Anemia of Thermal Injury: Combined Acute Blood Loss Anemia and Anemia of Critical Illness

Posluszny, Joseph A.; Gamelli, Richard L.

doi:10.1097/bcr.0b013e3181d0f618

Cited by 55 publications

(51 citation statements)

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“…In sub-Saharan Africa, with the existing endemic falciparum malaria and malnutrition there exists a baseline anemia prevalence rate between 57 and 77% in children less than 11 years [23]. Additionally, anemia is also a consequence of severe burn [24]. The opponents of early excision when it was first practiced were mainly concerned with the associated massive blood loss [25].…”

Section: Discussionmentioning

confidence: 99%

Timing of early excision and grafting following burn in sub-Saharan Africa

Gallaher¹,

Mjuweni²,

Shah³

et al. 2015

Burns

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Background This study sought to establish appropriate timing of burn wound excision and grafting in a resource-poor setting in sub-Saharan Africa. Methods All burn patients (905 patients) admitted to Kamuzu Central Hospital (KCH) Burn Unit in Lilongwe, Malawi over three years (2011–2014) were studied. Results 275 patients (30%) had an operation during their admission. In patients who received an operation, median age was 5 years (IQR, 2.7–19) and median total body surface area burn was 15% (IQR, 8–25). 91 patients (33%) had early excision (≤5 days) and 184 patients (67%) had late excision (>5 days). Mortality was significantly greater in the early group (25.3% vs. 9.2%, p = 0.001). Controlling for total body surface area burn and age, the adjusted predictive probability of mortality were 0.256 (CI 0.159–0.385) and 0.107 (CI 0.062–0.177) if operated ≤5 and >5 days, respectively ( p = 0.0114). The odds ratio for mortality if operated >5 days is 0.34 (CI 0.15–0.79, p < 0.000). Conclusions Early excision and grafting in a resource-poor area in sub-Saharan Africa is associated with a significant increase in mortality. Delaying the timing of early excision and grafting of burn patients in a resource-poor setting past burn day 5 may confer a survival advantage.

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Section: Discussionmentioning

confidence: 99%

Timing of early excision and grafting following burn in sub-Saharan Africa

Gallaher¹,

Mjuweni²,

Shah³

et al. 2015

Burns

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“…[7] The global acceptance of a restrictive approach to blood transfusion has led to its adoption in most burn surgery units. [4] The association between the number of units of blood transfused and increased morbidity, especially infectious complications, is of concern in the burn population.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the postoperative inflammatory response from major burn surgery affects haemostasis and results in ineffective haematopoiesis, all of which have an impact on Hb changes. [7] Moreover, this study has not considered depth and location of burn wounds, surgical experience and technique, presence of infected wounds, and time from burn injury to surgery. However, the factors that were included in the regression model represent the most commonly collected and clinically significant factors.…”

Section: Discussionmentioning

confidence: 99%

Predicting postoperative haemoglobin changes after burn surgery

et al. 2017

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Background. Burn surgery is associated with significant blood loss and fluid shifts that cause rapid haemoglobin (Hb) changes during and after surgery. Understanding the relationship between intraoperative and postoperative (day 1) Hb changes may assist in avoiding postoperative anaemia and unnecessary peri-operative blood transfusion. Objective. To describe the Hb changes into the first day after burn surgery and to identify factors predictive of Hb changes that would guide blood transfusion decisions. Methods. This was a single-institution, retrospective cohort study that included 158 patients who had undergone burn surgery. Hb was measured at the start and end of surgery, and on the first day (16 -32 hours) after surgery, and the results were analysed. Peri-operative factors (Hb at the end of surgery, total body surface area operated on (TBSA-op), fluid administration and intraoperative blood administration) were evaluated to determine their association with Hb changes on the first day after surgery. Results. The mean (standard deviation) preoperative Hb was 10.6 (2.29) g/dL, the mean postoperative Hb was 9.4 (2.01) g/dL, and the mean Hb on the first day after surgery was 9.2 (2.19) g/dL. Median total burn surface area was 7% (interquartile range 9%, min. 1%, max. 45%), with a mean body surface area operated on (debridement area plus donor area) of 9.7%. Of the 158 patients, 26 (16%) had an Hb <7 g/dL (transfusion trigger) on the first day after surgery. For patients with a high (≥9 g/dL), intermediate (≥7 -<9 g/dL), or low (<7 g/dL) Hb measurement at the end of burn surgery, those with an Hb below the transfusion trigger on the first day after burn surgery were 0%, 27%, and 75%, respectively. End-of-surgery Hb and TBSA-op strongly predicted the first day Hb level. In the intermediate group, 55% of patients with a TBSA-op ≥11% had an Hb below the transfusion trigger on the first day after surgery. Conclusion. Hb at the end of burn surgery was the best predictor of Hb on the first day after surgery. Patients with an Hb <7 g/dL remained as such on the first postoperative day. Half of the patients with an end-of-surgery Hb ≥7 -<9 g/dL and who had ≥11% TBSA-op had an Hb <7 g/dL on the first postoperative day.

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“…19,20 Some data suggest that erythropoiesis in the bone marrow is dampened after a burn injury, leading to a decrease in overall erythrocyte production. 4,5 Studies in the critical care literature indicate that blood loss from phlebotomy may contribute as well.…”

Section: Discussionmentioning

confidence: 99%

Classifying Transfusions Related to the Anemia of Critical Illness in Burn Patients

Posluszny

Conrad

Halerz

et al. 2011

Journal of Trauma: Injury, Infection &Amp; Critical Care

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Background Critically ill patients require transfusions because of acute blood loss and the anemia of critical illness. In critically ill burn patients, typically, no distinction is made between transfusions related to acute surgical blood loss and those related to the anemia of critical illness. We sought to identify the percentage of blood transfusions due to the anemia of critical illness and the clinical characteristics associated with these transfusions in severely burned patients. Methods Sixty adult patients with ≥20% total body surface area (TBSA) burn who were transfused at least 1 unit of packed red blood cells during their hospitalization were studied. Clinical variables including age, %TBSA burn, Acute Physiology and Chronic Health Evaluation (APACHE) II score, number of ventilator days, inhalation injury, and number of operative events were correlated with the total number of packed red blood cell units and percentage of nonsurgical transfusions in these patients. Nonsurgical transfusions were defined as transfusions occurring after postoperative day 1 for each distinct operative event and were classified as being caused by the anemia of critical illness. Results Patients were transfused an average of 16.6 units ± 21.2 units. Nonsurgical transfusions accounted for 52% of these transfusions. APACHE II score, %TBSA burn, number of ventilator days, and number of operative events, all correlated with total transfusions. However, nonsurgical transfusions correlated with only APACHE II score (p = 0.01) and number of ventilator days (p = 0.03). There was no correlation between nonsurgical transfusions and other clinical variables. Conclusion The anemia of critical illness is responsible for >50% of all transfusions in severely burned patients. The initial severity of critical illness (APACHE II score) and duration of the critical illness (number of ventilator days) correlated with transfusions related to anemia of critical illness. Further investigation into the specific risk factors for these transfusions may help to develop strategies to further reduce transfusion rates.

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Anemia of Thermal Injury: Combined Acute Blood Loss Anemia and Anemia of Critical Illness

Cited by 55 publications

References 100 publications

Timing of early excision and grafting following burn in sub-Saharan Africa

Timing of early excision and grafting following burn in sub-Saharan Africa

Predicting postoperative haemoglobin changes after burn surgery

Classifying Transfusions Related to the Anemia of Critical Illness in Burn Patients

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