Results of a protocol of transfusion threshold and surgical technique on transfusion requirements in burn patients

Introduction: Blood loss and high rates of transfusion in burn centers remains an area of ongoing concern. Blood use brings the risk of infection, adverse reaction, and immunosuppression. Methods: A protocol to reduce blood loss and blood use was implemented. Analysis included 3-year periods before and after institution of the protocol. All patients were transfused for a hemoglobin below 8.0 gm/dL. Results: Operations per admission did not change during the two time periods (0.78 in each). Overall units transfused per operation decreased from 1.56 ± 0.06 to 1.25 ± 0.14 units after instituting the protocol (p < 0.05). Also, units transfused per admission decreased from 1.21 ± 0.15 to 0.96 ± 0.06 units of blood (p < 0.05). This was noticed particularly in burns of less than 20% surface area, declining from 386 to 46 units after protocol institution, from 0.37 to 0.04 units per admission, and from 0.79 to 0.08 units per operation in this group of smallest burns. There was no change noted in the larger burns. Conclusions: This study suggests that a defined protocol of hemostasis, technique, and transfusion trigger should be implemented in the process of burn excision and grafting. This will help especially those patients with the smallest burns, essentially eliminating transfusion need in that group.