Packed red blood cell transfusion causes greater hemoglobin rise at a lower starting hemoglobin in patients with subarachnoid hemorrhage

Andrew M. Naidech, Marc J. Kahn, Wayne Soong, David Green, H. Hunt Batjer, Thomas P. Bleck

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Introduction: Each unit of packed red blood cells (PRBCs) is expected to raise circulating hemoglobin (HGB) by ∼1 g/dL. There are few data on modifiers of this relationship other than gender and body mass index (BMI). Methods: We recorded HGB before and after PRBC transfusion in a retrospective cohort of 103 patients and a prospective cohort of 93 patients with subarachnoid hemorrhage (SAH). Results: In the retrospective cohort, 48 of 103 patients were transfused, and in the prospective cohort, 56 of 93 patients were transfused. In both groups, lower pre-transfusion HGB was associated with a larger increase in HGB (P < 0.001) after correction for the number of units of PRBCs given. In the prospective cohort, lower pre-transfusion HGB was associated with a greater rise in HGB (P < 0.001) after correction for number of units of PRBCs given, gender, and BMI in repeated measures analysis. Pre-transfusion HGB explained an additional 12% of variance in the data (P < 0.001). In both cohorts, the magnitude of the effect was similar. Conclusion: In patients with SAH, transfusion at lower HGB leads to a greater increase in HGB. Transfusion at lower HGB may be relatively more cost-effective, and this should be balanced against any potential benefit from higher HGB in SAH. One rather than 2 units of PRBCs are likely to be sufficient for most HGB targets after SAH, especially in patients with more severe anemia.

Original languageEnglish (US)
Pages (from-to)198-203
Number of pages6
JournalNeurocritical Care
Volume9
Issue number2
DOIs
StatePublished - Oct 2008

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Erythrocyte Transfusion
Subarachnoid Hemorrhage
Hemoglobins
Erythrocytes
Body Mass Index
Cohort Effect
Anemia
Costs and Cost Analysis

Keywords

  • Anemia
  • Intensive care
  • Subarachnoid hemorrhage
  • Transfusion
  • Vasospasm

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

Cite this

Packed red blood cell transfusion causes greater hemoglobin rise at a lower starting hemoglobin in patients with subarachnoid hemorrhage. / Naidech, Andrew M.; Kahn, Marc J.; Soong, Wayne; Green, David; Batjer, H. Hunt; Bleck, Thomas P.

In: Neurocritical Care, Vol. 9, No. 2, 10.2008, p. 198-203.

Research output: Contribution to journalArticle

Naidech, Andrew M. ; Kahn, Marc J. ; Soong, Wayne ; Green, David ; Batjer, H. Hunt ; Bleck, Thomas P. / Packed red blood cell transfusion causes greater hemoglobin rise at a lower starting hemoglobin in patients with subarachnoid hemorrhage. In: Neurocritical Care. 2008 ; Vol. 9, No. 2. pp. 198-203.
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abstract = "Introduction: Each unit of packed red blood cells (PRBCs) is expected to raise circulating hemoglobin (HGB) by ∼1 g/dL. There are few data on modifiers of this relationship other than gender and body mass index (BMI). Methods: We recorded HGB before and after PRBC transfusion in a retrospective cohort of 103 patients and a prospective cohort of 93 patients with subarachnoid hemorrhage (SAH). Results: In the retrospective cohort, 48 of 103 patients were transfused, and in the prospective cohort, 56 of 93 patients were transfused. In both groups, lower pre-transfusion HGB was associated with a larger increase in HGB (P < 0.001) after correction for the number of units of PRBCs given. In the prospective cohort, lower pre-transfusion HGB was associated with a greater rise in HGB (P < 0.001) after correction for number of units of PRBCs given, gender, and BMI in repeated measures analysis. Pre-transfusion HGB explained an additional 12{\%} of variance in the data (P < 0.001). In both cohorts, the magnitude of the effect was similar. Conclusion: In patients with SAH, transfusion at lower HGB leads to a greater increase in HGB. Transfusion at lower HGB may be relatively more cost-effective, and this should be balanced against any potential benefit from higher HGB in SAH. One rather than 2 units of PRBCs are likely to be sufficient for most HGB targets after SAH, especially in patients with more severe anemia.",
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N2 - Introduction: Each unit of packed red blood cells (PRBCs) is expected to raise circulating hemoglobin (HGB) by ∼1 g/dL. There are few data on modifiers of this relationship other than gender and body mass index (BMI). Methods: We recorded HGB before and after PRBC transfusion in a retrospective cohort of 103 patients and a prospective cohort of 93 patients with subarachnoid hemorrhage (SAH). Results: In the retrospective cohort, 48 of 103 patients were transfused, and in the prospective cohort, 56 of 93 patients were transfused. In both groups, lower pre-transfusion HGB was associated with a larger increase in HGB (P < 0.001) after correction for the number of units of PRBCs given. In the prospective cohort, lower pre-transfusion HGB was associated with a greater rise in HGB (P < 0.001) after correction for number of units of PRBCs given, gender, and BMI in repeated measures analysis. Pre-transfusion HGB explained an additional 12% of variance in the data (P < 0.001). In both cohorts, the magnitude of the effect was similar. Conclusion: In patients with SAH, transfusion at lower HGB leads to a greater increase in HGB. Transfusion at lower HGB may be relatively more cost-effective, and this should be balanced against any potential benefit from higher HGB in SAH. One rather than 2 units of PRBCs are likely to be sufficient for most HGB targets after SAH, especially in patients with more severe anemia.

AB - Introduction: Each unit of packed red blood cells (PRBCs) is expected to raise circulating hemoglobin (HGB) by ∼1 g/dL. There are few data on modifiers of this relationship other than gender and body mass index (BMI). Methods: We recorded HGB before and after PRBC transfusion in a retrospective cohort of 103 patients and a prospective cohort of 93 patients with subarachnoid hemorrhage (SAH). Results: In the retrospective cohort, 48 of 103 patients were transfused, and in the prospective cohort, 56 of 93 patients were transfused. In both groups, lower pre-transfusion HGB was associated with a larger increase in HGB (P < 0.001) after correction for the number of units of PRBCs given. In the prospective cohort, lower pre-transfusion HGB was associated with a greater rise in HGB (P < 0.001) after correction for number of units of PRBCs given, gender, and BMI in repeated measures analysis. Pre-transfusion HGB explained an additional 12% of variance in the data (P < 0.001). In both cohorts, the magnitude of the effect was similar. Conclusion: In patients with SAH, transfusion at lower HGB leads to a greater increase in HGB. Transfusion at lower HGB may be relatively more cost-effective, and this should be balanced against any potential benefit from higher HGB in SAH. One rather than 2 units of PRBCs are likely to be sufficient for most HGB targets after SAH, especially in patients with more severe anemia.

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