Anemia and red blood cell transfusion in neurocritical care View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2009-06-11

AUTHORS

Andreas H Kramer, David A Zygun

ABSTRACT

INTRODUCTION: Anemia is one of the most common medical complications to be encountered in critically ill patients. Based on the results of clinical trials, transfusion practices across the world have generally become more restrictive. However, because reduced oxygen delivery contributes to 'secondary' cerebral injury, anemia may not be as well tolerated among neurocritical care patients. METHODS: The first portion of this paper is a narrative review of the physiologic implications of anemia, hemodilution, and transfusion in the setting of brain-injury and stroke. The second portion is a systematic review to identify studies assessing the association between anemia or the use of red blood cell transfusions and relevant clinical outcomes in various neurocritical care populations. RESULTS: There have been no randomized controlled trials that have adequately assessed optimal transfusion thresholds specifically among brain-injured patients. The importance of ischemia and the implications of anemia are not necessarily the same for all neurocritical care conditions. Nevertheless, there exists an extensive body of experimental work, as well as human observational and physiologic studies, which have advanced knowledge in this area and provide some guidance to clinicians. Lower hemoglobin concentrations are consistently associated with worse physiologic parameters and clinical outcomes; however, this relationship may not be altered by more aggressive use of red blood cell transfusions. CONCLUSIONS: Although hemoglobin concentrations as low as 7 g/dl are well tolerated in most critical care patients, such a severe degree of anemia could be harmful in brain-injured patients. Randomized controlled trials of different transfusion thresholds, specifically in neurocritical care settings, are required. The impact of the duration of blood storage on the neurologic implications of transfusion also requires further investigation. More... »

PAGES

r89-r89

References to SciGraph publications

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  • 2006-02. A review of red cell transfusion in the neurological intensive care unit in NEUROCRITICAL CARE
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  • 2008-09-23. Implications of Early Versus Late Bilateral Pulmonary Infiltrates in Patients with Aneurysmal Subarachnoid Hemorrhage in NEUROCRITICAL CARE
  • 2006-09-22. Transfusion of erythrocyte concentrates produces a variable increment on cerebral oxygenation in patients with severe traumatic brain injury in INTENSIVE CARE MEDICINE
  • 1993-09. Early ischaemia after severe head injury preliminary results in patients with diffuse brain injuries in ACTA NEUROCHIRURGICA
  • 2002-07. Effects of Iso- and Hypervolemic Hemodilution on Regional Cerebral Blood Flow and Oxygen Delivery for Patients with Vasospasm after Aneurysmal Subarachnoid Hemorrhage in ACTA NEUROCHIRURGICA
  • 2008-10-15. Transfusion practices for acute traumatic brain injury: a survey of physicians at US trauma centers in INTENSIVE CARE MEDICINE
  • 2008-02-14. Aggressive Red Blood Cell Transfusion: No Association with Improved Outcomes for Victims of Isolated Traumatic Brain Injury in NEUROCRITICAL CARE
  • 2002-02-14. Specialist neurocritical care and outcome from head injury in INTENSIVE CARE MEDICINE
  • Identifiers

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    http://scigraph.springernature.com/pub.10.1186/cc7916

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    http://dx.doi.org/10.1186/cc7916

    DIMENSIONS

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    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/19519893


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