Subarchnoid Hemorrhage Following Severe Anemia: A Rare Case Report

Abstract

Introduction: Anemia occurs in approximately 40–50% of patients with subarachnoid hemorrhage (SAH), while blood transfusion used to correct severe anemia has been associated with an increased risk of intracerebral hemorrhage. Approximately 85% of non-traumatic SAH cases result from ruptured intracranial aneurysms. We report a rare case of SAH following multiple blood transfusions in a patient with severe anemia. Case Presentation: A 30-year-old woman presented with status epilepticus after receiving eight units of packed red cell transfusions for severe anemia. She reported a preceding thunderclap headache, photophobia, scotoma, and nausea. On admission, her blood pressure was 145/89 mmHg with a heart rate of 70 bpm. Non-contrast head CT demonstrated subarachnoid hemorrhage in the occipital region, while electroencephalography showed generalized intermittent slow activity. Her SAH was classified as Fisher grade II, Hunt and Hess grade III, and World Federation of Neurological Surgeons grade I. Before transfusion, her hemoglobin level was 3.1 g/dL, which increased to 8.7 g/dL at discharge. Blood pressure rose from 83/57 mmHg before transfusion to 147/86 mmHg afterward. No additional transfusions or antihypertensive therapy were required during the second hospitalization, and she was discharged with stable blood pressure (101/64 mmHg). CT angiography was planned to evaluate for cerebral aneurysms. Conclusion: Rapid correction of severe anemia may contribute to acute hemodynamic changes that increase the risk of intracranial hemorrhage. Careful blood pressure monitoring and cautious transfusion strategies should be considered in patients with severe chronic anemia undergoing blood transfusion.