Agaronov Maksim, DiBattista Anthony, Christenson Ellen, Miller-Murphy Richard, Strauss Donna, Shaz Beth H
New York Blood Center, 310 East 67th Street, New York, NY 10065, USA.
New York Blood Center, 310 East 67th Street, New York, NY 10065, USA.
Transfus Apher Sci. 2016 Aug;55(1):141-5. doi: 10.1016/j.transci.2016.05.018. Epub 2016 Jun 16.
To alleviate the shortage of AB plasma, an alternative plasma product, low-titer group A plasma (LTGAP), is now available. The product is indicated for emergency transfusions when the patient's blood group has not been identified. The product's defining anti-B titers vary across institutions, and at our blood center we define <1:100 as low-titer.
We created two surveys and emailed them to hospital blood bank managers, supervisors, and medical directors who currently use LTGAP and those that have not ordered it. We calculated the amount of LTGAP that met our <1:100 cutoff. We searched our inventory database to obtain sales of LTGAP, AB, and all other types of plasma in 2014.
We learned from the surveys that the product is safe and being used as indicated for only life or limb-threatening emergencies until patient's blood group is known and specific products can be provided. Most common reasons for not using LTGAP were lack of need in non-trauma hospitals and limiting capabilities in blood bank software. Although sales of LTGAP increased by ~5% by end of the first year since introduction, sales of AB plasma remained relatively steady.
LTGAP appears to be a safe alternative to group AB plasma for emergency indications. By reviewing our percentage of group A plasma units that meet our low-titer cutoff and the current interest for the product, we can reduce the amount of units we titer each day by ~30% and can readjust that amount if there is increased interest. Besides lack of familiarity and limitations in computer software to incorporate LTGAP, the steady demand for AB plasma can potentially be attributed to trauma centers ordering more AB plasma than needed and potentially wasting it in nonurgent cases to avoid outdating the product and lack of institutional guidelines on when to switch from AB to type-specific plasma resulting in excess AB plasma being transfused.
为缓解AB型血浆短缺的问题，一种替代血浆产品——低滴度A组血浆（LTGAP）现已可供使用。该产品适用于患者血型尚未确定时的紧急输血。该产品的抗B滴度界定值因机构而异，在我们的血液中心，我们将<1:100定义为低滴度。
我们创建了两份调查问卷，并通过电子邮件发送给目前使用LTGAP的医院血库经理、主管和医学主任，以及那些尚未订购该产品的人员。我们计算了符合我们<1:100临界值的LTGAP数量。我们搜索了库存数据库，以获取2014年LTGAP、AB型及所有其他类型血浆的销售情况。
我们从调查中了解到，该产品是安全的，仅在危及生命或肢体的紧急情况下使用，直至确定患者血型并能提供特定产品。不使用LTGAP的最常见原因是非创伤医院没有需求以及血库软件功能有限。尽管自推出以来的第一年年底，LTGAP的销量增长了约5%，但AB型血浆的销量仍相对稳定。
对于紧急适应症，LTGAP似乎是AB型血浆的一种安全替代品。通过审查符合我们低滴度临界值的A组血浆单位比例以及当前对该产品的兴趣，我们可以将每天进行滴度检测的单位数量减少约30%，并且如果兴趣增加，可以重新调整该数量。除了对LTGAP缺乏熟悉度以及计算机软件纳入LTGAP存在限制外，AB型血浆的稳定需求可能归因于创伤中心订购的AB型血浆超过需求，并且可能在非紧急情况下浪费，以避免产品过期，以及缺乏关于何时从AB型血浆转换为特定血型血浆的机构指南，导致过量输注AB型血浆。
