Dear Editor,

Blood is a valuable resource that has specific guidance related to its safe and effective use (National Institute for Health and Care Excellence, 2015). In an effort to reduce the number of blood transfusions in our burn patients, we audited and changed our practice guidelines, resulting in a 100% reduction of unnecessary crossmatching investigations, thus increasing resources and reducing costs. Our previous practice guidelines recommended Group and Save (i.e., determining patient blood group [ABO and RhD] and screening for atypical antibodies) as a minimum for all burn patients undergoing operative treatment regardless of burn size. For patients with burns on more than 10% of their body requiring operative treatment, we routinely crossmatched two units of red blood cells and other blood products as considered necessary based on individual patient circumstances.

Since implementing these guidelines, we have changed the way we treat burns. We now routinely perform enzymatic debridement (ED) of burns. Enzymatic debridement involves the application of a debriding enzyme in the form of a gel dressing. In many cases, ED can be performed outside of the operating room. The procedure is performed under local, regional, or general anesthesia as needed, and patients tolerate this procedure very well.

We retrospectively reviewed 47 patients who were referred to our unit with burns on more than 10% of their total body surface area (TBSA). The patients were grouped according to the percentage of TBSA of their burns: 10%-20% (n = 31), 20%-30% (n = 10), and 30%-40% (n = 6). A total of 12 patients underwent ED, 32 underwent surgical debridement, and three were managed conservatively. Within the ED group, there were eight patients in the 10%-20% TBSA group and four patients in the 20%-30% TBSA group. None of these patients (n = 12) required a blood transfusion. Within the surgical debridement group, there were 20 patients in the 10%-20% TBSA group and six patients in the 20%-30% and 30%-40% TBSA groups. Within this group, nine patients (19.1%) required a blood transfusion (10%-20% group, n = 3; 20%-30% group, n = 2; and 30%-40% group, n = 4). Patients who underwent surgical debridement had a mean drop in hemoglobin levels of 21 g/L (10%-20% group) to 22 g/L (20%-30% group). Patients who underwent ED had a mean drop in hemoglobin level of 10.37 g/L.

The results of our study suggest that ED reduces the need for blood transfusions in burn patients. These findings are consistent with results of similar studies comparing the amount of blood transfusions in patients undergoing ED compared with patients undergoing surgical debridement published in the literature (Giudice et al., 2017; Rosenberg et al., 2015). We adhere to the current National Institute for Health and Care Excellence guidance on blood transfusion for patients (2015).

Sincerely,

Ahmed Hagiga, MBBCh, is a plastic surgery fellow,

Queen Victoria Hospital NHS Foundation Trust, East

Grinstead, United Kingdom.

Saahil Mehta, MD, MBBS, BSc(Hon), FRCS(Plast),

is a plastic surgery registrar, Queen Victoria Hospital

NHS Foundation Trust, East Grinstead, United Kingdom.

Mohamed Shalabi, MSc, MRCS, is a plastic surgery

fellow, Queen Victoria Hospital NHS Foundation Trust,

East Grinstead, United Kingdom.

Baljit Dheansa, FRCS(Plast), is a plastic surgery

consultant, Queen Victoria Hospital NHS Foundation

Trust, East Grinstead, United Kingdom.

REFERENCES