To establish the incidence and timing of red cell allo-immunisation following
transfusion, pretransfusion and serial post-transfusion samples were screened for
allo-antibodies in a total of 452 patients who had undergone elective surgery.
Antibody screening was performed by 2-stage papain, manual polybrene and
indirect antiglobulin techniques (1AT). Red cell allo-antibodies were found in 42
patients and 38 of these (8.4% overall) demonstrated antibodies only after transfusion;
76% of them had Rh specificity. This rate of red cell allo-immunisation is
higher than what would be expected if transfused patients were tested only once
post-transfusion, as has been the case in several previous studies. For the type of
patients studied, this finding may not be of clinical relevance at present because
most patients undergoing elective surgery do not require further transfusion in
their lifetime. However, this is changing with the longer life expectancy of the
population and the increased probability of repeat surgery. Twenty-two (58%) of
the antibodies were initially detected by the 2-stage papain and/or polybrene
techniques, when the IAT was negative, although later 19 became positive by
I AT; this added sensitivity of techniques other than the IAT, to detect early alloimmunisation
may be relevant in pretransfusion testing to prevent haemolytic
transfusion reactions in patients requiring repeated transfusions.