Florez-Perdomo William A, García-Ballestas Ezequiel, Martinez-Perez Rafael, Agrawal Amit, Deora Harsh, Joaquim Andrei F, Quiñones-Ossa Gabriel A, Moscote-Salazar Luis Rafael
Latin American Council of Neurocritical Care- CLaNi, Cartagena, Colombia.
Faculty of Medicine, Centro De Investigaciones Biomédicas (CIB), University of Cartagena, Cartagena, Colombia.
Br J Neurosurg. 2021 Jun 21:1-7. doi: 10.1080/02688697.2021.1940850.
Several factors can influence the outcome of severe head injuries including the patient's hemoglobin levels. There has often been a dilemma regarding levels of hemoglobin at which red cell blood transfusion (RCBT) should be performed.
To systematically review the literature to determine the usefulness of management protocols that have hemoglobin levels <10 g/dL vs <7 g/dL as an RCBT criterion.
Following the PRISMA statement, the search was constructed using terms and descriptors of the Medical Subject Heading (MeSH), combined with Boolean operators. Full text of these articles was studied, and outcome measures at 3-6 months were considered for patients who were given a RCBT at <10 g/dL or at 7 g/dL hemoglobin levels.
A total of 4 articles were found suitable for inclusion in the meta-analysis. RCBT below 7 g/dL was not associated with an increased risk of mortality as compared to RCBT using the value of less than 10 g/dL. RCBT at lower levels of hemoglobin was also not associated with a poor neurological outcome (GOS 4-5) but rather RCBT at lower levels lead to better outcomes (GOS 1-3) and the association was significant.
Allogenic RCBT was associated with poorer neurological outcomes, within a wide range of reported differences in the hemoglobin threshold to decide for RCBT in TBI patients. Restrictive RCBT strategy may be useful in moderate to severe TBI cases although the risk of anemia-induced cerebral injury needs further investigation regarding the risks and complications inherent to RCBT.
包括患者血红蛋白水平在内的多种因素会影响重度颅脑损伤的预后。对于进行红细胞输血（RCBT）时的血红蛋白水平，一直存在两难的情况。
系统回顾文献，以确定将血红蛋白水平<10 g/dL与<7 g/dL作为RCBT标准的管理方案的有效性。
按照PRISMA声明，使用医学主题词表（MeSH）的术语和描述符构建检索，并结合布尔运算符。研究这些文章的全文，对于血红蛋白水平<10 g/dL或7 g/dL时接受RCBT的患者，考虑其3至6个月时的结局指标。
共发现4篇文章适合纳入荟萃分析。与使用低于10 g/dL的值进行RCBT相比，血红蛋白水平低于7 g/dL时进行RCBT与死亡率增加无关。较低血红蛋白水平时进行RCBT也与不良神经学结局（GOS 4 - 5）无关，相反，较低水平时进行RCBT会带来更好的结局（GOS 1 - 3），且这种关联具有显著性。
在报道的TBI患者决定进行RCBT的血红蛋白阈值存在广泛差异的情况下，异体RCBT与较差的神经学结局相关。限制性RCBT策略可能对中度至重度TBI病例有用，尽管贫血诱导的脑损伤风险以及RCBT固有的风险和并发症需要进一步研究。
