The prevalence of RhD-negative individuals in the Korean population is approximately 0.15-0.30% and the supply of RhD-negative blood often faces potential shortage. Furthermore, 15-17% of serologically RhD-negative Korean individuals were revealed to be DEL variants and should be treated as RhD-positive when being considered as blood donors. This change is expected to result in a further shortage of RhD-negative blood supply, whereas surplus DEL variant blood stock is created. Therefore, it is now required to amend blood donation and supply policies, and transfusion strategies. In this review, a new transfusion strategy for patients with RhD-negative or variant blood in Korea is discussed, with particular interest in women of child-bearing age, patients with anti-D, and Asia type DEL (c.1227G>A) variants.
Asia ; Blood Donors ; Female ; Humans ; Korea ; Prevalence

BACKGROUND: Adverse transfusion reactions (ATRs) are clinically relevant to patients with significant morbidity and mortality. This study aimed to review the cases of ATR reported in the recipient-triggered trace back system for a recent nine-year period in Korea. METHODS: Nine-year data obtained from 2006 to 2014 by the trace back system at the Division of Human Blood Safety Surveillance of the Korean Centers for Disease Control (KCDC) were reviewed. The suspected cases were assessed according to six categories: (i) related to, (ii) probably related to, (iii) probably not related to, (iv) not related to transfusion, (v) unable to investigate, and (vi) under investigation. RESULTS: Since 2006, 199 suspected serious ATRs were reported in hospitals and medical institutions in Korea, and these ATRs were reassessed by the division of Human Blood Safety Surveillance of the KCDC. Among the reported 193 cases as transfusion related infections, hepatitis C virus (HCV) infection (135, 67.8%) was reported most frequently, followed by hepatitis B virus (HBV) infection (27, 13.6%), HIV infection (13, 6.5%), syphilis (9, 4.5%), malarial infection (4, 2.0%), other bacterial infections (3, 1.5%), HTLV infection (1, 0.5%), and scrub typhus infection (1, 0.5%), respectively. Of the 199 cases, 13 (6.5%) cases were confirmed as transfusion-related (3 HCV infections, 3 malarial infections, 1 HBV infection, 2 Staphylococcus aureus sepsis, 3 transfusion-related acute lung injuries, and 1 hemolytic transfusion reaction). CONCLUSIONS: This is the first nationwide data regarding serious ATRs in Korea and could contribute to the implementation of an effective hemovigilance system.
Acute Lung Injury/epidemiology/etiology ; Blood Transfusion/*adverse effects ; HIV Infections/epidemiology/etiology ; Hepatitis C/epidemiology/etiology ; Humans ; Malaria/epidemiology/etiology ; Republic of Korea ; Retrospective Studies ; Transfusion Reaction/*etiology

BACKGROUND: Donor screening test is one of the most important processes for blood safety management. Korea Center for Disease Control and Prevention (KCDC) has been conducting an annual proficiency test program that includes the distribution of specially manufactured panels for hepatitis B surface antigen (HBsAg) and antibody to hepatitis C virus (anti-HCV) to blood centers. Here, KCDC reports the results of these proficiency tests for HBsAg and anti-HCV blood donor screening for all licensed blood centers in Korea between 2012 and 2015. METHODS: Panels for the proficiency tests were manufactured and distributed to blood centers by Chung-Ang University Hospital, which has been participating in the Korea Blood Safety Commission. Well-proven reactive sera and healthy donor's sera acquired from the Human Serum Bank in Chung-Ang University were used to make the panels. To identify the S/CO ratio of the panel, three medical institutes triple-checked the results of each panel. RESULTS: Most blood centers reported correct answers for the proficiency test with six panels. The average percentages (year) of correct answers were as follows: 98.7% (2012), 98.5% (2013), 99.1% (2014) and 99.6% (2015) for the HBsAg proficiency tests; and 97.7% (2012), 99.5% (2013), 99.1% (2014), and 99.8% (2015) for the anti-HCV proficiency tests. CONCLUSION: To improve the blood center's ability for donor screening tests, KCDC will continue the proficiency test program by managing specialized panels for HBsAg and Anti-HCV tests. Furthermore, we will investigate the level of satisfaction to improve the quality of the program.
Academies and Institutes ; Blood Donors* ; Blood Safety ; Centers for Disease Control and Prevention (U.S.) ; Donor Selection ; Hepacivirus ; Hepatitis B Surface Antigens* ; Humans ; Korea ; Mass Screening*

BACKGROUND: The Korean Blood Safety Commission has implemented external proficiency testing (PT) for blood grouping test (BGT) since 2011. We analyzed the results of 2015 PT for BGT including hemagglutination grade for ABO BGT to help in planning the future PT for BGT and improving the quality of blood centers (BC). METHODS: Two kinds of whole blood survey samples composed of three panels for ABO grouping and three panels for D typing were sent to 68 institutes. Evaluation criteria for BGT were as follows: 'Good' for the answers matched with intended results, 'Acceptable' for the consensus answers other than that of 'Good', 'Unacceptable' for the answers other than those of 'Good+acceptable' as correct answers. RESULTS: The answer rates of 'Unacceptable' for ABO BGT were 0% for A(A1) antigen (Ag), 1.5% for B Ag, and 1.5% for ABW (A2BW) Ag, 15% of blood centers were graded as 'Acceptable' for ABW (A2BW) Ag because they could not detect BW Ag. All answers for D typing were 'Good' except one institute reported wrong switched results as D positive and D negative. Hemagglutination grade for ABO BGT varied from 77.2%~100% depending on blood groups and laboratories. CONCLUSION: Because some hospital BC could not detect BW Ag and there was a clerical error, continuous education should be required, and comparison of hemagglutination grade for ABO BGT of each BC would be helpful in improving quality of BC.
Academies and Institutes ; Blood Donors ; Blood Group Antigens ; Blood Grouping and Crossmatching ; Blood Safety ; Consensus ; Education ; Hemagglutination ; Humans

BACKGROUND: The appropriate procedures and equipment for the pretransfusion test are fundamental to a safe blood transfusion. The present study aimed to assess the current status of procedures and equipment for pretransfusion tests at small- and medium-sized medical institutions, as well as to use this basic raw data to better manage blood transfusions at these institutions. METHODS: Offline and online questionnaire surveys were performed at institutions that used between 24 and 1,000 units of blood products in 2014. A total of 338 institutions participated, and the survey results were subsequently analyzed. RESULTS: Among 307 institutions where on-site ABO blood typing was performed, 15.0%, 2.1%, and 43.5% did not conduct ABO serum typing, RhD typing, and irregular antibody screening tests, respectively, and 12.8% only conducted the saline phase for crossmatching. Moreover, among 338 institutions, only 66.7% of blood banks had centrifuges, 84.5% had 37℃ incubators, 41.1% had slide view boxes; in addition, 66.1% and 18.6% had refrigerators and deep freezers, respectively, for blood storage. CONCLUSION: Certain small- and medium-sized institutions did not have the essential equipment required to operate as blood banks. Moreover, they also needed to improve their testing procedures. To address these issues, the initiation of systematic training programs and the employment of institutional strategies are necessary to enhance testing procedures and equipment, respectively.
Blood Banks ; Blood Grouping and Crossmatching ; Blood Transfusion ; Education ; Employment ; Incubators ; Korea* ; Mass Screening

BACKGROUND: It is important to check the blood group antigens to ensure the safety of blood transfusions. Recently, the number of multicultural families and foreigners has increased in Korea; therefore, a survey for red blood cell antigens for multicultural families is need. We performed a phenotyping of their red blood cell antigens and found the characteristics in providing basic data. METHODS: We recruited young people under the age of 26 years from multicultural family between September 2015 and March 2016. The participants were divided into two groups: the multicultural youth group (MCY) and the non-multicultural youth group (non-MCY). Subjects underwent phenotyping of ABO, Rh, Kell, Kidd, Duffy, MNS, and Diego blood group, and the results were compared and characterized between the two groups. RESULTS: A total of 226 subjects (89 MCY, 137 non-MCY) were recruited. The blood groups with differences between MCY and non-MCY were E, e in Rh and S in MNS. In MCY, the frequency of CDe expression in the Rh blood group was higher and the cDE expression was lower. There were 3.4% and 2.2% of MCY with no expression of Fy(a) and s, respectively, which were rare blood types in Koreans. CONCLUSION: The difference in frequency of red blood cell antigens between MCY and non-MCY have been identified. These results suggest that the national blood policy reflects an increasing number of multicultural families and Korea needs to be prepared for a population change.
Adolescent* ; Blood Group Antigens ; Blood Transfusion ; Emigrants and Immigrants ; Erythrocytes* ; Humans ; Korea

BACKGROUND: Korean Blood Safety Commission has implemented external proficiency testing (PT) for blood grouping test (BGT) to help improve the quality of blood centers since 2011. We analyzed the results of 2014 PT for BGT to help in planning the future PT for BGT and to improve the quality of blood centers. METHODS: Whole blood survey samples including three panels for ABO grouping and three panels for D typing were sent to 69 institutes. Evaluation criteria for BGT were as follows: 'Good' for answers matched with intended results, 'Acceptable' for correct answers other than that of 'Good', 'Unacceptable' for answers other than those of 'Good+acceptable' as correct answers; and 'Not graded' for answers in case of different answers in the two standard laboratories. RESULTS: All of the answer rates of 'Good' for D typing were 100%. However, the answer rates of 'Good' for cell typing, serum typing and interpretation for 14-ABO-2 samples with discrepant result between cell typing and serum typing were 39.1%, 29%, and 47.8%, respectively. Those of 'Unacceptable' for cell typing and interpretation for 14-ABO-2 samples were 2.8% and 1.4%. CONCLUSION: Because the answer rates of ABO grouping for samples with discrepant result between cell typing and serum typing were not high, education for this case is needed. Diversity of materials for PT would be necessary for more accurate evaluation of the performance of BGT in blood centers.
Academies and Institutes ; Blood Grouping and Crossmatching ; Blood Safety ; Education

Red cells that express extremely low levels of D antigen that cannot be detected by routine serologic tests are designated as DEL. Most DEL blood donors are typed as D-negative. However, DEL red blood cells can be recognized by serological adsorption and elution test or molecular RHD genotyping. Anti-D production in patients with D-negative who received transfusion containing DEL blood has reported, therefore distinction between DEL variant and true D- negative is clinically important. This review highlights a transfusion strategy and laboratory update on the DEL variant in the Korean population.
Adsorption ; Blood Donors ; Erythrocytes ; Humans ; Serologic Tests

BACKGROUND: It was reported that a continuous education program and external proficiency testing (PT) for blood grouping test (BGT) might be necessary because some blood centers of medical institutions could not correctly examine ABO subtype and D variant, according to the results of the first year project in 2011. Therefore, the results of PT for BGT in blood centers in 2012 and 2013 were compared to those in 2011 in order to assess the impact of projects during a period of three years and to help in planning the future PT for BGT. METHODS: Whole blood survey samples composed of three panels for ABO grouping and three panels for D typing were sent to 74 and 71 institutes in 2012 and 2013, respectively. Evaluation criteria for BGT were as follows: 'Good' for the answers matched with intended results, 'Acceptable' for the correct answers other than that of 'Good', and 'Unacceptable' for the answers other than those of 'Good+acceptable' as correct answers. RESULTS: The answer rates of 'Unacceptable' for ABO subtype were 1.4% in 2012 and 4.2% in 2013. However, the answer rate of 'Good' increased from 44.6% in 2012 to 83.1% in 2013. The answer rate of 'Unacceptable' for D variants showed a marked decrease, from 16.2% in 2012 to 1.4% in 2013. CONCLUSION: Projects for PT for BGT during a period of three years have improved laboratory quality in blood centers. However, the acquisition and change of the materials for PT would be necessary in order to continuously and practically provide help to blood centers.
Academies and Institutes ; Blood Grouping and Crossmatching* ; Education

BACKGROUND: In the Republic of Korea, due to the low birth rate, blood donation is expected to decrease. However, the demand for blood is increasing as the proportion of elderly has increased. Korea Centers for Disease Control and Prevention operate the Korea Blood Inventory Monitoring System (KBIMs) for detection and response to the shortage of blood. The aim of this study was to show the trend of blood supply monitored by KBIMs. METHODS: This study analyzed the red blood cell inventory ratio, average daily usage, time-lag from blood donation to transfusion and from receipt to transfusion in blood banks monitored by KBIMs from 2009 to 2012. RESULTS: A total of 25 hospitals have participated in KBIMs since 2009. The average inventory ratio of blood banks was 5.3 days. By month, the inventory ratio was highest between November and February; and by week, highest on Fridays. Daily amount of RBC utilized in hospitals peaked on Thursday by week. Time-lag from blood donation to transfusion and from receipt to transfusion in blood banks was 12.2 and 6.4 days, respectively. The inventory ratio of type-A RBC was the lowest, because of the highest level of demand. In addition, time-lags from blood donation to transfusion and from receipt to transfusion were shortest in type-A RBC. CONCLUSION: The inventory ratio in blood banks monitored by KBIMs was stable throughout the years. However, due to higher level of demand, there is a risk of shortage of type-A RBC.
Aged ; Birth Rate ; Blood Banks ; Blood Donors ; Centers for Disease Control and Prevention (U.S.) ; Erythrocytes ; Humans ; Korea ; Republic of Korea