Akiko Tsuruga (敦賀明子, Tsuruga Akiko in Japanese order) was the eldest of three children, born in Osaka on 1 September 1967 to a father who ran a manufacturing company. She started at a Yamaha music school at three, got her first organ as a small child, and learned standards on it early. In high school she was listening to Hammond B-3 players: Jimmy Smith, Charles Earland, Jack McDuff, Jimmy McGriff and Dr. Lonnie Smith. A jazz-loving grandmother gave her much of her early musical education. She played piano and organ in an Osaka lounge in her late teens, then chose the organ, and graduated from the Osaka College of Music in 1988.

Osaka is where she met the Americans who sent her to New York. At a jazz club called the Don Shop, across from the city's Blue Note, visiting musicians sat in, among them the drummer Grady Tate, and Tate and others urged her to go. She has said Tate was the biggest influence on her career, and he played on her first record. Accounts of her Osaka years also name the trumpeter Roy Hargrove and the drummer Jeff "Tain" Watts among the visitors she played with; those come from biographies rather than from record credits.

Harlem Dreams (M&I Jazz, 2004) was recorded in New York in December 2003 with Tate on drums, Frank Wess on saxophones and the Japanese guitarist Satoshi Inoue, and released in Japan on 19 May 2004. A CD release tour that August brought Tate and Inoue to Japan with her, and a second trip in September 2005 with the guitarist Eric Johnson and drummer Fukushi Tainaka took her to the Hammond Suzuki factory, where she was presented with a Hammond XK-3 organ and an endorsement. By then she had settled in New York, in 2001, and had begun lessons with Dr. Lonnie Smith, who remained her chief mentor. Her trio with Johnson and the drummer Vince Ector worked clubs including Dizzy's Club at Lincoln Center and the Blue Note, and she played Showman's Jazz Club in Harlem, where the saxophonist Lou Donaldson heard her. He asked her into his band.

She stayed with Donaldson's quartet for more than fifteen years, sources dating the start to 2006 or 2007, and toured internationally with him until his death in 2024 at 98. Obituaries say he taught her to comp behind horn players and told her she was better than any musician he knew in New York. In 2007 the group played Birdland, the Village Vanguard and Carnegie Hall, and the "Queen of the Organ" title that Japanese promoters later used for her was credited to Donaldson. Her first American release, Sweet and Funky (18th & Vine), earned a four-star review and a place among DownBeat's best CDs of 2007. Her honours included Swing Journal's New Star Award in Japan, the first it gave to an organist, Hot House magazine's Best Organist title in New York, and a place in the Rising Star organ category of the DownBeat critics poll. Sources disagree on the years of these honours, so none are given here.

The leader dates came steadily. St. Louis Blues (Mojo, 2007) had the tenor saxophonist Houston Person and the drummer Bernard Purdie. NYC Serenade (Mojo, 2008) was billed "with Jimmy Cobb". Oriental Express (18th & Vine, 2009) and Sakura (American Showplace Music, 2011, recorded 19 and 20 April 2011) built a front line around the tenor saxophonist Jerry Weldon and, on Sakura, the trumpeter Joe Magnarelli. Her recordings with Jeff Hamilton began with Commencement (2014, recorded 16 and 17 March 2014), and So Cute, So Bad (2017, AT Records in the United States and Somethin' Cool in Japan) and Equal Time (Capri, 2019) added the guitarist Graham Dechter. She also appeared on Posi-Tone as the organist of Lioness, the all-women collective whose Pride & Joy came out in 2019.

Her husband, the trumpeter Joe Magnarelli, is on the front line of her last album under her own name. Beyond Nostalgia (SteepleChase, 2024, recorded in February 2023) pairs him with Weldon, the guitarist Ed Cherry and the drummer Byron Landham, and includes a reading of Lonnie Smith's "Back Track". In 2025 she appeared on the Jeff Hamilton Organ Trio's Coast to Coast with the guitarist Steve Kovalcheck, a trio that had toured the United States and Europe, and in 2023 she joined the Clayton-Hamilton Jazz Orchestra for its European tour. She toured Japan several times as a leader, and a 2017 visit was billed as a pair of talk-and-performance dates on the Hammond organ in Tokyo and Osaka.

Akiko Tsuruga passed away on 13 September 2025 in Brooklyn at 58, after a short terminal illness; Magnarelli confirmed her death. She was survived by her husband, her mother Hiroko, her sister Naomi and her brother Shingo. Her husband said she had picked up the baton from Jimmy Smith and Jack McDuff, and the organist Mike LeDonne wrote that she was one of the greats.

Tsuruga played the Hammond B-3 in the line that runs from Jimmy Smith and Jack McDuff through Charles Earland and Dr. Lonnie Smith: a bluesy, funky foundation under a wide range of sounds. Obituary writers stress how many textures she got from one instrument; Magnarelli described the effect as anything from a meteor to a truck on a highway to falling snowflakes. Reviewing a 2012 Chicago concert, DownBeat's Hilary Brown wrote that she balanced restraint with forceful playing, and the Chicago Tribune's Howard Reich wrote that she sometimes sounded as if she had grown up on Chicago's South Side. She said she could express more emotion at the organ than at the piano and wanted to play like a big band by herself.

The material is the soul-jazz organ trio repertoire pushed into other corners: standards ("The Lady Is a Tramp," "You Don't Know What Love Is"), soul and pop ("When a Man Loves a Woman," "Killing Me Softly," "How Deep Is Your Love"), blues, Wes Montgomery's "S.O.S.," Slide Hampton's "Frame for the Blues" and Lonnie Smith's "Back Track." Her own compositions include "Peachie," "Pretty Please," "Funky Girl," "Tiger" and "So Cute, So Bad." Japanese material comes up as well: "Sukiyaki" and the title track "Sakura" on Sakura, and the folk song "Tanbata" on So Cute, So Bad. Her bands were small and steady, typically organ, guitar and drums, with tenor saxophone and trumpet added on the quintet records.