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Anaphylactic reactions are excluded by the presence of red plasma or urine, discordant pretransfusion and posttransfusion ABO blood types, or a positive direct antiglobulin (Coombs) test result. Demonstration of anti-IgA in a pretransfusion sample of the recipient's serum or plasma establishes the diagnosis.
The occurrence of marked bleeding during the operation was attributed to replacement of the patient's blood with stored blood deficient in viable platelets and labile clotting factors. At one point during the postoperative course, the patient's blood became incoagulable due to a deficiency of ionized calcium. This transitory phenomenon, however, was not thought to be a factor in the pathogenesis of the abnormal bleeding.