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Blood utilization in patients with burn injury and association with clinical outcomes (CME)

Authors

  • Rommel P. Lu,

    Corresponding author
    1. Department of Medicine, Division of Hematology/Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC
    2. Department of Biostatistics and North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC
    3. Department of Surgery, North Carolina Jaycee Burn Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
    4. Department of Surgery, Division of Trauma and Critical Care Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
    • Department of Pathology & Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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  • Feng-Chang Lin,

    1. Department of Pathology & Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
    2. Department of Medicine, Division of Hematology/Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC
    3. Department of Biostatistics and North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC
    4. Department of Surgery, North Carolina Jaycee Burn Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
    5. Department of Surgery, Division of Trauma and Critical Care Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
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  • Shiara M. Ortiz-Pujols,

    1. Department of Pathology & Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
    2. Department of Medicine, Division of Hematology/Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC
    3. Department of Biostatistics and North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC
    4. Department of Surgery, North Carolina Jaycee Burn Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
    5. Department of Surgery, Division of Trauma and Critical Care Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
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  • Sasha D. Adams,

    1. Department of Pathology & Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
    2. Department of Medicine, Division of Hematology/Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC
    3. Department of Biostatistics and North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC
    4. Department of Surgery, North Carolina Jaycee Burn Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
    5. Department of Surgery, Division of Trauma and Critical Care Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
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  • Herbert C. Whinna,

    1. Department of Pathology & Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
    2. Department of Medicine, Division of Hematology/Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC
    3. Department of Biostatistics and North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC
    4. Department of Surgery, North Carolina Jaycee Burn Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
    5. Department of Surgery, Division of Trauma and Critical Care Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
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  • Bruce A. Cairns,

    1. Department of Pathology & Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
    2. Department of Medicine, Division of Hematology/Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC
    3. Department of Biostatistics and North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC
    4. Department of Surgery, North Carolina Jaycee Burn Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
    5. Department of Surgery, Division of Trauma and Critical Care Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
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  • Nigel S. Key

    1. Department of Pathology & Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
    2. Department of Medicine, Division of Hematology/Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC
    3. Department of Biostatistics and North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC
    4. Department of Surgery, North Carolina Jaycee Burn Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
    5. Department of Surgery, Division of Trauma and Critical Care Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Address reprint requests to: Rommel P. Lu, University of North Carolina Hospitals, 101 Manning Drive, CB # 7600, Chapel Hill, NC 27514; e-mail: rlu@med.unc.edu.

Abstract

Background

Uncontrolled bleeding is an important cause of increased transfusion in burn victims; however, description of blood utilization patterns in the burn population is lacking.

Study Design and Methods

We conducted a single-institution, retrospective cohort study to measure blood utilization in 89 consecutive burn patients with 15% to 65% total body surface area (TBSA) burn within 60 days of injury. We also evaluated the relationship of blood product utilization with clinical variables including anticoagulant usage and mortality.

Results

We determined that: 1) the predictors for increased red blood cells (RBCs) and plasma transfusions were high TBSA burn and the use of argatroban anticoagulation (for suspected heparin-induced thrombocytopenia [HIT]); 2) TBSA burn and patient age were independent predictors of mortality, but not RBC or plasma transfusion; and 3) the incidence of symptomatic venous thromboembolic events is not uncommon (11.2%), although HIT is rare (1.1%).

Conclusion

Despite concerns about adverse correlation between increased number of transfusions and mortality in other clinical settings, we did not find this association in our study. However, we demonstrated that the type and intensity of anticoagulation carries substantial risk for increased RBC as well as plasma usage.

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