HEMOSTATIC DISTURBANCES IN BURNED PATIENTS DURING EARLY EXCISION AND SKIN-GRAFTING

Bleeding is a major problem during early excision of burned skin. Ther efore, 13 severely burned adult patients operated on during the first week after the trauma were studied. Blood loss was replaced with cryst alloids, colloids and packed red cell concentrates (PRC). After ten in fused PRCs, four fresh frozen plasma (FFP) units were given and therea fter one FFP unit with one PRC unit. Arterial blood samples were drawn before anaesthesia (S0), during operation after every four units of P RC transfusion (S1-4), 4 h postoperatively (S5) and on the first posto perative morning (S6). Prothrombin time (%) and activated partial thro mboplastin time (s) were abnormal before operation (median values 67%, range 22-99% and 44 s, range 30-86 s, respectively). Prothrombin time decreased during operation and reached the critical level for normal haemostasis at S2. Thrombelastography showed decreased clot formation rate and impaired fibrin platelet interaction peri-and postoperatively . Fibrinogen and factor VIII activity were high preoperatively (median 6:1 g/l and 253%) and the critical values for normal haemostasis were not reached. Burned patients have a consumption coagulopathy which, i n combination with haemodilution during operation, results in a clinic ally significant deficiency of coagulation factors II, VII and X, in s pite of reactive elevation of coagulation factor VIII and fibrinogen. (C) 1998 Rapid Science Ltd.