Liberal Versus Restrictive Transfusion Trigger after Acute Brain Injury: More than Just Higher Blood Oxygen Content

Previous studies on restrictive versus liberal blood hemoglobin transfusion triggers in critically ill or cardiac surgery patients had established a paradigm favoring restrictive triggers. In contrast, the hemoglobin transfusion threshold in traumatic brain injury optimization and transfusion strate...

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Main Author: Adrienne K. Ho
Format: Article
Language:English
Published: Mary Ann Liebert 2025-01-01
Series:Neurotrauma Reports
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Online Access:https://www.liebertpub.com/doi/10.1089/neur.2025.0008
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author Adrienne K. Ho
author_facet Adrienne K. Ho
author_sort Adrienne K. Ho
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description Previous studies on restrictive versus liberal blood hemoglobin transfusion triggers in critically ill or cardiac surgery patients had established a paradigm favoring restrictive triggers. In contrast, the hemoglobin transfusion threshold in traumatic brain injury optimization and transfusion strategy in patients with acute brain injury trials (2024) suggest that a liberal hemoglobin (90–100 g/L) transfusion trigger is associated with better neuro-outcomes than a restrictive (70 g/L) trigger in anemic patients with acute brain injury. Increased blood oxygen content is one obvious possible reason for the observed superior neuro-outcomes with more liberal red blood cell transfusion. In this author’s opinion, another plausible reason is that in replacing extracranial blood loss, which most of the patients in both trials had, avoidance of blood alternatives that could worsen intracranial hypertension might also have benefitted the liberal transfusion cohorts.
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spelling doaj-art-86279b2cf01a48b5b9c96065a9ef26042025-08-20T02:30:55ZengMary Ann LiebertNeurotrauma Reports2689-288X2025-01-016125726010.1089/neur.2025.0008Liberal Versus Restrictive Transfusion Trigger after Acute Brain Injury: More than Just Higher Blood Oxygen ContentAdrienne K. Ho0Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada.Previous studies on restrictive versus liberal blood hemoglobin transfusion triggers in critically ill or cardiac surgery patients had established a paradigm favoring restrictive triggers. In contrast, the hemoglobin transfusion threshold in traumatic brain injury optimization and transfusion strategy in patients with acute brain injury trials (2024) suggest that a liberal hemoglobin (90–100 g/L) transfusion trigger is associated with better neuro-outcomes than a restrictive (70 g/L) trigger in anemic patients with acute brain injury. Increased blood oxygen content is one obvious possible reason for the observed superior neuro-outcomes with more liberal red blood cell transfusion. In this author’s opinion, another plausible reason is that in replacing extracranial blood loss, which most of the patients in both trials had, avoidance of blood alternatives that could worsen intracranial hypertension might also have benefitted the liberal transfusion cohorts.https://www.liebertpub.com/doi/10.1089/neur.2025.0008brain injurytransfusion
spellingShingle Adrienne K. Ho
Liberal Versus Restrictive Transfusion Trigger after Acute Brain Injury: More than Just Higher Blood Oxygen Content
Neurotrauma Reports
brain injury
transfusion
title Liberal Versus Restrictive Transfusion Trigger after Acute Brain Injury: More than Just Higher Blood Oxygen Content
title_full Liberal Versus Restrictive Transfusion Trigger after Acute Brain Injury: More than Just Higher Blood Oxygen Content
title_fullStr Liberal Versus Restrictive Transfusion Trigger after Acute Brain Injury: More than Just Higher Blood Oxygen Content
title_full_unstemmed Liberal Versus Restrictive Transfusion Trigger after Acute Brain Injury: More than Just Higher Blood Oxygen Content
title_short Liberal Versus Restrictive Transfusion Trigger after Acute Brain Injury: More than Just Higher Blood Oxygen Content
title_sort liberal versus restrictive transfusion trigger after acute brain injury more than just higher blood oxygen content
topic brain injury
transfusion
url https://www.liebertpub.com/doi/10.1089/neur.2025.0008
work_keys_str_mv AT adriennekho liberalversusrestrictivetransfusiontriggerafteracutebraininjurymorethanjusthigherbloodoxygencontent