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?
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 overall demand 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 to the Rescue?
Enter the star of this episode: Group A plasma! This product 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 choosing group A “yellow stuff” when the transfusion service doesn’t know the recipient’s blood type.
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 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.
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.
Take the Quiz and See What You Learned!
- Dr. Dunbar’s Paper: Dunbar NM and Yazer MT, on behalf of the Biomedical Excellence for Safer Transfusion (BEST) Collaborative and the STAT Study Investigators. Safety of the use of group A plasma in trauma: the STAT study. Transfusion 2017;57;1879–1884.
- Dr. Stevens’ Paper: Stevens WT et al. Incompatible type A plasma transfusion in patients requiring massive transfusion protocol: Outcomes of an Eastern Association for the Surgery of Trauma multicenter study. J Trauma Acute Care Surg 2017;83(1):25-29.
- Survey of Current Practice Mentioned by Dr. Dunbar: Dunbar NM, Yazer MH. A possible new paradigm? A survey-based assessment of the use of thawed group A plasma for trauma resuscitation in the United States. Transfusion 2016; 56:125-9.
Previous Literature on this Issue (cited in blog post)
- Chhibber V et al. Is group A plasma suitable as the first option for emergency release transfusion? Transfusion 2014;54:1751-5.
- 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.
- Isaak EJ, et al. Challenging dogma-Group A donors as universal plasma in massive transfusion protocols. Immunohematology 2011;27:61-65 (NOTE: Free pdf download of full issue).
- Mehr CR, Gupta R, von Recklinghausen FM, et al. Balancing risk and benefit: maintenance of a thawed group A plasma inventory for trauma patients requiring massive transfusion. J Trauma Acute Care Surg 2013;74:1425-31.
- Zielinski MD et al. Emergency use of prethawed group A plasma in trauma patients. J Trauma Acute Care Surg 2013;74:69-75.