Kinuyo Kawabata

Culture-based bacterial detection systems for platelets: the effect of time prior to sampling and duration of incubation required for detection with aerobic culture

BACKGROUND: Bacterial contamination of platelet (PLT) products occurs at low concentrations requiring a period of incubation for growth to minimize sampling error. Culture‐based detection methods also need sufficient incubation time; together these periods may limit the useful life of PLTs. This study characterizes the impact of sampling and detection times with two commercially available bacteria detection products.

Survival and recovery of apheresis platelets stored in a polyolefin container with high oxygen permeability

Background and Objectives  Oxygen permeability is important in platelet storage media. We compared a new polyolefin container with enhanced oxygen permeability (PO‐80; Kawasumi, Tokyo, Japan) to a widely used alternative (PL2410; Baxter Healthcare, Deerfield, IL, USA).

Massive intracranial hemorrhage caused by neonatal alloimmune thrombocytopenia associated with anti-group A antibody.

Neonatal alloimmune thrombocytopenia (NAIT) is a rare but clinically important etiology of intracranial hemorrhage. There have been no reported cases of intracranial hemorrhage caused by anti-group A or anti-group B antibodies. A Japanese boy weighing 1550 g was born at 37 weeks. He suffered from refractory thrombocytopenia and developed severe intracranial hemorrhage on his second day. Despite repeated platelet, red-cell and fresh-frozen-plasma transfusions, he died at day 10 of life. Serological studies and genotyping of the patient and his parents were performed. There were no incompatible genotypes of platelet antigens between the patient and the mother. Serological studies revealed that the mother had extremely high-titer anti-group A immunoglobulin G2 (4096-fold) that reacted strongly with the fathers platelets. The reaction against the fathers platelets disappeared when her serum was adsorbed with group A red blood cells. Maternal anti-group A antibody was associated with NAIT and severe bilateral intracranial hemorrhage.

Hemolytic Disease of the Fetus and Newborn With Late-Onset Anemia due to Anti-M: A Case Report and Review of the Japanese Literature

Hemolytic disease of the fetus and newborn (HDFN) attributed to M/N-incompatibility varies from asymptomatic to lethally hydropic. Case reports are rare, and the clinical significance of anti-M is not completely understood. A challenging case of HDFN due to anti-M prompted an investigation of the Japanese literature, in order to characterize the clinical spectrum of M/N-incompatibility pregnancies in Japan and report results to English-language readers. Japanese reports of HDFN attributed to M/N incompatibility were compiled. Abstracted data include maternal antibody titers at delivery, fetal direct antiglobulin test, hemoglobin, total bilirubin, reticulocyte count at birth, and therapeutic interventions. We investigated characteristics of HDFN due to M/N-incompatible pregnancies in Japan after encountering a case of severe HDFN along with late-onset anemia in an infant born to a woman carrying IgG anti-M with a titer of 1. In total, thirty-three babies with HDFN due to anti-M and one due to anti-N have been reported in Japan since 1975. The median maternal antibody titer was 64 at delivery and was 16 or less in 10 of 34 women (29%). Five of 34 babies (15%) were stillborn or died as neonates. Twenty-one of 29 survivors (72%) had severe hemolytic anemia and/or hydrops fetalis. The reticulocyte count of neonates with anemia stayed below the reference interval. Sixteen (55%) developed late-onset anemia and 14 (48%) were transfused with M-negative RBCs. Significant positive correlation (P < .05) between the hemoglobin value and the reticulocyte count within 4 days of birth was obtained in 16 babies with anti-M HDFN. In the Japanese population, 21 of 34 cases of M/N-incompatible HDFN (72%) have manifested as severe hemolytic anemia and/or hydrops fetalis. Low reticulocyte count in neonates with late-onset anemia is consistent with suppressed erythropoiesis due to anti-M.

Increased detection of clinically significant antibodies and decreased incidence of delayed haemolytic transfusion reaction with the indirect antiglobulin test potentiated by polyethylene glycol compared to albumin: a Japanese study

BACKGROUND The indirect antiglobulin test (IAT) can be potentiated by agents such as polyethylene glycol (PEG-IAT) and albumin (Alb-IAT). PEG-IAT is generally regarded as superior to Alb-IAT for the detection of clinically significant red blood cell (RBC) antibodies. However, supporting data come from Caucasian-dominant populations. Non-Caucasian populations should be investigated as well. MATERIAL AND METHODS In this single-centre, retrospective, sequential study, Alb-IAT was used from 1989 to 1996 (8 years) and PEG-IAT from 1997 to 2008 (12 years). Pre-transfusion RBC alloantibody detection rates and specificity, post-transfusion alloantibody production, and the incidence of delayed haemolytic transfusion reaction were assessed and compared for the two periods. RESULTS Although overall RBC alloantibody detection rates were comparable, PEG-IAT more frequently detected clinically significant antibodies such as anti-E, anti-Fy(b), and anti-Jk(a), and less frequently detected insignificant antibodies such as anti-Le(b) and anti-P(1). New alloantibodies emerged comparably during the two periods. Delayed haemolytic transfusion reaction was less frequent during the PEG-IAT period (0.30% versus 0.12%, p<0.05). CONCLUSION PEG-IAT was superior in the detection of clinically significant antibodies, reduced the detection of insignificant antibodies, and prevented delayed haemolytic transfusion reaction better than Alb-IAT among Japanese transfusion recipients in this retrospective survey of limited power.

CD34+ cell enumeration by flow cytometry: a comparison of systems and methodologies.

CONTEXT An increasing number of medical centers can collect bone marrow, peripheral blood, or umbilical cord stem cells. Pathology laboratories should accommodate this trend, but investment in additional equipment may be impractical. OBJECTIVES To compare CD34(+) cell counting results by using 2 widely available flow cytometry systems, with and without the use of a separate hematology analyzer (ie, single-platform versus dual-platform methodologies). DESIGN Whole blood and peripheral blood stem cell (PBSC) samples were analyzed from 13 healthy allogeneic PBSC donors and 46 autologous PBSC donors with various malignancies. The Cytomics FC500 (Beckman Coulter, Fullerton, California) was compared with the FACSCalibur (BD Biosciences, San Jose, California). Dual-platform CD34(+) cell counting incorporated data from a KX-21 hematology analyzer (Sysmex, Kobe, Japan). RESULTS Subtle differences in CD34(+) cell counting between 2 systems and 2 methods did not achieve statistical significance. CONCLUSION Different systems and methods for CD34(+) cell enumeration, properly validated, can support care for patients undergoing transplants and provide meaningful data for multicenter studies or meta-analyses.

A noninvasive near infrared system for detection of platelet components contaminated with bacteria.

BACKGROUND: Platelet (PLT) transfusion–associated bacterial sepsis has remained a substantial patient risk, primarily due to lacking effective and point‐of‐issue measures to detect bacterial contamination. This study describes near infrared (NIR) spectroscopy to examine inoculated PLTs without sampling within a few seconds.

Recommendations for the electronic pre-transfusion check at the bedside

The current risk of acquiring viral transmission through blood components is very small1. Thus, serious non-infectious hazards of transfusion have emerged as the most common complications2. The risk of non-infectious complications, including risks related to hospital-based steps in transfusion care, is at least 100 times greater than the risk of acquiring human immunodeficiency virus or hepatitis C virus infection through blood components3. One of the most frequent causes of transfusion-associated morbidity or mortality is mistransfusion, when the wrong blood is transfused to the wrong patient. Mistransfusion is the final outcome of one or more procedural errors or technical failures in the transfusion process, starting with the decision to transfuse a patient and ending with the actual administration of blood components3. In particular, ABO-incompatible transfusions attributable to incorrect identification of the patient or the blood unit are among the most serious transfusion hazards3–5. The Japan Society of Transfusion Medicine and Cell Therapy (JSTMCT) conducted nationwide surveys in Japan regarding ABO-incompatible blood transfusions (1st survey: January 1995–December 1999; 2nd survey: January 2000–December 2004). They found that the main cause of ABO-incompatible transfusion was identification error between the patient and blood unit6. These two surveys reported 9 and 8 “preventable” fatalities, respectively. Mislabelled and wrongly collected patient samples (wrong blood in tube [WBIT]) can also initiate a chain of events leading to mistransfusion3. Thus, correct patient identification at the time of sample collection and administration of blood components is critical. The Serious Hazards of Transfusion (SHOT) scheme in England showed that approximately 70% of incorrect blood component transfused (IBCT) errors take place in clinical areas, with the most frequent error being failure of the final patient identification checking procedure at the bedside; the frequency of IBCT events was calculated as 7 per 100,000 components7. However, the true incidence of mistransfusion seems to be even higher due to a failure to recognise many of the errors, and because complete data on transfusion episodes are not available. Thus, the pre-transfusion checking procedure at the bedside is the most critical step to prevent mistransfusion, and represents the final opportunity to prevent blood component misuse. However, a large observational audit revealed a failure to perform the final bedside checking procedure8, in which the practice compliance of healthcare workers for identification and vital sign monitoring of patients receiving blood transfusions were substandard in many hospitals. Machine-readable identification technology, especially a bar code-based electronic identification system (EIS), is ideally suited for pre-transfusion checking procedures and has been reported to significantly improve transfusion practice9–15. The British Committee for Standards in Haematology (BCSH) Guidelines for the Use of Information Technology (IT) in blood transfusion laboratories were recently up-dated16, providing mainly guidance on the operational use of laboratory information management systems (LIMS). Thus, to our knowledge, there are no available recommendations addressing the issues regarding the pre-transfusion check procedures at the bedside employing an EIS. The JSTMCT Task Force proposed the original draft of recommendations for the electronic pre-transfusion check procedures at the bedside and raised public awareness regarding the draft of recommendations on the home page of the JSTMCT17. The draft of the current recommendations developed by the Task Force adopted the opinions were submitted without major changes to the description. The objective of this study was to establish recommendations for the electronic pre-transfusion checking procedures at the bedside, appropriate for clinical situations, where a bar code-based EIS is used.

Efficacy of D- red blood cell transfusion and rituximab therapy in autoimmune hemolytic anemia with anti-D and panreactive autoantibodies arising after hematopoietic stem cell transplant: AIHA RESCUED BY D- RBCs AND RITUXIMAB

Autoimmune hemolytic anemia (AIHA) is caused by autoantibodies to red blood cells (RBCs), which can be panreactive and/or specific to Rh/other blood group antigens. We report a severe case of AIHA after bone marrow transplantation (BMT) due to autoanti‐D triggered by reactivation of Epstein‐Barr virus (EBV) infection. A combined strategy of D– RBC transfusion and administration of anti‐CD20 monoclonal antibody (MoAb) resolved the hemolysis.

Transfusion-related alloimmunization to red cell antigens among pediatric recipients

Aims: Alloimmune response to red cell transfusion has not been widely investigated in pediatric patients. We retrospectively compared the frequency and specificity of red cell antibody formation among pediatric recipients grouped by age, versus an adult control cohort. Methods: A total of 331 pediatric red cell transfusion recipients were studied in four age groups: 0 to 4.9 months (Group A), 5.0 to 11.9 months (Group B), 1.0 to 5.9 years (Group C), and 6.0 to 14.9 years (Group D). Similarly transfused adult males, 20.0 to 59.9 years old, as a control cohort group. Alloimmunization was defined as posttransfusion detection of red cell alloantibodies not detected prior to transfusion. Results: After red cell transfusion, no one in Group A (0 of 106) developed alloantibodies, whereas 8.0% (2 of 25) Maiko Abe1, Hitoshi Ohto1, Keiji Minakawa1, Kinuyo Kawabata1, Satoshi Ono1, Nozomi Takano1, Hiroe Suzuki1, Mao Watanabe1, Akiko Sugawara1, Masami Kikuchi1, Saori Miura1, Chikako Takeuchi-Baba1, Hiroyasu Yasuda1, Kenneth E. Nollet1, Yoshiko Tamai2, Junichi Kitazawa1,3, Kazuhiko Ikeda1 Affiliations: 1Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University Hospital, Fukushima, Japan; 2Division of Blood Transfusion Medicine, Hirosaki University Hospital, Hirosaki, Japan; 3Department of Clinical Laboratory, Aomori Prefectural Central Hospital, Aomori, Japan. Corresponding Author: Hitoshi Ohto, MD, PhD, Department of Blood Transfusion and Transplantation Immunology and Department of Advanced Cancer Immunology, Fukushima Medical University, Fukushima City, Fukushima-960-1295, Japan; Email: hit-ohto@fmu.ac.jp Received: 17 March 2018 Accepted: 10 May 2018 Published: 07 June 2018 in Group B, 1.1% (1 of 95) in Group C, and 2.9% (3 of 105) in Group D, versus 2.1% (8 of 380) of adult male controls who developed alloantibodies. However, these differences did not achieve statistical significance. Conclusion: This investigation of alloimmunization in pediatric recipients found no cases in patients younger than five months old, however, the incidence rates of older age groups were statistically indistinguishable from a control cohort of male adults. Until larger studies suggest otherwise, current antibody screening and cross-matching policies should be continued.