Given recent reports that the number of blood donations by younger people has decreased, concerns have been expressed about future shortages in the blood supply with the aging of the population. We analyzed past donor numbers in statistical reports to make appropriate plans for the future. The analysis showed that the change in donation numbers is largely due to the increased efficiency in blood collection and increased selectivity for donors able to provide higher volumes of blood.
At the same time, a real-time, comprehensive blood supply system is required, while stocks of each blood type must be managed on a daily basis. When future blood supply needs are estimated based on population projections, results indicate that the aging population will require a slight increase in the blood supply, but the target amount of plasma collection will have a greater impact on donor recruitment. Blood services should undertake systematic preparations to secure donor recruitment based on long-term planning.

View full abstract

In Akita Prefecture, a joint meeting of the transfusion committees of all medical institutions in the prefecture has been held every year since 1998 to promote the proper use of blood products. In this study, we analyzed changes in blood transfusion practices in the past 10 years. The survey included the transfusion management system of approximately 50 institutions; status of the usage of blood products, including albumin; the number of patients transfused classified by disease, sex and age; and the status of autologous blood transfusion. Currently, blood products are mainly managed in an established blood transfusion service. There has been little change in the number of patients with red cell transfusion over 10 years. While the number of patients with platelet transfusion has increased, the number with plasma transfusion has considerably decreased. By disease, gastrointestinal conditions accounted for the largest usage of red cell transfusion and hematological conditions the largest usage of platelet transfusion. The decrease in the number of plasma transfusion patients is mainly due to the decrease in the incidence of gastrointestinal diseases. By age and sex, the number of patients aged 80 years or older has recently increased, particularly woman. The number of patients with autologous blood transfusion has increased in Akita Prefecture, as have the percentages of patients with autologous blood among patients receiving red cell transfusion and percentages of units of autologous blood among total units of red cell products. The joint meeting of transfusion committees in Akita Prefecture provides a good opportunity for the exchange of information and education for hospitals, and the meeting survey is useful for evaluating the status of blood transfusion practice. The joint meeting plays a significant role in promotion of the proper use of blood products.

View full abstract

Neonatal alloimmune thrombocytopenia (NAIT) mainly results from anti-HPA antibodies, and occasionally from anti-HLA antibodies. We present a NAIT case in which the mother's antibody showed the prozone phenomenon by MPHA with intact platelets.
The patient, the mother's first child, had a platelet count of 11,000/μl at birth. Lymphocyte cross-matching tests between parents was negative. Platelet cross-matching of the mother's serum was negative without dilution, but positive with a score of 1+ after 2 to 8 times dilution, and with a score of 2+ after 16 to 64 times dilution, thus showing the prozone phenomenon.
Anti-HLA-Class I antibodies by Luminex assay were negative for both mother and infant. Anti-HPA antibodies in the mother was negative by MPHA with extracted platelet antigen (n = 8) and the MACE method. Anti-HPA antibodies in the infant were negative by MPHA with extracted platelet antigen (n = 8). When the mother's serum was tested by M-MPHA with 18 types of intact panel platelets, 16 of the 18 panels showed a positive reaction with the prozone phenomenon. The other 2 panels showed a negative reaction. The positive reactions were attenuated or disappeared by chloroquine treatment.
These results suggest that the antibody which may be a cause of NAIT is reacting with platelet antigens which show the prozone phenomenon on intact platelet surface but are lost by the extraction process, and are denatured by chloroquine treatment.

View full abstract

Institutional practices regarding pre- and post-transfusion hepatitis testing and serum storage were surveyed in Aomori Prefecture. Of 186 medical institutions at which more than one and some kind of blood products were transfused during 2004 and 2005 in Aomori Prefecture, 154 responded (82.8%). Pre-transfusion serum was stored at 55.2% of institutions, and 18.8% of the institutions used a dedicated refrigerator for serum storage. Of all institutions, 76.6% and 21.4% performed pre- and post-transfusion hepatitis testing, respectively. However, the exact pre- and post-transfusion test panels recommended by the Ministry of Health, Labor, and Welfare (MHLW) were performed at only 14.4% and 54.5% of institutions, respectively. Institutions that participated in the Aomori Prefecture Transfusion Practice Association showed relatively higher frequencies of serum storage, dedicated refrigerator use, post-transfusion testing, and compliance with MHLW guidelines. Among these, institutions with their own transfusion committees showed even higher frequencies of serum storage, dedicated refrigerator use, and post-transfusion testing. Thus, priority should be given to adequately informing institutions about MHLW guidelines, especially those that do not have their own transfusion committee or attend forums such as the Joint Meeting of the Transfusion Committees of Aomori Prefecture or the Aomori Prefecture Transfusion Practice Association.

View full abstract

Results concerning cellular therapy were collected and analyzed from questionnaire surveys on transfusion medicine conducted by the Japanese Society of Transfusion Medicine and Cell Therapy/Japanese Association of Medical Technologists for 2007 and by the Working Group for Adverse Events of the Transfusion Conference of University Hospitals for fiscal 2006.
In the survey conducted by the Society, a comprehensive questionnaire on transfusion medicine was sent to 1,341 hospitals to which 844 institutions replied. Nurses were concurrently posted to transfusion departments and other departments in 420 institutions. Full-time and part-time nurses were posted to transfusion departments in very few hospitals. Aphereses were conducted in 128 hospitals, but most did not conduct more than 5 procedures, except for autologous blood stem cell collection. Cells were processed in 99 hospitals, most of which dealt with collection and processing for bone marrow; collection, processing, freezing and storage for peripheral blood; and storage only for cord blood. In 14 hospitals, transfusion-related departments were involved in cell processing not for stem cell transplantation or immunotherapy, 8 of which were involved in vascular regeneration. Cells were processed in sections other than transfusion-related departments in 11 hospitals where hematology, surgery or oncology departments dealt with dendritic cells, cytotoxic T lymphocytes, pancreatic islet cells or cells for vascular regeneration.
The survey of 80 university hospitals conducted by the Working Group, to which 79 institutions replied, showed transfusion departments in 59 hospitals processed cells for hematopoietic stem cell transplantation and 15 hospitals dealt with pancreatic islet cells, mesenchymal stem cells or cells for vascular, hepatic or alveolar bone regeneration. In 25 hospitals, cells were processed in sections other than transfusion departments. In most hospitals, aphereses was conducted in transfusion departments but vessels were punctured by the attending physicians.
Information on circumstances concerning cell processing is important to the compilation of guidelines, as well as to the promotion of education and qualification of personnel for cell processing, and should be systematically collected.

View full abstract

[in Japanese]

View full abstract