Hello everyone.  How was giving group A plasma for trauma patients (who don't have a historical ABO on file) implemented at your hospitals? Sorry if this was already addressed in an earlier post.  

MTP POLICY IS IN PLACE: USE A PLASMA IF AB IS NOT AVAILABLE. 

Edited September 22, 20186 yr by LIMPER55

We use type A liquid plasma (never frozen) for traumas and massive transfusions until type-specific/compatible can be thawed.

We give low titer liquid plasma to the traumas and hasn't been an issue. But right now it is only for the emergency pack that is sent to the ED waiting for the patient to arrive. And the first round of the MTP if we don't have a blood type. 

>emergency pack: 6 O+ or O= red cells, 4 liquid plasma and a pphl

>mtp: 4 red cells, 4 fp and 1 pphl ( could change depending on the PT, fibrinogen, hct or platelet count

When we do not have AB plasma or platelets we use type A on patients of unknown blood type but document the physician was notified on a deviation Form as it is not our normal protocol.  In MTP we notify the nurse who picks up the blood and she documents in the chart that she notified the physician.  Same when using O Pos instead of O Neg RBCs.

We reached out to the trauma team and discussed with them.  We discussed that we use non group platelets all the time, we studied the affects to these patients once we made the change in 2014 to present with no adverse concerns with the patient.  When it was approved by trauma, it was made into our MTP protocol and emergency release protocol.

On ‎9‎/‎25‎/‎2018 at 7:57 AM, JoyG said:

We reached out to the trauma team and discussed with them.  We discussed that we use non group platelets all the time, we studied the affects to these patients once we made the change in 2014 to present with no adverse concerns with the patient.  When it was approved by trauma, it was made into our MTP protocol and emergency release protocol.

We did the same, sharing the information about the availability of AB FFP and how the majority of patients are A or O. They agreed that we could make that change.

We went through all the various committees for approval - Trauma, Med Exec, Therapeutics, and 1 more I've forgotten the name of. The info was presented at a General Staff meeting by our medical director.

Use of A plasma is written into our SOPs for traumas and emergency release - basically, until we can type the patient and get type specific thawed, type A liquid plasma will be issued.

I am currently trying to implement this at my hospital. I do have a question for all of you at trauma centers: do you use the same form that the physician signs for emergency release as you do for an MTP? At our hospital many MTP's start out as emergency release, but we do have MTP's on patients in surgery sometimes and there's already a type and screen so no need to sign a form there. We are also trying to have the form in an electronic format that the physician will electronically sign. How do others handle Emergency Release vs. MTP?

Thanks in advance!

We have three electronic "uncrossmatched" orders that can be used:  Emergency Release, Initial Resuscitation Cooler (2 RBCs and 2 plasmas), and a MTP initiation.  These orders include physician documentation for uncrossed transfusions.

Scott

Given that the BB/BB Medical Director has the knowledge and background to determine transfusion safety and is responsible for blood transfusions that the MD's order, we simply wrote our policy.   Yes, sometimes we get questions from the infusionists, but the BB Staff can easily answer them.

We use a form (paper) that covers all kinds of things - emergency release uncrossmatched; warm auto w/ incompatible crossmatch; type A plasma emergency release; Rh positive blood released for Rh negative patient; etc. We fill out most of the form and the provider only has to put the reason for the request (like MVA, or whatever applies) and sign his/her name and date it. If it's something they are reluctant to sign for, our medical director will sign it if need be. The signature is not required prior to product issue for emergency release or other urgent situations. We do not require a signature for mass transfusion protocol as such, only if product is released uncrossmatched.

I am on the trauma committee where I brought up the idea of using A plasma instead of AB several years ago. The head Trauma physician was there and thought it was a great idea. He just wants plasma when he needs it. I approached our Medical Lab Director and had to provide him with documentation I found from Mayo so he felt better about it. Unfortunately, my pathologist limits us to only 2 until we have a confirmed blood type. I pushed for 4 but couldn't change his mind. I wrote up my policies and was done with it. I did not bring this up to nursing

We keep 2 A thawed at all times. We rotate it by sending thawed plasma to surgery when they need it and thaw out more. We discard very little except around holidays when there is not much surgery. It works for us.

On 9/23/2018 at 6:25 PM, Carrie Easley said:

We use type A liquid plasma (never frozen) for traumas and massive transfusions until type-specific/compatible can be thawed.

Will you be willing to share the Journal Reference(s) that supports(s) your policy?

5 hours ago, kelliott15506 said:

Will you be willing to share the Journal Reference(s) that supports(s) your policy?

• Chhibber V et al. Is group A plasma suitable as the first option for emergency release transfusion? Transfusion 2014;54:1751-5.
• Cooling L. Going from A to B: The safety of incompatible group A plasma for emergency release in trauma and massive transfusion patients. Transfusion 2014;54:1695-1697.
• Isaak EJ, et al. Challenging dogma-Group A donors as universal plasma in massive transfusion protocols. Immunohematology 2011;27:61-65 (NOTE: Free pdf download of full issue).
• Mehr CR, Gupta R, von Recklinghausen FM, et al. Balancing risk and benefit: maintenance of a thawed group A plasma inventory for trauma patients requiring massive transfusion. J Trauma Acute Care Surg 2013;74:1425-31.
• Zielinski MD et al. Emergency use of prethawed group A plasma in trauma patients. J Trauma Acute Care Surg 2013;74:69-75

 

Some of these are several years old.  A quick search will literally provide dozens of articles.  It was well publicized @ AABB 2018 and the Blood Bank Guy has a podcast from August 2017 that provides more info.

There was an article in Transfusion a few years ago.  I think the research came out of Pennsylvania.  Sorry, can't find the reference at the moment.  Mayo has a powerpoint called Emergent Use of Group A Thawed Plasma that I hope is still at this link. 

MayoMedicalLaboratories.com/hot-topics

On 10/10/2018 at 8:31 AM, JPSCANNELL f. CROKE said:

Given that the BB/BB Medical Director has the knowledge and background to determine transfusion safety and is responsible for blood transfusions that the MD's order, we simply wrote our policy.   Yes, sometimes we get questions from the infusionists, but the BB Staff can easily answer them.

We did the same.  Our Medical Director did send out a letter to all the physicians notifying them of the change, and we heard nothing from any of them about it.