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Balancing risk and benefit: Maintenance of a thawed Group A plasma inventory for trauma patients requiring massive transfusion

Mehr, Chelsea R. BA; Gupta, Rajan MD; von Recklinghausen, Friedrich M. PhD; Szczepiorkowski, Zbigniew M. MD, PhD; Dunbar, Nancy M. MD

Journal of Trauma and Acute Care Surgery: June 2013 - Volume 74 - Issue 6 - p 1425–1431
doi: 10.1097/TA.0b013e31828b813e
Original Articles

BACKGROUND Transfusion of plasma and red blood cell (RBC) units in a balanced ratio approximating 1:1 has been shown in retrospective studies to be associated with improved outcomes for trauma patients. Our low-volume rural trauma center uses a trauma-activated transfusion algorithm. Plasma is thawed upon activation to avoid wastage. However, the time required for plasma thawing has made achievement of a 1:1 ratio early in resuscitation challenging. In this study, the time required for plasma thawing is characterized, and a potential solution is proposed.

METHODS A retrospective chart study of 38 moderately and massively transfused (≥6 U in the first 24 hours) trauma patients admitted from January 2008 to March 2012 was performed. We evaluated the time required to dispense plasma and the number of RBCs dispensed before plasma in these patients.

RESULTS The average time between the dispense of RBCs and plasma was 26 minutes (median, 28; range, 0–48 minutes). The average number of RBCs dispensed before plasma was 8 U (median, 7 U; range, 0–24 U). Nearly one third of massively transfused patients had 10 RBCs or greater dispensed before plasma was available.

CONCLUSION There exists the potential for delayed plasma availability owing to time required for thawing, which may compromise the ability to provide balanced plasma to RBC transfusion to trauma patients. Maintenance of a thawed Group AB plasma inventory may not be operationally feasible for rural centers with low trauma volumes. Use of a thawed Group A plasma inventory is a potential alternative to ensure rapid plasma availability.

LEVEL OF EVIDENCE Therapeutic study, level V.

Submitted: November 27, 2012, Revised: January 29, 2013, Accepted: January 29, 2013.

From the Geisel School of Medicine at Dartmouth (C.R.M., F.M.V.R.), Hanover; and Department of Surgery (R.G., F.M.V.R.), Pathology (Z.M.S., N.M.D.), and Medicine (Z.M.S., N.M.D.), Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.

Address for reprints: Nancy M. Dunbar, MD, One Medical Center Dr, Lebanon, New Hampshire 03756; email: Nancy.M.Dunbar@hitchcock.org.

© 2013 Lippincott Williams & Wilkins, Inc.