DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20164211

Evaluating the appropriateness of blood component utilization in burns patients

Ravishankar J., Jagannathan S. Y., Arumugam P., Chitra M.

Abstract


Background: Blood transfusion is a common intervention in critically ill surgical patients, especially Burns patients. But transfusions have potentially life threatening risks. The aim of the study was to evaluate the appropriateness of various blood components, utilized in Burns patients.

Methods: Burns patient who were admitted at Burns ward, Government Kilpauk Medical College, Chennai, India with age more than 16 years, with 15-40% Total body surface area burns and had survived treatment were included for a period of one year (September 2014-August 2015). New York State health guidelines for RBC transfusion in Burns, Baxter’s original Parkland formula and platelet transfusion thresholds given by AABB were used to categorize appropriate transfusions from inappropriate transfusions.

Results: A total of 122 burns patients who fulfilled the inclusion criteria were followed. 85 patients received 308 red cell units of which 64% were appropriate. 114 patients were transfused with 441 fresh frozen plasma units of which 47% were appropriate. One patient was transfused with platelet concentrate and all patients, who had their platelet count more than 10,000/μL, were not transfused.

Conclusions: In our study, 64% of red blood cell transfusions and 47% of FFP transfusions were appropriate. Successful outcome of burns patients purely depends on proper wound care, along with appropriate use of fluids and blood components.


Keywords


Appropriateness, Burns, Blood transfusion

Full Text:

PDF

References


Warrell DA, Cox TM, Firth JD. Chapter: Structure and function of skin. Oxford Textbook of Medicine. 5th edn. doi: 10.1093 / med /9780199204854.003. 2301_update_001.

The Clinical Use of Blood in Medicine, Obstetrics, Paediatrics, Surgery and Anaesthesia, Trauma and Burns. WHO document WHO/BTS/99. 2-337.

Lelubre C, Vincent JL. Red blood cell transfusion in the critically ill patient. Ann Intens Care. 2011;1(1):43.

Menabde N (IL). World Blood Donor Day: Safe Blood for Saving Mothers (June 2014) Available from: http://www.searo.who.int/india/ world blood_ donor_day_2014_ message_ wr.pdf. Accessed on May 21, 2015.

Audet AM, Goodnough LT, Parvin CA. Evaluating the Appropriateness of Red blood cell Transfusions: the Limitations of Retrospective Medical record Reviews. Int J Quality in Health Care. 1996;8(1):41-9.

Dejam A, Malley BE, Feng M, Cismondi F, Park S, Samani S, et al. The effect of age and clinical circumstances on the outcome of red blood cell transfusion in critically ill patients. Critical Care. 2014;18(4):487.

Posluszny JA, Conrad P, Halerz M, Shankar R, Gamelli RL. Classifying Transfusions Related to the Anemia of Critical Illness in Burn Patients. J Trauma. 2011;71(1):26-31.

Gupta JL, Makhija LK, Bajaj SP. National programme for prevention of burn injuries. Indian Journal of Plastic Surgery: Official Publication of the Association of Plastic Surgeons of India. 2010;43(Suppl):S6-10.

National Crime Records Bureau, Ministry of Home Affairs, Government of India. Crime in India 2013. New Delhi: NCRB, MHA; 2013. Available from ncrb.gov.in/adsi2013/ADSI-2013.pdf.

National Crime Records Bureau, Ministry of Home Affairs, Government of India. Crime in India 2013. New Delhi: NCRB, MHA; 2013. Available from ncrb.gov.in/adsi2013/ suicides%202013.pdf.

Tyson AF, Boschini LP, Kiser MM, Samuel JC, Mjuweni SN, Cairns BA, et al. Survival after burn in a sub-Saharan burn unit: Challenges and opportunities. Burns: journal of the International Society for Burn Injuries. 2013;39(8):10.1016/j.burns.2013.04.013.

Palmieri TL, Caruso DM, Foster KN, Cairns BA, Peck MD, Gamelli RL, et al. Effect of blood transfusion on outcome after major burn injury: A multicenter study. Crit Care Med. 2006;34:1602-7.

Carson JL, Carless PA, Hebert PC. Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. Cochrane Database Syst Rev. 4:CD002042.

Curinga G, Jain A, Feldman M, Prosciak M, Phillips B, Milner S. Red blood cell transfusion following burn. Burns: journal of the International Society for Burn Injuries. 2011;37:742-52.

Neamtu MC, Parvu A, Parvanescu H, Neamtu LR, Vrabete M. Could store blood transfusions (SBT) alter the mechanisms implied in wound healing, in burned patients? Rom J Morphol Embryol. 2011;52(2):599-604.

Guidelines for Transfusion of Red Blood Cells – Adults, Third Edition 2012. New York State Council on Human Blood and Transfusion Services.

Liumbruno G, Bennardello F, Lattanzio A, Piccoli P, Rossetti G. Italian Society of Transfusion Medicine and Immunohaematology (SIMTI) Working Party. Recommendations for the transfusion of red blood cells. Blood Transfus. 2009;7:49-64.

Liumbruno G, Bennardello F, Lattanzio A, Piccoli P, Rossetti G. Italian Society of Transfusion Medicine and Immunohaematology (SIMTI) Working Party. Recommendations for the transfusion of plasma and platelets. Blood Transfus 2009;7:132-50.

Roback JD, Grossman BJ, Harris T, Hillyer CD. AABB Technical Manual. 17th Edition. 573-4.

Roubinian NH, Murphy EL, Swain BE, Gardner MN, Liu V, Escobar GJ. Predicting red blood cell transfusion in hospitalized patients: role of hemoglobin level, comorbidities, and illness severity. BMC Health Services Research. 2014;14:213.

French CJ, Bellomo R, Finfer SR, Lipman J, Chapman M, Boyce NW. Appropriateness of red blood cell transfusion in Australasian intensive care practice. Med J Aust. 2002;177:548-51.

Afzal, S. A comparison of public and private hospital on rational use of blood in Islamabad. JPMA. J Pak Med Assoc. 2013;63(1):85-9.

Wong MP, Droubatchevskaia N, Chipperfield KM, Wadsworth LD, Ferguson DJ. Guidelines for frozen plasma transfusion. BCMJ. 2007;49(6):311-9.

Kaufman RM, Djulbegovic B, Gernsheimer T, Kleinman S, Tinmouth AT, Capocelli KE, et al. Platelet Transfusion: A Clinical Practice Guideline From the AABB. Ann Intern Med. 2015;162:205-13.

Herndon DN. Total Burn Care. Elsevier Saunders. 4th edn. c2012.

Transfusion Medicine Technical Manual. Directorate General of Health Services. 2nd Edition. 2003.

Guidelines for Transfusion of Red Blood Cells – Adults, Third Edition 2012. New York State Council on Human Blood and Transfusion Services.

Ioannovich, Alexakis D, Parker, Mantas N. Parkland Formula as a guide for resuscitation. Annals of the MBC. 1989;2(1):29-39.

Fung MK, Grossman BJ, Hillyer CD, Westhoff CM. Chapter 20 Hemotherapy decisions. AABB Technical Manual. 18th Edition. 503.

Vincent JL, Baron JF, Reinhart K, Gattinoni L, Thijs L, Webb A, et al. Anemia and Blood Transfusion in Critically Ill patients. JAMA. 2002;288(12):1499-507.

Gupta AK, Uppal S, Garg R, Gupta A, Pal R. A clinico-epidemiologic study of 892 patients with burn injuries at a tertiary care hospital in Punjab, India. J Emergencies, Trauma and Shock. 2011;4(1):7-11.

Aubron C, Nichol A, Cooper DJ, Bellomo R. Age of red blood cells and transfusion in critically ill patients. Annals of Intensive Care. 2013;3:2.

Atiyeh BS, Dibo SA, Ibrahim AE, Zgheib ER. Acute burn resuscitation and fluid creep: it is time for colloid rehabilitation. Annals of Burns and Fire Disasters. 2012;25(2):59-65.

Oliver RI, Spain D, Stadelmann W. Burns, resuscitation and early management. 2014.

Fresh Frozen Plasma: Indications and Risks. NIH Consensus Statement Online. 1984;5(5):1-12.

Rudmann SV. Textbook of Blood banking and Transfusion medicine. Second edition. Elsevier Saunders. 465-67.

Reviewers CIGA. Human albumin administration in critically ill patients: systematic review of randomized controlled trials. BMJ. 1998;317(7153):235-40.

Nautiyal S. Human albumin serum not available across India post NPPA price cut. www.pharmabiz.com. 2014.

Kulkarni N. Evaluation of fresh frozen plasma usage at a medical college hospital – A two year study. International J Blood Transfusion Immunohematology. 2012;2:16-20.

Fodor L, Fodor A, Ramon Y, Shoshani O, Rissin Y, Ullman Y. Controversies in fluid resuscitation for burn management: Literature review and our experience. Injury Int J Care injured. 2006;37:374-9.

Schofield WN, Rubin GL, Dean MG. Appropriateness of platelet, fresh frozen plasma and cryoprecipitate transfusion in New South Wales public hospitals. Med J Aust. 2003;178(3):117-21.