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We performed a retrospective study of 167 women undergoing hysterectomy in a large tertiary-care teaching hospital in order to assess intraoperative blood requirements and to study the decision-making process that occurs when blood is transfused intraoperatively. Recommended preoperative blood orders for hysterectomy patients based on data from the study are provided. Although "type and screen" is commonly considered to be an adequate preoperative order for patients undergoing vaginal hysterectomy, our data indicate that 2 units may be a more appropriate order when the procedure is combined with pelvic floor repair. The preoperative hematocrit, the estimated intraoperative blood loss, and the duration of the hysterectomy were integral to the decision-making process. If women undergoing hysterectomy were transfused intraoperatively only when their hematocrit actually fell to 30 percent, and not in anticipation of such an event, unnecessary transfusions would be reduced.

The first example of anti-Lea, as an autoantibody, in the serum of a phenotypically Le(a-b+) individual is described. The patient is a 55 year old male with squamous cell carcinoma of the esophagus. His saliva contains Lea, Leb and H substances, and inhibits the hemagglutinating activity of his serum anti-Lea. The Leb antigen content of his red blood cells is approximately half that of control Le(a-b+) red blood cells. The patient's disease process may be responsible for the development of this unexpected autoantibody.