The Anemia of Thermal Injury. I. Studies of Pigment Excretion 12

Abstract

Our interest in the metabolism of hemoglobin in patients with thermal injury was stimulated by early observations that (a) in spite of multiple whole blood transfusions anemia often developed rapidly in the first 96 hours after injury, and (b) in the protracted convalescence of a patient with only a small burn, moderate anemia inevitably ensued. The latter was exceptionally refractory to all except replacement therapy. With these two facts in mind we have undertaken our present study of the burn patient in an attempt to answer the following questions: (1) to what extent does hemolysis occur, and (2) Previous work on the same general problem has already been presented by Moore, Peacock, Blakeley, and Cope (1), who demonstrated an increased excretion of urobilinogen in the urine of four patients and an increased excretion in the feces in one patient. Similarly, the British workers, Anderson and Semeonoff (2), described increased excretion of urinary urobilinogen. Others have pointed out the potentiality of increased osmotic fragility and plasma hemolysis (3, 4) early in the post-burn period as well as agglutination and "sludging" of the red cells (5) in the peripheral circulation removed from the site of the injury.

The Anemia of Thermal Injury. Iii. Erythropoiesis and Hemoglobin Metabolism Studied With N15-Glycine in Dog and Man 1

“…This was in striking contrast to similar studies to be described later in the burned man where there were significant changes in serum iron, copper, and free erythrocyte protoporphyrin (vide infra). Figure 4 (dog 29) shows the same changes in fecal urobilinogen excretion and urinary coproporphyrin excretion which have been described in man following burns (1). From the time of the injury to the 10th day there was an increased fecal urobilinogen output.…”

“…of nitrogen and sufficient calories to maintain body weight under control conditions. Hemo- 1 This study was conducted under Contract Number DA 49-007-MD-99 between the Office of the Surgeon General, Department of the Army, Washington, D. C., and the Medical College of Virginia, Richmond, Virginia.…”

Studies of Radioiron Utilization and Erythrocyte Life Span in Rats Following Thermal Injury 1

“…The anemia which develops following thermal burns and the occurrence of a continuing anemia in burned patients and animals has been a frequent finding (1)(2)(3)(4). Studies in this laboratory have indicated that in burned rats there is a rapid reduction in circulating red cell volume following high intensity radiant energy thermal burns (4).…”

“…This reduction in red blood cell volume is followed by a period of increased red cell production as shown by the return of the circulating red cell volume to normal and by a significant reticulocytosis. Clinical studies in severely burned patients (2,3) have revealed evidence of an immediate reduction in the circulating red cell volume and frequently a continuing reduction of the red cell volume.…”

The Anemia of Thermal Injury. Ii. Studies of Liver Function 12

“…In a previous communication it was demonstrated that an increased excretion of urine urobilinogen was an early and constant finding in thermal injury even in burns of a relatively small amount of third degree (1). Since this particular finding was interpreted by us as a manifestation of hepatic injury, we undertook the further study of certain liver function tests in burned patients, none of whom received sulfonamides, tannic acid or other escharing therapy.…”