It is well known that human T-cell leukemia virus type 1 (HTLV-1) infection is contributed to deficient immunity.
Some association between HTLV-1 infection and hepatitis virus infection were investigated, particularly the effect of HTLV-1 infection on the acquisition of hepatitis B and C virus carrier state, and on liver function in hepatitis virus carriers.
The subjects consisted of 945 HTLV-1 positive donors aged 16-64 (mean±S. D.=37.4±11) and 2, 000 negative controls aged 16-64 (mean±S. D.=30.4±10).
The prevarence of hepatitis B surface antigen in HTLV-1 positive donors and negative controls were 1.9% and 1.6%, respectively. However, there was no statistically significant difference. On the other hand, the prevalence of antibody to hepatitis C virus in HTLV-1 positive groups was 2.5% and significantly higher than in negative controls being 0.4%. Frequency of donors with high value of GPT was not different between HTLV-1 positive group and negative.
In conclusion, HTLV-1 infection may not affect on the acquisition of HBV carrier state and liver function. However, an association between HTLV-1 and HCV infection was suggested.

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181 women donated an average of 460ml of autologous blood before elective gynecological surgery at our blood transfusion service from January 1990 to December 1992. No adverse reactions were found during the donation periods.
We propose a criteria of autologous blood transfusion for gynecological operations.
1) This program should be indicated in all the patients in need of modified hysterectomy with retroperitoneal lymph node dissection. Storing about 600ml of autologous blood is desirable in these cases.
2) Among the cases planned to have total abdominal hysterectomy, these with endometriosis or a history of gynecological operations are suitable for donation of 400ml of autologous blood.
3) At the time of radical hysterectomy, 800ml or more of autologous blood is needed for an operation.

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Analyses were conducted on issues related to autologous blood donation. Out of a total of 840 donor-patients who donated autologous blood prior to elective surgery from November 1987 to March 1993, 138 (16%) presented problems of various kinds. Among them, anemia-related problems are encountered most frequently in adult patients. In regard to donor reactions, 23 cases experienced mild symptoms due to hypovolemia or vasovagal reflex, but recovered by crystalloid infusion.
Our data revealed that the etiology of anemia in elderly patients appeared to be a relative iron deficiency: iron sulphate administered was not used efficiently for erythropoiesis but was stored in the reticuloendothelial cells. We also observed an impaired endogenous erythropoietin response to phlebotomy-induced anemia. Therefore, we recommend that recombinant human erythropoietin has the potential for facilitating successful autologous blood donation in selected cases.
Incidentally, there seemed to be no use in measurement of the most immature reticulocyte as a parameter to predict successive autologous blood donation in elderly patients.
In conclusion, proper attention to such factors as hemoglobin level before donation, age and weight are of importance for successful blood donation; however, we should also put emphasis on patients' general health and complete cooperation.

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In our blood center, we have been screening red cells of donors with various antibodies (monoclonal antibodies, human antisera), Ulex lectin and 2 M urea by the use of Groupamatic-2000 machine and manual technique. We detected 522 donors of the rare phenotype bloods (Rh-positive —Oh: 1, para-Bombay: 2, -D-: 11, Lu (a-b-)·In (Lu): 2, Ko: 10, McLeod-like: 2, Jk (a-b-): 16, SS: 56, Fy (a-b+): 150, Di (a+b-): 53, Jr (a-): 36;Rh-negative— Rhmod: 2, SS: 32, Fy (a-b+): 119, Di (a+b-): 20, Jr (a-): 10).
These donors did not contain any irregular antibody in their sera except 1 Bombay and 2 para-Bombay phenotype donors. On the other hand, only 55 rare phenotype donors were detected by antibody screening. Consequently, we are confident that the screening of the rare phenotypes using Groupamatic-2000 machine with monoclonal antibodies is very useful and clinically significant.
Our blood center shipped 749 total units of the rare phenotype bloods including 683 units (91.2%) of frozen and thawed red cells from April 1, 1985 to March 31, 1992. Total units shipped of the rare phenotype bloods by all the Japanese Red Cross Blood Centers amounted to 4, 558. Especially, the ratio of Jr (a-) to the total units was 49.3%. Three thousand six hundred and eighteen (79.4%) of the 4, 558 units shipped were frozen thawed red cells.

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This study evaluated the usage and discard of all the blood products (124533 units) supplied from the Japan Red Cross blood center from April in 1989 to Marchin 1993.
The units of fresh whole blood and stored whole blood purchased and used significantly decreased during 4 years. The units of fresh whole blood purchased was 22% in 1992 compared with those in 1989. The purchase and use of platelet concentrate significantly increased, especially in recent 2 years.
The percentage of discarded blood was extremely lowered to 0.78% in 1992. Discards of whole blood and red cell concentrate due to inadequate management at the ward were especially decreased. The units of red cell concentrate discarded due to the expiration of stored period were also decreased because of the introduction of concentrated red cells stored in MAP solution (RC-MAP) in April 1992.
Frequent communication between our division and the doctors in charge was necessary to reduce the discard of platelet concentrate which were over ordered for patients. In addition, the blood management system should be clearly understood among the doctors to reduce the discards of whole blood and red cell concentrate.

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To make the most of the blood products, we have introduced maximum blood order schedule (MSBOS) and Type and Screen (T & S) into Nagahama City Hospital. By investigating the transfused blood products according to major surgical procedures of last 2 years, we set up MSBOS and the procedure of blood preparations for elective surgery in our hospital.
As a result of one year's experience, the cross-match to transfusion ratio (C/T ratio) in many surgical procedures and that of red cell products in our hospital have decreased, and the effective use of red cell products has elevated.
However, because our hospital dose not have the blood products in deposit system and we can not return the products, it was impossible to decrease the out-date.

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In developing countries, blood transfusion is the easiest and at times the sole therapeutic method available for treating not only anemia but also malnutrition etc. Its indication is not very strict. Moreover several tropical diseases, such as Malaria and Chagas' disease, should be considered as transfusion related infection.
Chagas' disease, a parasitic disease caused by Trypanosoma cruzi, is endemic in Bolivia. Now it is becoming a serious problem even in urban area because of rural/urban migration in Latin America. Although the blood transfusion system includes screening tests, it is not sufficient.
In Bolivia, one of the poorest countries in Latin America, the blood transfusion system has not been thoroughly studied.
This is a report on the current situation for blood transfusions in Bolivia; especially in relation to the prevalence of the transfusion related infections Hepatitis B, Hepatitis C, HIV, HTLV-1 and Chagas' disease.
The seropositive rate of Chagas' disease in blood donors was 23% with the IHA method, making it one of the most serious public health problems in Bolivia. A Nation wide program for it should be started as soon as possible. First of all, to prevent the infections through blood transfusions, appropriate blood screening system is required in Bolivia.
The prevalence of Hepatitis B, Hepatitis C, HIV and HTLV-1 were not so high. It is necessary to do more epidemiological studies.

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For the purpose of making Donor Plasmapheresis (DP) more popular, a novel device (MS-201, TERUMO Corporation, Tokyo) for DP has been developed, which is composed of a membrane plasma separator, a blood and a plasma collection bag each and connected tubes. The module consists of 16 circular layers of the membrane made of polypropylene coated with hydrophilic polymers. This device requires no priming operation with saline. DP using this system was carried out on 31 healthy male donors.
This device functioned well to collect plasma and was accepted favorably by the donors. None of the donors experienced adverse effects. Our study showed that the module had good biocompatibility since mean values of activation markers of complement (C3a and C5a), platelet (β-TG, PF-4) and coagulation (FPA) as well as hemolysis (free Hb, Hp, LDH) increased a little more than or within normal limits. The recovery and sieving coefficients of TP, Alb, AT-III, F-VIII and Fibrinogen were more than 0.95.
It took a mean time of 33.7±6.2 minutes from needle punctures of vein to collecting 450ml of plasma including anticoagulant.
In conclusion, this donor plasmapheresis system could be safely used and easily accepted to process in mobiles with a portable size.

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The efficacy of a double-bag system to preserve platelet concentrates (PCs) in liquid condition for 21 days was examined by detecting platelet membrane glycoproteins and granule membrane protein using a flow cytometry and EIA method. In PCs stored in the double-bag system, major platelet plasma membrane glycoproteins, such as GPIb, GPIIb/IIIa and GPIV, and an α-granule membrane protein, P-selectin, were much better maintained than those stored in a polyolefin (PO) or a polyvinyl chloride (PVC) container.
The morphology of platelets stored in each bag was observed by transmission electron microscopy. In the platelets stored for 14 days in the PO-bag or the PVC-bag, the number of granules was decreased, the open canalicular system (OCS) was damaged, and the platelets were balloon-shaped. On the other hand, the granules and OCS in the platelets stored in the double-bag system were well maintained up to 21 days at 22°C.

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Delayed hemolytic trasfusion reactions (DHTR) developed in ten cases from 1981 to 1990 in National Cancer Center Hospital.
The incidence of DHTR was 0.05% for transfusion (10 among 18, 231 transfusions) and 0.01% for units (10 among 122, 560 units). Anemia and fever were recongized in all cases and fever were associated with chill in 7 cases. Hemoglobinuria was recongnaized in 6 cases.
The commonest laboratory findings were the elevated level of LDH and decreased level of hemoglobin and haptoglobin. Red blood cell antibodies involved in the DHTR were detected in 6 of 10 cases. Anti-E was identified in 3 out of the 6 cases. When the hemolytic manifestations are recongnized after blood transfusion, red blood cell antibodies must be examined as soon as possible.

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Recently, blood components have been irradiated with X-ray prior to transfusion to prevent PT-GVHD. In order to evaluate how long RC-MAP can be stored after irradiation, we examined several in vitro qualities of the RC-MAP, which had been irradiated with X-ray of 15Gy and stored at usual condition for five weeks.
There were no differencies in ATP, 2, 3-DPG contents and osmotic membrane fragility of red cells between the irradiated and unirradiated RC-MAP for five weeks after the treatment. No difference was found also in free hemoglobin in plasma between them over the whole period. However, the irradiated components showed significantly higher concentration of potassium in plasma than the control after a week.
From these results, we concluded that the RC-MAP irradiated with X-ray of 15Gy can be used within a week after the treatment without impairment of red cells.

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We retrospectively studied HLA typing which had been performed since 1986. The results of HLA typing determined by the serological typing were compared with those determined by DNA typing using the modified PCR-RFLP method. With the serological method, HLA-A, B, C, typings were 100% feasible but HLA-DR, DQ typing were unfeasible in 20.9% of recipients for bone marrow transplantation all of which were definitively defined for HLA class II alleles by the PCR-RFLP method. Most of these serological “blank” antigens were DR5, DR6 and DR8 which could be easily detected by DNA typing. The PCR-RFLP method which is not influenced by lymphocyte viability, is essential for the practice of recipient-donor matching in bone marrow transplantation.

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We have retrospectively analyzed the relationship between the platelet counts and severe hemorrhagic episodes in 56 patients with aplastic anemia with platelet counts lower than 20, 000/μl to establish better standardization for indications of prophylactic platelet transfusion in aplastic anemia. Severe hemorrhagic episodes, especially cerebral bleeding, occurred more frequently in patients with the platelet counts below 5, 000/μl than 5, 000 to 20, 000/μl, mostly within 6 months after platelet counts fell below 5, 000/μl. On the other hand, most of patients with no severe hemorrhagic episodes in spite of platelet counts below 5, 000/μl recovered by therapy or died of infection within 3 months. Seventeen out of 21 patients who were complicated with cerebral bleeding were supposed to have died because of ineffectiveness or delay of platelet transfusions. From the history of platelet transfusions, it was speculated that at least in 6 patients cerebral bleeding could have been prevented by adeqate prophylactic platelet transfusions.
From these findings, we have proposed a scoring system to determine the indications of platelet transfusions in aplastic anemia. In this proposal, prophylactic platelet transfusions are necessary at least for 6 months in patients the platelet counts last below 5, 000/μl, irrespective of the degree of bleeding symptoms and the complications of infections or DIC.

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Periheral blood stem cells (PBSC) were collected from six patients by a method using only recombinant human granulocyte colony stimulating factor (rhG-CSF) without the aid of chemotherapy. Four patients with malignant lymphoma and two with acute lymphoblastic leukemia were all in the CR state. rhG-CSF was given subcutaneously for 3 to 5 days when the effect of their last chemotherapies no longer remained (more than 30 days after chemotherapies).
PBSC collection was started 4 or 5 days after initiation of rhG-CSF administration when the leukocyte count reached a mean of 22, 800/μl (range 3, 800-26, 00). The mean number of CFU-GMs was 0.23×10⁵/kg (range 0.023-0.63×10⁵/kg).
This study led us to the conclusion that PBSC can be collected easily and in a shorter time only by mobilization by rhG-CSF.

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