Neurological Complications following Blood Transfusions in Sickle Cell Anemia

Alharbi, Hana; Khawar, Nayaab; Kulpa, J; Bellin, Anne; Proteasa, Simona; Sundaram, Revathy

doi:10.1155/2017/3649397

Cited by 5 publications

(9 citation statements)

References 12 publications

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“…Case reports of patients with sickle cell anaemia (SCA; HbSS and HbSβ 0 genotypes) who developed complications after RBC transfusions have contributed to recommendations for avoiding Hb increases beyond 100 g/l. Patients in these reports developed adverse neurological outcomes, ranging from headaches to seizures and fatal cerebral bleeds, within days of receiving RBC transfusions 7–11 . As such, the rate of Hb increase, in addition to the final Hb value, may be an important factor that engenders complications, e.g.…”

Section: The Rationale Behind the Haemoglobin 100 G/l Limit With Red Blood Cell Transfusionmentioning

confidence: 99%

“…Circulating free haem, resulting from chronic haemolysis, reduces nitric oxide bioavailability and restricts vasodilation 14,15 . An acute rise in blood pressure has been noted in case reports of patients who received several RBC transfusions before developing neurological complications 7–11 . Given the underlying vascular dysfunction, the microvasculature may be unable to compensate for this rapid change in blood volume and Hb level.…”

Section: The Effect Of Viscosity On Blood Flow In Sickle Cell Diseasementioning

confidence: 99%

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Time to rethink haemoglobin threshold guidelines in sickle cell disease

Ballas

Kuypers²,

Hankins

et al. 2021

Br J Haematol

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Summary Alleviating anaemia in patients with sickle cell disease (SCD) is crucial in managing acute complications, mitigating end‐organ damage and preventing early mortality. Some disease‐modifying and curative therapies have increased haemoglobin (Hb) levels to exceed 100 g/l, a threshold above which complications from red blood cell (RBC) transfusions have occurred, raising concern about whole‐blood viscosity‐related complications with these therapies. Here we discuss the rationale behind this limit, the effect of viscosity on blood flow and the applicability of this Hb threshold to therapies for SCD beyond RBC transfusions.

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Section: The Rationale Behind the Haemoglobin 100 G/l Limit With Red Blood Cell Transfusionmentioning

confidence: 99%

Section: The Effect Of Viscosity On Blood Flow In Sickle Cell Diseasementioning

confidence: 99%

Time to rethink haemoglobin threshold guidelines in sickle cell disease

Ballas

Kuypers²,

Hankins

et al. 2021

Br J Haematol

View full text Add to dashboard Cite

show abstract

“…Those microhemorrhages could contribute to neurological conditions that these subjects might suffer from [69]. In fact, this is supported by a study with children affected by hemoglobinopathies [70], and developing a reversible neurological complication, known as leukoencephalopathy syndrome, upon blood transfusion [71]. This means that blood treatments might cause long-term effects to organs such as the brain, which might result from potential iron accumulation over time.…”

Section: The Cytotoxicity Of Iron In the Brainmentioning

confidence: 99%

Multilevel Impacts of Iron in the Brain: The Cross Talk between Neurophysiological Mechanisms, Cognition, and Social Behavior

2019

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Iron is a critical element for most organisms, which plays a fundamental role in the great majority of physiological processes. So much so, that disruption of iron homeostasis has severe multi-organ impacts with the brain being particularly sensitive to such modifications. More specifically, disruption of iron homeostasis in the brain can affect neurophysiological mechanisms, cognition, and social behavior, which eventually contributes to the development of a diverse set of neuro-pathologies. This article starts by exploring the mechanisms of iron action in the brain and follows with a discussion on cognitive and behavioral implications of iron deficiency and overload and how these are framed by the social context. Subsequently, we scrutinize the implications of the disruption of iron homeostasis for the onset and progression of psychosocial disorders. Lastly, we discuss the links between biological, psychological, and social dimensions and outline potential avenues of research. The study of these interactions could ultimately contribute to a broader understanding of how individuals think and act under physiological and pathophysiological conditions.

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“…It should be noted that although complications of blood transfusion are rare, it can be life threatening because massive blood transfusions can result in abnormalities of coagulation status, vascular permeability, acid-base balance and temperature hemostasis 31 . Previous studies have demonstrated that the large quantity of blood transfusions can cause complications such as reversible posterior leukoencephalopathy syndrome [32][33][34] . Furthermore, blood transfusion may cause a rapid increase in total blood volume, which further leads to cerebral blood flow overload.…”

Section: Surgical Outcome Of Ich With Prior Antithrombotic Treatmentmentioning

confidence: 99%

“…Furthermore, blood transfusion may cause a rapid increase in total blood volume, which further leads to cerebral blood flow overload. It has been suggested that an abrupt or acute cerebral hyperperfusion exceeding the capacity of autoregulation of cerebral capillary perfusion pressure could result in vasogenic edema 34 .…”

Section: Surgical Outcome Of Ich With Prior Antithrombotic Treatmentmentioning

confidence: 99%

Previous Antithrombotic Therapy, Particularly Anticoagulant, Is Associated with Unfavorable Outcomes in Patients with Primary Spontaneous Intracerebral Hemorrhage Receiving Craniotomy: A Nationwide Population-Based Cohort Study

Liu

Chen

et al. 2019

World Neurosurgery

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Objective The impact of antithrombotic agents on primary intracerebral hemorrhage (ICH) patients remains controversial, especially with patients that require emergent craniotomy. This study was to evaluate clinical outcomes in operated ICH patients with and without prior antithrombotic agents. Methods This is a retrospective cohort study. Between January 2001 to December 2013, all ICH patients that received emergent craniotomy and is present in Taiwan's National Health Insurance Research Database were screened, and divided into prior antiplatelet therapy, anticoagulant therapy and non-antithrombotic therapy according to patient's healthcare claims data within 3 months of index admission. The primary endpoints included in-hospital mortality and complication, and short-term outcome. Results Of 18,872 eligible patients, 16,251 (87.1%) patients did not receive any antithrombotic therapy, 2,267 patients had antiplatelet therapy and 354 patients had anticoagulation therapy. After propensity score matching, significantly higher amount of blood transfusion and number of craniectomy was identified in the patients with prior antithrombotic treatment compared with non-antithrombotic therapy. In comparison with the non-antithrombotic treatment cohort, patients under prior anticoagulant treatment had significantly higher in-hospital mortality rate (Odds ratio, 2.12; 95% confidence interval, 1.45-3.10). Furthermore, during the 6-month follow-up period, prior anticoagulant therapy was independently associated with a greater risk of all-cause mortality rates (P = 0.001). Interestingly, the in-hospital and 6-month all-cause mortality of patients with prior antiplatelet treatment was not significantly different to patients with non-antithrombotic treatment. Conclusion These findings suggested an increased risk of in-hospital mortality and poor short-term outcome among operated ICH patients with prior antithrombotic therapy, particularly anticoagulant therapy, but not with antiplatelet therapy. .

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Neurological Complications following Blood Transfusions in Sickle Cell Anemia

Cited by 5 publications

References 12 publications

Time to rethink haemoglobin threshold guidelines in sickle cell disease

Time to rethink haemoglobin threshold guidelines in sickle cell disease

Multilevel Impacts of Iron in the Brain: The Cross Talk between Neurophysiological Mechanisms, Cognition, and Social Behavior

Previous Antithrombotic Therapy, Particularly Anticoagulant, Is Associated with Unfavorable Outcomes in Patients with Primary Spontaneous Intracerebral Hemorrhage Receiving Craniotomy: A Nationwide Population-Based Cohort Study

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