Blood Transfusion and Burns

Anaemia is a common complication of burn injury and is usually multifactorial in nature. Causes include:

• Blood loss directly from the site of tissue damage and/or surgical management
• Dilution effect from fluid resuscitation
• Critical illness anaemia
• Serial venepuncture
• Reduced erythropoiesis. (1)

75% of those diagnosed with burns >20% total body surface areareceive packed red blood cells (RBCs). (2) The likelihood of transfusion increases with increasing patient age and inpatient mortality of burns patients if higher amongst transfused than non-transfused patients. (1)

The 2018 Transfusion Requirement in Burn Care Evaluation (TRIBE) study randomised burns patients to a liberal (maintain Hb 10-11gl/dl) or restrictive (maintain at 7-8g/dl) transfusion strategy. The restrictive strategymarkedly reduced transfusion volume, but found no statistically significant differencein the primary outcome of blood stream infections, or insecondary outcome measures, including mortality, pneumonia, urinary tract infection, wound infection, hospital length of stay, ICU length of stay, organ dysfunction, or wound healing.

References

1. Koljonen V, Tuimala J, Haglund C, et al. The Use of Blood Products in Adult Patients with Burns.Scandinavian Journal of Surgery. 2016;105(3):178-185.
2. Palmieri TL, Caruso DM, Foster KN, et al: Effect of blood transfusion on outcome after major burn injury: A multicenter study.Crit Care Med2006;34:1602–1607.
3. Palmieri TL et al.. Transfusion Requirement in Burn Care Evaluation (TRIBE): A Multicenter Randomized Prospective Trial of Blood Transfusion in Major Burn Injury. Ann Surg. 2017 Oct;266(4):595-602.