Blood boosting no good in TBI

TBI transfusionThis 2 by 2 study looking at both Epo and transfusion triggers in closed TBI makes interesting reading and re-reading. Although large outcome benefit levels were sought (20%) there was no difference in neurological outcome (or mortality, ARDS, infection rate) between Epo and placebo or between a transfusion trigger of 7 and 10. Nor did Epo seem to work convincingly. Part of the reason for trying Epo was an apparent animal experiment neuro-protective effect, clearly not very evident here. There was even potential harm from the higher transfusion target in the form of higher thromboembolic events (20 ‘v’ 8%) and from Epo in the form of (predominantly arm) DVT incidence. Maybe they should have looked for smaller benefit?