Automated plasmapheresis using four different membrane devices (NDP-100 and 200, Nipro; APC-2000, Asahi Medical; Autopheresis-C, Baxter) was carried out on 396 healthy volunteer donors. The purpose of this study was to verify donor safety, acceptability of the procedure to donors, quality of collected plasma, and the cost efficacy of plasma collection in our blood center.
Using each device, the procedure was performed without causing any significant alteration in the donor's physical condition, or in the biochemical tests. At the same time, plasma obtained showed good protein recoveries of total protein, albumin, IgG, and factor VIII levels. Slight activation of complement was observed in obtained plasma using NDP-100, NDP-200 and APC-2000. NDP-100 and 200 required a longer procedure time and had the disadvantages of larger extracorporeal volume and difficulty in carrying the device for mobile plasma collection. APC-2000 permitted rapid collection of 450ml plasma, but this system also was not portable for mobile collection. Autopheresis-C had a few problems caused by insufficient venous flow; NDP-200 was easy to set up and portable for mobile collection, but the procedure time was longer than the other devices.
In conclusion, it is expected that a new portable device which makes possible rapid collection and easy portability for mobile plasmapheresis will be developed.

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Three membrane plasma separator, each of which was composed of module made from polyethylene (PE), polycarbonate (PC) or polypropylene (PP) membrane, were studied from a biocompatibility point of view, especially activation of complement (C3a, C5a), platelet (β-TG, PF-4), coagulation and fibrinolysis (FPA, Bβ-15-42) as well as hemolysis (free Hb, Hp, LDH).
Plasmapheresis for collection of 400ml plasma by these systems was carried out on 102 healthy donors.
Mean values of C3a and C5a in the donors blood were almost within normal range.
There was slightly activation of platelet, coagulation systems in return cycle (outlet) of these equipments.
Free Hb level in plasma was increased, which remained within normal range. Any adverse reach reaction caused directly by these equipments was not observed in all donors.
The collected plasma contained few platelets, no amount of C3a and C5a. In conclusion, these donor plasmapheresis systems can be safely performed and have a promising future for collection of a large amount of source plasma.

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To add to the traditional method of blood separation by centrifugation, a membrane method has in recent years been coming into wide clinical use in treating autoimmune diseases by plasma exchange. The membrane method which not only is easy but also needs simple equipment has been the focus of attention as a new means to collect blood components, especially plasma.
This paper discusses the results of clinical evaluation of the safety and performance of Terumo Corporation's membrane type plasma separator Donor Set GDS-1.
As a result, it was demonstrated that 174ml of plasma could be separated from approximately 408ml of blood in a little more than 10min, and that the N-N time from needle insertion to withdrawal was approximately 21min. The laboratory data of the donors were not remarkable after plasma separation, and no adverse effects plasma separation were observed. Accordingly, plasmapheresis by this system may be considered to be for practical purpose adequately safe. The activation of the coagulation, fibrinolysis and complement systems was so slight that biocompatibility was considered satisfactory.
This system which separates plasma from the blood by gravity is high of clinical use for its safety and procedural simplicity.

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Intraoperative autotransfusion has proven to be a valuable technique in major vascular surgical procedures in which a large amount of blood loss sometimes occurs.
We analysed 45 cases of abdominal aortic aneurysm resection using the autotransfusion system at Mitsui Memorial Hosptal from 1985 to 1988. The patient's age, operating time, amount of intraoperative blood loss, volume of perioperative blood transfusion, occurrence of postoperative complication and changes in the blood coagulating system was compared with 32 cases without this system underwent abdominal aortic resection during 1982 to 1986.
There were no specific differences between two groups regarding age, and operating time. However the group without autotransfusion showed higher homologous blood transfusion rate (95.7%) than in the group with autotransfusion (44.7%) (p<0.01). Intraoperative blood transfusion were significantly (p<0.01) lower in autotransfusion group.
In the emergency cases, a decrease by autotransfusion was not apparent. One of the key points in the operative techniques is to control the sudden decrease of circulating blood volume when aneurysms are opened.
Our method enables the shed blood to retransfuse to the patient directly within about one minute, there is no instablity of circulation.
This technique made it possible to succeed in reducing the amount of operative blood loss and the volume of homologus blood transfusion and in increasing the number of non-homologous blood transfusion cases in abdominal aortic aneurysm resection and no coagulation abnormality was found in our method.
We concluded that intraoperative autotransfusion technique is useful for the abdominal aortic operation.

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Whole blood (400ml) was collected in citrate-phosphate dextrose in quodruple bag system. After centrifugation for 6min at 2, 200rpm, blood was separated into platelet rich plasma, huffy coat (approximately 45ml), and concentrated red cells. The platelet rich plasma was separated into platelet concentrates and plasma. The buffy coat contained approximately 98% lymphocytes, 70% granulocytes and 12% red cells of the original value. The leukocyte contents of huffy-coat-depleted concentrated red cells were 50±28×10⁷per unit, in particular, lymphocytes decreased to 1.4±0.5×10⁷per unit, because of the most lymphocytes were removed with buffy coat. This system seems to be as safe and effective for preparation of leukocytes poor red cells, and can be operated without machines.

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In order to evaluate the optimal surface area of the container to maintain a good quality of platelet, platelet concentrate (PC) were stored in several bags with different sizes at 22°C for three days, and the quality and function of PC were examined.
The pH of the PC fell steeply as the ratio of surface area to platelets decreased below 5cm²/10⁹plt, while it increased gradually over the ratio. The aggregability induced by collagen, ATP release and hypotonic shock response showed the highest values at the ratio of 5.0, 5.5 and 5.0cm²/10⁹pit, respectively. The release of β-TG increased signficantly below the ratio of 3.8.
Therefore, it was concluded that, when PC is stored in the bag made of polyvinylchloride with DEHP as plasticizer, which has oxygen permeabilty of 520ml/day·atm ·m², the best ratio of surface area of the container to platelet is 5cm²/10⁹plt, and the effective range of the ratio to maintain a good qualty of platelet for three days is 4.0-11.0cm²/10⁹pit.
It indicates that, when the concentration of platelet is in the range of 1.0-2.5×10⁹plt/μl, the suitable surface area of the container for storage of PC derived from 200ml or 400ml blood is 210cm² or 420cm², respectively.

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In order to prevent bacterial contamination during the procedure of plateletapheresis, preconnected platelet rich plasma (PRP) packs were prepared which include the apheresis bowel set of a plasma collecting system (PCS) with a 16 G AVF needle and a double-or triple-bag system. The anticoagulant line of the PRP pack and that from the bag containing acid-citrate-dextrose solution formula A were welded by a sterile connection device (SCD model 312, Du Point). No additional care was needed to perform plateletapheresis with the present closed system. The 388 preparations of platelet concentrates (PCs) tested were demonstrated to be sterile. PCs stored in conventional PVC plastic bags for 3 days at room temperature were evaluated. PC5 with a plasma volume of 100ml containing 1-<2×10¹¹ platelets stored in two 0.6 liter bags and PC10 with a plasma volume of 200-280ml containng 2-4×10¹¹ platelets stored in two or three 1-liter PVC bags maintained their pH at the neutral level for 3 days. The percent hypotonic shock response (%HSR) of platelets was also improved during storage of 3 days. These data suggest that the present closed system will be useful for reducing the risk of bacterial contamination in platelet products during cytapheresis.

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Blood from 67 males whose blood donation was rejected because of blood gravity being less than 1.052 by copper sulfate screening were examined by laboratory studies such as red cell count, Hb concentration, hematocrit values, biochemical analyses and serological examinations. More than 70% of cases were found to have low levels of hemoglobin concentration (49 out of 67, less than 12.2g/dl) and serum iron contents (47 out of 67, less than 60μg/dl). Total iron binding capacity was high in 42% of cases (28 out of 67) and serum transferrin levels were also high in 33% of cases (22 out of 67). In 7% of cases (5 out of 67), GPT levels were higher than 36 unit. These laboratory findings suggest that 12 cases were considered to be healthy, but 10 cases were borderline between healthy and anemia, and another 33 cases were clearly designated as iron deficiency anemia. The 12 remaining cases were suspected of liver functional disorder with or without anemia. It is recommended from the results that those male donors, especially above 50 years of age, found to be ineligible or deferred to donate by copper sulfate screening test, have better to consult a doctor and have further examination of their blood. Therefore, doctors at blood center or on the blood donor coach should remind the background of blood gravity being less than 1.052 and give proper advice to the blood donors for their health and for their intension to donate blood.

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The hemagglutination inhibition (HI) method was evaluated as a screening test of antibodies to hepatitis B core antigens (anti-HBc).
Of 1000 donors samples tested, 272 were HI-positive which included all the anti-HBc positive samples by EIA. Five samples were HBsAg positive only by EIA, which were also HI-positive.
The HI titer of HBsAg positve samples were mostly 2⁶ or higher, although some of the HBeAg positive samples were HI-negative.
The HI method could be adapted to PK7100, an automated pretransfusion screening system. Of the 2523 samples tested for anti-HBc by PK7100, 694 were positive, most of which were confirmed by the manual HI test. Eighteen samples were positive only by the PK method probably due to carry-over.
Finally, we developed the SC-HI for PK7100. The SC-HI cells are double-labeled cells with anti-HBc and HBsAg so that the anti-HBc and anti-HBs are simultaneously detectable.
The HI method is an useful method for detecting HBV carriers, when it is supplemented by RPHA for HBsAg and PHA for anti-HBs.

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Adoptive immunotherapy (AIT) in 8 patients with brain tumor was performed. LAK cells were induced from PBLs of the patients by incubation in the medium (TIL-media I+4% human AB serum), spplemented with 1000 unit/ml of rIL-2 (Sionogi Pharmac. Co.). In these patients, Ommaya's reservoir was inserted at the operative location, and the LAK cells were injected into this tube at one or two times per week. All patients were treated with radiation therapy at the start or before AIT. Any unfavorable effects of this therapy were not observed. A temporary reduction of tumor mass was observed in 3 patients. AIT with LAK cells may be useful as a supporting therapy in the post-operative patients. The obstruction of the injection tube is the most difficult problem to continue this therapy.

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The effect of mixed tumor-lymphocyte culture (MTLC) on the induction of lymphokine activated killer (LAK) cells was described. The LAK cells were generated from the PBLs of cancer patients by incubation in medium with rIL-2 (1000u/ml, Sionogi Pharmac. Co.) during several days. At the start of the LAK induction, the PBLs were stimulated with autologous tumor cells which were already treated with Mitomycin C. MTLC elevated the killer activity of the LAK cells significantly, compared with that of non-stimulated LAK cells. We also recognized the elevation of killer activity in the LAK cells stimulated with allogeneic tumor cells, accompanied with several differences among the samples. We discussed the effective procedures of MTLC.

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A 52 years old woman with ruptured esophageal varix, who had hemolytic transfusion reaction without any detectable irregular antibodies in her serum, was reported. She had history of twice blood transfusions on each caesarean operation in 1979 and 1980.
She has received 10 units of fresh whole blood from 16 to 18 May in 1988. Ten days after blood transfusions, she noticed hemoglobinuria. Laboratory tests showed increase in LDH and indirect bilirubin levels with decreased haptoglobin level.
The irregular antibodies were weakly detected in her serum by low ionic strength polybren method on the Autoanalyzer, but not by saline, albumin, bromelin and indirect antiglobulin method. Specificity of the antibodies were anable to be identified, and direct antiglobulin test wa negative. The blood groups of the patient were A1, ccDee. She received blood with Rh phenotype of ccdee. Ever since, she has been saved from occurrences of any hemolytic reactions. Thus delayed hemolytic transfusion reaction by anti-E+C was mostly suspected, though irregular antibodies could not be detected in her serum in March, 1989.

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A 20 year-old male with congenital afibrinogenemia was admitted to our hospital because of chronic subdural hematoma of the right temporal area. He had had several episodes of hypersensitivity reactions to fibrinogen administration, including hypotension, bronchospasm and cutaneous rash. An intradermal test for fibrinogen was positive without precipitating antifibrinogen antibodies.
Because subdural hemorrhage progressed despite of cerebral decompression by medication, fresh frozen plasma was administered usng a method of rapid desensitization after pretreatment with adrenocorticosteroid, bronchodilator, antiallergic drug and H₁-antihistamine, resulting in arise of a plasma fibrinogen level to 100mg/dl without occurrence of any hypersensitivity reactions. Immediately after this procedure he received surgical therapy for the hematoma. Fresh frozen plasma could be uneventfully administered without pretreatment or rapid desensitization to maintain a plasma fibrinogen level more than 50mg/dl during 2 weeks after the operation. He is in good condition 9 months after this episode.

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In an attempt to improve transfusion-related procedures at our hospital, the effects of introducing of Type and Screen (T & S) were investigated.
Subjected to study were 4978 requests for RBC, 1171 requests for PC, 3518 requests for FFP, 388 requests for 0 units, and 952 requests for elective surgical procedures during the 15-month period from January 1988 to March 1989.
In order to prevent transfusion accidents, all patients data were controled using a personal computer.
The execution rate of T & S amounted to more than 80%, and 41% of the operative cases having requests for 0 units transfusion.
The introduction of T & S enabled us to omit minor crossmatching and anti-globulin tests for RBC and performed non-crossmatch tests for additional surgical blood, PC and FFP.
There was a decrease of 16.2% in the rate of consumption of anti-globulin serum. C/T ratio and rate of returning blood showed decreases of 30% and 21%, respectively. A contribution was also made to decreases of 17 and 71% in warehousing and returning concentrated RBC units from red cross blood center, respectively. Blood delivery time could be shortened to within 5minutes for additional surgical blood, FFP and PC and within 30minutes for RBC.
T & S was found to not only help smooth our hospital's blood supply system, but also to contribute to a reduction in due waste of manpower and of reagents. Overall, it is though to be an excellent method.

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