In the Neuro Intensive Care Unit (neuro-ICU), time is brain. Treatment plans must be executed swiftly, and common treatments such as red blood cell transfusion can counteract critical conditions such as acute blood loss or severe anemia. For some patients, though, receiving blood products is not an option – often due to sincerely held religious beliefs – and require a different option. Led by Yale School of Medicine faculty, the Yale New Haven Hospital Neuro-ICU has successfully administered a transfusion replacement therapy, which benefits patients with aneurysmal subarachnoid hemorrhage (SAH), as well as those with severe anemia from blood loss and critical illness.
SAH is characterized by bleeding in the subarachnoid area between the brain and skull, most often caused by a ruptured blood vessel on the surface of the brain. It can result in severe brain cell damage and long-term physical impairments. Maintaining homeostasis, including adequate blood and oxygen supply to vital organs, especially the brain, is critical to maximizing outcomes for survivors.
Research into red blood cell transfusion substitutes goes back centuries. The substitutes were initially administered experimentally in the 17th century, and then in the 20th century, their use was driven by wars and the HIV epidemic. These alternative products are unique, given their long shelf life, effective oxygen-carrying capacity, and sterility, for example (Fridey, 2021).
Today, alternative therapy can be a synthetic bovine hemoglobin that serves to increase the oxygen carrying capacity of the blood. The lab of Nenad Sestan, MD, PhD, Harvey and Kate Cushing Professor of Neuroscience, and professor of comparative medicine, of genetics, and of psychiatry conducted initial research, which was published as the lead study in the April 19 issue of Nature. Sestan’s team found evidence of certain restored neurological functions in pig brains post-mortem, when treated with the alternative therapy. These findings have potential for application across a wide array of mammalian species experiencing decreased blood flow (Vrselja et al. 2019, 336-343), and the product administered at Yale required emergency FDA approval through the investigational new drug process.
Emily Gilmore, MD, associate professor of neurology, who led the neuro-ICU team on an alternative transfusion case, reports that the alternative therapy can ultimately be beneficial to the patient, following a previous treatment plan. “We have seen that within days of receiving an alternative therapy, hemoglobin increases, cognition and heart stress improved, and a patient can move out of the neuro-ICU to the floor,” she said.
The Yale New Haven neuro-ICU, in collaboration with hematology, envisions continued use of transfusion replacement therapies when needed, expanding not only treatment options, but also hope to the most critically ill neuro-ICU patients.