In a recent editorial, the case is made that transfusion of Group A plasma in recipients of unknown ABO blood group violates the precautionary principle. We disagree, but not necessarily because Group A plasma is the ideal resuscitation choice. The comparison being made is with Group AB plasma as the time‐honored “universal donor” plasma, because clinically evident hemolytic reactions are not seen with AB plasma, regardless of recipient ABO blood group. “Emergency release” transfusion recipients of unknown ABO group also invariably receive multiple universal donor Group O red blood cells (RBCs) (containing 20‐40 mL of plasma incompatible with 55% of recipients), one or more doses of ABO nonidentical platelets, and cryoprecipitate in typical North American transfusion practice. The ABO type of the plasma transfused may make little difference to patient outcomes given these realities. ABO‐mismatched plasma is universally going to be present in multiple components transfused, some plasma rich, regardless of whether Group AB or A plasma is selected. A typical trauma patient receives O RBCs and A (or O) platelets, which are antigen and/or antibody incompatible with 55 to 60% of recipients. These estimates do not take into account the secretor status of the donor. Even nonsecretors in
Transfusion – Wiley
Published: Jan 1, 2018
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