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国立がん研究センター 中央病院

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Department of Blood Transfusion and Cellular Therapy

Ryuji Tanosaki

Introduction

The missions of the Department of Blood Transfusion and Cellular Therapy are management of in-hospital transfusion and support for the hematopoietic stem cell transplantation team in respect of providing safe and secure cellular products. In common with the Department of Clinical Laboratories, our blood transfusion examination laboratory received ISO 15189 accreditation, which certifies the quality and competence of a medical laboratory with regard to quality management and techniques, developed by the International Organization for Standardization Technical Committee 212 (ISO/TC 212). Our hospital is also accredited by the Japan Society of Transfusion Medicine and Cell Therapy (JSTMCT). The chief doctor (R.T.) also supervises the phlebotomy section of the outpatient clinics.

Routine activities

Currently, our staff members consist of one JSTMCT-accredited medical doctor and six specifically engaged medical technologists (MT) (including two JSTMCT-accredited technologists) who come to us from the Department of Pathology and Clinical Laboratories. Most activities in our department are undertaken in collaboration with the Department of Pathology and Clinical Laboratories. The Transfusion Medicine Committee is held every month, an administrative meeting is held weekly, and an all-staff meeting is held weekly in our department and once a month in the Department of Clinical Laboratories.

As an in-hospital transfusion service section, we purchase blood products, which are required and ordered by clinicians, from the Red Cross, and examine and confirm the ABO blood type, and provide them for clinical use without any delay. In 2015, the total units of red blood cells (RBC), platelet concentrates (PC) and fresh frozen plasma (FFP), which were used in our hospital, were 9,871, 40,225 and 4,302, respectively, with wastage rates of RCC 0.5%, PC 0.04%, FFP 0.2%, respectively. Thanks to the Tokyo Red Cross and the convenient location of our hospital, blood products are available within one hour almost every time when they are needed in an emergency.

We employ the Type & Screen and computer cross-match system, but special attention is paid to blood typing, because about 100 cases of hematopoietic stem cell transplantation (SCT) are performed in our hospital every year including many ABO-mismatched donor-recipient pairs. All transfusion procedures are performed under a strict hemo-vigilant system that employs electronic medical records managed by the computer system at the blood transfusion service. Hematopoietic stem cells that are to be transplanted to the SCT patients, that is, grafts, are also subject to the same safety and bio-vigilant system as other blood products.

We also manage the processing, storage, and quality control of hematopoietic stem cells used for transplantation as a routine activity in collaboration with medical engineers and members of the Department of Hematopoietic Stem Cell Transplantation. We inform other SCT-team members of the optimal timing for peripheral blood stem cell harvest (PBSCH) by monitoring counts of chemotherapy/G-CSF-mobilized progenitor cells, for not only CD34-positive (CD34+) cell count, but also HPC, a new enumeration marker developed in our department. The management meeting is held once a month, the members of which consist of staff from the Department of Hematopoietic Stem Cell Transplantation, Medical Engineering Section, the head of technologists, and the members of our department. The chief doctor is also involved in the management of transplant patients both as inpatients and in the outpatient clinic as a staff member of the hematopoietic stem cell transplantation team, which facilitates and promotes inter-departmental collaboration, as mentioned above.

Since April 2015, we started a modified Cell- Free and Concentrated Ascites Reinfusion Therapy (KM-CART) for the management of patients with refractory ascites. Ascites from each patient were registered in our blood computer system with a minor modification, which could be processed in the same manner as a blood product. About 100 procedures were performed in the first year without any major problems, and almost no serious adverse events were observed in infusion to patients.

Research activities

One of the Department's research projects is to develop a new enumeration technique for hematopoietic stem cells using an automated hematology analyzer, which is designated as 'HPC', in collaboration with a medical diagnostic company. The multicenter study for evaluation of HPC with the support of JSTMCT demonstrated that there was a very strong correlation between HPC values and CD34+ cell counts, and we concluded that HPC is very promising as a candidate of an alternative for CD34+ cell.

Another project is to establish a nationwide infrastructure of processing and management of cellular products used for hematopoietic stem cell transplantation as a committee member of the corresponding academic societies with the support of the Ministry of Health, Labour and Welfare. In 2015, we conducted a nationwide external quality assessment of CD34+ cell counts for the first time. We also published a Textbook of Cell Processing for Hematopoietic Stem Cell Transplantation. We also launched an accreditation system for Clinical Cell Therapy Specialists for the first time in Japan, and 431 medical experts were given accreditation in the first year.

Education

The chief doctor supervises the education program of the Department of Clinical Laboratories for all medical technologists. The education program consists of a monthly educational conference in which each medical technologist presents his or her research, doctors' lectures, and RCPC (twice a year) were performed. It also includes educational lectures concerning ISO 15189. We also support and facilitate academic presentations and publications by all the MT members.

List of papers published in 2015

Journal

  1. Suehiro Y, Hasegawa A, Iino T, Sasada A, Watanabe N, Matsuoka M, Takamori A, Tanosaki R, Utsunomiya A, Choi I, Fukuda T, Miura O, Takaishi S, Teshima T, Akashi K, Kannagi M, Uike N, Okamura J. Clinical outcomes of a novel therapeutic vaccine with Tax peptide-pulsed dendritic cells for adult T cell leukaemia/lymphoma in a pilot study. Br J Haematol, 169:356- 367, 2015