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Updated: Dec 9, 2025
Microfluidics in Assessing Platelet Function
Published on: November 8, 2024
Group A emergency-release plasma in trauma patients requiring massive transfusion
Amory de Roulet1, Jeffrey D Kerby, Jordan A Weinberg
1From the Division of General Surgery (A.d.R.), Department of Surgery, New York Presbyterian Queens, Flushing, New York; Division of Trauma, Burns and Surgical Critical Care (J.D.K.), Department of Surgery, School of Medicine, University of Alabama, Birmingham, Alabama; Division of General Surgery (J.A.W.), Department of Surgery, Dignity Health Medical Group Arizona, Phoenix, Arizona; Department of Surgery (R.H.L.Jr), University of Tennessee Health Science Center, Memphis, Tennessee; Department of Pathology (J.P.H., I.A.S.), LAC+USC Medical Center, University of Southern California, Los Angeles, California; Center for Translational Injury Research (E.E.F., J.B.H.), Division of Acute Care Surgery, Department of Surgery, University of Texas Health Science Center, Houston, Texas; Division of Trauma (K.J.B., M.A.S.), Critical Care and Acute Care Surgery, School of Medicine, Oregon Health and Science University, Portland, Oregon; Division of Trauma and Critical Care (E.M.B.), Department of Surgery, School of Medicine, University of Washington, Seattle, Washington; Department of Surgery (M.J.C.), University of Colorado, Denver, Colorado; Center for Translational Injury Research (B.A.C.), Division of Acute Care Surgery, Department of Surgery, University of Texas Health Science Center, Houston, Texas; Division of Trauma and Surgical Critical Care (T.C.F.), Department of Surgery, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee; Division of Trauma (T.O.), Critical Care and Emergency Surgery, Department of Surgery, University of Arizona, Tucson, Arizona; Trauma and Acute Care Service (S.R.), St. Michael's Hospital, Toronto, Ontario, Canada; R Adams Crowley Shock Trauma Center (T.M.S.), University of Maryland, Baltimore, Maryland; and Division of Trauma and Critical Care (K.I.), LAC+USC Medical Center, University of Southern California, Los Angeles, California.
Background:
Both groups A and AB plasma have been approved for emergency-release transfusion in acutely bleeding trauma patients before blood grouping being performed. The safety profile associated with this practice has not been well characterized, particularly in patients requiring massive transfusion.
Methods:
This secondary analysis of the Pragmatic, Randomized, Optimal Platelet and Plasma Ratios trial examined whether exposure to group A emergency-release plasma (ERP) was noninferior to group AB ERP. We also examined patients whose blood groups were compatible with group A ERP versus patients whose blood groups were incompatible with group A ERP. Outcomes included 30-day mortality and complication rates including systemic inflammatory response syndrome, infection, renal injury, pulmonary dysfunction, and thromboembolism.
Results:
Of the 680 patients predicted to receive a massive transfusion, 584 (85.9%) received at least 1 U of ERP. Of the 584 patients analyzed, 462 (79.1%) received group AB and 122 (20.9%) received group A ERP. Using a hazard ratio (HR) of 1.35 as the noninferiority margin, transfusion with group A versus group AB ERP was not associated with increased thromboembolic rates (HR, 0.52; 95% confidence interval [CI], 0.31-0.90). Mortality (HR, 1.15; 95% CI, 0.91-1.45) and nonfatal complication rates (HR, 1.24; 95% CI, 0.87-1.77) were inconclusive. In the subgroup analysis, transfusion with incompatible ERP (group B or AB patients receiving group A ERP) was not associated with increased nonfatal complications (HR, 1.02; 95% CI, 0.80-1.30). There were no reported hemolytic transfusion reactions.
Conclusion:
The use of ERP is common in patients requiring massive transfusion and facilitates the rapid balanced resuscitation of patients who have sustained blood loss. Group A ERP is an acceptable option for patients requiring massive transfusion, especially if group AB ERP is not readily available.
Level Of Evidence:
Therapeutic/Care Management, level IV; Prognostic, level III.
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