Antithrombin (human) concentrate infusion in pediatric patients with >50% TBSA burns.

Abstract

Antithrombin (human) [AT(H)] concentrate infusions have been safely utilized in adult burn patients to counteract subclinical disseminated intravascular coagulopathy and pulmonary complications. AT(H) concentrate was given to two thermally injured pediatric patients to evaluate safety and dosage requirements. The first patient was a 2-year-old with 83% total burn surface area (TBSA) full thickness flame burn and severe inhalation injury. The second patient was a 14-month-old who sustained 56% TBSA deep partial and full thickness scald injury. Each child received 10 infusions of AT(H) concentrate (106 units/kg) in the first 4 days post-injury. For these two patients, the plasma AT level (normal range: 100+/-20%) increased, respectively, from 25 and 66% on admission to 224 and 217% on day 1, 114 and 116% on day 2, and 193 and 171% on day 3. Both patients tolerated the infusions well. In one patient, the eschar on all four extremities easily peeled off the subcutaneous tissues along a natural demarcation between viable and non-viable tissue with only a 40cc estimated blood loss (EBL). AT(H) concentrate is tolerated in the pediatric population in the acute phase of injury. Lack of bleeding during eschar removal may be of benefit to burn excision and grafting.