A clinical trial comparing morbidity and mortality of restrictive blood transfusion with tradition approach in thermal burn injury and investigation of factors associated with the rate of blood transfusion

Background and Aim : Although blood transfusion is common in burns, data are lacking on appropriate transfusion thresholds. It has been reported that a restrictive blood transfusion policy decreases blood utilization and improves outcomes in critically ill adults, but the impact of a restrictive blood transfusion policy in burn patients is unclear. We decided to investigate the outcome of decreasing the blood transfusion threshold. Methods : Eighty patients with TBSA> 20% who met our inclusion criteria were included. They were randomly divided into control and intervention groups. The intervention group received packed-cell only when Hemoglobin declined to less than 8.5 g/dL at routine laboratory evaluations. While the control group received packed-cell when hemoglobin was declined to less than 10g/dl. The total number of the received packed cell before, during and after any surgical procedure was recorded. The outcome was measured by the evaluation of the infection rate and other complications. Results : The mean hemoglobin concentration level before transfusion was 7.5±o.44 g/dL in the restrictive group and 8.9±0.76 g/dL in the Liberal group (p-value<0.001). The mean number of RBC unit transfusion per patient in the restrictive group was significantly lower than the traditional group (3.28 ± 2.2 units vs.5.9 ±3.7 units) (p-value=0.006). The total number of RBC transfused units varied significantly between the two groups (p-value=0.014). The number of transfused RBC units outside the operation room showed a significant difference between groups (restrictive: 2.8±1.4 units vs. liberal: 4.4±2.6 units) (p =0.004). We did not find any significant difference in the mortality rate between groups (with p-value =0.075). Although the mean length of stay at ICU and hospital and the incidence of septicemia, were lower in patients of the restrictive transfusion strategy, these differences were not statistically significant. Conclusion : A restrictive transfusion strategy in thermal burn patients who are highly prone to all kinds of infection decreases the amount of blood transfused, does not adversely impact the patient outcome, and results in significant cost savings to the institution and lower rate of infection. We conclude that the restrictive transfusion practice during burn excision and grafting is well tolerated and effective in reducing the number of transfusions without increasing complications.

کلیدواژه ها:

Restrictive Transfusion ، Liberal transfusion ، thermal burn ، Blood Transfusion