The Cause of the Reactions Following Transfusion of Citrated Blood

In analyzing the reactions following blood transfusion by any of the different methods now in vogue, all figures should be based on cases in which donor and recipient have been properly matched prior to the operation.By means of the methods for grouping and direct matching given us by Moss1 and others it is possible to exclude a cer- tain number of gross hemolytic reactions which used to be inevitable.It is also a very simple matter to list a number of Group 4 donors, and with this done no emergency transfusion need ever become a completely reckless venture.In our experience it would appear pos- sible to use carefully classified Group 4 donors for all cases, relying on the fact that the high dilution to which the incompatible plasma is brought nullifies its toxic effect.While this statement is in agreement with the views of Lee,2 it is interesting to find it contradicted in the recent report of the Interallied Surgical Conference,3 where it is stated that, "fatal accidents have occurred from agglutination of the blood corpuscles by the donor's plasma, but the danger of this is relatively small and it may be disregarded at an advanced post."In spite of the apparent reliability of our best methods for match¬ ing donor and recipient, evidence steadily accumulates to the effect that these in vitro reactions are occasionally wrong.Thus Percy,4 using a slightly modified Kimpton-Brown5 tube, reports two trans¬ fusions with extensive hemolysis in a total of fifty-four cases, in which careful testing had shown no in vitro hemolysis.Neither of