- Around 50% of patients with severe TBI
- Mechanism
- Can activate hypoxic cell signalling pathways
- Adversely affect cerebral oxygen delivery.
- It seems unlikely that the restrictive transfusion approaches used in general critical care can be extrapolated to patients with TBI because of the increased susceptibility of the injured brain to ischaemia.
- Robertson 2014
- An RCT of erythropoietin and two transfusion thresholds
- Hb 70 g/ litre
- Hb 100 g/ litre
- Found that neither administration of erythropoietin nor maintenance of Hb more than 100 g/ litre improved neurological outcomes at six months after TBI,
- Maintenance of Hb> 100 is associated with more adverse events particularly thromboembolism
- LeRoux, 2013:
- Hb should be maintained >90 g/ litre in the acute phase after TBI,
- Aggressive transfusion practices avoided
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