Association Between Spontaneous Intracerebral Hemorrhage and Blood Donors: A Retrospective Cohort Study

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Spontaneous Intracerebral Hemorrhage (ICH) is a medical emergency characterized by bleeding within the brain tissue, often resulting in severe neurological deficits or death.

Risk Factors

The most common risk factor for ICH is high blood pressure (hypertension). Other risk factors include:

  • Age: ICH is more common in older adults.
  • Sex: Men are more likely than women to have ICH.
  • Race and ethnicity: Black Americans and Hispanics are more likely to have ICH than white Americans.
  • Family history: People with a family history of ICH are at increased risk.
  • Other medical conditions: Certain medical conditions, such as diabetes, kidney disease, and liver disease, can increase the risk of ICH.
  • Lifestyle factors: Smoking, alcohol abuse, and drug use can all increase the risk of ICH.

Symptoms

The symptoms of ICH can vary depending on the size and location of the hemorrhage. Common symptoms include:

  • Sudden severe headache
  • Weakness or numbness in one side of the body
  • Confusion or disorientation
  • Difficulty speaking or understanding speech
  • Difficulty with vision or balance
  • Dizziness or loss of coordination
  • Seizures
  • Loss of consciousness

Recent scientific inquiry has introduced an intriguing concept: the possibility of a transfusion-transmissible agent linked to specific types of spontaneous ICH.

In light of this, an exploratory retrospective cohort study was conducted in Sweden and Denmark to investigate if there is an association between the occurrence of spontaneous ICH among blood donors and the risk of spontaneous ICH in patients who receive transfusions from these donors.

Study Design and Objectives

The study utilized nationwide blood bank and health register data from Sweden (main cohort) and Denmark (validation cohort) and included all patients aged 5 to 80 years who had received a red blood cell transfusion between January 1, 1970 (Sweden) or January 1, 1980 (Denmark), and December 31, 2017.

The primary objective was to determine whether receiving red blood cell transfusions from donors who later developed spontaneous ICH was associated with an increased risk of developing spontaneous ICH in transfusion recipients. Ischemic stroke was used as a negative control outcome.

Methodology

The study cohort consisted of 759,858 patients in Sweden and 329,512 patients in Denmark. These patients were followed for a median duration of 5.8 and 6.1 years, respectively. Three exposure groups were defined: recipients of red blood cell units from donors who developed (1) a single spontaneous ICH, (2) multiple spontaneous ICHs, or (3) no spontaneous ICH.

Key Findings

The study’s findings were remarkable. Patients who received transfusions from donors who developed multiple spontaneous ICHs were found to have a significantly higher risk of experiencing a single spontaneous ICH themselves when compared to patients receiving transfusions from donors without spontaneous ICH development.

n the Swedish cohort, the unadjusted incidence rate (IR) was 3.16 vs. 1.12 per 1000 person-years, with an adjusted hazard ratio (HR) of 2.73 (95% CI, 1.72-4.35; P < .001). Similarly, in the Danish cohort, the unadjusted IR was 2.82 vs. 1.09 per 1000 person-years, with an adjusted HR of 2.32 (95% CI, 1.04-5.19; P = .04).

However, there was no significant difference in the risk of spontaneous ICH among patients who received transfusions from donors with a single spontaneous ICH. In both cohorts, the risk was comparable to patients who received transfusions from donors without spontaneous ICH development. The findings remained consistent when ischemic stroke was assessed as a negative control outcome.

Discussion

These findings suggest a potential association between transfusions from donors who developed multiple spontaneous ICHs and an increased risk of spontaneous ICH in recipients. This raises intriguing questions about the existence of a transfusion-transmissible agent linked to specific types of spontaneous ICH.

It is important to note that the study acknowledges certain limitations, including the possibility of selection bias and residual confounding. Therefore, further research is imperative to gain a comprehensive understanding of the underlying mechanism and establish causation.

Conclusion

This exploratory retrospective cohort study conducted in Sweden and Denmark provides initial evidence of an association between receiving red blood cell transfusions from donors who later developed multiple spontaneous ICHs and an increased risk of spontaneous ICH in recipients.

While this suggests the presence of a transfusion-transmissible agent linked to specific types of spontaneous ICH, caution should be exercised due to potential biases and confounding factors. Additional research is needed to unravel the underlying mechanisms and confirm these findings definitively. The implications of such a discovery could be far-reaching, potentially impacting blood transfusion practices and our understanding of the transmission of cerebral amyloid angiopathy.


The link between Spontaneous Intracerebral Hemorrhage (ICH) and COVID-1

The link between Spontaneous Intracerebral Hemorrhage (ICH) and COVID-19, the disease caused by the novel coronavirus SARS-CoV-2, has been a topic of concern and research since the beginning of the pandemic. Here are some key points regarding the potential association between ICH and COVID-19:

  • Increased Risk of Thrombotic Events: COVID-19 is known to be associated with a pro-thrombotic state, which means it can increase the risk of blood clot formation. This heightened tendency toward blood clotting can lead to various cardiovascular and cerebrovascular complications, including ischemic strokes and intracerebral hemorrhage.
  • Cytokine Storm and Endothelial Dysfunction: COVID-19 can trigger a cytokine storm, an excessive immune response that can cause widespread inflammation and damage to blood vessels. This endothelial dysfunction can weaken blood vessel walls and potentially lead to bleeding, including intracerebral hemorrhage.
  • Pre-existing Conditions: Many COVID-19 patients have pre-existing conditions such as hypertension and diabetes, which are risk factors for ICH. COVID-19 can exacerbate these conditions, further increasing the risk of intracerebral hemorrhage.
  • Anticoagulation Therapy: Some COVID-19 patients receive anticoagulation therapy to prevent blood clot formation. However, finding the right balance between preventing clotting and avoiding excessive bleeding can be challenging, potentially increasing the risk of hemorrhagic events like ICH.
  • Vasculitis and Coagulopathy: COVID-19 can lead to vasculitis, inflammation of blood vessels, and coagulopathy, a disorder of blood clotting. Both of these conditions can contribute to ICH.
  • Severity of Illness: The severity of COVID-19 illness appears to be a significant factor in the risk of ICH. Severely ill COVID-19 patients, particularly those who require intensive care and mechanical ventilation, may be at higher risk for various complications, including intracerebral hemorrhage.
  • Research and Studies: Research on the link between COVID-19 and ICH is ongoing. Various case reports, case series, and observational studies have explored this association, but a definitive causal relationship is yet to be established. Further studies are needed to better understand the mechanisms and risk factors.
  • Vaccination: It’s essential to note that COVID-19 vaccination has been shown to be effective at reducing the risk of severe illness and complications associated with the virus, including ICH. The benefits of vaccination in preventing COVID-19-related complications outweigh the rare risks associated with vaccination.

In summary, while there is evidence to suggest a potential link between COVID-19 and Spontaneous Intracerebral Hemorrhage, the exact mechanisms and risk factors are still being studied. It’s important for healthcare providers to be vigilant and consider the possibility of ICH in COVID-19 patients, especially those with severe illness and other risk factors. Vaccination remains a crucial tool in reducing the overall risk of COVID-19-related complications, including ICH.


reference link : https://jamanetwork.com/journals/jama/article-abstract/2809417

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