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

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

Research output: Contribution to journalArticle

6 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)25-29
Number of pages5
JournalJournal of Trauma and Acute Care Surgery
Volume83
Issue number1
DOIs
StatePublished - Jul 1 2017

Keywords

  • Incompatible plasma
  • massive transfusion
  • plasma

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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    Stevens, W. T., Morse, B. C., Bernard, A., Davenport, D. L., Sams, V. G., Goodman, M. D., Dumire, R., Carrick, M. M., McCarthy, P., Stubbs, J. R., Pritts, T. A., Dente, C. J., Luo-Owen, X., Gregory, J. A., Turay, D., Gomaa, D., Quispe, J. C., Fitzgerald, C. A., Haddad, N. N., ... Zielinski, M. D. (2017). Incompatible type A plasma transfusion in patients requiring massive transfusion protocol: Outcomes of an Eastern Association for the Surgery of Trauma multicenter study. Journal of Trauma and Acute Care Surgery, 83(1), 25-29. https://doi.org/10.1097/TA.0000000000001532