P3.N276: Use of Group A Thawed Plasma in Emergency Transfusions at a Pediatric Trauma Center

Background: Plasma is frequently transfused in order to increase survival percentages in critical conditions. Problems arise for plasma transfusions because < 4% of Americans are AB positive, the universal donor. In order to prevent wastage in emergencies and provide better availability during emergency transfusions, we implemented 5-day group A thawed plasma at our level I trauma center in February 2022.

Methods: Frozen plasma is thawed and labeled with a 5-day shelf-life. We maintain thawed group A plasma units ready for immediate issue in the blood bank (from February 2021) and trauma code room (from August 2022). We do not perform titers. Once units are ≥3 days old, they can be used to fill non-emergency, ABO compatible orders to prevent wastage. In adult trauma practice, we allow group A plasma to be issued for patients with unknown blood type during emergency situations. We retrospectively reviewed clinical charts and laboratory results of plasma recipients. Patients with unknown blood types correlated with high mortality rates due to the severity of their condition and were thus separated from the survival percentages.

Results: Between January 2022 and June 2023, 88 emergency release plasma requests occurred for 68 patients (19 for trauma, 49 for either medical or surgery circumstances). Seventeen (17) out of 68 patients were of type B, AB, or unknown blood, receiving incompatible group A plasma. The ages ranged from 0-18+ years (some ages approximated based on clinical notes), and weights ranged from under 10 kg to over 50 kg. These patients did not have any significant differences in survival outcomes compared to those who received only compatible plasma (survival at 30 days: 40% vs 63.5%, p = 0.78). Twenty-five (25%) received over 70 mL per kilogram of plasma. Some plasma units might be issued but not entirely used, especially for low-weight preterm newborns. Even younger patients with a high amount of plasma transfused showed no signs of red blood cell hemolysis. Our average turnaround time for emergency release was below 2 minutes during the 12-month period. No increase in wastage (issued plasma not transfused) occurred upon thawed plasma implementation.

Conclusion: Incompatible Group A plasma was successfully transfused to emergency patients with groups B and AB blood with no adverse effects attributable to the plasma. Since January 2022, 5-day thawed plasma has been successfully implemented and continues to be used. Patient outcomes continue to be tracked in case of complications, however none relating to red blood cell hemolysis have appeared over the timespan of two years.