[Recent circumstances in the supply and demand of various blood products in Japan, and appropriate use of blood components or plasma protein derivatives].

In Japan, as in the United States and several other advanced countries, the use of fresh frozen plasma (FFP) and albumin has increased dramatically over the past 10 years. Especially in Japan the increase has been at least tenfold, and half of this usage has been for surgery. Most reviews of albumin usage acknowledge that there is a high ratio of wastage, or use in clinical circumstances without a firm scientific basis. Recently Japan has imported an enormous volume of various plasma fraction products such as albumin, Factor VIII etc., or plasma as raw material from foreign countries, especially the United States. As a result, Japan has come to monopolized a quarter of the albumin manufactured in the world, and has therefore received much internal and external criticism from or ethical standpoint. As countermeasures against shortage of these blood products, it will be necessary for doctors to use these blood products more sparingly and to increase the yield of volunteer donor's blood, especially plasma. More red blood cell concentrate should be utilized for hemorrhage in routine surgical operations. Because whole blood transfusion is rarely used except in cases of massive bleeding that cannot be stopped immediately, exchange transfusion has been performed in the United States and European countries recently. Transfusion of FFP is appropriately used only for replacement of coagulation factor deficiencies, massive transfusion etc. in the United States. It should be particularly noted that these carry the risk of transmission of diseases such as hepatitis and possibly AIDS. Albumin is an effective oncotic agent in the treatment of acute shock and in the maintenance of intravascular volume and cardiac output. However, albumin and FFP have no demonstrable effect in the general supportive management of chronic hypoproteinemia and undernutrition.