Group A Plasma for Trauma/Massive Transfusion

[gene20354]

I have 2 questions for those of you that use group A plasma for trauma/massive transfusion instead of AB plasma.  

1. Do you have a limit on the amount of group A plasma that is transfused?

2. Once the type is complete and its determined that the patient is B or AB, do you continue to provide group A plasma until the bleeding event is over or do you switch to ABO compatible products?

[mollyredone]

We use A liquid plasma for emergency release and massive transfusion protocol.  Once we have a specimen we would switch to ABO compatible.  We only keep 4 liquid plasma, after which we would thaw plasma.  If we still didn't have a type, I would thaw AB plasma, but we rarely have the need.  Most of our MTPs, which start out with 4 PRBCs and 2 FFP, end up returning 2 PRBCs and 2 FFP.  Not really true MTPs, fortunately but annoying that they call it an MTP. We have only thawed 1 AB FFP since September, and it expired because we don't use it in a non-emergency case unless the patient is AB.

[DebbieL]

We keep 2 thawed (5-day) A plasma ready for trauma. My pathologist would only let us issue 2 to an unknown type. I tried to push for 4 but couldn't convince him. If we still don't have a blood type we have to go to AB. Thus far we have been able to get a specimen and recheck before we have had to thaw AB. Once we find out the patient's type, we go to type specific FFP.

We also have one ER doc that loves to say MTP but they also send back most of the blood we send down. Good for the patient, aggravating to us

[Mabel Adams]

We go to type specific as soon as we have some thawed. That means we might continue with the A plasma for a short time after we know the type because the type specific isn't thawed yet.  We don't use A plasma as universal donor for kids under about 40 lbs.  We don't have a specific limit for bigger patients.  If we don't have a blood type yet, we are giving O red cells.  By the time we have given more than 4 A plasma units the patient is about half full of O red cells so the anti-B in the plasma has fewer targets. 

[BB1956]

Does anyone use a FDA approved Microwave plasma thawer?  I have read about them and inspected a hospital that had purchased one in the past year.  They seemed to be pleased with it.  It would be great for trauma situations allowing us to provide plasma very quickly.

[Sandy L]

We place our limit at 12 group A for a patient with unknown blood type.  Mabel makes a good point, by then the patient has been issued 12 group O red cells.  We start thawing AB plasma after the first 12, but it's pretty rare that we don't have a blood type by then.

[gene20354]

Thanks for the responses! Its been very helpful!  I also agree with Mabel.