Anemia and the Brain

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Presentation by Dr. Phillippe Van der Linden as presented during the 8th NATA Symposium on April 20, 2007. The symposium was held in Budapest, Hungary.

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Anemia and the Brain

  1. 1. Anemia and the Brain Presented during the 8th Annual NATA Symposium Budapest, Hungary 20 April, 2007 Philippe Van der Linden MD, PhD CHU Brugmann-HUDERF, Free University of Brussels
  2. 2. Risks associated with anemia Risks associated with blood transfusion Effectiveness of blood transfusion
  3. 5. Microvascular Oxygenation During Hemodilution From van Bommel J et al. Anesthesiology 97:660-70, 2002.
  4. 6. Microvascular Oxygenation During Hemodilution From van Bommel J et al. Anesthesiology 97:660-70, 2002. Intestinal blood flow Internal carotid artery blood flow
  5. 7. Microvascular Oxygenation During Hemodilution From van Bommel J et al. Anesthesiology 97:660-70, 2002. Intestinal O2 extraction Cerebral O2 extraction
  6. 10. Neuronal NO Synthase During Hemodilution From Hare GM et al. J Appl Physiol 94:2058-67, 2003. Hb: 127 ±7 to 60±3 g/L
  7. 11. Neuronal NO Synthase During Hemodilution From Hare GM et al. J Appl Physiol 94:2058-67, 2003. Hb: 127 ±7 to 60±3 g/L
  8. 16. Observational study Healthy volunteers (N=9: 29 ± 5 years) Verbal memory & standard computerized neuropsychologic tests: Before and after acute isovolemic hemodilution After re-transfusion of autologous blood On a separate day, without alteration of hemoglobin Isovolemic Anemia and Human Cognitive Function From Weiskopf RB et al. Anesthesiology 92:1646-52, 2000.
  9. 17. P VdL
  10. 18. P VdL
  11. 24. Hypoxia From Hare GM et al Curr Opin Anaesthesiol 17:363-9, 2004. Endotheliol NOS e NOS e NOS No No e NOS No Vascular smooth muscle Vasodilation No No No Perivascular neurons nNOS No No Neuronal nitric oxide synthase (nNOS)
  12. 25. Hypoxia From Hare GM et al Curr Opin Anaesthesiol 17:363-9, 2004. Increased cerebral blood flow Endotheliol NOS e NOS e NOS No No e NOS No Vascular smooth muscle Vasodilation No No No Perivascular neurons nNOS No No Neuronal nitric oxide synthase (nNOS)
  13. 26. Hypoxia From Hare GM et al Curr Opin Anaesthesiol 17:363-9, 2004. Increased cerebral blood flow Endotheliol NOS e NOS e NOS No No e NOS No Vascular smooth muscle Vasodilation No No No Perivascular neurons nNOS No No Neuronal nitric oxide synthase (nNOS) Vascular endothelial growth factor (VEGF) Angiopoietin Angiogenesis
  14. 27. Hypoxia From Hare GM et al Curr Opin Anaesthesiol 17:363-9, 2004. Increased cerebral blood flow Endotheliol NOS e NOS e NOS No No e NOS No Vascular smooth muscle Vasodilation No No No Perivascular neurons nNOS No No Neuronal nitric oxide synthase (nNOS) Vascular endothelial growth factor (VEGF) Angiopoietin Angiogenesis Erythropoietin (EPO) Neuro-protection
  15. 28. Hypoxia From Hare GM et al Curr Opin Anaesthesiol 17:363-9, 2004. Increased cerebral blood flow Endotheliol NOS e NOS e NOS No No e NOS No Vascular smooth muscle Vasodilation No No No Perivascular neurons nNOS No No Neuronal nitric oxide synthase (nNOS) Vascular endothelial growth factor (VEGF) Angiopoietin Angiogenesis Erythropoietin (EPO) Neuro-protection Anemia
  16. 29. Cerebral HIF-1  ,nNOS and VGEF During ANH <ul><li>Isoflurane anesthetized rats </li></ul><ul><li>Acute hemodilutional anemia: 30 ml/kg arterial blood exchange with same volume of 10% pentastarch </li></ul>From McLaren AT et al. Am J Physiol Regul Integr Comp Physiol 292:R403-R414, 2007.
  17. 30. Cerebral HIF-1  ,nNOS and VGEF During ANH From McLaren AT et al. Am J Physiol Regul Integr Comp Physiol 292:R403-R414, 2007.

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