Objective: This study analyzed the impact of transfusion nurses on the observation and reporting system for adverse reactions to blood transfusion by comparing the enrollment status of transfusion nurses among institutions. We expected that the results would help clarify issues for strengthening the national hemovigilance system.

Methods: A self-administered, anonymous questionnaire survey was conducted at 1,791 healthcare facilities with ≥200 beds.

Results: Responses were received from 685 facilities (valid response rate 38%). Facilities with transfusion nurses on staff (229 facilities) tended to have higher rates of vital sign measurement than those without (456 facilities). Vital sign measurement rate significantly differed before (p<0.01) and at the end of transfusion (p<0.05), as did the use of the "List of Symptoms Items" (p<0.01) and "List of Diagnostic Items" (p<0.01). However, overall use rate of the "List of Symptom Items" was 82%, while the "List of Diagnostic Items" was only 55%.

Discussion: The rate of vital sign measurement was higher in facilities which employed transfusion nurses, suggesting that these nurses contribute to strengthening the system for detecting changes in patient condition at an early stage. Nationwide standardization of the reporting system for adverse reactions was identified as an issue.

On March 15, 2023, the Japanese Red Cross Society extended the shelf life of red blood cell (RBC) products from 21 to 28 days after blood collection. In our hospital, the stock of in-hospital RBC products was increased in number on and after April 1, 2023. The wastage rate of RBC products in the 2020, 2021, 2022, and 2023 years was 0.36%, 0.50%, 0.25%, and 0.06%, respectively. Extension of the shelf life of RBC products may contribute to a decrease in the in-hospital wastage rate of RBC products.

In March 2023, the Japanese Red Cross extended the shelf life of red blood cell (RBC) products from 21 to 28 days. This study evaluated the impact of this change on transfusion practices in our hospital. The discard rate decreased from 0.39% to 0.16%, mainly due to the elimination of expiration-related waste, which previously accounted for 80% of discarded units. The median remaining shelf life at delivery increased from 12 to 17 days. Although adverse event rates increased slightly (0.49% to 0.73%), no increase in adverse events was linked to longer storage duration or the extended shelf life. The extension improved RBC utilization.

The patient was a 94-year-old woman with mild cognitive decline and multiple underlying conditions who was referred for home transfusion therapy for severe anemia. Although the cause of anemia had not been investigated at the two previous institutions, home blood transfusion was unavoidably initiated due to worsening symptoms and the family's request. Simultaneously, an examination for the cause of anemia was conducted, and thyroid hormone replacement therapy for primary hypothyroidism was initiated, thereby avoiding red blood cell transfusion for more than one month. However, as the effect was temporary and red blood cell transfusion needed to be resumed, further investigation for the cause of anemia was carried out. Bone marrow aspiration ruled out myelodysplastic syndrome, and darbepoetin therapy was started for renal anemia, which successfully prevented the need for further transfusions. Throughout the clinical course, a total of five red blood cell transfusions were performed in collaboration with home nursing services. The implementation of home blood transfusion involves issues such as patient/family support system, multidisciplinary cooperation, and blood product management. From the perspective of judicious use of limited blood resources, minimizing transfusion volume and frequency is essential. This case suggests that anemia in the elderly is often due to multiple causes, and that it is important for healthcare providers to comprehensively evaluate and respond to the patient's anemia while seeking transfusion avoidance whenever possible, rather than just randomly continuing home blood transfusions.