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In the Japan Marrow Donor Program (JMDP), autologous blood is collected from most unrelated bone marrow (BM) donors. We retrospectively evaluated 5772 donors who underwent BM harvest between 2010 and 2015 through the JMDP. Autologous blood was collected in 96.8% of the donors; the wastage rate was 0.6%. Allogeneic blood transfusion was not required. The mean hemoglobin (Hb) levels were 12.1 g/dL after the BM harvest (mean 891 mL) together with autologous blood transfusion (mean 596 mL). Propensity-score matching was used to adjust the backgrounds. Among donors with harvested BM of 100–400 mL, autologous blood transfusion had no impact on Hb levels or complications after BM harvest. Among donors with harvested BM of > 400 mL, more autologous blood transfusion followed by a bleeding volume of ≤ 100 mL did not confer clinical benefit to donors compared with less autologous blood transfusion followed by a bleeding volume of > 300 mL. The findings of the present study suggest that autologous blood transfusion to BM donors is excessive in terms of Hb changes and post-harvest outcomes.

Background After experiencing several cases of transfusion-transmitted hepatitis E (TT-HE) in Hokkaido, Northern Japan, hepatitis E virus (HEV) screening in blood donors, using a nucleic acid amplification test (NAT), was introduced in 2005. Study design and methods The frequency of HEV RNA-positive donations (2005-2019) was investigated, and the HEV RNA-positive specimens were phylogenetically analyzed. In August 2014, the 20-pooled NAT (20P-NAT) was replaced with an individual-NAT (ID-NAT) system. Results Until 2019, the frequency of HEV RNA-positive donors was 0.011% (289/2,638,685) with 20P-NAT and 0.043% (597/1,379,750) with ID-NAT, and no TT-HE cases were observed in Hokkaido. The prevalence among male, but not female donors, increased significantly between 2015 and 2019. Eighty-nine percent of HEV isolates from donors were genotype 3 and the remainder were genotype 4, and many clusters existed in each genotype. ALT levels at the time of donation were significantly higher in donors with genotype 4. Four subgenotypes, namely 3a (37%), 3b (41%), 3e (6%), and 4c (10%), comprised 94% of the total. During this period, the most identified subgenotype, 3a, transitioned to 3b. Majority of the HEV strains within the same clusters were detected in the same geographical region around the same period. Many of the human HEV isolates were shown to coexist closely with animal HEV isolates phylogenetically. Conclusion In Hokkaido, multiple divergent HEV strains have been circulating, and small outbreaks of hepatitis E have occurred in the last 15 years. The results suggested that HEV NAT can contribute significantly in ensuring safety during blood transfusions.

Background Plasma removal by washing is an effective approach to prevent transfusion reactions by platelet concentrates (PCs). Recently, washed PCs were released by the Japanese Red Cross Society (JRCS). Materials and methods This retrospective multicenter study evaluated the efficacy and safety of released washed PCs (RWPCs) between September 2016 and January 2017 in Japan. The RWPCs were prepared by washing leukoreduced apheresis PCs with the platelet additive solution, BRS-A, using automated cell processors. Results Clinical data were obtained from 91 patients and 1210 RWPC transfusions at 50 institutions. The median number of RWPC transfusions per patient was 8 (range, 1–91). RWPCs were used in 94.5% of the patients with a history of recurrent or severe transfusion reactions for preventing such reactions. Responses of RWPCs were evaluated as complete response (91.6%), partial response (8.2%), no-change (0.2%), and progression (0%) and overall response was equal across subgroups divided by patients’ profiles. The median corrected count increment (CCI) at 1 and 24 h post-transfusion were 13.5 (range, 1.9–35.4) × 109/L and 3.5 (range, −13 to 53.6) × 109/L, respectively, and median CCI at 24 h was 5.5 (range, −13 to 53.6) × 109/L in patients without risk factors associated with platelet transfusion refractoriness. Transfusion reactions to RWPCs were observed in only nine transfusions (0.7%), all of which were mild allergic reactions. Conclusion This study demonstrated that RWPCs were effective and safe in patients with a history of transfusion reactions. Further prospective studies on efficacy together with cost-benefit analysis in RWPCs are needed.

BACKGROUND Transfusion-associated circulatory overload (TACO) is an adverse reaction associated with a high risk of mortality. The actual incidence of TACO and hypertension associated with transfusion in Japan is unknown. METHODS A multicentre retrospective observational study was conducted across 23 institutions during the 1-year period of 2016. Patients were included if they developed TACO or their blood pressure (either systolic or diastolic) increased by at least 30 mmHg during the transfusion. TACO was confirmed by the primary physicians and transfusion medicine teams and recorded in the data on passive surveillance, and additional data were extracted from electronic medical records. RESULTS In our patient cohort of 31 384 patients who underwent transfusion, the incidence of TACO and hypertension was 0·03% and 0·2%, respectively. However, 43% of the participating institutions didn't report any cases. When comparing risk factors between the TACO and hypertension groups, there were significant differences in comorbidities, such as abnormal findings on chest x-ray. Significant differences between the two groups were observed post-transfusion pulse rate, body temperature and oxygen saturation (P

The detection of HLA antibodies is important in clinical practice, such as platelet transfusion refractoriness and transfusion-related lung injury. However, difficulties are associated with the preparation of panel cells for conventional HLA detection systems using intact cells, such as the immunocomplex capture fluorescence analysis (ICFA). Based on an ICFA analysis, HEK293 cells stably transfected with the HLA-A locus were used instead of peripheral blood mononuclear cells (PBMC). The reactivity, sensitivity, and stability of transfectants were examined. All 20 antisera to HLA-A identified by LABScreen® Single Antigen class I (LS-SA1) were reactive to our modified-ICFA (m-ICFA) and showed the same specificities as those in LS-SA1, indicating the cell surface expression and correct antigenicity of the HLA-A locus in transfectants. The expression of HLA class I antigens was similar between transfectants frozen for 6 years and those prior to freezing. In the reaction of the anti-A24 or anti-A33 antibody vs each transfectant, the index of m-ICFA was higher than that of WAKFlow® ICFA. Our m-ICFA also showed that false negative reactions sometimes observed in capture assays may be avoided. By using HLA-A transfectants as ICFA targets, we herein developed m-ICFA. Our m-ICFA may avoid false negative reactions of capture assay like enzyme-linked immunosorbent assay and can also be carried out in almost any laboratory without cell culture facilities.

Antibody-mediated phagocytosis of platelets using a flow cytometric monocyte-based phagocytosis assay (FMPA) has been shown to predict the outcome of platelet transfusion. The easy adherence between platelets and monocytes even in the absence of an antibody is regarded as one of limitations of the FMPA. To improve the FMPA for prediction of transfusion outcome, we used the pH-sensitive dye pHrodo succinimidyl ester (pHrodo-SE), which has weak fluorescence at neutral pH and has increased fluorescence intensity in low pH conditions such as in lysomes. Platelets stained with pHrodo-SE were sensitized with an HLA class I monoclonal antibody (w6/32 clone) or anti-HLA class I containing antisera. The platelets were incubated with monocyte-enriched mononuclear cells. Phagocytic activity was assessed by the percentage of monocytes that phagocytosed platelets. Sensitization of platelets with w6/32 significantly increased platelet phagocytosis by monocytes in dose- and time-dependent manners. Anti-HLA class I antibody-containing sera caused platelet phagocytosis in a cognate antigen-antibody-dependent manner. There was a significant correlation (r=0.69, p

Plasma removal by washing platelet concentrates (PCs) is effective in preventing adverse reactions to PC transfusions. The Japanese Red Cross Society (JRCS) started releasing washed PCs (WPCs) as a commercially approved blood product in September 2016. This retrospective multicenter study investigated the change in the number of transfused WPCs and the impact on the incidence of adverse reactions to PCs before and after the release. The numbers and types of transfused PCs and the adverse reactions to the PCs for a year before the start of the WPC release and for a year after the release were reported by 27 medical institutes in Japan. Transfusion information for approximately 8% of the amount of PCs supplied in Japan was analyzed during the study period. After the start of WPC release by the JRCS, the number of transfused WPCs doubled. The rate of adverse reactions to PCs decreased significantly (p = 0.0223), from 4.30% before the release to 4.05% after the release. The rates of adverse reactions to unwashed and WPCs were 4.13% and 0.84%, respectively. Allergic adverse reactions were significantly decreased after the release (3.60% before versus 3.37% after). No severe allergic reactions to WPCs were reported. The release of WPCs by the JRCS significantly reduced transfusion-related adverse reactions to PCs in Japan.

Antibody-mediated phagocytosis of platelets using a flow cytometric monocyte-based phagocytosis assay (FMPA) has been shown to predict the outcome of platelet transfusion. The easy adherence between platelets and monocytes even in the absence of an antibody is regarded as one of limitations of the FMPA. To improve the FMPA for prediction of transfusion outcome, we used the pH-sensitive dye pHrodo succinimidyl ester (pHrodo-SE), which has weak fluorescence at neutral pH and has increased fluorescence intensity in low pH conditions such as in lysomes. Platelets stained with pHrodo-SE were sensitized with an HLA class I monoclonal antibody (w6/32 clone) or anti-HLA class I containing antisera. The platelets were incubated with monocyte-enriched mononuclear cells. Phagocytic activity was assessed by the percentage of monocytes that phagocytosed platelets. Sensitization of platelets with w6/32 significantly increased platelet phagocytosis by monocytes in dose- and time-dependent manners. Anti-HLA class I antibody-containing sera caused platelet phagocytosis in a cognate antigen-antibody-dependent manner. There was a significant correlation (r=0.69, p

Cees Th Smit Sibinga,1 Maruff A Oladejo,2 Olamide Hakeem Adejumo,3 Quentin Eichbaum,4 Midori Kumagawa,5 Shuichi Kino,5 Sima Zolfaghari,6 Silvano Wendel,7 Gordana Rasovic,8 Namjil Erdenebayar,9 Maya Makhmudova,10 Loyiso Mpuntsha,11 Charlotte Ingram,11 Bakyt B Kharabaev,12 Isaac Kajja,13 Zainab Mukhtar Hussain Sanji,14 Maria M M Satti15 1IQM Consulting for International Development of Quality Management in Transfusion Medicine, University of Groningen, Groningen, the Netherlands; 2Department of Educational Management, University of Lagos, Lagos, 3Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria; 4Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA; 5Japanese Red Cross Hokkaido Block Blood Center, Japan; 6IBTO, Tehran, Iran; 7Blood Bank, Hospital Sirio Libanês, Sao Paulo, Brazil; 8Montenegro National Blood Transfusion Center, Podgorica, Montenegro; 9National Center for Transfusion Medicine, Ulaanbaatar, Mongolia; 10Consultant IQM Consulting, Tashkent, Uzbekistan; 11South Africa National Blood Transfusion Service, Johannesburg, South Africa; 12National Blood Transfusion Service, Bishkek, Kyrgyzstan; 13Department of Orthopedics, Mulago Hospital, Makerere University, Uganda; 14Consultant, Dow University of Health Sciences, Karachi, Pakistan; 15National Blood Transfusion Service, Khartoum, Sudan Introduction: Clinical use of blood has shown the least developed part in the vein-to-vein transfusion chain. This global study was carried out in order to investigate the level of awareness, accessibility and utilization of continuous e-learning and education, and quality of blood use among blood prescribing clinicians and nurses.Approach: Descriptive ex post facto survey design.Methods: A total of 264 purposively selected blood prescribing clinicians and nurses from the four Human Development Index (HDI) groups of countries (low, medium, high, and very high) participated in this study. Three research questions were answered, while seven null hypotheses were tested at 0.05 level of significance. Descriptive statistical tools (frequency counts and percentage) were used to analyze demographic backgrounds; inferential statistics – Pearson product-moment correlation coefficient (PPMCC) and analysis of variance (ANOVA) were used to analyze hypotheses.Results: Quality of clinical blood use was positively and significantly correlated with the level of awareness (r=0.137; p=0.03; df=262) and accessibility (r=0.184; p=0.01; df=262) to e-continuous learning among clinicians/nurses. There was a significant difference in the levels of awareness (F[3,260]=53.942, p=0.01), accessibility (F[3,260]=38.582, p=0.01), and utilization (F[3,260]=24.858, p=0.01) of continuous e-learning and education among clinicians/nurses based on HDI grouping, particularly between very high and low HDI. Furthermore, there was a significant difference in the levels of accessibility (F[6,257]=6.444, p=0.01) and utilization (F[6,257]=13.704, p=0.01) of continuous e-learning and education among clinicians based on clinical specialty/department and a significant difference in the quality of clinical blood use based on clinical specialty/department (F[6,257]=9.677, p=0.01).Conclusion and recommendations: The higher the HDI level the better is the awareness, accessibility, and utilization of continuous education, both through e-learning and conventional in teaching curricula. This has an immediate impact on the quality of clinical care and in particular on supportive hemotherapy and the development of patient blood management systems. Keywords: continuous E-learning and education programs, awareness, accessibility, utilization, blood prescribing clinicians/nurses, Human Development Index, quality management, clinical blood use, patient blood management

Background Premedication before transfusion is commonly administered in clinical practice despite a lack of evidence for its efficacy. The aim of this study was to clarify the status of premedication and evaluate expert opinions regarding its use in Japanese medical institutions. Method Between May and July 2016, we conducted a questionnaire survey on premedication before transfusion in 252 medical institutes that were certified by an academic society or employed transfusion experts. Results A total of 141 institutes (54.2%) responded, and hematologists (n = 113) comprised the most frequent respondents. The purpose of premedication was to prevent urticaria, pruritus, and fever, and washed blood products were used for anaphylactic shock or refractory transfusion reactions before. Drugs for premedication were intravenously administered either just before or 30 min before transfusion. Both inpatients and outpatients were premedicated in a similar manner, and institutional guidelines were not established. More than half of the experts recognized premedication as efficient and necessary, and premedication for previous transfusion reactions was frequently implemented, particularly for platelet transfusion or in patients with hematological diseases. Some institutions administered one or more drugs for premedication from the first transfusion. Antihistamines and hydrocortisone were the most frequently used as premedication. Conclusion Our study reports the current status of premedication for transfusion in Japan. Antihistamines and hydrocortisone were most commonly used for premedication despite a lack of evidence of their use. These findings may help clarify the indications for premedication and the use of washed blood products.

Serological diagnosis of syphilis can be made by using the serological test for syphilis (STS) method for detecting a lipid antibody and Treponema pallidum (TP) method for detecting the anti-TP-specific antibody. In STS and TP methods, the basis using latex agglutination reaction has been used in many facilities. However, in latex agglutination, false-positive results due to non-specific reaction have sometimes been obtained in reactions of a routine laboratory test reagent detecting the anti-TP antibody used in our medical laboratory. We evaluated the fundamental performance of 4 reagents to measure anti-TP antibody concentration using latex agglutination: Reagents A, B, C and D produced by SEKISUI MEDICAL, FUJI REBIO, DENKA SEIKEN and SHINO TEST, respectively. We examined the correlations between Reagent A (routine laboratory test reagent) and Reagents B, C, and D in sera from 68 patients, and we performed additional investigation by using a neutralization test, immunochromatography, Western blotting, FTA-ABS (IgG), and STS method by an automatic analyzer for 13 decision-mismatched samples. The fundamental performance of each reagent was as good as that previously reported. Eight of the 13 decision-mismatched samples were false positives due to non-specific reaction of Reagent A. In latex agglutination non-specific reaction is inevitable. However, this study strongly suggests that using a neutralization test and immunochromatography that can be performed quickly is sufficient to verify whether positive reactions are true or false.

As a national study, we evaluated the frequencies of irregular erythrocyte antibodies (Abs) by gender and history of transfusion or pregnancy. In total, data from 248,785 patients were analyzed, from whom 4222 irregular erythrocyte Abs were detected in 3554 cases (1.43%). Abs frequencies in these 4222 cases were as follows: anti-E, 26%; anti-Le(a), 26%; anti-P(1), 11%; anti-M, 6%; anti-E+c, 4%; anti-Fy(b), 4%; anti-Di(a), 3%; anti-Le(b), 3%; and anti-D, 2%. In pregnancy, anti-D (5%), anti-Jr(a) (3%) and anti-E+c (6%) Abs were, with statistical significance, more frequent. Among transfused patients, anti-E (38%), anti-E+c (8%), anti-Jk(a) (4%), anti-e+C (2%) and anti-E+Jk(a) (1%) Abs were, with statistical significance, more frequent.

【背景】当院では2005年7月以降，輸血患者全例実施を前提に輸血前後の感染症検査を実施している．その方法と成績について報告する． 【方法】輸血予定患者には，輸血前検査セット（HBs抗原，HBs抗体，HBc抗体，HCV抗体，HCVコア抗原，HIV抗体）を用いて検査を行った．輸血前検体として交差試験の残血清を凍結保存した．最終輸血から2カ月以上経過した患者を抽出し，輸血後検査のおすすめをダイレクトメール（DM）で郵送し，検査受検を促した．2006年1月∼9月にDMを郵送した患者に輸血後検査についてアンケート調査を行った． 【結果】2005年下半期，2006年上半期·下半期，2007年上半期ごとに各指標を集計した．輸血前検査セット利用率は徐々に増加した．当院での輸血後検査実施率は35∼40%であった．輸血後検査のアンケートを344名に送付し，192名（56.6%）の回答を得た．死亡例を除く179名中144名（80.4%）が輸血後検査を受検していた．当院での受検者は99名，他医は45名であった． 【結論】当院での輸血後検査受検率はDM送付者の約40%であった．アンケート調査の結果を加味すると輸血後患者の50∼80%程度は輸血後検査を受けていると推定される．輸血患者の安全確保のためには輸血後検査が必須である．輸血後の感染症マーカー陽性例の原因を明らかにするためには，輸血前に通知に記載されているマーカーが検査されているか，輸血前検体が保存されている必要がある．

背景·目的: 病院輸血部門は血液センターと輸血使用現場を中継する位置にあり，危機的出血発生時には迅速な対応が要求される．今回，病院輸血部門の体制をアンケート調査し，危機的出血発生時の対応における問題点を明らかにした． 対象·方法: 病床数500床以上の麻酔科認定病院385施設を対象とし，2007年11月に調査を実施した． 成績: 輸血管理体制はほぼ整備されていたが，緊急輸血や大量輸血時への対応マニュアルの記載内容は不十分であった．危機的出血への対応ガイドライン（危機的出血GL）は認識されていたが，院内周知は不足していた．異型適合血使用を阻む要因が多々あった．輸血検査の所要時間，緊急出庫要請から使用可能になるまでの時間は，時間外で延長していた．血液センターからの緊急搬送時間は，時間内·時間外で変わらなかった．過去1年間に未交差同型血の使用実績がある施設は時間内，時間外とも43%，異型適合血に関しては時間内24%，時間外28%であった． 結論: 危機的出血GLなどを参考に危機的出血発生時の院内手順を定め，異型適合血使用に対する啓発活動を行う必要がある．危機的出血発生時には，状況を迅速に判断し，未交差同型血や異型適合血の使用を躊躇しないことが必要である．

大量化学療法施行後に, B型肝炎ウイルス (HBV) が再活性化したと考えられる輸血患者を経験した. 多発性骨髄腫と診断された50歳代の女性に対し自己末梢血幹細胞移植を含む大量化学療法を施行した際, 赤血球濃厚液を20単位, 血小板濃厚液を305単位使用した. 治療1年後 (2005年9月) に輸血後感染症検査を行ったところ, HBV-DNAが陽性であった. 治療前 (2002年8月) と輸血継続中 (2004年2月) のHBs抗原が陰性であったため, 輸血によるHBV感染を疑い, 2003年9月から2005年4月までの患者保管検体 (合計12本) で検査を行った. 輸血前 (2003年9月) の検体では, HBsAg (-), HBsAb (+), HBV-DNA (-) であったがHBcAb (+) で, 潜在性HBV感染と推定された. 以降, 2004年9月までは同様の検査結果であったが, 2005年4月にはHBs抗原の陽性化とともに血清中にHBV-DNAが確認され, HBVの再活性化と診断. HBs抗体の力価は, 2003年9月から行われた大量化学療法に一致し徐々に低下, 2005年4月には陰性化した. HBV陽性の期間, ウイルス再活性化による肝炎は発症していない. 輸血血液保管検体の個別核酸増幅検査はすべて陰性で, 輸血によるHBV感染は否定された. 本症例では輸血後感染症検査によってHBV感染が初めて認識され, 輸血前を含む保管検体の遡及調査で, HBV再活性化にいたる変化を追跡し得た. 輸血後にはじめてウイルス感染が確認された場合には, その原因をつきとめるために輸血前検体の保存が必須である.

輸血総括アンケート調査を2004年度調査と同様の手法により実施した. また, 適正使用委員会 (または輸血療法委員会) の活動方針等を規定する「血液製剤適正使用マネジメントシステム」ガイドライン案 (ガイドライン案) を同封し, 有用性等に関する意見を求めた. 1,355病院に依頼し, 857施設 (63.2%) より回答を得た.輸血部または検査部が輸血の検査, 管理を一元的に担当している施設は717施設 (84.0%) であったが, アルブミン等の血漿分画製剤を薬剤部が管理している施設は833施設 (97.7%) であり, その使用状況を輸血部門が把握していたのは285施設 (33.7%) であった. 輸血療法委員会または同様の機能を持つ委員会が769施設 (90.3%) に設置されていたが, 専任の輸血責任医師がいる施設は75施設 (8.8%) に過ぎなかった.病床数及び輸血責任医師の専任, 兼任, 不在により分類した5群で比べると, 輸血責任医師が不在の施設において, 各血液製剤の廃棄率が多く, 新鮮凍結血漿 (FFP) 使用単位数/濃厚赤血球液 (RBC) 使用単位数比およびアルブミン使用g/RBC使用単位数比が統計学的な有意差はないものの, より多い傾向を認めた.ガイドライン案を569施設 (74.1%) が肯定的に評価したことから, 適正輸血の具体化に有用な実践マニュアルに基づく輸血療法委員会の活性化が重要と思われた.

症例は65歳の男性. 2004年12月, 当科にてHCCに対する胸腔鏡下ラジオ波焼灼術の既往あり. 2005年12月, 腹痛・嘔気を主訴に当院再受診しイレウスの診断により入院となる. 当初保存的に治療するも第3病日から急激にショック症状を呈し, 絞扼性イレウスの診断により緊急手術施行. ラジオ波による焼灼部直上の横隔膜に非生理的な裂孔が存在し, 小腸が嵌頓・壊死に陥っていた. 壊死小腸の切除および横隔膜裂孔の閉鎖を行ったが術後3日目に多臓器不全により死亡した. HCCに対する経横隔膜的ラジオ波焼灼術は近年その適応を拡げているが, 術後のフォローアップにあたっては横隔膜ヘルニアは念頭に置くべき合併症のひとつと考えられた.

腫瘤形成型肝内胆管癌と鑑別が困難であった左肝管壁外付属腺原発の肝門部胆管癌の1切除例を経験した. 患者は61歳の女性で, 平成16年3月, 腹痛のため近医を受診し, 血液検査で肝機能異常を認め当院紹介となった. ERCおよび経口胆道鏡で左肝管から右肝管, 上部胆管に進展する乳頭状腫瘍を認め, 生検では乳頭腺癌であった. CTでは, 肝門部胆管に近接するS4に15mm大の腫瘤を認めた. 肝左葉, 尾状葉, 肝外胆管切除を施行した. 病理組織学的には左肝管壁外付属腺内で腫瘤を形成する乳頭腺癌で, 左肝管への乳頭状進展を認めた. 肝門部付属腺原発胆管癌は極めてまれであり, 術前に腫瘤形成型肝内胆管癌と鑑別することは困難であると思われるが, 本例では充実性乳頭状の組織型と膨脹性発育を示す増殖形態が, CTでみられた境界明瞭で内部に点状の造影効果に反映されていると考えられた.

In 2007, "the Guidelines for Actions against Intraoperative Critical Hemorrhage" were established by the Japanese Society of Anaesthesiologists and the Japanese Society of Blood transfusion and Cell Therapy. The documentation of in-hospital procedures for critical hemorrhage, especially about how to select RBC units, has widely standardized hospital practice. Patients with intraoperative critical hemorrhage sometimes suffer from massive blood loss. In this situation, some patients develop coagulopathy. To treat them, we need to evaluate their coagulation status based on laboratory test results. So, we performed a nationwide questionnaire survey on the current status of hospital clinical laboratories evaluating critical hemorrhage. From the results of this survey, it was recommended that central hospital laboratories should try to reduce the turn-around time required to test for coagulation parameters as much as possible for appropriate substitution therapy. (Review).

It has been reported that fibrinogen products, such as fibrinogen concentrates, cryoprecipitate (CRYO), and fresh frozen plasma, are beneficial for treating coagulopathy due to massive blood transfusion. For the appropriate use of these products, it is necessary to evaluate the status of coagulopathy and determine the trigger level of the fibrinogen concentration for the administration of fibrinogen products. In our institution, we established a treatment procedure for coagulopathy due to massive transfusion in 2011. This procedure includes determination of the trigger level for administration of CRYO (150 mg/dL), timing of sample collection for the evaluation of coagulation parameters (prothrombin time, activated partial thromboplastin time, and fibrinogen) and concentration status during the operation, and a method for rapid coagulation testing (turnaround time within 15 minutes) in critical bleeding. Since 2011, we have performed 56 rapid coagulation tests for patients suffering from critical bleeding. The average turnover time was 13 minutes. According to the rapid coagulation test results, CRYO was administered to 27 patients. These results are satisfactory for treating critical bleeding patients. We stress the need for the establishment of a rapid coagulation test system in the central hospital laboratory. (Review).

「安全な血液製剤の安定供給の確保等に関する法律」に医療関係者の責務と明記された「安全かつ適正な輸血」の実施状況及び課題を把握するため, 輸血管理体制及び輸血療法委員会に関する調査を含む輸血関連総括的アンケート調査を2004年度に実施した.300床以上で血液製剤使用量が3,000単位以上の全医療機関777を含む1,355病院を対象とし, 829施設 (61.2%) より回答を得た. 輸血部または検査部による輸血検査・輸血用血液の一元管理体制は, 各々164施設 (19.9%), 513施設 (62.1%) において確立し, 輸血療法委員会あるいは同様の機能を持つ委員会が733施設 (88.7%) に設置されていたが, 同委員会の中心となるべき専任の輸血責任医師が任命されている施設は86施設 (10.5%) と少なかった (表2, 表4).医療機関の病床数及び輸血責任医師の専任, 兼任, 不在により分類した5群 (表1) における血液製剤の使用量, 廃棄率を比較した結果, 輸血責任医師不在の300床以上の医療機関において, 濃厚赤血球液 (RBC) 及び新鮮凍結血漿 (FFP) の廃棄率が多く, FFP使用単位数/RBC使用単位数が統計学的有意差はないものの, より多い傾向が認められた (表6).以上より, 輸血療法委員会を活用し, [安全かつ適正な輸血医療] を実践するために, 専任の輸血責任医師が重要な鍵を握るものと考えられた.

Nerve growth factor (NGF) is suggested to have a role in tumor progression in addition to its role in differentiation and survival of neuronal cells. We investigated expression of NGF and its receptors, TrkA and p75NTR, in hepatocellular carcinomas (HCCs). Although hepatocytes and hepatic stellate cells (HSCs) showed respectively weak and intense NGF immunostaining in the background livers of patients suffering from liver cirrhosis (LC) or chronic hepatitis (CH), intense staining was demonstrated in HCC cells of 33 of 54 (61.1%) tumors. RT-PCR detected NGF mRNA in 7 freshly-isolated HCC samples, and in 2 of 4 cases, in which both background livers and tumors could be analyzed, NGF mRNA was more abundant in the tumors than the background livers. TrkA was detected in the smooth muscle cells of hepatic arteries, but it was negative in tumor cells as well as non-neoplastic hepatocytes. p75NTR and α-smooth muscle actin (αSMA) was expressed in HSCs in the background liver and fibroblast-like cells in stromal septa, whereas HSCs within the HCC tissues were mostly negative for p75NTR but positive for αSMA. This suggests that HSCs in HCC have a different property from those in background livers. Furthermore, the stromal septa contained abundant nerve fibers, which may be related to the increased NGF expression in HCC cells. NGF and its receptors are then thought to have a role in cellular interactions involving HCC cells, HSCs, arterial cells and nerve cells in HCC tissues. © 2004 Wiley-Liss, Inc.