Analysis On Platelet-count Fluctuation In Patients After Severe Burns

BackgroundIn our recent clinic work,we found that almost every severe burned patient had platelet-reduction symptom,which could induce serious clinic consequences.There are severeal factors that could theoretically induce the symptom such as operation area, severity of burns,infection,MODS,etc.However,there is no report of cases analysis to prove whether they are responsible for thrombocytopenia in serve burns patients.So we conducted this research to identify the factors which can induce thrombocytopenia.PartⅠResearch of tendency of platelet after severe burns and analysis of its reasonsMethod:From 1980 through 2007,180 severe burned cases were collected;we excluded 65 of them which was not registed in early days after burned or who was dead within the first two weeks after registation.The renant 114 cases were divided by different ways, such as different operation area,different severity,different therapies,different overcome, bleeding symptom,and etc.And then use SPSS 11.5 to analyse the data to come to statistic conclusions.Result:In the past 27 years,almost every severe burned patient had thrombocytopenia symptom,the average of lowest platelet count(LPC) is(50.12±26.33)×10~9/L;platelet count started reducing 3.28±1.05 days after burned,and to the nadir 6.50±1.66 days after burned.;the reduction of platelet count had negative correlation with severity of burns (coefficient correlation in full-thickness burn area is -0.384,and which is -0.344 in total burn area.P＜0.001);LPC of patients with component blood transfusion was significant different from those who with whole blood transfusion,P＜0.001,average lowest count of platelet of former is(71.31±26.65)×10~9/L,whILe(44.47±25.26)×10~9/L in later:average LPC of patients under GF therapy is(69.77±29.69)×10~9/L,the data is(57.82±20.81)×10~9/L in the other group;different area of operations not makes same attribution on thrombocytopenia,platelet reduction in area＜30%TBSA is significant different from those in 30-40%TBSA and 40%TBSA,the latter 2 group with no static significance.Conclusion:1.severe burns can induce platelet reduction,which began on the third day after burned,strait down untIL day 7,the level of reduction may influence the recovery of patient,and can indicate the severity of burns;2.component blood transfusion may be one of the reasons inducing thrombocytopenia;3.excision of eschar and eschar shaving area＜30%TBSA may not induce platelet reduction as much as＞30%TBSA;4.GF therapy may ameliorate the severity of thrombocytopenia.5.Thrombocytopenia wIL1 significantly increase the incidence of bleeding,but when blood count drop down below 100×10~9/L,there is no statistic different of incidence of bleed between each group.PartⅡRelationship between mediators of inflammations and thrombocytopeniaObject:It is clear that platelet reduced within the first days of severe burns.In spite of therapeutic factors,infection is another important wh one which influence the changes of platelet.Our study was to figure out the relationship between inflammations(interleukine, CRP,etc) and thrombocytopenia,and to prove the relation between infection and thrombocytopenia.Methods:From 2007-8 through 2008-1,get serum samples from 14 burn-area＞30%TBSA patients,on different days(1,3,5,7days after burns)before platelet transfusion. ELISA was carried out using ABC-HRP kit for detecting plasma ILs,whiLe latex boosting immune scatter turbidimetric method for CRP.And than use SPSS 11.5 to analyse the data to prove the relationship between infection and platelet-count.Result:According to Multivariable linear regression,platelet count have significant relationship with inflammations IL-6(B=-0.245,p＜0.005),CRP(B=-0.490,p＜0.05);IL-1b and IL-8 don't have such significant relationship(p＞0.1).Conclusion:From serum samples we got,platelet count have significant relationship with IL-6 &CRP,which can indicate the high reactivity to infection.It may prove that inflamations can inhibit platelet generated,and promote the aggregation of platelet.