The Impact of Red Cell Substitutes on the Blood Service in Japan

The total number of blood donors in 1994 was 6.6 millions, and 200 ml whole blood donation occupied 41.8 % of all donations, whereas 400 ml and apheresis donations occupied 35.6 %, 22.5 % of all donations respectively. From the donated blood, about 8.35 million bags of blood components were prepared and were used for blood transfusion. Besides used as blood components, 720,000 L source plasma was used to produce plasma derivatives, and therefore Japan has achieved self-sufficiency in Factor VIII by donated blood. Blood transfusion has become quite safer but there are still risks of acquiring transfusion-associated GVHD(TA-GVHD) or infecting with HIV from blood in window period. To avoid adverse reactions of blood transfusion, the strategies for reducing homologous blood transfusion has been promoting. The use of red cell substitutes will be an option of using non-human derived substitutes toward "zero" adverse reaction of transfusion, and when red cell substitutes are accepted in Japan, they will be applied as the substitution to allogeneic blood transfusion below 1200 ml hemorrhage. They will also be applied as an alternation to and/or combination with allogeneic and autologous blood transfusion and the use of erythropoietin.