We renewed our blood transfusion management system in January, 2014, and the computer crossmatch (CC) became available in May, 2014. In addition, we constructed the system to collect post-transfusion adverse reactions and to improve the rate of post-transfusion infection tests. We compared CC with serological crossmatch by the amount of RBC-LR before and after system renewal. We analyzed 280 patients who developed side effects from January, 2013 to August, 2015. We also calculated the rate of post-transfusion infection tests with 3,482 transfused patients from 2011 to 2015. After introduction of CC, CC became predominant and the amount of wasted RBC-LR units reduced in number significantly (11.2 U/month vs 1.8 U/month, p<0.05). Post-transfusion reactions were mainly caused by PC-LR (42.9%), RBC-LR (37.1%) and FFP-LR (17.7%), respectively. Urticaria was the most frequent (45.7%). The rate of post-transfusion infection tests tended to increase after system renewal. It was suggested that the new blood transfusion management system improves the efficiency of routine work and contributes to the safety of transfusion medicine.
On behalf of the Japanese Society of Transfusion Medicine and Cell Therapy (JSTMCT), we have conducted a nationwide survey to assess the implementation and performance of systems to ensure safe and appropriate blood transfusion throughout Japan. Deficiencies among hospitals with fewer than 300 beds were suspected, but the response of these facilities to previous questionnaires has been inadequate. This prompted us to develop a new questionnaire specifically for hospitals of this size. In our 2013 survey of 11,015 facilities, 9,119 having fewer than 300 beds were enrolled, with the following results. First, qualified health professionals were disproportionately decreased according to the number of hospital beds. This jeopardizes transfusion safety from the standpoint of blood typing and cross-matching. Next, the informed consent process and associated documentation, systems for detecting and reporting adverse transfusion events, and measures to address transfusion-transmitted infection were substandard. Solving these problems in a large number of small facilities is a major challenge. Accordingly, concerted efforts by government authorities, the JSTMCT, and prefectural transfusion committees should be aimed at improving this situation.
Allogeneic hematopoietic stem cell transplantation (SCT) can be performed across the ABO barrier if measures are taken to prevent acute hemolysis. In minor and bidirectional ABO-incompatible SCT, the lack of graft-versus-host (GvH) isoagglutinin is often experienced in routine blood tests; however, changes in donors' isoagglutinins against recipients' A or B antigen are not fully understood. We reviewed the routine ABO blood typing test of 61 recipients of hematopoietic stem cells from minor or bidirectional ABO-incompatible donors. Isoagglutinins were persistently negative in 52 recipients, transiently positive in 6, and positive after the transition of red cell type to donors' in 3. In the 3 recipients, one was the third SCT (patient was originally O, the 2nd donor AB, the last donor A), and the others were the second SCT and returned to each patient's original blood type. GvH isoagglutinins were detected if the last donor's isoagglutinin was the same or a part of the recipient's original pattern in this study. Although the mechanism has not been elucidated, absorption of GvH isoagglutinins to various sites of the body is considered to play an important role in the lack of detection of GvH agglutinin in minor or bidirectional ABO-incompatible SCT.
The in vitro properties of washed platelets (wPLTs) suspended in BRS-A additive solution which were prepared from one- or two-day-old platelet concentrate (PC) with an automated cell processor (ACP215) were studied during 72-hour storage.
Rate of plasma protein removal and platelet recovery by washing of PC were more than 98% and 87%, respectively.
When preparation was from one-day-old PC, pH was maintained above 6.8 during 72-hour storage. E800/E0, which is a parameter reflecting platelet shape, and MPV values increased and %HSR values were decreased by 10% immediately after washing, and then returned to pre-wash levels in a time-dependent manner. CD62P values were increased up to 36.8% by washing, but after that these values did not significantly change during 72-hour storage. Although swirling of wPLTs resulted in cloudiness immediately after washing, the solution became clear a couple of hours later. Similar results were obtained with wPLTs prepared from two-day-old PC.
These results indicate that the process of washing PC with ACP215 did not markedly degrade the in vitro properties of wPLTs.
Blood donor recruitment and retention in the younger generation is an important concern for an aging population in Japan. Successful recruitment of high school student donors will ensure long term supplies of blood. To enhance the effectiveness of this approach it is important to communicate the need for blood donation by high school students and conduct appropriate surveys. Anonymous surveys were designed for high school students, who answered of their own volition. The survey included 50 questions including lifestyle, knowledge of blood donation, efficacy of a campaign to recruit blood donors and previous education on blood donation in their school etc.
We obtained answers from 95.0% of 16,333 students surveyed. The proportion of male and female students was even. 7.7% of students had at least one experience of blood donation. The students often experienced feelings of fatigue, suffered from sleeplessness and tried dieting in their daily life, these could relate to adverse event. The study clarified that many students lacked sufficient information about blood donation and transfusion. Substantial time and effort must be devoted to educating the student population on the need for blood transfusion, as well as on the safety and risk factors associated with blood donation.
In the survey conducted in 2015, among the 10,166 Japanese medical institutions receiving blood supply from the Japanese Red Cross Blood Center, the 5,261 institutions that responded to the questionnaire were enrolled, representing a response rate of 51.8%, the highest result in the past 8 annual surveys. Of the total supply from the Japanese Red Cross Society, 73.5% of the red blood cell products, 82.1% of the platelet concentrate, and 78.1% of the freshly frozen plasma were able to be investigated. Authorization to impose the blood transfusion management charge I and II increased in 476 and 1,234 institutions, respectively. Further, 1,215 institutions were able to impose the blood transfusion proper use addition (27.6%). The number of transfused patients is predicted to be 937,390 subjects for donated blood, and 114,473 subjects for autologous blood. Immunoglobulin product consumption increased this year as in the past few years. The amount of blood products consumed per sickbed varied greatly for each prefecture, suggesting the need to reconfirm appropriate blood transfusion management systems in each prefecture.
The Gunma Prefectural Joint Committee of Blood Transfusion Therapy has established a transportation system for preoperative autologous blood donation when a patient moves to another hospital. We investigated whether a novel cold storage agent, STS3, is useful for product transportation with appropriate temperature management. It was possible for the agent to maintain a temperature lower than 6°C for up to 289 minutes in a precooled transportation bag. The short storage period of the agent before use was also important. STS3 is a useful agent for the safer transportation of autologous blood packs in terms of appropriate temperature management.
We encountered a case of platelet transfusion refractoriness (PTR) due to low-titer anti-human leukocyte antigen (HLA) antibodies. The patient was a teenage girl with aplastic anemia admitted to our hospital in June 2011. Initially, good responses were obtained with random apheresis platelets (PLT), but from day 16 (the fifth platelet transfusion), we often observed low 1-hour post-transfusion corrected platelet count increments (CCI-1). We suspected immunologic PTR. We detected low-titer HLA antibodies (specificity: anti-HLA-A31, B51) by bead array technology in patient serum obtained on day 22, although we did not detect any anti-HLA or anti-human platelet antigen (HPA) antibodies by the mixed-passive hemagglutination test (MPHA) or anti-human globulin lymphocyte cytotoxicity test (AHG-LCT). Generally good increments were subsequently obtained by directed-donor and HLA-matched PLTs (HLA-PLT). HLA antibodies developed in spite of no presensitization, in a relatively short period after starting PLT transfusion therapy. Moreover, the antibodies caused PTR even at a low titer.
We experienced a case of anti-E. This patient has both anti-f and anti-c, despite receiving a red blood cell transfusion from apparently R1R1 (CCDee) donors.
This history suggests that the cause might have been alloimmunization by platelet transfusion. We examined the existence of Rh-Hr type in 10 packs of transfused PC. As a result, 4 of 10 packs showed the R1R2 (CcDEe) type. Further, 2 packs had been administered before the anti-E appearance.
This suggests that the E-antigen in the PC bags might have produced anti-E antibodies. There may be the possibility of antibody production by platelet transfusion with the inclusion of a few red blood cells.