Effect of blood transfusion on outcome after major burn injury: A multicenter study*

Abstract

The number of transfusions received was associated with mortality and infectious episodes in patients with major burns even after factoring for indices of burn severity. The utilization of blood products in the treatment of major burn injury should be reserved for patients with a demonstrated physiologic need.

Predicting postoperative haemoglobin changes after burn surgery

“…[4] The association between the number of units of blood transfused and increased morbidity, especially infectious complications, is of concern in the burn population. [8] Therefore, given the associated risks and cost, it is crucial that every unnecessary blood transfusion be avoided.…”

Should red cell transfusion be individualized? Yes

“…In an early epidemiological survey of 3534 patients admitted to 146 western European ICUs [2], RBC transfusion was found to be an independent risk factor for death after adjusting for possible confounding factors and in a propensity score-matched analysis [2]. Similar results were reported in trauma patients [11], in patients with burns [12], in patients undergoing cardiac surgery [13], and in patients with acute coronary syndromes [14]. More recent observational studies [1,15] gave different results.…”

Evaluating the appropriateness of blood component utilization in burns patients

“…12,13 Burn patients, not receiving blood transfusion, had fewer complications than patients receiving transfusion due to the fact that those not receiving transfusion have smaller burn injury and less inhalation injury. Survivors required fewer escharatomies and fasciotomies.…”

“…30 But other studies by Posluzny et al (16.6 units), Palmieri et al (13.7 units) and Gupta et al (8 units) showed a higher mean number of blood units transfused. 7,12,31 Most of the red cells transfused in burn patients in this present study belonged to second and third week of storage, which was similar to mean storage age of 16.2 days in the study by Vincent et al and 16-21 days by Aubron et al 30,32 The patient profiles in the present study had varied, from a patient who was conservatively managed without any blood component transfusion to an electrical burns patient, who was transfused with 25 units of red cells, 7 units of fresh frozen plasma and 1 unit of platelets and underwent 4 surgical procedures. Use of blood components when are they are not necessary, for example patients with minor or partial thickness burns, who can be managed with fluids only, constitutes inappropriateness.…”

“…Survivors required fewer escharatomies and fasciotomies. 12 The specific level of hemoglobin or hematocrit which dictates when to transfuse red cells is known as the 'Trigger'. But there is no one 'common trigger' with values ranging from 6 gm% to 8 gm% in different centers.…”