Joseph R. Bove

Patterns of Blood Use in Connecticut

Blood use patterns were studied in a setting essentially free of the constraints of shortage, high‐cost, nonreplace‐ment penalties, and high hepatitis risk. Connecticuts hospitals used an average of 0.299 unit of blood per patient discharge in 1978. Interhospital variation was great, with large hospitals using more blood per discharge. The percentages of blood ordered by individual hospitals as red blood cells ranged from 38.9 to 96.2 per cent. Frozen red blood cells were ordered in greater proportion by large hospitals. Relative plasma use was greater in large hospitals, ranging from 0.003 to 0.232 unit per unit of blood. Hospital outdating ranged from 0.1 to 21.3 per cent, with large hospitals outdating proportionately less. Such striking variations suggest that habits and personal preferences may determine the pattern of a hospitals blood use, and, therefore, the costs of blood provision. Statewide from 1971 to 1978, red blood cell ordering increased from 13.8 to 63 per cent of total blood order. Plasma use has increased from 0.025 to 0.130 unit per unit of blood. Blood use per patient discharge has also increased, but more slowly.

A FATAL HEMOLYTIC TRANSFUSION REACTION WITH ACUTE AUTOHEMOLYSIS.

A fatal hemolytic transfusion reaction due to anti‐Kidd (Jka) is described in a woman with aplastic anemia associated with acute leukemia. Radioactive chromium studies, which were in progress at the time, made it possible to demonstrate that a severe autohemolytic crisis was a part of the reaction. The relationship between a hemolytic transfusion reaction and the initiation or intensification of autohemolysis is discussed. The difficulties of serologic diagnosis and selection of blood for transfusion in patients with nonspecific antibodies are reviewed. This case again illustrates that nonspecific agglutinins can mask the presence of specific anti‐red cell antibodies.

Testing in the years ahead: new pressures and new concerns.

In the past, testing by blood banks was intended primarily to ensure product quality or donor safety or to meet existing regulations. As a result of recent pressures, especially the AIDS epidemic, additional reasons to test have become evident. Although some of these reasons are not easy to accept, it is appropriate to review them and to evaluate a new approach to reaching blood bank decisions that have public policy implications. It is suggested that The Institute of Medicine of the National Academy of Sciences sponsor a new and permanent structure for this purpose.

THE ANTIGLOBULIN REACTION ON ALBUMIN ENRICHED CELL SUSPENSIONS.

The strength of the antiglobulin reaction with cells incubated in saline was compared with a similar reaction when albumin was added before or after incubation. In one case studied a weak rh“(E) antibody was not detected by the antiglobulin test with saline suspended cells and a transfusion reaction occurred. The incompatibility could be found by the antiglobulin test if the incubation mixture included added albumin. In another case an unidentified antibody had consistently weaker antiglobulin reactions after incubation in albumin compared to saline. An investigation of the antiglobulin activity of 40 antibodies showed antiglobulin agglutination scores that were significantly greater after incubation in the presence of albumin rather than saline. These data suggest that the sensitivity of the antiglobulin test is usually increased when antibodies and erythrocytes are incubated with added albumin.

Collection of Granulocytes for Transfusion

Abstract. When granulocytes are collected by either discontinuous‐flow centrifugation or filtration leukapheresis, lysozyme is released. More lysozyme is released during the filtration procedure than during the centrifugation procedure. A small amount of red cell lysis occurs during the centrifugation but not the filtration procedure. A rise in lactate dehydrogenase levels consonant with the amount of hemolysis is observed. These findings suggest that granulocytes collected by either filtration or discontinuous‐flow centrifugation undergo degranulation but not lysis sufficient to cause cytoplasmic enzyme release during the donation.