BACKGROUND: Although transfusion in neonates needs to be strictly regulated due to the vulnerability of neonates, there is lack of systematic studies and the working process is not well-established. This study was aimed to point out the problems of current status and to improve the efficiency of systems used in blood aliquots for neonatal transfusions. METHODS: Total red blood cell (RBC) aliquots were analyzed between May 2009 and January 2016 in the neonate intensive care unit. We investigated the aliquot number, issued day interval from the first issued aliquot among the post-aliquots, patients' blood type, and discarded RBC units among the requested RBC units. RESULTS: Of the 472 RBC aliquots, 95.4% (450/472) were divided into two units. The distribution of patients' blood type was similar to that of the Korean population, in decreasing order: A blood group (34.3%), B group (28.2%), and O group (27.5%). The second, third, and forth units of post-aliquots were taken after an average of 49.9 (0∼617.9) hours. Among the post-aliquots, the number of units discarded without use was 22.5%. CONCLUSION: According to the evaluation of current status for neonatal transfusions, we should use aliquot RBC properly and reduce unnecessary requests for aliquot RBC. In addition, in order to reduce the number of near misses, we propose a new label to be attached on the aliquotted blood bags and suggest a development of electronic blood issuing system.
Erythrocytes* ; Humans ; Infant, Newborn ; Intensive Care Units

BACKGROUND: When unexpected antibodies are identified, selection for specific antigen-negative blood units is needed in order to ensure transfusion safety. We estimated the number of blood units required for antigen testing to obtain specific antigen-negative units in Korean medical institutes. METHODS: We analyzed cases of selection for specific antigen-negative units for recipients who had antibodies identified in Seoul National University Bundang hospital from January 2008 to December 2010 and cases entered into the KRBP (Korean Rare Blood Program) online database from July 2013 to February 2014 from eight medical institutes. RESULTS: A total of 559 cases of 266 patients were analyzed. The antigen types requiring two units on average for one specific antigen-negative unit were E, P1, and Lea. Three units on average were required for one Fyb-negative blood unit, four units for one Jka-negative unit, four units for one Jkb-negative unit, 4.5 units for one Leb-negative unit, five units for one C-negative unit, six units for one M-negative unit, and seven units for one S-negative unit. In cases of obtaining specific antigen-negative units for more than one antigen type, three units on average were required for one E, c-negative unit and seven units for one C, e-negative unit. Other multiple antigen-negative units required up to 20 units. CONCLUSION: The accurate antigen-negative frequency in the Korean population should be investigated. Following this effort, the number of blood units required for selection of specific antigen-negative units could be predicted and practical measures for obtaining specific antigen-negative blood units could be suggested for Korean medical institutes.
Academies and Institutes* ; Antibodies ; Humans ; Korea ; Seoul

BACKGROUND: The Rh blood group includes several antigens, of which D, C, E, c, and e are clinically important. Although nucleic acids from whole blood can be used for Rh blood group genotyping, it is also possible to genotype free circulating fetal nucleic acids from plasma and serum. We performed Rh blood group phenotyping and genotyping using nucleic acids from whole blood and free circulating nucleic acids from plasma and serum, respectively. The results were compared. METHODS: Forty-four blood samples were phenotyped and genotyped for RhD and RhCE blood groups. Phenotyping was performed by hemagglutination assay. Further tests were performed on RhD-negative samples. Nucleic acids were extracted from whole blood, plasma, and serum. Plasma and serum were prepared after filtration and genotyped by real-time polymerase chain reaction. RESULTS: RhD blood group results showed one (2.3%) discrepant case in which the DEL phenotype appeared wild RHD genotype. Among nucleic acids, there were seven discrepant results: two from plasma and five from serum based on whole blood nucleic acids. RhCE blood group results showed three (6.8%) phenotype-genotype discordances. Among nucleic acids, seven (15.9%mpared to phenotypes. Kappa coefficients of serum were lower than those of plasma. CONCLUSION: RHD and RHCE genotype could be identified by assaying free circulating nucleic acids in plasma or serum. This study suggests that plasma is more reliable than serum as a specimen for RHD and RHCE genotyping of free circulating nucleic acids.
Blood Group Antigens ; Filtration ; Genotype ; Hemagglutination ; Nucleic Acids* ; Phenotype ; Plasma* ; Real-Time Polymerase Chain Reaction

BACKGROUND: CD36 deficiency was first identified in a patient who showed refractoriness to HLA-matched platelet transfusion. CD36 deficiency can be divided into two subgroups. The type I phenotype is characterized by platelets and monocytes exhibiting CD36 deficiency. The type II phenotype lacks surface expression of CD36 in platelets only. In this study, the frequency of type I and type II CD36 deficiency in Koreans was evaluated. METHODS: A total of 220 samples were randomly selected from subjects who requested CBC testing from August 2013 to February 2014. The expression levels of CD36 on platelets and monocytes were analyzed by flow cytometry using FITC-conjugated CD36 antibodies. Correlation between the median fluorescence intensity of CD36 and the number of platelets or monocytes was evaluated using Pearson's correlation coefficient. RESULTS: Type I phenotype, lacking CD36 on platelets and monocytes, was present in 0.9% and type II, lacking CD36 on platelets, was present in 3.2%. The median fluorescence intensity of CD36 did not show correlation with the count of platelets or monocytes. CONCLUSION: Type I subjects may produce alloantibodies against CD36 following transfusion or pregnancy, leading to refractoriness to HLA-matched platelet transfusion, post-transfusion purpura, or neonatal immune thrombocytopenia. Studies to determine exact frequency of CD36 deficiency in Koreans, including a larger population, should be conducted, and more case reports on patients immunized against CD36 are also needed in order to elucidate the clinical importance and relevance of CD36 deficiency testing and the transfusion of CD36-deficient platelets.
Antibodies ; Blood Platelets ; Flow Cytometry ; Fluorescence ; Humans ; Isoantibodies ; Monocytes* ; Phenotype ; Platelet Transfusion ; Pregnancy ; Purpura ; Thrombocytopenia

BACKGROUND: Xenotropic murine leukemia virus-related virus (XMRV) has been detected in peripheral blood mononuclear cells (PBMNs), therefore, it has been regarded as being infectious and transmittable by transfusion. Thus, we attempted to detect XMRV in blood samples in order to confirm the absence of XMRV from blood donors. METHODS: We achieved 165 blood donors and four chronic fatigue syndrome (CFS) patients. We performed real-time polymerase chain reaction using the LightCycler 480 (Roche, Penzberg, Germany) for the gag and env genes of the XMRV genome. DNA was extracted from peripheral blood samples. We used Uracil-N-Glycosylase in order to prevent contamination and DNA extracted from mouse embryonic fibroblasts (MEF) for amplification control. RESULTS: No XMRV was detected in any of the blood donors in both the gag and env genes. In four CFS patients, amplification was not detected in the gag gene. In two of four CFS patients, amplifications were detected and the melting temperature was in agreement with that of MEF control in the env gene. CONCLUSION: Although XMRV was not present in blood samples from blood donors, this is the first report on XMRV in Korean blood donors. We confirmed the absence of XMRV in Korean blood donors, the same as studies reported in other countries.
Animals ; Blood Donors ; DNA ; Fatigue Syndrome, Chronic ; Fibroblasts ; Freezing ; Genes, env ; Genes, gag ; Genome ; Humans ; Mice ; Real-Time Polymerase Chain Reaction ; Xenotropic murine leukemia virus-related virus

BACKGROUND: Alloimmunization of human platelet antigens (HPA) is associated with clinically significant disease, such as platelet refractoriness, neonatal alloimmune thrombocytopenia, or posttransfusion purpura. It is determined by single nucleotide polymorphism of genes for platelet membrane glycoprotein. To date, approximately 27 HPAs have been discovered, and their frequencies differ depending on ethnicity and country. METHODS: We conducted an investigation of prevalence of HPA in the Korean population using a multiplex single-base primer extension reaction (SNaPshot). With 84 specimens from healthy donors, HPA genotyping was performed on 11 different HPAs, including HPA-1, -2, -3, -4, -5, -6, -7, -8, -9, -13, and -15. RESULTS: A total of 90 blood samples were genotyped. The genotype frequencies of HPA were as follows: HPA-1a/1a: 100.0%, -2a/2a: 83.3%, -2a/2b: 14.3%, -2b/2b: 2.4%, -3a/3a: 39.3%, -3a/3b: 52.4%, -3b/3b: 8.3%, -4a/4a: 100.0%, -5a/5a: 95.2%, -5a/5b: 4.8%, -6a/6a: 94.0%, -6a/6b: 6.0%, -7a/7a: 100.0%, -8a/8a: 100.0%, -9a/9a: 97.6%, -9a/9b: 2.4%, -13a/13a: 100.0%, -15a/15a: 23.8%, -15a/15b: 51.2%, and -15b/15b: 25.0%. CONCLUSION: The SNaPshot assay was employed for detection of SNPs in various clinically significant HPA genes. In addition to well-known frequencies of previously reported HPA-1 to -8, this study showed frequencies of HPA-9, -13, and -15 in Koreans for the first time. The SNaPshot technique might be suitable for use in actual clinical testing in patients with platelet alloimmunization.
Antigens, Human Platelet ; Blood Platelets ; Genotype ; Humans ; Membrane Glycoproteins ; Polymorphism, Single Nucleotide ; Prevalence ; Purpura ; Purpura, Thrombocytopenic ; Thrombocytopenia, Neonatal Alloimmune ; Tissue Donors

BACKGROUND: Tissues for transplantation can save lives or restore essential functions. According to national policies and regulations, access to suitable transplantation, as well as the level of safety, quality, efficacy of donation, and transplantation of tissues, differ significantly between countries. We reviewed a few guidelines on tissue banking from the aspect of screening tests. In addition, four-year experience with screening panels for donated bones and donors at a tertiary hospital is introduced. METHODS: Seven national and international guidelines for screening tests for donors and donated tissues were reviewed. At our institution, screening tests for donation involve two steps. At retrieval, the first screening panel, including ABO/Rh typing, unexpected antibody screening, VDRL, HBsAg, anti-HBs, anti-HBc IgM, anti-HCV, anti-HIV, and microbiological cultures was performed. The second screening panel, including the same tests, except culture studies, was performed after 90 days. From 2008 to 2011, a total of 245 retrievals of bone tissue were performed and the screening panel results were analyzed. RESULTS: Mandatory screening serologic tests for living donors can differ according to local law or regulation and/or screening for endemic diseases. At our institution, among 245 donated bones for a period of four years, 61 bone tissues were discarded due to noncompliance for the second screening (n=32), contamination or no culture study results (n=9), abnormal serologic test results (n=8), and so on. CONCLUSION: Donor screening policies for tissue banking are various according to national laws or endemic disease status. Second screening tests with consideration of the window period should be adopted.
Adoption ; Bone and Bones ; Donor Selection ; Endemic Diseases ; Hepatitis B Surface Antigens ; Humans ; Immunoglobulin M ; Jurisprudence ; Living Donors ; Mandatory Testing ; Mass Screening ; Serologic Tests ; Social Control, Formal ; Tertiary Care Centers ; Tissue Banks ; Tissue Donors ; Transplants

BACKGROUND: For pretransfusion testing, ABO and D antigen tests along with unexpected antibody screening tests are performed. When unexpected antibodies are identified, selection for specific antigen-negative blood units is needed in order to ensure safety of transfusion. METHODS: A questionnaire survey was conducted from August 23 to September 10, 2012 in 36 medical institutes in order to evaluate the current status of management for specific antigen-negative blood units in Korea. The questionnaire consisted of a method for detection of unexpected antibodies, the number of antibodies identified in the last year, and the antigen tests performed for specific antigen-negative blood units. For the institutes where blood donations are obtained, we asked about the enrollment of donors for specific antigen-negative or rare blood types. RESULTS: Among the 36 institutes, antigen testing for specific antigen-negative blood units was performed in 20 institutes. Of the remaining 15 institutes, except for one institute which answered as not applicable, eight institutes requested blood units at blood centers and another seven institutes replaced antigen tests with crossmatching tests. Among the 21 institutes where blood donations are obtained, two institutes had enrolled donors for specific antigen-negative or rare blood types. CONCLUSION: For selection of specific antigen-negative blood units for recipients who have identified antibodies, standardization of antibody detection tests and antigen tests is needed. In addition, the accurate antigen frequency in the Korean population should be investigated and donors for specific antigen-negative or rare blood types should be enrolled and managed systematically. Following these efforts, practical measures for obtaining specific antigennegative blood units could be suggested for medical institutes in Korea.
Academies and Institutes ; Antibodies ; Blood Donors ; Humans ; Korea* ; Mass Screening ; Methods ; Tissue Donors ; Surveys and Questionnaires

Good's syndrome (thymoma with immunodeficiency) is a rare cause of combined B-cell and T-cell immunodeficiency in adults. We present here a case of Good's syndrome involving a 52 year-old man with an ABO blood group abnormality. He had undergone surgery for thymoma with myasthenia gravis 27 years ago. He also had a history of pulmonary tuberculosis, herpes zoster and pure red cell aplasia. On admission, he was suspected of having pneumonia, and S. pneumoniae was isolated from blood culture. The immunoglobulin levels were markedly decreased. Lymphocyte subset analysis revealed the absence of CD19+ B cells. The result of ABO typing showed a normal strong reaction on the cell typing, but a relatively weak reaction on the serum typing. Therefore, we performed ABO genotyping to confirm his ABO type, which was revealed to be B/O1 . This case suggests that ABO typing should be performed when the diagnosis of Good's syndrome is made. Moreover, Good's syndrome (thymoma with hypogammaglobulinemia) should be considered and evaluated for in patients with a weak ABO reverse type.
Adult ; B-Lymphocytes ; Herpes Zoster ; Humans ; Immunoglobulins ; Lymphocyte Subsets ; Myasthenia Gravis ; Pneumonia ; Red-Cell Aplasia, Pure ; T-Lymphocytes ; Thymoma ; Tuberculosis, Pulmonary

BACKGROUND: Anti-K is one of the most significant unexpected antibodies that cause hemolytic transfusion reactions. Individuals with anti-K have to be transfused with K antigen-negative red cells. Although Koreans rarely have the K antigen, we have detected three cases of anti-K and we analyzed the Kell blood group genotypes for the KEL*1/KEL*2 alleles at the same time. METHODS: We analyzed the KEL*1/KEL*2 allele genotypes from 261 blood donors at Seoul National University Bundang Hospital. Kell genotyping were carried out using polymerase chain reaction (PCR) and restriction enzyme length polymorphism (RFLP). Identification of anti-K was performed using three kinds of methods; 37degrees C albumin, an anti-human globulin phase tube, a bead cassette and a gel card. Three cases of anti-K also underwent PCR with a sequence specific primer (SSP) for Kell genotyping. For comparison, the KEL*1 allele (698C>T) was synthesized by site-directed-mutagenesis. RESULTS: All 261 donors were KEL*2/KEL*2 homozygotes and a digested KEL*1 allele was not found. The three patients with anti-K were also KEL*2/KEL*2 homozygotes and the reactivities of the anti-K identification test were the same. CONCLUSION: The KEL gene frequency for the KEL*1/KEL*2 allele corresponded with that of the Kell phenotype, as was previously reported. We experienced three cases of anti-K and two out of the three were assumed that they had been transfused with the K antigen-positive blood of foreigners. This study revealed that the possibility of anti-K alloimmunization and hemolytic transfusion reactions cannot be excluded in Koreans.
Alleles ; Antibodies ; Antigens, Bacterial ; Antigens, Surface ; Blood Donors ; Blood Group Incompatibility ; Emigrants and Immigrants ; Gene Frequency ; Genotype ; Homozygote ; Humans ; Phenotype ; Polymerase Chain Reaction ; Tissue Donors