At what hematocrit should a patient who is undergoing craniotomy for tumor be transfused?

Abstract

A 67-year-old retired operating room nurse is scheduled for craniotomy for tumor resection. The presumptive tissue diagnosis is a renal cell carcinoma metastasis. The lesion measures 3 cm by 2 cm, and imaging shows that the tumor encases a segment of the middle cerebral artery. This will be her third craniotomy in the last 3 years, all on the right side. This unfortunate woman had a right radical nephrectomy, and the left kidney has significant tumor burden. Her preoperative hematocrit is 25. She mentions that she received a blood transfusion after coronary artery bypass graft (CABG) surgery 15 years ago following a ST-segment elevation myocardial infarction (STEMI) and ended up in the intensive care unit (ICU) for 2 weeks with septic shock; she thinks from contaminated blood products. She asks you what the likelihood is of needing a blood transfusion, and she would like to know what your transfusion strategy is because she only wants to receive blood if it is absolutely necessary.