Revue Fran~aise de Transfusion et d'Immuno-h6matologie Tome XXI. - - N o 2. - - 1978 575

Computers and automated technical procedures in

Blood Transfusion laboratories by G.W.G. BIRD

Regional Blood Transfusion Service, BIRMINGHAM (England).

1. Historical.

Automa ted b lood grouping was f i rs t desc r ibed by MCNEIL et

at [11]. Anyone in t e res t ed in the ear ly h i s to ry of a u t om a t i on and

l abo ra to ry au toma t ion would do well to read a pape r by STUR-

GEON [22] p re sen ted at a sympos ium on Au tomat ion in Haemato logy

held dur ing the X l t h Congress of the In t e rna t i ona l Society of

Haemato logy at Sydney in 1966.

2. Automated serological procedures.

Because of the enormous work load of a m o d e r n Blood Trans-

fusion Service, au toma t ion of bo th technical and the re levant admi-

n is t ra t ive p rocedures is essential .

In Bri ta in , a t the p re sen t t ime, a u t o m a t e d b lood group serology

is en t i re ly ca r r i ed out wi th Technicon machines , f i r s t i n t roduced

into Br i t a in by the Blood Transfus ion Centre at Br is to l and exten-

sively s tud ied at the Trans fus ion Centres at Br is to l and Brent-

wood [10, 12]. These machines have served, and are stil l serving,

a very useful purpose . There are, however , a reas in which the i r

pe r fo rmance is not qui te as good as many of us would desire.

576 S Y M P O S I U M SUR LES SYSTEMES G R O U P A M A T I C

For example, in the b lood grouping machine , the f i l ter p a p e r ~.read out 7, is by no means ideal, par t icu lar ly for weak ant igens such as the weake r f o r m s of A and B, ~.nd it is not poss ible a lways to keep the mach ine in phase, so tha t sample ident i f icat ion m a y p resen t a p rob lem. However , an a u t o m a t e d electronic read-out device for the Technicon 8-channel b lood grouping mach ine has been tes ted by RECHSTEINER and BENJAMIN [19]. Although the phas ing p rob l em was not comple te ly solved, the sys tem was s ta ted to give be t t e r resul ts than those ob ta ined by visual inspect ion of the f i l ter paper . I unde r s t and tha t a s imi lar device for the Technicon 15-channel b lood grouping mach ine is soon to undergo a trial.

In B i rmingham, the Auto Analyzer an t ibody screening machine has been modi f ied [13] to enable it to be used s imul taneous ly wi th the 15-channel b lood grouping mach ine at a sampl ing ra te of 120 specimens pe r hour. This co lor imet r ic sys tem is m o r e eff icient than the fi l ter p a p e r an t ibody screening method . Sample identi- f icat ion is made by posi t ioning a red m a r k e r solution every 20 specimens on the sample tray. The solution causes an increase in optical densi ty due bo th to the p resence of t h e red dye and the ear ly haemolys is of the cells. The increase in optical densi ty causes the r eco rde r to t race a peak in one direction, the p resence of anti- body causes a decrease in optical densi ty so tha t the recorder t races a peak in the o ther direction.

Because the s ample r opera tes at a fixed ra te and the recorder char t moves at a cons tan t speed, the dis tance be tween the wash m a r k e r s on the char t will a lways be constant . The dis tance is, in fact 72 m m . The pos i t ion of a sample containing an an t ibody can be easily calculated. I f the dis tance f r o m the s ta r t of the wash peak to the s ta r t on the an t ibody peak is Ymm, the spec imen n u m b e r

20 can be found by use of the fo rm u la ~ × Y.

72 20 This m e t h o d produces ambiguous r e s u l t s only when ~ X Y

72 gives a f igure N. 5 ins tead of a whole n u m b e r N. I t is ' then imposs ib le to de te rmine jus t which spec imen contains the ant ibody. I n such instances, the spec imens are tes ted again in a di f ferent order .

For some t ime, the Marsh (BMC) sys tem [12], known in Birmin- g h a m as SPASM, was used in one b lood grouping machine , and the

S:YSTEME A U T O M A T 1 S E DE GESTION 577

Lalezari or LISP sys tem [8] in the other . Both me thods are essential because SPASM is able to detect some ant ibodies be t t e r than LISP and v i ce v e r s a [5, 17, 19]. A fu r the r modif ica t ion has been in t roduced which enables bo th me thods to be used simulta- neously wi th a single b lood grouping machine.

I m u s t emphas i se that whereas this me thod is sui table for ant ibody screening of donor bloods, or in a search for b lood donors wi th ra re groups, it is not as sensit ive as es tabl ished Auto- Analyzer techniques for an t ibody screening of pat ients , or for the identif icat ion of ant ibodies or es t imat ion of thei r s t rength.

The Technicon b lood grouping mach ine is prone, as indeed are all machines , to develop var ious faults. In Bi rmingham, we have therefore devised [3] a visual display electrical uni t wi th an electr ical a la rm system, which enables us convenient ly to mon i to r the ope- rat ion of the machine. The visual display sys tem consists of several light bulbs, for example, one which indicates tha t the sampl ing t ray has f inished its cycle. Alarms are also sounded when a faul t develops, for example, when the t ray moves fo rward several spaces ins tead of one. This system, known as RETCH, is to be extended to cover all possible types of electronic or mechanica l faults.

3. Antibody assay.

The Technicon single-channel Auto Analyzer has been used for

anti-D assay by ROSENHELD et al [21] and the rea f t e r by several o ther

workers . This is pe rhaps its m o s t useful applicat ion, since the

ant ibody can be c o m p a r e d wi th In te rna t iona l S tanda rd anti-D under

virtually identical condit ions. The results , expressed as In te rna t iona l

Units, are margina l ly m o r e useful than manua l t i t ra t ion values in

assessing the prognosis in Rhesus haemoly t ic disease [15].

In Bi rmingham, MORLEY [15] applies log-probit analysis to anti-

body quant i ta t ion. The p lo t of percen tage agglut inat ion against ant ibody concent ra t ion is s igmoid ; it is conver ted to a s t ra ight line

by plot t ing the p rob i t % agglut inat ion against the log of an t ibody concentrat ion. MORLEY uses two s tandards , one in the beginning and

one at the end, to compensa te for base-line d r i f t ; he finds tha t use of a single sample of R1R 2 gives m o r e reliable resul ts than pooled

cells, e.g. a mix tu re of R1R 1 and R2r cells. This me thod has been

578 SYMPOSIUM SUR LES SYSTEMES GROUPAMAT1C

found to give be t t e r corre la t ion wi th clinical severi ty of Rhesus

haemolyt ic disease than manua l or o ther a u t o m a t e d procedures .

Details of this s tudy have been p resen ted e lsewhere [16].

4. Automated screening for immune anti-A and anti-B.

A sys tem has been developed at B i r m i n g h a m [14] for the auto- m a t e d detect ion of i m m u n e anti-A and anti-B. Mercap toe thanol

and urea are used to inhibi t IgM and IgA antibodies, leaving IgG ant ibodies intact . This m e t hod is based on the pr inciple tha t high- t i tre i m m u n e IgM anti-A and anti-B ant ibodies are invar iably or a lmos t invar iably accompan ied by IgG antibodies. One of the channels of the 15-channel b lood grouping mach ine is used and a posi t ive resul t is indicated by agglut inat ion on fi l ter paper . There is good corre la t ion wi th o ther methods . This pr inciple has been appl ied by others for the manua l [4, 6, 20] demons t r a t ion of i m m u n e anti-A and anti-B. However , a really reliable me thod for the detec- t ion of i m m u n e anti-A and anti-B has not yet been developed [2].

5. Data processing.

Transfus ion services acquire a vast a m o u n t of admin is t ra t ive

and scientific da ta which can usefully be p rocessed for rout ine and

research purposes . Those who intend to process data would do

well to read STURGEON'S warn ing [22] tha t the data-process ing poten-

tial of au toma t ion may lead to one 's bur ia l in an avalanche of data,

m o r e than can be digested by the scientist wi th pencil, pape r and

calculator . The help of a consul tan t in advanced stat is t ics and

compu te r technology is essential if one is to be ext r ica ted f r o m the

avalanche.

There are four di f ferent aspects of data process ing at the

B i r m i n g h a m Centre :

1. The Blood Donor Service.

2. Control of I ssue and Dis t r ibut ion of Blood Components .

3. Antenata l Serology.

4. Tissue Typing.

SYSTEME AUTOMAT1SE DE GESTION 579

6. The b l o o d d o n o r s y s t e m .

It is genera l ly agreed that of all the ac t iv i t i e s of a B l o o d Trans- fus ion Centre , b l o o d d o n o r a d m i n i s t r a t i o n is the m o s t su i tab le for c o m p u t e r i s a t i o n . Use fu l s c h e m e s are in o p e r a t i o n in var ious parts of the wor ld .

W E S T M I D L A N D S R E G I O N A L B L O O D T R A N S F U S I O N S E R V I C E - - SESSION SL P

PANEL & S E S S I O N 8 ~

. . . . . . . . . . . . 1+~+7~++7:J+::;::+:,:::~::+::++ + + " : ~ + t

DATE OF LAST DONATION HAEMOGLOBIN ( C o t ~ ~Jlphlm) 2O DONATIONS TO OA33E

TYPE OF BLEED

. . . . . . . . . . . . . . . ii!.i::i iiiii ::iil iiiiiii E. VOL. BLOOD DONATED 2 2 ~ ~dZ=O~, r Sot= S,= S,r~Nur,~ G , o ~ R ~ D . A . NO+ I o & + s ~

R E M A R K S : - -

HAEMOGLOBIN (Laboratory) 2 ~

::1~: ~: :II: :1~1 ::~:: ::~::

DONOR TO BE RETIRED (Enter t ype o f mt i~ment } 34

Signature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HfSTORY

Ii::i?ii::li i t i: il:ii;ii+ii::i;iti:iiiilili:::ililiiiii;Iii;ii ;~ili i lii~ ilililiii: ::i l: i::ii [ ii;;ili:;il]:iiii::ifiii :iit:::ili iIiiiiit iiiillii ;iil;; i iiif iii i l i ilil!iiii ::i: :il i l i: :it i]i i l : i f : I: :; :ilnt: t ~ I 71 PREVIOUS DONATIONS 159

SERIAL DATE OF HEI RHESUS TITRES OTHER OTHER VOL. NUMBER DONATION ANTIBODY ANTIBODY ANTIBODY

,~ ,o ,~ ,_+ , . ,o° . , . . .~ .v v ,M . s _, ~ ° K ~_ ~. .,,

~o s 20 2S 30 3S

40 45 so ss 6o ' S5

A~o ~ B S~p D C D ~ DB

S E R I A L No COL. SS 7~

so BS 90

FIG. 1. - - Blood donor session slip.

580 S Y M P O S I U M SUR LES SYSTEMES GROUPAMAT1C

The Birmingham system was in t roduced at the same time as

automat ion of blood donor serology as an integrated scheme. All

donors are on the computer . Calling letters are prepared by the

compute r which also prepares a session slip for each donor (Fro. 1).

Medical notes and other relevant observations are made on the slip

at the session.

The session slip itself is used also to record the results of

laboratory tests. A complete and comprehensive administrat ive

labora tory record of every donor is held on file and regularly updated.

The compute r also prepares lists of suspended donors, donors due for awards or ret irement, and provides statistical informat ion for

administrat ive reports. Procedural details are given in a repor t

to the Council of Europe Working Par ty on Automat ion in Blood

Transfusion Laboratories [7]. The Birmingham scheme has been adopted by some other Centres.

7. Control of i s sue and distr ibut ion of b lood component s .

This is a logical extension of the blood donor system. I t is

necessary here to remind readers that I am not speaking about a hospital blood bank bu t about a Service which supplies 54 hospital blood banks. The recent ~< explosion ,, in blood component therapy

has created certain problems, for example, the difficulty in tracing components of a par t icular donat ion which may have been issued to different hospitals at different times. The rapid location of compo-

nents is essential when an adverse react ion is repor ted for one component when other components f rom the same donat ion may still be in storage at the Centre or in a regional hospital, or when the Centre is notified a few days af ter a donat ion that the donor has developed infectious hepatitis or o ther infectious disease.

For each donat ion received at the Centre, the Blood Donor Panel

system produces a record showing basic donat ion information, e.g.

donor ' s reference number , ABO group and Rhesus factor, and the

components produced f rom that donation. This record is held on

the compute r file and is updated by documents produced at the

point of issue. Each unit which is issued to a hospital blood bank

is accompanied by a usage record, which is completed by the hospital

blood bank staff. This record is re turned to the Transfusion Centre

S Y S T E M E A U T O M A T 1 S E DE GESTION 581

for upda t ing on the c o m p u t e r file. To ensure tha t all uni ts which are p rocessed by the Trans fus ion Centre a re sat isfactor i ly accounted for, the sys tem repor t s on any unit, the disposal of which has not been notif ied wi th in a given per iod of t ime. I t also p roduces var ious stat ist ical r epor t s on the use of b lood wi th in the Region as a whole, and also allows the detai led examina t ion of the usage pa t t e rns of the var ious hospi ta l b lood banks. Some benef i ts of the sys tem are expected to be a reduct ion in was tage of blood and its componen t s and potent ia l ly useful analysis of b lood componen t therapy.

8. Antenatal serology.

In Bi rmingham, an tena ta l serological tests for the whole region are done by the Transfus ion Centre. About 400 spec imens are inves- t igated every day. A subs tant ia l file of da ta has accumula ted over the years. Since the physical task of manua l ly searching and extract ing f r o m this m a m m o t h file became s t re tched to full capacity, a compu t e r scheme for the antenata l serology service has been devised and is now in opera t ion [1]. I t is proceeding successfully.

As in the blood donor system, the an tena ta l sys tem is co-ordinated with l abora to ry au tomat ion .

A p r i m a r y reques t f o r m has been developed which is s imilar to the blood donor session slip. I t is a mu l t i pu rpose f o r m for mother , f a ther and child. S t anda rd r epor t s are p roduced by the compute r and are sent out wi th a tear-off slip which should accompany the next specimen. Compl ica ted repor t s are, of course, made by special letter. An ins t ruc t ion bookle t is issued to all users . I n fo rma t ion on all pa t ien ts wi th clinically significant ant ibodies is held on a special c o m p u t e r file and is regular ly updated . The sys tem provides an efficient and reliable day to day service, and provides readily accessible da ta for research.

Thus a f o r m needs to be filled in only once - - for the f i rs t specimen f r o m a p regnan t woman.

9. HLA serology.

In Bi rmingham, the c o m p u t e r is used in bo th rout ine and research aspects of HLA serology. We owe this m o s t fascinat ing appl icat ion of the c o m p u t e r to Blood Transfus ion Service p rob l ems

582 S Y M P O S I U M SUR LES S Y S T E M E S G R O U P A M A T I C

to the genius and indus t ry of Professor John Edwards and Mrs. Pauline Mackintosh.

Because of the complexi ty of the HLA system, manua l analysis of sera which contain HLA ant ibodies is difficult and time- consuming. Compu te r techniques have there fore been developed to examine sera wi th reference to every HLA antigen on our cell panel. Wherever no specifici ty is recognised, the Chi-square value, deter- mined by the compute r , shows whe the r the react ion pa t t e rn is r a n d o m or not. When it is not r andom, it indicates tha t a new specifici ty m a y have been discovered. This is very i m p o r t a n t because the full extent of the HLA sys tem is not yet known.

The p r o g r a m m e includes a visual display of an an t ibody ' s perfor- mance, together wi th 2 X 2 tables and s imilar i ty and match ing figures. The visual display is very useful to serologists who are not s tat is t ical ly minded because it clearly shows an t ibody specificity, and rapidly reveals o ther areas of interest . The analysis is obtai- nable whenever required, i.e. as of ten as a react ion ma t r ix is ready, and provis ion is m a d e for the comple te ident if icat ion of every se rum under test, and the HLA type of every panel ~, cell, , , so that the pr int -outs can be examined wi thou t re ference to any o ther document .

I n f o r m a t i o n on the survival of renal t r ansp lan t s (by cour tesy of Mr. A.D. Barnes) i~ analysed by c o m p u t e r and is available on demand. By use of our HLA card, recipient in fo rmat ion is upda ted weekly to p rov ide a list which is d i s t r ibu ted to all local units. When a k idney has been t ransp lan ted , a dupl icate ca rd is m a d e out and donor in fo rmat ion punched on to it, together wi th the date of the t ransplant . New in format ion is cont inual ly added to the file so that , at any t ime, analysis can be made of all cases.

T ransp lan t survival at var ious intervals can be p lo t ted by com- puter . Compar i son of survival can also be made, for example, on a year to year basis, if it is desired to examine the possible effects of changes in clinical procedures . This type of cont inuously analy- sable da ta is par t icu lar ly appl icable to a rapidly developing field such as t ransplan ta t ion . I f it is to be of real value, survival data should be examined frequent ly . Manual analysis of ever-growing lists of t r ansp lan t s will becom e increasingly difficult and t ime-consuming ; a few minu tes spent each week on a punch card mach ine is all the t ime needed to keep in fo rmat ion bo th up to date and readily available.

S Y S T E M E A U T O M A T I S E DE GESTION 583

The com pu t e r is also appl ied in B i rmingham to research studies of l inkage and associat ion re levant to the HLA system. All these appl icat ions will be repor ted e lsewhere in g rea te r detail.

The cur ren t in teres t in HLA and disease associat ions has involved us in t issue typing several series of pa t ien ts and examining the antigen dis t r ibut ion relat ive to a control populat ion. A compu te r p rog ram has been wr i t t en by Professor J.H. Edwards which handles the raw figures and produces a g raph showing the relat ive r isk for each antigen, i.e. how m a n y t imes a person ei ther carrying a par t icular ant igen or lacking it is likely to have the disease. When the graph is examined, those ant igens plot t ing far above or below the median line are showing stat ist ically significant var ia t ions f rom normal .

10. Possibility of incorporating a Groupamatie machine into the Birmingham scheme.

There is no doubt that Groupama t i c blood grouping machines are ingenious in design, compac t and efficient, and their speed of operat ion is grea ter than tha t of o ther machines . Sample identi- f ication and the electronic - r e a d out ,, and , p r in t out ,, a re more reliable than those in any existing machine. Fur the rmore , it has a compute r facility, albei t of l imited scope.

I t would be no m a j o r p rob l em in the B i rmingham scheme to replace Technicon with Groupama t i c 360 blood grouping machines for blood donor serology and antenata l serology. Modificat ion of the existing sys tem for number ing specimens would be necessary. Fur thermore , s imul taneous an t ibody screening by the Marsh and Lalezari me thods would not be possible, bu t this could be done separa te ly wi thout m u c h loss of t ime because of the grea ter speed of the Groupama t i c machine.

Blood donor adminis t ra t ion , an tena ta l serological repor ts , s tock control, and the var ious HLA appl icat ions of the B i rmingham model may be outside the scope of the Groupamat i c computer , bu t these aspects could be dealt wi th in the existing way.

Perhaps it would not be beyond the ingenuity of m a n to cons t ruc t a single compos i te mach ine which can mee t all the requ i rements of an a u t o m a t e d and compute r i s ed t ransfus ion service.

584 S Y M P O S I U M SUR LES S Y S T E M E S G R O U P A M A T I C

11. Conclusion.

Automat ion in a Blood Trans fus ion Service is now a necessity. I t s m a n y advantages great ly outweigh its few disadvantages. I t cannot comple te ly replace m anua l techniques, and a ba lanced view m u s t be t aken in the appl ica t ion of its vas t potential . The compu te r m u s t adap t itself to the Service, not the Service to the compute r .

Many of our colleagues have an illogical fear of compute r s . I m u s t r emind t h e m tha t it is m a n who is in charge of machines , not machines of man . In the words of an edi torial in the Lancet [9], compu te r s are only as good as the m e n who organise them.

RESUME

Ordinateurs et procddures techniques automatisdes dans des laboratoires

de transfusion sanguine

La charge de t ravai l d 'un service de t rans fus ion m o d e r n e est au jourd 'hu i si i m p o r t a n t e que l ' au tomat i sa t ion de cer ta ines proc6- dures ~ caract~re admin i s t r a t i f et technique est h a u t e m e n t souhai- table. Au Centre de Transfus ion de B i rmingham, cer ta ines proc6- dures sont au tomat is~es et les o rd ina teurs ont ~t6 utilis6s avec succ~s pou r accro t t re la vi tesse et le rendement . I1 y a 4 niveaux diff6rents de t r a i t emen t de l ' in format ion dans no t re Cen t re : 1) le syst6me des donneurs de sang ; 2) le contr61e de la disponibil i t6 et de la d is t r ibut ion des p rodui t s sangu ins ; 3) le service de s6rologie pr~- na t a l e ; 4) le service de groupage t issulaire.

Le syst6me des donneurs de sang :

Ce syst~me a ~t6 in t rodui t en m 6 m e t emps que l ' au tomat i sa t ion des proc6dures techniques sous fo rme d 'un sch6ma int6gr6. Tous les donneurs sont m a i n t e n a n t sous le contr61e de l 'ordinateur . Un enreg i s t rement comple t et a isdment compr6hens ib le des donn6es adminis t ra t ives et s6rologiques est effectu4 sur chaque unit6 de sang pr61ev6, et est archiv6 darts un f ichier mis h jour r6guli6rement.

S Y S T E M E A U T O M A T I S E DE GESTION 585

Contr61e de la disponibilitd et de ia distr ibution des produi ts

sanguins :

I1 s'agit d 'une extension logique du systdme des donneurs de sang. Ce contr61e a dtd mis en place pr incipalement pour rdsoudre

des probl~mes dus ~t l 'explosion actuelle de l 'hdmothdrapie, avec comme consdquence la difficultd d 'assurer le suivi des divers compo-

sants d 'un m~me don du sang. Une localisation rapide des divers composants est de toute dvidence essentielle, en part iculier lorsqu 'une rdaction anormale intervient sur un composant , et lorsque d 'autres

composants du m~me don de sang peuvent 6tre encore stockds au

centre ou darts un h6pital quelconque, on lorsque le centre se voit notifier dans les quelques jours suivant un don de sang que le donneur cor respondant a ddveloppd une hdpatite infectieuse par exemple.

Le service de sdrologie prdnatale :

Les tests de sdrologie prdnatale sont effectuds au centre de t ransfusion pour toute la rdgion (5 comtds). Cela implique un con-

trBle quotidien de 400/: 500 dchantillons. Les mdthodes manuelles ont

atteint un point de saturat ion et une proposi t ion a dtd faite pour automat iser ce service.

Le service de groupage tissulaire :

Ce systdme a dtd informatisd depuis quelques temps, non seule- ment pour faciliter la recherche des receveurs les plus adaptds

une transfusion d'organe, mais dgalement pour l 'analyse des rdac- tions sdrologiques complexes des antigdnes HLA afin de ddterminer la spdcificitd des anticorps correspondants . II est dgalement utilisd pour dtudier les linkages, les associations ou les interactions lids

au systdme HLA, et aussi dvaluer s ta t is t iquement les chances d 'une t ransplantat ion d'organe.

Ces divers aspects sont ddcrits en ddtail ainsi que la possibilitd d ' introduire Groupamat ic dans ce systdme.

Dr. G.W.G. BI~D,

Regional Blood Transfusion Service, Vincent Drive Edbaston BIRMINGHAM B 15 2 SG, Grande-Bretagne.

21

586 SYMPOSIUM SUR LES SYSTEMES GROUPAMAT1C

BIBLIOGRAPHIE

[1] BIR~ G.W.G., WAIN M., BATTEY DA., HOLMES A. and BUTLER A.J. - - Computer isa t ion of a large an tenata l serology service. J. Clin. Path., 29, 711, 1976.

[2] CONTE P. and PIOUET Y. - - Screening for ,, immune ,, anti-A antibodies. In t roduc t ion of an au tomated method. Prel iminary report. Council of Europe Working Party on Automated Blood Grouping Document CESP/WP/AUT (76)7 (presented by Prof. J. MOULINIER), 1976.

[3] DUDDIN R. - - A moni tor ing and a larm system for use with a Technicon 15-channel blood grouping machine. Vox Sang., 32, 185, 1977.

[4] GRAHAM H., MORRISON M. and MacANDREW R. - - A simple method for the predict ion of ABO incompat ibi l i ty using Sephadex A-50. Vox Sang., 29, 371, 1975.

[5] HABIBI B., GERBAL A. and SALMON C. - - A papain-bromelin-polybrene four-channel autoanalyser system for blood group ant ibody screening. Analysis of 22, 912 sera. Vox Sang., 25, 289, 1973.

[6] HASEKURA H . - - Mercaptoethanol-stable ant ibody test predict ing hemolytic disease of the newborn due to ABO incompatibil i ty. Vox Sang., 26, 439, 1974.

[7] IBBOTSON R.N., SHIRLEY A., LOEB W., GALLAGHER O. and PRESCOTT S. - - The blood donor system. Council of Europe Working Party on Auto- mated Blood Grouping Document CESP/WP/AUT (75)2 (presented by Dr. G.W.G. BIRB).

[8] LALEZARI P. - - A new method for the detection of red cell antibodies, in ,, Automation in Analytical Chemistry ,,, Technicon Symposium, New York, 169, 1967.

[9] LANCET (Editorial). - - Computers in Routine Haematology, 1, 118, 1974.

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