A serial study of the erythropoietic response to thermal injury

Since controversy exists over whether erythropoietin levels are increased or decreased after thermal injury, a prospective study was performed to answer this question as well as to characterize the erythropoietic response to thermal injury.

The concept of using erythropoietin to reduce the need for blood transfusions after thermal injury is attractive. However, since the etiology of burn anemia is both unclear and multifocal, prior to initiating a trial of erythropoietin therapy, it will be necessary to better define the erythropoietic response to thermal injury.

Twenty-four burn patients with a mean burn size of 31 +/- 18% had serial measurements of serum iron, total iron binding capacity (TIBC), ferritin, erythropoietin, transferrin saturation, hemoglobin, and reticulocyte counts performed on burn days 1, 3, 5, 7, 10, 14, and then weekly.

The erythropoietic response was characterized by a decrease in hemoglobin levels as well as serum iron, TIBC, and transferrin saturation (p < 0.05). Ferritin and erythropoietin levels increased as did the reticulocyte count. The erythropoietin response to anemia appeared to be at least grossly intact, since there was an appropriate inverse relationship between the degree of anemia and the magnitude of the erythropoietin response (r2 = .61, p < 0.00001).

Since the erythropoietin levels of these anemic burn victims reached supranormal levels and they manifested a moderate reticulocytosis, the role of replacement erythropoietin therapy after thermal injury requires further study.