In order to develop novel methods for the treatment of blood group incompatible pregnancy, the immunoadsorbent bound to P antigen was prepared by covalently coupling to an epoxy activated sepharose 6B globoside which was obtained from human erythrocyte's stroma. The immunoadsorbent specificially adsorbed anti-P. The optimum condition for anti-P with our immunoadsorbent was estimated to be an incubation time of 1 min, an incubation temperature of 4-37°C, and an immunoadsorbent-to-plasma ratio of 1:5. After adsorption the titer of anti-P fell from 1/256 to 1/32. As the immunoadsorbent adsorbed anti-P was washed with pH 3.0 glycine buffer, its antibody adsorption property recovered to a level of the unused. These results indicate that the immunoadsorbent is useful for the treatment of P blood group-incompatible pregnancy.

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Coagulation factor VIII (FVIII) concentrate with intermediate purity and potency (RCG-5) was prepared by heat-defibrinating method. Fibrinogen, which was a major contaminated protein of cryoprecipitate, was reduced to about 10% of the initial material by heating for 5min at 54°C in the presence of 10mg/ml glycine as the stabilizer. On the other hand, FVIII procoagulant activity (VIII: C) was recovered more than 80% in this process. Some test-products of RCG-5 were made from about 1000ml of fresh frozen plasma. The recovery of VIII: C was 36% and the content of VIII: C was 17.9unit/ml. Ratios of VIII: C/von Willebrand factor antigen (vWF: Ag) and Ristocetin co-factor (RCof)/vWF: Ag were 0.99 and 1.1, respectively. These ratios were near to the values of normal plasma. Contents of fibrinogen and total protein were about 0.35mg and 1.9mg per one unit of VIII: C, respectively. These data show the capability of application of RCG-5 to home-therapy and high-dose therapy in haemophilia A and to the therapy in von Willebrand disease.

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We have studied in vitro properties of a new intermediate type of factor VIII (FVIII) concentrate, lyophilized anti-hemophilic globulin concentrate with low content of fibrinogen (RCG-5, Japan Red Cross), and compared it with those of commercial cryoprecipitate (cryo) and FVIII concentrates with special reference to FVIII/vWF activities. RCG-5 was prepared from cryoprecipitation and subsequent defibrination with heat treatment at 56°C for 5min.
RCG-5 was found to contain 19.5u/ml of FVIII clotting activity (VIII: C) on the average, 28.0u/ml of FVIII antigen (VIII: Ag), 29.0u/ml of ristocetin co-factor (RCof), 30.7u/ml of vWF antigen (vWF: Ag) and 10.4mg/ml (0.5mg/u. of VIII: C) of fibrinogen. The ratio of VIII: Ag to VIII: C and vWF: Ag to RCof in RCG-5 was 1.4 and 1.1, respectively. They were very close to those in cryo. These suggest that the inactivation of biological activities of VIII: C and RCof, and/or denaturation of antigenicity of FVIII and vWF little occurred during production procedure.
RCG-5 has a remarkable correcting effect on the defective ristocetin induced platelet aggregation (RIPA) in the patient with von Willebrand disease (vWD). It also showed large, intermediate and small multimer of vWF just similar to normal plasma or cryo. These results may lead to a conclusion that RCG-5 is expected to be effective for good hemostasis not only in the patients with hemophilia A but vWD.

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An interesting case of TTP, which responded dramatically well to plasma exchange (P. E.), is presented in detail. Besides, case reports that have appeared in the Japanese literatures in the last decade is summarized and reviewed in terms both of clinical features and of treatment, with emphasis on P. E. as a pertinent therapeutic procedure of the disease.
A 46-year-old man with macrohematuria and purpuric skin lesions at his shoulders with a week duration was admitted to the hospital on December 22, 1983, in suspicion of thrombocytopenia and hemolytic anemia presumed to be induced by some medicine prescribed for cold-like symptoms. By the hospital day 3, his consciousness became confused, then the clinical diagnosis of TTP was made. On the hospital day 7, he fell into unconsciousness despite combined use of corticosteroids and antiplatelet agents. Then he was started on P. E. And, on the hospital day 31, when the 13th procedure of P. E. was finished, his consciousness got clear and hematological findings improved. About 60 days after the current admission, almost all indices of hematological examination were within normal limit.
In Japan, sixty-three cases of TTP including this case have been reported during the last 10 years. On grounds of clinicopathological studies on these sixty-three cases of TTP in Japan, the following results were obtained: 1) The age of patients with TTP ranged from 8 to 63, with mean value of 33.1.2) Ratio of male to female was 20 to 43.3) Major symptoms which patients had consisted of purpuric skin lesions, hematuria, hemolytic anemia, psychiatric symptoms, febrile episodes, and renal dysfunction. 4) Twenty-five out of sixty-three patients (39.7%) died within a year after the onset of the disease, while thirty-eight (60.3%) survived: Eight among those sixty-three cases received P. E. Complete remission were attained in four out of those eight cases that were given P. E., while two out of those eight cases reached to partial remission. The rest two gained no beneficial effects.
Meanwhile, neither corticosteroid, antiplatelet agents nor any combination of these measures could exert any definite beneficial effects. Taken altogether, there have been few case reports of TTP in Japanese literatures so far and a large majority of those cases reported could not survive despite any combined usage of corticosteroid, antiplatelet agents or anticoaglants, whereas, P. E. turned out to be of significant value by comparison with any other regiments of treatment ever used.

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Anti-Mit was found in a Japanese female who had never received a blood transfusion. Her red cells had not Mit antigen. And, Mit antigen on red cells of her husband and child was negative.
The antibody was characterized as IgG1 with kappa chain. Negative results were obtained when the patient's serum was tested against red cells from 1177 Japanese.
This example is the first reported “Naturally Occurring” anti-Mit.

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S-ALT (S-GPT) is to be measured weekly or biweekly after blood transfusion.
1. Posttransfusion non-A non-B hepatitis is suspected in cases in whom S-ALT has increased after one week of blood transfusion to at least two times the normal upper limit at each laboratory twice or more successively.
2. The diagnosis of non-A non-B hepatitis is established in cases in whom the increase of S-ALT to at least two times the normal upper limit has continued for at least three weeks with the S-ALT value elevating more than five times the normal upper limit at least once during the time.
3. The above standards are not applied to cases showing S-ALT increase due to underlying diseases, postoperative liver dysfunction due to operation itself, liver damage due to drugs, fatty liver, hepatitis B, or other known viral diseases which manifest hepatitis symptoms.
(Comment 1) To diagnose precisely, all patients receiving blood transfusion should be followed up weekly or biweekly after blood transfusion during for at least three consecutive months or longer, if possible.
(Comment 2) For statistical studies patients with liver damage before operation are to be excluded.
Liaison Council of Hepatitis Research Groups
The Intractable Disease (Hepatitis) Research Committee Section for non-A non-B Hepatitis Research
The Research Committee concerning Posttransfusion Infection Section for Posttransfusion Hepatitis Research
This standards has been investigated and drawn up by the following members:
H. Suzuki, K. Okochi, T. Miyagawa, S. Iino, K. Akahane, M. Shimizu, T. Takano, M. Yano, H. Tateda, Y. Egusa, A. Obayashi and T. Katayama

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