Posluszny et al evaluated transfusions in burn patients. Reducing transfusions related to anemia of chronic illness may improve outcomes. The authors are from Loyola University and Case Western Reserve University.
Patient selection: adult with burn involving >= 20% of total body surface area
Reasons for transfusion:
(1) acute blood loss anemia related to trauma and to surgery
(2) anemia of chronic illness
Transfusions for acute blood loss anemia were those given on the day of surgery and on postoperative day 1. Other transfusions were related to anemia of chronic disease. Using this criteria half of transfusions were for acute anemia and half were for anemia of chronic illness.
The total number of transfusion were related to:
(1) percent total body surface area burned
(2) number of operative events
(3) APACHE II score (a marker of critical illness) from within 24 hours of admission
(4) number of ventilator days (a marker of critical illness)
The number of transfusions for anemia of critical illness was related to:
(1) APACHE II score (a marker of critical illness) from within 24 hours of admission
(2) number of ventilator days (a marker of critical illness)
APACHE II and number of ventilator days were evaluated in tertiles.
|
Parameter
|
Finding
|
Severity
|
|
APACHE II
|
< 18
|
low
|
|
|
18 to 27
|
mediium
|
|
|
> 27
|
high
|
|
ventilator days
|
< 10
|
low
|
|
|
10 to 39
|
medium
|
|
|
> 39
|
high
|
where:
• Table 1 does not explicitly define 40 ventilator days (ranges 10 to 39 and > 40).
