Anaemia and red blood cell transfusion in intracranial neurosurgery: a comprehensive review

Abstract

Both anaemia and blood transfusion are associated with poor outcomes in the neurosurgical population. Based on the available literature, the optimal haemoglobin concentration for neurologically injured patients appears to be in the range of 9.0-10.0 g dl, although the individual risks and benefits should be weighed. Several perioperative blood conservation strategies have been used successfully in neurosurgery, including correction of anaemia and coagulopathy, use of antifibrinolytics, and intraoperative cell salvage. Avoidance of non-steroidal anti-inflammatory drugs and starch-containing solutions is recommended given the potential for platelet dysfunction.

Response to: ‘Patient blood management in intracranial neurosurgery—do we have sufficient data to define a transfusion threshold?’ (Br J Anaesth 2018; 121: 974–76)

“…our recent publication. 2 We agree with Dr. Goebel's points that transfusion of allogeneic blood is associated with increased morbidity and that the individual risks and benefits of transfusion and anaemia should be weighed before transfusion. We have emphasised these points in our discussion and conclusion.…”

“…The authors concluded that further evaluation was needed with data from RCTs having low risk of bias for a definitive answer on the subject, and that the evidence of each included RCT must be interpreted with caution in the context of the individual study quality. 2 Risk of bias is associated with overestimation of benefit and underestimation of harm. 4 No single RCT was found to be at low risk of bias according to the standard of Cochrane Review Guidelines.…”

“…1 Our main point of concern is that when looking at the TSA figure of the Cochrane review on the primary outcome of mortality, only 717 patients of the required information size of 1325 patients had been included. 2 The newly added RCT by Karkouti and colleagues, 6 however, does not report on mortality as a single outcome, but rather as an integrated part of the secondary outcome 'in-hospital major complications', combined with seven other major complications. No separate data concerning mortality were reported.…”

Year in Review: Synopsis of Selected Articles in Neuroanesthesia and Neurocritical Care from 2018

“…Kisilevsky et al conducted a comprehensive review of transfusion thresholds in neurosurgical patients and recommended an optimal hemoglobin concentration of 9.0 to 10.0 g dL. 14 Smith 15 reviewed neuromonitoring in TBI and Harvey et al have provided some guidance to physicians caring for those with devastating brain injury via a consensus statement including direction on the decision to transition to palliative care. 16 Cordonnier et al have summarized the current management of acute ICH.…”

Pengaruh Asam Traneksamat Intravena terhadap Jumlah Perdarahan Intraoperatif dan Kebutuhan Transfusi pada Operasi Meningioma

“…Strategi-strategi diatas bukan tanpa komplikasi dan tidak semua dapat dikerjakan karena ketersediaan dan cost-effectiveness, mendorong ditelitinya efikasi dari agen-agen hemostatik seperti asam aminokaproat, asam traneksamat, desmopressin, aprotinin, serta estrogen terkonjugasi. 9,10 Asam traneksamat (trans-4-amino methyl cyclohexane carboxylic acid) merupakan golongan antifibrinolitik yang bekerja menghambat aktivasi plasminogen menjadi plasmin pada pembekuan darah.…”