The high incidence antigert Jr" was first identified in 1970 by Stroup and Macllroy. Anti-Jr~ was immune antibodies developed by transfusion or pregnancy and occasionally cause hemolytic disease of the newborn and transfusion reaction, but these usually mild. We are reporting the first case of anti-Jra in Korea, which was identified in pregnant woman with transfusion history. The 35 year old pregnant woman(G6P4L1D3A1) admitted to treat for incompetent internal os of cervix on department of Obstetrics and Gynecology. Prenatal irregular antibody screening was negative. One unit of RBC was transfused at 21 gestational weeks for correction of anemia. One week later, irregular antibody was detected in her serum. The antibody reacted best by indirect antiglobulin test and panagglutinated all identified cells. The titer was 1 : 8. The antibody was identified as anti-Jr by Dr. Osaka Red Cross Center. Her phenotype of Jra was Jr(a-), but there was no Jr(a-) person in her family. She might have anti-Jra in her serum with undetectable level due to multiple pregnancies. In this case, the development of anti-Jr was stimulated by one unit of RBC transfusion with anamnestic reaction. The titer of anti-Jr was gradually reduced during pregnant period. She delivered at 37 gestational weeks by cesarian section. The baby was clinically well at birth and typed as Jr(a+).
Adult ; Anemia ; Antibodies ; Blood Group Incompatibility ; Cervix Uteri ; Coombs Test ; Female ; Gynecology ; Humans ; Incidence ; Infant, Newborn ; Korea ; Mass Screening ; Obstetrics ; Parturition ; Phenotype ; Pregnancy ; Pregnancy, Multiple ; Pregnant Women* ; Red Cross

BACKGROUND: The sensitivity of the blood screening test is crucial to ensure blood safety. Generally the test methods with greater sensitivity tend to have lower specificity. Therefore, secondary confirmatory tests are required to solve this problem. Since the confirmatory test for hepatitis B virus surface antigen (HBsAg) has not been routinely applied yet in Korea for blood donors, the true positive rate of HBsAg is unknown. This study was intended to determine the true seroprevalence of the hepatitis B virus (HBV) among Korean blood donors. METHODS: A total of 906 blood donor samples found to be positive for HBsAg with Prism qualitative assay from November 2010 to April 2011 at Korean Red Cross blood centers were tested with Architect HBsAg qualitative assay and confirmatory assay. Blood samples with negative results using Architect HBsAg qualitative assay were tested with Prism HBsAg confirmatory test. RESULTS: Of the 906 samples positive by Prism HBsAg qualitative assay, 793 were confirmed as positives. The positive predictive value of Prism HBsAg qualitative assay was 87.5%, and the true seroprevalence of HBV among Korean blood donors was 8 out of 100,000. The sample-to-cut-off ratio (S/CO) value of one true positive sample was lower than 1. CONCLUSION: The positive predictive value of HBsAg by Prism was higher than expected. Baseline data for estimation of residual risk of HBV as well as the cost-effectiveness analysis for lookback policy were drawn. Finally, the current cut-off level for repeat assay looked reasonable and it should be maintained at least until the nucleic acid amplification test is implemented as a routine screening method.
Antigens, Surface ; Blood Donors ; Blood Safety ; Dietary Sucrose ; Hepatitis ; Hepatitis B ; Hepatitis B Surface Antigens ; Hepatitis B virus ; Humans ; Korea ; Mass Screening ; Nucleic Acid Amplification Techniques ; Prevalence ; Red Cross ; Sensitivity and Specificity ; Seroepidemiologic Studies

The direct antiglobulin test (DAT) is used in investigating autoimmune hemolytic anemia, drug-induced antibodies, hemolytic diseases of newborn and alloimmune reactions to recently transfused red cells. We performed 3,033 DATs in our blood bank from 1985 to 1992. When using a polyspecific antihuman globulin reagent, the DAT was positive in 7.2% of all cases tested. In further studies using monospecific anti-IgG and anti-C3d reagents, three patterns of reactivity were founded: in 37% of cases, red cells are coated with IgG alone; in 18% of cases, the red cells are coated with both IgG and complement; and in 45% of cases only with complement. We evaluated clinical significance of DAT positive results with the 227 patients' medical records which can be available for reviewing among the positive DAT patients. The male to female ratio of DAT positive patient was 1:2 and 41% of cases were belong to the 20-30 years old age group. The most common underlying disorders were systemic lupus erythematosus (29.5%), idiopathic (10.1%), hematologic malignancy (8.8%), and liver disease (6.2%). Patients with warm reactive autoantibodies account for 60.4% of all DAT positive cases. Cold reactive autoantibodies were demonstrated in 11%, and the mixed-types were 2.6%. Drug-induced DAT positive findings were observed in 15.4% and the DAT positve caused with transfusion associated alloantibodies were 7.5%. IgG warm-reactive autoagglutinins were more commonly detected in patients with autoimmune hemolytic anemia and drug induced hemolysis. Definite hemolysis was present in 37% of all DAT positive patients and especially in all patients with mixed type autoagglutinin. Drugs caused a positive DAT were cephalosporin, penicillin, isoniazid, and rifampicin.
Anemia, Hemolytic, Autoimmune ; Antibodies ; Autoantibodies ; Blood Banks ; Complement System Proteins ; Coombs Test* ; Female ; Hematologic Neoplasms ; Hemolysis ; Humans ; Immunoglobulin G ; Indicators and Reagents ; Infant, Newborn ; Isoantibodies ; Isoniazid ; Liver Diseases ; Lupus Erythematosus, Systemic ; Male ; Medical Records ; Penicillins ; Rifampin

BACKGROUND: The commonly recommended therapeutic range is an activated partial thromboplastin time(APTT) of 1.5 to 2.5 times the control value, which may be inappropriate for some reagents. The aim of this study is to evaluate the correlation of APTT and anti-Xa activity and to compare two methods of determining the therapeutic range of APTT during unfractionated heparin treatment. METHODS: We measured anti-Xa activity and APTT in 80 plasmas from patients treated with unfractionated heparin. We performed correlation analysis between anti-Xa activity and APTT or APTT ratio(heparinized APTT/baseline APTT). The therapeutic range determined by anti-Xa activity of 0.35-0.7 U/mL was compared with the therapeutic range based on minimizing potential thrombosis and bleeding error. RESULTS: The anti-Xa activity-vs-APTT correlation was slightly, but not significantly, improved by converting APTT(r=0.835) to APTT ratio(r=0.883). The APTT therapeutic range predicted by anti-Xa activity-vs-APTT regression analysis was 68.7 to 139.5 seconds(66.6-127.9 seconds for logarithmatically transformed APTT), whereas the range predicted by minimization-of-error technique was 68 to 97 seconds. CONCLUSIONS: The established therapeutic APTT range based on linear regression analysis was not considered to be optimal. The therapeutic range based on minimizing the potential clinical errors may further improve error rate, but prospective study with a larger number of patient samples would be required to apply in clinical field.
Hemorrhage ; Heparin* ; Humans ; Indicators and Reagents ; Linear Models ; Partial Thromboplastin Time* ; Plasma ; Thromboplastin ; Thrombosis

BACKGROUND: D-dimer, cross-linked fibrin degradation fragment, is an important parameter for the diagnosis of disseminated intravascular coagulation (DIC). The commonly used method for detecting D-dimer levels is latex agglutination, which is rapid but lacks sufficient sensitivity. Recently, quantitative and rapid D-dimer assay have been available for routine laboratory use. METHODS: We compared quantitative D-dimer by VIDAS system with semiquantitative latex D-dimer. Sixty-six patients at risk for DIC were classified as DIC and subclinical DIC based on the modified DIC criteria by Mant et al. VIDAS D-dimer (BioMerieux, Marcyl'Etiole, France), latex D-dimer (Diagnostica Stago, Asnieres, France), fibrinogen (Diagnostica Stago), prothrombin time (Diagnostica Stago), activated partial thromboplastin time (Diagnostica Stago), and platelet count (Sysmex SE9000, Japan) were measured. RESULTS: In 9 patients with documented DIC it was found that VIDAS D-dimer level was markedly elevated (>2,000 ng/mL) in 100%, with the mean D-dimer level being 10,720+/-7,727 ng/mL and that latex D-dimer was markedly elevated in 33.3%. There was no significant difference of VIDAS D-dimer level according to the clinical diagnosis. The concordance rate between VIDAS and latex D-dimer is 33.3% (22/66). Thirty-four (51.5%) of all patients had VIDAS D-dimer level of more than 2,000 ng/mL and latex D-dimer of 1000-2000 ng/mL. There was negative correlation between VIDAS D-dimer levels and APTT (or fibrinogen). CONCLUSIONS: We concluded the quantitative VIDAS D-dimer to be more sensitive than latex D-dimer and to be a useful parameter in diagnosing DIC. It is needed to set cutoff value of D-dimer in order to get more specific information for the diagnosis of DIC.
Agglutination ; Dacarbazine* ; Diagnosis ; Disseminated Intravascular Coagulation ; Fibrin ; Fibrinogen ; Humans ; Latex ; Partial Thromboplastin Time ; Platelet Count ; Prothrombin Time

No abstract available.
Plasma

BACKGROUND: Heat shock proteins (HSPs), or stress proteins, are immunodominant antigens of many microorganisms. In this study, we have detected the anti-HSP 70 antibody and tried to explain the role of the antibody with respect to the pathogenesis of SLE. Furthermore, we have attempted to find out the possibility to link the presence of the autoantibody with the monitoring and diagnosis of systemic lupus erythematosus (SLE). METHODS: A total of 80 samples from 55 SLE patients were screened for the presence of anti-HSP 70 antibodies. Simultaneously 59 healthy people were tested as a control group. The anti-HSP 70 antibodies were measured by enzyme-linked immunosorbent assay (ELISA) and confirmed by western blot in anti-HSP 70 antibody ELISA positive samples. The activity of disease state was confirmed by the patients' medical record and systemic lupus activity measure (SLAM). RESULTS: The mean optical density (O.D.450) of ELISA in healthy controls and SLE patients were 0.15+/-0.18 (mean+/-S.D.) and 0.13+/-0.14. The correlation of SLAM Score and ELISA O.D. was r2=0.19, P=0.014. And, the mean O.D. value of ELISA was 0.18+/-0.02 and 0.11+/-0.01 before and after treatment (P <0.05). We compared samples with SLAM Score. The O.D. of anti-HSP 70 ELISA in these patients were 0.20+/-0.02 and 0.08+/-0.002 before and after treatment respectively (n=10, mean+/-S.D., P <0.01). CONCLUSIONS: Anti-HSP 70 antibody was not a clinically useful diagnostic marker in SLE patients. However, the titer of anti-HSP 70 antibody can be used for the monitoring of the therapeutic effectiveness in these patients.
Antibodies ; Blotting, Western ; Diagnosis ; Enzyme-Linked Immunosorbent Assay ; Heat-Shock Proteins ; Humans ; Immunodominant Epitopes ; Lupus Erythematosus, Systemic* ; Medical Records

BACKGROUND: Due to the slowing of population growth, population ageing, and more aggressive medical treatment, Korea will be faced with the challenge of blood shortage. One solution to the blood shortage problem is to take advantage of the multicomponent collection technique. However, clinical application is limited due to the low prices of blood products. In this study, we compared the prices of blood products in 6 major countries. METHODS: Prices of leukoreduced red blood cells (RBC), platelet concentrate (PC), fresh frozen plasma (FFP), cryoprecipitate (CRYO), and apheresis platelets (AP) were compiled from US, United Kingdom, Japan, Australia, Spain, and Korea. Adjusted prices using per capita gross domestic product (GDP) and purchasing power parity (PPP) were estimated and analyzed. RESULTS: The RBC price in Korea was only 30% of the mean RBC price of the other 5 countries. Considering per capita GDP and PPP, the RBC prices in Korea were estimated up to 41% and 46%, respectively. The PPP adjusted price of PC, FFP, and AP of Korea was 70%, 72%, and 70% of mean price of the other 5 countries. Price ratios of PC, FFP, and CRYO to RBC were 0.59, 0.63, and 0.57, which were higher than the means of the other 5 countries (0.38, 0.47, and 0.32). CONCLUSION: Considering per capita GDP and PPP, blood product prices in Korea were cheaper than the mean prices of the other 5 countries. For adoption of multicomponent collection, the prices of blood products should be raised, especially the price of RBCs.
Adoption ; Australia ; Blood Component Removal ; Blood Platelets ; Erythrocytes ; Female ; Great Britain ; Gross Domestic Product ; Guanosine Diphosphate ; Imidazoles ; Japan ; Korea ; Nitro Compounds ; Parity ; Plasma ; Population Growth ; Spain

A heterozygous GTG to ATG (Val297Met) mutation was detected in a patient with inherited protein C deficiency and deep vein thrombosis. Cosegregation of the mutation with protein C deficiency was observed through a family pedigree study. Molecular models of the serine protease domains of wild type and mutant protein C were constructed by standard comparative method. Val 297 was found to be located in the hydrophobic core of the protein. Although the substitution of Met for Val does not greatly alter the hydrophobicity of the protein, it introduces a bulkier side chain, which yields steric hindrance between this residue and adjacent residues, such as Met364, Tyr393, Ile321, Ile323, and Val378. It seems that the Met can not fit into the tight packing into which it is trapped, thereby probably inducing misfolding and/or greater instability of the protein. Such misfolding and/or instability thereby eventually disturbs the catalytic triad, in consistent with the observed type I deficiency state.
Adult ; Base Sequence ; Female ; Human ; Male ; Middle Age ; Models, Molecular* ; Molecular Sequence Data ; Pedigree ; Point Mutation* ; Polymerase Chain Reaction/methods ; Protein C/genetics* ; Protein C/chemistry* ; Protein C Deficiency/genetics* ; Protein Conformation ; Serine Endopeptidases/genetics ; Serine Endopeptidases/chemistry* ; Venous Thrombosis/genetics

BACKGROUND: High plasma levels of coagulation factor VII (FVII) are associated with a risk of coronary artery disease (CAD). Plasma FVII levels are influenced by environmental and genetic factors. We investigated whether the risk of CAD is associated with R353Q polymorphism and whether this polymorphism is associated with factor VII activity METHODS: We analysed plasma levels of FVII:C and FVII genotype for R353Q polymorphism in 85 CAD patients, 63 healthy controls, and 27 patient controls. And total cholesterol, HDL-cholesterol and triglyceride were measured in the same study populations. RESULTS: There was no difference among CAD patients, healthy controls, and patient controls in plasma levels of FVII:C. Allele Q of the R353Q polymorphism was less frequent in CAD patients (11.8%) than healthy controls (17.5%), although the difference was not statistically significant. Patients with the RQ genotype had a decreased risk of CAD (odds ratio, 0.29). There was no association between R353Q polymorphism and plasma levels of FVII:C. Plasma levels of FVII:C were positively correlated with total cholesterol and triglyceride. CONCLUSIONS: Our findings suggest that R353Q polymorphism may confer significant protection from CAD and that plasma levels of FVII:C may influenced by total cholesterol and triglyceride.
Alleles ; Blood Coagulation Factors* ; Cholesterol ; Coronary Artery Disease* ; Coronary Vessels* ; Factor VII* ; Genotype ; Humans ; Plasma ; Triglycerides