Public Release: 

Anemia negatively affects recovery from traumatic brain injuries

Finding lays foundation for new treatment protocols for anemic patients

University of Missouri-Columbia


IMAGE: This is N. Scott Litofsky, M.D., chief of the University of Missouri School of Medicine's Division of Neurological Surgery. view more

Credit: Justin Kelley/MU Health

COLUMBIA, Mo. (May 25, 2016) - Approximately half of patients hospitalized with traumatic brain injuries are anemic, according to recent studies, but anemia's effects on the recovery of these patients is not clear. Now, researchers from the University of Missouri School of Medicine have found evidence that anemia can negatively influence the outcomes of patients with traumatic brain injuries.

"More research is needed to develop treatment protocols for anemic patients with traumatic brain injuries," said N. Scott Litofsky, M.D., chief of the MU School of Medicine's Division of Neurological Surgery and lead author of the study. "Anemia occurs when there is a shortage of red blood cells, which causes reduced oxygen flow to vital organs throughout the body. There has been a lack of consensus among physicians regarding the relationship of anemia and traumatic brain injuries on a patient's health. Because of this uncertainty, treatment protocols are unclear and inconsistent. Our observational study found that a patient's outcome is worse when he or she is anemic."

Red blood cells contain hemoglobin, a protein crucial to the delivery of oxygenated blood. The researchers studied the outcomes of 939 traumatic brain injury patients with anemia admitted to the Frank L. Mitchell Jr., M.D., Trauma Center, a Level I trauma center that is part of MU Health Care. The researchers compared hemoglobin levels of these patients and their outcomes within one year of surgery.

Despite also having more severe head and systemic injuries, patients with lower levels of hemoglobin had a poor outcome. For each increase in hemoglobin of 1 gram above 7 grams per deciliter of blood, the likelihood of a good outcome increased by 33 percent.

To restore a patient's hemoglobin level, a patient can receive a blood transfusion. However, stored blood may not perform as well as a patient's own blood, and patients may experience allergic reactions or viral infections as a result of the transfusion. Additionally, the cost of one unit of blood ranges from $200 to $300.

"The purpose of this study is not to propose transfusion guidelines, but rather to show that anemia can be harmful to patients with traumatic brain injuries," Litofsky said. "Now that we have shown that anemia affects a patient's recovery, further studies are needed to determine the best way to correct it. The ultimate goal of this research is to help patients recover more quickly from traumatic brain injuries."

The study, "The Negative Impact of Anemia in Outcome from Traumatic Brain Injury," was presented at the recent 84th American Association of Neurological Surgeons Annual Scientific Meeting. The research also was recently published by the peer-reviewed journal World Neurosurgery. Research reported in this publication was supported by the MU School of Medicine and the MU Department of Surgery. The researchers have no conflicts of interest to declare related to this study.


In addition to Litofsky, the research team included Simon Martin and Jenna Diaz, medical students at the MU School of Medicine; Bin Ge and Greg Petroski; statisticians with the MU Medical Research Office; Douglas Miller, M.D., professor in the MU Department of Pathology and Anatomical Sciences; and Stephen Barnes, M.D., professor and chief of the MU Division of Acute Care Surgery.

Note to reporters and editors: Although observational studies cannot provide definitive evidence of safety, efficacy, or effectiveness, they can: 1) provide information on "real world" use and practice; 2) detect signals about the benefits and risks of complementary therapies use in the general population; 3) help formulate hypotheses to be tested in subsequent experiments; 4) provide part of the community-level data needed to design more informative pragmatic clinical trials; and 5) inform clinical practice. ("Observational Studies and Secondary Data Analyses To Assess Outcomes in Complementary and Integrative Health Care. (Richard Nahin, Ph.D., M.P.H., Senior Advisor for Scientific Coordination and Outreach, National Center for Complementary and Integrative Health, June 25, 2012)

About the MU School of Medicine

The MU School of Medicine has improved health, education and research in Missouri and beyond for more than 165 years. MU physicians treat patients from every county in the state, and more Missouri physicians received their medical degrees from MU than from any other university. For more information, visit

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