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Emergency use of prethawed Group A plasma in trauma patients

Zielinski, Martin D. MD; Johnson, Pamela M. MD; Jenkins, Donald MD; Goussous, Naeem MD; Stubbs, James R. MD

Journal of Trauma and Acute Care Surgery: January 2013 - Volume 74 - Issue 1 - p 69–75
doi: 10.1097/TA.0b013e3182788f8e
AAST 2012 PLENARY PAPERS

BACKGROUND Massive transfusion protocols lead to increased use of the rare universal plasma donor, Type AB, potentially limiting supply. Owing to safety data, with a goal of avoiding shortages, our blood bank exploited Group A rather than AB for all emergency release plasma transfusions. We hypothesized that ABO-incompatible plasma transfusions had mortality similar to ABO-compatible transfusions.

METHODS Review of all trauma patients receiving emergency release plasma (Group A) from 2008 to 2011 was performed. ABO compatibility was determined post hoc. Deaths before blood typing were eliminated. p < 0.05 was considered statistically significant.

RESULTS Of the 254 patients, 35 (14%) received ABO-incompatible and 219 (86%) received ABO-compatible transfusions. There was no difference in age (56 years vs. 59 years), sex (63% vs. 63% male), Injury Severity Score (ISS) (25 vs. 22), or time spent in the trauma bay (24 vs. 26.5 minutes). Median blood product units transfused were similar: emergency release plasma (2 vs. 2), total plasma at 24 hours (6 vs. 4), total red blood cells at 24 hours (5 vs. 4), plasma–red blood cells at 24 hours (1.3:1 vs. 1.1:1), and plasma deficits at 24 hours (2 vs. 1). Overall complications were similar (43% vs. 35%) as were rates of possible transfusion-related acute lung injury (2.9% vs. 1.8%), acute lung injury (3.7% vs. 2.5%), adult respiratory distress syndrome (2.9% vs. 1.8%), deep venous thrombosis (2.9% vs. 4.1%), pulmonary embolism (5.8% vs. 7.3%), and death (20% vs. 22%). Ventilator (6 vs. 3), intensive care unit (4 vs. 3), and hospital days (9 vs. 7) were similar. There were no hemolytic reactions. Mortality was significantly greater for the patients who received incompatible plasma if concurrent with a massive transfusion (8% vs. 40%, p = 0.044). Group AB plasma use was decreased by 96.6%.

CONCLUSION Use of Group A for emergency release plasma resulted in ABO-incompatible transfusions; however, this had little effect on clinical outcomes. Blood banks reticent to adopt massive transfusion protocols owing to supply concerns may safely use plasma Group A, expanding the pool of emergency release plasma donors.

LEVEL OF EVIDENCE Therapeutic study, level IV; prognostic study, level III.

From the Division of Trauma, Critical Care and General Surgery, St. Mary’s Hospital, Mayo Clinic, Rochester, Minnesota.

Submitted: August 1, 2012, Revised: September 14, 2012, Accepted: October 3, 2012.

This study was presented at the 71st annual meeting of the American Association for the Surgery of Trauma, September 12–15, 2012, in Kauai, Hawaii.

Address for reprints: Martin D. Zielinski, MD, Division of Trauma, Critical Care and General Surgery, Mary Brigh 2-810, St. Mary’s Hospital, Mayo Clinic, 1216 Second St, SW Rochester, MN 55902; email: zielinski.martin@mayo.edu.

© 2013 Lippincott Williams & Wilkins, Inc.