A 79-year-old male suffering from gastric cancer with stomach and gall bladder resection exhibited severe anaphylactic transfusion reactions after administration of fresh frozen plasma (FFP). One month before these reactions, he had received 800ml of MAP treated whole blood. An antibody of IgG class against the fourth complement component (C4) was detected. Phenotype determination of the patient's C4 group showed that he was Chido-positive and Rodgers-positive.
The patient did not have detectable anti-IgA, anti-C9, anti-haptoglobin, anti-ceruloplasmin or anti-α2-macroglobulin antibodies. Given the presence of IgG alloantibodies against complement C4 and low plasma levels of C3 and C4,activation of the complement system might be a major mechanism for post-transfusion anaphylactic reaction in this case. In addition, IgE antibody and eosinophilia were detected and an increase in serum tryptase concentrations released from mast cell granules was demonstrated, which might suggest the generation of anaphylatoxin (C3a,C4a,C5a) or the interaction of allergen with IgE receptors.

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A 37-year-old woman underwent blood examination for screening in pregnancy at 10 weeks of her first pregnancy. The irregularity test for antibodies was negative. She experienced premature rupture of membranes and pain, and was hospitalized at 40 weeks. The fetal heart rate fell as low as 70 per minute during labor, and engagement of the head became poor. The baby was delivered with a vacuum extractor. After delivery, massive bleeding continued and the patient developed hemorrhagic shock. However, although blood pressure rapidly recovered following aggressive treatment, bleeding continued. She was given an emergency transfusion of 6 units of RCC and 4 units of FFP, which requires examination for compatibility (saline method). Thereafter, blood samples of transfused and newly ordered RCC were examined for compatibility (PEG-IAT), all of which turned out to be positive. Further examination showed that the patient was Jr^a-negative. As Jr^a-antigen is highly common in Japanese, Jr^a-negative women are often sensitized by Jr^a-positive fetal RBCs and produce Jr^a-antibody during pregnancy. In such cases, hemolytic manifestations may be observed after usual transfusion. Fortunately, the patient recovered soon without prolonged hemolytic symptoms or signs. The present case showed that irregular testing for antibodies might be required, even in the later stage of pregnancy as well as in the early stage.

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We analyzed the effect of deferasirox (DFX) therapy in 73 patients with a nonelective need for blood transfusion. Median age was 67 years (20-89). Median observation period was 182 days (19-428). Among 73 evaluable patients, 3 were able to discontinue DFX after achieving a predetermined treatment goal (SF<500), 19 had significant decrease in SF, and 17 failed to show significant response. Among 36 patients who were able to continue DFX for more than 6 months, serum ferritin (SF) levels were decreased by an average of 103ng/ml per month. In contrast, 17 patients (23.3%) discontinued DFX because of adverse effects, including digestive organ symptoms and renal function abnormalities. There were difficulties in sufficiently increasing the dose of DFX because of adverse effects. In order to fully perform chelation therapy with DFX, it is important to start administration of DFX from a low dose at an early stage of iron overload.

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In the survey conducted in 2011, among the 10,428 Japanese institutions receiving blood supply from the Japanese Red Cross Blood Center (JRCBC) (except the 4 provinces from eastern Japan affected by the Tohoku earthquake), the 4,322 institutions, which replied to the questionnaire, were enrolled. Concerning the establishment of the blood management system, except for the appointment of the responsible transfusionist, more than 90% of the large institutions (more than 300 beds) had good achievements. However, among the small institutions (less than 300 beds), the achievement rate ranged 50-70%, and no significant improvement was observed in the last 3 years. In especial, the appointment rate of the responsible transfusionist was as low as 51.8%. The number of blood products used per number of beds was almost unchanged, or slightly increased, in the fiscal year 2011. Concerning the implementation of the computer system for the safety of blood transfusion, the mobile terminal was available in 69.17% of the large institutions, with the rate of utilization higher than 80%, whereas in small institutions, both rates were below 20%. Among the 4,322 institutions, 50.8% had used more than 10 units of red cell concentrates (RCC) per day, and about 15.95% of the total RCC, and 28.58% of fresh frozen plasma (FFP) supplied by the JRCBC were used in these institutions. About 60.83% of the human hepatitis B immunoglobulin, a product with a national self-sufficiency ratio of 2%, and indicated for the prevention of hepatitis B infection in cases of accidental blood contamination or materno-fetal transmission, was used for the prevention of hepatitis infection after liver transplantation.

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