RBC transfusion linked to improved survival after intracerebral hemorrhage

In patients with intracerebral hemorrhage (ICH)—a type of stroke caused by bleeding inside the brain—transfusion with red blood cells may improve the chances of survival, reports a study in the May issue of Neurosurgery, official journal of the Congress of Neurological Surgeons. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Packed red blood cell transfusions are sometimes used to treat anemia occurring after ICH. The new study, led by Dr. Kevin N. Sheth of University of Maryland Medical Center, Baltimore, suggests that patients who receive these transfusions are nearly three times more likely to survive.

Packed Red Blood Cell Transfusion Linked to Improved Survival after ICH
Intracerebral hemorrhage is the most devastating form of stroke—up to 40 percent of patients die within a month. It occurs when a ruptured blood vessel causes bleeding inside the brain. Many patients with ICH develop anemia: inadequate levels of red blood cells to carry oxygen throughout the body.

Dr. Sheth and colleagues previously found that ICH patients who develop anemia are at increased risk of death. In the current study, they sought to determine whether packed red blood cell transfusions to treat anemia lead to improved outcomes of ICH.

Of 546 patients with ICH treated from 1999 to 2005, nearly three-fourths developed anemia while in the hospital. Overall, 18 percent of patients with ICH—including 24 percent of those with anemia—received packed red blood cell transfusions.

Patients who got transfusions were at lower risk of dying in the month after ICH, after adjustment for severity of stroke and other factors. This was so even though their levels of hemoglobin—the oxygen-carrying compound found in red blood cells—were not significantly increased. (Patients with anemia were still at higher risk of death.)

Thirty days after ICH, patients who received transfusions were nearly three times more likely to be alive. The difference remained significant after accounting for the possibility that patients who received transfusions were treated more aggressively.

Although the study permits no firm conclusions, the results suggest that patients receiving packed red blood cell transfusion for anemia after ICH may have a better chance of survival. That's consistent with previous studies suggesting that patients with brain injury benefit from higher levels of hemoglobin. "With the highest metabolic demands of any organ of the body, even the briefest interruption in adequate oxygen delivery to the brain can result in substantial irreversible injury," Dr. Sheth and coauthors write. They urge further research to see if maintaining hemoglobin—and at what level—improves the survival rate after ICH.