Background: Japan, where the elderly population is increasing rapidly while the younger generations are in state of decrease, is anticipated in the near future to experience a shortage of blood components as the demand for blood transfusions will correspondingly expand. This survey was performed in order to establish countermeasures to use blood components efficiently through analyzing those factors which contribute to good utilization.
Method: A questionnaire was sent to 131 hospitals in Fukushima Prefecture inquiring as to their use of whole blood/blood components between April, 1999 and March, 2000.
Results: Among 96 institutions, 32 (33%), 44 (46%), or 45 (47%) had a transfusion committee, a blood transfusion division, or a doctor responsible for transfusions, respectively. Discard ratios were 7.9% (6, 492/82, 348 units) for red cells, and 0.6% (405/68, 284 units) for fresh frozen plasma. However, through the establishment of a transfusion committee, a transfusion division, or a responsible doctor, the discard ratio of red cells decreased: Corresponding odds ratios were 0.6, 0.36, or 0.53, respectively. Conversely, the introduction of MSBOS had minimal effect in reducing discarded red cells (odds ratio: 0.89).
Conclusion: For the optimal use of blood components, the establishment of a transfusion division plays a key role, and accordingly, such a practice should be expanded nationwide.

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71kDa heat shock cognate protein (HSC70) is a member of the Hsp70 family and is constitutively expressed in organisms as diverse as slime molds, bacteria, plants and higher eukaryotes. Proteins in the Hsp70 family are known as chaperones that involve quality control of cellular proteins, folding of nascent polypeptide chains and trafficking of proteins via membrane structure. Recently, it was revealed that Hsp/HSC70 proteins were presented on surface of virus- or bacteria-infected cells, immortalized cells and blood cells of autoimmune disease patients. We previously reported that the HTLV-1 receptor consists of HSC70, β-actin and phosphatidylglycerol on the surface of MOLT-4 cells. In this study, we examined the induction of HSC70 protein on the surface of peripheral blood mononuclear cells (PBMCs) from healthy individuals. Little HSC70 protein was observed on the surface of PBMCs before cultivation. However, after 72 hours culture, 41±9.1% of PBMCs presented HSC70 proteins on the cell surface. On the other hand, in culture with phytohemagglutinin (PHA), 70±14% of PBMCs exposed HSC70 protein on the cell surface after 24 hours, and 84±5.0% after 72 hours. PHA stimulated the presentation of HSC70 protein on the cell surface of CD4⁺ T cells, which are the target cells of HTLV-1 in vivo, as well as that on the surface of PBMCs. Susceptibility to HTLV-1 of target cells was parallel to the expression level of HSC70 molecules on the cell surface. These results demonstrate that HSC70 protein on the surface of PBMCs and CD4⁺ T cells exposes the domains which are functional for HTLV-1 infection, and that stimulation by cultivation and mitogen enhances the trafficking of HSC70 proteins to the surface of plasma membrane. This is the first finding that HSC70 on the surface of CD4⁺ T cells functions as a receptor for cell-to-cell transmission of HTLV-1.

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We present a new surgical blood management method. In this method, surgical blood units in elective operations are divided into two groups, a group of crossmatched blood judged as having a high probability of being used in transfusions, and a group of un-crossmatched blood with a low probability of being used during or early after the operation. Each blood group is ordered separately before the operation. If excessive bleeding occurs, the reserved blood units are transfused using either crossmatched or un-crossmatched blood, using the well-known Type and Screen method. This new method was implemented in our hospital beginning in April 1998. The number of crossmatched, reserved, and transfused blood units in general surgery from January 1995 to December 2001 were reviewed. During this period, the total number of transfused blood units decreased slightly and blood units that were crossmatched but not used decreased remarkably (Fig. 2). Therefore, the ratio of crossmatched to transfused blood decreased from around 2.0 to less than 1.5 (Fig. 3). In this method, it is necessary for the surgeon to make two blood-ordering sheets for one patient. This somewhat intricate procedure will have a provocative effect on efficient utilization of limited blood products.

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Homogenate of matured roe of the female loach (Misgurnus anguillicaudatus) was absorbed with the stromas of A and O red cells. A lectin could be obtained after centrifugation to remove the stromas. This crude lectin was further purified by column chromatography on DEAF-cellulose (DE-52). Agglutination was carried out by centrifugation after reaction with 5% washed RBC and 22% polymerized bovine albumin.
This crude or partially purified lectin reacted with B and AB red cells but not A, O or acquired B red cells. The subgroups (B₃, B_m, A₁B₃, A₂B₃, A₁B_m A₁B_x) of red cells could not react. This lectin was therefore defined as B-specific lectin.
Agglutinating activity was inhibited by monosaccharides such as L-rhamnose and L-mannose more effective than by D-galactose, D-fucose, L-arabinose and L-lyxose. Other monosaccharides failed to inhibit agglutination. Oligosaccharides possessing a galactose residue as a terminus such as trisaccharide (raffinose) and tetrasaccharide (stachyose) also inhibited agglutinatin.
This B-specific lectin may be suitable for application to ABO blood typing by a manual or automatic mechanical procedure like A₁ or H lectin.

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We report on a patient who developed acquired B antigen and Tk polyagglutination in Escherichia coli (E coli) septicaemia during the course of ulcerative colitis.
In vitro analysis showed that E coli was the cause of the acquired B phenomenon. The level of intensity of both Tk and acquired B antigen changed simultaneously and both disappeared at the same time. Both antigens were also abolished by acetylation of the patient's red blood cells. These findings indicate that the Tk polyagglutination was closely related to the acquired B antigen.
H activity decreased during the course of hospitalization. From the results of acetylation of the patient's red blood cells, the decrease in H activity was explained by the fact that acquired B- and Tk-expressing red blood cells showed stronger than H activity of A₁ red blood cells.
The antigenic modification appeared prior to the onset of E coli septicaemia. This finding suggests that the early detection of blood abnormalities is helpful in the early diagnosis and proper treatment of these patients.

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We conducted a blood products utilization review in Oita Medical University Hospital (Oita) and Miyazaki Medical College Hospital (Miyazaki) before and after revision of the Japanese Guideline for Appropriate Usage of Blood Products. During the period from April 1998 to September 2001, the usage of red blood cells (RC-MAP), fresh frozen plasma (FFP), platelet concentrate (PC) and autologous blood in both hospitals was concurrently analyzed. Usage of RC-MAP and PC were reduced by about 30% and 10-15%, respectively, in both hospitals during the study period. A greater than 60% reduction in FFP usage was achieved in Oita as compared to 14% in Miyazaki. In surgical departments, the decrease in RC-MAP and FFP usage was similar in the two hospitals. In internal medicine departments, however, a greater than 80% reduction in FFP usage was observed in Oita. The ratio of autologous red cells to all red cells transfused during operation was increased to more than 30% in Miyazaki. The activities of blood transfusion committees for the education of doctors as well as the computer ordering programs justified by the blood coagulation data seem to have been effective in eliminating unnecessary FFP transfusion, especially in Oita. These results indicate that activities undertaken to inform and promote the new Japanese Guideline for blood transfusion have been successful in producing an overall improvement in transfusion practice in both university hospitals, especially with regard to decreasing FFP usage in Oita and increasing autologous blood usage in Miyazaki.

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We conducted a survey of exchange transfusions performed in our neonatal medical center during the last 5 years.
From January 1, 1996 to December 31, 2000, 2296 neonates were admitted to our neonatal nursery. Sixteen exchange transfusions were performed upon 10 infants whose birth weights ranged from 512g to 3610g. The incidence of exchange transfusion was 0.44%. The indication for each exchange transfusion was hyperbilirubinemia (eight instances), sepsis with DIC (four instances), shock with massive hemorrhage (three instances) and hydrops fetalis. Hyperkalemia was a complication in one case. Adequate blood was difficult to get in emergency situations.
Exchange transfusion is one of the essential techniques in the neonatal care, although it may involve some complications including hyperkalemia, bleeding, hypocalcemia, hypoglycemia, graftversus-host disease, infections, etc., especially in very low birth weight infants. In our nursery, the incidence of exchange transfusion was very low in comparison with that of previous reports. This may represent a difference in the indication of this therapy.
We propose that we should discuss the appropriate indications and safe procedures concerning exchange transfusion. We note that adequate blood supplies should be available immediately in the event of an emergency.

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