Massive transfusion of reconstituted whole blood is well tolerated in pediatric burn surgery

Background: Massive transfusions can produce cardiovascular instability, metabolic abnormalities, dilutional coagulopathy, and pulmonary dysfunction. They also have been related to a higher incidence of infections. The purpose of this study was to assess the safety of massive transfusion of reconstituted whole blood. Methods: Twenty consecutive severely burned pediatric patients underwent near-total burn excision on admission and blood transfusion with reconstituted whole blood. Patients were studied for coagulopathies and postoperative complications related to massive transfusion. Results: Only one patient presented with postoperative bleeding related to acute renal failure. No other complications occurred. There were no septic episodes or pulmonary dysfunction. The amount of massive blood transfusion did not correlate with any laboratory or clinical disturbance. Conclusion: Massive transfusion of reconstituted whole blood in severely burned pediatric patients is safe; it does not compromise hemostasis nor is it associated with an increased rate of septic episodes or pulmonary complications. A prospective randomized clinical trial comparing its effectiveness versus packed red cells is necessary.