The effect of allogeneic blood transfusion on burn mortality in a resource-limited setting

There are nearly 9 million new burn cases worldwide, with a disproportional burn burden in low- and middle-income countries. Patients with significant burn injury frequently require multiple blood transfusions; however, there is a paucity of data regarding the effect of allogeneic blood transfusion following burn injury in a resource-limited setting with a high anemia prevalence at baseline. This study aimed to determine the effect of blood transfusion on burn mortality.

We performed a retrospective review of patients presenting with burns between 2011 and 2019, using prospectively collected burn registry data from Kamuzu Central Hospital (KCH). We performed multivariate logistic regression modeling to identify predictors of mortality, and we considered potential confounders.

A total of 2359 patients were included. Mean age was 10 ± 14 with a male preponderance (58 %). The mean percent total body surface area burned (%TBSA) was 17.52 ± 14.46. 60 % of burns were caused by scald injuries and 37 % by flame. Below 40 % TBSA, our model predicted a higher probability of mortality for those transfused. However, above 40 % TBSA, the predicted probability of mortality is decreased for those transfused.

Allogeneic blood transfusion confers 1.23 (p < 0.03) times higher odds of mortality in burn patients. Mortality risk increased with age and units transfused. This study highlights the need for proper guidelines and protocols for allogeneic blood transfusion in burn patients. A more restrictive blood transfusion strategy may be more appropriate in a resource-limited setting.