The purpose of this study is to find out if burn injured patients do better receiving fewer blood transfusions than what is traditionally given. We traditionally provide blood transfusions to maintain a hemoglobin level, which is an indicator of the level of red blood cells that carry oxygen in your body, to above 10 g/dl (g/dl stands for grams per deciliter and is the standard measurement used to indicate the level of red blood cells in your blood). However, a preliminary study indicated that maintaining the hemoglobin level to above 7-8 g/dl with less blood transfusion, as compared to a hemoglobin level of 10 g/dl and above, would reduce the occurrence of blood infection, duration on the respirator and length of hospital stay, yet would achieve similar survival in both groups.

Inclusion Criteria:

• >20% TBSA burn with anticipated operation need on admission as determined by attending physician
• age >18 years
• Admission within 96 hours of injury

Exclusion Criteria:

• <18 years of age
• pregnancy
• inability or unwillingness to receive blood products
• history of chronic anemia (hemoglobin <9.0 g/dL one month prior to enrollment)
• preexisting need for hemodialysis
• brain death or imminent brain death
• non-survivable burn as determined by the attending burn surgeon
• angina or acute myocardial infarction
• preexisting hematologic disease
• Length of hospital stay anticipated to be < 2 weeks
• Transfusion administered at outside hospital before admit