As a post-marketing survey for Cell-free and Concentrated Ascites Reinfusion Therapy (CART), a forward vision survey was conducted on 350 cases among 147 patients. We investigated the dynamics and therapeutic effects of albumin in ascites, and examined the usefulness and problems associated with filtered and concentrated ascites in albumin preparations. The amount of albumin recovered was 66.5 g for exudative ascites and 31.1 g for transudative ascites. Reinfusion of filtered and concentrated ascites significantly increased serum total protein and albumin by 0.5 g/dl and 0.3 g/dl for transudative ascites, and 1.1 g/dl and 0.7 g/dl for exudative ascites. Although administration of hypertonic albumin preparations is recommended for hypoalbuminemia associated with ascites puncture for refractory ascites (pleural effusion) caused by cirrhosis, the domestic self-sufficiency rate of albumin in Japan is as low as around 50%. Further, administration to terminal cancer patients is considered inappropriate. CART is expected to contribute to reducing the amount of albumin preparations used and improving the domestic self-sufficiency rate in Japan.

Background: Liver transplantation is associated with massive bleeding and transfusion in recipients with coagulopathy. A previous study reported that intraoperative fibrinogen concentrate (IOFC) reduces transfusion volume in liver transplant procedures. In our institute, IOFC was introduced in 2012 for preventing massive bleeding in cadaveric liver transplantation. We studied the effects of IOFC on the amount of bleeding and transfusion during surgery.

Patients andMethods: We retrospectively analyzed 44 adult patients who underwent cadaveric liver transplantation between February 2001 and August 2016. The amount of intraoperative bleeding and transfusion in 25 transplantations that did not use IOFC was compared to that in 19 cases that used IOFC. We also analyzed 33 patients who bled more than their circulating blood volume (16 cases without IOFC, 17 cases with IOFC).

Results: The amount of intraoperative bleeding and transfusion was not significantly different between the two groups. In sub-analysis of 33 patients who bled more than their circulating blood volume, the amount of intraoperative bleeding was significantly reduced in the group that used IOFC. Further, the amount of intraoperative PC transfusion was significantly reduced and the amount of red blood cells and fresh frozen plasma tended to be lower.

Conclusion: Use of IOFC reduced intraoperative massive hemorrhage and PC requirements in cadaveric liver transplantation.

The basophil activation test (BAT) was developed for the diagnosis of specific immunoglobulin E (sIgE)-dependent allergy, and was recently used to analyze allergic transfusion reactions (ATRs). Subsequently, passive immune BAT (pi-BAT) was developed for patients under myelosuppression.

We recently encountered a serious platelet transfusion-induced ATR case after bone marrow transplantation (BMT). We performed BAT and pi-BAT on the patient and residual blood products and found that both test results were positive. In this study, we attempted to elucidate the source of the sIgE using the patient's plasma and whole blood obtained during the 2-year period encompassing the entire BMT course. BAT was positive on days 34 and 106 but negative on day 573 after BMT. pi-BAT was negative 146 days before BMT, but was positive on day 34 and negative on days 106 and 573 after BMT.

In conclusion, to explain the origin of sIgE, which is responsible for ATR, studies have suggested that sIgE-producing cells may be differentiated from transplanted hematopoietic progenitor cells. However, our findings suggest that the discrepancy between BAT and pi-BAT results may indicate that sIgE-producing cells are infused along with bone marrow infusion.

We encountered a patient who received multiple transfusions during treatment for hematologic disease and was found to be infected with hepatitis E virus (HEV). Elevated concentrations of hepatobiliary enzyme led to the discovery of HEV infection during outpatient follow-up for Hodgkin's lymphoma. Viral hepatitis-related tests yielded positive results for anti-HEV immunoglobulin A antibody, despite negative results from stored samples collected before transfusion. We reported this case of suspected transfusion-associated HEV infection to the Japanese Red Cross Society. According to a survey by the Japanese Red Cross Society, HEV nucleotide sequences from the patient's post-transfusion specimen were identical to those of the corresponding stored donor specimen, confirming that HEV infection originated from the transfusion. His condition resolved rapidly and did not show a chronic course. While HEV is not included in infectious disease tests for blood donors, the frequency of HEV infection in transfusion recipients has increased in recent years. Indeed, we encountered another transfusion-associated hepatitis E case in the same period at our hospital. Our findings from these two cases suggest that medical institutions in the Hokkaido area, as well as the Kanto-Kohshinetsu area should be on alert regarding the high prevalence of HEV. Our findings also highlight the importance of pre-transfusion storage of patient specimens.