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Annual Report on the External Quality Assessment Scheme for Transfusion Medicine in Korea (2017)
J Lab Med Qual Assur 2018;40:9-20
Published online March 31, 2018
© 2018 Korean Association of External Quality Assessment Service.

Young Ae Lim1,2, Hyun Soo Cho2

1Department of Laboratory Medicine, Ajou University School of Medicine, Suwon, Korea,
2Department of Laboratory Medicine, Ajou University Hospital, Suwon, Korea
Correspondence to: Young Ae Lim Department of Laboratory Medicine, Ajou University Hospital, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon 16499, Korea Tel: +82-31-219-5786 Fax: +82-31-219-5778 E-mail: limyoung@ajou.ac.kr
κ΅μ‹ μ €μž: μž„μ˜μ•  우)16499 경기도 μˆ˜μ›μ‹œ μ˜ν†΅κ΅¬ μ›”λ“œμ»΅λ‘œ 164, μ•„μ£ΌλŒ€ν•™κ΅ μ˜κ³ΌλŒ€ν•™ μ•„μ£ΌλŒ€ν•™κ΅λ³‘μ› μ§„λ‹¨κ²€μ‚¬μ˜ν•™κ΅μ‹€ Tel: 031)219-5786, Fax: 031)219-5778, E-mail: limyoung@ajou.ac.kr
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract

Here, we have reported results of the surveys on the external quality assessment scheme (EQA) of the Transfusion Medicine Program (TMP) in Korea that were carried out in 2017. The proficiency testing specimens were prepared at Ajou University Hospital, and sent to the participants biannually. The average accuracy rates (N=the number of participants) for ten different test items on the regular survey were as follows: ABO typing, 99.1%–99.9% (N=714); RhD typing, 99.3%–100.0% (N=695); crossmatching, 88.9%–98.5% (N=618); ABO subtyping, 80.7% and 96.0% (N=51); Rh CcEe antigen testing, 98.8%–100.0% (N=51); weak D test, 99.3% and 100.0 (N=150); antibody screening, 98.6%–100.0% (N=295); direct antiglobulin test (DAT) using a poly-specific reagent, 99.2%–100.0 (N=256); DAT using an immunoglobulin-G monospecific reagent, all 100.0% (N=68); DAT using a C3d-monospecific reagent, 83.6%–100.0% (N=72); antibody identification, 88.7%–99.2% (N=123); and ABO Ab titration, 84.6%–100.0% (N=73). The number of participants for the EQA for TMP in 2017 was much higher than that in 2016. Except for the case of ABO subtyping, excellent survey results for the 2017 EQA for TMP were obtained, compared to those in 2016. Thus, the EQA for TMP in 2017 should be helpful for improving the quality of the participating laboratories.

Keywords : Transfusion medicine, Quality improvement, Laboratory proficiency testing
μ„œ λ‘ 

수혈 μ „ κ²€μ‚¬μ˜ 정확성은 ν™˜μžμ˜ 생λͺ…과도 관련이 μžˆμœΌλ―€λ‘œ 정확성이 λ³΄μ¦λ˜μ–΄μ•Ό ν•œλ‹€. λŒ€λΆ€λΆ„ ν˜ˆμ•‘μ€ν–‰μ—μ„œ μ‹€μ‹œν•˜κ³  μžˆλŠ” κ²€μ‚¬μ˜ μ›λ¦¬λŠ” μ ν˜ˆκ΅¬μ™€ 혈μž₯ ν˜Ήμ€ ν˜ˆμ²­μ„ μ΄μš©ν•œ λ©΄μ—­ν˜ˆκ΅¬ 응집법 검사이며 μˆ˜κΈ°λ²•μœΌλ‘œ μ‹œν–‰ν•˜κ³  μžˆλ‹€λŠ” νŠΉμ§•μ΄ μžˆλ‹€. μ΄λŸ¬ν•œ μˆ˜κΈ°λ²•μ€ μžλ™ν™”μ— λΉ„ν•˜μ—¬ κ²€μ‚¬κ²°κ³Όμ˜ νŽΈμ°¨κ°€ 클 수 있으며 사무적인 였λ₯˜ λ°œμƒκ°€λŠ₯성도 크닀고 λ³Ό 수 μžˆλ‹€. μ΄λŸ¬ν•œ 이유둜 ν˜ˆμ•‘μ€ν–‰κ²€μ‚¬μ˜ 외뢀정도관리 μ°Έμ—¬λŠ” κ²€μ‚¬μ˜ 신뒰도λ₯Ό 평가할 수 μžˆλŠ” 맀우 μ€‘μš”ν•œ 과정이라고 ν•  수 μžˆλ‹€.

λŒ€ν•œμž„μƒκ²€μ‚¬μ •λ„κ΄€λ¦¬ν˜‘νšŒμ—μ„œ μƒˆλ‘­κ²Œ μ‚¬μ—…ν”„λ‘œκ·Έλž¨μ„ κ΅¬μ„±ν•˜κ³  μ°¨μ„ΈλŒ€ μ „μ‚°μ‹œμŠ€ν…œμ„ κ°œλ°œν•˜μ—¬ μ°¨μ„ΈλŒ€ 신빙도쑰사사업을 μ‹œν–‰ν•˜κ²Œ 된 지 μ˜¬ν•΄λ‘œ 2년이 λ˜μ—ˆλ‹€. 2016년에 이어 2017λ…„λΆ€ν„°λŠ” μˆ˜ν˜ˆμ˜ν•™κ²€μ‚¬λ“€μ΄ λ‹€μŒκ³Ό 같이 4개의 ν”„λ‘œκ·Έλž¨μœΌλ‘œ λ‚˜λ‰˜μ–΄ 10κ°€μ§€μ˜ ν•­λͺ©μœΌλ‘œ μ‹œν–‰ν•˜κ³  μžˆλ‹€[1]. (1) μΌλ°˜μˆ˜ν˜ˆκ²€μ‚¬: ABO typing (ABO ν˜ˆμ•‘ν˜•), RhD typing (RhD ν˜ˆμ•‘ν˜•), crossmatching(κ΅μ°¨μ‹œν—˜); (2) μˆ˜ν˜ˆν•­μ›κ²€μ‚¬, 특수: ABO subtyping (ABO μ•„ν˜• ν˜ˆμ•‘ν˜•), Rh CcEe antigen testing (Rh CcEe 항원검사), weak D test(μ•½ D검사); (3) μˆ˜ν˜ˆν•­μ²΄κ²€μ‚¬, 일반: antibody screening(λΉ„μ˜ˆκΈ°ν•­μ²΄ 선별검사), direct antiglobulin test(μ§μ ‘ν•­κΈ€λ‘œλΆˆλ¦°κ²€μ‚¬); (4) μˆ˜ν˜ˆν•­μ²΄κ²€μ‚¬, 특수: antibody identification(λΉ„μ˜ˆκΈ°ν•­μ²΄ 동정검사), ABO Ab titration (ABO 항체 역가검사). 이 4개의 μˆ˜ν˜ˆμ˜ν•™ν”„λ‘œκ·Έλž¨μ€ 2016λ…„κ³Ό λ™μΌν•œ μˆ˜ν˜ˆμ˜ν•™ν”„λ‘œκ·Έλž¨ κ΄€λ¦¬μžμ— μ˜ν•˜μ—¬ κ΄€λ¦¬λ˜μ–΄ μ™”λ‹€.

이에 μ €μžλ“€μ€ 2017년에 4개의 μˆ˜ν˜ˆμ˜ν•™ν”„λ‘œκ·Έλž¨μ—μ„œ μ‹€μ‹œν•œ 10κ°€μ§€μ˜ 검사항λͺ©μ— λŒ€ν•˜μ—¬ 2차에 걸쳐 신빙도쑰사λ₯Ό μ‹€μ‹œν•˜μ˜€κ³ , 기관별 검사방법에 λŒ€ν•œ 결과와 μ‹€μ‹œν•˜μ˜€λ˜ μ‚¬μ—…λ‚΄μš©μ„ λ³΄κ³ ν•˜κ³ μž ν•œλ‹€.

재료 및 방법

1. 쑰사항λͺ©

쑰사항λͺ©μ€ μ„œλ‘ μ—μ„œ μ–ΈκΈ‰ν•œ 바와 λ§ˆμ°¬κ°€μ§€λ‘œ ABO ν˜ˆμ•‘ν˜•, RhD ν˜ˆμ•‘ν˜•, κ΅μ°¨μ‹œν—˜, ABO μ•„ν˜• ν˜ˆμ•‘ν˜•, Rh CcEe 항원검사, μ•½ D검사, λΉ„μ˜ˆκΈ°ν•­μ²΄ 선별검사, μ§μ ‘ν•­κΈ€λ‘œλΆˆλ¦°κ²€μ‚¬, λΉ„μ˜ˆκΈ°ν•­μ²΄ 동정검사, ABO 항체 μ—­κ°€κ²€μ‚¬μ˜ 10가지 ν•­λͺ©μ— λŒ€ν•œ 신빙도쑰사λ₯Ό μ‹€μ‹œν•˜μ˜€λ‹€.

2. 외뢀신빙도 μ‘°μ‚¬λ¬Όμ§ˆμš© 제쑰

검체 μ œμ‘°λŠ” 2016년도와 λ§ˆμ°¬κ°€μ§€λ‘œ 2017λ…„ μ°¨μ„ΈλŒ€ 신빙도쑰사사업을 μœ„ν•œ μžκ°€μ œμ‘°λ¬Όμ§ˆ 개발의 μš©μ—­μ—°κ΅¬λ₯Ό 맑은 μ•„μ£ΌλŒ€ν•™κ΅λ³‘μ›μ—μ„œ λ‹€μŒκ³Ό 같이 μ œμ‘°ν•˜μ˜€λ‹€. 검체 μ œμ‘°μ— μ‚¬μš©λœ ν˜ˆμ•‘μ œμ œλ“€μ€ λŒ€ν•œμ μ‹­μžμ‚¬μ™€ ν•œλ§ˆμŒ ν˜ˆμ•‘μ›μœΌλ‘œλΆ€ν„° 생λͺ…μœ€λ¦¬μ‹¬μ˜λ₯Ό λ“ν•œ 후에 μ‚¬μš©ν•˜μ˜€λ‹€. μžκ°€μ œμ‘°λœ λͺ¨λ“  κ²€μ²΄λŠ” 객관적 νŒλ…μ„ μœ„ν•˜μ—¬ κ²€μ‚¬μž 2인이 각각 κ²€μ‚¬ν•˜μ—¬ κ²°κ³Ό 및 응집 정도λ₯Ό ν™•μΈν•˜μ˜€λ‹€. μ•„μ£ΌλŒ€ν•™κ΅λ³‘μ›μ—μ„œ 제쑰되고 λΆ„μ£Ό ν›„ ν‘œμ‹μ΄ 뢙여진 μ™ΈλΆ€μ‹ λΉ™λ„μ‘°μ‚¬λ¬Όμ§ˆλ“€μ€ λŒ€ν•œμž„μƒκ²€μ‚¬μ •λ„κ΄€λ¦¬ν˜‘νšŒλ‘œ μš΄λ°˜λ˜μ–΄ 포μž₯된 ν›„ 각 μ°Έμ—¬κΈ°κ΄€μœΌλ‘œ λ°œμ†‘λ˜μ—ˆλ‹€. 외뢀신빙도쑰사 κ²€μ²΄λŠ” 1μ°¨ 4μ›” 17일, 2μ°¨λŠ” 9μ›” 18일에 계약 택배λ₯Ό μ΄μš©ν•˜μ—¬ 각각 λ°œμ†‘ν•˜μ˜€λ‹€. κ²€μ‚¬κ²°κ³ΌλŠ” μ°¨μ„ΈλŒ€ 신빙도쑰사사업 ν™ˆνŽ˜μ΄μ§€μ— μž…λ ₯ν•˜λ„λ‘ ν•˜μ˜€λ‹€.

1) ν˜ˆκ΅¬λΆ€μœ μ•‘ 제쑰

신빙도쑰사 검사항λͺ©(각 νšŒμ°¨λ‹Ή 검체 수)인 ABO ν˜ˆμ•‘ν˜•μ˜ ν˜ˆκ΅¬ν˜• 검사(3개), RhD ν˜ˆμ•‘ν˜•(3개), ABO μ•„ν˜• ν˜ˆμ•‘ν˜•(1개), Rh CcEe 항원검사(1개), 그리고 μ•½ D검사(1개)λ₯Ό μœ„ν•œ 적혈ꡬ λΆ€μœ μ•‘μ€ λͺ©μ ν•˜κ³ μž ν•˜λŠ” ν˜ˆμ•‘ν˜•μ„ 가진 ν˜ˆμ•‘μ„ ν˜ˆκ΅¬λ³΄μ‘΄μ•‘μΈ EC stabilizing solution (DiaMed GmbH, Cressier, Switzerland)을 μ‚¬μš©ν•˜μ—¬ ν¬μ„ν•˜μ˜€λ‹€. ABO ν˜ˆμ•‘ν˜•μ˜ ν˜ˆκ΅¬ν˜• 검사와 RhD ν˜ˆμ•‘ν˜• κ²€μ‚¬μš© ν˜ˆκ΅¬λΆ€μœ μ•‘μ€ μžλ™ν™” μž₯비에도 μ‚¬μš©μ΄ κ°€λŠ₯ν•˜λ„λ‘ ν•˜μ˜€λ‹€. 이λ₯Ό μœ„ν•˜μ—¬ 20%의 μž¬μ‘°ν•© μ „ν˜ˆμ΄ λ˜λ„λ‘ μ‹ μ„ λ™κ²°ν˜ˆμž₯κ³Ό EC stabilizing solution으둜 ν¬μ„ν•˜μ˜€κ³ , ABO μ•„ν˜• ν˜ˆμ•‘ν˜•, Rh CcEe 항원검사 그리고 μ•½ Dκ²€μ‚¬μš© 적혈ꡬ λΆ€μœ μ•‘μ€ 3%κ°€ λ˜λ„λ‘ ν•˜μ˜€λ‹€. κ΅μ°¨μ‹œν—˜μš© 적혈ꡬ λΆ€μœ μ•‘μ€ 3개의 ABO ν˜ˆμ•‘ν˜•μ˜ ν˜ˆκ΅¬ν˜• κ²€μ‚¬μš© 검체 쀑 ν•˜λ‚˜λ₯Ό μ‚¬μš©ν•˜λ„λ‘ ν•˜μ˜€λ‹€. ABO μ•„ν˜• ν˜ˆμ•‘ν˜•κ³Ό μ•½ D검사 κ²€μ²΄λŠ” λ™μΌν•œ ν˜ˆμ•‘ν˜•μ„ 가진 EDTA (ethylenediamine tetraacetic acid) μœ λž˜κ²€μ‚¬μš© 검체듀을 각각 ν˜Όμ£Όν•˜μ—¬ μ‚¬μš©ν•˜μ˜€κ³ , κ·Έ μ΄μ™ΈλŠ” CPDA (citrate phosphate dextrose adenine)-1 ν˜ˆμ•‘ λ°±μ—μ„œ λΆ„λ¦¬λœ λ†μΆ•μ ν˜ˆκ΅¬λ₯Ό μ‚¬μš©ν•˜μ˜€λ‹€[1,2]. λ™μΌν•œ ABO ν˜ˆμ•‘ν˜•μ˜ ν˜ˆμ•‘λ°±μ˜ 혼주 μ‹œλŠ” λ¬΄κ· λ΄‰ν•©κΈ°λ‘œ μ—°κ²°ν•˜μ—¬ ν˜Όν•©ν•œ λ‹€μŒ λΆ„μ£Όν•˜μ˜€λ‹€.

2) 혈μž₯용 검체 제쑰

ABO 혈청 κ²€μ‚¬μš©μ€ ν˜ˆκ΅¬ν˜•κ³Ό λ™μΌν•œ ABO ν˜ˆμ•‘ν˜•, ABO 항체 μ—­κ°€κ²€μ‚¬μš©μ€ Oν˜•μ˜ μ‹ μ„ λ™κ²°ν˜ˆμž₯을 μ‚¬μš©ν•˜μ˜€λ‹€. ν˜ˆμ•‘λ°±μ˜ 혼주 μ‹œλŠ” λ¬΄κ· λ΄‰ν•©κΈ°λ‘œ μ—°κ²°ν•˜μ—¬ ν˜Όν•©ν•œ λ‹€μŒ λΆ„μ£Όν•˜μ˜€λ‹€[1,2].

3) μž¬μ‘°ν•© 혈μž₯ 검체 제쑰

신빙도쑰사 검사항λͺ©(각 νšŒμ°¨λ‹Ή 검체 수)인 κ΅μ°¨μ‹œν—˜(3개), λΉ„μ˜ˆκΈ°ν•­μ²΄ 선별검사(3개), λΉ„μ˜ˆκΈ°ν•­μ²΄ 동정검사(2개)λŠ” ν•­ν˜ˆμ²­μ— μ‹ μ„ λ™κ²°ν˜ˆμž₯으둜 ν¬μ„ν•˜μ—¬ μž¬μ‘°ν•©ν•˜μ˜€λ‹€. κ΅μ°¨μ‹œν—˜ μ–‘μ„± κ²€μ²΄λŠ” ν•­κΈ€λ‘œλΆˆλ¦° λ‹¨κ³„μ—μ„œλ§Œ κ²€μΆœλ˜κ³  κ·Έ μ΄μ™Έμ˜ λ‹¨κ³„μ—μ„œλŠ” κ²€μΆœλ˜μ§€ μ•Šκ±°λ‚˜ μ•½ν•˜κ²Œ κ²€μΆœλ  μ •λ„μ˜ ν•­ν˜ˆμ²­μ˜ 항체 μ—­κ°€λ₯Ό ν¬μ„ν•˜μ—¬ 검체λ₯Ό μ œμ‘°ν•˜μ˜€λŠ”λ°, μƒν’ˆν™”λœ μΈκ°„μœ λž˜ 닀클둠성 anti-D (DiaMed GmbH)λ₯Ό λ™μΌν•œ ABO ν˜ˆμ•‘ν˜•μ˜ μ‹ μ„ λ™κ²°ν˜ˆμž₯에 ν¬μ„ν•˜μ—¬ μ‚¬μš©ν•˜μ˜€λ‹€[1,2].

λΉ„μ˜ˆκΈ°ν•­μ²΄ μ„ λ³„κ²€μ‚¬μš© μ–‘μ„± κ²€μ²΄λ‘œλŠ” 1회차 anti-K, anti-Eλ₯Ό, 2회차 anti-eλ₯Ό λ°œμ†‘ν•˜μ˜€κ³ , λ™μ •μš© μ–‘μ„± κ²€μ²΄λ‘œλŠ” 1회차 anti-Fya, anti-Nλ₯Ό, 2회차 anti-K, anti-eλ₯Ό λ°œμ†‘ν•˜μ˜€λ‹€. κ²€μ²΄λŠ” ν•­ν˜ˆμ²­ μ‹œμ•½μ„ 각각 ν¬μ„ν•˜μ—¬ μ‚¬μš©ν•˜μ˜€λŠ”λ° μ‚¬μš©λœ ν•­ν˜ˆμ²­ μ‹œμ•½μ˜ μ’…λ₯˜λŠ” 각각 닀클둠성 anti-Fya (CE Diagnostika GmbH, Eschelbronn, Germany), 단클둠성 anti-N (CE Diag-ostika GmbH), 닀클둠성 anti-K (CE Diagnostika GmbH), 단클둠성 anti-e (Diagast, Parc EurasantΓ©, France)μ˜€λ‹€. 희석 μ‹œλŠ” AB ν˜ˆμ•‘ν˜•μ˜ μ‹ μ„ λ™κ²°ν˜ˆμž₯에 ν¬μ„ν•˜μ˜€λ‹€[1,2].

4) μ§μ ‘ν•­κΈ€λ‘œλΆˆλ¦°κ²€μ‚¬μš© 혈ꡬ 제쑰

μ–‘μ„± μ§μ ‘ν•­κΈ€λ‘œλΆˆλ¦°κ²€μ‚¬μš© κ²€μ²΄λŠ” μΈκ°„μœ λž˜ 닀클둠성 anti-D (DiaMed GmbH)λ₯Ό μ‚¬μš©ν•˜μ—¬ μΈμœ„μ μœΌλ‘œ κ°μž‘μ‹œν‚¨ 혈ꡬλ₯Ό μ‚¬μš©ν•˜μ˜€λ‹€. μŒμ„± μ§μ ‘ν•­κΈ€λ‘œλΆˆλ¦°κ²€μ‚¬μš© ν˜ˆκ΅¬λŠ” μ§μ ‘ν•­κΈ€λ‘œλΆˆλ¦° 검사결과 μŒμ„±μΈ 적혈ꡬλ₯Ό μ‚¬μš©ν•˜μ˜€λ‹€. μ–‘μ„± 및 μŒμ„± ν˜ˆκ΅¬λ“€μ€ ν˜ˆκ΅¬λ³΄μ‘΄μ•‘μΈ EC stabilizing solution (DiaMed GmbH)에 3%둜 ν¬μ„ν•˜μ—¬ μ΄μš©ν•˜μ˜€λ‹€.

3. κ²°κ³Ό νŒμ • 및 뢄석 검체

μΌλ°˜μˆ˜ν˜ˆκ²€μ‚¬μ˜ ABO ν˜ˆμ•‘ν˜•, RhD ν˜ˆμ•‘ν˜•κ³Ό κ΅μ°¨μ‹œν—˜μ˜ 경우 ν˜ˆκ΅¬μ‘μ§‘ 강도에 λŒ€ν•˜μ—¬ μ˜λ„ν•œ λ²”μœ„λŠ” λ³΄κ³ μ„œμ— μ œκ³΅ν•˜μ˜€μœΌλ‚˜ 이듀은 λͺ¨λ‘ code 507둜 μ‹œλ²”ν•­λͺ©μœΌλ‘œ κ°„μ£Όν•˜μ—¬ ν‰κ°€μ—μ„œ μ œμ™Έν•˜μ˜€λ‹€. λ˜ν•œ ABO typing κ²€μ‚¬μ—μ„œ ν˜ˆκ΅¬ν˜•μ΄λ‚˜ ν˜ˆμ²­λ§Œμ„ μ‹€μ‹œν•˜κ±°λ‚˜ 특수 ν˜ˆμ•‘ν˜•ν•­μ›κ²€μ‚¬μ—μ„œ 응집 κ°•λ„λ§Œ ν‘œμ‹œν•˜κ³  ν•­μ›ν˜• νŒμ •μ„ ν•˜μ§€ μ•Šμ€ 기관에 λŒ€ν•΄μ„œλŠ” μ‹œλ²”ν•­λͺ©μœΌλ‘œ κ°„μ£Όν•˜μ—¬ ν‰κ°€ν•˜μ§€ μ•Šμ•˜λ‹€. κ΅μ°¨μ‹œν—˜μ΄λ‚˜ ν•΄λ‹Ή 검사λ₯Ό μ‹œν–‰ν•˜κΈ°μ— μ μ ˆν•˜μ§€ μ•Šμ€ slide법은 λΆ„μ„μ—μ„œ μ œμ™Έν•˜μ˜€λ‹€. κ΅μ°¨μ‹œν—˜μ˜ 경우 μŒμ„±μœΌλ‘œ 적합 νŒμ •μ„ ν•œ 검체에 λŒ€ν•΄μ„œλŠ” 응집이 μ—†λ‹€κ³  λ³΄κ³ ν•œ 경우만 μ •λ‹΅μœΌλ‘œ κ°„μ£Όν•˜μ˜€λ‹€. Rh CcEe 항원검사와 μ§μ ‘ν•­κΈ€λ‘œλΆˆλ¦°κ²€μ‚¬μ˜ 경우 1+ 이상을 μ–‘μ„±μœΌλ‘œ κ°„μ£Όν•˜μ—¬ μ–‘μ„± κ²€μ²΄μ˜ μ •λ‹΅λ₯ μ„ μ‚°μ •ν•˜μ˜€λ‹€. ABO 항체 μ—­κ°€κ²€μ‚¬μ˜ ν—ˆμš©λ²”μœ„λŠ” 참여기관이 10κΈ°κ΄€ 이상인 검사법에 λŒ€ν•˜μ—¬ μ΅œλΉˆλ„μ™€ μƒν•˜ 단계씩 μΆ”κ°€ν•˜μ˜€κ³ , 이 λ²”μœ„μ— μ†ν•˜λŠ” 참여기관이 80%λ₯Ό λ„˜μ§€ μ•Šμ„ κ²½μš°μ—λŠ” μ΅œλΉˆλ„μ™€ μƒν•˜ 단계 근처의 λΉˆλ„μˆ˜κ°€ λ§Žμ€ 단계λ₯Ό 더 μΆ”κ°€ν•˜μ—¬ κ²°μ •ν•˜μ˜€λ‹€.

κ²° κ³Ό

1. μΌλ°˜μˆ˜ν˜ˆκ²€μ‚¬

1) ABO와 RhD ν˜ˆμ•‘ν˜•

ABO ν˜ˆμ•‘ν˜•κ²€μ‚¬λŠ” 2차에 걸쳐 총 6개의 κ²€μ²΄λ‘œ μ‹€μ‹œν•˜μ˜€κ³ , μ •λ‹΅λ₯ μ€ 99.1%-99.9%λ₯Ό λ‚˜νƒ€λƒˆλ‹€(Table 1). 1μ°¨(2μ°¨)의 ν˜ˆκ΅¬ν˜• 검사법은 μŠ¬λΌμ΄λ“œλ²• 48.9% (52.0%), μ‹œν—˜κ΄€λ²• 43.3% (40.3%) μˆœμ΄μ—ˆμœΌλ©°, 1μ°¨(2μ°¨)의 ν˜ˆμ²­ν˜• 검사법은 μ‹œν—˜κ΄€λ²•μ΄ 85.7% (84.6%), μŠ¬λΌμ΄λ“œλ²• 7.4% (8.7%) 순으둜 λ‚˜νƒ€λ‚¬λ‹€. RhD ν˜ˆμ•‘ν˜•κ²€μ‚¬λ„ 2차에 걸쳐 총 6개의 κ²€μ²΄λ‘œ μ‹€μ‹œν•˜μ˜€κ³ , μ •λ‹΅λ₯ μ€ 99.3%-100.0%λ₯Ό λ‚˜νƒ€λ‚΄μ–΄ μž‘λ…„λ„μ— λΉ„ν•˜μ—¬ μ •λ‹΅λ₯ μ΄ μ†Œν­ μ¦κ°€ν•˜μ˜€λ‹€(Table 2). 1μ°¨(2μ°¨)의 검사법은 1μ°¨μ—μ„œλŠ” μ‹œν—˜κ΄€λ²•μ΄ 51.5% (48.7%), μŠ¬λΌμ΄λ“œλ²• 40.2% (43.7%) μˆœμ΄μ—ˆλ‹€.

Table 1 . Number (%) of participants in the proficiency tests for ABO blood grouping in 2017.

 TrialSpecimenTotalABODisNAIntended response
1BB-17-01669 (100.0)668 (99.9)1 (0.1)---A
BB-17-02669 (100.0)-2 (0.3)663 (99.1)4 (0.6)-O
BB-17-03669 (100.0)1 (0.1)664 (99.3)3 (0.5)1 (0.1)-B
2BB-17-07759 (100.0)1 (0.1)755 (99.5)-3 (0.4)-B
BB-17-08759 (100.0)755 (99.5)1 (0.1)-3 (0.4)-A
BB-17-09759 (100.0)--755 (99.5)4 (0.5)-O

Values are presented as number (%), unless otherwise stated.

Abbreviations: Dis, discrepancy between cell typing and serum typing; NA, not available.


Table 2 . Number (%) of participants in the proficiency tests for RhD typing in 2017.

 TrialSpecimenTotalPositiveVariantNegativeNAIntended response
1BB-17-01650 (100.0)649 (99.8)1 (0.2)--  Positive
BB-17-02650 (100.0)650 (100.0)---  Positive
BB-17-03650 (100.0)1 (0.2)-649 (99.8)-  Negative
2BB-17-07740 (100.0)740 (100.0)---  Positive
BB-17-08740 (100.0)739 (99.9)1 (0.1)--  Positive
BB-17-09740 (100.0)3 (0.4)2 (0.3)735 (99.3)-  Negative

Values are presented as number (%), unless otherwise stated.

Abbreviation: NA, not available.


2) κ΅μ°¨μ‹œν—˜

κ΅μ°¨μ‹œν—˜κ²€μ‚¬λŠ” 2차에 걸쳐 총 6개의 검체가 μ‚¬μš©λ˜μ—ˆμœΌλ©°, 적합 κ²€μ²΄λŠ” 97.6%-98.5%, 뢀적합 κ²€μ²΄λŠ” 88.9%와 90.4%의 κ΅μ°¨μ‹œν—˜ νŒμ • μ •λ‹΅λ₯ μ„ 보여 95.3%의 평균 μ •λ‹΅λ₯ μ„ λ³΄μ˜€λ‹€(Table 3). 뢀적합 κ²€μ²΄μ˜ 경우 각 λ°©λ²•λ³„λ‘œ λΆ„μ„ν•œ κ²°κ³Ό, μ‹œν—˜κ΄€λ²•μ˜ μ‹μ—Όμˆ˜λ‹¨κ³„μ™€ 37Β°C μ•ŒλΆ€λ―Όλ‹¨κ³„μ—μ„œλŠ” λŒ€λΆ€λΆ„μ˜ κΈ°κ΄€μ—μ„œ μŒμ„±μœΌλ‘œ λ³΄κ³ ν•œ 반면, μ‹œν—˜κ΄€λ²•μ˜ 37Β°C μ•ŒλΆ€λ―Όλ‹¨κ³„λŠ” traceμ—μ„œ 2+의 λ²”μœ„λ₯Ό λ‚˜νƒ€λ‚΄κΈ°λ„ ν•˜μ˜€μœΌλ©°, λŒ€λΆ€λΆ„μ˜ μ‹œν—˜κ΄€λ²• ν•­κΈ€λ‘œλΆˆλ¦°λ‹¨κ³„μ™€ 원주응집법은 1+ μ΄μƒμ˜ 응집을 λ‚˜νƒ€λ‚΄μ—ˆλ‹€(Fig. 1).

Table 3 . Number and % of participants in the proficiency tests for blood crossmatching.

  Trial (RBC)SpecimenIntended response ResultsNo. (%)
1st (BB-17-02)BB-17-04 IncompatibleAcceptable518 (88.9)
Unacceptable65 (11.1)
BB-17-05 CompatibleAcceptable574 (98.5)
Unacceptable9 (1.5)
BB-17-06 CompatibleAcceptable568 (97.6)
Unacceptable14 (2.4)
2nd (BB-17-08)BB-17-10 CompatibleAcceptable642 (98.3)
Unacceptable11 (1.7)
BB-17-11 CompatibleAcceptable642 (98.3)
Unacceptable11 (1.7)
BB-17-12 IncompatibleAcceptable591 (90.4)
Unacceptable63 (9.6)

Abbreviation: RBC, sample codes for red blood cell suspensions..


Figure 1.

(A, B) A graph showing the number of participants (Y-axis) versus the grade of hemagglutination strength (X-axis) of incompatible samples for blood crossmatching. *The number of participants using tube-saline.


2. 특수 μˆ˜ν˜ˆν•­μ›κ²€μ‚¬

1) ABO μ•„ν˜• ν˜ˆμ•‘ν˜•

1μ°¨ κ²€μ²΄λŠ” A2ν˜•μœΌλ‘œ 96.0% (48/50)의 μ •λ‹΅λ₯ μ„ λ³΄μ˜€λŠ”λ° ν•­-A1 μ‹œμ•½κ³Όμ˜ λ°˜μ‘μ—μ„œ μŒμ„± ν˜Ήμ€ traceλ₯Ό 보인 기관은 96.0%, ν•­-H μ‹œμ•½κ³Όμ˜ λ°˜μ‘μ—μ„œ 1+ 이상을 λ³΄κ³ ν•œ 기관은 89.7%μ˜€λ‹€. 2μ°¨ κ²€μ²΄λŠ” A2Bwν˜•μœΌλ‘œ 80.7% (42/50)의 μ •λ‹΅λ₯ μ— μ§€λ‚˜μ§€ μ•Šμ•˜λ‹€. ν•­-B μ‹œμ•½κ³Όμ˜ λ°˜μ‘μ—μ„œ ν˜Όν•©μ‹œμ•½μ„ ν¬ν•¨ν•˜μ—¬ traceλΆ€ν„° 3+κΉŒμ§€μ˜ 응집을 λ³΄κ³ ν•œ 기관은 92.3%μ˜€μœΌλ©° B μ•„ν˜•μ„ κ²€μΆœν•œ 기관은 84.6%μ˜€λ‹€. ν•­-H μ‹œμ•½κ³Όμ˜ λ°˜μ‘μ—μ„œ ν•œ 개의 기관을 μ œμ™Έν•˜κ³ λŠ” λͺ¨λ“  κΈ°κ΄€μ—μ„œ 1+ 이상을 λ³΄κ³ ν•˜μ—¬ 97.9%μ˜€λ‹€(Table 4).

Table 4 . Number (%) of participants in the proficiency tests for ABO subtyping.

Trial (specimen)CategoryAnti-seraABO subgroup

Anti-AAnti-BAnti-A1Anti-H
1st (BGS-17-01)Number50505039A11 (2.0)*
Negative-50 (100.0)46 (92.0)-A248 (96.0)
Β±--2 (4.0)4 (10.3)*Aw1 (2.0)*
1+---13 (33.3)
2+1 (2.0)*-1 (2.0)*16 (41.0)
3+2 (4.0)--6 (15.4)
4+47 (94.0)---
MF--1 (2.0)*-
2nd (BGS-17-04)Number52525248A2B7 (13.5)*
Negative--52 (100.0)-A2Bw42 (80.7)
Β±-2 (3.8)-1 (2.1)*AwB2 (3.9)*
1+-4 (7.7)-6 (12.5)AwBw1 (1.9)*
2+-13 (25.0)-18 (37.5)
3+2 (3.8)12 (23.1)-12 (25.0)
4+50 (96.2)4 (7.7)*-11 (22.9)
MF-17 (32.7)--

Values are presented as number (%), unless otherwise stated..

Abbreviation: MF, mixed field agglutination..

*Unacceptable responses for ABO subgrouping.


2) Rh CcEe 항원검사

Rh CcEe ν•­μ›κ²€μ‚¬λŠ” 1μ°¨ 50개, 2μ°¨ 51개 κΈ°κ΄€μ—μ„œ μ°Έμ—¬ν•˜μ˜€λ‹€. 1μ°¨ κ²€μ²΄λŠ” CcEe, 2μ°¨ 검체 Cce 검체λ₯Ό λ°œμ†‘ν•˜μ˜€λŠ”λ° 2μ°¨ κ²€μ²΄μ—μ„œ E항원에 μ–‘μ„±, c항원에 μŒμ„±μ΄λΌ 각각 μ‘λ‹΅ν•œ 두 개의 기관듀을 μ œμ™Έν•œ λ‚˜λ¨Έμ§€ κΈ°κ΄€κ³Ό 1차의 λͺ¨λ“  κΈ°κ΄€μ—μ„œλŠ” μ •λ‹΅μœΌλ‘œ λ‹΅λ³€ν•˜μ˜€λ‹€(Table 5).

Table 5 . Number (%) of participants in the proficiency tests for Rh CcEe antigen typing.

Trial (specimen)CategoryAnti-sera

CEce
1st (BGS-17-02)Number50505050
1+2 (4.0)-1 (2.0)2 (4.0)
2+6 (12.0)3 (6.0)6 (12.0)11 (22.0)
3+16 (32.0)21 (42.0)18 (36.0)15 (30.0)
4+26 (52.0)26 (52.0)25 (50.0)22 (44.0)
2nd (BGS-17-05)Number51515151
Negative-50 (98.0)1 (2.0)*-
1+1 (2.0)-1 (2.0)-
2+6 (11.8)-3 (59)1 (2.0)
3+16 (31.4)-14 (27.5)21 (41.2)
4+88 (54.8)1 (2.0)*32 (62.7)29 (56.9)

Values are presented as number (%), unless otherwise stated..

*Unacceptable responses for the Rh CcEe antigen test.


3) μ•½ D검사

2017년에 보낸 μ•½ Dκ²€μ‚¬λŠ” λͺ¨λ‘ RhD typingμ—μ„œλ„ 응집을 λ³΄μ˜€λ˜ λ³€μ΄ν˜• Dν˜• κ²€μ²΄μ˜€μœΌλ‚˜, 1μ°¨ 51.7% (74/143), 2μ°¨λŠ” 78.7% (126/160)μ—μ„œλ§Œ μ˜λ„ν•œ λ³€μ΄ν˜• D둜 λ³΄κ³ ν•˜μ˜€λ‹€. κ·ΈλŸ¬λ‚˜ 1차와 2μ°¨ 검체 λͺ¨λ‘ μ°Έμ—¬κΈ°κ΄€μ˜ μƒλ‹Ήμˆ˜μ—μ„œ D μ–‘μ„±μœΌλ‘œ λ³΄κ³ ν•˜μ—¬ μ˜¬ν•΄μ— ν•œν•˜μ—¬ μ •λ‹΅μœΌλ‘œ κ°„μ£Όν•˜μ—¬ μ •λ‹΅λ₯ μ€ 1μ°¨ 99.3%, 2μ°¨λŠ” 100.0%에 λ‹¬ν•˜μ˜€λ‹€. RhD ν˜ˆμ•‘ν˜•κ²€μ‚¬μ—μ„œ 4+ 응집을 보여 λΆ€μ κ²©μœΌλ‘œ νŒμ •λœ 기관은 1μ°¨ 2κΈ°κ΄€, 2μ°¨λŠ” 1κΈ°κ΄€μ΄μ—ˆλ‹€(Table 6).

Table 6 . Number (%) of participants in the proficiency tests for weak D test.

Trial (specimen)1 (BGS-17-03)2 (BGS-17-06)


RhDWeak DRhDWeak D
 Number141142158159
 Negative34 (24.1)3 (2.1)*100 (63.3)-
 ±15 (10.6)-33 (20.9)-
 1+39 (27.7)6 (4.2)18 (11.4)8 (5.0)
 2+44 (31.2)25 (17.6)5 (3.2)35 (22.0)
 3+7 (5.0)39 (27.5)1 (0.6)46 (28.9)
 4+2 (1.4)*55 (38.7)1 (0.6)*66 (41.5)
 Not done-14 (9.9)-4 (2.5)
 D positive68 (47.6)34 (21.3)
 D variant74 (51.7)126 (78.7)
 D negative1 (0.7)*-

Values are presented as number (%), unless otherwise stated..

*Unacceptable responses for weak D testing.


3. 일반 μˆ˜ν˜ˆν•­μ²΄κ²€μ‚¬

1) λΉ„μ˜ˆκΈ°ν•­μ²΄ 선별검사

λΉ„μ˜ˆκΈ°ν•­μ²΄ μ„ λ³„κ²€μ‚¬λŠ” 1차와 2차의 경우 λͺ¨λ‘ 2개의 μ–‘μ„± 검체와 1개의 μŒμ„± 검체λ₯Ό λ°œμ†‘ν•˜μ˜€λ‹€. 1μ°¨ κ²€μ²΄μ—μ„œ 2개의 항체 μ–‘μ„± 검체에 λŒ€ν•˜μ—¬ 각각 μŒμ„±μœΌλ‘œ λ³΄κ³ ν•œ 1κ°œμ™€ 5개 기관을 μ œμ™Έν•œ 98.6%, 그리고 2μ°¨ κ²€μ²΄μ—μ„œλŠ” λͺ¨λ“  κ²€μ²΄μ—μ„œ 100.0%의 μ •λ‹΅λ₯ μ„ λ³΄μ˜€λ‹€(Table 7). 1μ°¨(2μ°¨) κ²€μ‚¬λ²•μ˜ λΉ„μœ¨μ€ 원주응집법 93.8% (94.5%), erythrocyte-magnetized technique 1.7% (2.4%), liquid microwell plate 0.7% (0.7%), solid phase red cell adherence assay 3.5% (2.1%), 그리고 μ‹œν—˜κ΄€λ²•μ€ 3.5% (2.1%)λ₯Ό μ°¨μ§€ν•˜μ˜€λ‹€.

Table 7 . Number (%) of participants in the proficiency tests for antibody screening.

TrialSpecimenNumberResults Intended response

PositiveNegative
1stBBG-17-01288287 (99.7)1 (0.3)*   Positive
BBG-17-02288283 (98.3)5 (1.7)*   Positive
BBG-17-032884 (1.4)*284 (98.6)   Negative
2ndBBG-17-07292-292 (100.0)   Negative
BBG-17-08292292 (100.0)-   Positive
BBG-17-09292292 (100.0)-   Positive

Values are presented as number (%), unless otherwise stated..

*Unacceptable responses for antibody screening.


2) μ§μ ‘ν•­κΈ€λ‘œλΆˆλ¦°κ²€μ‚¬

μ§μ ‘ν•­κΈ€λ‘œλΆˆλ¦°κ²€μ‚¬λŠ” 2차에 걸쳐 총 6개의 검체가 μ‚¬μš©λ˜μ—ˆλ‹€. λ‹€νŠΉμ΄μ„± ν•­κΈ€λ‘œλΆˆλ¦°κ²€μ‚¬λŠ” ν•œ 개의 μŒμ„± 검체에 λŒ€ν•˜μ—¬ μœ„μ–‘μ„±μœΌλ‘œ λ³΄κ³ ν•œ 2개 κΈ°κ΄€κ³Ό μ–‘μ„± 검체에 λŒ€ν•˜μ—¬ μœ„μŒμ„±μœΌλ‘œ λ³΄κ³ ν•œ ν•œ 개의 기관을 μ œμ™Έν•œ 4개 검체 λͺ¨λ‘μ—μ„œ 100.0%의 μ •λ‹΅λ₯ μ„ λ³΄μ˜€λ‹€. Immunoglobulin-G (IgG) λ‹¨νŠΉμ΄μ„± ν•­κΈ€λ‘œλΆˆλ¦°κ²€μ‚¬λŠ” 6개의 λͺ¨λ“  κ²€μ²΄μ—μ„œ 100.0%의 μ •λ‹΅λ₯ μ„ λ³΄μ˜€λ‹€. κ·ΈλŸ¬λ‚˜ C3d λ‹¨νŠΉμ΄μ„± ν•­κΈ€λ‘œλΆˆλ¦°κ²€μ‚¬μ˜ 경우 λ‹€νŠΉμ΄μ„± ν•­κΈ€λ‘œλΆˆλ¦°κ²€μ‚¬μ˜ 결과에 따라 κ²°κ³Όκ°€ λ‹¬λžλŠ”λ°, 4개의 λ‹€νŠΉμ΄μ„± ν•­κΈ€λ‘œλΆˆλ¦°κ²€μ‚¬ μŒμ„± κ²€μ²΄λŠ” λͺ¨λ‘ 100.0%의 μ •λ‹΅λ₯ μ„ 보인 반면, λ‹€νŠΉμ΄μ„± ν•­κΈ€λ‘œλΆˆλ¦°κ²€μ‚¬ μ–‘μ„± 검체에 λŒ€ν•΄μ„œλŠ” 1μ°¨λŠ” 16.4%, 2μ°¨λŠ” 12.7%의 μœ„μ–‘μ„±μ„ λ³΄μ˜€λ‹€(Table 8).

Table 8 . Number (%) of participants in the proficiency tests for the direct antiglobulin test.

TrialAntiglobulinSpecimenNumberResult Intended response

PositiveNegative
1stPolyspecificBBG-17-04253253 (100.0)   Negative
BBG-17-05253 (100.0)   Negative
BBG-17-06253 (100.0)0   Positive
Anti-IgGBBG-17-0467067 (100.0)   Negative
BBG-17-05067 (100.0)   Negative
BBG-17-0667 (100.0)0   Positive
Anti-C3dBBG-17-0473073 (100.0)   Negative
BBG-17-05073 (100.0)   Negative
BBG-17-0612 (16.4)*61 (83.6)   Negative
2ndPolyspecificBBG-17-10258258 (100.0)   Negative
BBG-17-112 (0.8)*256 (99.2)   Negative
BBG-17-12257 (99.6)1 (0.4)*   Positive
Anti-IgGBBG-17-106868 (100.0)   Negative
BBG-17-1168 (100.0)   Negative
BBG-17-1268 (100.0)   Positive
Anti-C3dBBG-17-107171 (100.0)   Negative
BBG-17-1171 (100.0)   Negative
BBG-17-129 (12.7)*62 (87.3)   Negative

Values are presented as number (%), unless otherwise stated..

Abbreviation: IgG, immunoglobulin G..

*Unacceptable responses for direct antiglobulin test.


참가기관듀은 원주응집법과 μ‹œν—˜κ΄€λ²•μ„ μ‚¬μš©ν•˜κ³  μžˆλŠ”λ°, λ‹€νŠΉμ΄μ„± ν•­κΈ€λ‘œλΆˆλ¦°κ²€μ‚¬μ˜ 원주응집법과 μ‹œν—˜κ΄€λ²•μ˜ %λŠ” 1차의 경우 79.5%와 20.5%, 2차의 경우 80.3%와 19.7%μ˜€λ‹€. λ‹€νŠΉμ΄μ„± ν•­κΈ€λ‘œλΆˆλ¦°κ²€μ‚¬ μ–‘μ„± κ²€μ²΄μ˜ 경우 2+ μ΄μƒμ˜ 응집 강도λ₯Ό 보인 기관듀이 전체 μ°Έμ—¬κΈ°κ΄€ 쀑 μ°¨μ§€ν•˜λŠ” λ°±λΆ„μœ¨μ€ 1μ°¨ 95.6%, 2μ°¨λŠ” 91.8%μ˜€λ‹€. λ‹€νŠΉμ΄μ„±κ³Ό C3d λ‹¨νŠΉμ΄μ„± ν•­κΈ€λ‘œλΆˆλ¦°κ²€μ‚¬μ—μ„œ μœ„μ–‘μ„±μ„ 보인 κΈ°κ΄€λ“€μ˜ ν˜ˆκ΅¬μ‘μ§‘μ€ 1+λΆ€ν„° 4+κΉŒμ§€ κ°•ν•œ 응집을 λ³΄κ³ ν•œ 기관듀도 ν¬ν•¨λ˜μ–΄ μžˆμ—ˆλ‹€.

4. 특수 μˆ˜ν˜ˆν•­μ²΄κ²€μ‚¬

1) λΉ„μ˜ˆκΈ°ν•­μ²΄ 동정검사

각 항체별 λ™μ •κ²€μ‚¬μ˜ μ •λ‹΅λ₯ μ€ anti-C 97.6%, anti-S 98.4%, anti-Jkb 99.2%둜 μš°μˆ˜ν•˜μ˜€μœΌλ‚˜, anti-cλŠ” 88.7%의 μ •λ‹΅λ₯ μ„ λ³΄μ˜€λ‹€(Table 9). λ˜ν•œ 맀 회차 μ‹œ 2개 κ²€μ²΄μ˜ 닡변을 ν•œ 개 검체에 ν‘œμ‹œν•˜κ³  λ‚˜λ¨Έμ§€ κ²€μ²΄μ—λŠ” β€˜not done’을 ν‘œμ‹œν•œ 기관이 1μ°¨ 2κΈ°κ΄€, 2μ°¨μ—λŠ” 1κΈ°κ΄€μ˜ 총 3κΈ°κ΄€μœΌλ‘œ μ΄λ“€μ˜ κ²°κ³ΌλŠ” μ˜€λ‹΅μœΌλ‘œ μ²˜λ¦¬ν•˜μ˜€λ‹€.

Table 9 . Number (%) of participants in the proficiency tests for antibody identification.

TrialSpecimenNumberIntended response   Other responses (no. of participants)

AbNo. (%)
1BBS-17-01123Anti-C120 (97.6) Anti-C&S (2), anti-E (1)
BBS-17-02123Anti-S121 (98.4) Not done (2)
2BBS-17-04123Anti-c109 (88.7) Anti-c+anti-E (11), anti-Jk+anti-c (1), not done (2)
BBS-17-05123anti-Jkb122 (99.2) Not done (1)

2) ABO 항체 역가검사

각 방법별 ABO 항체 μ—­κ°€κ²€μ‚¬κ²°κ³ΌλŠ” Table 10κ³Ό κ°™μœΌλ©° ν—ˆμš©λ²”μœ„λŠ” ꡡ은 κΈ€μ”¨λ‘œ ν‘œμ‹œν•˜μ˜€λ‹€. Anti-A의 경우 ν—ˆμš©λ²”μœ„μ— λ“œλŠ” μ°Έμ—¬κΈ°κ΄€ λΉ„μœ¨μ€ 1차와 2μ°¨λŠ” 각각 μ‹œν—˜κ΄€ μ¦‰μ‹œμ›μΉ¨λ²•μ€ λͺ¨λ‘ 95.2%와 88.1%, μ‹œν—˜κ΄€ μ‹€μ˜¨λ°°μ–‘λ²•μ€ λͺ¨λ‘ 100.0%, μ‹œν—˜κ΄€ ν•­κΈ€λ‘œλΆˆλ¦°λ²• 100.0%와 94.1%, 원주응집 μ‹€μ˜¨λ²• 100.0%와 84.6%, 원주응집 ν•­κΈ€λ‘œλΆˆλ¦°λ²•μ€ λͺ¨λ‘ 96.0%μ˜€λ‹€. Anti-B의 경우 ν—ˆμš©λ²”μœ„μ— λ“œλŠ” μ°Έμ—¬κΈ°κ΄€ λΉ„μœ¨μ€ 1차와 2μ°¨λŠ” 각각 μ‹œν—˜κ΄€ μ¦‰μ‹œμ›μΉ¨λ²•μ€ λͺ¨λ‘ 97.6%와 92.9%, μ‹œν—˜κ΄€ μ‹€μ˜¨λ°°μ–‘λ²•μ€ λͺ¨λ‘ 100.0%, μ‹œν—˜κ΄€ ν•­κΈ€λ‘œλΆˆλ¦°λ²• 93.8%와 94.1%, 원주응집 μ‹€μ˜¨λ²• 100.0%와 92.3%, 원주응집 ν•­κΈ€λ‘œλΆˆλ¦°λ²•μ€ λͺ¨λ‘ 100.0%μ˜€λ‹€(Table 10). 검사법은 μ‹œν—˜κ΄€ μ¦‰μ‹œμ›μΉ¨λ²•μ„ μ‚¬μš©ν•˜λŠ” 기관이 42κΈ°κ΄€μœΌλ‘œ κ°€μž₯ λ§Žμ•˜μœΌλ©°, 원주응집 ν•­κΈ€λ‘œλΆˆλ¦°λ²• 25κΈ°κ΄€, μ‹œν—˜κ΄€ μ‹€μ˜¨λ°°μ–‘λ²•κ³Ό μ‹œν—˜κ΄€ ν•­κΈ€λ‘œλΆˆλ¦°λ²•μ΄ 각각 17κΈ°κ΄€, 원주응집 μ‹€μ˜¨λ²• 13κΈ°κ΄€ 순으둜 λ‚˜νƒ€λ‚¬λ‹€.

Table 10 . Number of participants involved in each of the techniques for ABO antibody titration.

   TechniqueTrialNumberAcceptable range (%)Titer

248163264128256
Anti-A
 Tube-IS14295.2262212
 Tube-RT16100.0115
 Tube-AHG16100.0268
 Tube-AHG, DTT52111
 CAT-RT12100.039
 CAT-AHG2596.061261
 CAT-AHG, DTT6114
 Others11
 Total123021252371910
 Tube-IS24288.13181632
 Tube-RT17100.01133
 Tube-AHG1794.11295
 Tube-AHG, DTT5131
 CAT-RT1384.6256
 CAT-AHG2596.013111
 CAT-AHG, DTT61311
 CAT-AHG, DTT11
 Total126006283932192
Anti-B
 Tube-IS14297.6111246
 Tube-RT16100.01105
 Tube-AHG1693.81492
 Tube-AHG, DTT51211
 CAT-RT12100.075
 CAT-AHG25100.09124
 CAT-AHG, DTT6222
 Others11
 Total12303331572720
 Tube-IS24292.9171316311
 Tube-RT17100.0854
 Tube-AHG1794.112104
 Tube-AHG, DTT5311
 CAT-RT1392.3148
 CAT-AHG25100.05137
 CAT-AHG, DTT61122
 Others11
 Total1262113032252150

The bold text indicates acceptable range..

Abbreviations: IS, immediate spin; RT, room temperature incubation; AHG, indirect anti-human globulin test; DTT, dithiothreitol; CAT, column agglutination technology..


5. μ›Œν¬μˆ 개졜

수혈 μ „ 검사 μ‹€κΈ° μ›Œν¬μˆμ„ 2017λ…„ 8μ›” 26일(금) μ˜€μ „ 9μ‹œλΆ€ν„° 17μ‹œκΉŒμ§€ μ•„μ£ΌλŒ€ν•™κ΅ μ˜κ³ΌλŒ€ν•™ μ†‘μž¬κ΄€ν•™μƒμ‹€μŠ΅μ‹€μ—μ„œ 1회만 κ°œμ΅œν•˜μ˜€λ‹€. λ‚΄μš©μ€ ABO μ•„ν˜•, RhD λ³€μ΄ν˜• 검체검사 κ²€μΆœλ²•, λΉ„μ˜ˆκΈ°ν•­μ²΄ κ²€μΆœμ›λ¦¬, λΉ„μ˜ˆκΈ°ν•­μ²΄ 선별과 동정에 λŒ€ν•˜μ—¬ μ‹€μ‹œν•˜μ˜€λ‹€. μ˜€μ „μ—λŠ” μ΄λ‘ κ°•μ˜λ₯Ό μ‹€μ‹œν•˜μ˜€λŠ”λ° 68λͺ…이 μ°Έμ„ν•˜μ˜€κ³ , μ˜€ν›„μ—λŠ” μ‹€μŠ΅μ΄ μ΄λ£¨μ–΄μ‘ŒμœΌλ©° 50λͺ…이 μ°Έμ„ν•˜μ˜€λ‹€.

κ³  μ°°

κ²€μ‚¬κ±΄μˆ˜λŠ” 2016년도에 λΉ„ν•˜μ—¬ 2017년도에 많이 μ¦κ°€ν•˜μ˜€λŠ”λ°, 특히 μΌλ°˜μˆ˜ν˜ˆκ²€μ‚¬μ™€ 특수 μˆ˜ν˜ˆν•­μ›κ²€μ‚¬μ˜ μ•½ Dκ²€μ‚¬μ˜ μ°Έμ—¬κΈ°κ΄€ μˆ˜κ°€ 많이 μ¦κ°€ν•˜μ˜€κ³  1차에 λΉ„ν•˜μ—¬ 2차에 λ”μš± μ°Έκ°€κΈ°κ΄€ μˆ˜κ°€ μ¦κ°€ν•˜μ˜€λ‹€. μ΄λŠ” 2017λ…„ 7μ›”λΆ€ν„° κ±΄κ°•λ³΄ν—˜ 등에 β€˜κ²€μ²΄κ²€μ‚¬ μ§ˆκ°€μ‚°β€™ μ œλ„κ°€ 신섀됨에 λ”°λ₯Έ 영ν–₯으둜 여겨진닀.

2016λ…„κΉŒμ§€λŠ” 혈ꡬ용 κ²€μ²΄λ‘œ ν¬μ„λœ ν˜ˆκ΅¬λΆ€μœ μ•‘κ³Ό ν˜ˆμ²­ν˜• κ²€μ²΄λ‘œ 혈μž₯을 λ³„λ„λ‘œ λΆ„λ¦¬ν•˜μ—¬ λ°œμ†‘ν•˜μ˜€μœΌλ‚˜ μ΄λŠ” ν™˜μžλ‘œλΆ€ν„° 유래된 μ „ν˜ˆμ„ μ΄μš©ν•˜μ—¬ ν˜ˆμ•‘ν˜•κ²€μ‚¬λ₯Ό μ‹€μ‹œν•˜μ—¬μ•Ό ν•˜λŠ” μ‹€μ œ κ²€μ‚¬μ‹€μ˜ ν˜„ν™©μ„ λ°˜μ˜ν•˜μ§€ λͺ»ν•˜κ³  졜근 μ¦κ°€ν•˜λŠ” μžλ™ν™” μž₯비에 검체λ₯Ό μž₯μ°©ν•  수 μ—†λ‹€λŠ” 단점이 μžˆμ—ˆλ‹€. λ”°λΌμ„œ 이λ₯Ό λ³΄μ™„ν•˜κ³ μž 2017λ…„λΆ€ν„°λŠ” μ‹€μ œ 검사싀 ν™˜κ²½μ„ λ°˜μ˜ν•˜κ²Œλ” μ •λ„κ΄€λ¦¬μš© 검체λ₯Ό 20%의 μž¬μ‘°ν•© μ „ν˜ˆμ΄ λ˜λ„λ‘ λ†μΆ•μ ν˜ˆκ΅¬μ™€ λ™ν˜•μ˜ μ‹ μ„ λ™κ²°ν˜ˆμž₯κ³Ό μ„Έν¬λ³΄μ‘΄μ•‘μœΌλ‘œ ν¬μ„ν•˜μ—¬ μ œμ‘°ν•˜μ˜€λ‹€. κ·ΈλŸΌμ—λ„ λΆˆκ΅¬ν•˜κ³  μΌλΆ€μ˜ μžλ™ν™” μž₯λΉ„μ—μ„œλŠ” 검사가 λΆˆκ°€λŠ₯ν•˜μ˜€λŠ”λ° 이 κ²½μš°μ—λŠ” 검체λ₯Ό λ†μΆ•ν•˜κ±°λ‚˜ μˆ˜κΈ°λ²•μœΌλ‘œ μ‹œν–‰ν•˜λŠ” 것을 ꢌμž₯ν•˜λ©°, νŠΉμ • μ œμ‘°μ‚¬μ˜ μžλ™ν™” μž₯λΉ„λ₯Ό μœ„ν•œ λ³„λ„μ˜ 검체 μ œκ³΅λ„ κ³ λ €ν•  ν•„μš”κ°€ μžˆκ² λ‹€.

ν˜ˆκ΅¬μ‘μ§‘ μ •λ„λŠ” 적혈ꡬ 항원과 ν•­μ²΄λ°˜μ‘μ˜ κ°„μ ‘μ§€ν‘œμ΄λ©° 항원 정도 ν˜Ήμ€ 항체 μ—­κ°€λ₯Ό μ˜ˆμΈ‘ν•˜λŠ” 데 도움을 쀄 수 μžˆμœΌλ―€λ‘œ λ‹¨μˆœνžˆ 응집과 λΉ„μ‘μ§‘μœΌλ‘œ ν‘œμ‹œν•˜λŠ” κ²ƒλ³΄λ‹€λŠ” ν˜ˆκ΅¬μ‘μ§‘ 정도λ₯Ό μŒμ„±, Β±, 1+, 2+, 3+, 4+의 6λ‹¨κ³„λ‘œ κ΅¬λΆ„ν•˜μ—¬ ν‘œμ‹œν•˜λŠ” 것이 μ€‘μš”ν•˜λ‹€[3]. 2017년도 μ΅œμ’…λ³΄κ³ μ„œκ°€ μ§€μ—°λ˜μ–΄ μ°Έμ—¬κΈ°κ΄€λ“€μ—κ²Œ ν”Όλ“œλ°±μ˜ κΈ°νšŒκ°€ μ—†μ—ˆλ‹€λŠ” 점 λ•Œλ¬Έμ— 2017년도에 ν•œν•˜μ—¬ μΌλ°˜μˆ˜ν˜ˆκ²€μ‚¬μ˜ ABO ν˜ˆμ•‘ν˜•, RhD ν˜ˆμ•‘ν˜•κ³Ό κ΅μ°¨μ‹œν—˜μ˜ 경우 ν˜ˆκ΅¬μ‘μ§‘ 강도에 λŒ€ν•˜μ—¬ λͺ¨λ‘ code 507둜 μ‹œλ²”ν•­λͺ©μœΌλ‘œ κ°„μ£Όν•˜μ—¬ ν‰κ°€μ—μ„œ μ œμ™Έν•˜μ˜€κ³ , ABO ν˜ˆμ•‘ν˜•κ²€μ‚¬μ—μ„œ ν˜ˆκ΅¬ν˜•μ΄λ‚˜ ν˜ˆμ²­λ§Œμ„ μ‹€μ‹œν•œ 기관에 λŒ€ν•΄μ„œλ„ μ‹œλ²”ν•­λͺ©μœΌλ‘œ κ°„μ£Όν•˜μ—¬ λΆ€μ ν•©μœΌλ‘œ ν‰κ°€ν•˜μ§€λŠ” μ•Šμ•˜λ‹€.

ν˜ˆκ΅¬μ‘μ§‘ μ •λ„λŠ” 항원과 ν•­μ²΄λ°˜μ‘μ˜ κ°„μ ‘μ§€ν‘œμ΄λ―€λ‘œ 적혈ꡬ 항원 정도λ₯Ό κ°€λ¦„ν•˜μ—¬ ABO ν˜Ήμ€ D ν˜ˆμ•‘ν˜•μ˜ μ•„ν˜•μ„ κ²€μΆœν•˜κ±°λ‚˜ ABO 항체 μ—­κ°€μ˜ κ°μ†Œλ₯Ό μ˜ˆμΈ‘ν•˜λŠ” 데 도움을 쀄 수 μžˆμœΌλ―€λ‘œ μ •ν™•ν•œ ν˜ˆμ•‘ν˜•μ„ νŒμ •ν•˜κ±°λ‚˜ ν™˜μžμ˜ μž„μƒμƒν™©μ„ νŒλ‹¨ν•˜λŠ” 데 도움을 쀄 수 μžˆλ‹€. λ”°λΌμ„œ 동일 검체에 λŒ€ν•˜μ—¬ 타 κΈ°κ΄€κ³Όμ˜ ν˜ˆκ΅¬μ‘μ§‘ μ •λ„μ˜ λΉ„κ΅λŠ” 검사법 μˆ˜κΈ°μ™€ νŒλ…μ˜ 정확성을 검증할 수 μžˆλŠ” μœ μ΅ν•œ μ •λ³΄λ‘œ κ°„μ£Όν•  수 μžˆλ‹€. λ”°λΌμ„œ 2018λ…„λΆ€ν„° μ΄λŸ¬ν•œ κ²½μš°λŠ” λͺ¨λ‘ λΆ€μ ν•©μœΌλ‘œ κ°„μ£Όν•  μ˜ˆμ •μ΄λ―€λ‘œ ABO와 RhD ν˜ˆμ•‘ν˜•κ²€μ‚¬μ˜ 경우 응집 정도λ₯Ό λ°˜λ“œμ‹œ 선택할 ν•„μš”κ°€ μžˆκ² λ‹€.

ν˜ˆκ΅¬ν˜•μ΄λ‚˜ ν˜ˆμ²­ν˜•μ˜ λ‹¨λ…μœΌλ‘œ ν˜ˆμ•‘ν˜• νŒμ •μ„ ν•  κ²½μš°μ—λŠ” ν˜ˆμ•‘ν˜• νŒμ •μ΄ μ •ν™•ν•˜μ§€ μ•Šμ„ 수 μžˆμœΌλ‚˜ 이λ₯Ό 인지할 수 μ—†λŠ” κ²½μš°κ°€ μžˆμœΌλ―€λ‘œ λ°˜λ“œμ‹œ ν˜ˆκ΅¬ν˜•κ³Ό ν˜ˆμ²­ν˜•μ„ λͺ¨λ‘ μ‹€μ‹œν•˜μ—¬μ•Ό ABO ν˜ˆμ•‘ν˜• νŒμ •μ΄ κ°€λŠ₯ν•˜λ‹€[3]. 즉 ν˜ˆκ΅¬ν˜•κ³Ό ν˜ˆμ²­ν˜•κ²€μ‚¬λŠ” ABO ν˜ˆμ•‘ν˜•κ²€μ‚¬κ³Όμ • 쀑 두 단계λ₯Ό μ˜λ―Έν•˜λ―€λ‘œ 이 두 단계λ₯Ό λͺ¨λ‘ μ‹œν–‰ν•˜μ—¬μ•Όλ§Œ 검사λ₯Ό ν˜ˆμ•‘ν˜•κ²€μ‚¬λ₯Ό μ™„λ²½νžˆ μ‹œν–‰ν•œ 것이며, 선택할 수 μžˆλŠ” ABO ν˜ˆμ•‘ν˜•κ²€μ‚¬λ²•μ˜ μ’…λ₯˜κ°€ μ•„λ‹ˆλΌλŠ” 점을 검사기관듀이 λͺ…심할 ν•„μš”κ°€ μžˆκ² λ‹€. λ”°λΌμ„œ ν˜ˆμ²­ν˜•μ— ν•„μš”ν•œ λ¬Όν’ˆλ“€μ΄ κ΅¬λΉ„λ˜μ–΄ μžˆμ§€ μ•Šκ³  이λ₯Ό μ‹œν–‰ν•˜μ§€ μ•ŠλŠ” 검사싀이라면 ABO ν˜ˆμ•‘ν˜•κ²€μ‚¬λ₯Ό μ •ν™•ν•˜κ²Œ κ²€μ‚¬ν•˜κ³  μžˆλŠ” 검사싀이라고 보기가 μ–΄λ ΅λ‹€. κ·ΈλŸΌμ—λ„ λΆˆκ΅¬ν•˜κ³  2017년도 1차와 2차의 경우 ν˜ˆμ²­ν˜•κ²€μ‚¬λ₯Ό μ‹€μ‹œν•˜μ§€ μ•Šμ€ κΈ°κ΄€μ˜ λΉ„μœ¨μ΄ 4.7%와 5.5%λ₯Ό μ°¨μ§€ν•˜μ˜€λ‹€(자료 μ œμ‹œν•˜μ§€ μ•ŠμŒ). 보건볡지뢀 κ³ μ‹œ 제2015-145호(2015λ…„ 8μ›” 18일)μ—μ„œλ„ κ±΄κ°•λ³΄ν—˜ ν–‰μœ„κΈ‰μ—¬μ˜ μˆ˜ν˜ˆκ²€μ‚¬ 쀑 β€˜λ‚˜-201 ABO ν˜ˆμ•‘ν˜•κ²€μ‚¬λŠ” ν˜ˆκ΅¬ν˜•κ²€μ‚¬μ™€ ν˜ˆμ²­ν˜•κ²€μ‚¬λ₯Ό λͺ¨λ‘ μ‹œν–‰ν•œ κ²½μš°μ—λ§Œ μ‚°μ •ν•œλ‹€.’라고 λͺ…μ‹œλ˜μ–΄ μžˆλ“―μ΄ ABO ν˜ˆμ•‘ν˜•κ²€μ‚¬λ²•μ— λŒ€ν•œ ν˜ˆκ΅¬ν˜•κ²€μ‚¬μ™€ ν˜ˆμ²­ν˜•κ²€μ‚¬μ˜ μ€‘μš”μ„±μ„ κ°•μ‘°ν•  ν•„μš”κ°€ μžˆκ² λ‹€.

비둝 2017λ…„ ν‰κ°€μ—λŠ” ABO ν˜ˆμ•‘ν˜•κ²€μ‚¬μ˜ 경우 ν˜ˆκ΅¬ν˜•κ²€μ‚¬λ§Œ μ‹€μ‹œν•˜κ³  ν˜ˆμ²­ν˜•κ²€μ‚¬λ₯Ό μ‹€μ‹œν•˜μ§€ μ•Šμ€ 경우 ν”Όλ“œλ°± κΈ°νšŒκ°€ μ—†μ—ˆκ³  ν˜‘νšŒμ˜ μ „μ‚°μž‘μ—…μ˜ μΆ”κ°€μž‘μ—…μ΄ ν•„μš”ν•˜μ—¬ λΆ€μ ν•©μœΌλ‘œ ν‰κ°€ν•˜μ§€ μ•Šμ•˜μœΌλ‚˜ 2018λ…„λΆ€ν„° μ΄λŸ¬ν•œ κ²½μš°λŠ” μ„€λͺ…문에 ν™•μ‹€νžˆ μ•ˆλ‚΄ν•˜κ³  μ „μ‚°μž‘μ—…μ„ μ™„λ£Œν•˜μ—¬ λͺ¨λ‘ λΆ€μ ν•©μœΌλ‘œ κ°„μ£Όν•  μ˜ˆμ •μ΄λ―€λ‘œ 이에 λŒ€ν•œ 사항은 μ„€λͺ…문에 κ°•μ‘°ν•˜κ³ , 참여기관듀은 검사 μ „ μ„€λͺ…문을 μžμ„Ένžˆ κ²€ν† ν•  ν•„μš”κ°€ μžˆκ² λ‹€.

λ°œμ†‘ν•˜λŠ” 검체 쀑 뢀적합 κ΅μ°¨μ‹œν—˜ κ²€μ²΄λŠ” ν•­κΈ€λ‘œλΆˆλ¦°λ‹¨κ³„μ—μ„œ λŒ€λž΅ 2μ—μ„œ 3+ 응집이 λ˜λ„λ‘ μ œμ‘°ν•œ κ²€μ²΄μ΄λ―€λ‘œ ν•­κΈ€λ‘œλΆˆλ¦°μ΄ μ²¨κ°€λ˜μ§€ μ•Šμ€ μ‹œν—˜κ΄€ 37Β°C low-ionic-strength solution (LISS)법, μ‹œν—˜κ΄€ 37Β°C PEG (polyethylene glycol)법, μ‹œν—˜κ΄€ 37Β°C μ•ŒλΆ€λ―Όλ²•, μ‹œν—˜κ΄€ LISS법과 μ‹œν—˜κ΄€ μ‹μ—Όμˆ˜λ²•μ—μ„œλŠ” 2+ μ΄μƒμ˜ 응집을 λ‚˜νƒ€λ‚΄κΈ° μ–΄λ €μ› μŒμ—λ„ λΆˆκ΅¬ν•˜κ³  이 정도 ν˜Ήμ€ μ΄μƒμ˜ 응집을 λ³΄κ³ ν•œ 기관듀이 μžˆμ—ˆλ‹€. 이에 따라 κ΅μ°¨μ‹œν—˜ 적합 검체λ₯Ό λΆ€μ ν•©μœΌλ‘œ νŒμ •ν•œ 기관이 검체에 따라 μ „μ²΄κΈ°κ΄€μ˜ 1.5%-2.4%λ₯Ό μ°¨μ§€ν•˜μ˜€λ‹€. λ”°λΌμ„œ μ΄λŸ¬ν•œ 기관듀은 검사λ₯Ό λ―Όκ°ν•˜κ²Œ μ‹œν–‰ν•˜μ˜€λ‹€κΈ°λ³΄λ‹€λŠ” μ‹€μ œ ν™˜μžμ˜ 검체에 λŒ€ν•˜μ—¬ μœ„μ–‘μ„±μ„ 보고할 κ°€λŠ₯성이 λ§ŽμœΌλ―€λ‘œ ꡐ차검사법을 점검할 ν•„μš”κ°€ μžˆκ² λ‹€. μ΄μ™€λŠ” λ°˜λŒ€λ‘œ 뢀적합 검체λ₯Ό λ°˜λ“œμ‹œ κ²€μΆœν•  수 μžˆμ–΄μ•Ό ν•˜λŠ” ν•­κΈ€λ‘œλΆˆλ¦°λ‹¨κ³„λ₯Ό μ‚¬μš©ν•¨μ—λ„ λΆˆκ΅¬ν•˜κ³  μœ„μŒμ„±μ„ 보인 기관듀도 μžˆμ—ˆλŠ”λ°, κ΅μ°¨μ‹œν—˜ 뢀적합 검체λ₯Ό μ ν•©μœΌλ‘œ νŒμ •ν•œ 기관이 검체에 따라 μ „μ²΄κΈ°κ΄€μ˜ 11.1%와 9.6%λ₯Ό μ°¨μ§€ν•˜μ—¬ μˆ˜ν˜ˆν˜„μž₯μ—μ„œ ν™˜μžμ—κ²Œ μ‹¬κ°ν•œ μœ„ν•΄λ₯Ό 쀄 κ°€λŠ₯성도 μžˆμœΌλ―€λ‘œ 이듀 기관에 λŒ€ν•œ μ˜¬λ°”λ₯Έ 검사법 ꡐ윑이 μ ˆμ‹€ν•œ κ²ƒμœΌλ‘œ μ—¬κ²¨μ‘Œλ‹€. 졜근 μ˜λ£ŒκΈ°κ΄€μ—μ„œ κ΅μ°¨μ‹œν—˜μ„ μ‹€μ‹œν•œ ν˜ˆμ•‘μ„ μˆ˜ν˜ˆλ°›μ•˜μŒμ—λ„ λΆˆκ΅¬ν•˜κ³  ν•­-E, ν•­-c, ν•­-Jkb 볡합 λΉ„μ˜ˆκΈ°ν•­μ²΄μ— μ˜ν•œ κΈ‰μ„± μš©ν˜ˆμˆ˜ν˜ˆλ°˜μ‘ 1예의 λ³΄κ³ μ—μ„œλŠ” λΉ„μ˜ˆκΈ°ν•­μ²΄μ— μ˜ν•œ μˆ˜ν˜ˆλΆ€μž‘μš©μ„ μ˜ˆλ°©ν•˜κΈ° μœ„ν•΄μ„œλŠ” ν•­κΈ€λ‘œλΆˆλ¦°λ‹¨κ³„λ₯Ό ν¬ν•¨ν•œ λΉ„μ˜ˆκΈ°ν•­μ²΄ κ²€μΆœκ²€μ‚¬κ°€ ν•„μˆ˜μ μœΌλ‘œ μ‹œν–‰λ˜μ–΄μ•Ό ν•˜λ©° μ‹€μ‹œκΈ°κ΄€μ—μ„œμ˜ λ”μš± μ—„κ²©ν•œ μ •λ„κ΄€λ¦¬μ˜ ν•„μš”μ„±μ„ κ°•μ‘°ν•˜μ˜€λ‹€[4].

정상 ABO ν˜ˆμ•‘ν˜•μ€ 일반적으둜 μ‹œν—˜κ΄€λ²• ν˜ˆκ΅¬ν˜•κ³Ό ν˜ˆμ²­ν˜•μ—μ„œ 3+ μ΄μƒμ˜ 응집을 λ³΄μ΄κΈ°λŠ” ν•˜λ‚˜ 3+ μ΄μƒμ˜ 응집을 보인닀고 ν•΄μ„œ 무쑰건 정상 ABO ν˜ˆμ•‘ν˜•μœΌλ‘œ κ°„μ£Όν•˜λŠ” 것은 μ˜³μ§€ λͺ»ν•˜λ‹€[5]. A2Bw 검체에 λŒ€ν•˜μ—¬ B항에 3+ 이상을 λ³΄μ˜€λ˜ 16개 κΈ°κ΄€ 쀑 9개 κΈ°κ΄€μ—μ„œ 정상 Bν˜• ν•­μ›μœΌλ‘œ νŒμ •ν•˜μ˜€λ‹€. λ”°λΌμ„œ 검사기관 ν˜Ήμ€ 검사법에 따라 정상 ABO ν˜ˆμ•‘ν˜•μ— λŒ€ν•œ 응집 λ²”μœ„κ°€ λ‹¬λΌμ§ˆ 수 μžˆμœΌλ―€λ‘œ 각 κ²€μ‚¬μ‹€μ—μ„œ 정상인을 λŒ€μƒμœΌλ‘œ ABO ν˜ˆμ•‘ν˜•μ˜ 경우 ν˜ˆκ΅¬ν˜•κ³Ό ν˜ˆμ²­ν˜•κ²€μ‚¬μ—μ„œ 보일 수 μžˆλŠ” ν˜ˆκ΅¬μ‘μ§‘ λ²”μœ„λ₯Ό νŒŒμ•…ν•˜μ—¬ 이 λ²”μœ„λ₯Ό λ²—μ–΄λ‚  경우의 μž¬κ²€ν†  λ²”μœ„λ₯Ό μž¬μ‚°μ •ν•  ν•„μš”κ°€ μžˆκ² λ‹€.

2017년에 1차와 2차에 보낸 μ•½ D검사 κ²€μ²΄λŠ” λͺ¨λ‘ D ν˜ˆμ•‘ν˜•κ²€μ‚¬μ—μ„œλ„ 정상 Rh 양성에 λΉ„ν•΄μ„œλŠ” μ•½ν•˜μ§€λ§Œ 응집을 보인 λ³€μ΄ν˜• D κ²€μ²΄μ˜€λ‹€. 일반적으둜 정상 D μ–‘μ„± ν˜ˆμ•‘ν˜•μ˜ 경우 μ‹œν—˜κ΄€λ²•μ—μ„œ 3+ μ΄μƒμ˜ 응집을 λ³΄μ΄λŠ” 반면, λ³€μ΄ν˜• Dν˜•μ€ 2+ μ΄ν•˜μ˜ 응집을 λ³΄μ΄λŠ” κ²ƒμœΌλ‘œ λ˜μ–΄ μžˆλ‹€[5]. λ”°λΌμ„œ D ν˜ˆμ•‘ν˜•κ²€μ‚¬μ—μ„œ 2+ μ΄ν•˜μ˜ 응집을 λ³΄μ΄λŠ” κ²½μš°μ—λŠ” 무쑰건 D μ–‘μ„± ν˜ˆμ•‘ν˜•μ΄λΌκ³  νŒμ •ν•˜κΈ°λ³΄λ‹€λŠ” 응집이 정상 D 양성에 λΉ„ν•˜μ—¬ λ―Έμ•½ν•˜μ˜€μœΌλ―€λ‘œ λ°˜λ“œμ‹œ D λ³€μ΄ν˜•μ„ μ˜μ‹¬ν•˜κ±°λ‚˜ λ‹€λ₯Έ μ‹œμ•½μœΌλ‘œ μž¬κ²€ν•  수 μžˆμ–΄μ•Ό ν•œλ‹€. 2017λ…„ μ™ΈλΆ€μ‹ λΉ™λ„μ‘°μ‚¬μ—μ„œλŠ” 3+ μ΄μƒμ˜ 응집을 λ³΄κ³ ν•œ 기관듀이 1μ°¨ 66.2%, 2μ°¨ 70.4%μ—μ„œ λ³΄κ³ ν•˜μ˜€μœΌλ©° D μ–‘μ„±μœΌλ‘œ λ³΄κ³ ν•œ 기관듀도 47.6%와 21.3%에 λ‹¬ν•˜μ˜€λ‹€. 2017λ…„λ„μ—λŠ” 1μ°¨ λ³΄κ³ μ„œ λ°œμ†‘μ΄ λŠ¦μ–΄μ Έ μ°Έμ—¬κΈ°κ΄€λ“€μ—κ²Œ ν”Όλ“œλ°±ν•  κΈ°νšŒκ°€ μ—†μ–΄μ„œ D μ–‘μ„± ν˜ˆμ•‘ν˜•μ΄λΌκ³  νŒμ •ν•œ μƒλ‹Ήμˆ˜μ˜ 기관에 λŒ€ν•΄μ„œλ„ 2017λ…„μ—λŠ” μ‹œλ²”μ μœΌλ‘œ β€˜acceptableβ€™λ‘œ ν‰κ°€ν•˜μ˜€μœΌλ‚˜, 2018λ…„λΆ€ν„° 비둝 80%λ₯Ό λ„˜μ§€ μ•Šλ”λΌλ„ D λ³€μ΄ν˜•μœΌλ‘œ 규λͺ…λœ 검체에 ν•œν•΄μ„œλŠ” D λ³€μ΄ν˜•λ§Œμ„ μ •λ‹΅μœΌλ‘œ κ°„μ£Όν•  μ˜ˆμ •μ΄λ‹€.

2017λ…„λΆ€ν„°λŠ” μ§μ ‘ν•­κΈ€λ‘œλΆˆλ¦°κ²€μ‚¬μ˜ λ³΄κ³ μ„œ 방식을 κ²€μ²΄λ²ˆν˜Έ μ€‘μ‹¬μ—μ„œ λ‹€νŠΉμ΄μ„±, ν•­-IgG λ‹¨νŠΉμ΄μ„±, ν•­-C3d λ‹¨νŠΉμ΄μ„± 검사법 μ€‘μ‹¬μœΌλ‘œ λ°”κΎΈμ–΄ λ³΄κ³ ν•˜κ²Œ λ˜μ—ˆλ‹€. IgGκ°€ κ°μž‘λœ 적혈ꡬ κ²€μ²΄μ˜ κ²½μš°μ— λ‹€νŠΉμ΄μ„±κ³Ό ν•­-IgG λ‹¨νŠΉμ΄μ„±λ§Œ μ–‘μ„±μœΌλ‘œ λ³΄κ³ ν•˜μ—¬μ•Ό 함에도 λΆˆκ΅¬ν•˜κ³  1μ°¨ 16.4%, 2μ°¨ 12.7%의 κΈ°κ΄€μ—μ„œ ν•­-C3d λ‹¨νŠΉμ΄μ„±κΉŒμ§€ μ–‘μ„±μœΌλ‘œ λ³΄κ³ ν•˜κ³  μžˆλ‹€. λ§Œμ•½ 검사λ₯Ό ν•˜κΈ° 전에 이미 ν˜ˆκ΅¬μ‘μ§‘μ΄ μžˆλŠ” κ²½μš°μ—λŠ” λͺ¨λ‘ 양성을 보일 수 μžˆμœΌλ―€λ‘œ λ°˜λ“œμ‹œ 이런 경우 ν•­κΈ€λ‘œλΆˆλ¦°μ„ μ²¨κ°€ν•˜μ§€ μ•ŠλŠ” μŒμ„± λŒ€μ‘°κ΅°κ³Ό ν•¨κ»˜ μ‹œν–‰ν•˜μ—¬ ν˜ˆκ΅¬μ‘μ§‘ μ—¬λΆ€λ₯Ό λ°°μ œν•  ν•„μš”κ°€ μžˆλ‹€. λ˜ν•œ μ΄λŸ¬ν•œ 기관듀은 μŒμ„±μΈ 검체에 λŒ€ν•΄μ„œλŠ” λͺ¨λ‘ μŒμ„±μœΌλ‘œ λ³΄κ³ ν•˜λŠ” κ²ƒμœΌλ‘œ 보아 검사 수기λ₯Ό 잘λͺ»ν•˜μ˜€λ‹€κΈ°λ³΄λ‹€λŠ” ν•­-IgG λ‹¨νŠΉμ΄μ„±κ³Ό ν•­-C3d λ‹¨νŠΉμ΄μ„± μ‹œμ•½μ΄ ν˜Όν•©λ˜μ–΄ μžˆλŠ” λ‹€νŠΉμ΄μ„± μ‹œμ•½μ— 양성을 보인 것을 ν•­-IgG λ‹¨νŠΉμ΄μ„±κ³Ό ν•­-C3d λ‹¨νŠΉμ΄μ„± μ‹œμ•½ 각각에 μ–‘μ„±μœΌλ‘œ 잘λͺ» λ³΄κ³ ν•˜μ˜€μ„ κ°€λŠ₯성도 μžˆμœΌλ―€λ‘œ 이에 λŒ€ν•œ μ •ν™•ν•œ νŒμ • 해석에 λŒ€ν•œ ꡐ윑이 ν•„μš”ν•œ κ²ƒμœΌλ‘œ 보여진닀.

2017λ…„ λΉ„μ˜ˆκΈ°ν•­μ²΄ λ™μ •κ²€μ‚¬μ˜ κ²€μ²΄λŠ” anti-C, anti-S, anti-c 그리고 anti-Jkb둜 κ΅¬μ„±ν•˜μ˜€λŠ”λ° 이 쀑 anti-c의 경우 μ •λ‹΅λ₯ μ΄ 88.7%에 μ§€λ‚˜μ§€ μ•Šμ•˜λ‹€. Anti-c의 경우 anti-c 이외에도 anti-EκΉŒμ§€ 같이 λ³΅ν•©ν•­μ²΄λ‘œ λ³΄κ³ ν•œ 기관이 11κΈ°κ΄€μœΌλ‘œ 9%에 λ‹¬ν•˜λŠ”λ°, μ΄λŠ” μƒν’ˆν™”λœ 항체 λ™μ •μš© 혈ꡬ의 항원ꡬ성이 E항원은 λͺ¨λ‘ c항원과 같이 ν‘œν˜„λ˜μ–΄ 있기 λ•Œλ¬Έμ— μ‘μ§‘λ°˜μ‘μ΄ μ—†λŠ” μ ν˜ˆκ΅¬κ°€ 가진 항원을 λ°°μ œν•˜λŠ” exclusion법(rule out)을 μ‚¬μš©ν•˜κ²Œ 될 λ•Œ E항원에 λŒ€ν•œ 항체λ₯Ό λ°°μ œν•˜κΈ°κ°€ 쉽지 μ•ŠκΈ° λ•Œλ¬Έμ΄λ‹€. λ˜ν•œ ν™˜μž μ ν˜ˆκ΅¬μ—μ„œ 항원 ν‘œν˜„ν˜•κ²€μ‚¬λ₯Ό μ‹€μ‹œν•˜λŠ” 것이 도움이 되긴 ν•˜λ‚˜ μ •λ„κ΄€λ¦¬λ¬Όμ§ˆμΈ κ²½μš°μ—λŠ” ν™˜μžμ˜ μ ν˜ˆκ΅¬κ°€ μ œκ³΅λ˜μ§€ μ•ŠμœΌλ―€λ‘œ 항원 ν‘œν˜„ν˜•κ²€μ‚¬λ₯Ό μ‹€μ‹œν•  수 μ—†λ‹€. 일반적으둜 λ³΅ν•©ν•­μ²΄λŠ” 단일항체에 λΉ„ν•˜μ—¬ ν˜ˆκ΅¬μ‘μ§‘μ΄ κ°•ν•˜μ—¬ λ™ν˜•μ ‘ν•©μ²΄ 항원을 가진 μ ν˜ˆκ΅¬λŠ” μ΄ν˜•μ ‘ν•©μ²΄ 항원을 가진 μ ν˜ˆκ΅¬μ— λΉ„ν•˜μ—¬ ν•΄λ‹Ή ν•­μ²΄μ™€μ˜ λ°˜μ‘μ΄ 더 κ°•ν•˜λ‹€λŠ” μš©λŸ‰νš¨κ³Ό(dosage effect)λ₯Ό 항체동정 μ‹œμ—λŠ” λ°˜λ“œμ‹œ κ³ λ €ν•  ν•„μš”κ°€ μžˆλ‹€. 2μ°¨ κ²€μ²΄μ˜ anti-c의 경우 E항원과 c항원이 ν‘œν˜„λœ μ ν˜ˆκ΅¬λ“€μ˜ 응집 강도가 cν•­μ›λ§Œ ν‘œν˜„λœ μ ν˜ˆκ΅¬μ— λΉ„ν•˜μ—¬ κ°•ν•˜μ§€ μ•Šκ³  λ™μΌν•˜μ˜€μœΌλ―€λ‘œ λ³΅ν•©ν•­μ²΄μ˜ κ°€λŠ₯성을 λ°°μ œλ˜μ—ˆμ–΄μ•Ό ν•œλ‹€. 2014λ…„ 2μ°¨ κ²€μ²΄μ˜ anti-C와 anti-e κ²½μš°λŠ” λ°˜λŒ€λ‘œ μš©λŸ‰νš¨κ³Όλ₯Ό κ³ λ €ν•˜μ§€ μ•Šμ•„ anti-e만 λ³΄κ³ ν•œ 기관도 μžˆμ–΄ μ •λ‹΅λ₯ μ΄ 69.8%에 μ§€λ‚˜μ§€ μ•Šμ•˜λ‹€[6]. λ”°λΌμ„œ λΉ„μ˜ˆκΈ°ν•­μ²΄ 동정 μ‹œμ—λŠ” μš©λŸ‰νš¨κ³Όλ‘œ μΈν•˜μ—¬ ν˜ˆκ΅¬μ‘μ§‘μ˜ 강도가 λ‹€λ₯΄κ²Œ λ‚˜νƒ€λ‚˜λŠ” 것을 잘 κ΄€μ°°ν•  ν•„μš”κ°€ μžˆλ‹€.

μ°¨μ„ΈλŒ€ 신빙도쑰사사업을 처음으둜 μ‹œν–‰ν•œ 2017년도 4개의 μˆ˜ν˜ˆμ˜ν•™ν”„λ‘œκ·Έλž¨μ˜ 10가지 μ’…λͺ©μ„ μ‹œν–‰ν•˜μ˜€κ³  이에 λŒ€ν•œ κ²°κ³Όλ₯Ό λΆ„μ„ν•˜μ—¬ λ°œμ†‘ν•˜μ˜€κΈ°μ— μ°Έμ—¬κΈ°κ΄€λ“€μ˜ 검사싀 ν–₯상에 도움을 μ£Όμ—ˆμ„ κ²ƒμœΌλ‘œ 평가할 수 μžˆμ—ˆλ‹€.

References
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