, 11.7% (8.3%); SDP, 5.7% (2.4%); FFP, 20.2% (2.4%); and cryoprecipitates, 22.1%. CONCLUSION: Based on the 2009 guidelines, there was a notable inappropriate use of blood transfusions. Education programs promoting evidence-based guidelines and the use of this new program will help clinicians make better decisions in transfusion practice and lower inappropriate transfusion rates.
Birth Rate ; Blood Component Transfusion ; Blood Platelets ; Blood Transfusion ; Decision Support Systems, Clinical ; Electronics ; Electrons ; Erythrocytes ; Gastroenterology ; Humans ; Medical Audit ; Plasma ; Tissue Donors

Midshaft clavicle fractures are the most common fracture of the clavicle accounting for 80% of all clavicle fractures. Traditionally, midshaft clavicle fractures are treated with conservative treatment even when prominent displacement is observed; however, recent studies revealed that nonunion or malunion rate may be higher with conservative treatment. Moreover, recent studies have shown better functional results and patient satisfaction with surgical treatment. This review article provides a review of clavicle anatomy, describes the current clavicle fracture classification system, and outlines various treatment options including current surgical options for clavicle fracture in adults.

Midshaft clavicle fractures are the most common fracture of the clavicle accounting for 80% of all clavicle fractures. Traditionally, midshaft clavicle fractures are treated with conservative treatment even when prominent displacement is observed; however, recent studies revealed that nonunion or malunion rate may be higher with conservative treatment. Moreover, recent studies have shown better functional results and patient satisfaction with surgical treatment. This review article provides a review of clavicle anatomy, describes the current clavicle fracture classification system, and outlines various treatment options including current surgical options for clavicle fracture in adults.

Rotator cuff tear is a common shoulder injury that compromises both function and quality of life. Despite the prevalence of the injury and advancements in repair techniques, a significant percentage of these repairs fail. This review aims to explore the multifactorial reasons behind this failure, including the degenerative nature of the rotator cuff tendon, inherent and extrinsic factors, and the role of hypoxia in tissue degeneration. Additionally, it elucidates potential strategies for improving healing outcomes.

BACKGROUND: Transfusion guidelines play an important role for the appropriate use and quality assurance of blood and transfusion services. The Korean national transfusion guideline was developed in 2009 and went under full amendment in 2016. The purpose of this study was to investigate the awareness and practicality of the transfusion guideline in Korea. METHODS: Questionnaires about the Korean national transfusion guideline were sent by traditional mail or e-mail to a total of 1,179 clinicians, 32 academic societies, and 6 institutions. RESULTS: Three hundred and seventy-four answers were received; a response rate of 30.7%. The proportion of respondents with good awareness of the guideline was 23.3%, which is a significant increase compared with 10.9% in 2008. Respondents with good awareness were more dependent on the transfusion guideline when making transfusion decisions. CONCLUSION: There was a considerable increase in the awareness of the national transfusion guideline in Korea.
Electronic Mail ; Korea* ; Postal Service ; Surveys and Questionnaires