Blood coagulation alterations over the first 10 days after severe burn injury

Abstract

Introduction: Coagulation disorders occur during the first 48 h after major burn injury, affecting mainly PT/INR and aPTT. Some authors consider them burn specific. The aim was to assess the magnitude of coagulation disorders during the first 10 days after severe burn injury and its eventual association with fluid intakes. Methods: Retrospective study of prospectively collected data including patients with burns ≥ 20%BSA (body surface area) who stayed ≥ 24 h at the burn-intensive care unit (ICU). Predetermined data for the analysis of fluid and blood products administration and laboratory values were extracted from the computerized information system. Descriptive statistics, data as median. Results: 167 patients included. The volumes of fluid resuscitation decreased over the first 10 days (median 6815 ml on day 1 decreasing to 4190 ml by day 10, p < 0.0001). During the first 48 h, PT was frequently abnormal and strongly related to fluid volumes (R2 = 0.124, p < 0.0001). Perturbations of PT/INR and aPTT improved after 72 h while the thrombocytopenia had a nadir by day 4, persisting in the most severely burned. Overall, only 12 (7.2%) patients presented combined coagulation alterations. Conclusions: This study shows transient and self-resolutive coagulation disorders related to fluid delivery, apparently without burn specificity. The late thrombocytopenia is a new observation.

Keywords

• Burn injury
• Coagulopathy
• Blood products
• Fluid resuscitation
• Thrombocytopenia