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윤응준,이현승,박형두,이수연 대한진단검사의학회 2022 Laboratory Medicine Online Vol.12 No.4
Background: Recent American guideline published in 2020 recommend using 24-h area under the curve (AUC)/minimum inhibitory concentration instead of vancomycin serum concentration (Ctrough) for vancomycin therapeutic drug monitoring (TDM). However, Ctrough-based TDM is widely used in clinical practice. Thus, this retrospective study aimed to compare Ctrough-based and AUC-based TDM. Methods: We evaluated patients’ TDM data with at least one vancomycin trough measurement. Patients younger than 18 years, admitted to an intensive care unit, or on renal replacement therapy were excluded. The variables of Ctrough-based and AUC-based TDM were simulated using MwPharm++ (Mediware, Czech Republic) with vancomycin two-compartment model. The therapeutic range was 400-600 mg*h/L and 15-20 mg/L for AUC and Ctrough, respectively. We evaluated the correlation between Ctrough and AUC, the attainment rate of AUC target range, and changes in vancomycin dose and Ctrough when AUC-based TDM is applied. Results: One hundred and four patients were enrolled. Ctrough and AUC correlated moderately (R=0.707, P <0.001). Among 31 patients with Ctrough of 15-20 mg/L, the AUC of only 18 patients was within the target range (18/31, 58.1%). In addition, most patients with Ctrough of 10-15 mg/L had the AUC within the target range (57/66, 86.4%). The respective vancomycin dose and Ctrough were expected to be significantly lower in AUC-based TDM simulation than those in Ctrough-based TDM simulationConclusions: Ctrough of 15-20 mg/L for vancomycin monitoring is not appropriate for attaining AUC target range. Targeting either AUC or lower Ctrough is recommended for vancomycin TDM.
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윤응준,김태열,문선경,조덕 대한수혈학회 2021 大韓輸血學會誌 Vol.32 No.3
Immune-related adverse events, including immune hemolytic anemia, have been reported in patients treated with immune checkpoint inhibitors. In particular, RBC autoantibodies are important because they can cause hemolytic anemia and interfere with pre-transfusion tests. On the other hand, there are few reports on the characteristics of RBC autoantibodies induced by immune checkpoint inhibitors in Korea. The medical history and laboratory results, including pretransfusion tests of ten patients treated with immune checkpoint inhibitors, were reviewed retrospectively. The median interval from the first administration of immune checkpoint inhibitors to the development of autoantibodies was 12 weeks. In eight patients, only cold autoantibodies were developed. Both warm and cold autoantibodies developed in one patient, and warm autoantibodies alone were detected in one patient. Of seven patients tested by a direct antiglobulin test, two were negative, and the remaining five were positive for IgG and negative for C3d. In conclusion, this study presented ten cases of autoantibody developments in patients treated with immune checkpoint inhibitors and the possible relationship between the immune checkpoint inhibitors and RBC autoantibody development. Further comprehensive studies will be needed to elucidate this relationship. (Korean J Blood Transfus 2021;32:201-208)
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