Civico and Benfratelli Hospital Burn Center, Palermo, Italy.
Burns. 2011 Aug;37(5):742-52. doi: 10.1016/j.burns.2011.01.016. Epub 2011 Mar 1.
A severe burn will significantly alter haematologic parameters, and manifest as anaemia, which is commonly found in patients with greater than 10% total body surface area (TBSA) involvement. Maintaining haemoglobin and haematocrit levels with blood transfusion has been the gold standard for the treatment of anaemia for many years. While there is no consensus on when to transfuse, an increasing number of authors have expressed that less blood products should be transfused. Current transfusion protocols use a specific level of haemoglobin or haematocrit, which dictates when to transfuse packed red blood cells (PRBCs). This level is known as the trigger. There is no one 'common trigger' as values range from 6 g dl(-1) to 8 g dl(-1) of haemoglobin. The aim of this study was to analyse the current status of red blood cell (RBC) transfusions in the treatment of burn patients, and address new information regarding burn and blood transfusion management. Analysis of existing transfusion literature confirms that individual burn centres transfuse at a lower trigger than in previous years. The quest for a universal transfusion trigger should be abandoned. All RBC transfusions should be tailored to the patient's blood volume status, acuity of blood loss and ongoing perfusion requirements. We also focus on the prevention of unnecessary transfusion as well as techniques to minimise blood loss, optimise red cell production and determine when transfusion is appropriate.
严重烧伤会显著改变血液学参数，并表现为贫血，这在总表面积（TBSA）大于 10%的患者中很常见。多年来，输血一直是治疗贫血的金标准，以维持血红蛋白和血细胞比容水平。虽然对于何时输血尚未达成共识，但越来越多的作者表示应减少输血。目前的输血方案使用特定的血红蛋白或血细胞比容水平来决定何时输注浓缩红细胞（PRBC）。这个水平被称为触发值。由于血红蛋白值范围从 6 g/dL 到 8 g/dL 不等，因此没有一个“通用触发值”。本研究旨在分析目前治疗烧伤患者时红细胞（RBC）输血的现状，并提供有关烧伤和输血管理的新信息。对现有输血文献的分析证实，与前几年相比，各个烧伤中心的输血触发值较低。寻找通用的输血触发值应该被放弃。所有 RBC 输血都应根据患者的血容量状态、失血的急性程度和持续的灌注需求进行调整。我们还关注预防不必要的输血以及减少失血、优化红细胞生成和确定何时进行输血的技术。
