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The second example of anti-Lub was found in a Milwaukee woman who had a mild atypical hemolytic transfusion reaction. The family study revealed an amazing pedigree. The parents of the propositus represent a mating with an expected frequency of 0.0002. The properties of this anti-Lub and five examples of anti-Lua will be discussed. The results of a large population survey utilising these anti-sera will be presented. Eight examples of the rare genotype LuaLua have been found. Representative family studies will be included in the discussion.

Sera and questionnaires were evaluated retrospectively from 128 volunteer blood donors whose blood had been implicated in cases of clinically recognized post-transfusion hepatitis in recipients of one- or two-unit blood transfusion between 1971 and 1977. Serologic markers of hepatitis B virus (HBV) infection were found in 23 percent, compared to 9.7 percent of 3,230 prospective blood donors. The prevalence of antibody to hepatitis A virus was similar among implicated donors (44%), prospective donors (58%), and among those implicated donors with (41%) and without (44%) HBV markers. Among implicated donors, none had a history at the time of donation of having had clinically recognizable hepatitis, 93 percent had no history of prior blood transfusion, and 80 percent had normal hepatic enzymes. Data from this study confirm that non-A, non-B hepatitis has been a common form of posttransfusion hepatitis in recent years, since 77 percent of these implicated donors had no HBV serologic markers. In addition, these donors could not be distinguished by age, race, sex, history of clinical hepatitis or of prior blood transfusion, or in most cases by hepatic enzyme levels.

Sixteen patients who received Konyne for bleeding episodes or for hemostasis during surgical procedures were evaluated for signs of posttransfusion hepatitis. Four patients died from their primary disease. Of the remaining 12 patients at risk, six patients developed posttransfusion hepatitis. Sera from four of the six patients with hepatitis were positive for the hepatitis B antigen (HBAg). Aliquots of Konyne from the specific lot (K4797) implicated in three cases of HBAg-positive hepatitis were negative for HBAg by immunodiffusion, immunoelectroosmophoresis, and radioimmunoassay. The high incidence of hepatitis associated with Konyne considerably limits the use for this specialized coagulation factor concentrate. HBAg screening by available technics does not necessarily detect Konyne preparations capable of transmitting HBAg-positive hepatitis.

Resume Anti-Jka etait la cause d'une forme legere de la maladie hemolytique du nouveau-ne. Zusammenfassung Anti-Jka-Antikorper haben eine leichte Form des Morbus haemolyticus neonatorum hervorgerufen.

Summary The eighth child of a woman who had received five pints of blood in the past was born with mild erythroblastosis foetalis due to anti-Duffy(anti-Fya). The specificity of the antibodies on the infant's erythrocytes was established by elution. The maternal antibody was shown to be a gamma globulin by neutralization studies. Seven additional cases of erythroblastosis due to anti-Fya were culled from the files of other laboratories making a total of eleven known to the authors. It is suggested that anti-Fya is a more frequent cause of haemolytic disease of the newborn than was suspected. Reume: Le huitieme enfant d'une femme qui avait regu, de par le passe, 5 ampoules de sang, presenta a la naissance une maladie hemolytique peu grave due a un anticorps anti-Fya. Ce dernier put etre elue des hematies de l'enfant, et l'etude du serum maternel montra, par des tests de neutralisation, qu'il s'agissait d'une gamma globuline. Sept autres cas d'erythroblastose due a l'anti-Fya ont ete recueillis dans les listes d'autres laboratoires, ce qui fait un total de onze cas connus des auteurs. Ceux-ci sont par consequent d'opinion que l'anti-Fya est une cause plus frequente de maladie hemolytique du nouveau-ne qu'on ne le pensait jusqu'a maintenant. Zusammenfassung Das achte Kind einer Frau, welche fruher 5 Vollblutkonserven erhalten hatte, wurde mit einem Anti-Fya-bedingten leichten Morbus haemolyticus neonatorum geboren. Mit den kindlichen Erythrozyten wurde ein Elutionsversuch durchgefuhrt, wobei die Spezifitatsbestimmungder Antikorper bestatigt werden konnte. Die mutterlichen Antikorper zeigten die Antigenstruktur von γ-Globulinen. Auser dem erwahnten Fall wurden aus dem Untersuchungsgut anderer Laboratorien 7 weitere Falle ermittelt. Die Autoren kennen heute 11 Falle von Anti-Fya-bedingtem Morbus haemolyticus neonatorum. Es ist deswegen naheliegend, anzunehmen, das Anti-Fya-bedingte Morbus haemolyticus-Falle haufiger vorkommen, als bisher vermutet wurde.

Familiarity with the phenomenon of red cell polyagglutinability, while of prime importance to laboratory personnel, can be useful to the clinician as well. The presence of T-polyagglutinability, for instance, may be a clue to infection. Thrombocytopenia, leukopenia, or even hemolytic anemia can be associated with Tn-polyagglutinability. The Cad type of polyagglutinability is inherited.

Platelet concentrates prepared from freshly drawn blood were infused into patients with thrombocytopenic complicating disease. All exhibited a prolonged bleeding time, no clot retraction of a whole blood clot, platelet counts between 20,000 to 100,000 per cu. mm., usually, abnormal platelet ultrastructure and prothrombin consumption times under 15 seconds. Detection of platelet antibodies was attempted and the ultrastructure with a differential platelet count under the electron microscope of the patient's own platelets was documented. The platelet concentrates were given and it was possible to follow the fate of the donor's platelets by ultrastructural changes. Parallel studies of the coagulation mechanisms of the patients were followed serially. We found that some platelets survived up to seven days, although in some patients, platelets circulated but did not survive. Therefore immediate circulation of platelets cannot be equated with survival. In one patient with hypersplenism and a positive platelet agglutinin test no transfused platelets appeared to circulate. The ultrastructure of transfused platelets is greatly altered in bleeding patients. In the two patients with aplastic anemia and one with leukemia surviving platelets circulated which did not enter into the mechanisms of prothrombin activation, but which continued to circulate for some days with no improvement in the prothrombin consumption time over the pretransfusion level. Ultra-structural studies of these platelets showed that the circulating platelets possessed their granules which contain platelet factor 3 activity. The differential platelet count under the electron miscroscope becomes abnormal as the donor platelets are stored. Our work suggests that the ultrastructure and differential platelet count of a platelet concentrate must be essentially normal for survival to be achieved. We confirmed the work of others indicating that donor platelets do not survive if stored or, if the recipient has detectable platelet antibodies. Donor platelets did not survive in some patients for reasons we could not explain. This may be dependent on utilization of platelets in hemostatic plugs, in thrombin production or for the endothelial supporting function but to date we cannot estimate to what extent or in what fashion a thrombocytopenic patient utilizes donor platelets.

Blood collected by 11 Red Cross Regional Blood Centers were screened by the method of agar gel diffusion (AGD) for the presence of hepatitis-B antibody. Of the 185,134 units tested, 114 were found to be positive for HBAb by the Regional Centers and were forwarded to National Special Projects Laboratory for confirmation. Only five out of 114 samples revealed lines of identity with a control anti-HBAg when reacted with a pool of plasma positive for hepatitis-B antigen that was different from that which was provided to the Centers. Apparently, the precipitation reactions observed by the Centers were largely due to the antithrombin antibodies in the donors' sera reacting with the residual thrombin used by the manufacturer to convert HBAg positive plasma to serum. We conclude that the incidence of hepatitis-B antibody as measured by agar gel diffusion in the Red Cross Blood donor population was extremely low.

The results of hepatitis B surface antigen (HBs-Ag) testing in a large volunteer blood donor population are described. Counterelectrophoresis and three versions of solid-phase radioimmunoassay technic are compared and evaluated. Initial results suggested that the radioimmunoassay technic are compared and evaluated. Initial results suggested that the radioimmunoassay technic detected more than five times as many reactive donors as did counterelectrophoresis. The specificity of the radioimmunoassay technic has been increased by successive modifications, and recent results show that the technic detects 73 percent more reactive donors than does counterelectrophoresis. Not all of these reactions are specific, and it is estimated that the true gain in detection of HBsAg carriers is 49 percent of the value found by counterelectroesis. The incidence of HBsAg carriers in the America Red Cross donor population is about 1.25 per 1,000.

THE serum of Mrs. Y. M., a 34-year-old Memphis negress, was found to be incompatible with all donors cross-matched when she was admitted with vaginal haemorrhage and hypofibrinogenaemia complicating the missed abortion of her eleventh pregnancy. After having five normal live births, her sixth pregnancy resulted in a macerated stillborn at eight months; the last five were missed abortions at four or five months, and hypofibrinogenaemia occurred with four of these. In the management of these pregnancies she was given 16 pints of blood between 1955 and 1957. No evidence of any transfusion reactions could be found in her hospital records.

Summary A simple method for sterilizing andstoring polyethylene catheters has been presented.

Those of us who have had our 25th class reunions will recall that there was a time when a blood transfusion was a formidable procedure to be avoided whenever possible. The technical developments in blood-banking procedures during the last two decades have made blood transfusion appear superficially as simple as ordering an infusion of glucose. Many fail to recognize that it is rather remarkable that blood, the fluid portion of the hematopoietic organ, can be taken from one person and given to another with beneficial effects. With most other tissues, elaborate preparations are necessary before transplantation is attempted, unless donor and recipient are identical twins. It is therefore not surprising that blood transfusions may be complicated by deleterious reactions and should be undertaken only after judicious weighing of expected benefits against potential dangers. The literature describing new developments in transfusion practice has become prohibitively voluminous. In order to help the