This report describes the results of a survey on the present state of incompatible blood transfusions other than ABO group red blood cell transfusion at national university hospitals. The survey population consisted of medical technologists of blood transfusion services at 43 national university hospitals in Japan. The questionnaire focused on incompatible blood transfusion in patients with irregular antibodies from 1991 through 1999.
A total of 110 cases were reported from 20 hospitals. Red cell transfusion was performed in 49 cases, and antibodies were divided into 7 categories ( ): 1) Saline reactive antibody (8), 2) Saline Enzyme reactive antibody (6), 3) Saline Enzyme Antiglobulin reactive antibody (7), 4) Saline Antiglobulin reactive antibody (4), 5) Enzyme reactive antibody (10), 6) Enzyme Antiglobulin reactive antibody (11), 7) Antiglobulin reactive antibody (3). Of these cases, 24 were compatible transfusions for cold antibody and 25 inappropriate transfusions for 37°C antiglobulin reactive antibody. Nine patients of 25 incompatible transfusions showed abnormalities of subsequent clinical testing. The causes of incompatible transfusion were error in detection due to weakly reactive antibodies and omission of antiglobulin test and antibody history by physicians not used to testing. The present findings suggest the need for 24 hour support systems for transfusion services, and the necessity of considering whether compatible or identical transfusion is suitable for irregular antibodies showing positive on antiglobulin tests and the enzyme method, similar to the situation with the saline method. Anti-IgG antiglobulin test and DTT (Dithiothreitol) method are useful techniques in distinguishing clinically significant antibody from those difficult to determine.
I appreciate the extensive collaboration of Kazuhiko Itoh MD, Makoto Tamura MD, Masayoshi Minegishi MD and medical technologists at the Blood Transfusion Service of national university hospitals.

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It has been recently reported that many Caucasians with IgA deficiency carry the HLA-A1, B8, DR3 haplotype. This haplotype may be widely associated with the pathogenesis of immune deficiency. To date, however, there has been no study of HLA typing of IgA deficiency in Japanese.
We performed HLA-A, B, and DR typing in nine healthy blood donors who had been identified to be IgA-deficient by systematic screening in Saitama Prefecture, Japan. Results showed that these IgA-deficient blood donors had HLA antigens generally found in the Japanese population and no HLA-A1, B8 or DR3 antigens were observed. While the gene frequency of B54 antigen was significantly higher in this group than in the Japanese population, no significant differences for other antigens were identified. It is suspected that the characteristics of IgA deficiency in Japanese are different from those in Caucasians.

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We report a case of Rh-incompatible hemolytic disease of bizygotic twin new borns delivered from a Rh D and C-negative woman without a history of prior pregnancy or blood transfusion.
The alloimmune hemolysis was caused by maternal anti-D (first baby) and anti D+C (second baby) alloantibodies, which were detected at 32 week's gestation by gel tests (Micro Typing System) and at 34 weeks by conventional agglutination tests with glass tubes. The former method was more sensitive than the latter for detecting red cell alloantibodies.
This case suggests that hemolytic disease of the newborn can occur during a first pregnancy even in a woman without prior blood transfusion.

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