Indications for and complications of transfusion and the management of gynecologic malignancies

Abstract

Anemia, which is highly prevalent in oncology patients, is one of the most established negative prognostic factors for several gynecologic malignancies. Multiple factors can cause or contribute to the development of anemia in patients with gynecologic cancers; these factors include blood loss (during surgery or directly from the tumor), renal impairment (caused by platinum-based chemotherapy), and marrow dysfunction (from metastases, chemotherapy, and/or radiation therapy). Several peri- and intra-operative strategies can be used to optimize patient management and minimize blood loss related to surgery. Blood transfusions are routinely employed as corrective measures against anemia; however, blood transfusions are one of the most overused healthcare interventions. There are safe and effective evidence-based blood transfusion strategies used in other patient populations that warrant further investigation in the surgical oncology setting. Blood is a valuable healthcare resource, and clinicians can learn to use it more judiciously through knowledge of the potential risks and complications of blood interventions, as well as the ability to properly identify the patients most likely to benefit from such interventions.

Optimisation of pre‐operative anaemia in patients before elective major surgery – why, who, when and how?

“…The most common causes in this patient group are: blood loss from the tumour; renal dysfunction secondary to platinum‐based chemotherapy and marrow dysfunction from chemotherapy and/or radiotherapy . Many patients have iron deficiency anaemia . Several studies have shown that a preventive strategy of administering i.v.…”

Impact of perioperative red blood cell transfusion on postoperative recovery and long-term outcome in patients undergoing surgery for ovarian cancer: A propensity score-matched analysis

“…This may be caused by the different number of patients between the high and low volume subgroup of PRBCT, and these two subgroups are not matched during comparison. Allogeneic blood transfusion induces profound biology alterations on the immune system, which has been indicated as a potential mechanism for increased risk of infections, post-transfusion graft-versushost disease, and cancer recurrence [11,31,32]. Systematic inflammation and immunosuppression contribute to the malignant progression of cancer [33].…”

“…For patients with severe anemia, blood transfusions can be lifesaving [6,7]. However, some studies in recent years have shown that the average length of hospital stay and the rates of postoperative infection, cancer recurrence, metastasis, and cancer-related mortality are significantly higher in cancer patients undergoing transfusion during surgery, and the cancer recurrence rate is also higher [8][9][10]. This may be because allogeneic blood cells are exogenous substances that induce immune responses in recipients and inhibit systematic anti-tumor immune function [11,12].…”

On Quality Improvement in Gynaecological Cancer Surgery

“…Other complications are more seldom seen, but include infectious pathogen transmission, when an emerging infectious agent is identified as a risk to the blood supply, and transfusionrelated acute lung injury with often fatal pulmonary oedema. By transfusion-related immune modulation, perioperative blood transfusions have been shown to increase the risk of bacterial infections after the operation and also cause an increased risk of cancer recurrence with a reduced survival rate after optimal cytoreductive or curative operation (De Oliveira, et al 2012, Schiergens, et al 2015, Cybulska, et al 2017. Perioperative blood transfusions are likewise associated with an increased risk of venous thromboembolism, and higher composite morbidity, mortality, and length of hospital stay (Prescott, et al 2015).…”

“…Further research is warranted to guide blood transfusion practices in patients with gynaecological malignancies. In this patient population blood transfusion is often given based on individual or local experience rather than evidence-based guidelines (Cybulska, et al 2017). The indications for blood transfusion should be to improve tissue oxygen delivery, treat anaemia symptoms and consequently improve quality of life.…”