Anti-erythrocyte irregular antibody screening and blood utilization during surgery

Between April 1984 and March 1989, anti-erythrocyte irregular antibodies (Abs) were detected in 329 (4.0%) of 8, 208 patients by a screening test using saline, bromelin and Coombs' methods. Most of them were anti-P(1), Lewis, M, Rh-D, -E, and -c Abs. Of the detected Abs, 174 were reactive at 37°C, with 79 Abs (45.4%), 131 Abs (75.3%) and 150 Abs (86.2%) being detected by the saline, bromelin and Coombs' methods, respectively. Our Ab screening test was found to be 99.99 per cent effective in preventing the transfusion of incompatible blood. We also examined blood utilization during surgery for 28 different types of elective operation in 1976 patients. By analysis of the results of this examination, it was possible to decide on preoperative crossmatch guidelines, i.e. a maximum surgical blood order schedule, for 9 operations in abdominal surgery, 2 in lung surgery, 5 in cardiac surgery, 2 in neurosurgery, 2 in orthopedic surgery and 1 in gynecologic surgery. Arrangements for blood transfusion were unnecessary for cholecystectomy and 6 other operations, but the introduction of “type and screen” appears to be the best way to avoid an urgent order from the surgeon and for improvement in blood availability.