We assessed the safety of autologous blood donation during pregnancy in a Japanese population using a prospective study design.
A total of 190 donations were performed by 66 patients between March 1, 2005 and May 31, 2006. Indications for autologous blood donation were blood type Rh negative (n=11), atypical antibody positive test results (n=5), placenta previa (n=17), lower lying placenta (n=14), leiomyoma of uterus (n=17), and a history of massive blood loss at previous delivery (n=2).
Among 190 donations by 66 patients, 11 donations (5.8%) were complicated with Vasovagal Reaction (VVR). All donations were conducted with fetal heart rate (FHR) monitoring. No abnormal FHR pattern was observed during any donation. Sixty-eight neonates (2 twins) were delivered. Gestational age at delivery, birth weight, Apgar score at 1 minute, and Apgar score at 5 minutes was 37.6±3.5 (mean±SD) (gestational weeks). 2,892±431 (mean±SD) (g), 8 (median), and 9 (median), respectively. The neonatal period was uneventful in all babies. Average blood loss at delivery was 980±861 ml (mean±SD). Among 66 patients, 11 patients (16.7%) were transfused with autologous blood. Blood loss in patients who received transfusions was significantly greater than that in patients without transfusion (1,992±1,279 ml (mean±SD) vs 752±531 ml (mean±SD)). All transfusions were achieved without side effects.
In conclusion, autologous blood donation may present a slightly higher risk of VVR in pregnant women than in non-pregnant women. However, because no adverse events were observed in perinatal course, this procedure appears to be applicable for patients at high risk of bleeding at delivery.

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A comprehensive questionnaire of transfusion medicine, including similar questions of the questionnaire in fiscal year 2004 as well as proposed guidelines for appropriate transfusion management (proposed guidelines) was sent to 1,355 hospitals in fiscal year 2005.
Replies were obtained from 857 hospitals (63.2%). Although a unified management system for blood components was established in 717 hospitals (84.0%) and a hospital transfusion committee (HTC) was established in 769 (90.3%), doctors responsible for transfusion (transfusionists) with full-time involvement in transfusion were present in only 75 hospitals (8.8%). Plasma derivatives such as albumin solutions (AS) were managed in the department of pharmacology in 833 hospitals (97.7%), while transfusion departments in only 285 hospitals (33.7%), had information on plasma derivatives used in the hospital. Among the five groups of hospitals categorized according to the number of beds and presence or absence of transfusionists, the discharge rate of blood components and the fresh frozen plasma or AS/red cells transfusion ratio were higher in the groups of hospitals without transfusionists (Table 1 and 6). The proposed guidelines were considered useful in 569 hospitals (74.1%), including that HTC activities based on practical guidelines are important to the establishment and maintenance of appropriate transfusion practices.

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ABO-incompatible transfusion due to human error is the most important cause of adverse events during transfusion. The National Survey on the present status of ABO-incompatible blood transfusions in Japan was conducted by the Japanese Society of Blood Transfusion. The survey targeted 1,355 hospitals. Data were collected by an anonymous questionnaire-based survey. Reports of ABO-incompatible transfusion in the 5-year period between January 2000 and December 2004 were analyzed. Target blood products included whole blood, red cell concentrates and fresh-frozen plasma (FFP) and platelet concentrates (PC). Among the 1,355 hospitals surveyed, responses were obtained from 829 (61.2%). Sixty cases of ABO-incompatible transfusion were reported, involving major mismatch of red cell concentrates in 22 cases, minor mismatch of red cell concentrates in 9, FFP in 19, PC in 8 and unknown products in 2. The main causes of transfusion error were identification error between patient and blood product in 27 (45%), phlebotomy error in 2 (3%), prescription error in 8 (13%), testing error by doctors in 10 (17%), laboratory error by technicians in 10 (17%) and other error in 3 (5%). Outcomes in patients transfused with ABO-incompatible blood were recorded as deceased in 8, in 4 of whom the cause of death could nevertheless not be distinguished as due to the ABO-incompatible transfusion or the underlying disease. Incorrect blood recipient identification at the patient's bedside remains the main cause of ABO-incompatible transfusion.

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