BACKGROUND

Pre-transfusion testing is done to avoid transfusion morbidity from unexpected RBC antibodies. Available commercial kits from Western brands may not consider racial differences in antibody frequencies between East/Southeast Asians and Western populations. The limited number of blood banks in the Philippines precludes research on RBC antibody screening and identification in the country.

This study aimed to compare RBC antibody screening and identification methods in patients at a tertiary hospital in the Philippines, assess the frequency of major blood group antibodies using both techniques, and review clinical histories of discrepant and nonspecific cases.

Retrospective review showed 118 cases with both screening and identification tests using both conventional tube-based technique and column agglutination or gel-based technique. Antibody frequencies and discrepant or nonspecific results were recorded. Concordance rates were calculated, and differences between the two methods were analyzed using 95% confidence interval (95% CI). Clinical histories of discrepant and nonspecific cases were also reviewed.

The most frequent major blood group was Rh (41 cases or 34.7%), followed by MNS (34 cases or 28.8%) and Kidd (15 cases or 12.7%). The most common antibody was Anti-E (24 cases or 20.3%), followed by Anti-Mia (19 cases or 16.1%), and Anti-M and Anti-c (12 cases each, or 10.2% each). The concordance rate for screening was statistically significant at 72%. Concordance rate for identification was 59.3%, with significant difference in identifying Anti-Mia. Clinical histories for discrepant or nonspecific cases showed previous transfusions, pregnancy, lymphoproliferative conditions, and certain medications.

Statistically significant differences between the two methods were found, with the gel-based technique identifying more Anti-Mia cases. Negative results from the tube-based method do not fully exclude Anti-Mia. These discrepancies highlight the benefit of using both methods for comprehensive RBC antibody screening and identification, done as a complement to the other.

BACKGROUND: Information on biochemical changes following rapid transfusion of blood mixtures in liver transplantation patients is limited. METHODS: A blood mixture composed of red blood cells, fresh frozen plasma, and 0.9% saline was prepared in a ratio of 1 unit:1 unit:250 ml. During massive hemorrhage, 300 ml of the blood mixture was repeatedly transfused. A blood mixture sample as well as pre- and post-transfusion arterial blood samples were collected at the first, third, fifth, and seventh bolus transfusions. Changes in pH, hematocrit, electrolytes, and glucose were measured with a point-of-care analyzer. The biochemical changes were described, and the factors driving the changes were sought through linear mixed effects analysis. RESULTS: A total of 120 blood samples from 10 recipients were examined. Potassium and sodium levels became normalized during preservation. Biochemical changes in the blood mixture were significantly related to the duration of blood bank storage and reservoir preservation (average R2 = 0.41). Acute acidosis and hypocalcemia requiring immediate correction occurred with each transfusion. Both the pre-transfusion value of the patient and the blood mixture value were significant predictors of post-transfusion changes in the body (average R2 = 0.87); however, the former was more crucial. CONCLUSIONS: Rapid infusion of blood mixture is relatively safe because favorable biochemical changes occur during storage in the reservoir, and the composition of the blood mixture has little effect on the body during rapid transfusion in liver recipients. However, acute hypocalcemia and acidosis requiring immediate correction occurred frequently due to limited citrate metabolism in the liver recipients.
Acidosis ; Blood Banks ; Blood Safety ; Blood Transfusion ; Citric Acid ; Electrolytes ; Erythrocytes ; Glucose ; Hematocrit ; Hemorrhage ; Humans ; Hydrogen-Ion Concentration ; Hypocalcemia ; Liver Transplantation* ; Liver* ; Metabolism ; Plasma ; Point-of-Care Systems ; Potassium ; Sodium

BACKGROUND: Disasters themselves can increase the blood transfusion requirements due to an increase in injuries, and can lead to deficiencies in the blood transport system. To prepare for a disaster, it is important to know the actual blood requirements at the time of the disaster and the changes in blood supply according to the type of disaster. METHODS: From March 2018 to May 2018, all RBC transfusion cases at Pusan National University Yangsan Hospital were analyzed retrospectively. The patients were divided into Categories 1 to 3 according to the urgency of transfusion by disease. Priority one was defined as having only a category 1 patient receiving a transfusion, and priority two was defined as an emergency situation where only category 1 and 2 patients could receive transfusions. RESULTS: The amount of RBC concentrates used in this hospital was 53.1 units per day, which was 19.4%, 42.2%, and 38.4% in category 1, 2, and 3, respectively. The results of simulating the number of blood products that can be used according to the priorities when having a blood product inventory held by the blood banks are as follows: 2.45 days (normal), 12.64 days (P1), and 3.97 days (P2) can be used. CONCLUSION: The simulation showed the time of blood transfusion without additional blood supply in the event of a crisis, and will help establish the transfusion countermeasures in the event of a disaster.
Blood Banks ; Blood Transfusion ; Busan ; Disaster Planning ; Disasters ; Emergencies ; Gyeongsangnam-do ; Humans ; Korea ; Retrospective Studies ; Tertiary Healthcare

In terminally ill patients, organ transplantation could be recommended as the treatment of choice. In Korea, living donor liver or kidney transplantation is much more frequent than deceased donor transplantation due to organ shortages from deceased donors. ABO or HLA incompatibility in transplantation can be a major barrier in living donor transplantation. Currently, the rate of ABO incompatible organ transplantation accompanied by desensitization is 20~25% of living donor transplantation, and the blood bank laboratory plays an active role by plasmapheresis. The desensitization of HLA incompatible transplantation in highly sensitized patients is more difficult than that of ABO incompatible transplantation. The HLA antibody is not easy to remove and it is difficult to prevent sensitization. In addition, setting the target treatment goals and predicting the treatment outcomes based on the HLA antibody results are problematic. Therefore, a range of desensitization protocols have been attempted and various therapeutic goals have been introduced. This article reviews the various desensitization methods for antibody removal focusing on HLA incompatible kidney transplantation, and discusses the prognosis of desensitization methods for antibody removal based on the literature.
Blood Banks ; Humans ; Kidney Transplantation ; Korea ; Liver ; Living Donors ; Organ Transplantation ; Plasmapheresis ; Prognosis ; Terminally Ill ; Tissue Donors ; Transplantation ; Transplants

Brian Allgood Army Community Hospital (BAACH) is one of the US military General Hospitals in Korea that have blood services. The author of this paper is a civilian employee who has been working in the blood bank for 37 years. Through this experience, a difference between BAACH and the Korean Medical Center has been observed. First, BAACH performs a blood culture for the sterility test upon the receipt of platelets from the Korean Red Cross, and measures the pH at the end of allowable storage. Second, some military facilities use the Frozen Blood Program as the storage/thawing system of Deglycerolized Red Blood Cells (DRBC) and the use of DRBC. Third, most military facilities have a continuous training education program for those working in the blood bank provided by the Armed Service Blood Program.
Arm ; Blood Banks ; Education ; Erythrocytes ; Hospitals, Community ; Hospitals, General ; Humans ; Hydrogen-Ion Concentration ; Infertility ; Korea ; Military Facilities ; Military Personnel ; Red Cross

BACKGROUND: Automated systems are used widely for pre-transfusion tests in blood banks, in an attempt to reduce effort and human error. We evaluated the clinical performance of an automated blood bank system, ORTHO VISION (Ortho-Clinical Diagnostics, Switzerland), for blood cross-matching. METHODS: Saline cross-matching was performed for 93 tests using 56 samples. Coombs cross-matching was performed for 400 tests using 166 samples. Saline cross-matching was compared for the automated ORTHO VISION and manual tube methods. Coombs cross-matching was compared for the automated ORTHO VISION and manual column agglutination technique (CAT) methods. The evaluation of 32 antibody-positive samples using the automated ORTHO VISION and manual CAT methods was compared by performing 97 cross-matching tests. Additionally, the ORTHO VISION efficiency and carryover were evaluated. RESULTS: The concordance rate of the saline cross-matching results between the manual method and automated ORTHO VISION was 100%. The concordance rate of coombs cross-matching results between manual CAT and automated ORTHO VISION was 97.9%. The concordance rate of cross-matching for antibody positive samples between manual CAT and the automated ORTHO VISION was 97.9%. Coombs cross-matching was efficient using ORTHO VISION, whereas saline cross-matching was efficient using the tube manual method. CONCLUSIONS: ORTHO VISION showed reliable results for cross-matching and was more efficient than manual CAT for coombs cross-matching. Thus, ORTHO VISION can be used for pre-transfusion tests in blood banks.
Agglutination ; Animals ; Automation ; Blood Banks ; Cats ; Humans ; Methods

BACKGROUND: A hemovigilance system is essential to detect and analyze adverse transfusion reactions to various blood components. A blood bank physician has the role of discriminating the adverse transfusion reactions based on the hemovigilance criteria. This study investigated the incidence of adverse transfusion reactions per transfused case and the incidence of adverse transfusion reactions according to the various blood components in recipients. METHODS: From January 2016 to February 2017, 38,689 blood component units were transfused into 3,768 patients. A total of 11,170 transfused cases were reported. The patients’ signs or symptoms were monitored and reported by nurses using an electronic reporting system. A blood bank physician classified the adverse transfusion reactions according to the Korean hemovigilance reporting definitions. RESULTS: The frequency of all transfusion-related events was 469 according to the nursing record. Out of 469 events, 175 (37.3%) were classified as adverse transfusion reactions. The incidence of a febrile nonhemolytic transfusion reaction according to the blood component was highest for red blood cells (1.3%), followed by a platelets (0.8%) and fresh frozen plasma (0.3%). The incidence of allergic reactions was 1.0% (platelets), 0.8% (fresh frozen plasma), and 0.3% (red blood cells). The incidence of febrile nonhemolytic transfusion reactions was lowered significantly by leukocyte-reduction. CONCLUSION: The incidence of adverse transfusion reactions was 37.3% of the transfusion-related events. Therefore, close monitoring by the blood bank physician is essential for safe transfusion. The use of leukocyte-reduced blood components could reduce the incidence of febrile nonhemolytic transfusion reactions.
Blood Banks ; Blood Safety* ; Erythrocytes ; Humans ; Hypersensitivity ; Incidence* ; Nursing Records ; Plasma ; Transfusion Reaction*

BACKGROUND: For effective blood usage and reduction of unnecessary workload at blood banks, we established the maximum surgical blood order schedule (MSBOS) for major elective surgeries and evaluated indicators, including the rate of returned red blood cells (RBCs). METHODS: During August 2016 and May 2017, MSBOS for neurosurgery, thoracic surgery, orthopedic surgery, and general surgery was established using two formulas: the mean units of transfusion per procedure (MSBOS 1) and the mean units of transfusion in transfused patients per procedure (MSBOS 2). The crossmatch to transfusion (C/T) ratio, transfusion probability, and rate of returned RBCs were calculated and analyzed. RESULTS: Based on MSBOS 1, type and screen can be applied to all elective surgeries of the general surgery department. MSBOS 2 was higher than MSBOS 1 in most surgeries ranging from 1 to 3 units. The C/T ratio and transfusion probability of surgery exhibited similar tendencies, and the general surgery department was over-prescribed compared to the actual transfusion requirement. The rate of returned RBCs was the highest in thoracic surgery (32/101, 32%), and the total number of returned RBC unit was the highest in orthopedic surgery (276 of 1131 units). CONCLUSION: MSBOS 1 was the formula corresponding to the purpose of the maximum blood application protocol. Application of an appropriate MSBOS protocol and concurrent utilization of C/T ratio, probability of transfusion, and rate and number of returned units of RBCs will further aid the efficiency of blood bank resources.
Appointments and Schedules* ; Blood Banks ; Erythrocytes ; Humans ; Neurosurgery ; Orthopedics ; Thoracic Surgery

The blood supply can become disrupted in situations of increased demand during unexpected national catastrophes and when a patient needs a rare blood transfusion, which depends on the blood inventory in peacetime. Cryopreservation of blood, which can be stored up to 10 years, represents a possible solution to this problem by avoiding storage lesions. This review describes frozen red cell technologies, quality control issues related to post-thaw red blood cells, and preconditions and practical considerations for implementation of a frozen blood banking system in Korea.
Blood Banks ; Blood Transfusion ; Cryopreservation ; Erythrocytes ; Humans ; Korea ; Quality Control ; Strategic Stockpile*

BACKGROUND: The management of red blood cell inventory in hospital's blood bank is crucial. The Australian Red Cross Blood Service developed a RBC safety stock calculation method (abbreviated as the ‘Australian formula’). In this study, we applied this method to four Korean hospitals to calculate the safe RBC stock level. METHODS: The hospitals included in this study were three tertiary teaching hospitals and one teaching hospital. The number of hospital beds in these hospitals were 1093, 1330, 1400, and 854, respectively. The data were collected from the Korea Blood Inventory Monitoring System of Centers for Disease Control & Prevention. The target/minimal/maximal RBC inventory levels and inventory days (inventory level/average daily usage) by ABO blood types were calculated using the daily red cell transfusion, wastage, and supply data between May and October 2016. RESULTS: The enrolled hospitals showed different levels for the target/minimal/maximal RBC inventory according to each blood group. The average of RBC inventory days in the four hospitals was 4.2 days. For each blood group, RBC inventory days were 3.2~4.4 days for O blood group type, 3.5~4.7 days for A blood group, 3.9~4.5 days for B blood group, and 3.9~5.5 days for AB blood group. CONCLUSION: Because the optimal RBC inventory levels are different depending on the hospital characteristics and the ABO blood group, it is necessary to set the RBC inventory levels for each hospital distinctly. The data obtained in this study will help manage blood product inventory in various hospital blood banks.
Blood Banks ; Centers for Disease Control and Prevention (U.S.) ; Erythrocytes* ; Hospitals, Teaching ; Korea ; Methods ; Red Cross