Today we will be discussing the safety of transfusing blood group A plasma to unidentified trauma patients. Group AB plasma, the universal plasma, does not contain anti-A or anti-B antibodies and is routinely given to trauma patients when their blood type is unknown. Group AB plasma, however, is in short supply.
Dr. Cooling elaborates:
“American Red Cross estimates only 2.5-2.6% of their active donors are going to be group AB. In addition, the use of AB plasma has skyrocketed over the last five years due in large part to the widespread adoption of massive transfusion protocols.”
The shortage of group AB plasma is also exacerbated by an AABB standard to mitigate TRALI risk.
Physicians at the UMass Memorial Medical Center hypothesized that group A plasma instead of AB plasma may be safely given to emergency trauma patients with an unknown blood type. Eighty-five percent of their patients are either group A or O, and incompatible plasma is already safely transfused with apheresis platelets. Out of 385 requests for emergency plasma over five years, 23 individuals received incompatible group A plasma transfusions—15 patients with group B blood and 8 with group AB blood.
Dr. Weinstein describes the major findings of the study:
“ It appears safe to give small numbers of plasma units of incompatible group A plasma. There were no adverse effects in the patients expressing the B allele who were either group B or group AB who received group A plasma and there was no evidence of hemolysis; there were no reported transfusion reactions.”
Additionally, two other smaller studies previously found similar results when using group A plasma for trauma patients.
Dr. Weinstein adds:
“Only 6% of our patients received group A plasma while the patient expresses the B allele. So I think other centers have to study this as well, and I think we need more data because presumably this will become a common practice but it would be better if it became a common practice based on high quality evidence.”
A large, multicenter trial likely needs to be implemented to confirm the safety of using group A plasma for trauma patients with unknown blood type.
We’ll be back with another edition of Transfusion News on August 30. Thanks for joining us.
1. Chhibber V, Greene M, Vauthrin M, Bailey J, Weinstein R. Is group A thawed plasma suitable as the first option for emergency release transfusion? Transfusion 2014.
2. Cooling L. Going from A to B: The safety of incompatible group A plasma for emergency release in trauma and massive transfusion patients. Transfusion 2014(54):1695–1697.
Transfusion offers CME credit for this study! Log on at www.wileyhealthlearning.com/trf.