(P-PB-6) Blood Bank Survey on the use of A Plasma for Initial Trauma Resuscitation in Pediatric Patients

Avoiding acute severe hemolytic transfusion reaction due to blood donor-recipient ABO mismatch is the main reason for pre-transfusion crossmatching. Type AB plasma, which lacks both anti-A and anti-B, is preferred for emergency transfusions, especially for initial trauma resuscitation, when the ABO type is unknown. However, only 4% of the US population have type AB blood, so donors of this type are much less common than the potential need. In contrast, about 36% of the population have type A blood and 11% have type B.  Therefore, the chances of anti-B from type A plasma being given to a susceptible recipient would be at most 11%.  In an analysis of a US multicenter trauma registry, among >1500 patients who received A plasma for initial trauma resuscitation, only 8% received incompatible plasma, with no reports of hemolytic transfusion reaction. In fact, 91% of US adult Level 1 trauma centers use A plasma for initial trauma resuscitation. While older adolescents are sometimes seen at those centers, there is no data in pediatrics. Therefore, we aim to describe the current policies/practices and patient outcomes of using A plasma in initial trauma resuscitation in children.

Study

Design/Methods:

An online Qualtrics survey comprised of 18 questions was distributed to blood banks (BB) in US hospitals serving pediatric patients. Collected data was synthesized with Qualtrics and reported as frequencies and percentages.

Results/Findings:

A total of 22 BB (out of 78 emails sent out) responded, majority (81%) serving academic hospital/medical center and one BB serving both an academic and nonacademic hospital. 8/22 served only pediatric patients with 3/8 of them using A plasma for initial MTP and one did not answer. Most respondents (80%) stated that they use 1 plasma:1 red cell:1 apheresis platelet for their pediatric MTPs. 14 of 20 respondents use A plasma for initial trauma resuscitation, 2 did not answer this question. Among these, 2 restricted recipients by age ( >15 yo and >1 yo), 1 by those weighing >45 kg, and 1 by those aged >13 yo and >35 kgs and only if AB plasma was unavailable; 8 had no restrictions.  Post-transfusion, 7 of 12 checked for hemolysis if there are clinical signs, 6 as part of work up for reported transfusion reaction, 8 did not check for hemolysis, 1 checked DAT after every MTP, and 1 checked DAT after transfusing incompatible plasma. 7 of the 12 reported no hemolysis post-transfusion; 5 did not know if there was hemolysis. Of the 7 who don’t currently use A plasma, 3 were not willing to switch, 2 were willing but not yet planning, and 2 are planning to switch.

Conclusions:

As seen by our survey more than half (58%) of the responders did not identify any indication of hemolysis after using A plasma for initial trauma resuscitation. As more hospitals switch to A plasma for their pediatric traumas, more data will be available to evaluate the safety of A plasma in pediatric patients.