Background: Pretransfusion testing is vital for safe transfusion. However, in situations without time to perform sufficient testing, all or part of the pretransfusion testing may be skipped to issue blood quickly. This study evaluated the safety of red blood cell (RBC) transfusion released by an emergency blood transfusion protocol through retrospective analysis at a tertiary hospital for eight years. Methods: All RBC transfusions following the emergency blood transfusion protocol from 2011 to 2018 at Seoul National University Hospital were included in the study. Crossmatching and unexpected antibody screening test results conducted after RBC release and the occurrence of hemolytic transfusion reactions were analyzed. Results: A total of 1,541 cases (5,299 RBCs issued) of emergency blood transfusion were identified. RBCs were issued after performing the immediate spin crossmatch without an unexpected antibody screening test in most cases (1,443; 93.64%), while RBCs were issued with no pretransfusion testing in 98 cases (6.36%). Antibody screening tests performed after the issue of RBCs showed that 17 (1.1%) cases were positive. Two units of RBCs from two different cases showed positive antiglobulin crossmatch test results. However, none of them were suspected to be associated with a hemolytic transfusion reaction. Conclusion The incidence of incompatible RBC release was very low in patients receiving RBC transfusion through the emergency blood transfusion protocol suggesting it can be used safely with minimal risk of hemolytic transfusion reactions caused by incompatible blood transfusions.

Background: Hematopoietic stem cell (HSC) transplantation is an important therapeutic option for many malignant and non-malignant diseases. The whole transplant process involves multiple areas and complex steps. The laboratory procedures include the collection, processing, and storage of HSC. The HSC registry aims to identify the current situation and draw improvement points by voluntarily registering the information of an HSC graft collected by each institute sharing the analyzed data. This study analyzed and shared the data for 2018. Methods: Data for 2018 registered at the HSC registry website (www.ksfa-registry.org) was downloaded and analyzed. The data were to enter the information of each collection and include the demography of the donors, transplant type, instrument, vascular access, mobilization modality, and the number of CD34＋ cells. Results: Two thousand eight hundred eighty-eight collection datasets from 1,373 donors were registered from 19 institutes, which was slightly higher than that reported in 2017. The number of collections in one patient was in the range of 1∼17 times, and the average was two times. In allogeneic HSCT, the number of related donors was higher than that of unrelated donors. The frequency of collecting more than four times per donor was 25.2% for autologous donors, compared to 95.4% for allogeneic donors less than twice. Conclusion The HSC registry is not limited to identifying the current situation and sharing the analyzed data, but is expected to contribute to the development of guidelines, education of human resources, and the standardization of laboratory procedures involved in hematopoietic stem cell transplantation.

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

No abstract available.
Humans ; Korea*

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

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

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

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

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

BACKGROUND: Heparin-induced thrombocytopenia (HIT) is a significant complication of heparin therapy induced by antibodies to heparin/platelet factor 4 (PF4) complexes. We investigated the diagnostic performance of four commercial immunoassays that detect the anti-heparin/PF4 antibody. METHODS: Four different anti-heparin/PF4 antibody assays were performed in 39 patients with suspected HIT: HemosIL AcuStar HIT-IgG, HemosIL AcuStar HIT-total antibody (Ab) (Instrumentation Laboratory, USA), STic Expert HIT (Diagnostica Stago, France), and PF4 Enhanced (Immucor GTI Diagnostics, USA). Patients were diagnosed with HIT when the Chong score was > or =5. RESULTS: The estimated sensitivity and specificity for diagnosis of HIT were 33.3% and 80.0% for AcuStar HIT-IgG, 55.6% and 53.3% for AcuStar HIT-total Ab, 100.0% and 37.9% for STic Expert HIT, and 33.3% and 66.7% for PF4 Enhanced. All specificities significantly increased when 4Ts scores were included in the diagnosis. The areas under the curves (AUCs) for predicting thrombosis in the AcuStar HIT-IgG, AcuStar HIT-total Ab, and PF4 Enhanced assays were 0.639, 0.522, and 0.681, respectively. When the results of each assay were analysed along with 4Ts scores, the AUC increased to 0.927 in the AcuStar HIT-IgG assay and 0.944 in the AcuStar HIT-total Ab and PF4 Enhanced assays. CONCLUSIONS: The STic Expert HIT assay had high sensitivity but low specificity for diagnosis of HIT. The performances of the three other immunoassays were comparable to each other. Specificity significantly increased when assay data were combined with 4Ts scores. Differences in the diagnostic performance of the four immunoassays were not evident, and simultaneous consideration of clinical scoring systems improved performance.
Antibodies ; Area Under Curve ; Diagnosis* ; Heparin ; Humans ; Immunoassay* ; Sensitivity and Specificity ; Thrombocytopenia* ; Thrombosis