Emm is a high-frequency antigen classified as the blood group system of the ISBT 901 series. Although eight cases of anti-Emm have so far been reported overseas, none were transfused; thus, its clinical significance remained unknown, and the antibodies may be "naturally-occurring". Moreover, there have been no such reports in Japan. We encountered the first case of a Japanese patient (58-year-old, man) with anti-Emm who developed an acute hemolytic transfusion reaction caused by crossmatch-incompatible RBCs. In this case, anti-Le^a was identified in the patient's plasma by pretransfusion testing as one of his irregular antibodies. One bag of crossmatch-incompatible Le (a-) RBCs had to be transfused. Thirty minutes after transfusion, his blood pressure had dropped, and hemoglobinuria was observed. However, he was subsequently transfused with an additional two bags of RBCs on the same day, and he was further transfused with one more bag of RBCs three days later, without any hemolytic transfusion reaction. On the sixth day, after the transfusion of 30 ml of RBCs, the patient vomited, and his urine was cola-colored; the transfusion was then stopped. Thereafter, anti-Emm was identified by further examinations. This case suggests that anti-Emm may be clinically significant and considered to be a "naturally-occurring" antibody.

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In the survey conducted in 2014, among the 10,802 Japanese medical institutions receiving blood supply from the Japanese Red Cross Blood Center, the 5,434 institutions that responded to the questionnaire, were enrolled, representing a response ratio of 50.66%, the highest result in the past 7 years. Of the total supply from the Japanese Red Cross Society, 74.50% of the red blood cell products, 81.47% of the platelet concentrate, and 77.98% of the freshly frozen plasma were able to be investigated. Institutions authorized to impose the blood transfusion management charge I and II increased in 472 and 1,189 institutions, respectively. In addition, 1,159 institutions were able to impose the blood transfusion proper use addition (26.2%). The number of transfused patients is predicted to be 10% down in total, 22.3% in autologous blood, and 8.7% in donated blood, compared with the previous fiscal year. Only immunoglobulin products consumption increased this year. The amount of blood products consumed per one sickbed showed large variation by each prefecture, suggesting the need to strengthen cooperation between combined blood transfusion therapy committees in each prefecture in order to assess success rate for proper blood transfusion.

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A 66-year-old man was admitted to this hospital for light-headedness, loss of consciousness, and right-sided thoracic hematoma. On arrival in the emergency department, prothrombin time (PT) and PT-international normalized ratio (INR) were prolonged (PT, 81.0 s; PT-INR, 6.30). The prolonged activated partial thromboplastin time (APTT) (158.2 s) and abnormal cross-mixing test results revealed the possibility of an acquired inhibitor against a common coagulation factor after admission. He was diagnosed as a severe acquired factor V inhibitor by identification of factor V inhibitor (0.69 Bethesda unit/ml) with decreased activity of factor V (0.6%). Iliopsoas muscle hematoma had progressed during administrations of fresh-frozen plasma. High-dose intravenous methylprednisolone pulse therapy with a subsequent tapering dose of oral prednisolone and several platelet transfusions dramatically ameliorated coagulation abnormalities and intractable hematoma. Although 50% decreased activity of factor V was transiently detected, the patient has sustained remission with no fluctuation in PT and APTT test results and has had no recurrence of hemorrhagic tendency in the 7 years since treatment. Potent immunosuppressive therapy and platelet transfusions could be an effective strategy for treating acquired factor V inhibitor with severe hemorrhagic manifestations.

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Bacterial infection through blood products is a rare and severe side effect. An eight-year-old boy with recurrent acute myeloid leukemia underwent umbilical cord blood transplantation. Forty minutes after initiation of platelet concentrate (PC) transfusion, fever, chill, shivering, vomiting, and headache occurred, although we confirmed swirling before blood transfusion. He further experienced decreased blood pressure, tachycardia, and oxygen desaturation. Blood transfusion was discontinued immediately, and then antibiotics, immunoglobulin, cardiovascular agents, and steroids were administered. His symptoms recovered three days after onset. He was diagnosed with septic shock due to PC contamination with Escherichia coli (E. coli) because his symptoms developed within 4 hours of initiation of transfusion and because the same E. coli strain was identified in the peripheral blood of the patient and in the PC specimen on serologic and genotypic testing. In the last decade in Japan, no E. coli-related infections have developed although 8 cases have suffered bacterial infection after PC transfusion. E. coli is likely to produce serious symptoms, since some patients have died from this pathogen in other countries. These findings suggested that we need to identify the pathogen promptly and provide appropriate treatment if symptoms suggestive of bacterial infection develop.

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