title: Are there any alternatives for transfusion of AB plasma as universal donor in an emergency release setting?
abstract: AB plasma is used as the universal donor plasma product in patients requiring massive transfusion. However, currently it is a recommended policy to transfuse plasma derived from male donors only as transfusion of plasma from HLA antibody-positive female donors is associated with an increased risk for transfusion-related acute lung injury. As a result, due to high demands, supplies of blood banks may run out of AB plasma, calling for alternatives. Therefore, the aim of this review was to investigate alternatives for emergency release of AB plasma as the universal donor.
  
  
  
  A systematic search was conducted in Embase and PubMed. Studies on adult patients, who were transfused with at least 1 unit of plasma, investigating the incidence of transfusion-related complications or mortality in patients transfused with ABO-identical, ABO-compatible, or ABO-incompatible plasma were eligible for inclusion. The primary outcomes were the incidence of transfusion-related complications and mortality.
  
  
  
  In total six studies were included. Transfusion of ABO-compatible plasma was associated with an increased incidence of lung injury and mortality (odds ratio, 1.10; 95% confidence interval, 1.04-1.15; p = 0.0003) compared to transfusion of ABO-identical plasma. No significant differences were observed regarding transfusion-related complications and mortality between patients transfused with ABO-compatible or ABO-incompatible plasma.
  
  
  
  Studies are insufficient to formulate advice about alternatives for transfusion of AB plasma as universal donor plasma in the emergency setting due to the small number of studies. The results of this review underline the need for further research.
authors.affiliation: Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.|Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Balvers
authors.affiliation: Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.|Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Sarah
authors.initials: S
authors.lastname: Saleh
authors.affiliation: Department of Hematology, Academic Medical Center, Amsterdam, the Netherlands.|Department of Immunopathology, Sanquin Research; Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Sacha S
authors.initials: SS
authors.lastname: Zeerleder
authors.affiliation: Laboratory for General Clinical Chemistry, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: J Henriette
authors.initials: JH
authors.lastname: Klinkspoor
authors.affiliation: Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: J Carel
authors.initials: JC
authors.lastname: Goslings
authors.affiliation: Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Nicole P
authors.initials: NP
authors.lastname: Juffermans
mesh_terms: D000017:ABO Blood-Group System; D001787:Blood Group Incompatibility / Q000150:complications* / Q000276:immunology; D004630:Emergencies; D006801:Humans; D010949:Plasma / Q000276:immunology; D065227:Transfusion Reaction
chemical_list: D000017:ABO Blood-Group System