Adding AB Plasma Units to Emergency Release O Negative Red Blood Cells (RBC) Issued to the Emergency Department (ED)

Recent studies have shown improved mortality and decreased early coagulopathy in trauma patients with administration of RBCs, platelets and fresh frozen plasma in a 1:1:1 ratio (Shaz BH et al. Transfusion 2010;50:493–500). As a result, massive transfusion protocols (MTP) have become common at large academic institutions with level I trauma programs. Our institution recently added 2 units of AB plasma to our standard ED trauma cooler which contains 2 units of O negative RBCs and which is ordered by ED staff upon notification of an incoming trauma patient. The treating physicians can escalate blood component support by ordering an MTP if indicated. The purpose of this study was to assess the use and wastage of plasma and RBCs in the ED trauma cooler.

Orders received for the trauma cooler from January 1 2011 to June 30 2011 at a large academic Trauma I center were reviewed retrospectively. Transfusions of RBC and plasma for each order were assessed as well as wastage of plasma or RBCs not transfused. Patients may have used more blood products than initially issued in the ED trauma cooler.

Ninety one orders were received for an ED trauma cooler during the 6-month period assessed. Fifteen (16%) of 91 orders resulted in transfusion of RBCs. Nine (10%) of 91 orders resulted in transfusion of plasma. Five of 182 (3%) plasma units issued were wasted because temperature parameters were exceeded before return to the transfusion service (TS). No untransfused RBC units were wasted and all were returned to available inventory. See table. The 15 O negative RBC units transfused from the ED trauma cooler during this time period represent 0.8% (15/1891) of our medical center's transfused O negative RBC units, and the 14 AB plasma units transfused or wasted from the ED trauma cooler represent 2% (14/573) of the AB plasma units transfused by the TS.

Of the 48 academic hospitals participating in the 2009 University Health System Consortium (UHC) Efficient Blood Management Benchmarking Project, the published mean wastage of plasma was 3.36% (range 0.36% – 9.44%). Our 3% wastage rate for AB plasma in the ED trauma cooler was within this range. The addition of 2 units of AB plasma to the ED trauma cooler with 2 units of O negative RBCs was feasible at our institution with acceptable wastage of plasma and no undue strain on our supply and inventory of donor O negative RBC and AB plasma.

No relevant conflicts of interest to declare.