Anemia of Thermal Injury: Combined Acute Blood Loss Anemia and Anemia of Critical Illness

Anemia is a pervasive and difficult-to-treat consequence of a severe burn injury. The most effective method of correcting anemia is the transfusion of packed red blood cells, but this therapy is not without complications. Surgical techniques including tourniquets and epinephrine tumescence have reduced blood loss and stricter thresholds have limited transfusions, but for severe burns, transfusion requirements are still massive. In this review of the current literature of anemia of thermal injury, we will provide a new framework for addressing this anemia and will show how this approach may help to develop better interventions and further reduce transfusion rates. The terms burn anemia,1 anemia of thermal injury,2,–9 anemia of thermal burns,10 and anemia in burns11 have all been used to describe anemia in burn patients. These terms encompass anemia occurring throughout the entire duration of burn care. They describe not only acute onset decreases in hemoglobin concentration immediately following the burn injury and before and after operative intervention but also, later, during wound healing and resolution of the critical injury. The causes of anemia at each stage of treatment differ; not distinguishing between them may limit patient care and research into the specific causes of anemia. Clearly defining the type of anemia will better coordinate research efforts to identify the mechanisms responsible for anemia and develop methods to reduce transfusion rates. As a result, we recommend the terms, acute blood loss anemia and anemia of critical illness, to describe the two types of anemia present in burn patients.