HEMATOLOGIC CHANGES IN MASSIVE BURN INJURY

Objective: To study and report the striking hematologic changes that occur in patients with massive burn injury. Design: Case reports and description of hematologic studies. Setting: A municipal general hospital burn unit. Patients: Three severely burned patients who survived, respectively, 45 mins, 22 hrs, and 57 hrs after hospitalization. Methods: Routine clinical hematologic laboratory studies. Results: The patients had intravascular hemolysis, and their RBCs exhibited spherocytosis, fragmentation, and vesiculation. Numerous fragments of red cell membranes were originally present in the blood and cleared within 4 hrs. These fragments may have contributed to the renal failure seen in these patients. The patients also had marked pseudothrombocytosis, presumably owing to "incorrect recognition" by the automatic counter of red cell microvesicles as platelets. Conclusions: Pseudothrombocytosis should be anticipated with massive burn injury. Despite high or normal platelet counts reported by the laboratory, evidence of intravascular coagulation should be promptly investigated.