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To analyze the influence of red blood cell (RBC) transfusions on mortality and outcome of patients with spontaneous subarachnoid hemorrhage (SAH) and to determine predictors of unfavorable neurologic long-term outcome in this patient population.Cohort study with post–intensive care unit (ICU) prospective evaluation of functional long-term outcome.Ten-bed neuro-ICU in a tertiary care university hospital.A consecutive cohort of 292 patients with spontaneous SAH admitted to a neuro-ICU during a 70-month period.None.A total of 292 consecutive patients with SAH were enrolled in the study. At admission, mean hemoglobin was 13.3 g/dL (±sd 1.8 g/dL), comparable in all Hunt and Hess groups (p = 0.61 by analysis of variance). Seventy-nine patients received at least one unit of RBC transfusion in the study period. In-ICU mortality was 20.5% (n = 60). Binary logistic regression analysis comparing survivors with nonsurvivors found only higher Hunt and Hess grades (i.e., Hunt and Hess 3–5) to be significantly (p < 0.01) associated with mortality in the neuro-ICU, whereas transfusion, sex, and even age had no significant influence. Functional long-term outcome was assessed after a mean of 3.3 years (sd ±1.7 years) by evaluating modified Rankin Scale (mRS) and Glasgow Outcome Scale (GOS). More than 41% of all patients have almost fully recovered (i.e., mRS 0–1; GOS 4–5). Factors associated with unfavorable long-term outcome (i.e., GOS 1–3 and mRS 2–6) were age (odds ratio 1.06; 95% confidence interval 1.03–1.09; p < 0.01), Hunt and Hess Grade (odds ratio 11.43; 95% confidence interval 4.1–31.9; p < 0.01) but not transfusion (p = 0.46).Transfusion of RBCs was not associated with in-neuro-ICU mortality or unfavorable long-term outcome. Of all patients with SAH, >41% have almost fully recovered with favorable neurologic long-term outcome.