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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
Risks associated with anemia Risks associated with blood transfusion Effectiveness of blood transfusion
 
 
Microvascular Oxygenation During Hemodilution From van Bommel J et al. Anesthesiology 97:660-70, 2002.
Microvascular Oxygenation During Hemodilution From van Bommel J et al. Anesthesiology 97:660-70, 2002. Intestinal blood flow   Internal carotid artery blood flow
Microvascular Oxygenation During Hemodilution From van Bommel J et al. Anesthesiology 97:660-70, 2002. Intestinal O2 extraction   Cerebral O2 extraction
 
 
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
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
 
 
 
 
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.
P VdL
P VdL
 
 
 
 
 
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)
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)
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
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
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
Cerebral HIF-1  ,nNOS and VGEF During ANH ,[object Object],[object Object],From McLaren AT et al. Am J Physiol Regul Integr Comp Physiol 292:R403-R414, 2007.
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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Anemia and the Brain

  • 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. Risks associated with anemia Risks associated with blood transfusion Effectiveness of blood transfusion
  • 3.  
  • 4.  
  • 5. Microvascular Oxygenation During Hemodilution From van Bommel J et al. Anesthesiology 97:660-70, 2002.
  • 6. Microvascular Oxygenation During Hemodilution From van Bommel J et al. Anesthesiology 97:660-70, 2002. Intestinal blood flow Internal carotid artery blood flow
  • 7. Microvascular Oxygenation During Hemodilution From van Bommel J et al. Anesthesiology 97:660-70, 2002. Intestinal O2 extraction Cerebral O2 extraction
  • 8.  
  • 9.  
  • 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
  • 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
  • 12.  
  • 13.  
  • 14.  
  • 15.  
  • 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.
  • 17. P VdL
  • 18. P VdL
  • 19.  
  • 20.  
  • 21.  
  • 22.  
  • 23.  
  • 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)
  • 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)
  • 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
  • 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
  • 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
  • 29.
  • 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.
  • 31.  
  • 32.