RED BLOOD CELL TRANSFUSION AND ASSOCIATED OUTCOMES IN SEVERE ISOLATED TRAUMATIC BRAIN INJURY AT HOSPITAL UNIVERSITI SAINS MALAYSIA

Abstract

Background: Prevalence of anaemia is high in severe traumatic brain injury (TBI). However, there is no clear transfusion guideline available in the ICU or ward. This study aims to determine the prevalence of anaemia and transfusion practice in TBI patients and to compare two groups of transfusion strategies; liberal transfusion strategy and restrictive transfusion strategy.

Materials and methods: This was a retrospective cohort conducted in Hospital Universiti Sains Malaysia, Kelantan. Data from 2012 to 2017 were extracted from the medical records, Laboratory Information System (LIS) and transfusion record (MyTransfusi). Samples were divided into liberal transfusion strategy and restrictive transfusion strategy group and compared with the outcome. For statistical analysis, Mann Whitney, independent t-test and chi square were used to compare both groups. Simple linear and logistic regression were used to determine the association of the outcome.

Result: Out of 146 patients, 21.9% had mild anaemia, 60.3% had moderate anaemia and 17.8% had severe anaemia. All patients who had severe anaemia received red blood cell (RBC) transfusion. Whereas, in mild and moderate group of anaemia, about 34.4% and 79.5% received RBC transfusion respectively. Restrictive transfusion strategy had significantly lower value of lowest haemoglobin level (P=0.001) and unit of RBC transfused (P=0.008) as compared to liberal transfusion strategy. Post transfusion haemoglobin (P<0.001, b=1.809, 95% CI -2.453, -1.17) is significantly lower in restrictive transfusion strategy. There was no significant difference in mortality and morbidity.

Conclusion: Liberal transfusion strategy does not have better outcome compared to restrictive transfusion strategy. Prospective study with larger sample is needed.

Keywords: TBI, anaemia, RBC transfusion, liberal, restrictive