Background and Objects: Blood products such as red cell concentrates (RCC), platelet concentrates (PC), and fresh frozen plasma (FFP) are a part of the human body, and should therefore be treated carefully and effectively. Nevertheless, some blood products are wasted due to expiration. Although blood products are reused before expiration in other patients in a hospital to avoid wastage, this may be limited within one hospital. We therefore developed a method to reuse blood products effectively among hospitals.
Methods: Seven hospitals operated by Tokyo Metropolitan Government took part in this study. First, we investigated the amount of blood products which were wasted due to expiration from January to July, 2005. Daily from September to December, 2007, each hospital sent information about unused and nearly time-expired blood products to the other hospitals by an internet mailing system. If any of these blood products were needed by another hospital, they were transported to that hospital and used for transfusion. A container with a temperature stabilizer for blood product was used for transportation to maintain an appropriate temperature. To assess product acceptability, the temperature and appearance of blood, transport time, and other details, were recorded after transportation.
Results: Eighteen RCCs, one PC, and four FFPs were transported from one hospital to another and used for transfusion from September to December in 2007. The wastage rate of RCCs during this period was 1.06%, which was significantly lower than the rate of 1.78% during the other period.
Conclusion: We consider that reuse of blood products in other hospitals before expiration is an effective means of reducing the wastage of blood products, and is meaningful to implement among large groups of hospitals.

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Our experience in several cases has suggested that the use of the fully automated compatibility testing system AutoVue to detect donor-type antigens on red blood cells (RBCs) early after ABO-mismatched allogeneic stem cell transplantation (SCT) causes a delay compared to the use of the tube test. In this study, we investigated the differences between the two methods.
We selected a patient with blood type O who underwent bone marrow transplantation (BMT) from an HLA-matched sibling donor with blood type A. We centrifuged the patient's blood and separated the RBCs as follows: the thin top layer, and the upper, middle, and bottom layers according to the specific gravity of each. We then investigated the level of A₁ antigen on RBCs in each layer. On day 32 after BMT, AutoVue could detect A₁ antigen abundantly only in the thin top layer. The tube test estimated the titer of A₁ antigen as ×32 before centrifugation, but after centrifugation as ×64 in the thin top layer, compared to ×8 in the other layers. On day 35, AutoVue could detect A₁ antigen in the bottom layer. Two months after BMT, AutoVue and the tube test detected equal A₁ antigen titer from the upper to bottom layers. We speculate that most of the donor RBCs remained immature within the early reticulocyte stage with low-level gravity early after BMT, so they were concentrated abundantly in the upper layer after centrifugation. Using AutoVue, a sample is generally aspirated from the bottom layer RBCs after centrifugation, which might delay the detection of donor-type antigens early after BMT.
In conclusion, using the thin top layer of RBCs might allow much earlier detection of donor-type antigens after SCT. Further, monitoring of donor-type antigens may be better done using whole RBCs that are mixed well.

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Samples from 151 patients with platelet tranfusion refractoriness were screened for anti-platelet antibodies by MPHA and M-MPHA, using the anti-PLT-MPHA-Screen.
The antibody detection rate was 49.0% (74/151) by MPHA and 52.3% (79/151) by M-MPHA. Comparison of antibody titration between the two methods revealed higher detection levels by M-MPHA than MPHA.

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Background: Acute non-hemolytic transfusion reactions (ANHTRs) and the decrease in young blood donors are two major issues of transfusion medicine in Japan. Many factors are associated with ANHTRs, some derived from donors, and others from recipients. In proportion to the decrease in younger donors, middle-and older- aged donors have relatively increased. With age, atherosclerotic risk factors such as obesity, hypertension and hyperlipidemia increase. Several reports have suggested that a reduction in body iron by blood donation may be beneficial in preventing atherosclerosis. However, the question of whether atherosclerotic risk factors of donors are associated with ANHTRs has not been examined.
Methods: Atherosclerotic risk factors and related laboratory data were compared between donors associated with ANHTRs (T group) and normal donors (C group).
Results: There were no significant differences in age, gender ratio, body mass index, blood pressure, or lipids between the two groups. However, average WBC count and total protein were significantly higher in the T group than in the C group. Although the difference was not significant, T group donors with C-reactive protein (CRP) >0.1mg/dl tended to be associated with dyspnea more than with other types of ANHTRs.
Conclusion: There were no differences between the T and the C groups for age, blood pressure or HDL cholesterol. Although higher WBC count in the T group and an apparent association between CRP and ANHTR type were observed, further investigation is necessary for confirmation.

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In May 2006, we established an examination system in our hospital for transfusion-related viral infections, such as hepatitis and HIV, according to the "Guideline for Transfusion Therapy" and "Guideline for Retrospective Survey of Blood Donors."
Briefly, follow-up testing of HBs-Ag, HBs-Ab, HBc-Ab, HCV-Ab, HCV-core-Ag and HIV-Ab is conducted on serum obtained immediately prior to transfusion, such as at the cross-match test. Post-transfusion testing of HBV-DNA, HCV-core-Ag and HIV-Ab is carried out three months after the transfusion.
A total of 576 patients received transfusions in our hospital between May 2006 and June 2009. Pre-transfusion testing was performed for 518 patients (89.9%), of whom 86 died, and 415 of the remaining 432 patients (96.1%) had post-transfusion tests. However, 58 patients (10.1%) refused both pre- and post-transfusion tests. Low implementation rate of testing was likely due to low awareness of transfusion-related viral infections on the part of doctors, nurses, patients, and patient family members. Following participation in a study session held by our division, nurses were able to educate transfusion patients about transfusion-related viral infections and the importance of pre- and post-transfusion testing. As a result, the implementation rate of pre- and post-transfusion testing increased. In addition, direct phone calls to transfused patients, their family members and/or their current doctors have contributed to improving the implementation rate of post-transfusion testing.

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Background: Enzyme techniques are highly sensitive assays for the detection of weak or developing Rh antibodies. Therefore, many facilities in Japan prefer to use enzyme techniques for irregular antibody screening. However, enzyme techniques often detect cold antibodies and benign autoantibodies. The purpose of this study was to evaluate the clinical significance of enzyme techniques in irregular antibody screening.
Methods: Antibodies detected by enzyme techniques (n=123) were tested by the indirect antiglobulin test (Sal-IAT), polyethylene glycol test (PEG-IAT) and MTS gel system (MTS-IAT). Clinical significance of the antibodies was evaluated according to Ig isotype, level of cell-bound IgG, and monocyte monolayer assay (MMA).
Results: Of 123 samples, 71 were positive by all IAT (group A), 34 were positive by PEG-IAT and/or MTS-IAT (group B), and 18 were negative by all IAT (group C). In groups A and B, levels of cell-bound IgG were high and most Ig isotypes were IgG1. In group C, levels of cell-bound IgG were lower and IgM was the main isotype. The MMA-positive rate of group A and B were 87% and 24%, respectively, while that of group C was 0%.
Conclusion: PEG or MTS-IAT was able to detect clinically significant antibodies. Most antibodies detected by enzyme techniques alone were clinically non-significant. Enzyme techniques appear to be unnecessary for antibody screening.

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[in Japanese]

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