First Case of Trueperella bernardiae Bacteremia in an Immunocompromised Patient in Korea

노주혜,김명숙,김도균,용동은,이경원 대한진단검사의학회 2019 Annals of Laboratory Medicine Vol.39 No.6

Blood Supply and Demand in Korea: What is in Store for the Future?

노주혜,최승준,김신영,민혁기,김현옥 연세대학교의과대학 2020 Yonsei medical journal Vol.61 No.5

Purpose: Presently, Korea is facing new challenges associated with an imbalance in blood supply and demand. The purpose of this study was to examine trends in blood supply and demand in Korea over the past 10 years through 2018 and to propose what to prepare in the future. Materials and Methods: Age demographics in Korea were analyzed using data from the Statistics Korea. Blood donation and blood supply data were analyzed using Blood Services Statistics 2018 by the Korean Red Cross. Blood transfusion data from hospitals in 2018 were obtained from the Health Insurance Review and Assessment Service. Results: In 2018, 2883270 whole blood and apheresis units were collected in Korea. The Korean Red Cross supplied 4277762 blood components to 2491 hospitals. The overall blood donation rate was 5.6%, and the most frequent donors were young male donors. Leukoreduced red blood cells (RBCs) constituted 25% of all RBCs used, and 40% of all platelets were supplied by single-donor platelets. The self-sufficiency rate of domestic plasma with which to produce plasma-derived medicinal products was 68.7% in 2018. Blood use was the most frequent among patients aged 70–79 years. Conclusion: Blood management in Korea is changing rapidly due to a low birth rate, rapid aging, and an increase in severely ill patients who require most of the blood supply. Therefore, future plans to promote donation at a national level and optimal use of blood in hospitals is necessary.

혈구포식림프조직구증 환자에서의 치료적 혈장교환술 시행 증례보고

노주혜,김신영,나현진,이경애,김현옥 대한진단검사의학회 2019 Laboratory Medicine Online Vol.9 No.4

A 22-year old female patient with systemic lupus erythematosus presenting microangiopathic hemolytic anemia was treated with therapeutic plasma exchange 23 times. The patient's condition and laboratory findings (aspartate aminotransferase, alanine aminotransferase, ferritin, total bilirubin, and lactate dehydrogenase) did not improve despite the initial 18 therapeutic plasma exchange treatments. Thrombotic thrombocytopenic purpura was ruled out due to normal ADAMTS-13 activity test result; hemophagocytic lymphohistiocytosis was diagnosed based on fever, splenomegaly, pancytopenia, hypertriglyceridemia, hyperferritinemia, and hemophagocytosis in bone marrow aspiration. The patient's condition improved rapidly upon treatment with a combination of immunosuppressants and cytotoxic agents, and more therapeutic plasma exchanges were performed five consecutive times with prolonged intervals in between. We observed that therapeutic plasma exchange treatment alone was not effective enough to treat hemophagocytic lymphohistiocytosis, unlike thrombotic thrombocytopenic purpura. Therefore, it is necessary to determine and start drug administration promptly in the treatment of hemophagocytic lymphohistiocytosis with thrombotic microangiopathy. 미세혈관병용혈빈혈을 동반한 전신홍반루푸스에 이환된 22세 여자 환자에게 총 23회의 치료적 혈장교환술을 시행하였다. 초기 18회의 치료적 혈장교환술에도 불구하고 환자의 상태 및 검사소견(아스파르테이트 아미노전이효소, 알라닌 아미노전이효소, 페리틴, 총 빌리루빈 및 젖산탈수소효소)은 개선되지 않았다. 혈전혈소판감소자색반병은 ADAMTS-13 활성 결과가 정상으로 측정되어 배제되었으며, 발열과 비장비대, 혈구감소증, 고중성지방혈증 및 고페리틴혈증과 골수 검사에서 혈구포식 소견이 관찰되어 혈구포식림프조직구증으로 확진되었다. 이후 면역억제제와 세포독성항암제를 병행 투여함으로써 환자의 상태는 급격히 호전되었으며, 치료적 혈장교환술은 점차 간격을 두고 횟수를 줄여 5회 더 시행 후 종료하였다. 혈구포식림프조직구증인 본 증례에서는 혈전혈소판감소성자색반병과는 달리 치료적 혈장교환술 단독요법에는 충분한 치료반응을 보이지 않았다. 따라서 혈전미세혈관병증이 보이더라도 혈구포식림프조직구증으로 진단되는 경우 빠른 약물치료의 결정 및 시행이 필요할 것으로 보인다.

코로나바이러스감염증-19에서의 회복기혈장치료 시 고려사항

노주혜,김현미,김준년,김신영,김현옥 대한수혈학회 2020 大韓輸血學會誌 Vol.31 No.1

Convalescent plasma therapy has been used to achieve passive immunization against diverse infectious agents by administering pathogen-specific antibodies. Coronavirus disease 19 (COVID-19), which originated in Wuhan, China, has recently become a major concern all over the world. There are no specific treatment recommendations for COVID-19 because of the lack of knowledge and evidence about this virus. Convalescent plasma therapy can be used as an empirical and investigational treatment for COVID-19, and so we briefly describe the main issues related to convalescent plasma therapy from the perspective of transfusion medicine. (Korean J Blood Transfus 2020;31:67-69)

Application of the Whole Genome-Based Bacterial Identification System, TrueBac ID, Using Clinical Isolates That Were Not Identified With Three Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS) Systems

하성민,김창기,노주혜,변정현,양승조,최선빈,전종식,용동은 대한진단검사의학회 2019 Annals of Laboratory Medicine Vol.39 No.6

Background: Next-generation sequencing is increasingly used for taxonomic identification of pathogenic bacterial isolates. We evaluated the performance of a newly introduced whole genome-based bacterial identification system, TrueBac ID (ChunLab Inc., Seoul, Korea), using clinical isolates that were not identified by three matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) systems and 16S rRNA gene sequencing. Methods: Thirty-six bacterial isolates were selected from a university-affiliated hospital and a commercial clinical laboratory. Species was identified by three MALDI-TOF MS systems: Bruker Biotyper MS (Bruker Daltonics, Billerica, MA, USA), VITEK MS (bioMérieux, Marcy l’Étoile, France), and ASTA MicroIDSys (ASTA Inc., Suwon, Korea). Whole genome sequencing was conducted using the Illumina MiSeq system (Illumina, San Diego, CA, USA), and genome-based identification was performed using the TrueBac ID cloud system (www.truebacid.com). Results: TrueBac ID assigned 94% (34/36) of the isolates to known (N=25) or novel (N=4) species, genomospecies (N=3), or species group (N=2). The remaining two were identified at the genus level. Conclusions: TrueBac ID successfully identified the majority of isolates that MALDI-TOF MS failed to identify. Genome-based identification can be a useful tool in clinical laboratories, with its superior accuracy and database-driven operations.

단일 기관에서의 수혈관련 급성폐손상 증례보고 및 새로운 진단 기준에 대한 고찰

이광섭,김신영,노주혜,최승준,김현옥 대한수혈학회 2019 大韓輸血學會誌 Vol.30 No.3

Background: Transfusion-related acute lung injury (TRALI) is defined as acute respiratory distress syndrome with non-cardiogenic pulmonary edema caused by transfusion. It occurs only rarely but could result in patient mortality. TRALI has been declining since the successful adoption of TRALI risk mitigation strategies in several countries. The new diagnostic criteria were suggested in 2019 based on the knowledge and experience gained throughout the last decade. This article integrated a series of TRALI cases diagnosed in a tertiary hospital while reviewing each case based upon the new diagnostic criteria. Methods: Among the reported transfusion adverse reactions that occurred from March 2013 to June 2019, seven TRALI cases were recruited for this study. Each case was retrospectively reexamined with its clinical condition and transfusion history. The diagnosed cases were classified into TRALI subtypes newly suggested in the 2019 version. Results: The mean time interval to adverse reaction was 117 minutes (range: 7~370 minutes) and all satisfied the condition of hypoxemia and bilateral pulmonary infiltrations. The transfused blood components were apheresis platelets in three cases, platelet concentrates in one case, red blood cells in one case and combinations of different products in two cases. Five cases were diagnosed as possible TRALI, and all five cases were diagnosed as TRALI type 2 (2019 criteria). Conclusion: In our center, seven patients were diagnosed TRALI during the last 6 years. Screening more TRALI patients according to the new criteria, along with investigating the patients’ clinical characteristics, transfused blood components, treatments and integrated research, will facilitate Korean research on this field of medicine. (Korean J Blood Transfus 2019;30:219-229)

Use of Convalescent Plasma Therapy in Two COVID-19 Patients with Acute Respiratory Distress Syndrome in Korea

안진영,Yujin Sohn,Su Hwan Lee,Yunsuk Cho,Jong Hoon Hyun,Yae Jee Baek,Su Jin Jeong,Jung Ho Kim,Nam Su Ku,JoonSupYeom,노주혜,Mi Young Ahn,Bum Sik Chin,김영삼,이혁민,용동은,김현옥,김신영,최준용 대한의학회 2020 Journal of Korean medical science Vol.35 No.14

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 not yet has established its treatment, but convalescent plasma has been expected to increase survival rates as in the case with other emerging viral infections. We describe two cases of COVID-19 treated with convalescent plasma infusion. Both patients presented severe pneumonia with acute respiratory distress syndrome and showed a favorable outcome after the use of convalescent plasma in addition to systemic corticosteroid. To our knowledge, this is the first report of the use of convalescent plasma therapy for COVID-19 in Korea.