Determinants and time to blood transfusion among thermal burn patients admitted to Mulago Hospital

Abstract

BackgroundBlood transfusion, a practice under re-evaluation in general, remains common among thermal burn patients due to the hematological alterations associated with burns that manifest as anemia. Today advocacy is for restrictive blood transfusion taking into account individual patient characteristics. We went out to identify the parameters that may determine transfusion requirement and the time to blood transfusion for thermal burn patients in Mulago Hospital in order to build statistics and a basis to standardize future practice and Hospital protocol.Methods112 patients with thermal burns were enrolled into a prospective cohort study conducted in the Surgical Unit of the Accidents and Emergency Department and Burns Unit of Mulago Hospital. Relevant data on pre-injury, injury and post-injury factors was collected including relevant laboratory investigations and treatment modalities like surgical intervention. Patients were clinically followed up for a maximum period of 28 days and we identified those that were transfused.Results22.3% of patients were transfused. The median time to transfusion was 17 days from time of injury and varied with different patient characteristics. The median pre-transfusion hemoglobin (Hb) level was 8.2 g/dL. Transfusion was significantly related to; admission to the intensive care unit (p = 0.001), a body mass index (BMI) <2 kg/m2 (p = 0.021), % total burn surface area (TBSA) >20 (p = 0.049), pre-existing illness (p = 0.046), and white blood cell (WBC) count <4000 or >12,000/μL (p = 0.05).ConclusionPre-existing illnesses, a low BMI, TBSA of >20%, admission to the intensive care unit and abnormalities in the WBC count are useful predictors of blood transfusion among thermal burns patients admitted to Mulago Hospital. The precise time to transfusion from time of burns injury cannot be generalized. With close monitoring of each individual patient lies the appropriateness and timeliness of their management.

Intraoperative transfusion practice in burned children in a university hospital over four years: a retrospective analysis

“…A multicenter retrospective study in a mixed population of adults and children with burn injury found that 75% of patients with TBSA > 20% received blood transfusion [ 20 ]. Another observational study evaluating predictive factors for blood transfusion in adults and children found TBSA > 20% is a useful predictor for blood transfusion [ 21 ]. Only few data are available to evaluate the association between TBSA and transfusion in an exclusively pediatric collective study like ours.…”

Evaluation of blood product transfusion therapies in acute injury care in low- and middle-income countries: a systematic review

“…With the far-reaching impacts of injuries in LMICs [ 1-5 , 29 ] and the limited available research from these settings, additional study of blood product therapies, which are key to combating injury-related mortality, is crucial for informing clinical practice and policy. [42] 3, 5 Low Javali (2017) [43] 3 Moderate Kilyewala (2017) [57] 3, 4, 5 Very Low London (2001) [41] 2, 4 Low Mofidi (2010) [47] 2, 4, 5 Very Low Musau (2006) [50] 3, 4 Low Newton (2015) [51] 1, 3, 4, 5 Very Low Otieno (2004) [52] 3, 4 Low Sadeghi (2017) [48] 2, 3 Low Saidi (2014) [53] 3, 5 Low Sokhal (2017) [44] 3, 5 Low Srikant (2003) [45] 1, 3, 4 Very Low Tavousi (2018) [49] 3, 5 Low Yanar (2008) [56] 3 There is substantial research, including well-performed RCTs from HICs, that has led to development of consensus guidelines on the use of blood products in the treatment of acute injuries [ 14-16 , 18 , 59 , 60 ] [ 8 , 18 , 61 , 62 ]. Even though the global burden of injuries lies predominantly in LMICs [ 1-5 , 29 ], this systematic review demonstrates that there is a paucity of high-quality research from these settings.…”

“…Included reports were derived from Ghana (1) [41] , India (4) [42][43][44][45] , Iran (4) [46][47][48][49] , Kenya (4) [50][51][52][53] , South Africa (2) [ 54 , 55 ], Turkey (1) [56] and Uganda (1) [57] . The cumulative number of patients studied in all reports was 6535.…”

Viral Infections in Burn Patients: A State-Of-The-Art Review

“…Therefore, usually, large amounts of blood are required to prevent impaired erythropoiesis and serious blood loss. Other factors, such as a burn greater than 20% of the TBSA, a low BMI status, and abnormal white blood cell counts, might be potential indicators during consideration for blood transfusion [ 139 ]. Tavousi et al showed that, in a group of 701 burn patients, the mortality rate was two times higher among patients who had received blood transfusions compared to groups that were not treated with any blood products [ 140 ].…”