Implications of the 5th Edition of the World Health Organization Classification and International Consensus Classification of Myeloid Neoplasm in Myelodysplastic Syndrome With Excess Blasts and Acute Myeloid Leukemia

The fifth edition of the WHO classification (2022 WHO) and the International Consensus Classification (2022 ICC) of myeloid neoplasms have been recently published. We reviewed the changes in the diagnosis distribution in patients with MDS with excess blasts (MDS-EB) or AML using both classifications. Forty-seven patients previously diagnosed as having AML or MDS-EB with available mutation analysis data, including targeted next-generation and RNA-sequencing data, were included. We reclassified 15 (31.9%) and 27 (57.4%) patients based on the 2022 WHO and 2022 ICC, respectively. One patient was reclassified as having a translocation categorized as a rare recurring translocation in both classifications. Reclassification was mostly due to the addition of mutation-based diagnostic criteria (i.e., AML, myelodysplasia-related) or a new entity associated with TP53 mutation. In both classifications, MDS diagnosis required the confirmation of multi-hit TP53 alterations. Among 14 patients with TP53 mutations, 11 harbored multi-hit TP53 alterations, including four with TP53 mutations and loss of heterozygosity. Adverse prognosis was associated with multi-hit TP53 alterations (P=0.009) in patients with MDS-EB, emphasizing the importance of detecting the mutations at diagnosis. The implementation of these classifications may lead to the identification of different subtypes from previously heterogeneous diagnostic categories based on genetic characteristics.

Evaluation of the CellaVision Advanced RBC Application for Detecting Red Blood Cell Morphological Abnormalities

Background@#The Advanced RBC Application of the CellaVision DM9600 system (CellaVision AB, Lund, Sweden) automatically characterizes and classifies red blood cells (RBCs) into 21 morphological categories based on their size, color, shape, and inclusions. We evaluated the diagnostic performance of the CellaVision Advanced RBC Application with respect to the classification and grading of RBC morphological abnormalities in accordance with the 2015 International Council for Standardization in Haematology (ICSH) guidelines. @*Methods@#A total of 223 samples, including 123 with RBC morphological abnormalities and 100 from healthy controls, were included. Seven RBC morphological abnormalities and their grading obtained with CellaVision DM9600 pre- and post-classification were compared with the results obtained using manual microscopic examination. The grading cut-off percentages were determined in accordance with the 2015 ICSH guidelines. The sensitivity and specificity of the CellaVision DM9600 system were evaluated using the manual microscopic examination results as a true positive. @*Results@#In pre-classification, > 90% sensitivity was observed for target cells, tear drop cells, and schistocytes, while > 90% specificity was observed for acanthocytes, spherocytes, target cells, and tear drop cells. In post-classification, the detection sensitivity and specificity of most RBC morphological abnormalities increased, except for schistocytes (sensitivity) and acanthocytes (specificity). The grade agreement rates ranged from 35.9% (echinocytes) to 89.7% (spherocytes) in pre-classification and from 46.2% (echinocytes) to 90.1% (spherocytes) in post-classification. The agreement rate of samples with withinone grade difference exceeded 90% in most categories, except for schistocytes and echinocytes. @*Conclusions@#The Advanced RBC Application of CellaVision DM9600 is a valuable screening tool for detecting RBC morphological abnormalities.

De Novo Pure Trisomy 20p: Report of a Novel Case of a Marker Chromosome and Literature Review

No abstract available.

Recommendation for the Peripheral Blood Cell Morphology Report

There is considerable heterogeneity in the peripheral blood smear reports across different diagnostic laboratories, despite following the guidelines published by the International Council for Standardization in Haematology (ICSH). As standardization of reports can facilitate communication and consequently the diagnostic efficiency in both laboratories and clinics, the standardization committee of the Korean Society for Laboratory Hematology aimed to establish a detailed guideline for the standardization of peripheral blood smear reports. Based on the ICSH guidelines, additional issues on describing and grading the peripheral blood smear findings were discussed. In this report, the proposed guideline is briefly described.

An Automated Draft Report Generator for Peripheral Blood Smear Examinations Based on Complete Blood Count Parameters

BACKGROUND: Complete blood count (CBC) results play an important role in peripheral blood smear (PBS) examinations. Many descriptions in PBS reports may simply be translated from CBC parameters. We developed a computer program that automatically generates a PBS draft report based on CBC parameters and age- and sex-matched reference ranges. METHODS: The Java programming language was used to develop a computer program that supports a graphical user interface. Four hematology analyzers from three different laboratories were tested: Sysmex XE-5000 (Sysmex, Kobe, Japan), Sysmex XN-9000 (Sysmex), DxH800 (Beckman Coulter, Brea, CA, USA), and ADVIA 2120i (Siemens Healthcare Diagnostics, Eschborn, Germany). Input data files containing 862 CBC results were generated from hematology analyzers, middlewares, or laboratory information systems. The draft reports were compared with the content of input data files. RESULTS: We developed a computer program that reads CBC results from a data file and automatically writes a draft PBS report. Age- and sex-matched reference ranges can be automatically applied. After examining PBS, users can modify the draft report based on microscopic findings. Recommendations such as suggestions for further evaluations are also provided based on morphological findings, and they can be modified by users. The program was compatible with all four hematology analyzers tested. CONCLUSIONS: Our program is expected to reduce the time required to manually incorporate CBC results into PBS reports. Systematic inclusion of CBC results could help improve the reliability and sensitivity of PBS examinations.

Standardization of Terminology in Laboratory Medicine ll

Standardization of medical terminology is essential in data transmission between health care institutes and in maximizing the benefits of information technology. The purpose of this study was to standardize medical terms for laboratory observations. During the second year of the study, a standard database of concept names for laboratory terms that covered those used in tertiary health care institutes and reference laboratories was developed. The laboratory terms in the Logical Observation Identifier Names and Codes (LOINC) database were adopted and matched with the electronic data interchange (EDI) codes in Korea. A public hearing and a workshop for clinical pathologists were held to collect the opinions of experts. The Korean standard laboratory terminology database containing six axial concept names, components, property, time aspect, system (specimen), scale type, and method type, was established for 29,340 test observations. Short names and mapping tables for EDI codes and UMLS were added. Synonym tables were prepared to help match concept names to common terms used in the fields. We herein described the Korean standard laboratory terminology database for test names, result description terms, and result units encompassing most of the laboratory tests in Korea.

Standardization of Terminology in Laboratory Medicine I / 대한진단검사의학회지

BACKGROUND: Standardization of medical terminology is essential for data transmission between health-care institutions or clinical laboratories and for maximizing the benefits of information technology. Purpose of our study was to standardize the medical terms used in the clinical laboratory, such as test names, units, terms used in result descriptions, etc. During the first year of the study, we developed a standard database of concept names for laboratory terms, which covered the terms used in government health care centers, their branch offices, and primary health care units. METHODS: Laboratory terms were collected from the electronic data interchange (EDI) codes from National Health Insurance Corporation (NHIC), Logical Observation Identifier Names and Codes (LOINC) database, community health centers and their branch offices, and clinical laboratories of representative university medical centers. For standard expression, we referred to the English-Korean/ Korean-English medical dictionary of Korean Medical Association and the rules for foreign language translation. Programs for mapping between LOINC DB and EDI code and for translating English to Korean were developed. RESULTS: A Korean standard laboratory terminology database containing six axial concept names such as components, property, time aspect, system (specimen), scale type, and method type was established for 7,508 test observations. Short names and a mapping table for EDI codes and Unified Medical Language System (UMLS) were added. Synonym tables for concept names, words used in the database, and six axial terms were prepared to make it easier to find the standard terminology with common terms used in the field of laboratory medicine. CONCLUSIONS: Here we report for the first time a Korean standard laboratory terminology database for test names, result description terms, result units covering most laboratory tests in primary healthcare centers.

Survey Results of Medical Insurance Reimbursement System for Independent Medical Laboratories in Korea / 대한진단검사의학회지

BACKGROUND: A questionnaire survey was performed to perceive the problem of the current medical insurance reimbursement system for laboratory tests referred to independent medical laboratories; then, we intended to find a way to improve the reimbursement system. METHODS: Questionnaires were distributed to 220 independent medical laboratories and 700 laboratory physicians from July through October 2005. Frequency analysis was used to analyse the replies from 109 respondents to 25 questionnaire items regarding the current medical insurance reimbursement system for referral tests, problems with the system, and suggestions for the improvement of the system. RESULTS: Among the 109 respondents to this survey, 49 (45.8%) considered the current reimbursement system to be unsatisfactory, while only 16 (15.0%) answered satisfactory. The problem was that the referral clinics-not the laboratories that performed the tests--would first receive their reimbursement for the laboratory tests from Health Insurance Review Agency (HIRA) and then give a portion of the laboratory test fees to the independent medical laboratories after the deduction of administrative fees. They (62.5% of the respondents) would prefer a separated reimbursement system by which the referral clinic-as well as the independent medical laboratory-would receive their reimbursement directly from HIRA through an Electronic Data Interchange (EDI) system. In this new system, 34% of the respondents expected the quality of the laboratory tests to be improved; however, 41.6% answered that the income of the referral clinic is expected to decrease. CONCLUSIONS: For the improvement of the medical insurance reimbursement system, the administrative fee for the referral clinic and the test fee for the independent medical laboratory should be reimbursed directly to the respective organizations. These changes could be made possible with the proper analysis of medical costs and the development of an effective EDI reimbursement system.

Decrease in Plasma Adiponectin Concentrations in Patients with Vasospastic Angina

BACKGROUND AND OBJECTIVES: Plasma adiponectin, which decreases the progression of atherosclerosis and insulin resistance, as well as suppressing lipid accumulation in macrophages, is decreased in patients with acute myocardial infarction and unstable angina pectoris; however, the correlation between plasma adiponectin and vasospastic angina pectoris (VAP) remains to be verified. We compared the plasma adiponectin concentration between patients with VAP and other coronary artery diseases; moreover, we investigated the association between the plasma adiponectin concentration and VAP. SUBJECTS AND METHODS: Following coronary angiography for the evaluation of chest pain, 395 subjects (180 women and 215 men) were divided into 4 groups: acute coronary syndrome (ACS)(n=117), VAP (n=94), stable angina pectoris (SAP)(n=108) and angiographically normal coronary artery (n=76). The acetylcholine provocation test was used to confirm VAP, and plasma adiponectin concentrations were measured in all participants. RESULTS: The plasma adiponectin concentrations in patients with VAP and ACS were significantly lower than that of the normal coronary artery group (6.6+/-5.4 vs. 5.2+/-4.0 vs. 9.0+/-6.2 microgram/mL, p<0.001, respectively). A multivariate analysis indicated that plasma adiponectin [odd ratio (OR) 0.744, 95% confidence interval (CI) 0.645 to 0.858, p=0.001], smoking (OR 2.054, 95% CI 1.027 to 4.106, p=0.042) and age (OR 0.966, 95% CI 0.935 to 0.997, p=0.031) were independently correlated in patients diagnosed with VAP. CONCLUSION: Our results suggest that a decreased plasma adiponectin concentration may be associated with VAP.

Diagnostic Performance of the Anti-Cyclic Citrullinated Peptide Antibodies and Rheumatoid Factor Isotypes in Rheumatoid Arthritis / 임상검사와정도관리

BACKGROUND: The rheumatoid factor (RF) is the only serological marker in American College of Rheumatology criteria for the diagnosis of rheumatoid arthritis (RA), but its specificity is not satisfactory for the diagnosis of RA. We evaluated the diagnostic performance of a new anti-cyclic citrullinated peptide antibodies (anti-CCP) test with those of RF isotypes for the diagnosis of RA. METHODS: Anti-CCP was determined in 186 serum samples: 110 from RA patients, 30 from non-RA patients(rheumatic diseases other than RA), and 46 normal individuals. IgM RF by latex fixation test and IgA RF by ELISA were also assayed in each samples, and the results were compared to anti-CCP for sensitivity and specificity by the receiver-operating characteristic curve on optimal cut-off values. RESULTS: The sensitivity of anti-CCP was highest (80.0%) and the sensitivities of IgM RF, IgA RF were 71.8%, 45.5%, respectively. The sensitivity increased (from 80.0% to 88.2%) especially in the combination of anti-CCP with IgM RF. The specificity of IgA RF by ELISA were highest (96.0 %) and the specificity of anti-CCP (94.7%) was higher than that of IgM RF (71.4%). Anti-CCP was positive in 58.1% in 31 RA patients with negative IgM RF. CONCLUSIONS: The results said that the combination test of anti-CCP with IgM RF might be useful for the diagnosis of RA because of its higher sensitivity and specificity than IgM RF alone.

Serologic Markers of Viral Hepatitis of Korea University Medical Center Patients / 대한진단검사의학회지

BACKGROUND: As an endemic area of viral hepatitis B, many studies on hepatitis B and C have been reported in Korea, but no on all five viral types, A, B, C, D, and E. We surveyed ten serologic markers for the five different viral hepatitis and reviewed the seropositivity of each viral hepatitis and concurrent infection. METHODS: Ten serologic markers of five viral hepatitis (anti-HAV IgM, anti-HAV IgG, HBsAg, anti-HBs, anti-HBc, HBeAg, anti-HBe, anti-HCV, anti-HDV, and anti-HEV IgM) were tested for 260,488 samples requested for viral marker studies at three hospitals of Korea University Medical Centers from January through December, 2003. Anti-HAV IgM, anti-HAV IgG, anti-HDV, and anti-HEV IgM were tested by RIA and HBsAg, anti-HBs, anti-HBc, HBeAg, anti-HBe, and anti-HCV were analysed by ELISA or RIA method. RESULTS: Anti-HAV IgM and IgG seropositivity was 1.2% and 88.0%, respectively. Anti-HAV IgM seropositivity was high in a patient group 20 to 29 years of age. The overall seropositivity of HBsAg was 10.4% and for anti-HBs 60.4%. The seropositivity was 1.3% for anti-HCV, 1.1% for anti-HDV, and 22.2% for anti-HEV IgM. The concurrent positivity of HBsAg and anti-HBs was 4.0%. HBsAg was positive in 7 (0.1%) of anti-HCV positive patients; anti-HEV IgM was positive in 2 (25%) of anti-HAV IgM positive patients. CONCLUSIONS: Hepatitis A infection was rare in children but increased in patient group 20 to 29 years of age. The concurrent infection rate of hepatitis A with hepatitis E was high, suggesting that hepatitis E should be considered in hepatitis A patients. In view of the finding that the concurrent infection of hepatis B and C was detected, though at a relatively low rate, patients with viral hepatitis need to be assessed for the possibility of concurrent infection with other types of hepatitis.

A Case of Fatal Scedosporium prolificans Fungemia in a Patient with Acute Myeloid Leukemia / 대한임상미생물학회지

Scedosporium prolificans is a saprophytic fungus widespread in the environment. It has become an emerging pathogen in recent years causing disseminated infections, especially in profoundly neutropenic immunocompromised patients. We report a case of fatal Scedosporium fungemia in a 45 year old female with acute myeloid leukemia in relapse. She received salvage chemotherapy and antibiotic treatment, and was neutropenic with relapsing fever. S. prolificans was isolated repeatedly from the aerobic bottles on the second day of two successive blood cultures. Amphotercin B was started; however, the patient expired the next day.

Epidemiologic Study of Enterobacter cloacae Infection in Neonatal Intensive Care Unit / 병원감염관리

Enterobacter cloacae is isolated from 10 newborns in the neonatal Intensive care unit(NICU) of Seoul Red Cross Hospital from April, 1997 to June, 1997. Their gestational age is from 195-299 days(mean 244.3 days), and their birth weight was from 980-4,100g(mean 2,287g). We obtained 16 E, cloacae strains form their blood, urine, endotracheal tube, umbilical catheter and 4 of them were isolated from the same patient at different culture sites. We also obtained another 3 strains of E. cloacae from 14 persons who worked in NICU and 26 places of NICU. We analysed the molecular types of 19 isolates by using rep-PCR method. We get 6 different types of PCR-products from the patients and NICU workers, and NICU environments. We observed that the incidence of E. cloacae was decreased by handwashing and wearing personal plastic gloves during the care of NICU patients.

Management of Clinical Laboratory Staffs in Korea (II) / 임상검사와정도관리

BACKGROUND: For the efficient management of clinical pathology laboratory, not only the economic side but also the quality of test should be considered. Therefore, the authors investigated the status of laboratory in the management point including the status of technical personnel by survey and tried to find out the fundamental status of work environment, laboratory automation, computerization, and to evaluate the efficiency of management of clinical pathology laboratories in Korea. METHOD: The questionnaires included those for investigating laboratory management status, qualities of laboratory personnels, workloads, test items and numbers of tests performed annually. It contained 22 items with 32 detailed sub-questionnaires for laboratory personnel survey, and 9 items with 106 detailed sub-questionnaires for facilities. We sent those three times to 400 laboratories that were participating in the National External Quality Assessment Scheme in Korea and analysed the answers by descriptive statistics, ANOVA, t-test and correlation analysis. RESULTS: The replies were from 96 laboratories and 326 technical personnels. Among the 96 laboratories, there were 71 full time employed clinical pathologists. The annually performed number of tests were increased with the increased the size of laboratory, that was classified by number of personnels. As the laboratory size was increased, part time personnels, cases of test per technical personnel, automation and computerization, satisfaction for their work (58,2%) were increased but decreased satisfaction of salaries. CONCLUSIONS: We surveyed the present employee status of laboratory personnels and status of laboratory and offered fundamental data of clinical laboratory management in Korea.

Effects of Cilostazol on Platelet Activation in Coronary Stenting Patients Who Already Treated with Aspirin and Clopidogrel

BACKGROUND: A recent study has shown that triple anti-platelet therapy (cilostazol+clopidogrel+aspirin) resulted in a significantly lower restenosis rate after coronary stenting than did conventional therapy (clopidogrel+aspirin). However, the anti-platelet effects of cilostazol, when combined with clopidogrel and aspirin, have not been evaluated. METHODS: Low dose cilostazol (50 mg/BID) was given to 47 patients who had already been taking clopidogrel (75 mg/day) and aspirin (100 mg/day) for more than 1 month subsequent to coronary stenting due to AMI and unstable angina. Markers of platelet activation, P-selectin and activated GPIIb/IIIa on platelets, were measured at baseline and 2 weeks after cilostazol treatment. We empirically divided patients into tertiles (low, n=16; moderate, n=14; high group, n=17), according to the baseline P-selectin expression. We then performed a comparative assessment of the anti-platelet effects of cilostazol at baseline and after 2 weeks of cilosatzol administration. RESULTS: P-selectin was significantly decreased after 2 weeks of cilostazol treatment in total patients (n=47, 3.2 +/- 2.4% to 2.0 +/- 1.9%, p=0.03). This inhibition of P-selectin expression was mainly achieved in the moderate and high P-selectin groups (low group; 1.4 +/- 0.5 to 1.9 +/- 1.3%, p> 0.05, moderate group; 2.5 +/- 0.3 to 1.3 +/- 0.3%, p 0.05). Underlying disease, cardiovascular risk factors, concomitant medication including statin, and hsCRP were not related to the degree of P-selectin expression. CONCLUSION: Our data demonstrated that cilostazol treatment in addition to conventional anti-platelet therapy provides more effective suppression of platelet P-selectin expression in patients with relatively high platelet activity.

A Case of Human Brucellosis Who had No Contact with Infected Animal: Sero-epidemiology Study on Market, by-product, Stock-raising / 감염과화학요법

Brucellosis is a world-wide zoonotic disease. We report the first case of brucellosis in South Korea that is not related to direct contract with intected cattles. The patient had been working in the market of by-product, stock raising for twenty years and complained of 1-month history of fever, chill, and intermittent epistaxis. We confirmed brucellosis by anti-brucella antibody test and PCR. After 6 weeks' treatment with rifampicin and doxycycline, fever and chilling subsided, and, generalized weakness and oral intake improved. We performed seroepidemiology study against workers who were working in the same market as the patient. However, we couldn't find out other cases with seropositivity. We concluded that although the workers of by-product market have a risk of getting brucellosis, the risk is low.

A Case of Human Brucellosis Who had No Contact with Infected Animal: Sero-epidemiology Study on Market, by-product, Stock-raising / 감염과화학요법

Brucellosis is a world-wide zoonotic disease. We report the first case of brucellosis in South Korea that is not related to direct contract with intected cattles. The patient had been working in the market of by-product, stock raising for twenty years and complained of 1-month history of fever, chill, and intermittent epistaxis. We confirmed brucellosis by anti-brucella antibody test and PCR. After 6 weeks' treatment with rifampicin and doxycycline, fever and chilling subsided, and, generalized weakness and oral intake improved. We performed seroepidemiology study against workers who were working in the same market as the patient. However, we couldn't find out other cases with seropositivity. We concluded that although the workers of by-product market have a risk of getting brucellosis, the risk is low.

A Case of Splenic Marginal Zone Lymphoma / 대한진단검사의학회지

Splenic marginal zone lymphoma (SMZL) is a rare B-cell neoplasm characterized by massive splenomegaly, moderate lymphocytosis, bone marrow intrasinusoidal involvement of lymphocytes and a relatively indolent course. We report a case of SMZL diagnosed by bone marrow studies using immunophenotyping and immunohistochemical stain, and confirmed by splenectomy. The patient was a 61-year old male, who showed mild lymphocytosis in peripheral blood and bone marrow aspirates. Immunophenotyping of bone marrow aspirates showed lymphocytes positive for CD19, CD20, CD22 (dim), CD23 (dim) and negativie for CD5 and CD10. The immunohistochemistry of bone marrow and spleen also showed lymphocytes positive for CD20 and negative at for cyclin D1. Now he is being treated for chronic obstructive pulmonary disease and will receive chemotherapy.

Adequacy of Individualized Heparinization during Hemodialysis / 대한신장학회잡지

BACKGROUND: Most chronic hemodialysis units select heparin doses on an empirical basis. Too little heparin causes clotting in the extracorporeal circuit and too much heparin may lead to excessive bleeding. We conducted a prospective, randomized, repeated cross over study to evaluate the effect of two different heparin regimens. The empirical standard dose regimen (empirical heparinization, EH) was used for all patients, and the individualized dose regimen (individualized heparinization, IH) determined by measuring the activated clotting time (ACT) was performed for more adequate heparinization during hemodialysis. METHODS: Twenty-four outpatients with systemic heparinization who had been on hemodialysis for more than 3 months were enrolled. In both METHODS, anticoagulation was achieved with a loading dose and a continuous infusion of heparin. Each regimens were prescribed alternately, and repeated after 2 weeks later. The study evaluated pre-post dialytic Hgb, Hct, Platelet and predialytic albumin, heparin loading dose and infusion rate, ACT, total blood compartment volume (TBCV), visible blood clots, bleeding, pre-post dialytic and next predialytic BUN, predialytic Cr, URR, Kt/Vurea. RESULTS: Twenty-two patients were analyzed in this study. Pre-post dialytic Hgb, Hct, Platelet and predialytic albumin, heparin loading dose were not significantly different between two methods. But heparin infusion rate were significantly increased in individualized heparinization than in empirical heparinization. Activated clotting times were prolonged and maintained adequately in individualized heparinization during hemodialysis. The loss of TBCV and visible blood clots were significantly decreased in individualized heparinization than in empirical heparinization. There was no bleeding complication in two methods. Pre-post and next predialytic BUN, predialytic Cr, URR, Kt/Vurea were not significantly different between two methods.0.CONCIUSION: We concluded that the individualized heparinization can maintain adequate anticoagulation than the empirical heparinization without any other problems and compromising the delivery dose of dialysis.

Adequacy of Individualized Heparinization during Hemodialysis / 대한신장학회잡지

BACKGROUND: Most chronic hemodialysis units select heparin doses on an empirical basis. Too little heparin causes clotting in the extracorporeal circuit and too much heparin may lead to excessive bleeding. We conducted a prospective, randomized, repeated cross over study to evaluate the effect of two different heparin regimens. The empirical standard dose regimen (empirical heparinization, EH) was used for all patients, and the individualized dose regimen (individualized heparinization, IH) determined by measuring the activated clotting time (ACT) was performed for more adequate heparinization during hemodialysis. METHODS: Twenty-four outpatients with systemic heparinization who had been on hemodialysis for more than 3 months were enrolled. In both METHODS, anticoagulation was achieved with a loading dose and a continuous infusion of heparin. Each regimens were prescribed alternately, and repeated after 2 weeks later. The study evaluated pre-post dialytic Hgb, Hct, Platelet and predialytic albumin, heparin loading dose and infusion rate, ACT, total blood compartment volume (TBCV), visible blood clots, bleeding, pre-post dialytic and next predialytic BUN, predialytic Cr, URR, Kt/Vurea. RESULTS: Twenty-two patients were analyzed in this study. Pre-post dialytic Hgb, Hct, Platelet and predialytic albumin, heparin loading dose were not significantly different between two methods. But heparin infusion rate were significantly increased in individualized heparinization than in empirical heparinization. Activated clotting times were prolonged and maintained adequately in individualized heparinization during hemodialysis. The loss of TBCV and visible blood clots were significantly decreased in individualized heparinization than in empirical heparinization. There was no bleeding complication in two methods. Pre-post and next predialytic BUN, predialytic Cr, URR, Kt/Vurea were not significantly different between two methods.0.CONCIUSION: We concluded that the individualized heparinization can maintain adequate anticoagulation than the empirical heparinization without any other problems and compromising the delivery dose of dialysis.