title: Acute severe isovolemic anemia impairs cognitive function and memory in humans.
abstract: BACKGROUND
  Erythrocytes are transfused to prevent or treat inadequate oxygen delivery resulting from insufficient hemoglobin concentration. Previous studies failed to find evidence of inadequate systemic oxygen delivery at a hemoglobin concentration of 5 g/dl. However, in those studies, sensitive, specific measures of critical organ function were not used. This study tested the hypothesis that acute severe decreases of hemoglobin concentration alters human cognitive function.
  
  
  METHODS
  Nine healthy volunteers, age 29 +/- 5 yr (mean +/- SD), were tested with verbal memory and standard, computerized neuropsychologic tests before and after acute isovolemic reduction of their hemoglobin to 7, 6, and 5 g/dl and again after transfusion of their autologous erythrocytes to return their hemoglobin concentration to 7 g/dl. To control for duration of the experiment, each volunteer also completed the same tests on a separate day, without alteration of hemoglobin, at times of the day approximately equivalent to those on the experimental day.
  
  
  RESULTS
  No test showed any change in reaction time or error rate at hemoglobin concentration of 7 g/dl compared with the data at the baseline hemoglobin concentration of 14 g/dl. Reaction time, but not error rate, for horizontal addition and digit-symbol substitution test (DSST) increased at hemoglobin 6 g/dl (mean horizontal addition, 19%; 95% confidence interval [CI], 4-34%; mean DSST, 10%; 95% CI, 4-17%) and further at 5 g/dl (mean horizontal addition, 43%; 95% CI, 6-79%; mean DSST, 18%; 95% CI, 4-31%). Immediate and delayed memory was degraded at hemoglobin 5 g/dl but not at 6 g/dl. Return of hemoglobin to 7 g/dl returned all tests to baseline, except for the DSST, which significantly improved, and returned to baseline the following morning after transfusion of all autologous erythrocytes.
  
  
  CONCLUSIONS
  Acute reduction of hemoglobin concentration to 7 g/dl does not produce detectable changes in human cognitive function. Further reduction of hemoglobin level to 6 and 5 g/dl produces subtle, reversible increases in reaction time and impaired immediate and delayed memory. These are the first prospective data to demonstrate subtle degraded human function with acute anemia of hemoglobin concentrations of 6 and 5 g/dl. This reversibility of these decrements with erythrocyte transfusion suggests that our model can be used to test the efficacy of erythrocytes, oxygen therapeutics, or other treatments for acute anemia.
authors.affiliation: Departments of Anesthesia, the Cardiovascular Research Institute, University of California, San Francisco, California 94143-0648, USA. weiskopf@jemo.ucsf.edu
authors.forename: R B
authors.initials: RB
authors.lastname: Weiskopf
authors.forename: J H
authors.initials: JH
authors.lastname: Kramer
authors.forename: M
authors.initials: M
authors.lastname: Viele
authors.forename: M
authors.initials: M
authors.lastname: Neumann
authors.forename: J R
authors.initials: JR
authors.lastname: Feiner
authors.forename: J J
authors.initials: JJ
authors.lastname: Watson
authors.forename: H W
authors.initials: HW
authors.lastname: Hopf
authors.forename: P
authors.initials: P
authors.lastname: Toy
mesh_terms: D000328:Adult; D000740:Anemia / Q000097:blood / Q000523:psychology*; D001810:Blood Volume / Q000502:physiology; D003071:Cognition / Q000502:physiology*; D005260:Female; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D008297:Male; D008568:Memory / Q000502:physiology*; D011939:Mental Recall / Q000502:physiology; D011597:Psychomotor Performance / Q000502:physiology; D011930:Reaction Time / Q000502:physiology
chemical_list: D006454:Hemoglobins