The existence of maternal anti-A and/or anti-B antibodies has to be clarified in selecting ABO-blood type for red blood cell (RBC) transfusion in infants aged up to 4 months. In Okayama University Hospital, we have not had a standardized policy for ABO-blood type selection based on the results of assays for maternal anti-A and anti-B antibodies in patients. In this study, we retrospectively reviewed the data about selecting ABO-blood type for RBC transfusion in infants aged up to 4 months with anti-A and/or anti-B antibodies between April 2009 and March 2013.

There were 44 cases (14.2%) where maternal anti-A and/or anti-B antibodies were detected by indirect antiglobulin tests among 309 patients of blood type A, B, or AB aged up to 4 months. Blood type O was selected for 24 of the 44 cases, while the same blood type as that reported for the respective patients was selected 20 cases. Hemolysis was not reported in any cases, however, there were 17 cases of positive agglutination in back typing blood tests using the same patients' ABO-blood type by column agglutination technology. This back typing blood test by column agglutination technology that detected maternal anti-A and anti-B IgG antibodies might be useful for determining ABO-blood type for transfusion.

Peripheral blood stem cells (PBSCs) are generally collected using two peripheral venous catheters (PVCs): one for drawing blood and the other for returning processed blood. A single double-lumen central venous catheter (dCVC) can alternatively be used for PBSC harvest (PBSCH). It is occasionally feared that the processed blood might dilute the stem cell concentration in blood drawn using dCVC, decreasing CD34-positive cell collection efficiency. However, there are no obvious data suggesting that collection efficiency using dCVC is inferior to that using PVC. In this study, we defined [the number of collected CD34-positive cells (counts) ]/[the number of CD34-positive cells in peripheral blood (counts/ml) × processed blood volume (ml) ] as estimated collection efficiency and retrospectively evaluated the collection efficiency of 64 PBSCHs from 36 patients with hematological malignancies. The estimated collection efficiency using dCVC was not inferior to that using PVC. Therefore, PBSCH using dCVC is considered not to be inferior to that using PVC in terms of CD34-positive cell collection efficiency.

Fresh frozen plasma (FFP) is thawed at a temperature of 30-37°C, and should be used within 3 hours of thawing. A specialized FFP thawing device or water bath is usually used for thawing FFP at the appropriate temperature. However, for departments that do not frequently use FFP, warm water in a vat is often used for thawing FFP. We introduce a simple FFP thawing method that involves the use of warm water in a vertical container, which is employed as the standard method in our hospital. The coagulation factors of thawed FFP using a water bath and our novel method were measured. There were no significant differences between the two methods in these coagulation factors. The nurses were trained in the use of this method, and a system wherein FFP is thawed at the appropriate temperature was established even in departments that do not frequently use FFP. This novel thawing method and the training was useful in providing safe and effective FFP transfusion.

Purpose: This study aimed to examine the effects of cryoprecipitate (CRYO) on the clinical outcomes of obstetric hemorrhage.

Methods: Obstetric patients (CRYO: N=29; non-CRYO: N=35) were classified into three subgroups according to their clinical condition: Subgroup 1 consisted of patients transferred from other clinics or hospitals before delivery, Subgroup 2 consisted of patients transferred from other clinics or hospitals after delivery, and Subgroup 3 consisted of patients admitted in our hospital. Their profile when obstetric hemorrhage occurred (age; shock index; obstetrical disseminated intravascular coagulation [DIC] score; and levels of hemoglobin, fibrinogen, fibrin and fibrinogen degradation product, antithrombin) and clinical outcomes (transfusion volume, circulatory overload, embolization for uterine artery, hysterectomy, anti-DIC therapy, and hospital stay) were compared.

Results: The volume of transfused red blood cells (Subgroups 1-3) and fresh frozen plasma (Subgroup 1) in the CRYO group was significantly lower than that in the non-CRYO group. Fewer patients in the CRYO group had circulatory overload (Subgroup 3) or required anti-DIC therapy (Subgroup 2). Moreover, patients in the CRYO group required a shorter hospital stay than patients in the non-CRYO group (Subgroups 1 and 3).

Conclusion: Our results indicate that CRYO is effective in certain clinical subgroups.

【Background】Anemia in angioimmunoblastic T-cell lymphoma (AITL) is caused by bone marrow involvement of tumor cells, pure red cell aplasia, or autoimmune hemolytic anemia. We present the results of transfusion therapy in two AITL cases. 【Case 1】An 86-year-old male was diagnosed with AITL by lymph node biopsy. Hemoglobin level was 8.9 mg/dl. Direct anti-globulin test (DAT) and indirect anti-globulin test (IAT) were positive, and a pan-agglutinin pattern was shown on a blood antibody detection test. Oral anti-tumor therapy and steroids were started, which were effective for 6 months. IAT titer reduced and transfusion was spared. 【Case 2】A 75-year-old male with eruption and fever was diagnosed with AITL. Tumor cells infiltrated the bone marrow. Hemoglobin level was 8.5 mg/dl. Both DAT and IAT were positive, and a pan-agglutinin pattern was shown on a blood antibody detection test. After three cycles of systemic chemotherapy, IAT titer was reduced. Transfusion of 34 units of red blood cells (RBCs) and 80 units of platelet concentrate (PC) were needed. 【Discussion】Blood transfusion was spared by therapeutic effects in case 1. Bone marrow suppression and hyper-destruction of blood cells resulted in case 2. Transfusion effectiveness may be reduced in activated AITL.

We encountered a lung cancer patient whose HIV screening test result became falsely positive after transfusion, which we consider rare. The patient was hospitalized for right lower lobectomy for adenocarcinoma. Before admission, the patient's screening for HIV was negative. During the lobectomy, the patient received 14 units of red blood cells and 6 units of fresh frozen plasma transfusion. After 3 months, the patient visited our hospital and underwent an HIV screening test as a routine follow-up, which revealed a positive result for the HIV-1 p24 antigen.

To verify this result, the TaqMan HIV-1 test and an in-house PCR test, which can detect HIV-1 proviral DNA, were performed. Both methods showed that the patient was negative for HIV. Western blot analysis also failed to detect HIV-1 and HIV-2. These HIV validation tests clearly indicated that the positive result observed in the HIV screening test was a false positive. Ten months later, the false-positive reaction against the HIV-1 p24 antigen in the HIV screening test disappeared. Although the etiology for the false-positive HIV-1 p24 antigen test result remains unclear, possible IgM-like substance which may react with ALP in patient's serum may have caused the false result. This case emphasizes the importance of validation tests.