A prospective study was undertaken to determine the change in
coagulation factors in patients undergoing tangential excisions of
burn wounds when red blood cells preserved with
ADSOL (
adenine,
dextrose, saline, and
mannitol) and
crystalloid solution were used for volume replacement. Nine patients with
burns were studied, three on two separate occasions. No patient had a history of a
bleeding disorder or had taken
aspirin within 10 days of surgery. Results of preoperative coagulation studies were all within normal limits. The initial levels of
coagulation factor and rates of removal were compared with those of 12 patients without
burns who were undergoing elective surgery and who also had massive intraoperative blood loss.
Coagulation factor levels measured included the platelet count,
fibrinogen, factors V, VIII, and IX. These were determined before blood loss and each time loss and replacement of one third of a patient's calculated blood volume occurred during a tangential excision of a
burn wound. The data showed that patients with
burns have significantly higher baseline levels of platelets,
fibrinogen, and
factor VIII than patients without
burns do. The removal rates of platelet and
factor IX are significantly lower among patients with
burns than among patients without
burns. No patient in the study group developed a coagulopathy or received fresh frozen plasma or platelet supplementation. These findings suggest that the intraoperative blood losses that occurred during tangential excisions of
burn wounds were made safe by the higher than normal preoperative levels of platelets,
fibrinogen, and
factor VIII and by the slow wash-out curve for platelets and
factor IX. Prophylactic use of either fresh frozen plasma or platelet concentrates is not indicated unless a specific deficit or coagulopathy has been identified.