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merky125

AABB 5.15.4 (European input welcome)

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AABB has updated standard 5.15.4 to include wording for "shall have a policy concerning transfusion of significant volumes of plasma containing incompatible ABO antibodies"...

I am looking for some information on A. significant, B. really just concerned about plasma during times of massive transfusion (the AB plasma shortage is real)

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It really helps a ton if you are getting your specimens ASAP for massive transfusion protocol. It avoids using AB plasma or low titer A plasma...

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Yes, but what facility has the volume of AB plasma for a MTP? What happens when you have an AB patient, run our of AB plasma? You go to A. My question is still "what is a significant amount"?

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That came up at an AABB session I attended last year. Policies seemed to range from 1-2 units up to 6-8 units of incompatible plasma. Some policies specified a time frame as well as number of units - X number of ABO incompatible units over X number of hours. I was hoping to hear some kind of concensus, but there didn't seem to be one from the comments I heard. Do your research, draw a line in the sand for what you think is reasonable, and write your policy accordingly. Since the standard does not spell out what reasonable is, you get to decide.

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I'm going to go for the high end. Over a 24 hour period. They really should not be so vague. If you're going to write a standard make it detailed. It makes writing policy easier.

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As Eagle Eye said, check into low titer A plasma.  We use it for all our massive transfusions and emergency release, in the form of liquid plasma.  They have quite a few studies done (including over 8 years at Mayo) with using A instead of AB.  And of course stress patient blood bank specimens ASAP.  We actually quit carrying O plasma since it was outdating and use A instead.  But we have very few "real" MTPs.

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3 minutes ago, merky125 said:

Could you share it here?

I don't have any specifics on how much is too much...only that we switch to type-compatible as soon as we possibly can.  Are you already using Type A liquid plasma? 

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We are going to add Type A liquid plasma to our inventory this month. It's been approved by the necessary committees. My medical director and I just need to hash out a policy for using it. Once I educate Blood Bank staff, we'll be ready to start stocking it.

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17 hours ago, Carrie Easley said:

I don't have any specifics on how much is too much...only that we switch to type-compatible as soon as we possibly can.  Are you already using Type A liquid plasma? 

Since we are a VA and are a "small" transfusion service it is not in our best interest to purchase Type A liquid plasma. Our policy is to get a specimen immediately so those suggestions above don't help. I'm specifically looking to see if anyone had any research on what volume is acceptable. Honestly, it looks like everyone is just going to have to figure it out themselves.

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I've put off weighing in on this topic for as long as I can.  I really hate impossible "shall have" rules and regulations.  First you would need to know/calculate the body mass/blood volume of the patient.  Then you would need know the level of activity of the incompatible ABO antibodies in each unit of plasma going into that patient.  Then you would need to know the volume they are bleeding it back out.  All this to give you an accurate estimate of the volume of incompatible plasma you could "safely" give one specific patient.  I'm sure I've left out a factor or two but you get the gist of what I'm saying.  My minor level of OCD really whats me to do it right if I'm going to do it at all.  I had a non-technical lab director (BA in business) throw me out of his office for trying to explain why the request for certain data by a VP was not only impossible to accurately provide but was a stupid, worthless waste of time.  

This is one of those times where you and your lab director will have to make something up based on your best guess and basic instincts because there is no one size fits all answer to this.

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Agreed. Here's some new rules, now follow them. No guidance. At least they aren't asking for validation when you come up with your policy. That will come next.

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Due to the lack of definitive guidance via actual studies (Seriously, how can that be done?), we have taken a 'logic' approach with our policy (my comments for this posting in italics) :

Select Product in this order ...

Indated product using shortest outdate first.  (This means that plasma that is already thawed is used first, regardless of ABO Group as long as it is not Group O, see next rule.)

ABO Group: ABO compatible are preferred but not essential.  (And then there's a chart because it is a procedure and that has to have everything in it.)

  • Do not issue Group O to a Non-Group O or Group Unknown patient without the consent of a pathologist.
  • Caution: The use of ABO Incompatible plasma may cause significant hemolysis if sufficient volume is given (e.g. over 1000ml) within a 24 hour period.  Notify attending physician prior to ordering and/or issuing so an assessment could be made of the risk vs need when larger volumes are anticipated.  (And then instructions about how this is done and documented.)

 

 

 

 

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We start with A plasma for our traumas, so our MDs review for any adverse events if the patient ends up typing B or AB.  And we have that written into our policy. 

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