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The effect of blood transfusion on brain oxygenation in children with severe traumatic brain injury
Anthony A Figaji1, Eugene Zwane, M Kogels
1Division of Neurosurgery, School of Child and Adolescent Health, University of Cape Town, Red Cross Childrens Hospital, Cape Town, South Africa. Anthony.Figaji@uct.ac.za
Insights
Blood transfusions in children with severe traumatic brain injury (TBI) can transiently increase brain tissue oxygen tension in most patients. However, this effect is short-lived, returning to baseline within 24 hours, with no clear predictors identified.
Area of Science:
- Pediatric critical care medicine
- Neurotrauma research
- Transfusion medicine
Background:
- Indications for blood transfusion in pediatric traumatic brain injury (TBI) are not well-established.
- The impact of blood transfusion on brain tissue oxygenation in pediatric TBI patients remains unclear.
Purpose of the Study:
- To investigate the effect of blood transfusion on brain tissue oxygen tension in children with severe TBI.
- To analyze early and late changes in brain tissue oxygen tension following blood transfusion in this population.
Main Methods:
- Retrospective analysis of a prospective observational database.
- Inclusion of pediatric patients with severe TBI undergoing brain tissue oxygen tension monitoring and receiving blood transfusion.
- Comparison of pre- and post-transfusion brain tissue oxygen tension values, with analysis of changes at 1-4 hours and 24 hours.
Main Results:
- Brain tissue oxygen tension significantly increased in the early period (1-4 hours) post-transfusion in 79% of pediatric TBI patients.
- The observed increases in brain tissue oxygen tension were generally small and transient, returning to baseline by 24 hours.
- No significant predictors for the magnitude of brain tissue oxygen tension change were identified in multivariate analysis.
Conclusions:
- Blood transfusion can lead to a transient increase in brain tissue oxygen tension in a majority of pediatric TBI patients.
- The effect of blood transfusion on brain tissue oxygen tension is temporary, with levels normalizing within 24 hours.
- Predictors for the brain tissue oxygen tension response to blood transfusion in pediatric TBI remain elusive.
Objective:
The indications for blood transfusion in traumatic brain injury are controversial. In particular, little is known about the effect of blood transfusion in childhood traumatic brain injury. This study aimed to examine the influence of blood transfusion on brain tissue oxygen tension in children with severe traumatic brain injury.
Design:
A retrospective analysis of a prospective observational database of children with severe traumatic brain injury who received brain tissue oxygen tension monitoring and a blood transfusion.
Setting:
University-affiliated pediatric hospital.
Patients:
Children with severe traumatic brain injury and blood transfusion.
Interventions:
None.
Measurements And Main Results:
Brain tissue oxygen tension was measured in normal-appearing white matter with a commercially available polarographic Clarke-type electrode. Brain tissue oxygen tension values after blood transfusion were compared with pre-transfusion values in hemodynamically stable patients. Limited interventions were allowed during the studied period. Brain tissue oxygen tension values were examined for early (1-4 hrs) and late (24 hrs) changes after blood transfusion, controlling for multiple clinical and physiologic variables with regression techniques. Further comparison was made with matched non-transfused controls to examine the influence of time after injury. Nineteen blood transfusions in 17 patients were evaluated. Brain tissue oxygen tension increased significantly in the early period after blood transfusion (p = .0018; 79% increased, 21% decreased) in comparison with baseline values and matched controls, but the overall changes were small and, in part, influenced by accompanying cerebral perfusion pressure changes. Also, this effect was limited to the early period after blood transfusion and was not significant after 24 hrs. In general, the brain tissue oxygen tension increase was larger in patients with higher baseline brain tissue oxygen tension and lower initial hemoglobin; however, no factors associated with the magnitude of the brain tissue oxygen tension change were significant in multivariate analysis. Increased age of blood did not appear to impair brain tissue oxygen tension changes, but most blood transfusion were <14 days old.
Conclusions:
Brain tissue oxygen tension increased transiently in 79% of blood transfusion in pediatric traumatic brain injury patients, and decreased transiently in 21%. Brain tissue oxygen tension returned to baseline within 24 hrs. Reliable predictors of this brain tissue oxygen tension response to blood transfusion, however, remain elusive.
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