6 Blood Tests Before Transfusion [Sept. 



for a transfusion, the transfusion is followed by an intense hemo- 

 globinuria with severe toxic Symptoms and sometimes death. The 

 results of mixing by transfusion, two bloods, one of which aggluti- 

 nates the other, are not yet fully understood. Of the accidents 

 reported in the literature, a number were probably (but in the 

 absence of tests, not certainly) due to this cause. The authors 

 have Seen two transfusions of blood, which was agglutinable by the 

 patient's serum, followed by death in each case in a few hours. On 

 the other band, they have seen a case in which the donor's serum was 

 agglutinative to the patient's red cells, and in which nothing un- 

 toward happened. These discrepancies, Ottenberg has shown, are 

 probably due to the fact that the amount of iso-agglutinin in a given 

 volume of blood-serum is only sufficient to agglutinate a relatively 

 small volume of cells. When a comparatively small volume of ag- 

 glutinable blood-cells is transfused into a relatively large volume of 

 agglutinative plasma (and the amount actually transfused is always 

 small compared to the total blood volume of the patient), then 

 agglutination may occur. But when the reverse is done, and a 

 relatively small volume of agglutinative plasma is mixed with a com- 

 parative excess of red cells (and even in a very anemic patient the 

 Proportion is generally excessive), then the agglutinin is diluted and 

 distributes itself without producing noteworthy clumps of cells. 

 Furthermore, Ottenberg has shown that when agglutinable cells are 

 transfused, there is active phagocytosis of red cells within the 

 circulating blood of the patient. This renders it probable that even 

 when no serious accidents occur, the body does not long retain such 

 transfused blood. 



These facts render it necessary to make agglutination and 

 hemolysis tests before all transfusions, and to reject donors whose 

 blood, when mixed with that of the patient, produces either aggluti- 

 nation or hemolysis. During the past two years, we have per- 

 formed hundreds of such tests for over fifty human transfusions. 

 A report on this work with details of the technic will be published 

 at an early date. 



