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Changes in transfusion practices in burn patients
R Mann1, D M Heimbach, L H Engrav
1University of Washington Burn Center, Harborview Medical Center, Seattle 98104.
The Journal of Trauma
|August 1, 1994
Summary
Burn patients received significantly less blood transfusions in 1990 compared to 1980. This change in practice, lowering hematocrit thresholds, did not negatively impact patient outcomes, reducing transfusion risks.
Area of Science:
- Trauma Surgery
- Transfusion Medicine
- Burn Care
Background:
- Historically, burn patients with >10% total body surface area (TBSA) burns received substantial blood transfusions.
- Concerns regarding transfusion risks prompted a re-evaluation of transfusion triggers, specifically questioning the necessity of maintaining hematocrits above 30%.
Purpose of the Study:
- To compare blood transfusion quantities in burn patients between 1980 and 1990.
- To assess the impact of revised transfusion practices on patient outcomes.
Main Methods:
- Retrospective review of medical records for burn patients with >10% TBSA requiring surgery.
- Comparison of transfusion volumes, patient demographics, surgical details, and hospital stay between 1980 (n=41) and 1990 (n=38).
Main Results:
- Blood transfused per square centimeter of excised surface area decreased from 1.2 mL in 1980 to 0.23 mL in 1990 (p < 0.0001).
- Blood transfused per patient per percent burn decreased from 133 mL in 1980 to 20 mL in 1990 (p < 0.0001).
- No significant differences were observed in patient age, timing of first excision, length of hospital stay, or extent of burn excision.
Conclusions:
- Revised transfusion protocols allowing lower hematocrit levels (15-25%) in burn patients significantly reduced blood transfusion volumes.
- These updated practices did not lead to adverse cardiac events like myocardial infarction or congestive heart failure.
- Lowering transfusion thresholds is a safe and effective strategy in managing burn patients.