Iso-oncotic human serum albumin (HSA) is the primary replacement fluid of choice during therapeutic plasma exchange (TPE). Hypersensitivity reactions to HSA are rare, but require proper evaluation and management. In this article, we report two cases of hypersensitivity reactions to 5% HSA during TPE and discuss strategies to address this problem. The first case was a 60-year-old female patient, who was scheduled for TPE for treatment of recurrent focal segmental glomerulosclerosis after ABO-incompatible kidney transplantation. She developed a pruritic rash on her entire body during the first two sessions of TPE using 5% HSA. The third session was conducted using 500 mL normal saline, 1,000 mL 10% pentastarch, and 750 mL 5% HSA, where she eventually developed a pruritic rash when HSA was infused. There were no adverse events during the fourth and fifth session when fresh frozen plasma was used in place of HSA. The second case was a 50-year-old male patient diagnosed with optic neuritis, who was admitted for five sessions of TPE. The patient developed a pruritic rash on his entire body during the first session of TPE using 5% HSA. The patient experienced no adverse events during the following four sessions using fresh frozen plasma. Certain elements contained in HSA, such as albumin aggregates, prekallikrein activator, and caprylate-modified albumin, might be the reason for these hypersensitivity reactions. Careful selection of alternative replacement fluids is important to avoid premature termination of TPE procedures and secure optimal treatment options for patients.
Caprylates ; Exanthema ; Factor XIIa ; Female ; Glomerulosclerosis, Focal Segmental ; Humans ; Hydroxyethyl Starch Derivatives ; Hypersensitivity ; Kidney Transplantation ; Male ; Middle Aged ; Optic Neuritis ; Plasma Exchange ; Plasma ; Serum Albumin

BACKGROUND: Phlebotomy performed for laboratory testing has the potential to cause anemia in newborns and infants. This study investigated the minimum specimen volume required for an automated immunohematology analyzer DAYmate S. METHODS: Three combinations of tubes were evaluated: I. 6 mL EDTA tube, II. 0.5 mL microtainer (on top of 3 mL EDTA tube), and III. 1 mL sample cup (on top of 6 mL EDTA tube). ABO/RhD cell typing was done using centrifuged red cells; unexpected antibody screening was carried out using plasma, and Type & Screening was conducted using whole blood samples. The lowest specimen volume capable of performing 10 repetitive tests without errors was investigated. RESULTS: ABO/RhD cell typing could be performed from I. 30 μL, II. 25 μL, and III. 25 μL. Unexpected antibody screening could be performed from I. 170 μL, II. 150 μL, and III. 140 μL. According to the hematocrit levels, Type & Screening could be performed from 30%, I&III 650 μL, II. 800 μL; 40%, I&III 650 μL, II. 900 μL; and 50%, I&III 1,000 μL, II. Testing using specimen volumes below 1,000 μL was difficult. CONCLUSION: By separating red cells and plasma, pre-transfusion testing of ABO/RhD cell typing and unexpected antibody screening could be conducted with very small specimen volumes using DAYmate S compared to Type & Screening using whole blood. The application of small-sized sample tubes was more competitive and this is expected to be very useful for preventing iatrogenic anemia in neonates and infants less than 4 months old.
Anemia ; Edetic Acid ; Hematocrit ; Humans ; Infant ; Infant, Newborn ; Mass Screening* ; Phlebotomy ; Plasma

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

There has been continuous effort to prevent transfusion-transmitted infection (TTI). Strategies to prevent TTI can be divided into two components: first, determining donor eligibility, and second, managing bacterial contamination of blood products. To determine donor eligibility, medical history taking and screening tests for infectious diseases should be performed. To prevent bacterial contamination, blood collection process should be aseptic, tests for bacterial detection should be performed, and an application of pathogen reduction technology should also be considered. In this review, screening test items and methods, including nucleic acid amplification tests for determining donor eligibility, and precautions for blood collection, bacterial detection methods, and pathogen reduction technology for the prevention of bacterial contamination of blood products were discussed in detail.
Communicable Diseases ; Donor Selection ; Humans ; Mass Screening ; Medical History Taking ; Nucleic Acid Amplification Techniques ; Tissue Donors

Amelanotic melanoma comprises only 1.8~8.1% of malignant melanomas, and is difficult to diagnose clinically due to the lack of the diagnostic evidence of clinical pigmentation. To our knowledge, it is rarely reported, and only 10 cases have been reported in the Korean dermatological literature. It presents rather conflicting features such as a pink or red macule, papule, plaque, or nodule mimicking various benign and malignant conditions; therefore, it is difficult to diagnose. We performed a review of six patients with amelanotic melanoma focusing on differential diagnosis, particularly at the time of the initial visit. Clinical impressions included pyogenic granuloma, dermatofibrosarcoma protuberans, eccrine poroma, epidermal cyst, keloid, pilomatricoma, and squamous cell carcinoma in addition to malignant melanoma. The biopsy specimens were consistent with malignant melanoma with little or no melanin pigment on hematoxylin and eosin and Fontana-Masson stains. Four of the six patients were positive for S-100 and HMB-45, but two patients were positive for S-100 only. We report these cases to remind clinicians of the necessity of including malignant melanoma in the differential diagnosis process when patients show poor and unpredictable responses to treatment after a clinical diagnosis of other benign and malignant conditions.
Biopsy ; Carcinoma, Squamous Cell ; Coloring Agents ; Dermatofibrosarcoma ; Diagnosis ; Diagnosis, Differential* ; Eosine Yellowish-(YS) ; Epidermal Cyst ; Granuloma, Pyogenic ; Hematoxylin ; Humans ; Keloid ; Melanins ; Melanoma ; Melanoma, Amelanotic* ; Pigmentation ; Pilomatrixoma ; Poroma

Therapeutic plasma exchange (TPE) is one possible treatment for patients resistant to conventional antithyroid drugs or requiring urgent attention for thyrotoxicosis. We report a 35-yr-old man with thyrotoxicosis, ultimately attributed to Graves' disease in whom antithyroid drug used initially was soon discontinued, due to abnormal liver function, and replaced by Lugol's solution. Three weeks later, an escape phenomenon (to Lugol's solution) was apparent, so we performed TPE to control the thyrotoxicosis. Two courses of TPE by a centrifugal type machine resulted in diminished levels of thyroid hormone levels, which then rebounded after another two courses of membrane filtration type TPE. However, the patient could be treated with radioactive iodine therapy without any complications at present.
Adult ; Antithyroid Agents/adverse effects/therapeutic use ; Cetirizine/adverse effects/therapeutic use ; Graves Disease/*radiotherapy ; Hepatitis B, Chronic/complications ; Humans ; Iodides/therapeutic use ; Iodine Radioisotopes/*therapeutic use ; Male ; Methimazole/adverse effects/therapeutic use ; Plasmapheresis/*methods ; Thyroid Gland/*pathology ; Thyrotoxicosis/*therapy

We investigated how the dual inhibition of the molecular mechanism of the mammalian target of the rapamycin (mTOR) downstreams, P70S6 kinase (P70S6K) and eukaryotic initiation factor 4E (eIF4E), can lead to a suppression of the proliferation and progression of urothelial carcinoma (UC) in an orthotopic mouse non-muscle invasive bladder tumor (NMIBT) model. A KU-7-luc cell intravesically instilled orthotopic mouse NMIBC model was monitored using bioluminescence imaging (BLI) in vivo by interfering with different molecular components using rapamycin and siRNA technology. We then analyzed the effects on molecular activation status, cell growth, proliferation, and progression. A high concentration of rapamycin (10 microM) blocked both P70S6K and elF4E phosphorylation and inhibited cell proliferation in the KU-7-luc cells. It also reduced cell viability and proliferation more than the transfection of siRNA against p70S6K or elF4E. The groups with dual p70S6K and elF4E siRNA, and rapamycin reduced tumor volume and lamina propria invasion more than the groups with p70S6K or elF4E siRNA instillation, although all groups reduced photon density compared to the control. These findings suggest that both the mTOR pathway downstream of eIF4E and p70S6K can be successfully inhibited by high dose rapamycin only, and p70S6K and Elf4E dual inhibition is essential to control bladder tumor growth and progression.
Animals ; Cell Line ; Cell Proliferation/drug effects/genetics ; Cell Survival/drug effects ; Disease Progression ; Eukaryotic Initiation Factor-4E/*antagonists & inhibitors/genetics ; Female ; Mice ; Mice, Nude ; Mucous Membrane/pathology ; Phosphorylation/drug effects ; RNA Interference ; RNA, Small Interfering ; Ribosomal Protein S6 Kinases, 70-kDa/*antagonists & inhibitors/genetics ; Signal Transduction/drug effects ; Sirolimus/*pharmacology ; TOR Serine-Threonine Kinases/*antagonists & inhibitors/metabolism ; Urinary Bladder Neoplasms/genetics/*pathology ; Urothelium/pathology

We investigated how the dual inhibition of the molecular mechanism of the mammalian target of the rapamycin (mTOR) downstreams, P70S6 kinase (P70S6K) and eukaryotic initiation factor 4E (eIF4E), can lead to a suppression of the proliferation and progression of urothelial carcinoma (UC) in an orthotopic mouse non-muscle invasive bladder tumor (NMIBT) model. A KU-7-luc cell intravesically instilled orthotopic mouse NMIBC model was monitored using bioluminescence imaging (BLI) in vivo by interfering with different molecular components using rapamycin and siRNA technology. We then analyzed the effects on molecular activation status, cell growth, proliferation, and progression. A high concentration of rapamycin (10 microM) blocked both P70S6K and elF4E phosphorylation and inhibited cell proliferation in the KU-7-luc cells. It also reduced cell viability and proliferation more than the transfection of siRNA against p70S6K or elF4E. The groups with dual p70S6K and elF4E siRNA, and rapamycin reduced tumor volume and lamina propria invasion more than the groups with p70S6K or elF4E siRNA instillation, although all groups reduced photon density compared to the control. These findings suggest that both the mTOR pathway downstream of eIF4E and p70S6K can be successfully inhibited by high dose rapamycin only, and p70S6K and Elf4E dual inhibition is essential to control bladder tumor growth and progression.
Animals ; Cell Line ; Cell Proliferation/drug effects/genetics ; Cell Survival/drug effects ; Disease Progression ; Eukaryotic Initiation Factor-4E/*antagonists & inhibitors/genetics ; Female ; Mice ; Mice, Nude ; Mucous Membrane/pathology ; Phosphorylation/drug effects ; RNA Interference ; RNA, Small Interfering ; Ribosomal Protein S6 Kinases, 70-kDa/*antagonists & inhibitors/genetics ; Signal Transduction/drug effects ; Sirolimus/*pharmacology ; TOR Serine-Threonine Kinases/*antagonists & inhibitors/metabolism ; Urinary Bladder Neoplasms/genetics/*pathology ; Urothelium/pathology

We found an error in our published article.

PURPOSE: Complications after prostate biopsy have increased and various causes have been reported. Growing evidence of increasing quinolone resistance is of particular concern. In the current retrospective study, we evaluated the incidence of infectious complications after prostate biopsy and identified the risk factors. MATERIALS AND METHODS: The study population included 1,195 patients who underwent a prostate biopsy between January 2007 and December 2012 at Chung-Ang University Hospital. Cases of febrile UTI that occurred within 7 days were investigated. Clinical information included age, prostate-specific antigen, prostate volume, hypertension, diabetes, body mass index, and biopsy done in the quinolone-resistance era. Patients received quinolone (250 mg intravenously) before and after the procedure, and quinolone (250 mg) was orally administered twice daily for 3 days. We used univariate and multivariate analysis to investigate the predictive factors for febrile UTI. RESULTS: Febrile UTI developed in 39 cases (3.1%). Core numbers increased from 2007 (8 cores) to 2012 (12 cores) and quinolone-resistant bacteria began to appear in 2010 (quinolone-resistance era). In the univariate analysis, core number> or =12 (p=0.024), body mass index (BMI)>25 kg/m2 (p=0.004), and biopsy done in the quinolone-resistance era (p=0.014) were significant factors. However, in the multivariate analysis adjusted for core number, the results were not significant, with the exception of BMI>25 kg/m2 (p=0.011) and biopsy during the quinolone-resistance era (p=0.035), which were significantly associated with febrile UTI. CONCLUSIONS: Quinolone resistance is the main cause of postbiopsy infections in our center. We suggest that further evaluation is required to validate similar trends. Novel strategies to find alternative prophylactic agents are also necessary.
Aged ; Anti-Bacterial Agents/*therapeutic use ; Antibiotic Prophylaxis/methods ; Cross Infection/etiology/prevention & control ; *Drug Resistance, Bacterial ; Fluoroquinolones/*therapeutic use ; Humans ; Image-Guided Biopsy/*adverse effects/methods ; Incidence ; Male ; Middle Aged ; Prostatic Neoplasms/*pathology ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors ; Ultrasonography, Interventional ; Urinary Tract Infections/epidemiology/*etiology/prevention & control