Anemia management after acute brain injury.
Anemia is frequent among brain-injured patients, where it has been associated with an increased risk of poor outcome. The pathophysiology of anemia in this patient population remains multifactorial; moreover, whether anemia merely reflects a higher severity of the underlying disease or is a significant determinant of the neurological recovery of such patients remains unclear. Interestingly, the effects of red blood cell transfusions (RBCT) in moderately anemic patients remain controversial; although hemoglobin levels are increased, different studies observed only a modest and inconsistent improvement in cerebral oxygenation after RBCT and raised serious concerns about the risk of increased complications. Thus, considering this "blood transfusion anemia paradox", the optimal hemoglobin level to trigger RBCT in brain-injured patients has not been defined yet; also, there is insufficient evidence to provide strong recommendations regarding which hemoglobin level to target and which associated transfusion strategy (restrictive versus liberal) to select in this patient population. We summarize in this review article the more relevant studies evaluating the effects of anemia and RBCT in patients with an acute neurological condition; also, we propose some potential strategies to optimize transfusion management in such patients.
Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles (ULB), Route de Lennik 808, 1070, Brussels, Belgium.|Laboratoire de Médecine Expérimentale, Université Libre de Bruxelles (ULB) - Unité 222, CHU Charleroi (Hôpital André Vésale), Rue de Gozée 706, Montigny-Le-Tilleul, Belgium.
Christophe
C
Lelubre
Department of Anaesthesiology and Critical Care, Grenoble University Hospital, Hôpital Albert Michallon, Avenue Maquis du Grésivaudan, Grenoble, F-38043, France.|Grenoble Neurosciences Institute, Grenoble Alpes University, Grenoble, F-38043, France.
Pierre
P
Bouzat
Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles (ULB), Route de Lennik 808, 1070, Brussels, Belgium.
Ilaria Alice
IA
Crippa
Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles (ULB), Route de Lennik 808, 1070, Brussels, Belgium. ftaccone@ulb.ac.be.
Fabio Silvio
FS
Taccone
D000740:Anemia / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy*; D001930:Brain Injuries / Q000150:complications / Q000503:physiopathology* / Q000628:therapy*; D000070642:Brain Injuries, Traumatic / Q000150:complications / Q000503:physiopathology; D017707:Erythrocyte Transfusion / Q000009:adverse effects / Q000379:methods; D006801:Humans; D009026:Mortality; D010477:Perfusion / Q000379:methods / Q000592:standards; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000503:physiopathology
Anemia; Red blood cell transfusion; Subarachnoid hemorrhage; Threshold; Traumatic brain injury