Analysis of HCV RNA Genotypes and Quantitative Values of Korean HCV NAT Reactive Blood Donors / 대한수혈학회지

BACKGROUND@#Ever since the Korean Red Cross adopted HCV NAT for blood donor screening in 2005, HCV NAT reactive donors have been identified every year. The identification of the clinical features for these HCV NAT reactive donors may be helpful for the treatment and prevention of HCV infection.@*METHODS@#We analyzed HCV NAT reactive samples to examine the distribution of HCV RNA genotypes and the quantitative values of 128 and 47 HCV NAT reactive samples in 2007 and 2017, respectively.@*RESULTS@#The dominant genotype of the HCV NAT reactive donors was 1b showing 50.0% (64/128) in 2007 and 44.7% (21/47) in 2017. The genotype 2a was the second most dominant at 40.6% (52/128) in 2007 and 40.4% (19/47) in 2017. The mean titers of HCV RNA were 3.17×106 IU/mL in 2007 and 2.61×106 IU/mL in 2017. More than 90% of the donors showed a range of more than 1,000 IU/mL for the HCV RNA titer. There was no difference of quantitative values in the different genotypes.@*CONCLUSION@#In this study, the distribution of HCV RNA genotypes in Korean blood donors showed a similar pattern compared to that of the general population. There was no correlation between the quantitative values and genotypes in the HCV NAT reactive blood donors, and there was no significant variation in the distribution of HCV RNA genotypes of the HCV NAT reactive donors between 2007 and 2017. Yet it is thought that the characteristics of HCV NAT reactive samples in other years have to be analyzed to achieve more significant results.

Reduction Plan of ‘Undeterminable’ in the Unexpected Antibody Screening by the Microcolumn Agglutination Automated Instrument / 대한수혈학회지

BACKGROUND: Among the results of an unexpected antibody screening test using IH-1000, ‘undeterminable’ results can be obtained. Repeated tests not only use reagents and consumables but also cause a turnaround time delay. Therefore, it is important to reduce the ‘undeterminable’ results and to determine the effects. METHODS: From January to early June, 2016, 2,872 cases/259,455 tests (1.11%) of ‘undeterminable’ were detected in the screening test. The factors considered to affect the ‘undeterminable’ were classified into four categories: ① reagent, ② consumables, ③ inspection environment & specimen, and ④ enhancing the equipment management. For data comparison, a chi-square test was conducted (95% confidence interval, 0.05 significant level). RESULTS: The incidence of ‘undeterminable’ cases decreased from 1.11% before management to 0.66% (P < 0.001) after Pool Cells management. The consumption of ‘LISS/Coombs Card’ decreased from 1.07% before management to 0.51% (P < 0.001) after management. By maintaining a clean inspection environment and strengthening sample management, the rate decreased from 1.11% before management to 0.66% (P < 0.001) after management. On the other hand, there was no difference in the incidence of ‘undeterminable’ between before and after IH-1000 management reinforcement. CONCLUSION: Among the factors predicted to affect the decrease in the incidence of ‘undeterminable’, the management of Pool Cells and keeping the inspection environment clean as well as improving sample management contributed the most to the reduced ‘undeterminable’. Improvements in the management of consumables, and removing dust from the inside of the equipment, had a positive impact. A continuous quality improvement theme has been adopted and it is helpful for managing and improving the predicted factors.

Experience of Rh & Others Antigen Negative Rate Elicitation in a Blood Laboratory Center / 대한수혈학회지

BACKGROUND: The demand for Rh-related and other specific antigen negative donations has increased recently, and in response, we need to improve work efficiency while decreasing reagent consumption. Thus, we desire to create a ‘table of Nambu Blood Laboratory Center's own Rh-related and other antigen negative rate’. METHODS: We analyzed the results of Rh-related specific antigen test for 2,806,330 donors using ‘PK-7300’ and the results of manual test for 10,024 other blood type antigen-related specific and compound antigens. We made a table summarizing the results using two cases. RESULTS: The negative rate of Rh-related specific antigens was approximately 12.9% for C, 41.7% for c, 49.5% for E, and 9.2% for e antigens. The negative rate of compound antigens was increased when compared with the number of inspections. The negative rate for C and e antigens was increased from 90.1% to 97.3%, and that for E, c, and JKa was increased from 7.6% to 31.6%. CONCLUSION: The negative rate table made in July 2016 has been determined to be very effective in screening for specific and compound antigen negative blood. Also it was very efficient in terms of examining and supplying the compound antigen negative blood. It would be helpful to improve the supply of specific antigen negative blood to better meet the unique needs of each medical institution.

Experience in Improving ABO Blood Typing Error at the Blood Donation Site / 대한수혈학회지

BACKGROUND: In the Korean Red Cross Blood Center, ABO blood typing are routinely performed only via red cell grouping at blood donations sites. However, when an error occurs in this process, it is impossible to issue a blood product contrary to the result of the blood type of the Blood Laboratory Center, thereby resulting in delayed supply. Therefore, efforts are needed to reduce typing errors at blood donation sites. METHODS: We analyzed 656,786 donor screenings between January 1, 2016 and December 31, 2016;we also analyzed the statistical data of donor ABO typing between 2013 and 2015. To reduce ABO typing error, we notified and trained nurses at Busan, Gyeongnam, Ulsan, and Daegu-Gyeongbuk Blood centers in June, 2016. We tried to confirm the improvement of ABO typing error at blood donation sites by comparing ABO typing before and after training. For data comparison, chi-square test was conducted (95% confidence interval, 0.05 significant level). RESULTS: The blood typing error rate was significantly lower (P=0.003) four months after training (0.005%) than before training (0.015%), and the blood typing error rate was significantly higher for the first blood donor (P<0.001). CONCLUSION: Educational training for nurses at blood donation sites may be effective in reducing ABO typing error. Continuous and regular training seems to be needed in future to reduce ABO typing error.

Primary Anti-D Alloimmunization Induced by "Asian Type" RHD (c.1227G>A) DEL Red Cell Transfusion

No abstract available.

Plasmodium vivax Infection Accompanied by Acute Renal Failure / 대한신장학회지

Malaria is one of the most important parasitic infection in the world. Four species of the genus Plasmodium cause nearly all malarial infections in humans, but the clinical features vary according to the causative species. Among them, Plasmodium falcifarum malaria is associated with numerous complications such as renal failure, cerebral malaria, and DIC, but Plasmodium vivax malaria usually has benign course. The proposed mechanism is blockage of microcirculation to vital organ by sequestration of parasitized erythrocytes. In Korea, for recent 20 years, there have been increasing numbers of malaria infection especially at North area of Geonggi-do. But serious complications in association with Plasmodium vivax malaria are rarely reported. Recently we experienced a case of Plasmodium vivax infection complicated by acute renal failure and report it with literature review.

Evaluation of a Colorimetric Broth Microdilution Method for Antimicrobial Susceptibility Testing Using 2,3,5-Triphenyltetrazolium Chloride / 대한임상미생물학회지

BACKGROUND: The broth microdilution susceptibility testing method is considered a standard for determining minimum inhibitory concentrations, and the addition of the redox indicator 2,3,5-triphenyltetrazolium chloride (TTC) to the broth microdilution method simplifies and increases its objectivity. The current study evaluated the usefulness of a TTC-modified broth microdilution method for antimicrobial susceptibility test of frequently encountered clinical isolates. METHODS: The minimal inhibitory concentrations (MICs) of 10 antimicrobials for 111 clinical isolates of four bacterial species, Staphylococcus aureus, Escherichia coli, Enterobacter cloacae, and Acinetobacter baumannii, were investigated by a modification of the Clinical and Laboratory Standards Institute (CLSI)-recommended broth microdilution method with the addition of 2,3,5-triphenyltetrazolium chloride (TTC). The inhibitory effects of TTC against 192 strains of 22 bacterial species isolated from clinical specimens were also evaluated. RESULTS: The number of colonies of all 192 strains of 22 bacterial species grown on TTC-containing Mueller-Hinton agar did not differ from those grown on Mueller-Hinton agar only. The MICs with TTC were within 2 dilutions of those obtained by the CLSI method in 569 (97.6%) of 583 organism-antimicrobial agent combinations. CONCLUSIONS: The colorimetric MIC method using TTC may be a useful surrogate of antimicrobial susceptibility testing for most of the frequently isolated bacteria.

Diagnostic Usefulness of Antibody Identification Test Including Enzyme Method / 대한혈액학회지

BACKGROUND: Many medical institutions in Korea have recently been performing an antibody screening test as one of the essential elements of a pre-transfusion test. In this study we will determine the advantage and clinical significance of adding an enzyme method to the antiglobulin method while conducting the antibody identification test. METHODS: We performed antibody identification tests between December 2002 and December 2005, for a total of 37 months at Pusan National University Hospital. In this study we have analyzed 550 cases that were conducted by both the antiglobulin method and the enzyme method at the same time. RESULTS: A total of 111 of the results were cases of detection using the adding an enzyme method. Among these results, Rh antibodies that included the anti-E had the highest number of results 77 (69.4%), 28 antibody (25.2%), 2 anti-P1 (1.8%) and one anti-Jkb (0.9%). CONCLUSION: Using the enzyme method in the antibody identification test proved to us that there were more clinically significant warm antibodies than cold antibodies. In order to have a more secured transfusion, it is required to identify a clinically significant antibody using the additional enzyme method during the antibody identification test.

Detection of Serum Anti-p53 Antibodies and Their Significance in Patients with Colorectal Cancer / 대한진단검사의학회지

BACKGROUND: Mutations of the tumor suppressor gene p53 cause subsequent cellular accumulation of p53 gene product and a specific immunologic response. Detection of circulating antibodies against p53 protein has been evaluated for a tumor marker or prognostic factor for several cancers including those of the breast, stomach, ovary and lung. METHODS: Serum samples from 74 colorectal cancer patients were obtained preoperatively and anti-p53 antibody was measured by enzyme immunoassay (Anti-P53 ELISA II: PharmaCell, France). Carcinoembryonic antigen (CEA) and Carbohydrate antigen (CA) 19-9 were measured in parallel. Tissue p53 protein expression was examined by immunohistochemical staining. RESULTS: Anti-p53 antibodies were positive in the serum from 34% (25/74) of patients, but normal controls were all negative. Anti-p53 antibodies were significantly associated with p53 protein overexpression. CEA and CA19-9 were detected in 38% and 11%, respectively. There was no correlation among anti-p53 antibody, CEA and CA19-9. No differences were found between the anti-p53 antibody positive and negative groups in the following parameters: tumor site, histologic grades, Dukes stages, margin invasion, vessel invasion, lymph node and distant metastasis, and survival duration. CONCLUSIONS: The measurement of serum anti-p53 antibody is not suitable for preoperative markers of prognostic significance, but can be used as a simple serological marker for detection of p53 alteration. There should be more studies of the serum p53 antibody as a possible marker for postoperative monitoring in colorectal cancer.

Frequency of Legionella Infection in Patients with Community-Acquired Pneumonia / 대한진단검사의학회지

BACKGROUND: Legionella spp. cannot be cultivated in routine bacterial culture media, causing underdiagnosis of community-acquired pneumonia (CAP) due to this microorganism. The purpose of this study was to evaluate the prevalence of legionellosis in patients with CAP by using several diagnostic techniques. METHODS: Patients' sputum, serum and urine samples were collected from 38 patients with CAP in Pusan National University Hospital during November 2002 to May 2004. The laboratory procedures for diagnosis of legionellosis was performed by sputum cultures, urine antigen tests, nucleic acid amplification tests, and serologic indirect immunofluorescence antibody tests. RESULTS: Legionella pneumonia was diagnosed in 2 of the 38 patients (5.3%); one was L. pneumophila serogroup 1 positive in urine, and the other was serum IgG antibody positive for L. micdadei. CONCLUSIONS: Legionellosis may play an important role in adult CAP in Korea. The diagnosis of legionellosis may require various testing methods, such as sputum culture, urine antigen test, nucleic acid amplification test, and serologic antibody test.

Multi-center Study on Cost Effectiveness of Anti-Tuberculosis Drug Susceptibility Test

BACKGROUND: The anti-mycobacterial susceptibility test is performed on only a small percentage of clinical isolates in Korea. The aim of this study is to propose an anti-mycobacterial susceptibility testing scheme, which is not only economic and practical but also fully informative to physicians. MATERIALS AND METHODS: The anti-mycobacterial susceptibility test results of 502 strains, isolated from five university-affiliated hospitals, were analysed. The interpretation of the results and the need for second-line drug susceptibility test were judged according to the recommendation of NCCLS M24-A guidelines. RESULTS: The isolates from 10% (38/363) of treatment-navie patients and 61% (85/139) of re- treatment patients showed resistance to at least one of the anti-mycobactial agents; 3% (11/363) and 44% (61/139) of isolates from each group were multi-drug resistant. According to the recommendation by NCCLS, the percentage of patients not needing the susceptibility test results for second-line drugs were 96% for treatment-naive and 47% for re-treatment patients. CONCLUSION: Since the susceptibility test against first-line drug is sufficient for 95% of treatment- navie patients with tuberculosis patients, susceptibility test against second-line drugs may be performed only when it is necessary. As for the re-treatment patients with tuberculosis, susceptibility test for both first-line and second-line drugs should be performed simultaneously.

Multi-center Study on Cost Effectiveness of Anti-Tuberculosis Drug Susceptibility Test

BACKGROUND: The anti-mycobacterial susceptibility test is performed on only a small percentage of clinical isolates in Korea. The aim of this study is to propose an anti-mycobacterial susceptibility testing scheme, which is not only economic and practical but also fully informative to physicians. MATERIALS AND METHODS: The anti-mycobacterial susceptibility test results of 502 strains, isolated from five university-affiliated hospitals, were analysed. The interpretation of the results and the need for second-line drug susceptibility test were judged according to the recommendation of NCCLS M24-A guidelines. RESULTS: The isolates from 10% (38/363) of treatment-navie patients and 61% (85/139) of re- treatment patients showed resistance to at least one of the anti-mycobactial agents; 3% (11/363) and 44% (61/139) of isolates from each group were multi-drug resistant. According to the recommendation by NCCLS, the percentage of patients not needing the susceptibility test results for second-line drugs were 96% for treatment-naive and 47% for re-treatment patients. CONCLUSION: Since the susceptibility test against first-line drug is sufficient for 95% of treatment- navie patients with tuberculosis patients, susceptibility test against second-line drugs may be performed only when it is necessary. As for the re-treatment patients with tuberculosis, susceptibility test for both first-line and second-line drugs should be performed simultaneously.

Evaluation of FAN-aerobic Blood Culture Bottle in BacT/Alert3D System / 대한임상미생물학회지

BACKGROUND: This study was designed to evaluate the performance of FAN-aerobic bottles (FANA) in comparison with standard-aerobic bottles (STD-A) in BacT/Alert3D blood culture system. METHODS: A total of 596 pairs of blood cultures, submitted from Emergency Department of Pusan National University Hospital between July and December 2004, were evaluated. In addition to the routine blood culture protocol using standard blood culture bottles, 5 ml of blood samples was inoculated into FAN-A bottles for this study. RESULTS: Microorganisms were grown in 84 (14.1%) of 596 cultures; of those, 15 were positive in STD-A only (2.5%), 35 in FAN-A only (5.9%), and 34 in both (5.7%). The positive rate in FAN-A bottles was significantly higher than that in STD-A bottles (P<0.001). The species of isolates and detection time showed no difference between the blood culture bottles. CONCLUSION: In the BacT/Alert3D blood culture system, the use of FAN-A bottles instead of the standard aerobic bottles should yield a higher positive rate.

The Clinical Significance of Antibody Screening Test Including Di(a+) Panel Cell in Asian-Mongoloid Populations

The Di(a) antigen is well known as one of the antigens with low incidence among Caucasians; however, it has been discovered with a relatively higher incidence among Mongoloid populations. Thus, it has been speculated that the incidence of unexpected antibody against the Di(a) antigen might be relatively higher among these populations. Hemolytic transfusion reactions (HTRs) and hemolytic disease of the newborns (HDNs) caused by anti-Di(a) have been reported sporadically. However, there has been no prospective study on the incidence of anti-Di(a) in Mongoloid populations particularly. The authors conducted a series of antibody screening tests on 11,219 Korean individuals for 25 months, by using three kinds of screening cells including Di(a) cell. Anti-Di(a) was detected in 8 patients, seven of whom had a history of transfusions or were multigravida. The incidence of anti-Di(a) measured in this study was higher than expected, ranked third among unexpected antibodies identified during the period of the study, so it is strongly recommended that the Di(a+) panel cell must be incorporated into antibody screening test for safer transfusion in Asian-Mongoloid populations.