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For the past three years, we have routinely used the one‐hour in vivo survival of 51Cr‐labeled donor red blood cells to select units for transfusion to patients for whom crossmatch compatible blood was unavailable. This technique successfully evaluated in vivo compatibility, thus avoiding acute hemolytic transfusion reactions in 38 problem patients. New or confirmatory data regarding the hemolytic potential of several well defined antibodies was also obtained. Antibodies which proved to be clinically insignificant included: anti‐IT (all IgG), anti‐Sda, anti‐Kir, Mil, Oca, anti‐Chido, anti‐Bg, 14 of 15 “nonspecific warm autoantibodies” (three of which were associated with the ingestion of alphamethyldopa), and four of five antibodies to high‐incidence antigens. Clinically significant antibodies included: anti‐Yta, anti‐Jkb, the antibody in PCH (with “P” specificity), one intensely hemolytic “nonspecific warm autoagglutinin,” and one of five incompletely characterized antibodies to high‐incidence antigens. An acceptable in vivo compatibility test in every instance was associated with an appropriate rise in hematocrit and no clinical symptoms of hemolytic transfusion reaction.

In patients with severe allergic reactions to plasma proteins it is possible to observe such reactions to even the small quantity of plasma contained in platelet concentrates. A platelet washing solution was designed, and platelet concentrates for four such patients were washed before infusion. Transfusion reactions were completely eliminated by the washing procedure. Platelet recovery was equivalent to that of unwashed platelets, and hemostatic effectiveness of the infused platelet concentrates was evidenced by abrupt cessation of bleeding episodes, including purpura and hematuria. Platelet washing represents a valuable, rapid and simple approach to the problem patient with thrombocytopenia and severe reactions to plasma proteins.