🎙️ 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.

Transcript

Speaker 1 0:02

let's talk about transfusion and aneurysmal subarachnoid hemorrhage . Now we're talking about acute aneurysmal subarachnoid hemorrhage and anemia .

Transfusion in Subarachnoid Hemorrhage

Speaker 1 0:13

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 0:25

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

Measuring Neurological Outcomes

Speaker 1 0:34

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

Study Results and Conservative Policy

Speaker 1 1:09

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 1:55

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

Limiting Foreign Objects in Patients

Speaker 1 2:06

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 .