At What Hematocrit Should a Patient Who is Undergoing Craniotomy for Tumor be Transfused?
A 67-year-old retired operating room nurse is scheduled for craniotomy for tumor resection. The presumptive tissue diagnosis is a renal cell carcinoma metastasis. The lesion measures 3 cm by 2 cm, and imaging shows that the tumor encases a segment of the middle cerebral artery. This will be her third craniotomy in the last 3 years, all on the right side. This unfortunate woman had a right radical nephrectomy, and the left kidney has significant tumor burden. Her preoperative hematocrit is 25. She mentions that she received a blood transfusion after coronary artery bypass graft (CABG) surgery 15 years ago following a ST-segment elevation myocardial infarction (STEMI) and ended up in the intensive care unit (ICU) for 2 weeks with septic shock; she thinks from contaminated blood products. She asks you what the likelihood is of needing a blood transfusion, and she would like to know what your transfusion strategy is because she only wants to receive blood if it is absolutely necessary.
KeywordsNeurosurgical anesthesia Intracranial tumor Anemia Intraoperative blood transfusion Cerebral oxygen delivery