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Revisiting the Pre-transfusion Test: A Case of Acute Hemolytic Transfusion Reaction due to Multiple Alloantibodies of Anti-E, Anti-c, Anti-Jk(b).

Gyu Dae AN ; Kyeong Hee KIM ; In Hwa JEONG ; Hyeon Ho LIM ; Kwang Sook WOO ; Jin Yeong HAN ; Jeong Man KIM ; Jin Heon JEONG ; Young Ki SON

Korean Journal of Blood Transfusion.2017;28(2):170-176. doi:10.17945/kjbt.2017.28.2.170

We report a case of acute hemolytic transfusion reaction due to multiple alloantibodies. A 41-year-old male with multiple histories of transfusion was admitted for jaundice and oliguria after receiving two units of red blood cells in a local clinic. He showed acute renal failure and disseminated intravascular coagulation. Direct Coombs test was negative and antibody screening test showed strong positive results. Anti-E, anti-c, and anti-Jk(b) antibodies were identified in two panels of unexpected antibody assays. Acute hemolytic transfusion was diagnosed, and he was discharged after 1 month of supportive treatment. Unexpected antibody detection tests, including the antiglobulin phase, should be performed to prevent adverse transfusion reactions by unexpected antibodies. Better precision and quality control are necessary when performing pre-transfusion tests.
Acute Kidney Injury ; Adult ; Antibodies ; Coombs Test ; Disseminated Intravascular Coagulation ; Erythrocytes ; Humans ; Isoantibodies* ; Jaundice ; Male ; Mass Screening ; Oliguria ; Quality Control ; Transfusion Reaction*

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Delayed Hemolytic Transfusion Reaction with Alloimmunization of Rh Phenotype: A Two-Case Study.

Dong Won YOO ; Hyun Ji LEE ; Sun Min LEE ; In Suk KIM ; Duyeal SONG ; Chulhun L CHANG ; Kyung Hwa SHIN ; Hyung Hoi KIM

Korean Journal of Blood Transfusion.2017;28(2):163-169. doi:10.17945/kjbt.2017.28.2.163

Delayed hemolytic transfusion reaction is difficult to prevent using an unexpected antibody test performed prior to transfusion, and unlike acute hemolytic transfusion reaction, it occurs a few days after blood transfusion. Hence, determining the reason for delayed hemolytic transfusion reaction may be a tim-consuming task for clinicians Here, we report our experience of two cases of delayed hemolytic transfusion reaction as a result of the unexpected antibody production to Rh blood group antigens after transfusion. The first patient with a history of transfusion during admission was identified as having anti-E and anti-C antibodies according to the antibody identification test at the time of re-admission. The second patient who had chronic blood transfusion due to cancer treatment was found to have anti-C antibody. Both patients received transfusion of Rh antigen-compatible RBC units only after unexpected antibody development. However, like both cases, patients receiving continuous blood transfusion should be considered for a routine Rh phenotype test.
Antibodies ; Antibody Formation ; Blood Group Antigens ; Blood Transfusion ; Humans ; Phenotype* ; Transfusion Reaction*

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A Case of Anti-JMH Antibody with High-Titer, Low-Avidity Characteristics: The First Case in Korea.

Tae Yeul KIM ; Yun Ji HONG ; Hyungsuk KIM ; Kyoung Un PARK ; Kyou Sup HAN

Korean Journal of Blood Transfusion.2017;28(2):155-162. doi:10.17945/kjbt.2017.28.2.155

Anti-John Milton Hagen (JMH) is a high-titer, low-avidity (HTLA) antibody against the high frequency red blood cell (RBC) antigen JMH. It occurs very rarely and has not yet been reported in Korea. Here, we report a case of anti-JMH antibody identified in a 92-year-old man without previous blood transfusion history, who had been hospitalized with pneumonia. The patient's hemoglobin level was reduced to 7.6 g/dL on the 35th day of hospitalization, requiring RBC transfusion. Antibody identification test revealed antibodies that showed pan-reactivity to all panel cells at the antiglobulin phase. A titration test confirmed that it was a HTLA antibody. He was given one least-incompatible unit of RBC without any adverse events, and his hemoglobin level increased to 9.3 g/dL. The patient's sample was referred to a reference laboratory and the antibody was identified as anti-JMH. He was successfully transfused with 6 additional units of least-incompatible RBCs without complication. HTLA antibodies against high frequency antigens, such as anti-JMH, are less likely to cause significant destruction of transfused antigen positive RBCs. However, identifying the specificity of these antibodies is necessary to appropriately understanding the clinical significance of the antibody, detecting other clinically important alloantibodies that may coexist, and determining the appropriate blood for transfusion.
Antibodies ; Blood Transfusion ; Erythrocytes ; Hospitalization ; Isoantibodies ; Korea* ; Pneumonia ; Sensitivity and Specificity

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Experience in Improving ABO Blood Typing Error at the Blood Donation Site.

Dae Dong LEE ; Eun Jin KIM ; Youkyung SEO ; Minji JO ; Yongjun JO ; Mi Kyung LEE

Korean Journal of Blood Transfusion.2017;28(2):149-154. doi:10.17945/kjbt.2017.28.2.149

BACKGROUND: In the Korean Red Cross Blood Center, ABO blood typing are routinely performed only via red cell grouping at blood donations sites. However, when an error occurs in this process, it is impossible to issue a blood product contrary to the result of the blood type of the Blood Laboratory Center, thereby resulting in delayed supply. Therefore, efforts are needed to reduce typing errors at blood donation sites. METHODS: We analyzed 656,786 donor screenings between January 1, 2016 and December 31, 2016;we also analyzed the statistical data of donor ABO typing between 2013 and 2015. To reduce ABO typing error, we notified and trained nurses at Busan, Gyeongnam, Ulsan, and Daegu-Gyeongbuk Blood centers in June, 2016. We tried to confirm the improvement of ABO typing error at blood donation sites by comparing ABO typing before and after training. For data comparison, chi-square test was conducted (95% confidence interval, 0.05 significant level). RESULTS: The blood typing error rate was significantly lower (P=0.003) four months after training (0.005%) than before training (0.015%), and the blood typing error rate was significantly higher for the first blood donor (P<0.001). CONCLUSION: Educational training for nurses at blood donation sites may be effective in reducing ABO typing error. Continuous and regular training seems to be needed in future to reduce ABO typing error.
Blood Donors* ; Blood Grouping and Crossmatching* ; Busan ; Donor Selection ; Humans ; Red Cross ; Tissue Donors ; Ulsan

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Experience of Failure Mode and Effect Analysis in Transfusion Medicine.

Kyung Hwa SHIN ; Sun Min LEE ; Hyun Ji LEE ; Hyerim KIM ; Duyeal SONG ; Eu Jeen YANG ; In Suk KIM ; Hyung Hoi KIM ; Chulhun L CHANG

Korean Journal of Blood Transfusion.2017;28(2):140-148. doi:10.17945/kjbt.2017.28.2.140

BACKGROUND: Blood transfusions are complicated procedures, and are highly sensitive to mistakes that could seriously endanger the life of patients. The failure mode and effect analysis (FMEA) can be used to inspect and improve high risk processes. Here, we aimed to identify the risk factors of a blood transfusion process and to improve its safety by optimizing the process. METHODS: We conducted a weekly meeting from March to April 2014. We investigated the frequency of events for 2013 (before FMEA) and 2015 (after FMEA). The FMEA process was performed in eight steps and the improvement priorities were determined in accordance with the magnitude of calculated fatalities (multiplied by severity, occurrence, and detection scores). RESULTS: The whole process of blood transfusion was analyzed by detailed steps: Decision of blood transfusion, blood transfusion request, pre-transfusion test, blood product discharge, delivery, and administration process. Then, we identified the types of failures and likelihood of occurrence, discovery, and severity. Based on the calculated risk priority number, strategies to improve the highest failure modes were developed. Eleven transfusion-related events occurred before FMEA, and three events occurred after FMEA. CONCLUSION: In this study, we analyzed the failure modes that may occur during a transfusion procedure. The FMEA was a useful tool for analyzing and reducing the risks associated with a blood transfusion procedure. Continuous efforts to improve the failure modes would be helpful to further improve the safety of patients undergoing blood transfusion.
Blood Transfusion ; Healthcare Failure Mode and Effect Analysis* ; Hematologic Tests ; Humans ; Patient Safety ; Risk Factors ; Transfusion Medicine*

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Experience of Rh & Others Antigen Negative Rate Elicitation in a Blood Laboratory Center.

Dae Seong KIM ; So Ri LEE ; Hoe Seok KIM ; Sang Bong KIM ; Sang Ho EOM ; Hee Dong KIM ; Dae Dong LEE ; Mi Kyung LEE

Korean Journal of Blood Transfusion.2017;28(2):134-139. doi:10.17945/kjbt.2017.28.2.134

BACKGROUND: The demand for Rh-related and other specific antigen negative donations has increased recently, and in response, we need to improve work efficiency while decreasing reagent consumption. Thus, we desire to create a ‘table of Nambu Blood Laboratory Center's own Rh-related and other antigen negative rate’. METHODS: We analyzed the results of Rh-related specific antigen test for 2,806,330 donors using ‘PK-7300’ and the results of manual test for 10,024 other blood type antigen-related specific and compound antigens. We made a table summarizing the results using two cases. RESULTS: The negative rate of Rh-related specific antigens was approximately 12.9% for C, 41.7% for c, 49.5% for E, and 9.2% for e antigens. The negative rate of compound antigens was increased when compared with the number of inspections. The negative rate for C and e antigens was increased from 90.1% to 97.3%, and that for E, c, and JKa was increased from 7.6% to 31.6%. CONCLUSION: The negative rate table made in July 2016 has been determined to be very effective in screening for specific and compound antigen negative blood. Also it was very efficient in terms of examining and supplying the compound antigen negative blood. It would be helpful to improve the supply of specific antigen negative blood to better meet the unique needs of each medical institution.
Hepatitis B e Antigens ; Humans ; Mass Screening ; Tissue Donors

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Comparison of ABO Blood Group Typing between Automated Blood Bank Analyzer IH-500 and Manual Method.

Jeong Won SHIN ; Woo Yong SHIN ; Do Lee LEE

Korean Journal of Blood Transfusion.2017;28(2):126-133. doi:10.17945/kjbt.2017.28.2.126

BACKGROUND: According to increased availability and awareness of automated blood bank analyzer with its speed and efficiency, use of automated analyzer in hospital blood bank has been increasing rapidly. We compared the ABO blood group typing results between automated analyzer IH-500 and manual method in healthy adults and patients with ABO discrepancies to provide useful information on interpretation of blood grouping results by automated analyzer. METHODS: Among healthy adults who underwent medical examinations, 400 samples (each 100 samples of A, B, O and AB type) were selected and evaluated the results and grades of blood grouping by automated and manual methods. Also, 50 samples showing ABO discrepancies among patients requested for pretransfusion test were selected and compared between two methods. As for samples with ABO discrepancies, further tests such as microscopic examination, reactivity with anti-A1 or ABO genotyping along with medical record review were performed. RESULTS: Agglutination results and grades in healthy adults were consistent between two methods. Meanwhile, 30 (60%) of ABO discrepant samples were related to rouleaux formation and their frequencies and agglutination grades were higher in automated method (Wilcoxon signed rank test, P=0.001). Results of discrepant samples caused by unexpected antibody or ABO subgroup showed no differences between two methods. CONCLUSION: IH-500 automated analyzer was considered useful for mass examination of healthy individuals. Meanwhile, considering the fact that ABO discrepancies by rouleaux formation were more frequent and stronger in automated method, it is recommended to retest their results by manual methods along with medical record review.
Adult ; Agglutination ; Blood Banks* ; Blood Grouping and Crossmatching ; Humans ; Medical Records ; Methods*

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The Current Global Status and Production Trends of Plasma Fractionation.

Moon Jung KIM ; Thierry BURNOUF

Korean Journal of Blood Transfusion.2017;28(2):113-125. doi:10.17945/kjbt.2017.28.2.113

The demand for medicinal products derived from plasmas are increasing on a global scale. In particular, the demand for intravenous immunoglobulin has continuously been increasing. The increase in the capacity of commercial plasma fractionators is prominent compared with that of non-profit plasma fractionators; thus, the percentage of plasmapheresis has increased with respect to that of plasma from whole blood. The inequality between the consumption of plasma-derived medicinal products and supply of raw plasma among developed countries and developing countries is due to the direct, proportional relationship between the consumption of plasma-derived medicinal products and the size of gross domestic products. Each country decides on its own system to achieve a stable supply of plasma-derived medicinal products. Although domestic production is an ideal option, many countries establish contracts with plasma fractionators. Owing to a great ripple effect, safety measures are increasingly applied, so detailed review should be conducted with consideration given to the cost-effectiveness and the situation unique to each country.
Blood Coagulation Factors ; Developed Countries ; Developing Countries ; Gross Domestic Product ; Immunoglobulins ; Plasma* ; Plasmapheresis ; Socioeconomic Factors

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The Global Developments in Transfusion Replacements and Patient Blood Management.

Hannah YANG ; Young Woo KIM

Korean Journal of Blood Transfusion.2017;28(2):103-112. doi:10.17945/kjbt.2017.28.2.103

Blood transfusions were once believed to the most potent and cost-effective method of improving patients' survival outcomes, but accumulating evidence over the past thirty years strongly suggests allogeneic transfusions as independent prognosticators of complications, prolonged hospital stay, and higher costs. A growing body of health care providers in Korea and throughout the world recognize a causal relationship between these adverse outcomes with liberal transfusion policies and call for a universal paradigm shift regarding the management of blood. Currently, the most promising contender is Patient Blood Management (PBM), which has been found to improve patient outcomes by conserving or optimizing the patient's own blood and physiologic reserves and advocating for restrictive transfusion policies. PBM incorporates evidence-based transfusion replacements to address anemia, bleeding, and blood disorders. These various methods–such as intravenous iron, erythropoiesis stimulating agents, coagulating factors, and topical hemostatic agents–are gaining recognition because of their ability to preclude the need for allogenic transfusions while effectively managing the patient's blood.
Anemia ; Blood Transfusion ; Health Personnel ; Hematinics ; Hemorrhage ; Humans ; Iron ; Korea ; Length of Stay ; Methods

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Thawing Fresh Frozen Plasma Using a Microwave Oven.

Hyun Sook CHI ; Seog Woon KWON ; Joon NAH

Korean Journal of Blood Transfusion.1995;6(2):217-223.

Thawing fresh frozen plasma(FFP) by waterbath(WB) requires about 30 minutes, which is too slow in emergency situations and carries the risk of bacterial contamination of FFP. To solve these problems, a new thawing method using a microwave oven(MWO) has been developed. Twenty units of equally divided plasma from 10 units of plasma were frozen, stored at -55 degrees C, and thawed in parallel using microwave oven or waterbath. Coagulation factors, plasma proteins and thawing time were measured. Except for antithrombin III(MWO: 85.2+/-6.94%, WB : 90.8+/-9.14%, p<0.05), no significant differences were observed in the 18 other coagulation parameters and the plasma proteins studied. Mean thawing time by MWO was 5.9 minutes per 1 unit, 10.4 minutes per 2 units and 12.5 minutes per 3 units; by WB, it was 19.0, 20.0 and 22.0 minutes, respectively. In conclusion, FFP can be thawed faster using a microwave oven than using 37 degrees C waterbath and the thawed plasma proteins were generally equivalent to those of FFP thawed by waterbath.
Blood Coagulation Factors ; Blood Proteins ; Emergencies ; Microwaves* ; Plasma*

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