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Alloantibodies and Australia antigen after open heart surgery

The development of irregular serum antibodies (alloantibodies) following massive transfusion was studied in 144 patients who had undergone cardiac valve replacement. An overall incidence of alloimmunization of 8·3% was found. Of the 15 antibodies detected nine were Rhesus anti-E and four anti-Kell. The incidence of anti-E formation in Rhesus E-negative patients was 11·4%; the corresponding figure for anti-Kell was 3·2%. The results suggest that the risk of allo-immunization is directly related to the volume of blood transfused, and Rhesus E-negative persons appear to be at particular risk. Australia (Au) antigen investigations were also carried out in 102 of these cases. Three patients were Au antigen positive, one of them developing acute hepatitis. In each case no Au antigen could be detected in the donor blood that was used. It is suggested that tests for alloantibodies and for the Australia antigen should become part of the routine follow-up of any patient receiving massive transfusion.