This research focused on the design of a decision-support system to assist blood bankers in identifying alloantibodies in patients' blood. It was hypothesized that critiquing, a technique in which a computer monitors human performance for errors, would be an effective role for such a decision-support system if the error monitoring was unobtrusive and if the critiquing was in response to both intermediate and final conclusions made by the user. A prototype critiquing system monitored medical technologists for (a) errors of commission and errors of omission, b) failure to follow a complete protocol, (c) answers inconsistent with the data collected, and (d) answers inconsistent with prior probability information. Participants using the critiquing system had significantly better performance (completely eliminating misdiagnosis rates for 3 out of 4 test cases) than a comparable control group. Detailed analysis of the behavioral protocols provided insights into how specific design features influenced performance. Practical applications of this research include its use (after refinements) as a tool for routine antibody identification in blood banks.

Two patients who had hemolysis after receiving large doses of intravenous immune serum globulin are reported. Both patients had positive direct antiglobulin tests due to alloantibodies contained in the immune serum globulin. Markedly increased red cell transfusion requirements and elevated serum bilirubin levels provided evidence of hemolysis.

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Low-ionic-strength solution (LISS) reagents and methodologies have become popular in recent years in hospital transfusion service laboratories for alloantibody detection and compatibility testing of blood recipients. It has been the experience with all other hemagglutination technics that some examples of alloantibodies unpredictably fail to react. Such is the case with this patient's alloantibody with respect to LISS. The patient had a significant hemolytic transfusion reaction due to Kell incompatibility of one unit of packed human erythrocytes. Using various LISS reagents and methodologies, the anti-Kell was undetectable in pretransfusion and posttransfusion samples through the fifth day. The anti-Kell was of immunoglobulin class IgG, and it was detected in saline solution or albumin at room temperature, at 37 C and by the antiglobulin technic.