Background: The risk of post-transfusion hepatitis B virus (HBV) infection has been reduced following the implementation of HBV nucleic acid amplification technology (NAT). However, the problem of HBV-DNA-positive and HBsAg-negative occult HBV infections remains to be solved. Here, in an attempt to resolve such problems, we report the development of a convenient method to concentrate HBV and HBs-antigen (HBsAg) in order to improve detection sensitivity.
Objects: Seventy-eight anti-HBc-positive (≥2⁵: HI), HBsAg-negative and 20-pool NAT negative donations were examined.
Methods: Virus concentration is achieved by the enhancement of the agglutination of viruses using poly-L-lysine-coated magnetic beads in the presence of a bivalent metal. HBsAg and HBV-DNA levels were concentrated up-to 20-fold and 8-fold respectively.
HBsAg and anti-HBc were tested by enzyme immunoassay (EIA) (AxSYM: Abbott) and hemagglutination inhibition test (HI: Japanese Red Cross) respectively.
Results: Of 78 anti-HBc-positive and HBsAg-negative donors, 16 were HBV-DNA-positive by individual NAT and 62 were HBV-DNA-negative by individual NAT. Twenty five of 62 HBV-DNA-negative by individual NAT became HBV-DNA-positive by HBV concentration. Twenty nine of 78 donations which were HBsAg-negative by conventional EIA became HBsAg-positive by HBsAg concentration.
Conclusion: Our new method of concentrating HBV and HBsAg increased the sensitivities of EIA and HBV NAT and enabled us to detect HBV-DNA from individual-NAT-negative samples and HBsAg from conventional-EIA-negative samples.

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Background: Some operations for thoracic aortic aneurysm (TAA) have been accompanied by massive bleeding and often required large amounts of blood transfusion. This may be, in part, due to local disseminated intravascular coagulation, including hyperfibrinolysis (e.g., elevated FDP and D-dimer) in patients with aneurysms. Although autologous fresh platelet-rich plasma has been suggested to contribute to a reduction in blood transfusion in cardiac surgery, its clinical significance appears controversial. This study examined the efficacy of autologous fresh platelet concentrate (PC) in patients undergoing aortic replacement surgery.
Patients and Methods: We retrospectively evaluated several parameters, including volume of blood loss and amounts of blood transfusion in 60 TAA patients (26 of autologous PC transfusion and 34 controls) from April 2005 to March 2007. Background and characteristics of TAA patients were not significantly different between two groups. Harvest of autologous PC by plasmapheresis was started just after induction of anesthesia. Approximate 3.0∼4.0 × 10¹¹ autologous platelets were transfused to patients following neutralization of heparin after completing cardiopulmonary bypass.
Results: We observed significant reduction of blood loss and of blood transfusion in TAA patients who were transfused with autologous platelets. For example, the amount of red blood cell transfusion was 5.7±7.3 units in the autologous PC group vs. 12.8±14.2 units in the control group. The transfusion units of fresh frozen plasma (8.5±10.8 vs. 17.1±20.8) and allogenic PC (2.7±6.5 vs. 13.5±12.2) also significantly decreased in autologous PC group. Volume of blood loss during operation was dramatically reduced in the autologous PC group against control group (mean: 688ml vs. 1,322ml).
Conclusion: Transfusion of autologous fresh PC was effective in producing a significant reduction of blood loss and blood transfusion in TAA surgery, and would thus contribute to better prognosis in TAA patients. Harvest of autologous PC by apheresis could be performed safely and is recommended for TAA surgery.

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Following formation by the Japan Blood Transfusion Society of a subcommittee for I&A in 1999, the Chugoku/Shikoku branch has encouraged society members to participate in education courses for I&A inspector held in conjunction with general or local meetings of the Society. A total of 13 physicians and 23 medical technologists, 16 physicians and 70 medical technologists have attended the courses held at general and local meetings, respectively. During this period, on-site inspections were carried out at five hospitals. Through these activities, 6 physicians and 18 medical technologists were approved as formal I&A inspectors of the Society, and 5 hospitals were certified to meet the I&A standard determined by the Society. Through these activities, we consider it necessary to increase the recognition and efficiency of I&A, as well as the number of inspectors to promote I&A.

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