(P-TS-104) Reducing Group AB Plasma Utilization in a Rural Trauma Center

Background/Case Studies: The expanded use of plasma given to massively bleeding patients during the past 20 years has contributed to the disproportionate use of group AB plasma. Only 4% of the US population is group AB, yet approximately 12% of plasma distributed is AB, straining blood collection and manufacturing capacity. This emphasizes the need for blood centers and hospitals to work together, in a sustainable and evidence-based manner, to conserve AB plasma and thereby optimize the transfusion-related outcomes of all plasma-using patient groups.

Group A plasma has the potential to relieve much of the current pressure on the AB plasma supply during management of severe and massive bleeding. The preponderance of existing evidence supports its use during at least the initial transfusion management of most emergently bleeding adult patients. This practice has been adopted by almost all large trauma centers; however, many rural trauma centers have yet to implement this practice. Herein we describe enhanced use of group A for all emergency release transfusions in a rural Level III trauma center.

Study

Design/Methods: On May 22, 2022 hospital policy was modified to allow for the routine transfusion of group A plasma to adult trauma/massively bleeding patients with unconfirmed ABO type. To assess the impact of this change, numbers and ABO types of plasma units transfused and outdated were compared during the 2-plus-year intervals immediately before and after this protocol change. Reported adverse reactions associated with incompatible plasma transfusions were also compared during the same periods.

Results/Findings: The table summarizes usage and outdate rates for group AB and A plasma over a five-year duration during which, approximately midway through, the abovementioned protocol change was implemented. No transfusion reactions associated with the use of ABO incompatible plasma were observed during the study period.

Parameter	Jan. 1, 2020 – May 21, 2022	May 22, 2022 – Dec. 31, 2024
AB PLASMA
Transfused	688 (44.5%)	250 (12.7%)
Outdated	253 (64.2%)	88 (16.6%)
A PLASMA
Transfused	314 (20.3%)	1329 (67.6%)
Outdated	47 (11.9%)	300 (56.7%)
TOTAL PLASMA
Transfused	1545	1967
Outdated	394	529

Conclusions: Implementing a policy to initially provide group A plasma, rather than AB, to emergently and massively transfused adult patients led to a 31.8% absolute reduction in group AB plasma utilization without a measurable increase in adverse effects while also ensuring our severely bleeding patients continue to receive appropriate transfusion support. This practice will contribute to reduced strain on the limited group AB plasma supply while maintaining therapeutic efficacy and patient safety. It is recommended that all rural facilities that have not done so establish similar processes.