A 58-year-old man was admitted to our hospital because of cerebral hemorrhage. Blood type testing on admission with the automated instrument AutoVue Innova^® showed weak reactivity to anti-D, indicating the possibility of weak D or partial D. Further examinations using anti-D polyclonal and monoclonal antibodies showed a similar reactivity pattern as for the partial D category DBT phenotype.
The genomic DNA analysis by polymerase chain reaction with RHD exon-specific primers revealed no amplification of exons 5 to 7, and the following cDNA analysis suggested exons 5 to 7 of the RHD gene were replaced by RHCE equivalents. Thus, the patient was identified as DBT-1 (RHD-CE (5-7)-D).
Reactivity of the anti-D by column agglutination technology is generally strong compared to that of the tube method. It is therefore important to keep in mind the possibility of weak D or partial D if the reactivity of the anti-D by column agglutination technology is weaker than 3+.

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We report two elderly patients aged over 80 years who developed serious complications (acute circulatory failure and loss of consciousness) after autologous blood donation. In the first case, it appears that acute circulatory failure was caused by decreased circulatory blood volume after the collection of autologous blood. In the second case, the patient apparently developed postprandial hypotension after the meal subsequent to autologous blood collection, which led to the loss of consciousness. For elderly patients, age-related factors must be taken into account, such as decreased circulatory blood volume, hemodynamic changes and deterioration of blood pressure-regulating mechanisms. Thus, when collecting autologous blood from elderly patients, it is necessary to monitor for not just the vasovagal reflex (VVR) but also side-effects, as reported in these cases. Elderly patients aged over 80 years are considered to be at particularly high risk of developing complications resulting from autologous blood donation.
Safe collection of autologous blood from elderly patients therefore requires the establishment of criteria, such as reducing the volume of blood collected or not permitting the procedure to be performed on patients over 80 years of age. At the same time, a management system that allows hospital staff performing autologous blood collection on elderly patients to adjust the volume of blood requested by physicians according to patient condition is required.

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In October, 2009, a survey regarding albumin products was urgently conducted. From the responses, an analysis was conducted on the transition to the use of domestically produced human albumin solution (HAS) versus imported blood products, which included the effect of DPC (Diagnosis Procedure Combination) or IC (informed consent) on the use of drug formulations. Further, methods for increasing the rate of self-sufficiency were reported. At 5% HSA, the ratio of domestically produced blood products in 2008 was low, at approximately 28%, and decreased by about 1% in 2009. At 20% or 25% HSA, the ratio of domestically produced blood products in 2008 was relatively high, of 86% for the former and 77% for the latter, with the former decreasing to 81% in 2009 and the latter increasing to 79%. In regard to the influence of the introduction of DPC, the average rate of self-sufficiency for albumin products was lower in hospitals where DPC was introduced than in non-DPC hospitals. Although more than 90% of facilities conducted IC for albumin administration, only about 20% of facilities provided information regarding the country of origin of the raw materials and whether they were from non-remunerated blood donation or remunerated blood collection. In hospitals which did conduct IC regarding the raw blood materials, the usage rate of all types of domestically produced blood products was high. On the other hand, only 7% of facilities used both domestic and imported blood products at formulations of 5% and 25%. These findings suggest that IC regarding the source of raw blood materials will be effective in raising the rate of self-sufficiency of albumin products. To improve effectiveness, however, it is also necessary to make efforts in each facility to expand choices for blood products.

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Peripheral blood stem cell harvest (PBSCH) is recommended to be done using a dialysis central venous catheter (dCVC) to maintain constant high blood flow rates. We retrospectively evaluated PBSCH with standard CVC (sCVC) in a total of 36 patients with hematopoietic malignancy and 74 aphereses. All catheters (standard double-lumen, 7Fr or 12G) were inserted into the subclavian vein prior to mobilization chemotherapy in order to minimize CV-related bloodstream infection and bleeding/hematoma during thrombocytopenia. Median period from CVC insertion to collection was 25 days. Specta (COBE) was used for all aphereses. Result shows that the median blood volume processed was 8.8l(range, 3.2-10.9) and median flow rate was 48.5ml/min(range, 20.9-64.6). Poor mobilization was shown in six patients (16.7%). The median number of CD34+cells harvested per apheresis and per patient were 1.1×10⁶/kg (range, 0.1-16.7) and 3×10⁶/kg (range, 0.8-26.8), respectively. CVC-related complications were infection (n=2) and thrombosis (n=1); reinsertion of the CVC and continuous PBSCH were successfully performed in all three cases. When inadequate blood flow during apheresis procedures (n=21) occurred, this was mostly resolved by reducing the blood flow rate and symptomatic therapies such as the use of a handgrip. In conclusion, PBSCH using long-term subclavian sCVC appears to be safe and effective.

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