Transfusion therapy in the care of trauma and burn patients

There is an acute coagulopathy of severe trauma that is driven by blood loss and dilution, hypothermia and acidosis, and consumption of coagulation factors and platelets and fibrinolysis. Correcting this coagulopathy by resuscitation with blood products has proven to reduce blood product use and save lives following severe injury. The composition of modern blood components severely limits the ways that hemostatically balanced resuscitation can be accomplished and makes resuscitation with 1:1:1 unit ratios of red cells, plasma and platelets the most appropriate treatment for severe uncontrolled hemorrhage. Following severe burns, bone marrow becomes erythropoietin hyporesponsive probably as a result of severe inflammation. Topical and regional hemorrhage control measures allow wider early resection of burned tissue and a 5-fold reduction of blood product use. This allows early control of inflammatory myelosuppression and more effective skin grafting.