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. 2017 Jun 17;21(1):159.
doi: 10.1186/s13054-017-1748-4.

Hemoglobin concentrations and RBC transfusion thresholds in patients with acute brain injury: an international survey

Rafael Badenes  1 , Mauro Oddo  2 , José I Suarez  3 , Massimo Antonelli  4 , Jeffrey Lipman  5   6 , Giuseppe Citerio  7   8 , Fabio Silvio Taccone  9
Affiliations

Hemoglobin concentrations and RBC transfusion thresholds in patients with acute brain injury: an international survey

Rafael Badenes et al. Crit Care. .

Abstract

Background: The optimal hemoglobin (Hb) threshold at which to initiate red blood cell (RBC) transfusion in patients with acute brain injury is unknown. The aim of this survey was to investigate RBC transfusion practices used with these patients.

Methods: We conducted a web-based survey within various societies of critical care medicine for intensive care unit (ICU) physicians who currently manage patients with primary acute brain injury.

Results: A total of 868 responses were obtained from around the world, half of which (n = 485) were from European centers; 204 (24%) respondents had a specific certificate in neurocritical care, and most were specialists in anesthesiology or intensive care and had less than 15 years of practice experience. Four hundred sixty-six respondents (54%) said they used an Hb threshold of 7-8 g/dl to initiate RBC transfusion after acute brain injury, although half of these respondents used a different threshold (closer to 9 g/dl) in patients with traumatic brain injury, subarachnoid hemorrhage, or ischemic stroke. Systemic and cerebral factors were reported as influencing the need for higher Hb thresholds. Most respondents agreed that a randomized clinical trial was needed to compare two different Hb thresholds for RBC transfusion, particularly in patients with traumatic brain injury, subarachnoid hemorrhage, and ischemic stroke.

Conclusions: The Hb threshold used for RBC transfusion after acute brain injury was less than 8 g/dl in half of the ICU clinicians who responded to our survey. However, more than 50% of these physicians used higher Hb thresholds in certain conditions.

Keywords: Brain injury; Hemoglobin; Outcome; Threshold; Transfusion.

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Figures

Fig. 1
Fig. 1
Number of respondents (n) for the recommended threshold of hemoglobin (Hb) used to initiate red blood cell transfusion (RBCT) in patients with acute brain injury
Fig. 2
Fig. 2
Proportion of respondents (%) for the different thresholds of hemoglobin used to initiate blood transfusion according to different cerebral pathologies. SAH Subarachnoid hemorrhage, TBI Traumatic brain injury, Isch stroke Ischemic stroke, ICH Intracranial hemorrhage, NS Neurosurgery SE Status epilepticus, HIE Hypoxic-ischemic encephalopathy, CNS Infect Infections of the central nervous system
Fig. 3
Fig. 3
Median normal hemoglobin (Hb) values and altered values in the presence of trigger factors
See this image and copyright information in PMC

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