[in Japanese]

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Serological differentiation of decreased red cell A and B antigen expression, seen in hematological malignancies, and serovars is difficult. I antigens that reside in the subterminal portions of oligosaccharides converted to A, B, H antigens can be analyzed with flow cytometry, and so agreement between the A and B antigens and expression dynamics is useful in diagnosing decreased A and B antigen expression due to hematological malignancies. The I antigen expression rate was investigated with flow cytometry in two patients with myelodysplastic syndrome and one patient with acute myeloid leukemia in whom A and B antigen abnormalities were seen. Results showed that it was significantly lower in all three cases than in healthy subjects. This suggests that analysis of I antigen with flow cytometry may help in diagnosing decreased A and B antigen expression.

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Precise evaluation of donor-specific HLA antibody (DSA) is essential because the existence of DSA is closely associated with poor prognosis in allogeneic transplantation of solid organs such as the kidney, lung, heart and liver, and in non-HLA-matched allogeneic hematopoietic stem cell transplantation. We experienced two patients whose high level of DSAs were underestimated by LABScreen single-antigen beads class I methods. In contrast, the DSAs were measured precisely by using LABScreen mixed beads methods, as well as flow cytometric crossmatch. Surprisingly, DSAs were measured precisely using single-antigen beads (SAB) assay when the patient sera were treated by heat (56°C, 30 minutes), ethylenediaminetetraacetic acid (EDTA) or dithiothreitol (DTT). These results suggest that complements inhibited binding of the secondary antibodies to the primary antibody (DSA) in the detection of DSA using SAB assay. Such inhibition was observed specifically when antibody titers were markedly high. We call the inhibition by complements "prozone-like phenomenon," and here propose that inactivation of complements in the test serum by treatment with EDTA is mandatory for the precise measurement of DSA using SAB assay.

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Cell-free and concentrated ascites reinfusion therapy (CART) has been applied for over 30 years in the treatment of patients with intractable ascites (or pleural effusion): collected ascites (pleural effusion) is filtered, concentrated, and reinfused intravenously into the patient. Since the purified ascites might be accidentally administered to other patients in large-scale hospitals, we decided to establish a computer-aided system, similar to that used in blood transfusion, to enable safer management by using bar-code labels.
We next examined biochemical properties, including total protein and albumin concentration, of ascites before and after filtration/concentration, and found that the mean recovery of albumin was 66.8%, and mean albumin content was 26.5±2.7g after processing.
We also introduced a rapid testing system for endotoxin, which enabled us to show that purified ascites does not contain harmful levels of endotoxin (over 0.1EU/ml). Finally, biochemical properties as well as endotoxin concentration were not significantly altered after storage either overnight at 4°C or for 14 days at -30°C, suggesting that it may be possible to perform CART after overnight storage in refrigerators or provide purified ascites after cryopreservation.
Since the present guideline suggests that albumin products should be avoided for end-stage patients, CART might be useful in cancer patients with intractable ascites in palliative care units.

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In this study, we combined an image monitoring system in operation rooms with a blood transfusion information system to understand clinical practice in operation rooms more precisely and strengthen the relationship between surgeons and hospital transfusion units. Members of the transfusion unit transported blood components directly to the operation rooms and adjusted transfusion practice in accordance with information provided by the system. We analyzed the amount and frequency of wasted red cell component (RCC), and compared them before and after adoption of the combined system. We also analyzed the amounts of RCC ordered, RCC used and RCC returned to the transfusion unit in cardiovascular operations. The number of cases with wasted RCC significantly decreased from 15 cases to 2 cases (p=0.002); the amount of expired RCC from 51 units and 3 units (p<0.001); and the frequency of expiration from 1.02% to 0.09%. The mean amounts of RCC initially delivered from the transfusion unit to cardiovascular operations in which 10 units or more RCC were used, decreased from 7.5 units to 6.7 units (P=0.020).
The combined system is effective in improving transfusion practice, decreasing expired blood, and establishing better cooperation between clinicians and the transfusion unit.

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In 2007, the amount in units of fresh frozen plasma (FFP) was modified. In FFP-LR-1 and FFP-LR-2, the new standards, the volume is 1.5 times that of the previous FFP-1 and FFP-2, respectively. However, despite the increased amount, orders for FFP are still made in "units" which although not an official unit has been used customarily. In our hospital, FFP consumption increased at the time of the dosage form modification and remained at the increased level despite our announcement about it to all staff members. Considering the possibility of unnecessary consumption, we started a system of counting each unit as 80ml, as we previously did before the dosage form modification, and adjusted the number of FFP units for dispensation according to the conversion. In order to examine the influence of the dosage form modification and amount adjustment, we measured and observed the amount of dispensed FFP and cost transition in three periods: before the dosage form modification, after it, and after amount adjustment. Average monthly consumption in each period was 14.24l, 23.87l, and 17.01l, respectively, indicating that the amount of dispensed FFP increased significantly after the dosage form modification (p<0.001) and decreased after the amount adjustment (p=0.014). The amount of dispensed FFP did not differ significantly between the periods after the amount adjustment and before the dosage form modification (p=0.086). Our attempt to solve the confusion caused by the FFP dosage form modification through amount adjustment in the blood transfusion laboratory resulted in decreasing the amount of dispensed FFP to be almost equal to that before the dosage form modification, suggesting that adjusting the amount of dispensed FFP by unit conversion is effective.

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For pregnant and nursing women who were screened for irregular antibodies at our center, the kinds of irregular antibodies, incidence of hemolytic disease of the newborn, and its treatment (fetal transfusion, exchange transfusion, neonatal transfusion, phototherapy, and immunoglobulin therapy) were tabulated and analyzed.
A total of 13,902 serum samples were screened for irregular antibodies between February 2003 and July 2011. Of these samples, 279 (2.0%) were positive for irregular antibodies (excluding cold antibodies). Eighty-nine (1.1%) of 8,251 women had irregular antibodies: 47 (52.8%), 19 (21.3%), 15 (16.9%), and 8 (9.0%) had antibodies to Rh, MNSs, other, and unidentified antigens, respectively. Of the 83 infants of these women, 21 (25.3%) required treatment, and 10 (12.0%) received fetal, exchange, or neonatal transfusion. The rate of treatment was significantly higher in the infants of mothers with anti-D antibodies or anti-Rh complex antibodies than in those of mothers with other irregular antibodies. In addition, the former group of infants more frequently required blood transfusion. The infants of mothers with anti-M or anti-Jr^a antibodies had severe hemolytic disease.

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[in Japanese]

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