Background: Surgery for liver transplantation may be accompanied by massive bleeding and often requires large amounts of blood transfusion. This may result from coagulopathy due to liver dysfunction, which leads to the decreased expression of some coagulant proteins and to a low platelet count. This study analyzed coagulopathy during surgery and examined the hemostatic efficacy of fibrinogen product in massive bleeding in patients undergoing liver transplantation.
Patients and Methods: We analyzed several hemostatic parameters, including platelet count, PT, APTT, and fibrinogen during surgery in 31 patients from 2003 to 2005. When massive bleeding occurred, we administered fibrinogen product to the patient and evaluated its hemostatic efficacy by counting blood loss volume and amounts of blood transfusion in comparison with cases treated without fibrinogen.
Results: The lowest level of fibrinogen (82±49mg/dl) was observed at the re-establishment of portal circulation. Patients whose total blood loss was more than 5 liters, showed significantly lower levels of fibrinogen during 4 hours after the re-establishment of portal circulation. Blood loss during 2 hours after re-establishment in patients with the lowest fibrinogen level of>75mg/dl was significantly reduced when compared with patients showing<75mg/dl. Finally, we observed decreases in blood loss (30% decrease) and transfusion volume (20% decrease in RCC, 50% in FFP, 60% in PC) in patients treated with fibrinogen product in comparison with control cases.
Conclusion: Coagulation tests should be performed during liver transplantation. When patients show severe hypofibrinogenemia (i.e.<100mg/dl), administration of fibrinogen product should be effective in establishing hemostatsis, and therefore in reducing blood loss and transfusion volume.

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Allergic reactions, including urticaria, are the most frequently observed symptoms of non-hemolytic transfusion reactions. Although it is easy to consider that allergic reactions are induced by IgE-mediated type I allergy, there is only limited evidence for this possibility. In addition to IgE-dependent activation, IgE-independent direct activation of mast cells/basophils is also found, for example in some allergies to contrast media. Therefore, the direct activation of mast cells/basophils might plausibly be involved in allergic transfusion reactions. In such cases, basophil antibody, including HLA antibody, is a good candidate for the direct stimulator of mast cells/basophils. In this study, we developed a detection system for basophil antibody by modifying our previously developed 5-cell lineage immunofluorescence test. Using this detection system, we examined 23 cases of allergic transfusion reaction. Results showed non-HLA leucocyte antibodies in 14 patient samples and 6 blood components. Of these 20, 7 samples contained antibodies against basophils.

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To enable discussion on the proper use of blood products and exchange-related information, a joint meeting of the transfusion committees of Aomori Prefecture was first held in 2,000, and has been conducted annually since then. The meeting includes in its agenda reports of the results of questionnaire surveys, introduction of successful strategies for improving the efficiency of institutions, information from blood centers and a special lecture. Our investigations cover over 90% of all blood products supplied in Aomori Prefecture during the previous year. The activities of the committee are summarized in this report. Briefly, the results of these meetings have been as follows: First, the number of institutions with well-systematized transfusion control systems has increased. Second, the number of institutions with well-controlled systems for collecting information on the side effects of transfusion has increased. Third, the volumes of platelet concentrates and fresh frozen plasma used have been decreasing annually. Fourth, the volume and rates of discarded packed red blood cells and platelet concentrates have decreased. We concluded that this establishment of an annual joint meeting of several transfusion committees has played an important role in promoting the proper use of blood products and provides a good opportunity for the exchange of information and education among medical institutions in Aomori Prefecture. The meeting has also been useful in promoting the establishment of transfusion committees at medical institutions in Aomori Prefecture.

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