Framework for Establishing the Use of Universal Low-Titer Group A Plasma

This post outlines a framework for establishing the use of low-titer group A plasma as a universal donor.  Manual titering large number of donor specimens in my organization is not practical.  Using an automated system will also increase the precision of the results.

Process:

  1. Select a cut-off anti-B titer.  This should be determined by the blood bank medical director.
    1. I selected saline 1:64 based on recent THOR (Thrombosis Hemostasis Oxygenation Research) meetings
  2. Perform a survey of the anti-B titers in your blood donor population.
    1. At my sites, about 50% had titers less than or equal to 1:64.
    2. Determine how stable the titer is:
      1. For serial donor plasmapheresis, how long could you accept the donor as low-titer?
      2. Does the titer change between whole blood donations?
  3. Determine the target inventory level for universal plasma (group AB and low-titer A) based on current/past usage.
  4. Assess availability of automated immunohematology analyzers for titration.
    1. Titration may take up to 30 minutes per sample, during which time the machine cannot be used for any other purpose.
  5. Add a new blood type AU (for group A universal) for plasma in your blood typing algorithm.
    1. AU should be used interchangeably with group AB.
  6. Software:
    1. Set up new truth table in your blood bank computer system.
    2. Validate the modification in your blood bank donor and patient modules.
    3. Update ISBT code for this new product, verify your transfusion service module can read this.

Special notes:

  1. At my last location, we had only 3 analyzers capable of doing the titration.  Thus, we could only do 6 titrations per hour at the expense of stopping all other testing.  You will have to coordinate the titration with your other immunohematology testing.  Also, verify if all these equipment interface to your production software.  In my system, any test (including titration) could be performed at any location and its results be used for production purposes.
  2. Donor ABO antibody titers may fluctuate.  I would not use previous results to qualify a donor to be AU.  I would repeat the anti-B titer each donor encounter.  If I collect donor plasmapheresis, I would determine for how long the titer can be used (see 2.2.1 above).

References:

  1. Technical Manual, Current Edition, Bethesda, MD, USA
  2. Standards for Blood Banks and Transfusion Services Current Edition, AABB, Bethesda, MD, USA
  3. Medinfo Hematos IIG Donor Production Module