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Blood transfusion in burns: what do we do?
Tina L Palmieri1, David G Greenhalgh
1Shriners Hospital for Children Northern California and University of California Davis Regional Burn Center, Sacramento, California 95817, USA.
The Journal of Burn Care & Rehabilitation
|January 17, 2004
Summary
Blood transfusion thresholds in burn care vary widely among physicians, with no established standard of care. Factors like burn severity, patient age, and cardiac conditions influence decisions, highlighting the need for further research.
Area of Science:
- Trauma Surgery
- Critical Care Medicine
- Transfusion Medicine
Background:
- Blood transfusions are common in burn patient management, with over 11 million units transfused annually in the US.
- Current data on appropriate blood transfusion thresholds for burn patients are limited.
- Burn centers lack standardized protocols for blood product administration.
Purpose of the Study:
- To investigate current blood transfusion practices and thresholds employed by burn center physicians.
- To identify factors influencing transfusion decisions in the management of burn injuries.
Main Methods:
- A 30-question survey was distributed to burn center directors, assessing demographics, burn care experience, and transfusion thresholds.
- Physicians reported factors affecting transfusion decisions and provided specific hemoglobin thresholds based on patient age and percentage of total body surface area (TBSA) burn.
- Case scenarios were used to evaluate the impact of physiological parameters on transfusion thresholds.
Main Results:
- A response rate of 31% (55 of 180 surveys) was achieved.
- The mean hemoglobin transfusion threshold reported was 8.12 g/dL (±1.7 g/dL).
- Key factors influencing transfusion decisions included ongoing blood loss, anemia, hypoxia, cardiac disease, and inhalation injury.
- Transfusion thresholds increased with higher TBSA burn, history of cardiac disease, acute respiratory distress syndrome, and patient age.
Conclusions:
- Significant variability exists in blood transfusion thresholds among burn center physicians.
- Patient-specific factors such as burn severity, age, and comorbidities influence transfusion decisions.
- The absence of a standardized care protocol necessitates further prospective research to establish evidence-based guidelines for blood transfusion in burn patients.