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. (Grit Care Med 1992; 20:1284–1288)
