[Background]
We have conducted pre- and post-transfusion viral marker tests in all patients who are candidates for transfusion from July, 2005. Here, we report two years' experience with these activities.
[Materials and Methods]
We tested a series of viral markers (HBs-Ag, HBs-Ab, HBc-Ab, HCV-Ab, HCV core Ag, HIV Ab) in patients before transfusion. Also, patient blood samples that were unused following cross-match testing were frozen and stored in a freezer. We selected patients whose most recent transfusion was more than two months previously, and sent them a letter of notification of the post-transfusion viral marker test directly. We sent out a questionnaire about the post-transfusion viral test to patients who had received the direct mail from January to September, 2006.
[Results]
The data were analyzed every half-year. The rate of implementation of pre-transfusion viral marker tests has increased gradually. The examination ratio of post-transfusion viral tests was about 30-40% in each half-year period. According to the questionnaire, 77% of patients who received a blood transfusion were subject to post-transfusion viral marker testing.
[Summary]
About 40% of patients who received a letter of notification were examined by a post-transfusion viral marker test in our hospital. According to the questionnaire, we estimate that 50-80% of patients who received direct mails checked their viral status after transfusion. To maintain the health of patients, post-transfusion viral testing should be done. Moreover, to determine the cause of any post-transfusion infection, it is necessary to store patient blood samples, or to conduct viral testing before transfusion.

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Background: To overcome the shortage of blood and blood products, it is necessary to increase the total volume of blood collected from donors. This requires modifying the current standard of 200-ml whole-blood collection for young people (16-17 year-old), which is specified by the Departmental Regulation No.22 (Kouseishou-rei dai-22 gou). The objectives of this study were to evaluate the safety of 400-ml whole-blood collection in 17-year-old males.
Methods: A total of 322 male volunteers aged 17 years and 363 aged 18 or 19 years were recruited for blood collection through advertisements at schools and blood center donation sites. Blood collected from the 17-year-old males was not used for transfusion, whereas that collected from the 18-19 year-olds was used for transfusion as normal. To evaluate the safety of 400-ml whole-blood collection in the 17-year-old males, Fisher's exact test was used to compare vasovagal reaction (VVR) occurrence rates between the two groups by using a two-by-two contingency table. Significance was defined as P<0.05.
Results: Among the 17-year-old males, six side effects (1.86%)-five cases of VVR and one of subcutaneous hemorrhage-were observed at the blood collection site. Among the 18-19 year-olds, eight cases of VVR (2.22%) were reported. As for late-onset donor reaction, 56 (17.7%) were reported in the 17-year-old males and 35 (10.0%) in the 18-19 year-olds as assessed by post donation questionnaire. No difference was observed in the recovery rate of biochemical data (plasma components) between the two groups.
Conclusion: In terms of the VVR occurrence rate, there was no significant difference between the two groups (P=0.7935; P>0.05). The recovery rate of cell counts and plasma components to the original level was similar between the two groups. We conclude that 400-ml whole-blood collection can be performed safely in 17-year-old males in Japan.

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A 27-year-old man with acute myelogenous leukemia (AML, M2) who was in complete remission following induction therapy was treated with high-dose cytosine arabinoside (HDAraC). He subsequently developed severe pneumonia, caused by methicillin-resistant Staphylococcus aureus (MRSA), as a result of bone marrow suppression. In spite of treatment with antibiotics, granulocyte colony-stimulating factor (G-CSF) and intravenous immunoglobulin therapy (IVIG), his condition deteriorated into respiratory failure, and he required artificial respiration support. He later relapsed, but achieved complete remission following two courses of re-induction chemotherapy. He was treated with HDAraC again, which once more led to severe MRSA infection. He was then transfused granulocytes from a sibling donor by the apheresis method combined with antibiotics, G-CSF and IVIG, which resulted in a clinical improvement. Antibiotics and IVIG are widely employed in the treatment of severe bacterial infections in patients with hematological malignancies; however the effect of IVIG is not fully obtained in neutropenic conditions, since immunoglobulin requires the co-operation of neutrophils to be effective against bacterial infection. In our case, granulocyte transfusion (GTX) appeared to have prevented the deterioration of MRSA infection, suggesting that combination therapy with antibiotics, IVIG and GTX might be valuable in critically neutropenic patients suffering from severe infection.

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This study was intended to identify strategies for preventing adverse events by analyzing incidents occurring during the 7-year period from January 2000 to December 2006. The report form included the contents, ratio of incidents to number of blood products used, place and location, person involved with the patient, and causes. In total, 101 cases were reported, giving a frequency of incidents to the total number of transfusions of 0.51%. By location, the incidents occurred in inpatient wards, laboratories, operation rooms and ICU, in ascending order of frequency. The percentage of incidents in relation to autologous blood among the total number of autologous blood collections was relatively high (1.8%). Of the 90 cases involving patients, 70% of patients were over 70 years of age and 30% had physical disorders such as delusion and dementia. The incidents were identified by nurses in most cases. By type, there were 56 cases in starting and during the use of blood products, 24 cases in handling blood, 11 cases in stocking and preparation for transfusion, 3 cases in testing and 7 other cases. These were caused by errors in identification in 48.5%. Many of the incidents in our hospital are characteristic of actions relating to autologous blood, and handling this is thought to be important.

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Aims: Knowing the lifetime frequency of transfusion is useful when explaining the necessity of blood donation to volunteer donors at the time of recruitment.
Methods: The following data were collected: 1. male/female population, 2. number of donated blood units supplied, 3. patient sex and age at transfusion, and 4. number of blood units used by each hospital. These data were collected for 2002 in Fukuoka and for 2005 in Kanagawa. The probability calculation formula at each age is as below. [P_age=n_age/N_age×T/t]{n_age: number of transfused patients at each age in the hospitals, N_age: population at each age; T: number of supplied blood in the prefecture, t: number of transfused blood in the hospitals.}
Results: 1) The population of Fukuoka Prefecture was 5,034,311 (male 2,391,829; female 2,642,482) in 2002. The regional Red Cross Blood Center supplied all the blood transfused in Fukuoka Prefecture, with a total number of blood components of 226,533. The number of transfused patients at a single university hospital was 1,190 (male 646, female 544). These patients received 13,298 (male 7,210; female 6,088) units of blood. 2) The population of Kanagawa Prefecture was 8,748,731 (male 4,420,831; female 4,327,900) in 2005. The regional Red Cross Blood Center supplied all of the blood transfused with a total number of blood components collected of 297,592. Patients at five university hospitals and one cancer center were studied. The number of transfused patients was 3,744 (male 1,673, female 2,071), who received 57,405 (male 31,760; female 25,645) units of blood. The average number of transfusions, assuming an average male life expectancy of 79 years, was 0.420 for Fukuoka and 0.297 for Kanagawa. For females, assuming an average life expectancy of 87 years, the averages were 0.344 for Fukuoka and 0.275 for Kanagawa.
Conclusion: Our data indicated that the frequency of transfusion in the two prefectures studied was basically the same. The data shows that about 0.33 of Japanese males receive a blood transfusion once during their lives, as did about 0.25 of Japanese females. Furthermore, the probability rapidly increases for both males and females over the age of 80.

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Adverse reactions such as vaso-vagal reaction (VVR) in phlebotomy are considered to be serious. Although the frequency of VVR occurring during voluntary donation has been well reported, there are a few reports regarding adverse reactions in autologous blood donation. In this study, questionnaires were sent to 79 national, public and private university hospitals to survey personnel in charge of collection of autologous blood on the presence of a VVR manual, records of autologous blood collection in transfusion service, types of adverse reactions, grade and number of VVR and patient age in VVR. Results showed that collection of autologous blood was performed by doctors in many hospitals (22 hospitals by transfusion service doctors, 27 hospitals by surgical division doctors), and by transfusion service nurses in 10 hospitals. A VVR manual was not available in 20% of hospitals and records of collection of autologous blood were not managed in the transfusion service in 13% of hospitals. These results suggest that autologous blood collection was largely dependent on the surgical division. VVR was observed in 209 cases in total, of which 196 cases were grade I, 13 were grade II, and no case was grade III. The number of VVR cases observed in those aged 60 years or older was 46, accounting for the largest number. The frequency of VVR per number of patients and number of blood collections was highest in the 10-19 years age group, at 4.0% and 1.7%, respectively. Management of autologous blood collection with regard to the personnel in charge, VVR manual and record of collection was not completely centralized, even in university hospitals where the transfusion service was well established. Transfusion services of university hospitals should be responsible for the management of autologous blood collection, including the management of adverse reactions such as VVR.

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In the transfusion sections of local hospitals, safety and economy is an important problem. In this study, we established a system for massive blood transfusion and improved communication among clinicians, blood section and blood center (BC). Among characteristics of this system, the BC is able to understand the emergency and the possibility of additional ordering besides quantitative information on a continuous basis. Physicians can easily understand the time required to obtain the ordered blood.
Cardiovascular operations accounted for 94% of 99 resisted cases. Additional blood was ordered in 30%, with no problem seen in the blood supply. Use of the massive blood transfusion system was increased, and the optimism of the surgeons was improved to 82%. Moreover, cancellation of ordered blood was significantly decreased, and the waste ratio calculated from the pharmaceutical units and that calculated from cost decreased from 1.6% to 0.4%. These results clarified the importance of the transfusion section in hospitals and local area.

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