Stevens W Tait, Morse Bryan C, Bernard Andrew, Davenport Daniel L, Sams Valerie G, Goodman Michael D, Dumire Russell, Carrick Matthew M, McCarthy Patrick, Stubbs James R, Pritts Timothy A, Dente Christopher J, Luo-Owen Xian, Gregory Jason A, Turay David, Gomaa Dina, Quispe Juan C, Fitzgerald Caitlin A, Haddad Nadeem N, Choudhry Asad, Quesada Jose F, Zielinski Martin D
From the Loma Linda University School of Medicine, Department of Pathology (W.T.S.) and Trauma Division, Department of Surgery (X.L.-O., D.T., Q.J.C.), Loma Linda, California; Emory School of Medicine, Department of Surgery-Grady Memorial Hospital (B.C.M., C.J.D., C.A.F.), Atlanta, Georgia; University of Kentucky (A.B., D.D.), Department of Surgery, Lexington, Kentucky; San Antonio Military Medical Center, Division of Trauma Critical Care (V.G.S.), Department of Pathology (J.G., J.Q.), and Uniformed Services University of the Health Sciences (P.M.C.), San Antonio, Texas; University of Cincinnati (M.G., T.P., D.G.), Cincinnati, Ohio; Department of Trauma Research, Medical City Plano, Plano, Texas; The Medical Center of Plano (R.D.), Plano, Texas; Conemaugh Memorial Medical Center (M.C.), Johnstown, Pennsylvania; Mayo Clinic, Department of Surgery; Division of Trauma, Critical Care and General Surgery; Rochester, Minnesota.
J Trauma Acute Care Surg. 2017 Jul;83(1):25-29. doi: 10.1097/TA.0000000000001532.
With a relative shortage of type AB plasma, many centers have converted to type A plasma for resuscitation of patients whose blood type is unknown. The goal of this study is to determine outcomes for trauma patients who received incompatible plasma transfusions as part of a massive transfusion protocol (MTP).
As part of an Eastern Association for the Surgery of Trauma multi-institutional trial, registry and blood bank data were collected from eight trauma centers for trauma patients (age, ≥ 15 years) receiving emergency release plasma transfusions as part of MTPs from January 2012 to August 2016. Incompatible type A plasma was defined as transfusion to patient blood type B or type AB.
Of the 1,536 patients identified, 92% received compatible plasma transfusions and 8% received incompatible type A plasma. Patient characteristics were similar except for greater penetrating injuries (48% vs 36%; p = 0.01) in the incompatible group. In the incompatible group, patients were transfused more plasma units at 4 hours (median, 9 vs. 5; p < 0.001) and overall for stay (11 vs. 9; p = 0.03). No hemolytic transfusion reactions were reported. Two transfusion-related acute lung injury events were reported in the compatible group. Between incompatible and compatible groups, there was no difference in the rates of acute respiratory distress syndrome (6% vs. 8%; p = 0.589), thromboembolic events (9% vs. 7%; p = 0.464), sepsis (6% vs. 8%; p = 0.589), or acute renal failure (8% vs. 8%, p = 0.860). Mortality at 6 (17% vs. 15%, p = 0.775) and 24 hours (25% vs. 23%, p = 0.544) and at 28 days or discharge (38% vs. 35%, p = 0.486) were similar between groups. Multivariate regression demonstrated that Injury Severity Score, older age and more red blood cell transfusion at 4 hours were independently associated with death at 28 days or discharge; Injury Severity Score and more red blood cell transfusion at 4 hours were predictors for morbidity. Incompatible transfusion was not an independent determinant of mortality or morbidity.
Transfusion of type A plasma to patients with blood groups B and AB as part of a MTP does not appear to be associated with significant increases in morbidity or mortality.
Therapeutic study, level IV.
由于AB型血浆相对短缺，许多中心已改用A型血浆来复苏血型未知的患者。本研究的目的是确定作为大量输血方案（MTP）一部分接受不相容血浆输血的创伤患者的结局。
作为东部创伤外科学会多机构试验的一部分，收集了八个创伤中心从2012年1月至2016年8月作为MTP一部分接受紧急发放血浆输血的创伤患者（年龄≥15岁）的登记和血库数据。不相容的A型血浆定义为输给B型或AB型患者。
在确定的1536例患者中，92%接受了相容血浆输血，8%接受了不相容的A型血浆。除不相容组穿透伤更多（48%对36%；p = 0.01）外，患者特征相似。在不相容组中，患者在4小时时输注的血浆单位更多（中位数，9对5；p < 0.001），住院期间总体输注量也更多（11对9；p = 0.03）。未报告溶血性输血反应。相容组报告了两例输血相关急性肺损伤事件。不相容组和相容组之间，急性呼吸窘迫综合征发生率（6%对8%；p = 0.589）、血栓栓塞事件发生率（9%对7%；p = 0.464）、败血症发生率（6%对8%；p = 0.589）或急性肾衰竭发生率（8%对8%，p = 0.860）无差异。两组在6小时（17%对15%，p = 0.775）、24小时（25%对23%，p = 0.544）以及28天或出院时（38%对35%，p = 0.486）的死亡率相似。多变量回归表明，损伤严重程度评分、年龄较大以及4小时时更多的红细胞输血与28天或出院时的死亡独立相关；损伤严重程度评分和4小时时更多的红细胞输血是发病的预测因素。不相容输血不是死亡率或发病率的独立决定因素。
作为MTP一部分，将A型血浆输给B型和AB型患者似乎与发病率或死亡率的显著增加无关。
治疗性研究，IV级。
