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Incompatible type A plasma transfusion in patients requiring massive transfusion protocol: Outcomes of an Eastern Association for the Surgery of Trauma multicenter study

Stevens, W. Tait MD; Morse, Bryan C. MS, MD; Bernard, Andrew MD; Davenport, Daniel L. PhD; Sams, Valerie G. MD; Goodman, Michael D. MD; Dumire, Russell MD; Carrick, Matthew M.; McCarthy, Patrick MS; Stubbs, James R. MD; Pritts, Timothy A. MD, PhD; Dente, Christopher J. MD; Luo-Owen, Xian PhD; Gregory, Jason A. MD; Turay, David MD, PhD; Gomaa, Dina; Quispe, Juan C. MD; Fitzgerald, Caitlin A. MD; Haddad, Nadeem N. MD; Choudhry, Asad MD; Quesada, Jose F. MD, MS; Zielinski, Martin D. MD

Journal of Trauma and Acute Care Surgery: July 2017 - Volume 83 - Issue 1 - p 25–29
doi: 10.1097/TA.0000000000001532
EAST Plenary Paper
Editor's Choice
EAST Journal Club

ABSTRACT With a relative shortage of type AB plasma, many centers have converted to type A plasma for resuscitation of patients whose blood type is unknown. The goal of this study is to determine outcomes for trauma patients who received incompatible plasma transfusions as part of a massive transfusion protocol (MTP).

METHODS As part of an Eastern Association for the Surgery of Trauma multi-institutional trial, registry and blood bank data were collected from eight trauma centers for trauma patients (age, ≥ 15 years) receiving emergency release plasma transfusions as part of MTPs from January 2012 to August 2016. Incompatible type A plasma was defined as transfusion to patient blood type B or type AB.

RESULTS Of the 1,536 patients identified, 92% received compatible plasma transfusions and 8% received incompatible type A plasma. Patient characteristics were similar except for greater penetrating injuries (48% vs 36%; p = 0.01) in the incompatible group. In the incompatible group, patients were transfused more plasma units at 4 hours (median, 9 vs. 5; p < 0.001) and overall for stay (11 vs. 9; p = 0.03). No hemolytic transfusion reactions were reported. Two transfusion-related acute lung injury events were reported in the compatible group. Between incompatible and compatible groups, there was no difference in the rates of acute respiratory distress syndrome (6% vs. 8%; p = 0.589), thromboembolic events (9% vs. 7%; p = 0.464), sepsis (6% vs. 8%; p = 0.589), or acute renal failure (8% vs. 8%, p = 0.860). Mortality at 6 (17% vs. 15%, p = 0.775) and 24 hours (25% vs. 23%, p = 0.544) and at 28 days or discharge (38% vs. 35%, p = 0.486) were similar between groups. Multivariate regression demonstrated that Injury Severity Score, older age and more red blood cell transfusion at 4 hours were independently associated with death at 28 days or discharge; Injury Severity Score and more red blood cell transfusion at 4 hours were predictors for morbidity. Incompatible transfusion was not an independent determinant of mortality or morbidity.

CONCLUSION Transfusion of type A plasma to patients with blood groups B and AB as part of a MTP does not appear to be associated with significant increases in morbidity or mortality.

LEVEL OF EVIDENCE Therapeutic study, level IV.

From the Loma Linda University School of Medicine, Department of Pathology (W.T.S.) and Trauma Division, Department of Surgery (X.L.-O., D.T., Q.J.C.), Loma Linda, California; Emory School of Medicine, Department of Surgery-Grady Memorial Hospital (B.C.M., C.J.D., C.A.F.), Atlanta, Georgia; University of Kentucky (A.B., D.D.), Department of Surgery, Lexington, Kentucky; San Antonio Military Medical Center, Division of Trauma Critical Care (V.G.S.), Department of Pathology (J.G., J.Q.), and Uniformed Services University of the Health Sciences (P.M.C.), San Antonio, Texas; University of Cincinnati (M.G., T.P., D.G.), Cincinnati, Ohio; Department of Trauma Research, Medical City Plano, Plano, Texas; The Medical Center of Plano (R.D.), Plano, Texas; Conemaugh Memorial Medical Center (M.C.), Johnstown, Pennsylvania; Mayo Clinic, Department of Surgery; Division of Trauma, Critical Care and General Surgery; Rochester, Minnesota.

Submitted: December 1, 2016, Revised: March 18, 2017, Accepted: April 10, 2017, Published online: April 27, 2017.

Presented at the 30th EAST Annual Scientific Assembly, January 12, 2017, in Orlando, Florida.

Address for reprints: Andrew Bernard, MD, C207 Division of General Surgery, UK College of Medicine, 800 Rose Street, Lexington, KY 40356; email:

© 2017 Lippincott Williams & Wilkins, Inc.