日本輸血学会雑誌

自己血採血におけるVVR発症例の検討と対策

佐藤裕二, 西部俊哉, 小林寿美子, 岩谷ユリ子, 篠原敏樹, 近藤正男, 神山俊哉, 安田慶秀

2002 年 48 巻 4 号 p. 329-334
発行日: 2002/08/01
公開日: 2010/03/12

DOIhttps://doi.org/10.3925/jjtc1958.48.329

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Background: Recently autologous blood predonation has been used in preoperative blood preparation. Among side effects, VVR is one of the most dangerous. The purpose of this study was to clarify causative factors in and prevention of VVR. Methods: A total of 762 patients made 1, 279 donations. The 33-months investigation was divided into 4 periods, Period I-IV. Results: VVR occurred in 76 donations (71 patients, or 5.9% of patients). Sixty-six occurrences were grade I. Incidence in Period III was significantly lower than that in Period I or II. With regard to age, incidence of VVR was 41.7% in those aged 10-15 years. For body weight, it was 15.6% for patients less than 50kg. In paticular, incidence was a high 47.4% in patients aged 15 years or younger and weighing 50kg or less. Conclusion: The data emphasize the importance of informed consent in patients aged less than 15 and weighing less than 50kg.

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ABO不適合骨髄移植後の赤血球におけるABH抗原型物質の解析

岸野光司, 室井一男, 中木陽子, 大槻郁子, 尾島佐恵子, 渡辺一枝, 小幡隆, 菅野直子, 小野崎文子, 永嶋貴博, ...

2002 年 48 巻 4 号 p. 335-341
発行日: 2002/08/01
公開日: 2010/03/12

DOIhttps://doi.org/10.3925/jjtc1958.48.335

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ABH-antigens and A-and B-glycosyltransferase activity were examined in four patients who received an ABO-incompatible bone marrow transplant from HLA-matched donors. ABO phenotype and ABO genotype were analyzed using flow cytometry and polymerase chain reaction with sequence specific reaction, respectively. On day 14 after bone marrow transplantation (BMT), the ABO genotype of erythroid burst-forming units was converted into the ABO genotype of the donors in all of the recipients. Afterward, ABO phenotype of red blood cells (RBC) in all recipients completely changed to that of the donors. Rh, P, Diego, Kidd, Duffy and MNSs phenotypes were also changed into the donor's phenotypes. However, in one patient the Lewis blood type did not change into the donor's phenotype. Similarly, using an elution method, ABH antigens of the recipients were detected in RBC in all of the recipients after BMT. In two recipients, the serum glycosyltransferase activities of the recipients were only detected after BMT. These findings indicate that ABH antigens may be released from non-blood cells and adsorbed by RBC, although the possibility of ABO chimeras or unknown mechanisms is not ruled out. Further studies are needed to determine the nature of ABH antigens eluted from RBC of recipients receiving an ABO-incompatible bone marrow transplant.

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ポリエチレングリコール間接抗グロブリン試験 (PEG-IAT) における高グロブリン血症による血球凝集 false negative 現象

渡部和也, 竹内千華子, 横田睦子, 山口富子, 安田広康, 大戸斉, 吉田詠子, 青木義政

2002 年 48 巻 4 号 p. 342-349
発行日: 2002/08/01
公開日: 2010/03/12

DOIhttps://doi.org/10.3925/jjtc1958.48.342

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IgG-coated RBCs are routinely used to confirm appropriate procedures when negative hemagglutination occurrs in the indirect antiglobulin test (IAT). We undertook this study after encountering a case of agglutination failure of IgG-coated RBCs by polyethyleneglycol (PEG)-IAT in a patient with hyperglobulinemia.
We investigated whether IgG-coated RBCs could be agglutinated by anti-IgG using the PEG-IAT technique after incubation with 143 sera, in which no irregular anti-red cell antibodies were present, from patients with hyperglobulinemia.
Failure of agglutination (false negative reaction) was found more frequently (p<0.001) with the original PEG-IAT (4 drops in test mixture) (46/143 sera; 32%) than the modified PEG-IAT (2 drops) (15/143 sera; 11%). The rate of residual-IgG in the supernatant in the mixture of PEG and patient's serum was significantly (p<0.01) higher with the modified than the original method, at 14.4% vs. 3.0% in hyperglobulinemia patients and 28.5% vs. 5.7% in healthy controls.
The addition of anti-D alloantibody (final titer 1:4) in 3, 000-5, 000mg/dL of immunoglobulin concentration revealed that PEG could cause false-negative IAT results due to the neutralization of anti-IgG through precipitation of immunoglobulins in testing tubes.
Albumin-IAT, low ionic strength solution-IAT or saline-IAT may assist in resolving interference by PEG in cases of hyperglobulinemia.

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医薬品等安全性情報

2002 年 48 巻 4 号 p. 373-376
発行日: 2002/08/01
公開日: 2010/03/12

DOIhttps://doi.org/10.3925/jjtc1958.48.373

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緊急安全性情報

2002 年 48 巻 4 号 p. 377-380
発行日: 2002/08/01
公開日: 2010/03/12

DOIhttps://doi.org/10.3925/jjtc1958.48.377

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