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. 2010 Feb;12(1):4-9.
doi: 10.1007/s12028-009-9273-1. Epub 2009 Sep 24.

Factors associated with the development of anemia after subarachnoid hemorrhage

Tomoko R Sampson  1 , Rajat Dhar, Michael N Diringer
Affiliations

Factors associated with the development of anemia after subarachnoid hemorrhage

Tomoko R Sampson et al. Neurocrit Care. 2010 Feb.

Abstract

Introduction: Anemia is common after subarachnoid hemorrhage (SAH) and may exacerbate the reduction in oxygen delivery that underlies delayed cerebral ischemia. Fall in hemoglobin may relate to blood loss as well as inflammatory suppression of erythropoiesis. Identifying factors associated with anemia may facilitate targeted interventions, such as the use of erythropoiesis-stimulating agents, which could minimize the burden of anemia and reduce red blood cell (RBC) transfusion requirements.

Methods: We analyzed a cohort of patients with spontaneous SAH admitted over a 3-year period who survived at least 4 days. All patients had daily hematocrit values drawn while in the ICU. Multivariate regression was performed to determine baseline and early post-admission variables associated with development of anemia (defined as hematocrit < 30%).

Results: Anemia developed in 47% of 243 patients with SAH after a mean of 3.5 days (median 2 days). Admission variables independently associated with anemia were female gender (OR 3.7, 95% CI 1.8-7.6), baseline hematocrit < 36% (OR 3.9, 1.5-10.1 compared to 36-45%), history of hypertension (OR 2.1, 1.05-4.2), and poor clinical grade (OR 5.9, 2.3-15.0). Surgical aneurysm treatment (OR 13.5, 6.0-30.3) and greater admission SIRS score (OR 5.7, 1.7-19.2 if 3-4 criteria for systemic inflammatory response syndrome were met on day of admission compared to none) were also associated with fall in hematocrit.

Conclusions: It may be possible to predict those most likely to develop anemia using simple baseline clinical variables. Anemia was strongly related to surgery, likely through greater blood loss, and greater systemic inflammatory response on admission, possibly explained by cytokine-mediated inhibition of RBC production.

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Figures

Fig. 1
Fig. 1
Survival curve of incidence and time to develop anemia by intervention
See this image and copyright information in PMC

References

    1. Kassell NF, Torner JC, Haley EC, Jr, Jane JA, Adams HP, Kongable GL. The International Cooperative Study on the Timing of Aneurysm Surgery. Part 1: overall management results. J Neurosurg. 1990;73(1):18–36. - PubMed
    1. Powers WJ, Grubb RL Jr, Baker RP, Mintun MA, Raichle ME. Regional cerebral blood flow and metabolism in reversible ischemia due to vasospasm. Determination by positron emission tomography. J Neurosurg. 1985;62(4):539–46. - PubMed
    1. Giller CA, Wills MJ, Giller AM, Samson D. Distribution of hematocrit values after aneurysmal subarachnoid hemorrhage. J Neuroimaging. 1998;8(3):169–70. - PubMed
    1. Kramer AH, Gurka MJ, Nathan B, Dumont AS, Kassell NF, Bleck TP. Complications associated with anemia and blood transfusion in patients with aneurysmal subarachnoid hemorrhage. Crit Care Med. 2008;36(7):2070–5. - PubMed
    1. Naidech AM, Drescher J, Ault ML, Shaibani A, Batjer HH, Alberts MJ. Higher hemoglobin is associated with less cerebral infarction, poor outcome, and death after subarachnoid hemorrhage. Neurosurgery. 2006;59(4):775–9. - PubMed

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