• 대한임상검사과학회지
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• 제55권1호
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• pp.65-70
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• 2023

헌혈을 중심으로 하는 혈액 관리보다 혈액의 사용을 적절히 관리하는 것이 중요하다. 수혈용 혈액 현황의 관리, 수혈의 적정성에 대한 평가, 수혈 관련 부작용의 발생 감시 및 대응, 그 밖에 수혈관리에 필요한 업무를 수행하는 수혈관리실의 역할을 통해 개선효과를 살펴보았다. 수혈관리실의 개설·운영을 통해 수혈적정성 평가 업무를 효율적으로 관리할 수 있지만 혈액의 적정성 평가에 시간이 소요되고 수혈관리실 전담인력이 모든 혈액의 적정성을 평가하기에는 어려운 단점도 있다. 앞으로 한국형 환자 혈액관리(patient blood management, PBM)를 도입해 의료기관 내 안전하고 적정한 수혈관리 구현을 위한 수혈관리실과 수혈관리위원회를 정착시키고, 인력을 교육해야 하는 의료기관의 참여가 필수적이다.

• 한국의료질향상학회지
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• 제28권2호
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• pp.30-38
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• 2022

Purpose: The Health Insurance Review and Assessment Service (HIRA) in South Korea initiated a quality assessment (QA) program for blood transfusion healthcare services in 2020 to ensure patient safety and appropriate blood use. This study examines the quality of blood transfusion services since the first national QA program for blood transfusion services in Korea. Methods: We analyzed HIRA claims and QA investigation data based on inpatient medical records from all tertiary, general, and primary hospitals between October 2020 and March 2021. The target population was patients aged 18 years and older who received either total knee arthroplasty or red blood cell transfusion. The QA indicators for transfusion healthcare service consisted of four quality indicators and four monitoring indicators. Results: We analyzed the results of QA indicators for transfusion service from the medical records of 189,668 patients from 1,171hospitals and expressed indicators as proportions. The average results for evaluation indicators were as follows: transfusion checklist presence, 64.8%; irregular antibody tests, 61.8%; transfusions in which the hemoglobin levels before transfusion met the transfusion guidelines for patients undergoing total knee arthroplasty, 20.6%, and transfusions in patients undergoing total knee arthroplasty, 59.3%. The average results for monitoring indicators were as follows: transfusion management implementation in medical institutions, 56.9%; preoperative anemia management in anemia patients undergoing total knee arthroplasty, 43.9%; one-unit transfusions, 82.5%; and the transfusion index. Conclusion: The quality of blood transfusion healthcare varied and the assessment revealed that there is scope for improvement. Hospitals require more effective blood transfusion management and this can be facilitated by providing feedback on the QA results about blood transfusion healthcare services to medical institutions, and by disclosing the results to the public.

• Annals of Laboratory Medicine
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• 제38권6호
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• pp.599-603
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• 2018

Frequencies of red blood cell (RBC) blood group antigens differ by ethnicity. Since the number of immigrants is increasing in Korea, RBC antigens should be assessed in children/youths with parents of different ethnicities to ensure safe transfusions. We investigated the frequency of RBC antigens, except for ABO and RhD, in 382 children and youths with parents having Korean and non-Korean ethnicities. Subjects were divided into those with ethnically Korean parents (Korean group; N=252) and those with at least one parent of non-Korean ethnicity (non-Korean group; N=130). The 37 RBC antigens were genotyped using the ID CORE XT system (Progenika Biopharma-Grifols, Bizkaia, Spain). The frequencies of the Rh (E, C, e, $hr^S$, and $hr^B$), Duffy ($Fy^a$), MNS ($Mi^a$), and Cartwright ($Yt^b$) antigens differed significantly between the two groups. Eight and 11 subjects in the Korean and non-Korean groups, respectively, exhibited negative expression of high-frequency antigens, whereas 14 subjects in the non-Korean group showed positive expression of low-frequency antigens. The frequency of RBC antigens has altered alongside demographic changes in Korea and might lead to changes in distribution of RBC antibodies that cause acute or delayed hemolytic transfusion reaction.

• Journal of Trauma and Injury
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• 제33권1호
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• pp.1-12
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• 2020

Purpose: Despite recent developments in the management of trauma patients in South Korea, a standardized system and guideline for trauma treatment are absent. Methods: Five guidelines were assessed using the Appraisal of Guidelines for Research and Evaluation II instrument. Results: Restrictive volume replacement must be used for patients experiencing shock from trauma until hemostasis is achieved (1B). The target systolic pressure for fluid resuscitation should be 80-90 mmHg in hypovolemic shock patients (1C). For patients with head trauma, the target pressure for fluid resuscitation should be 100-110 mmHg (2C). Isotonic crystalloid fluid is recommended for initially treating traumatic hypovolemic shock patients (1A). Hypothermia should be prevented in patients with severe trauma, and if hypothermia occurs, the body temperature should be increased without delay (1B). Acidemia must be corrected with an appropriate means of treatment for hypovolemic trauma patients (1B). When a large amount of transfusion is required for trauma patients in hypovolemic shock, a massive transfusion protocol (MTP) should be used (1B). The decision to implement MTP should be made based on hemodynamic status and initial responses to fluid resuscitation, not only the patient's initial condition (1B). The ratio of plasma to red blood cell concentration should be at least 1:2 for trauma patients requiring massive transfusion (1B). When a trauma patient is in life-threatening hypovolemic shock, vasopressors can be administered in addition to fluids and blood products (1B). Early administration of tranexamic acid is recommended in trauma patients who are actively bleeding or at high risk of hemorrhage (1B). For hypovolemic patients with coagulopathy non-responsive to primary therapy, the use of fibrinogen concentrate, cryoprecipitate, or recombinant factor VIIa can be considered (2C). Conclusions: This research presents Korea's first clinical practice guideline for patients with traumatic shock. This guideline will be revised with updated research every 5 years.

• 대한소아치과학회지
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• 제47권3호
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• pp.352-358
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• 2020

글란즈만 혈소판무력증(Glanzmann Thrombasthenia, GT)은 상염색체 열성 유전으로 나타나는 희귀한 선천성 질환으로 혈소판 기능에 이상이 있어 혈액 응고 장애를 보이며 대표적인 증상은 지혈이 잘 되지 않는 출혈이다. 1918년 소아과의사 글란즈만에 의해 처음보고 되었으며 글란즈만씨병(Glanzmann's disease)이라고도 불리 운다. GT는 남성과 여성에서 동등하게 나타나고, 중동, 인도 프랑스 등 근친결혼을 하는 곳에서 많이 발생하며, 대략 1,000,000명당 1명에서 발견된다. 우리나라에서는 2018년 질병관리본부 희귀질환과에 따르면 200여명의 환자가 보고되고 있다. 임상증상은 점상출혈, 반상출혈, 비 출혈, 치은 출혈 등이 관찰되고, 유치의 자발적 탈락에서도 수혈을 고려해야 할 정도의 출혈이 발생할 수 있다. 치료의 일반적인 목표는 출혈 예방과 지혈이다. 여러 가지 지혈을 위한 처치에도 출혈이 지속되면 혈소판 수혈을 해야 한다. 소아치과의사는 구강을 청결히 하여 치은염과 치아 우식증을 예방함으로써 치은 출혈을 최소화하고, 구강 위생과 규칙적인 치과 검진의 중요성을 주지시켜야 하며, 치과치료시 출혈에 대비한 치료계획의 수립 및 세심한 진료가 필요하다. GT를 동반한 만6세 여아로 치아우식증을 주소로 내원하여 아산화질소-산소를 이용한 흡입진정하에 레진수복을 시행하였으며 술 후 치료부위의 압박지혈이 필요하였다.