Characteristics of Red Blood Cell Alloimmunization in Patients with Hematologic Diseases / 대한수혈학회지

Background@#Patients with hematologic diseases receive frequent transfusions of red blood cells (RBCs), platelets (PLTs), and fresh frozen plasma (FFP). These patients are more likely to develop alloimmunization due to repeated exposure to RBC antigens. The purpose of this study was to investigate the need for extended RBC matching in patients with hematologic diseases and a history of repeated transfusions. @*Methods@#We assessed patients who had undergone bone marrow examination at the Dong-A University hospital, Busan, South Korea from January 2008 to December 2012. A total of 571 patients were examined. We retrospectively investigated the frequency and volume of the transfusions of RBCs, PLTs, and FFP, the diagnosis of each patient, and the generation of unexpected antibodies. @*Results@#Alloimmunization occurred in 18 out of 571 patients (3.15%). Among the identified antibodies, Rhesus (Rh) group antibodies were the most frequently detected (58.6%). The number of RBC transfusion episodes was higher in the alloimmunized group than that in the non-alloimmunized group (P=0.0016). The RBC transfusion volume was also significantly higher in the alloimmunized group than that in the non-alloimmunized group (P=0.0020). Also, the number of PLT transfusion episodes and transfusion volume were higher in the alloimmunized group. There were no statistically significant differences in the sex, age, or FFP transfusions between the two groups. @*Conclusion@#The number of RBC transfusion episodes and the RBC transfusion volume affected the possibility of generating unexpected antibodies. The number of PLT transfusion episodes and the PLT transfusion volume also affected alloimmunization. The Rh antigen should therefore be matched in elderly patients who are expected to receive repeated blood transfusions.

Rhus verniciflua Stokes extract suppresses migration and invasion in human gastric adenocarcinoma AGS cells

BACKGROUND/OBJECTIVES@#Many studies have suggested that Rhus verniciflua Stokes (RVS) and its extract are anticancer agents. However, RVS had limited use because it contains urushiol, an allergenic toxin. By improving an existing allergen-removal extraction method, we developed a new allergen-free Rhus verniciflua Stokes extract (RVSE) with higher flavonoid content. In this study, we examined whether RVSE inhibits the ability of AGS gastric cancer cells to migrate and invade.MATERIALS/METHODS: The flavonoids content of RVSE was analyzed by HPLC. The effects of RVSE on migration and invasion in AGS cells were analyzed by each assay kit. Matrix metalloproteinase (MMP)-9, plasminogen activator inhibitor-1 (PAI-1) and urokinase-type plasminogen activator (uPA) protein expression was analyzed by protein antibody array. The Phosphorylation of signal transducer and activator of transcription (STAT) 3 were assayed by Western blot analysis. @*RESULTS@#RVSE treatment with 0–100 μg/mL dose-dependently reduced the ability of AGS cells to migrate and invade. Notably, treatment with RVSE strongly inhibited the expression of MMP-9 and uPA and the phosphorylation of STAT3. In contrast, RVSE treatment dramatically increased the expression of PAI-1. These results indicate that the inhibition of MMP-9 and uPA expression and STAT3 phosphorylation and the stimulation of PAI-1 expression contributed to the decreased migration and invasion of AGS cells treated with RVSE. @*CONCLUSIONS@#These results suggest that RVSE may be used as a natural herbal agent to reduce gastric cancer metastasis.

Different Quantitative Interferon-γ Response in Active Tuberculosis of Various Primary Infection Sites

Improving Storage Policy in Korean Public Cord Blood Banks: Comparison of Quality between Long-Term and Short-Term Storage of Cord Blood / 대한수혈학회지

Background@#The decreased use of cord blood units (CBU) due to improvements in haploidentical transplantation is a financial burden for public cord blood banks. Currently, there is no guidance regarding the length of cryopreservation of CBU in Korean public banks. The relative quality of long-term storage CB (LTCB) and short-term storage CB (STCB) needs to be evaluated to establish a storage policy. @*Methods@#Thirty-four and thirty-one units of CB cryopreserved for less than one year and up to 14∼15.5 years, respectively, in the Busan Gyeongnam Public Cord Blood Bank were assessed. The total nucleated cells (TNCs), CD34+ cell counts, and colony-forming units-granulocyte monocyte (CFU-GM) were examined. The cell viabilities were evaluated by Eosin-Y exclusion staining and 7-aminoactinomycin D flow cytometry. The number of stored Korean public CB units from 2000 to 2016 was determined and categorized according to TNCs. @*Results@#The post-thawing viability of the STCBs measured by flow cytometry was consistently higher than that of the LTCBs (TNCs, 62.5% vs 57.3%; MNCs, 93.1% vs 88.9%; CD34+ cells 95.7% vs 94.0%). The CD34+ cell viability was significantly higher in STCB (P=0.03). The CFU-GM after thawing was higher in STCBs (61.5±23.4 vs 49.9±22.8 [0.95 mm 2 ] P=0.05). Of the 48,161 CB units stored until 2016, Dec, 9,493 (19.7%), which were stored until 2006, had been stored for more than 10 years. @*Conclusion@#LTCB with a low number of cells (＜0.7×10 9 cells) should be considered to exclude from storage for therapeutic purposes to improve the storage efficiency.

First Case in Korea of a Patient With Anti-PP1Pk Antibodies: Successful Blood Management via Acute Normovolemic Hemodilution

No abstract available.

Red Blood Cell Alloimmunization in Korean Patients With Myelodysplastic Syndrome and Liver Cirrhosis

Red blood cell (RBC) alloimmunization varies across human populations and ethnic groups. We evaluated the characteristics of RBC alloimmunization and compared the risk of alloimmunization in Korean patients with myelodysplastic syndrome (MDS) and liver cirrhosis (LC), two representative diseases in which chronic transfusion is required. In total, 115 MDS patients and 202 LC patients transfused with RBCs between 2013 and 2015 were retrospectively included. Twenty patients (6.3%) were newly alloimmunized (five MDS patients, 4.3%; 15 LC patients, 7.4%). The median number of RBC units transfused in alloimmunized patients was nine (interquartile range, 4–15 units). As the number of transfused RBC units increased, the cumulative risk of alloimmunization was higher in LC than in MDS patients (P=0.001). The most common alloantibody detected in patients was anti-E (45%), followed by anti-c (17%), anti-e (10%), anti-C (7%), anti-Fyb (7%), and anti-Jka (7%). The present data indicate the need for matching of extended RBC antigens (Rh, Duffy, and Kidd systems) for chronically transfused patients with MDS and LC in Korea.

A Rare Case of Acute Myeloid Leukemia With SET-NUP214 Fusion and Massive Hyperdiploidy

No abstract available.

Distribution of Hemoglobin Concentration before Transfusion for Evaluation of Appropriateness of Red Blood Cell Transfusion / 대한수혈학회지

Red blood cell transfusions have been associated with the risk of transfusion transmitted infections, and inappropriate transfusions may have an adverse effect on the patient's clinical course. The laboratory information system was used to examine the distribution of the hemoglobin level before transfusion and to use it as a basis for evaluating the appropriateness. A program was developed for assessing the hemoglobin level that was checked within five days before a red blood cell transfusion. The hemoglobin level was analyzed according to each clinical department and the site where the transfusion had been done from Jun to Dec 2018. A total of 10,520 units of red blood cells were transfused, and leuko-reduced units accounted for 2,225 units (21.2%). The hemoglobin measurements were taken in all units within five days. The median hemoglobin level before the transfusion was 7.9 g/dL. A significant difference in the hemoglobin level (P<0.0001) was observed among clinical departments and transfusion sites. The median hemoglobin level in cardiology was significantly higher than the other medical sub-departments. The hemoglobin level was significantly higher in the operating room (10.3 g/dL) than in the hemodialysis room (7.15 g/dL). The difference in the distribution of the hemoglobin level before a transfusion may be used as data for communication with the clinical department.

A Case of Hemolytic Disease of Newborn due to Anti-Di(a): Consideration of the Inclusion of Di(a) Antigen in Antibody Screening Test / 대한수혈학회지

The Diego blood group is expressed as the Di(a) antigen and Di(b) antigen, and the frequency of the Di(a) antigen among the Korean population is estimated to be 9.4~14.5%. We report here on a case of hemolytic disease caused by anti-Di(a) antibody. A full-term male infant was admitted due to hyperbilirubinemia on the first day of life. The total bilirubin level was decreased after phototherapy, but the hemoglobin level was decreased 6.9 g/dL and an exchange transfusion was then performed. The direct antiglobulin test was strongly positive, but the indirect antiglobulin test using screening blood cells without the Di(a) antigen was negative. After we suspected neonatal hemolytic disease caused by the anti-Di(a) antibody, it was confirmed using selected blood cells containing Di(a) antigen. The newborn and father had DI*A/DI*B and the mother had DI*B. The inclusion of Di(a) antigens in an unexpected antibody screening test should be actively discussed in Korea.

Difference in Characteristics in the Formation of Anti-E and Anti-E/-c in Patients with the CDe Phenotype / 대한수혈학회지

BACKGROUND: Anti-E or paired anti-E/-c antibodies can develop in patients with the Rh CDe phenotype. This study examined the differences in transfusion in patients with the CDe phenotype according to formation of anti-E or anti-E/-c antibodies. METHODS: Retrospective reviews were carried out on the results of antibody identification tests performed in 2014. The Rh phenotype and antibody specificity were investigated. The transfusion and medical records of patients with the CDe phenotype were examined. RESULTS: In total, 76 patients were included in the review. Of these 76 patients, 38 (50.0%) were of the CDe phenotype. Anti-E antibodies were the most frequent (60.5%), followed by anti-E/-c antibodies (23.7%). The total transfusion units and platelet transfusion units were significantly higher in patients with anti-E/-c antibodies (P=0.028 and P=0.01, respectively). The distribution of categorized diseases was similar in the patients with the anti-E and anti-E/-c antibodies. A frequency of transfusion episodes greater than or equal to four was higher in patients with hepatobiliary diseases (85.7%). CONCLUSION: In CDe phenotype patients, platelet transfusion was significantly higher in the anti-E/-c positive group than the anti-E positive group, indicating that platelets play a role in red blood cell alloimmunization. Because E is the most immunogenic antigen in Korea, it is important to define the disease group, in which patients with CDe phenotype require a transfusion of E and c-negative blood.

A Case of Bone Marrow Necrosis in B-Acute Lymphoblastic Leukemia with Philadelphia Chromosome at Presentation

Bone marrow necrosis (BMN) is a pathologic state which is derived from various disease entities. Most commonly, it is accompanied by hematologic malignancies such as acute leukemia. The patients with marrow necrosis are generally known to have dismal prognoses but variations exist according to early diagnosis. Here we report a case of BMN in an acute lymphoblastic leukemia patient with Philadelphia chromosome at presentation.

Platelet Function Analyzer-200 P2Y Results Are Predictive of the Risk of Major Adverse Cardiac Events in Korean Patients Receiving Clopidogrel Therapy Following Acute Coronary Syndrome

BACKGROUND: Clopidogrel is one of the most commonly used anti-platelet agents in cardiovascular diseases. We analyzed the relationship between the platelet function analyzer (PFA)-200 P2Y (INNOVANCE PFA-200 System, Siemens Healthcare, Germany) results and occurrence of major adverse cardiac events (MACEs) in Korean patients with recent-onset acute coronary syndrome (ACS) taking clopidogrel. METHODS: Between August 2013 and June 2016, we prospectively enrolled 106 patients with recent-onset ACS who had been treated with clopidogrel. We obtained blood samples and measured closure time (CT) using the PFA-200 P2Y test. Patients were divided into two groups on the basis of a CT cut-off value of 106 seconds. We compared patient characteristics and various MACEs that occurred during the follow-up period. RESULTS: The CTs for 78 patients exceeded the cut-off value. At the time of these analyses, 11 patients had been diagnosed with MACEs. In the time-to-event analysis, there was a difference between the two groups (P<0.001). After adjusting other variables associated with MACE occurrence, CT value was the strongest predictor of MACEs, with a 7.30-fold occurrence risk (P=0.002). CONCLUSIONS: We found a strong relationship between CT and MACE risk in Korean patients with recent-onset ACS taking clopidogrel. Accordingly, PFA-200 P2Y results could be used as a predictive marker for MACE risk in such patients.

Analysis for the Cause of Inadequate Specimens in Blood Bank: A Single Center Study / 대한수혈학회지

No abstract available.

Comparison of Interferon-gamma Secretion by Stimulated NK Cells and T cells from Healthy Subjects

Interferon-γ (IFN-γ) is an important cytokine produced by natural killer (NK) cells and T cells in response to various stimuli. The levels of IFN-γ secreted after stimulation of NK cells using a recombinant cytokine is represented as one of functions of NK cells. Recently, a method for evaluating NK cell activity in whole blood samples was developed. The levels of IFN-γ secreted after NK cell stimulation with PROMOCA™ (ATGen, Korea) and T cell stimulation with phytohemagglutinin (PHA) were compared using two different commercial kits: NK Vue Gold (ATGen, Korea) and QuantiFERON-TB Gold In-Tube (Cellestis, Australia). Participants included 43 healthy individuals. Whole blood samples were incubated with either PROMOCA, a recombinant cytokine that specifically activates NK cells, or with PHA. IFN-γ levels in the supernatants were measured by ELISA. The level of IFN-γ by PROMOCA stimulation (PROMOCA IFN-γ) was more varied than that by stimulation with PHA (PHA IFN-γ) (median 1,544.4 pg/mL [ range 193.7–2,530.9] vs. median 2,470.1 pg/mL [ 2,250.1–2,874.4] P=0.0001). The median of PHA IFN-γ/PROMOCA IFN-γ ratio was 1.9 (1.1–12.4). There was a significant difference in levels of IFN-γ secreted after stimulation with PROMOCA or PHA in the healthy population.

Application of digital implant system on implant treatment with “all-on-4” concept / 대한치과보철학회지

Recently, digital implant systems are expanding its influence in dental area. Due to technical improvement, they jumped over their limits nowadays. We can use these newest systems to treat edentulous patient, from implant surgery to fabrication of prosthesis. In this case, The patient was a fifty years old female. She had a full edentulous ridge on mandible and wanted to reconstruct occlusion with using implants. We planned to use digital implant system with “all-on-4” concept on mandible and produced surgical guide for flapless implant surgery. After the surgery, we tried to fabricate full arch prosthesis just using a digital devices and confirmed satisfying result.

Acute Hemolytic Transfusion Reaction due to ABO-Incompatible Blood Transfusion: A Fatal Case Report and Review of the Literature / 대한수혈학회지

A 77-year-old female patient who was suspected to have had an acute hemolytic transfusion reaction was admitted to the emergency room. She received one unit of type A red blood cells in a type B patient during a total knee arthroplasty operation at another medical institution. ABO-incompatible transfusion was carried out due to an identification error between the patient and blood product. At the time of admission, acute hemolytic reaction, lactic acidosis, and disseminated intravascular coagulation were observed. She was admitted to the intensive care unit and received continuous renal replacement therapy. She maintained renal function and was moved to the general ward on the 7th day. Complications such as pulmonary edema, gastrointestinal bleeding, and ischemic colitis persisted, and the patient died on the 111th after admission. This case is the first report of death due to an ABO-incompatible transfusion in Korea. Efforts to establish a safe transfusion environment are necessary not only at individual medical institutions but also at the national level.

A Case with Changes in Autoantibodies with Mimicking Specificity in a Patient with Hepatocellular Carcinoma / 대한수혈학회지

Changes in autoantibodies with mimicking specificity for Rh antigens are quite rare. Here, we report a 73-year-old male patient with hepatocellular carcinoma that showed changes in the autoantibodies with mimicking specificity. He was admitted to our hospital with mental alterations and hypoglycemia. The antibody identification test for RBC transfusion showed a pattern of agglutination, suggesting anti-E alloantibody and anti-c autoantibody. The patient was then diagnosed with hepatocellular carcinoma, and after 18 months, the antibody identification test showed a different pattern of agglutination, suggesting anti-E alloantibody and anti-C autoantibody. We recommend a careful evaluation to make sure an appropriate transfusion is performed when encountering fluctuating autoantibodies with mimicking specificity.

Revisiting the Pre-transfusion Test: A Case of Acute Hemolytic Transfusion Reaction due to Multiple Alloantibodies of Anti-E, Anti-c, Anti-Jk(b) / 대한수혈학회지

We report a case of acute hemolytic transfusion reaction due to multiple alloantibodies. A 41-year-old male with multiple histories of transfusion was admitted for jaundice and oliguria after receiving two units of red blood cells in a local clinic. He showed acute renal failure and disseminated intravascular coagulation. Direct Coombs test was negative and antibody screening test showed strong positive results. Anti-E, anti-c, and anti-Jk(b) antibodies were identified in two panels of unexpected antibody assays. Acute hemolytic transfusion was diagnosed, and he was discharged after 1 month of supportive treatment. Unexpected antibody detection tests, including the antiglobulin phase, should be performed to prevent adverse transfusion reactions by unexpected antibodies. Better precision and quality control are necessary when performing pre-transfusion tests.

A Case of Acute Promyelocytic Leukemia with Co-existence of BCR-ABL1 and PML-RARA Rearrangements Detected by PCR

Acute promyelocytic leukemia (APL) is a distinct subtype of acute myeloid leukemia (AML) characterized by PML-RARA fusion and specific morphology. The BCR-ABL1 rearrangement is mainly observed in patients with chronic myeloid leukiemia (CML). However, it is also found in patients with acute lymphoblastic leukemia (ALL) and in a few patients with AML. However, it is very rarely observed in patients with APL. Here, we report a case of APL with t(15;17) and co-existence of PML-RARA and BCR-ABL1. Further study with more cases is warranted to find the right treatment and prognostic significance.

Implant prosthesis for fully edentulous patients using intra-oral scanning and abutment merging technique: A case report / 대한치과보철학회지

In this case, the impression surface of the existing denture was scanned and was inverted three-dimensionally to express the residual ridge form. Implant planning was performed on the superimposed data of the CT with the scanned image of the denture with radiopaque markers attached. At the day of surgery, customized abutments fabricated in accordance with the form of the gingival margin were linked with fixtures and temporary restorations were set. In the process of fabricating the final prosthesis after the osseointegration of implant fixture, the intraoral scan images at abutment level were merged with images of the abutments scanned and stored before implant surgery. By fabricating the final prosthesis with the abutments obtained by merging can increase the marginal fitness of the final prosthesis and simplify the clinical process.