Dr Dinuksha De Silva1, Dr Aruna Wijewardana1, Dr Esther Ting1, Prof Ian Kerridge1,2, Dr John Vandervord1
1Royal North Shore Hospital, St Leonards, Australia, 2Northern Blood Research Centre, Kolling Institute, Sydney, Australia
Burn injuries exert enormous physiological stress on the body. Anaemia has been documented as a complication following severe burn injury (Curinga et al., 2011). The cause of anaemia in this setting is multifactorial and differs with the stage of injury and recovery, so requires a tailored approach to management. Anaemia occurring 1-2 weeks following burn injury results largely from acute blood loss from thermal injury and surgical wound management, red blood cell (RBC) sequestration and direct, non-immune haemolysis. The physiological contributors to chronic anaemia following severe burns are less well characterised but include nutritional deficiencies, reduced bone marrow erythropoiesis, erythropoietin resistance and reduced iron availability with secondary iron deficiency.
This report outlines the experience of a dedicated burns centre in managing a patient with extensive (>80% total body surface area) chemico-thermal burn wounds. We will describe the progress of treatment during the course of the 170-day hospital admission, and discuss challenges resulting from the haematological manifestations of the burn. Accounting for initial fluid resuscitation requirements and operative blood loss, it became clear that the patient was suffering a persistent normocytic anaemia. The haemoglobin count continued to fall despite replacing relevant substrates and transfusing blood products. All other haematological parameters remained within normal limits.
This report discusses the course, diagnosis and management of persistent anaemia in a patient with severe burns at a tertiary Australian burns centre. We present the results of specialist haematological investigation, and putative contributors to the anaemia.
Dr De Silva is a resident medical officer who has worked with the Severe Burns Unit and Plastic Surgery Department at Royal North Shore Hospital. As a medical student he was selected to travel to Fiji as part of a surgical outreach program run by Interplast. He has a special interest in Burns and Reconstructive Surgery.