Emergency use of prethawed Group A plasma in trauma patients

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

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)69-75
Number of pages7
JournalJournal of Trauma and Acute Care Surgery
Volume74
Issue number1
DOIs
StatePublished - Jan 2013

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Emergencies
Wounds and Injuries
Blood Banks
Acute Lung Injury
Erythrocytes
Tissue Donors
Blood Grouping and Crossmatching
Injury Severity Score
Mortality
Adult Respiratory Distress Syndrome
Mechanical Ventilators
Pulmonary Embolism
Venous Thrombosis
Intensive Care Units
Safety

Keywords

  • ABO compatibilit
  • blood products
  • Hemostatic resuscitation
  • plasma
  • transfusion

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Zielinski, M. D., Johnson, P. M., Jenkins, D., Goussous, N., & Stubbs, J. R. (2013). Emergency use of prethawed Group A plasma in trauma patients. Journal of Trauma and Acute Care Surgery, 74(1), 69-75. https://doi.org/10.1097/TA.0b013e3182788f8e

Emergency use of prethawed Group A plasma in trauma patients. / Zielinski, Martin D.; Johnson, Pamela M.; Jenkins, Donald; Goussous, Naeem; Stubbs, James R.

In: Journal of Trauma and Acute Care Surgery, Vol. 74, No. 1, 01.2013, p. 69-75.

Research output: Contribution to journalArticle

Zielinski, MD, Johnson, PM, Jenkins, D, Goussous, N & Stubbs, JR 2013, 'Emergency use of prethawed Group A plasma in trauma patients', Journal of Trauma and Acute Care Surgery, vol. 74, no. 1, pp. 69-75. https://doi.org/10.1097/TA.0b013e3182788f8e
Zielinski, Martin D. ; Johnson, Pamela M. ; Jenkins, Donald ; Goussous, Naeem ; Stubbs, James R. / Emergency use of prethawed Group A plasma in trauma patients. In: Journal of Trauma and Acute Care Surgery. 2013 ; Vol. 74, No. 1. pp. 69-75.
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abstract = "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.",
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