Based on the hypothesis that long-term fetomaternal microchimerism is associated with acquired immunologic hyporesponsiveness to noninherited maternal antigens (NIMAs) or inherited paternal antigens (IPAs), we examined the outcomes of 13 patients with hematologic malignancies who underwent HLA-incompatible stem cell transplantation from a microchimeric NIMA-mismatched donor. Eleven of the 13 patients had sustained hematopoietic recovery with short-term methtrexate and tacrolimus for graft-versus-host disease (GVHD) prophylaxis. Grade II acute GVHD occurred in 3 (27%) of 11 evaluable patients, while extensive chronic GVHD developed in 4 (36%) of 11 patients. Five (38%) patients are alive, all of whom are disease-free with a median follow-up of 55 (range, 6 to 72) months. These results indicate that T cell-replete SCT from an HLA-haploidentical NIMA-mismatched donor can offer durable remission with an acceptable risk of GVHD in selected patients with hematological malignancies who lack immediate access to a conventional stem cell source.

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The effect of diverting the first 30 ml of blood during whole blood collection on the frequency of bacterial contamination was evaluated. Nearly 6,000 blood aliquots from whole blood collected by either the conventional or diversion method were cultured using an automatic culture system. Seven of 2,967 (0.24%) and two of 2,890 (0.07%) samples collected by the conventional and diversion methods were found to be positive for bacterial contamination, respectively. Six of the nine bacterial isolates obtained were identified as Propionibacterium acnes. Although the data is not statistically significant, it is suggested that the diversion method may decrease the frequency of bacterial contamination in collected blood.

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The Ministry of Health, Labour and Welfare amended the guideline for blood transfusion in September, 2004. This guideline states that pre-transfusion examinations for HBsAg, HBsAb, HBcAb, HCVAb, HCV core Ag, and HIV Ab are necessary to understand a patient's infectious status, and that post-transfusion examinations of HBV (NAT), HCV core Ag, and HIV Ab are required when transfusion-associated infection is suspected. Accordingly, the Japan Society of Transfusion Medicine and Cell Therapy prepared an operation manual for the diagnosis of transfusion-associated infection. The main points are as follows: (1) Before transfusion, patient's blood sample should be kept frozen (below-20°C) in a tube for nucleic acid amplification testing in preparation for suspected transfusion-associated infection. (2) Serological markers for HBV, HCV, and HIV should be examined, as physicians need to know this information before blood transfusion. (3) Liver functions should be examined and screening tests for HBsAg, HCV Ab, and HIV Ab should be performed about three months after transfusion for early detection of post-transfusion infection. Optimal implementation of these post-transfusion diagnostic examinations requires that physicians be kept informed about this operational manual. Further, doctors should explain the possible risks of transfusion-associated infection to patients before undergoing transfusion at the time consent is provided.

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The Revised Guideline for Transfusion Practice, (2004) and Guideline for retrospective investigation for transfusion transmitted infection (2005) recommended that hospitals conduct pre- and post-transfusion viral marker tests and sample preservation. In order to investigate whether these measures have been adopted in hospitals in the Tokai area, a questionnaire survey of 232 hospitals was conducted in November 2005 regarding 1) hospital information, 2) transfusion department management, 3) pre- and post-transfusion viral marker tests, 4) sample preservation, 5) items on informed consent (IC), and 6) measures against bacterial infection by blood products.
Responses were received from 139 hospitals (59.9%). Viral marker tests were adopted by only 20%, and the proportion of patients actually tested was under half because tests are costly and can be replaced by sample preservation. Also, the timing of tests (post-transfusion) was difficult for doctors. As an alternative, 84.9% of hospitals preserved pre-transfusion samples for RBC transfusion; however, the rate decreased to 40.3% overall for transfusions of all products. For post-transfusion, 20.8% of hospitals preserved samples. Items relevant to transfusion-transmitted infection (TTI) on the IC proposed by the Revised Guideline were actually described in 77%, although items irrelevant to TTI were adopted in less than 50%. Regarding sterile preservation of used blood product bags, most hospitals deemed this impossible in practice.
Patients' costs to cover TTI can be recovered thanks to a new policy instituted in 2004. However, the infection must be proved to be caused by blood products. In order to provide such verification, viral marker tests should be performed pre- and post-transfusion. However, this study revealed that most hospitals have not adopted these tests, and that less than half preserved pre-transfusion samples. All hospitals are strongly advised to conform to the Guideline and to preserve pre-transfusion samples, in order to better deal with cases of TTI.

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Autoantibodies against red blood cells (RBC) which react with all cells of a screening panel potentially mask the presence of clinically significant alloantibodies, and interfere with pretransfusion antibody screening and compatibility testing.
To remove these autoantibodies, patients' sera were treated using either the ZZAP-or PEG-adsorption methods. Five patients with non-autoimmune hemolytic anemia (non-AIHA) had a single or multiple alloantibodies with the specificities of anti-Di^a, anti-E, anti-c+E, anti-c+E+Jk^b+Di^a, and anti-C+e, respectively. These patients received transfusion of antigen-negative RBCs corresponding to the specificity of the alloantibodies which had been detected in the auto-adsorbed sera after removal of the autoantibodies.
The rate (mean, 89%) of hemoglobin increments in all 5 patients was concordant with that (mean, 84%) of the control group. Lactate dehydrogenase levels did not increase significantly after transfusion of compatible RBCs.
There findings indicate that autoantibody adsorption procedures are necessary to detect underlying alloantibodies along with autoantibodies. Further transfusion of major alloantigen-matched RBCs is efficient for non-AIHA patients with both allo- and autoantibodies.

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We developed a simple methodology for platelet cross-matching based on the M-MPHA method. Cross-match testing using patient sera and the transfused platelets was performed retrospectively, and the results were compared with the efficacy of platelet transfusion. In cross-match-positive cases, platelet transfusion was ineffective.

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