676a - 677: Prevention of Complications in Blood Transfusion Free

Our vast experience of 50,000 transfusions performed in two Buenos Aires Hospitals (The Italian Hospital and the Institute of Oncology) enables us to draw the following conclusions:The best treatment of transfusion reactions and their prevention is only obtained by good organization of the transfusion service. Classification of the donor's and receiver's blood according to the ABO and RH system must always be performed both with test serum and test blood cells. All Rh-negative bloods must be examined for Du and for probable immune antibodies.Complete crossmatching must be done before each transfusion, not forgetting to reclassify the contents of the bottle. The most frequent cause of hemolytic reactions at present is errors in annotation, and for this reason we prefer to use bracelets of plastic material containing the patient's name and surname, room and bed number, and Rh group.Prevention of pyrogen reactions depends on thorough washing and sterilization of the material to be used. As in our country, for economic reasons, we resterilize nearly all the material, including the plastic transfusion fittings, we have designed a special device to introduce them into the autoclave so as to avoid breakages, etc.In case of reaction, a panel investigation is performed, using known antigens, and in this way we found over 210 incompatible crossmatchings, anti-K-sensitive, anti-Fya, anti-S besides anti-Rh sensitization. Excluding incompatibility due to erythrocyte antigen-antibody, the leukocyte antibodies are then tested, and if a positive result is obtained, leukocyte-free washed red cells are transfused. We always perform isogroup transfusions and we also prefer to use isogroup plasma and, for Rh-negative patients, we take special care in investigating hot antibodies which might simulate Rh antigen. Working on these lines we have been able to decrease the percentage of pyrogen reactions from 7.70% in 1951 to 1.31 % in 1957. (We believe that many reactions thought to be caused by pyrogens, in 1951, were not really so.) At the same time, we have always tried to increase the number of our panel donors who, in certain cases, may act as special donors. In 370 determinations we found the following frequencies:Kell positive: 11 % ; Celiano positive: 96 % ; Duffya, positive: 68 % ; M positive: 25 %; N positive: 25 %; MN positive: 50 %; S positive: 45 %.