The use of blood transfusions to augment hemodynamic status has become a common practice, with over 11 million units of red blood cells transfused in more than 3 million patients every year in the United States. Traditionally, blood transfusions have been administered when the patient's hemoglobin is less than 10 g/dL or hematocrit less than 30%. Limited data exists regarding the effects of a restrictive blood transfusion policy in burn patients.

To evaluate burn center transfusion practices, we reviewed the actual use of blood transfusion in patients with burn injury >20% TBSA admitted to a member of the Burn Multicenter Trials Group over a one year period. Data was collected from 23 different burn centers on a total of 666 patients. Mortality was related to age, TBSA burn, presence of inhalation injury, and the number of units of PRBC transfused. Although this study suggests that blood transfusions influence outcome, it does not provide direct evidence that maintenance of a lower transfusion trigger improves survival. A prospective, randomized, multicenter study is needed to determine the appropriate blood transfusion threshold for burn patients.