Background: Cold-reactive antibodies such as anti-M, anti-N, anti-P1, anti-Le^a and anti-Le^b, are usually active at cold temperature. Although these antibodies are not considered clinically significant in body temperature, few systematic studies on such cold-reactive antibodies have been reported in Asian populations. Matched (i.e., antigen-negative) red blood cells have been rarely selected and transfused to patients who have a cold-reactive antibody in Japan.
Aim: We conducted a collaborative study to clarify whether cold-reactive antibodies such as anti-M, anti-N, anti-P1, anti-Le^a and anti-Le^b can cause hemolytic transfusion reactions in patients.
Methods: From April 2007 to March 2011, screening of cold-reactive antibody in recipients who were transfused with randomly selected red blood cells was routinely tested. Antigens of transfused red blood cells were retrospectively determined. Recipients transfused with antigen-positive red blood cells against cold-reactive antibody were followed-up by measuring markers of hemolysis, particularly serum lactate dehydrogenase (LDH), alanine transaminase (ALT), and total bilirubin, to determine whether hemolytic reaction had occurred after transfusion.
Results: 55 patients with positive cold-reactive antibodies received 79 blood transfusions with antigen-positive red blood cells. Among 18 anti-M, 13 anti-P1, 16 anti-Le^a, 31 anti-Le^b and 1 anti-Le^a+b recipients, no patient developed clinically significant hemolysis.
Conclusion: These results support the idea that patients having cold-reactive antibodies can be transfused with antigen-positive red cells without any side effects. However, studies with more cases are needed to draw a concrete conclusion.

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The Fukushima Prefectural Joint Committee of Blood Transfusion Therapy was established for the purpose of promoting safe blood transfusion and proper use of blood products in 2007, based on the nucleus of the Fukushima Friendly Meeting on Transfusion established in 1988. Since 2007, we have undertaken a variety of activities in transfusion medicine, including the Fukushima blood transfusion therapy social gathering, autologous blood transfusion training, blood transfusion educational study session for nurse, transfusion medical care workshop, discussion meeting for proper blood transfusion, and questionnaire surveys about blood transfusion. To improve transfusion therapy and transfusion safety, the joint committee has contributed by educating various staff about transfusion medicine and by exchanging experiences and information with each other. The committee is making progress in transfusion therapy in Fukushima Prefecture with cooperation between physicians, medical technologists, nurses, pharmacists and administrative officers.

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Organ transplantation from brain-dead donors has become increasingly common since the organ transplant law was revised in July 2010. The revision led to a 6-fold increase in the procedure in Tohoku University Hospital in 1 year and transfusion requirements at the time of organ transplantation have been expanding. The transfusion records of sixty recipients undergoing organ transplantations in Tohoku University Hospital for 11 years (January 2001 to December 2011) were reviewed.
The average number of units of red cell concentrates, fresh frozen plasma, and platelet concentrates used were 14, 16, and 12 in 26 single-lung transplantations, 64, 52, and 50 in 14 double-lung transplantations, 39, 33, and 34 in 5 heart transplantations, 7, 4, and 0 in 5 simultaneous pancreas-kidney transplantations, 9, 13, and 7 in 7 small intestine transplantations, and 97, 102, and 37 in 3 liver transplantations.
In the cases of two or three organ transplantations on the same day, double-lung transplantation, and liver transplantation, a large amount of blood products were needed. Characteristically, about a half of the organ transplantations were performed on weekends and national holidays. These data suggests that it is important for the transfusion service to develop surgical blood order schedules and to prepare blood products for use in organ transplant procedures from brain-dead donors in close communication with the surgical departments as well as the blood center.

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