A scoping review of reversible cerebral encephalopathy syndromes following blood transfusion in the settings of anemia and clinical recommendations.

Abstract

Background: Reversible cerebral encephalopathy syndromes (RCES), encompassing both posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction syndrome (RCVS), represent a group of acute, neurotoxic neurological disorders that have been rarely linked to blood transfusion.

Methods: A systematic search of PubMed, Web of Science, and Scopus using relevant keywords was carried out, followed by screening and extraction of only detailed cases of blood transfusion-induced PRES/RCVS until April 2025. Data on demographics, transfusion details (type, volume, and duration), clinical symptoms, imaging findings, and management details were extracted. Quality assessment using the Joanna Briggs Institute's (JBI) tool was performed.

Results: Only 33 reports of 41patients were included, with a female majority (96.56%) and a mean (SD) age of 43.27 (14.53) years. The mean (SD) baseline and post-transfusion hemoglobin were 2.85 (1.23) and 9.55 (1.97) g/dL, respectively. The majority (95.12%) received packed red blood cells. The mean (SD) total volume transfused was 2100 (2560) ml. Headache (75.61%) was the most common symptom, followed by seizure (73.17%), visual disturbance (31.71%), and altered mental status (29.27%). Imaging studies revealed subcortical edema (46.34%), cortical infarcts (34.15%), subcortical infarcts (26.83%), and cortical edema (19.51%). PRES was diagnosed in 21 cases (51.22%), RCVS in nine cases (21.95%), and 11 (26.83%) had overlapping syndrome. The majority of cases (92.7%) were of high quality.

Conclusions: In conclusion, anemia and its rapid correction via transfusion can precipitate RCES. Most cases have a good prognosis, and management is mainly supportive. Future studies need to guide preventive strategies and optimize patient outcomes.