Comparative Analysis of AB vs. ABO-specific Plasma for Desensitization in Blood Group O Recipients: An In Vitro Study

Neutralizing capacity measurement (NCM) of soluble ABH substances (SAS) in plasma was assessed to guide the selection of the appropriate ABO group of fresh-frozen plasma (FFP) for plasma exchange (PE) in blood group O recipients with ABO-incompatible transplantations. Neutralizing capacity was assessed by measuring anti-A and/or anti-B titers in samples comprising one unit of O FFP and 10 O EDTA plasma samples and subtracting the binary logarithm of the titer in each group with a saline dilution. Ten EDTA plasma samples with Lewis b (Leb) antigen positivity and 10 sets of pooled FFP from each blood group were used as diluents. In O FFP, the NCM values (mean±SD) were 3.4±0.52 (2.6±0.52) and 2.6±0.52 (1.5±0.3) in B and AB for IgM (total antibody) anti-B (both P<0.001), and in the 10 O EDTA plasma samples, they were 3.9±0.88 (3.1±0.88) and 3.2±0.79 (2.4±0.97) for IgM (P=0.0013) and total anti-B (P=0.025), respectively. In vitro analysis revealed that B FFP is more effective than AB FFP in reducing IgM and total anti-B antibody titers in O recipients, regardless of Leb antigen positivity.

Optimizing the Hospital Blood Bank Stock in Korea: A Comparative Analysis of the Uniform 5-Day Stock Index and a Novel Blood Stock Index

Background

Maintaining optimal blood inventory levels in hospitals is important to prevent blood shortage and wastage. We aimed to provide an efficient blood inventory management strategy for hospital blood banks nation-wide by comparing the current use of 5-day issuable stock (IS) with Lim's IS as a novel target IS.

Methods

The average and CV of daily usage (DU) were calculated from information entered into Korea's Blood Management System by 194 participating hospitals in 2019 and 2020. Using these data, Lim's IS was calculated by determining the simulated annual average blood shortage day nearest to 1 for each blood group in each hospital. The 5-day IS (5IS) was estimated by multiplying the average DU in 2018 by five to count the shortage days in 2019.

Results

The average DU (0.3-231.3 units) and corresponding CV (0.33-7.14) in the participating hospitals were inversely proportional (r=-0.699 to -0.695). The hypothetical averages of 5IS and Lim's IS were 27.0±41.2 and 24.7±20.8, respectively (P=0.006). The shortage days for 5IS and Lim's IS were 8.9±22.7 and 1.0±1.9, respectively (P<0.001).

Conclusions

While 5IS was unacceptable for universal application, Lim's IS remained near one shortage day and is considered more efficient than 5IS. Hospitals should implement indicators that consider DU and its variations. This is the first study to introduce Lim's IS as an indicator of optimal blood inventory, and the data are expected to provide guidance for effective blood inventory management nationwide, particularly during blood shortages.

Investigation of Discrepant ABO Blood Grouping Results from an Autoanalyzer

Background

A paucity of studies evaluating failed cases of ABO grouping using autoanalyzers exists. We investigated autoanalyzer rejected cases, including serologically suspicious ABO subgroups and discrepant ABO blood grouping results from Erytra Eflexis (Grifols, Spain), to demonstrate efficient use of autoanalyzers for ABO grouping.

Methods

Samples requested for ABO grouping throughout 2020 were tested using two Eflexis instruments and standard ABO RhD and reverse grouping cards. Neonatal cards were not used. When necessary, a conventional tube technique (TUBE) was used to resolve rejected/discrepant Eflexis ABO grouping results.

Results

The overall sample rejection rate (RR) was 3.2% (628/19,466), 1.3% of which were due to various error flags and 1.9% for discrepant results. Cases from neonates ≤1 year old accounted for 35.3% of the rejected cases based on Eflexis results. The ABO groups with the highest and lowest RR (excluding neonates) were A and O, respectively. The 628 samples resulted in 682 rejections, which were frequently associated with reverse grouping, including 28.4% against A₁ and 54.5% for B red cells. Among 14 serologically weakened A and/or B blood groups, six A₂BW and two ABw, which had been missed by Eflexis, were detected using TUBE and our follow-up laboratory criteria.

Conclusions

The ABO group and a proportion of neonatal samples influenced the RR due to weak reverse grouping reactivity, especially toward B red cells. Confirmatory ABO grouping by TUBE in a new patient and/or extra rejection criteria for forward grouping are needed to detect cis-AB, which is relatively common in Korea.

External quality assessment providers' services appear to more impact the immunohaematology performance of laboratories than national regulatory and economic conditions

OBJECTIVES

Medical laboratories may, at their own discretion, exceed but not undercut regulatory quality requirements. Available economic resources, however, may drive or hinder eagerness to exceed minimum requirements. Depending on the respective scopes of regulatory and economic framework conditions, differing levels of quality efforts to safeguard laboratory performance can be anticipated. However, this has not yet been investigated.

METHODS

Immunohaematology external quality assessment (EQA) results collected by 26 EQA providers from their participant laboratories in 73 countries from 2004 to 2019 were evaluated. Error rates were aggregated in groups according to the respective national regulatory and economic framework conditions, to whether or not expert advice was provided in case of incorrect results, and the frequency of EQA samples.

RESULTS

These representative data indicate no association between national regulatory (mandatory participation in EQA, monitoring of performance of individual laboratories by authorities, financial consequences of incorrect results) and economic (level of national income, share of national health expenditure) conditions to the quality performance of medical laboratories in immunohaematology. However, EQA providers' support for laboratories in the event of incorrect results appear to be associated with lower error rates, but a high EQA sample frequency with higher error rates.

CONCLUSIONS

Further research into the impact of introducing or changing services of EQA providers is needed to confirm the results found in this first of its kind study.

Early recognition of possible transfusion reactions using an electronic automatic notification system for changes in vital signs in patients undergoing blood transfusions

BACKGROUND

The study was designed to evaluate the ability of a novel electronic automatic notification system (EANS) to detect significant changes in transfusion-associated vital signs (VSs) during transfusion and to determine whether the EANS improved acute transfusion reaction (ATR) detection rates and suspected ATR reporting rates.

STUDY DESIGN AND METHODS

VSs were measured three times per unit or batch product transfused:-before, 15 minutes after commencement, and at the completion of the transfusion-and recorded on the EANS. Significant changes in VSs were defined as increased temperature (≥38°C or ≥1°C change in baseline temperature), 20 mm Hg or 20% increase or decrease in systolic blood pressure, or 20% increase in pulse rate. The 6-month periods preceding and after the introduction of the EANS were defined as "before" and "after." Data from these periods were used for comparison and evaluation.

RESULTS

During the after period, 945 notifications were reported from the EANS and 521 suspected ATR were detected. The suspected ATR reporting rates for the before and after were 0.29% (73/25 213) and 2.06% (521/25 304, P < .001) and the ATR detection rates before and after were 0.13% (33/25 213) and 0.49% (116/25 304, P < .001), respectively. Among 116 ATR cases, 49.1% could be detected only by significant changes in VSs.

CONCLUSION

The EANS was very effective in detecting ATRs that could have been overlooked by medical staff. Further data are needed to demonstrate the extent to which the introduction of an EANS may improve the safety of transfused patients.

Evaluation of kodecytes using function-spacer-lipid constructs as a survey material for external proficiency testing for ABO subgrouping

BACKGROUND

It is not easy to find natural red blood cells (RBCs) with weak A (A_w ) or weak B phenotype (B_w ) for use as quality controls in ABO subgroup testing (subgrouping). The aim of this study was to prepare RBC kodecytes with synthetic blood group A and/or B function-spacer-lipid (FSL) constructs and to evaluate the possibility of using such kodecytes as a survey material for an external proficiency test (PT) to improve the quality of subgroup analysis.

METHODS

Three types of survey samples, including O phenotype RBCs and A kodecytes with A_w (0.02 mg/mL FSL-A solution) and B kodecytes with B_w (0.15 mg/mL FSL-B solution) were sent to 53 laboratories for an educational trial of PT for subgrouping. Cell typing was done using the manual tube technique.

RESULTS

Forty-three laboratories responded, and the re-activities of the survey samples varied from 0 to 4+ against anti-A and anti-B monoclonal reagents(MoAbs). Twenty-nine laboratories (67%) correctly grouped the B_w kodecytes as B_w . Fifteen (35%), 21 (48%), and 6 (13%) laboratories grouped the A_w kodecytes as A_w , A₂ , and O phenotypes, respectively. The anti-A MoAb clone affects the results of cell typing for A_w kodecytes. The stability of kodecytes was similar to that of natural O RBCs during storage.

CONCLUSION

Our kodecytes were useful as a survey material, and the survey results showed the necessity of materials for PT for subgrouping to improve the quality of laboratory analysis regardless of the different reactions according to the MoAb.

Toxoplasmosis in HIV and non HIV prisoners in Malaysia

This is the first Malaysian study to determine the trend and risk factors of Toxoplasma gondii infection in HIV and non-HIV among prisoners in terms of socio-demographic and behavioural characteristics, clinical presentations and haematological distributions. Blood samples from 303 participants, comprising 133 HIV positive and 170 HIV negative inmates were collected in EDTA and plain tubes. Two mls of each blood sample in plain tubes were centrifuged at 1500 rpm for 10 minutes and the sera obtained were subjected to ELISA for detection of Toxoplasma IgM and IgG antibody towards Toxoplasma antigen. Seropositive samples for Toxoplasma IgM or both Toxoplasma IgM and IgG were further tested with Novalisa Toxoplasma gondii IgG avidity test to rule out acute from latent infections. Blood in EDTA tubes were sent to Clinical Diagnostic Lab (CDL), University Malaya Medical Centre (UMMC), Kuala Lumpur for complete blood count and differential count analysis. Overall seroprevalence of anti-T. gondii antibodies was detected in 41.9% (127 out of 303) of the participants. Anti-T. gondii antibodies was detected in 63.2% (84 out of 133) of HIV positive subjects and in 25.3% (43 out of 170) of HIV negative subjects. Seroprevalence of anti-T. gondii antibodies was significantly higher in HIV positive than in HIV negative subjects (OR = 5.06; 95% CI = 3.09-8.30; p < 0.001). The rate of T. gondii seropositivity increased significantly in those aged 40 years and above, HIV positive individuals and those with history of drug abuse. White blood cells (WBCs), neutrophils and basophils counts decreased significantly in those infected with Toxoplasma. Creating awareness about T. gondii infection and follow-up of their status is recommended. Moreover, screening of T. gondii infection in HIV-infected individuals should be considered for better treatment and management, including control and prevention.

Standardization of ABO antibody titer measurement at laboratories in Korea

Background

Measurement of the ABO antibody (Ab) titer is important in ABO-incompatible transplantation. However, to the best of our knowledge, no standard protocol or external survey program to measure the ABO Ab titer has been established in Korea. We investigated the current status of ABO Ab titer measurements at various laboratories in Korea and the impact of the protocol provided to reduce interlaboratory variations in the methods and results of ABO Ab titers.

Methods

The Korean external quality assessment of blood bank laboratories sent external survey samples with a questionnaire to 68 laboratories across Korea for the measurement of ABO Ab titers in May 2012. After 6 months, a second set of survey samples were sent with a standard protocol to 53 of the previously surveyed laboratories. The protocol recommended incubation at room temperature only and use of the indirect antihuman globulin method for the tube test as well as and the column agglutination test (CAT).

Results

Several interlaboratory variations were observed in the results, technical procedures, and methods selected for measurement. We found that 80.4% laboratories hoped to change their protocol to the provisional one. Additionally, CAT showed significantly lower variation among laboratories (P=0.006) than the tube test.

Conclusions

Our study provides baseline data regarding the current status of ABO Ab titer measurement in Korea. The standard protocol and external survey were helpful to standardize the technical procedures and select methods for ABO Ab titer measurement.

Comparison of ABO antibody titers on the basis of the antibody detection method used

BACKGROUND

Detection methods for ABO antibody (Ab) titers vary across laboratories, and the results are different depending on the method used. We aimed to compare titer values using different detection methods for the measurement of ABO Ab titers.

METHODS

For ABO Ab detection, pooled group A or B red blood cells (RBCs) were reacted with each of 20 sera from blood groups A, B, or O without dithiothreitol treatment. The room-temperature (RT) incubation technique and the indirect antiglobulin test (IAT) were used in the tube test and gel card test. Flow cytometry (FCM) was performed by using anti-IgM and anti-IgG Abs.

RESULTS

Regardless of the blood groups tested, the FCM assay with anti-IgM showed the highest titer compared to the tube test and gel card test with RT incubation in both. The tube test with IAT showed a higher titer than the gel card test with IAT (Gel-IAT) or FCM with anti-IgG in blood group A and B, while Gel-IAT showed the highest titer relative to the other tests, only for the anti-A Ab in blood group O.

CONCLUSIONS

There were significant differences in the titers depending on the detection method used, and each method showed a different detection capacity for each ABO Ab depending on the ABO blood group tested. Therefore, caution should be exercised in interpreting ABO Ab titer results, taking into consideration the detection method used and the blood group.

Effects of platelet lysate preparations on the proliferation of HaCaT cells

Background

Standard protocols are lacking for the preparation of platelet lysates (PL) as an alternative to using fetal bovine serum as a cell culture supplement. This study aimed to establish optimum conditions for preparing PL for use in cell cultures.

Methods

Cell density in three pooled platelet concentrates (PC) were adjusted to 1×10¹²/L and 2×10¹²/L. PL was prepared from PC by 1 to 3 freeze-thaw (FT) cycles. HaCaT cells were cultured in media supplemented with 5% or 10% PL. Cell numbers were estimated using a Cell Counting Kit-8 (CCK-8; Dojindo Laboratories, Japan). Growth factors were quantified by using the Luminex 200 system (Luminex Corporation, USA).

Results

Cell proliferation rates in the presence of PLs were similar when prepared from PCs of both cell densities. The rates were higher in media containing 5% PL than 10% PL when prepared by two FT cycles. Concentrations of vascular endothelial growth factor (VEGF), platelet-derived growth factor-AB/BB (PDGF-AB/BB), PDGF-AA, and epidermal growth factor (EGF) were significantly higher in PL prepared from PC with a cell density of 2×10¹²/L than 1×10¹²/L PC. However, only VEGF and PDGF-AA concentrations in PLs were correlated with HaCaT cell counts.

Conclusions

The 5% PL from PC with a cell density of 1×10¹²/L prepared by two FT cycles treatment was the most effective condition that supported steady HaCaT cell proliferation. Our finding may be useful for preparing PL-supplemented cell culture media.

NeuroAiD® (MLC601) and amyloid precursor protein processing

BACKGROUND

Amyloid precursor protein (APP) undergoes cleavage under physiological conditions, predominantly by α- and γ-secretases, to form the nonpathogenic sAPPα and p3 fragments. By contrast, amyloid-beta (Aβ) is produced via proteolytic cleavage by β- and γ-secretases. In Alzheimer's disease (AD), APP is preferentially processed via the amyloidogenic pathway, producing large amounts of Aβ that form the major constituent of senile plaques and tau-containing neurofibrillary tangles. Similarly, stroke patients have a higher level of Aβ around the area of infarct, suggesting that Aβ may mediate at least some of the secondary neurotoxicity observed in stroke patients.

METHODS

To investigate the effects of MLC601 (NeuroAiD(®)) on regulation of APP processing, the human neuroblastoma cell line SH-SY5Y was used for all experiments. Stocks of MLC601 were prepared at a final concentration of 50 mg/ml. Cells were treated with different concentrations of MLC601 before assessing changes in the levels of released lactate dehydrogenase (LDH), full-length APP and secreted sAPPα.

RESULTS

Concentrations of MLC601 between 1 and 1,000 µg/ml significantly lowered the levels of LDH released into the media when compared to control cells. In contrast, MLC601 concentrations at 5,000 and 10,000 µg/ml resulted in a significant increase in the LDH release. Treatment with 100, 500 and 1,000 μg/ml of MLC601 significantly increases the levels of sAPPα secreted by SH-SY5Y into the media. Treatment with 1,000 μg/ml of MLC601 significantly decreased the levels of full-length APP.

CONCLUSION

MLC601 is a possible modulator of APP processing and has implications as a putative therapeutic strategy for the treatment of poststroke dementia and AD.

Hemophagocytosis by leukemic blasts in B lymphoblastic leukemia with t(12;21)(p13;q22); TEL-AML1 (ETV6-RUNX1): a case report

Blasts showing hemophagocytosis have been very rarely reported in acute lymphoblastic leukemia. We report a pediatric case of B lymphoblastic leukemia (BLL) with t(12;21)(p13;q22); TEL-AML1 (ETV6-RUNX1) showing erythrophagocytosis and thrombophagocytosis by leukemic blasts. About 4% of the leukemic blasts in marrow aspirate smears showed phagocytosis of erythrocytes, platelets, or nuclear remnants in a 3-year-old Korean boy with a diagnosis of BLL. Conventional cytogenetics and molecular analysis revealed the presence of t(12;21)(p13;q22); TEL-AML1 (ETV6-RUNX1). The patient responded well to chemotherapy and is in a state of complete remission.

The Effects of Helicobacter pylori on the prognosis of patients with curatively resected gastric cancers in a population with high infection rate

PURPOSE

The goal of this study was to assess the correlation between the Helicobacter pylori status of patients who underwent curative resection for gastric adenocarcinoma and their prognosis in Eastern societies where H. pylori infection is prevalent.

METHODS

Between 2006 and 2007, 192 patients who had a curative resection for the treatment of gastric adenocarcinoma were enrolled in the study. Of these patients, 18 were excluded due to an inexact evaluation of the H. pylori status, thereby leaving 174 patients in the final analysis. Serologic testing for H. pylori was assessed using an enzyme-linked immunosorbent assay kit for immunoglobulin G, and the histological presence of H. pylori was identified using the Giemsa stain.

RESULTS

Of the 174 patients, 111 patients (63.8%) were confirmed for H. pylori infection. H. pylori status did not correlate with the overall or disease-free survival. For patients with stage III or IV gastric cancer, a positive H. pylori status was a significant predictive factor for recurrence over that of a negative H. pylori status (P = 0.019). Negative H. pylori status was a predictive factor for recurrence in multivariable analysis (relative risk, 2.724; 95 confidence interval, 1.192 to 6.228).

CONCLUSION

Helicobacter pylori status did not correlate with the clinicopathologic factors of gastric adenocarcinoma. However, a negative Helicobacter pylori status may be a predictive factor for recurrence in patients diagnosed with advanced gastric adenocarcinoma.

P2-15-11: Outcomes of Corrective Procedure with Vicryl Mesh as an Oncoplastic Surgery of the Breast

Background: Both cosmetic and oncologic outcomes are becoming more important for breast cancer patients. Breast-conserving surgery (BCS) has an acceptable cosmetic result compared with mastectomy, but BCS is also associated with cosmetic failure. In this study, we evaluated the cosmetic outcome of reconstructive surgery with the absorbable implant vicryl mesh after BCS compared with the outcome of BCS alone.

Methods: From May 2007 to December 2009, 101 patients were involved in this study at Hallym University Sacred Heart Hospital. We used absorbable implants made of folding vicryl mesh and wrapped them with Interceed. In 79 cases, BCS with vicryl mesh implantation was performed; in the other 56 cases, only BCS was performed. Patient satisfaction with cosmetic outcomes was evaluated. We also analyzed other factors that affected cosmetic outcomes, including patient ages, body mass indices, tumor locations, and removed breast tissue.

Results: In the vicryl mesh implantation group, 65 of 79 patients (82.3%) were satisfied; in the BCS-only group, 24 of 56 patients (43%) were satisfied (P &lt; 0.05). In the vicryl mesh implantation group, patient ages, body mass indices, and removed breast tissue did not affect cosmetic outcomes. When the tumor was located in the upper outer quadrant, the patients were more satisfied (P &lt; 0.05). Conclusions: Reconstructive procedures with vicryl mesh are simple, safe, and less expensive than other plastic reconstruction techniques. This study suggests that the procedure was superior to BCS alone in cosmetic outcomes. We believe that the procedure could become a favorable technique in oncoplastic surgery.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-15-11.

Usefulness of delta value of platelet parameters on ADVIA 120 for the functional reactivity of stored platelets

An agonist-induced expression of CD62P by flow cytometry analysis for evaluating platelet functional reactivity has some disadvantages. We investigated the usefulness of platelet parameters by ADVIA 120 to predict an agonist-induced expression of CD62P in stored platelets. The CD62P expression by flow cytometry and the platelet parameters by ADVIA 120 were studied in samples from 27 platelet pheresis products. Delta (Delta) values were calculated as the degree of change of the platelet parameters studied with or without adenosine 5'-diphosphate sodium (ADP) stimulation. The CD62P expression of the ADP-activated platelets were correlated with the Delta platelet count (r=0.517) in the short-term storage group (within 10 hr from preparation), with the platelet component distribution width (PCDW) without ADP (r=-0.744) and the DeltaPCDW (r=-0.755) in the long-term storage group (after 10 hr from preparation). Therefore, the delta values of platelet parameters on ADVIA 120 analysis in platelets between with and without ADP stimulation could be useful as a simple predictor for the functional reactivity of stored platelets.

The development of a national surveillance system for monitoring blood use and inventory levels at sentinel hospitals in South Korea

We developed a web-based program for a national surveillance system to determine baseline data regarding the supply and demand of blood products at sentinel hospitals in South Korea. Sentinel hospitals were invited to participate in a 1-month pilot-test. The data for receipts and exports of blood from each hospital information system were converted into comma-separated value files according to a specific conversion rule. The daily data from the sites could be transferred to the web-based program server using a semi-automated submission procedure: pressing a key allowed the program to automatically compute the blood inventory level as well as other indices including the minimal inventory ratio (MIR), ideal inventory ratio (IIR), supply index (SI) and utilisation index (UI). The national surveillance system was referred to as the Korean Blood Inventory Monitoring System (KBIMS) and the web-based program for KBIMS was referred to as the Blood Inventory Monitoring System (BMS). A total of 30 256 red blood cell (RBC) units were submitted as receipt data, however, only 83% of the receipt data were submitted to the BMS server as export data (25 093 RBC units). Median values were 2.67 for MIR, 1.08 for IIR, 1.00 for SI, 0.88 for UI and 5.33 for the ideal inventory day. The BMS program was easy to use and is expected to provide a useful tool for monitoring hospital inventory levels. This information will provide baseline data regarding the supply and demand of blood products in South Korea.

The implementation and effects of a clinical laboratory accreditation program in Korea from 1999 to 2006

BACKGROUND

The Korean Laboratory Accreditation Program (KLAP) by the Korean Society of Laboratory Medicine (KSLM) was started in 1999. We summarized history and achievement of KLAP for the last 8 yr.

METHODS

We analyzed 8 yr data (1999-2006) of historical events, trends of participating laboratories, and scores according to the impact of the question to the outcome of the tests. Inspection check lists are for 'laboratory management', 'clinical chemistry', 'diagnostic hematology', 'clinical microbiology', 'diagnostic immunology', 'transfusion medicine', 'cytogenetics', 'molecular genetics', 'histocompatibility', 'flow cytometry', and 'comprehensive laboratory test verification report'. The laboratories with score 90 or higher got 2-yr certificate and laboratories with score between 60 and 89 got 1-yr certificate. The laboratories with score below 60 failed accreditation.

RESULTS

The number of accredited laboratories was 2.4 times higher in 2006 (n=227) than in 1999 (n=96). Inspection check lists have been revised 5 times till 2006. The average accreditation rate was 99.6% during these periods and the 2-yr accreditation rate was 32.4% in 2000, 45.6% in 2001, 53.3% in 2002, 47.3% in 2003, 68.5% in 2004, 37.7% in 2005, and 47.7% in 2006. Number of participants in inspector training workshops increased from 89 in 2000 to 766 in 2006.

CONCLUSIONS

The KLAP has been in place successfully and stabilized over the past 8 yr. It seemed to enhance the laboratory quality. Efforts for improvement of quality control and inspector training workshops appeared to be in the main contributing factors.

[A hemolytic transfusion reaction due to Anti-Ku antibody in a patient with Knull phenotype: the first case in Korea]

Knull phenotype completely lacks all Kell system antigens. Anti-Ku antibody is seen in immunized persons with Knull phenotype by transfusion or pregnancy. It can cause a fatal hemolytic transfusion reaction. A 66-yr-old male patient with liver cirrhosis visited emergency center due to acute bleeding. The patient was at hypovolemic shock status: his blood pressure was 80/50 mmHg, pulse rate was 110/min and hemoglobin level was 4.4 g/dL. Because of the presence of antibody against high incidence antigen, we could not find any compatible blood for the patient. Nevertheless, 4 units of packed RBCs had to be transfused. Moderate hemolytic transfusion reaction was developed after transfusion. At endoscopic examination, blood was spurting from gastric cardiac varix. Endoscopic histoacryl injection was tried, and bleeding was successfully controlled. After bleeding stopped, he was managed for anemia using steroid and other medical therapy instead of transfusion. His hemoglobin level was improved to 7.7 g/dL at the time of discharge. Later he has been proved to have a Knull phenotype, which is very rare, and anti-Ku antibody. This report is the first case of anti-Ku in a Knull phenotype person in Korea, who experienced a moderate hemolytic transfusion reaction.

Change of platelet activation markers using flow cytometry in patients with hematology/oncology disorders after transfusion

In spite of the frequent need of platelet transfusions, there is limited information on the association of platelet activation markers, in transfused patients with hematology/oncology disorders, with platelet function using flow cytometry. The goal of this study was to evaluate the changes of PAC-1 binding and CD62P expression, with or without agonists in patients after transfusions. Twenty-eight whole blood samples were obtained from 24 patients admitted to the department of Hematology & Oncology and transfused with platelets; these samples were compared to 30 healthy controls. Whole blood samples, either with or without agonists, such as 20 microM adenosine diphosphate (ADP) or 100 microM thrombin receptor activating peptide (TRAP), were stained with the fluorescein conjugated monoclonal antibodies PAC-1 or CD62P. Then, the percent expression for each marker was analysed using flow cytometry. ADP and TRAP induced an increased percentage of CD62P expression and PAC-1 binding after platelet transfusions compared to the samples studied before transfusion, and these findings were lower than those of the healthy controls. However, the expression of platelets without the agonists was not significantly changed, despite the transfusions. Therefore, agonist-induced platelet activation markers, studied by flow cytometry, appear to be more useful for the evaluation of platelet function after transfusions than platelet activation markers without agonists.

Genetic rearrangements of TN1546-like elements in vancomycin-resistant Enterococcus faecium isolates collected from hospitalized patients over a seven-year period

The heterogeneity of Tn1546 results from point mutations, deletions, and the integration of insertion sequence (IS) elements. Among these variations, the presence of IS elements accounts for much of the heterogeneity. Such a rearrangement could play a key role in the evolution of the vanA gene cluster, and hence, it may modify its transferability. In this study, we characterized the consequence of Tn1546 in vanA-containing Enterococcus faecium isolates collected from patients over time. From 1998 to 2004, 57 vanA-containing E. faecium isolates were collected from hospitalized patients at Ajou University Hospital in Korea. PCR amplification of internal regions of Tn1546 was performed, and both DNA strands were directly sequenced by the dideoxy termination method. All isolates were divided into three main types, including the prototype, according to the distribution of IS elements integrated into Tn1546 elements. Type I was characterized by an IS1542 insertion in the orf2-vanR intergenic region and an IS1216V insertion in the vanX-vanY intergenic region. Type II was represented by the presence of two copies of IS1216V at the 3' end of IS1542 and in the vanX-vanY intergenic region, as well as IS1542 in the orf2-vanR intergenic region. Seventeen strains isolated from 1998 to 2000 represented type I, and 38 strains isolated from 2000 to 2004 represented type II. The remaining two isolates were the prototype. The tendency for the rearrangement of Tn1546 was that the sequences were shortened as time passed, especially at the left or the right end, and hence, this could gradually modulate their transferability.

Reduction in glycopeptide resistance in vancomycin-resistant enterococci as a result of vanA cluster rearrangements

The molecular characterization of five clinical isolates of vanA-containing vancomycin-resistant enterococci with altered resistance to glycopeptides was examined. One strain represented an IS1216V insertion accompanied by partial deletion of the reading frame of vanX following a transposition event. The other four strains represented IS1216V within the vanX-vanY intergenic region associated with deletion of vanY or vanZ.

Current Status of Therapeutic Plasma Exchange in Korea

A nationwide survey on the status of plasma exchange in Korea was performed during the 2 year period 2001-02. Data from 496 patients were collected from 15 major hospitals. The most common indication was myasthenia gravis (15.3%), followed by thrombotic thrombocytopenic purpura (14.5%) and hemolytic uremic syndrome (9.7%). Clinical improvement was noted in 70.1% of the 415 cases. Plasma exchange by centrifugation alone accounted for 92.4%. Postcentrifugal filtration was carried out in 5.6% and double filtration in 2.0% of treatments. The most common instruments for the centrifugation were Cobe Spectra (71.3%) and Fenwal CS3000 (15.8%). Filtration was performed by either Kuraray KM8300 or Kuraray KM8800. The overall frequency of complications was 11.1% (293/2647 cases), of which symptomatic hypocalcemia was the most common (2.3%).

A study of blood usage by diagnoses in a Korean university hospital

BACKGROUND AND OBJECTIVES

There is paucity of comprehensive data on the blood usage with regard to diagnostic categories of Asian recipients. The purpose of this study is to analyse data for blood usage in a korean university hospital in order to obtain additional information on transfusion practices in relation to diagnoses.

MATERIALS AND METHODS

Data of information on patients discharged during the period from March 1996 to February 2002, who have received packed red blood cells (RBC), fresh frozen plasmas (FFP), and platelet components (PLT) were extracted from the computerized registers. We used only the principal four-digit diagnostic categories of the Tenth Revision of International Classification of Diseases.

RESULTS

A total of 397 489 units of blood components (RBC 171 916 units; FFP 69 301 units; and PLT 156 272 units) were transfused for 17.2% of all discharged patients. Acute myeloid leukaemia, liver cell carcinoma, advanced gastric cancer, alcoholic or other unspecified cirrhosis of liver were the top 5 diagnoses related with the highest usage of blood component.

CONCLUSIONS

The results showed a different blood usage pattern compared to those of previous studies. These provide a baseline transfusion practice at our institution, and the data would help in predicting future blood needs in a variety of diagnostic categories.

Evaluation of platelet parameters on the ADVIA 120 as the quality indicator for stored platelets

In order to investigate the possible use of platelet parameters on the ADVIA 120 hematologic analyzer as the routine quality control indicator for preparation and storage of platelets, platelet parameters, pH and CD62P expression were determined in stored platelet concentrates. Platelet component distribution width (PCDW) was decreased progressively on days 1 and 3 of storage for 5 days when compared with 0 day. PCDW correlated with CD62P expression on unstimulated platelets and the difference in CD62P expression following agonistic stimulation (a measure of functional reserve). Mean platelet component (MPC) was decreased on day 1 of storage. It did not however, show a progressive decrease over storage time and did not correlate with CD62P, although MPC has been known to be a useful screening test for platelet activation. Therefore, PCDW is considered to be a simple, convenient and cost-effective quality indicator for determining the viability and storage lesion of platelets for transfusion.

Effect of transfusion of fresh-frozen plasma on recipients' antibodies to hepatitis B surface antigen and hepatitis B surface antigen status in countries where hepatitis B virus is endemic

BACKGROUND AND OBJECTIVES

Antibodies to hepatitis B virus (HBV) that are passively acquired through transfusions may lead to confusion and inappropriate clinical decisions. We evaluated the effects of transfusing fresh-frozen plasma (FFP) on serological tests for HBV antibodies in patients without such antibodies.

MATERIALS AND METHODS

Tests for HBV surface antigen (HBsAg), and for antibodies to HBV surface antigen (anti-HBs) and HBV core antigen (anti-HBc), were carried out using enzyme immunoassay on the FFP and sera of 50 patients transfused with FFP containing anti-HBs.

RESULTS

After FFP transfusion, the incidences of 'false' positivity for anti-HBs and anti-HBc were 64% (32/50) and 100% (seven of seven), respectively, and of 'false' negativity for HBsAg was 18.8% (three of 16) in previously positive patients. The post-transfusion seropositivity for antibodies results from passive transmission, whereas the inability to detect HBsAg is the result of decreased detectable levels.

CONCLUSIONS

Laboratory staff and clinicians alike should be cautious in interpreting the results of the HBV marker tests in patients who have recently been transfused, and in obtaining specimens for such studies.

Autoimmune hemolytic anemia predominantly associated with IgA anti-E and anti-c

A patient with warm autoimmune hemolytic anemia (AIHA) due to predominance of immunoglobulin A (IgA) with an Rh specificity, considered to be the first case in Korea, is described. A 13-year-old male patient with severe hemolytic anemia showed a weak reactivity (1+) in the direct antiglobulin test (DAT) by using anti-IgG antiglobulin reagent. This finding, however, could not fully explain the patient's severe AIHA. When anti-IgA reagent was used for the DAT, strong reactivity (4+) was observed and free anti-E and anti-c autoantibodies were also detected by anti-IgA and anti-IgG reagents. The patient's hemoglobin began to rise with the administration of steroids. Because RBCs coated with multiple types of immunoglobulins are associated with more severe hemolysis than those only with IgG, the DATs using anti-IgA and other reagents are needed for the correct diagnosis when the result of DAT is not compatible with patient's clinical manifestations.

Antitumor effect of GnRH agonist in epithelial ovarian cancer

OBJECTIVE

The effects of the gonadotropin releasing hormone (GnRH) agonist (D-Trp(6)) were examined in two human ovarian cancer cell lines and in severe combined immune deficiency (SCID) mice to evaluate its potential as a cytocidal, cytostatic, or differentiating antitumor agent.

METHODS

We treated the human ovarian cancer cell lines OVCAR-3 and SKOV-3 for 5 or 7 days and sex-matched SCID mice with GnRH agonist for 29 days. The antitumor effect of GnRH agonist were studied in various aspects. To confirm the antiproliferative effect, we used 3-(4,5-dimethylthiazol-2-yl) -2,5-diphenyltetrazolium bromide colorimetric assay, in vitro, and a serial measurement of tumor growth in vivo. The disturbances of progression in the cell cycle and the changes of cyclin-dependent kinase 1 following treatment with GnRH agonist were evaluated with flow cytometric analysis in vitro. The induction of apoptosis following treatment with GnRH agonist was studied using in situ terminal deoxyribonucleotidyl transferase (Tdt) and further quantitated with ELISA in vitro. The presence of telomerase activity following treatment with GnRH agonist was measured by PCR-based telomeric repeat amplification protocol and ELISA detection in cell lines and xenografts in vitro and in vivo.

RESULTS

Continuous exposure of cell lines and xenografts to GnRH agonist resulted in growth inhibition of cancer cells in a dose- and time-dependent manner. In cultured cells, the GnRH agonist blocked cell cycle progression in G0/G1 phase and thus reduced the number of cells in S and G2/M phases. The phenomenon of apoptosis was documented in cultured cells treated with GnRH agonist by in situ Tdt assay. The frequency of apoptotic cells in the in situ Tdt assay was 5-6% compared with control, 4-5%. Apoptosis quantified by ELISA revealed a high incidence in cultured cells treated with GnRH agonist. The activities of telomerase in cell lines and xenografts were not decreased by GnRH agonist. There were not any significant changes of expression of CA-125 by flow cytometry and of the cellular morphology observed with light microscopy.

CONCLUSIONS

Our results indicate that the antiproliferative effect of GnRH agonist in epithelial ovarian cancer cells may be mainly attributed to cytostatic activities resulting in blocking of cell cycle progression in the G0/G1 phase and minimally related to the induction of apoptosis.

A search for anti-viral properties in Panamanian medicinal plants. The effects on HIV and its essential enzymes

Aqueous and methanolic extracts of 39 Panamanian medicinal plants were tested for anti-human immunodeficiency virus (HIV) effects. The extracts were tested for the inhibition of HIV-induced cytopathic effects in cultured cells, HIV-reverse transcriptase (RT) and HIV-protease (PR) enzymes. The water extract of the branches of Jatropha curcas (Euphorbiaceae) inhibited strongly the HIV-induced cytopathic effects with low cytotoxicity. On the other hand, the water extracts of the whole plant of Chamaesyce hyssopifolia (Euphorbiaceae), the leaves of Cordia spinescens (Boraginaceae) and the aerial parts of Hyptis lantanifolia (Labiatae), and the methanol extract of the aerial parts of Tetrapteris macrocarpa (Malpighiaceae) were potent inhibitors of HIV-RT (IC50: 6-8 microg/ml). Seven out of 39 plants were found to be moderate inhibitors of HIV-PR (IC50: 43-100 microg/ml). Furthermore, we report on the respective inhibitory substances of J. curcas, C. hyssopifolia and C. spinescens, and their possible mechanism of action.

Two vivax malaria cases detected in Korea

On June and July 1994, two cases of vivax malaria were consecutively diagnosed at the Yongsan Hospital, Chung-Ang University in Seoul. The first patient was a soldier serving in western parts of the demilitarized zone (DMZ) while the second case was a resident of a village near DMZ. Neither patients had history of being abroad. Republic of Korea (ROK) has been free of malaria since the mid-1970s except for imported cases. The two vivax malaria cases, together with an additional patient detected in 1993, occurred in relatively small areas near DMZ. This necessitated an epidemiologic surveillance. When medical records and blood smears in the areas were examined, no other cases were found. Of 7,723 mosquitoes collected by a black light trap for two nights in June, 7,066 (91.5%) were Anopheles sinensis. In order to evaluate a significance of the recent malaria occurrence, a surveillance system should be operated in the areas.

Effects of qigong on cardiorespiratory changes: a preliminary study

Qigong, a special form of breathing exercise, was investigated to examine its effect on cardiorespiratory changes. Ten volunteers (five males and five females) participated in a 20-minute group instructional session for 10 consecutive days before testing of its treatment effects. The testing protocol followed a C1-T-C2 design, where C1, T, and C2 represented the first, treatment, and second control period, respectively. Each period consisted of a 5-minute interval, and thus each testing session consisted of 15 minutes. The results indicated there were no statistically significant differences (p > 0.05) in heart rate or tidal volume for the three 5-minute periods. There was a significant decrease (p < 0.05) in respiratory exchange ratio between T and C2. A significant increase in ventilatory efficiency for carbon dioxide production was found between C1 and T. Statistically significant differences (p < 0.05) were found in the volume of oxygen consumed and carbon dioxide produced, frequency of breath, expired ventilation, and ventilatory efficiency for oxygen produced between the T and the two control periods. This preliminary study of Qigong demonstrates that the subjects were able to learn the technique in a short period of time. The data also suggest that, with an improvement of nearly 20% in ventilatory efficiency for oxygen uptake and carbon dioxide production, this technique may have useful therapeutic value.