Background: Burn injuries are frequently complicated by septic complications, leading to disturbances in the hemostatic system. This study evaluates the impact of burn severity on coagulation parameters, fibrinolytic activity, and microcirculatory changes in 59 patients aged 18–79 years.

Methods: Patients were stratified by burn severity into three groups according to the Frank index. Coagulation parameters, fibrinogen levels, thrombotest, plasma recalcification time, and platelet counts were monitored. Early necroectomy and autodermoplasty using the local hemostatic agent “Heprocel” were performed. Morphological studies were conducted on 19 deceased patients to evaluate microvascular thrombotic changes.

Results: Burn severity significantly affected coagulation parameters during septic progression. Early surgical intervention combined with local hemostatic therapy restored hemostatic balance and promoted graft integration. Morphologically, microthrombi, fibrin strands, and tissue necrosis were predominant in lungs, kidneys, liver, heart, and brain.

Conclusions: Severe burns induce hypercoagulation, thrombocytopenia, and microvascular thrombotic phenomena, leading to critical organ dysfunction. Early identification and correction of hemostatic disorders, along with adequate surgical and hemostatic therapy, significantly improve outcomes.

Burn trauma often leads to systemic inflammatory response and septic complications, which trigger profound disturbances in the hemostatic system. Septicotoxemia may result in hypercoagulation, fibrinolysis suppression, and microthrombosis in vital organs. Early intervention, including necroectomy and autodermoplasty with hemostatic agents, may restore coagulation parameters and improve survival. This study aims to analyze the dynamics of hemostatic disturbances in burn patients during septicotoxemia and to evaluate the effectiveness of local hemostatic therapy.

Aim. To investigate the alterations in the hemostatic system during the septic toxemia stage in patients with burn injuries of varying severity, and to assess the effects of early surgical and conservative interventions on coagulation parameters, fibrinolytic activity, and microvascular changes.

Patients: 59 burn patients (18–79 years) were included. Patients were divided into three groups based on burn severity using the Frank index:

Group I: FI ≤60 (n=15)

Group II: FI 61–90 (n=20)

Group III: FI >90 (n=15)

Coagulation Assessment: Parameters measured included:

Bleeding time (BT)

Plasma recalcification time (PRT)

Fibrinogen concentration

Thrombotest

Platelet counts

Fibrinolytic activity

Surgical Intervention: Early necroectomy followed by autodermoplasty was performed. “Heprocel” hemostatic powder was applied locally to control bleeding.

Morphological Study: Autopsies were performed on 19 deceased patients. Organs studied included lungs, liver, kidneys, heart, brain, spleen, and pancreas. Histological examination focused on microthrombi, fibrin deposits, and tissue necrosis.

Statistical Analysis: Data were analyzed using descriptive statistics. Differences between groups were considered significant at p less than 0.05.

1. Hemostatic Parameters:

*Significant difference from control (p less than 0.05).

                                                                               Table 1: Hemostatic parameters in burn patients after auto-trans plantation (n=49).

2. Coagulation Dynamics:

Group I showed shortened bleeding time (5.5 ± 0.5 min) and gradual normalization of plasma recalcification. Group II and III patients exhibited more pronounced hypercoagulation and early fibrinolysis suppression.

3. Morphological Findings:

Microthrombi (hyaline, fibrinoid, globular) were observed predominantly in lungs, kidneys, liver, heart, and brain. Necrotic changes were pronounced in kidneys (cortical necrosis), liver (central hepatocyte necrosis), and pancreas (pancreonecrosis). Figures 1–6 illustrate representative histological images of organ microcirculation and microthrombosis.

4. Effect of Heprocel:

Application of “Heprocel” powder facilitated complete hemostasis during autodermoplasty. Early graft adherence and healing were observed by day 7 post-operation with minimal pain and no infection.

Burn-induced septic complications initiate a cascade of systemic inflammatory and hemostatic disturbances that profoundly alter the coagulation–fibrinolysis balance. The observed hypercoagulability during the early stages of septic toxemia reflects excessive activation of procoagulant pathways under the influence of inflammatory mediators such as interleukin-6 and tumor necrosis factor-α. These cytokines stimulate the expression of tissue factor on endothelial cells and monocytes, triggering the extrinsic coagulation pathway and resulting in increased thrombin generation.

At the same time, the platelet count tends to decrease due to both consumption in disseminated microthrombosis and impaired megakaryopoiesis. The resulting thrombocytopenia aggravates hemostatic imbalance and contributes to hemorrhagic risk in later stages. Suppression of fibrinolysis, indicated by reduced plasmin activity, further promotes fibrin deposition and microvascular obstruction in vital organs such as the lungs, kidneys, liver, and brain. These findings are consistent with previous reports describing burn-associated coagulopathy as a dynamic process progressing from hypercoagulation to hypocoagulation and fibrinolytic exhaustion.

Early surgical necroectomy plays a decisive role in preventing further release of endotoxins and procoagulant substances from necrotic tissues, thereby reducing systemic inflammation and stabilizing hemostasis. The topical application of the local hemostatic agent “Heprocel” proved effective in limiting intraoperative blood loss and supporting the formation of stable fibrin clots at the grafting site. This, in turn, enhanced the integration of skin grafts and accelerated wound healing.

Morphological analysis confirmed that microthrombi formation within small vessels represents a major cause of tissue hypoxia and organ dysfunction in severe burns. Hence, early recognition and correction of hemostatic abnormalities—through timely surgery, adequate hemostatic support, and monitoring of coagulation parameters—are critical for improving survival and clinical outcomes in patients with septic burn disease.

Severe burn trauma is associated with hypercoagulability and microvascular thrombosis. Early surgical necroectomy and autodermoplasty with local hemostatic therapy restore hemostasis and improve graft outcomes. Morphological examination confirms microthrombotic lesions as a major pathophysiological feature in burn patients with septicotoxemia.