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Antithrombin (human) concentrate infusion in pediatric patients with >50% TBSA burns
Areta Kowal-Vern1, Barbara A Latenser
1Department of Trauma, Sumner L. Koch Burn Center, John H. Stroger Jr. Hospital of Cook County, 1901 West Harrison Street, Chicago, IL 60612, USA. avern@rcn.com
Insights
Antithrombin (human) concentrate infusions are safe and well-tolerated in pediatric burn patients. This treatment may reduce bleeding during eschar removal, aiding in burn wound healing.
Area of Science:
- Pediatric Burn Care
- Coagulation Management
- Pharmacology
Background:
- Antithrombin (human) [AT(H)] concentrate is used in adult burn patients to manage coagulopathy.
- Its safety and efficacy in pediatric burn patients are not well-established.
Observation:
- Two pediatric patients with severe burns received Antithrombin (human) [AT(H)] concentrate infusions.
- Patient 1: 2-year-old, 83% TBSA flame burn with inhalation injury.
- Patient 2: 14-month-old, 56% TBSA scald injury.
Findings:
- Both pediatric patients tolerated Antithrombin (human) [AT(H)] concentrate infusions well.
- Plasma AT levels significantly increased post-infusion, remaining elevated.
- One patient experienced minimal blood loss during eschar removal.
Implications:
- Antithrombin (human) [AT(H)] concentrate appears safe for pediatric burn patients in the acute injury phase.
- Potential benefits include reduced bleeding during eschar removal, assisting in burn excision and grafting procedures.
Background:
Antithrombin (human) [AT(H)] concentrate infusions have been safely utilized in adult burn patients to counteract subclinical disseminated intravascular coagulopathy and pulmonary complications.
Objective:
AT(H) concentrate was given to two thermally injured pediatric patients to evaluate safety and dosage requirements.
Design:
The first patient was a 2-year-old with 83% total burn surface area (TBSA) full thickness flame burn and severe inhalation injury. The second patient was a 14-month-old who sustained 56% TBSA deep partial and full thickness scald injury. Each child received 10 infusions of AT(H) concentrate (106 units/kg) in the first 4 days post-injury.
Result:
For these two patients, the plasma AT level (normal range: 100+/-20%) increased, respectively, from 25 and 66% on admission to 224 and 217% on day 1, 114 and 116% on day 2, and 193 and 171% on day 3. Both patients tolerated the infusions well. In one patient, the eschar on all four extremities easily peeled off the subcutaneous tissues along a natural demarcation between viable and non-viable tissue with only a 40cc estimated blood loss (EBL).
Conclusions:
AT(H) concentrate is tolerated in the pediatric population in the acute phase of injury. Lack of bleeding during eschar removal may be of benefit to burn excision and grafting.