Requirements for cross-matched blood in burns surgery

Burn surgery and blood loss – a review

“…Dye (1993) suggested that if PRC were used instead of whole blood then the rest of the volume should be made up in human albumin or FFP. He stated that ordering by this protocol would cover the requirement for over 75% of cases.…”

“…It is therefore important to know how much blood is being lost during surgery so that the correct number of units of blood can be ordered and delivered. This has been shown to be most closely related to the area excised, but assessing the volume has been shown in several studies to be difficult (Desai et al, 1990; Dye, 1993; Budny et al, 1993; Brecher et al, 1997; Hart et al, 2001; Jeschke et al, 2007). The difficulty in estimating blood loss often leads to a disparity between the number of units cross-matched and the number of transfusions required.…”

“…The difficulty in estimating blood loss often leads to a disparity between the number of units cross-matched and the number of transfusions required. Under-ordering blood may leave patients dangerously anaemic, whereas over-ordering and over-transfusing is associated with an increased risk of immunosuppression and sepsis (Dye, 1993; Jeschke et al, 2007; Tricklebank, 2009). It also places a greater financial burden on the health service (Criswell and Gamelli, 2005; Rahe-Meyer et al, 2009).…”

“…One study by Brown et al (1995) at a centre in South Africa found that, despite awareness of the potential for unnecessary expenditure, 46% of their total year’s blood costs went on unutilised blood. While some studies advocate ‘eye-balling’ the volume of blood lost during surgery as the most exact method of assessing the required replacement (Budny et al, 1993; Criswell and Gamelli, 2005), others state that the inherent difficulties in monitoring intra-operative blood loss make this inaccurate (Desai et al, 1990; Dye, 1993; Brecher et al, 1997). This situation has highlighted the need for a method of determining, before the start of surgery, the likely blood loss a patient will suffer.…”

Anemia of Thermal Injury: Combined Acute Blood Loss Anemia and Anemia of Critical Illness

“…Therefore, these studies should be viewed in light of the surgical techniques used and transfusion thresholds in relation to current standard practice and matched to individual practice as best possible. Methods used to estimate surgical blood loss include combining differences in preoperative and postoperative hemoglobin concentrations with volume of transfusion, 16,17 simple estimates of blood loss by surgical and anesthesia teams, 18 measuring areas of grafting and debridement and dividing or multiplying by predetermined constants, 19–21 complex formulas based on patient age, weight, and area of excision, 22 weighing of laparotomy pads pre- and postoperatively, 23 and measurements from gowns and drapes using a swab washing machine. 21 Interestingly, Budny et al 18 compared blood loss using a calculation based on hemoglobin concentrations and transfusion volume with surgical and anesthesia team estimates and found that the surgical and anesthesia estimates were very close to calculated blood loss and may be just as reliable.…”