Blood for exchange transfusion-Leukocytes Reduced, 'Nisseki' (BET-LR) is mainly used in emergencies for exchange transfusion in cases of neonatal hemolytic disease. However, recent consolidation of blood centers by the Japanese Red Cross may prolong the transportation time to hospitals, resulting in the expiration or reduction in validity of BET-LR.
Currently, we use a cooling centrifuge with a large-volume capacity, to which hospitals rarely have access, to prepare BET-LR. This limited access is considered to make it difficult for hospitals other than blood centers to prepare BET-LR independently.
We developed a simple method of preparing BET-LR with a quality equivalent to that of BET-LR and at 1/3 volume (reconstituted blood for exchange transfusion, R-BET). We were able to prepare R-BET outside of a clean room using a compact table-top centrifuge. Further, we were able to raise the hematocrit relatively easily by changing the volume of red cells concentrates-Leukocytes Reduced, 'Nisseki' (RCC-LR) and fresh frozen plasma-Leukocytes Reduced, 'Nisseki' (FFP-LR) to 55%.
The quality of the resulting R-BET was equivalent to that of BET-LR.
Our method of preparing R-BET is feasible for practical use, particularly during emergencies in hospitals.

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G-CSF-mobilized peripheral blood stem cells (PBSCs) are frequently used for autologous and allogeneic hematopoietic cell transplantation. Although the COBE Spectra^® Apheresis system has been commonly used, Spectra Optia^®, a novel automatic interface-controlled apheresis system, became available at Okayama University Hospital in July 2011. We retrospectively analyzed a total of 73 cases of apheresis, 49 performed with the COBE system and 24 with the Optia system, for 51 autologous and 22 allogeneic PBSC samples collected between January 2011 and June 2012. For autologous PBSCs, total product volume and RBC contamination of products were significantly lower in the Optia group than in the Spectra group. For allogeneic PBSCs, total WBC counts and platelet contamination, as well as total product volume and RBC contamination, were lower in the Optia group than in the Spectra group, despite MNC collection efficacy and CD34⁺ cell numbers being similar in both groups for autologous and allogeneic PBSCs. Automatic apheresis with the Spectra Optia system is patient- and user-friendly, and has a similar collection efficacy to that of the COBE Spectra system.

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Although subcutaneous injection of erythropoiesis-stimulating agent (ESA) is a convenient administration method, pain at the injection site remains problematic. Currently, two ESAs are available in Japan. Differences in pain have been observed between these two ESAs in several reports; however, most of the studies consisted of patients with renal failure.
To clinically determine important factors associated with pain after subcutaneous ESA injection, we conducted a single-blind clinical trial comprising autologous blood donors. Two ESAs were administered 405 times to a total of 203 patients. Both the Visual Analogue Scale (VAS) and the Faces Scale (FS) were used to measure perception of pain after ESA injection. The median VAS score was significantly lower in the epoetin β (EPOβ) group than in the epoetin α (EPOα) group, although a significant difference between groups was not seen on the FS. Multiple regression analysis for the VAS at first injection revealed that both ESA and sex were statistically significant factors for pain. Intriguingly, when the VAS score was compared among four groups that had been divided by sex and ESA preparation, the VAS score of females injected with EPOα was significantly higher than that of the other three groups. EPOα causes more severe pain than EPOβ, especially in females, although this difference in pain does not affect blood collection.

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Changes on the expression of Rh blood-group antigens have been observed when hematologic malignancies progressed. It is reported that mosaic uniparental isodisomy on chromosome 1 induces unusual Rh blood-group phenotypes, showing both RhD positive and RhD negative erythrocyte cell-populations. Here we report on the loss of E and c antigen-expressions during exacerbation of myelodysplastic syndrome (MDS), in which anti-E autoantibody was detected by indirect antiglobulin test (IAT) but not by direct antiglobulin test (DAT).
A 79-year-old Japanese female was admitted to our hospital to undergo a detailed examination and treatment of her pan-cytopenia in March, 2010. In the bone marrow abnormal erythroblasts were dominantly observed, and chromosomal analysis revealed complex aberrations, including monosomy 19, and trisomy 21. She was diagnosed with MDS (RAEB-1). Periodical transfusion was selected for medical treatment because of her advanced age. On first admission, the examination on blood cell type proved to be B type RhD positive, and antibodies to red blood cells were negative by IAT. On the 55th day after first admission, anti-E was detected by IAT; however, DAT was negative. At that time, reactivity of patient red blood cells was (w+^mf) to both anti-E and anti-c. On day 83, anti-c was also detected by the Bromelin method. There was no abnormality in the short arm of chromosome 1 although many chromosomal aberrations were detected in her marrow cells with the G-banding method. Moreover, RHCE gene analysis of the day-55 sample showed normal RHC, RHc, RHE, and RHe with PCR-SSP, which showed that this phenotype was R₁R₂ (CcDEe).
These results indicate that decrease expression of E and c antigen is associated with the exacerbation of MDS in our patient.

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Third-party inspection and accreditation (I&A) systems were pioneered by the American Association of Blood Banks (AABB) to assess quality and operational systems in facilities, in an effort to improve the safety of collecting, processing, testing, distributing, and administering blood and blood products. The Tohoku branch of the Japan Society of Blood Transfusion (then JSBT, now JSTMCT), established a regional I&A system in 1998 to improve transfusion safety in accordance with new guidelines from the Japanese Ministry of Health and Welfare (now the Japanese Ministry of Health, Labour and Welfare). In 1999, JSBT created a national I&A subcommittee (under the Institutional Accreditation Committee) to oversee regional I&A activities, thus bringing regional efforts to national standards. Here, we report the Tohoku experience under local and national leadership from the 1990s forward. Encouraging hospital participation and providing adequate training for inspectors are among the challenges faced over the past 20 years. Nevertheless, attention to details in the present must be accompanied by continuous improvement for the decades ahead.

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The following three practices in a blood center were attempted to increase blood donation in an aged society with a low birth rate: blood center-delivered lectures to schools, experience of training physicians as staff of a blood center, and improvements of work efficiency in the blood center. Blood center-delivered lectures to schools dramatically increased the motivation for blood donation by the students. Experience in training physicians as staff of a blood center was beneficial to their understanding of the blood donation system and efficient use of blood products. Improvement in work efficiency in the blood center was attained by specialization of 400ml donation, a blood collection plan to meet demand, and an increase in the utilization rate of blood donation per bus. These practices were considered as key factors in blood donation reform.

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In the survey conducted in 2012, among the 11,348 Japanese institutions receiving blood supply from the Japanese Red Cross Blood Center (JRCBC), the 4,812 institutions, which responded to the questionnaire, were enrolled. Except for the appointment of the doctor responsible for the management of transfusion, more than 90% of the large institutions (more than 300 beds) achieved the establishment of blood managing system. In cases of small institutions (less than 300 beds), however, only 50 to 70% of them achieved it and no significant improvement was observed in the last 5 years. Especially, the appointment rate of the doctor responsible for the management of transfusion was as low as 50.3%. Compared to the fiscal year 2008, the number of red blood cells, platelets products and fresh frozen plasma (FFP) used per number of beds in the fiscal year 2012 has increased by 15.6%, 21.5% and 30.1%, respectively. 2-5 times regional variations in the amount of blood product usage (red blood products by 2.1 times, platelet products by 4.1 times, FFP by 4.4 times, albumin by 4.1 times and IVIG by 5.1 times) was observed. It is an important issue to promote the establishment of blood managing system in the small institutions, which account for 90% of all transfusions, and is also critical to decrease the differences in the use of blood products between regional institutions.

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