We analyzed perioperative packed red cell blood transfusion (RBC-TF) in surgery for esophageal carcinoma to improve the usage of blood products.
Methods: From 1993 to 2002, 52 patients (mean, 63.5 years) underwent esophagectomy for esophageal cancer. By stage, there were 13 cases of stage 0 disease (25%), 11 stage 1 (21%), 12 stage 2 (23%), 9 stage 3 (17%) and 7 stage 4 (14%).
Results: Irradiated red cell products (Ir-RBC) were used in 12 patients (22%) for intraoperative bleeding (mean 1,187 ml), whereas no RBC-TF was performed in 40 patients (609 ml; p<0.001). Operation time did not differ statistically between the two groups (452 min vs 426 min). RBC-TF was often performed intraoperatively in patients with episodes of low blood pressure (<80 mmHg) during anesthesia, although their blood loss was less than 500 ml. Fresh frozen plasma (FFP) was used in parallel with RBC-TF during surgery, whereas plasma protein fraction (PPF) was used in no relation to blood loss. RBC-TF was performed postoperatively in 17 of 40 patients (43%) with no intraoperative RBC-TF and in 11 of 12 patients (92%) with intraoperative RBC-TF. Multivariate analysis revealed that blood loss and water imbalance in body fluid were independently correlated with postoperative RBC-TF. Serum sodium (Na) level in body fluid decreased from 142 mEq/l (mean) to 135 mEq/l after surgery. Postoperative pneumonia and anastomotic leakage occurred in patients with RBC-TF at the ratio of 10% (p<0.198) and 28% (p<0.0009), respectively, whereas these complications did not occur in patients without periperative RBC-TF.
Conclusion: The use of RBC-TF often appeared excessive. Proper management of BTF therapy is necessary.

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Nonhemolytic transfusion reaction is a relatively common complication of allogeneic transfusion. However, the frequency of nonhemolytic transfusion reaction has not been precisely determined in Japan. We analyzed the frequency of nonhemolytic transfusion reactions at Kinki University Hospital. Total frequency after transfusion of platelet concentrates (PC), red blood cells (RBC) and fresh frozen plasma was 3.29%. Of these three blood products, PC was associated with the highest frequency of reactions (5.18%). Mean incidence of reactions by transfusion of washed PC was 0.29% compared to 5.79% with non-washed PC. Mean incidence of reactions by transfusion of RBC was 2.43%, compared with those with RBC using a leukoreduction filter and leukocyte reduction RBC of 1.13% and 0.57%, respectively. These results indicate that the prevention of nonhemolytic transfusion reactions remains an important issue in allogeneic transfusion.

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In national university hospitals, nationwide records have been maintained of the transfusion side effects occurring each year. After the recommended criteria for transfusion-related acute lung injury (TRALI) were established during the TRALI Consensus Conference held in 2004, cases of respiratory failure were re-examined.
Thirty-four cases of respiratory failure were reported by 44 facilities during the fiscal year 1998 to 2003. Eight cases were diagnosed as TRALI and three cases as possible TRALI according to the recommended criteria. The antileukocyte antibody was positive in 63% (7/11) of cases that met the recommended criteria, although the anti-HLAclass II antibody was tested in only three cases. One case showed signs of acute lung injury (ALI) before transfusion, and 22 cases that did not show bilateral infiltrate on the chest radiograph were excluded. Twenty-two cases with no bilateral infiltrate on the chest radiograph seemed to be the result of an allergic reaction or condition similar to TRALI.
Seven deaths occurred in cases involving TRALI, which was the most important serious complication related to transfusion during the investigational period.

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Background: In Japan, all platelet products are provided as single donor apheresis platelets (SDPs), and the storage period is limited to a maximum of 72 hours due to the possibility of bacterial contamination. In several countries, however, extension of storage to 5 to 7 days has been implemented with routine bacterial testing. Two culture methods, BacT/ALERT^® and eBDS^®, and one direct bacterial detection method, Scansystem™, were studied to evaluate their performance and detection sensitivity for contaminated platelets.
Study design and methods: Twelve freshly collected leukocyte-reduced SDPs were spiked with one of four bacteria species, Serratia liquefaciens, Staphylococcus epidermidis, Bacillus cereus, Propionibacterium acnes (each n=3), at a concentration of 10 colony forming units (cfu)/ml. After inoculation, SDPs were stored for 7 days under standard conditions. Samples were taken every 24 hours until positive results with each detection system were obtained.
Results: One sample spiked with Serratia liquefaciens and obtained at 24 hours showed false-negative results with all detection systems. Detection sensitivity of aerobic bacterial species was almost the same between BacT/ALERT^® and eBDS^® (≤10 cfu/mL). Only anaerobic culture bottles with the BacT/ALERT^® system detected Propionibacterium acnes, but the mean detection time was 3.2 days. As the total test time for Scansystem™ is 70 minutes, it showed an advantage for the detection of rapidly growing bacteria.
Conclusion: Although bacterial screening methods effectively contribute to reducing transfusion-transmitted infections, attention should be paid to possible false-negative results, and their dependence on sampling time. With implementation of bacterial testing, it is essential for platelet shelf-life extension because platelet products will have to be held inventory one or two more days. Strategies to maintain high platelet efficacy for longer periods should be considered at the same time.

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Nonhemolytic transfusion reactions (NHTR), such as urticaria or fever, are frequently experienced after transfusion. These reactions are seldom reported to the transfusion division or regional blood center because these are not particularly severe. Therefore, accurate data on the incidence of NHTR are scarce. We surveyed 216 hospitals with a comprehensive reporting system for these reactions about the incidence of NHTR. The study periods were the first 6 months of 2004 and of 2005.
We received replies from 160 hospitals (reply rate, 74%). Total RBCs, platelets and fresh frozen plasma transfused during the study periods were 365,513 bags, 129,741 bags and 182,460 bags, respectively. The most frequently experienced NHTR was urticaria by platelets, with an incidence per bag of 2.76% in 2004 and 2.79% in 2005. The second was itching by platelets, with an incidence of 0.62% and 0.54%, respectively, followed by fever by RBCs, at 0.41% and 0.40%, respectively, and fever by platelets, at 0.35% and 0.34%, respectively.
The incidence of NHTR per bag of platelets did not change before and after prestorage leukocyte reduction.

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[in Japanese]

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