To enhance the safety and efficacy of cord blood transplantation, the Japanese Cord Blood Bank Network recommends a number of tests for all cord blood units before preservation. However, as the guidelines are not particularly strict, methods and samples used in each bank differ, with an especially large difference in sterility testing. In this test, an increase in the amount of sample increases sensitivity, but on the other hand results in the loss of cells in the cord blood unit. We therefore attempted to determine whether by-products obtained in cell processing can be utilized for this test.
We selected seven kinds of standard strain of bacteria frequently isolated from cord blood. After adding each to the starting materials, we examined how they were distributed to two by-products, red cell fraction (RCF) and plasma fraction, and to the final product (FP). Quantitative analysis revealed that the majority (64-98%) of bacteria were distributed to RCF for six strains, but for one strain distribution to RCF was low (11%,) and 73% were instead distributed to FP. Even in the latter case, the total number of bacteria in the test sample from RCF was more than that from FP because the volume of RCF able to be used for the test was 10 times greater than that of FP.
In accordance with the above findings, we have used RCF for sterility tests in addition to FP since February 2005. Detection rate of bacteria has consequently increased nearly three-fold (from 1.2% to 3.5%). However, in one rare case bacteria could be detected in FP but not in RCF (1/1,201). This finding confirms that the use of both RCF and FP samples for sterility testing is important for the safety of cord blood transplantation.

View full abstract

The Astrim system (Sysmex Co.) can measure hemoglobin concentrations in a noninvasive manner using the near-infrared spectroscopic imaging method. We measured the hemoglobin concentration of 258 applicants for blood donation using the Astrim and conventional methods at the same time. Results showed a good correlation between concentrations measured by Astrim and the conventional methods at an ambient atmospheric temperature between 22°C and 26°C (202 applicants). In this condition, there was a good correlation between the ability to donate blood as determined by Astrim and that by conventional methods. However, at ambient temperatures below 20°C (56 applicants), hemoglobin concentration could not be obtained correctly by Astrim as has been reported previously. ROC analysis revealed that noninvasive hemoglobin concentration measurement can determine the ability of blood donation in about half of cases. In conclusion, noninvasive hemoglobin concentration measurement by Astrim is a useful method for blood donor selection. This noninvasive method can avoid the side effects of needle stick such as VVR or nerve injury.

View full abstract

The Japanese Red Cross Society (JRCS) has been collecting information on adverse reactions and infectious diseases nationwide as part of hemovigilance since 1993. The number of non-hemolytic adverse reactions increased yearly from 155 cases in 1993 to 1,609 cases in 2004, and leveled off thereafter. In 2006, 1,591 cases of non-hemolytic adverse reactions were reported from medical institutions in Japan, showing a slight increase compared to that in 2005. Cases included 529 of urticaria and other skin eruption (33.2%), 238 of fever (15.0%), 173 of anaphylactic reaction (10.9%), 246 of anaphylactic shock (15.5%), 62 of hypotension (3.9%), 179 of dyspnea (11.3%), 66 of TRALI/possible TRALI (4.1%) and 98 of others (6.2%). Sixteen cases of psychoneurotic disorders were included among these 98 others. While 1.8 and 1.9 cases of adverse reactions were reported per 10,000 doses for plasma and red cells, respectively, 9.2 cases were reported for platelet products. Severe adverse reactions (590 cases) were reported to the Ministry of Health, Labour and Welfare according to the Pharmaceutical Affairs Law. The number and rate of severe adverse reaction has been increasing since 2004. Further studies and analyses are required to improve transfusion safety.

View full abstract

We carried out two in vitro studies aimed at extending the shelf life of frozen thawed red cells (FTRC). In both studies, an automated cell processor ACP215 (Haemonetics) was used to prepare frozen red cells (FRC) and FTRC. In the first study, we compared two washing methods, the modified Meryman and Valeri methods. The results indicated that FTRC prepared by the former method showed better washing effects. In the second study, we compared two preservative solutions, AS-3 used in the US and MAP used in Japan. After washing with ACP215, FTRC were stored in either AS-3 or MAP until further investigation. The percentage of hemolysis in FTRC after 7 and 14 days storage in AS-3 was 1.0±0.2% and 1.2±0.2%, respectively. For FTRC in MAP, these percentages were 0.8±0.2% and 1.4±0.2%. These results were much better than that achieved currently using FTRC, which was 2.9±1.4% after 12 hours storage.
Given that the Food and Drug Administration currently recommends a hemolysis level below 1% for FTRC, these findings indicate that the shelf life of FTRC in MAP can be extended up to 7 days.

View full abstract

Objective: Use of blood products should be improved in Japan. We investigated the present status of blood transfusion administration before and during various abdominal surgeries in major hospitals of Kanagawa Prefecture in order to improve transfusion practices.
Materials and Methods: We conducted a questionnaire survey about the use of various blood products, including autologous blood transfusion (ABT), before and during surgeries among 55 hospitals in Kanagawa Prefecture. Responses were analyzed and tabulated.
Results: Thirty-five hospitals (64%) responded to the questionnaire. ABT was routinely performed in 9 of these hospitals for procedures such as hepatectomy, pancreato-duodenectomy, and esophageal resection. In 60% of the hospitals, red cell concentrate was transfused before surgery when the hemoglobin level of the patient was below 8g/dl. Trigger levels for intraoperative blood transfusion varied among hospitals, where blood was transfused according to the physical characteristics of the patient. The rate of red cell concentrate (RCC) transfusion was highest during pancreato-duodenectomy (49.4%) and lowest during colo-rectal surgery (8.8%). Fresh frozen plasma (FFP) was transfused very frequently in hepatectomy and pancreato-duodenectomy. The use of FFP and albumin products varied widely among hospitals. Further investigation of details such as trigger criteria for these blood products is required.
Conclusion: RCC transfusion was performed reasonably in almost all responding hospitals in Kanagawa Prefecture. However, there were a few hospitals in which surgeons should make efforts to prevent waste of FFP and albumin products.

View full abstract