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The efficacy of 30 platelet concentrate (PC) products transfused to a patient with myelodysplastic syndrome (MDS) was evaluated by calculating the 1-hour post-transfusion corrected count increment (1h-CCI). Of the 30 transfusions, all HLA-A/B-matched, the cross-match (CM) test was negative in 23 (CM(-)-PC) and weakly positive (CM(+)-PC) in 2, and the CM test was not conducted in 5 (non-CM-PC). The effective rate was higher with CM(-)-PC compared to non-CM-PC (82.6% vs 60%), but statistical significance was not achieved, which suggested that the CM test of PC may still be a not satisfactorily effective predictor of PC refractoriness. Studies are ongoing in Japan to confirm on the importance of CM test of PC.

BACKGROUND/OBJECTIVES Relapsed or refractory brain tumors in childhood continue to have a dismal prognosis in spite of intensive multidisciplinary treatment. Cancer immunotherapy is newly developed to be expected as next promising treatment for highly aggressive pediatric cancer. This trial was designed to evaluate the safety and effectiveness of an immunotherapy with fusions of dendritic cells (DCs) and tumor cells in patients with malignant brain tumors. METHODS Patients with histopathologically confirmed malignant and recurrent/refractory brain tumor were eligible for this immunotherapy trial. Autologous cultured tumor cells obtained from surgical specimens were fused with autologous DCs using polyethylene glycol. The fusion cells (FC) were inoculated intradermally in the cervical region and repeated 3–10 times in each 28–84 days cycle. Treatment-related toxicity, progression-free survival (PFS), and overall survival (OS) were evaluated. RESULTS Six patients were enrolled, three with high grade glioma and three with ependymoma. Median age at first course of immunotherapy was 10 years (range 8–25 years) and median follow-up time from the first course of immunotherapy was 13.5 months (range 3–33 months). All patients with immunotherapy were well tolerated to this treatment with no adverse events except local erythema in injected site. Median progression free survival and overall survival were 18 months and 18.5 months, respectively. CONCLUSIONS FC immunotherapy with autologous DCs and tumor cells for brain tumor in children and young adults were extremely well tolerated and showed encouraging responses in this series. Further phase II study of FC immunotherapy is planned to improve survival and reduce treatment related morbidity.

This trial was designed to evaluate the safety and clinical responses to a combination of temozolomide (TMZ) chemotherapy and immunotherapy with fusions of DCs and glioma cells in patients with glioblastoma (GBM). GBM patients were assigned to two groups: a group of recurrent GBMs after failing TMZ-chemotherapy against the initially diagnosed glioma (Group-R) or a group of newly diagnosed GBMs (Group-N). Autologous cultured glioma cells obtained from surgical specimens were fused with autologous DCs using polyethylene glycol. The fusion cells (FC) were inoculated intradermally in the cervical region. Toxicity, progression-free survival (PFS), and overall survival (OS) of this trial were evaluated. Expressions of WT-1, gp-100, and MAGE-A3, recognized as chemoresistance-associated peptides (CAP), were confirmed by immunohistochemistry of paraffin-embedded tumor samples. Patient’s PBMCs of pre- and post-vaccination were evaluated by tetramer and ELISPOT assays. FC-immunotherapy was well tolerated in all patients. Medians of PFS and OS of Group-R (n = 10) were 10.3 and 18.0 months, and those of Group-N (n = 22) were 18.3 and 30.5 months, respectively. Up-regulation and/or cytoplasmic accumulation of CAPs was observed in the recurrent tumors of Group-R patients compared with their initially excised tumors. Specific immune responses against CAPs were observed in the tetramer and ELISPOT assays. The combination of TMZ-treatment leading to up-regulation and/or cytoplasmic accumulation of CAPs, with FC-immunotherapy as a means of producing specific immunity against CAPs, may safely induce anti-tumor effects in patients with GBM.

Background A surveillance system for transfusion-related adverse reactions and infectious diseases in Japan was started at a national level in 1993, but current reporting of events in recipients is performed on a voluntary basis. A reporting system which can collect information on all transfusion-related events in recipients is required in Japan. Methods We have developed an online reporting system for transfusion-related events and performed a pilot study in 12 hospitals from 2007 to 2010. Results The overall incidence of adverse events per transfusion bag was 1.47%. Platelet concentrates gave rise to statistically more adverse events (4.16%) than red blood cells (0.66%) and fresh-frozen plasma (0.93%). In addition, we found that the incidence of adverse events varied between hospitals according to their size and patient characteristics. Conclusion This online reporting system is useful for collection and analysis of actual adverse events in recipients of blood transfusions and may contribute to enhancement of the existing surveillance system for recipients in Japan.

Background Pediatric apheresis for peripheral blood stem cell transplantation should be carried out with due concern for low corporeal blood volume and vulnerability to hypocalcemia-related complications, hypovolemic shock, and hypervolemic cardiac overload. Study Design And Methods We retrospectively investigated a total of 267 apheresis procedures from 1990 to 2013 on 93 children between 0 and 10 years old, including 89 patients and 4 healthy donors, with body weights of 6.3 to 44.0 kg. Results The median CD34+ cell yield per apheresis procedure was 2.3 × 10 6 CD34+ cells/kg (0.2–77.9 × 10 6 CD34+ cells/kg). Adverse events occurred in 11.6% of procedures (n = 31), including mild perivascular pain (n = 12), emesis (n = 9), hypotension (n = 3), urticaria (n = 2), numbness (n = 2), chest pain (n = 1), facial flush (n = 1), and abdominal pain (n = 1). Among hypotensive events, shock in a 9.6 kg one-year-old boy required emergency treatment in 1996. Thereafter, we adopted continuous injection of calcium gluconate, ionized calcium monitoring, central venous catheter access and circuit priming with albumin in addition to concentrated red cells. Since then we have had fewer complications: 16.4% per apheresis during 1990–1997 versus 5.8% during 1998–2013. No healthy pediatric donors suffered from any late-onset complications related to apheresis or G-CSF administration. Conclusion By employing appropriate measures, peripheral blood stem cell apheresis for small children can have an improved safety profile, even for children weighing

Background and Objectives To reveal the associations between cytokines in blood and transfusion-related adverse events, we studied whether pre-storage leucoreduction of autologous blood could reduce the degree of inflammatory responses, infection rates, or the duration of hospitalizations. Materials and Methods Patients scheduled to donate autologous blood for elective orthopaedic surgery were assigned to receive either leucoreduced (LR) or non-leucoreduced (N-LR) autologous blood based on their date of birth. Levels of cytokines in the autologous blood, values for C-reactive protein, complete blood count and body temperature of the patients, as well as adverse clinical events, were evaluated periodically. Results Four hundred patients entered this study (LR group: 196, N-LR group: 204). The production of cytokines, excluding interleukin 1β (IL-1β), was suppressed for the LR group. However, for unknown reasons, IL-1β actually increased during storage for the LR group. There were no differences between the two groups in the length of hospital stay, postoperative C-reactive protein changes, leucocyte count, or body temperature, and no clinical problems associated with blood transfusion were observed in either group. Conclusion Pre-storage leucoreduction for autologous blood may be effective to suppress cytokine accumulation. However, clinical benefits such as prevention of febrile non-haemolytic reactions could not be demonstrated.

BACKGROUND: Under the rationale that children undergoing elective surgery are the best candidates for autologous blood donors because of their long life expectancy, aggressive donations of autologous blood, even from infants, have been reported. A number of problems are associated with the procedure, however, whereas the risks of homologous blood are very low. STUDY DESIGN AND METHODS: From 1987 through 2005, of 5792 patients referred to blood transfusion services at two Japanese university hospitals for autologous blood donations, 314 children younger than 16 years old served as subjects for assessment. RESULTS: Of 314 children, 7 were not suitable as autologous donors. In most cases this was due to uncooperative behavior. Over a follow‐up period of 19 years, the authors encountered 53 cases (17.3%) of donation‐related problems, and this rate was higher than the 6 percent rate recorded for adult cases (316/5305). Nine children suffered crucial complications such as vasovagal reactions, and one 14‐year‐old boy required a vasopressor drug. Important findings were that 6 of these were first‐time donors, and the amount of blood drawn was under 10 percent of their estimated blood volume. CONCLUSION: Of 53 donation‐related problems, 9 (17.0%) were accompanied by marked hypotension. Drawing autologous blood from children has become easier with advanced devices; however, lessening of anxiety and tension are essential for the safety of children's autologous blood donation programs. Aggressive donation should be avoided.

We retrospectively compared the cost of platelet concentrates (PCs) used for patients whose serum had already been screened for platelet-reactive antibodies with the cost for patients whose serum was examined after the commencement of treatment using platelets. On the basis of 774 patients' data, the mean cost of PCs for the latter group of patients ($5562) was higher than that for the former group ($2547). Screening beforehand ensured a prompt supply of specific PCs, and costs were suppressed by the avoidance of multiple transfusions. We conclude that screening for platelet-reactive antibodies followed by administration of crossmatch-negative PCs appears to be both clinically and economically advantageous.

A case of acute myelocytic leukemia has been reported in which the patient's surviving original B lymphocytes after pretransplant-conditioning chemotherapy probably reproduced hemagglutinins that reacted with red blood cells (RBCs) derived from engrafted donor marrow for a prolonged period of time. Although the direct antiglobulin test was negative and hemagglutinins were not detectable in the patient's sera but only in the eluate, the antibodies reappeared in the sera. Therefore, it is important to confirm that the eluate does not contain antibodies that would react with donor-derived RBCs when the type of red cell used for transfusion is switched from the patient's type to the donor's type in a major ABO-mismatched bone marrow transplantation (BMT). Testing of ABO subgroups using lectins is also recommended to avoid a delayed hemolytic transfusion reaction following BMT.

It is not clear whether platelet-reactive antibody screening is clinically significant for patients facing frequent platelet transfusions. On the basis of data from 96 patients who had been examined for platelet-reactive antibodies by the mixed passive hemagglutination method for a variety of reasons, we investigated the following three issues retrospectively: (1) the relationship between platelet-reactive antibodies and the occurrence of problems in platelet transfusions, such as refractoriness or nonhemolytic reactions;(2) the influence of a history of transfusion on the production of those antibodies; and (3) the effect of screening for those antibodies on the prompt administration of appropriate platelet components. More than half of the platelet transfusion-related problems were associated with platelet-reactive antibodies. For patients with a history of transfusion, the mean period before a clinical problem occurred with platelet transfusions was 9 days,compared with 66 days for those without such a history. Accordingly, during the period, patients with a history of transfusions received fewer units of platelets and had fewer donor exposures than did patients without such a history. On the other hand, most patients who had been screened in advance for those antibodies received appropriate platelet components without delay, whereas an average of 10 days was needed before those who had not been screened received compatible platelets. The patients who had not been screened were transfused with 68 units of random platelets on average during the period. When frequent platelet transfusions are anticipated, especially for patients with a history of transfusion, screening for platelet-reactive antibodies beforehand would be helpful for prompt administration of appropriate platelets, although problems, such as the cost of those platelets and the burden on donors, remain to be resolved. Immunohematology 2002;18:104–108

In 1999, the Japan Society of Blood Transfusion organized a small committee on autologous blood transfusion. The committee was assigned to evaluate the status of predeposit autologous blood transfusion in hospitals approved by the Japan Society of Blood Transfusion and to clarify problems concerning the promotion of autologous blood transfusion. Questionnaires were sent to 86 hospitals. Information on each hospital (number of beds, number of doctors and medical technologists approved by the Society, etc), establishment of blood transfusion service, preservation methods, and management and compatibility testing of autologous blood were evaluated. In addition, number of cases and units of autologous blood transfusion from. Jan 1999 to Dec 1999 and status of homologous blood transfusion during operation were analyzed. Predeposit autologous blood transfusion was performed in all 68 hospitals which answered the questionnaire. Blood transfusion service was established in 64 hospitals. However, the place of autologous blood collection and the personnel involved in blood collection were not centralized. Percentage of autologous blood without allogeneic blood cases in cases of blood transfusion during operation was 17% in total. Percentages among hospitals ranged from 3.6% to 76.9%. Percentage of autologous blood units in units of blood used during operation was 12% in total, and ranging from 0.5% to 77.6%. Differences in the status of predeposit autologous blood transfusion were significant among hospitals. Doctors approved by the Japan Society of Blood Transfusion should assume an important role in the promotion of autologous blood transfusion in hospitals.

It is known that circulating immune complexes bind to platelets via the Fc-receptor and/or C3 receptor to result in platelet destruction in the mononuclear phagocyte system. We postulated that transfusion-associated thrombocytopenia is transiently caused by the bystander involvement of autologous platelets during the alloimmune destruction of allogeneic leukocytes and/or platelets in patients with anti-HLA antibodies when allogeneic blood is transfused.To clarify whether allogeneic red blood cells cause postoperative thrombocytopenia, we assessed the residual rate (%PLT) in platelet count at 1 day after surgery by estimating hemorrhage volume and the number of blood transfusion units among recipients. Of 71 patients studied, 34 received allogeneic and 37 received autologous blood transfusions. Mean %PLT in the allogeneic transfusion group was significantly lower than that in autologous transfusion group (65.1% vs 75.1%, p

We compared apheresis products collected by two cell separators (Spectra and CS3000) for peripheral blood stem cell harvest (PBSCH), the total number of 110 apheresis procedures were done in 46 patients, who underwent two or three procedures over consecutive days. Respective results for apheresis products collected by Spectra and CS3000 were as follows (mean±standard deviation): whole white cells (×109), 16.2 (±14.0) and 11.1 (±9.15); mononuclear cells (×109), 9.21 (±6.59) and 7.74 (±6.12); CD34-positive cells (×108), 3.20 (±6.49) and 2.06 (±3.78); and CFU-GM (×105), 381 (±687) and 252 (±398). Thus, the ratio of mononuclear cells harvested using CS3000 was higher than that by Spectra (76% vs 68%, p

To clarify the influence of recombinant human erythropoietin (r-HuEPO) on endogenous erythropoietin production, experiments using rats were designed as follows.Firstly, to evaluate the effect of acute blood loss on endogenous erythropoietin production, five rats (Wistar; mean body weight 280g) were bled of 1.3% of body weight (g) by cardiac puncture under pentobarbital sodium (30mg/kg, ip) anesthesia, followed by periodic blood examinations, including serum erythropoietin (s-EPO) levels, hemoglobin and reticulocyte counts. Secondly, 12 rats were divided into two groups of six rats each, control and r-HuEPO-treated groups. Rats received no r-HuEPO or 200U/kg of r-HuEPO subcutaneously once a week after the first blood sampling. All rats were given iron sulphate. Blood (0.6% of body weight) was drawn from each rat at three weekly intervals. At the fourth donation, blood volume of 1.5% of body weight was drawn. The results were as follows: 1) serum erythropoietin significantly increased at 3h after phlebotomy. s-EPO level peaked at 24h after phlebotomy, then returned to normal within 7 days; 2) mean hemoglobin level in the r-HuEPO-treated group decreased gradually during the 3 weeks of blood donation; 3) after the fourth donation, the peak in s-EPO level in control group occurred on day one, whereas in half of the rats in the r-HuEPO-treated group it occurred on day 7. On the basis of our data, however, no significant difference was found in recovery from phlebotomy-induced anemia between the two groups. In conclusion, r-HuEPO seems useful for the speed correction of anemia associated with successive phlebotomy. However, our data suggest that the administration of r-HuEPO suppres endogenous erythropoietin production after acute massive bleeding. Further study remains to be done to ascertain the clinical implications of these findings.

Although iron deficiency is undoubtedly the commonest cause of anaemia even in elderly people, the aetiology is not always clear owing to various underlying diseases. Correction of anaemia is sometimes needed before surgery. The use of drugs that may influence blood coagulation, such as aspirin (acetylsalicylic acid), should be checked. Perioperative allogenic blood transfusion can often be avoided by the use of autologous blood and improved surgical techniques. Autologous blood donations are preferable in cases of planned surgery. Epoetin (recombinant human erythropoietin) in combination with iron supplementation facilitates the donation of autologous blood, even in elderly patients. Another method of avoiding allogenic blood transfusion is the collection and reuse of the blood a patient sheds in operations. During and/or after surgery, many haemostatic agents are available. Moreover, recent developments in gene engineering have enabled the utilisation of recombinant cytokines and coagulation factors. Further work remains to be done to define the proper use of these agents.

Little information is available regarding the influence of non-ionic low-osmolar iodinated contrast medium (CM) in stored blood on the quality of blood components. We sought to evaluate the quality of such CM-contaminated blood in terms of the degree of hemolysis, production of microaggregates, level of iodine concentration, and RBC shape, and to identify the pros and cons of autologous blood donation immediately after X-ray examination using CM. In conclusion, contamination by such CM in blood collected around 2h after the completion of X-ray examination appears unlikely to induce deleterious effects on blood components.

Background: The importance of autologous blood donation for elective surgery is recognized, and the method is being used at many hospitals. Not all patients are able to deposit a sufficient amount of blood before surgery because they cannot recover rapidly enough from phlebotomy-induced anemia. The ability to donate sufficient blood for autologous use was studied in patients who are particularly susceptible to phlebotomy-induced anemia. Study Design and Methods: Of 840 patients who donated blood for autologous use in elective surgery from November 1987 through May 1993, 20 with rheumatoid arthritis, 24 with iron deficiency anemia, and 37 aged 65 years and above with normocytic anemia were compared with 24 nonanemic elderly patients who donated a total of 1000 mL of blood for autologous use. Patients received iron sulfate orally and donated blood once a week until operation. Results: The amount of blood collected before surgery per control patient was more than that in others. Consequently, there was a tendency to allogeneic blood transfusion in patients with rheumatoid arthritis or elderly patients. The ferritin levels in controls and in patients with iron deficiency anemia during the donation period were almost within the normal range in spite of iron supplementation, which implied a good utilization of iron sulfate for erythropoiesis. On the other hand, the rise in ferritin levels in the elderly and in patients with rheumatoid arthritis suggested inappropriate iron availability for erythropoiesis and resulted in an increase in iron storage. Since an adequate endogenous erythropoietin response to phlebotomy-induced anemia was not observed in these patients, impaired erythropoietin production was considered one of the reasons for anemia. Conclusion: Patients with iron deficiency anemia are able to continue donating blood for autologous use so long as they have sufficient iron supplementation. However, the elderly or those with rheumatoid arthritis occasionally fail to donate a sufficient volume of blood before surgery as a result of phlebotomy-induced anemia, which is caused in turn by impaired erythropoietin production.

181 women donated an average of 460ml of autologous blood before elective gynecological surgery at our blood transfusion service from January 1990 to December 1992. No adverse reactions were found during the donation periods.We propose a criteria of autologous blood transfusion for gynecological operations.1) This program should be indicated in all the patients in need of modified hysterectomy with retroperitoneal lymph node dissection. Storing about 600ml of autologous blood is desirable in these cases.2) Among the cases planned to have total abdominal hysterectomy, these with endometriosis or a history of gynecological operations are suitable for donation of 400ml of autologous blood.3) At the time of radical hysterectomy, 800ml or more of autologous blood is needed for an operation.

Autologous blood donation was conducted without using recombinant human erythropoietin (r-HuEPO) in 16 patients with rheumatiod arthritis. As a rule, 200 or 400ml of autologous blood was drawn once a week, if the hemoglobin (Hb) level before each donation was 11g/dl or more. The results were compared with that in 17 patients with iron deficiency anemia.It required an average of 4 weeks to yield 500ml of autologous blood per patient in both groups.The administration of iron sulphate rose the mean Hb levels in patients with iron deficiency anemia and made it possible to collect autologous blood. Ferritin (Ft) levels were within the normal range during the donation period, which implied an effective utilization of iron sulphate for erythropoiesis. Serum erythropoietin levels returned gradually to normal.On the other hand, in patients with rheumatoid arthritis appropriate endogenous erythropoietin response to phlebotomy-induced anemia was not observed even they received sufficient iron supplementation. The change in Ft levels suggested an increase in iron storage due to iron overdose. Thus, r-HuEPO administration may have the potential for the success of autologous blood donation in patients with rheumatoid arthritis.

Analyses were conducted on issues related to autologous blood donation. Out of a total of 840 donor-patients who donated autologous blood prior to elective surgery from November 1987 to March 1993, 138 (16%) presented problems of various kinds. Among them, anemia-related problems are encountered most frequently in adult patients. In regard to donor reactions, 23 cases experienced mild symptoms due to hypovolemia or vasovagal reflex, but recovered by crystalloid infusion.Our data revealed that the etiology of anemia in elderly patients appeared to be a relative iron deficiency: iron sulphate administered was not used efficiently for erythropoiesis but was stored in the reticuloendothelial cells. We also observed an impaired endogenous erythropoietin response to phlebotomy-induced anemia. Therefore, we recommend that recombinant human erythropoietin has the potential for facilitating successful autologous blood donation in selected cases.Incidentally, there seemed to be no use in measurement of the most immature reticulocyte as a parameter to predict successive autologous blood donation in elderly patients.In conclusion, proper attention to such factors as hemoglobin level before donation, age and weight are of importance for successful blood donation; however, we should also put emphasis on patients' general health and complete cooperation.

Fifty children (26 girls and 24 boys) scheduled for autologous blood donation before elective surgery were studied. As a rule, about 10% of intravascular blood volume estimated by the Morse formula was drawn once a week. Before surgery, an average of 3.5 units of autologous blood per patient were prepared during the 25 days of donation period. Two patients excited at the thought of phlebotomy failed to donate autologous blood, but none of the autologous blood donors was deferred due to phlebotomy-induced anemia. Since an appropriate endogenous erythropoietin response was observed, which might stimulate erythropoiesis.The ages of the donor-patients ranged from 4 to 15 years with a mean of 9.8 years, and weighing from 15 to 70kg with a mean of 34kg. All patients received about 50mg of iron sulphate per day orally. Of the 48 patients who donated autologous blood, 48 underwent surgery without using homologous blood. Three units of homologous blood were transfused to each of 2 orthopedic patinets.We conclude that a predeposit autologous transfusion program in children can be performed safely when patients are cooperative.

To evaluate the effect of recombinant human erythropoietin (r-HuEPO) on a preoperative blood donation and on hematological influence after surgery, we studied patients undergoing elective orthopedic surgery. r-HuEPO was administered intravenously twice a week from one week before the first donation except with the 12 controls. All patients received 200mg iron sulfate a day orally and 40mg twice a week intravenously. 400ml of autologous blood was donated at weekly intervals up to 1200ml. A dose-dependent hemoglobin increase for three weeks was observed in the 3000U (2.02g/dl), 6000U (2.22g/dl), and 9000U (2.89g/dl) groups respectively, as compared with 1.34g/dl in controls.We also observed the delay in recovery from postoperative anemia in patients using r-HuEPO compared to the controls and a suppressive effect of r-HuEPO on endogenous erythropoietin secretion. In conclusion, although preoperative administration of r-HuEPO in collection of autologous blood is very useful, the preoperative anemia induced by repeated phlebotomy may accelerate the postoperative secretion of endogenous erythropoietin.

Granulocyte transfusion (GTX) has recently been revived by the ability to stimulate granulocyte donors with granulocyte colony-stimulating factor (G-CSF), resulting in a greatly increased number of cells that can be collected. However, there is a paucity of guidelines for assessing the appropriateness and safety management of GTX. The objective of this study was to establish guidelines for the safety management of GTX appropriate for the clinical situation in Japan. The Japan Society of Transfusion Medicine and Cell Therapy, Granulocyte Transfusion Task Force issued the first version of guidelines for GTX considering the safety management of both granulocyte donors and patients who receive GTX therapy. The current guidelines cover issues concerning: (1) the appropriateness of medical institutions, (2) management of granulocyte donors, (3) quality assurance of granulocyte concentrates, (4) administration of granulocyte concentrates, (5) evaluation of the effectiveness of GTX therapy, and (6) complications of GTX therapy. The simple ‘bag separation method’ without apheresis may be recommended for granulocyte collection in pediatric patients. The first version of guidelines for GTX therapy has been established, which may be appropriate for the clinical situation in Japan. Care should be taken to perform the safety management of both granulocyte donors and patients who receive GTX therapy.

In order to obtain a sufficient volume of autologous blood for elective surgery, we used a Sterile Connection Device (SCD, DuPont, Mass. U.S.A.) and a liquid storage method that is called the leap-frog. 1,2 From 300 to 2800 mL (mean 1158 mL) of blood were collected from 126 patients during an average of six donations over 14–125 days (mean 33 days). 101 patients (80%) required no homologous blood during their surgery. No bacterial contamination was observed in the connected tubes. We submit that it is possible to obtain an adequate volume of blood with a simple technique using this method.

Accumulated inflammatory cytokines are considered to be a cause of febrile nonhemolytic transfusion reactions (FNHTRs) of platelet transfusions. Inflammatory cytokines have been found in red cell components stored at 4 degrees C; however, their relationship to FNHTRs has not been clearly demonstrated following red cell transfusions. We measured cytokine levels in stored blood, and determined whether inflammatory marker concentrations were elevated in subjects infused with autologous blood stored for 5 weeks. In conclusion, cytokines accumulated in blood stored at 4 degrees C, but their increases were small. No changes were seen in recipients' inflammatory markers after blood transfusion. Our results indicate that cytokines in stored autologous blood are not responsible for FNHTRs.

The blood of two patients were investigated for immune hemolytic anemia after administration of the following antibiotic drugs: Aspoxicillin (Asp. Doyle®) in the first case, Sodium Sulbactam/Sodium Cefoperazone (SBT/CPZ, Sulperazon®) in the second case.Anti-Asp antibodies of the IgG1 subclass were found in the patient's sera and in the eluates of direct antiglobulin test (DAT) positive red blood cells in the first case, therefore we suggested that hemolysis was caused by anti-Asp antibodies reacting by a well-known ‘hapten-type’ drug absorption mechanism.The other, the autologous red blood cells in the second case was positive by DAT, but only with anti-C3d reagents, and when the patient's serum was incubated (2 hrs at 37°C) with enzyme-treated red blood cells in the presence of the drugs (SBT-CPZ) and complement, hemagglutination was obserbed by indirect antiglobulin test (IAT). It was interesting that, at the time of these findings, the patient's serum reacted weakly with SBT-coated red blood cells but not with CPZ-coated red blood cells by the flow cytometric analysis. These would suggest that so-call ‘immune complex’ mechanism and another mechanism (perhaps drug absorption mechanism) were involved. It is probable that one or both of these mechanisms were responsible for the patient's immune hemolytic anemia in the second case.

Many hospital staff, including doctors, nurses, pharmacists, etc., are engaged in blood transfusion practice, and various inquiries are referred to the blood transfusion services. In order to provide a prompt and proper reply, transfusionists must have a wealth of knowledge and experience concerning blood transfusion medicine. QA relating to blood transfusion can be found on the home page of the Japanese Society of Blood Transfusion, and these are useful staff resources to obtain simple information. However, we sometimes encounter difficult problems in the management of a patient's treatment. Three representative transfusion-related issues are described in this article: (1) blood transfusion to patients with a positive DAT; (2) emergency transfusion, especially in cases where unexpected antibodies are encountered; (3) management of platelet transfusion refractoriness. Minimum standards for the investigation of transfusion-related adverse reactions developed by SHOT (Serious Hazards of Transfusion) are also introduced in this article, and these have a highly practical value. Finally, the importance of education in transfusion medicine is described. The number of doctors in Japan who are engaged exclusively in transfusion medicine is small, but blood transfusions are performed in every hospital, regardless of whether such a specialist is present. We have recently had to deal with a wide range of transplantation-related issues. Therefore, there is a great need for special education in transfusion medicine for doctors in the transplantation and cell therapy age.

A 50-year-old man with AML[M2,t(8;21)] underwent BMT from his younger sister. At that time, he had no unexpected antibody and his blood type was O(+), CcDEe. The type of Kidd was not examined. The donor's blood type was O(+), CCDee, Jk(a+b−). One year after the BMT, the patient's blood type had changed to that of the donor's and anti-E antibody was detected. Despite the use of platelet concentrates (PCs) only, anti-c antibody was later identified. We conclude that there is a need to check red cell antibodies at regular intervals, even when using PCs only, for earlier detection of unexpected antibodies after BMT.

Studies were made on 59 children (cardiac 42, orthopaedic 13, miscellaneous 4) scheduled for autologous blood donation before elective surgery. The donor-patients' ages ranged from 3 to 15 years (mean 9.9 years) and their weights from 13 to 70 kg (mean 34 kg). All patients received 50-100 mg of oral iron sulphate per day. As a rule, about 10% of intravascular blood volume was drawn once a week. Before surgery, an average of 720 ml of autologous blood per patient was prepared. Two patients failed to donate autologous blood because of anxiety about the procedure; however, none of the donors was deferred due anaemia associated with the phlebotomy. Of the 53 patients undergoing surgery and participating in autologous predonation, 50 (94%) were able to avoid homologous blood transfusion. 600 ml of homologous blood were transfused to each of 2 orthopaedic patients and 400 ml to 1 cardiac patient. We conclude that a predeposit autologous transfusion programme is logistically possible in small children when the patients are cooperative.