Japanese Journal of Transfusion and Cell Therapy
Online ISSN : 1883-0625
Print ISSN : 1881-3011
ISSN-L : 1881-3011
Volume 55, Issue 6
Displaying 1-7 of 7 articles from this issue
Originals
  • Tatsuya Sugimoto, Kaoru Sato, Hitomi Sasaki, Chie Nakashioya, Osamu Hy ...
    2009 Volume 55 Issue 6 Pages 683-690
    Published: 2009
    Released on J-STAGE: January 15, 2010
    JOURNAL FREE ACCESS
    Background: Since CBT is performed using frozen cells, it is important to evaluate the hematopoietic function of frozen cells. However, it is not yet clearly known how long this hematopoietic stem cell function can be maintained in liquid nitrogen.
    Study design and Methods:
    First, we evaluated the hematopoietic function of 617 cord blood units, including 23 validation units, which were frozen between 1997 and 2006 and thawed one month to eight years after freezing. Nucleated cell numbers, viability, CD34 positive cell numbers and CFU-GM numbers were measured in the bigger and smaller compartments of the freezing bags, and values from segment samples of each cord blood unit were compared with those before freezing. Second, hematopoietic cell function was evaluated according to freezing period.
    Results:
    1. Comparison according to sample type
    Viability, total nucleated cell numbers, CD34 positive cell numbers and total CFU-GM numbers of segments appeared lower than those of pre-freezing samples or those of the bigger and smaller compartments of the bag. However, significant correlation was found among samples.
    2. Comparison according to freezing period
    The viability of samples frozen for more than five years was significantly lower than those less than five years. CD34-positive cell numbers and CFU-GM numbers did not differ based on each freezing period.
    Conclusion:
    This study proves the validity of predicting hematopoietic cell number and function of frozen cord blood cells in a freezing bag by segment sampling. Although hematopoietic stem cells have not been reduced during freezing periods of up to eight years, follow-up examination is required.
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  • Tsutomu Nomura, Yoshitsugu Kubota, Natsumi Baba, Kikuo Izeki, Takeshi ...
    2009 Volume 55 Issue 6 Pages 691-697
    Published: 2009
    Released on J-STAGE: January 15, 2010
    JOURNAL FREE ACCESS
    Background and Purpose: The ability to predict platelet recovery after chemotherapy allows for a more reasonable approach to platelet transfusion. We assessed the clinical utility of monitoring the percentage of immature platelet fraction (IPF%) using the XE-2100 automated hematology analyzer to predict platelet recovery.
    Patients and Methods: The IPF% of 130 healthy volunteers and 100 patients was measured using the XE-2100. Further, IPF% was serially monitored in 19 cancer patients who received 35 courses of chemotherapy and hematopoietic stem cell transplantation (HSCT), and data were then retrospectively analyzed.
    Results: The IPF% in 130 healthy volunteers was 2.8±1.4% and inversely correlated with platelet count (r=0.319). In cancer patients undergoing chemotherapy and HSCT, a transient increase in IPF% (IPF% peak) was observed prior to recovery of the platelet count to more than 30×109/l within 1 to 11 days. In cases undergoing chemotherapy with more than 10% of the IPF% peak value, platelet recovery (>30×109/l) occurred significantly earlier than in those with less than 10% of the IPF% peak value (3 and 5 days, respectively; p=0.0164). In one case undergoing autologous HSCT with more than 10% of the IPF% peak value, platelet recovery occurred earlier than in cases undergoing allogeneic HSCT with less than 10% of the IPF% peak value (2 days and 4-11 days, respectively).
    Conclusion: Findings in the present study suggest that IPF% is a useful parameter for predicting platelet recovery after chemotherapy and HSCT, as well as has the potential to facilitate optimal platelet transfusion.
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  • Mitsuaki Akino, Satoru Tamura, Junichi Hirayama, Yuki Naito, Masako Ka ...
    2009 Volume 55 Issue 6 Pages 698-704
    Published: 2009
    Released on J-STAGE: January 15, 2010
    JOURNAL FREE ACCESS
    Washed and/or replaced platelet concentrates (W/R-PCs) are used to prevent the adverse effects of platelet transfusion. W/R-PCs are prepared mostly by one of two methods, but no comparison of these methods has been reported. In this study, platelet function and transfusion effects were compared between a PC prepared by washing apheresis-derived platelets (plasma-PC) with the washing-replacement-preservation solution M-sol and resuspending them with the same solution (WR-method), and that prepared by centrifuging plasma-PC and replacing the plasma with M-sol (R-method).
    The two methods were compared in vitro with respect to platelet recovery, concentration of residual plasma protein and functional parameters (pH, aggregation, %HSR, CD62P, %disk). They were also compared in vivo for transfusion effects, i.e. corrected count increment (CCI) and prophylactic effects on adverse reactions.
    Percent recovery of WR-PC and R-PC were 90.5±1.4% (n=7) and 89.5±1.8% (n=7), respectively (p=0.209), and percent removal of plasma protein was 96.9±0.7% (n=7) and 95.4±0.9% (n=7), resulting in a residual plasma protein per bag of 428±95mg (n=7) and 627±130mg (n=7), respectively (p<0.01). Except for pH, no difference in parameter values in vitro was found between the two methods during 48 hours storage (5 days after donation). While the pH of plasma-PCs declined to 7.05±0.04 after 24 hours storage, that of WR-PC and R-PC remained at 7.37±0.03 and 7.40±0.02, respectively, after this time, although a transient pH reduction was observed immediately after preparation in both methods. For patients who suffered severe anaphylactic shock by plasma-PC transfusion, 75 bags of WR-PC (for 6 patients) and 31 bags of R-PC (for 4 patients) were transfused. Post-transfusion 24-hour CCI was 1.53±0.82 (n=51) in WR-PC and 1.59±0.78 (n=18) in R-PC. Prophylactic effects were observed in both PCs. No adverse reaction was observed with either WR-PC or R-PC.
    R-PC was comparable to WR-PC in all regards. Thus, the R-method, which is more feasible in practice, is preferable as a plasma-reduction method.
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Case Report
  • Masao Ogata, Tomoyuki Imamura, Junji Ikewaki, Eiichi Ohtsuka, Yoshiaki ...
    2009 Volume 55 Issue 6 Pages 705-710
    Published: 2009
    Released on J-STAGE: January 15, 2010
    JOURNAL FREE ACCESS
    Donor lymphocyte infusions (DLI) are often used to convert mixed to full donor chimerism. Here, we present the case of a patient who developed agranulocytosis accompanied by mixed chimerism following allogeneic peripheral blood stem cell transplantation (PBSCT) and then responded to DLI.
    In 1998, a 59-year-old man presented with unexplained neutropenia. Although immunosuppressive therapies were ineffective, his neutropenia responded moderately to high-dose G-CSF, with which he was treated for 5 years. In 2003, transformation to acute myeloid leukemia occured. He received allogeneic PBSCT from an HLA-identical sister. The conditioning regimen consisted of busulfan and cyclophosphamide. Engraftment of neutrophils was documented on day 24 after PBSCT. However, on day 53, severe neutropenia recurred. Bone marrow examination revealed marked cytolysis and a specific decrease in myeloid lineage cells. T-cell chimerism was assessed against peripheral blood mononuclear cells by PCR analysis of short tandem repeat loci, and the presence of recipient CD3-positive T cells was demonstrated (recipient type: 48.3%). DLI was performed to convert mixed to full donor chimerism. After one course of DLI (CD3-positive dose of 1×107/kg of recipient body weight), his neutropenia improved. However, the patient developed idiopathic pneumonia syndrome concurrent with neutrophil recovery, and he died of respiratory failure 92 days after PBSCT.
    This case emphasizes the importance of recipient cells in transplant-associated immune neutropenia, and the effectiveness of DLI in converting mixed to full donor chimerism.
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Reports
  • Manabu Yamaoka, Shuji Onishi, Miyoko Arimoto, Akemi Ichibe, Misao Abe, ...
    2009 Volume 55 Issue 6 Pages 711-716
    Published: 2009
    Released on J-STAGE: January 15, 2010
    JOURNAL FREE ACCESS
    The presence of donor-specific HLA antibodies often causes humoral rejection in liver transplantation. When a direct cross-match test (DCT) on liver transplantation is positive, the result should be considered a particularly important clinical sign. We report a case of a female patient aged fifties with HLA antibody who was transplanted with an ABO-incompatible living-donor liver with positive DCT. Pretransplantation, she underwent immunosuppression using Rituximab and had three plasma exchanges to reduce anti B antibody titer because of the ABO-incompatible transplantation. PC-HLA-transfusions were effective in terms of thrombocytopenia on the operative day and after 4 weeks, but were refractory after 8 weeks when liver function was reduced. She later died of liver failure and sepsis. We had expected that strong immunosuppression would provide the patient with protection against strong rejection. Retrospective study showed that the platelet transfusion refractoriness (PTR) after 8 weeks was caused by thrombotic microangiopathy (TMA). This study demonstrated that prompt recognition and investigation concerning thrombocytopenia is important to allow the implementation of appropriate treatment.
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  • Shigeyoshi Makino, Asashi Tanaka, Koki Takahashi, Kimitaka Sagawa
    2009 Volume 55 Issue 6 Pages 717-722
    Published: 2009
    Released on J-STAGE: January 15, 2010
    JOURNAL FREE ACCESS
    A comprehensive questionnaire on transfusion medicine was performed for 4 consecutive years, from 2004 to 2007, to evaluate the establishment of an adequate transfusion management system and activities of Hospital Transfusion Committees. A unified management system for blood products as well as the centralized performance of transfusion tests was present in 748 hospitals (88.7%). Adequate control of albumin products was observed in 621 institutions (75%). This finding is attributable to the transfusion management fee, approved by the Ministry of Health, Labor and Welfare of Japan in 2005, on the basis that control of the usage of albumin products is one of the conditions to obtain the transfusion management fee. Hospital Transfusion Committees were established in 799 institutions (95.2%), and the number of hospitals with full-time or part-time transfusionists as well as laboratory technologists responsible for transfusion increased gradually from 2004 to 2007. However, a substantial discrepancy was seen in the rate of hospitals with a 24-hour system for transfusion tests between those with more than 300 beds (90.9%), and those with less than 300 beds (44.4%). Introduction of a computer system for transfusion gradually increased, but it is still too low, with only 55.5% of the hospitals with less than 300 beds using such systems. More than 1/3 of responding hospitals had already met the conditions required to get the transfusion management fee (type I: 133 institutions, type II: 188 institutions). Analyzing the usage and wastage rates of blood products per number of beds, according to the presence or absence of full-time transfusionists, hospitals with transfusionists had a higher usage rate but lower wastage rate than hospitals without transfusionists, and the difference was more evident among hospitals with more than 300 beds. Moreover, among the hospitals with more than 300 beds in which only part-time transfusionists were present, the wastage rate was lower in those where laboratory technologists responsible for transfusion were present.
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