Does anyone currently have a policy regarding the use of A FFP for ungrouped patients in emergent situations where the facility is running out of AB FFP? 

 

We are trying to develop a policy here, after a weekend of multiple traumas when we already were short on AB FFP.

 

Thanks, Scott

No policy yet, but here's a couple good articles, if you don't have these already.

Jnl Trauma Balancing Risk and Benefit article.pdf

Jnl Trauma Emergency Use of group A plasma.pdf

We do in the UK (but that is probably no help to you), but I am not back in my office until Friday.

We are a Level II trauma center. We keep 2 group A and 1 group B plasma thawed at all times. We rarely discard these thawed plasma because we rotate them to surgery as needed and thaw more. Surgery has gotten used to being able to get plasma faster so they are happy too. We only keep 6 AB FFP in the freezer at any time.

 

Most traumas that pass thru our doors do not have previous blood types in the computer so there was always a delay to thaw group AB FFP until we had a blood type. I approached the main trauma physician and asked him if he had any issues with giving type A plasma. He was all for it since it would cut the time delay to almost nothing.

 

I talked it over with the Lab medical director who was a bit hesitant but I provided information for him to read. My lab director almost croaked when I told him my plans. I had to reassure him by letting him know we have been issueing non-group specific platelets to patients for years without issues. It also helped that one of our sister hospitals had already gone to this policy

 

Our policy states that we may issue up to 2 group A plasma to a patient of unknown type in an emergency. That should give us time to get a blood type on the patient to begin to start thawing type specific. The computer is set up to allow us to issue group A with a warning that we must override.

 

I feel better because we can provide some thawed FFP in a hurry along with the RBC. We will always be behind in a massive trauma but at least we are not so far in the hole.

Mayo clinic air flights have been issuing prethawed A plasma in the field since 2008.  We plan to stock 4 A liquid plasma for our Massive Transfusion Protocols and emergency release.  Our docs are fine with it.

Yes we also stock liquid plasma type A to be used only for emergency release or MTP.

We are a Level II trauma center. We keep 2 group A and 1 group B plasma thawed at all times. We rarely discard these thawed plasma because we rotate them to surgery as needed and thaw more. Surgery has gotten used to being able to get plasma faster so they are happy too. We only keep 6 AB FFP in the freezer at any time.

 

Most traumas that pass thru our doors do not have previous blood types in the computer so there was always a delay to thaw group AB FFP until we had a blood type. I approached the main trauma physician and asked him if he had any issues with giving type A plasma. He was all for it since it would cut the time delay to almost nothing.

 

I talked it over with the Lab medical director who was a bit hesitant but I provided information for him to read. My lab director almost croaked when I told him my plans. I had to reassure him by letting him know we have been issueing non-group specific platelets to patients for years without issues. It also helped that one of our sister hospitals had already gone to this policy

 

Our policy states that we may issue up to 2 group A plasma to a patient of unknown type in an emergency. That should give us time to get a blood type on the patient to begin to start thawing type specific. The computer is set up to allow us to issue group A with a warning that we must override.

 

I feel better because we can provide some thawed FFP in a hurry along with the RBC. We will always be behind in a massive trauma but at least we are not so far in the hole.

Debbie, I really like your plan. So when you thaw your 2 type A and 1 type B, do you extend them to thawed plasma (5 day outdate)?

_{Thanks for your responses.}

 

_{As Molly indicated above, The Mayo Clinic did a nice job of validating the use of A FFP in emergent situations.  They have video explaining the process and reasoning here if anyone is interested:}

 

_{http://www.mayomedicallaboratories.com/articles/hot-topic/2014/03-15-group-a-thawed-plasma/}

 

_Scott

Edited September 30, 20159 yr by SMILLER

Thanks Terri, Debbie and Scott - good info.

Yes, we extend all our plasma to 5 day expiration. The info that I gave my Medical Director was from the Mayo clinic so he wasn't so hesitant.

 

We keep the thawed plasma on the top shelf of our crossmatched refrigerator. We have these little squares of paper with several blank lines. We write the expiration date on the lines. When we hand them out, we immediately thaw more. If the expiration date changes when we thaw the replacements, we cross out the old exp date and write the new one down on the little square. If we are thawing FFP to replace, we use a magnet to clip the paper square to the waterbath so everyone knows the FFP is to replace the trauma plasma. Sending them to surgery as needed keeps us from discarding a bunch. If someone uses the FFP for a surgery, it is their responsibility to pop more in the waterbath. The little squares of paper have several lines so we could use them multiple times because we are cheap.    That is how we deal with always keeping some ready and it works pretty well for us.

We keep two AB thawed plasma for regular emergency release and pediatric traumas, but for any other traumas, or in the case of a massive transfusion in OR or on the floor, we use all A plasma. We use those when they get short on any patient and put a note for night shift to thaw two more after midnight so we get an extra day on the replacements.

 

We keep between 6 and 12 liquid plasma (never frozen, 26 day expiration) to be stored in our trauma bay refrigerator and in our blood bank refrigerator, so they have a couple of batches (we do 6 PC, 6 FFP per batch, with a platelet every other batch) ready immediately in most situations. After that, we thaw A plasma and give O packed cells.

 

We find that the easiest thing for us to do is stick to O packed cells and A plasma throughout the MTP -- we have plenty of those types available and in the event that there are multiple bleeders at once, IF a cooler gets switched, there's less risk.

We use HT negative group A units

We use HT negative group A units

 

Ah, yes, I should mention that when we went live with this last year, our blood supplier made segs for us on the first 200 units of liquid plasma we received and we did titers -- more than 80% were <64, if I remember correctly. We also log all patients who receive emergency release blood at our hospital, largely so we can do chart audits to make sure the emergency release form makes it onto the file, signed, but also so that we can catch the rare B and AB patients who receive group A plasma. If those patients survive long enough, we wait until the massive transfusion is over and draw some fresh samples for a DAT, hepatic panel, and we always do free anti-A testing before switching them over to B or AB units. We've not collected much data from that simply due to the fact that B and AB patients are fairly rare and about half passed during the MTP simply due to the nature of their injuries.

_{Does anyone have the article from Transfusion from July, 2014 about this they can share? Any other publications? I'm trying to find out how widespread this practice is, is this the new normal?}

YES. We are keeping 3 A plasma in ER and OR ref. along with uncrossmatch blood.

_{Match, see my post above about the video from Mayo.}

 

_Scott