Abstract
BackgroundBlood transfusion, a practice under re-evaluation in general, remains common among thermal burn patients due to the hematological alterations associated with burns that manifest as anemia. Today advocacy is for restrictive blood transfusion taking into account individual patient characteristics. We went out to identify the parameters that may determine transfusion requirement and the time to blood transfusion for thermal burn patients in Mulago Hospital in order to build statistics and a basis to standardize future practice and Hospital protocol.Methods112 patients with thermal burns were enrolled into a prospective cohort study conducted in the Surgical Unit of the Accidents and Emergency Department and Burns Unit of Mulago Hospital. Relevant data on pre-injury, injury and post-injury factors was collected including relevant laboratory investigations and treatment modalities like surgical intervention. Patients were clinically followed up for a maximum period of 28 days and we identified those that were transfused.Results22.3% of patients were transfused. The median time to transfusion was 17 days from time of injury and varied with different patient characteristics. The median pre-transfusion hemoglobin (Hb) level was 8.2 g/dL. Transfusion was significantly related to; admission to the intensive care unit (p = 0.001), a body mass index (BMI) <2 kg/m2 (p = 0.021), % total burn surface area (TBSA) >20 (p = 0.049), pre-existing illness (p = 0.046), and white blood cell (WBC) count <4000 or >12,000/μL (p = 0.05).ConclusionPre-existing illnesses, a low BMI, TBSA of >20%, admission to the intensive care unit and abnormalities in the WBC count are useful predictors of blood transfusion among thermal burns patients admitted to Mulago Hospital. The precise time to transfusion from time of burns injury cannot be generalized. With close monitoring of each individual patient lies the appropriateness and timeliness of their management.
Highlights
Blood transfusion, a practice under re-evaluation in general, remains common among thermal burn patients due to the hematological alterations associated with burns that manifest as anemia
We recruited 112 thermal burn patients admitted to the Surgical Unit of the Accidents and Emergency Department within 72 h from the time of the burn injury
All patients received standard burns care as per the Burns Unit of Mulago Hospital protocol which included, among others, resuscitation according to the Acute Trauma and life Support (ATLS) protocol, wound care, Fluid replacement according to the parkland formula, pain management, electrolyte replacement and nutritional rehabilitation, infection control, and counseling
Summary
A practice under re-evaluation in general, remains common among thermal burn patients due to the hematological alterations associated with burns that manifest as anemia. Due to the demonstrable complications of transfusion among burns patients in concert with the improved patient outcome on restrictive blood use trials, the role of blood transfusion in burns has undergone re-evaluation over years [1, 2]. These data, have led to recommendations that blood transfusions be used only when there is an apparent physiologic need [3] based on the patients. There is no one ‘common trigger’ but with on-going research, different triggers are adopted This has changed from the traditional Hb
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