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Brilliant Board Review & CME
🎙️ Brilliant Medicine: Your Internal Medicine Edge
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Each episode delivers high-yield insights on the latest breakthroughs, practice-changing guidelines, and cutting-edge treatments in Internal Medicine — with just enough board review to keep your clinical reasoning razor-sharp.
We cut through the noise, simplify complex studies, and translate new data into actionable knowledge for your daily practice. Whether you're prepping for boards or staying ahead in clinic, hospital, or telemed — we've got your back.
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Brilliant Board Review & CME
🎙️ Episode 37: Transfusions in SAH: 8 or 10? Pick 8
🧠 Study:
Compared transfusion thresholds of Hgb <8 vs <10 in subarachnoid hemorrhage.
📊 Findings:
No difference in modified Rankin Score at 12 months.
Fewer transfusions, fewer complications in <8 group.
🧩 Clinical Takeaway:
Restrictive transfusion strategy is safe in neuro ICU.
Less exposure = better outcomes.
let's talk about transfusion and aneurysmal subarachnoid hemorrhage. Now we're talking about acute aneurysmal subarachnoid hemorrhage and anemia. Now we're talking about two strategies. It could be conservative less than equal to 8 is when we're going to transfuse, or less than equal to 10 is when we're going to transfuse. Now what was the outcome?
Speaker 1:We looked at and this is the important thing for strokes it was an unfavorable neurological outcome and we're looking for what the modified Rankin score Remember here is at 12 months and if they had a score greater than four. So remember it goes from zero to six. Zero is perfect, six is dead. And why is this so important? Just think about this. What do we worry about in strokes? Is somebody going to be so debilitated that healthcare resources, family resources, patients can suffer poor outcomes if they can't move and they're stuck, and they're literally stuck in a bed and they have to have someone wipe their ass and flip them every two hours. Just think of the amount of resources that takes. Just think about how the quality of life is and how is a patient going to feel Extremely depressed, not feeling well, not doing well, having their butt wiped and then flipped every two hours. Now they also used several other scores at 12-month functional independence for secondary outcomes, and this was at 742 patients at 23 centers, and just they kind of they had a good mix of ruptured aneurysm and the anterior circulation was 638. And then patients that had endovascular coiling, so it's endovascular coiling would be 443. And there was some clipping cases in this. Well, guess what? There was no difference between the groups, so we can go with more of a conservative policy.
Speaker 1:Why is that important? Because every time we give a blood product there's a risk for harm. It's somebody else's blood in their body. Now, they do a great job of matching things, but there's things we probably don't understand. Maybe there's a cytokine response that we really don't fully understand when we're getting somebody else's blood, and maybe it's not always. There could be certain types of people, certain types of blood. So we want to limit the amount of a foreign object that we place in somebody's body, just like we want to limit the amount of catheters and catheter days that patient has. We want to limit the amount of things that we place in somebody's body, just like we want to limit the amount of catheters and catheter days that patient has. We want to limit the amount of things that we put in people's body, because we can cause harm.