The effects of iron deficiency on blood transfusion requirements in traumatic brain injury

Introduction: Traumatic brain injury (TBI) is the leading cause of preventable death in trauma patients. TBI often need blood transfusion, iron deficiency (ID) is known as the first cause of anemia worldwide, but no known predictors of transfusion requirements are available at intensive care unit (ICU). The aims of this study were to investigate ID relationship with blood transfusion requirements in TBI patients at ICU. Methods: One hundred forty-two patients with severe TBI, as defined by Glasgow Coma Scale (GCS) scores < 8 with an expected ICU length of stay >= 48 hours were admitted to the general ICU were enrolled in the prospective observational study between April 1, 2013, and December 31, 2015. Patients were divided into 2 groups according to their baseline iron status: iron-deficient (ID) and non-ID (normal iron profile) cohorts. Demographic features, laboratory values, blood transfusions, and length of ICU stay were recorded. Results: A total of 134 patients were included in this analysis. The mean Glasgow coma score at baseline was 6 +/- 5 and Injury Severity Score (ISS) 18.5 +/- 4.5. ID with TBI patients, which was diagnosed in 65 patients (48.5%), compared with non-ID patients, with higher ISS but no difference in admission GCS score or APACHE II scores. ID was associated with a greater use of blood transfusions (5 and 2 U/patient, respectively; p=.0001). The median length of ICU stay after TBI was longer among the ID versus the non-ID group (25 and 17 days per patient, respectively; p=.0001). Conclusion: We found that ID was highly prevalent at ICU admission patients with TBI and that it was associated with higher blood transfusion requirements. Therefore, ID may be a prognostic factor for the blood transfusion requirements in TBI at ICU.