New paradigms in trauma transfusion require prompt delivery of plasma in increased amounts. This has led blood banks to start using group A plasma instead of AB in these emergency settings. But, is the practice safe?

Nancy Dunbar and Tait Stevens

Dr. Nancy Dunbar and Dr. Tait Stevens

Over the last ten years or so, the world of trauma transfusion has undergone nothing short of a revolution. We’ve heard all about the famous “1:1:1” ratio of platelets to plasma to red cells that has become standard practice in massive trauma transfusion (described in BBGuy Essentials episodes 007 and 033). One of the dirty little secrets of this whole situation is that we are using more plasma than before (shown in published studies). With more demand for plasma comes more demand for group AB plasma, in particular, since AB has traditionally been considered the “universal” plasma component to give when you don’t know someone’s ABO type. However, since AB donors only make up about 4% of our donor pool, keeping up can be a struggle!

Group A Plasma to the Rescue?

Enter the star of this episode: Group A plasma! Group A plasma is compatible with about 85% of recipients (groups A and O), but is incompatible with 15% (groups B and AB). According to a recent survey, most US transfusion services providing trauma transfusion services have already switched to routine use of group A rather than AB plasma for trauma and emergency transfusion. They did so mostly based on a little bit of data supplied by facilities that pioneered the AB to A switch and didn’t see any problems with hemolysis in group B and AB recipients. Well, today, I have as my guests two stellar transfusion medicine physicians who are lead authors on papers actually analyzing how well over 400 group B and AB patients actually do when they get incompatible group A plasma in trauma transfusions! They tell us what we now know (and do NOT know) about the safety of using group A plasma when the transfusion service doesn’t know the recipient’s blood type.

Speaker Bios:

Dr. Nancy Dunbar is an associate professor of pathology and lab medicine and a clinical assistant professor of medicine at Dartmouth. She is lead author, along with Mark Yazer, of a paper called, “Safety of the use of group A plasma in trauma: The STAT study” that is currently in early view publication for the journal Transfusion (08/07/2017 UPDATE: The paper is now published in the August 2017 Transfusion; see link below).

Dr. Tait Stevens is an associate professor of pathology and lab medicine at Loma Linda University. He is the director of Transfusion Medicine and the histocompatibility lab at Loma Linda. Tait is the lead author of a paper called, “Incompatible type A Plasma Transfusion in Patients Requiring Massive Transfusion Protocol: Outcomes of an EAST Multicenter Study” published in July 2017 in the Journal of Trauma and Acute Care Surgery.

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DISCLAIMER: The opinions expressed on this episode are those of my guests and I alone, and do not reflect those of the organizations with which any of us is affiliated. Neither Dr. Stevens, Dr. Dunbar, nor I have any relevant financial disclosures.

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