국내 RhD 음성자 수혈 안전성 확보방안, 2016 = Safe Transfusion Strategy in Korean RhD Negative Patients (third year)

국문 초록 (Abstract)

최근 RHD 유전자 검사로 국내 D 음성 헌혈자 중 15-20%가 DEL형을 포함한 D변이형으로 규명되었다. D 변이형 중 Asia type DEL형 혈액제제는 D 음성으로 분류되어 D 음성 환자들에게 수혈했는데, 항-D 항체가 생성된 사례가 발생하여 D 음성자 안전수혈정책이 필요하게 되었다. 지난 1, 2차년도에서는 공급혈액원의 RhD 검사 전략을 연구했는데, 이번 3년차에서는 의료기관에 RhD 혈액형 검사 전략 및 수혈전략을 새롭게 세우고, 이를 적용해보았다, 또한, 이러한 정책을 임상의 및 혈액은행 업무 관련자들, 학생, 그리고 RhD 음성자들에게 교육하고, 홍보하였다. 본 과제를 통해 다음과 같은 연구를 수행하였다.
1. D 음성에서 D 변이형 조사
- 의료기관에서 D 혈청학적 검사로 D 음성인 검체에 RhCE 검사를 시행한 후 RHD 유전자 검사 실시로 D(-) 중 D 변이형 선별함.
2. 수혈가이드라인에 변화된 D 음성 수혈정책 반영
- 제 4판 수혈가이드라인 (2016전면개정)에 정책을 반영함.
3. D 음성 관련 교육자 개발 및 교육
- D 음성자 검사와 수혈에 대한 교육자료를 만들고, 임상병리과 학생, 검사 실무자, 의료인들에게 교육하고 홍보하였음.
4. 전문가 설문조사
- 의료기관 RhD 음성 및 변이형 환자 수혈에 정책에 대한 전문가 의견을 제시하고, 또한 공급혈액원에서 RhD 변이형에 대한 공급전략을 세우는 기초자료를 제공하였음.

다국어 초록 (Multilingual Abstract)

After the recent discovery of the DEL variant, it was revealed that 15-20% of individuals that are serological D negative were actually of this variant in the Korean population. As the DEL variant was previously classified as D negative, there has been reports of formation of anti-D to blood recipients after the transfusion of blood products derived from DEL variant donors, and new protocols regarding safe transfusion was warranted. As we provided new testing schemes for serological D negative blood in the blood supplier`s prospective during the 1st and 2nd year of this project, we applied this to the clinical environment, along with planning a revised transfusion strategy to DEL subjects in the 3rd year of this project. Furthermore, we have educated this subject to clinicians, medical technologists, health care-related major students and D negative individuals.
We have achieved the following;
1. Investigation of D-variants in D negative subjects – subjects that were tested D negative patients by serological tests from clinics were selected and were tested for CE phenotype prior to RHD genotyping
2. Application of the results from the previous two years in the revised transfusion guidelines – Changes in the transfusion strategy to D negative individuals have been applied to the fully revised 2016 version of the national blood transfusion guidelines (4th revision).
3. Preparation of education material for health care-related professionals and students on this subject – We have prepared educational material for clinicians, medical technologists, health care-related professionals and students. We have also attended multiple sessions in various conventions and lectures for actual education of relevant personnel and have publicized this matter.
4. Survey of health care-professionals – We have provided the insight of transfusion professionals to first line clinics and also supplied the background theory in establishing revised blood supplying strategy to blood suppliers.