Coombs test)I0 as methods to demonstrate nonagglutinating, "incomplete" antibodies. Proteolytic enzymes were added to the blood banks armamentanum in 1947." In 1964, the use of low ionic strength media, which was reported to accelerate antibody uptake by red cells, was recommended.'* As knowledge of new blood group systems expanded, the search for even more sensitive and rapid test systems continued. By the early 1960s, the impression emerged that pretransfusion testing should be designed to detect any and all serologic incompatibilities. Pretransfusion testing included a determination of ABO groups, screening for antibodies in the sera of donors and recipients, and major and minor crossmatch procedures. Antibody screening and crossmatching were done in saline at room temperature to detect IgM agglutinins, and at 37°C followed by the indirect antiglobulin test to detect IgG nonagglutinating antibodies. Some laboratories also incorporated enzyme-treated red cells and/or low ionic strength media into their routine procedures.Within the past decade, the issue of cost containment has affected the entire field of health care. Clinical laboratories have been forced to face some important issues; how much testing is enough and how can tests be performed more efficiently? The concept has gradually evolved that the minimum amount of compatibility testing which will ensure patient safety should be performed. As a result, redundant procedures have been eliminated whenever possible; e.g., minor crossmatches have generally been discontinued. Antibody screening and crossmatching procedures have been modified to detect only antibodies thought to be of clinical significance, most of which are antiglobulin reactive. Many laboratories no longer perform antibody screening or crossmatching procedures at room temperature, favoring instead incubation at 37"C, usually in low ionic strength media, followed by an antiglobulin test.Blood bank test protocols have been changed in response to the economy, but the basic technology has remained the same. The blood bank has always been committed to the traditional technique of hemagglutination. Continued reliance on hemagglutination has impeded progress and proven to be the major obstacle to the ultimate goal of automated pretransfusion testing.Other areas of the clinical laboratory have responded to the pressures of cost containment by replacing outmoded test procedures with newer, more efficient methodology. Sophisticated immunoassays, such as radioimmunoassays, immunofluorescence assays, enzymelabeled immunoassays, particle counting assays, chemiluminescence assays, and immune precipitation are now common procedures in serology, virology, microbiology, endocrinology, toxicology, and clinical chemistry laboratories. Ironically, the blood bank, among the first areas of clinical medicine to utilize immunologic techniques, is conspicuously absent from this list. For a number of reasons, these immunoassays have not been adapted to perform routine pretransfusion serology.The disadvantages of radio...