Washed/replaced platelet concentrate (W/R-PC) has been used successfully in patients suffering from adverse transfusion reactions caused by plasma-containing platelets. Recently, we reported that a novel additive solution (M-sol) with a high ability to preserve platelets can be prepared by a combination of solutions that are approved for clinical use. In this study, we compared the ability of M-sol to preserve platelets with that of three additive solutions widely used in Japan. Further, we also investigated methods for preserving M-sol in the fluid conditon.
The W/R-PC in additive solutions were stored for up to 96 hours and tested for various parameters including pH, CD62P, %HSR, %Disk, MPV, collagen-induced agglutination, glucose and lactate. While all solutions were shown to be able to preserve platelet functions for up to 6 hours after preparation, only M-sol was able to preserve platelets beyond 24 hours. M-sol could be preserved in the liquid condition for at least 3 months by the use of a plastic bag coated with aluminium.

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Background: In order to assure domestic self-sufficiency in albumin in Japan, dosages of albumin should be limited by promoting its appropriate usage.
In particular, the amount of albumin used in Ehime Pref. is much greater than that used in other areas of Japan. Furthermore, the amount of albumin used in our hospital was high in comparison to other hospitals in our prefecture. As we are the primary institution in Ehime Prefecture, it is necessary that we promote the appropriate use of albumin. We therefore implemented various plans to coordinate the provision of albumin, and to promote its appropriate use.
Method: We developed a system that uses a serum albumin value, with the administration records and the patient's diagnosis automatically compiled for every patient. The documents were printed out to provide a patient data list (Fig. 1), and the data were sent to each physician who used albumin with the encouragement that they carefully consider appropriate usage.
Furthermore, we provided graphs of the data to visually confirm the differences regarding albumin usage as compared with the mean value for each month. These data were reported to the hospital steering committee and to the business affairs conference (Fig. 3).
Results: After the implementation of the above program, the amount of albumin used decreased by about half in 2 years (Fig. 5).
Conclusion: It was difficult to decrease the total albumin consumption volume only by appealing to physicians to adhere to the appropriate use guidelines. However, it was useful to recognize that the amount of albumin used in our hospital was much larger than that of the other hospitals in our area, as reported by the albumin use survey. In addition it was also important that the director of the hospital strongly supported us in our efforts.

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[Background] The issue of medical beneficence for patients of the Jehovah's Witness faith has been under consideration.
[Objective] The role of informed consent (IC) and medical cooperation between respective medical units was reviewed in order to improve bloodless surgery and medicine for patients of the Jehovah's Witness faith, on the basis of a common understanding of the patient's right to bodily self-determination.
[Materials & Methods] During the decade, 113 patients and 128 cases were subjected to IC as well as ongoing medical cooperation. Discussion focused on confirmation of the refusal of blood transfusion, the extent of acceptable alternatives and due caution or recognition of possible life-sustaining treatment. Medical community involvement included surgeons, anesthetists, radiologists, gastroenterologists, emergency physicians and other specific medical co-workers.
[Results] No case failed to meet at least one indications for treatment. Bloodless surgery was performed in 107 cases, interventional radiological procedures in 10, endoscopic treatment in 4 and irradiation-chemotherapy in 17. Emergency cases numbered 15. Decision-making for treatment was established after the repetition of IC and medical assessment between all parties concerned. All patients refused allogenic blood and storaged autologous blood transfusion. Acceptable alternatives included intraoperative autotransfusion consisting of hemodilutional and/or salvaged blood in continuity with circulation, which was adopted in 29 cases (23% of all). Bloodless management did not disturb the curability per se of after treatment and there were no associated fatal complications or death.
[Conclusion] Bloodless surgery and medicine were promoted by IC achieved in an open, concrete and comprehensive form, as well as with advanced care by medical communities in individual hospital.

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Reports of transfusion-related bacterial infection have recently increased, although direct causality between patient infection and blood products has been proven in only few instances. Here, the authors report a case of sepsis caused by methicillin-sensitive Staphylococcus aureus (MSSA) contamination of platelet concentrate (PC). The 70-year-old patient concerned had aplastic anemia, and was receiving regular out-patient treatment at Aichi Medical University Hospital.
When his platelet count fell to 10,000/μl and hemoglobin to 7.9g/dl, he was transfused with ten units of PC and two units of RBC. Fifteen minutes after the beginning of RBC transfusion, he developed a fever (40.7°C) and mild dyspnea, and was admitted as an in-patient, receiving medication, including antibiotics, in a Clean Room. Although vital signs were stable (systolic blood pressure: 130mmHg; fever: 38-39°C; SaO₂:97%), he died unexpectedly the following morning. His family refused autopsy.
After he had developed fever and chills, his blood tests and blood culture had been examined. Additionally, blood samples in the PC bag, the segment tube and the RBC bag were subjected to blood culture. He was found to be leukocytopenic (WBC: 300/μl), and his blood yielded Staphylococcus aureus. Blood taken from the PC bag and the segment tube similarly developed Staphylococcus aureus, while no bacteria were detected from the RBC bag. Drug sensitivity testing of the three strains proved them to be MSSA, and the coagulase test and DNA analysis showed them to be identical, revealing that the sepsis was caused by MSSA contamination of the PC. Thus, when bacterial infection by blood products is suspected, blood culture should be examined not only for patient blood, but also relevant bags or segment tubes. It is necessary to prevent contamination of blood products by bacteria such as Staphylococcus residing in the skin, especially regarding PC, which is primarily kept at room temperature.

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The first Japanese standard for human coagulation factor IX was established in 1995 using the 2^nd International standard as a reference. In 2004, the 2^nd Japanese standard for human coagulation factor IX was developed. This report describes a collaborative study among five laboratories conducted to assign the potency of the 2^nd Japanese standard. The data shown here are the results obtained with the one-stage assay followed by parallel line analysis using the 3^rd international standard as a reference. In conclusion, the 2^nd Japanese standard was established with a potency of 75.0IU/ml.

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