Impact of ABO-Identical vs ABO-Compatible Nonidentical Plasma Transfusion in Trauma Patients
ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX
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Hypothesis Exposure to ABO-compatible nonidentical plasma will result in worse outcomes than transfusion with ABO-identical plasma only. Design Retrospective study. Setting Level I trauma center. Patients All patients requiring plasma from 2000-2008 were identified. Propensity scores were used to match patients exposed to ABO-compatible plasma with those receiving exclusively ABO-identical plasma. Main Outcome Measures Mortality and complications acute respiratory distress syndrome ARDS, sepsis, renal failure, and liver failure. Results A total of 284 patients who received ABO- compatible nonidentical plasma were matched 11 with patients who received ABO-identical plasma only 230 group O, 39 A, and 15 B. ABO-compatible plasma did not affect mortality 35.2 vs 33.5, P .66. However, the overall complication rate was significantly higher for patients receiving ABO-compatible plasma 53.5 vs 40.5, P .002. The ARDS and sepsis rates were also significantly increased 19.4 vs 9.2, P .001, and 38.0 vs 28.9, P .02, respectively. As the volume of ABO- compatible plasma infused increased, a stepwise increase in complications was seen, reaching 70.0 for patients receiving more than 6 U. Patients receiving more than 6 U also had a 4-fold increase in ARDS. All recipient blood groups had an increase in overall complications, ARDS, and sepsis with exposure. This was significant for group O recipients with a higher risk of overall complications and ARDS 50.9 vs 40.0, P .03, and 17.4 vs 7.8, P less than .001, respectively. Conclusions Exposure to ABO-compatible plasma results in an increase in overall complications, in particular ARDS and sepsis. There is a stepwise increase in the complication rate as exposure increases. Further prospective evaluation of the impact of limiting factor replacement to ABO-identical plasma only as warranted.
- Anatomy and Physiology
- Medicine and Medical Research