title: Balancing risk and benefit: maintenance of a thawed Group A plasma inventory for trauma patients requiring massive transfusion.
abstract: BACKGROUND
  Transfusion of plasma and red blood cell (RBC) units in a balanced ratio approximating 1:1 has been shown in retrospective studies to be associated with improved outcomes for trauma patients. Our low-volume rural trauma center uses a trauma-activated transfusion algorithm. Plasma is thawed upon activation to avoid wastage. However, the time required for plasma thawing has made achievement of a 1:1 ratio early in resuscitation challenging. In this study, the time required for plasma thawing is characterized, and a potential solution is proposed.
  
  
  METHODS
  A retrospective chart study of 38 moderately and massively transfused (≥6 U in the first 24 hours) trauma patients admitted from January 2008 to March 2012 was performed. We evaluated the time required to dispense plasma and the number of RBCs dispensed before plasma in these patients.
  
  
  RESULTS
  The average time between the dispense of RBCs and plasma was 26 minutes (median, 28; range, 0-48 minutes). The average number of RBCs dispensed before plasma was 8 U (median, 7 U; range, 0-24 U). Nearly one third of massively transfused patients had 10 RBCs or greater dispensed before plasma was available.
  
  
  CONCLUSIONS
  There exists the potential for delayed plasma availability owing to time required for thawing, which may compromise the ability to provide balanced plasma to RBC transfusion to trauma patients. Maintenance of a thawed Group AB plasma inventory may not be operationally feasible for rural centers with low trauma volumes. Use of a thawed Group A plasma inventory is a potential alternative to ensure rapid plasma availability.
  
  
  METHODS
  Therapeutic study, level V.
authors.affiliation: Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA.
authors.forename: Chelsea R
authors.initials: CR
authors.lastname: Mehr
authors.forename: Rajan
authors.initials: R
authors.lastname: Gupta
authors.forename: Friedrich M
authors.initials: FM
authors.lastname: von Recklinghausen
authors.forename: Zbigniew M
authors.initials: ZM
authors.lastname: Szczepiorkowski
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Dunbar
mesh_terms: D000017:ABO Blood-Group System; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001803:Blood Transfusion / Q000379:methods* / Q000706:statistics & numerical data; D002648:Child; D015925:Cryopreservation; D017707:Erythrocyte Transfusion / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006780:Hospitals, Rural / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D017713:Platelet Transfusion / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013997:Time Factors; D014193:Trauma Centers / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000628:therapy*; D055815:Young Adult
chemical_list: D000017:ABO Blood-Group System