The Bromcresol purple modified (BCPm) method for testing albumin (Alb) is superior to the Bromcresol green (BPG) method. The Alb in 592 specimens including cases administered hypertonic albumin products (hHSA) was measured using both methods. A multiple regression analysis including the A/G ratio showed r=0.98, and the BCG value varied more as the A/G ratio decreased, with a higher average value of 0.3 g/dl than that of BCPm. There was no difference in the average Alb value for both groups prior to administration with a BCG value of 2.0 g/dl converted to a BCPm value, and the hHSA dosage did not increase during the BCPm period. The average Alb value (BCPm) prior to administration during the 25% and 20% hHSA dosage period (102 cases and 113 cases, respectively) was 2.0 g/dl, with no substantial difference between the two, and the amount used was significantly less during the 20% stage (p<0.01). Comparing the groups based on the value (g/dl) prior to administration (group I: 1.2 to 1.6 [82 cases], group II: 1.7 to 2.1 [178 cases], and group III: 2.2 to 2.7 [118 cases]), there were no differences in the average value, median value, or IQR of the average number of days of initial successive administration within three days, with the average dosage showing significantly less in lower Alb values (<0.05). Although the overall mortality rate within one month was significantly higher in the cases with a lower Alb value prior to administration (p=0.03), there was no difference in the dosage between the death and survival group. During the investigation (April 2008 to March 2011), the HSA/RCC ratio was less than 2, the average Alb value prior to administration was 2.0 g g/dl, with more than 60% of all cases having a value of less than 2.2 g/dl. The amount of hHSA used for each case decreased from the initial dose of 67.2 to 37.9 g, but increased to 56.4 g in 2010, suggesting difficulty in warning clinicians when the Alb value prior to administration is 2.5 g/dl or more. The amount used may therefore be suppressed by setting the value to less than 2.2 g/dl prior to administration, continuing to use 20% hHSA, and evaluating all cases two days following administration, as well as by regularly recording the administration objective and effect in the medical records.

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The efficacy of blood transfusion in esophageal surgery has not been well documented. This report presents a retrospective analysis on postoperative outcomes of esophageal resection and effects of blood transfusion. Patients: A hundred and two patients (pts; 1994-2012) were entered in this study: mean, 64 years old; pathological stage (st) 0, 18 pts; st 1, 17 pts; st 2, 30 pts; st 3, 21 pts; and st 4,13 pts. Pts were divided into 4 groups (grp) by the use of blood products: no transfusion (grp A, 41 pts), fresh frozen plasma (grp B, 10 pts), red cell concentrates (grp C, 26 pts) and FFP+RCC (grp D, 22 pts). Results: Hb levels decreased shortly after operation to 68% of preoperative level. Levels recovered 2 weeks after operation in all groups. Odds ratio for postoperative complications was 0.182 in grp B and 1.621 in grp C (highest). Incidence of pneumonia was low in FFP-administered pts, and that of anastomotic leakage was high in grp C and D. Five-year survival rate was 72% in grp A, 88% in grp B, 41% in grp C and 73% in grp D. In stage 2, lowest survival rate of 46% was estimated in grp C. Poor survival was observed in pts administered RCC>4 U, no FFP and albumin>100 g. Survival rate significantly decreased (47%, others 64-77%) in pts with low postoperative lymphocyte count (<800 /μl), which was most frequent (55%) in grp C. Reduction of lymphocyte count after operation was related with albumin and intraoperative RCC. Postoperative lymphocyte count was related with postoperative FFP transfusion. Conclusion: Patients with low postoperative lymphocyte count had poor outcomes after esophageal surgery. The phenomenon appeared to be associated with blood products. Further study is necessary to confirm this phenomenon.

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Although serving as a local core medical facility and designated as an emergency and critical care center in eastern Nagano Prefecture, our hospital is located 90 minutes by car from the nearest regional blood center. To curb the discard rate of concentrated red cells (CRC) and determine the appropriate quantity of CRC in storage for emergency blood transfusion, we checked relationships among consumption at our major clinical departments, blood type-specific consumption, quantity of CRC in storage and that of CRC for disposal. We also checked relationships among massive blood transfusion (MBTF), urgent transportation of CRC, and short-term consumption of CRC in 2011. The blood type-specific discard rate rose in years when the quantity of CRC in storage exceeded three times the daily average rate of consumption, corresponding to three days in terms of the daily average rate of consumption. The weekly rate of consumption differed, depending on MBTF, and approximately 20% was consumed for MBTF. Emergency transportation was for MBTF in most cases. There were three cases for which ABO-mismatched compatible blood was used due to a lack of the same blood type. Not only the number of cases with MBTF but also that of cases for urgent transportation are in proportion to the frequency of blood types. Nevertheless, if a system allows use of ABO-mismatched compatible blood when the same type of blood is insufficient, the quantity of stock which offsets the average quantity of use, or the quantity enough for three days, should likely be sufficient until stocking is done as an emergency measure. Studies on relationships among daily average quantity of use, quantity of stock and rate of discard are considered useful in determining the appropriate quantity of stock which reflects each medical facility's scale and its function for the delivery of medical care.

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Anti-HLA antibodies is one of important factors which affect humoral rejection against graft as well as efficacy of platelets transfusion in allogeneic bone marrow transplantation (alloBMT). Here, we had a patient who produced anti-HLA antibodies following alloBMT. These anti-HLA antibodies was considered to be derived from the donor registered in Japan Marrow Donor Program, who had anti-HLA antibodies. The patient was male in 20-years generation. He was diagnosed as philadelphia chromosome-positive acute lymphoblastic leukemia in February 2009. He achieved remission after induction chemotherapy. He underwent BMT on July 31 in the same year. Anti-HLA antibodies was detected in the patient two months after that transplantation. These antibodies exhibited the same specific reactivity against HLA-A and B antigens as donor. It is important to observe the patient by checking these antibodies periodically. Because platelets play a major role in transfusion following alloBMT. Once anti-HLA antibodies is detected in a recipient, we should choose platelets not reacting with the antibodies of donor.

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We conducted a survey of the current state of autologous blood transfusion (ABT) by sending a questionnaire to institutes in Gunma Prefecture, Japan, that were supplied allogeneic blood products in 2011. Surveys were sent to 176 institutes, with 103 responding, for a response rate of 58.5%. Thirty-five (34.0%) institutes performed ABT in 2011. The median number of beds was 212, with a mode of 100-199 beds, suggesting that ABT was performed even in small-scale institutes as practice. Most institutes had prepared standard operating procedures for autologous blood collection, with 48.6% of institutes further having procedures for adverse events prepared. Phlebotomy was performed at outpatient clinics (48.6%) or hospital wards (25.7%) by doctors in charge (54.3%). Although most institutes considered oral iron supplementation, 26% selected intravenous injection first. Several institutes did not follow the revised guidelines for antiseptic methods. Collected blood was stored in blood transfusion centers or clinical laboratories managed by technicians, and 27.3% of institutes did not perform any testing before ABT. Overall, we were able to identify several points to be fine-tuned, including preparing procedures for adverse events and specifying the type of iron supplementation, antiseptic method, and compatibility testing at transfusion. To improve the quality of our ABTs, we must address these issues through activities of joint regional transfusion committees.

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Jra is a frequently detected red blood cell antigen known as antigen 901005 according to the ISBT nomenclature. The frequency of Jr (a-) is 0.065% among the Japanese population. We herein report a case of a bone marrow transplantation (BMT) recipient in whom donor-derived anti-Jra was detected on day 15 after BMT. The recipient, a male patient in his fifties, had chronic myeloid leukemia in the second chronic phase after a lymphoid blast crisis. He was group A, D+, and Jr (a+) and had no other irregular antibodies. The donor, a female patient in her forties, was group A, D+, Jr (a-) and had anti-Jr (a) antibodies. A total of 6 units of randomly selected red cell concentrate (RCC) was transfused on days 9, 11, and 14 after BMT. The direct globulin test of the recipient was negative before transplantation; however, it changed to positive on day 12 after transplantation. The irregular antibody test result subsequently changed to positive, and anti-Jra was detected on day 15. Based on this result, we used Jr (a-) RCC for the next 16 units of RCC transfusion. Clinically, there were no hemolytic adverse effects. His direct globulin test and irregular antibody test became negative on days 39 and 53, respectively. Although the clinical importance of irregular antibodies in BMT donors remains unclear, establishment of guidelines for blood product selection might be useful when BMT is planned from a donor with irregular antibodies.

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