Incompatible type A plasma transfusion in patients requiring massive transfusion protocol

Stevens, W. Tait; Morse, Bryan C.; Bernard, Andrew C.; Davenport, Daniel L.; Sams, Valerie G.; Goodman, Michael D.; Dumire, Russell; Carrick, Matthew M.; McCarthy, Patrick M.; Stubbs, James R.; Pritts, Timothy A.; Dente, Christopher J.; Luo-Owen, Xian; Gregory, Jason A.; Turay, David; Gomaa, Dina; Quispe, Juan C.; Fitzgerald, Caitlin A.; Haddad, Nadeem N.; Choudhry, Asad J.; Quesada, José F.; Zielinski, Martin D.

doi:10.1097/ta.0000000000001532

Cited by 23 publications

(9 citation statements)

References 23 publications

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“…With a relative shortage of type AB plasma, to allow plasma transfusion for resuscitation of patients whose blood type is unknown, the use of type A plasma has been proposed [582–584]. Preliminary data show that transfusion of incompatible type A plasma to patients with blood groups B and AB as part of a massive transfusion protocol does not appear to be associated with significant increases in morbidity or mortality [585]. Freeze-dried plasma use has been recently implemented in the military setting [530] as well as in civilian pre-hospital care [531] and might help to reduce the time needed to start plasma transfusion.…”

Section: Resultsmentioning

confidence: 99%

The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition

et al. 2019

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Background: Severe traumatic injury continues to present challenges to healthcare systems around the world, and post-traumatic bleeding remains a leading cause of potentially preventable death among injured patients. Now in its fifth edition, this document aims to provide guidance on the management of major bleeding and coagulopathy following traumatic injury and encourages adaptation of the guiding principles described here to individual institutional circumstances and resources. Methods: The pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma was founded in 2004, and the current author group included representatives of six relevant European professional societies. The group applied a structured, evidence-based consensus approach to address scientific queries that served as the basis for each recommendation and supporting rationale. Expert opinion and current clinical practice were also considered, particularly in areas in which randomised clinical trials have not or cannot be performed. Existing recommendations were reexamined and revised based on scientific evidence that has emerged since the previous edition and observed shifts in clinical practice. New recommendations were formulated to reflect current clinical concerns and areas in which new research data have been generated. Results: Advances in our understanding of the pathophysiology of post-traumatic coagulopathy have supported improved management strategies, including evidence that early, individualised goal-directed treatment improves the outcome of severely injured patients. The overall organisation of the current guideline has been designed to reflect the clinical decision-making process along the patient pathway in an approximate temporal sequence. Recommendations are grouped behind the rationale for key decision points, which are patient-or problem-oriented rather than related to specific treatment modalities. While these recommendations provide guidance for the diagnosis and treatment of major bleeding and coagulopathy, emerging evidence supports the author group's belief that the greatest outcome improvement can be achieved through education and the establishment of and adherence to local clinical management algorithms. Conclusions: A multidisciplinary approach and adherence to evidence-based guidance are key to improving patient outcomes. If incorporated into local practice, these clinical practice guidelines have the potential to ensure a uniform standard of care across Europe and beyond and better outcomes for the severely bleeding trauma patient.

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Section: Resultsmentioning

confidence: 99%

The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition

et al. 2019

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“…Die Auswahl der Evidenz mittels vorab festgelegter Selektionskriterien im PICOS-Format („population, intervention, comparison, outcome, study design“; [ 66 ]) führte zu 15 [ 9 , 20 , 33 , 41 , 42 , 49 , 52 , 53 , 56 , 57 , 77 , 78 , 94 , 102 , 104 ] bzw. 59 berücksichtigten Publikationen [ 1 , 3 , 6 – 8 , 12 , 14 – 16 , 18 , 21 , 24 – 26 , 28 , 30 – 32 , 34 , 35 , 37 – 40 , 43 , 45 , 48 , 50 , 51 , 54 , 58 , 59 , 63 , 64 , 68 , 69 , 71 – 74 , 76 , 79 – 85 , 88 , 89 , 95 , 97 , 99 – 101 , 105 – 108 ]. Entsprechend der methodischen Qualität der vorliegenden Publikationen sowie ihrer klinischen Bewertung durch die Leitliniengruppe wurden die Aussagen mit einem Empfehlungsgrad („grade of recommendation“ [GoR]) A („soll“), B („sollte“) oder 0 („kann“) versehen [ 5 ].…”

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The chapters “Stop the bleed—prehospital” and “Coagulation management and volume therapy (emergency departement)” in the new S3 guideline “Polytrauma/severe injury treatment”

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Goossen

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2023

Notfall Rettungsmed

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Die S3-Leitlinie „Polytrauma/Schwerverletzten-Behandlung“ der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) wurde zwischen 2020 und 2022 aktualisiert und überarbeitet. Der vorliegende Beitrag beschreibt die Kernaussagen des neuen Kapitels „Stop the Bleed – Prähospital“ sowie des komplett überarbeiteten Kapitels „Gerinnungsmanagement und Volumentherapie“.

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“…As this practice becomes widely accepted it is important to evaluate patient safety. Hemolytic transfusion reactions are underreported, and subclinical hemolysis may be present 3 . We report herein a retrospective review of blood group B and AB patients receiving plasma from blood group A donors in our institution over the past 4 years.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of A plasma for incompatible patients

et al. 2020

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Background Plasma transfusion is a critical treatment in managing bleeding patients. In an effort to make plasma immediately available in spite of the limited amount of AB plasma, providers have begun using A plasma in life‐threatening emergencies. As this practice becomes widely adopted it is important to evaluate safety. Hemolytic transfusions reactions are underreported, and hemolysis may be subclinical. Study Design and Methods A retrospective study was performed at the University of Florida/Shands Hospital of B and AB patients who received 1 unit or more of A plasma. Patient charts were reviewed and data collected included age; sex; mortality; intensive care unit (ICU) length of stay; and laboratory tests used in identifying hemolysis including direct antiglobulin test, lactate dehydrogenase, haptoglobin, indirect bilirubin, aspartate aminotransferase, urinalysis, hemoglobin, and hematocrit. The primary end points of the study were immune mediated hemolysis, mortality, and length of ICU stay. Results Ninety‐three patients were identified as eligible for the study. One patient suffered a delayed hemolytic transfusion reaction determined to be due to an anti‐Jka. No evidence of hemolysis due to ABO‐incompatible plasma transfusion was identified. The volume of A plasma transfused was found to be weakly related to mortality and ICU stay. Conclusion No evidence of ABO immune‐mediated hemolysis was observed in the patient population. The results of the study support the safety of A plasma transfusion in B and AB patients. We hypothesize the relationship observed between A plasma volume and mortality/ICU stay may be from collinearity with disease severity.

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Incompatible type A plasma transfusion in patients requiring massive transfusion protocol

Abstract: Therapeutic study, level IV.

Cited by 23 publications

References 23 publications

The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition

The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition

The chapters “Stop the bleed—prehospital” and “Coagulation management and volume therapy (emergency departement)” in the new S3 guideline “Polytrauma/severe injury treatment”

Evaluation of A plasma for incompatible patients

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