Optimizing Blood Transfusion Practices in Traumatic Brain Injury and Subarachnoid Hemorrhage

Purpose of Review: Anemia is a frequent complication in patients suffering from traumatic brain injury (TBI) or subarachnoid hemorrhage (SAH) and has been associated with poor outcome. Interestingly, red blood cell transfusion (RBCT), which is the most common therapeutic intervention in anemic brain-injured patients, was also reported as an independent predictor of mortality in several studies. The aim of this review was to summarize the current literature on the use of RBCT in brain-injured patients and to provide some insights on how to optimize their use in this setting. Recent Findings: In moderately anemic TBI/SAH patients, RBCT could increase hemoglobin (Hb) levels while the effects on cerebral oxygenation were modest and inconsistent, raising serious concerns about the effectiveness and the risk/benefit ratio of this intervention. The optimal Hb level to trigger RBCT in TBI and SAH patients has not been defined yet. Thus, in those patients who are awake and without any further neurological deterioration, RBCT should be initiated as in other critically ill patients, e.g., for Hb levels below 7 g/dL. In case of poor-grade clinical status, the use of indicators of inadequate systemic oxygen delivery (e.g., low venous hemoglobin saturation or high lactate levels) or of brain hypoxia (e.g., low regional hemoglobin saturation or brain oxygen pressure) may be helpful to guide RBCT. Nevertheless, there is no evidence to provide strong recommendations based on this strategy to initiate transfusions in this patients’ population. Summary: Few good quality data exist about the effects of RBCT on the outcome of TBI and SAH patients. While randomized trials will be initiated, the optimal Hb level to trigger RBCT in these patients may be related to the clinical status or on systemic and/or cerebral monitoring values. © 2016, Springer Science + Business Media New York.