title: Haemoglobin management in acute brain injury.
abstract: OBJECTIVE
  Anaemia is common among patients in the neurocritical care unit (NCCU) and is thought to exacerbate brain injury. However, the optimal haemoglobin (Hgb) level still remains to be elucidated for traumatic brain injury (TBI), subarachnoid haemorrhage (SAH) and acute ischaemic stroke (AIS). This review outlines recent studies about anaemia and the effects of red blood cell transfusion (RBCT) on outcome in TBI, SAH and AIS patients admitted to the NCCU.
  
  
  RESULTS
  Patients with severe SAH, AIS and TBI often develop anaemia and require RBCT. In general critical care, a restrictive RBCT strategy (Hgb ~7 g/dl) is preferable in patients without serious cardiac disease. In severe TBI, AIS and SAH, both anaemia and RBCT may negatively influence clinical outcome. However, the appropriate RBCT trigger remains unclear and there is great variance in how these patients are transfused. There is evidence from PET and microdialysis studies in humans that RBCT can favourably influence brain metabolism and oxygenation. This correction of hypoxia or altered metabolism rather than anaemia may be of greater importance.
  
  
  CONCLUSIONS
  Results from general critical care should not be extrapolated to all patients with acute brain injury. Transfusion is not risk free, but RBCT use needs to be considered also in terms of potential benefit.
authors: Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA 191406, USA. lerouxp@uphs.upenn.edu
authors: Peter
authors: P
authors: LeRoux
mesh_terms: D000740:Anemia / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D001930:Brain Injuries / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D003422:Critical Care / Q000379:methods; D017707:Erythrocyte Transfusion / Q000379:methods*; D005260:Female; D006454:Hemoglobins; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D020521:Stroke / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D013345:Subarachnoid Hemorrhage / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D006454:Hemoglobins