[in Japanese]

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In this study, we investigated the current situation on how autologous and/or allogeneic blood is used to determine the appropriate preparation of a perioperative transfusion in cardiovascular surgical procedures. In our institution, 2,601 cardiovascular surgical procedures were performed from September 2003 to March 2013. The use of both allogeneic and autologous transfusions was investigated in the following patient groups: those who had undergone coronary artery bypass grafting (CABG), off-pump CABG (OPCAB), valve replacement or plasty (VALVE), graft replacement for thoracic aortic aneurysm (TAA), graft replacement for acute aortic dissection (AAD), graft replacement for abdominal aortic aneurysm (AAA), and ruptured AAA. We made a comparison between the allogeneic and non-allogeneic groups regarding the factor of transfusion. We also analyzed the appropriate dosage of each blood transfusion, which included the surgical blood order equation (SBOE) and maximum surgical blood order schedule (MSBOS). Factors of transfusion were blood loss during surgical operation, ratio against total blood volume, and hemoglobin level before operation. In our institution, we suggest the following blood transfusion strategies for cardiovascular surgery: 1. For OPCAB and AAA, only intraoperative blood collection (IBC) should be prepared. For CABG and VALVE, acute normovolemic hemodilution (ANH) and IBC should be prepared. Anemic cases require preparation in accordance with SBOE. 2. For TAA, it's possible to avoid an allogeneic transfusion with a preoperative autologous blood donation (PABD) and ANH. Anemic cases require preparation of allogeneic blood in accordance with SBOE. 3. For AAD and ruptured AAA, preparation should be done in accordance with the MSBOS. In addition, anemic cases require preparation of allogeneic blood in accordance with SBOE.

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In ABO-incompatible living donor liver transplantation (LDLT), antibody-mediated rejection (AMR) due to anti-ABO antibodies plays a critical role on the outcome of the transplantation. Recently, rituximab has been used for the prophylaxis of AMR. From the viewpoint of transfusion medicine, we retrospectively evaluated the effect of rituximab prophylaxis on the amount of FFP used in plasma exchange (PE) for anti-ABO antibodies in ABO-incompatible LDLT. A total of 17 patients were divided into 3 groups: Group I (8 patients, no prophylaxis), Group II-1 (3 patients, rituximab prophylaxis one week before transplantation), and Group II-2 (6 patients, rituximab prophylaxis 2 weeks before transplantation). In Group I, 5 of 8 patients showed elevated anti-ABO antibody titers after LDLT compared with before, while in Group II, no patients showed any elevation. PE was performed after LDLT in 4 of 8 patients in Group I and 2 of 3 patients in Group II-1, and the average amount of FFP used for PE was 122 units (1 unit of FFP in Japan is 120 ml) and 187 units in Groups I and II-1, respectively. In sharp contrast, PE was not performed in any Group II-2 patients after LDLT. Our data suggest that rituximab prophylaxis 2 weeks before LDLT may be effective in reducing the amount of FFP used in ABO-incompatible LDLT.

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Accurate enumeration of CD34⁺ cells is crucial for peripheral blood stem cell transplantation. However, there is currently no standardization or external quality control of CD34⁺ cell enumeration technics in Japan. To assess data variability among laboratories, we quantified CD34⁺ cells isolated from the same fresh peripheral blood stem cell samples at six expert laboratories on the same day that they were harvested from patients. The coefficient of variation was less than 25%, and data from all laboratories were closely correlated. However, data obtained from one laboratory were significantly lower than data from other laboratories. Inappropriate methods of erythrocyte lysis and cell washing-rather than non-ISHAGE gating or dual platform methods-may have caused these significantly lower counts. However, expected results were obtained when fixed control cells were enumerated. External quality assessment using appropriate samples and standardization of methodologies for CD34⁺ enumeration are important for reducing inter-laboratory variation in results.

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[in Japanese]

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