The automated blood group testing system based on column agglutination technology (CAT) does not provide a standard for reversed typing. If the tube test (TT) method standard is introduced into automated the CAT method, the frequency of confirmation testing with the TT method will increase. In this study, we compared the results of the CAT and TT methods using samples which produced weak results with the automated CAT method (reactivity<3+; AutoVue System, Ortho).
Forty-five percent of weak samples showed an increase in agglutination reactivity after a fixed 3-minute incubation time with the manual CAT method (Bio Vue, Ortho). All 481 weak samples had greater than 3+ reactivity with the TT method. Eighty percent of weak samples possessed IgM antibody. Titration and scoring results with the TT method were greater than with the manual CAT method for all samples. Titration and scoring of the weak samples were low with all methods for all samples. In conclusion, we propose that 1+ reactivity in the automated CAT method requires a confirmation test with the TT method because CAT 2+ samples can present as 3+ with the TT method.

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We introduced an automated instrument for pretransfusion testing during off-hours based on column agglutination technology. As the time required for testing ABO group and Rh type is at least 20 minutes, we also prepared manuals regarding emergency transfusion of uncrossmatched blood. During a two-year period, 25 patients received 209 units (8.4 units per patient) of group O blood, and 19 patients received 289 units (15.2 units per patient) of group-specific blood. Additionally, 5 patients received 98 units of group-specific blood following group O blood. Fourteen patients (26.9%) required massive transfusion (20 or more units of blood within 24 hours). Accurate blood typing was carried out by using a blood sample drawn from the patient prior to infusion of group O blood. Antibody screening was carried out using this specimen the next day, and if a patient was positive for an antibody, complete compatibility testing was also performed. All patients were followed clinically and for any signs of transfusion reactions or crossmatching difficulties, but none developed. Although one patient had anti-E antibody present on admission and received E antigen-positive blood, no elevation of antibody level or delayed hemolytic reaction occurred. Two near-miss incidents associated with clerical errors were experienced with group-specific blood transfusion. We conclude that urgent transfusion of uncrossmatched blood is safe, and that group O blood transfusion may be safer than group-specific blood transfusion in some emergency situations. Off-hour manuals based on the time required for blood preparation will avoid transfusion errors.

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The performance of platelet concentrates (PCs) for transfusion is greatly limited by their short shelf life. A highly oxygen-permeable container (PO-80, Kawasumi, Tokyo) was developed as an approach to extending the shelf-life of PCs. Here, we compared PCs containing a high number of platelets (4×10¹¹/250mL plasma/bag) stored in a PO-80 container with those stored in a standard bag (control) (PL2410, Baxter Healthcare, USA) by monitoring platelet biochemical and functional parameters for up to 9 days.
Three of six bags in the control bags had a pH below 6.2 by day 7. These PCs also showed the disappearance of swirling, a rapid drop in glucose combined with a marked increase in lactic acid, accelerated P-selectin expression on platelets and an earlier decrease in both %HSR and aggregation of platelets in the observation period. In contrast, only one of six bags had a pH below 6.2 by day 9 in the PO-80 container. Further, there was no disappearance of swirling. Other biochemical and functional parameters of PCs in PO-80 showed a slower change compared with those in the control bag. Overall, the in vitro characteristics of PCs showed a lower level of deterioration over 9 days when stored in a higher oxygen-permeable container than in a conventional bag. It is suggested that this newly developed highly oxygen-permeable PO-80 container will preserve adequate platelet function for longer storage periods and with higher PC yields.

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We experienced a case in which an anti-D antibody was developed after transfusion of RBCs from 19 apparently D-negative donors over a half-year period beginning in July 2000. The patient was 67-year-old. B-negative female with a history of sensitization by transfusion of D-positive RBCs. Antibody screening became positive and an anti-D was detected by indirect antiglobulin testing. However, no hemolytic episodes due to the anti-D were found in her clinical course. Specificity of the antibody was confirmed as an allo-anti-D by serological studies using differential absorption-elution or dithiothreitol-treated RBCs. We initially suspected the possibility of transfusion from D-positive or weak D donors and the Rh phenotypes of all 19 donors were back-checked. However, none was positive for D antigen by the indirect antiglobulin test and 5 donors included Ce haplotype. Genomic analysis to detect a D_el, allele will demonstrate whether RBCs from a donor carrying a Del allele with Ce haplotype induced an allo-anti-D immune response.

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An 82-year-old female was admitted to our hospital for treatment of a fracture of the femur. She demonstrated anemia and received red cell transfusion before and after surgery. Mild hypoxia was noted after the second red cell transfusion. At 72hr after the first red cell transfusion (45hr after the second), she developed marked hypoxia. She also complained of transient mild chest discomfort, but no clinical symptoms were reported at the time the marked hypoxia occurred. Bilateral pleural effusion and pulmonary edema were found on chest roentgenography. Acute myocardial infarction, cardiac failure, and pulmonary embolism were excluded by blood examination, ultrasonic cardiography, electrocardiography, and pulmonary perfusion scintigraphy, respectively; however, hypoalbuminemia was found. She was administered oxygen, diuretics, and human serum albumin, after which pleural effusion, pulmonary edema, and hypoxia were resolved. Antigranulocyte antibodies or anti-HLA antibodies were not detected in sera from donors or recipient. The clinical features of this case were similar to those of transfusion-related acute lung injury, but, the course was slowly progressive.

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We report here a rare case of delayed hemolytic transfusion reaction (DHTR) probably caused by a primary immune response. The patient was a 69-year-old Japanese female who underwent neurosurgery for subarachnoid hemorrhage. For treatment of post-operative hemorrhage, she received 2 units of packed red cells (Ir-RC-MAP) per day for 6 days, for a total of 12 units. On day 33 after the first transfusion, she showed symptoms of hemoglobinuria, anemia, thrombocytopenia, elevated levels of serum LDH and total bilirubin, and a decreased level of serum haptoglobin. Her blood was typed as A, ccDEE. Partial coagulation was observed on Rh blood-type examination for C and e but disappeared on day 37 after the first transfusion. On irregular antibody screening of patient serum collected 37 days after the first transfusion, IgM type anti-C+e was detected by MTS-Pap. We found that the immunoglobulin class of anti-C+e switched from IgM to IgG during the clinical course. These findings suggest that the DHTR was probably due to anti-C+e caused by a primary immune response.

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Living-donor liver transplantation (LDLT) is now an important option for the treatment of patients with end-stage or irreversible liver disease. We have previously reported the quantities of blood required for transplantation in 772 cases of LDLT performed from June 1990 to March 2002 at Kyoto University Hospital. In the present study we retrospectively analyzed the preoperative factors associated with massive blood losses during LDLT. The patients were divided into two groups, with the upper quartile was defined as the high blood loss (HBL) group and the lower three quartiles as the low blood loss (LBL) group. Preoperative variables between the groups were compared and statistically analyzed by chi-square analysis or the Mann-Whitney U-test. Results showed that predictors of HBL were age (<2 years old); low body weight (<10kg); decreased Hb (<8.0g/dl); elevated CRP (>2.0g/dl), T-Bil (>10.0g/dl), D-Bil (>10.0g/dl), Cre (>1.0g/dl) and BUN (>30.0g/dl); pre-operative hospitalization; re-transplantation; and diagnosis (Biliary atresia, Budd-Chiari syndrome). In conclusion, particular care against the possibility of massive intra-operative blood loss should be taken in patients with low age, anemia, severe liver dysfunction, and renal dysfunction.

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