Background: Transfusion-transmitted bacterial infection is a serious and unresolved problem. We evaluated the efficacy of DOX^TM (Daikin Industries) which is a commercially available system that has developed to detect a contaminated food by measuring oxygen potential to detect bacterial contamination in PC.
Methods: Staphylococcus aureus, Serratia marcescens, Staphylococcus epidermidis, Bacillus cereus, Streptococcus pneumoniae, and Propionibacterium acnes were inoculated into PC at a final concentration of approximately 10⁰, 10¹ and 10² CFU/ml. Dissolved oxygen potential of the sample taken from each PC just after inoculation was measured consecutively.
Results: The detection rate by DOX^TM system in samples inoculated with S. aureus at a concentration of 10⁰, 10¹ and 10²CFU/ml was 28.6%, 78.6% and 85.7%, respectively. That of S. epidermidis was 23.0%, 84.6% and 92.3%, of S. marcescens was 50.0%, 100% and 100%, and of B. cereus was 57.1%, 100% and 100%, respectively. The aerobic organisms were detected in a mean of 7.0 to 18.2 hours.
Conclusion: DOX^TM system detected aerobic bacteria in PC within 20hours if their initial concentration was more than 10¹CFU/ml. We consider that this system can be introduced as a useful method to detect the contaminated PC, and can improve the platelet transufusion safety without increasing the medical costs.

View full abstract

The Japanese Health, Welfare and Labor Ministry in 2006 published guidelines for the use of blood products which mandated that the ratio of volume of albumin/volume of red cell products (At/RBCt) be lower than 2.0. At Fukuoka University Hospital, this ratio has been about 4 for the past 10 years. The Transfusion Service analyzed albumin usage in March 2006 and proposed to lower the value by: 1) limiting consecutive orders of albumin to two days; 2)removing the most concentrated albumin product, 25% albumin, from use; and 3) lowering the target serum albumin level after administration because method of analysis changed from the bromcresol green method to the improved bromcresol purple method. Promotion of appropriate albumin usage began in July 2006 after agreement to these proposals by the Transfusion Committee.
We analyzed the consumption of albumin from March to May of 2006 and of 2007 to determine the effectiveness of this effort. The number of patients receiving albumin decreased from 300 to 240 and the amount of total albumin consumed decreased from 23,657g to 14,673g. The median dose and the median number of days of administration of hypertonic albumin per patient decreased from 75g to 40g and from 3 to 2, respectively. The median serum albumin level after administration decreased to just below the lowered target level for isotonic albumin, but was still above the corresponding target level for hypertonic albumin. Lastly, the proportion of albumin used appropriately increased from 47% to 68%, but At/RBCt decreased only to 2.6 from 3.0. Clearly, more effort is needed to reach the goal of 2.0.

View full abstract

A 70-year-old woman who had experienced 5 gestations and 3 deliveries, underwent surgery for ovarian cancer under general anesthesia condition. She received blood transfusion consisting of 18 units of red blood cell concentrates (Ir-RC-MAP) and 14 units of fresh frozen plasma (FFP) for 2.5hr. SpO₂ decreased to 70% while deoxygenated Hb (FHHb) increased upto 8.8%. The blood pressure subsequently fell to 65/35mmHg with signs of pulmonary edema. Chest X-ray revealed decreased transparency of the bilateral lung fields without enlargement of the cardiac shadow. Cardiac ultrasonogram showed normal function of the heart. The shock was treated with epinephrine without steroids. WBC count was 1,600/mm³ at 15 hrs after onset.
Three of 17 blood products had anti-HLA (class I & II) antibodies whereas none had anti-granulocyte antibodies. Among them, two products, RC and FFP, showed positive results in cross-match testing. She had no intrinsic antibodies against IgA, C4, C9, haptoglobin, ceruloplasmin, or α2 macroglobulin. No deficiency of those proteins was found in her serum. The blood donors, who were cross-match-positive, were all females.
On the basis of these results, this case was diagnosed as TRALI (transfusion-related acute lung injury).

View full abstract

We experienced a 61-year-old male patient with acute leukemia who was diagnosed with hepatitis B virus (HBV) infection after blood transfusion. At 3 months after transfusion, a blood sample from the same donor was positive for HBV DNA on 50-pooled sample nucleic acid amplification testing (NAT). Lookback study showed that the first donated blood was negative for HBV DNA on 50-pooled sample NAT but positive on individual sample NAT (ID-NAT). Before transfusion, the patient was negative for HBsAg and anti-HBc. HBV DNA sequence analysis of the patient and of the donor showed 99% homology. Lamivudine treatment was started, and prevented acute hepatitis B. The present patient was a member of the ID-NAT screening study for post-transfusion infection. In eight of 921 patients (excluding the present patient), HBV DNA was detected only after blood transfusion. Seven of these eight patients were positive for anti-HBc was positive and four had been transfused during chemotherapy for neoplasm. Retrospective study of all donor samples showed no detection of HBV DNA by ID-NAT. Recently it was reported that cytotoxic chemotherapy induced HBV reactivation in patients with past HBV infection. We therefore speculate that HBV reactivation occurred in some of our eight patients positive for HBV DNA after blood transfusion.

View full abstract

A comprehensive questionnaire on transfusion medicine, including the same questions as in the questionnaires of fiscal years 2004 and 2005, as well as some related to the proposed guidelines for Hospital Transfusion Committee (HTC) activities (proposed guidelines), was sent to 1,355 hospitals in fiscal year 2006.
Replies were obtained from 872 hospitals (64.4%). Although 752 hospitals (86.5%) had an established unified management system for blood components and an HTC was established in 813 hospitals (93.6%), doctors responsible for transfusion (transfusionists) with full-time involvement in transfusion were present in only 122 hospitals (14.0%). In 766 hospitals (89.3%) plasma derivatives such as albumin solutions (AS) are controlled by the department of pharmacy, but in 588 hospitals (68.4%) the transfusion departments are provided with information related to AS usage in their hospitals, which is an evident improvement.
These improvements certainly reflect the positive application of the transfusion management fee by many hospitals. In fact, 108 hospitals (13.0%) and 189 hospitals (22.7%) have already achieved the criteria to obtain the hospital fees for transfusion management 1 and 2, respectively. Since 610 hospitals (77.0%) considered the proposed guidelines useful, it can be concluded that HTC activities based on the practical guidelines are important to appropriate transfusion practice.

View full abstract

Background: For the investigation of transfusion-transmitted bacterial infection and transfusion-related acute lung injury (TRALI), examination of residual transfused blood is essential. However, methods for the collection of residual transfused blood have not been fully implemented at respective hospital level. Therefore, the causes of these reactions are not being fully investigated.
Methods: We developed a procedure for investigating the cause of acute transfusion reactions, including a method for collecting residual blood. Using this method, we investigated serious acute transfusion reactions at 50 large hospitals between 2005 and 2006.
Results: Transfusion was performed using 283,636 bags of red cell concentrate, 183,591 bags of fresh frozen plasma and 141,538 bags of platelets concentrate at these facilities during the investigation period. Transfusion-transmitted bacterial infection was diagnosed in two cases and suspected in 12 cases. Three cases met the diagnostic criteria for TRALI and one case was identified as possible TRALI. Transfusion-associated circulatory overload was diagnosed in one case. Five patients demonstrated deterioration of clinical condition after transfusion during treatment of acute lung injury. Four patients demonstrate dyspnea without pulmonary edema. Severe allergic reactions were detected in 15 cases and febrile non hemolytic transfusion reaction in one case. The cause was not precisely known in two cases.
Conclusion: This type of investigation is useful for detecting the cause of acute transfusion reactions, such as allergic reactions, TRALI and transfusion-transmitted bacterial infection. The frequency of acute transfusion reactions will be clarified by increasing the number of participating facilities, thereby contributing to hemovigilance.

View full abstract

[in Japanese]

View full abstract