Determinants and time to blood transfusion among thermal burn patients admitted to Mulago Hospital
Background: Blood transfusion is common practice among thermal burn patients due to significant alteration in haematological parameters associated with burns. Whereas it’s beneficial and the most effective method to treat anemia in burns, blood transfusion has got side effects hence the current trends to limit transfusions in these patients. Individual burn centers transfuse at haemoglobin levels lower than in the past years with current transfusion protocols using a specific level of haemoglobin ranging from 6-8 g/dl. There is therefore a need to identifying the parameters that may determine transfusion requirement in a burns patients and later develop protocols in light of this practice in Mulago burns unit. Objectives: To determine parameters associated with blood transfusion requirement among thermal burns patients and the time to transfusion. Methods: 112 patients with thermal burns were enrolled into a prospective cohort study that was conducted in the Surgical Unit of the Accidents and Emergency Department and Burns Unit of Mulago Hospital. Patients were followed for a maximum period of 28 days. Relevant data on pre-injury, injury and post-injury factors was collected including relevant laboratory investigations and treatment modalities. Results: 22.3 % of patients were transfused. The median time to transfusion was 17 days from injury at a median pre-transfusion HB level of 8.2g/dl. Transfusion was significantly related to admission to ICU (p=0.001), which correlates with disease severity and in line with a significant risks of transfusion for: %TBSA>20 (p=0.049), pre-existing illness (p=0.046), a BMI <2kg/m² (p=0.021), and WBC count <4000 or >12000/uL (p=0.05). Conclusion: The admission to the burns ICU, presence of pre-existing illnesses, a low BMI, TBSA of >20%, and abnormalities in the WBC count are useful predictors of blood transfusion among thermal burns patients admitted to Mulago hospital.