We surveyed by questionnaire the management of transfusion systems and transfusion-related events during the 10-year period from 1989 to 1998 in 104 hospitals in the Tohoku district. Only thirty percent of the hospitals have their own transfusion service unit. Sixty-eight percent of hospitals which do not have transfusion service units have no plans to establish such units for several reasons: 1) lack of space and personnel 2) financial insufficiency 3) satisfaction with the existing situation 4) insufficient annual number of transfusions, and 5) reliance on other divisions or sections within the institution. More than half of the hospitals have a transfusion regulation committee; however, 45 (47%) have no committee, and 29 out of 45 have no plans to establish a committee. Laboratory controls including equipment and calibration maintenance are carried out in half of the hospitals, but few hospitals engage in error management, record and sample keeping, and staffing and personnel competency in quality audits. Fifty-three cases of transfusion-related serious events have been reported from 32 hospitals: 18 cases of ABO-incompatibile transfusion, 9 cases of transfusion associated GVHD (including suspected cases), 8 cases of hemolysis or other symptoms due to red cell antibody in recipient, 8 cases of shock or anaphylaxis of unknown cause, 6 cases of hepatitis (HB:3, HC:3), and others. Most of the major errors of ABO-incompatible transfusion occurred during nonemergency situations, in wards or on scheduled surgical operations. We conclude that retrospective information of this kind in a survey can provide the impetus to reduce transfusion-associated errors or complications. A quality control program should be established in each hospital to ensure the quality of blood procedures and the safety of transfusion practices.
