Thawed A Plasma Questions

[bowerj1 14]

Hello,

 

We are going to begin keeping 2 thawed A Plasma units on hand at all times for MTPs and Traumas. We are a level 2 trauma center. A few questions come to mind:

• Are there ever any MTPs or Traumas where you would not use the Thawed A plasma? For example, you know the patient is Type B historically? Or an OB hemorrhage scenario (a non trauma patient) where the patient is Type B or AB?
• Do you always use the thawed A plasma units on all compatible patients. For example if you get an O patient needing plasma, and the A units are available but were thawed about a day ago (and still have 4 days until expiration) do you always give the A, or is it a case by case basis?
• Does everyone limit the use of A thawed plasma to 2 units, until the blood type is known and type specific plasma can be given?
• Is anyone willing to share their policy?

Thanks,

Jesse

[Joanne P. Scannell 219]

Yes on every question except the 2u limit.

If we have verified the ABO Group and we need to use 'incompatible' plasma (i.e. emergency), we use our Emergency Release Protocol, e.g. MD signs for it.

If you want to view our policy, please message me.

[bowerj1 14]

I messaged you - thanks!

[slsmith 55]

We keep 6 low titer A  liquid plasma on hand . Right now our medical director only allows it for MTP and traumas so we can't give the product to another patient if they become shortdated. We do waste quite of a bit of product, guess it is the cost of doing business but it is frustrating. 

[TreeMoss 71]

We have 4 units of Group A liquid plasma on stock. As it becomes short-dated, we are able to use it on other patients. The liquid plasma is generally used for MTP patients, but we have the choice to use it as needed.

[Baby Banker 84]

We still use AB, but we are pediatric only, and we often don't know how big the patient is at the beginning of an MTP.  Our thinking is that the smaller a patient is the easier it would be to give them too much anti-B, or at least enough anti-B to potentially cause problems.

[bowerj1 14]

A question that also comes to mind as we are writing our SOP for thawed plasma, is it necessary to have the provider sign an Emergency Release form when A plasma is given to someone with no blood type on record. Does anyone do that? Or is the policy stating when to use the A plasma sufficient?

[HN327 2]

We keep 4 thawed A plasma at all time for emergent adult population transfusion.  We use these for daily transfusion and replenish them with new batch immediately.  They are not strictly for emergent need only.

There is no limit to the # of plasma.  Recently, we had a level 1 gsw and they used over 15+ emergent plasma so we provide as much as needed until they can send us a type&screen.   

If the patient end up typing as a B, we ask the careteam if they can wait 20-25min for the thawing.  If they cannot wait, we will give them the A plasma regardless.  Usually, they require more of RBC and can hold off on plasma but there were case that they transfuse B patient with group A.

If there is no current sample or blood typing; for us, all emergency plasma dispense require provider to sign an Emergency Release form and return the form whenever possible.  We will not stop them for getting plasma if there is no signature and often time we just tube the form along with the plasma.  These product does get issue in the LIS for tracking purpose, otherwise it document on the Emergency Release form.  The form does need to be sign within the shift or in a 24 hours period.  There were case where the provider left and does not come sign the form days later and required our Medical Director intervention. 

We only need 1 signature and keep track of all emergent product they use.  Provider does not have to sign a sheet for every product.  We used to require signature on every sheet, and trust me, it require a lot of effort to track the provider down.

 

[Joanne P. Scannell 219]

On 9/11/2020 at 11:46 AM, bowerj1 said:

A question that also comes to mind as we are writing our SOP for thawed plasma, is it necessary to have the provider sign an Emergency Release form when A plasma is given to someone with no blood type on record. Does anyone do that? Or is the policy stating when to use the A plasma sufficient?

There are actually 2 scenarios in this string:  1. Issuing plasma that you know is incompatible with a patient (i.e. ABO is verified) and 2. Issuing plasma when you haven't verified the patient's ABO with a current sample.

For #1: If you are in the US, the CDC/FDA wants us to treat all incompatible plasma as if it were 'Emergency Release' so use your Emergency Release Protocol.

For #2: If your patient's ABO Group has not been verified (e.g. sample tested using your protocol for verification), use your Emergency Release Protocol.