Erythropoietin and Transfusion Threshold: What Role in Traumatic Brain Injury?

Head trauma occurs in 1.5 million Americans annually, at a cost of more than $56 billion. Erythropoietin (EPO) has potential as a neuroprotective agent in the treatment of traumatic brain injury (TBI; Surg Neurol 2009; 71:527). Hemoglobin transfusion is often used out of concern about the harm of low hemoglobin during trauma, despite some evidence of harm from transfusion. This is a randomized clinical trial comparing the effects of EPO and two hemoglobin transfusion thresholds (7 and 10 g/dL) on neurologic recovery after TBI. Two hundred patients met eligibility criteria and were randomized: 49 to hemoglobin transfusion threshold of 10 g/dL plus EPO, 50 to a hemoglobin threshold of 7 g/dL plus placebo, 53 to hemoglobin threshold of 10 g/dL…