Determinants and time to blood transfusion among thermal burn patients admitted to Mulago Hospital

Abstract

Background: 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. 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.

Methods: 112 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.

Results: 22.3% 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).

Conclusion: Pre-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.

Keywords: Blood transfusion; Determinants of transfusion; Thermal burns; Time to transfusion.

Fig. 1

Survival curve for the time to blood transfusion. Study participants that we transfused with blood got the first unit within the first month from time of injury. The median time [(t) = 0.5] of transfusion from this figure is 17 days. Chances of blood transfusion were very high with in the first 3–21 days unlike in the immediate post injury time which can be argued that the fluid of choice in our practice is ringers lactate in the first 24 h and remains crystalloids for maintenance or replacing deficits. Also, that the ostensible Hematocrit/hemoglobin values for an initial haemo-concentration and later dilution in this period are highly influenced by the severity of injury and resuscitation and true physiological values are achieved after about 3 days from time of injury