The Rh blood group D antigen is the most immunogenic of all antigens, next to ABO antigens. Anti-D immunization is clinically important since it may cause clinical problems, such as severe hemolytic transfusion reactions and hemolytic disease of the newborn. DEL is an extremely weak D variant that cannot be detected by basic serologic typing and is typed as D-negative without the absorption-elution techniques and RHD genotyping. Of the DEL phenotype, RHD (c.1227G>A) allelic variant is the most common in Korea. The DEL phenotype has been considered to carry only a few D antigens to induce anti-D immunization, but a few cases have reported that this allelic variant is capable of inducing anti-D immunization in a D-negative recipient, for which it is clinical significant. Herein, we present a case of primary anti-D alloimmunization in a RhD negative patient after receiving RHD (c.1227G>A) DEL red cell transfusion identified by serological and molecular tests, including RHD genotyping.
Erythrocyte Transfusion* ; Erythrocytes* ; Humans ; Immunization ; Infant, Newborn ; Korea ; Phenotype ; Transfusion Reaction

BACKGROUND: Gamma or X-ray irradiation of blood components is used to prevent transfusion associated graft-versus-host disease (TA-GVHD). In this study, we assessed the current status of irradiated blood components and blood irradiators in Korean medical institutes. METHODS: We surveyed 306 medical institutes in Korea by a questionnaire, between August 2015 and October 2015. Institutions were asked to answer 9~16 questions, including whether they had facilities for irradiation of blood, type of irradiators used, dose of irradiation used, and if they did not have irradiation facilities, they were asked whether their blood components were irradiated. RESULTS: One-hundred and ninety-seven (64.4%) out of 306 questionnaires were returned and analyzed: 96 institutions provide irradiated blood, and 101 institutions do not use irradiated blood components. Forty-eight institutions have on site facilities with gamma blood irradiator for the irradiation of blood components and uses a dose of 20 to 50 Gy. Of the 48 institutions without facilities that use irradiated blood components, 38 (79.2%) have their blood components by referral to Korean Red Cross Blood Centers and 9 (18.8%) refer to other medical institutes for their irradiation needs. The survey showed that there is lot of regional variation in the supply and demand of irradiated blood components in Korea. CONCLUSION: Our survey does suggest that the establishment of the supply system for irradiated blood component by nation-wide blood establishments may provide national nuclear safety and stability of irradiated blood supply. It may also alleviate some regional disparity for the transfusion service of irradiated blood in Korea.
Academies and Institutes* ; Graft vs Host Disease ; Korea ; Red Cross ; Referral and Consultation

BACKGROUND: Platelets (PLTs) stored in platelet additive solution (PAS) presents potential benefits in clinical use by reducing the risk of several plasma-associated adverse transfusion reactions and more plasma may be recovered for fractionation. In this study, we compared in vitro characteristics of apheresis PLTs stored in CompoSol PS (Fenwal, Lake Zurich, IL, USA), InterSol (Fenwal, Lake Zurich, IL, USA), SSP+ (MacoPharma, Tourcoing, France), T-PAS+ (Terumo BCT, Lakewood, CO, USA), or plasma to evaluate the effectiveness of PAS. METHODS: PLTs were collected two times by apheresis from 12 healthy volunteers in a study comparing four kinds of PASs with 35% autologous plasma and 100% plasma-stored apheresis PLTs. The parameters of PLTs, including PLT counts, pH, PLT activation markers, blood gases, and metabolic variables were assessed up to 7-day. RESULTS: The results of in vitro assay including PLT concentration, mean PLT volume, pH, and blood gases for PLTs in four kinds of PASs were similar to those in 100% plasma PLTs. All units had Day 5 pH greater than 6.2. In vitro quality rating results, PLTs in T-PAS+ had a rating of 5, 4 for CompoSol PS, 2 for SSP+, 1 for InterSol, and 2 for plasma on Day 5. CONCLUSION: Partial replacement of plasma with CompoSol PS, SSP+, or T-PAS+ in PLTs showed better or equivalent quality and preservability of PLTs compared to PLTs in 100% plasma. The use of PAS for storage of PLTs in clinical practice may have an advantage as PAS-stored PLTs have a reduced volume of plasma.
Blood Component Removal* ; Blood Group Incompatibility ; Blood Platelets* ; Gases ; Healthy Volunteers ; Hydrogen-Ion Concentration ; Lakes ; Plasma

BACKGROUND: Electronic Donor Health Questionnaire (e-DHQ) could prevent omissions in filling in the questionnaire. Compared with the paper Donor Health Questionnaire (p-DHQ), it can expect honest answers from donors to the questions relating to high risk behaviors. The aim of this study is to evaluate the effect of e-DHQ on the answers from donors by analyzing variations of the reasons for deferral after the introduction of e-DHQ to the Korean Red Cross (KRC). METHODS: The reasons for deferral determined by p-DHQ in 2008~2011 and by e-DHQ in 2011~2014, which have been accumulated in the database of the Blood Information Management System in KRC, were analyzed and compared. RESULTS: The results showed that the deferral rates for the general health status and medication taken were 0.47% (P=0.0100) and 0.16% (P=0.0103) higher in e-DHQ than in p-DHQ. In particular, for questions including hunger, lack of sleep, fatigue, endoscopy, dental treatment, surgery, tattoo, and acupuncture, the proportion of answers was higher in e-DHQ than in p-DHQ. CONCLUSION: The deferral rates for general health status and medication taken increased after the implementation of e-DHQ. The rate of deferral by some details of general health status, medical treatment for recent one month, and history for recent one year also increased because e-DHQ induced donors to give straightforward answers. e-DHQ is expected to contribute to the strengthening of health protection of blood donors and recipients. However the questions relating to high risk behaviors should be reformed so that honest answers can be induced from donors.
Acupuncture ; Blood Donors ; Endoscopy ; Fatigue ; Humans ; Hunger ; Information Management ; Red Cross ; Risk-Taking ; Tissue Donors*

BACKGROUND: Since 2001, the Korean Red Cross has performed malaria antibody test for blood donors in malaria-risk areas to prevent transfusion-transmitted malaria. However, due to insufficient sensitivity and specificity the malaria antibody assay is not considered an efficient screening method. Therefore, we have considered discontinuing malaria antibody testing for blood donors. METHODS: We analyzed the results of malaria antibody test from 2001 to 2014 utilizing data from the Blood Information Management System of the Korean Red Cross. RESULTS: Among 16,650,812 donations tested from 2001 to 2014, 50,143 donations (0.30%) showed positive results. However, there was no truly infected case at the time of donation. The positive rate among blood donations was between 34 and 39 per 10,000 in 2001, but between 9 and 10 per 10,000 in 2014. There was no interregional disparity in the positive rate of blood donations. CONCLUSION: Korea is in a malaria elimination phase and malaria antibody testing in limited areas is not effective, therefore we propose discontinuing the malaria antibody test.
Blood Donors* ; Humans ; Information Management ; Korea ; Malaria* ; Mass Screening* ; Red Cross ; Sensitivity and Specificity

BACKGROUND: In the Korean Red Cross, anti-HTLV (Human T-cell lymphotropic virus)-1/2 screening assay has been performed in all donated blood except plasmapheresis since April 2009. For anti-HTLV-1/2 positive donors, both Western blot (WB) and nucleic acid amplification test (NAT) are performed as confirmatory assays. In this study, we evalutated the efficiency of the current confirmatory assay scheme to improve the confirmatory assay scheme for anti-HTLV1/2. METHODS: The results of the HTLV confirmatory assay from April 15th 2009 to April 14th 2015 were analyzed using the Blood Information Management System of the Korean Red Cross. We also investigated the current situation in other countries. RESULTS: Of 12,923,854 donations, 3,483 (0.027%) showed positive results in anti-HTLV-1/2. Of the 3,483 donations, 499 (14.3%) showed positive results in WB or NAT or both. The number of positive cases in both was 461. Therefore, the concordance rate was 92.4%. In the cases of positive results only in NAT, the WB results were all indeterminate (ID). Most countries are using immunoblot assay as a confirmatory assay for anti-HTLV positive blood donors. In the results, there were no cases of positive result in only NAT with a negative result in immunoblot assay. CONCLUSION: It was considered that the accomplishment of only WB as a confirmatory assay for anti-HTLV-1/2 positive donors may be sufficient in the aspect of safety and economics. However, in the case of WB ID result, it may be better to perform NAT as a supplemental test.
Blood Donors* ; Blotting, Western ; Humans ; Information Management ; Mass Screening ; Nucleic Acid Amplification Techniques ; Plasmapheresis ; Red Cross ; T-Lymphocytes ; Tissue Donors

BACKGROUND: While plateletpheresis donation results in less red blood cell loss and therefore less depletion of storage iron, repeated plateletpheresis can also lead to iron depletion. To determine the safety of regular plateletpheresis donations, this study estimated donor's iron status according to age, gender, number of donations, and donation interval. METHODS: The study population included 5,109 plateletpheresis donors (4,824 males, 285 females), who passed the hemoglobin (Hb) criteria for plateletpheresis donation of 12.0 g/dL or more in an inclusion period (September 2013~November 2013). During donor screening, serum ferritin levels were measured for assessment of iron status of plateletpheresis donors. RESULTS: Mean age of donors was 30.4 years (range: 17~59). Donors with a history of donation of more than 3 years accounted for 89.3% and 74.0% in males and females, respectively. Mean donation interval and annual donation number in male (female) donors was 11.9 (7.2) weeks and 4.2 (8.7) times, respectively. Approximately 37.8% of male donors and 64.2% of female donors had a serum ferritin level of less than 15 ng/mL. Serum ferritin levels showed correlation with donation interval, as the percentage of donors with a low ferritin level decreased with increase in donation interval (rho: 0.191~0.438, P<0.001). Serum ferritin levels also showed correlation with annual plateletpheresis number (rho: -0.261~-0.411, P<0.001). CONCLUSION: Depleted iron store was observed in nearly 40% of donors who had acceptable Hb levels for plateletpheresis donation. Hb pre-donation screening is not sufficient to reduce the risk of iron deficiency in regular plateletpheresis donors.
Anemia, Iron-Deficiency ; Blood Donors ; Donor Selection ; Erythrocytes ; Female ; Ferritins* ; Humans ; Iron ; Male ; Mass Screening ; Plateletpheresis* ; Tissue Donors*

BACKGROUND: Determination of the hemoglobin (Hb) levels of prospective blood donors has been performed on capillary blood obtained by finger prick using a gravimetric CuSO4 method. Noninvasive Hb testing devices based on pulse oximetry technology have recently been developed. This study was conducted to evaluate the performance of two noninvasive Hb testing devices, NBM 200 and Pronto-7 as a predonation Hb screening test. METHODS: Hb levels of 993 blood donors (727 males, 266 females) were measured using five methods: two noninvasive methods, CuSO4 method, HemoCue, and hematology analyzer (Sysmex KX-21N). The hematology analyzer was considered as the reference method. RESULTS: Compared with Hb levels of the hematology analyzer, the bias was 0.7 g/dL for NBM 200, 0.1 g/dL for Prtonto-7, and 0.4 g/dL for HemoCue. The intraclass correlation coefficients of Hb measurements compared to the hematology analyzer were 0.57 (95% CI: 0.25~0.73) for NBM 200, 0.73 (95% CI: 0.69~0.75) for Pronto-7, and 0.87 (95% CI: 0.69~0.93) for HemoCue. The ability to detect Hb <12.5 g/dL and > or =12.5 g/dL was 16.4% and 99.2% for NBM 200, 55.8% and 95.9% for Pronto-7, 60.0% and 98.6% for HemoCue and 81.8% and 95.2% for the CuSO4 method, respectively. CONCLUSION: Unsatisfactory results were obtained using the noninvasive Hb testing devices for a predonation Hb screening test, although they have the apparent advantage of reducing pain and stress in donors thereby increasing donor satisfaction. However, for application in the blood donation setting, performance of these devices should be improved.
Bias (Epidemiology) ; Blood Donors ; Capillaries ; Fingers ; Hematology ; Humans ; Male ; Mass Screening ; Oximetry ; Prospective Studies ; Tissue Donors

Recently, the emergency of Middle East Respiratory Syndrome in Korea raised public concern regarding emerging infectious disease (EID) and affected the strategy for blood safety. Although some cases of EID such as West Nile virus in the United States and hepatitis E virus in Japan emerged in a restricted area, the emergence can rapidly affect the situation in other countries in a globalized society with advancements in transportation and international exchange. Because the risk of transfusion-mediated infection may occur by the agent of EID which can be transmitted through blood, the strategy for safety must be considered for agents that were not tested in the stage of blood donor screening. We reviewed the characteristics of transfusion-transmissible EIDs raising concerns worldwide and the strategies which had been adopted.
Blood Donors ; Blood Safety ; Communicable Diseases, Emerging* ; Emergencies ; Hepatitis E virus ; Humans ; Japan ; Korea ; Mass Screening ; Middle East ; Transportation ; United States ; West Nile virus

BACKGROUND: Establishment of a national reference panel for syphilis antibodies is necessary to evaluate the performance of in-vitro diagnostic tests for syphilis and to verify test quality. This study aimed to establish a national reference panel for syphilis antibodies, to assess the suitability of a panel for non-treponemal and treponemal testing, and to assess the reactivity of the various tests currently in use. METHODS: Treponemal pallidum particle agglutination (TPPA)-positive and -negative fresh frozen plasma samples were obtained. After the fresh frozen plasma was converted to serum by defibrination, the samples were pooled. Two candidate reference standards containing no syphilis antibodies and 10 candidate reference standards containing syphilis antibodies were prepared on the basis of reactivity in the TPPA assay. Candidate reference standards were tested by three laboratories using five non-treponemal tests and four treponemal tests. RESULTS: All three laboratories reported positive non-treponemal test results for the mixed-titer performance panel (MP)/6-MP/12. MP/1, MP/2, and MP/3 were negative for non-treponemal tests. MP/4 and MP/5 were reported either as positive or negative according to the laboratories. All laboratories reported positive TPPA results for MP/3-MP/12 and negative results for MP/1 and MP/2. No significant difference was detected among the treponemal testing results in three laboratories. CONCLUSIONS: We established 12 candidate national reference standards containing various concentrations of syphilis antibodies. A collaborative study using nine tests demonstrated that 12 candidate national reference standards presented consistent results, except a few assays with low sensitivity, and thus could be used as a national reference panel for syphilis antibody testing.
Agglutination ; Antibodies* ; Diagnostic Tests, Routine ; Korea* ; Plasma ; Syphilis*