The Korean Rare Blood Program (KRBP) is divided into two registries: a transfusion registry and a case registry. A recent study on the transfusion registry provided data on the frequencies of blood group antigens and the distributions of red cell antibodies. The case registry is an archive of challenging cases associated with blood group immunogenetics, and it collaborates with the KRBP reference laboratory. As an extension of the recent study, this study aimed to establish the case registry, and analyze and resolve the challenging cases registered to the case registry from July 2013 to June 2022. In total, 845 cases were registered from 66 hospitals, including cases related to the ABO system, Rh system, red cell antibody, and others (269, 183, 317, and 76 cases, respectively). Registered cases were resolved through ABO genotyping, RHD genotyping, and antibody identification using various panels. Sixty-two cases of cisAB and twenty-one cases of DEL were identified, which are rare in Western countries but relatively common in Korea. Challenging cases involving blood group immunogenetics were resolved through collaboration between the case registry and the reference laboratory. The case registry and reference laboratory should operate continuously to resolve practical problems and advance transfusion medicine.
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