Blood Bank: Practice Question

A patient with a very high INR needs reversal from warfarin. Her blood is typed as B+, but FFP specific for the patient's blood type is currently unavailable. Which of the following can be used as a substitute instead?
  1. AB+ FFP
  2. O+ FFP
  3. O- FFP
  4. B+ cryoprecipitate
  5. AB- cryoprecipitate
Show Answer and Explanations

AB+ FFP — Correct answer

Correct. An AB+ plasma product does not contain anti-A or anti-B antibodies (AB individuals have both A and B antigens on their red cells, so they do not produce antibodies against these antigens). This makes AB plasma compatible with all blood types, making AB+ the universal donor for plasma products. When type-specific FFP is unavailable, AB+ FFP can be safely transfused to a B+ patient for warfarin reversal.

O+ FFP

Incorrect. An O+ person has antibodies in their plasma against A and B antigens. Transfusing O+ FFP to a B+ patient would introduce anti-B antibodies that could cause hemolysis of the patient's B+ red blood cells.

O- FFP

Incorrect. An O- person has antibodies in their plasma against A and B antigens. Transfusing O- FFP to a B+ patient would introduce anti-B antibodies that could cause hemolysis of the patient's B+ red blood cells. Note: Anti-D antibodies are not naturally occurring and would only be present if the person was previously sensitized.

B+ cryoprecipitate

Incorrect. Cryoprecipitate contains concentrated fibrinogen, factor VIII, vWF, and factor XIII, but lacks adequate amounts of the vitamin K-dependent clotting factors (II, VII, IX, X) that are depleted by warfarin. FFP contains all coagulation factors in plasma concentrations and is the appropriate product for warfarin reversal. Additionally, blood type matching is not the primary consideration for cryoprecipitate as it is for FFP.

AB- cryoprecipitate

Incorrect. Cryoprecipitate contains concentrated fibrinogen, factor VIII, vWF, and factor XIII, but lacks adequate amounts of the vitamin K-dependent clotting factors (II, VII, IX, X) that are depleted by warfarin. FFP contains all coagulation factors in plasma concentrations and is the appropriate product for warfarin reversal. Additionally, blood type matching is not the primary consideration for cryoprecipitate as it is for FFP.

Summary

Summary: For plasma products (FFP), AB+ is the universal donor because AB plasma lacks anti-A and anti-B antibodies, making it compatible with all blood types. In contrast, O plasma contains both anti-A and anti-B antibodies and cannot be used universally. Warfarin reversal requires FFP (which contains all coagulation factors including vitamin K-dependent factors II, VII, IX, X), not cryoprecipitate (which contains only fibrinogen, Factor VIII, Factor XIII, vWF, and fibronectin). O-: universal donor of RBCs. AB+: universal donor of plasma products
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