Optimizing RBC Transfusion Strategies in Traumatic Brain Injury: Insights on Early Resuscitation and Cerebral Oxygenation

Abstract

Effective early resuscitation and maintenance of brain oxygenation are critical for improving the outcomes of patients with severe traumatic brain injury (TBI). Red blood cell (RBC) transfusion plays a vital role in this process. Although RBC transfusion can enhance cerebral oxygenation and stabilize hemodynamics, it also poses significant risks including transfusion-related lung injury and transfusion-associated circulatory overload, highlighting the importance of meticulous transfusion management. This review explores transfusion strategies during the early resuscitation phase and the management of anemia in patients with severe TBI, focusing on appropriate treatment targets, utilizing monitoring-based personalized approaches, and summarizing recent research and current insights.

Keywords: Anemia; Blood transfusion; Oxygen saturation; Traumatic brain injury.

FIGURE 1. Effects of anemia and red blood cells transfusions in patients with traumatic brain injury.

TRALI: transfusion-associated acute lung injury, TACO: transfusion-associated circulatory overload.

FIGURE 2. Cerebral hypoxia triggered transfusion. This figure illustrates the management protocol when cerebral hypoxia is detected using PbtO₂ tension or NIRS. Upon cerebral hypoxia detection, interventions such as sedation, augmentation of CPP, and increasing the FiO₂ are implemented. If Hb levels are <9 g/L, a transfusion should be considered to enhance oxygen-carrying capacity, which allows transfusion decisions to be based on the patient's cerebral oxygenation status, thereby optimizing outcomes while preventing unnecessary transfusions.

PbtO₂: brain tissue oxygen, NIRS: near-infrared spectroscopy, CPP: cerebral perfusion pressure, FiO₂: fraction of oxygen, Pao₂: Partial Pressure of Oxygen in Arterial Blood, Hb: hemoglobin.