2008년 국내 의료기관의 혈액사용 및 폐기량 분석

권정란,이상원,이현주,김창훈,조영희,권윤형,김혜정,정성훈,신영학 대한수혈학회 2009 大韓輸血學會誌 Vol.20 No.3

Background: Investigating the blood usage and blood wastage in Korea hospitals national wide, and including all types of medical institutes, has not been sufficient with the only study having been carried out by the KCDC thorough an Academic Research Contract in 2007. Yet that study was limited due to lack of participation from hospitals. Our study tried to establish a fundamental database for blood transfusion management by investigating the current status of blood products usage, under the KCDC's supervision, to improve participation from medical institutes. Methods: From January to December in 2008, the Blood Bank, Red Cross of the Republic of Korea looked into the blood product supply of all the medical institutes and we conducted a national survey using questionnaires distributed via the local public health centers on the blood use, blood waste, the reasons for waste and the inventory of the remaining blood. The supply, as compared to the actual use of blood products in the same period, was analyzed by the Korean Red Cross. Results: The total amount of blood products distributed by the Korean Red Cross to medical institutes in 2008 increased by 13.8% for platelets, 11.5% for RBC products, 8.4% for apheresis products and 2% for FFPs, as compared with that of 2006. A total of 2,500 institutions participated in the questionnaire and 60.7% (1,517 out of 2,500 institutes) of the institutes sent feed-back. The total amount of blood use was 3,483,636 units and 52% of the consumption was focused in metropolitan areas like Seoul, Geong-Ki and Busan. The total wastage rate for blood was 1.2% and it was 4.8% for institutes with admitting capacities of 100 beds or less, with expiration of the storage date being the main reason for wastage, while the wastage rate was 1.1% for general hospitals with admitting capacities of 500 beds or more, with an improving patient status or death being the main reason. Conclusion: The results of this study were similar to those of 2007, but the participation rate from medical institutes was much increased. Establishment of an investigational system for the use of blood products in medical institutes on a national level is needed to secure data for dealing with the increased projected demand of blood/blood products in the future. 배경: 그동안 국내의 전 의료기관을 대상으로 하는 전국적인 조사는 미비하여 2007년 질병관리본부의 학술연구용역을 통한 연구가 유일하였으나, 의료기관의 참여가 미흡한 제한점이 있었다. 본 연구는 국내 의료기관들의 참여율을 높이기 위해 질병관리본부가 주관하여 전체적인 혈액사용현황을 파악하여 수혈관리를 위한 기초자료를 마련하고자 하였다. 방법: 2008년 1년동안 대한적십자사 혈액원이 한단위 이상 혈액을 공급한 전국 의료기관을 대상으로 혈액공급량을 조사하였으며, 혈액사용량 및 폐기량, 폐기사유, 재고량은 전국 시도 및 보건소를 통해 수혈을 실시한 의료기관을 대상으로 설문조사를 수행하였다. 그리고 동기간 대한적십자사의 혈액공급량 대비 의료기관의 실제 혈액사용량을 비교분석하였다. 결과: 2008년 대한적십자사가 의료기관에 공급한 혈액량은 2006년에 비해 혈소판제제 13.8%, 적혈구제제 11.5%, 성분채혈제제 8.4%, 신선동결혈장제제가 2% 순으로 증가하였다. 조사대상 의료기관의 설문회신률은 60.7% (1,517/2,500기관)으로 이들 기관의 2008년 혈액 총 사용량은 3,483,636단위였으며 서울, 경기, 부산 등의 대도시 지역이 전체 혈액의 52.3%를 사용하였다. 혈액 총 폐기율은 1.2%를 차지하였는데, 이중 100병상 미만 중소병의원의 폐기율은 4.8%로 보존기간 경과로 인한 폐기가 가장 높은 반면 500병상 이상 종합병원의 폐기율은 1.1%로 환자증상 호전 및 사망이 가장 높았다. 결론: 국내 의료기관의 혈액사용량 및 폐기량은 2007년 국내 조사와 유사한 양상을 보였으며, 혈액사용 현황조사에 대한 의료기관들의 참여율은 상당히 증가하였다. 따라서 향후 국내 혈액수급예측자료 확보를 위해 국가 차원의 의료기관 혈액제제 사용량 조사체계 확립이 필요할 것으로 여겨졌다.

Serious Adverse Transfusion Reactions Reported in the National Recipient-Triggered Trace Back System in Korea (2006-2014)

권정란,원은정,조현정,최새롬,Kyoungyul Lee,김신영,안형식,최영실,조덕,이동한 대한진단검사의학회 2016 Annals of Laboratory Medicine Vol.36 No.4

Background: Adverse transfusion reactions (ATRs) are clinically relevant to patients with significant morbidity and mortality. This study aimed to review the cases of ATR reported in the recipient-triggered trace back system for a recent nine-year period in Korea. Methods: Nine-year data obtained from 2006 to 2014 by the trace back system at the Division of Human Blood Safety Surveillance of the Korean Centers for Disease Control (KCDC) were reviewed. The suspected cases were assessed according to six categories: (i) related to, (ii) probably related to, (iii) probably not related to, (iv) not related to transfusion, (v) unable to investigate, and (vi) under investigation. Results: Since 2006, 199 suspected serious ATRs were reported in hospitals and medical institutions in Korea, and these ATRs were reassessed by the division of Human Blood Safety Surveillance of the KCDC. Among the reported 193 cases as transfusion related infections, hepatitis C virus (HCV) infection (135, 67.8%) was reported most frequently, followed by hepatitis B virus (HBV) infection (27, 13.6%), HIV infection (13, 6.5%), syphilis (9, 4.5%), malarial infection (4, 2.0%), other bacterial infections (3, 1.5%), HTLV infection (1, 0.5%), and scrub typhus infection (1, 0.5%), respectively. Of the 199 cases, 13 (6.5%) cases were confirmed as transfusion-related (3 HCV infections, 3 malarial infections, 1 HBV infection, 2 Staphylococcus aureus sepsis, 3 transfusion-related acute lung injuries, and 1 hemolytic transfusion reaction). Conclusions: This is the first nationwide data regarding serious ATRs in Korea and could contribute to the implementation of an effective hemovigilance system.

보기 쉬운 결과지로 수검자의 만족도 증진

권정란 한국의료QA학회 2005 가을학술대회 Vol.2005 No.2

국내 의료기관 수혈동의서 활용 현황과 표준 수혈동의서 개발

권정란,이상원,신영학 대한수혈학회 2010 大韓輸血學會誌 Vol.21 No.3

Background: This study was conducted to standardize the written informed consent form for transfusion to establish the recipient’s self-determination and safe blood transfusion procedures of hospitals. This survey focused on doctors’ acknowledgment on informed consent before conducting a transfusion and its current situation. Methods: Data collection was conducted in 11 tertiary hospitals from February 2010 to March 2010 with random sampling among the 30 hospitals that have a blood transfusion committee. The survey was carried out in the division of medical services that supports blood transfusion or in the blood transfusion committee of each hospital. The questionnaires focused on the necessity of written consent and its contents before transfusion. Also, informed consent forms were collected when a hospital already had an informed content form. Results: The majority of hospitals (94.9%) agreed about the necessity of informed consent. However, only 6.7% of hospitals were obtaining informed consent before transfusion. The contents of the written form were the necessity of blood transfusion (94.9%), the adverse effects of transfusion (84.1%) and beneficiary of the transfusion (64.6%). Twenty-eight point two percent of the medical institutions were obtaining informed written consent forms and keeping them in the medical records. The problems for obtaining informed consent before a transfusion was insufficient standardized forms (40.4%) and a lack of time (33.9%). Conclusion: Though doctors agreed to the provision of information through consent forms, there were no standardized procedures and forms. Therefore, this study introduced the written form to medical institutions and academies. Also, it was applied to hospitals as an evaluation index in 2010. The written informed consent form can contribute to the safety of blood transfusions in the medical area. 배경: 수혈자의 자기결정권과 의료기관 안전한수혈절차 확립을 위하여 의료기관 임상의사들의수혈분야에 대한 인식과 설명 후 동의서 취득현황에 대한 설문조사를 시행하여, 표준 수혈동의서 개발을 위한 기초자료로 활용하였다. 방법: 2010년 2월부터 3월까지 전국 종합병원중 수혈관리위원회가 있는 30개 의료기관을 무작위 표본추출하여 혈액사용 청구량이 많은 상위11개 임상부서를 대상으로 조사하였다. 수혈동의서 필요성, 수혈의 설명내용 등은 각 의료기관 진료지원실 및 수혈관리위원회를 통해 시행하였다. 또한 수혈동의서를 사용하고 있는 의료기관의 경우 수혈동의서 서식도 함께 회신하도록 하였다.결과: 수혈 시 표준화된 수혈동의서가 필요하다는 응답은 94.9%인 반면, 실제 수혈동의서를사용하는 의료기관은 6.7% (2/30개소)로 나타났다. 수혈 시 설명하는 내용으로는 수혈의 필요성94.9%, 수혈부작용 84.1%, 치료효과 64.6% 등의순이었다. 해당 의료기관 중 수혈동의서를 활용하거나 진료기록지 등에 수혈기록을 남긴다는 응답은 28.2%였다. 설명 및 동의서 취득이 어려운이유는 표준화된 동의서 양식부재가 40.4%, 동의서 취득을 위한 시간적 여유가 없음이 33.9%로나타났다. 결론: 일선 의료기관 임상의사들은 수혈 시 설명 및 동의서 작성의 필요성을 공감하고 있었으나, 표준 절차 및 서식이 없어 수혈동의서를 작성하는데 어려움이 있는 것으로 판단되었다. 이에표준 수혈동의서를 개발하여 일선 의료기관, 관련 학회 홈페이지 및 소식지 등에 소개하였으며,2010년 의료기관 평가지표 항목에 반영되어 활용도가 높아질 것으로 생각된다. 향후 표준 수혈동의서는 수혈가이드라인과 함께 의료현장에서 널리 사용되어 수혈안전성과 적정성 향상에 기여할 것으로 기대된다.

원가족의 정서적 건강성과 자기분화에 따른 부부적응

권정란,이인수 한국가족관계학회 2006 한국가족관계학회지 Vol.11 No.1

TT Mutant Homozygote of Kruppel-like Factor 5 Is a Key Factor for Increasing Basal Metabolic Rate and Resting Metabolic Rate in Korean Elementary School Children

최정란,권인수,권대영,김명선,이명숙 한국유전체학회 2013 Genomics & informatics Vol.11 No.4

We investigated the contribution of genetic variations of KLF5 to basal metabolic rate (BMR) and resting metabolic rate(RMR) and the inhibition of obesity in Korean children. A variation of KLF5 (rs3782933) was genotyped in 62 Korean children. Using multiple linear regression analysis, we developed a model to predict BMR in children. We divided them into severalgroups; normal versus overweight by body mass index (BMI) and low BMR versus high BMR by BMR. There were nodifferences in the distributions of alleles and genotypes between each group. The genetic variation of KLF5 gene showed asignificant correlation with several clinical factors, such as BMR, muscle, low-density lipoprotein cholesterol, and insulin. Children with the TT had significantly higher BMR than those with CC (p = 0.030). The highest muscle was observed in thechildren with TT compared with CC (p = 0.032). The insulin and C-peptide values were higher in children with TT than thosewith CC (p= 0.029 vs. p = 0.004, respectively). In linear regression analysis, BMI and muscle mass were correlated with BMR,whereas insulin and C-peptide were not associated with BMR. In the high-BMR group, we observed that higher muscle, fatmass, and C-peptide affect the increase of BMR in children with TT (p < 0.001, p < 0.001, and p = 0.018, respectively), whileRohrer’s index could explain the usual decrease in BMR (adjust r2 = 1.000, p < 0.001, respectively). We identified a novelassociation between TT of KLF5 rs3782933 and BMR in Korean children. We could make better use of the variation withinKLF5 in a future clinical intervention study of obesity.

수도권 신도시의 종합적 고찰

윤정중,권일,김성길,백인길,성현곤,윤갑식,윤정란,이영성,최대식,최상희,한경희 대한국토·도시계획학회 2021 도시정보 Vol.- No.472

DEL 변이형의 수혈전략과 검사의 최신지견

서민희,김보람,권정란,최영실,김준년,박경운,조덕 대한수혈학회 2015 大韓輸血學會誌 Vol.26 No.1

Red cells that express extremely low levels of D antigen that cannot be detected by routine serologic tests are designated as DEL. Most DEL blood donors are typed as D-negative. However, DEL red blood cells can be recognized by serological adsorption and elution test or molecular RHD genotyping. Anti-D production in patients with D-negative who received transfusion containing DEL blood has reported, therefore distinction between DEL variant and true D- negative is clinically important. This review highlights a transfusion strategy and laboratory update on the DEL variant in the Korean population 극히 낮은 D 항원을 발현하는 적혈구는 기본혈청학적 검사법으로는 검출할 수 없어 DEL 이라고 부른다. 대부분 DEL형은 D 음성으로 보고된다. 그러나, 이들 DEL 적혈구는 흡착 및 용출시험(adsorption-elution test) 혹은 RHD 유전자 검사로 이를 규명할 수 있다. RhD 음성 환자가 DEL 혈액 수혈 후 항-D항체가 발생됨이 보고되었기때문에, DEL형과 순수 D 음성의 감별이 임상적으로 중요하다. 본 원고에서는 한국인에서 DEL 형에 대한 수혈전략과 검사법의 최신지견을 다루고자 한다.

잿빛만가닥버섯의 변이체 유도와 실용적 인공재배에 대한 연구

이대진,이원정,권미성,장주원,이원재,허정란,최창현,황철호,이병의 한국버섯학회 2011 한국버섯학회지 Vol.9 No.2

Artificial cultivation of Lyopyllun decastes is costly because the high expense is required for soil covering and bark. Therefore, most farmers of Lyopyllun decastes have recognized it is difficult to cultivate it. The purpose of this study is to reduce the cost of cultivation of Lyopyllun decastes by applying new cultivation method and introducing mutation of fungi. In this study, a new method of practical artificial cultivation was developed through many experiments using fermented pine sawdust and wheat bran. In conclusion, the method of practical artificial cultivation of Lyopyllun decaste is simple and cost efficient because neither soil covering nor bark is required.

Hypomyopathic Dermatomyositis 1예

김현태,이현욱,권병진,이지은,오동호,손민수,최정란 영남대학교 의과대학 2011 Yeungnam University Journal of Medicine Vol.28 No.2

Dermatomyositis is a rare and idiopathic inflammatory myopathy with a characteristic cutaneous manifestation. A 62-year-old female complained of polyarthralgia that lasted for many years. She was diagnosed with hypomyopathic dermatomyositis by the typical skin rash associated with dermatomyositis but without muscle involvement such as muscle weakness, elevated level of creatinine phosphokinase and aldolase. Her symptoms improved with treatment of hydroxychloroquine and prednisolone. We experienced a case of hypomyopathic dermatomyositis on 62-year-old female patient and report with review of literatures.