Platelet transfusion to neonates is usually not performed directly from a transfusion bag, but by syringe. We examined the effectiveness and safety of platelet transfusion by syringe.
Changes in oxygen and carbon dioxide concentration, lactate, pH, glucose, and platelet aggregation were examined for four types of apheresis platelet preparation: agitated at room temperature (apheresis bag), transferred to a separation bag and agitated at room temperature (separation bag), drawn into a syringe and agitated at room temperature with the addition of air (air-added syringe), and drawn into a syringe and allowed to stand at room temperature with air removed (air-removed syringe).
No changes were observed between the apheresis bag and separation bag even after 6 hours. Oxygen concentration in the air-removed syringe was significantly decreased after 2 hours. Carbon dioxide concentration in the air-removed syringe was significantly increased after 4 hours, lactate was increased, and pH, glucose and platelet aggregation were decreased. With regard to the air-added syringe, changes could be prevented by agitation.
For neonatal transfusion, a separation bag is considered to be an effective and safe method. Transfer of small amounts to a bag for transfusion is therefore desirable.
This study reports on in vitro effects only, and in vivo effects should be reviewed with respect to post-transfusion survival and recovery rates in order to make clinical decisions.

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Platelet (PLT) products are continuously agitated during storage to ensure preservation of their in vitro and vivo properties. However, PLT products cannot be continuously agitated during shipment. Furthermore, in the case of hospitals with no agitator, a delay in the start of injection of PLT products caused by an emerging change in the condition of a patient may prolong the period of agitation interruption. Here, we studied the effect of a 72-hour interruption of agitation on the in vitro properties of PLTs washed with M-sol.
The washed PLTs, which were stored in a polyolefin bag on an agitator, were divided into two equal aliquots (control and test groups) on Day 1. The test group was removed from the agitator and placed for 72 hours on a laboratory bench. Both groups were sampled on Day 4.
The MPV, %disc, CD62P (%), aggregation, and %HSR values of the test group were not significantly different from those of the control group on Day 4, whereas the pH, pCO2 and lactate values were significantly different.
These results indicate that the effect of a 72-hour interruption of agitation on the in vitro properties of washed PLTs was not particularly marked.

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RhoD (+) fetuses or newborns of women with anti-D frequently show serious hemolytic disease. We report herein a RhoD(+) newborn from a RhoD(-) woman who developed hemolytic disease of the fetus and newborn and describe the time course of the ratio between RhoD(-) and RhoD(+) erythrocytes after exchange transfusion (ET). Her fetus showed no serious complications without treatment, despite markedly increased titers of anti-D in plasma up to 1: 2,048 at birth. However, because total bilirubin and hemoglobin levels deteriorated immediately after birth, high-dose immunoglobulin administration, phototherapy, and ET were performed and proved successful. We administered a mixture of O-type RhoD(-) red cell concentrate and AB-type RhoD(+) flesh frozen plasma for ET. Flow cytometric analysis showed that most erythrocytes in the newborn were substituted for transfused O-type RhoD(-) red blood cells immediately after ET. The ratio of RhoD(+) erythrocytes then increased daily, in contrast to RhoD(-) erythrocytes, which disappeared by 86 days after ET. The half-life of transfused erythrocytes was approximately 36 days, suggesting that manipulated erythrocyte products show a half-life comparable to that of erythrocytes in healthy adults.

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We experienced a case of Evans syndrome with rapid and severe hemolysis due to mixed-type autoimmune hemolytic anemia (AIHA) and conducted an autoantibody assay for red blood cells (RBCs).
AIHA is characterized by autoantibody production against self RBCs, and is classified by the optimal temperature at which the antibodies react to the RBCs. Classifications of AIHA include warm-type AIHA, cold-type AIHA, paroxysmal cold hemoglobinuria, mixed-type AIHA, and drug-induced AIHA.
The patient was a 70-year-old woman who was admitted to our hospital on October 11, 2009 for general debility and numbness of the limbs. On admission, physical examination showed jaundice and anemia but enlargement of the liver and spleen were not observed. The blood exam showed a hemoglobin level of 4.7g/dl, hematocrit of 13.7%, reticulocyte count of 47.6‰, and platelet count of 11,000/μl. Blood chemistry tests showed a total bilirubin level of 3.24mg/dl, lactate dehydrogenase (LD) of 802U/l, and hemoglobinuria positive. The direct antiglobulin test was positive for broad spectrum (4+), anti-C3bC3d (4+), and anti-IgG (4+). In the antibody test, cold agglutinin was detected but specificity of anti-I or anti-i was not observed, and had a titer of 1 : 128 by the saline method at 4°C and 1 : 512 by the albumin method at 4°C. Three days later, the patient died of multiple organ failure due to severe hemolytic anemia.

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Background: To detect transfusion-transmitted viral infection, a blood test is performed 2-3 months after blood transfusion. Basically, this post-transfusion-transmitted infection test is promoted by informing patients about the test when the transfusion therapy procedure is explained. In addition, our institution uses two ways to provide the clinical physician concerned with information about the patient's transfusion history for possible further post-transfusion testing. The first is using the record of the patient concerned, and the second is using an alert signal function in the electronic medical record.
Purpose: To evaluate the efficacy of the two ways of providing information for post-transfusion testing.
Method: Patients transfused between January 2008 and September 2011 were studied (6,647 patients). The period was divided into three terms. The first term covered the time before patient records were transmitted. The second term covered the time during which patient records were transmitted, when relevant data from approximately two months after the blood transfusion were sent to the clinical physician every month. The third term covered the time when the electronic alert system was used as part of the electronic medical record. The rates of testing viral infection after blood transfusion were then calculated.
Results: The following rates of post transfusion testing for viral infection were obtained. HBV+HCV Test: First term, 21.6%; second term, 22.2%; third term, 39.7%. HBV+HCV+HIV Test: First term, 7.0%; second term, 8.2%; third term, 31.2%.
Conclusion: The alert system in the electronic medical record is effective for enhancing the rate of transfusion-related viral infection test administration.

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