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Incompatible type A plasma transfusion in patients requiring massive transfusion protocol: Outcomes of an Eastern
W Tait Stevens1, Bryan C Morse, Andrew Bernard
1From the Loma Linda University School of Medicine, Department of Pathology (W.T.S.) and Trauma Division, Department of Surgery (X.L.-O., D.T., Q.J.C.), Loma Linda, California; Emory School of Medicine, Department of Surgery-Grady Memorial Hospital (B.C.M., C.J.D., C.A.F.), Atlanta, Georgia; University of Kentucky (A.B., D.D.), Department of Surgery, Lexington, Kentucky; San Antonio Military Medical Center, Division of Trauma Critical Care (V.G.S.), Department of Pathology (J.G., J.Q.), and Uniformed Services University of the Health Sciences (P.M.C.), San Antonio, Texas; University of Cincinnati (M.G., T.P., D.G.), Cincinnati, Ohio; Department of Trauma Research, Medical City Plano, Plano, Texas; The Medical Center of Plano (R.D.), Plano, Texas; Conemaugh Memorial Medical Center (M.C.), Johnstown, Pennsylvania; Mayo Clinic, Department of Surgery; Division of Trauma, Critical Care and General Surgery; Rochester, Minnesota.
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.
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