Background: The shortage of blood donors mandates the proper management of blood products in city hospitals.
Methods: Use of blood products and deposit autologous blood was analyzed in 12 surgical departments. Perioperative use was investigated in 106 patients who underwent 4 major operations, including 36 esophageal resections (Eso-R), 24 liver resections (Liv-R), 23 total gastrectomies (Gas-R), 23 amputation of the rectum (Rec-R). Serum hemoglobin (Hb), total protein (TP) and albumin level during the perioperative period were examined. ALB usage for Eso-R by 8 doctors was compared.
Results: a) Total amount of red blood cells (RBC) in 12 surgical departments was 1,925U (allogenic-RBC), or 20% of all hospital RBC; digestive surgery, 487U (11.8% of general anesthesia), cardiovascular surgery 295U (7.2%), gynecology 272U (6.6%) and orthopedics 270U (6.5%). Autologous-RBC was used in 4 departments (506U) including orthopedic (335U). b) Intraoperative use of RBC was most frequent (61%, 4.4±2.5U) in Rec-R, followed by Liv-R (42%, 3.1±1.6U). Postoperative use of RBC was most frequent in Eso-R (31%, 4.4±1.7U), in which Hb decreased by 67% after surgery. Gas-R required RBC for intraoperative use in only 2 patients. Amount of postoperative RBC in Eso-R was independent of Hb. RBC in Liv-R was prepared in 78% of patients by cross match testing. Platelets were used in only one Liv-R. Fresh frozen plasma was used in 63% of Liv-R (13±12U) related with prothrombin time. Plasma protein fraction was used in 64% of Eso-R. Albumin solution (20%) was used postoperatively in accordance with physician discretion rather than TP (or albumin) level.
Conclusion: Autogeneic-RBC is still unpopular. The usage pattern of blood products differed among operative procedures. Rational rules for transfusion do not appear to have been sufficiently established.

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A 53-year-old female experienced delayed hemolytic transfusion reaction (DHTR). A fall in hemoglobin (Hb) in this patient required red cell concentrate (RCC) transfusion. Prior to the transfusion, screening for unexpected antibodies to red cell antigens revealed a positive reaction toward all red cell panels as well as to the autologous control. Crossmatching test-compatible RCC and weakest-positive RCC were selected, then transfused. Ten days after transfusion, a large fall in Hb occurred with red-brown urine. Clinical laboratory tests demonstrated hemolysis including high titer LDH and low haptoglobin (Hp) level. The sample was sent to Tokyo Metropolitan Red Cross Blood Center where the presence of anti-Di^b and anti-E antibodies was confirmed. Antigen-selected crossmatching test-compatible frozen thawed red cells (FTRC) were transfused with good recovery of Hb without adverse reaction. This case emphasizes that a good partnership should be established among physicians, transfusion medicine department staff, and the blood center to maintain safe transfusion therapies.

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Three patients were encountered in whom anti-S-like irregular antibody was identified by the enzyme method, but not by the indirect anti-globulin test.
Epitopes of S antigen in glycophorin are destroyed by the enzyme, and hence anti-S cannot react with enzyme-treated red blood cells (RBCs). We considered that the anti-S-like antibodies detected by this method can mimic allo-antibodies and therefore conducted further analyses. The mimicking anti-S were adsorbed by both S-antigen-positive RBCs and S-antigen-negative RBCs, while allo-anti-S were only adsorbed by S-antigen-positive RBCs. As the antibodies analyzed in this study were adsorbed by both S+RBCs and S-RBCs, we designated them mimicking anti-S. Among the three patients studied, one had no history of transfusion, another had received twenty units of S-RBCs without hemolytic reaction, while the third was a pregnant woman with no evidence or symptoms of neonatal hemolytic disorders.

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Antibodies against Rh antigens have been associated with clinically significant hemolytic transfusion reactions. We describe here the uneventful transfusion of C+e+ red cells to a previously transfused patient with anti-C and anti-e.
A 69-year-old male with a wound infection had a history of transfusion one year prior, at which time no alloantibodies were detected. Seven units of concentrated red cells were ordered for debridement surgery. Anti-HI was identified in the patient's plasma, but he required transfusion before antibody screening was complete. Compatibility testing with anti-HI-depleted plasma allowed the release and transfusion of 4 units (2 bags) of red cells. Anti-C and -e were identified after transfusion. Subsequently, 6 units (4 bags) of C- e- red cells were transfused for postoperative hemorrhage. Although the first 4 units of red cells were C+e+, no evidence of hemolysis was observed in 4 months following transfusion.
Titers of anti-C+e increased from 1 : 2 on Day 0 to 1 : 4 on Day 30 : however, no hemolysis was observed with this increase. IgG subclasses of anti-C+e could not be identified because of the low titer. While the direct antiglobulin test was negative on Days 5 and 7, panagglutinating antibodies including anti-C+e were eluted from patient's red cells on both 2 days.
Anti-C+e titer was low and incompatible blood was partially lost due to perioperative bleeding, so it is plausible that hemolysis was not observed in this situation. Nevertheless, to reduce the likelihood of incompatible transfusion events, it is important to educate physicians about the value of early antibody screening.

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Medical engineers (MEs) in our hospital used to perform apheresis procedures for peripheral blood stem cells (PBSC), while medical technologists (MTs) counted CD34-positive cells (CD34⁺) and processed and froze them. However, MEs ceased to perform this task in January 2005, and apheresis procedures have been done by MTs since then. Collection on holidays and weekends became possible once the MTs had been trained, after the restructuring of operations.
Apheresis is done in a private room of the patient ward. The floor nurse performs the venopuncture and drip. Oxygen and suction are piped into the private room, and a monitor and emergency cart are also set up. There is a doctor on duty in the ward on holidays and weekends. The status and vital signs of the patient during the apheresis procedure are recorded on a special chart, which enhances the safety of the procedure.
From March 2002 to December 2003, 13 PBSC apheresis procedures were done on 6 patients by MEs. From January 2004 to October 2008, after the restructuring of operations, 41 PBSC apheresis procedures were done on 23 patients by MTs.
The number of apheresis procedures on holidays and weekends increased from 0% before to 19.5% of the total after the restructuring. The success rate, measured in terms of collecting more than the preservation target for CD34⁺ (2.0×10⁶/kg), increased from 50% to 87%. There was no difference in the appearance of complications before and after restructuring.
MTs in our hospital have been performing PBSC apheresis procedures under various safety precautions and without incident since 2005. They have been praised for alleviating patient stress and anxiety during the apheresis procedure, and have made PBSC collection more efficient and economical.
These findings highlight the need for ongoing support for MTs with regard to all procedures associated with cell therapy.

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A surveillance program was conducted in collaboration with the members of the Platelet Granulocyte Workshop of the Japanese Society of Blood Transfusion and Cell Therapy between April 2007 and March 2009, including 66 cases with platelet count <15×10⁴/μl. Unlike hemolytic disease of the newborn, the majority of cases occurred in the first pregnancy. Neither the mother's history of previous pregnancies or blood transfusion, nor past history was significantly correlated with the detection rate of anti-platelet antibodies. Gestational age, body weight, and platelet count of the newborn at birth were not significantly correlated with the development of intracranial bleeding of the affected newborn. The specificity of the detected antibodies was as follows: anti-HLA antibody only in 29.2%, anti-HPA antibody in 17.6%, and none in 47.9%. The cross-matching test of anti-HPA-positive sera was positive in all case. Among HPA antibody, the most frequent was HPA-4b antibodies, followed by HPA-5b antibodies.

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A nationwide questionnaire survey on transfusion medicine was carried out in both 2005 and 2008 to investigate transfusion management systems and blood product use in Japan. Most (more than 80%) of domestic transfusion of blood products was performed at hospitals with 300 beds or more. Red blood cell, fresh frozen plasma and immunoglobulin consumption showed little change between 2005 and 2008, while platelet consumption increased by 18.9% in this period. On the other hand, albumin consumption showed a clear tendency to decrease. In Chiba and Tokyo, use of red blood cells and fresh frozen plasma was high, while use of platelets in Hiroshima was high in both 2005 and 2008. Albumin use was high in Kumamoto and Nagasaki, while immunoglobulin was high in Niigata and Okinawa. Use of transfusion management systems, that is, a unified and centralized transfusion system, appointment of a transfusionist and laboratory technologist responsible for blood transfusion, 24-hour transfusion testing system, and establishment of a transfusion committee tended to improve. The 2008 investigation showed an improvement in transfusion management systems and the proper use of blood products.

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[in Japanese]

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