Recently, the method used for massive transfusion has changed worldwide. We retrospectively reviewed 168 patients who underwent transfusion with more than 10 units of red blood cell concentrate (RCC) between January 2006 and June 2009 (1 unit=140ml [in Japan]). Of these patients, we studied 65 patients in particular; these patients had multiple injuries and had received moderate-to-massive blood transfusion with more than 10 RCC units within 24 hours of arriving at the hospital.
Hospital mortality of the patients with multiple injuries was 60%, and was independently associated with risk factors such as age, activated partial thromboplastin time (aPTT), and plasma fibrin/fibrinogen degradation product (FDP) value.
The 24-hour mortality rate of the group that was not transfused with fresh frozen plasma (FFP) was 90.0%. Mortality in the FFP: RCC ratio 0.5 or less group was 68.4%, but in contrast was 47.2% in the higher ratio group. These results suggest that the transfusion ratio is important with respect to initial transfusion treatment and that a separate protocol should be created at our hospital for massive transfusion.

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Bone marrow-derived mononuclear cells (BMMNC) include endothelial progenitor cells (EPC), which are characterized by their secretion of angiogenic factors such as vascular endothelial growth factor (VEGF) to recruit local endothelial cells, thereby enabling the establishment of new blood vessels. Implantation of BMMNC has been clinically used for therapeutic purposes in the treatment of critical limb ischemia (CLI); results showed that it was ineffective in a substantial number of cases. To evaluate the appropriate concentration of pyruvate to achieve the highest VEGF gene expression, cells were cultured with pyruvate at final concentrations up to 20mM in 5% CO₂ for 2-4 days. The intracellular concentration of pyruvate was measured enzymatically and cell number and viability were determined. Expression levels of VEGF genes and numbers of CD31⁺/CD34⁺ cells were evaluated. Finally, VEGF levels in the conditioned medium were examined in each condition. Pyruvate supplementation in murine BMMNC cultures successfully increased intracellular pyruvate levels in a concentration-dependent manner, and 5mM pyruvate was found to be the most appropriate to maintain viable cell number and up-regulate VEGF gene after 2-day culture. In addition, VEGF in the conditioned medium was significantly elevated by the use of 5mM pyruvate after 4-day culture. From these results, we suggest that preconditioning of BMMNC with 5mM pyruvate for 2 days may be a useful way to safely and inexpensively enhance the angiogenic properties of BMMNC and the therapeutic effectiveness of cellular therapy for CLI.

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Inappropriate albumin usage remains a grave problem at the Nippon Medical School Hospital despite directives from the Blood Transfusion Committee that all doctors use albumin appropriately. Therefore, the Committee for the Appropriate Administration of Albumin (CAAA) was established to regulate the usage of albumin and to reduce the amount of albumin used in clinical practice by active intervention. The present study was designed to ascertain the effects of active intervention by the CAAA on albumin usage. If patients were given more than 100g of albumin, their physicians were required to seek approval for their decision from the CAAA by lodging an application form for the proper usage of albumin. The application form contained the patient's background, the reason for albumin administration, the dosage of albumin needed, and the duration of administration. We studied the number of application forms submitted, and the amount of albumin used in each department and throughout the hospital. We also studied the outcomes of patients who received albumin in the Emergency and Critical Care Unit one year before and one year after active intervention by the CAAA came into effect. The average number of application forms submitted per month decreased from 14 to seven following active intervention by the CAAA, and the amount of albumin used was reduced by 55,668g per year. There was no difference in the number of deaths among patients who received albumin before and after active intervention in the Emergency and Critical Care Unit, even though the amount of albumin administered per patient was markedly reduced following active intervention. These results indicated that active intervention by the CAAA encouraged the proper usage of albumin in clinical practice.

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The Yamanashi Prefecture Joint Committee of Blood Transfusion Therapy, I&A Committee started an inspection program for transfusion medicine in 2006. The institutions under review were 10 small- and medium-sized hospitals, selected not on a voluntary basis but by designation by the Yamanashi Prefecture I&A Committee. Inspection revealed that items that "required improvement" were mostly concerned with blood type tests and the management of blood products for transfusion. Many items for which "improvement was desirable" were frequently concerned with the transfusion management system and the storage and management of products. A questionnaire on the state of improvement of problems recognized by the inspection program as requiring improvement showed that states of improvement varied among hospitals. Improvement was apparently hindered by such background factors as a lack of doctors responsible for blood transfusion and shortage of laboratory technicians. To standardize transfusion therapy and transfusion management procedures in hospitals and ensure equally safe and appropriate blood transfusion regardless of hospital size, it is necessary that the prefectural administration makes continuous efforts to tackle the problems identified with the goal of improving transfusion medicine in small- and medium-sized hospitals. It is hoped that in the future such small- and medium-sized hospitals will receive inspection and accreditation from The I&A Committee of The Japan Society of Transfusion Medicine and Cell Therapy.

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The Association of Transfusion Divisions of University Hospitals (ATDUH) was established in 1970 and has since held a meeting of its members every year. Currently, 90 university hospitals participate in the ATDUH. Major participants are doctors, medical technologists, and secretaries.
Representatives of the Ministry of Education, Culture, Sports, Science and Technology (MECSST), Ministry of Health, Labour and Welfare, and the Japanese Red Cross Society are welcomed to participate in the ATDUH. The 2011 meeting of the ATDUH was held in October. The ATDUH conducted a questionnaire survey before the meeting started to identify the status of faculty members in the transfusion divisions of university hospitals. Only 30% of faculty members were in a transfusion division, while the remaining were predominantly in other faculties and doubled as faculty members in the transfusion division. The status in the former was as follows: 48% professors, 29% associate professors, and 22% lecturers. The status of associate faculty members who were predominant in transfusion divisions, was 31% associate professors, 51% lecturers, and 17% assistant lecturers. An open discussion showed that the absence of faculty members in transfusion divisions meant that there was no leadership in transfusion medicine, and the presence of only one faculty member in the division meant that it was impossible to provide sufficient quality and quantity of education for transfusion medicine, transfusion practice, and succession planning. A representative of the MECSST prefaced his speech by apologizing for the introduction of management reform aimed at intensifying healthcare delivery in university hospitals, which was published in 2002. The ATDUH should attempt to promote both the development of transfusion divisions and improve the status of faculty members in the division.

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