Seven patients with amyloid light-chain (AL) amyloidosis underwent high-dose melphalan therapy and autologous stem cell transplantation in our department. Mobilization with granulocyte colony-stimulating factor alone enabled a sufficient harvest of CD34-positive stem cells, and these agents were well-tolerated. Two of seven patients (29%) evaluated 3 month's post transplantation showed complete resolution of plasma-cell dyscrasia. Two patients with cardiac involvement died on days 42 and 159, respectively, suggesting that they might not have been suitable candidates for high-dose melphalan therapy. Three of four patients who underwent additional salvage therapies, including allogeneic stem cell transplantation, tandem high-dose melphalan therapy and thalidomide, showed a hematological response. In four of five patients (80%) who showed hematological response with high-dose melphalan or salvage therapies, organ dysfunction was resolved or stabilized. Our experience indicates that high-dose melphalan therapy appears to be feasible when patients with cardiac amyloidosis are excluded. However, new therapeutic modalities should be further investigated to improve therapeutic efficacy and safety for those who have cardiac involvement, or fail to respond to high-dose melphalan therapy.

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We report a patient who was protected against a possible post-transfusion reaction by carrying an irregular antibody card.
A woman with a history of delayed hemolytic transfusion reaction (DHTR) caused by anti-C+e antibody and post-transfusion thrombocytopenia in our hospital was referred to Hirosaki University Hospital with a suspected aneurysm, identified by mediastinal widening on a chest x-ray during a medical checkup. Preoperative examination showed no irregular antibodies, but the patient's irregular antibody card stated that she had a history of anti C+e antibody and anti-HLA antibody. Rho blood type and HLA typing compatible blood products (packed red cell and platelet concentrate, respectively) were used during surgery. Postoperatively, the minimum hemoglobin concentration was 12.4g/dl on postoperative day (POD) 12. The minimum platelet count was 114,000/μl on POD 6, and anti-C antibody was detected on POD 22. The patient had no symptoms or laboratory evidence of hemolysis except for a haptoglobin value below the level of detection. Progression to DHTR was prevented.
This case highlights the merit of personal irregular antibody cards in preventing against post-transfusion reaction. Efforts should be made to increase understanding of the usefulness of personal irregular antibody cards.

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Quality control surveys are important in assuring standardization and comparability of laboratory data among hospitals in a region. In Fukuoka Prefecture, Japan, tests of quality control began in 1972 and about 200 labs have participated. Among these, about 120 laboratories have performed tests of quality control related to blood transfusion, of which about 10% failed to detect ABO and Rho (D) blood typing using the same samples given every year since the beginning of the survey. The reasons for failure were not determined. Further, no guidance or improving the results was given to these laboratories.
Therefore, we (members of the quality control committee) decided to inspect five laboratories which failed these tests in 2005 and 2006 to learn the reasons for their failures. We discovered that four out of the five laboratories employed inexperienced technicians with poor knowledge of testing. Moreover, some technicians did not belong to the association of laboratory technicians and therefore received no information updates, nor any systematic introduction to advances in laboratory techniques. Finally, the laboratory equipment used for testing was not well maintained in three of the five laboratories. We advised each laboratory after inspection on how to improve its testing procedures.

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The Kanagawa Prefecture Joint Committee of Transfusion conducted a questionnaire survey on the application of the transfusion management fee (TMF), which was introduced by the national medical insurance system from April, 2006. A questionnaire was sent to 283 hospitals in Kanagawa Prefecture in September, 2006, to which 148 (52.3%) hospitals responded by the end of October, 2006.
The total number of blood units used at these hospitals was 726,167, and covered 75% of the total number of blood units shipped from the Kanagawa Red Cross Blood Center in 2006. Forty-five (30%) of responding hospitals had already applied TMF, and 19 had applied TMF type I (TMF-I) and 26 type II (TMF-II), respectively, at the time of survey. Fifty (48.5%) of the remaining 103 hospitals had the intention to apply TMF as soon as the conditions for application were cleared. Thus, the introduction of TMF seems to be effective in promoting the good transfusion practice, even though the fees are not sufficient for actual needs.
We analyzed problems requiring solution before application as listed by the responding hospitals. Hospitals which intend to apply TMF-I listed manpower problems. It is not easy to employ a doctor and full-time technicians fixed to the transfusion service department. They also described difficulties in organizing albumin management as a unified section.
Hospitals for TMF-II listed difficulties in fulfilling conditions of blood usage, such as FFP/RBC ratio under 0.4 and albumin/RBC under 2.0 as a clinical policy. Six hospitals answered that they could not meet the FFP/RBC ratio because FFP units were used for plasma exchange. Therefore, a change in the of criteria of these ratios should be requested at the next medical insurance revision.

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