In 1985, New York Times Magazine sent a reporter to the burn unit at New York Hospital to cover a story that’s still providing lessons on the importance of blood transfusions for burn survivors. Doctors in New York were breaking ground with new techniques to increase survival rates for patients with burns that covered more than 40 percent of their body. Curtailing blood loss and manipulating the immune system to stave off infection were major focus areas.
The story took readers inside an operating room where bleeding created puddles on the floor as surgeons cut away at burned tissue to enable regrowth.
The Times recounted a nearly five-hour operation in which the patient required 10 units of donated blood and additional fluids to treat dehydration. Several days later, when surgeons performed skin grafting procedures on the burn survivor, he needed another 10 units of blood to survive. In the blood are white cells that fight infection. The reporter was reminded by doctors that probably 90 percent of burn patients who die succumb to infection.
“When skin, an organ about as thick as a sheet of paper toweling, is severely damaged, nearly every system in the body reacts. The metabolic system goes haywire and accelerates; the immune system changes, and the cardiovascular system falters,’’ the story explained. “A first-degree burn has slight impact, but a second-degree burn destroys all of the epidermis (the top layer of skin) and part of the dermis (the underlying layer), and a third-degree burn consumes both. Serious burns cause a catastrophic loss of fluid through the burned area by evaporation and through leakage from damaged capillaries.’’
Still today, severe burns can keep hospitals scrambling for blood donations to cover what could be months of treatments for a single patient. Researchers have learned that blood shortage is additionally problematic because significant burns suppress the inner workings of a person’s bone marrow – the body’s manufacturing center for new blood cells. Post-burn anemia is common and patients who receive blood transfusions are at a higher mortality risk.
Help for Burn Survivors
Researchers in Finland studied the use of blood products in burn patients between 2005 and 2011. Across 10 major hospital districts in the country, the study tracked 558 burn patients aged 18 and older who were admitted for more than a day. Of those 558 subjects, 192 or 34 percent of the group received blood components during their stay. The infusions ranged from plasma and platelets to red blood cells.
The study found that in-hospital mortality among transfused patients exceeded that of non-transfused patients by fivefold. For one thing, transfusions lead to an increased rate of infections among burn patients. The study results speak to the seriousness of severe burns. Authors of the study said the prognosis for a severe burn injury still relates to three major risk factors for death: an age of 60 or older; burn percentage across the body’s surface area of more than 40 percent and the presence of inhalation injury.
“Wound healing, strength, and endurance are the linchpins for survival in massive burns,’’ the study’s authors wrote. “A higher hemoglobin may increase endurance and wound healing in the massive burn patient.’’
Still, researchers have noted that patients with massive burns can benefit from not overdoing blood transfusions. That’s because striving for higher hemoglobin concentrations in severely burned patients can lead to increased incidence of lung dysfunction and increased risk of infection without positively impacting wound healing.
A closer look at the research – sponsored by the American Burn Association – showed better outcomes for patients whose hemoglobin levels were kept above 7-8 grams per deciliter. Another group of patients in the randomized trial were treated to carry what was then the standard measurement of hemoglobin: Above 10 grams per deciliter.
Almost 350 patients were included in the nearly six-year study. Survival rates were similar, but individuals who were cared for at the hemoglobin level of 7-8 grams experienced a reduced occurrence of blood infection, a shorter duration on the respirator, and shorter hospital stays.
Blood drives are not uncommon in communities hit by tragic fires or explosions. Citizens who volunteer to give blood in these scenarios can save lives. In some cases, donors get checked for blood pressure, pulse, and hemoglobin levels. Your blood has three components critical to helping needy hospital patients.
Here’s how your donation is useful according to Texas-based Valley Regional Medical Center:
- Red blood cells can be used for 42 days after they are donated. Besides their importance to burn survivors and other accident victims, red cells increase the blood’s oxygen-carrying capacity. They are also used to treat anemia that can’t be medically corrected.
- Platelets are stored separately from other components and must be used within five days after the donation.
- Plasma has a much longer shelf life and is often frozen for later use. Once thawed, plasma is used during cardiac surgery, for burn survivors, and to treat bleeding disorders. For example, bleeding disorders can occur in liver failure or when severe bleeding and massive transfusions result in low levels of clotting factors.
Talk to an Experienced Burn Injury Lawyer
Pritzker Hageman is one of the few law firms in the country with experience representing burn victims and their families. If you or someone you love was burned in a fire or explosion, it is important to talk to a lawyer as soon as possible.
Contact Pritzker Hageman’s team of burn attorneys for a free consultation on what to expect from the legal process, how burn compensation is distributed, and other impacts of taking legal action.