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Use of group A thawed plasma in emergency transfusions at a pediatric quaternary care center
Cyril Jacquot1,2, Tahirah Jones1, Burak Bahar1,2
1Division of Laboratory Medicine, Children's National Hospital, Washington, DC, USA.
Insights
Implementing 5-day group A thawed plasma in pediatric emergencies improved availability without increased wastage. Incompatible plasma transfusions in pediatric patients showed no adverse events or differences in outcomes.
Area of Science:
- Pediatric Emergency Medicine
- Transfusion Medicine
- Blood Banking
Background:
- Balanced plasma/red blood cell transfusions improve survival in emergencies.
- Plasma availability is critical in emergency scenarios.
- A 5-day group A thawed plasma protocol was implemented in a pediatric hospital.
Purpose of the Study:
- To assess the safety and efficacy of 5-day group A thawed plasma in pediatric emergencies.
- To evaluate adverse events associated with incompatible plasma transfusions in children.
- To determine the impact on plasma availability and wastage.
Main Methods:
- Retrospective review of pediatric patient records and laboratory results.
- Analysis of emergency plasma requests and massive transfusion protocol activations.
- Assessment of transfusion-associated adverse events and wastage rates.
Main Results:
- 173 emergency plasma requests for 161 pediatric patients were analyzed.
- 23 pediatric patients received incompatible group A plasma without adverse events.
- No significant differences in survival or hospital length of stay were observed between compatible and incompatible plasma recipients.
- No increase in plasma wastage or expiration was noted.
Conclusions:
- 5-day group A thawed plasma can be rapidly issued from the blood bank and trauma code room.
- The implementation did not lead to increased wastage.
- Pediatric recipients of incompatible group A plasma did not experience transfusion-associated adverse events.
Background:
Balanced plasma/red blood cell transfusions have shown survival benefit in emergency scenarios. To improve plasma availability, we implemented 5-day group A thawed plasma at our pediatric hospital in February 2021.
Study Design And Methods:
We maintain thawed group A plasma units (5-day shelf-life) ready for immediate issue in the blood bank (since February 2021) and trauma code room (since August 2022). Group A plasma (un-titered) is issued for patients with unknown blood type during emergencies. We retrospectively reviewed records and laboratory results of recipients to assess safety and identify possible adverse events related to incompatible plasma.
Results:
Between February 2021 and December 2023, 173 emergency plasma requests occurred for 161 patients. Ninety-one occurred with massive transfusion protocol activations. Thirty-six patients (22.4%) were blood group B or AB, and 23 received incompatible plasma (age 0-21.3 years, weight 0.74-149.8 kg, incompatible plasma dose 4.0-428.4 mL/kg). These patients did not have any differences in survival outcomes or hospital lengths of stay (LOS) compared with compatible plasma recipients, mirroring the adult experience. None experienced adverse events related to group A plasma. No transfusion reactions were reported. No increase in wastage/outdate occurred upon thawed plasma implementation (2020 versus 2021 to 2023, 7.73% [133/1721] vs. 8.58% [497/5792], p = .284).
Conclusions:
We implemented 5-day group A thawed plasma. Units are rapidly available from the blood bank and trauma code room without increased wastage. We did not identify any transfusion-associated adverse events in pediatric recipients of incompatible group A plasma.
