Pre-operative autologous blood donation and transfusion-related adverse reactions: A 14-year experience at a university hospital.

OBJECTIVE: The objective of this study was to determine the rate of adverse reactions to pre-operative autologous blood donation (PAD) transfusion in a single institution over a 14-year period. STUDY DESIGN AND METHODS: Between January 2003 and December 2016, we investigated adverse reactions to PAD transfusion and compared them with those to allogeneic blood transfusion in Juntendo University Hospital. Adverse reactions were categorized according to the definition proposed by the International Society of Blood Transfusion (ISBT) Working Party on Haemovigilance. RESULTS: A total of 178,014 blood components were transfused during the study period, of which PAD transfusions were 13,653 (8%), whereas allogeneic blood transfusions were 164,361 (92%). The number and rate of adverse reactions to PAD transfusion were 16 and 0.1%, whereas those of allogeneic blood transfusion were 1075 and 0.7%, respectively. The rate of adverse reactions to allogeneic blood transfusions excluding platelet transfusion was 0.3%, being significant (p < 0.01) against PAD transfusion. Among 16 adverse reactions to PAD transfusion, the most common was febrile non-hemolytic transfusion reaction (FNHTR) at 12 (75%), followed by allergic reaction at 4 (25%). The severity of adverse reactions to PAD transfusion was Grade 1 (non-severe) in all cases. With regard to blood component types, 16 adverse reactions involved: 12 cases of whole blood PAD, 2 of frozen PAD, and 2 of autologous fresh-frozen plasma. CONCLUSIONS: Non-severe adverse reactions were observed on PAD transfusion at a rate of 0.1% at our institution.

Implementation of electronic identification system for blood transfusion in the setting of hematopoietic progenitor cell infusion at the bedside.

Hematopoietic progenitor cell (HPC) infusion at the bedside is a critical step in HPC transplantation. In this study, we implemented a bar code-based electronic identification system (EIS) for blood transfusion in the setting of HPC infusion at the bedside. Between July 2003 and December 2014, a total of 518 HPC products were infused to 190 patients without a single misinfusion in the hospital. An overall compliance rate with the electronic pre-infusion check for HPC infusion at the bedside was 100%. Our observations suggest that an EIS can be successfully applied to the infusion of HPC products at the bedside.

Bar code-based pre-transfusion check in pre-operative autologous blood donation.

BACKGROUND: The objective of this study was to demonstrate the feasibility of a bar code-based identification system for the pre-transfusion check at the bedside in the setting of pre-operative autologous blood donation (PABD). MATERIALS AND METHODS: Between July 2003 and December 2008 we determined the compliance rate and causes of failure of electronic bedside checking for PABD transfusion. RESULTS: A total of 5627 (9% of all transfusions) PABD units were administered without a single mistransfusion. The overall rate of compliance with electronic checking was 99%. CONCLUSIONS: The bar code-based identification system was applicable to the pre-transfusion check for PABD transfusion.

Issuing of blood components dispensed in syringes and bar code-based pretransfusion check at the bedside for pediatric patients.

BACKGROUND: The pretransfusion check at the bedside is the most critical step for the prevention of mistransfusion in pediatric patients, as well as in adults. The objective of this study was to assess whether a bar code-based patient-blood unit identification system could be applied to the pretransfusion check at the bedside for the issuing of blood dispensed in syringes. STUDY DESIGN AND METHODS: The issuing of blood components dispensed in syringes and the bar code-based pretransfusion check at the bedside were initiated for pediatric patients in May 2003. The number of blood components transfused to pediatric patients and rate of compliance with electronic bedside verification for blood dispensed in syringes were determined. Several variables in blood samples that were freshly collected, irradiated, split into 20-mL aliquots, and stored in syringes at 4 degrees C were measured. RESULTS: Between May 2003 and April 2007, a total of 3957 blood components (10% of all transfusions) were administered to pediatric patients without a single mistransfusion, of which 871 (22%) were issued by dispensing in syringes. The compliance rate with electronic bedside verification for blood dispensed in syringes was 99%. The supernatant potassium concentrations and extracellular free hemoglobin in blood samples stored in syringes at 4 degrees C for 24 hours were 14 +/- 1.3 mmol/L and less than 0.3 g/L, respectively, and these were considered to be acceptable for transfusion to pediatric patients. CONCLUSION: The bar code-based identification system that we used was fully applicable to the pretransfusion check at the bedside for blood dispensed in syringes.

Risk factors for recurrent thrombosis: prospective study of a cohort of Japanese systemic lupus erythematosus.

Not only antiphospholipid antibodies (aPLs) but also other factors should be considered in assessing the risk of thrombosis development in patients with systemic lupus erythematosus (SLE) and antiphospholipid antibodies (aPLs). The kinds of risk factors, including past history of thrombotic event (PHTE), hypertension, hypercholesterolemia, diabetes mellitus (DM), obesity, and smoking, in conjunction with aPLs, that contribute to the development of new thrombotic events in patients with SLE and aPLs were studied prospectively over a 5-year observation period. One-hundred and sixty-six Japanese patients with SLE (55 patients with aPLs and 111 patients without aPLs) were examined and followed up for 5 years. Five major risk factors for ischemic coronary disease and stroke according to the Framingham heart cohort study were evaluated objectively in these patients. A significant difference was seen for 4 factors: past history of thrombotic event (PHTE; odds ratio: 101.93; 95% confidence interval: 12.29-845.22; p < 0.0001), hypertension (odds ratio: 8.87; 95% CI: 2.58-30.53; p < 0.001), DM (odds ratio: 5.42; 95% CI: 1.44-20.46; p < 0.05), and lupus anticoagulant (LAC; odds ratio: 47.41; 95% CI: 5.88-382.03, p < 0.0001) as aPLs, when the incidence of these risk factors was compared between patients with and without new thrombotic events. Furthermore, PHTE (odds ratio: 30.19, 95% CI: 1.33-683.13), hypertension (odds ratio: 15.44; 95% CI: 1.77-134.80), and LAC (odds ratio: 14.11; 95% CI: 0.48-412.42) showed higher odds ratios than DM (odds ratio: 11.53; 95% CI: 0.83-159.94) on multivariate logistic analysis as well as analysis of the combination of risk factors, suggesting that these are important risk factors for the development of new thrombotic events in patients with SLE and aPLs.

A computer-assisted transfusion management system and changed transfusion practices contribute to appropriate management of blood components.

BACKGROUND: ABO-incompatible blood transfusions attributable to inadequate identification (ID) of the patient or the blood unit are among the most serious of transfusion hazards. It has been unclear whether a computer-assisted transfusion management system connected to a bar code ID system could contribute to the appropriate management of blood components, as well as to the prevention of mistransfusions. STUDY DESIGN AND METHODS: A transfusion management system has been developed that links the hospital information system, a bar code patient-blood unit ID system, and an automated device for pretransfusion testing. The guidelines for issuing blood components from the transfusion service were also changed. The appropriateness of blood management was evaluated by monitoring the time to initiate transfusion after issuing a blood unit from the transfusion service (time after issuing [TAI]) and by calculating the number of units issued and subsequently returned, as well as the rate of date-expired red cell (RBC) components. RESULTS: From July 2002 to December 2006, a total of 49,974 blood components were transfused without a single mistransfusion. The monitoring of TAI and the notice to use the issued blood immediately had the effect of shortening TAI in the inpatient ward. The number of issued and subsequently returned RBC components, as well as the rate of date-expired RBC components, decreased significantly after the introduction of the system. CONCLUSION: A computer-assisted transfusion management system and changing transfusion practices appear useful in preventing mistransfusions and in contributing to the appropriate management of blood components.

Possible contribution of prior hepatitis B virus infection to the development of hepatocellular carcinoma.

BACKGROUND: The prevalence of prior hepatitis B virus (HBV) infection in hepatocellular carcinoma (HCC) patients and its role in hepatocarcinogenesis are not clear. The aim of the present study is to clarify the importance of prior HBV infection in development of HCC. METHODS: Of 1288 consecutive HCC patients between January 1999 and October 2002, 1008 patients were enrolled. To determine the influence of prior HBV infection in hepatitis B surface antigen (HBsAg)-negative HCC, the prevalence of antibody to hepatitis B core antigen (anti-HBc) was examined according to age, and the clinical features were compared between the anti-HBc positive and the negative groups. RESULTS: The proportion of HBsAg-negative HCC patients, HCC patients with antibody to hepatitis C virus (anti-HCV; C-HCC) and HCC patients negative for both HBsAg and anti-HCV (nBnC-HCC), increased with age. The anti-HBc-positive rates in C-HCC patients also increased with age. Those rates in nBnC-HCC patients were >50% in all age groups. Furthermore, it was found that the anti-HBc-positive rates of these patients were higher than those of corresponding control patients. Tumor size and a positive rate for vessel involvement both in C-HCC and nBnC-HCC patients were larger and higher, respectively, in anti-HBc-positive patients compared with anti-HBc-negative patients, although the difference in nBnC-HCC did not reach statistical significance because of the small numbers. These tumor characteristics were similar to those of B-HCC patients. CONCLUSION: A possible contribution of prior HBV infection to the development of HCC is indicated.