Transfusions for anemia in adult and pediatric patients with malignancies

Blood Reviews
Neil ShahLawrence Tim Goodnough

Abstract

Anemia is present in over two-thirds of patients with malignant hematological disorders. The etiology of anemia predominates from ineffective erythropoiesis from marrow infiltration, cytokine related suppression, erythropoietin suppression, and vitamin deficiency; ineffective erythropoiesis is further exacerbated by accelerated clearance due to antibody mediated hemolysis and thrombotic microangiopathy. As the anemia is chronic in nature, symptoms are generally well tolerated and often non-specific. Transfusion of red blood cells (RBCs) is a balance between providing benefit for patients while avoiding risks of transfusion. Conservative/restrictive RBC transfusion practices have shown equivalent patient outcomes compared to liberal transfusion practices, and meta-analysis has shown improved in-hospital mortality, reduced cardiac events, re-bleeding, and bacterial infections. The implications for a lower threshold for transfusion in patients with malignancies are therefore increasingly being scrutinized. Alternative management strategies for anemia with IV iron and erythropoietin stimulating agents (ESAs) should be considered in the appropriate settings.

References

Mar 1, 1992·Annals of Internal Medicine·H G WelchL T Goodnough
Jan 1, 1989·The Journal of Bone and Joint Surgery. American Volume·H R Cowell
Aug 1, 1995·The Annals of Thoracic Surgery·L T GoodnoughT B Ferguson
Mar 14, 2001·Critical Care Medicine·P C HébertUNKNOWN Transfusion Requirements in Critical Care Investigators for the Canadian Critical Care Trials Group
Mar 20, 2001·Thorax·UNKNOWN British Thoracic Society Standards of Care Committee
May 1, 2001·British Journal of Haematology·M F MurphyUNKNOWN British Committee for Standards in Haematology, Blood Transfusion Task Force
Oct 30, 2001·The New England Journal of Medicine·W C WuH M Krumholz
Oct 30, 2001·The New England Journal of Medicine·L T Goodnough, R G Bach
Mar 21, 2002·Journal of Pediatric Hematology/oncology·Marilyn J HockenberryBassem Razzouk
Aug 31, 2002·Medical and Pediatric Oncology·Antonio Ruggiero, Riccardo Riccardi
Nov 8, 2002·Transfusion·Susan D RoseffCatherine S Manno
May 22, 2003·Journal of the American Geriatrics Society·UNKNOWN AGS Clinical Practice Committee
Jan 28, 2004·The Hematology Journal : the Official Journal of the European Haematology Association·Semra Paydas
Jan 30, 2004·Journal of the American Society of Nephrology : JASN·Jerome RossertKai-Uwe Eckardt
Sep 30, 2004·European Journal of Cancer : Official Journal for European Organization for Research and Treatment of Cancer (EORTC) [and] European Association for Cancer Research (EACR)·Heinz LudwigDirk Schrijvers
Feb 24, 2005·Current Opinion in Hematology·Cindy N Roy, Nancy C Andrews
Mar 11, 2005·The New England Journal of Medicine·Guenter Weiss, Lawrence T Goodnough
Mar 8, 2006·Nature Clinical Practice. Oncology·Julia BohliusAndreas Engert
Jul 1, 2006·Anesthesiology·UNKNOWN American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies
Aug 1, 2006·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Bassem I RazzoukWayne R Rackoff
Apr 20, 2007·The New England Journal of Medicine·Jacques LacroixUNKNOWN Pediatric Acute Lung Injury and Sepsis Investigators Network
Jul 12, 2007·JAMA : the Journal of the American Medical Association·Amy J Markowitz, Michael W Rabow
Oct 16, 2007·Pediatric Clinics of North America·Christina K Ullrich, Oscar H Mayer
Feb 29, 2008·The Oncologist·Ananth Gouri Shankar
Aug 22, 2008·Indian Journal of Pediatrics·Anupam Verma, Hemlata
Oct 10, 2009·Journal of Pediatric Hematology/oncology·Hasim OlgunNaci Ceviz
Dec 17, 2009·The Journal of Trauma·Lena M NapolitanoUNKNOWN American College of Critical Care Medicine (ACCM) Taskforce of the Society of Critical Care Medicine (SCCM)
Jul 9, 2010·Seminars in Thrombosis and Hemostasis·Massimo FranchiniAntonio Coppola
Sep 10, 2010·Blood·Lawrence Tim GoodnoughTomas Ganz
Oct 14, 2010·JAMA : the Journal of the American Medical Association·Ludhmila A HajjarJose O C Auler
Apr 19, 2011·Transfusion Medicine Reviews·Aryeh ShanderUNKNOWN International Consensus Conference on Transfusion Outcomes Group
Aug 10, 2011·Archives of Internal Medicine·Adam C SalisburyMikhail Kosiborod

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Citations

Oct 22, 2016·Clinical Hemorheology and Microcirculation·Walter H Reinhart
Jun 4, 2019·Current Opinion in Anaesthesiology·Hua FengLingzhong Meng
May 26, 2017·International Journal of Cancer. Journal International Du Cancer·Elisabeth LangFlorian Lang

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