ABO-mismatched transfusion caused by human error is among the most serious problems in transfusion therapy. To prevent ABO-mismatched transfusion, improve blood availability and save laboratory labor, we established a computer cross-matching system in our hospital. This system is operated on the following conditions: confirmation of blood type of blood products from the blood center, confirmation of patient's blood type at least twice, at two different times, and negative testing results of unexpected alloantibody confirmed within 7 days before each transfusion. Between June 2002 and December 2004, 1, 311 patients received 9, 181 bags of RBCs, 97.3% of which were shipped using this system. No ABO-mismatched transfusions occurred. Although unexpected alloantibodies developed in 11 patients after last transfusion, no severe hemolytic complications were observed except mild hemolysis in one patient who developed anti-Jk^a antibody 9 days after the final transfusion. After the establishment of this network system, the past-expiration rate of RBCs has been reduced from 4.5% to 1.5%, whereas the crossmatch-to-transfusion ratio (C/T ratio) has not been reduced significantly. In addition, this system has allowed us to shorten the time to distribute blood components to operating rooms from 45 to 5 minutes, and to save approximately 4.5 hours of laboratory workload time per day. In conclusion, computer cross-matching systems can contribute to safe and efficient transfusion therapy without serologic blood-crossmatch testing, and reduce the burden of laboratory work.

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Samples from 111 patients with a diagnosis of suspected neonatal alloimmune thrombocytopenia (NAIT) obtained from various medical services in the past 20 years were simultaneously evaluated by the mixed-passive hemagglutination (MPHA) and magnetic-MPHA (M-MPHA) methods. Some samples were also tested by the ELISA methed. Alloantibodies were detected in 66.7% (74/111) of cases, some of which also contained autoantibodies. Detection rate with the MPHA method was 56.9% when intact platelet-coated plates were used, and 60.0% with platelet homogenate-coated plates. For M-MPHA, the detection rate was 63.2% with intact platelet-coated plates, and 60.3% with platelet homogenate-coated plates.

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In order to obtain more blood for an increasingly aged society, a questionnaire survey was conducted to discover whether it would be socially acceptable to accept 400ml whole blood (WB) and apheresis donations for the blood program from young persons of the age of 16 and 17 (mainly high school students), who are presently permitted to donate 200ml WB only. We surveyed high school students who did and did not participate in mass blood donations in schools, their high school teachers, and parents. They were asked to reply to the same questions before and after reading documents explaining both blood donation types. The total number of respondents (rate) was 1, 450 (81%). Before reviewing the documents 67% answered “acceptable” to 400ml WB and 61% to apheresis, and 28% and 35% answered “unclear”, respectively. One-third to one-half of those who ansewerd “unclear” changed their opinion to “acceptable” after reading the documents. This resulted in an increase of “acceptable” opinions to 77% for 400ml WB and to 74% for apheresis. The proposal was “declined” by around 10% or less in both questions.
It is considered that the introduction of 400ml WB and apheresis donations from young persons into the blood program would be commonly accepted after informed consent was obtained, and that the provision of suitable information on these donations can gain lead to an increase in acceptability.

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In ABO major incompatibility between a donor and a recipient on bone marrow transplantation (BMT), red blood cells (RBC) and/or plasma containing anti-A and anti-B antibodies should be removed from collected marrow aspirates to prevent hemolytic reactions. We processed 20 marrow aspirates to concentrate mononuclear cells using a COBE Spectra cell separator. BM processing resulted in a mean recovery of 34.0±8.38% of mononuclear cells and 112.3±36.3% of CD34+ cells in the final product. A mean of 98.4% of RBC was removed, with a mean of 4.2±2.4ml of RBC in the final product. Twenty patients receiving allogenic BMT showed no sign of hemolysis and a rapid hematopoietic recovery after BMT. BM processing using the COBE spectra cell separator proved to be a fast, safe, and effective procedure to remove RBC and plasma from the marrow harvest in ABO-incompatible BMT.

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Fresh frozen plasma (FFP), prepared from whole blood or blood for apheresis, should be frozen at -20°C and thawed in a water bath at 30-37°C. In this study, we evaluated a newly developed thermostatic thawing chamber (FP-40, Hokuyo; Kawasumi, Japan).
The FP-40 was evaluated in terms of the stability of its thawing performance and water temperature. The coagulation factors (prothrombin time, PT; activated partial thromboplastin time, APTT; fibrinogen, factors V and VIII) of thawed FFP were measured.
Thawing time using the FP-40 for FFP-1 was about 5 minutes, which was 17 minutes faster than that using a standard water bath FFP-2 and FFP-5 thawed in about 9 and 15 minutes, respectively. Thawing time was not influenced by the number of bags in the FP-40. Water temperature was stable during thawing. The PT of FFP thawed in the FP-40 was better than that of FFP thawed in the water bath (88.2% vs 81.7%, p<0.05). There were no significant differences between the two methods in terms of APTT, or fibrinogen activities, and factors V and VIII.
This new thermostatic chamber is effective in shortening the time needed to thaw FFP and in maintaining the activity of coagulation factors in thawed FFP.

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Relief for damage to health of the recipients of blood transfusion has been ensured by legislation, so that the safety and reliability of the blood system have been stabilized. On the other hand, sufficient legal relief blood donors experiencing health damage has not been planned. As pecuniary compensation, the only option is the original “solatia” system of Japan Red Cross, the only blood collecting establishment in Japan. In view of global trends, a relief system for adverse effects at the time of blood collection based on liability without fault seems to be desirable. To investigate directions as for a future compensation system for adverse effects of blood donors in Japan, we compared overseas systems, especially those of France, Germany, and the UK.

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We conducted a survey regarding the status of transfusion-related effects in National University (corporation) hospitals in fiscal year 2004. Response rate was 98% (43/44). Forty-seven percent (20/43) of universities recorded the incidence of side effects in all transfused cases. Although patient blood material was kept in all facilities before transfusion, only two facilities kept unopened samples. When side effects including suspicious cases occurred, collection of the remainder of transfused blood was performed in 88% of universities. Bacterial cultures of both blood products and the patients' blood were possible in half of the facilities in cases of bacteremia. The standard of investigation submitted to the Japan Red Cross Blood Center was enumerated as follows: requests from the diagnosis and treatment department, the severity of adverse effects, and the transfusion of infectious diseases. These findings emphasize the need for surveys by the transfusion treatment committee to maintain the system for the investigation of side effects, including collection of remaining transfused blood. Consultation by the transfusion division doctor is also important in investigating the cause, the treatment of the side effect, and the selection of further blood products.

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