[Relationship between red blood cell transfusion volume and posttransfusional iron overload in hematological diseases].

We retrospectively investigated the status of transfusional iron overload at Kinki University Hospital. One hundred and sixty three patients received more than 10 red blood cell (RBC) units per year in 2009 and 2010. Myelodysplastic syndrome (37.4%) and aplastic anemia (11.0%) accounted for about 50% of the underlying diseases. At the time of receiving a total of 20 RBC units, 90.8% and 66.2% of the 65 patients evaluated had more than 500 and 1,000 ng/ml of serum ferritin, respectively. The frequency of organ dysfunction associated with iron overload was 56.9% of all the patients assessed, 37.8% of patients with serum ferritin levels of 500∼999 ng/ml, and 67.4% of patients with serum ferritin levels >1,000 ng/ml. Although the Japanese guidelines propose 40 units of RBC transfusion and/or a serum ferritin level of 1,000 ng/ml as a good point to start iron chelation therapy, our results suggest that iron overload and consequent organ dysfunction may occur earlier than this. Therefore, it may be necessary to start iron chelation therapy earlier than that suggested by the Japanese guidelines.

[24-hour system of the blood transfusion services at the university hospital].

Blood transfusion is an essential medical treatment, from the everyday use in surgery to the treatment of large-scale bleeding accompanying external injury. Securing sufficient quantities of blood product and ensuring safe storage are critical. A 24-hour system of blood transfusion inspection by medical technologists has been enforced in our hospital since April, 1999 to improve the safety of blood transfusion treatment at night and on weekends. The medical technologists in the clinical laboratory and the division of blood transfusion carried out examinations in combination. There were no clinical problems after blood transfusion, and a safe blood supply has been maintained. As for medical technologists not specializing in the division of blood transfusion, blood type and crossmatching tests could be confirmed by the introduction of the Micro Typing System without problem. The execution of regular study meetings and maintenance of the manual are necessary so that the medical technologists not specializing in blood transfusion can carry out examinations confidently. An examination system is effective, but the safety of the blood transfusion treatment at night and on weekends can not be 100% secured. It is important to improve the consciousness of the clinical staff who perform blood transfusion treatment with regular training.