Background: TP53 mutations are associated with poor prognosis in myelodysplastic neoplasm (MDS) and AML. The updated 5th WHO classification and International Consensus Classification (ICC) categorize TP53-mutated MDS and AML as unique entities. We conducted a multicenter study in Korea to investigate the characteristics of TP53-mutated MDS and AML, focusing on diagnostic aspects based on updated classifications. Methods: This study included patients aged ≥ 18 yrs who were diagnosed as having MDS(N = 1,244) or AML (N = 2,115) at six institutions. The results of bone marrow examination, cytogenetic studies, and targeted next-generation sequencing, including TP53, were collected and analyzed. Results: TP53 mutations were detected in 9.3% and 9.2% of patients with MDS and AML, respectively. Missense mutation was the most common, with hotspot codons R248/ R273/G245/Y220/R175/C238 accounting for 25.4% of TP53 mutations. Ten percent of patients had multiple TP53 mutations, and 78.4% had a complex karyotype. The median variant allele frequency (VAF) of TP53 mutations was 41.5%, with a notable difference according to the presence of a complex karyotype. According to the 5th WHO classification and ICC, the multi-hit TP53 mutation criteria were met in 58.6% and 75% of MDS patients, respectively, and the primary determinants were a TP53 VAF > 50% for the 5th WHO classification and the presence of a complex karyotype for the ICC. Conclusions Collectively, we elucidated the molecular genetic characteristics of patients with TP53-mutated MDS and AML, highlighting key factors in applying TP53 mutation-related criteria in updated classifications, which will aid in establishing diagnostic strategies.

Background: The currently recommended pre-transfusion testing techniques for patients with autoantibodies are complex, time-consuming, and labor-intensive. Therefore, although the red blood cell (RBC) selection method using crossmatched RBC agglutination reaction grades (i.e., the “least incompatible” transfusion) is discouraged, many institutions still use it. We aimed to evaluate the effectiveness of this method combined with Rh subgroup phenotyping. Methods: We retrospectively investigated RBC transfusions from January 2019 to December 2021 in patients presenting as auto-control-positive via antibody identification (auto-control (+) group), where Rh subgroup phenotype-matched RBCs were selected based on the agglutination reaction grades of crossmatched units. For each study patient, an auto-control-negative patient was matched based on age, sex, department, and pre-transfusion Hb levels (auto-control (−) group). The mean Hb change per unit, transfusion-associated symptom/sign reports, and agglutination reaction grades upon crossmatching were analyzed. Results: In the auto-control (+) group, the Hb change per unit among different agglutination reaction grades of transfused RBCs and among different relative grades of transfused RBCs and crossmatching auto-controls was not significantly different (P=0.392 and P= 0.132, respectively). No significant difference was observed in Hb changes and transfusion-associated symptom/sign occurrence between the auto-control (+) and auto-control (−) groups (P=0.121 and P=0.822, respectively). In addition, no definite evidence of hemolysis in the auto-control (+) group was observed in the medical record review. Conclusions Together with Rh subgroup phenotyping, selecting the RBC unit with the lowest agglutination reaction grade upon crossmatching does not adversely affect transfusion efficiency.

The Dia and Mia antigens have been detected in Koreans with a frequency of 6.4∼14.5% and 0.9%, respectively. This study evaluated the effectiveness of different screening cells using the cells with Diaand Mia antigens for unexpected antibody screening. An unexpected antibody-screening test was performed separately using different screening cells, including the Dia antigen (Panel D) and Mia antigen (Panel M). A total of 2,077 specimens from 1,847 patients were collected, among which 49 (2.32%) and 43 (2.08%) were positive using Panel D and Panel M, respectively. Twenty-seven patients were positive with both panels, 2012 were negative with both panels, and thirty-eight patients showed a discordant result. The suspected anti-Diaand anti-Mia were detected in 4 (0.19%) and 5 (0.24%) patients, respectively. Therefore, the frequency of anti-Dia and anti-Mia antibodies in this study may be helpful for selecting unexpected antibody screening reagents.

Background: The maximum surgical blood order schedule (MSBOS) is a list of surgical procedures with the corresponding recommended number of blood units. Nevertheless, with the advances in surgery and transfusion medicine, a need for updates in the MSBOS has been suggested. This study evaluated the need for regular revision of the MSBOS. Methods: The surgical procedures performed between August 2016 and July 2021 were investigated retrospectively. The transfused blood units for each type of surgery were analyzed in elective, single surgeries performed more than ten times per year. The Transfusion index (TI) and the Transfusion probability (TP) for each type of operation were calculated in five one-year intervals. Furthermore, the surgeries performed more than 10 times in all one-year intervals and presented a TI≥0.5 at least once during the study period were subjected to further analysis. Results: A total of 96,040 elective surgical procedures were performed during the five-year study period, including 77,639 single surgeries performed ≥10 times in one year. The average transfused blood units and the average TP per year decreased over time. In addition, the percentage of the number and type of operations presenting TI≥0.5 changed. Among the 27 surgeries that were further studied, six showed constant TI≥0.5; six changed from TI≥0.5 to ＜0.5, and 15 displayed fluctuations in TI. Conclusion Changes in surgical blood utilization was observed among one-year periods, which implies the need for regular revision of MSBOS.

PURPOSE: The soluble programmed death-ligand 1 (sPDL1) has immunosuppressive activity and is a candidate biomarker for immuno-oncology drug development. In this study, we measured sPDL1 at pre- and post-chemotherapy and at disease progression to uncover the dynamics of sPDL1 during treatment in biliary tract cancer (BTC) patients. MATERIALS AND METHODS: From 90 BTC patients (training cohort, 53; validation cohort, 37) who were candidates for palliative first-line chemotherapy, blood was collected at pre- and post-chemotherapy (at the time of best response) and at disease progression. The sPDL1 levels were measured using an enzyme-linked immunosorbent assay. Responses to chemotherapy, overall survival (OS), and other prognostic factors including the neutrophil-lymphocyte ratio (NLR) were analyzed. RESULTS: The OS of all patients was 11.5 months (confidence interval [CI], 9.7 to 16.2). The best response was complete response in seven (7.8%), partial response in 20 (22.2%), stable disease in 52 (57.8%), and disease progression (PD) in 11 patients (12.2%). Patients with high pre-chemotherapy sPDL1 (≥ 1.30 ng/mL) showed worse OS than patients with low prechemotherapy sPDL1 (9.1 months vs. 12.5 months, p=0.003). In multivariate analyses, high pre-chemotherapy sPDL1 (hazard ratio [HR], 1.96; 95% CI, 1.2 to 3.9; p=0.011) and high pre-chemotherapy NLR (HR, 1.82; 95% CI, 1.1 to 3.0; p=0.020) were independent poor prognostic factors for OS. At the time of PD, sPDL1 was increased significantly compared with pre-chemotherapy sPDL1 (1.59 ng/mL vs. 0.72 ng/mL, p=0.003). CONCLUSION: The sPDL1 at pre-chemotherapy confers the prognostic value for OS in BTC patients under palliative chemotherapy. The dynamics of sPDL1 during chemotherapy correlate with disease burden and have prognostic value.
Biliary Tract Neoplasms ; Biomarkers ; Cohort Studies ; Disease Progression ; Drug Therapy ; Enzyme-Linked Immunosorbent Assay ; Humans ; Multivariate Analysis ; Prognosis

Patients with sickle cell anemia are chronically transfused. Therefore, it is important to prevent the alloimmunization of RBC antigens. The authors identified a high frequency antigen-negative blood group in patients with sickle cell anemia. As the number of foreigners residing in Korea is increasing, it is necessary to know what to consider when transfusing blood to sickle cell anemia patients. Patients with sickle cell anemia should be informed of the exact blood group type using extended RBC typing to confirm the ABO, Rh, Kell, and Duffy blood types at diagnosis or before the first blood transfusion. Extended matched blood transfusion can reduce the risk of alloimmunization of RBC antigens.
Anemia ; Anemia, Sickle Cell* ; Blood Transfusion ; Diagnosis ; Duffy Blood-Group System ; Emigrants and Immigrants ; Erythrocytes* ; Humans ; Korea

OBJECTIVE: Although the reference value of cardiac index (CI) is derived by pulmonary arterial pressure, the use of pulmonary arterial catheterization is limited by low cost effectiveness and many concerns regarding complications. Therefore, relatively noninvasive indirect measurement is used widely perioperatively. The goal of this study was to determine the accuracy of the CI derived by Mobil-O-Graph NG (cCI) noninvasively in patients undergoing general anesthesia by comparing that measured by FloTrac/Vigileo (fCI), the minimal invasive method. METHODS: The Bland-Altman method was used to quantify agreement. Bias (mean difference between fCI-cCI) represents the systematic error between methods and precision (standard deviation of the bias) represents the random error or variability between techniques. The percentage error was considered clinically acceptable, and the tested method (Mobil-O-Graph NG) was regarded as interchangeable with the reference method (FloTrac/Vigileo), if it was below 30%. RESULTS: One hundred and ninety-five patients were included in this study, and CI, measured in the 121 patients. The Bland-Altman analysis revealed a bias −0.01 and the percentage error of 32.4%. And the difference is inversely increased according the mean CI. CONCLUSION: Results showed that CI measured by Mobil-O-Graph NG had a wide limit of agreement with that measured by FloTrac/Vigileo, therefore regarded as not interchangeable.
Anesthesia, General ; Arterial Pressure ; Bias (Epidemiology) ; Cardiac Output ; Catheterization ; Catheters ; Cost-Benefit Analysis ; Humans ; Methods ; Monitoring, Physiologic ; Reference Values

BACKGROUND: Massive hemorrhage due to trauma is one of the major causes of death in trauma patients, and the quick supply of appropriate blood products is critical in order to reduce the mortality rate. We introduced a massive transfusion protocol (MTP) for safe and rapid transfusion of trauma patients. Using records collected since its adoption, we compared the characteristics of MTP applied group (MTP group) and MTP not applied group (non-MTP group) to determine whether there is an indicator for predicting patients to be treated with MTP. METHODS: We retrospectively reviewed the electronic medical records and laboratory findings of patients who received massive transfusions in the trauma emergency room of a single tertiary hospital from February to August 2018. We analyzed various laboratory test results, the amount and ratio of the transfused blood products, and the time required for blood products to be released for the MTP group and the non-MTP group. RESULTS: Of the 54 trauma patients who received massive transfusions, 31 were in the MTP group and 22 in the non-MTP group. There was no significant difference in initial vital signs (except blood pressure) and laboratory test results. Also there was no difference in the amount and ratio of blood products, but the time required for blood product release was shorter in the MTP group. CONCLUSION: There was no significant difference in clinical findings such as initial vital signs and laboratory test results between the MTP and non-MTP groups, but required blood products were prepared and released more quickly for the MTP group.
Cause of Death ; Electronic Health Records ; Emergency Service, Hospital ; Hemorrhage ; Humans ; Mortality ; Retrospective Studies ; Tertiary Care Centers* ; Vital Signs

OBJECTIVES: The demand for hospice has been increasing among patients with cancer. This study examined the current hospice referral scenario for terminally ill cancer patients and created a data form to collect hospice information and a modified health information exchange (HIE) form for a more efficient referral system for terminally ill cancer patients. METHODS: Surveys were conducted asking detailed information such as medical instruments and patient admission policies of hospices, and interviews were held to examine the current referral flow and any additional requirements. A task force team was organized to analyze the results of the interviews and surveys. RESULTS: Six hospices completed the survey, and 3 physicians, 2 nurses, and 2 hospital staff from a tertiary hospital were interviewed. Seven categories were defined as essential for establishing hospice data. Ten categories and 40 data items were newly suggested for the existing HIE document form. An implementation guide for the Consolidated Clinical Document Architecture developed by Health Level 7 (HL7 CCDA) was also proposed. It is an international standard for interoperability that provides a framework for the exchange, integration, sharing, and retrieval of electronic health information. Based on these changes, a hospice referral scenario for terminally ill cancer patients was designed. CONCLUSIONS: Our findings show potential improvements that can be made to the current hospice referral system for terminally ill cancer patients. To make the referral system useful in practice, governmental efforts and investments are needed.
Advisory Committees ; Cancer Care Facilities ; Health Information Exchange* ; Health Level Seven ; Hospices* ; Humans ; Investments ; Methods ; Patient Admission ; Referral and Consultation* ; Terminally Ill* ; Tertiary Care Centers

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*