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 strategy markedly reduced transfusion volume, but found no statistically significant differencein the primary outcome of blood stream infections, or in secondary outcome measures, including mortality, length of stay, organ dysfunction, or wound healing.

In 2025 the American Burn Association released a guidelineon transfusion in burn patients,(4)broadly in line with the principles described above. They indicatea lack of strong evidence for EPO in these patients, similarly there is not enough evidence to recommend a 1:1:1 RBC:FFP:PLT strategy. Patient blood management practices are felt to beimportant, with consideration oflimitingof phlebotomy and use of TXA as required,

References

1. Koljonen V et al. The Use of Blood Products in Adult Patients with Burns.Scandinavian Journal of Surgery. 2016;105(3):178-185.
2. Palmieri TL et al: Effect of blood transfusion on outcome after major burn injury: A multicenter study.Crit Care Med2006;34:1602–1607.
3. TRIBE study
4. ABA guidelines