Optimal transfusion goals for different patient populations remains controversial, which is highlighted in cases of intracerebral hemorrhage (ICH). Although ICH makes up approximately 15% of all strokes, it carries the highest morbidity and mortality of all stroke subtypes. These poor outcomes are largely driven by hemorrhage burden initially and impaired cerebral oxygen delivery secondarily. Thus, ICH treatment paradigms focus on optimizing hemostasis and cerebral oxygenation utilizing transfusion to improve clinical outcomes. While this may suggest the need for more liberal transfusion thresholds in these particularly vulnerable patients, it is unclear whether this reflects best evidence-based practice. In this educational session, we will present the history of transfusion in ICH, discuss evidence-based guidelines for transfusion in ICH with particular emphasis on red cell and platelet transfusions, and discuss novel diagnostic modalities, including viscoelastic testing/ROTEM and platelet function assays, transfusion strategies and transfusion-sparing pharmacotherapies for ICH.
All relevant financial relationships have been mitigated.
State the rationale for transfusion of patients with ICH.
Describe and apply up-to-date, evidence-based platelet and red cell transfusion practices when treating patients with ICH.
Summarize the novel diagnostic approaches to guide transfusion strategies as well as the new transfusion treatments for ICH that are on the horizon.