Background and Aim: It is important for the effective usage of blood products (BP) to reduce abandonment. The aim of this study was to evaluate effects by our Department of Blood Transfusion (DBT) to reduce abandoned BP over ten years (1998-2007).
Results: The main causes of abandoned BP were 1) unused BP after delivery from the DBT to the operating room, wards, or outpatients, 2) expiration, 3) death of patients who were allocated to receive blood transfusion, and 4) breakage of BP packages. Classifying the causes into four factors, namely 1. doctors, 2. nurses, 3. patients, and 4. technologists, medical appliances and blood center, the number of cases of abandoned BP due to doctor-related factors was largest.
Sixteen measures for reducing abandoned BP were developed, which included preceding reconfirmation of patient condition and laboratory data by the DBT, adequate amount of BP stored in the DBT, and sufficient communication between doctors and technologists of DBT on emergent blood transfusion. As for red cell concentrates, the frequency of assignment and/or restoration to the DBT decreased during the 10-year period, which reduced BP expiration. The ratio of abandoned to total BP was 0.24% in 1998, and was decreasing to 0.06% in 2007.
Conclusion: Measures to reduce abandoned BP due to expiration, encouragement of doctors to better understand blood transfusion, sufficient communication between doctors and technologists on emergent blood transfusion, and precautions against breaking the BP package can decrease abandoned BP.

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Background and objectives: The appropriate usage of albumin is expected because the ratio of self-sufficiency of the albumin products is as low as ever. Since we cannot evaluate the appropriate usage of albumin by the numerical parameters unlike other blood products, it is difficult to correct the inappropriate usage.
In this point, we had been promoting appropriate usage for years. Hereby, we investigated the effect of these promotions.
Methods: Since April 2005, we performed four promotions one after another, 1) thoroughness in evaluation before administration, 2) clarification of administrating grounds, 3) warning against inappropriate use, 4) promotion to assessment of albumin products. We compared the consumption of albumin in these period with that before promotion.
Results: The ratio of tests on serum albumin level before/after administration increased from 70.6/47.1% to 100.0/99.4%. The ratio of over 3.0g/dl of serum albumin level before administration of hypertonic albumin decreased from 14.6% to 2.3%. On the contrary, the ratio of below 2.5g/dl of that increased from 39.6% to 83.2%. The ratio of continuous hypertonic albumin administration over four days gradually decreased from 27.8% to 4.6%. The average dose of hypertonic albumin per patient per month decreased from 65.0g to 51.0g.
As a result of appropriate use, the ratio of reduced assessment by health insurance union improved from 11.9% to 2.8%, and the ratio of volume of albumin/volume of red cell products improved from 2.56 to 1.72.
Conclusion: We consider that the physician was concerned about appropriate use by the advice from Transfusion Committee and relative departments.
For the promotion of appropriate use of albumin, next five points were proved to be important, 1) presentation of concrete data of each patient, 2) pointing out the issue, 3) concrete presentation of the cases of inappropriate usage, 4) frequent contact with physicians, 5) close cooperation among related departments.

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Anhaptoglobinemia is one of the risk factors for severe anaphylactic transfusion reaction because the patient produces serum haptoglobin antibodies. The causal mutation of anhaptoglobinemia in Japan is the haptoglobin deletion allele (HP^del), and the frequency of HP^del homozygotes is estimated to be one out of 4,000 individuals. The clinical detection of HP^del before transfusion is important to prevent anaphylactic shock. In order to facilitate safe blood transfusion, we recently developed two rapid and simple methods for detection of HP^del, TaqMan probe- and SYBR green I-based real-time PCR, using diluted blood samples directly as templates. Both methods need only one tube per sample and about one and a half hours to obtain results. In this study, we evaluated these two methods for detection of HP^del in patients who were scheduled for blood transfusion at Kurume University Hospital. The genotypes of 2,954 patients as determined by the two real-time PCR methods from January 2009 to March 2010 were fully concordant, and 91 HP/HP^del and one HP^del/HP^del were detected. We can predict the results in real time by monitoring the raw data during the reaction and easily detect the HP^del/HP^del in many samples analyzed by a dual-scatter plot in the TaqMan-based method. This method seems to be suitable for high-throughput analyses such as detection before transfusion at large institutions or screening for HP^del in a large population study. On the other hand, the SYBR Green I-based method is appropriate for relatively small institutions due to its low initial cost and analyzability using economical real-time PCR machines.

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In polyagglutination, erythrocytes agglutinate with almost all samples of normal serum bue to erythrocyte expression of cryptic antigens caused by infectious disease or blood disease. There are many types and reasons for polyagglutination.
We report a fatal case of polyagglutination related to adult T-cell leukemia and Pseudomonas aeruginosa infection. A 53-year-old female patient had received a bone marrow transplantation from an unrelated donor as well as chemotherapy. She was admitted to our hospital because of back pain caused by lumber compression fracture. Eleven days later, she suddenly experienced cardiopulmonary arrest. She was resuscitated and admitted to intensive care unit. P. aeruginosa was detected by blood culture. In spite of intensive care, she died 9 days after admission. We observed non-specific agglutination in a minor cross-match test after P. aeruginosa infection. The patient's erythrocytes did not agglutinate with her own serum, but agglutinated with almost all serum samples of the same blood type. On analysis of the patient's blood sample at the Hiroshima Red Cross Blood Center, Tk polyagglutination was strongly suspected. We therefore conducted an additional test using a strain of P. aeruginosa cultured in the patient's blood sample. This strain was cultured and reacted with normal blood type O erythrocytes at 37°C. These erythrocytes reacted to blood type AB serum and agglutification was identified after 4 days. These results indicate that the agglutination was caused by the direct effect of erythrocytes of blood type O reacting with P. aeruginosa.

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We report a case of septic shock after transfusion of platelet concentrate (PC). The patient was a 69-year-old man receiving chemotherapy against acute myeloid leukemia. On day 12, his platelet count was 8,000/μl, so he was transfused 10 units of PC. At 15 minutes after starting PC transfusion, he complained of a nausea and dyspnea. Although there was no remarkable change in his vital signs, PC transfusion was stopped and he was observed carefully. At 40 minutes after PC transfusion, he had diarrhea, vomiting, and chills developed with high fever at 39.9°C. His systolic blood pressure and oxygen saturation suddenly decreased to 70mmHg and 74%, respectively. He was diagnosed with septic shock and antimicrobial treatment was started. After recuperation of his white blood cell count, he recovered without sequela.
Serratia marcescens was detected from all of the examined blood culture bottles, and on culture of a PC remnant. Both bacteria had the same DNA patterns in pulse field gene electrophoresis, suggesting that the septic shock was caused by PC contaminated with Serratia marcescens.
Because PC are stored under aerobic conditions at room temperature, the risk of bacterial contamination is high compared to other kinds of blood products. The introduction of ways to reduce this risk requires consideration, for example, routine bacterial screening, or the inactivation of pathogens in blood products.

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