Thrombosis Risk in Cancer Patients Receiving Red Blood Cell Transfusions

Abstract

Patients with cancer have increased risk of thrombosis and often need red blood cell (RBC) transfusions. However, RBC transfusions may also promote thrombosis because of raised hematocrit and viscosity, storage-related RBC damage, and exposure to thrombogenic mediators from obsolescent RBCs. The authors conducted a literature survey for studies examining whether RBC transfusions were associated with increased risk of venous thromboembolism (VTE) in cancer patients. In perioperative cancer surgery patients with categorical comparisons of any versus no RBC transfusion, increased risk of VTE with RBC transfusion was found in 11 of 31 studies, 5 by univariate correlation only and 6 in multivariate analysis. All six multivariate-positive studies had intermediate overall rates of thrombosis (1.4–6.0%), and three were in urological surgery series. In the larger studies of > 2,000 patients (range: 2,219–44,656), the maximum odds ratio among the multivariate-positive studies was 1.3. Perioperative RBC transfusion volume was more strongly associated with VTE risk, with a positive association in six of seven studies. One large registry-based study of hospitalized cancer patients, not restricted to the perioperative setting, found an adjusted odds ratio of 1.60 (95% confidence interval: 1.53–1.67) for VTE risk in patients receiving RBCs compared with nontransfused patients.

Venous Thromboembolism in Cancer Patients Undergoing Chemotherapy: Risk Factors and Prevention

“…Among the clinical trials that have investigated the role of LMWHs for VTE prevention in ambulatory cancer patients requiring chemotherapy, five deserve careful evaluation, of whom two were performed in a wide variety of patients with Blood transfusions " Hematocrit and viscosity " EV release " Platelet, WBC, and endothelial cell activation Cytokine release " Platelet-vessel wall interactions 15,42 Abbreviations: CT, chemotherapy; EV, extracellular vesicles; F 1 þ 2, prothrombin fragment 1 þ 2; PAI-1, plasminogen activator inhibitor-1; TAT, thrombin-antithrombin complex; TF, tissue factor; TFPI, tissue factor pathway inhibitor; VEGF, vascular endothelial growth factor; VWF, von Willebrand factor; WBC, white blood cells.…”

Massive Transfusion Protocol and Subsequent Development of Venous Thromboembolism: Statewide Analysis

“…10 The association between blood transfusion and VTE has also been shown in pediatric surgical patients, 11 pregnant patients, 12 and hospitalized cancer patients. 13,14 While the association between blood transfusions and VTE has been identified in multiple studies, little is known about the incidence of VTE in trauma patients who undergo MTP. We sought to determine the incidence of VTE following MTP in trauma patients.…”

“…10 The association between blood transfusion and VTE has also been shown in pediatric surgical patients, 11 pregnant patients, 12 and hospitalized cancer patients. 13,14…”

Emergent Paradigms of Thrombosis and Cancer (Part II): More on Thrombosis and Cancer

“…Notably, there is an association between transfusion and thrombosis, as presented by Ramsey and Lindholm. 11 We hope our readers will enjoy this issue as much as they did the first on Thrombosis and Cancer. 1 Fig.…”