A pale, tired-looking 65 yo F presents to your ED c/o bright red blood per rectum. When taking her history, you find out she takes Coumadin.
The labs you order return; most notably, her INR is 7.2.
You call up the lab to start thawing some FFP.
They send Blood Type AB, but… your patient is Blood Type A.
Was there a mix-up? Nope…
A quick refresher from Medical School:
If you belong to the blood group AB, you have both A and B antigens on the surface of your red blood cells and no A or B antibodies at all in your blood plasma.
If you belong to the blood group 0, you have neither A or B antigens on the surface of your red blood cells but you have both A and B antibodies in your blood plasma.
So what if a Type AB pt were incorrectly given Type O donor FFP? Well, the plasma of the Type O would retain anti-A & anti-B antibodies in its plasma, which would go on to attack the pt’s Type AB RBC antigens:
When incorrectly-matched FFP is infused, the foreign (donor) plasma already has preformed antibodies against the patient’s native antigens (patient’s RBCs) already present… those antibodies are already made.
Other Quick Fixes –
We all know that the universal donor for packed red cells is “O” and in the case of females of child-bearing age, specifically O-neg PRBC. Many hospitals now have thawed PRBC’s available for immediate transfusion in the critically ill, specifically trauma patients. Most commonly O-neg is used. In study done at Maryland Shock Trauma (Dutton, J Trauma 2005. http://www.ncbi.nlm.nih.gov/pubmed/16394920) O-neg was only used for female pt’s of child-bearing age and O-pos for all other pts. There were no transfusion reactions noted in the almost 581 transfusions given to 181 pt’s.
1 unit PRBC is 225cc and generally raises Hct by 3
1 unit of FFP is 250cc with a standard dose of 10cc/kg (2-3units)
Apheresis FFP is 500 or 750cc from single donor
*Plasma carries anti-A/B antibodies and can theoretically hemolyze pt’s RBC’s
AB is the universal donor for plasma
1 unit of random donor plt’s = 25-50cc and increases Plt count by 5-8 thousand
1 unit of apheresis (single donor) plt’s = 6 units of random donor plt’s and increases plt count by 30-50 thousand
-don’t typically get type-specific b/c of the minimal risk of hemolysis ( <0.5cc RBC in a plt unit).
RBC – O = universal donor
FFP – AB = universal donor
AB positive = universal acceptor
Life in the Fast Lane demonstrates these concepts nicely: