In this study, we evaluated the peripheral blood stem cell collection performance of a new fully automatic type cell separator Baxter Amicus, in comparison with a manual program, COBE Spectra. Patients scheduled to receive autologous peripheral blood stem cell transplantation (PBSCT) were alternately distributed to the Amicus and Spectra groups, and the collection efficiency of CD34-positive cells and the performance of the collection products were compared between the two groups. In the first study, Amicus was used with the default settings (MNC offset: 2.3ml, processing blood volume: 1, 400ml×7 cycles). The number of patients was five in both groups, with seven collections in the Amicus group and nine in the Spectra group. CD34-positive cell collection efficiency was 33.20±12.23% in the Amicus group and 54.51±12.07% in the Spectra group (p<0.05), with the latter clearly superior to the former. Contamination of platelets in the products was lower in the Amicus (4.57±1.93×1010/bag) than in the Spectra group (17.71±15.55×1010/bag) (p<0.05). We next modified the parameters of the Amicus program to improve collection efficiency (MNC offset: 2.1ml, processing blood volume: 1, 800ml×5 cycles). The number of patients was five in both groups, with seven collections in each. CD34-positive cell collection efficiency was 23.09±11.53% in the Amicus group and 50.66±15.15% in the Spectra group (p<0.05), showing that modification of parameters did not improve collection efficiency. The advantage of the Amicus system is that it is a fully automatic type cell separator. However, the CD34-positive cell collection efficiency of Amicus was inferior to that of the Spectra manual operation program, indicating the need for further improvement of the Amicus program.
Although HLA-class I antibodies (Abs) are considered one of the major obstacles in posttransfusion platelet increments for platelet transfusion refractory (PTR) patients, whether IgM-HLA-class I Abs are associated with accelerated platelet destruction and transfusion failure remains unclear. Accordingly, we assessed the frequency of IgM-HLA-class I Abs development in 121 PTR patients using the magnetic-mixed passive hemagglutination assay (M-MPHA), flow cytometric reagents for detection of panel-reactive antibody against HLA Class I antigens (FlowPRA) and the anti-human immunoglobulin lymphocyte cytotoxity test (AHG-LCT). The relationship between IgM-HLA-class I Abs and PTR was assessed by calculating 24h post-transfusion corrected platelet count increments (CCI24hours). Result showed that IgM-HLA-class I Abs were detected in 48 of 121 patients using the M-MPHA. Only 20 and 35 of these 48 IgM-HLA-class I Abs were detected using the AHG-LCT and FlowPRA respectively. In 7 of 48 patients positive for IgM-HLA-class I Abs, 74 transfusions without corresponding antigen for specificities of IgM-HLA-class I Abs had CCI24hours of 19.7±4.7(×109/L). In contrast, 38 transfusions with corresponding antigens for specificities of the same Abs had CCI24hours of 2.0±1.9(×109/L). Collectively, IgM-HLA-class I Abs were detected in 39.7% of PTR patients, and were considered to play a role in mediating refractoriness to platelet transfusions. In 28 of 48 cases, IgM-HLA-class I Abs could not be detected by the AHG-LCT. Detection of IgM-HLA-class I Abs using the M-MPHA may clarify the as yet unknown mechanism of the pathogenesis of PTR.
In an attempt to clarify the safety and appropriateness of transfusion practice in Japan, a global questionnaire on transfusion medicine, including the establishment of a transfusion management system and a hospital transfusion committee (HTC), was sent to 1, 355 hospitals in fiscal year 2004. Replies were obtained from 829 hospitals (61.2%). Although a unified management system was established in 681 hospitals (82.2%) and a HTC was in 733 (88.7%), doctors responsible for transfusion (transfusionists) with full-time involvement in transfusion were present in only 86 hospitals (10.5%). When the discharge rate of blood components and the fresh frozen plasma (FFP)/red cells (RBCs) transfusion ratio were compared among the five groups of hospitals categorized according to the number of beds and the presence or absence of transfusionists, as shown in Table I, the discard rate of RBCs and FFP and the FFP/RBCs transfusion rate were higher in the group of hospitals with 300 or more beds, where transfusionists were absent, when compared to the other four groups (Tables 6). In conclusion, full-time transfusionists play a crucial role in the organization of the HTC and the establishment of safe and appropriate transfusion practices.
Background Although intravenous immunoglobulin (IVIG) is widely used in clinical practice, there are no official guidelines for its proper usage in Japan. We have started the preparation of guidelines for appropriate usage of IVIG, firstly by collecting clinical cases treated with IVIG nationwide. Methods Questionnaires concerning the number of patients treated with IVIG and the amount of IVIG used by disease and age (children and adults) from July to September 2003 were sent to 732 hospitals with more than 400 beds. Results Replies were obtained from 319 hospitals, of which 268 (36.6%) were suitable for data analysis. The number of patients and the amount of IVIG used were 1, 955 cases and 28, 684g for children and 6, 615 cases and 142, 334g for adults, respectively. Main diseases in children and adults were infectious diseases (including post-operative infection) in 33% and 73%, autoimmune diseases in 28% and 10%, and immunodeficiency diseases in 16% and 8%, respectively. The differences between them were significant. In particular, Kawasaki disease in children was predominant among autoimmune diseases, representing 44.5% of cases. The amount of IVIG used in children was 60% for autoimmune diseases and 17% for immunodeficiency diseases, while that in adults was 45% for infectious diseases and 35% for autoimmune diseases. Pathogens in these infectious diseases of both children and adults were bacteria in more than half of the cases, and high CRP values as a factor of severe infection were 28% in children (more than 10mg/dl) and 51% in adults (more than 15mg/dl). Conclusions These results indicate that IVIG is mainly used in both autoimmune diseases and infectious diseases, and that IVIG is also used in some non-severe infectious diseases.