Blood Product Transfusion: Does Location Make a Difference?

Abstract

Early blood product administration during acute blood loss may improve outcomes, yet blood product transfusion for anemia of critical illness has been associated with increased mortality. After major burn injury, patients have two sources of anemia: massive acute blood loss during excision and insidious losses in the intensive care unit (ICU). The purpose of this study was to assess the relationship between the administration of fresh frozen plasma (FFP), platelets, and cryoprecipitate and outcomes in children with major burn injury. This was a retrospective review of children admitted with >20% TBSA burn from 2006 to 2009. Parameters measured included demographics, injury characteristics, operations, blood product transfusions, and outcomes. A total of 143 children received a mean of 3342 ± 283 ml blood. Nonsurvivors had larger burns (62.1 ± 4.6% vs 41.0 ± 1.5% TBSA, P < .001) and received similar amounts of packed red blood cells (PRBCs) during hospitalization (12.8 ± 2.4 units vs 10.9 ± 1.0 units, P = .5) than survivors. Nonsurvivors received more total units of FFP during hospitalization than survivors (8.0 ± 1.7 units vs 3.1 ± 0.4 units, P < .0001) because of the FFP units transfused in the ICU (5.5 ± 1.2 units vs 1.1 ± 0.2 units, P < .0001). The overall FFP:PRBC transfusion ratio in survivors was 1:4, whereas mean FFP:PRBC volume ratio in nonsurvivors was 3:4 (P < .0001). Nonsurvivors received more platelets (3.4 ± 1.0 units vs 0.50 ± 0.1 units, P < .001) and cryoprecipitate (1.9 ± 0.9 units vs 0.3 ± 0.1 units, P < .001) than survivors, both in the operating room and in the ICU. Blood product use in children with severe burns is associated with increased mortality. Appropriate use of blood products may need to be different in the operating room (massive acute hemorrhage) vs the ICU (ongoing red cell senescence).

Factors affecting mortality among victims of electrical burns

“…Nevertheless, we have determined that erythrocyte, FFP, or albumin transfusion requirements were all associated with the increased risk of mortality in electrical burn patients. Similar to our results, Palmieri et al [25] also defined an association of increased mortality with a blood product use in severe burns in childhood.…”

Prospective comparison of packed red blood cell–to–fresh frozen plasma transfusion ratio of 4

“…16 We reported that burned children receiving FFP had higher mortality and complications. 24 Given the retrospective nature of these studies, associations between FFP and outcome remain tentative, at best. Perhaps, most importantly, none of these studies address FFP transfusion in acute blood loss.…”

Plasma and Platelet Transfusion Strategies in Critically Ill Children Following Noncardiac Surgery and Critically Ill Children Undergoing Invasive Procedures Outside the Operating Room: From the Transfusion and Anemia EXpertise Initiative–Control/Avoidance of Bleeding

“…Two large point prevalence studies assessed plasma and platelet transfusion practices in large cohorts of critically ill children but did not independently report results for noncardiac surgical patients (9,16). The remaining analyzed literature included historical registry studies (28-30), a case series (31), an audit (32), prospective cohort studies (12,(33)(34)(35)(36)(37), and retrospective cohort studies (38)(39)(40)(41)(42)(43)(44)(45)(46). (9).…”