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The objective of this survey was to study the present status of autologous blood transfusion practice from January 2001 to June 2001 in Akita Prefecture and to evaluate changes in status by comparison with our previous survey in 1994. Questionnaires were sent to 151 surgical divisions of 34 hospitals with more than 50 beds in Akita Prefecture. A total of 112 answers (74.2%) were collected and evaluated.Autologous blood transfusion programs were conducted in 61 divisions (54.5%) in total. This value was increased compared with the previous result. The percentage of performance of autologous blood transfusion was highest in orthopedics (93.8%), and increased remarkably in gynecology. Status of collection and storage management of predeposit autologous blood further improved. Main practical problems identified in this survey were insufficient workforce in the predeposit method, a shortage of knowledge about hemodilutional methods, anxiety concerning contamination such as bacteria or fat, and insufficient workforce in salvaging methods. In future for allogeneic blood transfusion cases, 34 divisions are planning to institute autologous blood transfusion programs, mainly with predeposit method only or both predeposit and hemodilutional methods.Many divisions pointed out that in the promotion of autologous blood transfusion, it is necessary to arrange equipment and workforce, to enlighten doctors and to relieve limitations on medical insurance concerning autologous blood transfusion.

Guidelines for blood transfusion require that a transfusion committee should be established in each hospital to ensure proper blood transfusion. In 1998, Akita Prefecture, Akita Red Cross Blood Center and several major hospitals organized a joint meeting of transfusion committees of Akita Prefecture. This paper introduces the Joint Meeting of Transfusion Committees, and discusses its influence on proper blood usage. The Joint Meeting of Transfusion Committee has been held once a year since 1998 and consists of a special lecture, questionnaire analysis reports, and discussion of specific topics. Among results of a survey conducted in 2001, transfusion committees were established in 30 hospitals and blood transfusion service was established in 8 of a total of 46 hospitals. During a 6-month period (January 2001 to June 2001), red cells were transfused to 3, 046 patients, plasma was transfused to 739 patients and platelets were transfused to 518 patients in 46 hospitals, representing almost the classified total usage of blood in Akita Prefecture. The status of autologous blood transfusion in Akita Prefecture was also by the survey. However, differences in the status of predeposit autologous blood transfusion were significant among hospitals. The Joint Meeting of Transfusion Committees in Akita Prefecture provides a good opportunity for the exchange of information and education for hospitals. The Joint Meeting is also useful in promoting the establishment of blood transfusion services and activating transfusion committees in hospitals.

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.

Informed consent in autologous and homologous transfusion medicine was investigated by questionnaires sent to 77 blood transfusion departments of the university hospitals. On homologous transfusion, although 80% of physicians talked with patients about the risks of transfusion, 70% did not ask patients to sign a consent form before receiving blood. Further, most physicians spent no more than 10 minutes explaining to patients the risks and benefits of allogenic blood. With regard to autologous transfusion, more than 80% of physicians mentioned the risks and the benefits of this procedure, and also the procedures for preoperative donation. However, only 41% of physicians required written consent.In conclusion, the physician has the moral duty to inform the patient of the risks and benefits of blood transfusion. Institutions should consider written informed consent separate from surgical consent. This would result in increasing the patient's knowledge and autonomy in transfusion medicine. Further, the ethical and educational elements of informed consent for blood transfusion should be a part the curriculum of residential training or undergraduate study.

The objective of this survey was to study the present status of autologous blood transfusion practice from April 1994 to March 1995 in Akita Prefecture and to evaluate changes in status by comparison with our previous survey in 1993. A questionnaire was sent to 150 surgical divisions of 37 hospitals with more than 50 beds in Akita Prefecture.A total of 132 answers (88%) were collected and evaluated. Autologous blood transfusion programs were conducted in 49 divisions (37.1%) in total, this value being increased compared with the previous result. In addition to enforcement in cardiovascular surgery and orthopedic surgery divisions, autologous blood transfusion was also widely applied in another surgical divisions such as general and neurological surgery and gynecology. No homologous blood was transfused in 84% of total cases. In general, in orthopedic and neurological surgery, and in gynecology divisions, homologous blood was used in less than 10% of cases, with predeposit autologous blood. Ninety-six divisions (73%) answered that they have instituted or are planning to institute an autologous blood transfusion program. However, 44% of general surgery divisions and 58% of neurological surgery division have no plans to introduce autologous blood transfusion due to the specific status of patients. As in the previous survey, several practical problems such as a shortage of manpower or time to participate and the necessity of cooperation with the Japan Red Cross Blood Center were also noted.

The objective of this study is to evaluate the influence of shortened preservation period of concentrated red cells stored in MAP additive solution (RC-MAP), whose preservation period is currently 42 days, on the effective utilization of RC-MAP.Mean duration until the use of blood after blood collection from donors was 10.1 and 8.0 days in 1 unit and 2 unit product of RC-MAP, respectively. Most of all units were used within 21 days after blood collection (93.7% for 1 unit product and 97.8% for 2 unit product of RC-MAP). Most of blood units, which were used at our hospital over 21 days of collection, had already passed 15 days at the time of delivery by the blood center. Forty-six percents of such blood were Rh negative blood and/or were delivered from other prefectures. However, particular reason why they were delivered after 15 days of blood collection was not found in 54% of them. If the preservation period of RC-MAP will be decided to be 21 days or 28 days, the units of discarded blood, which is currently 0 unit at our hospital, is estimated to be 195 units (3.7%) or 67 units (1.3%), respectively. In addition, if the blood over 15 days of blood collection is not supplied from the blood center, the units of discarded blood can be decreased to 128 units (2.5%) for a 21 days preservation period and 27 units (0.5%) for a 28 days preservation period.Our data indicate that the blood centers should supply RC-MAP to all hospitals within 14 days after blood collection in order to achieve the effective utilization of RC-MAP if the preservation period is shortened.

This study evaluated the status of the use of platelet concentrate supplied from the Japan Red Cross blood center from April, 1989 to December, 1993. The units of platelet concentrate supplied were significantly increased in recent 2 years. The percentage of platelet concentrate products procured by apheresis was more supplied in 1993. The percentage of the patients who received only 1 or 2 unit product of platelet concentrate was approximately 40% until February, 1993, however, the number of patients receiving only more than 5 unit product of platelet concentrate was being increased since May, 1993. In addition, the number of donors transfused to the patient was significantly decreased to 2.13-3.71 donor number/patient in recent several months. Fifty four percent of the patients and 84% of the units transfused were for those with hematological diseases for which frequent platelet transfusion was performed. In hematological disease patients, an average platelet count was 20000-30000/μl before platelet transfusion. The levels of platelet counts were significantly lower in the patients with aplastic anemia and MDS compared with acute leukemia patients.

The objective of this survey was to study the present status of autologous blood transfusion practice from April 1992 to March 1993 in the hospitals including small clinics without blood transfusion service in Akita prefecture. A questionnaire was sent to 146 surgical divisions of 37 hospitals with more than 50 beds in Akita prefecture.A total of 129 answers (88.4%) were collected and evaluated. Autologous blood transfusion program was performed in 42 divisions (32.6%) in total. Predeposit autologous blood transfusion was widely applied. Enforcement percentage of autologous blood transfusion was higher in cardiovascular surgery and orthopedic surgery divisions compared with other surgical divisions. No homologous blood was transfused in 76% of total cases and 46% and 82% cases in cardiovascular surgery and orthopedic surgery, respectively. Ninety four divisions (73%) answered that they are performing or planning one of various autologous blood transfusion programs in future. However, 29% of general surgery divisions have no plans to perform autologous blood transfusion. Several practical problems such as a shortage of man power or time to participate, short preservation duration of predeposit blood and unavailability of erythropoietin for the program were pointed out to perform predeposit autologous transfusion program. Cooperation by the Japan Red Cross blood center was strongly requested in autologous transfusion practice. Since the MAP autologous blood needs to be separated by centrifugation, separation and freezing of autologous blood products were specially requested to be performed by the blood center.

This study evaluated the usage of concentrated red cells stored in MAP solution (RC-MAP), whose stored period is extended to 42 days, in comparison with ordinary concentrated red cells (CRC). Units of discarded blood, numbers of cross-match in each lot and the duration until the use of blood after blood collection from donors were studied both in RC-MAP and CRC.Only three units (0.1%) were discarded due to the expiration of stored period in 2386 units of RC-MAP, while 81 units (5.2%) were discarded in CRC. Although mean numbers of cross-match were comparable between RC-MAP and CRC, the numbers of lot that were cross-matched more than 4 times were significantly greater for RC-MAP than CRC. In addition, the duration until the use of blood were significantly longer for RC-MAP than CRC. These results suggest that RC-MAP is more effective in the usage of red cell concentrates than CRC. Meanwhile more than 93% of RC-MAP were used within 21 days after blood collection, especially 98% of RC-MAP were used in blood type A within that period. This indicates that most of RC-MAP can be used at the time as high quality red cells. RC-MAP were also alternatively used with washed red cells or leucocyte poor red cells in case, because of its excellent removal of plasma, granulocytes and lymphocytes compared with CRC.

This study summarized the cases of autologous blood transfusion in the Akita University Hospital since 1989 and evaluated the effects of autologous blood transfusion on the usage of homologous blood for surgical procedures.A total of 279 cases were entered in the autologous blood donation programs since 1989. No homologous blood was transfused for 232 cases (83%) in total and 49 cases (68%) and 148 cases (87%) in cardiovascular surgery and orthopedic surgery, respectively. Since MAP solution has been introduced in autologous blood donation programs, leap frog or switch back method will not be applied to collect autologous blood for a long period. The MAP autologous blood donation can make the program easier. In some of the surgical procedures with predeposit autologous blood, the average units of homologous blood prepared were decreased compared with the cases without autologous blood. However, C/T ratio of homologous blood was increased in the some cases with autologous blood. In such cases, the units of MSBOS should be allocated depending on the units of autologous blood prepared.Autologous blood donation programs and the MSBOS system should be closely linked to evaluate, thus, effective blood usage can be achieved.

This study evaluated the usage and discard of all the blood products (124533 units) supplied from the Japan Red Cross blood center from April in 1989 to Marchin 1993.The units of fresh whole blood and stored whole blood purchased and used significantly decreased during 4 years. The units of fresh whole blood purchased was 22% in 1992 compared with those in 1989. The purchase and use of platelet concentrate significantly increased, especially in recent 2 years.The percentage of discarded blood was extremely lowered to 0.78% in 1992. Discards of whole blood and red cell concentrate due to inadequate management at the ward were especially decreased. The units of red cell concentrate discarded due to the expiration of stored period were also decreased because of the introduction of concentrated red cells stored in MAP solution (RC-MAP) in April 1992.Frequent communication between our division and the doctors in charge was necessary to reduce the discard of platelet concentrate which were over ordered for patients. In addition, the blood management system should be clearly understood among the doctors to reduce the discards of whole blood and red cell concentrate.