Objective: HLA-mismatched stem cell transplantation (SCT) from a family donor using steroids for graft-versus-host disease (GVHD) prophylaxis is useful in refractory hematological diseases, but is associated with many complications. The purpose of this study was to investigate the efficacy of plasma exchange (PE) therapy for transplantation-associated thrombotic microangiopathy (TA-TMA) in patients with HLA-mismatched SCT. Methods: Between October 2016 and September 2021, we retrospectively evaluated 22 patients who developed TA-TMA and received PE after HLA-mismatched SCT from a family donor. Results: Median age was 36 years. Twenty-one patients were in a state of non-remission, and 4 patients had a 2-HLA-haplotype mismatched family donor. For GVHD prophylaxis, tacrolimus plus methylprednisolone was administered to all patients. PE was effective in 15 patients (68.2%), and duration from the onset of TA-TMA to PE initiation was slightly shorter in these cases. Three patients developed heart failure during PE, although this was reversible. The 100-day and 1-year survival rates were 50.0% and 9.1%, respectively. Conclusion: PE may be effective and safe for TA-TMA after allogeneic HLA-mismatched SCT.

A survey of blood transfusion medicine (including use of warm fresh whole blood) was performed in the remote islands in Kagoshima Prefecture. Responses were received from all 101 institutions targeted.

Results showed that patients at institutions on islands close to the Kagoshima mainland who require blood transfusion are transferred to a core institute on that island, or further transferred to a high-level institute on the Kagoshima mainland. However, in remote islands such as the Amami group of islands, the patient is transferred to a core institute on that island, or to a high-level institution in Amami-Oshima, but cannot be transferred to the Kagoshima mainland.

Red blood cells from Red Cross donations were stocked in six institutes among five islands. Among six islands, however, 44 patients received warm fresh whole blood over 3 years because blood from the Red Cross could not be supplied sufficiently quickly for treatment of massive hemorrhage.

Following our survey, improvements in the blood delivery system to core medical institutions in each island are expected to be introduced. Further assistance is required to ensure blood supply in Amami-Oshima, because of the distance involved and size of the population.

Blood services - which are managed in Japan by the Japanese Red Cross Society - are a key part of the national medical infrastructure. However, doctors' perception of blood services is often limited to a superficial understanding. Although the role of medical check-up doctors in securing safe and high-quality blood is important, there is a continuing shortage of doctors dedicated to blood centers and medical check-up doctors in terms of actual numbers and knowledge of blood services. The "Nara Regimen" consists of two protocols, namely "blood transfusion education and practical training (14 hours) " at the Blood Transfusion Division of the Nara Medical University Hospital and "practical training (3 hours), including blood donor experience" at the Nara Red Cross Blood Center, as pre-graduate education for medical students of Nara Medical University; and "On-the-Job Training for blood donation work" for 1 week at the Nara Red Cross Blood Center as post-graduate education for clinical residents. In this study, we examined the results of these programs, focusing on the number of participating medical check-up doctors, and clarified the contribution of doctors who completed the "Nara Regimen" to blood donation medical check-ups. Although training for medical students and clinical residents is a substantial burden on blood centers, the "Nara Regimen" of active and continuous education and training will increase doctors' awareness of blood services, and function effectively and efficiently to train and secure medical check-up doctors who will contribute to blood services.

In Japan, transfusion-transmitted bacterial infection remains an ongoing problem, and further preventive measures are necessary to ensure blood safety. Here, we developed a bacterial 16S rDNA real-time PCR assay (PCR assay) and compared its detectability with that of a fully automated blood culture system, BacT/ALERT VIRTUO (VIRTUO) by testing bacteria-spiked platelet concentrate (PC). All PC samples stored for 40 hours after inoculation with 4 bacterial species with a total of 8 strains tested positive by both methods, except for three samples with low bacterial concentrations under the detection limit (10 CFU/ml) by the agar plate culture method. However, PCR assay may have lower detectability than VIRTUO when testing slow-growing bacteria in PC. This PCR assay has a shorter running time than VIRTUO of about 3 hours, and incorporation of internal control allows the monitoring of false-negative results by PCR inhibitors.

Further development of bacterial DNA-free PCR reagents together with an automatic assay system will likely make this PCR assay a practical bacterial screening method.

Blood type mismatch between the fetus and mother leads to allogeneic IgG-type antibody production by the mother. These maternal alloantibodies may cause hemolytic disease of the fetus and newborn (HDFN). To prevent HDFN, it is important to conduct antibody screening tests during pregnancy. We have conducted a total of 9,029 tests among 6,516 pregnant women in the last decade. Forty-seven Rh+ pregnant women were identified. Anti-E antibody was predominant (29.8%), followed by anti-Le^a (23.4%) and anti-Jr^a (12.8%). Six patients had double antibodies, including three with anti-E+ c antibody. We examined 37 pregnant women to clarify the relationship between the history of pregnancies (number) and antibody production. Women with only 1 pregnancy had mainly the cold type antibodies and those against Lewis antigens (62.5%), showing low titers. Women with ≥2 pregnancies had antibodies against rhesus antigens (76.2%), with titers of more than 16-fold in 42.9% of cases. HDFN occurred in only one mother with anti-C+e. Just before her delivery, these antibodies could not be detected. Her baby, however, had HDFN which was caused by ABO mismatch. These findings confirmed the importance of the periodic implementation of antibody testing for pregnant women.

Management of blood component storage must be strictly controlled in accordance with the blood components storage management manual. Refrigerators used for storing blood bags should be equipped with a continuous temperature recorder and appropriate alarm systems. In the Blood Components Use Fact-finding Survey in Japan in 2021, however, it is reported that blood bags were sometimes stored in pharmaceutical or domestic refrigerators, especially in small-scale medical facilities or home transfusion where blood transfusion is not performed regularly. To investigate the actual internal temperature of blood components stored in such refrigerators, we measured the temperature distribution inside the cabinets and the internal temperature of simulated blood bags placed in various positions in of the cabinets. The lowest and the highest temperatures of blood bank-, pharmaceutical-, and domestic ( 'strong' setting) refrigerators were 2.4°C and 11.5°C, 0.2°C and 11.9°C, and −5.2°C and 13.1°C, respectively. The lowest and the highest internal temperatures of simulated blood bags placed in blood bank-, pharmaceutical-, and domestic refrigerators were 3.8°C and 5.8°C, 1.0°C and 3.9°C, and −4.8°C and 10.0°C, respectively. These results indicated that it is inappropriate to store blood components in refrigerators not equipped for blood banking. If such storage is temporarily unavoidable, it is recommended that blood bags should be placed in a position of stable temperature and that overcooling be prevented by avoiding direct cold airflow. It is also necessary to set up a continuous temperature-monitoring device with a chart recorder and an appropriate alarm system.