[Factor XIII-guided treatment algorithm reduces blood transfusion in burn surgery]

Area of Science:

• Surgical hemostasis and coagulation science.
• Burn patient management and critical care.
• Transfusion medicine and blood product utilization.

Context:

• Major burn surgery is associated with significant hemorrhage and impaired coagulation.
• Current treatment algorithms often utilize rotational thromboelastometry (ROTEM) and factor VIIa but lack evidence for factor XIII's role.
• Factor XIII deficiency can compromise clot stability and impede wound healing in burn patients.

Purpose:

• To evaluate the efficacy and safety of correcting factor XIII deficiency in burn surgery.
• To assess the impact of factor XIII correction on perioperative transfusion requirements.
• To determine if routine coagulation tests can identify factor XIII deficiency.

Summary:

• A randomized retrospective study compared 40 burn surgery patients, with (Group A) and without (Group B) factor XIII assessment.
• Group A patients with preoperative factor XIII deficiency showed significantly reduced erythrocyte concentrate transfusions (1.95 vs. 4.05 units).
• Routine coagulation tests did not identify factor XIII deficiency, but its correction was safe and effective, reducing transfusions without thromboembolic events.

Impact:

• Correction of factor XIII deficiency is a safe and effective strategy to decrease perioperative erythrocyte concentrate transfusions in burn surgery.
• This intervention may optimize blood product management and improve patient recovery following major burn injuries.
• Highlights the limitations of standard coagulation tests in detecting factor XIII deficiency and suggests targeted assessment in burn patients.