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

• Published in: Transfusion (Philadelphia, Pa.) Pa.), 2013-10, Vol.53 (10), p.2212-2221
• Main Authors: Lu, Rommel P., Lin, Feng-Chang, Ortiz-Pujols, Shiara M., Adams, Sasha D., Whinna, Herbert C., Cairns, Bruce A., Key, Nigel S.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age; Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anticoagulants - therapeutic use; Biological and medical sciences; Blood Transfusion - utilization; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis; Burns; Burns - mortality; Burns - therapy; Cohort Studies; Female; Humans; Linear Models; Logistic Models; Male; Medical sciences; Middle Aged; Mortality; Retrospective Studies; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Traumas. Diseases due to physical agents; Treatment Outcome; Venous Thromboembolism - epidemiology
• ISSN: 0041-1132; 1537-2995
• DOI: 10.1111/trf.12057

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% to 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: 1) the predictors for increased red blood cells (RBCs) and plasma transfusions were high TBSA burn and the use of argatroban anticoagulation (for suspected heparin‐induced thrombocytopenia [HIT]); 2) TBSA burn and patient age were independent predictors of mortality, but not RBC or plasma transfusion; and 3) the incidence of symptomatic venous thromboembolic events is not uncommon (11.2%), although HIT 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 RBC as well as plasma usage.