Japanese Journal of Transfusion and Cell Therapy
Online ISSN : 1883-0625
Print ISSN : 1881-3011
ISSN-L : 1881-3011
Volume 67, Issue 3
Displaying 1-11 of 11 articles from this issue
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Originals
  • Masahiro Anan, Hiroko Oki, Atsuko Imai, Yasufumi Suzuki, Mitsue Noro, ...
    2021 Volume 67 Issue 3 Pages 397-404
    Published: June 25, 2021
    Released on J-STAGE: July 16, 2021
    JOURNAL FREE ACCESS

    The effect of the number of transplanted CD34+ cells on post-transplant neutrophil engraftment and blood transfusion requirements in autologous peripheral blood stem cell transplantation (APBSCT) was retrospectively examined. We targeted patients who underwent APBSCT in our department from January 2006 to December 2017. APBSCT was performed 118 times in 107 cases. The median number of CD34+ cells was 4.24 × 106/kg. Transplants with fewer than 2.0 × 106/kg CD34+ cells occurred 11 times, but engraftment was observed in all cases. For plasma cell neoplasms, the number of days until neutrophil engraftment was significantly greater in the group transplanted with fewer than 2.5 × 106/kg CD34+ cells than in those receiving more than 2.5 × 106/kg, while transfused PC volume was significantly higher compared with the group transplanted with more than 5.0 × 106/kg CD34+ cells. Therefore, for plasma cell neoplasms, the ideal number of CD34+ cells required for transplantation is 2.5 × 106/kg or more. However, the risk of longer apheresis time to secure a suitable number of cells, and that of delayed engraftment of neutrophils and of PC transfusion should be carefully considered.

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  • Yoshiaki Hayashi, Mitsuhiro Fujihara, Shinobu Wakamoto, Hisae Fuse, Yu ...
    2021 Volume 67 Issue 3 Pages 405-413
    Published: June 25, 2021
    Released on J-STAGE: July 16, 2021
    JOURNAL FREE ACCESS

    The shelf-life of red blood cell (RBC) components in mannitol-adenine-phosphate additive solution was previously set at 42 days, but this was shortened to 21 days in 1995 due to the risk of bacterial contamination. Apart from this risk of bacterial contamination, however, the quality of current non-irradiated RBC components is assumed to be acceptable for usage up to 42 days after collection. If the quality of current irradiated RBCs beyond storage for 21 days is comparable to that of non-irradiated RBCs on Day 42, the shelf life of irradiated RBC components may be extended.

    Here, we compared the quality of irradiated and non-irradiated RBCs on storage for 42 days. The increase in hemolysis and decreases in ATP concentration and deformability during storage were greater in irradiated than non-irradiated RBCs. Nevertheless, levels in irradiated RBCs up to 35 days were superior or equal to those in non-irradiated RBCs on Day 42. Irradiation did not effect CD47 or phosphatidylserine expression on RBCs, nor RBC microparticle production. In contrast, it enhanced the increase in supernatant potassium concentration by storage.

    These results suggest that the shelf life of irradiated RBC components may be extended up to 35 days, with attention to increases in supernatant potassium concentration.

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  • Hiroshi Oki, Yoshitaka Furukawa, Akihiko Takehara, Hiroaki Nishisako, ...
    2021 Volume 67 Issue 3 Pages 414-424
    Published: June 25, 2021
    Released on J-STAGE: July 16, 2021
    JOURNAL FREE ACCESS

    "Amami Blood Rotation (BR) " is a collaborative project developed among four medical institutions, a blood center, and our hospital in Kagoshima Prefecture, Japan. BR allows the return and re-delivery of blood, and a consequent reduction in the amount of discarded blood. It achieves this by ensuring blood quality using blood transport refrigerators (ATRs).

    In the current system, an ATR containing 5 bags of type O red blood cell product, equivalent to 2 units, is received from the blood center once a week. Blood products in the ATR which have not been used at our hospital are returned and re-delivered for use at the four collaborating medical institutions. Here, we report outcomes with this project.

    After the launch of BR, the discard rate for type O red blood cells at our hospital decreased from 31.3% to 3.7%. The discard rate for blood delivered to the four collaborating medical institutions (BR blood) was 0%. The discard rate for non-BR red cells was 0.12% before BR and 0.9% after BR.

    Thus, Amami BR reduced the discard rate for type O red blood cells at our hospital while ensuring safety and reliability of these products. There was no BR blood discarded at any of the four collaborating medical institutions.

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  • Koudai Hiratsuka, Kenta Nakauchi, Hidekatsu Sakata, Shinichi Kishimoto ...
    2021 Volume 67 Issue 3 Pages 425-431
    Published: June 25, 2021
    Released on J-STAGE: July 16, 2021
    JOURNAL FREE ACCESS

    In August 2014, the Japanese Red Cross Blood Center introduced individual nucleic acid amplification test (NAT) screening using the PANTHER system. All blood donations are screened by multiplex-NAT (MPX-NAT) for hepatitis B virus, hepatitis C virus and human immunodeficiency virus. In this study, in MPX-NAT, we analyzed two blood donor samples that could not be tested due to repeated failures in the washing operation during the nucleic acid extraction process on PANTHER. The nucleic acid extraction process was reproduced in a test tube to confirm the effect of the Target Enhancer Reagent (TER), which is added in MPX-NAT only. In both cases, aggregates were formed in the test tubes to which TER was added, and IgG-type M protein was identified in blood donor samples. We speculated that aggregates were formed due to interaction between TER and M protein, and that these caused the failure in washing operations. The possibility of M protein in samples that cannot be tested due to repeated failures on PANTHER should be considered for the contribution of the health management of blood donors.

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  • Mami Matsumoto, Yohei Ikeda, Rieko Sobata, Rika A Furuta, Keiji Matsub ...
    2021 Volume 67 Issue 3 Pages 432-439
    Published: June 25, 2021
    Released on J-STAGE: July 16, 2021
    JOURNAL FREE ACCESS

    Screening of platelet concentrate (PC) for bacterial contamination is not currently performed in Japan. We evaluated the validity of screening PCs using the automated blood culture systems BacT/ALERT 3D (3D) and BacT/ALERT VIRTUO (VIRTUO). We compared the time to detection (TTD) of bacteria between the two systems, and then validated the screening protocol by testing bacteria-spiked PC bags using VIRTUO. In the comparative test, four bacterial species at two different concentrations were inoculated into aerobic and anaerobic culture bottle sets and 5 sets each were tested using 3D and VIRTUO. The TTD was significantly shorter for all bacterial inoculum using VIRTUO than 3D, demonstrating the superiority of VIRTUO. In the validation test, PCs inoculated with bacteria were tested using VIRTUO at 40h post-spiking. All four bacterial species were detected within 24 hours if the spiked bacteria had grown to a concentration >10CFU/ml after storage.

    Our results indicate that, although there is a possibility of missing slow-growing bacteria, bacterial screening of PCs stored for a certain period of time using VIRTUO is expected to reduce the risk of transfusion-transmitted bacterial infection.

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  • Chiaki Yamada, Akihiro Takeshita, Masaki Ri, Yuichi Hasegawa, Naoki Oh ...
    2021 Volume 67 Issue 3 Pages 440-448
    Published: June 25, 2021
    Released on J-STAGE: July 16, 2021
    JOURNAL FREE ACCESS

    Anti-CD38 antibody (Ab) is a human monoclonal antibody for the treatment of multiple myeloma. CD38 is expressed on red blood cells (RBCs), and can interfere with pretransfusion tests. Here, we conducted a nation-wide multi-institutional collaborative study to clarify the interference of anti-CD38 Ab in pretransfusion tests, and investigated the current situation regarding the preparation of RBCs for patients who are treated with anti-CD38 Ab, as well as communication between clinicians and transfusion units on anti-CD38 therapy.

    From December 2017 to December 2020, 136 cases were registered from 18 institutions. Information on patients receiving anti-CD38 therapy was provided from clinicians to the transfusion units before pretransfusion tests in 116 cases (85%). In 3 cases, pan-agglutination was observed on Ab screening by the saline method using dithiothreitol (DTT) -treated RBCs, but not observed using DTT-untreated RBCs. In 6 cases, pan-agglutination was observed in Ab screening by the enzyme method after the receipt of anti-CD38 Ab, but not observed before receipt. RBCs were transfused in 65 cases after receiving anti-CD38 Ab. Adverse reactions did not occur in any case. Median time of a clinically relevant delay due to anti-CD38 Ab was 60 minutes (range, 45 minutes-24 hours). Given the increasing use of therapeutic monoclonal Abs for the treatment of cancer and other conditions, unexpected results in pretransfusion tests may become more commonplace.

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Case Report
  • Tetsu Yamamoto, Katsuya Ikuta, Hiromi Sanyoshi, Emi Maeda, Satomi Koba ...
    2021 Volume 67 Issue 3 Pages 449-454
    Published: June 25, 2021
    Released on J-STAGE: July 16, 2021
    JOURNAL FREE ACCESS

    Analysis of heart rate variability was performed by continuous monitoring of pulse rate in prolonged vasovagal reactions (VVR) occurring during platelet apheresis.

    Before the onset of VVR, regular fluctuation of ΔNNI (0 ms, 8-10 ms, 15-19 ms) and a stable pulse rate were observed. Immediately before the onset of VVR, a sharp decrease in pulse rate was observed, followed by disappearance of regularity in ΔNNI. The onset of VVR was clinically recognized at the same time as the increase in pNN50.

    In the early stage of recovery, the frequency of pulsation with ΔNNI of 0 ms was increased, and regular fluctuations followed. However the peak of ΔNNI observed in the histogram appeared to be expanded position. When the donor moved to the treatment room, an increase of pNN50 was observed and the pulse rate again decreased. The clinical symptoms then worsened. It is likely that the activation of vagal activity during the recovery process lead to delayed recovery.

    Continuous pulse rate monitoring is thought to be useful for understanding the recovery process of blood donors. Monitoring is expected to allow a rational determination of the end of prolonged VVR.

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