We reported a case of hemolytic transfusion reaction that was related to multiple RBC antibodies such as anti-E, anti-M, anti-Jkb and anti-Lea after serial RBC transfusions. A forty-nine year old female visited the emergency room (ER) with hematochezia. She had previously received 16 units of packed RBCs from 2003 to Jan 2007 for her intermittent esophageal varix bleeding. No specific antibodies were identified before this visiting. At the ER, under the request for packed RBCs, we identified anti-E antibody within her serum. Her blood type was AB, RhD+ with the phenotype of CcDe. She received 5 units of E antigen negative RBCs. However, she showed hemolytic transfusion reactions such as mild fever with a decrease of hemoglobin from 11.4 g/dL to 6.8 g/dL after the transfusion. From the 8th to the 10th hospital day, another 3 units of E-antigen negative with the least incompatible RBCs were transfused to the patient, but the level of hemoglobin was not definitely increased. At the 14th hospital day, she received a final 2 units of leuko-reduced RBCs without E, M and Jkb antigens. Her hemoglobin was increased right after the final transfusion. We found that the patient's serum reacted with multiple RBC antibodies such as anti-E, anti-M, anti-Jkb and anti-Lea antibodies. She finally recovered from acute varix bleeding and was discharged on the 26th hospital day with the level of hemoglobin being 8.3 g/dL.
Antibodies ; Blood Group Incompatibility ; Emergencies ; Esophageal and Gastric Varices ; Female ; Fever ; Gastrointestinal Hemorrhage ; Hemoglobins ; Hemorrhage ; Humans ; Phenotype ; Varicose Veins

No abstract available.
Blood Group Incompatibility

Authors found a case of anti-Yka antibody in a 66-year-old female patient with acute peritonitis due to colon cancer perforation. Although anti-Yka antibody has no clinical significance, its high-titer, low-avidity (HTLA) characteristics with weak and variable reactivity to Yk(a+) RBC in the indirect antiglobulin test can cause confusion and difficulties in identifying coexisting clinically significant antibodies. Titration studies could be used to determine such reactions due to HTLA antibodies. Since anti-Yka antibody has not been shown to cause significant destruction of transfused Yk(a+) RBC, Yk(a+) units can be safely transfused to patients with anti-Yka antibody unless clinically significant antibodies coexist in their sera. This is the first case report of anti-Yka antibody as an high-titer, low-avidity antibody in Korea.
Aged ; Antibodies ; Blood Transfusion ; Colonic Neoplasms ; Coombs Test ; Female ; Humans ; Korea ; Peritonitis

BACKGROUND: There is a recent trend of increased use of the gel test for detecting unexpected antibodies because of its simplicity and the ease with which a definitive interpretation can be made. The aim of the present study was to evaluate the diagnostic performance of newly developed DG Gel microtube column agglutination system as compared with the tube method and other two microtube column agglutination systems (DiaMed-ID, Ortho BioVue). METHODS: We collected 305 patients who were screened for unexpected antibody from February to July 2007. These samples were screened and we identified the unexpected antibody with the tube method and three microtube column agglutination systems. RESULTS: The highest estimated sensitivity of the screening test was 97.4% for DiaMed-ID. The highest estimated specificity of the screening test was 100% for DG Gel. The least number of discordant identification results was seven for the DG Gel. CONCLUSION: DG Gel has good diagnostic efficacy and accuracy for identifying unexpected antibody. DG Gel might be used as a replacement or supplement for the previous tests.
Agglutination ; Antibodies ; Humans ; Mass Screening ; Sensitivity and Specificity

BACKGROUND: The AutoVue Innova (Ortho Clinical Diagnostic, Raritan, NJ, USA) is an automatic instrument for blood bank tests, and it has recently been introduced in Korea for the first time at our hospital. This instrument employs column agglutination technology and it performs blood bank tests automatically. We evaluated this instrument and we report on the results. METHODS: We performed ABO/RhD typing and antibody screening for 250 randomly selected samples, and crossmatching for 261 samples with using the AutoVue Innova in parallel with the conventional manual methods. For a sensitivity test, we added 3 samples of A(2)B(3) and 2 samples of weak-D and serially diluted reagent antisera to the test pool and we measured turnaround time (TAT) for the antibody screening test. RESULTS: The concordance rates between AutoVue Innova and the manual methods for ABO/RhD blood typing, antibody screening and crossmatching tests were 99.6%, 100% and 98.9%, respectively. The overall retest rate was 0.5% and the main cause of the discrepancy was revealed to be hemolysis or an inadequate amount of the samples. The overall sensitivity of AutoVue Innova seems to be same as or better than the manual methods. The TAT for the antibody screening test was significantly shorter for the AutoVue Innova (64+/-43 min, n=512) than for the tube method (89+/-57 min, n=99) (P<0.001). CONCLUSION: The test results of AutoVue Innova were accurate and sensitive for the ABO/RhD typing, crossmatching and antibody screening tests. The TAT for the antibody screening test was remarkably shortened up to five times more samples could be tested without an increase of manpower.
Agglutination ; Blood Banks ; Blood Grouping and Crossmatching ; Hemolysis ; Immune Sera ; Korea ; Mass Screening

BACKGROUND: The risk of transfusion-transmitted bacterial infection has been reported in addition to the risk of transmission of viral disease. Especially for platelets that are stored at 20degrees C~24degrees C with agitation to sustain platelet function. This storage method facilitates bacterial proliferation. Therefore, sensitive and rapid detection of bacteria must be considered for stored platelets. METHODS: Six concentrations of platelets were spiked (1.5 mL) with five different bacteria and were analyzed by the 16S rDNA real-time polymerase chain reaction (PCR) using the ABI PRISM 7500 (Applied Biosystems, Foster, CA, USA) and the LightCycler 2.0 (Roche, Penzberg, Germany). The 16S rDNA gene was analyzed in three lots by real-time PCR reagents with sterile water. Three concentrations of spiked platelets (0.5 mL) with three different bacteria were preincubated in thioglycollate medium at 37degrees C for 8, 12, 16, 20, and 24 hours and then were analyzed by the 16S rDNA real-time PCR. The spiked platelets (0.5 mL) with fast-growing (8 hours of preincubation) and slow-growing (24 hours preincubation) bacteria were analyzed for the minimum incubation time. RESULTS: The average crossing points (Cps) of the five bacteria were 21.2 with the ABI PRISM 7500 and 22.2 in the LightCycler 2.0. All five bacteria (10(1) bacteria/mL) were detected by both instruments. The average Cps of the three lots by real-time PCR was 29.3, 31.5 and 35.6. The contamination levels of the 16S rDNA were different. Fast-growing and slow-growing bacteria, preincubated at 8 and 24 hours, respectively, were detected at levels of 10(1) bacteria/mL. CONCLUSION: The results of this study suggest that slow-growing bacteria can be detected at concentrations of 10(1) bacteria/mL in platelets preincubated with thioglycollate medium, at 37degrees C for 24 hours using platelets segment.
Bacteria ; Bacterial Infections ; Blood Platelets ; Dihydroergotamine ; DNA, Ribosomal ; Indicators and Reagents ; Real-Time Polymerase Chain Reaction ; Virus Diseases ; Water

BACKGROUND: Efforts to reduce the wastage of blood components are necessary because of the shortage of blood components. To find ways of reducing the blood component wastage, we monitored the trends and reasons for wastage and we analyzed this data. METHODS: We have investigated and analyzed the amount and reasons for wastage from 2003 to 2005 by reviewing the wastage statements, and the information on these wastage statements was classified according to several aspects. Ouestions about the reasons for wastage and the methods for reducing such wastage were created and these were widely distributed to the doctors and nurses working at Pusan University Hospital. The results of the survey were analyzed. RESULTS: The wastage rates of blood component from 2003 to 2005 had a tendency to slightly decline: 1.49% in 2003, 1.26% in 2004 and 1.23% in 2005. The most frequent reason for wastage was the improvement in the patient's condition and the second most frequent reason was death of the patient. The favorite answers for the question about the most likely reason for wastage were related to different aspects of medicine, and also to the improvement in the patient's condition (52.6%) and the death of patient (22.6%) for the aspect of blood management, the most frequent answers were overcharge (43.3%) and delay of blood returning (17.7%). The analysis of the pattern of wastage showed that only 5 departments were responsible for 71.5%~78.1% of the wastage. CONCLUSION: Systematic and active management of the transfusion process, along with intensive cooperation of clinicians, is needed to prevent a considerable amount of blood component wastage.
Humans

BACKGROUND: The aim of this study is to organize the maximum surgical blood order schedule (MSBOS) of red blood cells (RBCs) for elective surgeries according to the International Classification of Diseases, Ninth Revision, Clinical Modification guidelines (ICD-9-CM) and we compared the results with the previously reported MSBOSs. METHODS: From 1 March to 31 August 2007, the data of the transfused RBCs for elective surgeries in our hospital were analyzed. The MSBOS was organized as the average number of units of transfused RBCs for the type of surgery, according to the ICD-9-CM. The results were compared with the MSBOSs that were previously reportedfrom 1982 to 2004 in Korea. RESULTS: A total of 121 types of 3,375 surgeries were performed. Type & screen for 91 types (81.3%), 1 unit for 20 types (13.8%), 2 units for 7 types (3.8%), 3 units for 1 type (0.4%) and 4 units for 2 types (1.8%) were recommended. There was a minimal difference between these results and the range for the previously reported MSBOSs. CONCLUSION: It seems that the MSBOS showed minimal change since 2004. We organized the MSBOS according to the guidelines of the ICD-9-CM. Standardization of the surgery name should be considered to achieve more useful utilization of MSBOS.
Appointments and Schedules ; Erythrocytes ; International Classification of Diseases ; Korea

BACKGROUND: Mycoplasma spp. occasionally colonize the genital tract and these organisms are some of the most important contaminants in cell culture laboratories and cell banks. We analyzed the Mycoplasma contamination rates in the donated cord blood units (CBUs) before cell processing. METHODS: A total of 151 CBUs that were donated with informed consent (November 3rd~December 28th, 2006) were randomly selected and enrolled in the study. We performed blood culture and Mycoplasma DNA PCR assay with using samples from the collection bags before processing. RESULTS: All of the CBUs were obtained from full-term (gestational age 37~42 weeks) deliveries. Two units showed positive results on blood culture however, Mycoplasma DNA is not found in the tested samples. CONCLUSION: The contamination rates of Mycoplasma in the CBUs, which are donated from the mothers who have full-term delivery and no pregnancy complications, are extremely low. The donated CBUs could be used in culture and for an expansion process without concern of incurring pre-processing Mycoplasma contamination. The rate of Mollicute contamination in the CBUs could become clear with the results of performing Ureaplasma assay.
Cell Culture Techniques ; Colon ; DNA ; Fetal Blood ; Humans ; Informed Consent ; Mothers ; Mycoplasma ; Polymerase Chain Reaction ; Pregnancy Complications ; Ureaplasma

BACKGROUND: Hemophilia B is an inheritable X-linked bleeding disorder that occurs as a consequence of genetic alterations within the factor IX (IX) gene. In the present study, pseudotyped HIV-I-derived lentiviral vectors expressing human IX (lentivirus-IX) were assessed for the ability to produce an active human IX in the animals transduced with lentivirus-IX. METHODS: The IX concentrations and activated partial thromboplastin times (aPTT) were measured from the supernatants of HeLa cells that were transduced with lentivirus-IX. In an animal study, we injected 1microgram of lentivirus-IX into the hind limbs of Sparague-Dawley (SD) rats. The IX concentrations were measured from the plasma of the vehicle injected rats and the plasma of the lentivirus-IX injected rats for 8 weeks. RESULTS: The in vitro expression of human IX was detected in a dose-dependent manner following the transduction of lentivirus-IX into the HeLa cells (control: 10+/-3 vs. 100 ng of lentivirus-IX: 1486+/-50 ng/mL, P<0.05). The aPTT also showed the tendency of dose-dependent decrease (control: 83.9+/-0.5 vs. 50 ng of lentivirus-IX: 80.1+/- 0.8 sec), but this was not statistically significant. In the animal experiment, the plasma IX concentration from the lentivirus-IX transduced rats (n=3) was significantly increased compared to the vehicle-injected rats (n=4) (5.9+/-3.9 vs. 46.4+/-20.6 ng/mL) at post-injection 1 week. CONCLUSION: This study demonstrated that in vivo delivery of lentiviral vectors expressing human IX to the muscle cells has the potential to be a therapeutic modality for hemophilia B.
Animal Experimentation ; Animals ; Blood Coagulation Factors ; Extremities ; Factor IX ; Genetic Therapy ; HeLa Cells ; Hemophilia A ; Hemophilia B ; Hemorrhage ; Humans ; Lentivirus ; Muscle Cells ; Plasma ; Rats ; Thromboplastin