Significance of Loss of Serum Protein in Therapy of Severe Burns

Abstract

That large amounts of blood plasma are lost into burned areas has long been known; its measurement, experimentally, has shown that it may be very extensive. It is also generally realized that it is the prime, if not the only factor in the blood concentration of burned patients. But its significance in therapy has not been sufficiently emphasized.

In a series of 40 patients with severe burns, many of them fatal, the degree of blood concentration was roughly estimated by the erythrocyte count. It was found that very rapidly, often within an hour or two, the red cells increased with few exceptions to values of over 6,000,000 and in 2 cases to over 8,000,000 per cmm. Comparison of venous and capillary counts in many instances revealed significant differences only in the severe cases; in them, moreover, the counts often had to be made in venous blood because capillary blood was unobtainable. The blood was often so viscid that aspiration of a sufficient amount for chemical study even from a large vein was difficult or impossible. Nevertheless the serum protein of such blood when examined soon after admission was usually normal or low; in only one instance was the value above 7%, in most of them it was between 6 and 7%, in 2 it was under 6%. This in itself indicated an actual or relative loss in blood protein when one considers the marked concentration as shown by the high erythrocyte count. The degree of this loss in serum protein is apparent if we compare the average figure of about 6% in burned patients with a serum protein of 10% or more which occurs in the concentrated blood due to extreme dehydration from vomiting, diarrhea, etc. Moreover, in several patients we noted after several days of treatment still lower values for the serum protein, i. e., as low as 4%.