한국인에서 Dia 선별혈구를 포함한 수혈 전 비예기항체 선별검사의 경험 = An Experience with Unexpected Antibody Screening Tests using a Panel That Included Dia Cells in Koreans

다국어 초록 (Multilingual Abstract)

Background: In Korea, a screening panel of cells from abroad without Dia positive cells has been commonly used when a patient has an unexpected antibody screening test. It has been reported that Dia occurs with a frequency of 6.14 to 14.5% among Koreans. However, the current popular antibody screening panels contain no Dia positive cells. In this study, we evaluate the clinical usefulness of the Dia Cell Panel (Diagnostic Grifols, Barcelona, Spain) for Koreans.
Methods: A total of 3,372 pretransfusion samples were employed for unexpected antibody screening testing using panels of cells by the DG Gel microtube column agglutination system, including additional Dia cells (Diagnostic Grifols, Barcelona, Spain). The positive cases in this system were confirmed again with DiaMed Dia antigen positive panel cells (DiaMed Ag, Cresssier, Morat, Switzerland) and this was followed by sequence- based Diego genotyping.
Results: The positive detection rate of an unexpected antibody screening test using SeraScan Diana I and II was 1.07% (36/3372), and seven samples were reactive (1＋∼2＋) with the SeraScan Dia panel cells (0.21%). However, among the 5 available genotyped samples, two cases were typed as Di(a−b＋).
Conclusion: Even though there is discrepancy between the genotype and the two antibody screening kits, the addition of Dia positive cells as unexpected antibody screening panel cells is recommended.

국문 초록 (Abstract)

배경: Dia 항원은 서구인에서는 거의 발견되지 않는 저 빈도 항원이라는 이유로 비예기 항체 선별검사시 포함되지 않지만, 한국인의 6.4∼14.5%에서 양성으로 보고되고, 항-Dia 항체는 용혈성 부작용 및 신생아 용혈성 질환을 일으킬 수 있는 것으로 보고되었다. 따라서 본원에서는 비예기 항체 선별검사에 Dia 선별 혈구를 포함시켰고, 양성인 경우 Diego 유전자에 대한 직접 염기서열 분석으로 Diego 유전자형을 결정하여 확인하여 항-Dia 항체 양성률을 조사하였다.
방법: 2009년 3월부터 비예기 항체 선별검사가 의뢰된 3,372명을 대상으로 하였고, SeraScan Diana I & II (GRIFOLS, S.A) 혈구에 Dia 혈구(GRIFOLS, S.A)를 추가하여 검사를 시행하였다. 양성인 경우 추가로 Dia 혈구(Diamed AG)검사와, Diego 유전자에 대한 직접 염기서열 분석으로 Diego 유전자형을 결정하였다.
결과: Dia 혈구(GRIFOLS, S.A)에 양성률은 0.21% (7/3372), Dia 혈구(Diamed AG)는 0.09% (3/3372)를 보였다. 검체를 확보한 5명에 대해서 유전자형 검사결과 Diagnostic Grifols Dia 혈구가 위양성을 보인 것으로 확인되어서 항-Dia 항체 양성률은 0.09%로 확인되었다.
결론: 유전자형과 표현형의 검사의 차이가 있음에도 불구하고 한국인에서의 Dia 항원과 항-Dia 항체의 높은 빈도를 고려할 때, 비예기 항체 검사에 Dia 혈구를 포함시키는 것이 필요하다고 생각 된다.

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