Trauma Patients Do Better With Identical Blood-Group Plasma

Using ABO-identical plasma in trauma patients lowers their rates of sepsis, renal failure, and other complications, according to a new study.

Researchers at the University of Southern California (UCS; Los Angeles, USA) conducted a retrospective study of all patients requiring plasma over an 8-year period at USC's level-1 trauma center. Propensity scores were used to match patients exposed to ABO-compatible plasma with those receiving exclusively ABO-identical plasma. The main outcome measures were mortality and complications such as acute respiratory distress syndrome (ARDS), sepsis, renal failure, and liver failure.

The researchers matched a total of 284 patients who received ABO-compatible nonidentical plasma with patients who received ABO-identical plasma only (230 in group O, 39 in group A, and 15 in group B). The researchers found that ABO-compatible plasma did not affect mortality; however, the overall complication rate was significantly higher for patients receiving ABO-compatible plasma (53.5% versus 40.5%), with ARDS and sepsis rates significantly increased. As the volume of ABO-compatible plasma infused increased, a stepwise increase in complications was seen, reaching 70% for patients receiving more than six units; patients receiving more than six units also had a four-fold increase in ARDS. While all recipient blood groups had an increase in overall complications, this was especially significant for group O recipients, with a higher risk of overall complications and ARDS. The study was published in the September 2010 issue of Archives of Surgery.

"Clearly, for most patients receiving plasma, this product is lifesaving and has allowed for decreased allogeneic transfusion requirements,” concluded lead author Kenji Inaba, M.D., and colleagues of the division of trauma and surgical critical care. "However, if outcomes can be improved by the transfusion of identical rather than compatible nonidentical plasma, technically this should drive a change in practice.”

Donor-recipient compatibility for plasma is the opposite of that for red blood cells (RBCs), so group O patients can receive group A, B, or AB plasma, while group A and B patients can receive AB donor plasma. Ideally, a patient with blood group A would receive A donor plasma, a group B patient would receive B donor plasma, group O patients would receive O plasma, and, although relatively rare, group AB patients would receive AB plasma. In reality, however, patients often receive ABO-compatible but not identical plasma.

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