Jose DeJesus‘ November 9 question about providing plasma to an AB patientbecame a dinner-table discussion at my house. You may think, “What a sad, dull existence–a two-MLS family,” however, we’ve turned up some interesting information by communicating with acquaintances at three institutions.
First, if you can give incompatible platelet concentrate, why not incompatible plasma? There are few recorded instances in which platelet concentrate administration is followed by hemolysis. The answer may relate to product volume. Platelet concentrate therapy typically involves infusion of up to 300 mL of product per unit, similar to plasma, however there is a tendency to infuse multiple plasma units, exposing the recipient to greater hemolysis risk, whereas platelet products are administered more sparingly.
Second, why not give group A plasma? By coincidence, there is a current article, Isaak EJ, Tchorz KM, Lang N, et al. Challenging dogma: group A donors as “universal plasma” donors in massive transfusion protocols. Immunohematology 2011, 27:61–5, that suggests group A plasma with low-titer (< 1:16) anti-B antibody is safe to use as a universal donor plasma in acute blood loss. This article is a free download from theAmerican Red Cross. Further, by anecdote, transfusion service medical directors may choose to use low-titer group A plasma if AB is unavailable. The discussions we’ve had have been theoretical, apparently none of our acquaintances has actually had to use group A plasma in an AB recipient.
However, Isaak’s publication addresses acute blood loss, not hemorrhage secondary to warfarin overdose, where blood loss is probably not severe enough to warrant using the multiple transfusion protocol. For warfarin overdose with severe hemorrhage, recombinant activated coagulation factor VII (rFVIIa, NovoSeven) or an unactivated prothrombin complex concentrate (Proplex) may have the advantage of restoring coagulation without risking incompatibility.
Finally, plasma may not fully restore hemostasis, as it provides only at best normal coagulation factor activity. There is the possibility of reaching transfusion-associated circulatory overload by using multiple plasma units, without restoring the INR. For this reason, we fall back on the recommendations of the American College of Chest Physicians 2008 publication.