A Case of ABO Discrepancy due to Anti-IH

The patient was a 70-year-old woman with hypertension and end stage renal disease, and she presented with left wrist pain due to falling a day before admission. On admission, laboratory testing revealed a hemoglobin level of 6.7 g/dL, and a physician ordered 2 units of packed RBCs. She had never received a RBC transfusion in the past. The ABO grouping showed a discrepancy between the cell type AB and serum type O, and the irregular antibody screening was negative. Crossmatchings with group AB and group O RBCs were incompatible. Anti-I, which is a cold antibody, was inferred because the degree of agglutination was decreased after warming. However, crossmatching with group O RBCs, which are the universal donor blood, was positive and the anti-IH was considered to be the specificity of the irregular antibody. The patient's serum did not react with group O cord (i) blood cells and anti-I was then considered. The genotype of this patient was AB, and it was inferred that the ABO discrepancy was due to anti-IH.ope

Evaluating the Appropriateness of a Single Unit Transfusion

Background: The domestic quantity of blood components consumed has been decreasing since 2002, but the rate of a single unit RBC transfusion (SUT) has been on the increase. In the past, a SUT was regarded as an uncesssary procedure, but currently is considered as an effective method to maintain a minimal hemoglobin concentration for physiological needs. We investigated the actual conditions of a SUT.Methods: We analyzed 800 cases of SUTs performed at a tertiary care university hospital between March 2006 March and February 2007. The subjects of the study were divided into a surgical group (n=561) and medical group (n=239) for the purpose of RBC unit usage and were analyzed by groups and ordering departments, with an analysis of the pre and post-transfusion hemoglobin concentration and hematocrit values. The distribution according to the pre and post-transfusion hemoglobin ranges were calculated.Results: The mean hemoglobin concentration increment of the surgical group was significantly lower than that of the medical group (P＜0.0001) and the mean pre and post-transfusion hemoglobin concentrations of the medical group were lower than that of the surgical group (P＜0.0001). Approximately 26% cases of the SUTs performed in the surgical group were appropriate, based on a post-transfusion hemoglobin concentration below 10 g/dL. In the medical group, about 75% of the SUTs were appropriate based on a pre-transfusion hemoglobin concentration below 9 g/dL.Conclusion: Most transfusions are decided based on various clinical situations and opinions of the clinicians. Therefore, continuous evaluation of the appropriateness of transfusion is necessary. In our study, the appropriateness of a SUT was estimated indirectly based on the pre and post-transfusion hemoglobin concentration. Consequently, policies and strategies for performing asingle unit RBC transfusion are required.ope

The Trends for Nationwide Blood Collection and the Supply of Blood in Korea during 2002∼2006

Background: The recent trends for blood collection and the blood supply were analyzed. Methods: Data from the annual reports of the Korean Red Cross from 2002 to 2006 were analyzed. Results: The number of donors in 2002∼2003 was about 2,530,000, but this decreased to 2,300,000 in the past 3 years with the population’s donation rate being 4.7%. By age, those donors between 16∼29 years made up 83% of all the donors. As donor verification became possible in real-time, blood collection from the registered deferral donors was decreased. Blood drawn by the KRC made up 98% of all the blood collected in Korea. Plasma collection for fractionation had recently decreased because of the blood shortage for transfusion in hospitals. The collection of single donor platelets has increased to up to 25% of all the platelets used in Korea. The supply of pre-storage leuko-reduced RBCs had increased. The inventory levels of blood components were lower than the proper levels for most of the days in 2006. The rate of discarding outdated blood components was markedly decreased due to a shortage of blood. The positive rate in screening tests for transfusion-related infection was an average of 2.4%. By nucleic acid tests,which were initiated from 2005, 14 cases during the window period (10 cases of HCV and 4 cases of HIV) were detected. Conclusion: For insuring a safe supply of blood, the donor information systems and up-to-date tests were deemed to become of good quality. However, the blood shortage should be resolved as soon as possible to maintain a consistent blood supplyope

A Case of Hemolytic Transfusion Reaction in a Patient with Anti-E, Anti-M, Anti-Jkb, and Anti-Lea

We reported a case of hemolytic transfusion reaction that was related to multiple RBC antibodies such as anti-E, anti-M, anti-Jkb and anti-Lea after serial RBC transfusions. A forty-nine year old female visited the emergency room (ER) with hematochezia. She had previously received 16 units of packed RBCs from 2003 to Jan 2007 for her intermittent esophageal varix bleeding. No specific antibodies were identified before this visiting. At the ER, under the request for packed RBCs, we identified anti-E antibody within her serum. Her blood type was AB, RhD＋ with the phenotype of CcDe. She received 5 units of E antigen negative RBCs. However, she showed hemolytic transfusion reactions such as mild fever with a decrease of hemoglobin from 11.4 g/dL to 6.8 g/dL after the transfusion. From the 8th to the 10th hospital day, another 3 units of E-antigen negative with the least incompatible RBCs were transfused to the patient, but the level of hemoglobin was not definitely increased. At the 14th hospital day, she received a final 2 units of leuko-reduced RBCs without E, M and Jkb antigens. Her hemoglobin was increased right after the final transfusion. We found that the patient's serum reacted with multiple RBC antibodies such as anti-E, anti-M, anti-Jkb and anti-Lea antibodies. She finally recovered from acute varix bleeding and was discharged on the 26th hospital day with the level of hemoglobin being 8.3 g/dLope

Automated Collection of Leukoreduced Double Red Blood Cell Units using an Alyx Apheresis Device

Background: Automated collection of leukoreduced double red blood cell (RBC) units has been used to improve blood collection efficiency in many countries. The aim of this study was to evaluate leukoreduced double RBC unit collection using apheresis and to determine its clinical uses. Methods: Automated leukoreduced double RBC units were collected from 17 healthy male volunteers using an Alyx apheresis device (Baxter, DeerWeld, IL). Our institutional criteria for male donors were as follows: height ≥170 cm, weight ≥70 kg, and hemoglobin ≥14.5 g/dL. Each donor's complete blood count (CBC) was determined before and after the apheresis procedure. In order to validate the final leukoreduced double RBC units, white blood cell (WBC) counts were measured manually using a Nageotte chamber. Results: Leukoreduced double RBC units were collected in an average of 27±7 min, without specific donor reactions. The average volume of one unit of leukoreduced RBCs was 281±6 mL. Each donor's hemoglobin (P＜0.001) and hematocrit (P＜0.001) were significantly lower after donation, though WBC and platelet counts were no different. No residual WBCs were found in the leukoreduced, filtered product upon Nageotte chamber counting. Twenty-eight units of leukoreduced RBCs from 14 donors were transfused to patients who required leukoreduced RBCs, without specific transfusion reactions. Conclusion: The Alyx apheresis device allowed for safe and effective collection of leukoreduced double RBC units from a single donor. Automatically collected leukoreduced double RBC units were transfused to patients for the first time in Korea.ope

Analysis of Characteristics of Mononuclear Cells Remaining in the Leukoreduction System Chamber of Trima Accel(R) and Their Differentiation Into Dendritic Cells

BACKGROUND: We investigated the characteristics of the mononuclear cells remaining in the leukoreduction system (LRS) chambers of Trima Accel(R) in comparison with those of standard buffy coat cells, and evaluated their potential for differentiation into dendritic cells. METHODS: Twenty-six LRS chambers of Trima Accel(R) were collected after platelet pheresis from healthy adults. Flow cytometric analysis for T, B, NK, and CD14+ cells was performed and the number of CD34+ cells was counted. Differentiation and maturation into dendritic cells were induced using CD14+ cells seperated via Magnetic cell sorting (MACS(R)) Seperation (Miltenyi Biotec Inc., USA). RESULTS: Total white blood cell (WBC) count in LRS chambers was 10.8x108 (range 7.7-18.0x108). The median values (range) of proportions of each cells were CD4+ T cell 29.6% (18.7-37.6), CD8+ T cell 27.7% (19.2-40.0), B cell 5.5% (2.2-12.1), NK cell 15.7% (13.7-19.9), and CD14+ cells 12.4% (8.6-32.3) respectively. Although total WBC count was significantly higher in the buffy coat (whole blood of 400 mL) than the LRS chambers, the numbers of lymphocytes and monocytes were not statistically different. The numbers of B cells and CD4+ cells were significantly higher in the buffy coat than the LRS chambers (P<0.05). The median value (range) of CD34+ cells obtained from the LRS chambers was 0.9x10(6) (0.2-2.6x10(6)). After 7 days of cytokine-supplemented culture, the CD14+ cells were successfully differentiated into dendritic cells. CONCLUSIONS: The mononuclear cells in LRS chambers of Trima Accel(R) are an excellent alternative source of viable and functional human blood cells, which can be used for research purposesope

High Dose Chemotherapy and Autologous Peripheral Blood Stem Cell Transplantation in Pediatric Patients with High-risk Neuroblastoma

Background: High dose chemotherapy followed by autologous peripheral blood stem cell transplantation (PBSCT) has become standard therapy for high-risk neuroblastoma patients. We performed a retrospective analysis to assess the characteristics of peripheral blood stem cell harvest (PBSCH) and PBSCT and its clinical outcome.Methods: We reviewed 17 cases of patients with high-risk neuroblastoma that underwent PBSCH and/or high dose chemotherapy followed by PBSCT.Results: Sixteen patients had stage IV neuroblastoma and one patient had a stage III neuroblastoma with MYCN amplification. The median age of the 17 patients was 43 months (range 22∼114 months) and the median body weight was 15 kg (range 10∼24 kg). After induction chemotherapy using a modified N7 protocol, 34 PBSCHs (1.5 leukapheresis per PBSCH) were performed. A statistically significant correlation was found between the pre-leukapheresis CD34+ cell count and the total number CD34+ cells of the harvested products (P＜0.0001). Tyrosine hydroxylase mRNA was not detected by RT-PCR in all of the leukapheresis products. High dose chemotherapy followed by PBSCT was performed in 24 cases. The mean infused CD34+ cell dose was 4.01×106/kg and WBC and platelet engraftment was performed on day 12.0 and 21.5, respectively. Eleven patients died, and six patients are surviving 11 to 68 months after PBSCT (median survival time, 35 months).Conclusion: In this single institution study, treatment with high dose chemotherapy and PBSCT was performed successfully for children with high-risk neuroblastoma.ope

도시 주변개체의 일상 표현

도시공간은 인간의 낭만적 상상을 만족시켜 주는 기술 문명이 밀집되어 있는 곳이다. 그러나 기술이 발달할수록, 물질적으로 풍요로와질수록 인간성 상실과 소외의 문제가 제기된다. 본 연구는 문명화된 도시가 반드시 이상적인 공간인가에 대한 의문을 가지고 시작되었다. 이 의문은 이러한 진보에 무관심한 개체들에서 출발하게 되었다. 이 개체들은 오히려 이러한 진보에 자신들의 공간이나 생태에 위협을 받고 있다. 본 연구자는 이들이 처한 상황을 불안 속에 내던져진 실존적 상황으로 보았다. 이러한 상황 속에서 그들이 생존을 위한 노력을 통하여 스스로 자기 존재를 창조하고 능동적인 삶을 영위해 나감으로써 그 상황을 극복한다고 보았다. 주변 개체들은 도시화가 추구하는 것과 부합되지 않아서 주변부로 밀려난 생명체들을 말한다. 연구의 목적은 이러한 도시 주변 개체들의 일상성에 초점을 맞추어 작품화시키는데 있다. 연구의 내용은 실존주의와 신구상회화를 이론적 근거로 제시하였고, 표현내용에서는 도시화의 과정에서 소외되어 주변개체의 상황을 서술하였다. 표현대상은 들고양이, 비둘기, 까치, 딱새, 달동네의 일상을 표현한 작품 7점이다. 연구의 결과를 종합하면, 주변개체들은 처음부터 도시공간에서 소외된 존재들이 아니었다. 그러나, 도시화는 그들에게 불균형한 삶을 초래했으며 이러한예상치 못한 변화 속에서 나름의 독특한 변형된 삶을 살고 있었다. 이에 본 연구는 이러한 상황의 극복을 위해 애쓰면서 소외라는 실존적 상황을 어떻게 극복하고 받아들이느냐에 초점을 맞추었다. 이들의 실존은 소외된 주변공간에 생기를 넣는 것이다. 본 연구자는 이런 의미에서 이들의 존재가치를 발견할 수 있었다. 주변개체가 등장하는 배경은 도시내부의 다양한 장소이다. 예를 들어 고층건물의 옥상, 재개발 지역 주택가골목, 주택의 지붕, 담장, 창문으로, 거시적인 시각에서부터 미시적 시각에 이르는 시점을 통해 도시의 다양한 얼굴을 찾았다. 그리고 이 장소들은 눈에 드러나지 않아 쉽게 지나치게 되는 곳을 찾아낸다는 일관된 방법을 통해 선택된다. 주변개체들은 작품에서 도시의 들고양이, 비둘기, 까치, 달동네로 나타난다. 이 개체들의 일상성은 밥먹기, 잠자기, 걸어가기, 꿈꾸기, 풍경, 쉬기, 만나기 들로 표현된다. 이러한 일상적 행동은 건물옥상, 골목, 건물천장, 담장 틈, 창문 등과 같은 중심의 공간이 아닌 주변의 공간에서 이루어진다. 그리고 이 공간들은 극도로 축소된 작은 장면으로 나타나는데, 그럼으로써 이 공간은 주변의 공간이라는 물질적인 공간에 그치는 것이 아니라 이들이 느끼는 소외감을 상징하는 심리적인 공간으로 변화되는 것이다. 표현방법으로는 중심의 공간을 기둥의 반복 배열, 사각형 기둥으로 규격화된 도시공간을 상징화 시켰으며, 이와 대비되는 주변 공간의 표현은 손자국이 드러나는 테라코타, 거칠게 채색된 드로잉으로 상징화 시켰다. 이러한 공간의 대비 속에서 이들 개체의 생존을 강하게 전달된다. ; A city is the right place where high technology converges satisfying romantic human imagination. However, as the technology advances and material prosperity increases, a matter of dehumanization and alienation has received much attention. This study has been initiated by doubting if the civilized city is a ideal place live in and started from beings indifferent to theses technological advances Ironically, these advances are threatening the living environment for these beings regardless of their will. Regarding the reality these beings are faced with as unstable existence, the researcher assumes that the underprivileged create their own being through painstaking efforts for existence under extreme situation and overcome unfavorable reality by leading active lives. The purpose of this study is to focus on the ordinary lives of city outsiders and make artistic works out of their vitalities through empathy. The contents of the study is to find how to express the vitalities against the city which belies apparent gloominess and pessimistic resignation through adducing aesthetics expressed in existentialism and new plastic arts as the theoretical basis and provide the explanation of 7 works with each expression methodologies and contents. The result of this study is as follows : Underprivileged creatures were not the outsiders in the urban environment at the beginning. Rather than being alienated by the human beings, they have been there just as they used to be in the past. However, urbanization has brought artificial and unnatural lives to them, but nonetheless they are making their own unique, though distorted a lot compared with their natural lives, lives under the unexpected environment. In the light of this reality, this study has a major focus on how the underprivileged creatures has accepted the artificial urban surroundings, face the difficulties encountered during the assimilation and eventually overcome their existential reality, alienation Their existential cause is to bring back the vitality to the alienated surroundings. Through this fact, the researcher has found what they are for, which is parallel to the tradition of existentialism. Various places in the city were selected for the backgrounds of the works and approached in two views, macro and micro : roof top of sky scrapers in the city, small alleys of wornout residential district to be redeveloped, ceilings of the buildings, fences in the residential area, windows of the houses etc. Outsiders are defined the beings driven out to the outskirts of the city, just because they are no appropriate for the urbanization. And they appear as wild cats in the city, pigeon, magpies, underprivileged residential area. Ordinary affairs are expressed in the works as eating, sleeping, walking, dreaming, landscape, resting, meeting etc. Their ordinary affairs can be seen in the surrounding spaces not in the central space of the city, which are roof top, alleys, ceilings, windows etc. Also, the ordinary affairs in these places are expressed by means of extreme minimization and small scenes. Theses methodologies turned the physical space of surrounding environment alienated from the main stream to the psychological space symbolizing the feeling of difference and closeness. The methodologies of expression are the followings. The central space are symbolized in a way of arraying the standardized columns repeatedly. On the contrary, surrounding underprivileged spaces are symbolized by means of pictures drawn roughly, terra-cotta showing the handprint of the researcher, backgrounds in awkward colors. The researcher intend to let the viewers feel the existence of underprivileged creatures through the contrast of theses two spaces.논문개요 = v I. 서론 = 1 A. 연구의 목적 = 2 B. 연구의 내용 = 2 C. 연구의 방법 = 2 II. 이론적 배경 = 3 A. 실존주의 = 3 B. 신구상회화 = 7 III. 표현 내용 및 표현 방법 = 15 A. 표현 내용 = 15 B. 표현 방법 = 16 IV. 작품분석 = 18 V. 결론 = 44 참고문헌 = 46 ABSTRACT = 4

Mossbauer spectroscopy study of buried silicide in antiferromagnetically coupled Fe/ Si multilayers

Maste

Ceftizoxime과 Cefobactam에 의한 면역용혈성 빈혈 1예

Simultaneous drug-induced immune hemolytic anemia (DIIHA) caused by multiple drugs is rare. We report a case of a patient who developed DIIHA caused by 2 drugs. The patient's serum exhibited agglutination of ceftizoxime- or sulbactam-coated red blood cells (RBCs; via a drug-adsorption mechanism) and of uncoated RBCs in the presence of sulbactam (via an immune-complex mechanism). Although ceftizoxime is known to exhibit a positive reaction by an immune-complex method with or without reactivity with drug-coated RBCs, this patient's antibodies were reactive only against drug-coated RBCs. On the other hand, sulbactam, which is known to cause hemolytic anemia by nonimmunologic protein adsorption, exhibited positive reactions in tests with both drug-coated RBCs and in the presence of sulbactam. This is the first report of DIIHA due to a sulbactam-cefoperazone combination and the fourth report of DIIHA due to ceftizoxime. Owing to the patient's complicated laboratory results, DIIHA was suspected only at a late stage. We propose that for the prompt diagnosis of DIIHA, tests for all possible causative drugs should be conducted by 2 methods.ope