1. Of 28,630 blood transfusions administered in Baylor Hospital over an eight year period there were 17 known hemolytic reactions (0.593 per 1000) of which 17.6 per cent were fatal.
2. Acute renal insufficiency occurred in 55.5 per cent of 18 cases of hemolytic reaction.
3. Factors other than hemolysis per se often occurred. The most common complication was hemorrhage with hypotension.
4. The mortality rate of the hemolytic cases with acute renal insufficiency need not be as high as one gathers from reports in the literature.
5. Good results may be obtained with a regime based on physiopathological principles and the main clinical abnormalities. The outstanding premise for the "three-phase" management is based on the consideration that damaged kidneys require time for regeneration and recovery.
6. Five main steps in the proposed method of management are: (a) adequate compatible blood for anemia and hypovolemia, (b) limitation of fluid intake during renal insufficiency to that immediately lost, (c) adequate dietary intake, (d) prevention of severe acidosis, (e) adequate water and salts replacement during diuresis.
7. Support was gained for this regime by successful application to other types of acute renal damage and insufficiency. Demonstrated complications were averted.
8. Common complications due to other types of management were: anemia and hypotension, fluid overload with cerebral and pulmonary signs, dehydration with shocklike state and at times convulsions during the recovery phase.
9. Peritoneal irrigation in its present form resulted in two major complications averted by the proposed method of management.