Blood use in the burn unit: a possible role for erythropoietin

Recently, several of our patients have raised questions concerning the safety of blood transfusions and especially the transmission of human immunodeficiency virus infection. We have noticed a growing reluctance of patients to receive blood transfusions. This prompted us to review the use of blood in our burn unit for 530 patients who were admitted from 1987 to 1989. Our traditional reasons for transfusion have been either an ongoing hemorrhage that leads to hypotension or a hematocrit of less than 30%. For these reasons 131 (24.7%) of the 530 patients reviewed required transfusions. The average number of units transfused in patients who received blood was 10 (range 1 to 69). Three hundred ninety-nine patients (75.3%) did not require transfusions. We undertook a prospective preliminary trial of recombinant erythropoietin in five patients who were admitted to our burn unit over a 2-month period to evaluate whether this agent could lessen the transfusion requirements. Because no definite value is given in the literature as to what level of hematocrit is most appropriate for transfusion, we chose a hematocrit of 20% as our new indication for transfusion. Inclusion into the trial required a total body surface area burn of over 10% that required at least one operation. Five patients met the inclusion criteria. Administration of erythropoietin was started on admission. According to our new criteria for transfusion none of the five patients receiving erythropoietin required the transfusion of blood or blood products. This study would suggest the need for both a prospective clinical trial of erythropoietin and further studies to better define the indications for transfusions in patients with burns.