• Pedro Kurtz, Raimund Helbok, Jan Claassen, J Michael Schmidt, Luis Fernandez, R Morgan Stuart, E Sander Connolly, Kiwon Lee, Stephan A Mayer, and Neeraj Badjatia.
• Neurological Intensive Care Unit, Brain Institute Paulo Niemeyer, Rio de Janeiro, Brazil. kurtzpedro@mac.com.
• Neurocrit Care. 2016 Feb 1; 24 (1): 118-21.

BackgroundAnemia 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.MethodsThis 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 (PbtO2) was tested using univariate and multivariable analyses.ResultsPRBC 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. PbtO2 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 SpO2, cerebral perfusion pressure, and LPR, the change in Hb concentration was independently and positively associated with a change in PbtO2 (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.ConclusionsPRBC transfusion resulted in PbtO2 improvement without a clear effect on cerebral metabolism prior to SAH.

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