Red blood cell transfusion in neurosurgical patients

Anemia is common in neurosurgical patients, and is associated with secondary brain injury. Although recent studies in critically ill patients have shifted practice toward more restrictive red blood cell (RBC) transfusion strategies, the evidence for restrictive versus liberal transfusion strategies in neurosurgical patients has been controversial. In this article, we review recent studies that highlight issues in RBC transfusion in neurosurgical patients.

Recent observational, retrospective studies in patients with traumatic brain injury, subarachnoid hemorrhage, and intracranial hemorrhage have demonstrated that prolonged anemia and RBC transfusions were associated with worsened outcomes. Anemia in patients with ischemic stroke was associated with increased ICU length of stay and longer mechanical ventilation requirements, but mortality and functional outcomes did not improve with RBC transfusion. In elective craniotomy, perioperative anemia was associated with increased hospital length of stay but no difference in 30-day morbidity or mortality.

There is a lack of definitive evidence to guide RBC transfusion practices in neurosurgical patients. Large randomized control trials are needed to better assess when and how aggressively to transfuse RBCs in neurosurgical patients.