Etiology and Pathogenesis of Burn Anemia. The Role of the Blood Transfusion in the Treatment of Patients with Burns

Спиридонова, Т. Г.; Жиркова, Е. А.

doi:10.23934/2223-9022-2018-7-3-244-252

Neotložnaâ med. pomoŝʹ

2018

DOI: 10.23934/2223-9022-2018-7-3-244-252

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Etiology and Pathogenesis of Burn Anemia. The Role of the Blood Transfusion in the Treatment of Patients with Burns

Т. Г. Спиридонова¹,

Е. А. Жиркова²

Abstract: Отделение острых термических поражений ГБУЗ «НИИ скорой помощи им. Н.В. Склифосовского Департамента здравоохранения г. Москвы» Б. Сухаревская пл., д. 3, Москва 129090, Российская Федерация * Контактная информация: Спиридонова Тамара Георгиевна, научный консультант отделения острых термических поражений,.

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Cited by 5 publications

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“…Триггерный показатель уровня гемоглобина у тяжелообожженных больных для определения показаний к проведению гемотрансфузий эритроцитсодержащих компонентов составляет 90 г/л и менее. Соблюдение подобной тактики будет способствовать проведению адекватного лечения, своевременного оперативного вмешательства и профилактике осложнений [36].…”

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Modern aspects of the monitoring of a burn wound readiness for autodermoplasty

Zurnadzh'yants,

Kchibekov,

Ragimov

et al. 2024

jour

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The leading principle of burned patients’ treatment is to perform free autodermoplasty with split autodermografts. The main criterion for a successful plastic surgery is the percentage of engraftment of skin grafts. The issues of readiness of burn wounds for such surgical interventions continue to be studied and remain open at the present time. The degree of readiness of burn wounds for skin grafting is known to depend on many factors, among which the state of the microbial flora and the level of bacterial contamination of the wound surface play an important role as one of the main criteria for maintaining inflammation in the wound. The method of cytological examination of prints from burn wounds has found wide application, which is associated with the peculiarities of pathomorphological processes in burn wounds. Great importance is attached to studying the state of microcirculation in the wound using laser Doppler flowmetry in order to determine the perfusion and reparative ability of granulation tissue of a burn wound. However, in addition to local criteria, general condition of the body and the state of its immune system in particular should be taken into account. A great number of research works is devoted to the study of immune reactions in response to burn injury. The results of these studies also make it possible to identify certain criteria for predicting the success or chance of unsatisfactory outcomes of autodermoplasty. The levels of hemoglobin and total protein allowing to expect successful surgical treatment have been determined. In spite of the wide range of methods to determe the readiness of a wound for autodermoplasty, many of them are imperfect and nonspecific. The development of complications in the form of lysis or rejection of skin grafts, the maintenance of inflammatory processes, the development of a shortage of donor resources, mortality and the likelihood of developing severe cicatricial deformities in long-term results depend on the quality and timing of surgical treatment. Therefore, the problem of uniform criteria identification for the readiness of a burn wound surface for plastic surgery remains relevant for combustiologists and surgeons.

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unclassified

Modern aspects of the monitoring of a burn wound readiness for autodermoplasty

Zurnadzh'yants,

Kchibekov,

Ragimov

et al. 2024

jour

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Comparative evaluation of the informative value of methods for determining the volume of intraoperative blood loss in the surgical treatment of burn victims

Zinoviev

Vagner

Chukharev

2021

VESTNIK KHIRURGII IMENI I.I.GREKOVA

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The OBJECTIVE was to evaluate the informative value of various methods for determining the volume of blood loss during early surgical excision with simultaneous skin grafting with split grafts in patients with full thickness burns.MATERIAL AND METHODS. Our study included 10 patients with burns more than 20 % TBSA. In these patients, from the 2nd to the 5th day after the burn, fascial surgical excision with simultaneous skin grafting with perforated split grafts was performed. To assess the volume of operative blood loss, we used visual, empirical (B. S. Vikhriev; 1986, I. V. Chmyrev; 2011, T. A. Housinger; 1993, T. Janezic; 1997) and calculated (J. B. Gross; 1983, P. G. Budny; 1993, G. D. Warden; 1982) methods. The obtained data were processed by the generally accepted methods of nonparametric statistics.RESULTS. The minimum volume of blood loss was ascertained by visual assessment. We observed the maximum losses in the same patients when using calculated methods. In 5 out of 10 patients, the difference between the minimum and maximum results obtained using different methods exceeded 1000 %.CONCLUSION. Most of the methods used in burn surgery for determining the volume of surgical blood loss are insufficiently representative. To determine the optimal tactics for surgical treatment of patients with severe burns, it is necessary to create formulas for assessing the volume of blood loss, which will take into account laboratory parameters, features of surgical treatment, hydrobalance indicators, anthropometric data and other variables with high predictive value.

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Multicenter research of the dependence of skin graft engraftment and the concentration of blood hemoglobin, total serum protein and albumin

Vagner,

Zinoviev,

Soloshenko

et al. 2022

VESTNIK KHIRURGII IMENI I.I.GREKOVA

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The Objective was to evaluate the effects of the concentration of blood hemoglobin, total serum protein and albumin on skin graft engraftment frequency.Methods and Materials. The study included 186 patients with full-thickness skin burn more than 5 % of total body surface area who were treated in five different burn departments of the Russian Federation. Depending on the readiness of the wounds, all performed surgical treatments were divided into four groups: 1) simultaneous skin graft after tangential necretomy; 2) simultaneous skin graft after radical necretomy; 3) skin graft for granulation wounds; 4) skin graft for a long time existing pathologically (hyper)granulation. Venous blood was taken from all the patients 12 hours before and 12–24 hours after skin graft. The concentration of blood hemoglobin, total serum protein and albumin was determined in the obtained samples. The evaluation of skin graft engraftment frequency was carried out by a combined method on the 7th day after skin graft. The data obtained were processed using descriptive and nonparametric statistics.Results. The concentration of total serum protein (p=0.001) and albumin (p=0.000) had a significant impact on the skin grafting results. This relationship was most pronounced during skin grafting on granulating wounds and after radical necretomy. The data obtained were identical for meshed and non-meshed skin grafts. Decrease in hemoglobin concentration did not lead to a degradation of skin grafts (p=0.068) in any of the study groups. According to the results of the laboratory parameters ranking, it was found that maintaining the concentration of total serum protein more than 6 g/dL allows 1.3 times to improve the results of skin grafting, and albumin concentrations more than 3.5 g/dL – 1.4.Conclusion. During the study, we were unable to confirm the existence of a relationship between the concentration of blood hemoglobin and the results of skin graft engraftment by any of the statistical analysis methods in any of the study groups. Accordingly, the inability to transfuse erythrocytes to a patient with anemia below 9–8 g/dL cannot be considered as an absolute contraindication for early surgical treatment of burned patients. Apparently, the concentration of total serum protein and albumin has a much greater effect on the skin grafting results. Trigger values of total serum protein can be recognized as 6 g/dL (albumin – 3.5 g/dL), which provides good results of engraftment in at least 90 % of operated patients.

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Etiology and Pathogenesis of Burn Anemia. The Role of the Blood Transfusion in the Treatment of Patients with Burns

Cited by 5 publications

References 70 publications

Modern aspects of the monitoring of a burn wound readiness for autodermoplasty

Modern aspects of the monitoring of a burn wound readiness for autodermoplasty

Comparative evaluation of the informative value of methods for determining the volume of intraoperative blood loss in the surgical treatment of burn victims

Multicenter research of the dependence of skin graft engraftment and the concentration of blood hemoglobin, total serum protein and albumin

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