Blood Transfusion in Critically Ill Patients with Traumatic Brain Injury

  • A. F. TurgeonEmail author
  • F. Lauzier
  • D. A. Fergusson
Part of the Annual Update in Intensive Care and Emergency Medicine book series (AUICEM)


Traumatic brain injury (TBI) is the main cause of death in the first half of life and a significant proportion of survivors of severe TBI are left with severe permanent impairment [12]. Not surprisingly, TBI patients also consume the majority of healthcare resources in trauma care [34]. Current management of critically ill patients with TBI focuses on preventing secondary cerebral injuries. Most interventions in the acute phase of care are thus directed at ensuring appropriate brain oxygen delivery (DO2). However, the majority of these interventions are based on very limited rigorous evidence [5], with highly variable within and between center practice. This variation has led to significant outcome differences being observed across centers [2], including regarding the use of red blood cell (RBC) transfusion. RBC transfusion is a common intervention administered in TBI given the high proportion of anemia in this population. Although there has been a move towards...


  1. 1.
    Myburgh JA, Cooper DJ, Finfer SR et al (2008) Australasian Traumatic Brain Injury Study. (traumatic brain injury) Investigators for the Australian and New Zealand Intensive Care Society Clinical Trials Group. Epidemiology and 12-month outcomes from traumatic brain injury in Australia and New Zealand. J Trauma 64:854–862CrossRefGoogle Scholar
  2. 2.
    Turgeon AF, Lauzier F, Simard JF et al (2011) Mortality associated with withdrawal of life-sustaining therapy for patients with severe traumatic brain injury: a Canadian multicentre cohort study. CMAJ 183:1581–1588CrossRefGoogle Scholar
  3. 3.
    World Health Organization (2012) The WHO strategy on research for health. Accessed 10 January 2018Google Scholar
  4. 4.
    SMARTRISK (2009) The economic burden of injury in Canada. Accessed 10 January 2018Google Scholar
  5. 5.
    Carney N, Totten AM, O’Reilly C et al (2016) Guidelines for the management of severe traumatic brain injury, fourth edition. Neurosurgery 80:6–15Google Scholar
  6. 6.
    Walsh TS, Lee RJ, Maciver CR et al (2006) Anemia during and at discharge from intensive care: the impact of restrictive blood transfusion practice. Intensive Care Med 32:100–109CrossRefGoogle Scholar
  7. 7.
    Scharte M, Fink MP (2003) Red blood cell physiology in critical illness. Crit Care Med 31:S651–S657CrossRefGoogle Scholar
  8. 8.
    Rogiers P, Zhang H, Leeman M et al (1997) Erythropoietin response in blunted in critically ill patients. Intensive Care Med 23:159–162CrossRefGoogle Scholar
  9. 9.
    Eyster E, Bernene J (1973) Nosocomial anemia. JAMA 223:73–74CrossRefGoogle Scholar
  10. 10.
    Krafte-Jacobs B, Levetown ML, Bray GL et al (1994) Erythropoietin response to critical illness. Crit Care Med 22:821–826CrossRefGoogle Scholar
  11. 11.
    Vincent J-L, Baron JF, Reinhart K et al (2002) Anemia and blood transfusion in critically ill patients. JAMA 288:1499–1507CrossRefGoogle Scholar
  12. 12.
    Corwin HL, Gettinger A, Pearl RG et al (2004) The CRIT study: anemia and blood transfusion in the critically ill—current clinical practice in the United States. Crit Care Med 32:39–52CrossRefGoogle Scholar
  13. 13.
    Carlson AP, Schermer CR, Lu SW (2006) Retrospective evaluation of anemia and transfusion in traumatic brain injury. J Trauma 61:46–56CrossRefGoogle Scholar
  14. 14.
    Salim A, Hadjizacharia P, DuBose J et al (2008) Role of anemia in traumatic brain injury. J Am Coll Surg 207:398–406CrossRefGoogle Scholar
  15. 15.
    Steyerberg EW, Mushkuidani N, Perel P et al (2008) Predicting outcome after traumatic brain injury: development and validation of international validation of prognostic scores based on admission characteristics. PLoS Med 5:1251–1261CrossRefGoogle Scholar
  16. 16.
    Boutin A, Chassé M, Shemilt M et al (2016) Red blood cell transfusion in patients with traumatic brain injury: a systematic review and meta-analysis. Transfus Med Rev 30:15–24CrossRefGoogle Scholar
  17. 17.
    Boutin A, Moore L, Lauzier F et al (2017) Transfusion of red blood cells in patients with traumatic brain injuries admitted to Canadian trauma health centres: a multicentre cohort study. BMJ Open 7:e14472CrossRefGoogle Scholar
  18. 18.
    Agency for Healthcare Research and Quality (2013) Most Frequent Procedures Performed in U.S. Hospitals, 2011. HCUP Statistical Brief #165. Accessed 10 January 2018Google Scholar
  19. 19.
    Rebel A, Ulatowski JA, Kwansa H et al (2003) Cerebrovascular response to decreased hematocrit: effect of cell-free hemoglobin, plasma viscosity, and CO2. Am J Physiol Heart Circ Physiol 285:1600–1608CrossRefGoogle Scholar
  20. 20.
    Chodobski A, Zink BJ, Szmydynger-Chodobska J (2011) Blood-brain barrier pathophysiology in traumatic brain injury. Transl Stroke Res 2:492–516CrossRefGoogle Scholar
  21. 21.
    Smith MJ, Stiefel MF, Magge S et al (2005) Packed red blood cell transfusion increases local cerebral oxygenation. Crit Care Med 33:1104–1108CrossRefGoogle Scholar
  22. 22.
    Zygun DA, Nortje J, Hutchinson PJ et al (2009) The effect of red blood cell transfusion on cerebral oxygenation and metabolism after severe traumatic brain injury. Crit Care Med 37:1074–1078CrossRefGoogle Scholar
  23. 23.
    Hébert PC, Wells G, Blajchman MA et al (1999) A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med 340:409–417CrossRefGoogle Scholar
  24. 24.
    Lacroix J, Hébert PC, Hutchison JS et al (2007) Transfusion strategies for patients in pediatric intensive care units. N Engl J Med 356:1609–1619CrossRefGoogle Scholar
  25. 25.
    Holst LB, Haase N, Wetterslev J et al (2014) Lower versus higher hemoglobin threshold for transfusion in septic shock. N Engl J Med 371:1381–1391CrossRefGoogle Scholar
  26. 26.
    Murphy GJ, Pike K, Rogers CA et al (2015) Liberal or restrictive transfusion after cardiac surgery. N Engl J Med 372:997–1008CrossRefGoogle Scholar
  27. 27.
    Carson JL, Stanworth SJ, Roubinian N et al (2016) Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. Cochrane Database Syst Rev 10:CD002042CrossRefPubMedGoogle Scholar
  28. 28.
    Docherty AB, O’Donnell R, Brunskill S et al (2016) Effect of restrictive versus liberal transfusion strategies on outcomes in patients with cardiovascular disease in a non-cardiac surgery setting: systematic review and meta-analysis. BMJ 352:i1351CrossRefGoogle Scholar
  29. 29.
    Desjardins P, Turgeon AF, Tremblay MH et al (2012) Hemoglobin levels and transfusions in neurocritically ill patients: a systematic review of comparative studies. Crit Care 16:R54CrossRefGoogle Scholar
  30. 30.
    Naidech AM, Drescher J, Ault ML et al (2006) Higher hemoglobin is associated with less cerebral infarction, poor outcome, and death after subarachnoid hemorrhage. Neurosurgery 59:775–779CrossRefGoogle Scholar
  31. 31.
    Robertson CS, Hannay HJ, Yamal JM et al (2014) Effect of erythropoietin and transfusion threshold on neurological recovery after traumatic brain injury: a randomized clinical trial. JAMA 312:36–47CrossRefGoogle Scholar
  32. 32.
    Badenes R, Oddo M, Suarez JI et al (2017) Hemoglobin concentrations and RBC transfusion thresholds in patients with acute brain injury: an international survey. Crit Care 21:159CrossRefGoogle Scholar
  33. 33.
    Sena MJ, Rivers RM, Muizelaar JP et al (2009) Transfusion practices for acute traumatic brain injury: a survey of physicians at US trauma centers. Intensive Care Med 35:480–488CrossRefGoogle Scholar
  34. 34.
    Kramer AH, Diringer MN, Suarez JI et al (2011) Red blood cell transfusion in patients with subarachnoid hemorrhage: a multidisciplinary North American survey. Crit Care 15:R30CrossRefGoogle Scholar
  35. 35.
    Kramer AH, Le Roux P (2012) Red blood cell transfusion and transfusion alternatives in traumatic brain injury. Curr Treat Options Neurol 14:150–163CrossRefGoogle Scholar
  36. 36.
    Bellapart J, Boots R, Fraser J (2012) Physiopathology of anemia and transfusion thresholds in isolated head injury. J Trauma Acute Care Surg 73:997–1005CrossRefGoogle Scholar
  37. 37.
    Roberts DJ, Zygun DA (2012) Anemia, red blood cell transfusion, and outcomes after severe traumatic brain injury. Crit Care 16:154CrossRefGoogle Scholar
  38. 38.
    Utter GH, Shahlaie K, Zwienenberg-Lee M et al (2011) Anemia in the setting of traumatic brain injury: the arguments for and against liberal transfusion. J Neurotrauma 28:155–165CrossRefGoogle Scholar
  39. 39.
    Kumar MA (2012) Red blood cell transfusion in the neurological ICU. Neurotherapeutics 9:56–64CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • A. F. Turgeon
    • 1
    • 2
    Email author
  • F. Lauzier
    • 1
    • 2
  • D. A. Fergusson
    • 3
  1. 1.Population Health and Optimal Health Practices Unit (Trauma – Emergency – Critical Care Medicine)CHU de Québec-Université Laval Research CentreQuebecCanada
  2. 2.Department of Critical Care MedicineCHU de Québec-Université LavalQuebecCanada
  3. 3.Clinical Epidemiology ProgramOttawa Hospital Research Institute Centre for Practice-Changing ResearchOttawaCanada

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