The Effect of Packed Red Blood Cell Transfusion on Cerebral Oxygenation and Metabolism After Subarachnoid Hemorrhage

• Published in: Neurocritical care 2016-02, Vol.24 (1), p.118-121
• Main Authors: Kurtz, Pedro, Helbok, Raimund, Claassen, Jan, Schmidt, J. Michael, Fernandez, Luis, Stuart, R. Morgan, Connolly, E. Sander, Lee, Kiwon, Mayer, Stephan A., Badjatia, Neeraj
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anemia; Blood; Brain - metabolism; Catheters; Critical Care Medicine; Erythrocyte Transfusion - methods; Female; Hemoglobin; Hemorrhage; Humans; Intensive; Internal Medicine; Ischemia; Male; Medicine; Medicine & Public Health; Metabolism; Middle Aged; Neurology; Original Article; Oxygen - metabolism; Oxygen Consumption - physiology; Physiology; Subarachnoid Hemorrhage - metabolism; Subarachnoid Hemorrhage - therapy; Treatment Outcome; Variables
• ISSN: 1541-6933; 1556-0961
• DOI: 10.1007/s12028-015-0180-3

Background Anemia adversely affects cerebral oxygenation and metabolism after subarachnoid hemorrhage (SAH) and is also associated with poor outcome. There is limited evidence to support the use of packed red blood cell (PRBC) transfusion to optimize brain homeostasis after SAH. The aim of this study was to investigate the effect of transfusion on cerebral oxygenation and metabolism in patients with SAH. Methods This was a prospective observational study in a neurological intensive care unit of a university hospital. Nineteen transfusions were studied in 15 consecutive patients with SAH that underwent multimodality monitoring (intracranial pressure, brain tissue oxygen, and cerebral microdialysis). Data were collected at baseline and for 12 h after transfusion. The relationship between hemoglobin (Hb) change and lactate/pyruvate ratio (LPR) orbrain tissue oxygen (PbtO 2 ) was tested using univariate and multivariable analyses. Results PRBC transfusion was administered on the median post-bleed day 8. The average Hb concentration at baseline was 8.1 g/dL and increased by 2.2 g/dL after transfusion. PbtO 2 increased between hours 2 and 4 post-transfusion and this increase was maintained until hour 10. LPR did not change significantly during the 12-h monitoring period. After adjusting for SpO 2 , cerebral perfusion pressure, and LPR, the change in Hb concentration was independently and positively associated with a change in PbtO 2 (adjusted b estimate = 1.39 [95 % confidence interval 0.09–2.69]; P  = 0.04). No relationship between the change in Hb concentration and LPR was found. Conclusions PRBC transfusion resulted in PbtO 2 improvement without a clear effect on cerebral metabolism prior to SAH.