A system for educating inspectors and accrediting hospitals for transfusion medicine (I&A System) did not become widespread under its former regulations. To clarify its significance in Japan, we examined the approximately 3-year outcomes after a relaunch of the system by the Japan Society of Transfusion Medicine and Cell Therapy.

The study involved 100 hospitals: 49 newly accredited and 51 re-accredited during the period from January, 2016 to March, 2019. The distribution of each of the accredited facilities and items for which improvement was advised upon inspection was examined. 2019.

A large number of accredited hospitals belonged to the Tohoku or Tokai Branch of the society. The mean number of mandatory and important items for accreditation for which improvement was advised upon inspection of the newly accredited hospitals was 2.6 and 5.3, respectively. Among the mandatory items requiring improvement, those related to the storage and management of blood products were the most frequent, followed by double-checking the blood type, and management of adverse events when collecting autologous.blood. Among the important items requiring improvement, those related to the management of and countermeasures against adverse events were the most frequent. The mean number of items for which there was a discrepancy between the self-inspection results and inspectors' opinion was 6.0. This suggests the importance of third-party inspections.

Our findings suggest that the I&A System was useful for improving medical safety, which is important for transfusion medicine. In the future, we will more actively disseminate useful information from an inspector/person concerned with accrediting facilities to healthcare professionals while promoting the sharing of this information with those engaged in transfusion medicine. We will also develop I&A programs that will further enhance the safety of blood transfusion.

BACKGROUND: Kagoshima Prefectural Oshima Hospital has a critical care center that provides helicopter ambulance services. However, the Japanese Red Cross Society withdrew its branch in the Oshima area in March 2018; therefore, it is important for us in Oshima Hospital to stock up on blood products by ourselves. Further, the donor system for whole blood transfusion (WBT) provided by blood donors for unexpected massive hemorrhage requires investigation.

MATERIALS and METHODS: From 2014 to 2018, 18 patients received WBT. We retrospectively analyzed the clinical features of the patients.

RESULTS: Half of the patients received WBT (51%) because of thrombopenia or insufficient platelet products. After WBT, the platelet count and serum fibrinogen ratio were significantly increased in these patients (p<0.01).

DISCUSSION: While the WBT donor system works well, it is important to consider the safety of this system and to reduce the burden on blood donors.

CONCLUSION: The platelet count and serum fibrinogen ratio of 18 patients were significantly increased after WBT. We expect that medical insurance will cover the cost of cryoprecipitate or fibrinogen products for massive bleeding.

Objective: We retrospectively assessed the efficacy of acute normovolemic hemodilution (ANH) for aortic valve stenosis surgery from the medical perspective.

Methods: In this study, we analyzed 42 patients who required aortic valve replacements for aortic valve stenosis between April 2016 and February 2019. We performed ANH in February 2018. Patients were divided into 2 groups as follows: group A patients on whom ANH was performed (n=18) and group C patients on whom ANH was not performed before February 2018 (n=24).

Results: There was no significant difference in the pre-operative patient background information between the 2 groups. The amount of post-operative bleeding and volume of post-operative blood transfused were significantly higher in group C patients than those in group A patients. The duration of inotropic agent infusion was not significantly different between the 2 groups.

Discussion: ANH for aortic stenosis might pose a risk of hemodynamic instability to the patient as he might have anemia. Our study was unable to show elongation of inotropic agent infusion or hemodynamic instability in these patients.

Conclusion: ANH might be performed for aortic valve stenosis if it is safe for the patient and contributes to reduction in the use of allogeneic blood products. It might also be beneficial for post-operative recovery.

ABO blood typing reactivity to cisA₂B₃ shows weak agglutination to anti-A, anti-B and anti-B antibody present in plasma. However, the reactivity of ABO to cis A₂B₃ in newborn babies remains to be elucidated. Here, we examined ABO blood typing reactivity and developmental change of A and B antigen levels in a boy with suspected cis A₂B₃. First, we checked his ABO blood typing with the column agglutination method on birth. Reactivity of anti-A was 2+, and anti-B was negative. On further ABO subtype tests, flow cytometric analysis (FCM) of antigen levels and ABO gene typing, we detected B antigens on his red blood cells by the adsorption-elution test. Expression levels of A and B antigens were lower than those of his mother. Both he and his mother's ABO gene type were defined as cisAB01/O01. As he grew, he showed higher B antigen levels and anti-B antibodies were detected at age 23 months. In infants with cisAB, B antigen levels are too low to be detected with usual ABO blood typing. ABO gene typing and FCM are therefore useful for ABO blood typing, particularly for newborn babies with suspected cisAB.