The best strategy for red blood cell transfusion in severe burn patients, restrictive or liberal: A randomized controlled trial

Introduction: Although blood transfusion is common in burns, data are lacking in appropriate transfusion thresholds. It has been reported that a restrictive blood transfusion policy decreases blood utilization and improves outcomes in critically ill adults, but the impact of a restrictive blood transfusion policy in burn patients is unclear. We decided to investigate the outcome of decreasing the blood transfusion threshold. Material and methods: Eighty patients with TBSA > 20% who met our inclusion criteria were included. They were randomly divided into control and intervention groups. The intervention group received packed cells only when Hemoglobin declined to less than 8 g/dL at routine laboratory evaluations. While the control group received packed-cell when hemoglobin was declined to less than 10 g/dl. The total number of the received packed cell before, during and after any surgical procedure was recorded. The outcome was measured by the evaluation of the infection rate and other complications. Result: The mean hemoglobin level before transfusion was 7.7 +/- 0.4 g/dL in the restrictive group and 8.8 +/- 0.7 g/dL in the liberal group. The mean number of RBC unit transfusion per patient in the restrictive group was significantly lower than the traditional group (3.28 +/- 2.2 units vs. 5.9 +/- 3.7 units) (p-value = 0.006). The total number of RBC transfused units varied significantly between the two groups (p-value = 0.014). The number of transfused RBC units outside the operation room showed a significant difference between groups (restrictive: 2.8 +/- 1.4 units vs. liberal: 4.4 +/- 2.6 units) (p = 0.004). We did not find any significant difference in mortality rate or other outcome measures between groups. Conclusion: Applying the restrictive transfusion strategy in thermal burn patients who are highly prone to all kinds of infection, does not adversely impact the patient outcome, and results in significant cost savings to the institution and lower rate of infection. We conclude that the restrictive transfusion practice during burn excision and grafting is well tolerated and effective in reducing the number of transfusions without increasing complications. Clinical Trial Registration Reference: IRCT20190209042660N1. (c) 2020 Elsevier Ltd and ISBI. All rights reserved.