An attempt was made to determine the sequence of events leading to the production of two distinct antibodies in patients with chronic renal failure who regularly undergo haemodialysis with formaldehyde-resterilizable dialysis units by Multipoint (UK) or Cordis (USA). A distinct pattern emerged-namely, the production of anti-formaldehyde red cells started about six months after the beginning of haemodialysis treatment. Only when the titre of these antibodies reached 64 or 128 another, apparently cross-reacting, antibody appeared which reacted like an anti-N antibody. A strong direct antiglobulin reaction was found to be positive for formalin-treated red cells after five minutes' contact with specific antibody, indicating a high affinity of the antibody fo the formalin-altered red cell.
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