• 한국임상수의학회지
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• 제34권5호
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• pp.356-358
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• 2017

A dog (neutered male Schnauzer, 11 years old, 8 kg) presented with recurrence of immune-mediated hemolytic anemia. Rapid whole blood transfusion was initiated, and then sudden tachycardia and dyspnea were observed. Invasive arterial blood pressure, arterial blood gas analysis, and thoracic radiograph indicated transfusion-associated circulatory overload (TACO). Persistent high blood pressure of 160-205 mmHg was observed; the thoracic radiograph revealed interstitial infiltration and a fissure line, which suggested pulmonary edema and pleural effusion. Despite furosemide administration and nasal oxygen supplementation, hypertension and respiratory distress were not completely controlled. Finally, cardiac arrest occurred and the patient expired due to TACO 24 hours after the transfusion.

• 대한수혈학회지
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• 제29권3호
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• pp.240-252
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• 2018

점탄성 응고 검사법은 전혈 검사법으로 혈장성분뿐 아니라 응고 과정의 세포 기반 측면까지 동시에 볼 수 있는 방법이다. 프로트롬빈시간이나 활성화부분트롬보플라스틴시간과 같은 기존의 응고 검사법과 달리 이 검사는 현장 현시 검사로 즉시 시행할 수 있다. 점탄성 응고 검사법은 사망률 등의 예후 예측 인자이고, 응고 장애를 좀 더 예민하게 감지하여 결과적으로 출혈을 줄여주는 효과를 줄 수 있다. 점탄성 응고 검사 결과를 이용한 수혈 전략이 수혈 요구량을 줄여주었다고 보고되기도 하였다. 아직 이 방법의 정확성과 신뢰도에 대한 우려가 있기도 하지만, ROTEM 등의 점탄성 응고 검사법은 환자혈액관리에 응용하는 것은 유용할 것이다.

• 한국시뮬레이션학회논문지
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• 제5권1호
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• pp.13-27
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• 1996

The management of blood inventory is very important within the medical care system. The efficient management of blood supplies and demands for transfusion is of great economic and social importance to both hospitals and patients. Fro any blood type, there is a complex interaction among the optimal inventory level, daily demand level , daily supply level, transfusion to crossmatch ratio, crossmatch release period, issuing policy and the age of arriving units that determine the shortage and outdate rate. In this paper, we develop an efficient decision rule for blood inventory management in a hospital blood bank which can support efficient hospital blood inventory management using simulation, The primary use of the efficient decision rule will be to establish minimum cost function which consists of inventory levels , period in inventory, outdate and shortage rate for whole blood and various component inventories for a hospital blood bank or a transfusion service, If the adminstrator compute the mean daily demand for each blood type, the mean daily supply for each blood type, the length of the crossmatch release period and the average transfusion to crossmatch ratio , then it is possible to apply the efficient decision rule to compute the optimal inventory level, inventory period , outdate and shortage rate. This rule can also be used as a decision support system that allows the blood bank adminstrator to do sensitivity analysis related to controlled blood inventory parameters.

• Journal of Chest Surgery
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• 제35권6호
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• pp.471-474
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• 2002

수혈관련 이식편대숙주병은 동양인에서 개심술후에 주로 보고되는 드물지만 치명적인 병이다. 이는 신선 전혈의 수혈 전 감마선 조사로 예방할 수 있다. 61세 남자환자가 관상동맥수술을 시행받은 후 수혈 관련 이식편대숙주병이 발생하였다. 술후 환자는 두 아들에게서 2단위의 전혈을 수혈받았다. 술후 10일째 퇴원 당시 경미한 설사만 있었다. 퇴원 이틀째 지속적인 설사와 전신적 홍반 및 고열을 주소로 재입원하였다. 임상검사상 간, 신장, 소화기 및 골수의 기능 부전을 보였고, 혈역학적으로 급격히 악화되어 술후 17일에 다발성 장기 기능부전으로 사망하였다. 저자들은 본원에서 심장수술을 시행한 이래 이식편대숙주병을 처음으로 경험하였고, 이 후 전혈수혈에 대한 방침을 수정하였다.

• 산업공학
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• 제10권1호
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• pp.119-134
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• 1997

The management of blood inventory is very important within the medical care system. The efficient management of blood supplies and demands for transfusions is of great economic and social importance to both hospitals and patients. For any blood type, there is a complex interaction among the optimal inventory level, daily demand level, daily supply level, transfusion to crossmatch ratio, crossmatch release period, issuing policy and the age of arriving units that determine the shortage and outdate rate. In this paper, we develop an efficient decision rule for blood inventory management in a hospital blood bank which can support efficient hospital blood inventory management using simulation. The primary use of the efficient decision rule will be to establish minimum cost function which consists of inventory levels, period in inventory, outdate and shortage rate for whole blood and various component inventories for a hospital blood bank or a transfusion service. If the administrator compute the mean daily demand for each blood type, the mean daily supply for each blood type, the length of the crossmatch release period and the average transfusion to crossmatch ratio, then it is possible to apply the efficient decision rule to compute the optimal inventory level, inventory period, outdate and shortage rate. This rule can also be used as a decision support system that allows the blood bank administrator to do sensitivity analysis related to controllable blood inventory parameters.

• 대한임상독성학회지
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• 제6권1호
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• pp.37-41
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• 2008

Methemoglobinemia can be caused by dapsone toxicity. We report a case dapsone induced methemoglobinemia unresponsive to methylene blue successfully treated by exchange transfusion. A 52-year-old male ingested a handful of dapsone. He presented with severe peripheral cyanosis in lips and fingertips and his methemoglobin level was found to be 21.9%. After admission, methylene blue (1%) at 1 mg/kg was injected each time peripheral cyanosis and rising serum methemoglobin occurred. Despite methylene blue therapy, the patient‘s methemoglobin level continued to fluctuate. Five days after the injections of methylene blue, many Heinz bodies were visualized in the peripheral blood, suggestive of hemolytic anemia occurrence. By hospital day 6, serum methemoglobine levels were elevated and not measurable (> 50%) and the patient was constantly in a semi-comatose mental state. An exchange transfusion carried out by utilizing 6 units of packed red blood cells and 4 units of fresh frozen plasma was performed. The patient's methemoglobin levels were subsequently kept up below 20% and his peripheral cyanosis receded. Physicians should recognize the important role of exchange transfusion in refractory dapsoneinduced methemoglobinemia.

• 한국임상수의학회지
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• 제34권3호
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• pp.197-199
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• 2017

A 14-year-old castrated male ShihTzu diagnosed with chronic kidney disease (CKD) 6 months prior was referred to our clinic. The patient had been experiencing symptoms such as vomiting, poor appetite and hind limbs weakness. Hematology tests showed that he had a non-regenerative anemia. With aggressive treatment, the patient's state had gotten worse. He showed ragged breath, vomiting blood and loss of consciousness temporarily. Hematocrit maintained low level. Gastric hemorrhage was strongly suspected by hematemesis. Whole blood transfusion was performed and heparin was used as an anticoagulant. Prior to transfusion, the blood cross matching between donor and patient was performed and the result was compatible. After the transfusion was stabilized, 1 mg of protamine sulfate for each 100 units of heparin was prepared and given intravenously over 3 minutes to reverse the effects of heparin. Immediately after protamine injection, the patient conducted severe anaphylactic shock. Protamine sulfate is used to reverse the anticoagulant action of heparin in dogs and humans. The adverse reaction of protamine sulfate range from mild reaction to fetal cardiac arrest. When using protamine sulfate as heparin neutralization, it can lead to the death of a patient cause of anaphylactic shock. For this reason, the protamine sulfate should be injected slowly with antihistamine and the clinician should carefully monitor patients.

• 대한수혈학회지
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• 제23권2호
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• pp.162-168
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• 2012

배경: 세포 내 공간에서 가장 흔한 양이온은 칼륨이며 생리적으로 중요한 역할을 한다. 칼륨 불균형 발생시 생명을 위협할 수 있는 문제가 생길 수 있으며 그 문제들은 전신 쇠약부터 심실 세동에 의한 심장마비까지 있다. 따라서 응급의학과 의사가 짧은 시간 내에 그런 문제를 찾아내야 하는 것은 매우 중요하다. 이 연구에서 우리는 전혈과 혈청의 샘플들을 서로 짝을 지어 비교 분석하여 전혈의 결과가 혈청의 결과만큼 유용하게 쓰일 수 있는지 알아보기로 했다. 방법: 227명의 환자에게서 두 종류의 샘플을 채취하여 비교했다. 하나의 샘플은 요골동맥에서 채취한 전혈을 헤파린 처리된 주사기에 담아 검사했으며 다른 하나는 혈청 샘플을 담아 검사실에서 검사했다. 그 후 샘플들을 정상, 저 칼륨, 고 칼륨의 세 그룹으로 나누어 각각의 그룹에서 혈청과 전혈의 샘플들을 비교하였다. 결과: 혈청과 전혈의 칼륨 수치들의 차이는 통계학적으로 큰 의미를 보이지는 않았으며(P<0.05) 세 그룹 내에서의 칼륨 수치들간의 연관성은 통계학적으로 의미 있게 상관관계를 보였다(P<0.05). 세 그룹 중 고 칼륨 그룹에서 전혈과 혈청의 칼륨 수치가 가장 높은 상관관계를 보였으며 저 칼륨 그룹에서 가장 낮은 상관관계를 보였다. 결론: 전혈을 이용한 응급 검사가 칼륨 이상 소견, 특히 고칼륨혈증이 의심되는 환자의 진단에 선별검사로써 유용하게 사용될 수 있을 것으로 사료된다.

• Journal of Chest Surgery
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• 제32권11호
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• pp.984-988
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• 1999

Background: Donor-specific blood transfusion(DSBT) before organ transplantation has been demonstrated to prolong allograft survival; the mechanism of this effect has remained unclear. Only a few researches have been performed on this subject in our country. Material and Method: To investigate the effect of DSBT, we selected 5 donor recipient combinations using rats of pure strain such as PVG, ACI, and LEW. One ml of donor whole blood was transfused to each recipient through the femoral vein 7 days prior to transplantation. The donor heart was transplanted to the recipient's abdominal vessels heterotopically using modified Ono and Lindsey's microsurgical technique. Five transplantations were done for each combination. Postoperatively, donor heart beat was palpated everyday through the recipent's abdominal wall. Rejection was defined as complete cessation of donor heart beat. Result: The allogeneic heart grafts transplanted from PVG strain to ACI strain(PVG ACI) without DSBT were acutely rejected(mean survival 10.2 days). With pretransplant DSBT, the cardiac allografts in PVG ACI and LEW PVG combinations survived indefinitely(more than 100 days), those in ACI PVG combination survived 12 to 66 days(mean 31.8 days), those in PVG LEW survived 8 to 11 days(mean 10.0 days), and those in ACI LEW survived 7 to 9 days(mean 8.0 days). In brief, DSBT prior to heart transplantation was definitely effective in PVG ACI and LEW PVG combinations and moderately effective in ACI PVG combination, but not effective in PVG LEW and ACI LEW combinations. Conclusion: DSBT prior to heart transplantation showed variable effects, but might prolong cardiac allograft survival indefinitely in some donor recipient strain combinations. The mechanism of this effect should be further investigated.

• 한국임상수의학회지
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• 제30권5호
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• pp.359-362
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• 2013

6살령의 중성화된 숫컷 말티즈(4.16 kg)가 2일전 스켈링과 발치를 실시한 후 지속적인 구강내 출혈로 본원에 내원하였다. 환축은 폰 빌레브란트 인자 항원 평가 결과 54% (정상 범위 70%에서 180%)였으며, 유전된 폰 빌레브란트병를 가진 동형접합체로 판정되었다. 초기 치료를 위해 신선 전혈 수혈을 실시하였다. 수혈 후 환축은 임상증상이 개선되었으며 현재까지 건강한 상태이다. 본 증례는 한국내 말티즈에서 발생한 제 1형 폰 빌레브란트병의 첫 번째 진단 보고이다.