A, incubation of RBC from universal donors (type O, Rh negative) with sera from trauma patients or healthy donors. B, the C4d deposition on RBC from trauma patients over time compared to normal controls by flow cytometry and mean fluorescence intensity. We used samples from 100 trauma patients (n, 0 hour =100, 6 hour =18, 24 hour =31 and 72 hour =14) and 37 samples from healthy donors (HD). The mean fluorescence intensity [Mean ± SD (min - max)] of C4d deposition on the surface of healthy control RBCs was [3233 ± 1610 (1197 – 9215)] for healthy donors, [6071 ± 2578 (1647–15404)] for 0 hour, [5817 ± 2701 (2795–13764)] for 6 hour, [4753 ± 1741 (1585 −7331)] for 24 hour and [4361 ± 2903 (2206 −13450)] for 72 hour patients. C, deposition of C4d in patients with an ISS of 9 and above remains elevated up to 72 hours when compared to patients with an ISS below 9.