Blood utilization in patients with burn injury and association with clinical outcomes (CME)

Abstract

BACKGROUND Uncontrolled bleeding is an important cause of increased transfusion in burn victims; however, description of blood utilization patterns in the burn population is lacking. STUDY DESIGN AND METHODS We conducted a single-institution, retrospective cohort study to measure blood utilization in 89 consecutive burn patients with 15–65% total body surface area (TBSA) burn within 60 days of injury. We also evaluated the relationship of blood product utilization with clinical variables including anticoagulant usage and mortality. RESULTS We determined that: (a) the predictors for increased packed red blood cells (PRBC) and plasma transfusions were high TBSA burn and the use of argatroban anticoagulation (for suspected heparin-induced thrombocytopenia); (b) TBSA burn and patient age were independent predictors of mortality, but not PRBC or plasma transfusion; and (c) the incidence of symptomatic venous thromboembolic events is not uncommon (11.2%), although heparin-induced thrombocytopenia is rare (1.1%). CONCLUSION Despite concerns about adverse correlation between increased number of transfusions and mortality in other clinical settings, we did not find this association in our study. However, we demonstrated that the type and intensity of anticoagulation carries substantial risk for increased PRBC as well as plasma usage.

Major burn injury is not associated with acute traumatic coagulopathy

“…As we have previously shown, the predictors for increased PRBC and plasma transfusions in burn patients are large TBSA burn and the use of systemic anticoagulation. 18 …”

“…We were also unable to determine the effect of surgery especially in patients with larger burns who do not only require large amounts of fluids for resuscitation but also are at risk for excessive perioperative bleeding requiring blood transfusions. 14–18 Lastly, while we were able to evaluate the laboratory tests of all patients on admission to determine whether ATC is detectable within 12 hours after injury, not all patients had daily laboratory studies to determine the hematologic profile of patients within the first 7 days; therefore, the observed trends may only be reflective of the laboratory values of patients who survived and had less severe injury rather than being a true representation of the hematologic response to burn injury.…”

“…For those patients that had these procedures performed, the administration of blood products, if any, was also recorded, since these patients may be at risk of excessive perioperative bleeding requiring blood transfusions. 14–18 …”

Factors affecting mortality among victims of electrical burns

“…In concomitant with our results, Caleman et al [23] defined the albumin transfusion requirement as a risk factor for mortality in burn patients. Lu et al [24] did not define the erythrocyte or plasma transfusion as a predictor of mortality in patients with a burn injury. Nevertheless, we have determined that erythrocyte, FFP, or albumin transfusion requirements were all associated with the increased risk of mortality in electrical burn patients.…”

Accurate Measurement of Intraoperative Blood Loss during Wound Excision Leads to More Appropriate Transfusion and Reduced Blood Utilization

“…Moreover, severe burn injuries are characterized by significant hemolysis, rapid fluid shifts and activation of inflammation and coagulation pathways potentially leading to coagulation system dysfunction and continued bleeding [17]. Because of these considerations burn patients were selected as an ideal population to study the impact of the novel system on red cell transfusion practice [18,19].…”